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oad situational factors, high speed, and crash locations has also been demonstrated on ruralroads in HICs [60].Table 2. Traffic fatalities according to road network type in France, 2004Road network Injury crashes Deaths Crash severity*Urban roads 57 825 1 451 2.5Rural roads 27 565 3 781 13.7Motorways 8 182 584 7.1National roads 5 436 951 17.5District roads 13 947 2 246 16.1* Fatality per crash × 100Traffic prevention on these road sections implies preventing risky road behaviours [61]. Roaddesign, surface, markings, furniture, and traffic management play an important role inreducing crash likelihood by reducing the inappropriate road user behaviours on these roadsections [60]. Previous research in developed countries has clearly demonstrated thatengineering measures were highly cost effective in reducing injury crashes compared to thosetargeting only road behaviours or vehicle factors [49]. A British study showed that completeupgrading of national highways to motorways reduced crashes by 76% and traffic fatalities by81% [62]. Similarly, installation of wired guardrail reduced the likelihood of head-on crasheson undivided rural road sections in Sweden [14]. However, development of these measuresrequires rigorous research methods to assess their appropriateness to local traffic conditionsand demands [14, 16].2.6 Factors limiting implementation of engineering measures in LMICsHighway traffic safety has not received appropriate attention in LMICs, both in terms ofestimating the injury burden and assessing risk factors [11]. Some of the few studiesconducted in such settings suggest that these road sections are important concentrations oftraffic crashes in LMICs, probably due to over-involvement of vulnerable road users [17, 19,63]. Although there is evidence of an increasing injury burden, adaptation and implementationof proven engineering interventions in LMICs is impeded by major knowledge gaps [50]:Firstly, reporting of injuries and availability of RTC and RTI data remains in general the mostimportant difficulty in LMICs. A study in Pakistan showed that police statistics accounts foronly 56% of traffic fatalities and 4% of severe injuries in urban settings [64]. Similar resultswere observed in Iran where the official data source for traffic fatalities was compared withhealth facility data [65]. As most LMICs do not have vital registration data, WHO recentlyestimated traffic fatalities in those countries while including information on traffic exposure,risk, preventive, and mitigating factors in their model [2]. The results showed that in mosthighly populated LMICs, official statistics included only half or less of the actual trafficfatalities occurred in those countries (Figure 4). Thus, without proper estimates, it becomesvery difficult to advocate for preventive measures in these countries [50].17