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Vision 2030 -Rethinking Road Traffic Accidents (RTAs) Management in Nairobi, Kenya

Vision 2030 -Rethinking Road Traffic Accidents (RTAs) Management in Nairobi, Kenya

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Published by nzioka
Road traffic accidents is the 9th cause of disabilities globally and is projected to be 3rd by 2020 globally. This is a case for action in Nairobi, Kenya.
Road traffic accidents is the 9th cause of disabilities globally and is projected to be 3rd by 2020 globally. This is a case for action in Nairobi, Kenya.

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Published by: nzioka on Jun 29, 2008
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12/18/2012

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Solomon M. Nzioka
(International Masters in Public Health (MPH), Israel 
 
Epidemiological Basis for Decision Making in Health Administration 
 
1
 Topic:
Needs Assessment for Centralized Road Traffic Accidents Surveillance Unit As Basis For Evidence-Based Public Healthy Policy Management On Road Traffic Accidents In Nairobi, Kenya.
Background:
Kenya is located within the Africa continent at coordinates between latitude 3
0
North and 5
0
Southand longitude 34
0
and 41
0
degrees East. The country lies across the equator on the East coast of  Africa. It borders Somalia, Ethiopia and Sudan to the North, Uganda to the West, Tanzania to theSouth and the Indian Ocean to the East. Kenya covers about 582,500km² with its capital being Nairobi (1
0
17
0
S, 36
0
49
0
E). The administrative units are divided into 7 provinces and 1 area namely;Central, Coast, Eastern, Nairobi Area, North Eastern, Nyanza, Rift Valley, Western. ( 
see annex 1
 ). Theprovinces are further divided into Districts or constituencies. Villages are the smallest administrativestructures while constituencies are the parliamentary electoral units with wards being the smallestconstitutional organs.In Kenya, the literacy level (those with age 15 and over able to read and write) is rated at 85.1% in thetotal population
(male: 
90.6% and
 female: 
79.7%) as per 2003 estimates (1). Notably, even though 98%of the of primary school entrants reach grade 5 as per the administrative data, between 2000-2005,secondary school enrolment ratio was 50% and 46% for gross male and female respectively. According to the same report, the 2006 estimates on GDP is US$ 40.77 billion and US$1,350 per head with a total expenditure on health being 8.3% of GDP and a per capita expenditure on health of $115.
Problem Statement/Problem Definition:
One of the current government visions is to transform Nairobi city into a metropolis by 2030. This will not only come with increased traffic flow but should also make road traffic accidents managementa central concern for the health systems. Road traffic injuries are currently ranked 9
th
globally among the leading causes of disease burden, in terms of disability adjusted life years (DALYs) lost. In the year2020, road traffic injuries are projected to become the 3
rd
largest cause of disabilities in the world (2).Developing countries bear the brunt of the fatalities and disabilities from road traffic crashes,accounting for more than 85% of the world’s road fatalities (2). An economic burden review by Jacobs
et al 
(3) found that the annual cost of road crashes is in excess of US $500 billion. They acknowledgedthat due to the scarcity of costing data for African countries, it was difficult to make a precise cost of road crashes in Sub-Saharan Africa. However, the estimated costs as a percentage of the nationalGross National Product (GNP) ranged from 0.8% in Ethiopia, 1% in South Africa, 2.3% in Zambia,2.7% in Botswana and almost 5% in Kenya.
 
Solomon M. Nzioka
(International Masters in Public Health (MPH), Israel 
 
Epidemiological Basis for Decision Making in Health Administration 
 
2
 This paper presents review of the current literature on linkages and challenges between health researchand public healthy policy management on road traffic accidents (RTAs) in Kenya, provides an outlineof the analytic framework for which evidence can contribute to public healthy policy on RTAsmanagement and identifies data gaps that needs to be addressed within vision 2030 framework.
Literature Review/Conceptual Framework:
Nairobi is the most populous city in East Africa, with an estimated urban population of about 3.5million in 2007 (1999 census). Nairobi is reputed to be the 4
th
fastest growing city in the world afterGuadaloupe, Mexico City (Mexico) and Maputo (Mozambique). According to the 1999 Census, thecity congestion was approximately 2925 persons/km². The Nairobi land use and transport Network has not been revised since its development in 1973 ( 
see annex 2 
 ). According to a recent report (4), thereare 7.5 million person trips per day translating to 2.1 trips per person per day (2007 populationprojection). The report further stated that home bound trips account for 46.5%, work 25%, school9.8%, while other trips e.g. hospital account for 18.7%. The report further noted that 93% of traffic within Nairobi boundary at any day is destined to Nairobi while only 7% is a pass through traffic ( 
see annex 3
 ). The following figures summarize the Nairobi traffic as further presented in the report: -
 
Fig. 2: Nairobi Daily Traffic Volume by Road Name Fig. 1: Nairobi Trip Composition by Travel Mode 
 A Global Road Safety Project (GRSP) study (5) showed that 4% of global vehicles are registered inSub-Saharan Africa and contributed about 10% of global road deaths in 1999. Comparatively, 60%of all globally registered vehicles are in developed world where only 14% of global road deathsoccurred (4). From Odero
et al 
(6) review of the GRSP study, they noted that the adjusted trueestimate of total road deaths for all Sub-Saharan African countries for the year 2000, based on thepolice department’s records, ranged between 68,500 and 82,200. They further stated that theestimated fatality of 190,191 for Sub-Saharan Africa presented in the 2004 World Report, based onhealth care data was much higher, and reflected the magnitude of under-reporting in police statistics. They acknowledged that given the widely recognized problem of under-reporting of road deaths in Africa, "the true figures were likely to be much higher, as the police-reported road fatalities representonly the tip of the injury pyramid".
Nairobi Daily Traffic Volume By Main RoadNetworks to CBD
 Jogoo Road16%Outering Road17% Thika Road13%Langata Road10%Mbagathi Road10% Waiyaki Way 10%Haile SelassieRoad11%Mombasa Road13%
 
Nairobi Trip Composition by Travel Mode
 Two – wheelmode, 1.20%KR(Railway),0.40%Others, 0.20%School orCollege Bus,3.10% Walking, 47%PrivateCar/Taxi/Truck,15.30%Bus, 3.70%Matatu, 29%
 
 
Solomon M. Nzioka
(International Masters in Public Health (MPH), Israel 
 
3
 Another related report on road traffic accidents and injury in Kenya (7) reported that people killedin road accidents increased by 578%, while non-fatal casualties rose by 506% between 1962 and1992. In addition, fatality rate per 10,000 vehicles increased from 50.7 to 64.2, while fatality per100,000 population ranged between 7.3 and 8.6. More over, the report stated that 66% of theaccidents occurred during daytime. Regarding causes of road traffic accidents, the same report notedthat human factors were responsible for 85% of all causes whereby vehicle-to-pedestrian collisions were most severe and had the highest case fatality rates of 24%. In addition, only 12% of injuriesresulting from vehicle-to-vehicle accidents were fatal. In the said study, public service vehicles wereinvolved in 62% of the injuries. In addition, of all traffic fatalities reported, pedestrians comprised42%, passengers 38%, drivers 12%, and cyclists 8%. The report concluded that the high pedestrianand passenger deaths implied the need to investigate the underlying risk factors, operational andpolicy issues involved in the transport system, and to develop and implement appropriate responsiveroad safety interventions. A 2003 related publication (8) stated that a "four-fold increase in road fatalities had beenexperienced over the last 30 years with over 3,000 people being killed annually on Kenyan roads within whom more than 75% are economically productive young adults". It further noted thatpedestrians and passengers were the most vulnerable accounting for 80% of the deaths. The reportinferred that "road safety interventions have not made any measurable impact in reducing thenumbers, rates and consequences of road crashes". It added that "despite the marked increase inroad crashes in Kenya, little effort has been made to develop and implement effectiveinterventions". The report adds that "impediments to road traffic injury prevention and controlinclude ineffective coordination, inadequate resources and qualified personnel, and limited capacity to implement and monitor interventions". Acknowledging most of the drawbacks, the reportrecommended that "there is need to improve the collection and availability of accurate data to helpin recognising traffic injury as a priority public health problem, raising awareness of policymakers onexisting effective countermeasures and mobilizing resources for implementation. Establishment of an effective lead agency and development of stakeholder coalitions to address the problem aredesirable". The above referenced reports are a sample of what has been documented and one will notice thatsome of the widely referenced publications are not only based on assumptions that conditionsremained the same over the long comparative periods (like comparing 1962-1992) but othersgeneralize sub-saharan Africa and developed countries and treat each of them as homogeneoussocieties and make strong comparative inferences. Notably, the utility of the combined evidence atpolicy level will be limited given the methodological weaknesses and inconsistency in variabledefinitions amongst researchers.

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Alfred Kirui added this note
it is a nice thing but informed policies must be made and implemented accordingly
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Jimoh Nurudeen added this note
it is a critical issue which must tackle by government of the countries.
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