|Year : 2013 | Volume
| Issue : 1 | Page : 8-11
Profile of non-fatal injuries due to road traffic accidents from a industrial town in India
Pankaj Bayan, JS Bhawalkar, SL Jadhav, Amitav Banerjee
Department of Community Medicine, D Y Patil Medical College, Pune - 411018, India
|Date of Web Publication||22-Mar-2013|
Department of Community Medicine, D Y Patil Medical College, Pune - 411018
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: India has one of the highest road traffic accident rates in the world. To lessen this burden, information on the contributing factors is necessary.
Materials and Methods: We studied a series of cases of non-fatal road traffic accidents in two tertiary care hospitals in Pimpri, Pune, India. A total of 212 non-fatal road traffic accidents admitted over a period of one year in these two hospitals constituted the study sample. The study variables were, the gender of the accident victims, mode of accident, days of week on which the accident took place, time of day when the injury was sustained, part of the body injured, nature of injury, and self-reported reasons for the accident.
Statistical Analysis: data were summarized using percentages. The Chi-square test for goodness of fit was applied, to see whether there was any association between the different weekdays or time of day and the accidents.
Results: Male : female ratio was almost 5 : 1, which was statistically significant (Chi-Square for goodness of fit = 95.11, df = 1, P < 0.0001). The maximum accidents occurred on Sundays and Mondays and the least around midweek (Wednesday). This pattern was also statistically significant (Chi-square for goodness of fit = 30.09, df = 6, P < 0.001). Pedestrians were the most vulnerable group, followed by drivers and pillions of two wheelers. These categories of road users contributed to almost 80% of the cases of Road Traffic Injuries (RTIs). Accidents were more likely in the time zone of 8 pm to midnight, followed by 4 pm to 8 pm (Chi-square for goodness of fit = 89.58, df = 5, P < 0.0001). A majority of the patients sustained multiple injuries followed by injuries to the lower limbs. A majority reported impaired visibility and fatigue as the cause of accident. Almost half (46.22%) of the injured admitted to drinking alcohol on a regular basis.
Conclusion: Wide pavements and safe zebra crossings should be provided for pedestrians, as the highest casualty in this study were pedestrians. More accidents occurred on Sundays and Mondays and in the late evenings. Extra supervision by traffic police may be considered on Sundays / Holidays and the day following. Roads should be well lit to improve visibility after sunset.
Keywords: Non-fatal, road traffic accidents, case series
|How to cite this article:|
Bayan P, Bhawalkar J S, Jadhav S L, Banerjee A. Profile of non-fatal injuries due to road traffic accidents from a industrial town in India. Int J Crit Illn Inj Sci 2013;3:8-11
|How to cite this URL:|
Bayan P, Bhawalkar J S, Jadhav S L, Banerjee A. Profile of non-fatal injuries due to road traffic accidents from a industrial town in India. Int J Crit Illn Inj Sci [serial online] 2013 [cited 2019 May 20];3:8-11. Available from: http://www.ijciis.org/text.asp?2013/3/1/8/109409
| Introduction|| |
Road Traffic Accidents (RTA) are among the top five causes of morbidity and mortality in South-East Asian countries.  They affect all age groups, but their impact is most striking on the young, in whom they are the leading cause of death globally, especially in those between the ages of 15 and 29 years. Even as road traffic injury rates in many high income countries have stabilized or declined in recent decades, the data suggest that in most regions of the world they are increasing as a result of increasing motorization. 
In India, nearly 80,000 people get killed and 340,000 are injured every year in about 300,000 accidents on the road network of 22, 00,000 km - there is an accident every minute and death every eight minutes. 
Even as strategies to reduce injuries and deaths due to road traffic accidents deserve priority, due to the magnitude of their burden, it has not received adequate attention from the health researchers. Information on the injury patterns, nature, and outcome are extremely limited in India, as trauma registries and hospital-based research have not developed systematically. 
To explore some of these basic issues, we studied a series of non-fatal road traffic injury cases, which were severe enough to require admission to the hospital.
| Materials and Methods|| |
Study Site and Population
The study was carried out in the twin cities of Pimpri-Chinchwad, in the Pune district, in the Indian state of Maharashtra. Pimpri-Chinchwad has a common municipal body (the Pimpri-Chinchwad Municipal Corporation or PCMC). It is located to the northwest of Pune. According to the 2011 census, Pimpri-Chinchwad has a population of 17.28 lakhs. The male population is 9.45 lakhs and female population is 7.83 lakhs.
Pimpri-Chinchwad is a major industrial hub and hosts one of the biggest industrial zones in Asia.
Pimpri-Chinchwad is well connected by road, rail, and air. The nearest airport is the Pune International Airport. The Pune-Lonavala suburban local trains run through the twin township. The old Pune-Mumbai Highway has been widened to four lanes, which has improved the connectivity to Pune and reduced the travel time. The State Transport Bus Service operates the public transport system in this area (which is, however, inadequate to cope with the commuting needs of this big industrial zone). The Maharashtra Government has proposed connectivity to Pimpri-Chinchwad under the Pune Metro Project.
Major Health Facilities
The largest public health facility is the PCMC Hospital run by the municipal corporation. It is a 750-bedded hospital with all specialist facilities. The other tertiary care center is in the private sector, in the form of the 1300-bedded Medical College Hospital and Research Center, run by the Private Medical College, Pimpri. Most road traffic injury cases in Pimpri-Chinchwad are brought to these two hospitals.
Study Design and Sample.
We studied a case series of non-fatal road traffic injuries, in these two tertiary care hospitals. A total of 212 non-fatal road traffic accidents admitted over a period of one year (2010 - 2011) in these two hospitals, comprised the sample for the study.
The instrument used was adapted from the one used in a World Health Organization (WHO)-sponsored, Indian Council of Medical Research Study.  It was pretested in a pilot study and minor modifications were made. The results of the pilot study were not included in the main study.
The data were summarized using percentages. The Chi-square test for goodness of fit, using statistical software Epi 6 [WHO / CDC Atlanta], was applied to see whether there was any association between the different weekdays or time of day and the accidents.
These were not a major concern as no intervention was used in the study. Nevertheless, ethical clearance for the study was obtained from the Institutional Ethical Committee. Besides, informed consent was taken from each participant and confidentiality of the information collected was ensured.
| Results|| |
Gender and Age Groups
The majority of victims were male, 177 (83.5%), while 35 (16.5%) were females. (χ2 for Goodness of fit = 95.11, d.f. = 1; P < 0.001)
Young adults, in the 25 to 34 years age range, constituted the highest age group sustaining RTIs (28.77 %) followed by adolescents, between the age of 15 and 24 years (24.52%).
Vulnerability of Different Types of Road Users to Road Traffic Injuries
This is shown in [Table 1]. The most vulnerable group were pedestrians followed by two-wheeler users, including pillion riders. Almost 80% of the road traffic injuries were contributed by pedestrians, two-wheeler riders, pillion riders, and cyclists.
Personal Characteristics of Road Traffic Accident Victims
Among the injured aged 15 years and above, unskilled laborers were the most common (46.0%) among the cases, followed by skilled laborers (23.2%), unemployed 18, homemakers (9.0%), students (8.5%), and office workers (1.9%). Alcohol consumption was reported by 46.22% of the injury victims.
Weekly Trends in Non-fatal Road Traffic Accidents
This is shown in [Table 2]. Most accidents (25.9%) took place on Sundays. The least number of accidents took place around midweek, Wednesday (7.1%).
Frequency of Accidents According to the Time of Day
This is shown in [Table 3]. Most accidents (35.37% took place after sunset), that is, from 8 pm to midnight.
The largest number of road traffic accidents occurred on a one way road (47.2%), followed by 14.2% occurring at a road junction, 12.7% occurred on a straight road, 10.4% accidents occurred due to a pot hole in the road, and 0.9% due to a ditch.
Parts of Body Injured
Multiple injuries were most common (54.24%), followed by injuries to the lower limbs (38.67%). Fracture of the bones (71.69%) was the most common nature of injury.
Determinants of Accident as Perceived by the Accident Victims
The most common cause cited for meeting with an accident was stated as poor visibility (14.62%), followed by fatigue (11.79%). Few complained of giddiness (1.41%) as cause of the accident. A majority (72.16%) did not attribute it to any specific cause.
Treatment-Seeking Behavior of Non-fatal Road Traffic Accident Cases
Out of the 212 cases, a majority, 149 (70.2%), were admitted to the PCMC public hospital and 63 (29.7%) were admitted to the private medical college and research center hospital.
| Discussion|| |
Countries like India that are undergoing rapid economic and social transition are experiencing an epidemiological mosaic. In addition to the burden of communicable diseases such as malaria, tuberculosis, and HIV / AIDS, rapidly developing countries have to cope with rising trends of non-communicable diseases including road traffic accidents.
Out of all non-communicable conditions, road traffic injuries engage the least attention from health administrators and health researchers, as evidenced by the paucity of trauma registries and hospital-based research on injuries, which are essential to set up an injury surveillance program. This may be due to the perception that determinants of road traffic accidents are non-medical, besides the belief that accidents are, 'accidental' and not 'preventable'. The most common reference to injurious events, 'accidents,' evokes a feeling of chance, misfortune, and helplessness. Hence, the word 'accident' should be avoided in discussing injury control, and instead, the focus should be on exposures to hazards and resulting injuries, as well as their preventability. 
The findings in the present study regarding the age and sex distribution of RTI cases are similar to those of other workers. A review article on road traffic accidents in India has brought out that a majority of the victims are young adults, with a male-to-female ratio of 4 : 1 to 5 : 1.  Likewise, the same review has brought out that pedestrians and two wheeler / pillion riders are the most vulnerable group in road traffic accidents. A large number of road users in India are pedestrians, two-wheeler riders, and cyclists - vulnerable road users (VRUs).  These groups of road users form the major bulk on Indian roads, and hence, their exposure is higher. Unlike occupants in cars and other heavy vehicles, these road users are directly exposed to the traffic environment, without adequate protection (helmet use among two wheelers is rather an exception than a rule in Pune city). Jirojwang et al.  and Singh et al.  also reported that the main vulnerable groups in non-fatal road traffic injuries were young adult males, and two-wheeler riders and pedestrians were more at risk. Jirojwant et al.  noted a similar cyclic trend in accidents, with more incidence around weekends and after sunset to midnight, as in the present study. The implications for a prevention policy based on these findings are wider pavements, zebra / underground crossings at busy places for pedestrians, and enforcement of the helmet rule for two-wheeler riders. The practice of compulsorily wearing helmets by two wheeler riders and pillions has lagged far behind the theory. Decades ago, around the Second World War, Cairns and colleagues conducted some of the first epidemiological studies, using defined populations with comparison groups, to compare head injury incidence between helmeted and non-helmeted motorcycle riders. , Their studies established the protective role of crash helmets in two-wheeler riders and pillions.
Similarly, the finding in the present study relating to time can guide the prevention policy. As more accidents occurred on Sundays (and presumably) holidays, extra attention by traffic police in enforcing traffic rules during Sundays and holidays may be helpful. Similarly, as more accidents occurred after sunset, between 8 pm and midnight, and many reported poor visibility as the cause of accident, better lighting of roads in busy streets is essential.
Few studies in India have documented the extent of injuries to the head, face, upper and lower limbs in hospitalized cases.  In our series a large proportion (54.24%) of cases had multiple injuries or polytrauma. This is in the higher range as other studies have reported multiple injuries or polytrauma ranging from 20 to 40% among RTI patients. ,, The higher proportion in our series may be due to the different setting or case selection (as only hospitalized and non-fatal cases were the study sample).
India is not the first country to have experienced a rapidly rising road traffic injury problem. Most currently developed countries have experienced a similar increase, prior to the 1970s. However, starting with the 1970s, these countries took a series of actions that reversed the rising trend. 
The Cochrane Collaboration provides scientific evidence-based reviews of healthcare interventions through the Cochrane Library. The Cochrane Injuries Group has published 57 reviews on the prevention, treatment, and rehabilitation of traumatic injuries. There are 16 reviews of prevention strategies to reduce traffic injuries, including graduated driver's licensing, increasing pedestrian's and bicyclist's visibility to prevent crashes, and safety education of pedestrians. A list of reviews conducted by the Cochrane Injuries Group is available. 
| Conclusion|| |
Coping with the rising burden of road traffic accidents as a result of rapid urbanization and economic development is a major challenge for the rapidly developing countries. As the causative factors are multiple, many of which are outside the traditional brief of health and medical authorities, they are not attracting the coordinated research and response efforts they deserve. Due to lack of inter-sectoral coordination there is a lack of appropriate policies and accident-prevention programs. Developed countries have addressed the problem over decades of industrialization by implementing a number of measures in an integrated manner. The task is more formidable in developing countries like India, because of a higher population density. Health authorities in India need to work with the traffic police to reduce RTIs, which is likely to increase with galloping economy, globalization, motorization, and unplanned development.
| References|| |
|1.||Mishra B, Sinha ND, Sukhla SK, Sinha AK. Epidemiological study of road traffic accident cases from Western Nepal. Indian J Community Med 2010;35:115-21. |
|2.||The Global Burden of Disease 2004 update [Internet]. World Health Organization, 2008 [updated 2004]. Available from: http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf [Last cited on 2012 Jan 25]. |
|3.||Ministry of Home Affairs. Accidental deaths and suicides in India 2010 [Internet]. Ministry of Home Affairs Government of India, 2011. Available from: http://www.ncrb.nic.in/ADSI2010/ADSI2010-full-report.pdf [Last cited on 2012 Jan 25]. |
|4.||Gururaj G. Road traffic deaths, injuries and disabilities in India: Current scenario. Natl Med J India 2008;21:14-20. |
|5.||Development of a feasibility module for Injury/Road Traffic Injury Surveillance, Pune [Internet]. World Health Organization. Available from: http://www.whoindia.org/LinkFiles/Diability,_Injury_Prevention_&__Rehabilitation_injuriespune_report.pdf. [Last cited on 2012 Jan 25]. |
|6.||Peek-Asa C. Heiden EO. Injury Control: The Public Health Approach. In: Wallace RB, editor. Maxy - Rosenau - Last Public Health and Preventive Medicine 15 th ed. New York: McGraw Hill; 2008. p. 1319-28. |
|7.||Jirojwong S, Rudtanasudjatum K, Watcharavitoon P, Sathitsathien W, Sangjun S. Non-fatal injuries sustained in road traffic accidents: A pilot study in provincial hospitals in Chon Buri, Thailand. Southeast Asian J Trop Med Public Health 2002;33:193-200. |
|8.||Singh A, Goel A, Sekhar. Epidemiological Study of non-fatal road traffic accidents in Rohilkhand Region. Medico-Legal Update 2011;11:1:5-9. |
|9.||Cairns H. Head injuries in motorcyclists: The importance of crash helmets. BMJ 1941;2:465-71. |
|10.||Cairns H, Holbourn H. Head injuries in motorcyclists with special reference to crash helmets. BMJ 1943;1:591-8. |
|11.||Gururaj G, Shastry KV, Chandramouli AB, Subbakrishna DK, Kraus JF. Traumatic brain injury. Bangalore: National Institute of Mental Health and Neurosciences: Publication No 61; 2005. |
|12.||Colohan AP, Akwes WM, Gross CR, Turner JC, Mehta VS, Tandon PN. Head injury mortality in two centres with different emergency medical services and intensive care. J Neurosurg 1989;71:202-7. |
|13.||Murlidhar V, Roy N. Measuring trauma outcome in India. An analysis based on TRISS methodology in a Mumbai university hospital. Injury 2004;35:386-90. |
|14.||Naghavi M, Shahraz S, Bhall K, Jafari N, Pourmalek F, Bartels D, et al. Adverse Health Outcomes of Road Traffic Injuries in Iran after Rapid Motorization. Arch Iran Med 2009;12:284-94. |
|15.||Cochrane Injuries Group [Internet]. London school of Hygiene and Tropical Medicine [updated 2011 Dec 02]. Available from: http://www.injuries.cochrane.org/. [Last cited on 2012 Jan 25]. |
[Table 1], [Table 2], [Table 3]
|This article has been cited by|
||Characteristics associated with alcohol consumption among emergency department patients presenting with road traffic injuries in Hyderabad, India
| ||Marissa B. Esser,Shirin Wadhwaniya,Shivam Gupta,Shailaja Tetali,Gopalkrishna Gururaj,Kent A. Stevens,Adnan A. Hyder |
| ||Injury. 2016; 47(1): 160 |
|[Pubmed] | [DOI]|
||Years of life lost due to premature death in traffic accidents in Bogota, Colombia
| ||Hoover Quitian-Reyes,Carlos Gómez-Restrepo,Maria Juliana Gómez,Salome Naranjo,Patricia Heredia,John Villegas |
| ||Journal of Clinical Epidemiology. 2016; |
|[Pubmed] | [DOI]|
||Risk Factors for Motorcycle-related Severe Injuries in a Medium-sized City in China
| ||Li Liping,Zhu Yao,Xiong Lili |
| ||AIMS Public Health. 2016; 3(4): 907 |
|[Pubmed] | [DOI]|
||Prevalence of facial trauma and associated factors in victims of road traffic accidents
| ||Lorena Marques Nóbrega,Gigliana M.S. Cavalcante,Monalyza M.S.M. Lima,Renata C.R. Madruga,Maria Letícia Ramos-Jorge,Sérgio dæAvila |
| ||The American Journal of Emergency Medicine. 2014; |
|[Pubmed] | [DOI]|
||Efficacy of Prehospital Spine and Limbs Immobilization in Multiple Traumas Patients
| ||Mohsen Adib-Hajbaghery,Farzaneh Maghaminejad,Mahdi Rajabi |
| ||Trauma Monthly. 2014; 19(3) |
|[Pubmed] | [DOI]|