Road Traffic Injury Prevention Initiatives: A Systematic Review and Metasummary of Effectiveness in Low and Middle Income Countries.

BACKGROUND: Road traffic injuries (RTIs) are a growing but neglected global health crisis, requiring effective prevention to promote sustainable safety. Low- and middle-income countries (LMICs) share a disproportionately high burden with 90% of the world's road traffic deaths, and where RTIs are escalating due to rapid urbanization and motorization. Although several studies have assessed the effectiveness of a specific intervention, no systematic reviews have been conducted summarizing the effectiveness of RTI prevention initiatives specifically performed in LMIC settings; this study will help fill this gap. METHODS: In accordance with PRISMA guidelines we searched the electronic databases MEDLINE, EMBASE, Scopus, Web of Science, TRID, Lilacs, Scielo and Global Health. Articles were eligible if they considered RTI prevention in LMICs by evaluating a prevention-related intervention with outcome measures of crash, RTI, or death. In addition, a reference and citation analysis was conducted as well as a data quality assessment. A qualitative metasummary approach was used for data analysis and effect sizes were calculated to quantify the magnitude of emerging themes. RESULTS: Of the 8560 articles from the literature search, 18 articles from 11 LMICs fit the eligibility and inclusion criteria. Of these studies, four were from Sub-Saharan Africa, ten from Latin America and the Caribbean, one from the Middle East, and three from Asia. Half of the studies focused specifically on legislation, while the others focused on speed control measures, educational interventions, enforcement, road improvement, community programs, or a multifaceted intervention. CONCLUSION: Legislation was the most common intervention evaluated with the best outcomes when combined with strong enforcement initiatives or as part of a multifaceted approach. Because speed control is crucial to crash and injury prevention, road improvement interventions in LMIC settings should carefully consider how the impact of improvements will affect speed and traffic flow. Further road traffic injury prevention interventions should be performed in LMICs with patient-centered outcomes in order to guide injury prevention in these complex settings.

Increasing Motorcycle Taxi Driver Conspicuity in Tanzania

Motorcycle crash related injuries and deaths are increasing rapidly in many African nations. Utilizing conspicuity measures, such as wearing reflective, fluorescent safety vests, are effective as crash prevention strategies. Furthermore, use of some conspicuity measures is mandated by law among motorcycle-taxi drivers in Tanzania. Nonetheless, uptake remains low. Locally appropriate strategies to improve crash preventative behaviors are needed.

To explore whether use of conspicuity measures could be improved through eliminating cost-barriers, we tested a distribution strategy involving the provision of free motorcycle safety vests among a population of motorcycle-taxi drivers in Moshi, Tanzania. We conducted a cluster randomized controlled trial among 180 motorcycle-taxi drivers in which half of the participants (90) were randomized to the intervention arm and received a free reflective vest. The other half of the participants (90) were randomized to the control arm and did not receive free vests. Whether motorcycle taxi drivers used the reflective vest was then unobtrusively observed on city streets over a period of three months.

Mixed-effects logistic regression was used to estimate differential uptake of the vests between trial arms. At baseline, 3.3% of individuals in both arms used a reflective vest. In three months of follow-up, 79 drivers in the intervention arm and 82 drivers in the control arm were able to be observed. In the intervention arm the average proportion of observations during which drivers were observed to be using a reflective vest was 9.5%, compared to 2.0% in the control arm (odds ratio: 5.5, 95% confidence interval: 1.1-26.9, p-value: 0.04). Distribution of free reflective vests did lead to an increase in vest usage, however, the increase was minimal. Removing economic barriers alone appears insufficient to adequately improve adherence to conspicuity measures.