Road traffic crashes, injury and fatality trends in Sri Lanka: 1938–2013

a. Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka.

b. Postgraduate Institute of Medicine, University of Colombo, one hundred sixty Prof. Nandadasa Kodagoda Mawatha, Colombo 7, 00700, Sri Lanka.

c. The Family Planning Association of Sri Lanka, Colombo, Sri Lanka.

Correspondence to Achala Upendra Jayatilleke (email: [email protected]).

(Submitted: nine November two thousand fourteen – Revised version received: seventeen April two thousand fifteen – Accepted: seven May two thousand fifteen – Published online: twenty five June 2015.)

Introduction

Road traffic injuries are a major but neglected global public health problem. One Each year, road traffic crashes are responsible for over one million deaths and twenty to fifty million injuries worldwide. One , two Low- and middle-income countries are the most affected, because road traffic crashes and injuries are linked not only to the number of vehicles, road conditions and drivers’ behaviour but also to the country’s level of economic and social development. One – three In particular, poor road infrastructure, inappropriate mixing of vehicle types, inadequate traffic law enforcement and delayed implementation of road safety policies can increase road traffic crashes. Three

Sri Lanka is a lower-middle-income country in south Asia that has a substantial cargo of road traffic injuries and fatalities. Four – seven Inbetween one thousand nine hundred thirty eight and 1997, the absolute number of road traffic fatalities in the country enhanced 10-fold to reach one thousand eight hundred thirty five deaths in one thousand nine hundred ninety seven in a population of around eighteen million. Five , seven Despite the need for instant act to reduce this growing cargo, there is a paucity of coordinated government road safety strategies and road safety research in the country. Seven

Sri Lanka has an interesting traffic history. Inbetween one thousand eight hundred fifteen and 1948, the island was governed by the United Kingdom of Good Britain and Northern Ireland. The British expanded the road infrastructure, eight enhanced the number of vehicles and developed railways to transport goods. Nine In 1948, Sri Lanka gained its independence and the fresh government further improved the road infrastructure. However, because railways were neglected, road transport was used for goods, enhancing the risk of crashes. Sri Lanka passed its very first traffic act in one thousand nine hundred thirty four and, from one thousand nine hundred thirty eight onwards, the police documented traffic accidents. Ten , eleven In 1951, the country mandated that all motor vehicles be registered with the Department of Motor Traffic, eight , twelve which meant that vehicles had to be roadworthy. The law specifically prohibited the registration of unlawfully fabricated motor vehicles, which were common at the time. In 1953, Sri Lanka established a separate traffic police division. Ten , eleven This enhanced the number of traffic police and improved traffic law enforcement.

In 1977, Sri Lanka introduced an open economic policy that promoted motor vehicle imports. This resulted in a massive influx of motorcycles and three-wheeled taxis, eight which are prone to crashes because they are unstable and topple lightly. Since two- and three-wheeled vehicles are less sturdy than other vehicles, occupants are more likely to be injured in a crash. One – three Ultimately, despite the large increase in motor vehicles, the road infrastructure did not develop at the same rhythm.

In Sri Lanka, a lack of road safety research and the limited availability of statistics on road traffic crashes and injuries made it difficult for policy-makers to propose interventions that would prevent road traffic crashes. The aims of this probe were to describe the trends in road traffic crashes, injuries and fatalities in Sri Lanka from one thousand nine hundred thirty eight to two thousand thirteen and to identify factors associated with these trends.

Methods

Our analysis used statistics on road traffic crashes and road traffic injuries from the road traffic crash statistics’ database maintained by the traffic police headquarters, which is the only comprehensive such database in Sri Lanka. Nine Permission to access these data was obtained from the police headquarters. By law, all road traffic crashes must be reported to the police within twenty four hours. For the database, a road traffic crash was defined as a crash on a public highway or road that involved a vehicle and also involved private injury or harm to property. One , eight Crashes were classified as involving one of four types of injury: (i) fatal (i.e. a victim died due to injuries sustained in the crash, irrespective of the time interval inbetween the crash and death); (ii) serious (i.e. the crash resulted in one or more kinds of severe injury, such as bone fractures, harm to internal organs, severe burns, permanent impairment of vision or hearing or serious disfigurement); (iii) minor; or (iv) none (i.e. the crash did not cause any injury and resulted in only harm to vehicles). Nine If more than one type of injury was present, the most serious type of injury was recorded.

Data were retrieved by hand from the traffic police’s database and entered into an Excel spreadsheet (Microsoft, Redmond, United States of America) for analysis. Information on the size of the population of Sri Lanka in the middle of each year was obtained from the Department of Census and Statistics thirteen and used to calculate road traffic fatality and injury rates per one hundred 000 population. In addition, we obtained information on the total number of registered vehicles for the period one thousand nine hundred thirty eight to two thousand thirteen from the Department of Motor Traffic. Eleven We plotted the number of road traffic crashes, the population and the number of registered vehicles over the probe period using Excel and R (R Foundation for Statistical Computing, Vienna, Austria). We analysed long-term trends in road traffic crashes, injuries and fatalities using the Joinpoint Regression Program Version Four.0.Four (National Cancer Institute, Bethesda, USA). Fourteen , fifteen Joinpoints are points in a time series at which statistically significant switches occur and joinpoint regression fits a series of joined straight lines inbetween these joinpoints. The program starts with the simplest model of fit and tests several models, while enhancing joinpoints, until a statistically significant fit is obtained. The program uses the Monte Carlo permutation method to test for significance. Fourteen , fifteen We reviewed the literature on Sri Lanka’s traffic and transportation history to identify events that might have contributed to the significant switches observed in the joinpoint analysis. Eventually, to supplement our findings, we conducted an extra analysis for the period one thousand nine hundred seventy seven to 2013, during which it was possible to separate data on serious and minor injuries.

Results

The incidence of road traffic crashes inbetween one thousand nine hundred thirty eight and two thousand thirteen is shown in Fig. 1. There were substantial switches in the trend: for the best fitting model, there were four joinpoints, in 1955, 1974, two thousand three and 2007, respectively (Table 1). Overall, road traffic crashes enhanced markedly from 61.Two per one hundred 000 population in one thousand nine hundred thirty eight to 183.6 per one hundred 000 in two thousand thirteen – a threefold increase. However, the increase was not continuous. Road traffic crashes enhanced steadily by 180% (from 61.Two to 170.8 per one hundred 000 population) inbetween one thousand nine hundred thirty eight and 1955, but inbetween one thousand nine hundred fifty five and 1974, it decreased by 36% (from 170.8 to 109.1 per one hundred 000 population). Crashes enlargened again inbetween one thousand nine hundred seventy four and 2003, by 185% (from 109.1 to 310.7 per one hundred 000 population), but decreased inbetween two thousand three and 2007, by 49% (from 310.7 to 159.8 per one hundred thousand population). Inbetween two thousand seven and 2013, the annual percentage switch was not significant. The highest incidence in the 75-year period was reported in 2003, at 310.7 per one hundred 000 population.

Fig. 1. Road traffic crashes, Sri Lanka, 1938–2013

• Table 1. Model of best fit, joinpoint regression analysis of road traffic crashes, Sri Lanka, 1938–2013

Fig. Two shows the incidence of road traffic injuries inbetween one thousand nine hundred thirty eight and 2013. Over the period, it enlargened from 35.1 to 98.6 per one hundred 000 population. The model of best fit had two joinpoints, in one thousand nine hundred fifty nine and 1967, respectively (Table Two). The road traffic injury rate enhanced until one thousand nine hundred fifty nine (to 92.Five per one hundred 000 population), decreased from one thousand nine hundred fifty nine to one thousand nine hundred sixty seven (to 58.1 per one hundred 000 population) and then enlargened again until 2013. However, during the latter half of the examine period, annual rates deviated substantially from the trend line.

Fig. Two. Road traffic injuries, Sri Lanka, 1938–2013

• Table Two. Model of best fit, joinpoint regression analysis of road traffic injuries, Sri Lanka, 1938–2013

Fig. Three shows that road traffic fatalities enlargened markedly inbetween one thousand nine hundred thirty eight and 2013, from Trio.0 to Ten.8 per one hundred 000 population. The joinpoint program indicated two join points, in one thousand nine hundred forty four (Five.Three per one hundred 000 population) and one thousand nine hundred forty seven (Three.0 per one hundred 000 population), respectively (Table Three). Fatalities enlargened continuously from one thousand nine hundred forty seven onwards.

Fig. Trio. Road traffic fatalities, Sri Lanka, 1938–2013

• Table Trio. Model of best fit, joinpoint regression analysis of road traffic fatalities, Sri Lanka, 1938–2013

Fig. Four and Fig. Five display the absolute number of road traffic crashes and vehicles, and the population size over the explore period. All three variables enlargened during the seventy five years but the most marked increases in road traffic crashes and in the number of vehicles were observed in the 2nd half of the investigate period. Fig. Six shows the number of registered vehicles inbetween two thousand three and 2012, by vehicle type. Categorized data were not available before 2003. Fig. Seven shows the number of deaths, serious injuries and minor injuries due to road traffic crashes per one hundred 000 population that were reported to the police inbetween one thousand nine hundred seventy seven and 2013. There was a marked increase in the number of serious injuries over the period, from 6.0 to 32.0 per one hundred 000. Albeit deaths enhanced steadily, the number of minor injuries fluctuated considerably.

Fig. Four. Population and absolute number of vehicles, Sri Lanka, 1938–2013

Fig. Five. Absolute number of road traffic crashes, Sri Lanka, 1938–2013

Fig. 6. Registered vehicles, by type, Sri Lanka, 2003–2012

Fig. 7. Deaths and injuries due to road traffic crashes, Sri Lanka, 1977–2013

Discussion

Our analyses cover seventy five years of road traffic crashes, injuries and fatalities in Sri Lanka. Albeit the global status report on road safety produced by the World Health Organization (WHO) in two thousand thirteen included details of road traffic fatalities in Sri Lanka inbetween two thousand one and 2010, it covered only a brief period and did not contain a detailed discussion of the possible reasons for any increase. Sixteen In addition, WHO’s two thousand four world report on road traffic injury prevention discussed road traffic fatality trends in Asia inbetween one thousand nine hundred eighty seven and one thousand nine hundred ninety five but did not explain trends in individual countries. One

We found that road traffic crashes, injuries and fatalities in Sri Lanka all enhanced inbetween one thousand nine hundred thirty eight and 2013. However, there were fluctuations over this time; and several factors are associated with these switches.

Road infrastructure developed rapidly inbetween one thousand nine hundred thirty eight and 1955. During this period, the greater numbers of crashes may have been due to more frequent road use or to more vehicles on the roads. One – three Also, during this period the country had a poorly regulated bus service and drivers competed for passengers and violated traffic laws – this behaviour may have enhanced the number of bus crashes and made roads less safe for other users. Moreover, albeit traffic laws were in place, law enforcement was likely to have been poor because Sri Lanka did not have a traffic police unit during this period. Monitoring traffic was one of the duties of general police units. Eleven

Three factors might have contributed to the reduction in road traffic crashes inbetween one thousand nine hundred fifty five and 1974. Very first, a fresh traffic law was introduced in one thousand nine hundred fifty one that required all motor vehicles to be registered with the Department of Motor Traffic. A vehicle’s roadworthiness had to be tested before registration. Twelve 2nd, in 1953, Sri Lanka established a traffic police division and enhanced the number of traffic police leading to better enforcement of traffic laws. This division also assisted the Inspector General of Police in introducing and implementing fresh traffic policies. Eleven Third, in 1958, the government nationalized the privately-owned bus service and improved the quality and availability of public transportation. Eight Better and more accessible public transportation might have encouraged more people to travel by bus and discouraged the use of private vehicles.

The introduction of an open economic policy in Sri Lanka could have contributed to the increase in road traffic crashes observed after 1977. This policy made it lighter to import vehicles and led to an exponential growth in their numbers: seventeen inbetween one thousand nine hundred seventy seven and two thousand three the number of vehicles enlargened by 2790%. The increase was greatest in motorized two- and three-wheeled vehicles, eleven which were involved in more crashes than other vehicle types. One – three During this period, there was no matching expansion of either the road infrastructure or the traffic police – this mismatch might have contributed to the marked increase in crashes observed inbetween one thousand nine hundred seventy seven and 2003.

The reduction in road traffic crashes after two thousand three might have been due to a smaller proportion of crashes being reported. Albeit Sri Lanka’s traffic law requires all road traffic crashes to be reported to the police, many drivers do not report those that involve only minor injuries or harm. Seven In Sri Lanka, reporting crashes to the police can be wearisome: drivers have to spend many hours at the crash site or at a police station until the police finish the initial investigation. If a police report is required for insurance purposes, drivers may have to wait a few days.

To simplify procedures for drivers, Sri Lankan insurance companies introduced an on-site insurance payment policy in 2002. The so-called on-the-spot insurance scheme paid insurance claims without police reports. Eighteen Albeit drivers benefited, the fresh policy very likely led to substantial underreporting of road traffic crashes. Our data on road traffic injuries indicate that underreporting most likely occurred: no reduction in road traffic injuries was observed inbetween two thousand three and 2007, when road traffic crashes appeared to be falling. People injured in road traffic crashes usually present to hospital emergency departments and hospitals report these injuries to the police based in the hospital, who in turn report them to the Police Statistics Unit. Nineteen Therefore, albeit drivers might not have reported crashes to the police, associated injuries would have been reported through the hospitals.

It is significant to note that the on-the-spot insurance scheme led not only to the underreporting of crashes but also enabled drivers involved in minor crashes to avoid police and legal procedures. These drivers could subsequently have been involved in further crashes, thereby making roads less safe for other drivers and pedestrians. To improve this situation, Sri Lanka should increase the traffic police workforce and require officers to reach accident sites quickly, to investigate and record all road traffic crashes and to provide on-site police reports for insurance purposes. Moreover, insurance companies should be required to obtain police reports before issuing insurance payments.

In 2007, a parliamentary committee was appointed to investigate reasons for the high number of road traffic injuries in Sri Lanka. Twenty There was an increase in road traffic crashes reported after 2007. The deeds of this committee and the two thousand nine end of the civil war in the north-east may have both contributed to this increase in crashes reported. However, no amendments were made to the on-the-spot insurance scheme and the discrepancies inbetween reported crashes and injuries continued. The parliamentary committee proposed several interventions to prevent road traffic crashes and a number have been implemented since 2010, including: computerizing driving licence registration; expanding the road network; displaying speed boundaries at the roadside; and training drivers. However, the available data do not permit us to test for any effects of these interventions.

The enhancing trend in road traffic fatalities over the examine period was much more consistent than those of road traffic crashes or injuries. This sustained increase in road traffic fatalities has also been reported in other low- and middle-income countries, including Cambodia, India, Iraq, Myanmar, Nepal and Saudi Arabia. Sixteen , twenty one As in Sri Lanka, these increases have been associated with a rise in the number of vehicles, poor traffic law enforcement and underdeveloped road infrastructure. One – three , twenty one – twenty three

Our descriptive analysis of road traffic injuries inbetween one thousand nine hundred seventy seven and two thousand thirteen displayed that all types of injuries enlargened. However, there were greater fluctuations in minor injuries than in serious injuries or fatalities. The one thousand nine hundred eighty one traffic laws that limited the number of passengers in motor vehicles and regularized the vehicle licencing process ten , eleven and better traffic law enforcement in one thousand nine hundred ninety five may have influenced these trends. However, passenger boundaries, licencing and law enforcement do not seem to have had a long-term effect in reducing minor injuries. Underreporting due to the introduction of the on-spot insurance scheme could be a plausible cause for the fluctuations seen after two thousand three and this hypothesis needs further research.

One limitation of our investigate was that we used traffic-police data, which included only road traffic crashes and injuries either recorded by the police or reported to them. However, albeit crashes were underreported after 2003, we were still able to draw significant conclusions from the data available. Another limitation was the paucity of scientific studies of the reasons underlying the fluctuations in road traffic crashes in Sri Lanka. A strength of our investigate was the use of joinpoint regression to analyse long-term trends in road traffic crashes, injuries and fatalities as has been done in high-income countries. Fourteen , fifteen , twenty four , twenty five

Sri Lanka’s cargo of road traffic injuries could be diminished by better enforcement of traffic laws, limitations on the importation of two- and three-wheeled motor vehicles and the introduction of fresh policies to improve road safety.

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