Hopp til innhold

Article

Malawi: Knowledge to curb the increase in traffic injuries

Published Updated

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 has received assistance to improve knowledge about traffic  accidents and the extent that alcohol may play a role. The results will be used to prevent accidents.

crashed car
Colourbox

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 has received assistance to improve knowledge about traffic  accidents and the extent that alcohol may play a role. The results will be used to prevent accidents.


"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 because of the lack of alcohol testing and investigation," 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.  

 
Grafisk figur
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.

Collected basic information about traffic accidents 

The idea of the project is that increased knowledge about traffic accidents will give attention and incentives to the authorities to start prevention.

The Ministry of Health in Malawi has recommended the project, which follows up on goals in Malawi’s health strategy and their 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 – a goal that has not been reached and therefore is suggested postponed till 2030.

The project received grants from the World Bank in 2017, and the planning and preparation has taken a long time. Only at the end of May 2019 could they start recruiting patients.

Voluntary participation

Traffic-injured patients (18 years or older) were informed of the project as they arrived at the emergency ward at Kamuzu Central Hospital, project partner and the largest public hospital in Malawi.  After being informed in English or the local language Chichewa, patients were then asked if they would like to participate in the project.

Thorough testing

Two young doctors at the emergency unit at Kamuzu measured the alcohol levels in the patients and registered this information in a form on iPad, developed for the project, in cooperation with the Norwegian project group and the group at Kamuzu. 

The hospital wants to build a database with basic information about adult patients who are admitted with injuries from road traffic accidents.
 
The doctors collected detailed information about the accident; the type of road through Google Maps; 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 involved; age and gender of the patient; if the patient was a driver, cyclist, passenger or pedestrian; the severity of the injury; and the alcohol level at admission. 

Depersonalised data

The data were depersonalised before registered in the iPad programme.Experts from the Norwegian Institute of Public Health and Oslo University Hospital are supervisors (see text box).

Preliminary results

High participation rate

In about three months, 1347 traffic-injured patients were asked to participate in the project. Of these, 88 refused to participate, which mean that the result was a participation rate of 93.5. Of those, 19.2 percent were women.– The high percentage of participants is particularly gratifying since the project was predicted low interest before we started the collection, as it was alcohol we should measure, says Asbjørg S. Christophersen.

Passengers is the largest patient group

The largest patient group was passengers (36%), followed by pedestrians (17.6%), cyclists (14.6%), motor vehicle drivers (14.5%), motorcyclists (12%), and a smaller group where the type of road user did not stay registered (about 5%).

Men and pedestrians more often influenced by alcohol

Alcohol was detected in 25.9% of men and only 2.5% of women. Alcohol was most common in the age group 26–34 years (25.6%) and in pedestrians (41.8%), followed by motorcyclists (24%), car drivers (23.8%), bus / minibus / lorry drivers (20, 8%), passengers (19.8%) and cyclists (19.1%).

Higher alcohol levels at weekend nights

Most dangerous and highest alcoholic occurence was detected at weekend nights (00.00 - 06.00) in 58.3%, and 36.8% in the afternoon / evenings (18.00 - 24.00). In the afternoon / evening on regular weekdays (18.00 - 24.00), alcohol was detected in 34.4%.

Publishing of data

Three articles are submitted for publication in various international journals. Two more articles are being planned.

Received the Robert Borkenstein Prize

The Norwegian Public Health Institute received the Robert Borkenstein Prize awarded to Asbjørg S. Christophersen at the ICADTS (International Council on Alcohol and Drugs and Traffic Safety) conference in Edmonton, Canada, in 2019, for the implementation of the project. The prize is only awarded every three years.

The corona pandemic has put the follow-up on hold

A seminar in Lilongwe scheduled for early fall 2020 has been cancelled due to the Covid-19 pandemic. In collaboration with the local World Bank branch, the project was to present results to representatives from ministries (health, transport, justice), the police, the embassy, the media and organisations working with traffic safety and prevention of alcohol and other substance abuse. Employees at Kamuzu should also get involved.Video seminars have been discussed, but for the time being, there are often major technical problems with this type of seminar in a country like Malawi.Since the World Bank has a deadline at the end of November 2020, the project has applied for postponement so that the seminar can be arranged with participants from the project group in Norway, for example around the summer of 2021. This will of course only happen if the Covid-19 situation allows it.
 
– We would like to believe that a seminar with project participants physically present will have a greater information effect than a video conference, says Asbjørg S. Christophersen.

A prerequisite for knowledge-based policy 

The results will provide the governmental authorities in health, transportation and justice with particularly valuable information to shape a knowledge-based policy to improve road safety and create effective information campaigns. Christophersen refers to a poll that found that the 0.8-alcohol legal limit in Malawi for driving a motor vehicle is little known to people.

− A reduction in traffic accidents could save Malawi health care resources, save lives and tragedies because individuals become disabled and destroyed for the rest of their lives.

Funding 

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) and the Norwegian Council for Road Safety have also contributed. The Church Aid’s local office in Lilongwe has been responsible for disbursements in Malawi.

Participants

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
Karine Nordstrand – department director, advisory role, Norwegian Institute of Public Health

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
Gift Mulimba – project coordinator, KCH
Chifundo Kajombo – project coordinator, KCH
 
Funding:
The World Bank (main sponsor), the international organisation ICADTS (International Council on Alcohol Drugs and Traffic Safety), and Trygg Trafikk (Norwegian Council for Road Safety) have contributed with funding to the project.  

References

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

Global status report on road safety 2018. Geneva: World Health Organization; 2018

Christophersen AS, Mørland J, Stewart K, Gjerde H. 2016. International Trends in alcohol and drug use among motor vehicle drivers. Forensic Sci Rev. 28(1):38–66.

World Health Organization. 2018a. Global status report on alcohol and health 2018. Geneva, Switzerland: World Health Organization. 

Dräger Alcotest 5820, Drägerwerk AG & Co., Lübeck, Germany.

Q.E.D.® A150, Orasure Technologies, Inc., Bethlehem, PA, USA.

Eide AH,,Braathen S, Azalde G, Munthali A,  Chiocha M, Ndawala J, Natvig H, Hoel E. Fighting poverty alcohol misuse prevention in Malawi – revised summary report (December  2013) SINTEF Technology and Society, 2013–12 -16.      

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

About this page

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