In this short piece, I highlight that road traffic accidents are a major public health problem in Bangladesh and argue the critical need to address this issue, and present an evidence-based approach to support my argument.

Every day thousands of families have to cope with the unexpected loss of a loved one as a result of a road traffic accident (RTA) worldwide. Over 1.2 million people are killed each year in RTAs (World Health Organisation [WHO], 2009). The Organisation for Economic and Corporate Development (OECD) defines a RTA as “an accident with occurred or originated on a way or street open to public traffic; resulted in one or more persons being killed or injured, and at least one moving vehicle was involved” (OECD, 2012). It has been estimated that without concerted global effort, road traffic injuries (RTIs) are predicted to escalate from the ninth leading cause of death in 2004 to the fifth by 2030 (WHO, 2009).

Alarmingly, 90% of road traffic deaths occur in low-income and middle-income countries, despite owning less than 50% of the worlds registered motor vehicles (WHO, 2009). According to the Global Burden of Disease Study 2010, road injury is the eleventh leading cause of disability-ability adjusted life years (DALYs) in South Asia (Murray, 2012).

Road traffic crashes occur on a daily basis in Bangladesh, and yet there are no planned medical emergency services in the country. According to the police reported road traffic accident database, there are at least 3,000 road traffic fatalities in Bangladesh each year, with direct costs of road traffic accidents estimated to be 76 million US dollars (Mashreky, 2010). However, the World Health Organisation (WHO) estimates the road traffic death rate to be 12.6 per 100,000 persons with around 20,038 fatalities per year (WHO, 2007).

Evidence suggests that the present and projected burden of road traffic injuries in Bangladesh is disproportionately borne by the poor, who can least afford to pay for medical costs, placing a major economic and emotional drain on families and on society in general (Sharma, 2008). Aeron-Thomas, A. et al. (2004) conducted a cross-sectional study in Bangladesh to examine the involvement and impact of road traffic crashes on the poor and found that the poor were involved in over 50 per cent of all the road traffic injury fatalities. Following a road death, the majority of poor bereaved households went into debt (or further debt) and incurred more medical costs and funeral costs. Also, one third of poor households sold an asset to meet their own out-of-pocket expenses (Aeron-Thomas, 2004) after the death of a family member in a road traffic accident. A nationwide community-based road safety programme needs to be developed to reduce road traffic crashes and morbidities, targeting the poor in order to halt a trigger into ultra-poverty.

Pedestrians alone account for more than 50 per cent of road traffic deaths (WHO, 2009) and are the most vulnerable road user group in Bangladesh. A review paper by Hyder et al. (2008) revealed that children in rural areas of South Asia are more likely to be affected by RTIs. Although the number of actual vehicles involved in road traffic accidents is low the number of passenger deaths is staggeringly high because the vehicles involved carry a large volume of passengers.

Given the increasing burden of road traffic injuries in Bangladesh, and the unregulated health care system, every effort should be made to ensure the nation’s commitment to this major public health problem, and to realise the goal of promoting and facilitating improvements in the prevention and treatment of road traffic injuries. It is commendable that Bangladesh has acknowledged the United Nation’s (UN) Decade of Action for Road Safety 2011-2020 in reducing the number of road traffic injuries.

One innovative approach to saving lives on the streets of Bangladesh is using a location-based mobile network to quickly dispatch volunteer first aid responders to the scene of the accident to provide life-saving help to injured citizens. CriticaLink, founded by a friend, medical doctor, and former Fulbright fellow, Jennifer Farell, is the first mobile-technology driven, volunteer-based medical system designed to connecting ordinary people to saving lives in Bangladesh. I recall Jennifer coming home to our modest apartment in Dhaka, dressed in her favourite teal-coloured salwar khameez (3-piece traditional dress worn by Bengali women),  exhausted but satisfied from training young, eager volunteers from all walks of life! She has trained over 3,000 volunteers. Her sheer determination and perseverance is disrupting the innovative e-health platform, scooping up mhealth awards, and bringing innovation and technology to a resource-poor setting. As suggested by Loo et. al. (2012), tackling RTAs calls for a multi-disciplinary approach to road safety involving input from public health professionals, engineers, local community leaders, and social entrepreneurs like Jennifer to saving lives at the community level in Bangladesh.

Bibliography

Aeron-Thomas, A. J. (2004). The involvement and impact of road crashes on the poor: Bangladesh and India case studies. London: TRL Limited.

Hyder, A. M. (2008). Road traffic injuries in urban Africa and Asia: A policy gap in child and adolescent health. Public Health , 122, 1104-1110.

Loo, B. C. (2012). Multidisciplinary efforts toward sustained road safety benefits: Integrating place-based and people-based safety analyses. Injury Prevention BMJ , 1-6.

Mashreky, S. R. (2010). Hospital burden of road traffic injury: Major concern in primary and secondary level hospitals in Bangladesh. Public Health , 124, 185-189.

Murray, C. V. (2012). Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet , 380, 2197-2223.

OECD. (2012). OECD Health Data 2012. Retrieved January 2, 2013, from Injuries in road traffic accidents: http://www.oecd.org/health/healthdata

Sharma, B. (2008). Road traffic injuries: A major global public health crisis. Public Health , 122, 1399-1406.

World Health Organisation. (2009). Global status report on road safety: time for action. Geneva.

World Health Organisation. (n.d.). WHO Global Health Observatory Data Repository. Retrieved January 3, 2013, from Mortality: Road traffic deaths: http://apps.who.int/gho/athena/data/GHO/RS_196,RS_198.html?profile=ztable&filter=COUNTRY:*