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AbstractBackground: Interurban traffic safety is a major public health problem, but has received little attention in LowandMiddle-Income Countries (LMICs). The objectives of this thesis were to assess the burden of injury relatedto interurban traffic, and reporting of these injuries in different datasets, to analyze situational factors (physicalcharacteristics and environmental circumstances) associated with crash sites, and road hazard perception of highriskcrash sites in LMICs. Methods and results: These objectives were assessed in five specific studiesconducted in two LMICs, Cameroon and Pakistan. In study I, traffic fatality per vehicle-km and associated crashfactors were assessed using police reports for years 2004 to 2007, on the two-lane Yaoundé-Douala road sectionin Cameroon. Traffic fatality was 73 per 100 million vehicle-km, a rate 35 times higher than a similar road in ahigh-income country. Fatality was higher for crashes involving vulnerable road users, crashes betweenoppositely-moving vehicles, and those due to mechanical failure including tyre burst. In study II, traffic injuryreporting to police, ambulance, and Emergency Department (ED) in 2008 was assessed, on the four-laneKarachi-Hala road section in Pakistan. Crash fatality was over 53 per 10 9 vehicle-km, a rate 13 times higher thana similar road in France. Police reported only one out of five fatalities and one out of ten severe injuries.Vulnerable road users were two times less reported in police data than ambulance or ED data. In study III,situational factors associated with injury crash sites were assessed on the Yaoundé-Douala road section, usingcase-control methods. Factors such as flat road profiles (adjusted Odds Ratios [OR]=1.52; 95% ConfidenceInterval [95%CI]=1.15-2.01), irregular surface conditions (OR=1.43; 95%CI=1.04-1.99), nearby road obstacles(OR=1.99; 95%CI=1.09-3.63), and three- (OR=3.11; 95%CI=1.15-8.39) or four-legged (OR=3.23; 95%CI=1.51-6.92) intersections were significantly associated with injury crash sites. Furthermore, the likelihood of crashincreased with built-up areas situated in plain regions (OR=2.33; 95%CI=1.97-2.77). In study IV, traffic injuryburden and factors associated with Highway Work Zones (HWZs) crashes were assessed on the Karachi-Halaroad section, using historical cohort methods. HWZs accounted for one third of traffic fatalities, and fatality pervehicle-km was four times higher in HWZs than other zones. One out of two HWZ crashes occurred betweenoppositely moving vehicles. In study V, hazard perception of high-risk (with ≥ 3 crashes in 3 years) and low-risksites (no crash reported) from the two above road sections was assessed by showing videos to voluntaryPakistani drivers. Drivers were able to identify only half of the high-risk sites as hazardous. Sites with a flat andstraight road profile had a lower hazard perception compared to those with curved and slope road profile. Highrisksites situated in built-up areas were perceived less hazardous (OR = 0.58; 95%CI=0.51-0.68) compared tolow-risk sites (OR = 2.04; 95%CI=1.51-2.74) with same road situation. Further, high-risk sites with vertical roadsigns were more likely to be perceived hazardous (OR = 2.75; 95%CI=2.38-3.16) than low-risk sites (OR = 0.50;95%CI=0.34-0.72) with such signs. Conclusion: This thesis illustrates how innovative yet simpleepidemiological methods can be useful in assessing the injury burden and specific risk factors in LMICs. Thesecountries face a high burden of interurban road injuries, mostly under-reported in police data. A reliable andaccurate injury surveillance system is needed in these countries. Moreover, prevention policy can be improvedby better information transfer between road and police authorities regarding situational factors. Similarly, amonitoring system is required to examine the HWZ safety interventions in these countries. Lastly, interurbanroad safety can be improved by making roads self-explaining, especially by implementing low-cost interventionssuch as vertical signs at high-risk sites.Keywords: Developing country; highway safety; injury; prevention; vulnerable road users.10
1. IntroductionLes traumatismes routiers sont un problème majeur et pourtant très négligé de la santépublique dans les Pays à Revenu Bas et Moyen (PRBM) [1]. Une enquête récente sur lasécurité routière dans 178 pays a montré que chaque année plus de 90 % des 1,2 million detués sur les routes surviennent dans ces pays [2]. De plus, ces traumatismes sont la principalecause de pertes des Années de Vie Corrigées du facteur Incapacité (AVCI) dans les PRBM,car de nombreux enfants et des hommes en âge de production souffrent de ces blessures [3].Les traumatismes pourraient coûter jusqu'à 1 à1,5 % du Produit Intérieur Brut (PIB) de cespays [4]. On estime que la mortalité routière augmenterait de 80 % entre 1990 et 2020 dansles PRBM, à moins que des mesures appropriées soient mises en œuvre [5].Pourtant, le transport routier est un facteur essentiel de développement dans les PRBM [6].Près de 90 % des voyageurs et du fret dans ces pays sont transportés par le réseau routierurbain et interurbain [6, 7]. La sécurité routière sur ces routes devient donc un élémentstratégique du processus d’accroissement du développement [8]. Même dans les paysdéveloppés, cette catégorie de routes contribue considérablement à la mortalité routière et àdes blessures graves [9]. Par exemple au Pakistan, plus de 27% des accidents mortelssurviennent sur les routes interurbaines alors qu'elles représentent moins de 5 % de l'ensembledu réseau [10]. Les avantages potentiels de la mise en œuvre des mesures de sécurité routièresur ces routes sont potentiellement énormes, comme cela a été montré par des études dans lespays développés [11].La recherche joue un rôle central dans la mise en œuvre des interventions sur la circulation[12]. Les conditions routières relativement sûres dans les Pays à Revenu Élevé (PRE) doiventbeaucoup aux recherches sur la sécurité routière menées dans les années 1960 et 1970 [13].Par exemple en Suède, il a été démontré que la recherche sur la gestion de la vitesse en zonesurbaines a largement contribué à réduire la mortalité et la morbidité routières, avec un bonrapport coût-bénéfice [14]. Malheureusement, la recherche sur la prévention et la prise encharge des traumatismes routiers reste encore rudimentaire dans les PRBM [15]. La BanqueMondiale a indiqué que des interventions à l'efficacité prouvée existent, mais leur mise enœuvre dans les PRBM est entravée par le manque de recherche pour documenter etcomprendre les problèmes spécifiques et locaux des traumatismes [16]. Si les interventions nesont pas adaptées à la situation locale, elles peuvent ne pas produire le même succès, commeen témoignent les études dans les PRE [17].Le manque de recherche dans les PRBM est illustré par notre revue de la littérature sur lefardeau des traumatismes routiers et les facteurs de risque associés aux routes interurbaines(Appendix 1) : les indicateurs comparables de la mortalité routier sont rarement évalués etrapportés ; certaines études mentionnent une certaine spécificité, comme la sur-implicationdes piétons et des occupants de transports collectifs dans les accidents sur des routesinterurbaines, mais la répartition réelle des usagers de la route impliqués dans ces accidentsn’est pas connue ; la plupart des études épidémiologiques se focalise sur les comportementsroutiers à risque alors que les facteurs situationnels (caractéristiques physiques etcirconstances de l'environnement) n’ont presque jamais été étudiés [18-48]. Des recherchesantérieures dans les PRE montrent clairement que ces facteurs sont impliqués dans un quartdes accidents et que les interventions mise en œuvre sur les routes pourraient réduire lesaccidents de 20 % [49].11
Page 1: Université Victor Segalen Bordeaux
Page 4 and 5: Publications (peer-reviewed).......
Page 6 and 7: Index of figuresFigure 1. Traffic f
Page 8 and 9: AbbreviationsAKUAVCIBMIEASESSDALYDW
Page 12 and 13: L'objectif de cette thèse était d
Page 14 and 15: 2. Background2.1 Road injury burden
Page 16 and 17: 2.4 Multiple factors involved in tr
Page 18 and 19: Figure 4. Percentage difference of
Page 20 and 21: 2.7 Interurban road safety research
Page 22 and 23: ObjectivesThe objectives of this fi
Page 24 and 25: ResultsCrash burdenA total of 935 R
Page 26 and 27: Figure 7. Monthly trend of traffic
Page 28 and 29: Injury outcome patternsMost of inju
Page 30 and 31: MethodsThe study setting was 196-km
Page 32 and 33: patients. In the ED, those with NIS
Page 34 and 35: Table 6. Traffic injuries reported
Page 36 and 37: 5. Analytical StudiesPrevious liter
Page 38 and 39: under supervision of Dr. Sobngwi-Ta
Page 40 and 41: Table 9. Situational variables at c
Page 42 and 43: MethodsStudy design and settingStud
Page 44 and 45: to Dec 08 were retrieved and photoc
Page 46 and 47: normal zones. However, this associa
Page 48 and 49: MethodsStudy design and settingsThe
Page 50 and 51: Figure 14. Picture extracted of a h
Page 52 and 53: located in built-up area in Pakista
Page 54 and 55: Table 15. Differences in hazard per
Page 56 and 57: 6. Discussion6.1 Originality of stu
Page 58 and 59: Although adjustments are possible,
Page 60 and 61:
observational studies on how the de
Page 62 and 63:
to understand the deficiencies in t
Page 64 and 65:
[24] Damsere-Derry J, Afukaar FK, D
Page 66 and 67:
[69] Central Intelligence Agency. T
Page 68 and 69:
[111] Geurts K, Wets G, Brijs T, Va
Page 70 and 71:
[154] Rosenbloom T, Shahar A, Elhar
Page 72 and 73:
4. Farooq U, Bhatti JA, Siddiq M, M
Page 74 and 75:
Appendix 1: Literature review on in
Page 76 and 77:
they identified a cluster of long b
Page 78 and 79:
more cost-effective than redesignin
Page 80 and 81:
Table 18. Traffic injury interventi
Page 86 and 87:
Appendix 3: Study I supplementary r
Page 88 and 89:
Appendix 4: Manuscript in preparati
Page 90 and 91:
BACKGROUNDPakistan, located at the
Page 92 and 93:
patients were recorded during their
Page 94 and 95:
This might motivate police officers
Page 96 and 97:
12. Peden M, Scurfiled R, Sleet D,
Page 98 and 99:
Table 1. Traffic injuries reported
Page 100 and 101:
Table 3. Ascertainment of police, a
Page 102 and 103:
Appendix 5: Article published - Stu
Page 104 and 105:
104
Page 106 and 107:
106
Page 108 and 109:
108
Page 110 and 111:
Appendix 6: Article under review -
Page 112 and 113:
1. INTRODUCTIONWith the aging of hi
Page 114 and 115:
A total of 180 crashes were identif
Page 116 and 117:
conspicuity at HWZs in Pakistan. 2
Page 118 and 119:
21. Sobngwi-Tambekou J, Bhatti J, K
Page 120 and 121:
Table 2. Highway work zone crash fa
Page 122 and 123:
122
Page 124 and 125:
ABSTRACTObjectives: Interurban road
Page 126 and 127:
oad). A matched strategy was used t
Page 128 and 129:
SitesOut of 131 crash sites identif
Page 130 and 131:
Similarly, it was shown previously
Page 132 and 133:
Majdzadeh, R., Khalagi, K., Naraghi
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Table 2. Characteristics of Pakista
Page 136 and 137:
Table 4. Factors associated with ha
Page 138 and 139:
Table 21. Situational factors at hi
Page 140 and 141:
Table 23. Situational factors assoc
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