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Malawi: Knowledge to curb the increase in traffic injuries


crashed car

While the number of traffic injuries and fatalities are decreasing in high-income countries, they are increasing significantly in low-income countries. Malawi is among the worst-case countries and will receive assistance to improve knowledge about traffic  accidents and the extent that alcohol may play a role. The results will be used to prevent accidents.

Traffic injuries in the world

  • Nearly 1.3 million people die each year in road traffic accidents
  •  20–50 million people are injured in traffic accidents each year 
  • 90 per cent of accidents occur in low and middle-income countries even though they only have 50% of the car fleet  
  • Road traffic accidents are among the three leading causes of death between the ages of 5 and 44 years 
  • Unless effective safety measures are introduced soon, road traffic accidents will become the fifth largest cause of deaths globally and the number of deaths will increase to 2.4 million per year 

Source: World Health Organization 

"Malawi is among the countries with the most road traffic fatalities in the world. Drunk driving is one of the problems, but to what extent we do not know," says Asbjørg S. Christophersen, senior researcher and project leader at the Norwegian Institute of Public Health. 
The experienced researcher emphasises that more knowledge about road traffic injuries will highlight the problem and give the authorities an incentive to develop and implement preventive measures.
In Malawi, traffic injuries crept up to 10th place in the ranking of causes of premature death in 2010, according to a study from the global burden of disease project, ref. figure below.   


Causes of premature death in Malawi in 1990 and 2010. Traffic injuries crept up two places to tenth place in 2010. Source: IHME, University of Washington, Seattle.

Collecting basic information about traffic accidents 

The project has chosen to collaborate with the emergency ward at Kamuzu Central Hospital in the capital of Lilongwe. Kamuzu is the largest public hospital in Malawi. In 2016, approximately 8000 injured patients from traffic accidents were admitted, a doubling in eight years. 

The doctors at the emergency unit will learn how to measure the alcohol levels in the patients and record this information in a database that will be established at the hospital. The database will be used to record basic information about adult patients who are admitted with injuries from road traffic accidents. They want to collect detailed information about the accident, the type of road, if it occurred in a rural or urban area, when the accident occurred, if it happened on a weekday or weekend, the type of vehicle was involved, age and gender of the patient, if the patient was a driver, cyclist, passenger or pedestrian, the severity of the injury was and the alcohol level at admission. 
Information about the alcohol level will be collected from the patients’ saliva or breath, and the doctors at the emergency ward will learn how to use the necessary measuring equipment. The equipment is included in the project funding. Information about the patients is anonymised when recorded in the database. 
Hospital staff will also be trained to test, analyse and interpret the data. The report from the project will specifically examine the test results for alcohol related to the other information collected in the study.
The staff at Kamuzu will establish routines for the systematic process of the project so that similar projects can be implemented in hospitals elsewhere in Malawi. Norwegian experts from the Norwegian Institute of Public Health and Oslo University Hospital will supervise and collaborate with the project staff at Kamuzu. The project also has funding for a Master’s degree student from Malawi at the University in Lilongwe.   

A prerequisite for knowledge-based policy 

The information in the database will enable the governmental authorities in health, transportation and justice to develop a knowledge-based policy. This in turn can be used to improve road safety and produce effective awareness campaigns. Christophersen refers to a survey which showed that not many people are aware that the blood alcohol limit in Malawi of 0.8 g/l.  

The Ministry of Health in Malawi has recommended the project, which follows up on goals in Malawi’s health strategy and the recently approved national alcohol policy. In addition, the project follows up on the UN Sustainable Development Goal number three, which states that the number of global deaths and injuries from road traffic accidents shall be halved by 2020

From project to daily operations

The project will involve patients from 18 years and older. Once the project becomes operative, the hospital can decide if children can also be included.

The permanent database will not include information abput alcohol.  

Hope to inspire other countries

"Traffic injuries involve health, both directly and indirectly. Beside the physical and mental health injuries and trauma that traffic accidents cause, the injuries are often so severe that the patients are permanently disabled and therefore dependent on other family members. The injuries not only result in loss of health, but also a financial loss. This problem is increasing in all low-income countries, says Christophersen. 
"In the next phase we hope that neighbouring countries will be inspired to copy the project. The World Bank is interested in supporting knowledge sharing, and in Norway we have the expertise to guide other countries through the initial phases. Therefore, we want to invite interested parties from other African countries to participate in a seminar about the final project results in Malawi," she adds.  


The World Bank is funding the project. This is the first time that the Norwegian Institute of Public Health has received project funding from the World Bank. The international organisation ICADTS (International Council on Alcohol Drugs and Traffic Safety) are also contributing with funding.  


From Norway:

Asbjørg S. Christophersen – project leader, Norwegian Institute of Public Health
Hallvard Gjerde – senior researcher, Oslo University Hospital
Stig Tore Bogstrand – senior researcher, Oslo University Hospital
Elin H. Wyller – project coordinator, Norwegian Institute of Public Health
Bjørn Iversen – Department director, advisory role, Norwegian Institute of Public Health
Norwegian Church Aid, local office in Lilongwe, responsible for financial obligations in Malawi.

From Malawi:

Dr. Carlos Varela, local project leader – main responsible in Malawi, Kamuzu Central Hospital (KCH)
Dr. Sven Young, senior co-investigator – advisory role, KCH
Dr. Jonathan Ngoma, senior co-investigator – advisory role, KCH
Dr. Leonard Banza, co-investigator, KCH
Project coordinator, KCH (to be confirmed)
The World Bank and the international organization ICADTS (International Council on Alcohol Drugs and Traffic Safety) have contributed with funding to the project.  


Institute for Health Metrics and Evaluation. GBD Profile: Malawi. Seattle WA: IHME; 2012 (pdf) 

McCarthy N. The Worst Countries For Road Traffic Fatalities, Hamburg, Germany: Statista GmbH, 2016  

World Health Organization: Death on the roads  

World Health Organization: Global status report on road safety 2015, Geneva, Switzerland: World Health Organization, 2015