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1. INTRODUCTIONWith the aging of highways, road authorities spend a considerable proportion of their budgeton maintenance. 1-3 For instance, federal and state highway departments of transportation inthe United States of America (USA) invest 10-15% of their annual budget on the maintenanceof highways, amounting to tens of billions of US$ each year. 4 5 Similarly, Low- and Middle-Income Countries (LMICs) spend a considerable portion of their development assistance onhighway maintenance projects. 6 7 Construction zones, often named Highway Work Zones(HWZ), are present on all road networks anywhere in the world. 1-7HWZs are different from work zones in urban areas, because provision of detours is oftenimpractical. 1 2 Thus regular traffic flows need to be restricted, leading to safety challenges. 8Previous research in developed countries has demonstrated an increased crash and fatality riskin HWZ as compared to other parts of the transport network. 9 For instance, in two-lanehighways of Kansas, 63% of fatal crashes and one-third of injury crashes took place onHWZs. 10 The estimated cost of HWZ crashes between 1995 and 1997 in the USA was 6.2billion US$ with an average cost of 3,687 US$ per crash. 11 Nevertheless, the safety problemrelated to HWZ has received some attention in high-income countries (HIC) and appropriatetraffic control interventions are implemented during the construction periods. 2Pakistan has a strategic national highway network of over 8 000 km. Over 90% of the inlandtraffic passes through these road sections and, consequently, these highways undergoextensive wear and tear due to overloading, heavy traffic, and delayed maintenance. 12-14Previous research has shown that 27% of road fatalities occurred on these roads although thatthey accounted for only 4% of the network. 14 A survey conducted in 2000 showed that 50%of the national highway network was in need of major pavement reconstruction. 12 15 Themaintenance demand had consistently increased from 10 billion Pakistani rupees (PKR) in1991 to over 30 billion PKR in 2005, yet only around 10 billion PKR were available in 2005for highway maintenance. 12 To date, no study has ever estimated the road crash burden due tosuch traffic conditions in Pakistan. 13 16 The objective of this study was to assess the burdenand factors associated with HWZ crashes on an interurban highway in Pakistan.2. METHODS2.1 Study design and settingAs we compared the incidence density rates, estimated from events (crash, fatality, or injury)and person-time exposure (km travelled) measures, between the HWZ and normal trafficzones, the study design was similar to an historical cohort study. 17 18 The study setting was a196-km-long four-lane, separated, non-access controlled Karachi-Hala road section in theprovince of Sindh, Pakistan. Traffic counts ranged from 16,356 vehicles per day onHyderabad–Hala sub section (50 km) to 24,707 vehicles per day on Karachi-Hyderabad subsection (146 km). 19 The National Highway Authority (NHA) manages the overallmaintenance and upgrade of this road section, mostly by private contractors. 12 The NationalHighway and Motorway Police (NHMP) have been enforcing traffic rules on this road sectionsince 2004.2.2 Traffic dataAnnual average daily traffic survey data were collected from NHA headquarters. Thesesurveys are conducted each year to assess traffic counts on different road sections under theFederal administration. 19 Locations near toll plazas are selected to assess 24-hour counts bythe NHA personals. We extracted information on traffic counts observed between Karachi-Hyderabad (146 km) and Hyderabad-Hala (50 km) road sections. Variables coded from traffic112
surveys included number, type (trucks, buses transporting ≥ 20 passengers, mini-truck,minibus or coasters transporting < 20 passengers, cars or jeeps, and motorcycles), anddirection of vehicle (North-bound or South-bound). 19In Pakistan, during maintenance works on separated highways, two or more lanes in a givendirection are completely blocked and traffic is diverted, most of the times, to the oppositedirected lanes (figure 1A & 1B). The police and highway authorities facilitate traffic duringthe construction period. Detail of HWZ commencement and completion dates and kmlocations of maintenance works are recorded in their memos. We collected this data fromNHA and NHMP regional offices, but these records were available only for the 50-km-longHyderabad-Hala sub section.2.3 Crash dataAfter a crash, NHMP patrolling officer files the details of crash on a standard four-pageaccident analysis report. 20 A copy of this report is kept in the regional office, whereas theoriginal is sent to the NHA headquarters. Moreover, the crash is recorded on a separateaccident register in each regional office. 20 All police crash reports and registers for the periodfrom Jan 06 to Dec 08 were retrieved and photocopied from regional NHMP offices with thepermission of the officer in charge.Variables coded from accident registers included date, time, number and type of involvedvehicles, number of persons injured or who died in a reported crash, and whether the crashoccurred during maintenance works. Variables coded from crash reports included date, time,location, direction of lane (North-bound or South-bound), light, weather, horizontal andvertical road profile, road surface and shoulder condition, ongoing maintenance, and causeand type of crash. 21 Type of crash was defined as single vehicle, same direction, oppositedirection, sidewise, pedestrian. When more than one type was identified, crashes were codedas crash of the most vulnerable involved road user; the vulnerability decreasing order was:pedestrian; opposite directions; sidewise or at intersection; single vehicle; same direction. 21Information on number, injury severity, and type of road user involved (pedestrian, riders oftwo-wheelers, or occupants of cars/jeeps, minibuses, buses, or trucks) were coded separately.Severity was defined as ‘severe’ when the involved person was transported to the hospital and‘fatal’ when the involved road user died at the crash scene or at hospital within the first 24hours following the event. 202.4 AnalysisInformation on crashes from registers and reports were linked to make a single file based oncrash location (km) and crash date, available for all crashes. Crashes, fatality, and severeinjury per 10 9 vehicle-km travelled for vehicle type and direction were computed using trafficcounts survey. Due to limited data on traffic exposition of work zones, these rates for workand normal traffic zone were computed using information on work zone dates and averagedaily traffic for the 50-km-long sub-section. Crash, fatality, and severe injury risks accordingto road directions, vehicle types and traffic conditions were compared using rate ratios with95% confidence intervals, rate differences, and attributable risk proportions whereappropriate. 17 22 Associations of factors with HWZs crashes were estimated from a multiplelogistic regression model, including all variables weakly associated (P
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Université Victor Segalen Bordeaux
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Publications (peer-reviewed).......
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Index of figuresFigure 1. Traffic f
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AbbreviationsAKUAVCIBMIEASESSDALYDW
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AbstractBackground: Interurban traf
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L'objectif de cette thèse était d
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2. Background2.1 Road injury burden
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2.4 Multiple factors involved in tr
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Figure 4. Percentage difference of
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2.7 Interurban road safety research
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ObjectivesThe objectives of this fi
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ResultsCrash burdenA total of 935 R
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Figure 7. Monthly trend of traffic
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Injury outcome patternsMost of inju
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MethodsThe study setting was 196-km
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patients. In the ED, those with NIS
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Table 6. Traffic injuries reported
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5. Analytical StudiesPrevious liter
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under supervision of Dr. Sobngwi-Ta
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Table 9. Situational variables at c
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MethodsStudy design and settingStud
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to Dec 08 were retrieved and photoc
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normal zones. However, this associa
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MethodsStudy design and settingsThe
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Figure 14. Picture extracted of a h
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located in built-up area in Pakista
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Table 15. Differences in hazard per
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6. Discussion6.1 Originality of stu
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Although adjustments are possible,
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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
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Page 106 and 107: 106
Page 108 and 109: 108
Page 110 and 111: Appendix 6: Article under review -
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
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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
Page 134 and 135: 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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