ROAD TRAFFIC INJURIES - A NEGLECTED EPIDEMIC??

BY GOPIKA MANIKYAM (VII TERM)*

Road traffic injury (RTI) is a major, but neglected public health problem especially in
developing countries. Motorization has enhanced the lives of many individuals and
societies, but the benefits have come with a price. The World Health Organization
(WHO) estimates that during 2013 Road Traffic Accidents (RTAs) led approximately to
3000 deaths and 30,000 injuries. This equates to 1.24million deaths and as many as 50
million injuries annually. Unfortunately, the low and middle-income countries are worst
hit and account for 85% deaths and 90% of all injuries. Presently,RTAs are the 8th
leading cause of death globally and the leading cause of death of people aged 1529
years. Young adults aged between 15 and 44 years account for 59% of all deaths,
leading to 2-4% of global loss of GDP every year . Further, road traffic accidents are
predicted to result in the death of around 1.9 million people annually by 2020, and by
2030 will become the fifth leading cause of death.

India has the largest road network in the world measuring 3.314 million kilometres,
consisting of National Highways, Expressways and State Highways etc. About 65 % of
freight and 86.7 % passenger traffic is carried by the roads. In our country we have 1
road accident every minute and 1 death every four minutes due to RTA i.e. nearly 1.5
lakh people lose their lives while nearly 5 lakh people get severely injured every
year.The RTA victims are mainly males(70%) and belong to the most productive age
__________________________________________________________________
GOPIKA MANIKYAM (VII TERM) M.B.B.S. STUDENT
AJ INSTITUTE OF MEDICAL SCIENCES & RESEARCH,MANGALORE,KARNATAKA (INDIA)

group of 15- 45 yrs, leading to nearly 3% loss of GDP every year. During last ten years
the population of our country has increased only 1.6 % per year but the road accidents
have increased at the rate of 4.6 % per year, leading to an increase in the RTA fatality
rate from 8.2/lakh to 10.9/lakh in 2014. Paradoxically,in the United States, which has
close to 300 million people and more than 250 million vehicles, the number of deaths
per 10,000 vehicles is only 1.6, while in India this number, known as the Road Fatality
Rate, is as high as 14. It is really tragic that w ith just 1% of the world's vehicles, India
manages to account for 10% of total global road fatalities.

We also find large disparities in road traffic death rates between various regions. The
risk of dying as a result of a road traffic injury is highest in the African Region (24.1 per
100 000 population), while it is lowest in the European Region (10.3 per 100 000).
Namibia has the highest RTA death
rate (53.4/ 100,000) followed by Swaziland
(48.2/100,000) , while it is lowest in Maldives (2.4/100,000) Malta (3.1/100,000) and
Japan (3.8/100,000). India ranks 77 with a death rate of 18.7/ 100,000.
If we analyse the victims of RTA ,it is observed that half of the worlds road traffic
deaths occur among motorcyclists (23%), pedestrians (22%) and cyclists (5%) i.e.
"Vulnerable Road Users". Car occupants account for 31% of deaths while the
remaining 19% deaths are among unspecified road users. In addition to the grief and
suffering, road traffic injuries also result in considerable economic losses to victims
and
their
families.

As we look at the main risk factors responsible for RTAs it has been universally
observed that Drunken driving , Over Speeding,Using Mobile phones while Driving
,Child Restraint and Not wearing of helmets and seatbelts , are the most important
causes of RTAs . Besides, Driver fatigue, Not obeying or following traffic rules,The
attitudes of the right of the mighty bigger vehicles toward the smaller vehicles,
Overloading of transport vehicles, Poor maintenance of the vehicles , Appalling
condition of the already choked roads and rampant encroachments further contribute to
the increasing rate of RTAs.
We know that d rinking and driving increases the risk of crash, as well as the severity of
the resulting injuries. The vigilence level of drivers gets impaired with a blood alcohol
concentration (BAC) of 0.05 g/dl, while at a BAC level of 0.1 g/dl the crash risk is
approximately ve times higher than that of someone with a BAC level of zero.
Unfortunately,only 89 countries, covering 66% of the worlds population (4.55 billion
people), have a comprehensive drinkdriving law, with a BAC limit of 0.05 g/dl or less
.Further,high-income countries have a legal BAC limit of 0.05 g/dl or less (67%) while
much lower percentage of
middle- or low-income countries (49% and 21%,
respectively) have these legal limits in place.

However,India has the lowes t legal BAC limit , i.e. 0.03g/dl as compared to other
countries. Unfortunately, the enforcement of drinking-driving law in India is
very
unsatisfactory and majority of the drunken driver s get away easily by paying a small
amount as bribe to the checking officials.
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It has been observed in various studies that wearing a standard, good quality motor
cycle helmet can reduce the risk of death by 40% and the risk of serious injury by over
70%. Fortunately,155 countries (covering 88% of the worlds population) have laws in
place for for helmet; both for drivers and co-passengers,including India.
It has been found in various studies that w earing a seat-belt can reduce the risk of a
fatal injury by 4050% for drivers and front seat occupants, and between 2575% for
rear seat occupants. It is heartening to know that comprehensive seat-belt laws are in
place in hundred and 111 countries, (covering 69% of the worlds population, 4.8 billion
people) ,including India.

It has also been observed

that d rivers using mobile phones are four times more
vulnerable to RTA than those not using a phone. The Risk is similar for both, hand
held as well as hands free phones. Globally 142 countries (covering 83% of the world
population ) have laws in place and prohibit
its use while driving, whereas 34
countries also prohibit hands free phones.India also has comprehensive law s against
use of mobile phones .However, in our country the enforcement of law again remains
far from satisfactory.
It is very heartening to learn that the revised MOTOR VEHICLE AMENDMENT BILL
2014 has been passed in parliament on 18 Dec 2014, which has provided for highly
stringent penal actions for drunken drivers .As per the provisions of this law, first offense
for drunken driving will attract a fine of Rs. 25,000 or imprisonment for a term not
exceeding 3 months, or both, and a six-month license suspension. Second offense
within three years will result in Rs.50,000 penalty or imprisonment for up to one year or
both and one year license suspension. Any subsequent offense shall result in the
cancellation of the license, and impounding of the vehicle which may extend for 30
days. If school bus drivers are caught driving drunk, Rs. 50,000 fine will be imposed
with imprisonment for three years while "immediate cancellation" of license will take
place . Causing death of a child will result in "Rs. 3 lakh fine, and imprisonment for a
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term not less than 7 years. Violating traffic signal three times will result in Rs. 15,000
fine, license cancellation for a month and compulsory refresher training.

To ensure proper care of RTA victims ,Honorable Supreme Court of India in its order
dated 19 Feb 2004 has made it mandatory for all medical establishments to attend to
all RTA victims without raising any objection that it is a medico-legal case requiring
information to the police authorities etc ; even if such a person is not in a position to
make payment for screening and emergency medical treatment immediately.
WHO in its initiative to prevent RTAs, in 2011, has drawn a Global Plan for the Decade
of Action for Road Safety 20112020 to guide efforts at national and local levels.
Subsequently, various Governments, international agencies, civil society organizations,
and private companies from more than 110 countries have launched the Decade of
Action for Road Safety 2011 2020 , which seeks to save 5 million lives over the 10year period. India is also a signatory to this. A road safety tag has also been
launched with a message Wear- Believe- Act which is a new global symbol for road
safety and the key visual for the Decade 2011-20 of Action for Road Safety.

Road traffic accidents (RTAs) are issues of national concern, considering their
magnitude and devastating impact on society, economy, public health and the welfare
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of the people. Therefore, there is an urgent need to completely revamp the alarming
Road safety situation in India and accord it the same priority as other important public
health issues. Enforcement of law to prevent drunken driving alone will save up to 70 %
of RTA deaths. Further, preventing over-speeding ,use of helmets by two-wheeler
drivers , use of seat belts and child restraints in cars , enforcement of
traffic
rules,proper maintenance of vehicle and improving the condition of our roads
will
significantly reduce road accidents . It may be emphasised here that with
strict
enforcement of road safety regulations and the wide range of effective road safety
interventions available the Road Traffic Injuries are preventable.
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ACKNOWLEDGEMENT:
I owe my most sincere thanks and humble gratitude to my respected teacher Brig (Dr)
Hemant Kumar who has always been my guiding light and a source of motivation
and inspiration in my academic persuit. l owe him very especial thanks for
motivating me for writing this article and l shall always remember him for his help in
giving this article the desired shape.

Gopika M