1. THE ECONOMIC AND SOCIAL EFFECTS OF ROAD-
TRAFFIC ACCIDENTS ON A SECTION OF PATIENTS AT
THE ACCIDENT CENTRE, KORLE-BU TEACHING HOSPITAL
BY
ADU-DARKO, MICHAEL AGYEKUM
CLASS OF 2012.
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2. DECLARATION
I, ADU-DARKO, MICHAEL AGYEKUM, author of THE ECONOMIC AND
SOCIAL EFFECTS OF ROAD TRAFFIC ACCIDENTS ON A SECTION OF
PATIENTS AT THE ACCIDENT CENTRE, KORLE-BU TEACHING HOSPITAL,
do hereby declare that, except for the reference to other people’s work which has been
duly acknowledged, the work I have presented in this dissertation was done entirely by
me as a final year student of the University of Ghana Medical School, Korle-Bu in the
2012/2013 Academic year and that the work presented has not been presented before in
part or whole for any degree in this University or elsewhere.
…………………………………………….
ADU-DARKO, MICHAEL AGYEKUM
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3. DEDICATION
To 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.
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4. ACKNOWLEDGEMENT
I 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 prayed
for 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 Medical
School for this opportunity.
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5. TABLE OF CONTENTS
DECLARATION………………………..………………………………………………….……….2
DEDICATION………………………….…………………………………………….……………..3
ACKNOWLEDGEMENT…………………………..………………………………………………4
TABLE OF CONTENTS…………………………………………………..……………………….5-7
LIST OF TABLES AND FIGURES……..………...…………………………………………….….8-10
ABSTRACT……………………………………………………………………………………….11-12
CHAPTER 1.0- INTRODUCTION……………………..……………………………………………13
1.1 BACKGROUND………….………………………..……………………………………………..13
1.2 PROBLEM STATEMENT….….……………………………………………………………....…14
1.3 RATIONALE……………………………………………………………..……………………...14
1.4 AIM……………………………………..…………………………………………………….…14
1.5 OBJECTIVES………………………..……………………………………………………….....15
CHAPTER 2.0- LITERATURE REVIEW………………..…………………………………..……...16
2.1 THE TRENDS OF JOB LOSS & WORK HOURS LOST AMONG DISABLED AND NON-
DISABLED PEOPLE…………………………………………………….…………….………….16-17
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6. 2.2 THE CAUSE & INCIDENCE OF ROAD TRAFFIC ACCIDENTS AND THE COMMON AREAS
IN ACCRA ASSOCIATED WITH THESE ACCIDENTS…………………….……………….17-24
2.3 INFORMATION ON CARE- SEEKING OPTION AND HOW COST OF TREATMENT
AFFECTS THE INTERVAL BETWEEN TEMPORARY AND DEFINITIVE
TREATMENT……………………………………………………………………….….……….24-26
2.4 TO DETERMINE THE METHODS OF PREVENTION OF THESE ROAD TRAFFIC
ACCIDENTS………………………………..………………………………..…………………26-28
2.5 THE USE OF PRIMARY SURVEY AT THE ACCIDENT SCENE..………………….…29-31
CHAPTER 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………………..………………………… 35-50
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7. 4.3 JOB ASSESSMENT………………..…………………………….………………50-57
4.4 IMPACT ON SOCIAL AND FAMILY LIFE………………..………………….…57-62
CHAPTER 5.0 - DISCUSSION……………………………..……………………..……….63
5.1 THE TRENDS OF JOB LOSS AND WORK HOURS LOST AMONG DISABLED AND NON-
DISABLED PEOPLE........................................................................................................63
5.2 THE CAUSE AND INCIDENCE OF ROAD TRAFFIC ACCIDENT AND THE COMMON
AREAS IN ACCRA ASSOCIATED WITH THESE ACCIDENTS……………….…...64-65
5.3 INFORMATION ON CARE- SEEKING OPTION AND HOW COST OF TREATMENT
AFFECTS THE INTERVAL BETWEEN TEMPORARY AND DEFINITIVE
TREATMENT…………………………………………………………………………..…..66-67
5.4 TO DETERMINE THE METHODS OF PREVENTION OF THESE ROAD TRAFFIC
ACCIDENTS………………………………………………………………………………67-69
5.5 THE USE OF PRIMARY SURVEY AT THE ACCIDENT SCENE…………..…….69
5.6 CONCLUSION……………………………………………………...…………………70
5.7 RECOMMENDATIONS……………………………………………………..………..70
5.8 REFERENCES………………………………………………....………...……………..71-73
5.9 APPENDIX QUESTIONNAIRE……………………………………………………….75-79
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8. LIST OF TABLES AND FIGURES PAGE
Table 1- Distribution of treatment sought by Road Traffic Injured people 25
Table 2 –Cost of treatment by various treatment categories 26
Table 3- Distribution of ambulances and Emergency Medical Team in Ghana 29
Table 4- Age distribution of road traffic accident (RTA) victims 34
Table 5- Educational level of interviewees 35
Table 6- Frequency of motor accidents on various roads in Ghana 36
Table 7- Distribution of RTA’s 39
Table 8- Vehicles involved in the accidents 40
Table 9- Total number of people involved in these accidents 48
Table 10- Number of mortalities in the various accidents 49
Table 11- Means of transportation to the nearest hospital 53
Table 12- Access to Primary Survey 54
Table 13- Where Primary Survey was initially provided 55
Table 14- Prevention of accidents 56
Table 15- Type of employment 57
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9. Table 16- Nature of jobs 57
Table 17- Work hours per week lost to RTA’s 59
Table 18- Number of days per week lost to RTA’s 59
Table 19- Salary estimation 60
Table 20- Expenses on treatment 68
Table 21- Duration of admission 70
Table 22- Extent to which injury has affected provision 72
Table23-25- Motor accident returns from the
MTTU Head Office for 01/01/2011-31/07/11 79
Figure 1- Road on which accidents occurred 44
Figure 2- Distribution of accidents 45
Figure 3- Incidence of RTI among various road users 46
Figure 4- Nature of roads 50
Figure 5- Timing of accidents 51
Figure 6- Causes of RTA 52
Figure 7- Preventable accidents 55
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10. Figure 8- Prevention of accidents 56
Figure 9- Some of the jobs affected by the RTA 58
Figure 10- Nature of the injuries 69
Figure 11- Duration of admission influenced by cost of treatment 71
Figure 12- Percentage of Breadwinners 71
Figure 13- Effect of hospitalization on finances 73
Figure 14- Nature of salary change among the interviewees 74
Figure 15- Impact of RTA’s on social life 75
Figure 16- Limitation to daily function as experienced by the interviewees 76
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11. ABSTRACT
BACKGROUND
Road 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 the
leading cause of death by injury and the tenth leading cause of all deaths globally. Injuries resulting
from RTAs are increasingly contributing to the burden of morbidity and mortality in sub- Saharan
Africa, especially Ghana.
Sadly, little appears to be known about the economic consequences and social disability associated with
them.
AIM
To explore the cost and disability consequences of road traffic accidents in a cross-section of patients
at the Accident Centre, Korle-Bu Teaching Hospital.
DESIGN
A cross- sectional study involving a hospital-based survey using convenience sampling was done.
SUBJECT/ SETTING
Information on care-seeking choice, cost of treatment, ability to work, reduction in earnings, cause and
prevention of accidents, and disability was collected from 70 subjects who had suffered one form of
road traffic accident or another. Respondents were both out- patients and in-patients of the Accident
Centre, Korle- Bu Teaching Hospital.
OUTCOME MEASURES
Univariate analysis was used to estimate the causes of road related injuries, the age distributions of these
injuries, to estimate the frequency of disability, the types of care sought, role of primary assessment,
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12. trend of work loss, functional ability and cost of treatment. It also included the impact on social and
family life.
RESULTS
Road traffic accidents involved 70 people of whom 34 (48.5%) had secondary education or higher and
38 out of the total 70 fell within the age group of 20 - 39years. Eighty eight percent of these accidents
occurred in Accra, of which more than half involved pedestrians. A total of 13 mortalities and 383
people 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 the
hospital by private car. Primary assessment/survey was not available at any accident scene; also an
average 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. the
longer 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% of
the 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 by
one reason or the other.
CONCLUSION
Economic and functional ramifications cannot be excluded when considering the impact of road traffic
injuries.
When appreciated, the burden of RTA injuries can be properly addressed by amicable measures and
reinforcement of existing strategies.
This implies that health systems in developing countries like Ghana should not only address the clinical
consequences of road traffic accidents, but also the financial ones as well.
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13. CHAPTER 1: INTRODUCTION
1.1 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)
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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.
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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.
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16. CHAPTER 2: LITERATURE REVIEW
2.1 THE TRENDS OF JOB LOSS AND WORK HOURS LOST AMONG DISABLED AND
NON-DISABLED PEOPLE
Trends of job loss are varied, depending on whether or not there is any sustained disability or deformity
following the road injury. In an article written by Asker in 2007, on “The effect of Road Traffic
Accidents”, he said there was loss of productive work time to those involved, (that is the victims of the
road traffic injuries) and also went further to add that loss of productive work time also occurred for
friends who needed to attend funerals. (6)
---A disabled person is defined by Webster’s Advanced Learned Dictionary as, “A person lacking one
or more physical strengths, such as the ability to walk or to coordinate one’s movements, as from the
effects 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 problem
in body function or structure; an activity limitation is a difficulty encountered by an individual in
executing a task or action; while participation restriction is a problem experienced by and individual
in involvement in life situations. Thus disability is a complex phenomenon, reflecting an interaction
between 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 common
type 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.
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17. Job loss was a direct consequence of the road traffic injury related disability for (16%) of the disabled
study subjects, while (88.6%) sustained a reduction in earnings. These were from a socioeconomic
impact assessment of road traffic injuries in West Africa: exploratory data from Nigeria involving a
study on 127 subjects. (9)
With regards to a study performed in Ghana on the economic consequences of injury and resulting
family 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 more
likely to borrow money than urban, although households in both areas were equally likely to sell
belongings, though the nature of the belongings sold were different. Although injuries in the urban area
had more severe primary impacts (job loss, treatment costs and disability time), the ultimate effect on
rural households appeared more severe. A greater percentage of rural households (28%) reported a
decline in food consumption than in urban households (19%). These findings result in several policy
implications, including measures that could be used to assist family coping strategies and measures
directed toward injuries themselves. (10)
Again long hospitalization or disabilities prevent victims from indulging in their usual and normal
productive activities rendering them dependent on others. (11)
2.2 THE CAUSE OF ROAD TRAFFIC ACCIDENTS AND THE COMMON AREAS IN
GREATER ACCRA REGION ASSOCIATED WITH THESE ACCIDENTS
To begin with, the causes of road traffic injuries in our region are varied, considering the fact that they
occur both on tarred and rough roads.
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18. Mr. Noble Appiah (Acting Director of the National Road Safety Commission), said that contrary to the
perception that accidents mostly occur on rough road 70% of the accidents happen on smooth and flat
roads. 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 our
roads, over –loading, fatigue driving, drunk driving and over-speeding. The latter three alone
constitutes about 50% of road accidents in the country. The poor nature of some of our roads, poor
maintenance of vehicles, disregard for traffic regulations by most drivers and indiscriminate use of the
road by some pedestrian are some of the other causes of motor accidents in the country. We also have
numerous unworthy and old aged cars on our highways, which also contribute to these road traffic
accidents. (13)
A chief pathologist of the Department of Pathology, Korle- Bu Teaching Hospital, indicated that most
drivers at autopsy had high percentages of blood alcohol (ranging from 300-372/100ml) which was far
above 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 try
to blame road conditions, equipment failure, or other drivers for those accidents. When the facts are
truthfully presented, however, the behavior of the implicated driver is usually the primary cause. Most
are caused by excessive speed or aggressive driver behavior.
Driver Behavior - Humans tend to blame somebody or something else when a mistake or accident
occurs. A recent European study concluded that 80% of drivers involved in motor vehicle accidents
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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 consider
themselves more skillful and safer than the average driver. Some mistakes occur when a driver becomes
distracted, perhaps by a cell phone call or a spilled cup of coffee. Very few accidents result from an 'Act
of 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 forces
experienced by the human body in a collision increase exponentially as the speed increases. Smart
motorist recommends that drivers observe the 3 second rule in everyday traffic, no matter what the
speed may be. Most people agree that going 100 mph is foolhardy and will lead to disaster. The problem
is that exceeding the speed limit by only 5 mph in the wrong place can be just as dangerous. Traffic
engineers and local governments have determined the maximum speeds allowable for safe travel on the
nation's roadways. Speeding is a deliberate and calculated behavior where the driver knows the risk but
ignores 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 luxury
cars, sports cars, SUVs and family cars. Almost every qualified driver admits to some type of risky
driving behavior, most commonly over-speeding.
Aggressive Drivers - As we've described, modern cars are manufactured to very safe standards, and the
environment they're driven in is engineered to minimize the injuries suffered during an accident. The
most difficult area to change is aggressive driver behavior and selfish attitudes. (15). A 2004 study by the
Automobile Association in Great Britain found that 85% of the respondents reported at least one of the
behaviors listed below directed at them (in order of descending frequency);
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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 abuse
Physical assault - The same group was then asked about aggressive behavior they had displayed
towards other drivers. 40% indicated that they had never behaved aggressively towards another driver. A
further 60% of the survey respondents admitted to one or more of the following behaviors (listed in
order 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 more
serious actions, even if no penalty exists. The majority of these incidents happened during the daylight
hours (70%), on a main road (not freeway or divided highway). (16)
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21. Poor Maintenance - Roadway maintenance contributes to some motor vehicle accidents, but not to the
extent that drivers use it as an excuse. Unfortunately maintenance schedules and procedures vary greatly
from city to city and state to state, so nationwide standards don't exist. Below are some of the potential
roadway 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 see
to them.
Faded road signs, and signs obscured by foliage, occasionally contribute to accidents. If you know of
any 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 accidents
usually occur at low speeds and don't cause many injuries. Some Northern US cities for example have
pothole complaint lines that are active during the winter and spring.
Roadway construction is a commonly mentioned reason for accidents. Again the blame usually rests
on 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 as
unsafe to speed. Stop-and-go traffic requires thoughtful, alert driving to avoid a collision with the car in
front of you. Too often drivers worry that their fellow drivers will intersect in-front of them in a traffic
jam. The real problem is that drivers forget about the vehicle directly in front, rear-ending it while
looking in their rearview mirror or daydreaming. Ideally, appropriate spacing should be left between
cars by drivers. The 3 second rule applies to traffic jams as well.
Roadway Design - Motorists may blame roadway design for accidents, but it's rarely the cause.
Consultants such as the Texas Transportation Institute have spent years getting road barriers, utility
poles, railroad crossings, and guardrails to their current high level of safety. Civil engineers, local
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22. governments, and law enforcement agencies all contribute to the design of safe road layouts and traffic
management systems. State and federal governments provide guidelines to their construction, with
design flexibility to suit local conditions. Roadways are designed by engineers with special
consideration 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) depending
on the environment, traffic speed, traffic volume, and location of the roadway (noise barriers). Roadway
markings let drivers know about their ability to pass safely (dotted & double lines), the location of the
roadway in inclement weather (reflective cats-eyes & stakes), and where road surface ends and the
shoulder 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, including
crash barrels, speed bumps, pedestrian islands, raised medians, high curbing, guard rails, and concrete
barriers.
Traffic Flow - Interstate highways remain the safest roads because their flow of traffic is in one
direction. One-way streets ease traffic congestion in city centers as well. Rural two-lane roadways are
statistically the most dangerous because of a high incidence of deadly head-on collisions and the
difficulty impatient drivers’ face while overtaking slower vehicles.
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23. Roadway Identification Signs - enable someone without a detailed map to travel from one place to
another. They give advance notice of intersections, destinations, hazards, route numbers, mileage
estimates, street names, and points of interest.
Equipment Failure - Manufacturers are required by law to design and engineer cars that meet a
minimum 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 failure
are loss of brakes, tire blowouts or tread separation, and steering/suspension failure. With the exception
of the recent rash of Firestone light-truck tire failures, combined totals for all reported equipment failure
accounts for less than 5% of all motor vehicle accidents.
Brake Failure - Modern dual-circuit brake systems have made total brake failure an unlikely event. If
one side of the circuit fails, the other side is usually sufficient to stop a vehicle. Disc brakes, found on
the front wheels of virtually every modern vehicle, are significantly more effective than the older drum
braking systems, which can fade when hot. ABS (Anti Blockier System) or anti-lock brakes prevent the
wheels from locking up during emergency braking maneuvers, allowing modern vehicles to avoid many
accidents that previously would have occurred.
Tires - Today's 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 considered
the main culprit in the recent Firestone tire-failure fatalities. Uneven or worn-out tires are the next most
serious problem and can also lead to tire failure. Uneven wear is caused by improperly balanced tires, or
misaligned or broken suspensions. Remember, all that keeps you connected to the roadway is your tires.
If you don't check your own, have your mechanic check them every 5,000 miles.
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24. Steering & Suspension - Your suspension keeps your tires in contact with the roadway in a stable and
predictable manner. Your steering enables you to go around road obstacles and avoid potential
accidents. Even a safe, well-trained driver is helpless in the event of a steering or suspension system
failure. Such failures are catastrophic, especially at high speeds. Have your suspension and steering
systems checked out by a mechanic every 10,000 miles.
With regular component inspections by trained individuals, equipment failures can be virtually
eliminated. (17)
In another study, to determine the six most common causes of automobile crashes, the following came
up;
- 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 accidents
on unplanned urban growth, an ever- increasing number of vehicles and lack of awareness on the
part of all road users. Road design doesn’t make adequate provision for pedestrians and therefore there
is a lot of competition between pedestrians and vehicles on the road. The drivers are undisciplined and
the hawkers take up everywhere the pedestrians are supposed to be. The study also implicated the Driver
and Vehicle Licensing Authority for making only cursory roadworthiness checks. The “Highway Code”
is taken as a suggestion rather than a set of rules. (18)
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25. 2.3 INFORMATION ON CARE SEEKING OPTIONS AND HOW COST OF TREATMENT
AFFECTS THE INTERVAL BETWEEN TEMPORARY AND DEFINITIVE TREATMENT
In 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 traffic
injuries in West Africa”; exploratory data from Nigeria”, of the 127 victims interviewed, 77% of study
subjects sought medical care. Hospital treatment and treatment by a private physician were the most
common types of initial care sought. Home treatment (22%) was the next most common, followed by
health 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 traditional
treatment after they had already been treated in a different setting. Traditional treatment was the most
common second treatment options chosen by road traffic injured people, comprising 39% of those study
subjects who sought more than one treatment, and 12% of all who had a RTI. Individual preferences was
the most common reason for a choice of first provider (42%), but proximity and cost of treatment were
also often quoted. (20) The table below summarizes this;
TABLE 1.0 showing the distribution of order of treatment sought by injured people
LOCATION 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 - - 25
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26. Clinic
Private 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 was
US$36.40 for disabled people and US$20.84 for non–disabled people. Although these results suggest a
disparity 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 more
likely to seek formal care and more often unable to return to work than their disabled counterparts. A
higher proportion of disabled people paid more than the Nigerian monthly average per capita income for
treatment 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 category
Treatment Mean cost 95% CI p-Value
All informal 6.65 3.44 to 13.47 -
All formal 35.64 23.09 to 49.86 < 0.0001
Total Cost 25.4 18.58 to 31.38 -
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27. Economic value of life lost due to an injury = Average loss of life expectancy × Per capita gross
national 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 of
the 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 ACCIDENTS
Irrespective of how sophisticated the national campaign against accidents may be, accidents cannot be
eliminated from our roads totally; however sustained road safety measures can cause road accidents to
subside.
There should be proper education, especially before one can secure a driving license. This concern
raises certain questions about the driving schools we have in the country. Who sets the curriculum? How
long should a training last, for someone who wants to secure a license? What should be the qualification
of 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 more
than the preliminary checks, before issuing out a road worthiness certificate. This is more so, since most
cars 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 by
broken-down vehicles on our roads. This is common on our highways, and therefore part of the road
funds should be used to buy heavy duty towing trucks for our roads. The time has come for us to use the
road fund, to serve the road users and transform our roads from a highway of death and disaster to a
haven of tranquility. (14)
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28. Breathalyzers should be made available to policemen, to enable them ascertain the blood alcohol
concentration 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 also
educating 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 priority
and commitment. Unfortunately, in Ghana there is lack of political will to put the appropriate
interventions in place. Examples from developed countries like the United States, Japan, Sweden and
Finland, where the personal commitment and interest of their heads of state, has maintained the sanity
on the roads and culminated in a drastic decrease in road accidents and the adherence to road
regulations. In Ghana, wearing of seat belts is yet to become mandatory, yet a lot more people are dying
through accidents when seat belts could have saved them.(14)
Another important aspect comes from the end of the manufacturer. Emphasis should be placed on
Haddon’s ten strategies for road traffic injury; this refers to technological modifications aimed at
reducing or managing the excess energy that may contribute to the occurrence of a crash and the severity
of the injuries sustained. It is important that we shape the road network, for road traffic injury
prevention, examples include; classifying roads and setting speed limits by their function, improving
safety 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 through
road 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, is
improving visibility of all road users by; using daytime running lights on the front of motorized vehicles
and the use of reflective and protective clothing, which increases the visibility of riders. (21)
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29. Once again, it is important that we set and secure compliance with road safety rules, by enacting and
enforcing 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 increasing
use of motorcycles as public transport; these should be banned and stopped, as they pose a great threat to
other road users. (22)
Public health sector campaigns in the field of road traffic injury prevention have encompassed a wide
range of measures, but education has always featured as one of the key activities of prevention. It has
been found that informing and educating road users can improve knowledge about the rules of the road
and 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 culture
of concern and develop sympathetic attitudes towards effective interventions. General non- specific road
safety campaigns should be avoided; campaigns should rather be used to put important questions on the
agenda, 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 SCENE
Primary survey is a crucial element in the “initial assessment” of a seriously injured patient. It involves
assessment of the patient and establishing treatment priorities based on their injuries, the stability of
their vitals and the injury mechanism involved. This process constitutes the “ABCDE’s” of trauma care
and identifies life- threatening conditions. It’s made up of;
- Airway maintenance with cervical spine control
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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, 2010
Number Region No. of Ambulance No. of EMT at post
Stations
1 Greater Accra 6 57
2 Ashanti 5 45
3 Eastern 4 37
4 Central 2 17
5 Volta 2 18
6 Western 1 9
7 Brong-Ahafo 1 9
8 Upper East 1 7
9 Upper West 1 9
10 Northern 1 9
11 Accra Control 1 6
12 Ashanti Control 1 5
Total 24 228
EMT = Emergency Medical Technicians (25)
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31. From the above table, it is obvious that the country as a whole is limited with regards to the resources
available for providing emergency medical service for accident victims. It is therefore not surprising that
there is actually no consistent data, with regards to the availability and patronage of these emergency
services following road traffic injuries. Emergency medical services are supplied, but they are a problem
outside the major cities. Some countries like Ghana have a private ambulance system (St. John
Ambulance 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 pay
for their services.
In Cote d’Ivoire the fire brigade is responsible for the transport of road accident victims. In Benin, the
police have the authority to require vehicles to transport accident victims; in. This seems to be working
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 reluctant to 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 on call or the equipment needed to treat badly injured
victims. (26)
Pertaining to a study carried out by Charles N. Mock et al, on “Admissions for injury at a rural
hospital in Ghana”, out of 451 people interviewed only 39% of people presented to the hospital within
the 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 route
to the hospital. (27)
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32. CHAPTER 3.0: METHODOLOGY
3.1 STUDY DESIGN AND AREA
The cross-sectional study was conducted in Korle-Bu Teaching Hospital, the leading tertiary hospital in
southern Ghana. The aim of this study was to ascertain the social and economic impact following road
traffic accidents, experienced by patients of the orthopedics and trauma unit/ ward. The respondents
were in-patients and a few out-patients who were coming for review at the Korle - Bu Teaching
Hospital. A total of 70 questionnaires were administered and analyzed.
3.2 STUDY POPULATION
The target population was 70 patients including males and females, from adolescents to the aged, cutting
across all levels of education. It is important to note that, these were all victims of road traffic accidents
from different parts of the metropolis.
Road traffic accidents, was defined in the survey as “Physical body damage as a result of being hit by
a motor vehicle, motor vehicle crash , or other transport related crash mechanism”.
3.3 SAMPLING STRATEGY
The sampling technique employed was convenience sampling. Patients from all the orthopaedic wards
of 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. Convenience
sampling was used to select the units of the sampling frame, with a sample size of 70.
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33. 3.4 DATA COLLECTION AND INSTRUMENT
An informed consent was taken and a well-structured self-administering questionnaire was given to the
patients 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 the
next patient. For patients who were not able to fill out the questionnaire because of language barrier, I
translated it into the preferred language (Twi or Ga) without alteration to the meaning as much as
possible.
Questions were drawn using information on road traffic accidents from the literature. Additional
questions were adopted, after modification, from questionnaires used in similar studies. Pre-testing was
conducted on 10 patients in the accident center ward following which some questions were modified to
improve clarity. Those that participated in the pre-test were not part of the study. The questionnaire was
in four parts.
The first part was to elicit the demographic data on age, ethnicity, religion, marital status, educational
level and occupation of each study participant. Questions relating to the nature of the road traffic
accidents were asked in the second part. This was to find out where the accident occurred, who was
involved, what time of the day on which it occurred, what they also thought was the cause of the
accident 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 and
salaries. The fourth section was related to the impact of the road traffic accident, on their social and
family life. I wanted to find out if it had, in anyway, changed their abilities to provide for their families
and how it affected their daily activities.
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34. 3.5 DATA HANDLING, ANALYSIS AND PRESENTATION
A 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 LIMITATIONS
Firstly, some of the patients refused to partake, because they didn’t know or understand how my study
was going to help or benefit them. Secondly, there was the problem of language barrier and also
illiteracy. I had to spend thirty or more minutes, in translating into Twi or Ga retaining the detail as
much as possible.
Thirdly, since the bed turnover was low (owing to prolonged admission for most patients), I was
compelled to interview some other patients who were coming for review. These patients had been
discharged not too long ago, and were coming for out-patient review at the Out-Patient Department.
(O.P.D).
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35. CHAPTER 4 RESULTS AND ANALYSIS
4.1 DEMOGRAPHY
The 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 group
was 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-group
TABLE 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 70 100.0
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36. Secondly, an assessment of the incidence of RTAs among people of various educational backgrounds
was 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 either
secondary 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 70 100.0
4.2 NATURE OF ROAD TRAFFIC ACCIDENT
The questionnaire also sought to find out the incidence of road traffic injury / accidents on various roads
within the Greater Accra Region. A total of 14 accidents occurred within the central business district of
Accra. No street names where obtained due to absence of official naming of the streets. While a total of
12 out of the 70 people interviewed had their accident on the Tema motorway, quite a number occurred
in isolation.
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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 human
traffic.
On the other hand, the Tema motorway (a 19km highway linking Tema to Accra) is usually marked with
various 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 summarized
in 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 1.4
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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 the
streets or roads of the central business district, to which people are referring wrongly to as Accra. Other
roads, on which a high incidence of road traffic accidents occurred were; High-street, Kasoa,
Bubuashie and the Mallam junction road.
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39. FIGURE 1.0
The above data is followed by a summary of which part of Greater Accra Region recorded the highest
incidence 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 the
compounds of the victims, when cars ended up skidding off the road.
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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 70 100.0
Pie chart showing the graphical distribution of the road traffic accidents in Greater Accra
Region. (FIGURE 2.0)
I went ahead to find out the incidence of road traffic accidents, among the different category of road
users in Accra. The GRAPH below summarizes the incidence among drivers, passengers and
pedestrians. 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 the
low, with a total of 13 drivers being hospitalized. This could mean that they may have survived but did
not require admission for their condition, accounting for the small numbers or may not have survived.
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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.
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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 84.4
Missing System 11 15.6
Overall Total 70 100.0
From the above data, it is obvious that there are some missing data. Unfortunately, these 11 people refer
to 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 it
was, and what could have been the problem. The subsequent question sought to bring out the number of
people 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 if
other people were involved in the accident, by virtue of the fact that, they were also passengers in the
same vehicle or for another reason.
The table below shows the total number of people involved in these accidents, with the exception of
those interviewed. This means that, 19 people said they were the only ones involved in the accident, 16
people said they were involved with one other person, 13 people said they were involved with 2 other
people in the accident and 3 other people said they were involved in the accident with 3 other people.
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43. TABLE 9.0 showing the total number of people involved in these accidents
frequency fx
0 19 0
1 16 16
11 1 11
12 1 12
15 1 15
17 1 17
18 1 18
2 13 26
23 2 46
3 3 9
4 4 12
5 8 40
9 1 9
TOTAL 70 231
From the data above, it is obvious that though 70 people were interviewed, there were 231 additional
victims 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.
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44. TABLE 10.0 showing number of mortalities in the various accidents.
frequency fx
0 54 0
1 4 4
10 1 10
17 1 17
2 3 6
3 2 6
5 1 5
7 4 28
Total 70 76
From the above table, the total number of interviewees witnessed 76 mortalities compared to the 231
victims of the road traffic accidents.
I subsequently tried to find out the nature of roads associated with these accidents, by finding out where
these 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 had
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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 the
importance of headlights and street lights in contributing to our road traffic accidents. Twenty nine
percent of the accidents occurred in the afternoon and 30% occurred in the morning making a total of
59%. Thirty one percent of the road injuries occurred at night, though this was the highest, the total of
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46. accidents that occurred during the day, would be more than that which occurred during the late hours of
the 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 of
the people interviewed felt that recklessness or carelessness on the part of the driver was the main
cause of the accidents in which they were involved in (35 people). This was followed by overtaking by
another vehicle or by same vehicle and then over speeding. Non-compliance to traffic signs contributed
least to the causes of road traffic accidents.
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47. An article entitled, “Another look into road accident in Ghana”, stated that the most common causes
of road accidents in Ghana include gross indiscipline on our roads, over- loading, and driving while
tired, drunk-driving and over speeding. Statistics show that 60% of road accidents are caused by drunk
driving and over speeding. The latter alone constitutes about 50% of road accidents in the country. The
poor nature of some of our roads, poor maintenance of vehicles, disregard for traffic regulations by most
drivers 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 every
month”, said that besides other causes of transport accidents, fatigue contributes to 25% of road
accidents globally. (32)”. The bar chart below gives more detail.
FIGURE 6.0 SHOWING CAUSES OF ROAD TRAFFIC ACCIDENTS
The 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 to
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48. the nearest hospital by a private car (45.7%), 28 people got to the hospital by taxi (40%), and just three
got to the hospital by an ambulance (4.3%). This trend observed was quite sad, only re-iterating the
inadequacy 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 while
transporting him/her to the hospital. Thus if more private cars are transporting victims to the hospitals
instead of ambulances, most victims may not survive to see the entrance to the hospital if they are
critically 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 70 100.0
The questionnaire also sought to find out how many people receive some form of primary
assessment/survey before arrival at a health care facility. From the data below none of the people
interviewed had any form of primary survey before arriving in hospital or during their conveyance to the
hospital. This observation was in keeping with the high number of ‘private car’ transport to the nearest
hospital in contrast to the low number of ambulance transport. (The ambulance team comprises qualified
personnel who can do primary assessment to determine the extent of injury either at the site of accident
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49. or on the way to the hospital, something which the private cars would most likely lack). The table below
summarizes that;
TABLE 12 SHOWING FREQUENCY OF PROVISION OF PRIMARY
ASSESSMENT/SURVEY
Frequency Percent Valid Percent
no
70 100.0 100.0
yes
0 0 0
Sixty 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 Accident
Centre, Korle-Bu Teaching hospital (8.6%). Two people said they didn’t have any form of primary
assessment 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
70 100.0
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50. So, were the road traffic accidents preventable? If yes then how? This was the next question this survey
sought to find. Eighty three percent of the respondents agreed with the statement that the accidents were
preventable, whiles 17% said the accident could not have been avoided. The response is captured in the
pie chart below.
(FIG. 7) PIE CHART SHOWING PERCENTAGE DISTRIBUTION OF RESPONDENT
OPINION AS TO WHETHER ACCIDENTS WERE PREVENTABLE OR NOT
From the above, 83% of the victims thought the road accidents could have been avoided and this is how.
(Summarized in the table below);
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51. TABLE 14 showing distribution of how the accidents could have been prevented as per the
respondents
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 70 100.0
FIG. 8.0
*RTR – road traffic regulation
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52. 4.3 JOB ASSESSMENT
The 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 of
them 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 91.4
Missing System 6 7.2
Total 70 100.0
TABLE 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 91.4
Missing System 6 8.5
Total 70 100.0
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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 week
and their number of working days per week. The table below shows the work hours per week. From the
data 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 West
Africa, 107 out of a total of 127 were able to go to work, following varied duration of stay in hospital.
(28)
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54. The total number of hours wasted on a weekly basis, due to hospital admission was 3,686hours, for all
the 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 3686
The table below shows the number of days/ week of job work that was lost as a consequence of hospital
admission.
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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 70 100.0
Total
70 100.0
Majority of respondents (34%) lost full week off work on the average, implying they either had to obtain
financial support from their savings, company or from family & friends.
Based on the above information gathered, and in an attempt to determine the socioeconomic impact of
road 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 70 100
Total 70 100.0
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56. TABLE 20.0 SHOWING THE DISTRIBUTION OF THE EXPENSES INCURRED BY
RESPONDENTS
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 2.9
Total 70 100.0
The 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 of
RTAs 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 at
the Accident Centre, Korle-Bu. A comparison between the budgetary allocation for road traffic
accidents and the amount lost in terms of services are almost on the same scale, showing that more has
to 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 ANNUALLY
FINANCIAL COST = $175,000,000 = GHC 241,000,000 EVERY YEAR
HUMAN LIVES = AVERAGE 1870 KILLED EVERY YEAR
SERIOUS INJURY = 15000 EVERY YEAR
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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 having
a 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 soft
tissue 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
0
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58. With regards to duration of admission, it ranged from 1week to 16 weeks. This could be attributed to
varied or multiple reasons. From the table below, 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, the financial burden to the individual, the costs to the hospital and the country as a whole
cannot be overemphasized. This undoubtedly adds to the reason why road traffic accidents are assuming
a public health importance.
----- From the Socioeconomic impact of road traffic injuries article, 80% of the 107 victims stayed in
hospital for less than 4 weeks, whiles 19.6% stayed for over a month. This shows a similar pattern as
what is tabulated below. (9)
TABLE 21.0 SHOWING THE FREQUENCY DISTRIBUTION OF DURATION OF
ADMISSION 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 70 100.0
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59. To make sense of the duration of stay, I went ahead to find out or better still rule out, those whose
admission 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 TO
DURATION OF ADMISSION BEING INFLUENCED BY INSUFFICIENT
46%
54%
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60. 4.4 IMPACT ON SOCIAL AND FAMILY LIFE
Following 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 the
number of interviewees, who were breadwinners.
--- From the studies conducted by the ODA, 67% out of a total of 89 respondents had no one wholly
dependent 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 AMONG
THE
RESPONDENTS
The table below shows the extent to which the prolonged admission, has affected the ability of the
interviewees to provide for their families.
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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 71.4
Missing System 20 28.6
Total 70 100.0
From the above table, it is obvious the number of people who were unaccounted for, the missing data
represents the students and also some of the non-breadwinners, who were directly not responsible for
anyone.
The study also tried to ascertain, how the respondent’s financial situation had been affected, since some
were students, others had their medical expenses being catered for by insurance and others yet still were
being supported by their families.
--- From the study of Julliard O et al, 88.6% of the total 127 interviewees realized a reduction in their
earnings.(9)
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62. FIG.13 showing the extent to which hospitalization has affected their financial situation
The effect of hospitalization on their finances was marked, with 10 respondents complaining of very
significant 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 family
support 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 had
changed. The bar chart below shows the relationship between the two. Compare with above. (9)
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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 applicable
Based on all the above information provided, the questionnaire sought to find out how their social lives
had been affected by the injury and also by prolonged hospitalization. Thirty four in patients declared
that they were limited to their beds, this was followed by 22 people complaining about their sports life
and these were all males. A total of 18 clients did not appreciate the fact of staying indoors. This in
comparison to the study of Julliard O et al on the “Socioeconomic impact of road traffic accidents”, she
found out that 37 people out of a total of 127 developed a permanent disability. Twelve respondents out
of the total 37 complained of inability to go about activities of daily living (ADL). (9)
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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 disturbance
in activities such as, bathing, sex life and religious responsibilities.
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65. FIG. 16 SHOWING DISTRIBUTION OF LIMITATIONS TO FUNCTIONING, AS
EXPERIENCED BY THE INTERVIEWEES
From the Pie chart above, 57% of the people interviewed complained about their activities of daily
living, which for some was permanent and for others it was temporary. A minor 35% did not have any
limitations to their activities of daily living.
--- This in comparison with the study of Julliard O et al on the “Socioeconomic impact of road traffic
accidents”, revealed that 37 people out of a total of 127 developed a permanent disability. Twelve
respondents out of the total 37 complained of inability to go about activities of daily living (ADL). (20)
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66. CHAPTER 5: DISCUSSION, CONCLUSION AND RECOMMENDATIONS
5.1 THE TRENDS OF JOB LOSS AND WORK HOURS LOST AMONG DISABLED AND
NON-DISABLED PEOPLE.
From the study conducted, none of the people interviewed lost his or her job as a result of being
hospitalized following road traffic injury. This could be attributed to the fact that, employers may not be
aware of their functional capacity, that is, if they can still do the work they used to do, or possibly
something else, and might require a transfer. From the data collected thirty six respondents were
permanently employed and twenty-eight were working on contract basis, however thirty three of these
workers belonged to the private sector and thirty-one belonged to the civil service. It is also important to
note, that based on worker policy or employer- employee relationship, it would be inappropriate to lay
any worker off, on the basis of mere disability. With the work hours lost, this was varied depending on
the duration of admission, but out of the 64 employees, twenty eight of them were losing a total of
300hours 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 of
road traffic injuries in West Africa (an exploratory data from Nigeria involving a study on 127
subjects) showed that among those who had the road traffic injury, seventeen percent were unable to
return to work, sixteen percent lost their job as a direct consequence of the road traffic injury related
disability and 88.6% sustained a reduction in their earnings. It is important to note that the most
common type of disability was difficulty in using a hand or arm for 24% of the respondents and
difficulty or inability to ambulate in 16% of the injured.
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67. 5.2 THE CAUSE AND INCIDENCE OF ROAD TRAFFIC ACCIDENTS AND THE COMMON
AREAS 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 of
the people interviewed felt that recklessness or carelessness was the main cause of the accidents, in
which they were involved in (35 people saying so). This was followed by overtaking by another vehicle
or by same vehicle and then over speeding. Non-compliance to road traffic regulations was the least
contributor to the causes of road traffic accidents, according to the study. This may have been due to
poor knowledge among respondents of the road traffic regulations, which was not one of the objectives
of this particular study.
--- An article entitled, “Another look into road accident in Ghana”, stated that the most common causes
of road accidents in Ghana include gross indiscipline on our roads, over- loading, fatigue driving, drunk
driving and over speeding. Statistics show that 60% of road accidents are caused by drunk driving and
over speeding. The latter alone constitutes about 50% of road accidents in the country. The poor nature
of some of our roads, poor maintenance of vehicles, disregard for traffic regulations by most drivers and
indiscriminate use of the road by some pedestrian are some of the other causes of motor accidents in the
country. (31)
--- A similar article entitled “150 Ghanaians die from road accident every month”, said that besides
other 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; of
these 28 were pedestrians, 22 were passengers and 20 were drivers.
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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 01/11/11-31/03/2012
Location Total Commercial Private Motorbik Pedestrian fatalities Persons Males Female
No. of Vehicles Vehicle e knocked injured killed killed
cases involved involved involved down
Accra 1061 716 971 125 166 78 587 51 17
Tema 154 121 133 12 19 24 161 16 8
(Table 24) showing Motor Accident Returns from the MTTU Head office for 01/04/12- 31/05/2012
Location Total Commerci- Private Motorbik Pedestrian fatalities Persons Males Female
No. of al Vehicles Vehicle e knocked injured killed killed
cases involved involved involved down
Accra 1276 814 983 121 201 62 537 49 15
Tema 304 202 233 37 63 29 274 23 6
From the tables shown above, between the months of November 2011 to May 2012 there was an
increase in the total number of RTAs recorded in both Accra and Tema. My study conducted on the 70
accident victims revealed most of the accidents occurring in the Accra metropolis mainly, followed
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69. closely by Tema. Most accidents occurred with private vehicular involvement from the tables above, as
seen similarly in this study among the respondents at Accident Centre, Korle-Bu.
5.3 INFORMATION ON CARE SEEKING OPTION AND HOW COST OF TREATMENT
AFFECTS THE INTERVAL BETWEEN TEMPORARY AND DEFINITIVE TREATMENT
From the survey conducted, most of the patients were not actually involved in deciding which
healthcare option they should seek, (probably because of shock) however for those who were conscious
and alert, they preferred to seek medical care first and resorted to bone setters if they were not satisfied
with the hospital treatment.
In Ghana, victims of road traffic accidents, usually have no initial decision with regards to where to
seek 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 traffic
injuries in West Africa; exploratory data from Nigeria”, of the 127 victims interviewed, 77% of study
subjects sought medical care. Hospital treatment and treatment by a private physician were the most
common types of initial care sought. Home treatment (22%) was the next most common, followed by
health 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 traditional
treatment after they had already been treated in a different setting. Traditional treatment was the most
common second treatment options chosen by road traffic injured people, comprising 39% of those study
subjects who sought more than one treatment, and 12% of all who had a RTI. Individual preferences was
the most common reason for a choice of first provider (42%), but proximity and cost of treatment were
also often quoted. (20)
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70. With regards to duration of admission, it ranged from 1week to 16 weeks. This could be attributed to
varied 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 to
the 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 for
less than 4 weeks, whiles 19.6% stayed for over a month. (9)
5.4 TO DETERMINE THE METHODS OF PREVENTION OF THESE ROAD TRAFFIC
ACCIDENTS
From the above, 83% of the victims thought the road accidents could have been avoided and this is
how; 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 said
their accidents could have been prevented had the driver been more careful and diligent, seventeen
people said by obeying the road traffic regulations. However 9 people thought the accident was not
preventable.
Owing to the socio-economic impacts of road traffic accidents, it deserves to be given political
priority and commitment. Although some interventions are underway by the government of Ghana to
tackle this menace (such as Road Safety Commission’s mass education through advertisements on
television), 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 the
roads and culminated in a drastic decrease in road accidents and the adherence to road regulations. In
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