Determinants of road traffic injury at Khulna division in Bangladesh: a cross sectional study of road traffic incidents

Introduction

Road traffic Injury (RTI) is one of the leading causes of deaths, injuries and disabilities worldwide, for both developed and developing countries. Every year about 1.25 million of people die worldwide due to RTI’s¹, and a high burden of traffic fatalities and injuries occur in low and middle-income countries (LMICs); this burden is enhanced due to rapid urbanization and motorization². Road traffic accident deaths are projected to increase to 2.1 million in 2030, mainly due to the increase in the use of motor vehicles related to economic growth in low and middle-income countries³. Bangladesh is a developing country situated in South Asia and its located between 20°34' to 26°38' north latitude and 88°01' to 92°42' east longitude, with an area of 1,47,570 sq.km. with a population of 162.9 million and density of 1251.5 people per sq.km.⁴. Presently the total length of roads in Bangladesh is 21,125.082 km⁵. In Bangladesh, road traffic accidents, injuries and fatalities are an area of great concern. According to the Bangladesh Road Transport Authority, the number of death stood at 2376 and injuries at 1958 as of 2015 in Bangladesh⁶. Khulna is an industrial and divisional city of Bangladesh, with an area of 45.65 km². The total number of vehicles running in Khulna city is greater than 20990, including about 13360 non-motorized and 7630 motorized vehicles as of 2005⁷.

The World Health Organization (WHO), has reported on RTIs that “Approximately 1.3 million people die each year on the world's roads and between 20 and 50 million sustain non-fatal injuries”⁸. Developing countries carry the greatest share of the burden⁹. Reviewing literature across different countries, it shows that people aged 15–49 years are more vulnerable to road traffic deaths^10,11. Men are involved in a greater proportion of road traffic accidents and fatalities in comparison to women^11–14). Motorcycles are the most common vehicles to be associated with RTIs. According to Nantulya et al.¹⁵ buses, trucks, pedestrians and passengers have the highest burden of morbidity and mortality in RTIs. For Asian countries, income, road design and management, and accidents involving vehicles are also important predictors of RTIs¹⁶. Different studies identified various reasons behind RTIs like excessive speed of the vehicles, inexperienced drivers, reckless driving, violation of traffic rules and signals etc.^17–19. A study from the Accident Research Center (ARC) of Bangladesh University of Engineering and Technology found that the death rate of road accidents in Bangladesh is much higher, about sixty deaths per 10,000 vehicles per every year, as compared with rates of two in the USA²⁰.

RTI’s are the 2^nd most common cause of injury and deaths in Bangladesh²¹ and the road traffic accident situation in Khulna city as well as the rest of Bangladesh is a vital issue, and the loss of lives and damage of valuable assets are expected to continue if proper measures are not adopted accordingly. Almost 1.8% to 2.2% of gross domestic product (GDP) is lost in road accidents in this country²², which itself demonstrates the severity both in terms of deaths and injuries. So, extensive research and investigation is needed urgently to improve the RTI situation.

Therefore, the main purpose of this study is to find out the socio-demographic differentials and socio-economic factors related to RTI, as well as knowledge and awareness about RTI, and to recommend suggestions regarding study results.

Methods

Results

The results of association between knowledge about traffic rules among the selected socio-demographic and economic characteristics of respondents in Bangladesh are presented in Table 1 and Table 2. In this study, 58% of the respondent had knowledge about traffic rules. Most of the victims were aged 15–44 years (65%), and most (58%) of the respondents had prior knowledge on traffic rules, of which 6.9%, 73.3% and 19.8% were 0–14 years, 15–44 years and 45< years age groups respectively. Males (87%) are at higher risk of RTI, however, of those with prior knowledge of traffic rules 92.2% were male. Among all the respondents, 67% and 33% live in rural and urban areas, respectively, where 58.6% and 41.4%, respectively, have knowledge of traffic rules. In Khulna division, 14.5% of people were illiterate and 45% and 40.5% of people had completed “primary to higher secondary school (HSC) level education and higher level of education, respectively and of which 4.3%, 37.1% and 58.6%, respectively, knew about traffic rules. It appears that knowledge of traffic rules increase with level of education. 47% of respondents belong to the occupation group job and business, of which 62% have knowledge about traffic rules. A total of 49.5% of the respondents had a monthly family income of 10001–25000 taka, termed as middle class families, of which 49.1% of the respondents had knowledge of traffic rules.

Most of the participants had RTI’s on urban roads (37.5%), followed by rural (33%) and highway roads (29.5%). 37.9% and 35.3% of respondents who had RTI’s on urban and rural roads, had known about traffic rules. We can define motorcycles as the most vulnerable vehicle based on this study. In this case, 47.4% reported a motorcycle as their RTI vehicle. 7.8% of respondents whose accident vehicle was a bicycle had prior knowledge of traffic rules. In the case of victim’s position during the RTI, passersby were most affected (39%) followed by passengers (34.5%). In this study area, 72% of participants received proper treatment, 81% of them had knowledge of traffic rules, and 68% claimed that they had a negative effect on family due to the RTI, especially financial 40.5%. With regards to the reasons behind RTIs, respondents who had knowledge of traffic rules said unskilled drivers (30.2%), unfit vehicles (20.7%), breaking traffic rules (32.8%) and faulty roads and road management (39. 7%). The number of participant who believed current traffic rules were not sufficient (71%) was significantly higher than those who believed the rules were sufficient (29%). 63.8% had knowledge of the current traffic rules and they felt traffic rules were not sufficient. 65.5% of the participants said government rules inadequate and 66.5% of respondents indicated about NGO roles adequate.

A logistic regression analysis was applied to identify the factors which were significantly associated with knowledge of traffic rules. The results of the logistic regression analysis are presented in Table 3 and Table 4. In this study, the regression odd ratio for primary to HSC educated respondents was 3.584 (95% CI = 0.907-14.155), and for higher educated was 24.070 (95% CI = 4.860-119.206), indicated that primary to HSC level educated respondents had 3.584 times more chances, and higher educated respondents had 24.070 times more chances to know traffic rules, when compared to illiterate respondents. So it was clear that higher educated people were more likely to know traffic rules than others. In the case of occupation, the regression odds ratio for farmers and labors was 0.528 (95% CI = 0.208-1.340), and for others was 0.263 (95% CI = 0.097-0.713) times less likely to know traffic rules than the respondents who were engaged in job and business.

The respondents injured by motorcycles had 4.137 (95% CI = 1.229-13.932) times more knowledge about traffic rules than those who were injured by trucks. Respondents who received proper treatment had a regression odds ratio of 4.690 (95% CI = 1.736-12.673) indicating that those who got proper treatment were 4.690 times more likely to know traffic rules than the respondents who had not received proper treatment. People who were conscious during their RTI had an odds ratio of 18.394 (95% CI = 6.381-53.025), which indicated that those who were conscious during their RTI were 4.690 more likely to have prior knowledge of traffic rules than who were not conscious. In the case of reasons behind RTI, unskilled driver had an odds ratio of 8.169 (95% CI = 0.96-16.51), unfit vehicles had an odds ratio of 3.696 (95% CI = 1.032-13.234), breaking traffic rules had an odds ratio of 6.918 (95% CI = 2.237-21.397), faulty roads and management had an odds ratio 3.037 (95% CI = 1.125-8.196), indicating respondents were 8.169, 3.696, 6.918 and 3.037 times more likely to know about the traffic rules than the respondents that answered was “No” respectively.

Discussion

Knowledge about traffic rules is a very important factor in reducing RTIs^17,28. According to this study, it is observed that the age group at most risk of being involved in an RTI in Khulna division is 15–44 years. Similar results showed up in Ethiopia in 2014²⁹ and in Nigeria³⁰ as well as India³¹. It was observed that those aged 15–44 years had more knowledge than the other age groups. Males were at relatively higher risk when compared to females, like other developing countries^14,32. Similarly, deaths from RTIs was higher for males in Iran³³, and in India³⁴, and knowledge of traffic rules was higher in the male population. In Khulna, the majority of victims are from the rural areas, this is similar to the findings of Mishra et al.³⁵, with an education level of “primary to HSC level”. Most of the individuals educated to a higher level were familiar with traffic rules. Education can play a positive role in preventing RTIs. In this area, the majority of the respondents had jobs or businesses, and had good knowledge about traffic rules compared to laborers, farmers etc. Middle-income individuals were termed as middle class families. A number of victims were from middle class families. Among these respondents, victims experienced RTIs on the urban and rural roads. We found motorcycles to be the most vulnerable vehicle, a result is similar to those found in Thailand in 2009³⁶ and also in Nigeria^30,37 and many other studies^31,38, where the majority had no knowledge of traffic rules. In the case of victim’s positioning at RTIs, passersby were affected most³⁹ along with passengers. A study in India showed similar findings^31,34,38. In this study area, the majority of participants got proper treatment and had knowledge about traffic rules. RTIs had an adverse effect on families, mostly financial, as victims take treatment cost due to RTI as a burden to them. Respondents identified several reasons behind RTIs; unskilled drivers⁴⁰, unfit vehicles, breaking traffic rules and faulty roads & management which shows similarities with the results from Iran⁴¹ and other developing countries^15,42. Disabilities and deaths caused by RTIs can only be addressed with a change in attitude⁴³. Most of the participants think traffic rules were not sufficient and the Government’s steps were not enough to reduce RTIs. The majority of respondents indicated about the role of NGO’s, similarly to Mohan & Roberts, that to reduce RTIs government and private partnership is needed⁴⁴. Further intervention studies are needed to put more focus on reducing RTIs.

Conclusion

This study has tried to explain the general characteristics of RTIs and their associated factors with RTIs in the Khulna division, Bangladesh. With the growing population and urbanization, a safe, properly managed and systematic transportation system is very urgent for Bangladesh to fulfill both current and future demand. Based on the study results increased emphasis on education is advised as well as increasing public awareness about RTIs. NGOs could play a role here. Awareness of RTIs through different training and awareness related programs especially in less well educated rural areas. Strict legislation must be compiled and followed. The government should not give licenses to unskilled drivers and those with unfit vehicles. Road management systems must be well planned and systematic, and all damaged roads must be repaired in time. Government and private organizations both are needed to eradicate road traffic accidents.

Ethical statement

Ethical approval (Number 0089) was obtained from the department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi-6205, Bangladesh.

Data availability

Dataset 1: Khula data set 10.5256/f1000research.15330.d212933⁴⁵