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they identified a cluster of long bone fracture as a result of motorcycle crashes. In depthanalysis revealed that the presence of speed bump without light resulted in these crashesduring low-light conditions. Further, a study from Hong Kong, a relatively resourceful setting,showed that in 12% of police reports, GPS coordinates were not recorded correctly, limitingtheir utilization by road agencies [35].Crash factorsRoad user factorsContribution of road user, vehicle, and road situational factors in interurban crashes was givenin only one study [18]. This study showed that these were involved in 65.2% (range 58.6 to73.5) of interurban road crashes. These included loss of control (30.0%), over-speeding(12.4%), misjudging traffic gap (11.9%), sudden slowing (7.9%), and careless overtaking(6.1%) [18].Almost all nine studies which analyzed factors associated with crashes and injuries, focussedon road user-related factors. Only three of these used case-control designs whereas rest ofthem assessed factors associated with crash or injury severity using single source data andcross-sectional designs (Table 17). For instance, a study showed that frontal and pedestriancollisions were more significantly associated with injury crashes than rear end collisions [21].Similarly, several studies confirmed that DWI was significantly associated with injury crasheson interurban roads [30, 31]. Moreover, not wearing a seat-belt or a helmet was shown to besignificantly associated with injury crashes in two different settings [31, 33, 36]. An interstatebus driver survey showed that Body Mass Index (BMI) ≥ 30 km/m² was significantlyassociated with drowsiness while driving (50.0% vs. 30.1% in those with BMI < 30 kg/m²; P
BehavioursSpeedingPrevalence of risky road behaviours on interurban studies was assessed by few studies. Forinstance, a study reported that speed alone could account for over 50% of the RTCs reportedin Ghana [19]. In two different studies, over-speeding was measured as a function of vehicleand road type on interurban road sections [24, 25]. Both studies showed that 90% of thevehicles travelling through built-up areas on such roads exceeded posted speed limits. Evenon rural road sections, nearly half of the sampled vehicles had exceeded posted speed limits.Mean speeds varied with road types, with higher speeds noted for national highways than onregional and inter-regional highways. Further, the highest vehicle speeds were associated withprivate cars and large buses [25].Driving while intoxicated (DWI)A Nigerian study showed that 44.6% of the drivers involved in traffic violations on highwayshad Blood Alcohol Concentration (BAC) higher than 0.05% [27]. A Brazilian study showedthat alcohol consumption could be higher in some risk groups such as truckers, where weeklyincidence of DWI could be as high as 91% [38]. Nearly half consumed it at the fuel station.Similarly, the incidence of DWI in Cuban commercial drivers on highways was 8.2%(N=66/832; 95% CI=5.9, 10.4), with 20% of them having a BAC ≥ 0.05% [29].Sleepy drivingLong working hours was an important cause of sleepiness in Brazil [38]. A Peruvian highwaybus driver survey showed that up to 80% of them drove continuously for more than five hours[41]. Sleep deprivation was measured in two different studies from Latin America, suggestingthat nearly one-fourth of commercial drivers slept less than 5 hours in the preceding 24-hourperiod [41, 44].Use of stimulant drugsIn relation to sleepiness in commercial drivers, several studies assessed stimulant use in thesetypes of samples. A Peruvian study reported that 14% of them used coffee, 4% smoked, 4%chewed coca, and 2% took alcohol mixed with coca leaves [41]. Higher caffeine use (95%)was reported elsewhere [44]. A Turkish study showed that 75% of such drivers used amedicinal drug with caffeine and paracetamol while driving, mostly for headache and fatigue.Its use resulted in sedation for 30 to 60 min (78.5%), stumbling (21.5%), and loss in visualacuity (6.5%) [47]. Two Brazilian studies reported that stimulants such as amphetamines wereused by commercial truck drivers to cope with sleepiness [38, 44]. According to one [44], itsuse was 66%, while the other reported it to be around 11%. These substances were availableon the highway and most of them used it for night driving [38].Pre-hospital and essential trauma careWe found four studies conducted on the Mexico-Cuernavaca highway that indicated that therewas some pre-hospital care system on those road sections [30-32]. A brief description wasavailable, but structure, process, and outcome of care were not described. An urban hospitalbasedstudy showed that 15.9% of all injured patients received in ED had been involved ininterurban road crashes [43]. A majority of these patients were transported by private means.None of the study reported commonly known evaluation parameters such as response time orlength of stay for those injured in interurban road crashes.Evidence on interventionsSeveral prevention and control measures were evaluated, almost all in non-controlled studieswith a before and after study design (Table 18). A study showed that installation of rumblestrips on a busy junction on a highway decreased crashes by 35% and fatalities by 55% [19]; a51-percent decrease in pedestrian collisions was recorded. This intervention was four times77
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Université Victor Segalen Bordeaux
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Publications (peer-reviewed).......
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Index of figuresFigure 1. Traffic f
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AbbreviationsAKUAVCIBMIEASESSDALYDW
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AbstractBackground: Interurban traf
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L'objectif de cette thèse était d
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2. Background2.1 Road injury burden
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2.4 Multiple factors involved in tr
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Figure 4. Percentage difference of
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2.7 Interurban road safety research
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ObjectivesThe objectives of this fi
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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 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
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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
Page 132 and 133:
Majdzadeh, R., Khalagi, K., Naraghi
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Table 2. Characteristics of Pakista
Page 136 and 137:
Table 4. Factors associated with ha
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Table 21. Situational factors at hi
Page 140 and 141:
Table 23. Situational factors assoc
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