Factors associated with motorcycle-related road crashes in Africa, a scoping review from 2016 to 2022 | BMC Public Health

It was noted that four main themes were identified from the data synthesis. The four main themes identified were driver and non-driver factors, prevalence and severity of RTC injuries, and measures to reduce RTC. The themes were formulated from the summary of critical findings in Table 1. These themes and sub-themes are presented below.

TABLE 1 SUMMARY OF MAIN FINDINGS

Driver-related factors associated with RTCs

Three sub-themes were identified and included user behavior, knowledge of road use and regulations, and compliance with traffic rules.

Rider Behavior Factors

Factors associated with RTC were alcohol and other drug use by passengers [2, 16, 25, 30, 32, 37, 39]. It was noted that 12.6% of passengers currently smoke and 68% usually consume alcohol [25]. Alcohol consumption [39] was common among road users as 24% had taken blood alcohol tests and 14% were positive [30]. Risky alcohol consumption was associated with almost six times the odds of RTI (OR = 5.98, 95% CI: 3.25 to 11.0) and remained significant after adjusting for sociodemographic factors, related driving and work (OR = 2.41, 95% CI: 1.01–5.76) [36]. Human error was a leading cause of road accidents among motorcyclists [28, 33]. Other behavioral factors included driving experiences less than 3 years [25, 32]longer driving periods [2, 32]ride till late [32]motorcycle sharing between bikers [32]speeding [2, 39, 40]careless and reckless driving [2, 29, 35, 40]. Crash risks were higher among drivers with more than 3-5 years of driving experience and generally with two or more passengers [25]. The driver’s age and sex influenced the risk of having a crash, as young people (under 30) had an increased risk of having a RTC [15, 25, 32, 35]. The mean RTC age was 28.7% [25] and mainly men involved [29, 30, 35]. RTC victims (70.2%) were between 18 and 45 years old and motorcycles were the main cause of road accidents (53.4%) [37]. Unmarried drivers had a higher probability of having a traffic accident [27]. Collisions occurring on weekdays, during rush hour, at intersections, involving a rear impact, in daylight, on roads and in clear weather decrease the probability of a fatality [34].

Knowledge of road traffic rules by drivers

Knowledge levels were generally considered to be lower, particularly in the use of personal protective equipment (PPE) by runners. Knowledge of helmet safety and speed limits was low for those who experienced RTC [16, 25]. Inadequate knowledge of traffic rules increased the risk of an RTC among passengers [2, 26, 29, 32, 40]. Only 20% of riders had formal motorcycle riding training and 95% had basic knowledge of PPE use [14]. Additionally, 80% of drivers had little or no knowledge of road safety, ethics or the importance of PPE [14]. Those who received traffic law training had an average age of 32.8 among the 86.4% who received road safety training [17]. Receipt of training and attitude towards road safety practices independently influenced compliance with road traffic rules [15].

Rider compliance with RT regulations

Most riders did not have a valid driver’s license [15, 24, 26] as the level of compliance with safety practices, including wearing a helmet, was 27.2% [15]. Reported compliance for wearing and owning the helmet was 7.6 and 89.1%, respectively [24]. In other regions, helmet use by the rider has been reported [28] at 43% [30]. The importance of the license was evident, as safe (“boda boda”) drivers were 39% less likely to be involved in RTC than regular drivers after adjusting for age, possession of a license and education. [17]. Helmet use on last trip was 69.4, and 86.1% carried only one passenger [24, 28, 40]. In addition, 75% of drivers knew the rules of the road and road signs, although 40% did not respect them. [14]. It was also noted that 47.1% of riders required driving licenses [24]. The Class A license is owned by 28.8%, while 39.1% would have owned the retro vest, with a few having used it on the last trip [24]. Factors that increase the probability of death were speed, driving under the influence, frontal impact, the presence of horizontal curves, reckless driving, off-peak hours, violations and driving without a helmet. [34].

Non-driver factors that influence RTC

This theme made it possible to identify the non-direct human factors linked to the occurrence of RTC in users. Within this theme, two sub-themes were identified which included automobile and police related factors and road related factors.

Auto and Police Related Factors

Explicitly motorcycle-related factors included lower engine capacity [32]don’t change bikes [32]and have too many motorcycles on the road [35]. The policy-related material mainly concerned the fact that the police stopped passengers at a place which was not designated [2, 26, 32].

Road factors

Several other factors have been identified as road-related factors that influence the occurrence of RTC in drivers. These factors include poor road conditions [2, 25, 39]vehicles parked in an unauthorized place [2, 25]slippery surfaces [2]reduced visibility [26, 39] and overspeed (over 45 km/h) [25, 34, 37, 39]. Other road-related factors were busy intersections with a high risk of RTC [26, 32, 34]riding on the main road [30]and RTC usually occurring in predictable high traffic locations [30].

Prevalence and severity of injuries from RCTs

This theme described two sub-themes which included the prevalence of collisions and injuries related to CCFs and factors related to injuries resulting from CCFs.

Prevalence of RTC Crashes and Injuries

The prevalence of RTC has been identified as being more common in urban areas in Uganda [35] and Tanzania [37]. In Ghana, the prevalence was 64%, with 74% involved in accidents in the past year [2], and about half have a history of RTC. The average time to access an RTC from the first driving point was 5.3 years [16]. Additionally, knowing someone who died or was involved in RTC was higher among motorcyclists [2, 16]. It was also reported that car and motorcycle collisions were 35% [30] and 77.4%, with an average of 3.3 accidents and 21.5% involvement in the 12 months [25]. The time of day of RTC onset showed that 67% occurred during daylight hours [30]. Victim with multiple injuries, cross-sectional collision, vehicle occupant traveling unrestrained in the back of a truck were linked to serious injuries [31, 38].

Factors Related to RTC Injuries

Victims extracted from the scene of the collision by medical professionals, police and traffic police were significantly associated with less serious injuries [31]. Immediate first aid in the hospital emergency department was crucial for the prognosis [32] although in the emergency department, neurosurgical care for people with traumatic brain injury may be delayed [35]. The cost and limited resources of the hospital’s neurosurgical intensive care unit could delay surgery [32, 35]. 12% of RTIs were reported to be severe [30] while serious injuries among RTC victims were reported at 36.4% [31]. Of 85 crashes, 80% resulted in driver injury, and 65.9% required medical care, 15.3% required hospitalized patients with a median hospital stay of 3 days [17]. The different forms of injuries included lower limbs 54%, upper limbs 23%, head/face 13% and trunk 9.8%. [2]. Factors associated with mortality were; use police vehicles to get to the hospital (P= 0.000), receiving medical attention within 2–10 h of injury (P = 0.000), age range 18–45 years (P= 0.019), without headphones (P= 0.007), serious injuries (P = 0.000) and multiple injuries (P = 0.000) [37].

Measures to reduce the incidence of RTC

Several measures have been identified to control the surge of RTC among users. These measures include strategies to minimize crash-related injuries by improving driver safety, infrastructure and the implementation of effective road traffic policies. [25, 28, 38]. Government investment in improving the road network, strict enforcement of current road traffic rules and penalties for anyone driving under the influence of alcohol, wearing a helmet and other PPE must be made compulsory [2, 16, 28, 40] . Driver’s licenses should not be issued to persons under the age of 25 [32]. Random drink and drive checks of motorists by traffic police should be extended to commercial drivers [26, 28, 32]. Screening drivers for alcohol-related disorders before they are hired or given licenses as funds are made available to raise awareness of road safety [2, 32]. Ensure a well-developed public transport system to help reduce RTC and youth-specific road safety programs and introduce road safety behaviors into the primary school curriculum [16]. Road traffic police should encourage road users through associations to continuously adopt and apply road safety best practices through periodic comprehensive training and retraining. [15, 31, 40]. Educational intervention strategies are needed immediately to reduce associated injuries [14, 31].

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