Aldina Mesic, MPH, PhD(c)

Nominated From: University of Washington

Research Site: Kwame Nkrumah University of Science and Technology

Research Area: Injury and Road Safety

Primary Mentor: Barclay Stewart

Research Project

Collaboration to inform Road safety intervention and hazard reduction in Ghana (CRASH Ghana)

The burden of road traffic injuries (RTIs) and deaths is disproportionately high in Ghana and other low- and middle-income countries (LMIC). Road traffic crashes result in more than 50 million injuries and 1.35 million deaths globally, 90% of which are in LMICs (James et al. 2020, Perel et al. 2007). The burden of road traffic deaths is disproportionately high in LMICs, with an average rate for 27.5 deaths per 100,000 population compared to 8.3 deaths per 100,000 in high income countries (HICs) (Bhalla et al. 2020, World Health Organization 2019). Road traffic injury (RTIs) is the 8th leading cause of death for all ages and the leading cause of death for people aged 5 to 29 (James et al. 2020). Associated economic losses are estimated to be US$100 billion each year for LMICs – an estimated 2-3% of their gross domestic products (Perel et al. 2007). RTIs and deaths are expected to increase by 80% with road development, a growing number of vulnerable road users, and increasing rates of motorized vehicle ownership. RTIs will become the second leading cause of global burden of disease in next 20 years (Perel et al. 2007). Despite the substantial burden, road safety has been a largely neglected research area in LMICs. In Ghana, despite the systematic collection of comprehensive road crash data nationally since 2003, spatiotemporal trends in road traffic crashes have not been analyzed.

This study will address this research gap and inform the implementation of evidence-based road safety interventions by pursuing three specific aims:

1) Establishing a multi-sectoral road traffic safety research working group;

2) Building a linked geospatial database using existing data sources; and

3) Answering consensus-derived priority road safety research and evaluation questions using a modified Delphi approach.

A linked geospatial database will be developed by combing the national road crash database with existing spatial datasets of the built environment. Retrospective statistical analyses will be conducted to understand spatiotemporal distribution of road traffic crashes, RTIs, and deaths. The impacts, population costs, and cost-effectiveness of intentional road safety policies, interventions, and natural experiments in specific geographies will be evaluated. The overall objective of this work is to assess consensus-derived, context-specific priority research questions and inform interventions and policies that reduce RTIs and deaths in Ghana and in other LMICs facing a high burden of RTIs.

Research Significance

The spatiotemporal trends in road traffic crashes, correlates to RTIs and death, and impacts of road safety interventions and natural experiments have not been well studied in Ghana despite the systematic collection of road crash data. Prior studies have assessed contextual factors as they relate to road traffic crashes, but have not linked these to geospatial data, intentional interventions or natural experiments to assess changes in patterns of crashes, injury and mortality, which are critical in determining priority interventions (Aidoo et al. 2013, Asare et al. 2020, Ackaah et al. 2020, Damsere-Derry et al. 2010, Damsere-Derry et al. 2017).

Under the National Road Safety Authority leadership, there have been many initiatives that may have impacted road safety (e.g., enforcement policies, changes in signage, creation of traffic calming measures) and natural experiments (e.g., diversion around town centers, barrier separation between lanes) that have not been rigorously evaluated.

We are proposing to fill this gap by establishing a working group of road safety stakeholders with support of NRSA and BRRI to identify short- and long-term research and evaluation priorities; developing a linked geospatial database of road traffic crashes, health outcomes (injury, death), road network, and built environment factors; and analyzing the data to address those priorities. By doing so, the collaboration and findings will guide policies to improve road safety and reduce RTIs. Further, we will estimate disability (e.g., incidence in traumatic brain injury), mortality, and costs that could be averted with targeted interventions in select geographies or road specifications to advise on context-specific intervention planning efforts. We will maintain connection with the working group and support the group in the dissemination of key findings to relevant stakeholders.

Lessons generated from this work will also be applicable to other low- and middle-income countries. This work will provide lessons on developing and linking a road traffic accident database with health outcomes, determining context-specific factors and interventions, and working collaboratively with a group of stakeholders to prioritize road traffic injury prevention and control, which is highly relevant for many LMICs facing similar challenges.


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