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4.2 Study II: Differences in police, ambulance, and emergency departmentreporting of traffic injuries on Karachi-Hala road section, PakistanPakistan located at the junction of Middle-East, South-East Asia, China, and Central AsianStates, is the sixth most populous nation of the world [69]. Approximately 1.4 million RTCsoccurred in Pakistan during 1999, resulting in over 7 000 fatalities [76]. A recent WHO reportshowed that actual traffic fatalities could be 4 to 10 times higher than official statistic [2].Similarly, two independent population-based surveys estimated incidence of traffic injuriesaround 15 to 17 per 1 000 persons per year [77, 78]; RTIs contribute significantly to the workload in hospitals [79]. The direct cost of RTIs to Pakistani economy is over 1 billon US$ [80].Interurban road sections are the back-bone of Pakistani economy. Its strategic interurban roadnetwork of approximately 8 000 km plays a significant role in transport, as it carries morethan 80% of inland passenger and freight traffic [76, 81]. Although these road sectionsaccount for 4% of the entire network, a high proportion of traffic fatalities (27%) occur onthese road sections [63]. Similarly, previous research in Pakistan has shown that injuryseverity was higher for crashes in rural areas [82]. However, no distinction has been madewhether this refers to interurban or other rural roads. Higher speeds and inappropriategeometrical design can explain this high fatality ratio, but no comparison indicators wereavailable for these road sections [60].The catchment area for traffic injuries is difficult to define on interurban road sections inLMICs, and police records remain to date the most reliable source of evaluating interurbanroad safety [7]. The use of police statistics alone can lead to underestimation of road burdenin LMICs, as previously illustrated by linking police and ambulance datasets in Karachi,Pakistan [64]. No notable research has been carried out to compare the differences in injuryreporting while linking different datasets with interurban road settings in LMICs [2, 3].ObjectivesThe objectives of this study were:1. To assess differences for crash and injury reporting in police, ambulance, andemergency department (ED) datasets on an interurban road section in Pakistan.2. To estimate variations of traffic fatality and injury per vehicle-km travelled whenlinking these datasets.The manuscript of this study is currently prepared for submission: Bhatti JA, Razzak JA,Lagarde E, Salmi L.-R. Differences in police, ambulance, and emergency departmentreporting of traffic injuries on Karachi-Hala road, Pakistan (Appendix 4).I have been involved in all steps of this study, from conception, to data collection, analysis,interpretation of results, and manuscript writing.29