The Public Health Threat of Road Traffic Accidents in Nigeria: A Call to Action

Abstract

Public health experts worldwide concede that there is a global epidemic of road traffic accidents (RTA). Globally, RTA is the leading cause of injury-related deaths. In Nigeria, injuries and deaths resulting from RTA are on the rise and are Nigeria's third-leading cause of overall deaths, the leading cause of trauma-related deaths and the most common cause of disability. Do RTA constitute a public health problem in Nigeria? If so, is there a pragmatic approach to combat this problem? A systematic literature search using the advanced features of various databases such as PubMed, Scopus, Embase, Google, and directory of open access journals was carried out using the key words “ RTA, public health problem, government response, Nigeria.” Out of initial 850 articles retrieved from the search 15 articles that suited the study were included in this review. There is need to view RTA s as an issue of urgent national importance that needs urgent attention aimed at reducing the health, social, and economic impact. Policy makers at the various levels of government need to recognize this growing problem as a public health crisis and design appropriate policy responses that will back up with meticulous implementation.

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© 2017 Annals of Medical and Health Sciences Research | Published by Wolters Kluwer - Medknow 199
Address for correspondence:
Dr. Onyemaechi NOC,
Department of Surgery, University
of Nigeria Teaching Hospital,
Ituku‑Ozalla, Enugu, Nigeria.
E‑mail: bisionyemaechi@yahoo.com
Introduction
According to data recently released by the World Health
Organization (WHO),[1] an estimated 55 million people died
worldwide in the year 2011. Of these, 1.3 million were due to
road injuries, equating to roughly 3500 each day from road
trafcinjuries.Bythesestatisticsroadtrafcaccidents(RTA)
ranked among the top 10 leading causes in 2011, a reality
that was not existent a decade ago almost at par with chronic
diseases such as HIV/AIDS and diabetes mellitus. By 2030, car
accidentswillbethefthleadingcauseofdeathintheworld,
if this trend were to continue.[2] Globally, RTA is the leading
cause of injury-related deaths.[3]
Public health experts worldwide concede that there is a
global epidemic of RTA. The incidence, however, is higher
in developing countries.[4-7] According to the WHO, low- and
middle‑incomecountriesaccountedfor 92% of road trafc
deaths but had only 53% of registered vehicles in 2011. In
Nigeria, injuries and deaths resulting from RTA are on the
rise,[8,9] and account for the highest proportion of deaths on the
Africa continent. Road accidents are Nigeria’s third-leading
cause of overall deaths, the leading cause of trauma-related
deaths and the most common cause of disability.[10-13] According
to the WHO, the country has 1042 deaths a year for every
100,000 vehicles, one of the highest rates of road fatalities
in the world; the equivalent gures for the United States
and Britain are 15 and 7, respectively.[14] Statistics show
that there is a rising incidence of RTA in Nigeria and other
developing countries with adverse physical and socioeconomic
implications. However, there is yet to be a comprehensive
and integrated approach to combat this menace. For effective
interventions to be developed, the process begins with
The Public Health Threat of Road Trac Accidents in
Nigeria: A Call to Acon
Onyemaechi NOC, Ofoma UR1
Department of Surgery, University of Nigeria Teaching Hospital, Ituku‑Ozalla, Enugu, Nigeria, 1Department of Critical
Care Medicine, Geisinger Medical Center, Danville, PA, USA
Abstract
Public health experts worldwide concede that there is a global epidemic of road traffic
accidents (RTA). Globally, RTA is the leading cause of injury‑related deaths. In Nigeria,
injuries and deaths resulting from RTA are on the rise and are Nigeria’s third‑leading cause
of overall deaths, the leading cause of trauma‑related deaths and the most common cause of
disability. Do RTA constitute a public health problem in Nigeria? If so, is there a pragmatic
approach to combat this problem? A systematic literature search using the advanced features
of various databases such as PubMed, Scopus, Embase, Google, and directory of open access
journals was carried out using the key words “ RTA, public health problem, government
response, Nigeria.” Out of initial 850 articles retrieved from the search 15 articles that suited
the study were included in this review. There is need to view RTA s as an issue of urgent
national importance that needs urgent attention aimed at reducing the health, social, and
economic impact. Policy makers at the various levels of government need to recognize this
growing problem as a public health crisis and design appropriate policy responses that will
back up with meticulous implementation.
Keywords: Nigeria, Public health problem, Road trac accidents
Review Article
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How to cite this article: Onyemaechi N, Ofoma UR. The public health
threat of road trafc accidents in Nigeria: A call to action. Ann Med Health
Sci Res 2016;6:199-204.
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Onyemaechi and Ofoma: Road trafc accidents and public health in Nigeria
200 Annals of Medical and Health Sciences Research | Volume 6 | Issue 4 | July-August 2016 |
providing an explicit statement of questions using the PICO
modelofproblemidentication,interventions,comparisons,
and outcome.
Methods of Literature Search
A web-based literature search using the advanced features
of various databases such as PubMed, Scopus, Embase,
Google, and directory of open access journals was carried
out independently by the two reviewers. The key words used
were: RTA, public health problem, government response,
Nigeria. Only studies published in English before the time
of search, September 2014 were included in the study.
The search retrieved 850 results. Data from these studies
were extracted and assessed for inclusion. The criteria for
inclusion in the review were: clinical and epidemiological
studieson RTA,studies thatfocusedon roadtrafcsafety
and prevention of RTA. A total of 15 articles that suited the
study formed the evidence base on which this call for action
is founded. In addition to the published articles, 10 website
resources were also used. Figure1showstheowchartof
the article selection process. The risk of bias of the study
was assessed using the Cochrane Collaboration’s tool for
assessment of risk of bias. Table 1 shows the characteristics
of the selected studies.
Why Does Road Trafc Accidents Deserve
the Government’s Time, Energy and
Focus?
In Nigeria, injuries and deaths resulting from RTA are on the
rise and are Nigeria’s third-leading cause of overall deaths, the
leading cause of trauma-related deaths and the most common
cause of disability.[11] The situation is especially problematic in
Nigeriabecauseofpoortrafcinfrastructure,poorroaddesign,
poorenforcementof trafc rules and regulations, a rapidly
growing population, and subsequent number of people driving
cars.As Nigeria’s economy grows, the volume of trafc is
expected to rise, from 8 million vehicles in 2013–2040 million
by 2020.[14]
RTA has physical, social, emotional, and economic
implications. Fatalities, physical disability, and morbidity
from road accidents predominantly affect the young and the
economically productive age groups.[15-17] Survivors often
endure a diminished quality of life from deformities and
disabilities, posttraumatic stress and lost personal income, in a
country not well known for exceptional rehabilitation services.
The rest of the populace lives in perpetual and pervasive fear
of traveling occasioned by not feeling safe on the roads. The
Figure 1: Flowchart of article selection process
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Onyemaechi and Ofoma: Road trafc accidents and public health in Nigeria
Annals of Medical and Health Sciences Research | Volume 6 | Issue 4 | July-August 2016 | 201
overall effects of these injuries constitute social economic and
psychological losses of great magnitudes.
In 2003, the direct global economic cost of RTA was estimated
at USD 518 billion/year with USD 100 billion of that occurring
in poor developing countries.[18] The WHO estimates the
national cost of RTA to be between 1% and 3% of the gross
domestic product.[19] In Nigeria, about 80 billion naira is lost
to RTA annually.[20] This economic cost includes the cost of
property and public amenity damaged, the cost of medical
treatment, and the cost of productivity lost due to the accident.
This is a huge economic loss particularly for a country plagued
with poverty.
Despite the statistics of RTA in Nigeria, it has not received
all the attention it deserves. There is need to view RTA as an
issue of urgent national importance that needs urgent attention
aimed at reducing the health, social, and economic impact.
Policy makers at the various levels of government need to
recognize this growing problem as a public health crisis and
design appropriate policy responses that will back up with
meticulous implementation.
Response by the Nigerian Government
Following a critical survey of the increasing burden of RTA
on the world economy, the UN general assembly in 2010
adopted a resolution which proclaimed a decade of action
for road safety.[21] The goal of the decade (2011–2020) is
to stabilize and reduce the increasing trend in road trafc
fatalities, saving an estimated 5 million lives over this period.
To guide countries on taking concrete national level actions
to achieve this goal, a global plan of action was developed.[22]
This provides a practical tool to help governments develop a
national plan of action. National activities should be based
on 5 key pillars which include: road safety management,
safer roads and mobility, safer vehicles, safer road users,
and postcrash response. We will assess the response of the
Nigerian government to the public health threat of RTA using
these yardsticks.
Road safety management
The government response to road safety management can
be evaluated by examining the institutional and legislative
frameworks. The Federal Road Safety Commission (FRSC) is
the lead agency in Nigeria on road safety administration that
was established in 1988. Their statutory functions include:
making the highways safe for motorists and other road
users; recommend works and infrastructures to eliminate or
minimize accidents on the highways and educating motorists
and members of the public on road discipline. They also have
themandatetoprosecutepersonswhohavecommittedtrafc
offenses.
It must be admitted that the FRSC has done a lot of work on
roadsafety campaigns and implementation of trafc safety
regulations in Nigeria. Before their establishment, there
was no concrete and sustained policy action to address the
road safety question. Earlier attempts by some states and
other government agencies were isolated and uncoordinated.
However,withstaffstrengthofabout18,000menandofcers,
it would appear that the commission is currently overwhelmed
with the task of keeping Nigerian roads safe. Poor funding,
lack of motivation, and corruption are some of the challenges
facing the commission. The public awareness and road safety
campaigns must be robust and sustained all-round the year and
not limited to only festive seasons as is currently the practice.
Theenforcementof the existingtrafcsafetylaws must be
pursued vigorously and offenders severely punished to serve
as a deterrent to other road users.
Intermsoflegislativeframework,manytrafc safety laws
exist in Nigeria, but their enforcement remains poor. Data
from the WHO global health observatory repository 2011
Table 1: Summary of the characteristics of the included articles
Number Authors Year of publication Country Study type Study sub‑type
1 Krug et al. 2000 USA Epidemiological Noninterventional
2 Odero et al. 1997 Kenya Epidemiological Noninterventional
3 Nordberg et al. 2000 Kenya Epidemiological Noninterventional
4Asogwa et al. 1978 Nigeria Epidemiological Noninterventional
5Ezenwa et al. 1986 Nigeria Clinical Noninterventional
6 Ekere et al. 2004 Nigeria Clinical Noninterventional
7 Nwadinigwe et al. 2005 Nigeria Clinical Noninterventional
8 Solagberu et al. 2003 Nigeria Clinical Noninterventional
9 Akinpelu et al. 2006 Nigeria Clinical Noninterventional
10 Labinjo et al. 2009 Nigeria Epidemiological Noninterventional
11 Julliard et al. 2010 Nigeria Epidemiological Noninterventional
12 Marburger et al. 1987 Germany Epidemiological Noninterventional
13 Routley et al. 2007 China Epidemiological Noninterventional
14 Evans et al. 1996 USA Epidemiological Noninterventional
15 Oluwadiya et al. 2005 Nigeria Clinical Noninterventional
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show that Nigeria has a seat belt law which is applicable to
drivers only.[23] There is also drink-driving law which is hardly
enforced. At present, there is no child restraint law in existence,
but there is a national speed limit law for both urban and rural
roads of 50 km/hour. A law on the use of motorcycle helmet
for all passengers and applicable to all road types exists, but
the level of enforcement is very low. There is a need for a
child restraint law in Nigeria, and the law on seat belt must be
reviewed to apply to all occupants. Above all, the enforcement
of all these laws must not be compromised in order to achieve
the desired results.
Safer roads and mobility
A journey through the highway and major roads in Nigeria,
particularly in the South-Eastern region, reveals that the road
infrastructure is in great disrepair.
With a total of road network of 194,394 km, Nigeria has the
largest road network in Sub-Saharan Africa. Most of these
roads were built more than 30 years ago when the volume of
vehiculartrafcwaslow,andtherewerealternativemeansof
transportation such as railways. However, the rate of increase
invehiculartrafchasnotbeenmatchedwithacommensurate
rate of road construction.
In addition, with a moribund railway systems and waterways as
alternative means of transportation, the burden on the roads has
continued to increase as a result of increased motorization. The
resultant effect is the breakdown of roads and increased rate of
road crashes. The current rehabilitation of road and railways by
the government will hopefully create safer roads and open up
alternative means of transportation and consequently decrease
the rate of road crashes in Nigeria.
Safer vehicles
The use of old and rickety vehicles that are not roadworthy
contributessignicantlytotherateofroadcrashesinNigeria.
In 2004, the national vehicle inspection scheme (a component
of road transport safety standardization scheme) created by
lawintheNationalRoadTrafcRegulationswasintroduced
to ensure that only roadworthy vehicles are allowed to ply the
roads.[24] It involves routine vehicle inspection on the highways
as well as postcrash inspection. The FRSC and the vehicle
inspectionofcerscollaborateinthisresponsibility.However,
the law in its current form applies only to eet operators,
i.e., organizations, companies, government ministries
and agencies, and road transport company owners with a
minimumof5vehiclesintheir eet. The smaller transport
companies (with <5 vehicles), privately owned vehicles and
other means of road transport such as tricycles and motorbikes
were not captured in this law. This is a major shortcoming in
this law because any unsafe vehicle on the road constitutes
a hazard to every road user. It, therefore, requires an urgent
review and judicious enforcement with appropriate punishment
for erring motorists.
Data from global health observatory repository of the WHO
show that Nigeria has an estimated 12.5 million registered
vehicles.[23] This number is very high when compared with
the gure from other countries with similar demographic and
socioeconomic statistics such as Pakistan and Bangladesh.
This gure may be traceable to government’s review in 2010
of the ban on importation of used vehicles by increasing the
age limit from 10 to 15 years. This policy may have paved the
way for the importation of old vehicles that are not roadworthy
into the country with consequent increased motorization and
increased rate of road crashes. There must be a strict regulation
of importation of vehicles in Nigeria to ensure that only safe
vehicles are brought into the country.
Safe road users
Theawareness andadherenceto trafcsafety regulationby
road users is an important factor in reducing the frequency
of RTA. The enforcement of road safety laws like the use of
seatbelthasbeenassociatedwithsignicantreductioninthe
fatality and severity of injury after a road crash.[25-29] Although
road safety laws exist in Nigeria, the level of implementation
by road users is quite low.
There is need to ensure that only drivers who are trained
and certied are allowed to drive in Nigeria. Sadly,this
responsibility of the FRSC has not been effectively discharged.
Individualsareissueddriver’slicensewithoutanycertication
oftheirdrivingcompetenceandtnesstotheextentthateven
blind or lame persons may be in possession of driver’s license.
The citizens more or less see a driver’s license as a tool for
identicationandnotforthepurposeforwhichitisintended.
Theconsequenceisthatincompetentanduntpersonsmaybe
certiedtodriveandthiscouldspelldisaster.Aboveall,public
enlightenment programs aimed at educating road users on the
safe use of roads should be vigorously pursued.
Postcrash response
After a road crash, an organized prehospital care, as well as
prompt medical attention, has proven to reduce the morbidity
and mortality among the victims.[30] In Nigeria, the state of
posttrauma response is very poor.[31,32] Only a few cities such as
Abuja, Lagos, and Port-Harcourt have an organized emergency
medical service. The FRSC is also ill-equipped to carry out
this responsibility.
Solagberu et al.[31] in their study in Ilorin described a poor state
of prehospital care of accident victims in Nigeria. Only 40.4%
oftheroadtrafcvictimswerebroughttothehospitalbyeither
the Police or FRSC. None of the victims was brought to the
hospital with airway protection or support of circulation of
equipment. The policy of building so called “Accident Clinics”
onthehighwaysbytheFRSCforgivingrstaidtothevictims
of RTA in our opinion constitutes misplaced priority and waste
of resources. These clinics lack the necessary personnel and
facilities to care for these victims. These resources could be
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Onyemaechi and Ofoma: Road trafc accidents and public health in Nigeria
Annals of Medical and Health Sciences Research | Volume 6 | Issue 4 | July-August 2016 | 203
well utilized in training of their personnel in rescue operations
and provision of state of the art equipment for effective
emergency medical services.
At the moment, there are only 3 national orthopedic hospitals
and one national trauma center in Nigeria. This number is
grossly inadequate to cope with the burden of trauma arising
from road traffic crashes in a country of approximately
160 million people. There is a need for the establishment of
more trauma centers dedicated to trauma care. In fact, all the
tertiary health institutions in the country should be designated
national trauma centers and subsequently equipped for effective
trauma care services. This will help to provide the much needed
posttrauma care to the rising number of RTA victims.
In addition, healthcare should be made easily accessible to all
citizens of Nigeria through a comprehensive health insurance
scheme. This will enable RTA victims to access healthcare
without having to pay by “out of pocket” method for their
treatment, a practice which has compelled the poor victims
to seek alternative care from the traditional bonesetters with
attendant complications.
What Can Physicians Do? The Public
Health Approach
Complex problems require well thought out and methodical
solutions. In the health domain, solutions to public health
problems deserve to be approached from a public health
perspective. The Centers for Disease Control and Prevention
describethepublichealthapproachasafour‑stepmodel:dene
the problem, identify risk and protective factors, develop and
test prevention strategies, and ensure widespread adoption of
effective programs.[33] The public health approach has resulted
in a successful reduction in motor vehicle deaths in developed
countries.[34]
Dening the problem
Despite Nigeria’shigh burden of RTAs,dening the full
magnitude of the problem has been hampered by a lack
of systematic information and robust empirical scientic
data. There is very limited information on national patterns,
distribution, and outcomes of RTAs across the country. For
many published studies relating to RTAs in Nigeria are limited
to single hospital or urban settings.[15,35,36] Even the statistics of
Nigerian deaths from RTAs provided by the WHO are hugely
approximated.
Lack of systematic data generation mechanisms both at the
national and state level leads to limitations in designing
appropriate intervention strategies to deal with the problem
in the country. Nigeria does not have an established national
trafcaccidentdatabase.Thereisnoframeworkforaccurate
reporting of road trafc incidents, involved casualties, the
probable physical and environmental determinants of each
accident, where they occurred, under what circumstances.
Thesearecrucialandimportantscienticdataelementsthat
constitute a trauma database.
Adopting a public health approach with a view to tackling
Nigeria’s RTA burden mandates the creation of data systems
that provide detailed, robust, consistent, and comparable
information across accident sites nationwide over time.
Analyses of such data will be crucial for highlighting the
problem and for developing, testing, targeting, and evaluating
interventions. Research efforts must also be channeled toward
improving our understanding of the societal implications of
the social and economic consequences of deaths, injuries and
long-term disabilities from RTAs.
Physicians have a role and responsibility to protect and
safeguard health. The health of the public is not an exception
to this role. Worldwide, physicians have been at the frontline
of public health advocacy with respect to health promotion
strategies such as smoking bans, seat belt use, and other
aspects of road injury mitigation. Nigeria is Africa’s most
populous country and our raw RTA statistics are pretty much
unacceptable. As a matter of urgency, Nigeria’s physician
bodies should initiate advocacy efforts directed at engaging
the Ministry of Health, nongovernmental organizations, other
health-care providers, industry and other stakeholders toward
efforts geared at establishing a national trauma database for
systematic data generation and creation of a national platform
to aggregate research inputs and resources. These efforts must
besimultaneouslyaccompaniedbyintensiedandrefocused
efforts by the government and other stakeholders at other
interventions to mitigate the problem of RTAs, including mass
safety awareness and educational initiatives targeted at key
demographic groups, improvements in access to healthcare
and in trauma management systems to reduce the intensity
of injuries suffered by the victims. According to the WHO,
low- and middle-income countries account for 92% of road
trafcdeathsworldwide.Nigeriahasonlybeenusedasacase
study to exemplify the burden of RTA. Therefore, many of the
features raised in this call for action are applicable to other
low-income countries.
Conclusion
There is an increasing burden of RTA and injury-related
deaths globally. Nigeria has one of the highest rates of road
trafcfatalitiesintheworld.Theresponseofthegovernment
in controlling this scourge has been inadequate. By taking a
public health approach to the prevention of RTA, we have the
opportunitytohaveabroaderinuenceonthephysical,social,
emotional, and economic manifestations of this scourge. We
can use data generated systematically to identify the burden
and risk factors, design and test interventions that will address
these, and then translate the interventions for implementation
in the community.
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Onyemaechi and Ofoma: Road trafc accidents and public health in Nigeria
204 Annals of Medical and Health Sciences Research | Volume 6 | Issue 4 | July-August 2016 |
Financial support and sponsorship
Nil.
Conicts of interest
Therearenoconictsofinterest.
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