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This might motivate police officers to report RTIs, to better identify the high-risk groups andcrash sites [13].Furthermore, police reported fewer pedestrian and motorcyclist involvement per hundredtraffic injuries. There could be several explanations: Firstly, it is likely that these injuries tookplace near built-up areas, so patients were transported by bystanders or ambulances directly tohospital, without police intervention [13, 32]. Secondly, it is possible that such road usersbelonged to lower socioeconomic status and did not want to be involved in cumbersome andexpensive legal procedures, and settled their issues without police [19]. Nevertheless, effortsare required to improve documentation of such road users to better design and implementeffective crash prevention policies [33].Limitations of secondary datasets such as ambulance or ED for RTC prevention have beenconsidered previously in Pakistan [34]. Availability of NISS was exceptional in this study,because of the existing RTI surveillance system [24]. It was observed that both EAS and EDrecorded the approximate location of traffic crash (town, motel…), whereas police dataincluded the km location of the sites. Linking of these datasets permitted to show a high crashand injury burden, but failed to identify high-risk crash sites. Moreover, seat-belt and helmetuse was not reported in a majority of ED patients, and not recorded at all in police data. Thisshows the need to improve police reporting of crash factors, information that could help indeveloping policies adapted to local settings [11].Finally, this study may have some limitation regarding RTI estimates because names were notavailable for one of three police and one of five ambulance records [34]. Some of these policeand ambulance records could be matched with only one common parameter, thus RTIs couldbe slightly overestimated in this study. Nevertheless, corrected fatality and injury rates werehigher than a similar road in an HIC [35]. Moreover, fatality numbers could be even higher,because patients were not followed for over 30 days, as in the WHO definition [13].Furthermore, half of the police-reported patients were injured away from Karachi and weretransported to hospitals outside Karachi [32]. This shows that the ascertainment of policerecords could be much lower than reported in this study.In conclusion, interurban traffic crash burden appears to be several times higher in Pakistanthan other HICs [35]. Police RTI documentation, particularly of non-fatal injuries and thoseinvolving vulnerable road users, should be improved in Pakistan [12, 14, 34]. Revising policeperformance evaluation, to account for number of traffic crashes in which the policeintervened, might motivate officers to report RTIs [13, 36]. Furthermore, a linked andcomprehensive database would be useful to monitor and implement traffic safetyinterventions in Pakistan [14].ACKNOWLEDGEMENTSWe are especially thankful to Dr. Aftab Ahmed PATHAN, Deputy Inspector General ofPolice, Mr. Irshad SODHAR, Senior Patrolling Officer, and Mr. Naeemullah SHIEKH , SeniorPatrolling Officer, National Highway and Motorway Police south sector III office, Pakistanfor their support in data collection. We are also thankful to Pr. Rasheed JOOMA (JPMC) andMr. Ameer HUSSAIN (JPMC) for providing us the ED data. Special thanks to Mr. FaisalEDHI for providing us the EAS log books.ETHICAL APPROVAL94
All the police, ambulance, and ED data used in this study was publicly accessible and dataanalysis was conducted with approval from their respective institutions. Furthermore, thismanuscript does not permit identification of any RTI patient.AUTHORS’ CONTRIBUTIONThis study is the part of PhD thesis work of JB supervised by LRS who contributed equally tostudy conception, design, analysis, and manuscript writing. JAR and EL provided technicalhelp in all of the above work.COMPETING INTERESTSThe authors declare that they have no competing interests.FUNDINGFirst author is the PhD candidate at Université Victor Segalen Bordeaux 2. This position isfunded by Higher Education Commission of Pakistan. Institut National de la Santé et de laRecherche Médicale Unité 897, France, funded the logistics for data collection. Fundingbodies had no input in study design, analysis and interpretation of results.REFERENCES1. Central Intelligence Agency: The World Factbook. Langley, VA: Directorate ofIntelligence; 2009.2. National Transport Research Centre: Manual of road safety improvement by theuse of low cost engineering countermeasures. Islamabad: National TransportResearch Centre, National Highway Authority, and Finnroad OY; 1999.3. Ghaffar A, Hyder AA, Masud TI: The burden of road traffic injuries in developingcountries: the 1st national injury survey of Pakistan. Public health 2004,118(3):211-217.4. Fatmi Z, Hadden WC, Razzak JA, Qureshi HI, Hyder AA, Pappas G: Incidence,patterns and severity of reported unintentional injuries in Pakistan for personsfive years and older: results of the National Health Survey of Pakistan 1990-94.BMC public health 2007, 7:152.5. Ahmed A: Road Safety in Pakistan. Islamabad: National Road Safety Secreteriat;2007.6. Raja IA, Vohra AH, Ahmed M: Neurotrauma in Pakistan. World journal of surgery2001, 25(9):1230-1237.7. Government of Pakistan: Pakistan Transport Plan Study in the Islamic RepublicOf Pakistan. Islamabad: tripartite collaboration of the Japan InternationalCooperation Agency (JICA); National Transport Research Centre (NTRC), andMinistry of Communications, Government of Pakistan; 2007.8. National Transport Research Centre: Traffic Counter measures in Pakistan.Islamabad: National Transport Research Centre, Ministry of Communication; 1985.9. Shah SG, Khoumbati K, Soomro B: The pattern of deaths in road traffic crashes inSindh, Pakistan. International journal of injury control and safety promotion 2007,14(4):231-239.10. Oxley J, Corben B, Koppel S, Fildes B, Jacques N, Symmons M, Johnston I: Costeffectiveinfrastructure measures on rural roads. Clayton, Victoria: MonashUniversity Accident Research Centre; 2004.11. Wootton J, Jacobs GD: Safe roads: A dream or a reality. Crowthorne: TransportResearch Laboratory; 1996.95
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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
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Figure 7. Monthly trend of traffic
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Injury outcome patternsMost of inju
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MethodsThe study setting was 196-km
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patients. In the ED, those with NIS
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Table 6. Traffic injuries reported
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5. Analytical StudiesPrevious liter
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under supervision of Dr. Sobngwi-Ta
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Table 9. Situational variables at c
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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 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 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
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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
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Page 124 and 125: ABSTRACTObjectives: Interurban road
Page 126 and 127: oad). A matched strategy was used t
Page 128 and 129: SitesOut of 131 crash sites identif
Page 130 and 131: Similarly, it was shown previously
Page 132 and 133: Majdzadeh, R., Khalagi, K., Naraghi
Page 134 and 135: Table 2. Characteristics of Pakista
Page 136 and 137: Table 4. Factors associated with ha
Page 138 and 139: Table 21. Situational factors at hi
Page 140 and 141: Table 23. Situational factors assoc
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