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2. Background2.1 Road injury burden in LMICsA recent World Health Organization (WHO) report showed that road mortality is twice ashigh in LMICs than in HIC (20 vs. 10 per 100 000 inhabitants) [2]. This trend was clearlyvisible when selecting the world most populated nations according to their income groups(Figure 1). Traffic fatality is 4 to 6 times higher in LMICs like Pakistan, Nigeria, and Russiathan in HICs like United Kingdom and France. Among different world regions, LMICssituated in East Mediterranean and African region had the highest traffic mortality rates (32.2per 100 000) as compared to other regions with similar economic situations [2, 5].Furthermore, for every traffic crash death, many more are injured, with temporary orpermanent disability [51]. For instance in India, for every reported death, 25 more people arehospitalized due to traffic injuries [52].Figure 1. Traffic fatality per 100 000 inhabitants in various countries [2]JapanUnited KingdomGermanyFranceBangladeshLow-income countryMiddle-income countryHigh-income countryUnited StatesCountryVietnamIndonesiaChinaIndiaBrasilMexicoRussiaPakistanNigeria0 5 10 15 20 25 30 35Fatality per 100 000 inhabitants2.2 Road safety is a key to development in LMICsRTCs are one of the three leading causes of death worldwide for persons aged 15-45 years[53]. They account for 2.7% of DALY losses worldwide, and 3.7% in middle-incomecountries [53]. Almost half of the traffic fatalities are recorded among vulnerable road users(Figure 2) such as pedestrians, bicyclists, and motorcyclists [2]. The impact of RTIs on thesocial fabric within LMICs is not straightforward [54]. Death of a man from a low- or middleincomegroup in their productive age significantly reduces the income of his household andleads to direct and indirect economic losses to the country [3]. Traffic safety is thus more thana health problem, and its improvement in LMICs may have significant consequences onoverall national development [8].14
Figure 2. Traffic fatalities according to road user groups in different countries10080%6040200United StatesMexicoRussiaFranceGermanyUnited KingdomJapanCountryBangladeshChinaIndiaBrazilIndonesiaOccupants of four wheeled motorized vehicles Vulnerable road users Others2.3 Risk factorsCrash prevention is a priority to reduce RTI burden [55]. Gordon and Gibson were the firstscientists who classified injuries as a public health problem by clearly defining it in terms ofinteraction between host (road user), agent (vehicle), and environmental factors (1949) [56].William Haddon, Jr., further conceptualized that the involvement of these factors within thephases of influence such as pre-crash, crash, and post crash [56]. Haddon’s matrix provided ameans to identify risk factors and preventive measures [57]. For instance for speeding, whichis one of the foremost factors involved in highway crashes, this matrix identifies differentpreventive measures related to road-user, vehicle and environmental factors; these measures,implemented before, during, or after the crash can contribute to the control of RTIs (Table 1).Table 1. The Haddon Matrix applied to highway crashes involving speed (examples ofintervention)Phases Possible outcome FactorsRoad userVehicle andequipmentPre crash Crash prevention Traffic enforcementto reduce speedingCrash Injury prevention Increased restraintusePost crash Life preservation Training possiblebystanders in firstaid skillsRegular vehiclecontrols to assessbrakingAirbag installationFoldable wind screenfor emergency exitEnvironmentSpeed calmingmeasures orimproved roaddesignImpact-absorbingbarriersPre-hospital andtrauma care system15
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 10 and 11: AbstractBackground: Interurban traf
Page 12 and 13: L'objectif de cette thèse était d
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
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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