Road traffic accidents in Tunisia: a man made disaster Pr Hassen Ghannem Department of Epidemiology University Hospital Farhat Hached Sousse, Tunisia

Disaster Webster’s Dictionary defines disaster as a baleful or fatal event leading to ruin. Family Country What’s more disastrous for someone than the death of a relative following a road traffic accident.

INTRODUCTION Injuries account for 12% of the global burden of disease (1, 2) Traffic accidents are costing countries between 1% to 2 % of their gross national product Traffic accidents are a major preventable public health problem About 1,2 millions persons were killed and 50 millions were injured, worldwide, in 2002.

DESCRIPTIVE EPIDEMIOLOGY Figure 2 : Road traffic injury mortality rates in the different regions of the world (1)

DESCRIPTIVE EPIDEMIOLOGY Worldwide Road traffic injuries mortality rates : * 1,2 millions persons killed every year * 3242 persons killed every day * Traffic accidents : 11th cause of death * Developing countries: - 2/3 of the world population - 90% of deaths due to road crashes

DESCRIPTIVE EPIDEMIOLOGY Worldwide Road traffic injury mortality rates : * Increase in the mortality rates of 10% between 1990 and 2002 (1) * Differences between developped and developing countries Figure 3 : Changes in road crashes mortality rates according to countries (1)

DESCRIPTIVE EPIDEMIOLOGY In Tunisia During the period 1996-1998 (3): - 32 197 accidents, with 14,9 deaths per 100 accidents - an average traffic accidents incidence : 116,3 / 100 000 inhabitants / year - an average mortality rate : 14,2 deaths / 100 000 inhabitants / year - 5,9 persons killed per 100 humans implied - the average age of the persons who were implied in the accidents : 33,6 years - About 61,7 % of drivers were aged 20-40 years; 21 times more males than females among drivers - Pedestrians were the most vulnerable and the most severely injured.

RISK FACTORS The risk depends on four elements : A)   Exposure excess (need to travel) B)   Risk of crash, given a particular exposure, C)   Risk of injury, given a crash, D)   Risk of death or severe consequences, given an injury.

PREVENTION Taffic accidents are preventable.   Taffic accidents are preventable. The three targets of the road safety actions : - the road users - the vehicles - the roads infrastructure as well as the traffic management.

PREVENTION A- A scientific approach to the issue is necessary : Many conditions are required to guarantee the efficiency of the prevention strategies which are adopted.  To collect, analyse and carefully interpret reliable data  : The National Traffic Observatory in Tunisia was established to fulfill theses missions. To define objectives. To promote research, which subjects are concerned with road safety. To encourage the cooperation between different organizations intervening in traffic accidents prevention (NETWORKING).

B- The key organizations intervening in the prevention strategies : Figure 7 : Organizations intervening in road safety actions(1)

C- Prevention measures : Prevention strategies are made of interventions which are aiming to : diminish the exposure risk. avoid road crashes, given a particular exposure. reduce the severity of injuries caused by crashes improve the medical care for victims.

Measures avoiding road crashes, given an exposure Speed limitation Measures against « alcohol and driving » Measures avoiding the drivers fatigue : Measures ensuring pedestrian and cyclists safety Prevention of traffic accidents implying young drivers The prohibition of the use of hand-held mobile telephones while driving More road visibility

a – The use of seat-belts Measures reducing the severity of injuries caused by crashes : a – The use of seat-belts  When used, the seat-belt reduce the risk of fatal or severe accident, between 40% and 65 % (1). Making the wearing of safety belts compulsory improves their use rates. b- Use of helmets  c- Availability of air bags

Actions improving post-crash injury outcome  - pre-hospital mesures : * Bystanders : call for help, carry out simple acts to rescue victims, protect victims from an other accident * Larger access to emergency services * Better pre-hospital medical care - actions in the hospital :  

CONCLUSION Traffic accidents constitute a huge public health problem: a man made disaster. The situation is going to be worse unless prevention strategies are adopted. There is a hope to avoid such losses of lives, of health and of money by setting road safety actions. A scientific approach to the issue is essential in every country, so that road safety policies could be founded on reliable data, and meeting financial resources of each region.

REFERENCES 1- World report on road traffic injury prevention. Geneva (Switzerland), World health organization, 2004. (http:/www.who.int/violence_injury_prevention) 2- Bovet B. Health transition and emerging cardiovascular disease in developing countries : situation and strategies for prevention, Super course. 3- Henchir N. Epidemiology of traffic accidents in Tunisia [thesis]. Sousse : Medicine Faculty of Sousse 2001.

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