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      Individual characteristics associated with road traffic collisions and healthcare seeking in low- and middle-income countries and territories

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          Abstract

          Incidence of road traffic collisions (RTCs), types of users involved, and healthcare requirement afterwards are essential information for efficient policy making. We analysed individual-level data from nationally representative surveys conducted in low- or middle-income countries (LMICs) between 2008–2019. We describe the weighted incidence of non-fatal RTC in the past 12 months, type of road user involved, and incidence of traffic injuries requiring medical attention. Multivariable logistic regressions were done to evaluate associated sociodemographic and economic characteristics, and alcohol use. Data were included from 90,790 individuals from 15 countries or territories. The non-fatal RTC incidence in participants aged 24–65 years was 5.2% (95% CI: 4.6–5.9), with significant differences dependent on country income status. Drivers, passengers, pedestrians and cyclists composed 37.2%, 40.3%, 11.3% and 11.2% of RTCs, respectively. The distribution of road user type varied with country income status, with divers increasing and cyclists decreasing with increasing country income status. Type of road users involved in RTCs also varied by the age and sex of the person involved, with a greater proportion of males than females involved as drivers, and a reverse pattern for pedestrians. In multivariable analysis, RTC incidence was associated with younger age, male sex, being single, and having achieved higher levels of education; there was no association with alcohol use. In a sensitivity analysis including respondents aged 18–64 years, results were similar, however, there was an association of RTC incidence with alcohol use. The incidence of injuries requiring medical attention was 1.8% (1.6–2.1). In multivariable analyses, requiring medical attention was associated with younger age, male sex, and higher wealth quintile. We found remarkable heterogeneity in RTC incidence, the type of road users involved, and the requirement for medical attention after injuries depending on country income status and socio-demographic characteristics. Targeted data-informed approaches are needed to prevent and manage RTCs.

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          The effect of COVID-19 and subsequent social distancing on travel behavior

          The spread of the COVID-19 virus has resulted in unprecedented measures restricting travel and activity participation in many countries. Social distancing, i.e., reducing interactions between individuals in order to slow down the spread of the virus, has become the new norm. In this viewpoint I will discuss the potential implications of social distancing on daily travel patterns. Avoiding social contact might completely change the number and types of out-of-home activities people perform, and how people reach these activities. It can be expected that the demand for travel will reduce and that people will travel less by public transport. Social distancing might negatively affect subjective well-being and health status, as it might result in social isolation and limited physical activity. As a result, walking and cycling, recreationally or utilitarian, can be important ways to maintain satisfactory levels of health and well-being. Policymakers and planners should consequently try to encourage active travel, while public transport operators should focus on creating ways to safely use public transport.
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            The World Health Organization STEPwise Approach to Noncommunicable Disease Risk-Factor Surveillance: Methods, Challenges, and Opportunities.

            We sought to outline the framework and methods used by the World Health Organization (WHO) STEPwise approach to noncommunicable disease (NCD) surveillance (STEPS), describe the development and current status, and discuss strengths, limitations, and future directions of STEPS surveillance.
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              Distribution of road traffic deaths by road user group: a global comparison.

              Road traffic deaths are a major global health and development problem. An understanding of the existing burden of road traffic deaths in the population is necessary for developing effective interventions. To outline systematically the global distribution of road traffic deaths by road user groups (pedestrians, bicyclists, motorcyclists, motorised four-wheeler occupants). Comprehensive searches of PubMed, Google, Google Scholar, TransportLink, grey literature and reference lists and communication with experts from international organisations and country-level institutions were conducted to identify eligible studies and data sources. All data sources that provided a breakdown of road traffic deaths by road user group at the national or sub-national level were eligible for inclusion. A breakdown of road traffic deaths by road user group was constructed for 14 epidemiologically defined World Health Organization (WHO) sub-regions in addition to World Bank income categories. In addition, the total number of road traffic fatalities by road user group in low-income, middle-income and high-income countries was estimated. The breakdown of road traffic deaths by road user group varies dramatically across epidemiological WHO sub-regions. The magnitude of pedestrian fatalities ranges from more than half in African sub-region AfrE (55%) to 15% or less in AmrA or EurA. The distribution also varies across low-income, middle-income and high-income countries. 45% of road traffic fatalities in low-income countries are among pedestrians, whereas an estimated 29% in middle-income and 18% in high-income countries are among pedestrians. The burden of road traffic injuries on vulnerable road users differs substantially across income levels. An estimated total of 227,835 pedestrians die in low-income countries, as opposed to 161,501 in middle-income countries and 22,500 in high-income countries each year. Ameliorating road safety requires the implementation of context-specific solutions. This review of the road traffic injury literature provides strong evidence that the distribution of road traffic fatalities varies dramatically across different parts of the world. Therefore, context-appropriate and effective prevention strategies that protect the particular at-risk road user groups should be carefully investigated.
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                Author and article information

                Contributors
                Role: Data curationRole: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: ValidationRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLOS Glob Public Health
                PLOS Glob Public Health
                plos
                PLOS Global Public Health
                Public Library of Science (San Francisco, CA USA )
                2767-3375
                19 January 2024
                2024
                : 4
                : 1
                : e0002768
                Affiliations
                [1 ] Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
                [2 ] King’s Centre for Global Health and Health Partnerships, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
                [3 ] Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom
                [4 ] Injury Epidemiology and Prevention Research Group, Turku Brain Injury Centre, Division of Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
                [5 ] Research Centre for Child Psychiatry, University of Turku, Turku, Finland
                [6 ] INVEST Research Flagship Center, University of Turku, Turku, Finland
                [7 ] Clinical Services and Systems, Integrated Health Services, World Health Organization, Geneva, Switzerland
                [8 ] Department of Nutrition and Food Safety, National Center for Public Health, Ulaanbaatar, Mongolia
                [9 ] Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
                [10 ] Universidade Federal de Minas Gerais, Departamento de Enfermagem Materno Infantil e Saúde Pública, Belo Horizonte, MG, Brasil
                [11 ] Institute of Global Health, Heidelberg University and University Hospital, Heidelberg, Germany
                [12 ] Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California, United States of America
                [13 ] Chan Zuckerberg Biohub–San Francisco, San Francisco, California, United States of America
                [14 ] Department of Medicine, University of Michigan, Ann Arbor, Michigan, United States of America
                [15 ] Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
                [16 ] Professorship of Behavioral Science for Disease Prevention and Health Care, Technical University of Munich, Munich, Germany
                [17 ] Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
                [18 ] Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
                SRMIST: SRM Institute of Science and Technology (Deemed to be University), INDIA
                Author notes

                I have read the journal’s policy and the authors of this manuscript have the following competing interests: LAW is employed by WHO; the material included in this article reflects the views of individuals and not necessarily the views of WHO. DGP provides scientific consultations through Epidemiologic Research & Methods, LLC (ERM); none of her consulting through ERM is related to the topic of the current study. Other authors declare no competing interests.

                ‡ MT and JD also contributed equally to this work.

                Author information
                https://orcid.org/0000-0003-3690-2359
                https://orcid.org/0000-0001-5877-4496
                https://orcid.org/0000-0002-8214-5734
                https://orcid.org/0000-0003-3413-232X
                https://orcid.org/0000-0001-6834-1838
                Article
                PGPH-D-23-01588
                10.1371/journal.pgph.0002768
                10798533
                38241424
                1d1a1026-0742-4400-9d1c-d5f43cccc4dd
                © 2024 Ghalichi et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 7 September 2023
                : 5 December 2023
                Page count
                Figures: 3, Tables: 5, Pages: 17
                Funding
                Funded by: NIHR Global Health Group on Equitable Access to Quality Health Care for Injured People in Four Low- and Middle-Income Countries: Equi-injury
                Award ID: Award number 133135
                Award Recipient :
                Funded by: NIHR Global Health Group on Equitable Access to Quality Health Care for Injured People in Four Low- and Middle-Income Countries: Equi-injury
                Award ID: Award number 133135
                Award Recipient :
                Funded by: Institute for Global Innovation, University of Birmingham
                Award Recipient :
                Funded by: Chan Zuckerberg Biohub – San Francisco investigator
                Award Recipient :
                The authors received no specific funding to conduct the study. JD and LG were supported to deliver the work using funding from the NIHR Global Health Group on Equitable Access to Quality Health Care for Injured People in Four Low- and Middle-Income Countries: Equi-injury (Award number 133135) and DGP was supported by the innovation funding from Institute for Global Innovation, University of Birmingham. PG is a Chan Zuckerberg Biohub – San Francisco investigator. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Epidemiology
                Biology and Life Sciences
                Nutrition
                Diet
                Alcohol Consumption
                Medicine and Health Sciences
                Nutrition
                Diet
                Alcohol Consumption
                Social Sciences
                Sociology
                Education
                Schools
                Social Sciences
                Economics
                Economic Geography
                Low and Middle Income Countries
                Earth Sciences
                Geography
                Economic Geography
                Low and Middle Income Countries
                People and Places
                Population Groupings
                Age Groups
                Engineering and Technology
                Civil Engineering
                Transportation Infrastructure
                Roads
                Engineering and Technology
                Transportation
                Transportation Infrastructure
                Roads
                Medicine and Health Sciences
                Epidemiology
                Medical Risk Factors
                Medicine and Health Sciences
                Epidemiology
                Medical Risk Factors
                Traumatic Injury Risk Factors
                Road Traffic Collisions
                Medicine and Health Sciences
                Public and Occupational Health
                Traumatic Injury Risk Factors
                Road Traffic Collisions
                Custom metadata
                This study includes individual-level data from 15 countries. All of this data is publicly available from the WHO NCD microdata repository ( extranet.who.int/ncdsmicrodata), WHO Multi-Country Studies Data Archive ( www.pns.icict.fiocruz.br/bases-de-dados) and PNS databases ( apps.who.int/healthinfo/systems/surveydata).

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