Suchergebnisse

Objective To identify and estimate the population costs and effects of a selected set of enforcement strategies for reducing the burden of road traffic injuries in developing countries. Design Cost effectiveness analysis based on an epidemiological model. Setting Two epidemiologically defined World Health Organization sub-regions of the world: countries in sub-Saharan Africa with very high adult and high child mortality (AfrE); and countries in South East Asia with high adult and high child mortality (SearD). Interventions Enforcement of speed limits via mobile speed cameras; drink-drive legislation and enforcement via breath testing campaigns; legislation and primary enforcement of seatbelt use in cars; legislation and enforcement of helmet use by motorcyclists; legislation and enforcement of helmet use by bicyclists. Main outcome measures Patterns of injury were fitted to a state transition model to determine the expected population level effects of intervention over a 10 year period, which were expressed in disability adjusted life years (DALYs) averted. Costs were expressed in international dollars ($Int) for the year 2005. Results The single most cost effective strategy varies by sub-region, but a combined intervention strategy that simultaneously enforces multiple road safety laws produces the most health gain for a given amount of investment. For example, the combined enforcement of speed limits, drink-driving laws, and motorcycle helmet use saves one DALY for a cost of $Int1000–3000 in the two sub-regions considered. Conclusions The potential impact of available road safety measures is inextricably bound by the underlying distribution of road traffic injuries across different road user groups and risk factors. Combined enforcement strategies are expected to represent the most efficient way to reduce the burden of road traffic injuries, because they benefit from considerable synergies on the cost side while generating greater overall health gains.

BACKGROUND: The use of non-standard motorcycle helmets has the potential to undermine multinational efforts aimed at reducing the burden of road traffic injuries associated with motorcycle crashes. However, little is known about the prevalence or factors associated with their use. METHODS: Collaborating institutions in nine low- and middle-income countries undertook cross-sectional surveys, markets surveys, and reviewed legislation and enforcement practices around non-standard helmets. FINDINGS: 5563 helmet-wearing motorcyclists were observed; 54% of the helmets did not appear to have a marker/sticker indicating that the helmet met required standards and interviewers judged that 49% of the helmets were likely to be non-standard helmets. 5088 (91%) of the motorcyclists agreed to be interviewed; those who had spent less than US$10 on their helmet were found to be at the greatest risk of wearing a non-standard helmet. Data were collected across 126 different retail outlets; across all countries, regardless of outlet type, standard helmets were generally 2-3 times more expensive than non-standard helmets. While seven of the nine countries had legislation prohibiting the use of non-standard helmets, only four had legislation prohibiting their manufacture or sale and only three had legislation prohibiting their import. Enforcement of any legislation appeared to be minimal. INTERPRETATION: Our findings suggest that the widespread use of non-standard helmets in low- and middle-income countries may limit the potential gains of helmet use programmes. Strategies aimed at reducing the costs of standard helmets, combined with both legislation and enforcement, will be required to maximise the effects of existing campaigns.