MethodsStudy <strong>de</strong>sign and settingsThe study settings were interurban road sections situated in Cameroon and Pakistan:1/ Karachi-Hala road section in Pakistan (196-km-long mostly four-lane separated road), and2/ Yaoundé-Douala road section in Cameroon (243-km-long mostly two-lane non-separatedroad). A matched strategy was used to select sites. ‘High-risk sites’ were those involved inthree or more RTCs in a prece<strong>de</strong>nt three-year period, whereas ‘low-risk sites’ were those notinvolved in a RTC, during the same period. For each high-risk site, a low-risk site wasrandomly selected on the same road section. Hazard perception was assessed by showingvi<strong>de</strong>os of these sites to voluntary Pakistani drivers. Ethical approval of the study was obtainedfrom the Aga Khan University Ethics Research Committee in May 2009 (ReferenceERC/2009/1179).Site selectionIn Pakistan, NHMP regional office was visited in the month of June 2009. Crash reports andregisters for the three-year period from Jan 1, 2006 to Dec 12, 2008 were retrieved andphotocopied. High-risk sites with given kilometre location were then i<strong>de</strong>ntified with GPScoordinates with help of a police officer. Similarly, traffic police offices in Cameroon werevisited and such sites were subsequently i<strong>de</strong>ntified in June 2007. The two road sections werefilmed from a four-wheeled sedan car moving within the authorized speed limit (July 2009 inPakistan and July 2007 in Cameroon). All high- and low-risk sites were then i<strong>de</strong>ntified bylinking GPS coordinates to the vi<strong>de</strong>os. For each high-risk site, a low-risk site was randomlyselected out of all sites which were not involved in crashes on the same road section.Vi<strong>de</strong>o setsTo measure hazard perception, vi<strong>de</strong>o of sites were cut so that each vi<strong>de</strong>o showed a 500 metrelong-roadsection during 30 seconds, including the last 100 m corresponding to the high- orlow-risk site (Figure 14). Further, a yellow indicator blinked five times to help drivers i<strong>de</strong>ntifythe site for which they had to emit a judgement on hazard perception right after vi<strong>de</strong>oprojection. We <strong>de</strong>termined sample size to be 26 pairs of sites, assuming that 95% of the highrisksites would be i<strong>de</strong>ntified as dangerous and 80% of the low-risk sites as not dangerouswith a precision of 7.5 [125].Participant selectionParticipants were Pakistani nationals residing in Karachi, aged 18 years or more, with a validdriving permit, who had driven a motorized vehicle on the Karachi-Hala road section in theprevious seven days. Random sampling was not possible because of heavy-traffic and higherspeeds conditions on this road section [30]. Thus, a convenience, but representative, samplingmethod was used to recruit 100 drivers. For this, we <strong>de</strong>termined the drivers’ sex and vehiculardistribution by observing traffic from a pilot study (N=5 496). It was observed that carsaccounted for 39.1%, heavy trucks for 36.5%, minibuses and mini-trucks for 7.8%, buses for9.6%, and motorcycles for 6.3% of the vehicles entering Karachi (Appendix 8). Distributionof cars and heavy vehicles was similar to that recor<strong>de</strong>d by highway authority [83]. Almost alldrivers were men (99.9%). Based on these findings, personal vehicle male drivers wereinvited from a roadsi<strong>de</strong> gas station at start of the highway near Karachi, and commercialvehicle drivers were invited from transport company offices at six different locations inKarachi.Data collectionFace-to-face interviews with drivers were conducted in Urdu language. Questions were<strong>de</strong>veloped from an English language questionnaire, using back translation, in<strong>de</strong>pen<strong>de</strong>ntlinguistic verification, and testing on five drivers. Interviews were either conducted at the Aga48
Khan University (AKU) Campus or at the company offices in separate rooms. Driver-relatedvariables inclu<strong>de</strong>d socio-<strong>de</strong>mographic variables (age, sex, marital status, education, an<strong>de</strong>mployment), whether driving permit was issued without practical test, frequency of reportedrisky driving behaviours (sleepy driving, mobile phone use while driving, seat-belt use, traffictickets, DWI during last three months), and involvement in RTC during last one year.Using 17-inch vi<strong>de</strong>o screens, five test vi<strong>de</strong>os (three from Pakistan and two from Cameroon)were shown to drivers before presenting selected sites. The or<strong>de</strong>r of sites was randomly drawnfor each participant. To avoid confusion from right- and left-hand driving practiced inCameroon and Pakistan, site vi<strong>de</strong>os from Cameroon followed those from Pakistan. For eachvi<strong>de</strong>o shown, drivers were asked to report their perception of site and traffic, on a four-levelscale; 1) Certainly safe; 2) Probably safe; 3) Probably dangerous; 4) Certainly dangerous(Figure 14). Further, they were asked to record their preferred speed (in km/h) for each site.Each site was characterized by the main investigator, using <strong>de</strong>finitions used in our previousstudy conducted in Cameroon [126]. Site-related variables assessed were built-up or ruralarea, horizontal and vertical road profile, road width, surface regularity, verge slope, <strong>de</strong>pth at10 m from the verge, location and type of nearby obstacles (within a road distance of 50 m ineach direction), horizontal marking, vertical road signs, and presence of an intersection or aU-turn [126]. Traffic-related variables assessed were traffic moving in same or oppositedirection, visible pe<strong>de</strong>strian, motorcyclist, or heavy vehicle, rain or wet surface, manoeuvringvehicle (crossing or overtaking), and number of lanes [127].49
- 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 14 and 15: 2. Background2.1 Road injury burden
- 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 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,
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Table 1. Traffic injuries reported
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Table 3. Ascertainment of police, a
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Appendix 5: Article published - Stu
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104
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106
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108
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Appendix 6: Article under review -
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1. INTRODUCTIONWith the aging of hi
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A total of 180 crashes were identif
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conspicuity at HWZs in Pakistan. 2
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21. Sobngwi-Tambekou J, Bhatti J, K
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Table 2. Highway work zone crash fa
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122
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ABSTRACTObjectives: Interurban road
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oad). A matched strategy was used t
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SitesOut of 131 crash sites identif
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Similarly, it was shown previously
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Majdzadeh, R., Khalagi, K., Naraghi
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Table 2. Characteristics of Pakista
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Table 4. Factors associated with ha
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Table 21. Situational factors at hi
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Table 23. Situational factors assoc