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Socio economic effects of RTAs - ghana (by dr ma adu-darko)

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  • 1. THE ECONOMIC AND SOCIAL EFFECTS OF ROAD- TRAFFIC ACCIDENTS ON A SECTION OF PATIENTS ATTHE ACCIDENT CENTRE, KORLE-BU TEACHING HOSPITAL BY ADU-DARKO, MICHAEL AGYEKUM CLASS OF 2012.1|Page
  • 2. DECLARATIONI, ADU-DARKO, MICHAEL AGYEKUM, author of THE ECONOMIC ANDSOCIAL EFFECTS OF ROAD TRAFFIC ACCIDENTS ON A SECTION OFPATIENTS AT THE ACCIDENT CENTRE, KORLE-BU TEACHING HOSPITAL,do hereby declare that, except for the reference to other people’s work which has beenduly acknowledged, the work I have presented in this dissertation was done entirely byme as a final year student of the University of Ghana Medical School, Korle-Bu in the2012/2013 Academic year and that the work presented has not been presented before inpart or whole for any degree in this University or elsewhere.…………………………………………….ADU-DARKO, MICHAEL AGYEKUM2|Page
  • 3. DEDICATIONTo God Almighty...it’s by his Grace I have come this far.To my parents, the entire Adu-Darko family both home & abroad,also to all my close friends.Thanks for your unflinching support.3|Page
  • 4. ACKNOWLEDGEMENTI will like to first and foremost thank the Almighty God for His provision and grace.To Professor Biritwum, my supervisor, I am grateful for your guidance.To my parents, Dr. and Mrs. Adu-Darko, my sister Mrs. Shirley Asare-Larson who have prayedfor me and supported me, I thank them.To all the patients who took the time to respond to my questionnaire, I say thank you.I am also thankful to the Department of Community Health of the University of Ghana MedicalSchool for this opportunity.4|Page
  • 5. TABLE OF CONTENTSDECLARATION………………………..………………………………………………….……….2DEDICATION………………………….…………………………………………….……………..3ACKNOWLEDGEMENT…………………………..………………………………………………4TABLE OF CONTENTS…………………………………………………..……………………….5-7LIST OF TABLES AND FIGURES……..………...…………………………………………….….8-10ABSTRACT……………………………………………………………………………………….11-12CHAPTER 1.0- INTRODUCTION……………………..……………………………………………131.1 BACKGROUND………….………………………..……………………………………………..131.2 PROBLEM STATEMENT….….……………………………………………………………....…141.3 RATIONALE……………………………………………………………..……………………...141.4 AIM……………………………………..…………………………………………………….…14 1.5 OBJECTIVES………………………..……………………………………………………….....15CHAPTER 2.0- LITERATURE REVIEW………………..…………………………………..……...162.1 THE TRENDS OF JOB LOSS & WORK HOURS LOST AMONG DISABLED AND NON-DISABLED PEOPLE…………………………………………………….…………….………….16-175|Page
  • 6. 2.2 THE CAUSE & INCIDENCE OF ROAD TRAFFIC ACCIDENTS AND THE COMMON AREASIN ACCRA ASSOCIATED WITH THESE ACCIDENTS…………………….……………….17-242.3 INFORMATION ON CARE- SEEKING OPTION AND HOW COST OF TREATMENTAFFECTS THE INTERVAL BETWEEN TEMPORARY AND DEFINITIVETREATMENT……………………………………………………………………….….……….24-262.4 TO DETERMINE THE METHODS OF PREVENTION OF THESE ROAD TRAFFICACCIDENTS………………………………..………………………………..…………………26-282.5 THE USE OF PRIMARY SURVEY AT THE ACCIDENT SCENE..………………….…29-31CHAPTER 3.0 METHODOLOGY…………………………..……….……………….……….31 3.1 STUDY DESIGN AND AREA………………………………….……………………31 3.2 STUDY POPULATION…………………………………..…………..........................31 3.3 SAMPLING STRATEGY………………………………….……..…………………..32 3.4 DATA COLLECTION AND INSTRUMENT………………………………………..32 3.5 DATA HANDLING, ANALYSIS AND PRESENTATION…………………….….33 3.6 LIMITATIONS………………….…………………………………….…..…………..33 CHAPTER 4.0- RESULTS AND ANALYSIS………………….……….…………………..34 4.1 DEMOGRAPHY………………..……………..………………..………………………..34 4.2 NATURE OF ROAD TRAFFIC ACCIDENT………………..………………………… 35-506|Page
  • 7. 4.3 JOB ASSESSMENT………………..…………………………….………………50-574.4 IMPACT ON SOCIAL AND FAMILY LIFE………………..………………….…57-62CHAPTER 5.0 - DISCUSSION……………………………..……………………..……….635.1 THE TRENDS OF JOB LOSS AND WORK HOURS LOST AMONG DISABLED AND NON- DISABLED PEOPLE........................................................................................................635.2 THE CAUSE AND INCIDENCE OF ROAD TRAFFIC ACCIDENT AND THE COMMON AREAS IN ACCRA ASSOCIATED WITH THESE ACCIDENTS……………….…...64-655.3 INFORMATION ON CARE- SEEKING OPTION AND HOW COST OF TREATMENTAFFECTS THE INTERVAL BETWEEN TEMPORARY AND DEFINITIVETREATMENT…………………………………………………………………………..…..66-675.4 TO DETERMINE THE METHODS OF PREVENTION OF THESE ROAD TRAFFICACCIDENTS………………………………………………………………………………67-695.5 THE USE OF PRIMARY SURVEY AT THE ACCIDENT SCENE…………..…….695.6 CONCLUSION……………………………………………………...…………………705.7 RECOMMENDATIONS……………………………………………………..………..705.8 REFERENCES………………………………………………....………...……………..71-735.9 APPENDIX QUESTIONNAIRE……………………………………………………….75-797|Page
  • 8. LIST OF TABLES AND FIGURES PAGETable 1- Distribution of treatment sought by Road Traffic Injured people 25Table 2 –Cost of treatment by various treatment categories 26Table 3- Distribution of ambulances and Emergency Medical Team in Ghana 29Table 4- Age distribution of road traffic accident (RTA) victims 34Table 5- Educational level of interviewees 35Table 6- Frequency of motor accidents on various roads in Ghana 36Table 7- Distribution of RTA’s 39Table 8- Vehicles involved in the accidents 40Table 9- Total number of people involved in these accidents 48Table 10- Number of mortalities in the various accidents 49Table 11- Means of transportation to the nearest hospital 53Table 12- Access to Primary Survey 54Table 13- Where Primary Survey was initially provided 55Table 14- Prevention of accidents 56Table 15- Type of employment 578|Page
  • 9. Table 16- Nature of jobs 57Table 17- Work hours per week lost to RTA’s 59Table 18- Number of days per week lost to RTA’s 59Table 19- Salary estimation 60Table 20- Expenses on treatment 68Table 21- Duration of admission 70Table 22- Extent to which injury has affected provision 72Table23-25- Motor accident returns from the MTTU Head Office for 01/01/2011-31/07/11 79Figure 1- Road on which accidents occurred 44Figure 2- Distribution of accidents 45Figure 3- Incidence of RTI among various road users 46Figure 4- Nature of roads 50Figure 5- Timing of accidents 51Figure 6- Causes of RTA 52Figure 7- Preventable accidents 559|Page
  • 10. Figure 8- Prevention of accidents 56Figure 9- Some of the jobs affected by the RTA 58Figure 10- Nature of the injuries 69Figure 11- Duration of admission influenced by cost of treatment 71Figure 12- Percentage of Breadwinners 71Figure 13- Effect of hospitalization on finances 73Figure 14- Nature of salary change among the interviewees 74Figure 15- Impact of RTA’s on social life 75Figure 16- Limitation to daily function as experienced by the interviewees 7610 | P a g e
  • 11. ABSTRACTBACKGROUNDRoad Traffic Accidents (RTAs) are a major cause of disability and death globally.Unfortunately, a disproportionate number of these occur in developing countries. Currently, it is theleading cause of death by injury and the tenth leading cause of all deaths globally. Injuries resultingfrom RTAs are increasingly contributing to the burden of morbidity and mortality in sub- SaharanAfrica, especially Ghana.Sadly, little appears to be known about the economic consequences and social disability associated withthem.AIMTo explore the cost and disability consequences of road traffic accidents in a cross-section of patientsat the Accident Centre, Korle-Bu Teaching Hospital.DESIGNA cross- sectional study involving a hospital-based survey using convenience sampling was done.SUBJECT/ SETTINGInformation on care-seeking choice, cost of treatment, ability to work, reduction in earnings, cause andprevention of accidents, and disability was collected from 70 subjects who had suffered one form ofroad traffic accident or another. Respondents were both out- patients and in-patients of the AccidentCentre, Korle- Bu Teaching Hospital.OUTCOME MEASURESUnivariate analysis was used to estimate the causes of road related injuries, the age distributions of theseinjuries, to estimate the frequency of disability, the types of care sought, role of primary assessment,11 | P a g e
  • 12. trend of work loss, functional ability and cost of treatment. It also included the impact on social andfamily life.RESULTSRoad traffic accidents involved 70 people of whom 34 (48.5%) had secondary education or higher and38 out of the total 70 fell within the age group of 20 - 39years. Eighty eight percent of these accidentsoccurred in Accra, of which more than half involved pedestrians. A total of 13 mortalities and 383people were involved in these accidents, with 68% of those interviewed suffering various morbidities.They were mainly attributed to carelessness on the part of the driver, with 57.3% of them getting to thehospital by private car. Primary assessment/survey was not available at any accident scene; also anaverage of 72hours per week was lost to road traffic accidents.Forty five percent felt the cost of their treatment was influenced by their duration of admission (i.e. thelonger they stayed on admission, the greater their financial cost)A total of 60% had difficulty with provision for the family out of total 59 breadwinners, while 57% ofthe total 70 encountered financial constraints following the RTAs.This was most likely since 72% of the total number of employed (58) had a decrease in their salary byone reason or the other.CONCLUSIONEconomic and functional ramifications cannot be excluded when considering the impact of road trafficinjuries.When appreciated, the burden of RTA injuries can be properly addressed by amicable measures andreinforcement of existing strategies.This implies that health systems in developing countries like Ghana should not only address the clinicalconsequences of road traffic accidents, but also the financial ones as well.12 | P a g e
  • 13. CHAPTER 1: INTRODUCTION1.1 BACKGROUND It cannot be over-emphasized how RTAs contribute in no small measure to death and disability worldwide, with a disproportionate number occurring in developing countries. Not only is it the leading cause of death by injury, but also the tenth (10th) leading cause of all deaths globally. An estimated 1.2 million people are killed in RTAs each year, and as many as 48 million are injured, occupying 30 - 70% of orthopedic beds in developing countries’ hospitals. (1) If the current trend should continue, it is predicted that by 2020 it will be the 3rd leading contributor to global burden of disease and injury. Road Traffic Accidents currently in developing countries accounts for 85% of annual deaths and 90% of disability - adjusted life years (DALYs) lost. While sub-Saharan Africa has a fraction of the motor vehicles found in Europe and North America, mortality from Road Traffic Accidents in Africa is among the highest in the world.(2) The economic consequences of Road Traffic Accidents have been documented in many high- income countries. In 2000, the Federal budget of the United States of America allocated US$ 150 billion towards provision of direct healthcare services, training and disease prevention; in the USA, the total cost to society of Road Traffic Accidents was estimated to be US$232.6 billion in the year (3) 2000, while injuries from road traffic crashes cost an estimated US$ 146 billion . Although the burden of Road Traffic Accidents in terms of incidence and mortality has been reported in several countries in sub Saharan Africa, data regarding both disability and socioeconomic effects of Road Traffic Accidents in this region remain woefully scarce. (4) Data on disability are extremely limited in sub-Saharan Africa, except for a study done in Ghana. (5)13 | P a g e
  • 14. 1.2 PROBLEM STATEMENT Road Traffic Accidents affect all age groups from under-5 to >65 years. About 73% of these deaths are between 15 - 49 years. This has grave economic implications. In this age group males are mostly involved than females and generally about 2.63 times involved in fatalities than females. Against the back- drop that males account for about 49% of the population, this is disproportionately high. (5) Road user type involvement can be classified as; pedestrians, car occupants (both bus and minibus), motorcycle, bicyclists, pick-up occupants and passengers. The pedestrians continue to constitute the target category of fatalities in the country; that is 42% of total fatalities, followed by occupants of buses and minibuses (passengers) that is 23% of total fatalities.(5)1.3 RATIONALE Considering, the ever increasing incidence of Road Traffic Accidents among the youthful age- group of the population, it has become more imperative to discuss not only morbidity and mortality consequences, but more importantly its social and economic bearing on the country as a whole. This study focuses on a cross-section of patients at the Accident Centre, Korle-Bu Teaching Hospital, where most referrals of RTAs report to, and is also therefore representative in predicting the economic and social effects of RTAs on the general population.1.4 AIM To explore the cost and disability consequences of Road Traffic Accidents in a section of patients at Accident Centre, Korle-Bu Teaching Hospital.14 | P a g e
  • 15. 1.5 OBJECTIVES To determine the following; 1. The trends of job loss and work hours lost among disabled and non-disabled people 2. The causes and incidence of Road Traffic Accidents among respondents 3. Information on care-seeking options and how cost of treatment affects the interval between temporary and definitive treatment. 4. To determine the ways of prevention of these Road Traffic Accidents 5. The common areas in Accra associated with these accidents. 6. The use of primary assessment/survey at the accident scene.15 | P a g e
  • 16. CHAPTER 2: LITERATURE REVIEW2.1 THE TRENDS OF JOB LOSS AND WORK HOURS LOST AMONG DISABLED ANDNON-DISABLED PEOPLETrends of job loss are varied, depending on whether or not there is any sustained disability or deformityfollowing the road injury. In an article written by Asker in 2007, on “The effect of Road TrafficAccidents”, he said there was loss of productive work time to those involved, (that is the victims of theroad traffic injuries) and also went further to add that loss of productive work time also occurred forfriends who needed to attend funerals. (6)---A disabled person is defined by Webster’s Advanced Learned Dictionary as, “A person lacking oneor more physical strengths, such as the ability to walk or to coordinate one’s movements, as from theeffects of a disease or accident or through mental impairment. (7)The World Health Organization had this to say about disability “Disability is an umbrella term,covering impairments, activity limitations, and participation restrictions. Am impairment is a problemin body function or structure; an activity limitation is a difficulty encountered by an individual inexecuting a task or action; while participation restriction is a problem experienced by and individualin involvement in life situations. Thus disability is a complex phenomenon, reflecting an interactionbetween features of a person’s body and features of the society in which he or she lives.” –WHO. (8)It is important to note that of most of these disabilities suffered by victims of RTAs, the most commontype of disability is difficulty in using a hand or arm (24%) and difficulty or inability to ambulate (16%).Among those who had the road traffic injury (17%) were unable to return to work.16 | P a g e
  • 17. Job loss was a direct consequence of the road traffic injury related disability for (16%) of the disabledstudy subjects, while (88.6%) sustained a reduction in earnings. These were from a socioeconomicimpact assessment of road traffic injuries in West Africa: exploratory data from Nigeria involving astudy on 127 subjects. (9)With regards to a study performed in Ghana on the economic consequences of injury and resultingfamily coping strategies in Ghana, it was found that rural households were more likely to utilize intra-family labor reallocation (90%) than were urban households (75%). Rural households were also morelikely to borrow money than urban, although households in both areas were equally likely to sellbelongings, though the nature of the belongings sold were different. Although injuries in the urban areahad more severe primary impacts (job loss, treatment costs and disability time), the ultimate effect onrural households appeared more severe. A greater percentage of rural households (28%) reported adecline in food consumption than in urban households (19%). These findings result in several policyimplications, including measures that could be used to assist family coping strategies and measuresdirected toward injuries themselves. (10)Again long hospitalization or disabilities prevent victims from indulging in their usual and normalproductive activities rendering them dependent on others. (11)2.2 THE CAUSE OF ROAD TRAFFIC ACCIDENTS AND THE COMMON AREAS INGREATER ACCRA REGION ASSOCIATED WITH THESE ACCIDENTS To begin with, the causes of road traffic injuries in our region are varied, considering the fact that theyoccur both on tarred and rough roads.17 | P a g e
  • 18. Mr. Noble Appiah (Acting Director of the National Road Safety Commission), said that contrary to theperception that accidents mostly occur on rough road 70% of the accidents happen on smooth and flatroads. He attributed this to over speeding on even very good roads. (12) The most common known causes of road traffic accidents in Ghana include gross indiscipline on ourroads, over –loading, fatigue driving, drunk driving and over-speeding. The latter three aloneconstitutes about 50% of road accidents in the country. The poor nature of some of our roads, poormaintenance of vehicles, disregard for traffic regulations by most drivers and indiscriminate use of theroad by some pedestrian are some of the other causes of motor accidents in the country. We also havenumerous unworthy and old aged cars on our highways, which also contribute to these road trafficaccidents. (13)A chief pathologist of the Department of Pathology, Korle- Bu Teaching Hospital, indicated that mostdrivers at autopsy had high percentages of blood alcohol (ranging from 300-372/100ml) which was farabove the accepted level of 2.43/100ml and was enough to cause accidents. (14)Four factors contribute to the vast majority of collisions. In descending order of importance they are:Driver behavior, Poor roadway maintenance, Roadway design and Equipment failure.Over 95% of motor vehicle accidents (MVAs, in the USA, or Road Traffic Accidents, RTAs, in Europe)involve some degree of driver behavior combined with one of the other three factors. Drivers always tryto blame road conditions, equipment failure, or other drivers for those accidents. When the facts aretruthfully presented, however, the behavior of the implicated driver is usually the primary cause. Mostare caused by excessive speed or aggressive driver behavior.Driver Behavior - Humans tend to blame somebody or something else when a mistake or accidentoccurs. A recent European study concluded that 80% of drivers involved in motor vehicle accidents18 | P a g e
  • 19. believed that the other party could have done something to prevent the accident. A miniscule 5%admitted that they were the only one at fault. Surveys consistently reveal that the majority considerthemselves more skillful and safer than the average driver. Some mistakes occur when a driver becomesdistracted, perhaps by a cell phone call or a spilled cup of coffee. Very few accidents result from an Actof God, like a tree falling on a vehicle.Speed Kills - The faster the speed of a vehicle, the greater the risk of an accident. The forcesexperienced by the human body in a collision increase exponentially as the speed increases. Smartmotorist recommends that drivers observe the 3 second rule in everyday traffic, no matter what thespeed may be. Most people agree that going 100 mph is foolhardy and will lead to disaster. The problemis that exceeding the speed limit by only 5 mph in the wrong place can be just as dangerous. Trafficengineers and local governments have determined the maximum speeds allowable for safe travel on thenations roadways. Speeding is a deliberate and calculated behavior where the driver knows the risk butignores the danger. Fully 90% of all licensed drivers speed at some point in their driving career; 75%admit to committing this offense regularly.Who are the bad drivers? They are young, middle-aged, and old; men and women; they drive luxurycars, sports cars, SUVs and family cars. Almost every qualified driver admits to some type of riskydriving behavior, most commonly over-speeding.Aggressive Drivers - As weve described, modern cars are manufactured to very safe standards, and theenvironment theyre driven in is engineered to minimize the injuries suffered during an accident. Themost difficult area to change is aggressive driver behavior and selfish attitudes. (15). A 2004 study by theAutomobile Association in Great Britain found that 85% of the respondents reported at least one of thebehaviors listed below directed at them (in order of descending frequency);19 | P a g e
  • 20. - Aggressive tailgating - Lights flashed at them because the other motorist was annoyed - Aggressive or rude gestures - Deliberate obstruction -- preventing them from moving their vehicle - Verbal abusePhysical assault - The same group was then asked about aggressive behavior they had displayedtowards other drivers. 40% indicated that they had never behaved aggressively towards another driver. Afurther 60% of the survey respondents admitted to one or more of the following behaviors (listed inorder of descending frequency): - Flashed lights at another motorist because they were annoyed with them - Gave aggressive or rude gestures - Gave verbal abuse - Aggressively tailgated another motorist - Deliberately obstructed or prevented another from moving their vehicle - Physically assaulted another motorist (one positive response)These behaviors are probably under-reported, since most people are not willing to admit to the moreserious actions, even if no penalty exists. The majority of these incidents happened during the daylighthours (70%), on a main road (not freeway or divided highway). (16)20 | P a g e
  • 21. Poor Maintenance - Roadway maintenance contributes to some motor vehicle accidents, but not to theextent that drivers use it as an excuse. Unfortunately maintenance schedules and procedures vary greatlyfrom city to city and state to state, so nationwide standards dont exist. Below are some of the potentialroadway maintenance shortcomings that you should be aware of;Debris on the roadway can be a problem, and it is the responsibility of local highway authorities to seeto them.Faded road signs, and signs obscured by foliage, occasionally contribute to accidents. If you know ofany offending signs, contact your local police department to see if they can get the problem remedied.Potholes cause a small number of accidents (primarily tire & suspension failures), but the accidentsusually occur at low speeds and dont cause many injuries. Some Northern US cities for example havepothole complaint lines that are active during the winter and spring.Roadway construction is a commonly mentioned reason for accidents. Again the blame usually restson aggressive drivers who are unwilling to observe regulations when approaching a construction zone.In most states in the USA for example, fines are doubled in work zones, making it expensive as well asunsafe to speed. Stop-and-go traffic requires thoughtful, alert driving to avoid a collision with the car infront of you. Too often drivers worry that their fellow drivers will intersect in-front of them in a trafficjam. The real problem is that drivers forget about the vehicle directly in front, rear-ending it whilelooking in their rearview mirror or daydreaming. Ideally, appropriate spacing should be left betweencars by drivers. The 3 second rule applies to traffic jams as well.Roadway Design - Motorists may blame roadway design for accidents, but its rarely the cause.Consultants such as the Texas Transportation Institute have spent years getting road barriers, utilitypoles, railroad crossings, and guardrails to their current high level of safety. Civil engineers, local21 | P a g e
  • 22. governments, and law enforcement agencies all contribute to the design of safe road layouts and trafficmanagement systems. State and federal governments provide guidelines to their construction, withdesign flexibility to suit local conditions. Roadways are designed by engineers with specialconsideration given to the following:Hazard Visibility - Permanent roadway hazards consist of intersections, merging lanes, bends, crests,school zones, and livestock or pedestrian crossings. Temporary hazards include road construction,parked or disabled vehicles, accidents, traffic jams, and wild animals (especially deer).Roadway Surfaces - Engineers can use different surfaces (for example, grooved pavement) dependingon the environment, traffic speed, traffic volume, and location of the roadway (noise barriers). Roadwaymarkings let drivers know about their ability to pass safely (dotted & double lines), the location of theroadway in inclement weather (reflective cats-eyes & stakes), and where road surface ends and theshoulder begins.Traffic Control Devices - Traffic light signals, speed limit signs, yield and stop signs, school &pedestrian crossings, turning lanes, police surveillance cameras, and traffic circles or roundabouts.Behavioral Control Devices - Built-in obstacles, that limit the ability of a vehicle to travel, includingcrash barrels, speed bumps, pedestrian islands, raised medians, high curbing, guard rails, and concretebarriers.Traffic Flow - Interstate highways remain the safest roads because their flow of traffic is in onedirection. One-way streets ease traffic congestion in city centers as well. Rural two-lane roadways arestatistically the most dangerous because of a high incidence of deadly head-on collisions and thedifficulty impatient drivers’ face while overtaking slower vehicles.22 | P a g e
  • 23. Roadway Identification Signs - enable someone without a detailed map to travel from one place toanother. They give advance notice of intersections, destinations, hazards, route numbers, mileageestimates, street names, and points of interest.Equipment Failure - Manufacturers are required by law to design and engineer cars that meet aminimum safety standard. Computers, combined with companies extensive research and development,have produced safe vehicles that are easy and safe to drive. The most cited types of equipment failureare loss of brakes, tire blowouts or tread separation, and steering/suspension failure. With the exceptionof the recent rash of Firestone light-truck tire failures, combined totals for all reported equipment failureaccounts for less than 5% of all motor vehicle accidents.Brake Failure - Modern dual-circuit brake systems have made total brake failure an unlikely event. Ifone side of the circuit fails, the other side is usually sufficient to stop a vehicle. Disc brakes, found onthe front wheels of virtually every modern vehicle, are significantly more effective than the older drumbraking systems, which can fade when hot. ABS (Anti Blockier System) or anti-lock brakes prevent thewheels from locking up during emergency braking maneuvers, allowing modern vehicles to avoid manyaccidents that previously would have occurred.Tires - Todays radial tires are significantly safer than the bias-ply tires of 25 years ago. They still,however, need attention regularly. Under inflation, the most frequent cause of tire failure is consideredthe main culprit in the recent Firestone tire-failure fatalities. Uneven or worn-out tires are the next mostserious problem and can also lead to tire failure. Uneven wear is caused by improperly balanced tires, ormisaligned or broken suspensions. Remember, all that keeps you connected to the roadway is your tires.If you dont check your own, have your mechanic check them every 5,000 miles.23 | P a g e
  • 24. Steering & Suspension - Your suspension keeps your tires in contact with the roadway in a stable andpredictable manner. Your steering enables you to go around road obstacles and avoid potentialaccidents. Even a safe, well-trained driver is helpless in the event of a steering or suspension systemfailure. Such failures are catastrophic, especially at high speeds. Have your suspension and steeringsystems checked out by a mechanic every 10,000 miles.With regular component inspections by trained individuals, equipment failures can be virtuallyeliminated. (17) In another study, to determine the six most common causes of automobile crashes, the following cameup; - Distracted drivers - Driver fatigue - Drunk driving - Speeding - Aggressive driving and the - Weather To end with, a study conducted by Amend Ghana blamed the increasing spate of road traffic accidentson unplanned urban growth, an ever- increasing number of vehicles and lack of awareness on thepart of all road users. Road design doesn’t make adequate provision for pedestrians and therefore thereis a lot of competition between pedestrians and vehicles on the road. The drivers are undisciplined andthe hawkers take up everywhere the pedestrians are supposed to be. The study also implicated the Driverand Vehicle Licensing Authority for making only cursory roadworthiness checks. The “Highway Code”is taken as a suggestion rather than a set of rules. (18)24 | P a g e
  • 25. 2.3 INFORMATION ON CARE SEEKING OPTIONS AND HOW COST OF TREATMENTAFFECTS THE INTERVAL BETWEEN TEMPORARY AND DEFINITIVE TREATMENTIn Ghana, victims of road traffic accidents, usually have no initial decision with regards to where to seek (19)medical care from, they usually wake-up to find themselves in hospital, usually the nearest one by.From the study performed by Catherine Juilliard et al, on the “Socioeconomic impact of road trafficinjuries in West Africa”; exploratory data from Nigeria”, of the 127 victims interviewed, 77% of studysubjects sought medical care. Hospital treatment and treatment by a private physician were the mostcommon types of initial care sought. Home treatment (22%) was the next most common, followed byhealth post or clinic treatment (17%). Although only 6% of road traffic injured (RTI) people sought first–line care from bone setters, herbalists and other traditional healers, 15 study subjects sought traditionaltreatment after they had already been treated in a different setting. Traditional treatment was the mostcommon second treatment options chosen by road traffic injured people, comprising 39% of those studysubjects who sought more than one treatment, and 12% of all who had a RTI. Individual preferences wasthe most common reason for a choice of first provider (42%), but proximity and cost of treatment werealso often quoted. (20) The table below summarizes this;TABLE 1.0 showing the distribution of order of treatment sought by injured peopleLOCATION First Second Third Fourth Total Visits per type of Provider Provider Provider Provider provider Home 28 11 3 42 Traditional 8 15 1 1 25 treatment Health Post/ 21 4 - - 2525 | P a g e
  • 26. ClinicPrivate doctor 35 2 1 38 Hospital 35 6 - - 41 treatment Total 127 38 5 1 171 The average total direct cost of treatment reported was US$25.4. The mean direct cost of care wasUS$36.40 for disabled people and US$20.84 for non–disabled people. Although these results suggest adisparity in direct cost of treatment between disabled and non-disabled, this difference based on the p-value was not significant. People who were disabled as a result of their road traffic injury were morelikely to seek formal care and more often unable to return to work than their disabled counterparts. Ahigher proportion of disabled people paid more than the Nigerian monthly average per capita income fortreatment of their injury than non-disabled people. (20)The table below summarizes the above;TABLE 2.0 showing the cost of treatment in US –dollars by treatment categoryTreatment Mean cost 95% CI p-ValueAll informal 6.65 3.44 to 13.47 -All formal 35.64 23.09 to 49.86 < 0.0001Total Cost 25.4 18.58 to 31.38 -26 | P a g e
  • 27. Economic value of life lost due to an injury = Average loss of life expectancy × Per capita grossnational product.It is noted that the cost of treatment, affects the interval between temporary and definitive treatment,more so in the so-called “cash and carry” system. Though this is not entirely the truth now, because ofthe introduction of the National Health Insurance scheme, for patients who do not have valid insurance,this continues to be the case.2.4 TO DETERMINE THE WAYS OF PREVENTION OF THESE ROAD ACCIDENTSIrrespective of how sophisticated the national campaign against accidents may be, accidents cannot beeliminated from our roads totally; however sustained road safety measures can cause road accidents tosubside. There should be proper education, especially before one can secure a driving license. This concernraises certain questions about the driving schools we have in the country. Who sets the curriculum? Howlong should a training last, for someone who wants to secure a license? What should be the qualificationof an instructor at a driving school? The Drivers and Vehicle Licensing Authority must be empowered,to ensure proper examination of all candidates before issuing out a license. They also need to do morethan the preliminary checks, before issuing out a road worthiness certificate. This is more so, since mostcars used in the country and on our roads are used cars.Motor Transport and Traffic Unit (MTTU) statistics also inform us that most accidents are caused bybroken-down vehicles on our roads. This is common on our highways, and therefore part of the roadfunds should be used to buy heavy duty towing trucks for our roads. The time has come for us to use theroad fund, to serve the road users and transform our roads from a highway of death and disaster to ahaven of tranquility. (14)27 | P a g e
  • 28. Breathalyzers should be made available to policemen, to enable them ascertain the blood alcoholconcentration of suspected drivers who are drunk driving. It is important that public education continues,an example being the road safety campaign advertisements, erecting bill boards on highways and alsoeducating pedestrians on the need to adopt the right road safety attitudes.Owing to the socio-economic impacts of road traffic accidents, it deserves to be given political priorityand commitment. Unfortunately, in Ghana there is lack of political will to put the appropriateinterventions in place. Examples from developed countries like the United States, Japan, Sweden andFinland, where the personal commitment and interest of their heads of state, has maintained the sanityon the roads and culminated in a drastic decrease in road accidents and the adherence to roadregulations. In Ghana, wearing of seat belts is yet to become mandatory, yet a lot more people are dyingthrough accidents when seat belts could have saved them.(14)Another important aspect comes from the end of the manufacturer. Emphasis should be placed onHaddon’s ten strategies for road traffic injury; this refers to technological modifications aimed atreducing or managing the excess energy that may contribute to the occurrence of a crash and the severityof the injuries sustained. It is important that we shape the road network, for road traffic injuryprevention, examples include; classifying roads and setting speed limits by their function, improvingsafety of single- lane carriageways by provision of slow moving traffic and for vulnerable road users,advisory speed limit at sharp bends, regular speed-limit signs and better highlighting of hazards throughroad lighting at junctions and roundabouts. We can also talk about traffic- calming measures, like;narrowing of streets, road humps, roundabouts, rumble device, link closure, speed bumps and chicanes.Another control measure that has been found to be useful in controlling road traffic injuries, isimproving visibility of all road users by; using daytime running lights on the front of motorized vehiclesand the use of reflective and protective clothing, which increases the visibility of riders. (21)28 | P a g e
  • 29. Once again, it is important that we set and secure compliance with road safety rules, by enacting andenforcing laws on alcohol impairment, speed limits, laws on the use of seat- belts and child restraints.Laws should also be enacted to enforce the use of crash- helmets as mandatory, also with the increasinguse of motorcycles as public transport; these should be banned and stopped, as they pose a great threat toother road users. (22) Public health sector campaigns in the field of road traffic injury prevention have encompassed a widerange of measures, but education has always featured as one of the key activities of prevention. It hasbeen found that informing and educating road users can improve knowledge about the rules of the roadand about such matters as purchasing safer vehicles and equipment.Also, basic skills on how to control vehicles can be taught. Education can help to bring about a cultureof concern and develop sympathetic attitudes towards effective interventions. General non- specific roadsafety campaigns should be avoided; campaigns should rather be used to put important questions on theagenda, and should preferably support other measures such as new legislation or police enforcement. (23)2.5 THE USE OF PRIMARY ASSESSMENT / SURVEY AT THE ACCIDENT SCENEPrimary survey is a crucial element in the “initial assessment” of a seriously injured patient. It involvesassessment of the patient and establishing treatment priorities based on their injuries, the stability oftheir vitals and the injury mechanism involved. This process constitutes the “ABCDE’s” of trauma careand identifies life- threatening conditions. It’s made up of; - Airway maintenance with cervical spine control29 | P a g e
  • 30. - Breathing and ventilation - Circulation with hemorrhage control - Disability; neurological status - Exposure/ Environmental control; completely undress the patient but prevent hypothermia. (24)TABLE 3.0 SHOWING THE DISTRIBUTION OF AMBULANCES AND EMT IN GHANA, 2010Number Region No. of Ambulance No. of EMT at post Stations1 Greater Accra 6 572 Ashanti 5 453 Eastern 4 374 Central 2 175 Volta 2 186 Western 1 97 Brong-Ahafo 1 98 Upper East 1 79 Upper West 1 910 Northern 1 911 Accra Control 1 612 Ashanti Control 1 5Total 24 228EMT = Emergency Medical Technicians (25)30 | P a g e
  • 31. From the above table, it is obvious that the country as a whole is limited with regards to the resourcesavailable for providing emergency medical service for accident victims. It is therefore not surprising thatthere is actually no consistent data, with regards to the availability and patronage of these emergencyservices following road traffic injuries. Emergency medical services are supplied, but they are a problemoutside the major cities. Some countries like Ghana have a private ambulance system (St. JohnAmbulance Service), others have even helicopter rescue, which help those who can pay for the service.In Zimbabwe the private emergency services arrive at accidents without considering if victims can payfor their services. In Cote d’Ivoire the fire brigade is responsible for the transport of road accident victims. In Benin, thepolice have the authority to require vehicles to transport accident victims; in. This seems to be workingwell in cities with fire brigades. Otherwise, injured people have to rely on the help of passing “goodSamaritans” for transport to hospital. Except for Cote d’Ivoire, where people seem to be reluctant to beinvolved in helping out accidents, people seem to be helpful in providing transport to hospital. Poortelecommunications is a problem in calling for help. Though most countries have hospitals, spread outall over the country, not all hospitals have doctors on call or the equipment needed to treat badly injuredvictims. (26) Pertaining to a study carried out by Charles N. Mock et al, on “Admissions for injury at a ruralhospital in Ghana”, out of 451 people interviewed only 39% of people presented to the hospital withinthe first 24hours of injury. Forty seven percent presented between 1 and 7 days after injury and 14%presented more than 1 week after injury. Only 23% of patients received any type of pre-hospital care,primarily first-aid measures at village health posts and no patient received ongoing medical care en routeto the hospital. (27)31 | P a g e
  • 32. CHAPTER 3.0: METHODOLOGY3.1 STUDY DESIGN AND AREAThe cross-sectional study was conducted in Korle-Bu Teaching Hospital, the leading tertiary hospital insouthern Ghana. The aim of this study was to ascertain the social and economic impact following roadtraffic accidents, experienced by patients of the orthopedics and trauma unit/ ward. The respondentswere in-patients and a few out-patients who were coming for review at the Korle - Bu TeachingHospital. A total of 70 questionnaires were administered and analyzed.3.2 STUDY POPULATIONThe target population was 70 patients including males and females, from adolescents to the aged, cuttingacross all levels of education. It is important to note that, these were all victims of road traffic accidentsfrom different parts of the metropolis.Road traffic accidents, was defined in the survey as “Physical body damage as a result of being hit bya motor vehicle, motor vehicle crash , or other transport related crash mechanism”.3.3 SAMPLING STRATEGYThe sampling technique employed was convenience sampling. Patients from all the orthopaedic wardsof the Korle-Bu teaching Hospital were interviewed, except from the orthopaedic paediatric ward.Discharged Out-patients, who were coming for review / follow-up, were also sampled. Conveniencesampling was used to select the units of the sampling frame, with a sample size of 70.32 | P a g e
  • 33. 3.4 DATA COLLECTION AND INSTRUMENTAn informed consent was taken and a well-structured self-administering questionnaire was given to thepatients on the ward. On the average it took twelve minutes for a questionnaire to be self-administered.If the patient was not in the position to see anyone, or fill out the questionnaire, he was skipped for thenext patient. For patients who were not able to fill out the questionnaire because of language barrier, Itranslated it into the preferred language (Twi or Ga) without alteration to the meaning as much aspossible. Questions were drawn using information on road traffic accidents from the literature. Additionalquestions were adopted, after modification, from questionnaires used in similar studies. Pre-testing wasconducted on 10 patients in the accident center ward following which some questions were modified toimprove clarity. Those that participated in the pre-test were not part of the study. The questionnaire wasin four parts. The first part was to elicit the demographic data on age, ethnicity, religion, marital status, educationallevel and occupation of each study participant. Questions relating to the nature of the road trafficaccidents were asked in the second part. This was to find out where the accident occurred, who wasinvolved, what time of the day on which it occurred, what they also thought was the cause of theaccident and how it can be prevented. The third section was designed to assess the nature of their jobs,how much they earn, cost of treatment till date and how their admission has affected their jobs andsalaries. The fourth section was related to the impact of the road traffic accident, on their social andfamily life. I wanted to find out if it had, in anyway, changed their abilities to provide for their familiesand how it affected their daily activities.33 | P a g e
  • 34. 3.5 DATA HANDLING, ANALYSIS AND PRESENTATIONA structured questionnaire was designed based on my aim and objectives. The collected data was coded,entered and analyzed with Microsoft Excel 2010 and SPSS V16.0 Statistical Package for Social Services(SPSS). Graphs and tables were produced from the variables.3.6 LIMITATIONSFirstly, some of the patients refused to partake, because they didn’t know or understand how my studywas going to help or benefit them. Secondly, there was the problem of language barrier and alsoilliteracy. I had to spend thirty or more minutes, in translating into Twi or Ga retaining the detail asmuch as possible. Thirdly, since the bed turnover was low (owing to prolonged admission for most patients), I wascompelled to interview some other patients who were coming for review. These patients had beendischarged not too long ago, and were coming for out-patient review at the Out-Patient Department.(O.P.D).34 | P a g e
  • 35. CHAPTER 4 RESULTS AND ANALYSIS4.1 DEMOGRAPHYThe following analysis was made, based on the data collected;Firstly, the data gathered showed age ranges from (10-14) years to (60-64) years. The modal age groupwas the (35-39) year group, represented by 16 people, and those with the lowest frequencies were the(15-19), (55-59) and the (60-64) year groups having just one (1) respondent each. - In comparison with the motor accident returns of last year, 2011, for the first quarter (ending on the 31st of march 2011), Greater Accra Region had a total of 1,171 cases of road traffic accidents with those aged 18yrs and who lost their lives numbering 44 out of a total of 68 victims.(29) These were in line with the results obtained in this study, showing that majority of the victims were actually in the youthful age-groupTABLE 4.0 SHOWING THE AGE DISTRIBUTION OF ACCIDENT VICTIMS Ages Frequency Percent 10-14 2 2.9 15-19 1 1.4 20-24 10 14.2 25-29 5 7.2 30-34 7 10.0 35-39 16 22.8 45-49 15 21.5 50-54 12 17.2 55-59 1 1.4 60-64 1 1.4 Total 70 100.035 | P a g e
  • 36. Secondly, an assessment of the incidence of RTAs among people of various educational backgroundswas made. The table below shows the literacy distribution with their frequencies.From the study 4.2% of the respondents were illiterates, while 48.5% of the respondents had eithersecondary or vocational education, making up almost half of the total of 70 patients interviewed. - Comparing with other studies done elsewhere in Nigeria, by Julliard et al, 30.18% had no formal education and 27. 58% had some form of secondary education (28). Tallied with the ages or the youthful nature of the accident victims, this indicates a relatively substantial number of the youth (15-49) yrs and the educated (primary, secondary/vocational) are involved in road traffic accidents.TABLE 5.0 SHOWING EDUCATIONAL LEVEL OF INTERVIEWEES Frequency Percent Primary 21 30.0 Secondary/ Vocational 34 48.5 Tertiary 12 17.3 none 3 4.2 Total 70 100.04.2 NATURE OF ROAD TRAFFIC ACCIDENTThe questionnaire also sought to find out the incidence of road traffic injury / accidents on various roadswithin the Greater Accra Region. A total of 14 accidents occurred within the central business district ofAccra. No street names where obtained due to absence of official naming of the streets. While a total of12 out of the 70 people interviewed had their accident on the Tema motorway, quite a number occurredin isolation.36 | P a g e
  • 37. Examples were Dansoman, Agege, La, Nungua, Achimota, Bremmi, Darkuman among others.Accra happens to be one of busiest business districts in the country, with a lot of vehicular and humantraffic.On the other hand, the Tema motorway (a 19km highway linking Tema to Accra) is usually marked withvarious kinds of road traffic accidents, involving all kinds of cars, trucks and motorcycles.The frequency of motor traffic accidents, on various roads in the Greater Accra Region, is summarizedin the table below.TABLE 6.0 SHOWING ACCIDENT DISTRIBUTION ON ACCRA ROADS Frequency Percent Accra 14 20.0 Achimota 1 1.4 Adaiman 1 1.4 Agege 1 1.4 Alajo 1 1.4 Alajo jxn 0 0.0 Bremmi 1 1.4 Bubuashie 2 3.0 Charman 1 1.4 Compound 2 1.4 Dansoman 2 1.4 Darkuman 1 1.4 Dowuenya 1 1.4 Highstreet 4 6.0 Jamestown 1 1.4 Kaneshie 1 1.4 Kasoa 2 3.0 Kokomlemle 1 1.437 | P a g e
  • 38. Korle-bu 1 1.4 Kwashieman 1 1.4 La 1 1.4 Madina 1 1.4 Mallam jxn 2 3.0 Mamprobi 1 1.4 Mataheko 1 1.4 Mortuary rd 0 0 Nsawam 0 0 Nungua 0 0 Ofankor 0 0 Osu 0 0 Owutubraku 0 0 Oyibi 0 0 Sakaman 0 0 Taifa st 0 0 Tantra 1 1.4 Tema 12 17.1 motorway Tesano 1 1.4 Zongo jxn 1 1.4 Total 70 100.0 The bar chart below summarizes the tabulated data above. It shows a high number of accidents on thestreets or roads of the central business district, to which people are referring wrongly to as Accra. Otherroads, on which a high incidence of road traffic accidents occurred were; High-street, Kasoa,Bubuashie and the Mallam junction road.38 | P a g e
  • 39. FIGURE 1.0The above data is followed by a summary of which part of Greater Accra Region recorded the highestincidence of road traffic accidents within the month the survey was conducted (June).Accra recorded 41 road traffic injuries, while Tema had a total of 20 incidents of road injury. However,9 cases were not really categorized into either Accra or Tema, and these cases had occurred on thecompounds of the victims, when cars ended up skidding off the road.39 | P a g e
  • 40. TABLE 7.0 showing the distribution of road traffic accidents in Accra, Tema and others. Frequency Percent Accra 41 59.0 Tema 20 29.0 Other 9 12.0 Total 70 100.0Pie chart showing the graphical distribution of the road traffic accidents in Greater AccraRegion. (FIGURE 2.0)I went ahead to find out the incidence of road traffic accidents, among the different category of roadusers in Accra. The GRAPH below summarizes the incidence among drivers, passengers andpedestrians. Pedestrians topped the list with a total of 31 interviewees being knocked down by vehicles,and a total of 26 passengers being involved in road injuries. The number of drivers was however on thelow, with a total of 13 drivers being hospitalized. This could mean that they may have survived but didnot require admission for their condition, accounting for the small numbers or may not have survived.40 | P a g e
  • 41. - In comparison with the study carried out in Nigeria, on the “Burden of road traffic injuries in Nigeria”, a total of 38 out of 127 motor-vehicles were involved. However, pedestrians recorded the lowest involvement in the road traffic injuries, in her article. (28)Graph showing the Incidence of road injuries among various road users. (FIG. 3)The table on the next page shows the vehicles which were frequently involved in these accidents.41 | P a g e
  • 42. TABLE 8.0 showing the frequency distribution of vehicles involved in the accident. Frequency Percent Bicycle 1 1.4 Motorcycle 18 26.0 Car 15 21.4 Truck 12 17.1 Other 13 18.5 Total 59 84.4Missing System 11 15.6Overall Total 70 100.0From the above data, it is obvious that there are some missing data. Unfortunately, these 11 people referto clients interviewed who didn’t know what hit them or happened to them, to land them in hospital.Though most of these people were aware of the accident, they couldn’t really tell what kind of vehicle itwas, and what could have been the problem. The subsequent question sought to bring out the number ofpeople who were involved in the road traffic accidents, and those who lost their lives in the process.Every road traffic accident could involve one or more persons. The next question sought to know ifother people were involved in the accident, by virtue of the fact that, they were also passengers in thesame vehicle or for another reason.The table below shows the total number of people involved in these accidents, with the exception ofthose interviewed. This means that, 19 people said they were the only ones involved in the accident, 16people said they were involved with one other person, 13 people said they were involved with 2 otherpeople in the accident and 3 other people said they were involved in the accident with 3 other people.42 | P a g e
  • 43. TABLE 9.0 showing the total number of people involved in these accidents frequency fx0 19 01 16 1611 1 1112 1 1215 1 1517 1 1718 1 182 13 2623 2 46 3 3 94 4 125 8 409 1 9TOTAL 70 231From the data above, it is obvious that though 70 people were interviewed, there were 231 additionalvictims of the road traffic accident, some of which are deceased and others in-patients at other facilities.This is quite a number, implying that in all these 70 accidents, a total of 231 citizens were involved.The total mortality experienced, from the study is captured in the table below.43 | P a g e
  • 44. TABLE 10.0 showing number of mortalities in the various accidents. frequency fx0 54 01 4 410 1 1017 1 172 3 63 2 65 1 57 4 28Total 70 76From the above table, the total number of interviewees witnessed 76 mortalities compared to the 231victims of the road traffic accidents.I subsequently tried to find out the nature of roads associated with these accidents, by finding out wherethese accidents occurred. Seventy five percent of the road traffic accidents occurred on tarred roads,whiles 25% occurred on rough roads in the region. - Compared with a study by O. Kobusingye, on the Injury patterns in rural and urban Uganda, he found out that out of 127 people interviewed, 92 (72.4%) people had their accident on a paved road, 17 people had their road traffic accident whiles at home (13.4%), and 14 other people had44 | P a g e
  • 45. their road injury on unpaved roads (11%). The last group of four people had their road traffic accident on paved intersections, making 3.1%. (30). - This was in keeping with what was seen in this survey I conducted, that majority of the RTAs occurred on tarred roads. This may have been due to drivers feeling comfortable to take more risks through over-speeding and ignoring traffic regulations, as stated in the literature review.Pie chart showing the percentage representation of the nature of the roads. (FIG. 4)The time of day that most accidents occurred was also important in the study, to enable us appreciate theimportance of headlights and street lights in contributing to our road traffic accidents. Twenty ninepercent of the accidents occurred in the afternoon and 30% occurred in the morning making a total of59%. Thirty one percent of the road injuries occurred at night, though this was the highest, the total of45 | P a g e
  • 46. accidents that occurred during the day, would be more than that which occurred during the late hours ofthe day. The pie chart below depicts this;A Pie Chart showing the time of the day most accidents occur (FIG. 5.0) The study tried to find out the cause of most accidents on our streets, whether they were due to non-compliance of traffic regulations, recklessness or carelessness among a range of other causes. Most ofthe people interviewed felt that recklessness or carelessness on the part of the driver was the maincause of the accidents in which they were involved in (35 people). This was followed by overtaking byanother vehicle or by same vehicle and then over speeding. Non-compliance to traffic signs contributedleast to the causes of road traffic accidents.46 | P a g e
  • 47. An article entitled, “Another look into road accident in Ghana”, stated that the most common causesof road accidents in Ghana include gross indiscipline on our roads, over- loading, and driving whiletired, drunk-driving and over speeding. Statistics show that 60% of road accidents are caused by drunkdriving and over speeding. The latter alone constitutes about 50% of road accidents in the country. Thepoor nature of some of our roads, poor maintenance of vehicles, disregard for traffic regulations by mostdrivers and indiscriminate use of the road by some pedestrian are some of the other causes of motor (31)accidents in the country. A similar article entitled “150 Ghanaians die from road accident everymonth”, said that besides other causes of transport accidents, fatigue contributes to 25% of roadaccidents globally. (32)”. The bar chart below gives more detail.FIGURE 6.0 SHOWING CAUSES OF ROAD TRAFFIC ACCIDENTSThe survey further wanted to find out how victims of road traffic accidents got to the nearest hospital,by inquiring the means of transport the interviewees employed. Thirty – two respondents said they got to47 | P a g e
  • 48. the nearest hospital by a private car (45.7%), 28 people got to the hospital by taxi (40%), and just threegot to the hospital by an ambulance (4.3%). This trend observed was quite sad, only re-iterating theinadequacy of the numbers of ambulances in this country. Ambulances contain early resuscitation tools(such as airway devices and oxygen supply) which may help sustain the patient’s critical condition whiletransporting him/her to the hospital. Thus if more private cars are transporting victims to the hospitalsinstead of ambulances, most victims may not survive to see the entrance to the hospital if they arecritically injured.TABLE 11 showing means of transportation to the nearest hospital Transport Frequency Percent ambulance 3 4.3 bus 4 5.7 police car 1 1.4 private car 32 45.7 taxi 28 40.0 trotro 2 2.9 Total 70 100.0The questionnaire also sought to find out how many people receive some form of primaryassessment/survey before arrival at a health care facility. From the data below none of the peopleinterviewed had any form of primary survey before arriving in hospital or during their conveyance to thehospital. This observation was in keeping with the high number of ‘private car’ transport to the nearesthospital in contrast to the low number of ambulance transport. (The ambulance team comprises qualifiedpersonnel who can do primary assessment to determine the extent of injury either at the site of accident48 | P a g e
  • 49. or on the way to the hospital, something which the private cars would most likely lack). The table belowsummarizes that;TABLE 12 SHOWING FREQUENCY OF PROVISION OF PRIMARYASSESSMENT/SURVEY Frequency Percent Valid Percent no 70 100.0 100.0 yes 0 0 0Sixty two respondents had some primary assessment done at their first point of call at the hospital(88.6%), while six people had the primary survey at the referral site from where they came to AccidentCentre, Korle-Bu Teaching hospital (8.6%). Two people said they didn’t have any form of primaryassessment on arrival at the referral site. The table below summarizes the outcome. TABLE 13 showing where primary assessment was initially provided Frequency Percent the first point of call 62 88.6 at the referral site 6 8.6 none 2 2.8 Total 70 100.049 | P a g e
  • 50. So, were the road traffic accidents preventable? If yes then how? This was the next question this surveysought to find. Eighty three percent of the respondents agreed with the statement that the accidents werepreventable, whiles 17% said the accident could not have been avoided. The response is captured in thepie chart below.(FIG. 7) PIE CHART SHOWING PERCENTAGE DISTRIBUTION OF RESPONDENTOPINION AS TO WHETHER ACCIDENTS WERE PREVENTABLE OR NOTFrom the above, 83% of the victims thought the road accidents could have been avoided and this is how.(Summarized in the table below);50 | P a g e
  • 51. TABLE 14 showing distribution of how the accidents could have been prevented as per therespondents Frequency Percentage better headlight 2 2.8 maintenance 6 8.6 more careful 16 22.8 no overtaking 2 2.8 normal speed 11 15.7 not preventable 9 12.8 obey RTR 17 24.3 obey speed 3 4.3 patience 4 5.7 Total 70 100.0FIG. 8.0*RTR – road traffic regulation51 | P a g e
  • 52. 4.3 JOB ASSESSMENTThe category of workers involved in road traffic accidents, was divided into permanent or contract-based, whether they are civil servants or are in the private sector. Thirty six of them had permanent jobs,twenty-eight of the respondents had contract based jobs (40%), and it is important to note that six ofthem were students (“missing” component of both tables).These are summarized in two tables below;TABLE 15.0 showing types of employment of the respondents Frequency Percent permanent 36 51.4 temporary/ contract based 28 40.0 Total 64 91.4Missing System 6 7.2Total 70 100.0TABLE 16.0 showing the various job distributions of the respondents Frequency Percent civil service/ government employed 31 44.0 private sector 33 47.1 Total 64 91.4Missing System 6 8.5Total 70 100.052 | P a g e
  • 53. The graph below represents the specific job descriptions of the RTA victims. (FIG. 9)With the knowledge about their various occupations, the next was to find out their work-hours per weekand their number of working days per week. The table below shows the work hours per week. From thedata collected the mode for the total number of hours spent at work, on a weekly basis was 40hours/week.In comparison to the study of Julliard et al, on Socioeconomic impact of road traffic accidents in WestAfrica, 107 out of a total of 127 were able to go to work, following varied duration of stay in hospital.(28)53 | P a g e
  • 54. The total number of hours wasted on a weekly basis, due to hospital admission was 3,686hours, for allthe working people interviewed.TABLE 17.0 showing the frequencies of work hours per week Hours Frequency fx 112 2 224 24 8 192 40 25 1000 42 2 84 48 2 96 50 7 350 54 2 108 60 3 180 70 12 840 72 2 144 84 1 84 90 1 90 98 3 294 Total 70 3686The table below shows the number of days/ week of job work that was lost as a consequence of hospitaladmission.54 | P a g e
  • 55. TABLE 18.0 showing number of days per week lost to Road Traffic Accidents Frequency Percent three days/ week 8 11.4 five days/ week 17 24.2 six days/ week 21 30.0 Seven ays/ week 24 34.4 Total 70 100.0Total 70 100.0Majority of respondents (34%) lost full week off work on the average, implying they either had to obtainfinancial support from their savings, company or from family & friends.Based on the above information gathered, and in an attempt to determine the socioeconomic impact ofroad traffic accidents, the questionnaire sought to find out salary being lost.Majority of the respondents earned between GHc 100-500 (56.2%).TABLE 19.0 showing the distribution of estimated salaries of respondents Salary Frequency Percent less than GHc 100.00 16 22.8 GHc 101.00 - GHc 500.00 38 56.2 GHc 501.00 - GHc 1000.00 10 14.2 GHc 1001.00 - GHc 1500.00 6 8.8 Total 70 100Total 70 100.055 | P a g e
  • 56. TABLE 20.0 SHOWING THE DISTRIBUTION OF THE EXPENSES INCURRED BYRESPONDENTS Expenses Frequency Percent less than GHc 100.00 10 14.3 GHc 101.00 - GHc 500.00 6 8.6 GHc 501.00 - GHc 1000.00 12 17.2 GHc 1001.00 - GHc 1500.00 40 45.7 more than GHc 2,000.00 2 2.9Total 70 100.0The second table below shows the expenses victims of road traffic accidents incurred for their treatment.While majority of the respondents earned between Gh c 100-500, about 60% of the total 70 victims ofRTAs incurred costs up to Gh c 1500. Considering that 56.2% of the 70 victims earn about only one-third of this cost, it clearly presents a huge financial challenge to patients admitted for various injuries atthe Accident Centre, Korle-Bu. A comparison between the budgetary allocation for road trafficaccidents and the amount lost in terms of services are almost on the same scale, showing that more hasto be done to control the spate of road traffic injuries in our country. It must be noted that GHc 97,821 –GHc 163,200 is spent monthly to provide services for victims of vehicular accidents. (33)2011 BUDGET AGAINST COST OF ROAD ACCIDENT ANNUALLYFINANCIAL COST = $175,000,000 = GHC 241,000,000 EVERY YEARHUMAN LIVES = AVERAGE 1870 KILLED EVERY YEARSERIOUS INJURY = 15000 EVERY YEAR56 | P a g e
  • 57. PHYSICAL DISABILITY = ABOUT 5000 EVERY YEAR (33)The nature of injuries suffered by the victims and the duration of admission to date was also assessed.The nature of injuries ranged from soft tissue injuries to fractures, with more than 90 respondents havinga fracture and more than 60 having an associated soft tissue injury.--- Comparing, with O. Julliard’s article on the Burden of road injuries, 47% had fractures and softtissue injury, 21% having head and neck injuries. The least injury she reported was spinal injury (1.6%)The graph below summarizes the distribution of injuries, among the interviewees.(FIG. 10) Graph showing distribution of the nature of injuries suffered by victims 45 40 35 30 25 20 15 10 5 Frequency 057 | P a g e
  • 58. With regards to duration of admission, it ranged from 1week to 16 weeks. This could be attributed tovaried or multiple reasons. From the table below, as many as six people had been on admission forsixteen good weeks, away from work, family and friends. The impact of prolonged hospitalization onthe individual, the financial burden to the individual, the costs to the hospital and the country as a wholecannot be overemphasized. This undoubtedly adds to the reason why road traffic accidents are assuminga public health importance.----- From the Socioeconomic impact of road traffic injuries article, 80% of the 107 victims stayed inhospital for less than 4 weeks, whiles 19.6% stayed for over a month. This shows a similar pattern aswhat is tabulated below. (9)TABLE 21.0 SHOWING THE FREQUENCY DISTRIBUTION OF DURATION OFADMISSION AND THEIR PERCENTAGES Frequency Percent 12wks 6 8.6 13wks 1 1.4 14wks 1 1.4 15wks 2 2.8 16wks 6 8.6 1wk 15 21.4 2wks 10 14.2 3wks 7 10.0 4wks 5 7.3 5wks 2 2.8 6wks 2 2.8 7wks 3 4.5 8wks 10 14.2 Total 70 100.058 | P a g e
  • 59. To make sense of the duration of stay, I went ahead to find out or better still rule out, those whoseadmission in hospital had been prolonged on account of insufficient funds. The pie chart below,describes this distribution.FIGURE 11.0 SHOWING THE PERCENTAGE DISTRIBUTION OF RESPONSE TODURATION OF ADMISSION BEING INFLUENCED BY INSUFFICIENT 46% 54%59 | P a g e
  • 60. 4.4 IMPACT ON SOCIAL AND FAMILY LIFEFollowing prolonged hospital admission, I decided to find out the extent, to which the ability of the in-patients to provide for their families had been impaired. This was analyzed in consideration with thenumber of interviewees, who were breadwinners.--- From the studies conducted by the ODA, 67% out of a total of 89 respondents had no one whollydependent upon them in Ghana. (34)The pie chart below, show the distribution of people who were breadwinners.FIGURE 12.0 SHOWING PERCENTAGE DISTRIBUTION OF BREADWINNERS AMONGTHERESPONDENTSThe table below shows the extent to which the prolonged admission, has affected the ability of theinterviewees to provide for their families.60 | P a g e
  • 61. TABLE 22 showing extent to which the injury affected respondent’s ability to provide Frequency Percent not significantly 20 28.6 significantly 23 32.4 very significantly 7 10.0 Total 50 71.4Missing System 20 28.6 Total 70 100.0From the above table, it is obvious the number of people who were unaccounted for, the missing datarepresents the students and also some of the non-breadwinners, who were directly not responsible foranyone.The study also tried to ascertain, how the respondent’s financial situation had been affected, since somewere students, others had their medical expenses being catered for by insurance and others yet still werebeing supported by their families.--- From the study of Julliard O et al, 88.6% of the total 127 interviewees realized a reduction in theirearnings.(9)61 | P a g e
  • 62. FIG.13 showing the extent to which hospitalization has affected their financial situationThe effect of hospitalization on their finances was marked, with 10 respondents complaining of verysignificant reduction in their finances, twenty eight people complained of being affected moderately.Twenty two respondents said their finances had not really been affected that much following the injury.This could be attributed to recent admission, the coverage of insurance or a good social and familysupport system. Some of these people may have also been students.The study also sought to find out if their salaries had changed in anyway, and if it did, how it hadchanged. The bar chart below shows the relationship between the two. Compare with above. (9)62 | P a g e
  • 63. FIG. 14 Bar chart showing the changes in frequency of salary compared with nature of salary change among the interviewees 60 50 40 yes Frequency 30 no 20 10 0 Increased Decreased Not applicableBased on all the above information provided, the questionnaire sought to find out how their social liveshad been affected by the injury and also by prolonged hospitalization. Thirty four in patients declaredthat they were limited to their beds, this was followed by 22 people complaining about their sports lifeand these were all males. A total of 18 clients did not appreciate the fact of staying indoors. This incomparison to the study of Julliard O et al on the “Socioeconomic impact of road traffic accidents”, shefound out that 37 people out of a total of 127 developed a permanent disability. Twelve respondents outof the total 37 complained of inability to go about activities of daily living (ADL). (9)63 | P a g e
  • 64. The Pie chart below, pictures how the road traffic injury has influenced their daily functioning state.This tells how the lives of a vast majority of accident victims change following injury, from disturbancein activities such as, bathing, sex life and religious responsibilities.64 | P a g e
  • 65. FIG. 16 SHOWING DISTRIBUTION OF LIMITATIONS TO FUNCTIONING, ASEXPERIENCED BY THE INTERVIEWEES From the Pie chart above, 57% of the people interviewed complained about their activities of dailyliving, which for some was permanent and for others it was temporary. A minor 35% did not have anylimitations to their activities of daily living.--- This in comparison with the study of Julliard O et al on the “Socioeconomic impact of road trafficaccidents”, revealed that 37 people out of a total of 127 developed a permanent disability. Twelverespondents out of the total 37 complained of inability to go about activities of daily living (ADL). (20)65 | P a g e
  • 66. CHAPTER 5: DISCUSSION, CONCLUSION AND RECOMMENDATIONS5.1 THE TRENDS OF JOB LOSS AND WORK HOURS LOST AMONG DISABLED ANDNON-DISABLED PEOPLE. From the study conducted, none of the people interviewed lost his or her job as a result of beinghospitalized following road traffic injury. This could be attributed to the fact that, employers may not beaware of their functional capacity, that is, if they can still do the work they used to do, or possiblysomething else, and might require a transfer. From the data collected thirty six respondents werepermanently employed and twenty-eight were working on contract basis, however thirty three of theseworkers belonged to the private sector and thirty-one belonged to the civil service. It is also important tonote, that based on worker policy or employer- employee relationship, it would be inappropriate to layany worker off, on the basis of mere disability. With the work hours lost, this was varied depending onthe duration of admission, but out of the 64 employees, twenty eight of them were losing a total of300hours per week, fourty five of them were losing a total of 340hours per week. This is significant,considering the fact that Ghana has achieved middle income status.--- A comparison with previous studies, by Juilliard O. on the Socioeconomic impact assessment ofroad traffic injuries in West Africa (an exploratory data from Nigeria involving a study on 127subjects) showed that among those who had the road traffic injury, seventeen percent were unable toreturn to work, sixteen percent lost their job as a direct consequence of the road traffic injury relateddisability and 88.6% sustained a reduction in their earnings. It is important to note that the mostcommon type of disability was difficulty in using a hand or arm for 24% of the respondents anddifficulty or inability to ambulate in 16% of the injured.66 | P a g e
  • 67. 5.2 THE CAUSE AND INCIDENCE OF ROAD TRAFFIC ACCIDENTS AND THE COMMONAREAS IN ACCRA ASSOCIATED WITH THESE ACCIDENTS. The study tried to find out the cause of most accidents on our streets; whether they were due to non-compliance of traffic regulations, recklessness or carelessness among a range of other causes. Most ofthe people interviewed felt that recklessness or carelessness was the main cause of the accidents, inwhich they were involved in (35 people saying so). This was followed by overtaking by another vehicleor by same vehicle and then over speeding. Non-compliance to road traffic regulations was the leastcontributor to the causes of road traffic accidents, according to the study. This may have been due topoor knowledge among respondents of the road traffic regulations, which was not one of the objectivesof this particular study.--- An article entitled, “Another look into road accident in Ghana”, stated that the most common causesof road accidents in Ghana include gross indiscipline on our roads, over- loading, fatigue driving, drunkdriving and over speeding. Statistics show that 60% of road accidents are caused by drunk driving andover speeding. The latter alone constitutes about 50% of road accidents in the country. The poor natureof some of our roads, poor maintenance of vehicles, disregard for traffic regulations by most drivers andindiscriminate use of the road by some pedestrian are some of the other causes of motor accidents in thecountry. (31)--- A similar article entitled “150 Ghanaians die from road accident every month”, said that besidesother causes of transport accidents, fatigue contributes to 25% of road accidents globally. (32)It is important to note that 88% of these road injuries occurred in Accra and 10% occurred in Tema; ofthese 28 were pedestrians, 22 were passengers and 20 were drivers.67 | P a g e
  • 68. This could be explained by the increase in influx of vehicles into the country over the past 12 years,which is not commensurate with the road network we have currently. (33)(Table 23) showing Motor Accident Returns from the MTTU Head-office for 01/11/11-31/03/2012Location Total Commercial Private Motorbik Pedestrian fatalities Persons Males Female No. of Vehicles Vehicle e knocked injured killed killed cases involved involved involved downAccra 1061 716 971 125 166 78 587 51 17Tema 154 121 133 12 19 24 161 16 8(Table 24) showing Motor Accident Returns from the MTTU Head office for 01/04/12- 31/05/2012Location Total Commerci- Private Motorbik Pedestrian fatalities Persons Males Female No. of al Vehicles Vehicle e knocked injured killed killed cases involved involved involved downAccra 1276 814 983 121 201 62 537 49 15Tema 304 202 233 37 63 29 274 23 6From the tables shown above, between the months of November 2011 to May 2012 there was anincrease in the total number of RTAs recorded in both Accra and Tema. My study conducted on the 70accident victims revealed most of the accidents occurring in the Accra metropolis mainly, followed68 | P a g e
  • 69. closely by Tema. Most accidents occurred with private vehicular involvement from the tables above, asseen similarly in this study among the respondents at Accident Centre, Korle-Bu.5.3 INFORMATION ON CARE SEEKING OPTION AND HOW COST OF TREATMENTAFFECTS THE INTERVAL BETWEEN TEMPORARY AND DEFINITIVE TREATMENT From the survey conducted, most of the patients were not actually involved in deciding whichhealthcare option they should seek, (probably because of shock) however for those who were consciousand alert, they preferred to seek medical care first and resorted to bone setters if they were not satisfiedwith the hospital treatment. In Ghana, victims of road traffic accidents, usually have no initial decision with regards to where toseek medical care from, they usually wake-up to find themselves in hospital, usually the nearest one by.(19)--- From the study performed by Catherine Juilliard et al, on the “Socioeconomic impact of road trafficinjuries in West Africa; exploratory data from Nigeria”, of the 127 victims interviewed, 77% of studysubjects sought medical care. Hospital treatment and treatment by a private physician were the mostcommon types of initial care sought. Home treatment (22%) was the next most common, followed byhealth post or clinic treatment (17%). Although only 6% of road traffic injured (RTI) people sought first–line care from bone setters, herbalists and other traditional healers, 15 study subjects sought traditionaltreatment after they had already been treated in a different setting. Traditional treatment was the mostcommon second treatment options chosen by road traffic injured people, comprising 39% of those studysubjects who sought more than one treatment, and 12% of all who had a RTI. Individual preferences wasthe most common reason for a choice of first provider (42%), but proximity and cost of treatment werealso often quoted. (20)69 | P a g e
  • 70. With regards to duration of admission, it ranged from 1week to 16 weeks. This could be attributed tovaried reasons. As many as six people had been on admission for sixteen good weeks, away from work,family and friends. The impact of prolonged hospitalization on the individual and the financial burden tothe individuals were evident. It is therefore no surprise that RTAs are of a major public health concern.From the “Socioeconomic impact of road traffic injuries” 80% of the 107 victims stayed in hospital forless than 4 weeks, whiles 19.6% stayed for over a month. (9)5.4 TO DETERMINE THE METHODS OF PREVENTION OF THESE ROAD TRAFFICACCIDENTS From the above, 83% of the victims thought the road accidents could have been avoided and this ishow; obeying the road traffic regulations, being more careful, maintenance of vehicles, no overtaking,normal speed, patience, better headlights and obeying the speed limit. Sixteen out of the total 70 saidtheir accidents could have been prevented had the driver been more careful and diligent, seventeenpeople said by obeying the road traffic regulations. However 9 people thought the accident was notpreventable. Owing to the socio-economic impacts of road traffic accidents, it deserves to be given politicalpriority and commitment. Although some interventions are underway by the government of Ghana totackle this menace (such as Road Safety Commission’s mass education through advertisements ontelevision), a lot more work is needed in this aspect to minimize RTAs.Examples of developed countries like the United States, Japan, Sweden and Finland are noteworthy;where the personal commitment and interest of their heads of state have maintained the sanity on theroads and culminated in a drastic decrease in road accidents and the adherence to road regulations. In70 | P a g e
  • 71. Ghana, wearing of seat belts is yet to become mandatory, yet a lot more people are dying throughaccidents when seat belts could have saved them. (14)Four factors contribute to the vast majority of collisions. In descending order of importance they are:Driver behavior, Poor roadway maintenance, Roadway design and Equipment failure.Over 95% of motor vehicle accidents (MVAs, in the USA, or Road Traffic Accidents, RTAs, in Europe)involve some degree of driver behavior combined with one of the other three factors. Drivers always tryto blame road conditions, equipment failure, or other drivers for those accidents. When the facts aretruthfully presented, however, the behavior of the implicated driver is usually the primary cause. Mostare caused by excessive speed or aggressive driver behavior.Driver Behavior - Humans tend to blame somebody or something else when a mistake or accidentoccurs. A recent European study concluded that 80% of drivers involved in motor vehicle accidentsbelieved that the other party could have done something to prevent the accident. A miniscule 5%admitted that they were the only one at fault. Surveys consistently reveal that the majority considerthemselves more skillful and safer than the average driver. Some mistakes occur when a driver becomesdistracted, perhaps by a cell phone call or a spilled cup of coffee. Very few accidents result from an Actof God, like a tree falling on a vehicle.Speed Kills - The faster the speed of a vehicle, the greater the risk of an accident. The forcesexperienced by the human body in a collision increase exponentially as the speed increases. Smartmotorist recommends that drivers observe the 3 second rule in everyday traffic, no matter what thespeed may be. Most people agree that going 100 mph is foolhardy and will lead to disaster. The problemis that exceeding the speed limit by only 5 mph in the wrong place can be just as dangerous. Trafficengineers and local governments have determined the maximum speeds allowable for safe travel on the71 | P a g e
  • 72. nations roadways. Speeding is a deliberate and calculated behavior where the driver knows the risk butignores the danger. Fully 90% of all licensed drivers speed at some point in their driving career; 75%admit to committing this offense regularly.Who are the bad drivers? They are young, middle-aged, and old; men and women; they drive luxurycars, sports cars, SUVs and family cars. Almost every qualified driver admits to some type of riskydriving behavior, most commonly over-speeding.Aggressive Drivers - As weve described, modern cars are manufactured to very safe standards, and theenvironment theyre driven in is engineered to minimize the injuries suffered during an accident. Themost difficult area to change is aggressive driver behavior and selfish attitudes. (15). A 2004 study by theAutomobile Association in Great Britain found that 85% of the respondents reported aggressivebehavior as the 2nd common cause of Road Traffic Accidents.5.5 THE USE OF PRIMARY ASSESSMENT / SURVEY AT THE ACCIDENT SCENE From my study, none of the victims of the road traffic injury received any form of primaryassessment, before arrival at a health facility. This is surprising considering the fact that, two peoplereported to the health facility via an ambulance.This goes further to imply that, apart from the absence of emergency rapid response teams andambulances at various accident scenes, where these are present, they lack the necessary human resourceto run them.To add to the above, the survey wanted also to find out if someone received any form of primary care,and by whom. But unfortunately, since none received any form of primary care, it was not applicable.72 | P a g e
  • 73. I went further to ascertain, where their primary survey was initially provided. Ninety five respondentshad some primary survey done at their first point of call (92.2%), while six people had the primarysurvey at the referral site (5.8%). Two people said they didn’t have any form of primary survey either attheir referral site or destination. In Benin, the police have the authority to require vehicles to transport accident victims; in Coted’Ivoire the fire brigade is responsible for the transport of road accident victims. This seems to beworking well in cities with fire brigades. Otherwise, injured people have to rely on the help of passing“good Samaritans” for transport to hospital. Except for Cote d’Ivoire, where people seem to be reluctantto be involved in helping out accidents, people seem to be helpful in providing transport to hospital.Poor telecommunications is a problem in calling for help.Though most countries have hospitals, spread out all over the country, not all hospitals have doctors oncall or the equipment needed to treat badly injured victims. (26)5.6 CONCLUSIONOn the whole, it has now been established that Ghana loses 1.6% of her Gross Domestic Product (GDP)to Road Traffic Crashes (RTCs). The factors of the cost include loss of productive hours, propertydamage, medical bills, human and administrative cost among many others. Even though my study didnot ascertain all the components of the socioeconomic impact determinants of road traffic accidents, Iwas able to establish using patients of the Accident Centre, Korle- Bu Teaching Hospital as my samplethat huge amounts of money are lost to road traffic accidents as well as lives and property. I was able to73 | P a g e
  • 74. assess some of the interventions put in place and also determine that, Ghana as a nation has a long wayto go in order to curb this menace. I must add that Ghana ranks in the top five countries of high incidence of road traffic accidentsglobally(8).5.7 RECOMMENDATION It is expedient that long lasting solutions be found to these problems outlined in my study above;mainly to reduce morbidity, mortality and the financial burden of road traffic injuries in Ghana.Intensifying the national campaign against RTAs, empowering our Driver Vehicle and License authorityand enforcing existing road safety measures will prove key.These will not only save the lives of our youth (future generation) but also our economy as a whole.74 | P a g e
  • 75. 5.8 REFERENCES(1) http://www:ncbi-nim.nih.gov/pmc(2) Ameratunga S, Hijar M, Norton R. Road-traffic injuries: confronting disparities toaddress a global-health problem. Lancet 2006;367:1533e40.(3) Blincoe L, Seay A, Zaloshnja E. The economic impact of motor vehicle crashes,2000. Washington, DC: National Highway Traffic Safety Administration, 2002.(4) The President of the United States. Budget of the United States government:fiscal year 2000. 1999. http://www.gpoaccess.gov/usbudget/fy00/browse.html(accessed 8 May 2010).(5) Peden M, Scurfield R, Sleet D, et al. World report on road traffic injury prevention.Geneva: World Health Organization, 2004.(6) http://answers.yahoo.com/question/index?qid=20080316075336AAByhQH(7 )http://www.thefreedictionary.com/disabled(8) World Health Organization – Disabilities(9) Catherine J, Mariam L, Olive k, Adnan A. Socioeconomic impact of road traffic injuries in West Africa:exploratory data from Nigeria. BMJ Volume 16 issue 6(10) Mock CN, Gloyd S, Adjei S, et al. Economic consequences of injury and resulting family coping strategies inGhana. Accid Anal Prev 2003;35:81–90. [CrossRef] [Medline] [Web of Science](11) http://www.ghanaweb.com/GhanaHomePage/features/artikel.php?ID=17745375 | P a g e
  • 76. (12) http://www.modernghana.com/news/42956/1/150-ghanaians-die-from-road-accident-every-month.html(13) http://www.modernghana.com/news/178039/50/another-look-into-road-accidents-in-ghana.html(14) http://www.ghanaweb.com/GhanaHomePage/features/artikel.php?ID=90849(15) http://www.smartmotorist.com/traffic-and-safety-guideline/what-causes-car-accidents.html(16) Blincoe L, Seay A, Zaloshnja E. The economic impact of motor vehicle crashes, 2000. Washington, DC:National Highway Traffic Safety Administration, 2002.(17)http://www.sixwise.com/newsletters/05/07/20/the_6_most_common_causes_of_automobile_crashes.htm(18) http://www.amend.org/docs/TL_West%20Africa_Amend.pdf(19) Personal communiqué by Dr. P. K. Amooh , Occupational Health Physician of the Korle- Bu TeachingHospital.(20) Catherine J, Mariam L, Olive k, Adnan A. Socioeconomic impact of road traffic injuries in West Africa:exploratory data from Nigeria. BMJ Volume 16 issue 6(21)http://www.who.int/violence_injury_prevention/road_traffic/activities/roadsafetytraining_manual_unit_4.pdf(22) Peden M et al. World report on road traffic injury prevention. Geneva, World Health Organization, 2004.(23) Ker K et al. Post-license driver education for the prevention of road traffic crashes: aSystematic review of randomized controlled trials. Accident Analysis & Prevention, 2005, 37: 305–313.(24) http://www.evidencebased.net/ce/case1/primarytext.html(25) http://www.nrsc.gov.gh/assets/2007%20annual%20report%20dav%20adom%20ruddy.pdf76 | P a g e
  • 77. (26) http://www4.worldbank.org/afr/ssatp/Resources/SSATP-WorkingPapers/SSATPWP33.pdf(27) Mock CN, Adzotor E, Denno D, et al. Admissions for injury at a rural hospital in Ghana: implications forprevention in the developing world. Am J Public Health 1995; 85:927e31.(28) Catherine J, Mariam L, Olive k, Hyder A. The burden of road traffic injuries in Nigeria: results of apopulation – based survey BMJ volume 15 issue 6, page 157-162.(29)Motor transport and traffic Union-Ghana; Motor accident returns for the 1st quarter ending 31/03/2011,nationwide.(30) Kobusingye O, Guwatudde D, Lett R. Injury patterns in rural and urban Uganda; Lancet 1997; 349: 1269-76.(31) http://www.modernghana.com/news/178039/50/another-look-into-road-accidents-in-ghana.html(32) http://www.modernghana.com/news/42956/1/150-ghanaians-die-from-road-accident-every-month.html(33) http://www.ghanaweb.com/GhanaHomePage/features/artikel.php?ID=177453(34) Ghee C, Astrop A, Silcock D, Jacobs G, Socio-economic aspects of road accidents in developing countries;TRLReport 24777 | P a g e
  • 78. 5.9 APPENDIX: QUESTIONNAIRENAME OF INSTITUTION: UNIVERSITY OF GHANA MEDICAL SCHOOL, DEPARTMENT OF COMMUNITY HEALTHNAME OF SUPERVISOR: PROF. BIRITWUMPROJECT TITLE: SOCIO-ECONOMIC IMPACT OF ROAD TRAFFIC ACCIDENTS IN A SECTION OF PATIENTS AT THE ACCIDENT CENTRE, KORLE-BU TEACHING HOSPITAL.MY NAME IS MICHAEL A. ADU-DARKO, FINAL YEAR MEDICAL STUDENTUNDERTAKING THIS DISSERTATION IN PARTIAL FULFILLMENT OF THE REQUIREMENTFOR THE AWARD OF MB ChB DEGREE.INFORMATION PROVIDED IN THIS QUESTIONNAIRE WILL SEEK TO DESCRIBE THEDEMOGRAPHIC CHARACTERISTICS OF PARTICIPANTS, IDENTIFY THE ECONOMIC ANDSOCIAL IMPACT OF ROAD TRAFFIC ACCIDENTS ON PARTICIPANTS, TO COMPARERESULTS OBTAINED WITH SIMILAR STUDIES ELSEWHERE AND TO PROVIDERECOMMENDATIONS TO THAT EFFECT.THIS INFORMATION WILL BE KEPT STRICTLY CONFIDENTIAL.YOU ARE AT LIBERTY TO WITHDRAW YOUR PARTICIPATION AT ANY POINT IN THESTUDY.THANK YOU FOR PARTICIPATINGINITIALS OF PARTICIPANT:DATE:78 | P a g e
  • 79. SERIAL NUMBER:INSTRUCTIONS: Please circle or fill as appropriateDEMOGRAPHY 1. Age……………………yrs Sex: MALE ….. FEMALE ….. 2. Ethinicity: a) Akan b) Ga c) Ewe d) Northern e) Other (specify) ………… 3. Religion: a) Christian b) Islam c) Traditional d) Other (specify)………… 4. Marital status: a) Single b) Married c) Divorced d) Widowed 5. Educational Level: a) Primary b) Secondary/Vocational c) Tertiary 6. Occupation: a) Student b) Formal Sector c) Informal Sector d) UnemployedNATURE OF ROAD TRAFFIC ACCIDENT: 7. Could you kindly identify or state the road on which is occurred? Eg. Tema Motorway …………………………………………………………… 8. Where the accident occurred, if in Accra or other (indicate) …………………………………. 9. Were you a: a) Pedestrian b) Passenger c) Driver 10. If you were a passenger, what vehicle were you in? a) Bicycle c) Car b) Motorcycle d) Truck e) Other, please specify ………………… 11. Were you the only one involved? a) Yes b) No 12. If no, was there any mortality involved? a) Yes b) No 13. Do you have a fair idea of how many? If so please state …………………….79 | P a g e
  • 80. 14. What was the nature of the road like? a) Rough road b) Tarred road c) Other (specify)…………………… 15. What time of the day was it? a) Morning b) Afternoon c) Night d) Dawn 16. Do you have an idea as to the cause of the accident? a) Over-speeding b) Over-taking by another vehicle or by your vehicle c) Bad Road d) Non-compliance of traffic signs or non-compliance of road regulations e) Mechanical fault or failure f) Poor road lighting g) Poor vehicle headlights h) Crossing animal or pedestrian i) Recklessness or carelessness on the part of the driver 17. How did you get to the nearest hospital? a) Ambulance b) Good Samaritan c) Relatives d) Public transport d) Other (please specify) ……………………… 18. Did you receive any primary assessment/survey before arriving at the hospital? a) Yes b) No If YES, by whom? …………………………………………. 19. Where was the primary assessment conducted? a) At the accident site b) The first point of call c) At the referral site 20. Was the accident preventable? a)Yes b) No 21. How could it have been prevented (If yes to the question above)? a) Better headlights g) Not preventable b) Better maintenance of vehicle h) Patience c) More careful i) obey speed limits d) No over-taking j) other…………………………. e) Normal speed f) Obey traffic regulations80 | P a g e
  • 81. JOB ASSESSMENT 22. If employed, please specify ………………………….. 23. Is the employment a) Permanent b) Temporary/contract based 24. Nature of job a) In the civil service/ government employed b) Private sector 25. Could you please specify; a. The work hours in a week ……………………. b. Number of days in a week ……………………. 26. Could you please provide an estimation of your salary/ wages a) Less than GHc 100 b) GHc 101 – GHc 500 c) GHc 501 – GHc 1,000 d) GHc 1001 – GHc 1500 e) GHc 1501 – GHc 2500 f) GHc 2501 – GHc 5,000 g) GHc 5001 – GHc 10,000 h) GHc 10,001 – GHc 20,000 i) >/ More than GHc 20,000 27. If there has been additional remuneration please indicate below ……………………………………………………………………… 28. What was the nature of the injury? Please tick more than one if applicable. a. Soft tissue injury b) Fracture c) Head injury ii) Penetrating injury d) Spinal injury e) Other (please specify)…………………………… 29. Duration of admission (till date if applicable) (in weeks/days)……………………………….. 30. Any identified morbidities / impairment………………………………………………81 | P a g e
  • 82. 31. Has your duration of admission been influenced by cost of treatment? a) Yes b) No c) Other, please specify……………………………………. 32. Estimated expenses/ cost of treatment (up till date if applicable). a. < GHc 100.00 b) GHc 101.00 – GHc 500.00 c) GHc 501.00 – GHc 1,000.00 d) GHc 1,001.00 – GHc 2,000.00 e) > GHc 2,000.00IMPACT ON SOCIAL AND FAMILY LIFE 33. Are you the bread-winner for your family? a) Yes b) No 34. If yes, how has your injury affected your ability to provide for your family? a) Very significantly b) Significantly c) Not significantly 35. If no, how has it affected your personal financial situation? ………………………………………………………………………………………… 36. Has there been a change in your current salary/ wages following the injury? a) Yes b) No --- If yes, has it a) increased b) decreased, following the injury? 37. Has your social life been influenced in anyway by the injury? If yes, please specify ……………………………………………………………………………………………………… ………………. 38. Have there been any limitations to your daily functioning state? If yes, please specify ……………………………………………………………………………………………… Thank you for your co-operation82 | P a g e
  • 83. 83 | P a g e