Road traffic accidents in Tunisia: a man made disaster Pr Hassen Ghannem Department of Epidemiology University Hospital Farhat Hached Sousse, Tunisia
Disaster • Webster’s Dictionary defines disaster as • a baleful or fatal event leading to ruin. • Family • Country • What’s more disastrous for someone than the death of a relative following a road traffic accident.
INTRODUCTION • Injuries account for 12% of the global burden of disease (1, 2) • Traffic accidents are costing countries between 1% to 2 % of their gross national product • Traffic accidents are a major preventable public health problem • About 1,2 millions persons were killed and 50 millions were injured, worldwide, in 2002.
DESCRIPTIVE EPIDEMIOLOGY Figure 2 : Road traffic injury mortality rates in the different regions of the world (1)
DESCRIPTIVE EPIDEMIOLOGY Worldwide • Road traffic injuries mortality rates : *1,2 millions persons killed every year * 3242 persons killed every day * Traffic accidents : 11th cause of death * Developing countries: - 2/3 of the world population - 90% of deaths due to road crashes
DESCRIPTIVEEPIDEMIOLOGY Worldwide • Road traffic injury mortality rates : * Increase in the mortality rates of 10% between 1990 and 2002 (1) * Differences between developped and developing countries Figure 3 : Changes in road crashes mortality rates according to countries (1)
DESCRIPTIVE EPIDEMIOLOGY In Tunisia During the period 1996-1998 (3): - 32 197 accidents, with 14,9 deaths per 100 accidents - an average traffic accidents incidence : 116,3 / 100 000 inhabitants / year - an average mortality rate : 14,2 deaths / 100 000 inhabitants / year - 5,9 persons killed per 100 humans implied - the average age of the persons who were implied in the accidents : 33,6 years - About 61,7 % of drivers were aged 20-40 years; 21 times more males than females among drivers - Pedestrians were the most vulnerable and the most severely injured.
RISK FACTORS The risk depends on four elements : • A) Exposure excess (need to travel) • B) Risk of crash, given a particular exposure, • C) Risk of injury, given a crash, • D) Risk of death or severe consequences, given an injury.
PREVENTION • Taffic accidents are preventable. • The three targets of the road safety actions : - the road users - the vehicles - the roads infrastructure as well as the traffic management.
PREVENTION A- A scientific approach to the issue is necessary : Many conditions are required to guarantee the efficiency of the prevention strategies which are adopted. • To collect, analyse and carefully interpret reliable data : The National Traffic Observatory in Tunisia was established to fulfill theses missions. • To define objectives. • To promoteresearch, which subjects are concerned with road safety. • To encourage the cooperation between different organizations intervening in traffic accidents prevention (NETWORKING).
B- The key organizations intervening in the prevention strategies : Figure 7 : Organizations intervening in road safety actions(1)
C- Prevention measures : Prevention strategies are made of interventions which are aiming to : • diminish the exposure risk. • avoid road crashes, given a particular exposure. • reduce the severity of injuries caused by crashes • improve the medical care for victims.
Measures avoiding road crashes, given an exposure • Speed limitation • Measures against « alcohol and driving » • Measures avoiding the drivers fatigue : • Measures ensuring pedestrian and cyclists safety • Prevention of traffic accidents implying young drivers • The prohibition of the use of hand-held mobile telephones while driving • More road visibility
Measures reducing the severity of injuries caused by crashes : a – The use of seat-belts • When used, the seat-belt reduce the risk of fatal or severe accident, between 40% and 65 % (1). • Making the wearing of safety belts compulsory improves their use rates. b- Use of helmets c- Availability of air bags
Actions improving post-crash injury outcome - pre-hospital mesures : * Bystanders : call for help, carry out simple acts to rescue victims, protect victims from an other accident * Larger access to emergency services * Better pre-hospital medical care - actions in the hospital :
CONCLUSION Traffic accidents constitute a huge public health problem: a man made disaster. The situation is going to be worse unless prevention strategies are adopted. There is a hope to avoid such losses of lives, of health and of money by setting road safety actions. A scientific approach to the issue is essential in every country, so that road safety policies could be founded on reliable data, and meeting financial resources of each region.
REFERENCES 1- World report on road traffic injury prevention. Geneva (Switzerland), World health organization, 2004. (http:/www.who.int/violence_injury_prevention) 2- Bovet B. Health transition and emerging cardiovascular disease in developing countries : situation and strategies for prevention, Super course. 3- Henchir N. Epidemiology of traffic accidents in Tunisia [thesis]. Sousse : Medicine Faculty of Sousse 2001.