Road Traffic Injuries Little-Discussed Killer in Sub-Saharan Africa

Globally, road accidents rank second among the leading causes of death in young adults, according to WHO, which reported recently that crashes kill 1.2 million people per year around the world and injure an estimated 20 million to 50 million more.

The problem is especially severe in developing countries, which account for more than 85 percent of the world’s traffic fatalities, said Wilson Odero, dean of the School of Public Health at Moi University in Kenya.

Odero noted in a report that he presented at the seminar that about 10 percent of global road deaths occurred in sub-Saharan Africa in 1999, even though the region only had about four percent of the world’s registered vehicles. One study estimated the total road deaths in the region as numbering up to 82,200 in 2002, he said.

"In Africa, we are having two epidemics now–HIV/AIDS and road crashes," Odero said. "There are now drugs for HIV/AIDS. There is no medicine for road crashes."

He noted that pedestrians and passengers–as opposed to drivers– are most often affected, accounting for 80 percent of all road deaths in sub-Saharan Africa. By comparison, non-drivers account for less than 13 percent of all road deaths in countries such as the U.S., France, or Germany, he said.

Children make up a large percentage of those killed as pedestrians. For example, up to 30 percent of all pedestrian casualties in Botswana were children under age 16, he said.

Odero cited a number of factors for the road death epidemic in Africa: speeding, alcohol and drug abuse, driver negligence, overloaded vehicles, inadequate vehicle maintenance, burst tires, bad roads, pedestrian negligence, driver fatigue, and drivers distracted while speaking on cell phones.

While many countries have established road safety agencies to try and deal with the problem, most have been ineffective due to lack of funding or inadequate authority to carry out their duties, he said.

A major problem is the lack of documentation on accidents and their consequences. "In Africa, in particular, no definite policies and institutions exist for injury surveillance and control in most countries," Odero wrote in his report.

The seminar was hosted by Michael Reich, director of the Harvard Center for Population and Development Studies, who himself was severely injured in a road accident while in the Dominican Republic in 1998.

"There is an epidemic of death and disability spreading around the world, and it is one that has been largely ignored," said Reich.

Gro Harlem Brundtland, former Director-General of WHO, told the seminar that WHO’s goal is to build capacity to monitor the magnitude and severity of the burden of road accidents and to work to incorporate prevention into the public health agenda. WHO issued a joint report with the World Bank on April 7 about reducing the toll of road crashes. The report predicted that road traffic injuries will become the third leading contributor to the global burden of disease and injury by 2020.

Brundtland, an HSPH alumna, called the WHO report "not only a wake-up call, but a tool to assist governments to identify actions they need to take to reduce the burden in their own countries."

Among the strategies outlined in the report are reducing rates of speed, limiting alcohol consumption, requiring proper seat restraints, and ensuring greater visibility of pedestrians.

"A few simple interventions can make an enormous difference," she said.

While the numbers of people killed or maimed in road crashes are staggering, they do not depict the human toll of suffering in the same manner as do personal stories, such as that of Philippe Wamba. Harvard College alumnus Wamba was conducting research for a book on the challenges facing youth in Africa when he was killed in a road accident in 2002 in Kenya. Born in California in 1971 to a Congolese father and an American mother, Wamba had developed an interest in the African Diaspora and had become a political and social activist. In 1999, he wrote the book Kinship: A Family’s Journey in Africa and America, which was part memoir and part historical text. A moment of silence was observed in his honor at the seminar’s outset.

Adding further personal reflections to complement the jarring statistics was Speciosa Wandira Kazibwe, former Ugandan Vice President and current HSPH doctoral student.

A surgeon, Kazibwe said that reports do not come close to conveying the horror that is seen in African hospitals on a daily basis. "The reality on the ground is much worse," she said. There is sometimes a significant lag between the time of injury and the availability for treatment, she explained. Victims in rural areas may be far from hospitals and may find getting to one difficult. Others first turn to traditional healers who may not have the expertise to treat serious injuries. Described Kazibwe, "A patient has come with a crash injury, and the leg is rotting because the crash occurred two weeks before. So you have to make a choice whether to cut the leg today, or wait for the anesthetist to come. The suffering, the disability, the burden of morbidity, on top of the burden of AIDS, on top of the underlying poverty, are actually going to sink Africa further and further."

The WHO report on road traffic injury prevention.

--ML