Publications

Walking is a predominant mode of travel in Addis Ababa representing more than half of the daily trips. The mild climate in Addis Ababa is conducive for this healthy and green mode of transport. However, sidewalks are often narrow, uneven, obstructed, or non-existent, causing discomfort and road safety risks to the most vulnerable road users: pedestrians. Studies done by the WHO and the Government showed that AA has disproportionately high pedestrian fatalities. 

The study on Addis Ababa Sidewalk Safety and Improvement takes the approach of integrating digital technology and Urban Inventory in sidewalk surveys, applies the Global Walkability Index in sidewalk assessments, and adapts the global best practice to the local context. The Addis Ababa Sidewalk Design and Maintenance Guidelines seek to promote the development of quality pedestrian infrastructure and environments, based on the condition’s assessment and global best practices. The design specifications and visual rendering provide recommendations for the policy makers to consider when developing the City’s design and maintenance standards for urban roads, sidewalks, public spaces, and transit-oriented development, some of which are being carried out as part of the technical assistance program of the World-Bank financed Transport Systems Improvement Project (TRANSIP).

In developing countries with inadequate public transport and road infrastructure, motorcycles present a fast, cheap, and efficient transport alternative. Motorcycles are widely used in many African countries for personal and public transport, as well as for service delivery. In some African countries, motorized two and three-wheelers constitute the largest proportion of the motorized vehicle population. However, despite their benefits, motorcycles expose their riders and passengers to a high risk of serious injury or death in the event of crashes. Motorcycle safety is therefore a significant problem in Africa. On average, 22.5% of road traffic deaths in 2016 involved riders/passengers of two- and three-wheelers, according to the last data published by World Health Organization (WHO, 2018).

This research study presents comprehensive strategic recommendations on how to improve motorcycle safety in Africa. The study will serve as policy advice and technical assistance to the Bank’s regional member countries (RMCs). The study focuses on motorcycle safety conditions in Cameroon, Burkina Faso, Rwanda, and Uganda, where the use of motorcycles for daily activities is reputedly high. Recommendations are predicated on an examination of the major causes of motorcycle crashes and injuries, as well as an extensive body of knowledge from various sources, notably:

• international literature and good practices on motorcycle safety;
• assessment of motorcycle crashes, regulations, risk exposure data, risk indicators in African countries (with more detailed analysis of Burkina Faso, Cameroon, Rwanda, and Uganda); and
• consultations with stakeholders.

An evaluation of the various Emergency Medical Services (EMS) models and mechanisms in place in Sub-Saharan Africa (SSA) is critical in order to have a better understanding of what can be improved upon for effective pre-hospital and emergency care services (PECS). With grant funding provided by the World Bank’s Global Road Safety Facility (GRSF), this report aims explore the State of EMS Systems in Sub-Saharan Africa through a review of the models and mechanisms being developed across various States.

The premise of the report focuses on the fundamentals for effectively providing satisfactory treatment to those in need of urgent medical care, while also recognizing that there are multiple pathways, framed by the respective legislative, legal and regulatory enabling environments, towards a more formal and sustainable EMS model. It represents an effort to identify the major similarities and differences, as well as potential opportunities for greater coordination or collaboration, that can lead to the development of sound policy recommendations for fostering and expanding post-crash response services in the region.

High-level system information has been collected through questionnaires distributed to National Respondents in each country, for which 25 of 44 countries substantially responded as of April 2019 (collectively hereinafter referred to as SSA countries): Botswana, Burkina Faso, Burundi, Cabo Verde, Cameroon, Central African Republic, Chad, Comoros, Congo Brazzaville, Gabon, Lesotho, Liberia, Madagascar, Malawi, Mauritania, Niger, Rwanda, Senegal, Sierra Leone, Sudan, Tanzania, Togo, Uganda, Zambia and Zimbabwe. Missing data and discrepancies triggered a detailed review of laws and other regulatory acts, policy and plan.

The Report does not consider the advantages and disadvantages for the EMS models adopted by SSA countries, nor does it take a position on which regulatory approach should be applied, or measure the degree of EMS standards implementation and the success or failure of implementing various EMS policies. The principal aim of this report is to capture the current range of the standards and regulations in key areas of EMS systems across SSA.

The State of Emergency Medical Services in Sub-Saharan Africa is supported by UK Aid through the World Bank’s Global Road Safety Facility.

This study is one part of a comprehensive study of lead road safety agencies in low- and middle-income countries (LMICs), which is being conducted on a collaborative basis by the World Bank, the World Health Organization, and the African Development Bank. This particular study is supported by UK Aid through the World Bank’s Global Road Safety Facility (GRSF). It focuses on the case of Nigeria, a federal republic with three tiers of government - federal (central), state and local governments - and its single institutional model for road safety.

This report responds to the following questions:

• What are the strengths and weaknesses of this model and what could be done to improve its’ efficiency and effectiveness?

• How efficient and effective is the “Single Organizational Model” institutional setup (both federal and state levels) in dealing with the road safety issues in Nigeria?

• Can this model be replicated in other LMICs and what are the factors that will determine the replicability of the model in those countries?

•  What are the steps in setting up “Single Organizational Model” institutions in LMICs?

Download the report to learn more!

RESOURCES ⌵︎

Presentation on key aspects

ACKNOWLEDGMENTS ⌵︎

‘The “Single Organization Road Safety” Institutional Model, its Efficacy and Replicability’ Study is supported by UK Aid through GRSF. The Report was written by three main authors: Martin Small, Mustapha Azzouzi and Arpita Roy. The study was led by Farhad Ahmed (Senior Transport Specialist) with support from Md. Towshikur Rahman, who was responsible for the overall coordination.

Road traffic crashes are one of the most important causes for physical and psychosocial disease burden and early death worldwide. The United Nations (UN) declared the Decade of Action for Road Safety during the period 2011-2020, with the objective to halve the number of road traffic deaths by 2020. While the number of fatal road traffic crashes has decreased since then in high-income countries (HIC), it has increased in low- and middle-income countries (LMIC). Worldwide, about 90% of the crashes are recorded in LMIC (2016), while these countries had only about 60% of the motor vehicles.

Driving under the influence of alcohol is one of the principal reasons for road traffic crashes. The use of alcohol is also a risk factor for other road users, such as pedestrians and bicyclists. The involvement of alcohol in injurious and fatal road traffic crashes has been well documented in most HICs, but data for LMICs is scarce, particularly for African countries.

The study is a collaborative effort among the Kamuzu Central Hospital (KCH), the Norwegian Institute of Public Health (NIPH) and the Oslo University Hospital (OUH), with the financial support of UK Aid through the Global Road Safety Facility (GRSF), the International Council on Alcohol Drugs and Traffic Safety (ICADTS) and the Norwegian Council for Road Safety (Trygg Trafikk).

The objective of the study was to generate new knowledge about road traffic injuries in Malawi and the extent of traffic accidents related to alcohol use, to increase capacity to conduct alcohol-testing, and develop a database for the findings, which in turn will form the basis for future policymaking to reduce traffic accidents.

The objectives were achieved through collecting data on patients who sought treatment after road traffic crashes and admitted to the Emergency Department at Kamuzu Central Hospital in Lilongwe, Malawi. The data included basic information about the patients, alcohol use before the injury, and information about accident circumstances, including types of road users and vehicles involved. Knowledge and training of local KCH employees to perform alcohol testing and record data were an important aspect of this study.

RESULTS  ⌵︎

• Of 1347 eligible patients who were asked to participate during a period of about three months, 1259 (93.5 percent) gave informed consent, eight patients were not tested for alcohol and thus excluded, resulting in 1251 patients in the study.

• The prevalence of alcohol was 30.7 percent among males and only 2.5 percent among females, who represented 19.2% of the total cases. There were minor differences across different age groups, with the highest prevalence of alcohol use among those between 25 and 44 years of age (26-27 percent) and lowest among those 45 years of age and older (19.7 percent).

• The highest prevalence of alcohol was found among patients with no formal education (33.3 percent) compared to patients with college or university education (22.1 percent) with the lowest prevalence.

• When comparing the different road users, the highest prevalence of alcohol was found among pedestrians (41.8 percent) while the prevalence among the other road users varied from 19.1 percent (bicycle riders) to 24 percent (motorcycle riders).

• Patients injured during weekend night crashes, showed the highest prevalence of alcohol (59.6 percent), followed by those injured during weekend evenings (36.8 percent) and weekday nights (35.3 percent).

• Regarding drinking habits, measured by the AUDIT-C questionnaire, hazardous drinking was more common among males (26 percent) than among females (4.2 percent). Age group 25-34 years had the highest prevalence of positive AUDIT-C test (26 percent).

• The blood alcohol concentrations (BACs) at the time of injury were estimated by back-calculation for road users who were tested for alcohol within five hours after injury in accordance with forensic medicine practices. An estimated proportion of 15.2% of the injured motor vehicle drivers had BAC at or above 0.08g/dl when the crash occurred.

Acknowledgments ⌵︎

This research project was made possible with the financial support of UK Aid through the Global Road Safety Facility, the International Council on Alcohol Drugs and Traffic Safety and the Norwegian Council for Road Safety.

The 2010 Global Burden of Disease (GBD-2010) was a systematic effort to quantify the comparative magnitude of global health loss due to 291 diseases and injuries, 67 risk factors, and 1,160 sequelae by age, sex, and country from 1990 to 2010. The project was led by the Institute for Health Metrics and Evaluation (IHME) and included a consortium of academic institutions. The World Bank Global Road Safety Facility commissioned a special effort at Harvard University to improve the estimates of road injuries in sub-Saharan Africa generated as part of GBD-2010 by incorporating more data and better methods for the region.

Executive Summary

The UN Decade of Action for Road Safety 2011-2020 calls on national governments in sub-Saharan Africa and worldwide to direct substantial resources to stem the increasing burden of road traffic injuries. Bringing such attention to road safety requires demonstrating the importance of the problem relative to other major threats that currently confront sub-Saharan Africa. Therefore, in this study, we estimate the burden of road injuries relative to other health issues in the region through a systematic and scientific effort to quantify the comparative magnitude of health loss due to all diseases and injuries. We track the relative evolution of diseases and injuries since 1990 to show the increasing importance of road injuries to the health and development agenda in sub-Saharan Africa. We find that:

• Road injury deaths are severely underreported in most sub-Saharan countries. Our estimates are often six times those of official government statistics. In Nigeria, they are 14 times the official statistics of the national road death toll.
• Road injuries killed 231,000 people in sub-Saharan Africa in 2010, accounting for almost one-fifth of the global road injury death toll. In addition, there were over 8 million non-fatal injuries, of which 885,000 were severe enough to warrant hospital admission if adequate access to medical care were available. The combined burden of non-fatal road injuries in sub-Saharan Africa exceeded 14 million healthy life years lost.
• Western, Central and Eastern sub-Saharan Africa have the highest road injury death rates of any global region. The death rate in Western sub-Saharan Africa is more than four times the rate in Western Europe. • Road injuries are the 8th leading cause of death in sub-Saharan Africa and the 10th leading cause of healthy life years lost. The public health burden of road injuries exceeds that from tuberculosis and maternal disorders.
• Deaths due to road injuries have grown by 84% in sub-Saharan Africa since 1990, almost twice the global increase. The Western and Southern regions of sub-Saharan Africa had the highest growth in road deaths of any region in the world, more than doubling over this period.
• Road injuries are the 7th leading cause of death in males in sub-Saharan Africa. They are the 13th leading cause of death in females, compared with 18th globally. The road injury death rate for females in Western sub-Saharan Africa is more than twice the global average and almost five times the rate in Western Europe.
• Road injuries pose a high burden over the entire life course in sub-Saharan Africa, impacting not just young adults but also children and the elderly. Among children aged 1-4 years, road injuries are the 8th leading cause of death in the region. Among adults aged 70+ years, road injuries are the 12th leading cause of death and 14th leading cause of healthy life years lost, compared with 26th and 23rd globally.
• Pedestrians comprise 44% of road deaths in sub-Saharan Africa, substantially more than the global average of 35%. The rate of pedestrian deaths in Western sub-Saharan Africa is 8 times the rate in Western Europe.
• Nigeria has the highest road injury death rate (52.4 per 100,000 people) of any country globally. Mozambique has the third highest death rate (46.7 per 100,000). These rates are more than 15 times the death rates in Sweden, UK, and the Netherlands, which have among the lowest death rates globally.
• Four countries (Nigeria, Ethiopia, South Africa, and Sudan) together account for half the road injury death toll of sub-Saharan Africa.

Road safety has emerged as an important health priority in sub-Saharan Africa. Trends over the last two decades show that road injury rates in the region have remained at among the highest in the world even though substantial improvements are being made in controlling other diseases, such as tuberculosis, malaria, and diarrheal disease. Unless significant preventive efforts are undertaken, road safety will continue to climb in regional health rankings during the UN Decade of Action for Road Safety. National governments and the international development community need to prioritize road safety in the region and implement the recommendations of the 2004 World Report on Road Traffic Injury Prevention.