thèse doctorat de l'université bordeaux 2 - ISPED-Enseignement à ...

INTRODUCTIONRoad traffic safety is an important health problem worldwide, resulting in anestimated 1.2 million deaths and another 50 million injuries each year (World HealthOrganization, 2009). Over 85% of these Road Traffic Crashes (RTCs) related deaths occur inLow- and Middle-Income Countries (LMICs) (Peden et al., 2004). Highways, which represent5 to 10% of national road networks, lead to significant injury burden in these countries. Forinstance in Pakistan, 27% of all police-reported fatal RTCs occur on National highway-5 (N5)(National Transport Research Centre, 1985). Similarly, on Yaoundé-Douala road-section inCameroon, approximately 73 deaths occurred per 100 million kilometer travelled, a rate 35times higher than on similar type of roads in Europe (Sobngwi-Tambekou, Bhatti, Kounga,Salmi, & Lagarde, 2010).RTCs are unevenly distributed along the network (Peden et al., 2004). They occur inclusters at single sites, often called high-risk sites, along particular sections of the road(Geurts & Wets, 2003). They can be defined as sites having a higher expected number ofcrashes than other similar sites (Elvik, 2008). Theoretically, inadaptability of driving behaviorto the local road and traffic hazards leads to crashes at these sites (Geurts & Wets, 2003). Ithas been documented that design improvement at these sites can result in significantdecreases in crash risk (Ross, Bagunley, Hills, McDonald, & Silcock, 1991). However, thisremains an expensive option, and not all high-risk sites can be improved in a timely manner(Geurts, Wets, Brijs, Vanhoof, & Karlis, 2006).Hazard perception is the ability to identify potential hazardous situations and takingnecessary actions to avoid them (Benda & Hoyos, 1983; SWOV, 2008). Driver-related factorssuch as age, sex, familiarity with road, driving experience, attitudes, and self-assessment ofskills could influence this ability (DeJoy, 1989; Finn & Bragg, 1986; Harre, 2000; Mayhew,Simpson, & Pak, 2003; McKenna, Stanier, & Lewis, 1991; Trankle, Gelau, & Metker, 1990).Road elements such as sharp bends, decreased widths, and presence of lane markings couldincrease hazard perception (Goldenbeld & van Schagen, 2007; Kanellaidis, Zervas, &Karagioules, 2000). Previous research has shown that augmenting hazard perception by drivertraining or by implementing appropriate road furniture could significantly reduce thelikelihood of RTCs (Deery, 1999; Rundmo & Iversen, 2004).Much work on high-risk crash sites stressed that identifying these sites using statisticalmethods so that safety work could be prioritized (Montella, 2010). Interactions betweendriver- and site-related factors had not been investigated in detail to prioritize such sites,particularly on interurban roads in LMICs (Sabey & Taylor, 1980). To our knowledge, thehypothesis that high-risk crash sites might not be perceived as dangerous by some drivers hasnot been tested (Geurts & Wets, 2003). Insight into how high-risk crash sites are perceived bydrivers could be useful in developing and implementing less expensive interventions,particularly in LMICs (Harre, 2000). The objective of this study was to compare hazardperceptions for sites involved in RTCs to those not involved in RTCs in voluntary drivers.Further, we assessed driver- and road- related factors associated with hazard perception level.METHODSStudy design and settingsThe study settings were interurban road sections situated in Cameroon and Pakistan:1/ Karachi-Hala road section in Pakistan (196-km-long mostly four lane separated road), and2/ Yaoundé-Douala road section in Cameroon (243-km-long mostly two-lane non-separated125