Two weeks ago, while travelling outside of Dhaka, I passed the remnants of an accident that had left a man dead on the road. It was a jarring sight and like most events in Bangladesh, there was an enormous crowd. However, this was not the first such accident that I have seen. I vividly remember similar occurrences when I lived in Pakistan and Nepal. People being killed in motor vehicle accidents is not just a rare tragedy, but rather something that happens with alarming frequency so much so that it clings to the edge of conversation like an urban legend. It made me wonder if this is just a strange coincidence or something larger, so I did a little research.
Did you know that it is predicted that by 2030, road traffic injuries will be the fifth leading cause of deaths globally? Already each year approximately 1.3 million people die due to road traffic accidents and an additional 20 to 50 million are injured or disabled in accidents. Despite being home to less than 50% of the world’s motor vehicles, low- and middle-income countries have 90% of the mortality burden for road traffic accidents (WHO, 2009).
One of the greatest reasons for this difference is the high number of pedestrians, cyclists, motorcycle or scooter riders as well as their passengers (known collectively as “vulnerable users”). In Bangladesh we must add rickshaws to the vulnerable road users – there are more than 400 000 rickshaws plying the streets of Dhaka alone. Deaths of the vulnerable users account for 46% of these deaths and specifically in low-income countries pedestrians account for nearly half of all deaths (Naci et al, 2009).
Specifically for Bangladesh, the overall estimates are that road traffic accidents accounted for 2% of all deaths (19 000) in 2002 (WHO 2006) yet police reports only captured 3160 traffic fatalities in 2006 (WHO 2006). Road accidents are the most common cause of serious injury for men, responsible for 40-45% of injuries in urban men. True to the global norms, 54% percent of deaths are among pedestrians (1), WHO, 2009b).
It was interesting to learn that road traffic accidents and deaths have far reaching impact on more than the individuals involved. Half of rural poor households in Bangladesh with a family member killed in an accident had not been poor before the traffic accident (Aeron-Thomas et al, 2004). Further, it is estimated that the total annual cost of road traffic accidents is approximately US$230m per year in Bangladesh (2).
The situation is grim, but certainly it is not hopeless. There are proven interventions that can lead to a reduction in the amount of road traffic deaths and injuries. They include the controlling of traffic or reduction of speed using speed bumps, the introduction of traffic circles or low-speed zones in urban areas, establishing and enforcing blood alcohol concentration limits, the use of helmets for both riders and passengers on motorcycles, the use of seat belts, and of infant seats and child booster seats.
However, because the burden of traffic related deaths and injuries is particularly high in developing countries, there exists a great paradox. The societal support services in low income countries like the enforcement of traffic laws, urban planning, and effective emergency health services are least able to apply the proven interventions that can reduce traffic related morbidity and mortality (Sharma, 2008). For example, the wearing of seatbelts in automobiles can reduce deaths in front seat passengers by 40-65% and by 25-75% for rear seat passengers; however, only 57% of countries require the wearing of seat belts by all passengers (WHO, 2009). Bangladesh is an example of such a country in which there are no laws governing the wearing of seatbelts or the use of child safety seats.
What are the next steps for me? In a world of competing priorities, I am not sure what my role is beyond driving very carefully, attempting to reinforce to my sons and my friends the need to use extreme caution while walking the streets, and perhaps trying to learn who within Bangladesh is working on road traffic safety – and learning more about what is being done and how if there is any way in which I can contribute – rather than just continuing to drive by the victims.
Tracey Koehlmoos is programme head for health and family planning systems at ICDDR,B and adjunct professor at the James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
(1) National Institute of Population Research and Training (NIPORT), MEASURE Evaluation, International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), and Associates for Community an d Population Research (ACPR) (2008). 2006 Bangladesh Urban Health Survey. Dhaka, Bangladesh and Chapel Hill, NC, USA: NIPORT, MEASURE Evaluation, ICDDR,B, and ACPR.
(2) National Institute of Population Research and Training (NIPORT), Mitra and Associates, and Macro International (2009). Bangladesh Demographic and Health Survey 2007. Dhaka, Bangladesh and Calverton, Maryland, USA: National Institute of Population Research and training, Mitra and Associates, and Macro International