SitesOut of 131 crash sites i<strong>de</strong>ntified in Pakistan, 16 were involved in three or morecrashes. Similarly, out of 474 crash sites i<strong>de</strong>ntified in Cameroon, 18 were involved in three ormore crashes. We randomly selected 10 high-risk sites. In Pakistan, most high-risk sites werewith straight road profile (87%), whereas this proportion was 20% in Cameroon (Table 1).Road surface conditions were irregular on most high-risk sites in Pakistan (75% vs. 65%) andCameroon (90% vs. 40%) than low-risk sites. Half of high-risk sites in Pakistan (62%) andCameroon (50%) were with flat road profile. A vertical road sign was visible at 38% of highrisksites in Pakistan and at 40% in Cameroon. Fewer high-risk sites were located in built-uparea in Pakistan (31%) than in Cameroon (50%). Similarly, one third of high-risk sites were atintersection in Pakistan (31%) and Cameroon (40%). In Pakistan, 19% of the high-risk siteswere situated at a U-turn and on 13%, maintenance works was ongoing.ParticipantsOut of 100 participants, 44 were interviewed at the AKU. Most participants wereaged between 26-45 years and one fifth had received no education (Table 2). While all driverslived in Karachi, 46 of them had a resi<strong>de</strong>nce in other regions of Pakistan as well. Seventy fourdrivers reported either not wearing a seat-belt at all or wearing it occasionally, and 92 of themreported using a cell phone while driving. No significant association was found for any of thedriver-related factor or interview location with recent crash history.Hazard perception of high- and low-risk sitesIn twelve site pairs, five from Pakistan and seven from Cameroon, site hazardperception level was significantly higher and reported speeds were significantly lower forhigh-risk than for low-risk sites (Table 3). Correlations of pair-wise reported speeds weremo<strong>de</strong>rate to high (0.51≥ICC≤0.95). The highest negative speed differences (> 25 km/h) wereobserved for pair 4 (toll plaza at high-risk site), 16 (built-up area with markets and traffic athigh-risk site), and 24 (a curve, with rain, oil tanker, and parked vehicle on high-risk site).Most high-risk sites where site hazard perception was not different or lower than low-risksites were straight (N=10) and plain (N=8).Factors associated with hazard perceptionCompared to middle-aged drivers, significantly high hazard perception was reportedby drivers aged 18-25 years and those aged 26-35 years (Table 4). Similarly, compared toheavy trucks, those driving cars or mini-trucks reported significantly lower hazard perception.Vehicle driven remained significantly associated with hazard perception in mo<strong>de</strong>ls 2 and 3.The association of age with hazard perception was not significant in mo<strong>de</strong>l 3 (P > 0.05).Hazard perception of Cameroonian sites was higher than Pakistani sites. Similarlyhazard perception at sites with irregular surface conditions, at intersections, and with ongoingmaintenance works was significantly higher than those without them. Hazard perception ofsites with straight and flat road profile was significantly lower than those with curve and sloperoad profile. Hazard perception of high-risk sites in built-up areas and having road width≤ 8 m was significantly lower than low-risk sites with same features. Hazard perception ofhigh-risk sites with visible hazard sign or a U-turn was significantly higher than low-risk siteswith same features. Hazard perception of sites vi<strong>de</strong>os with maneuvering or oppositely movingvehicles was higher than site vi<strong>de</strong>os without them. Hazard perception of site vi<strong>de</strong>os withheavy vehicle or motorcycles was significantly lower than site vi<strong>de</strong>os without them. Hazard128
perception for high risk site vi<strong>de</strong>os with rain was significantly lower than low risk site vi<strong>de</strong>oswith same conditions.DISCUSSIONThis study showed that drivers were able to discriminate only half of high-risk sitesfrom their matched low-risk sites. Further analysis showed that certain driver-, road-, andtraffic-related characteristics were associated with a low hazard perception. For instance,participants who drove cars and mini-trucks had overall low hazard perception as compared tothose driving trucks. Similarly, hazard perception of sites with flat and straight road profilewas significantly lower than those without these profiles. Furthermore, high-risk crash sitessituated in built-up area, with lane width ≤ 8 m, and during rainy conditions were perceivedless hazardous than low-risk sites with same features.The study methods were inspired from diagnostic test studies, to assess the accuracyof drivers in differentiating high-risk sites from the low-risk ones (Flahault et al., 2005), andto analyze factors associated with low hazard perception. This study, for instance, showed thathazard perception of high-risk crash sites generally remained low, particularly for those siteswhich were straight and flat. Confronting these findings with the fact, previously shown onYaoundé-Douala road section, that crashes were significantly higher for a road section withflat profile (Bhatti et al.); this study suggested that drivers preferred higher traffic speeds atflat road sites (Afukaar, 2003; Damsere-Derry, Afukaar, Donkor, & Mock, 2008). Suchinformation could be extremely useful for safety experts, and these methods might facilitateprioritizing and providing insights into possible interventions at high-risk sites (Bishai,Asiimwe, Abbas, Hy<strong>de</strong>r, & Bazeyo, 2008).Furthermore, these methods assessed the odds of poor hazard perception of high-riskcompared to low-risk sites with same road features. For instance, the high-risk sites situated inbuilt-up areas were not perceived hazardous compared to low-risk sites with similar roadcharacteristics. In<strong>de</strong>ed, the inci<strong>de</strong>nce of RTCs on interurban road sections is higher in LMICsthan in <strong>de</strong>veloped countries (Mohan, 2002). Ribbon <strong>de</strong>velopment, improper crossingfacilities, higher traffic mix, and absence of service lanes in LMICs could explain this crashrisk in built-up areas (Ross et al., 1991). Our results suggested that implementinginterventions which increase hazard perception might reduce crash risk on such sites (Bhattiet al.).Moreover, narrow lane widths increased road hazard perception and reduced trafficspeed except for high-risk sites. It is likely that drivers were unable to perceive thehazardousness of such sites, because of little road furniture and hazard signage regardingspeed adjustments, a condition frequent in LMICs (Mohan, 2002; Ross et al., 1991). This wasconsistent with the observation that high-risk sites with hazard signs resulted in higher hazardperception levels. This clearly indicated that proper installation and maintenance of such signscould have long-term road safety implications in LMICs (Milleville-Pennel, Hoc, & Jolly,2007).Previous studies have showed that adverse weather conditions significantly increasedinterurban RTC risk in LMIC (Hijar et al., 2000; Majdza<strong>de</strong>h, Khalagi, Naraghi, Motevalian,& Eshraghian, 2008). Our results showed that the ability to <strong>de</strong>tect hazardousness of high-risksites could be compromised during such weather conditions. Enforcing low traffic speeds andinstallation of real-time speed indications during such conditions could reduce crash risk onthese roads (Konstantopoulos, Chapman, & Crundall).129
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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
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to understand the deficiencies in t
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[24] Damsere-Derry J, Afukaar FK, D
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[69] Central Intelligence Agency. T
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[111] Geurts K, Wets G, Brijs T, Va
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[154] Rosenbloom T, Shahar A, Elhar
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4. Farooq U, Bhatti JA, Siddiq M, M
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Appendix 1: Literature review on in
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they identified a cluster of long b
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- Page 98 and 99: Table 1. Traffic injuries reported
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- Page 112 and 113: 1. INTRODUCTIONWith the aging of hi
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- Page 118 and 119: 21. Sobngwi-Tambekou J, Bhatti J, K
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- Page 124 and 125: ABSTRACTObjectives: Interurban road
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