Reducing the burden of road traffic injuries and deaths in Ghana: an implementation science approach

This dissertation comprises four studies that aim to develop contextually relevant evidence on high-risk areas and factors for targeted road traffic injury prevention initiatives in Ghana. We use an implementation science approach by conducting research to understand areas and populations at greater risk that may benefit from evidence-based policies and interventions. The first three studies use a longstanding database maintained by the Building and Road Research Institute of each police-reported motor vehicle collision, minor injury, severe injury, and death. The last study involves in-depth interviews with 24 people in high-risk areas of major roads in Ghana. In Chapter 1, we provide background on road traffic injuries and deaths, our research objectives, and our approach. In Chapter 2, we identify spatial-specific and precise (i.e., 100-meter locations) clusters of road traffic injury severity on major roads in rural and urban areas of Ghana using the Getis-Ord Gi* statistic in ArcGIS Pro. We map 35,109 road traffic events from 2017 to 2020 on major roads and weigh outcomes based on severity using a well-known injury severity index. We observed 223 hot spots in rural areas (6.2% of the road network) and 142 injury severity hot spots in urban areas (4.7%) of the road network to target for injury control. We find critical patterns in both types of hot spots, including that urban hot spots are often in the peripheral area of cities where major roads intersect, whereas rural hot spots are sporadic. In Chapter 3, we analyze spatiotemporal trends in road traffic injury severity, minor injuries, severe injuries, and deaths from 2005 to 2020 using space-time data mining tools (i.e., a space-time cube and emerging hot spot analysis) in ArcGIS Pro. We find the injury severity index and minor injuries significantly decreasing over the period while severe injuries and deaths are on the rise. We identify three specific 2 kilometers (km) by 2 km urban areas and 29 2 km by 2 km rural areas, which are intensifying, defined as hot spots for 90% of the 16 years and with increasing injury severity index scores. In Chapter 4, we use five years of data (2016 to 2020) to assess and compare factors associated with injury severity among vulnerable road users (VRUs), defined as those without external protection (e.g., pedestrians, powered two-wheeler occupants), to non-vulnerable. We find some factors that consistently increase the odds of severe outcomes, including head-on collisions, at night with no lights or the lights off, and in rural areas or villages. We also explore and compare VRU subgroups (powered two-wheeler occupants, powered three-wheeler occupants, cyclists, and pedestrians) and find substantial heterogeneity in the factors associated with injury severity. Findings indicate that a targeted and road user-specific injury prevention approach is warranted. Targeted interventions for each sub-group could include interventions related to nighttime risks (e.g., lighting, enforcement to reduce excessive speeding) for powered two-wheelers, improved regulation for passengers of powered three-wheelers, and pedestrian-oriented infrastructure. Lastly, Chapter 5 explores road user perspectives on the magnitude, contributing factors, and potential solutions for road traffic injuries and deaths. We find that participants feel excluded from road safety design, planning, and implementation efforts, despite their complex understanding of the problem’s magnitude and contributing factors. An emerging theme was that socio-economic conditions affect increased risks related to road traffic collisions, injuries, and deaths. For example, participants noted that roadside sellers were at higher risk because of their precarious economic status, requiring them to spend substantial time on busy, high-speed roads. Participants describe key implementation issues related to existing interventions, such as a lack of enforcement at certain places or times and poorly designed and built speed calming measures. When prompted for potential solutions, many road users focused on road user behavior and the need for increased enforcement, reflecting a national and global emphasis on changing road user behavior. We call for greater community involvement in road safety to adapt interventions to meet local needs and for the government to acknowledge the gravity of this crisis and allocate resources accordingly.

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