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5.2 Study IV: Burden and factors associated with highway work zonecrashes, Karachi-Hala road section, PakistanWith aging of highways, road authorities spend a considerable proportion of their budget ontheir preservation [94]. For instance, federal and state highway departments of transportationin the USA invest 10 to 15% of their annual budget on the maintenance of highways,amounting to tens of billions of US$ each year [95, 96]. Similarly, highway maintenancebecomes an essential component of development fund spending in LMICs [97, 98]. Theseconstruction zones, often named as Highway Work Zones (HWZs), are present on roadnetworks in all countries [99, 100].In HWZs, road lanes, which are normally available to accommodate the actual traffic flow,are closed, shifted, or encroached upon for construction purposes [99]. Although it is oftenbetter to provide detours to the commuters, this remains impractical in highway settings [99,101]. Thus, traffic flows need to be restricted giving rise to safety challenges [100]. Forinstance, 63% of fatal crashes and one-third of injury crashes took place on HWZs of the twolanehighways in Kansas [100]. In the US, the estimated cost of HWZ crashes between 1995and 1997 was 6.2 billion US$, with an average cost of 3,687 US$ per crash [102]. In HICs,traffic safety issues related to HWZs have been studied in detail, and appropriate trafficcontrol interventions are put in place before the construction begins [103].In Pakistan, the interurban network of over 8 000 km suffers extensively from wear and tearmostly due to overloading, heavy traffic, and delayed maintenance [81]. The pavementconditionsurvey conducted in 2001 showed that 50% of the National interurban road networkis in need of major rehabilitation [81]. The maintenance demands have been consistentlyincreased from 10 billion Pakistani rupees (PKR) in 1991 to over 30 billion PKR in 2005, yetslightly over 10 billion PKR were spent in 2005 for highway maintenance [81]. It is highlylikely that a significant proportion of the current road network undergoes maintenance, but nodata is available to estimate the traffic safety or exposition related to such conditions. Thecase of Pakistan is certainly not different from most LMICs, as almost no research has beencarried out to assess this problem in these countries [3, 90].ObjectivesThe objectives of this study were:1. To assess burden of HWZ crashes on an interurban road section in Pakistan.2. To assess factors associated with such crashes in Pakistan.This study is under second revision in Injury Prevention: Bhatti JA, Razzak JA, Lagarde E,Salmi L.-R. Burden and factors associated with highway work-zone crashes, Karachi-Halaroad section, Pakistan. Injury Prevention (Appendix 6).I have been involved in all steps of this study, from conception, to data collection, analysis,interpretation of results, and manuscript writing.41