NEW YORK — Reports by international agencies last year drew attention to the toll of traffic fatalities in lower-income countries, which disproportionately impacted vulnerable populations, such as pedestrians and motorists on two-wheelers. African and Southeast Asian countries had markedly higher rates of road fatalities on average when compared to the rest of the world, according to the reports by the World Health Organization and the World Bank.
“Almost half of the 650 people who die every day on Africa’s roads are pedestrians, cyclists, and motorcyclists,” Guangzhe Chen, World Bank senior director for transport road safety, told Devex in an email interview. Chen said Africa has the highest road traffic fatality rates in the world — 27 in 100,000 people — despite having less than 3 percent of the world’s vehicles.
But despite the seemingly high numbers, public health researchers in Africa and Southeast Asia caution that substandard reporting and gaps in data mean that the toll on vulnerable road users may be even higher.
“[Hospitals] note the cause of death as internal hemorrhage, though the initial reason is a road traffic crash.”— Nhan Tran, coordinator for unintentional injury prevention at WHO
Data gaps in lower-income countries
“The distribution of deaths among road user categories was based on reported data,” said Nhan Tran, coordinator for unintentional injury prevention at WHO, who was part of the team that put together last year’s “Global status report on road safety.”
“But in some countries, the reported data is about one-fifth of the estimates generated by the WHO. We don’t have information about 80 percent of the deaths and it’s entirely possible that pedestrians and bicyclists constitute a bigger proportion of those deaths,” Tran said.
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Tran added that under-reporting from countries, particularly those in Southeast Asia and Africa, was not intentional: “Most data comes from police, whose priority is to get people to a health center.”
Lower-income countries lack the linkages between different data sources — health centers, insurance, police — that exist in higher-income countries, Tran continued. So there is no way to update police data when people die in the hospital after a crash. “They [hospitals] note the cause of death as internal hemorrhage,” said Tran, “though the initial reason is a road traffic crash.”
Olive Kobusingye, senior researcher in public health in Kampala, Uganda, said she was concerned that her country didn’t currently have “a good handle on baseline data.” Once the data improves, Kobusingye suggested that the share of pedestrian and two-wheeler deaths will increase. This was the finding of a 2016 study in India, which found, through FOIA requests, that pedestrian deaths accounted for 40 percent of traffic fatalities, although official records, which were based on police reports, claimed that they comprised less than 10 percent.
“It’s highly likely that we are still underestimating the rates of injuries and deaths among vulnerable road users,” Kobusingye said.
The studies Kobusingye has conducted suggested that hospital data was more likely to capture fatalities among poorer, nonmotorized road users, than data from the police or insurance companies, she said. Nonetheless, there were crucial gaps in all sources of data, she added.
“Hospitals do not record whether the victim was a vehicle occupant or cyclist,” she said. “And the police may pride themselves on capturing every single traffic fatality, but they do not update ‘serious’ accidents when they turn fatal,” Kobusingye said.
Abdul Bachani, head of the injury research unit at Johns Hopkins, has studied traffic fatalities in Southeast Asia, as well as across Africa, including in Kenya, Ghana, South Africa, and Botswana. He agreed that data from low-income countries can have crucial gaps.
“In Indonesia, we noticed that pedestrian fatalities were really low,” Bachani said. “When we looked into it, we found out that the culture dictates that people should be buried immediately when they die. So pedestrian deaths were going unrecorded.”
Bachani added that in most countries he’s studied, deaths and injuries were missed in rural and remote roads, where cases such as hit-and-runs don’t get reported to the police.
Better data for more effective solutions
Bachani said better data is needed to determine “the true universe of crashes” among vulnerable road users so that improved and targeted interventions could be designed.
Bachani cited studies he conducted in Kenya, which revealed that a rising reliance on motorcycle taxis by commuters lead to an increased rate of injuries. According to data from police, injuries among commuters had risen at an annual rate of 29 percent between 2004 and 2009. A survey Bachani conducted over five years — among motorcyclists in two districts in Kenya — suggested one significant reason for the increase in injuries: passengers weren’t wearing helmets. “Helmet use among motorcycle taxi drivers was around 35 percent, but among passengers, it was as low as 2-3 percent,” Bachani said.
“Roads are built for cars, and there are no sidewalks or barriers between motorists and pedestrians.”— Olive Kobusingye, senior researcher in public health, Kampala, Uganda
Bachani’s research also suggested that enforcing a lower speed limit would make roads significantly safer for pedestrians — who make up approximately 40 percent or more of all road fatalities in Kenya each year. “In Kenya, our research three years ago found that 35-70 percent of vehicles exceeded the speed limit; the amount of speed has a direct bearing on probability of fatality and the outcome of the crash.” He said that several studies that found that at 50 kph, the risk of death for pedestrians is as much as eight times higher than at 30 kph.
Bigger investments in infrastructure
Both Bachani and Kobusingye agreed that infrastructure is the biggest problem in lower-income countries. “There is serious underinvestment in infrastructure,” Kobusingye said. “Roads are built for cars, and there are no sidewalks or barriers between motorists and pedestrians.”
Bachani added that highways and intercity roads plow through settlements, leaving inhabitants no safe way to go from one side to the other. This means that solutions that work in wealthier countries, such as seatbelts, would not be impactful in lower income countries.
“In Uganda, 79 percent of accidents happen to walkers or people in two-wheelers. This differs wildly from the U.S.,” Kobusingye said. Also unlike the U.S., in countries such as Uganda, urbanization is relatively recent, rapid, and uncontrolled. “That’s why the most effective intervention here would be longer-term investment in mass transit,” she said. “We’re moving 1 million people a day. Without that, we’re ensuring a lot of friction.”
Bachani said that “multipronged solutions” are needed and better data is needed to know exactly what the prongs should be. “How bad is the problem, how is it changing, who is increasingly affected and where, and what are the risk factors?” he asked. “We need better data on these questions before we can help advocate for more targeted investment to bring down crashes and fatalities in lower-income countries.”