BMJ  2004;328:895 (10 April), doi:10.1136/bmj.328.7444.895

Letter

Research on preventing road traffic injuries in developing countries is needed

EDITOR—The dedication of the World Health Organization's World Health Day 2004 to road safety is recognition of the global threat of road traffic injuries. Increasing population size, vehicle ownership, road infrastructure, and transnational transportation have created a substantial public health burden. However, little epidemiological research has been conducted into preventing road traffic injuries in developing countries. Currently global research and development funding per disability adjusted life year for HIV, asthma, and blindness are $26.2, $10.8, and $5.4, respectively, while only $0.40 for road traffic injuries.¹

Epidemiological studies of successful interventions preventing road traffic injuries have been conducted in developed countries.² But to assume the same effectiveness in developing countries is inappropriate because of behavioural, vehicular, and environmental differences.

A pooled analysis of street lighting intervention data from developed countries shows a protective effect,³ particularly in pedestrian injury (relative risk 0.56), the most common road traffic injuries in developing countries.

Annually, 1.2 million deaths are attributed to road traffic crashes, 85% occurring in developing countries.⁴ If an intervention such as street lighting could reduce deaths by as much as 30%, there is a potential to save thousands of lives.

Various international aid agencies are investing in road infrastructure development. These initiatives could be coupled with the need to develop concrete epidemiological data. Innovative strategies, such as step wedge study design,⁵ could lead to the evolution of an evidence based public health approach to this problem.

MSc Epidemiology Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT

megan.mcguire{at}lshtm.ac.uk, MSc Epidemiology Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT

MSc Epidemiology Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT

MSc Epidemiology Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT

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Competing interests: None declared.

References

1. Ad Hoc Committee on Health Research Relating to Future Interventions Options. Investing in health research and development. Geneva: World Health Organization, 1996. (Document TDRGen/96.1.)
2. Centers for Disease Control and Prevention. Achievements in public health, 1900-1999. Motor-vehicle safety: a 20th century public health achievement. Morb Mortal Wkly Rep MMWR 1999;48: 369-74.[Medline]
3. Renton F, Pond P. The effect of street lighting on the incidence of injury and death caused by road traffic crashes. Cochrane Library 2004 (in press).
4. Jacobs G, Aeron-Thomas A, Astrop A. Estimating global road fatalities. TRL report 445. Crowthorne: TRL Limited, 2000.
5. Kirkwood B, Cousens S, Victora C, Zoysa I. Issues in the design and interpretation of studies to evaluate the impact of community based interventions. Trop Med Int Health 1997;11: 1022-9.

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