الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Road traffic accidents are among the leading causes of disability adjusted life years lost. Road traffic injuries (RTIs) mean a fatal or non fatal injury incurred as a result of road traffic crash. The WHO defined road traffic crash (RTC) as a collision or incident that may or may not lead to injury, occurring on a public road and involving at least one moving vehicle.
Road traffic injuries represent a leading and increasing contributor to regional and global disease burden. Most of the increase in RTIs will occur in low and middle-income regions of the world, due to the rapid growth in motor vehicle numbers, increasing exposure to risk factors such as speed and alcohol, and increased by insufficient enforcement of traffic safety regulations and public health infrastructure. According to the WHO world health report on RTI prevention in 2002, RTIs were among the leading cause of deaths and injuries, the 11th leading cause of death and accounted for 2.1% of all deaths globally. RTIs are predicted to rise from 9th place in 2004 to 5th place by 2030 as a contributor to the global burden of diseases.
Road traffic crashes have also caused a huge burden on the economy and health care services. Interventions done to prevent the rising trends of deaths and disability following RTAs are sporadic, uncoordinated and ineffective in many countries. According to the WHO report on RTAs in 2012, RTAs caused an estimated 1.24 million deaths and 20-50 million non fatal injuries worldwide annually. In 2007, RTIs accounted for 23% of all injury deaths worldwide.
The present study was conducted to estimate the extent of the problem of RTAs in Sulaimaniyah city, to determine RTA victims’ characteristics and injuries and to investigate determinants of RTAs.
The study was conducted in Sulaimaniyah in the following settings: the Health Directorate/ MOH, the Road Traffic Registration Department/ Ministry of Interior, and the Main Emergency Hospital in Sulaimaniyah.
A cross sectional approach was designed for the implementation of the study. The study included available records of RTA victims registered at Sulaimaniyah Health Directorate/ MOH, and Road Traffic Registration Department/ Ministry of Interior, for two years 2012 and 2013. Victims of RTAs admitted to the Main Emergency Hospital in Sulaimaniyah during six months period from 1st of January 2014 to 1st of July 2014.
The following techniques were used to collect data:
A pre-designed structured interview questionnaire:
The collected data included: socio-demographic data such as age, sex, marital status, level of education, occupation, monthly income and pre injury health condition of RTAs victims, pre accident data such as victim usual sleeping hours and sleeping hours the day before the accident and reasons for being on the road and activity done before the crash. Accident related data were also collected such as nature of accident vehicle type, vehicle condition, and time of accidents, place and area of occurrence of accident, type of road (main or side roads and intersection), cause of accident, road condition such as road illumination, road surface, presence of pavements, and presence of objects that decrease visibility at roadside, weather condition, traffic condition. The collected post accident data included care given prior to arriving to hospital, time elapsed from crash till transport to health facility in minutes, way of transportation of victim to hospital, health care received at hospital and duration of stay of victim in hospital.
Record review:
• The available data records of RTIs at the Health Directorate/ MOH were reviewed. The researcher collected the required data which included: total RTIs, total RTIs according to the age and gender, total road traffic deaths according to the age and gender, total injury deaths by cause throughout the year 2012 and 2013.
• Census of Sulaimaniyah for 2012-2013 from the Census Department / Ministry of Planning.
• Available data records of RTAs from the Traffic Department/ Ministry of Interior, Sulaimaniyah for the two years 2012-2013. The records included data on the following: number of RTAs, number of RTIs by age, total number of road traffic injuries according to the causes of accident, accident type (rollovers, collision), time of accident (day or night), place of occurrence, and weather (normal, raining, dusty or snowy).
• Data were checked for completeness and accuracy and were analyzed using the Statistical Package for Social Sciences (SPSS version 21). Descriptive statistics such as frequencies, mean, standard deviation and rates were calculated such as: incidence rate of RTAs, incidence rate of RTIs, mortality rate of RTAs, injury rate of RTAs, RTI case fatality rate.
The results of the present study revealed the following:
Magnitude of RTAs:
• Incidence rate of RTAs was 62.2 per 100,000 population in the year 2012 and 43.8 per 100,000 population in the year 2013.
• Total number of RTIs was 7819 with 7.1% fatal RTIs (MOH) and 6864 with 8.0% fatal RTIs (Traffic Department).
• Incidence rate of RTIs was 223.5 RTI per 100,000 population in the year 2012 and 169.4 per 100,000 population in the year 2013 (Health Directorate/ MOH). It was 190.8 and 153.9 per 100, 000 respectively (Traffic Department).
• The injury rate increased from 306.5% in the year 2012 to 351.2% in the 2013 (Traffic Department).
• The total number of deaths was 550.
• RTAs ranked the first cause of injury death for both 2012 and 2013.
• The injury related death rate for the year 2012 was 36.7 per 100,000 and 37.9 in 2013.
• The mortality rate was 13.7 per 100,000 for the year 2012, and 13.8 per 100.000 for the year 2013
• The PMR was 37.3 in the year 2012 and 36.7 in the year 2013.
• The case fatality rate was 6.2% in 2012 and increased to 8.2 in the year 2013 (MOH).It was 7.2% and increased to 9.0% (Traffic).
• The age group 45-64 years old had the highest frequency of deaths (49.4%). (MOH)
• Males accounted for 77.5% of deaths and females accounted for 22.5%. (MOH)
Characteristics of RTA victims and related factors:
- Data from victims admitted to the Emergency Hospital:
• The age of RTA victims ranged from 1 to 81 with a mean age of 25.96±17.04 years. The most affected age group was 20 – 30 years old representing 34.7% of all cases.
• Males represented 68.1% of the cases while females represented 31.9% of the cases. The male to female ratio was 2.1:1.
• Under age and married victims, each represented around one third (32.2%) and 23.9% were single. Excluding 81 victims under marriage age, 47.6% were married, 35.3% were single, 10.6% were divorced and 6.5% were widowed.
• Regarding the level of education, 27.2% were illiterates. Those who read and write constituted 24.1%, 18.0% had preparatory education, 17.1% had secondary education, 13.2% were university graduates and one had post graduate education.
• Concerning occupation, 34.8% of RTA victims were students and 25.6% were manual workers.
• Half (50.1%) of RTA victims were healthy prior to the accident and those with visual acuity problems constituted 19.9%.
• Less than a quarter (21.1%) of RTA victims used seat belts. Among victims who should have used a seat belts, 66.9% did not use.
• Only five (20.8%) from 24 motorcyclists used helmets.
• Only 1.5% of RTA victims responded positively for alcohol consumption.
• Only one RTA victim had taken tranquilizers prior to accident.
• Only two RTA victims used the cell phone just before the occurrence of the accident.
• The usual sleeping hours of RTA victims per day ranged between 4 and 12 hours.
• The sleeping hours of RTA victims the day before the accident ranged between 2 and 12 hours with a mean of 7.50±1.53 hours.
• The most common reasons for being on the road were recreation for 31.5% of the victims, going and returning from work for 31.0% and 19.9% of the victims, respectively.
• The most common activities done before the accident were driving in 34.3% of the cases, sitting in 33.5%, walking and crossing 13.9% of each.
• Regarding the nature of accidents, car-car accidents constituted 32.7%, rollovers and falls constituted 29.9%, RTA victims who reported car-pedestrians, car-motorcycles and car-passenger were 27.0%, 9.6% and 0.8 respectively.
• Old vehicles (before 2010) constituted 70.1% while new vehicle models (from 2010 and after) represented 29.9%.
• The most common time of RTA occurrence was from 8.00 am till 2.00 pm.
• The highest percentage of victims (80.1%) reported that the accident occurred in broad daylight.
• Around two thirds of accidents (67.7%) occurred on roads outside the city.
• The majority of accidents (92.8%) occurred in urban areas.
• The type of roads involved were main roads in 80.5% and side roads in 16.7%.
• The main cause of accidents was over speeding which was reported by 33.0% of the victims, followed by sudden appearance of vehicle (27.5%), and negligence (13.9%).
• The most common site of injury was the head and neck (31.0%), followed by more than one site (26.3%).
• The most common type of injury was contused and lacerated wounds (30%), followed by abrasions (28.9%) and fractures which constituted 28.5%, respectively.
• Road surface was mentioned to be dry by 81.0% of RTA victims, wet by 18% and slippery by 1%.
• As regards the weather condition, rain was reported by 17.2% of the cases, and fog which decrease visibility was reported by 4.0% of cases.
• As regards the traffic condition, traffic jam at the time of the accident was reported by 45.8%, while 80.0% reported that the traffic was unorganized, and 83.2% reported the absence of a traffic officer at the site of the accident.
• The time elapsed from accident till transfer to the health facility was between 5 and 180 minutes with a mean of 40.48 ± 24.99 minutes.
• Less than two thirds of the victims (61.3%) were transferred to hospital by ambulance, 37.5% by a private car.
• Less than half of RTA victims (45.5%) received first aid in hospital and 37.5% received conservative treatment.
• The duration of stay in the hospital ranged from 1-30 days.
• Most of RTA victims (95.3%) stayed in hospital for less than 1week.
Data record (MOH and Traffic Department):
• According to data from the Health Directorate/ MOH in Sulaymaniyah the most common age group involved in RTIs was the age group 45-64 years which represented 68.6%.
• According to data from the Traffic Department, the age group 40-49 years old represented the highest percentage (50.1%).
• Around three quarters of the victims were males (73.9%).
• The recorded data from Traffic Department / Ministry of Interior showed variation by weather conditions. Most accidents occurred in normal weather (94.8%).
• Over speeding was the most important cause of RTAs and constituted 48.7%.
• Collision accidents represented more than three quarters (78.9%) of accidents.
The main recommendations of the study were:
• Development of a strategy for prevention and control of RTAs is essential and requires close inter sectoral collaboration between, traffic police, health, law, and transport authorities.
• Improve reporting and recording of data, and stress on accuracy and completeness.
• Conduction of more informative studies regarding the causes of RTAs in Sulaimaniyah and special registration in order to delineate proper preventive measures to decrease RTA casualties and deaths.
• Improve the conditions of the road e.g. regular maintenance, road marking, road humps, traffic lights, road mirrors and road signs.
• Education and training courses for the people on how to provide the first aid and deal with casualties of RTAs.
• Provision of training programs for doctors and paramedical on sorting out and dealing with RTAs casualties.
• Informing the people about the importance of the autopsy for the deceased cases as a result of RTAs to detect the causes of death.
• Increasing the number of peripheral emergency treatment centers inside city.
• Re- enforce traffic measures.