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CHAPTER ONE INTRODUCTION  About 3000 people die from Road Traffic Injuries (RTI’s) daily in the world. Eighty five percent of the deaths and 90% of health years of life lost due to RTIs are from the low income and middle income cou nt ries (Peden et al, 2004) . Mostl y pas sen ger s and pedestrians are affected (ibid). One of the top three causes of deaths for 5-44 years age group in many countries is RTIs (World Bank, 2011). This has enormous implications for development. The Road Transport and Safety Agency was establish ed by an Act of Parliamen t in 2002 to promote road safety through education, regulation and law enforcement. The Agency has since 2006 been promoting road safety through several activities aimed at reducing inj uries and dea ths rel at ed to roa d tr aff ic cr as hes. The Age ncy fur the r has bee n implementing the road transport policy in order to provide an efficient and effective road transport system. In 2011, a total of 22, 570 road traffic crashes were report ed as compared to 15, 186 road traffic accidents reported in the year 2010 representing a 49 percent increase in absolute terms. Lusaka and Copperbelt provinces continued to record the highest number of road traffic crashes due to the continued increase in motor vehicle population. Currently, a total of over 52,000 motor vehicles were imported in 2011 bringing the cumulative total to 381,948 motor vehicles in the country (RTSA,2012 :2). During 2011, a total of 212 fatalities involving children aged 16 years and below were reported. This represented 13 per cent of the total fatalities. Road traffic crashes are the leading cause of death among people aged between 10 and 24 years old. In Zambia, road traffic injuries have become one of the significant causes of childhood morbidity and mortality. The bulk of the crashes amongst these children are predictable and preventable. Many involve children playing on the streets, young pedestrians , cyclists, novice drivers and passengers of public service vehicles. 1 | Page

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    CHAPTER ONE

    INTRODUCTION

    About 3000 people die from Road Traffic Injuries (RTIs) daily in the world. Eighty five

    percent of the deaths and 90% of health years of life lost due to RTIs are from the low

    income and middle income countries (Peden et al, 2004). Mostly passengers and

    pedestrians are affected (ibid). One of the top three causes of deaths for 5-44 years age

    group in many countries is RTIs (World Bank, 2011). This has enormous implications

    for development.

    The Road Transport and Safety Agency was established by an Act of Parliament in 2002

    to promote road safety through education, regulation and law enforcement. The Agency

    has since 2006 been promoting road safety through several activities aimed at reducing

    injuries and deaths related to road traffic crashes. The Agency further has been

    implementing the road transport policy in order to provide an efficient and effective

    road transport system.

    In 2011, a total of 22, 570 road traffic crashes were reported as compared to 15, 186 road

    traffic accidents reported in the year 2010 representing a 49 percent increase in absolute

    terms. Lusaka and Copperbelt provinces continued to record the highest number of road

    traffic crashes due to the continued increase in motor vehicle population. Currently, a

    total of over 52,000 motor vehicles were imported in 2011 bringing the cumulative total

    to 381,948 motor vehicles in the country (RTSA,2012:2).

    During 2011, a total of 212 fatalities involving children aged 16 years and below were

    reported. This represented 13 per cent of the total fatalities.

    Road traffic crashes are the leading cause of death among people aged between 10 and

    24 years old. In Zambia, road traffic injuries have become one of the significant causes

    of childhood morbidity and mortality. The bulk of the crashes amongst these children

    are predictable and preventable. Many involve children playing on the streets, young

    pedestrians, cyclists, novice drivers and passengers of public service vehicles.

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    Due to this alarming situation where so many young lives are being lost to avoidable

    road traffic crashes, the United Nations (UN) General Assembly unanimously passed a

    resolution proclaiming the years 2011 to 2020 as the DECADE OF ACTION FOR ROAD

    SAFETY.

    In recognising the importance of this UN declaration, on behalf of the country,the

    Agency joined the rest of the world in launching the DECADE OF ACTION FOR ROAD

    SAFETY in May 2011 where a government commitment to ensure the reduction of road

    traffic crashes was made. This declaration is a challenge to all of us not just as RTSA

    but all Zambians because it implores us to reduce road traffic crashes by 50 per cent by

    2020.

    RTIs strongly contribute to mortality, morbidity and increased inequality among theproductive age group and their dependants in Zambia. Fatal road traffic accidents top all

    the risks and threats of life in the country (Andrews, 2011). The estimated road traffic

    death rate in the country is 27.5 per 100 000 population per year and the modelled

    number of road traffic deaths is 3,669 per year (WHO, 2011). However this number does

    not include those that die after 24 hours which implies under estimation (ibid). An

    estimation of 30% of patients at St Giles Rehabilitation Centre and 60% of people who

    need artificial limbs are a result of RTIs (RTSA, undated). RTIs contribute to loss of

    productive life due to death or due to disability. In Zambia the 26-45 years age group is

    the most affected (RTSA, undated). RTIs cost about 2% of gross domestic product

    (GDP) in the country (ibid).

    Public holidays have been heavily associated with loss of life due to road traffic accidents

    in Zambia (Towindo and Bulla, 2011). Mutore and Nyambuya (2011) in their article

    Dont be a stat this holiday cites Easter, heroes and festive season holidays as holidays

    that RTIs are particularly encountered. This is the time when most people have ample

    time to travel for social gatherings such as church gatherings and visiting friends and

    relatives thereby increasing traffic volume on roads. Occurrence of accidents is also

    related to time, most accidents occur from 0600-1800 hours (RTSA, undated) though

    fatal accident occurs at night with greater frequency than during the day due to reduced

    visibility (Parirenyatwa, 2004).

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    1.2 Statement of the problem

    Having gone through these worrying problems of RTIs one can conclude that RTIs are a

    huge public health and development problem in Zambia. The majority of RTIs affects

    young males who are bread winners. Reducing RTIs and fatalities will reduce sufferingand free resources for development and more productive uses. This leads me to the

    research questions that I intend to answer in my study.

    1.3 Research questions

    1. What are the burden, contributing factors and trends of RTIs in Zambia?

    2. What are the circumstances that lead to road traffic accidents?

    3. What are the strategies that can be used to reduce road traffic injuries?

    4. What can be done to strengthen the road transport sector legislation and policies in

    Zambia?

    1.4 Main Objective

    To analyse the situation on road traffic injuries in Zambia in order to make

    recommendations towards reduction of the burden of road traffic injuries.

    1.4.1. Specific objectives

    1. To describe and analyse road traffic injuries and their trends in Zambia.

    2. To critically analyse causes and contributing factors related to road users, road and

    road sides, vehicles factors and road safety decision making.

    3. To describe and discuss consequences of road traffic accidents in Zambia.

    4. To review current strategies in Zambia.

    5.To identify and discuss good practices from other countries.

    6. To formulate recommendations based on findings.

    2.4. Methodology

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    This study is based on both peer reviewed and grey literature. An active search for

    informal and formal information about RTIs in the country was done to analyse the RTI

    problem. An internet search was done to search for information on RTIs through Google

    scholar, Google search, Science direct, Cochrane library and Pub med. African

    development Bank, World Bank, World Health Organisation and Road Traffic and

    Safety Agency (RTSA) websites were also used to identify papers related to the topic as

    well as other international organisations.

    Analysis of available RTI statistics was done. Efforts to get updates of the situation in

    Zambia were made by listening to news, reading online newspapers and emails from

    colleagues and the Ministry of Transport.

    Current strategies which are being implemented were looked into and analysis of thegap between discourse and practice as well as gap in reducing health inequities has been

    made.

    Below is the adopted conceptual framework from a systems approach and some

    components from commission of social determinants of health framework (Australian

    Transport Council, 2008) (WHO, 2007).

    2.5 Conceptual framework

    To analyse contributing factors for RTI in Zambia the social political country contextual

    factors has been considered as basic contributing factors to RTIs. The systems approach

    model has been adopted (Australian Transport Council, 2008), to consider the system

    as whole, interaction between elements (vehicles, roads, road users and their physical,

    social and economic environments). Some components from the social determinants of

    health framework have been used in the block with country contextual factors and the

    block with socio economic position (WHO, 2007). The systems approach model for

    prevention did not include what happens when the road traffic injury occurs so this

    block has also been added.

    RTIs affect the poor more than the wealthy in developing countries especially

    pedestrians (Nantulya and Reich, 2003). This framework does not separate behaviour

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    from its context for example the intermediary determinants are linked to transport

    policy, land use policy and values of the society. From the left column the first box

    shows contextual factors that bring influence on social stratification leading to

    socioeconomic position. For example transport policy influences the transport

    infrastructure, land use influence distance to be travelled.

    Socioeconomic positions influences susceptibility to RTI; for instance the means of

    transport most frequently used by poor people in Zambia is walking (pedestrian), bus,

    minibuses and cycling and these are more vulnerable to RTIs. Poor people can only

    afford second hand vehicles. Poor people cannot afford trauma care hence this may lead

    to inequalities increasing severity of the problem.

    Zambians cultural and social values put men at more risk of RTI; men are expected toprovide for the family hence end up working more hours causing drivers exhaustion.

    Anxiety, stress, use of sedative drugs and sleeping problems also contributes to loss of

    concentration.

    Education, occupation and income are linked together. Incorporating road safety

    education at schools reduces number of RTIs and improves crossing behaviour

    (Duperex et al, 2002). Awareness of risks and ability to deal with information about

    risks shapes the behaviour and attitudes of an individual. Some occupations such astruck driving also place individuals at more risk. Income has been seen to influence a lot

    of accidents in roads for example commercial drivers are given a target that determines

    their salary, hence competing for passengers, leads to speeding. Demands for income at

    home forces people to work overtime.

    Socioeconomic position influences exposure to RTIs by acting through intermediary

    determinants. These include material factors such as vehicles conditions, roads

    conditions and working conditions, psychological factors and behavioural factors. Thesefactors are interlinked for example lack of material affects living and working conditions

    and this may lead to psychological problems resulting in bad behavioural acts such as

    speeding, drinking and driving. The health system is also influenced by the countrys

    economy. Road environment factors, human factors and vehicle factors are interrelated

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    factors that result in road traffic injuries or safe journeys travelled. They are also

    influenced by material circumstances, behavioural factors and psychological factors.

    Health systems determine the trauma care of the victims of RTI.

    One can conclude that the determinants of RTI are multifactorial. Structuraldeterminants of health form the basis of the RTI outcome. The framework explains how

    social inequities determine risk for RTI morbidity, mortality and differentials in

    socioeconomic groups.

    2.6. Limitations of the thesis

    The researcher faced a lot of problems trying to get updated RTI information from

    Zambia. It is very difficult. Statistics from the RTSA website were used and the World

    Health Organisation (WHO) Zambia profile has 2007 statistics for injury surveillance.

    Data reported and quoted by different entities were often conflicting, which may be

    related to differences in reporting (quality and completeness).The researcher used

    personnel experiences and newspapers articles in some situation which at times may not

    be valid.

    CHAPTER TWO

    LITERETURE REVIEW

    2.1. Understanding road traffic injuries in Zambia

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    Severe injuries and mortality in road traffic accidents are a public health problem with

    consequences such as long term disabilities which are similar to any other public health

    problem such as tuberculosis, HIV/AIDS and cancer, but they are not mentioned in the

    Millennium Development Goals (MDGs).

    Road injuries continue to increase in many countries, around 1.2 million die in road

    accidents annually, 65% being pedestrians and 35% of pedestrian deaths are children

    (UNECA et al, 2011). Low and middle-income nations account for 85% for all road

    traffic deaths (Arumugam, 2007). The top cause of death by injury is road traffic injuries

    (UNECA et al, 2011). Disability due to road traffic injuries account for about 30-

    50million people (ibid). The traumas involved account for lot of costs, about 1 to 3 % of

    GDP in most countries which implies that road injuries result in a lot of expenditure

    (UNECA et al, 2011).

    Road Traffic Accidents in Zambia

    In Zambia, Road traffic accidents and the deaths that follow have always been a major

    public concern. Each year thousands of Zambians fall victim to road traffic accidents.

    Each month, tens of Zambians are killed on our roads. Between April 18th and July 30th

    1988, 30 road traffic accidents were reported in one of the daily newspaper.1 This was in

    a midst a serious economic crisis and a time when Zambias motor vehicle number was

    still very small. On November 25th 2009, it was reported that 44 deaths occurred in just

    one month.2

    In 2002, there were 8 855 road traffic accidents and 1 000 dead. In 2003, there were 21

    692 road traffic accidents through which 1 046 people were killed and 2 696 seriously

    injured.3 In 2005/2006, a total of 33 165 road traffic cases were recorded by the Zambia

    Police. 14 075 of the accidents occurred in 2005 resulting in 1 075 killed and 3 397injured. In 2006, there were 19 095 recorded cases of road traffic accidents in which 1

    170 people killed and 3 963 seriously injured. 12 171 individuals were slightly injured. In

    1Zambia Daily, April-July, 1988.2Post newspapers, 12th November 2009.3 Mercy Mwila, New countrys highway code to lessen road traffic accidents, Times of Zambia. 30th January 2010.

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    2006/7 the Zambia Police recorded a total of 33 165 cases of road traffic accidents.4 The

    number of those killed on Zambian roads increased from 892 victims in 2004 to 1 170 in

    2006 to 1 266 people in 2007.5

    According to the Road Transport Safety agency (RTSA) Annual Report for the year

    2008, about 1 238 people were killed on Zambian roads from 19 727 road traffic

    accidents. Passenger deaths constituted 30% of the total number of accident victims

    while pedestrian deaths accounted for 48% of the total. 75% of the accidents occurred in

    urban areas, or 14 850 accidents compared to rural areas which recorded a total of 4 877

    accidents.6 There were 852 deaths recorded in the year 2009 out of a total of 16 531

    accidents while 2 740 people were seriously injured7.

    The above accidents were attributed to an increase in second hand vehicle on the

    Zambian roads and careless driving by some drivers. Even though there is a general

    belief that accidents are unavoidable, on the contrary, experts are of the view that 95%

    of the accidents in Zambia are due to human error while motor vehicle malfunction

    accounts for only 3% of the total. Poor transportation infrastructure accounts for

    remaining 2%.8

    The major causes of road traffic accidents have been linked to poor public service

    driving and a dilapidated road infrastructure, most of it built in the 1970s. Most of the

    roads have large potholes that are often the cause of accidents as motorists try to avoid

    them. Roads do no have street lights, therefore making it difficult for motorists to see

    pedestrians. Most road users, especially the young and elderly have no knowledge on proper

    road use, drivers do not go to driving schools or get their licenses before they could gain

    adequate competence in driving and there are no alcohol tests.9 These factors are compounded by

    corruption over licenses, road worthiness of motor vehicles, overloading, speeding and alcohol

    4Times of Zambia, Tuesday, 19th February, 2008.5 Joseph Schatz, On the road in Zambia, 2008.6 Mercy Mwila, New countrys highway code. 30th January 2010.7 http://www.znbc.co.zm/media/news/cgi?8 Mercy Mwila, New countrys highway code. 30th January 2010.9 Mercy Mwila, New countrys highway code, 30th January 2010.

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    abuse among drivers. Like elsewhere in the developing world, most of the road traffic victims

    are young people. School going children are most vulnerable.10

    Road traffic accidents rank as the third largest killer in the country after Malaria and

    HIV/AIDS.11 Even though this appears to be the official appreciation of the gravity of

    deaths from road traffic accidents, I find it difficult to accept such a ranking. An average

    death toll of about 1 200 individuals per annum, appears too low to constitute the third

    highest cause of death in Zambia. There is need therefore to come up with comparative

    statistics on the causes of death in the country before the above ranking could be

    affirmed. However, apart from loss of human lives, the road carnage also causes

    damage to property, results in serious injury and ends in temporal or permanent

    disability. The cost arising from road traffic accidents in Zambia has been estimated at1.3 trillion Zambian Kwacha (about 282 million US dollars) or about 3% of the GDP,

    each year.12 This is besides the grief and suffering that come with each accident.

    3.1. Country contextual factors contributing to road traffic injuries

    The conditions in which people live and work determine their health status (ICSU,

    2011). These conditions have an influence on the severity of RTIs and cause disparities

    among peoples chances of leading healthy lives. Cultural and social values also

    influence the road users perception on the impact of RTIs. Gordon Chavhunduka, atraditionalist, argues that cleansing ceremonies could help in treating the black spots

    through consultation with the spirit medium of the respective places where RTIs are

    common (Mukarati, 2011). Some also argues that African countries have faced many

    disasters such as war, famine and fatal diseases so they perceive RTIs as killing a

    relatively few people because they have witnessed many people dying in a massacre

    (Assum, 1998).

    Interpretations of sudden death in Zambia: A tentative discussion

    10 Mercy Mwila, New countrys highway code, 30th January 2010.11Times of Zambia, 16th November 2007. http://allafrica.com/stories/200711160013.html12 Mercy Mwila, New country highway code, 30th January 2010, Radio Phoenix News, 31st March 2010.

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    In his doctoral work Mwewa, a Catholic priest devoted some space to the discussion of

    various aspects of death in Zambia. He noted that except for sudden death, normally,

    nobody dies unattended to. He also distinguished between natural and unnatural

    deaths. Whereas natural death was easily accepted and often came about on account of

    old age, unnatural or bad death in contrast, was invariably problematic. The latter

    death was usually associated with evil men, witches, curses and aggrieved spirits. The

    deaths which this paper is concerned with and highlights fall in the category of

    unnatural or bad deaths. These are deaths that are occasioned by road traffic

    accidents, are sudden and therefore difficult to deal with. As Eyetsemitan noted;

    Whereas the grieving process begins before death occurs in the case of a dying person, it

    begins after death has occurred in the case of sudden or unexpected death. In the case of

    dying there is anticipation that death will ultimately result. Therefore, the loved ones

    have time to prepare both emotionally and cognitively for death when it occurs. Here,

    coping after death is easier for the survivors and the dying person has time to take care

    of unfinished business such as preparing a Will. However, in the case of sudden death,

    because such preparation is absent, coping by loved ones is difficult

    It is the difficulties associated with sudden death and in the case of road traffic

    accidents, the gruesome nature of such deaths, which lends them open to many

    interpretations

    Tradition views

    Traditionally, most road traffic accidents are caused by spirits or supernatural powers.

    How such an interpretation is arrived at depends on a number of factors such as; the

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    nature of the accident, the purpose of the trip, the means of travel or the spot on which

    the accident occurred. A few years ago, a colleague lost a brother in-law . After burial,

    relatives of the deceased decided to exhume the body for reburial without informing the

    husband or relatives of the deceased husband. On their way back from the village they

    were involved in an accident in which some members of the family died while others

    were injured. How could such deaths be explained? I discuss this story more fully below.

    There is also a generally held view that a road traffic accident could be caused by a

    chisomo, usually sent by someone to cause death.

    My account starts with the death of a Minister of Home Affairs Luckson Mapushi who

    died in a road traffic accident a few months after he was appointed and was elevated to acabinet post in December 2002. On the day he died he had gone back to his Keembe

    constituency. Whilst addressing a meeting a bolt of lightning struck his brother and left

    him unconscious. Suspicion over the incident led to the cancellation of the meeting. Still

    horning his driving skills, the Minister and his wife decided to drive back to his rural

    base in Chibombo. On the way, he lost control of his vehicle, hit into a tree and died

    instantly.

    The Home Affairs Ministers sudden death, created a furole. There were bitter

    recriminations among members of his family and between his family and that of a

    former Minister of Finance. Among those suspected of having being behind the death

    was a close member of the deceased family and a former Minister of Finance. The late

    Ministers sister who happened to be the then presidents wife openly accused the

    former government officials family of having killed his brother and called upon them to

    eat his body.

    The Ministers death occurred at a time when the accused government official was on

    the run for alleged corrupt activities and was therefore being sought after by the police.

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    The accused came from a part of Zambia that is noted for being a den of witches,

    Chiengi district and was he himself considered a powerful wizard who was able to evade

    capture by invoking his supernatural powers which made him invisible to his pursuers.

    The accused was said to be hiding in the bush in his native Luapula Province and it was

    claimed that he was able to communicate with the rest of the world using a laptop

    computer even though he was in an area without electricity or internet connection.

    It was reported that while driving, the Minister had seen someone in the middle of the

    road and had, in the process of trying to avoid hitting into a human figure, swerved off

    the road and hit into a tree. The man in the middle of the road was not real but a

    shadow sent by the wizard to provoke the accident.

    It was on account of the above beliefs that when the man who was the Minister in charge

    of the police died, fingers were immediately and directly pointed at the individual on the

    run. Taking the lead was the deceased sister who as already noted was the then

    Presidents wife. A bitter exchange of words ensued between the sister to the deceased

    Minister and the wife to the accused man. The matter was widely covered in the national

    media.

    A sober analysis of what caused the accident revealed that the Minister in question, who

    had just been elevated to cabinet level, was still learning how to drive what was a

    powerful 4X4 motor vehicle which may have proved difficult to handle in a bush track.

    However, given the incident that had led to the cancellation of a political meeting in

    Keembe earlier, and the acrimonious relationship that had emerged betweengovernment and the family of the former Minister of Finance, Mapushis sudden death

    was immediately looked at with suspicion and considered unnatural.

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    The above saga was not strange to most Zambians. Like everywhere else on the African

    continent, there are hundreds of myths concerning death and its causes and in

    particular, sudden death. It is explained in many ways. It may be caused by sorcery,

    witchcraft, magic, spirits or a curse among others. Magesa noted that in the African

    mentality, everything wrong or bad in society and in the world, and, most particularly,

    various afflictions and I add, or sudden death, originates in witchcraft.

    Mapushis death was sudden and traumatic. It was difficult to accept or deal with. It

    broke in the words of Zahan, the natural and regular progression of things. It was a

    distressful event which was striking because of the suddenness with which it shattered

    order by brutally destroying the continuum of time. Under such difficult circumstancesrelatives were compelled to seek answers on the cause of the accident by recourse to the

    supernatural.

    Traditional beliefs have remained persuasive and continue to hold sway despite

    increased recourse to modern science and apparent westernization of the Zambian

    society. Accidents in Zambia are a daily occurrence. However, the fact that the death of

    the Home Affairs Minister occurred at a time when the police were after an alleged

    wizard and suspect on the run, resulted in many accusations and counter accusations.

    Those involved were well educated and therefore part of the modern Zambian elite.

    However, faced with a sudden and accidental death, they fell back on traditional beliefs

    to explain its cause.

    Witchcraft was immediately suspected because for sometime before the accident, abitter and acrimonious exchange of words had ensued between the wife of the alleged

    wizard (the former Minister of finance) and suspect on the run and government officials

    in particular, the then President, his wife and the Minister of Home Affairs. Government

    was accused of using false accusations of corruption against certain former government

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    officials and in this particular case, the former Minister of finance, to wage war against

    people who were deemed close to the former President, Chiluba. It appeared logical

    therefore to consider the Ministers death as having been brought about by witchcraft.

    How anyone got to know about what the deceased saw in front of the bush track he was

    driving along, remains within the realm of African traditional beliefs and cannot

    therefore be explained through logic or modern science.

    Accident Black Spots as Haunted Places

    There is a common Africans traditional belief that a spot where road Traffic accidents

    occur for more than once, even if it is only twice must have a particular significance,

    mostly, a supernatural one. Dixon wrote of one such a spot in Chivhu in Zimbabwe; the

    road is scarred with skid marks, others pencil straight. They shriek the fate of unluckytravelers who lost their lives; they mark near-missed. Frequent road traffic accidents

    on the spot led Zimbabweans to the conclusion that the cause of such accidents was not

    natural but supernatural. Ancestral spirits were involved and performance of

    appropriate rituals to propitiate the spirits of the dead ancestors was deemed the only

    possible remedy. Why that particular part of the highway had become a black spot was

    traced back to Zimbabwes first contact with the white men who arrived in what later

    became Southern Rhodesia as members of the pioneer column in 1890. The pioneers

    established a camp at Fort Charter near the current highway. Local Africans believe that

    many of their ancestors were thrown into a burning pit by the foreigners.

    In the past, there were no accidents on the spot. This was because local people

    remembered their ancestors through performance of religious rituals which were

    characterized by the slaughter of cattle. The animals blood and meat would then be

    shared with the ancestors. In this way, the spirits of the living dead would be appeased

    and they in turn ensured the safety of their still living kinsmen and women. However,

    in the last 10-15 years, such local religious practices have been neglected. Non

    observance of traditional rituals can probably be partly explained by the economic crisis

    the country has been passing through but is most likely also due to the influence and

    impact that evangelical and fundamentalist Christianity has had on African traditional

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    religious practices. In most parts of Africa it is believed that when ancestral spirits are

    neglected or angered, they can cause affliction and even death.

    There are indications that South Africa may have its own black spots. A newly arrived

    pastor from South Africa told me of a recent spate of terrible road traffic accidents thathappened on Mabopane Highway. The first occurred on the 16th and the second on the

    17th March 2010. A taxi (known as mini bus in Zambia) hit into a barrier before

    plunging 8 metres down the bridge. A total of 24 people died, some on the spot, others

    in hospital. Newspapers reported a total death toll of only 8. In the second taxi incident,

    3 people were killed. This was within 36 hours of the first accident. My informant noted

    that an accident such as the first one had never happened before and was considered

    possible given the way the bridge was constructed. The cause of the accident was traced

    to a rear tyre burst. However, in spite of expert views, many people believe that a snake

    had crossed that stretch of the road. The snake represented a spirit and was the likely

    cause of the two accidents.

    When an accident occurred on a particular stretch of a road, relatives would collect the

    spirit of the dead as a way of cleansing the spot. It is believed that if someone dies on

    the road and his spirit is not taken are, the victim would haunt that place leading to

    more accidents. In Namibia, I was informed that accidents frequently occur at a place

    known as Okakalala, which is near a hill where Satanists are believed to perform their

    rituals.

    2.4 Consequences of road traffic injuries

    It is of great importance to note that road traffic accidents happen in a fraction of a

    second but their consequences take a long time (ETSC, 2007). Besides loss of life or

    reduced quality of life due to road traffic accident, consequences attributed to RTI

    include costs such as:

    Replacement and repair of property damaged

    Medical treatment

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    Home renovations, for example, toilet or bathroom to accommodate wheelchairs as

    well as vehicle adaptation

    physical pain, grief and suffering

    Permanent disability and disfigurement as well as travel anxiety (ETSC, 2007).

    Furthermore RTIs affect household income and national economy through cost of

    prolonged medical care, together with funeral costs and loss of income due to disability.

    Involvement of a breadwinner pushes the household affected into poverty (Odero et al

    1997).

    3.4.1 Socio-economic impact of road traffic injuries in Zambia

    Globally the estimated cost of RTI is 518 billion USD in low income countries the cost of

    RTI is around 65-100 billion USD which exceeds the total amount of assistance that the

    countries received for development (WHO, 2006b). Although no cost study was done in

    Zambia it is estimated that around 1-2% of GDP is spent on road traffic injuries (AfDB,

    undated).

    RTIs affect males in their active period of life, when they are socially important

    economic as heads of household. In 2006, 71% of deaths due to RTIs were males (WHO,

    2012). While women are less victims of RTIs they suffer as secondary victims; loss of

    their husband exposes them to socially, financially insecurity and likewise children also

    are impacted by the social and economic of the loss of their parent (Odero et al, 1997)

    (WHO, 2004).

    WHO noted that the impact of RTI on poor people is greater than the rich and they

    represent the higher risk group such as pedestrians, passengers and motorcyclists.

    Although not all pedestrians are poor, it is assumed that the poor cannot afford buying a

    vehicle hence will be pedestrians or passengers. Low socio economic group of people

    have less access to medical services and this results in disparities of recovery and

    survival (Sharma, 2008).

    3.5. Health systems response to RTIs

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    The health systems response to RTIs influences the degree of recovery as well as survival

    chances (Chen, 2010). Zambias health care system has been characterised with delays

    in attending to the victims. Shortages of resources and delays in detecting the scene of

    crash have been the hiccup of the health system. Presence of fire resulting from collision

    has also been a contributing factor to worsen the situation (ZBC, 2012). Hospital care

    has also been affected by lack of appropriate emergency care mainly due to lack of

    necessary resources (Biti, 2009); for example, lack of suture materials. Health care

    systems have also been affected with brain drain; many experienced human resources

    have moved out of country for greener pastures hence the poor economy has also lead to

    poor hospital care (IOM, 2012)(Zambia Health Workforce Observatory, 2009).

    Accessibility to services is also influenced by the economic status of the individuals so

    that those who afford to pay for the services are better cared for.

    CHAPTER THREE

    RESEARCH FINDINGS

    3.0 Background Information of Zambia

    Officially the Republic of Zambia, is a landlocked country in southern Africa. The

    neighbouring countries are the Democratic Republic of the Congo to the north, Tanzania

    to the north-east, Malawi to the east, Mozambique, Zimbabwe, Botswana and Namibia

    to the south, and Angola to the west. The capital city is Lusaka, located in the south-central part of the country. The population is concentrated mainly around Lusaka in the

    south and the Copperbelt Province to the northwest.

    Location: Zambia is located in Southern Africa, east of Angola and north of Botswana

    and Zimbabwe; see map below.

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    CHAPTER FOUR

    DATA ANALYSIS

    Figure 1: Map of Zambia

    3.1 Background information about the research setting

    The research was done in Lusaka, which is the capital city of Zambia. Lusaka is the

    capital and largest city of Zambia. One of the fastest-developing cities in Southern

    Africa, Lusaka is located in the southern part of the central plateau at an elevation of

    about 1,300 metres (4,265 feet). As of 2010, the city's population is about 1.7 million.

    Lusaka is the centre of both commerce and government in Zambia and connects to the

    country's four main highways heading north, south, east and west. English is the officiallanguage of the city, but Nyanja, and Bemba are also common.

    3.2 Background information about the respondents

    The researcher interviewed 50 respondents, which comprised of road users and Road

    Traffic Agency Officers. The following chart shows the respondents profile.

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    Profile of respondents

    20%50%

    30% Drivers

    General publicRTSA

    Figure 2: Information about the respondents

    As shown on Figure 2 above, 50 respondents representing 100% were involved in the

    study in which 25 comprised of drivers (road users, that included public transport

    drivers of Taxis and Busses).

    15 respondents comprised of the general public who were sampled from Lusaka main

    trading area representing 30% above.

    The study was comprised of 10 Road Traffic Safety Agency (RTSA) Officers)

    representing 20% in Figure 2 above.

    3.3 RESEARCH FINDINGS IN RELATION TO THE RESEARCH

    OBJECTIVES

    3.3.1 To analyse the situation on road traffic injuries in Zambia in order to

    make recommendations towards reduction of the burden of road traffic

    injuries.

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    From the secondary sources obtained at RTSA Headoffice . In 2011, a total of 22, 570

    road traffic crashes were reported as compared to 15, 186 road traffic accidents reported

    in the year 2010 representing a 49 percent increase in absolute terms.

    Figure 3: Road traffic accidents fatality and injuries between 2010 and 2011

    0

    2000

    4000

    6000

    8000

    10000

    12000

    Lusaka Cen tral C/belt Sout hern East ern W est ern N/W est ern Nort hen Luapula

    RTI between 2010 and 2011

    2010 2011

    As shown above, Lusaka and Copperbelt provinces continued to record the highest

    number of road traffic crashes due to the continued increase in motor vehicle populationbetween 2010 and 2011.Lusaka provinces alone in 2010 had 8217 and in 2011 it had

    recorded 11,498.In the copper belt in 2010, accidents were at 3116 and in 2011 they were

    11, 498. It was followed by Central province and the lowest province for accidents was

    Luapula province. Currently, a total of over 52,000 motor vehicles were imported in

    2011 bringing the cumulative total to 381,948 motor vehicles in the country.

    3.3 To describe and analyse road traffic injuries and their trends in Zambia.

    The researcher interviewed 50 (100%) on the trends of traffic accidents and injuries in

    Zambia.23 respondents representing 46 % indicated that road traffic injuries is human

    error i.e. dangerous driving, over speeding and failure to follow traffic rules.

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    Human error

    46%

    Economical

    24%

    Spiritual30%

    Human error

    Spiritual

    Economical

    Figure 4: causes of road traffic injuries

    12 respondents representing 24 % attributed road traffic injuries to economical

    challenges.

    15 respondentss representing 30 % said that, accidents in Zambia most of them are as a

    result of spiritual explanation, in which it was attributed that Satanists are causing

    major accidents in Zambia in their plea to getting rich.

    3.4 To critically analyse causes and contributing factors related to road

    users, road and road sides, vehicles factors and road safety decision

    making.

    A survey on the causes of sudden accidents in Zambia revealed that, human error is the

    major contributing factor followed by spiritual practices such as Satanism practices.(See

    Appendix 2).

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    17 die in Kabwe Lusaka Road when the bus collided with a Track, on 1st May 2013

    The wreckage of the bus that collided with a Kabwe-bound Sabot Zambia truck in Liteta

    area on 31st May 2013.

    3. 5 Strategies to prevent Road Traffic Injuries

    The research findings showed five good practices to be developed so as to prevent road

    traffic injuries in Zambia as shown on the table below

    Strategies Frequency

    50

    Percentage

    100%Road safety management

    Prayerful lifestyle amongst

    road users

    Restriction of

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    Safety education for

    pedestrians

    Enforcement to reducealcohol impaired driving

    Total 50 100%

    Table 1: strategies to prevent road traffic injuries

    CHAPTER FOUR

    DATA ANALYSIS

    4.1 To analyse the situation on road traffic injuries in Zambia in order to

    make recommendations towards reduction of the burden of road traffic

    injuries.

    What the paper does therefore is to take a look at the occurrence of sudden death, in

    particular sudden death through road traffic accidents that are more numerous and

    more frequent. What meanings do Zambians attach to such deaths and how have these

    meanings changed over time? Consideration of the nature and causes of road traffic

    accidents in Zambia and their explanations will cover a twenty- year period; 1980-2010.

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    This period has been chosen in that it covers two specific eras in Zambias history. The

    period 1980-1991 was characterized by a serious economic decline and a critical

    shortage of almost everything. During this period the existing basic transportation

    infrastructure deteriorated significantly and motor vehicle owners could not get spare

    parts for their vehicles. After 1991, the economy was liberalized. Purchase of motor

    vehicles became easier and spare parts became more readily available. It would be

    important to see what impact these developments had on the nature, causes and rate of

    road traffic accidents in Zambia and the meanings Zambians attached to them.

    Even though road traffic accidents have been a major source of concern and a subject of

    a Commission of enquiry at one time, no historical study has ever been carried out to try

    and better appreciate the nature of the problem, its causes and how those affected by

    consequent deaths dealt with sudden tragedy. Each year, thousands of Zambians are

    killed or maimed through road traffic accidents at great material, financial and

    emotional cost to the nation. What has been the Zambians attitude and reaction towards

    such loss of life?

    Apart from seeking to better appreciate the nature, causes and reactions to sudden

    death, the paper will also examine how Zambians have tended to explain deathsoccurring through road traffic accidents and how this has evolved over time. Deaths

    from road traffic accidents are often explained on the basis of traditional systems of

    beliefs and practices. This usually depends on how the accident occurred, the reason for

    travel, mode of transportation and in more recent times, whether or not a public service

    vehicle was involved. For example, currently, most deaths from road traffic accidents

    involving public service vehicles are increasingly attributed to the practices of Satanism.

    The first part of the paper presents a general overview of the subject of research. Thiswill be followed by a discussion of occurrence and nature of road traffic accidents in

    Zambia and the last part will focus on the various interpretations that have been

    proffered to explain sudden death through road traffic accidents.

    Road Traffic Accidents an Overview

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    Road traffic accidents and road traffic injuries are a major and growing public health

    problem that impacts on all sectors of society. They remain are major cause of death and

    disability in developing countries. According to the World Health Organization

    estimates, worldwide deaths from road traffic accidents increased from about 999 000

    in 1990 to about 1.2 in 2002 . The number is projected to rise to 2 million deaths per

    year by 2020. The number of such deaths is expected to continue to rise as societies

    become more motorised.

    Although developing countries have fewer vehicles, accounting for only about 40% of

    the worlds total, they bear the heaviest burden. 85% of the total road traffic fatalities

    Like in Zimbabwe and elsewhere, Zambia has its own black spots scattered across the

    country. The history of these spots varies from place to place. Mostly they are linked tosome unappeased spirit. The deaths are usually of a criminal natural in which an

    innocent life is brutally lost or a person is killed in a hit and run accident. These are also

    cases in which those involved are never known or brought to justice. The spirits of the

    dead are therefore said to haunt these places and the road traffic accidents and the

    deaths that occur are invariably linked to the spirits of those who were killed on that

    spot.

    Among a large number of places that are considered as black spots, is a spot in MunaliHills on the road to Mazabuka. I was informed that each time there was an accident in

    those hills it occurred on one particular spot and vehicles fell on the same side of the

    road and in the same ravine. The other was a spot on the Great North Road when

    crossing it from the Railway club to the town centre. I was told that many people have

    died on the spot and that last year alone, three people died while trying to cross the

    road. Other areas indicated as black spots were; Kapiri Ngozi along the Lusaka

    Chirundu road, the area around Shimabala on the Lusaka Kafue road, Landless corner

    on the Lusaka Kabwe road, a stretch on the same road near Zambia National Service, a

    corner near Mulungushi Textiles in Kabwe, the area between Chainama and Mumana

    Pleasure resort in Lusaka and Mubanga-Chipoya Basic School in Kasama. Each district

    and province has its own black spots.

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    Accident black spots have been central in the interpretations of sudden deaths on our

    roads. They are generally considered as haunted places or an abode of malevolent

    spirits. The black spot at Mubanga-Chipoya Basic School in Kasama was haunted by the

    first person to die on spot. Five accidents have been recorded on the spot since 1998. At

    the black spot near Chainama, drivers have reported sudden appearances of human

    figures in the middle of the road at night. In other instances, drivers are said to have

    seen a hump, an animal or some obstacle ahead of them or found themselves caught in

    the glare of headlamps of a vehicle that was not there. An attempt to avoid such a figure

    would result in an accident and certain death of the driver.

    All deaths that occur on black spots are as a consequence, invariably deemed unnatural

    and therefore as caused by a malevolent spirit, a curse, black magic or more increasingly

    by satanic practices. Up to sometime in the early 1990s, accidental deaths through road

    traffic accidents were attributed to witchcraft, curses or black magic. They were

    associated with ghosts, a woman who was not properly cleansed or simply jealousy.

    Today, most of these deaths are increasingly explained by satanic ritual practices.

    The need for blood is said to be behind the spate of accidents occurring on Zambian

    roads. Blood is considered to be a source of strength and it is used in sacrificial rituals. I

    was informed that initiates into Satanism are made to drink blood in order to enter into

    a covenant with Satan. However, spilling of blood, especially through road traffic

    accidents ensures continued success and growth of a business. Accidents bring wealth, a

    new fleet of buses or taxis. The issue of blood is central to many belief systems. In

    Christianity, we learn from the bible that blood cleanses, heals and is life itself.

    Even though in most cases accidents on particular black spots can be explained by

    technical means, once a spot has earned the tag of a haunted place, the tag remains and

    is generally believed to be so by both Christians and non Christians alike.

    Satanism or satanic practices are increasingly brought in to explain what is happening

    on Zambian roads. Unlike conventional explanations that tend to link recourse to the

    supernatural in times of increasing distress, in Zambia, it would appear that it is the

    apparent affluence of a few in societies and the dramatic increase in the number of

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    evangelical churches that has fuelled current theories on the nature and causes of deaths

    on our roads.

    Apparent affluence is mostly picked on to explain road traffic accidents and ensuing

    deaths. This has been the case in the rural towns and urban areas of Zambian. Thegeneral account is that young men sell their years in order to acquire material wealth.

    This is usually in form of a well stocked grocery shop, or means of transportation such

    as trucks, buses, mini-buses or taxis for ferrying goods or passengers. How one could

    sell years to live a shorter but prosperous life before dying has never been explained. It

    therefore follows that for the apparent level of wealth to be maintained and built upon,

    blood has to spill and some rituals performed at regular intervals. This occurs through

    road traffic accidents.

    Zambia like elsewhere in the world has been marked by a sharp rise Christian

    fundamentalism. Since the mid 1990s the country has seen a dramatic multiplication of

    born again churches which like in the case of Kinshasa in the Democratic Republic of

    Congo as de Boeck noted, have become the norm rather the exception. Thousands of

    Zambians have been drawn to these new churches. The quick development and spread

    of these evangelical or pentecostal churches can be largely attributed to a mix of factors

    such as; political change in 1991, the declaration of Zambia as a Christian Nation by the

    Chiluba regime, liberalization of the economy and the resultant increased social and

    economic indigence, HIV/AIDS, a general increase in the countrys disease burden and a

    quest for quick riches among men of God. The teachings of these relatively new

    churches have had a deep and at times an unsettling influence on their members. One of

    the areas in which these churches have had the greatest influence is over the

    interpretation of causes of death, including road traffic accidents

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    CHAPTER FIVE: DISCUSSION CONCLUSION AND RECOMMENDATIONS

    5.1. Conclusion

    The objective of this thesis was to analyse the situation on road traffic injuries in Zambia

    in order to make recommendations towards reduction of the burden. A conclusion was

    drawn based on a review of the RTI information in Zambia and on experiences from

    other countries. The analysis shows that the country has basic legislation in place for

    road safety, but the laws are not comprehensive in their relevance.

    Speed limits are above the global recommendation, seat belt laws do not apply to all

    vehicle occupants, and the BAC limits level is higher than the WHO recommendation.Above all the country does not have a well-publicised road safety strategic plan or

    national road safety policy which is a huge gap in all road safety activities. Absence of

    the policy documents compromise coordination of activities. Road safety activities are

    said to be implemented but with no target and funding to support the activities are

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    limited. RTIs data lack accuracy. There is negligence of road safety regulations by road

    users, poor law enforcement, and corruption.

    RTIs are a safety problem as well as an equity public health issue in Zambia. Fatal road

    traffic accidents are the greatest existing threat among all risks in the country. Thecountry has a road traffic deaths rate of 27.5 deaths per 100,000 populations per year.

    The most affected age group is 26-42 year and majority of the affected are passengers

    and pedestrians. Males have more risk than females.

    Reckless driving and violation of traffic laws are the human behaviours that influence

    RTIs occurrence. However alcohol impaired and over speeding have been identified as

    the worst human behaviour resulting in accidents in Zambia. Road users include

    motorists, passengers, pedestrians and cyclists.

    Inadequate and corrupted law enforcement coupled with public acceptance has resulted

    in the increase of unworthy overloaded damaged vehicles and unregistered vehicles on

    the road. Vehicle fleets have increased considerably in the country. However the

    majority of these vehicles are not roadworthy.

    Zambian roads have been found lacking in terms of safety measures, which are

    associated with a lot of road traffic injury risks such as poor technical design of the

    highway construction, narrow roads that cannot accommodate high traffic volumes,

    potholes, poor signage, bushes surrounding the roads and stray animals found in the

    road environment. There is no traffic separation such as cyclist lanes, pedestrian lanes

    and all these factors contribute significantly to risk of road traffic injury occurrence in

    the country.

    Those injured face challenges in order to access health care, due to lack of adequate post

    trauma care. RTIs cause suffering within families such as school drop outs and poverty

    due to involvement of the breadwinner. Universal national health insurance is needed to

    improve accessibility to health care services. Majority of the RTI victims are passengers

    and pedestrians. This implies public transport system needs improvement, proper

    pedestrian paths needs to be established and improvement in road traffic law

    enforcement. A sense of responsibility is required to share the road with others

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    A main challenge to road safety in Zambia is the lack of accurate data. Comprehensive

    data is essential for drawing attention from law makers, setting targets, designing and

    evaluating strategies and prioritizing activities.

    In order to improve understanding and awareness of road traffic injuries determinantsand consequences among decision makers, researchers, practitioners and people, I will

    give the following recommendations based on analysis of the study and proven good

    practices from other countries as well as feasibility.

    6.2. Recommendations

    Governments capacity, commitment and support to the established lead agency (RTSA)

    are needed in order to reduce RTI in Zambia. A number of interventions were analyzed

    as to their applicability for Zambia.

    Road safety management

    The Ministry of Transport and Infrastructure Development should finalize the

    national road transport safety policy in order to have an authenticated guiding

    document in all road safety activities.

    Public transport should be improved to address the road transport safety needs of

    vulnerable population (passengers), e.g., setting standards on minibuses and to enforce

    their compliance.

    RTIs data collection and recording by Zambia Republic Police, RTSA and MOH&CW

    should be done accurately. RTIs data is essential for explaining the burden, prioritizing

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    Safer road users

    Drinking and driving law, speed limit law should be reviewed and changed to meet

    the WHO recommendation.

    Seat belt use should be mandatory to all vehicle occupants. This can be done

    gradually to allow those cars with no seat belts to be fitted.

    Improve on regular, consistent and comprehensive enforcement of road rules to

    improve road user behaviours especially on drinking and driving, speeding, use of seat

    belts and helmet use.

    Place speed cameras on busy intersections and black spots to enforce speed limit.

    Defensive driving should be incorporated in driver licensing training. This involves

    training on knowing how to avoid traffic crashes and recognize potential hazards before

    its too late.

    Establish graduated drivers licensing system for novice drivers. This gives novice

    drivers time to gain experience, with some restrictions, e.g., on night driving or carrying

    passengers.

    Education and encouragement to improve alertness and obedience to road rules aswell as regular and consistent anti-corruption campaigns.

    NGOs and RTSA should advocate for policies such as public transport policy, policy

    to promote walking and cycling this helps in drawing policy makers attention to road

    safety.

    Safer vehicles

    All new cars should have seat belts. A period of time can be given for the old cars tohave seat belts fitted.

    Enforcement of regular vehicle services and proper inspection periodically.

    Collaborate with Environmental Management Agency in tracking unworthy vehicles

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    Mandatory daytime running lights usage and headlight usage for motorcyclists.

    Safer roads and road sides

    Establish policy on routine road maintenance

    Involve engineers in road accident investigation to detect road engineering problems

    Instant remedial action on black spots with traffic calming measures such as

    roundabout, speed humps with good signaling. This may help to reduce traffic accidents

    especially at intersections and at areas with repeated accidents.

    REFERENCES

    AfDB (2011). Infrastructure and growth in Zambia. An action plan for sustained strongeconomic growth.

    IRIN Africa, Southern Africa. Special Report on Road Traffic Injury Prevention. Friday

    12th March, 2010: htpp://irinnews.org/report.aspx?reportd=50251

    Joseph Schatz, On the road in Zambia. The Lancet, Vol. 372, issue 1637, 9th August

    2008. http://www.the lancet.com/journals/lancet/article/p1150140-6736(08)61179-

    4/fulltext

    Mercy Mwila, New countrys highway code to lessen road traffic accidents, Times of

    Zambia. 30th January 2010.

    World Bank. (2006). Zambia Infrastructure Assessment Note for Roads, Railways, and

    Water Sectors: Africa Transport Sector (AFTTR) Report No. 36978-ZW.

    World Bank. (2008). Zambia infrastructure dialogue in roads, railways, water, energy

    and telecommunication sub-sectors. Report no. 43855-zw. Lusaka.

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    APPENDIX A

    INTERVIEW GUIDE TO ROAD USERS

    1. For how long have you stayed in this area?

    2. How do you define, road traffic injuries?

    3. What do you think are the causes of road traffic injuries in Zambia

    4. What do you think should be done to prevent road traffic injuries in Zambia?

    5. In your own opinion, what strategies can be put in place in road safety

    management?

    6. What is role of road transport safety Agency (RTSA) and the Zambian police in

    accident prevention?

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    APPENDIX B

    CAUSES OF SUDDEN ROAD ACCIDENTS DEATHS IN ZAMBIA