THE OCCURRENCE

AND DETERMINANTS IN ADDIS ABABA,

OF MOTOR VEHICLE

INJURIES

ETHIOPIA

A THESIS PRESENTED TO THE STUDIES OF

SCHOOL OF GRADUATE

ADDIS ABABA UNIVERSITY

IN PARTIAL OF THE REQUIREMENTS

FULFILLMENT FOR THE DEGREE OF

MASTER OF PUBLIC HEALTH

BY TADDELE DESSIE, MAY, 1989 Bsc, MD

ACKNOWLEDGMENTS

wish

to

express

my

special

thanks

to Dr. Charles P. Health Project, helped make this

Larson, Director of the McGill-Ethiopia whose continuous supervision and

Community

correction

thesis possible. My gratitude Research study and Council to the also goes to the of Canada International Development and

(IORC) for generously Community throughout also

funding this

McGill-Ethiopia

Health Project team the study. to Dr. Getachew

for their support and cooperation My heart felt appreciation

goes

Tadesse, Vice-Minister, encouragement Finally, articipating

Ministry of Health of

Ethiopia, who gave

and administrative I forward my

support to my work. great thanks to the staff of the Health Planning Ababa

Addis Ababa hospitals,

Ministry Of

and Programming

Bureau, Road and Transport

Authority,Addis

affic Office, and Ethioian in every respect.

Insurance Corporation,

who assisted

TABLE OF CONTENTS PAGE Acknowledgement Table of Contents List of Tables List of Figures Abstract I. 11. Introduction State of knowledge A. B. C. Occurrence mortality Determinants Impact and hypotheses of motor vehicle injuries and
3 i ii iii

iv
v
1 3

of motor vehicle

injuries

4 9 10

Ill. Objectives

IV.

Methods A. B. C. D. Study design Study domain Population Measurement Conduct of study Data analysis

12
12 12 13 15

E.
F. V.
l.

17
17 19 46

Results Discussion and recommendations

11. Conclusions II.References Appendix A

B C

51 53

56 57 58

ABSTRACT

This is occurring terms causing of

a study

of hospital

treated motor vehicle Injuries are

injuries in

in Addis Ababa, their

Ethiopia. type,

described

circumstance,

and consequence. compared identify The

Drivers

injury and their drivers

vehicles in of

were

with randomly driver was

selected control and vehicle

order to injury.

important

determinants

investigation 12, 1988.

carried out between August 21, 1988 and November During reated ensityof the twelve were week period of for

study, an

1050 hospital incidence rate

injuries

identified, 100,000 person per

overall

279.4 per

years. year and

The mortality

as 17.6 per 100,000 population accounted for an estimated The annual

these fatalities life lost

11,154 years vehicle

of potential

efore age 65.

inflicted

injury incidence

ensity rate was 94.6 injuries per 1,000 cars registered. The majority (90.6%) 11 and 30 multiple of the injured were pedestrians age. (43.6%), The commonest the and body

.9% were between arts affected

years of parts

was

extremities

_ .5%) and the head (22.0%). _ e lacerations Driver of

The most frequent type of injuries (14.9%). an individual gender, under and at increased age 25 with

{42.1 .%) and fractures placing were male

characteristics injury

inflicting 5 years

than

driving small

experiences, bus for drivers the

being privately Elevated vehicle

oyed with a taxi or s were also

licence. motor

found

following

haracterist"cs;

buses, tax"s, pr"vate

ners

" , a

ess

ears on the road. the prediction of

Based upon a multiple motor vehicle

regress"on

ana ysis for

injuries, the most important were found

redictions o be;

in order of their strength of association

motor vehicle

age, drivers age, drivers gender and motor

vehicle type. This study has documented and mortality rates of the high motor vehicle morbidity among the young and vehicle

occurring, Ababa.

in particular, Several public health

male population determinants of

Addis

driver

this important recommendations programs,

problem have been the planning the road

"dentified,and

have been safegurding

given for

of future preventive user.

and educating

I. In the past 100 100

INTRODUCTION years approximately 2 million injured persons have

died and nearly trauma (1).

million become

have

been

from vehicular on motorized of the health

As people

increasingly

dependent

transport, single most problem

motor vehicle frequent wide 36% of

injuries

(MVIs) have

become one public

causes of death and a serious (2,3,4,5). all According to the

world

World Health and

Organization annually road (5).

injuries

involve

motor vehicles

more than six million

people are injured on the

MVI's are the highest under the impact of age of MVI's is far 40 years

ranking

cause

of death countries in

among people (6,7,8). The

in developed and

on- morbidity less well

mortality A

developing for greater

countries

documented.

call

consideration been made Health

of the impact of MVI's Economic Commission

in developing for Africa problem

countries

has

by the

and the World of lack of

organization. about

Recognizins MVI's, the to

the

information devoting njuries comparative eveloping "nvestigation igher injury

9).

World Health Organization the prevention This injuries African) developing of

is now

greater in

attention

road traffic a recent and This had

developing review East of

countries traffic and

stimulated in

developed countries. countries

Southern found that

unexpectedly

rates than those reported

from developed

countries

The adequately profiles physical

incidence documented. carried out

of

MVI's

in

Addis

Ababa upon

has

not the

been health

Nevertheless, based in its five districts,

accidents

causing

injuries were found to be one of (10), and according

the leading

causes of of Health

hospitalization

to the Ministry death in Addis

MVIs is the 6th leading cause of hospital Ababa (11). A major problem with incomplete or hospital recording the

documentation occurrence. relied upon

of

MVI's

is the police

of their been

Traditionally In

records have

Addis Ababa, rooms.

nearly all serious MVI's are treated Health Centers with the and other ambulatory

in hospital facilities

emergency

are not equipped to handle such it was

proper manpower

and physical

resources

emergencies. documented of hospital hile by

Prior to the initiation this study's MVI's police provided principa7

of this investigation jnvesti9ator

that about 30%

treated all

in Addis recorded

Ababa had

no police records, record

nearly

MVI's had a hospital support

12). This finding conducting

important

to the feasibility of MVls the incidence of

a hospital

based investigation

The purpose of this study was to determine l's , to document identify the characteristics vehicle

and outcome

of MVI's, and

driver and

characteristics

placing them at

eased risk for inflicting

=+

a MVIs. In the long run it is hoped and importance of the

by focusing

attention

on the magnitude

em that efforts

to prevent MVI's will gain

greater priority

VIII. REFERENCES

1.

Sleet OA.

Motor vehicle

trauma and

safety belt use in the J Trauma

1987; 27:

content of public health proprieties.

695 - 702.

2.

Bakar SP, Whitefild mortality

and O'nei'l

B.

Geographic

variations

in

from motor vehicle

crashes.

N Eng J Med 1987; 316:

1384 - 1387.

3.

Barancisk

JI, Chatteijee

BF,

YC,etal.

Motor

vehicle

trauma

in northeastern
4.

Ohio. I. Am J Epidemiol

1986; 128: 846 -861.

Newman RJ,

Jones IS. A prospective with chest injuries;

study of 413 consecutive J Truma 1984; 24:

car occupation
129 - 135.

5.

WHO.

Road traffic

accidents
1984.

in developing

countries.

World

Health Organization, 6. WHO Chrnnicle. Helath 7. Arya The

epidemiology

of

road

accidents.

World

Organization, OP and Bosa

1966; 20: 393 - 406.

CB.

Injury employees)

experience in

in a defined an
1972;

population

(university survey

Uganda

epidemiological
49: 417 - 427.

and prevention.

East Afr M J

8.

Simpson HM and Moyhew DR. and preventive.

Youth and traffic accident

causes

Can Fam Physicians for Africa.

1984.

1987, 33: 429 - 435.

9.

Economic

Commission

First African

road safety

congress,Nairobi,

Kenya,

10.

Tadelle Awraja,

Dessie.

Health profile 1988.

and action plan for Fenfene

Addis Aababa. of Health.

11.

Ministry

Comprehensive 1988.

Health Service

Directory

1986-1987,_Addis 12. 13. Ministry Norman

Ababa,

of Health. LG.

Stastic

Bureau, Unpublished accidents.

reports. World Health

Road 1962. Trends

traffic

Organization, 14. Ezenwa AO.

and

characteristics

of road traffic

accidents 15. Fisseha

in Nigeria.

JRSH 1986, 1: 27 - 29. in childhood. Ethiop Med J

Teklewold.

Accidents

1973, 11: 41 - 46. 16. Read JH, and Bradley EJ, Mqreson of traffic JD, LD, etal. The epidemiology accidents involving child

prevention

pedestrians. 17. Barbara

Can Med Ass J

1963; 89: Demographic

687 - 701. analysis of childhood

RB and Barbara M. injuries. Automobile

pedestrian 18. Dolan WD. 232- 254. 19.

Pediatrics related

1985; 76: injuries.

375 - 381.

JAMA 1983; 63:

Kohl'er L, and HacKson

H. Traffic

and children's Sweden, 1987.

health, The

Nordic School of Public Health, 20. Jenqdu

,

MK.

Epidemiology - a

of motor vehicle accidents Oyo state of Nigeria.

in a JRSH

developed

country

case of

1984;; 4: 153 - 156. 21. Cou1cil Report. Automobile related injuries. JAMA 1983;

249: 3216 - 3222.

22.

Premature

mortality

due

to

alcohol

related motor vehicle

traffic fatalities 753 - 755. 23. 24.

- United states,

1987. MMWR 1988; 37:

Hanlon RH. Motor ways and health, JRSH 1980; 4: 144 - 148. Brown BP, Salim LR, vehicle related Lecours S, and Battista RN. Motor and

injury on

the bridges between Montreal river, 1978 - 1982

South shore of the Public Health 25.

St. Lawrence

.Am J

1985; 75: 871 - 874. of road

Aganga Aa, Umoh JU and Abeche SA. Epidemiology traffic accidents 123 - 126. in Zaria, Nigeria.

JRSH 1983; 4:

26

Bennes G~, El-Sayyed. accidents

Epidemiology

of motor vehicle

in .Jeddah , JRSH 1985; 6:200 - 201. Dwellers Association Statistic Office.

27.

Addis Ababa Urban Unpublished report. Insurance

28. 29.

Ethiopian

Corporation.

/V1eden.Addis Ababa,1988. in family practices.

Backs H. The motor vehicle accidents Can Farn Physicians

1988; 34: 589 - 591. the trauma of

30.

Hall R~, and Fisher AJ. Some factors affecting pedestrians 313 - 317. involved in road accidents.

Med J Aust 1972; 2:

31.

Bakar S.P., Robertson collusion.

L.S., O'Neill

B. Fatal pediatrics

Am J Public Health

1974; 64: 318 - 325.