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Road traffic injuries in Namibia. A mixed methods study to analyse the trends in mortality and morbidity due to road crashes, and to investigate the long-term effects of road injuries
Abstract and Figures
Background: Road traffic injuries (RTIs) are a major problem worldwide. In this mixedmethods thesis I investigated the trend of RTIs in Namibia, which is one of the worst affected countries globally. I also investigated the long-term impacts of RTIs and the role of a fuel levy fund - The Motor Vehicle Accident Fund (MVAF) - in enhancing the availability of rehabilitation and counselling services to RTI survivors in Namibia. Methods: Using quantitative methods, I conducted analysis of data sets on RTIs from 2012 to 2014. Descriptive analysis was used to characterise crashes, injuries and deaths, and people affected. Further to this, I conducted multinomial logistic regression in order to investigate the likelihood of having been injured or killed. Using qualitative methods, I conducted semi-structured interviews with RTI survivors in Namibia, and healthcare workers involved in caring for them, in order to investigate the long-term impacts of RTIs and the availability of rehabilitation and counselling services to road injury survivors in Namibia and the role played by the MVAF. Results: The quantitative analysis showed over 2012-2014, the rates of injury and death had risen by 3.9% and 1.1%. Logistic regression identified the road user group had the greatest influence on the risk of being injured and killed. The method of transportation to hospital had the greatest influence on the risk of dying among those admitted to hospital. The qualitative analysis showed that RTIs are associated with long-term physical and mental health sequalae, financial hardships, and various social problems. The analysis also showed the MVAF is effectively helping to enhance access to rehabilitation and other health services for RTI survivors. Conclusion: The present study adds to the knowledge of the long-term impact of RTIs and presents new information from Namibia, where no previous studies of this kind have been done.
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... This qualitative study was part of a PhD study by the lead author (MC) investigating the longterm impact of road injuries in Namibia and began with a review of the literature described elsewhere in detail [22]. The design of this study was based on the principles of grounded theory research and involved conducting two sets of interviews face to face. ...
... Thus the lead author did all of the coding. The coding is tree is available elsewhere [22]. In line with an inductive approach, we had no pre-defined themes to guide the coding process and the codes formulated were data-driven. ...
... In line with an inductive approach, we had no pre-defined themes to guide the coding process and the codes formulated were data-driven. A thematic map was developed to show the themes and how they related to each other [22]. ...
Road traffic injuries (RTIs) are a major problem worldwide with a high burden of mental health problems and the importance of psychological support following road injury is well documented. However, globally there has been very little research on the accessibility of psychological services following road injury. Namibia is one of the countries most affected by RTIs but no previous studies have been done on this. In this qualitative study we investigated the availability of psychological services to RTI injured in Namibia. Our study findings are in line with those of other global studies in showing inadequate access to psychological support for injury survivors and we discuss the reasons. It is hoped these findings will help policymakers develop ways of enhancing access to psychological support for the many people injured in RTIs in Namibia. The models they develop may also be of use to other LMICs countries with high RTI rates.
... 46% of injuries and 40% of fatalities were aged between 16 and 35 years; 64% of those injured and 70% of fatalities were male. This is a critical factor because it frequently means that the breadwinner of a family is killed or injured, which multiplies the effect of the problem (Chatukuta, 2020). The MVA (2019) reported a 5% increase in 'road crash fatality' between 2018 and 2019 with an annual fatality of 676 in 2019. ...
... 46% of injuries and 40% of fatalities were aged between 16 and 35 years; 64% of those injured and 70% of fatalities were male. This is a critical factor because it frequently means that the breadwinner of a family is killed or injured, which multiplies the effect of the problem (Chatukuta, 2020). The MVA (2019) reported a 5% increase in 'road crash fatality' between 2018 and 2019 with an annual fatality of 676 in 2019. ...
... About 13% result from acts of violence, commonly knife and gunshot wounds (Hedimbi, Amakali-Nauiseb & Niikondo 2019). Statistically, Chatukuta (2020) observed that 60% of SCIs result from recreational activities, such as diving into shallow water, as well as cultural and traditional sports activities; 1% results from falls, mostly by senior citizens from the age of 65 and above. The researcher consequently considered it imperative to study the lived experiences of people with SCIs at the national referral hospital, as this is the primary care facility for those with traumatic spinal cord injury (TSCI) in Namibia. ...
Background: Spinal cord injury (SCI) remains one of the major causes of disability globally. It results in permanent physical disability secondary to devastating neurological defects. When a person sustains SCI, substantial changes and challenges in their lives occur, regardless of their age or socioeconomic status. In Namibia, the knowledge on SCI experiences could be used to improve the care rendered to patients with this injury.
Objectives: The purpose of this study was to explore and describe the experiences of patients with SCIs admitted to the rehabilitation unit at the national referral hospital in Khomas region, Namibia.
Method: A qualitative, explorative and descriptive study design was used. Data were collected by means of in-depth, semi-structured, face-to-face interviews with 15 participants from the rehabilitation unit. Data were analyzed using thematic analysis.
Results: Analysis of the data in this study identified three themes: negative experiences, positive experiences and measures to improve the lives of people living with SCI in the community. Participants experienced varied emotions from anger, stress, disbelief, frustration and sadness, which led to depression. In addition, participants experienced discrimination due to lack of community acceptance hence, improving awareness remains key.
Conclusion: This study provided insight into the lived experiences of those living with SCI as they narrated their struggle from the onset of SCI to their reintegration into the community. The study’s findings can be used to develop self-care strategies and ongoing interventions that focus on maintaining physical and psychological health for spinal-cord injured persons throughout the course of living with disability.
... These datasets were collected and collated by the MVAF based on data from three sources: police records on RTIs; data from calls made to the National Accident Call Centre; and data from claimants involved in RTIs. The MVAF is one of the key agencies involved in road safety in Namibia and is a statutory body funded through a fuel levy organized by the Namibian Ministry of Mines and Energy (Chatukuta, 2019). ...
Road traffic injuries (RTIs) are a major, global problem. Few studies on RTIs have been conducted in Namibia, despite having one of the highest RTI rates globally. We conducted multinomial logistic regression on national Namibian datasets on RTIs 2012–2014. Being a motorcyclist was associated with the greatest risk of being injured (adjusted Relative Risk Ratio (aRRR) 82.1 (95% CI 47.2–142.9)) or killed (aRRR 202.1 (112.7–362.7)). Risks were also elevated for cyclists (57.3 (23.6–139.5)), pedestrians (15.8 (13.2–18.9), passengers (6.1 (5.2–7.2)), relative to drivers. Among those admitted to hospital, the method of transportation to hospital had the largest association with the risk of dying. To our knowledge this study presents new information on vulnerability of different road users, which can be of use to policymakers to develop specific and targeted interventions to protect the most vulnerable road users.
Commissioned by World Bank and funded by United Kingdom government. The research explores the costs and consequences associated with RTI injury in long-term including rehabilitation
Namibia is one of five countries in sub-Saharan Africa that has a fuel tax levy designed to support road injury victims. This study examines how the scheme operates from the perspective of seriously injured or permanently disabled beneficiaries. Using qualitative methods, we conducted semi-structured interviews with RTI survivors in Namibia, and healthcare workers involved in caring for them, in order to investigate the role played by the MVAF. While some wealthier drivers continue to buy private insurance, most Namibians now rely on the MVAF. The analysis show the MVAF is effectively helping to enhance access to rehabilitation and other health services for RTI survivors. There however exist some weaknesses in the system which can be addressed. It is hoped these findings will contribute to discussions about whether the current system is fit for purpose and could serve as a replicable model in other low and middle-income countries (LMICs).
Individuals with disabilities in low-income countries face severe challenges with regards to participating in society on equal terms as non-disabled. Bearing in mind the demographic situation, it will be paramount for political stability and economic prosperity that youth are educated and employed. In poor countries, lacking the "security net" of developed welfare states, youth with disabilities face particular barriers in this regard. In spite of intensive international and national efforts to reach the Millennium Development Goalsi (MDGs) and the signing and ratification of the UN Convention on the Rights of People with Disabilities (CRDP)ii, there is marginal evidence on the particular situation of young people with disabilities and the barriers they face to be included in mainstream society. This chapter draws on recent and unique research on living conditions among people with disabilities in southern Africa, aiming at generating new knowledge about the situation and which barriers that will need to be overcome to achieve participation in society also for the disabled in the young generation of people in low-income countries.
A step-by-step guide to conducting a thematic analysis within the context of learning and teaching.
Background:
Navigating complex health care systems during the multiple phases of recovery following major trauma entails many challenges for injured patients. Patients' experiences communicating with health professionals are of particular importance in this context. The aim of this study was to explore seriously injured patients' perceptions of communication with and information provided by health professionals in their first 3-years following injury.
Methods:
A qualitative study designed was used, nested within a population-based longitudinal cohort study. Semi-structured telephone interviews were undertaken with 65 major trauma patients, aged 17 years and older at the time of injury, identified through purposive sampling from the Victorian State Trauma Registry. A detailed thematic analysis was undertaken using a framework approach.
Results:
Many seriously injured patients faced barriers to communication with health professionals in the hospital, rehabilitation and in the community settings. Key themes related to limited contact with health professionals, insufficient information provision, and challenges with information coordination. Communication difficulties were particularly apparent when many health professionals were involved in patient care, or when patients transitioned from hospital to rehabilitation or to the community. Difficulties in patient-health professional engagement compromised communication and exchange of information particularly at transitions of care, e.g., discharge from hospital. Conversely, positive attributes displayed by health professionals such as active discussion, clear language, listening and an empathetic manner, all facilitated effective communication. Most patients preferred communication consistent with patient-centred approaches, and the use of multiple modes to communicate information.
Conclusions:
The communication and information needs of seriously injured patients were inconsistently met over the course of their recovery continuum. To assist patients along their recovery trajectories, patient-centred communication approaches and considerations for environmental and patients' health literacy are recommended. Additionally, assistance with information coordination and comprehensive multimodal information provision should be available for injured patients.
Background
Cycling is perceived as an unsafe travel mode in many countries. However, road deaths in England have fallen sharply since 2007. We explored whether differences in fatality rates by age, gender and mode persist, and the associations of deprivation with these.
Methods
Using ONS (cycling, pedestrian) and Stats19 (driving) 2007–2012 data for travel-related deaths, including pedestrian falls, and National Travel Surveys 2007–2012 travel data, we calculated fatality rates for England by distance (f/bnkm) and time travelled (million hours’ use, f/mhu) by age, travel mode, and gender or residential Index of Multiple Deprivation.
Results
Fatality rates fell significantly 2007–2009 to 2010–2012: male f/bnkm from 2.8 (95%CI 2.7–2.9) to 2.0 (1.9–2.1) for driving; 32.1 (28.5–36.0) to 20.8 (18.1–23.9) for cycling; and 51.4 (48.5–54.4) to 36.7 (34.3–39.3) for walking. Fatality rates varied by age, gender, and mode. Driving and walking fatality rate ratios were generally higher for males than females. For males 17–20y, fatality rates were 0.76 (0.69–0.83)/mhu for driving and 0.28 (0.18–0.42)/mhu for cycling but were similar by distance. Age-specific rates were J-shape for cycling, U-shape for driving, and increased exponentially with age for walking. Fatality rates aged 80+ were an order of magnitude higher in each mode than the all-age mean. Compared with those aged 17–20, rate ratios were significantly lower for male drivers 21+ and female drivers 21–74, but were higher for male cyclists aged 55+ and pedestrians 45+ (male) and 65+ (female). People living in the most deprived quintile generally had higher fatality rates than those in the least deprived quintile overall (three modes combined) and for walking but not for cycling; Rate ratios were highest for pedestrians 35–64 and drivers 35–54.
Conclusions
Fatality rates for walking, cycling and driving are higher for males than females at almost every age and vary more by age than by travel mode. Deprivation exacerbates walking and driving fatality rates.
Aim: Persistent disability following traumatic injuries can disrupt future plans and create uncertainty about how to mitigate future impacts. It is unknown how or whether perceptions of the future change in the years after injury. Therefore, the aim of this study was to explore trauma survivors’ perceptions of their future over time.
Methods: A longitudinal qualitative study, nested within a population-based longitudinal cohort study, was undertaken in Victoria, Australia with survivors of serious injury. Sixty-six seriously injured adults (≥16 years) without severe neurotrauma were interviewed at 3 years post-injury (n = 66), and re-interviewed at 4 (n = 63) and 5 years (n = 57) post-injury. A longitudinal thematic analysis was performed.
Results: Many traumatically injured people had persistent physical and mental impacts. Participants reported being anxious about pain, mobility, work, housing and accommodation, social activities, and finances in their future. Others were hopeful and optimistic regarding their future and developed coping strategies and adopted new viewpoints.
Conclusion: Over time, most seriously injured people’s perceptions of the future remained consistent. Some had enduring anxiety and others sustained hopeful approaches. Personalised and targeted interventions that address specific concerns could reduce anxiety and support positive adjustment following traumatic injury.
• Implications for rehabilitation
• Many seriously injured people, particularly people who sustained orthopaedic injuries, held concerns about experiencing persistent pain, physical impairment, and reduced mobility in the future.
• Personalised and targeted interventions that address specific concerns about future financial, social, housing and employment issues could reduce anxiety and support coping and adjustment strategies.
• In addition to their direct impacts on post-injury recovery, health, rehabilitation, occupational, social, and insurance systems all have a role in facilitating positive responses of injury survivors that draw on their strengths and sources of resilience.
Title:
Care coordination experiences of people with traumatic brain injury and their family members 4-years after injury: A qualitative analysis.
Aim:
To explore experiences of care coordination in the first 4-years after severe traumatic brain injury (TBI).
Methods:
A qualitative study nested within a population-based longitudinal cohort study. Eighteen semi-structured telephone interviews were conducted 48-months post-injury with six adults living with severe TBI and the family members of 12 other adults living with severe TBI. Participants were identified through purposive sampling from the Victorian State Trauma Registry. A thematic analysis was undertaken.
Results:
No person with TBI or their family member reported a case manager or care coordinator were involved in assisting with all aspects of their care. Many people with severe TBI experienced ineffective care coordination resulting in difficulty accessing services, variable quality in the timing, efficiency and appropriateness of services, an absence of regular progress evaluations and collaboratively formulated long-term plans. Some family members attempted to fill gaps in care, often without success. In contrast, effective care coordination was reported by one family member who advocated for services, closely monitored their relative, and effectively facilitated communication between services providers.
Conclusion:
Given the high cost, complexity and long-term nature of TBI recovery, more effective care coordination is required to consistently meet the needs of people with severe TBI.
This paper investigates the effects of India's rural roads programme (PMGSY) on morbidity, using data on 279 households drawn from 30 villages in upland Orissa. The households were surveyed in 2010 and 2013, yielding an unbalanced panel of 1580 individuals, 1076 of whom were present in both years. Ten of the villages had received a direct all-weather road connection between 2004 and 2013. To estimate the programme's effects, the villages were treated as units within the whole network of roads and medical facilities. The provision of a connection, whether direct or in the neighbourhood, was associated with the following reductions in morbidity (random-effects estimates): for each km of unpaved track so replaced, an inhabitant's probability of suffering a bout of incapacitating illness fell by 4.5 percentage points and the expected duration of such illness by 0.53 days. The village fixed-effects estimates are qualitatively the same, but smaller and less precise. A simple indicator variable for the presence or absence of such a connection yields qualitatively similar estimates, but with very large standard errors, which confirms the importance of employing fine measures of the network regressors.
Alcohol abuse often co-exists with a major depressive disorder. In order to understand the development of this comorbidity, it is important to concentrate on the preceding process. It has been suggested that the link between alcohol use and depressive symptoms is a result of an interaction with genetic factors. The aim of this study was to longitudinally examine the effect of the 5-HTTLPR genotype on the association between depressive symptoms and alcohol use in a Dutch community sample. Following a stepwise approach, bivariate correlations, longitudinal regression analyses, and latent growth curve analyses were separately conducted for 316 males and 321 females. A positive correlation between depressive symptoms and alcohol use was shown in female carriers of the 5-HTTLPR short allele. In addition, latent growth curve analyses showed a positive association between alcohol use and the intercept of depressive symptoms (but not the slope), but only in female carriers of the 5-HTTLPR short allele. These findings show that alcohol use may be positively related, at least cross-sectionally, to depressive symptoms in female carriers of the 5-HTTLPR S allele, and indicate that moderators such as SLC6A4 genotype and sex need to be taken into account when examining associations between depressive symptoms and drinking behavior. In order to gain insight into the longitudinal association between alcohol use and depressive symptoms, studies should concentrate on earlier stages and focus on more fine-grained research designs that allow day-to-day changes in both alcohol use and depressive symptoms.
This study explores the importance of social networks and transport for people who had experienced a traumatic injury three years earlier. Many participants found travelling difficult because of pain, discomfort, fatigue and mobility impairments caused by their injuries which led them to be highly dependent on being a passenger in cars driven by others, or on public transport and taxis, to meet their travels needs. After injury, participants’ needs to travel were often high because they had to attend regular medical and physiotherapy appointments. They also needed to be able to travel to reengage with social activities. For those who used public transport or taxis, new challenges were faced in terms of the preplanning, lack of accessibility and availability of these modes. Participants that lived in rural areas with infrequent public transport keenly felt their dependence on others for transport as did those who were wheelchair dependent where car based travel was the only option. Participants described their dependence on others for travel as feeling they were a burden. For some participants their social network could not help with travel. This meant that they either did not travel or had to absorb the costs of taxis. Practical support from the Transport Accident Commission compensation scheme in terms of taxi vouchers were useful and appreciated. However, the service provided by taxis was perceived as costly and, at times, described as unreliable and unsafe. There were many hidden costs related to supporting the travel needs of injured people. Participants who could not travel and reengage with social activities felt emotionally low, isolated and vulnerable. Service providers need to consider injured people's ability to access support for travel, the availability of accessible transport and help with travel costs in order to support their physical and psychological recovery.