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THE ECONOMIC AND SOCIAL EFFECTS OF ROAD-

TRAFFIC ACCIDENTS ON A SECTION OF PATIENTS AT

THE ACCIDENT CENTRE, KORLE-BU TEACHING HOSPITAL

BY

ADU-DARKO, MICHAEL AGYEKUM

CLASS OF 2012.

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DECLARATION

I, ADU-DARKO, MICHAEL AGYEKUM, author of THE ECONOMIC AND

SOCIAL EFFECTS OF ROAD TRAFFIC ACCIDENTS ON A SECTION OF

PATIENTS AT THE ACCIDENT CENTRE, KORLE-BU TEACHING HOSPITAL,

do hereby declare that, except for the reference to other people’s work which has been

duly acknowledged, the work I have presented in this dissertation was done entirely by

me as a final year student of the University of Ghana Medical School, Korle-Bu in the

2012/2013 Academic year and that the work presented has not been presented before in

part or whole for any degree in this University or elsewhere.

…………………………………………….

ADU-DARKO, MICHAEL AGYEKUM

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DEDICATION

To God Almighty...it’s by his Grace I have come this far.

To my parents, the entire Adu-Darko family both home & abroad,

also to all my close friends.

Thanks for your unflinching support.

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ACKNOWLEDGEMENT

I will like to first and foremost thank the Almighty God for His provision and grace.

To Professor Biritwum, my supervisor, I am grateful for your guidance.

To my parents, Dr. and Mrs. Adu-Darko, my sister Mrs. Shirley Asare-Larson who have prayed

for me and supported me, I thank them.

To all the patients who took the time to respond to my questionnaire, I say thank you.

I am also thankful to the Department of Community Health of the University of Ghana Medical

School for this opportunity.

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TABLE OF CONTENTS

DECLARATION………………………..………………………………………………….……….2

DEDICATION………………………….…………………………………………….……………..3

ACKNOWLEDGEMENT…………………………..………………………………………………4

TABLE OF CONTENTS…………………………………………………..……………………….5-7

LIST OF TABLES AND FIGURES……..………...…………………………………………….….8-10

ABSTRACT……………………………………………………………………………………….11-12

CHAPTER 1.0- INTRODUCTION……………………..……………………………………………13

1.1 BACKGROUND………….………………………..……………………………………………..13

1.2 PROBLEM STATEMENT….….……………………………………………………………....…14

1.3 RATIONALE……………………………………………………………..……………………...14

1.4 AIM……………………………………..…………………………………………………….…14

1.5 OBJECTIVES………………………..……………………………………………………….....15

CHAPTER 2.0- LITERATURE REVIEW………………..…………………………………..……...16

2.1 THE TRENDS OF JOB LOSS & WORK HOURS LOST AMONG DISABLED AND NON-

DISABLED PEOPLE…………………………………………………….…………….………….16-17

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2.2 THE CAUSE & INCIDENCE OF ROAD TRAFFIC ACCIDENTS AND THE COMMON AREAS

IN ACCRA ASSOCIATED WITH THESE ACCIDENTS…………………….……………….17-24

2.3 INFORMATION ON CARE- SEEKING OPTION AND HOW COST OF TREATMENT

AFFECTS THE INTERVAL BETWEEN TEMPORARY AND DEFINITIVE

TREATMENT……………………………………………………………………….….……….24-26

2.4 TO DETERMINE THE METHODS OF PREVENTION OF THESE ROAD TRAFFIC

ACCIDENTS………………………………..………………………………..…………………26-28

2.5 THE USE OF PRIMARY SURVEY AT THE ACCIDENT SCENE..………………….…29-31

CHAPTER 3.0 METHODOLOGY…………………………..……….……………….……….31

3.1 STUDY DESIGN AND AREA………………………………….……………………31

3.2 STUDY POPULATION…………………………………..…………..........................31

3.3 SAMPLING STRATEGY………………………………….……..…………………..32

3.4 DATA COLLECTION AND INSTRUMENT………………………………………..32

3.5 DATA HANDLING, ANALYSIS AND PRESENTATION…………………….….33

3.6 LIMITATIONS………………….…………………………………….…..…………..33

CHAPTER 4.0- RESULTS AND ANALYSIS………………….……….…………………..34

4.1 DEMOGRAPHY………………..……………..………………..………………………..34

4.2 NATURE OF ROAD TRAFFIC ACCIDENT………………..………………………… 35-50

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4.3 JOB ASSESSMENT………………..…………………………….………………50-57

4.4 IMPACT ON SOCIAL AND FAMILY LIFE………………..………………….…57-62

CHAPTER 5.0 - DISCUSSION……………………………..……………………..……….63

5.1 THE TRENDS OF JOB LOSS AND WORK HOURS LOST AMONG DISABLED AND NON-

DISABLED PEOPLE........................................................................................................63

5.2 THE CAUSE AND INCIDENCE OF ROAD TRAFFIC ACCIDENT AND THE COMMON

AREAS IN ACCRA ASSOCIATED WITH THESE ACCIDENTS……………….…...64-65

5.3 INFORMATION ON CARE- SEEKING OPTION AND HOW COST OF TREATMENT

AFFECTS THE INTERVAL BETWEEN TEMPORARY AND DEFINITIVE

TREATMENT…………………………………………………………………………..…..66-67

5.4 TO DETERMINE THE METHODS OF PREVENTION OF THESE ROAD TRAFFIC

ACCIDENTS………………………………………………………………………………67-69

5.5 THE USE OF PRIMARY SURVEY AT THE ACCIDENT SCENE…………..…….69

5.6 CONCLUSION……………………………………………………...…………………70

5.7 RECOMMENDATIONS……………………………………………………..………..70

5.8 REFERENCES………………………………………………....………...……………..71-73

5.9 APPENDIX QUESTIONNAIRE……………………………………………………….75-79

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LIST OF TABLES AND FIGURES PAGE

Table 1- Distribution of treatment sought by Road Traffic Injured people 25

Table 2 –Cost of treatment by various treatment categories 26

Table 3- Distribution of ambulances and Emergency Medical Team in Ghana 29

Table 4- Age distribution of road traffic accident (RTA) victims 34

Table 5- Educational level of interviewees 35

Table 6- Frequency of motor accidents on various roads in Ghana 36

Table 7- Distribution of RTA’s 39

Table 8- Vehicles involved in the accidents 40

Table 9- Total number of people involved in these accidents 48

Table 10- Number of mortalities in the various accidents 49

Table 11- Means of transportation to the nearest hospital 53

Table 12- Access to Primary Survey 54

Table 13- Where Primary Survey was initially provided 55

Table 14- Prevention of accidents 56

Table 15- Type of employment 57

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Table 16- Nature of jobs 57

Table 17- Work hours per week lost to RTA’s 59

Table 18- Number of days per week lost to RTA’s 59

Table 19- Salary estimation 60

Table 20- Expenses on treatment 68

Table 21- Duration of admission 70

Table 22- Extent to which injury has affected provision 72

Table23-25- Motor accident returns from the

MTTU Head Office for 01/01/2011-31/07/11 79

Figure 1- Road on which accidents occurred 44

Figure 2- Distribution of accidents 45

Figure 3- Incidence of RTI among various road users 46

Figure 4- Nature of roads 50

Figure 5- Timing of accidents 51

Figure 6- Causes of RTA 52

Figure 7- Preventable accidents 55

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Figure 8- Prevention of accidents 56

Figure 9- Some of the jobs affected by the RTA 58

Figure 10- Nature of the injuries 69

Figure 11- Duration of admission influenced by cost of treatment 71

Figure 12- Percentage of Breadwinners 71

Figure 13- Effect of hospitalization on finances 73

Figure 14- Nature of salary change among the interviewees 74

Figure 15- Impact of RTA’s on social life 75

Figure 16- Limitation to daily function as experienced by the interviewees 76

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ABSTRACT

BACKGROUND

Road Traffic Accidents (RTAs) are a major cause of disability and death globally.

Unfortunately, a disproportionate number of these occur in developing countries. Currently, it is the

leading cause of death by injury and the tenth leading cause of all deaths globally. Injuries resulting

from RTAs are increasingly contributing to the burden of morbidity and mortality in sub- Saharan

Africa, especially Ghana.

Sadly, little appears to be known about the economic consequences and social disability associated with

them.

AIM

To explore the cost and disability consequences of road traffic accidents in a cross-section of patients

at the Accident Centre, Korle-Bu Teaching Hospital.

DESIGN

A cross- sectional study involving a hospital-based survey using convenience sampling was done.

SUBJECT/ SETTING

Information on care-seeking choice, cost of treatment, ability to work, reduction in earnings, cause and

prevention of accidents, and disability was collected from 70 subjects who had suffered one form of

road traffic accident or another. Respondents were both out- patients and in-patients of the Accident

Centre, Korle- Bu Teaching Hospital.

OUTCOME MEASURES

Univariate analysis was used to estimate the causes of road related injuries, the age distributions of these

injuries, to estimate the frequency of disability, the types of care sought, role of primary assessment,

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trend of work loss, functional ability and cost of treatment. It also included the impact on social and

family life.

RESULTS

Road traffic accidents involved 70 people of whom 34 (48.5%) had secondary education or higher and

38 out of the total 70 fell within the age group of 20 - 39years. Eighty eight percent of these accidents

occurred in Accra, of which more than half involved pedestrians. A total of 13 mortalities and 383

people were involved in these accidents, with 68% of those interviewed suffering various morbidities.

They were mainly attributed to carelessness on the part of the driver, with 57.3% of them getting to the

hospital by private car. Primary assessment/survey was not available at any accident scene; also an

average of 72hours per week was lost to road traffic accidents.

Forty five percent felt the cost of their treatment was influenced by their duration of admission (i.e. the

longer they stayed on admission, the greater their financial cost)

A total of 60% had difficulty with provision for the family out of total 59 breadwinners, while 57% of

the total 70 encountered financial constraints following the RTAs.

This was most likely since 72% of the total number of employed (58) had a decrease in their salary by

one reason or the other.

CONCLUSION

Economic and functional ramifications cannot be excluded when considering the impact of road traffic

injuries.

When appreciated, the burden of RTA injuries can be properly addressed by amicable measures and

reinforcement of existing strategies.

This implies that health systems in developing countries like Ghana should not only address the clinical

consequences of road traffic accidents, but also the financial ones as well.

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CHAPTER 1: INTRODUCTION

1.1 BACKGROUND

It cannot be over-emphasized how RTAs contribute in no small measure to death and disability

worldwide, with a disproportionate number occurring in developing countries. Not only is it the

leading cause of death by injury, but also the tenth (10th) leading cause of all deaths globally. An

estimated 1.2 million people are killed in RTAs each year, and as many as 48 million are injured,

occupying 30 - 70% of orthopedic beds in developing countries’ hospitals. (1)

If the current trend should continue, it is predicted that by 2020 it will be the 3rd leading

contributor to global burden of disease and injury. Road Traffic Accidents currently in developing

countries accounts for 85% of annual deaths and 90% of disability - adjusted life years (DALYs)

lost. While sub-Saharan Africa has a fraction of the motor vehicles found in Europe and North

America, mortality from Road Traffic Accidents in Africa is among the highest in the world.(2)

The economic consequences of Road Traffic Accidents have been documented in many high-

income countries. In 2000, the Federal budget of the United States of America allocated US$ 150

billion towards provision of direct healthcare services, training and disease prevention; in the USA,

the total cost to society of Road Traffic Accidents was estimated to be US$232.6 billion in the year

2000, while injuries from road traffic crashes cost an estimated US$ 146 billion (3). Although the

burden of Road Traffic Accidents in terms of incidence and mortality has been reported in several

countries in sub Saharan Africa, data regarding both disability and socioeconomic effects of Road

Traffic Accidents in this region remain woefully scarce. (4) Data on disability are extremely limited

in sub-Saharan Africa, except for a study done in Ghana. (5)

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1.2 PROBLEM STATEMENT

Road Traffic Accidents affect all age groups from under-5 to >65 years. About 73% of these

deaths are between 15 - 49 years. This has grave economic implications. In this age group males

are mostly involved than females and generally about 2.63 times involved in fatalities than

females. Against the back- drop that males account for about 49% of the population, this is

disproportionately high. (5)

Road user type involvement can be classified as; pedestrians, car occupants (both bus and

minibus), motorcycle, bicyclists, pick-up occupants and passengers. The pedestrians continue to

constitute the target category of fatalities in the country; that is 42% of total fatalities, followed by

occupants of buses and minibuses (passengers) that is 23% of total fatalities.(5)

1.3 RATIONALE

Considering, the ever increasing incidence of Road Traffic Accidents among the youthful age-

group of the population, it has become more imperative to discuss not only morbidity and

mortality consequences, but more importantly its social and economic bearing on the country as

a whole. This study focuses on a cross-section of patients at the Accident Centre, Korle-Bu

Teaching Hospital, where most referrals of RTAs report to, and is also therefore representative in

predicting the economic and social effects of RTAs on the general population.

1.4 AIM

To explore the cost and disability consequences of Road Traffic Accidents in a section of

patients at Accident Centre, Korle-Bu Teaching Hospital.

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1.5 OBJECTIVES

To determine the following;

1. The trends of job loss and work hours lost among disabled and non-disabled people

2. The causes and incidence of Road Traffic Accidents among respondents

3. Information on care-seeking options and how cost of treatment affects the interval between

temporary and definitive treatment.

4. To determine the ways of prevention of these Road Traffic Accidents

5. The common areas in Accra associated with these accidents.

6. The use of primary assessment/survey at the accident scene.

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CHAPTER 2: LITERATURE REVIEW

2.1 THE TRENDS OF JOB LOSS AND WORK HOURS LOST AMONG DISABLED AND

NON-DISABLED PEOPLE

Trends of job loss are varied, depending on whether or not there is any sustained disability or deformity

following the road injury. In an article written by Asker in 2007, on “The effect of Road Traffic

Accidents”, he said there was loss of productive work time to those involved, (that is the victims of the

road traffic injuries) and also went further to add that loss of productive work time also occurred for

friends who needed to attend funerals. (6)

---A disabled person is defined by Webster’s Advanced Learned Dictionary as, “A person lacking one

or more physical strengths, such as the ability to walk or to coordinate one’s movements, as from the

effects of a disease or accident or through mental impairment. (7)

The World Health Organization had this to say about disability “Disability is an umbrella term,

covering impairments, activity limitations, and participation restrictions. Am impairment is a problem

in body function or structure; an activity limitation is a difficulty encountered by an individual in

executing a task or action; while participation restriction is a problem experienced by and individual

in involvement in life situations. Thus disability is a complex phenomenon, reflecting an interaction

between features of a person’s body and features of the society in which he or she lives.” –WHO. (8)

It is important to note that of most of these disabilities suffered by victims of RTAs, the most common

type of disability is difficulty in using a hand or arm (24%) and difficulty or inability to ambulate (16%).

Among those who had the road traffic injury (17%) were unable to return to work.

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Job loss was a direct consequence of the road traffic injury related disability for (16%) of the disabled

study subjects, while (88.6%) sustained a reduction in earnings. These were from a socioeconomic

impact assessment of road traffic injuries in West Africa: exploratory data from Nigeria involving a

study on 127 subjects. (9)

With regards to a study performed in Ghana on the economic consequences of injury and resulting

family coping strategies in Ghana, it was found that rural households were more likely to utilize intra-

family labor reallocation (90%) than were urban households (75%). Rural households were also more

likely to borrow money than urban, although households in both areas were equally likely to sell

belongings, though the nature of the belongings sold were different. Although injuries in the urban area

had more severe primary impacts (job loss, treatment costs and disability time), the ultimate effect on

rural households appeared more severe. A greater percentage of rural households (28%) reported a

decline in food consumption than in urban households (19%). These findings result in several policy

implications, including measures that could be used to assist family coping strategies and measures

directed toward injuries themselves. (10)

Again long hospitalization or disabilities prevent victims from indulging in their usual and normal

productive activities rendering them dependent on others. (11)

2.2 THE CAUSE OF ROAD TRAFFIC ACCIDENTS AND THE COMMON AREAS IN

GREATER ACCRA REGION ASSOCIATED WITH THESE ACCIDENTS

To begin with, the causes of road traffic injuries in our region are varied, considering the fact that they

occur both on tarred and rough roads.

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Mr. Noble Appiah (Acting Director of the National Road Safety Commission), said that contrary to the

perception that accidents mostly occur on rough road 70% of the accidents happen on smooth and flat

roads. He attributed this to over speeding on even very good roads. (12)

The most common known causes of road traffic accidents in Ghana include gross indiscipline on our

roads, over –loading, fatigue driving, drunk driving and over-speeding. The latter three alone

constitutes about 50% of road accidents in the country. The poor nature of some of our roads, poor

maintenance of vehicles, disregard for traffic regulations by most drivers and indiscriminate use of the

road by some pedestrian are some of the other causes of motor accidents in the country. We also have

numerous unworthy and old aged cars on our highways, which also contribute to these road traffic

accidents. (13)

A chief pathologist of the Department of Pathology, Korle- Bu Teaching Hospital, indicated that most

drivers at autopsy had high percentages of blood alcohol (ranging from 300-372/100ml) which was far

above the accepted level of 2.43/100ml and was enough to cause accidents. (14)

Four factors contribute to the vast majority of collisions. In descending order of importance they are:

Driver behavior, Poor roadway maintenance, Roadway design and Equipment failure.

Over 95% of motor vehicle accidents (MVAs, in the USA, or Road Traffic Accidents, RTAs, in Europe)

involve some degree of driver behavior combined with one of the other three factors. Drivers always try

to blame road conditions, equipment failure, or other drivers for those accidents. When the facts are

truthfully presented, however, the behavior of the implicated driver is usually the primary cause. Most

are caused by excessive speed or aggressive driver behavior.

Driver Behavior - Humans tend to blame somebody or something else when a mistake or accident

occurs. A recent European study concluded that 80% of drivers involved in motor vehicle accidents

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believed that the other party could have done something to prevent the accident. A miniscule 5%

admitted that they were the only one at fault. Surveys consistently reveal that the majority consider

themselves more skillful and safer than the average driver. Some mistakes occur when a driver becomes

distracted, perhaps by a cell phone call or a spilled cup of coffee. Very few accidents result from an 'Act

of God,' like a tree falling on a vehicle.

Speed Kills - The faster the speed of a vehicle, the greater the risk of an accident. The forces

experienced by the human body in a collision increase exponentially as the speed increases. Smart

motorist recommends that drivers observe the 3 second rule in everyday traffic, no matter what the

speed may be. Most people agree that going 100 mph is foolhardy and will lead to disaster. The problem

is that exceeding the speed limit by only 5 mph in the wrong place can be just as dangerous. Traffic

engineers and local governments have determined the maximum speeds allowable for safe travel on the

nation's roadways. Speeding is a deliberate and calculated behavior where the driver knows the risk but

ignores the danger. Fully 90% of all licensed drivers speed at some point in their driving career; 75%

admit to committing this offense regularly.

Who are the bad drivers? They are young, middle-aged, and old; men and women; they drive luxury

cars, sports cars, SUVs and family cars. Almost every qualified driver admits to some type of risky

driving behavior, most commonly over-speeding.

Aggressive Drivers - As we've described, modern cars are manufactured to very safe standards, and the

environment they're driven in is engineered to minimize the injuries suffered during an accident. The

most difficult area to change is aggressive driver behavior and selfish attitudes. (15). A 2004 study by the

Automobile Association in Great Britain found that 85% of the respondents reported at least one of the

behaviors listed below directed at them (in order of descending frequency);

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- Aggressive tailgating

- Lights flashed at them because the other motorist was annoyed

- Aggressive or rude gestures

- Deliberate obstruction -- preventing them from moving their vehicle

- Verbal abuse

Physical assault - The same group was then asked about aggressive behavior they had displayed

towards other drivers. 40% indicated that they had never behaved aggressively towards another driver. A

further 60% of the survey respondents admitted to one or more of the following behaviors (listed in

order of descending frequency):

- Flashed lights at another motorist because they were annoyed with them

- Gave aggressive or rude gestures

- Gave verbal abuse

- Aggressively tailgated another motorist

- Deliberately obstructed or prevented another from moving their vehicle

- Physically assaulted another motorist (one positive response)

These behaviors are probably under-reported, since most people are not willing to admit to the more

serious actions, even if no penalty exists. The majority of these incidents happened during the daylight

hours (70%), on a main road (not freeway or divided highway). (16)

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Poor Maintenance - Roadway maintenance contributes to some motor vehicle accidents, but not to the

extent that drivers use it as an excuse. Unfortunately maintenance schedules and procedures vary greatly

from city to city and state to state, so nationwide standards don't exist. Below are some of the potential

roadway maintenance shortcomings that you should be aware of;

Debris on the roadway can be a problem, and it is the responsibility of local highway authorities to see

to them.

Faded road signs, and signs obscured by foliage, occasionally contribute to accidents. If you know of

any offending signs, contact your local police department to see if they can get the problem remedied.

Potholes cause a small number of accidents (primarily tire & suspension failures), but the accidents

usually occur at low speeds and don't cause many injuries. Some Northern US cities for example have

pothole complaint lines that are active during the winter and spring.

Roadway construction is a commonly mentioned reason for accidents. Again the blame usually rests

on aggressive drivers who are unwilling to observe regulations when approaching a construction zone.

In most states in the USA for example, fines are doubled in work zones, making it expensive as well as

unsafe to speed. Stop-and-go traffic requires thoughtful, alert driving to avoid a collision with the car in

front of you. Too often drivers worry that their fellow drivers will intersect in-front of them in a traffic

jam. The real problem is that drivers forget about the vehicle directly in front, rear-ending it while

looking in their rearview mirror or daydreaming. Ideally, appropriate spacing should be left between

cars by drivers. The 3 second rule applies to traffic jams as well.

Roadway Design - Motorists may blame roadway design for accidents, but it's rarely the cause.

Consultants such as the Texas Transportation Institute have spent years getting road barriers, utility

poles, railroad crossings, and guardrails to their current high level of safety. Civil engineers, local

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governments, and law enforcement agencies all contribute to the design of safe road layouts and traffic

management systems. State and federal governments provide guidelines to their construction, with

design flexibility to suit local conditions. Roadways are designed by engineers with special

consideration given to the following:

Hazard Visibility - Permanent roadway hazards consist of intersections, merging lanes, bends, crests,

school zones, and livestock or pedestrian crossings. Temporary hazards include road construction,

parked or disabled vehicles, accidents, traffic jams, and wild animals (especially deer).

Roadway Surfaces - Engineers can use different surfaces (for example, grooved pavement) depending

on the environment, traffic speed, traffic volume, and location of the roadway (noise barriers). Roadway

markings let drivers know about their ability to pass safely (dotted & double lines), the location of the

roadway in inclement weather (reflective cats-eyes & stakes), and where road surface ends and the

shoulder begins.

Traffic Control Devices - Traffic light signals, speed limit signs, yield and stop signs, school &

pedestrian crossings, turning lanes, police surveillance cameras, and traffic circles or roundabouts.

Behavioral Control Devices - Built-in obstacles, that limit the ability of a vehicle to travel, including

crash barrels, speed bumps, pedestrian islands, raised medians, high curbing, guard rails, and concrete

barriers.

Traffic Flow - Interstate highways remain the safest roads because their flow of traffic is in one

direction. One-way streets ease traffic congestion in city centers as well. Rural two-lane roadways are

statistically the most dangerous because of a high incidence of deadly head-on collisions and the

difficulty impatient drivers’ face while overtaking slower vehicles.

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Roadway Identification Signs - enable someone without a detailed map to travel from one place to

another. They give advance notice of intersections, destinations, hazards, route numbers, mileage

estimates, street names, and points of interest.

Equipment Failure - Manufacturers are required by law to design and engineer cars that meet a

minimum safety standard. Computers, combined with companies' extensive research and development,

have produced safe vehicles that are easy and safe to drive. The most cited types of equipment failure

are loss of brakes, tire blowouts or tread separation, and steering/suspension failure. With the exception

of the recent rash of Firestone light-truck tire failures, combined totals for all reported equipment failure

accounts for less than 5% of all motor vehicle accidents.

Brake Failure - Modern dual-circuit brake systems have made total brake failure an unlikely event. If

one side of the circuit fails, the other side is usually sufficient to stop a vehicle. Disc brakes, found on

the front wheels of virtually every modern vehicle, are significantly more effective than the older drum

braking systems, which can fade when hot. ABS (Anti Blockier System) or anti-lock brakes prevent the

wheels from locking up during emergency braking maneuvers, allowing modern vehicles to avoid many

accidents that previously would have occurred.

Tires - Today's radial tires are significantly safer than the bias-ply tires of 25 years ago. They still,

however, need attention regularly. Under inflation, the most frequent cause of tire failure is considered

the main culprit in the recent Firestone tire-failure fatalities. Uneven or worn-out tires are the next most

serious problem and can also lead to tire failure. Uneven wear is caused by improperly balanced tires, or

misaligned or broken suspensions. Remember, all that keeps you connected to the roadway is your tires.

If you don't check your own, have your mechanic check them every 5,000 miles.

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Steering & Suspension - Your suspension keeps your tires in contact with the roadway in a stable and

predictable manner. Your steering enables you to go around road obstacles and avoid potential

accidents. Even a safe, well-trained driver is helpless in the event of a steering or suspension system

failure. Such failures are catastrophic, especially at high speeds. Have your suspension and steering

systems checked out by a mechanic every 10,000 miles.

With regular component inspections by trained individuals, equipment failures can be virtually

eliminated. (17)

In another study, to determine the six most common causes of automobile crashes, the following came

up;

- Distracted drivers

- Driver fatigue

- Drunk driving

- Speeding

- Aggressive driving and the

- Weather

To end with, a study conducted by Amend Ghana blamed the increasing spate of road traffic accidents

on unplanned urban growth, an ever- increasing number of vehicles and lack of awareness on the

part of all road users. Road design doesn’t make adequate provision for pedestrians and therefore there

is a lot of competition between pedestrians and vehicles on the road. The drivers are undisciplined and

the hawkers take up everywhere the pedestrians are supposed to be. The study also implicated the Driver

and Vehicle Licensing Authority for making only cursory roadworthiness checks. The “Highway Code”

is taken as a suggestion rather than a set of rules. (18)

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2.3 INFORMATION ON CARE SEEKING OPTIONS AND HOW COST OF TREATMENT

AFFECTS THE INTERVAL BETWEEN TEMPORARY AND DEFINITIVE TREATMENT

In Ghana, victims of road traffic accidents, usually have no initial decision with regards to where to seek

medical care from, they usually wake-up to find themselves in hospital, usually the nearest one by. (19)

From the study performed by Catherine Juilliard et al, on the “Socioeconomic impact of road traffic

injuries in West Africa”; exploratory data from Nigeria”, of the 127 victims interviewed, 77% of study

subjects sought medical care. Hospital treatment and treatment by a private physician were the most

common types of initial care sought. Home treatment (22%) was the next most common, followed by

health post or clinic treatment (17%). Although only 6% of road traffic injured (RTI) people sought first

–line care from bone setters, herbalists and other traditional healers, 15 study subjects sought traditional

treatment after they had already been treated in a different setting. Traditional treatment was the most

common second treatment options chosen by road traffic injured people, comprising 39% of those study

subjects who sought more than one treatment, and 12% of all who had a RTI. Individual preferences was

the most common reason for a choice of first provider (42%), but proximity and cost of treatment were

also often quoted. (20) The table below summarizes this;

TABLE 1.0 showing the distribution of order of treatment sought by injured people

LOCATION First

Provider

Second

Provider

Third

Provider

Fourth

Provider

Total Visits per type of

provider

Home 28 11 3 42

Traditional

treatment

8 15 1 1 25

Health Post/ 21 4 - - 25

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Clinic

Private doctor 35 2 1 38

Hospital

treatment

35 6 - - 41

Total 127 38 5 1 171

The average total direct cost of treatment reported was US$25.4. The mean direct cost of care was

US$36.40 for disabled people and US$20.84 for non–disabled people. Although these results suggest a

disparity in direct cost of treatment between disabled and non-disabled, this difference based on the p-

value was not significant. People who were disabled as a result of their road traffic injury were more

likely to seek formal care and more often unable to return to work than their disabled counterparts. A

higher proportion of disabled people paid more than the Nigerian monthly average per capita income for

treatment of their injury than non-disabled people. (20)

The table below summarizes the above;

TABLE 2.0 showing the cost of treatment in US –dollars by treatment category

Treatment Mean cost 95% CI p-Value

All informal 6.65 3.44 to 13.47 -

All formal 35.64 23.09 to 49.86 < 0.0001

Total Cost 25.4 18.58 to 31.38 -

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Economic value of life lost due to an injury = Average loss of life expectancy × Per capita gross

national product.

It is noted that the cost of treatment, affects the interval between temporary and definitive treatment,

more so in the so-called “cash and carry” system. Though this is not entirely the truth now, because of

the introduction of the National Health Insurance scheme, for patients who do not have valid insurance,

this continues to be the case.

2.4 TO DETERMINE THE WAYS OF PREVENTION OF THESE ROAD ACCIDENTS

Irrespective of how sophisticated the national campaign against accidents may be, accidents cannot be

eliminated from our roads totally; however sustained road safety measures can cause road accidents to

subside.

There should be proper education, especially before one can secure a driving license. This concern

raises certain questions about the driving schools we have in the country. Who sets the curriculum? How

long should a training last, for someone who wants to secure a license? What should be the qualification

of an instructor at a driving school? The Drivers and Vehicle Licensing Authority must be empowered,

to ensure proper examination of all candidates before issuing out a license. They also need to do more

than the preliminary checks, before issuing out a road worthiness certificate. This is more so, since most

cars used in the country and on our roads are used cars.

Motor Transport and Traffic Unit (MTTU) statistics also inform us that most accidents are caused by

broken-down vehicles on our roads. This is common on our highways, and therefore part of the road

funds should be used to buy heavy duty towing trucks for our roads. The time has come for us to use the

road fund, to serve the road users and transform our roads from a highway of death and disaster to a

haven of tranquility. (14)

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Breathalyzers should be made available to policemen, to enable them ascertain the blood alcohol

concentration of suspected drivers who are drunk driving. It is important that public education continues,

an example being the road safety campaign advertisements, erecting bill boards on highways and also

educating pedestrians on the need to adopt the right road safety attitudes.

Owing to the socio-economic impacts of road traffic accidents, it deserves to be given political priority

and commitment. Unfortunately, in Ghana there is lack of political will to put the appropriate

interventions in place. Examples from developed countries like the United States, Japan, Sweden and

Finland, where the personal commitment and interest of their heads of state, has maintained the sanity

on the roads and culminated in a drastic decrease in road accidents and the adherence to road

regulations. In Ghana, wearing of seat belts is yet to become mandatory, yet a lot more people are dying

through accidents when seat belts could have saved them.(14)

Another important aspect comes from the end of the manufacturer. Emphasis should be placed on

Haddon’s ten strategies for road traffic injury; this refers to technological modifications aimed at

reducing or managing the excess energy that may contribute to the occurrence of a crash and the severity

of the injuries sustained. It is important that we shape the road network, for road traffic injury

prevention, examples include; classifying roads and setting speed limits by their function, improving

safety of single- lane carriageways by provision of slow moving traffic and for vulnerable road users,

advisory speed limit at sharp bends, regular speed-limit signs and better highlighting of hazards through

road lighting at junctions and roundabouts. We can also talk about traffic- calming measures, like;

narrowing of streets, road humps, roundabouts, rumble device, link closure, speed bumps and chicanes.

Another control measure that has been found to be useful in controlling road traffic injuries, is

improving visibility of all road users by; using daytime running lights on the front of motorized vehicles

and the use of reflective and protective clothing, which increases the visibility of riders. (21)

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Once again, it is important that we set and secure compliance with road safety rules, by enacting and

enforcing laws on alcohol impairment, speed limits, laws on the use of seat- belts and child restraints.

Laws should also be enacted to enforce the use of crash- helmets as mandatory, also with the increasing

use of motorcycles as public transport; these should be banned and stopped, as they pose a great threat to

other road users. (22)

Public health sector campaigns in the field of road traffic injury prevention have encompassed a wide

range of measures, but education has always featured as one of the key activities of prevention. It has

been found that informing and educating road users can improve knowledge about the rules of the road

and about such matters as purchasing safer vehicles and equipment.

Also, basic skills on how to control vehicles can be taught. Education can help to bring about a culture

of concern and develop sympathetic attitudes towards effective interventions. General non- specific road

safety campaigns should be avoided; campaigns should rather be used to put important questions on the

agenda, and should preferably support other measures such as new legislation or police enforcement. (23)

2.5 THE USE OF PRIMARY ASSESSMENT / SURVEY AT THE ACCIDENT SCENE

Primary survey is a crucial element in the “initial assessment” of a seriously injured patient. It involves

assessment of the patient and establishing treatment priorities based on their injuries, the stability of

their vitals and the injury mechanism involved. This process constitutes the “ABCDE’s” of trauma care

and identifies life- threatening conditions. It’s made up of;

- Airway maintenance with cervical spine control

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- Breathing and ventilation

- Circulation with hemorrhage control

- Disability; neurological status

- Exposure/ Environmental control; completely undress the patient but prevent hypothermia. (24)

TABLE 3.0 SHOWING THE DISTRIBUTION OF AMBULANCES AND EMT IN GHANA, 2010

Number Region No. of Ambulance

Stations

No. of EMT at post

1 Greater Accra 6 57

2 Ashanti 5 45

3 Eastern 4 37

4 Central 2 17

5 Volta 2 18

6 Western 1 9

7 Brong-Ahafo 1 9

8 Upper East 1 7

9 Upper West 1 9

10 Northern 1 9

11 Accra Control 1 6

12 Ashanti Control 1 5

Total 24 228

EMT = Emergency Medical Technicians (25)

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From the above table, it is obvious that the country as a whole is limited with regards to the resources

available for providing emergency medical service for accident victims. It is therefore not surprising that

there is actually no consistent data, with regards to the availability and patronage of these emergency

services following road traffic injuries. Emergency medical services are supplied, but they are a problem

outside the major cities. Some countries like Ghana have a private ambulance system (St. John

Ambulance Service), others have even helicopter rescue, which help those who can pay for the service.

In Zimbabwe the private emergency services arrive at accidents without considering if victims can pay

for their services.

In Cote d’Ivoire the fire brigade is responsible for the transport of road accident victims. In Benin, the

police have the authority to require vehicles to transport accident victims; in. This seems to be working

well in cities with fire brigades. Otherwise, injured people have to rely on the help of passing “good

Samaritans” for transport to hospital. Except for Cote d’Ivoire, where people seem to be reluctant to be

involved in helping out accidents, people seem to be helpful in providing transport to hospital. Poor

telecommunications is a problem in calling for help. Though most countries have hospitals, spread out

all over the country, not all hospitals have doctors on call or the equipment needed to treat badly injured

victims. (26)

Pertaining to a study carried out by Charles N. Mock et al, on “Admissions for injury at a rural

hospital in Ghana”, out of 451 people interviewed only 39% of people presented to the hospital within

the first 24hours of injury. Forty seven percent presented between 1 and 7 days after injury and 14%

presented more than 1 week after injury. Only 23% of patients received any type of pre-hospital care,

primarily first-aid measures at village health posts and no patient received ongoing medical care en route

to the hospital. (27)

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CHAPTER 3.0: METHODOLOGY

3.1 STUDY DESIGN AND AREA

The cross-sectional study was conducted in Korle-Bu Teaching Hospital, the leading tertiary hospital in

southern Ghana. The aim of this study was to ascertain the social and economic impact following road

traffic accidents, experienced by patients of the orthopedics and trauma unit/ ward. The respondents

were in-patients and a few out-patients who were coming for review at the Korle - Bu Teaching

Hospital. A total of 70 questionnaires were administered and analyzed.

3.2 STUDY POPULATION

The target population was 70 patients including males and females, from adolescents to the aged, cutting

across all levels of education. It is important to note that, these were all victims of road traffic accidents

from different parts of the metropolis.

Road traffic accidents, was defined in the survey as “Physical body damage as a result of being hit by

a motor vehicle, motor vehicle crash , or other transport related crash mechanism”.

3.3 SAMPLING STRATEGY

The sampling technique employed was convenience sampling. Patients from all the orthopaedic wards

of the Korle-Bu teaching Hospital were interviewed, except from the orthopaedic paediatric ward.

Discharged Out-patients, who were coming for review / follow-up, were also sampled. Convenience

sampling was used to select the units of the sampling frame, with a sample size of 70.

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3.4 DATA COLLECTION AND INSTRUMENT

An informed consent was taken and a well-structured self-administering questionnaire was given to the

patients on the ward. On the average it took twelve minutes for a questionnaire to be self-administered.

If the patient was not in the position to see anyone, or fill out the questionnaire, he was skipped for the

next patient. For patients who were not able to fill out the questionnaire because of language barrier, I

translated it into the preferred language (Twi or Ga) without alteration to the meaning as much as

possible.

Questions were drawn using information on road traffic accidents from the literature. Additional

questions were adopted, after modification, from questionnaires used in similar studies. Pre-testing was

conducted on 10 patients in the accident center ward following which some questions were modified to

improve clarity. Those that participated in the pre-test were not part of the study. The questionnaire was

in four parts.

The first part was to elicit the demographic data on age, ethnicity, religion, marital status, educational

level and occupation of each study participant. Questions relating to the nature of the road traffic

accidents were asked in the second part. This was to find out where the accident occurred, who was

involved, what time of the day on which it occurred, what they also thought was the cause of the

accident and how it can be prevented. The third section was designed to assess the nature of their jobs,

how much they earn, cost of treatment till date and how their admission has affected their jobs and

salaries. The fourth section was related to the impact of the road traffic accident, on their social and

family life. I wanted to find out if it had, in anyway, changed their abilities to provide for their families

and how it affected their daily activities.

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3.5 DATA HANDLING, ANALYSIS AND PRESENTATION

A structured questionnaire was designed based on my aim and objectives. The collected data was coded,

entered and analyzed with Microsoft Excel 2010 and SPSS V16.0 Statistical Package for Social Services

(SPSS). Graphs and tables were produced from the variables.

3.6 LIMITATIONS

Firstly, some of the patients refused to partake, because they didn’t know or understand how my study

was going to help or benefit them. Secondly, there was the problem of language barrier and also

illiteracy. I had to spend thirty or more minutes, in translating into Twi or Ga retaining the detail as

much as possible.

Thirdly, since the bed turnover was low (owing to prolonged admission for most patients), I was

compelled to interview some other patients who were coming for review. These patients had been

discharged not too long ago, and were coming for out-patient review at the Out-Patient Department.

(O.P.D).

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CHAPTER 4 RESULTS AND ANALYSIS

4.1 DEMOGRAPHY

The following analysis was made, based on the data collected;

Firstly, the data gathered showed age ranges from (10-14) years to (60-64) years. The modal age group

was the (35-39) year group, represented by 16 people, and those with the lowest frequencies were the

(15-19), (55-59) and the (60-64) year groups having just one (1) respondent each.

- In comparison with the motor accident returns of last year, 2011, for the first quarter (ending on

the 31st of march 2011), Greater Accra Region had a total of 1,171 cases of road traffic accidents

with those aged 18yrs and who lost their lives numbering 44 out of a total of 68 victims.(29)

These were in line with the results obtained in this study, showing that majority of the victims

were actually in the youthful age-group

TABLE 4.0 SHOWING THE AGE DISTRIBUTION OF ACCIDENT VICTIMS

Ages Frequency Percent

10-14 2 2.9

15-19 1 1.4

20-24 10 14.2

25-29 5 7.2

30-34 7 10.0

35-39 16 22.8

45-49 15 21.5

50-54 12 17.2

55-59 1 1.4

60-64 1 1.4

Total 70 100.0

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Secondly, an assessment of the incidence of RTAs among people of various educational backgrounds

was made. The table below shows the literacy distribution with their frequencies.

From the study 4.2% of the respondents were illiterates, while 48.5% of the respondents had either

secondary or vocational education, making up almost half of the total of 70 patients interviewed.

- Comparing with other studies done elsewhere in Nigeria, by Julliard et al, 30.18% had no formal

education and 27. 58% had some form of secondary education (28). Tallied with the ages or the

youthful nature of the accident victims, this indicates a relatively substantial number of the youth

(15-49) yrs and the educated (primary, secondary/vocational) are involved in road traffic

accidents.

TABLE 5.0 SHOWING EDUCATIONAL LEVEL OF INTERVIEWEES

Frequency Percent

Primary 21 30.0

Secondary/ Vocational 34 48.5

Tertiary 12 17.3

none 3 4.2

Total 70 100.0

4.2 NATURE OF ROAD TRAFFIC ACCIDENT

The questionnaire also sought to find out the incidence of road traffic injury / accidents on various roads

within the Greater Accra Region. A total of 14 accidents occurred within the central business district of

Accra. No street names where obtained due to absence of official naming of the streets. While a total of

12 out of the 70 people interviewed had their accident on the Tema motorway, quite a number occurred

in isolation.

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Examples were Dansoman, Agege, La, Nungua, Achimota, Bremmi, Darkuman among others.

Accra happens to be one of busiest business districts in the country, with a lot of vehicular and human

traffic.

On the other hand, the Tema motorway (a 19km highway linking Tema to Accra) is usually marked with

various kinds of road traffic accidents, involving all kinds of cars, trucks and motorcycles.

The frequency of motor traffic accidents, on various roads in the Greater Accra Region, is summarized

in the table below.

TABLE 6.0 SHOWING ACCIDENT DISTRIBUTION ON ACCRA ROADS

Frequency Percent

Accra 14 20.0

Achimota 1 1.4

Adaiman 1 1.4

Agege 1 1.4

Alajo 1 1.4

Alajo jxn 0 0.0

Bremmi 1 1.4

Bubuashie 2 3.0

Charman 1 1.4

Compound 2 1.4

Dansoman 2 1.4

Darkuman 1 1.4

Dowuenya 1 1.4

Highstreet 4 6.0

Jamestown 1 1.4

Kaneshie 1 1.4

Kasoa 2 3.0

Kokomlemle 1 1.4

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Korle-bu 1 1.4

Kwashieman 1 1.4

La 1 1.4

Madina 1 1.4

Mallam jxn 2 3.0

Mamprobi 1 1.4

Mataheko 1 1.4

Mortuary rd 0 0

Nsawam 0 0

Nungua 0 0

Ofankor 0 0

Osu 0 0

Owutubraku 0 0

Oyibi 0 0

Sakaman 0 0

Taifa st 0 0

Tantra 1 1.4

Tema

motorway 12 17.1

Tesano 1 1.4

Zongo jxn 1 1.4

Total 70 100.0

The bar chart below summarizes the tabulated data above. It shows a high number of accidents on the

streets or roads of the central business district, to which people are referring wrongly to as Accra. Other

roads, on which a high incidence of road traffic accidents occurred were; High-street, Kasoa,

Bubuashie and the Mallam junction road.

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FIGURE 1.0

The above data is followed by a summary of which part of Greater Accra Region recorded the highest

incidence of road traffic accidents within the month the survey was conducted (June).

Accra recorded 41 road traffic injuries, while Tema had a total of 20 incidents of road injury. However,

9 cases were not really categorized into either Accra or Tema, and these cases had occurred on the

compounds of the victims, when cars ended up skidding off the road.

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TABLE 7.0 showing the distribution of road traffic accidents in Accra, Tema and others.

Frequency Percent

Accra 41 59.0

Tema 20 29.0

Other 9 12.0

Total 70 100.0

Pie chart showing the graphical distribution of the road traffic accidents in Greater Accra

Region. (FIGURE 2.0)

I went ahead to find out the incidence of road traffic accidents, among the different category of road

users in Accra. The GRAPH below summarizes the incidence among drivers, passengers and

pedestrians. Pedestrians topped the list with a total of 31 interviewees being knocked down by vehicles,

and a total of 26 passengers being involved in road injuries. The number of drivers was however on the

low, with a total of 13 drivers being hospitalized. This could mean that they may have survived but did

not require admission for their condition, accounting for the small numbers or may not have survived.

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- In comparison with the study carried out in Nigeria, on the “Burden of road traffic injuries in

Nigeria”, a total of 38 out of 127 motor-vehicles were involved. However, pedestrians recorded

the lowest involvement in the road traffic injuries, in her article. (28)

Graph showing the Incidence of road injuries among various road users. (FIG. 3)

The table on the next page shows the vehicles which were frequently involved in these accidents.

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TABLE 8.0 showing the frequency distribution of vehicles involved in the accident.

Frequency Percent

Bicycle 1 1.4

Motorcycle 18 26.0

Car 15 21.4

Truck 12 17.1

Other 13 18.5

Total 59 84.4

Missing System 11 15.6

Overall Total 70 100.0

From the above data, it is obvious that there are some missing data. Unfortunately, these 11 people refer

to clients interviewed who didn’t know what hit them or happened to them, to land them in hospital.

Though most of these people were aware of the accident, they couldn’t really tell what kind of vehicle it

was, and what could have been the problem. The subsequent question sought to bring out the number of

people who were involved in the road traffic accidents, and those who lost their lives in the process.

Every road traffic accident could involve one or more persons. The next question sought to know if

other people were involved in the accident, by virtue of the fact that, they were also passengers in the

same vehicle or for another reason.

The table below shows the total number of people involved in these accidents, with the exception of

those interviewed. This means that, 19 people said they were the only ones involved in the accident, 16

people said they were involved with one other person, 13 people said they were involved with 2 other

people in the accident and 3 other people said they were involved in the accident with 3 other people.

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TABLE 9.0 showing the total number of people involved in these accidents

frequency fx

0 19 0

1 16 16

11 1 11

12 1 12

15 1 15

17 1 17

18 1 18

2 13 26

23 2 46

3 3 9

4 4 12

5 8 40

9 1 9

TOTAL 70 231

From the data above, it is obvious that though 70 people were interviewed, there were 231 additional

victims of the road traffic accident, some of which are deceased and others in-patients at other facilities.

This is quite a number, implying that in all these 70 accidents, a total of 231 citizens were involved.

The total mortality experienced, from the study is captured in the table below.

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TABLE 10.0 showing number of mortalities in the various accidents.

frequency fx

0 54 0

1 4 4

10 1 10

17 1 17

2 3 6

3 2 6

5 1 5

7 4 28

Total 70 76

From the above table, the total number of interviewees witnessed 76 mortalities compared to the 231

victims of the road traffic accidents.

I subsequently tried to find out the nature of roads associated with these accidents, by finding out where

these accidents occurred. Seventy five percent of the road traffic accidents occurred on tarred roads,

whiles 25% occurred on rough roads in the region.

- Compared with a study by O. Kobusingye, on the Injury patterns in rural and urban Uganda,

he found out that out of 127 people interviewed, 92 (72.4%) people had their accident on a paved

road, 17 people had their road traffic accident whiles at home (13.4%), and 14 other people had

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their road injury on unpaved roads (11%). The last group of four people had their road traffic

accident on paved intersections, making 3.1%. (30).

- This was in keeping with what was seen in this survey I conducted, that majority of the RTAs

occurred on tarred roads. This may have been due to drivers feeling comfortable to take more

risks through over-speeding and ignoring traffic regulations, as stated in the literature review.

Pie chart showing the percentage representation of the nature of the roads. (FIG. 4)

The time of day that most accidents occurred was also important in the study, to enable us appreciate the

importance of headlights and street lights in contributing to our road traffic accidents. Twenty nine

percent of the accidents occurred in the afternoon and 30% occurred in the morning making a total of

59%. Thirty one percent of the road injuries occurred at night, though this was the highest, the total of

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accidents that occurred during the day, would be more than that which occurred during the late hours of

the day. The pie chart below depicts this;

A Pie Chart showing the time of the day most accidents occur (FIG. 5.0)

The study tried to find out the cause of most accidents on our streets, whether they were due to non-

compliance of traffic regulations, recklessness or carelessness among a range of other causes. Most of

the people interviewed felt that recklessness or carelessness on the part of the driver was the main

cause of the accidents in which they were involved in (35 people). This was followed by overtaking by

another vehicle or by same vehicle and then over speeding. Non-compliance to traffic signs contributed

least to the causes of road traffic accidents.

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An article entitled, “Another look into road accident in Ghana”, stated that the most common causes

of road accidents in Ghana include gross indiscipline on our roads, over- loading, and driving while

tired, drunk-driving and over speeding. Statistics show that 60% of road accidents are caused by drunk

driving and over speeding. The latter alone constitutes about 50% of road accidents in the country. The

poor nature of some of our roads, poor maintenance of vehicles, disregard for traffic regulations by most

drivers and indiscriminate use of the road by some pedestrian are some of the other causes of motor

accidents in the country. (31) A similar article entitled “150 Ghanaians die from road accident every

month”, said that besides other causes of transport accidents, fatigue contributes to 25% of road

accidents globally. (32)”. The bar chart below gives more detail.

FIGURE 6.0 SHOWING CAUSES OF ROAD TRAFFIC ACCIDENTS

The survey further wanted to find out how victims of road traffic accidents got to the nearest hospital,

by inquiring the means of transport the interviewees employed. Thirty – two respondents said they got to

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the nearest hospital by a private car (45.7%), 28 people got to the hospital by taxi (40%), and just three

got to the hospital by an ambulance (4.3%). This trend observed was quite sad, only re-iterating the

inadequacy of the numbers of ambulances in this country. Ambulances contain early resuscitation tools

(such as airway devices and oxygen supply) which may help sustain the patient’s critical condition while

transporting him/her to the hospital. Thus if more private cars are transporting victims to the hospitals

instead of ambulances, most victims may not survive to see the entrance to the hospital if they are

critically injured.

TABLE 11 showing means of transportation to the nearest hospital

Transport Frequency Percent

ambulance 3 4.3

bus 4 5.7

police car 1 1.4

private car 32 45.7

taxi 28 40.0

trotro 2 2.9

Total 70 100.0

The questionnaire also sought to find out how many people receive some form of primary

assessment/survey before arrival at a health care facility. From the data below none of the people

interviewed had any form of primary survey before arriving in hospital or during their conveyance to the

hospital. This observation was in keeping with the high number of ‘private car’ transport to the nearest

hospital in contrast to the low number of ambulance transport. (The ambulance team comprises qualified

personnel who can do primary assessment to determine the extent of injury either at the site of accident

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or on the way to the hospital, something which the private cars would most likely lack). The table below

summarizes that;

TABLE 12 SHOWING FREQUENCY OF PROVISION OF PRIMARY

ASSESSMENT/SURVEY

Frequency Percent Valid Percent

no 70 100.0 100.0

yes 0 0 0

Sixty two respondents had some primary assessment done at their first point of call at the hospital

(88.6%), while six people had the primary survey at the referral site from where they came to Accident

Centre, Korle-Bu Teaching hospital (8.6%). Two people said they didn’t have any form of primary

assessment on arrival at the referral site. The table below summarizes the outcome.

TABLE 13 showing where primary assessment was initially provided

Frequency Percent

the first point of call 62 88.6

at the referral site 6 8.6

none 2 2.8

Total 70 100.0

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So, were the road traffic accidents preventable? If yes then how? This was the next question this survey

sought to find. Eighty three percent of the respondents agreed with the statement that the accidents were

preventable, whiles 17% said the accident could not have been avoided. The response is captured in the

pie chart below.

(FIG. 7) PIE CHART SHOWING PERCENTAGE DISTRIBUTION OF RESPONDENT

OPINION AS TO WHETHER ACCIDENTS WERE PREVENTABLE OR NOT

From the above, 83% of the victims thought the road accidents could have been avoided and this is how.

(Summarized in the table below);

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TABLE 14 showing distribution of how the accidents could have been prevented as per the

respondents

Frequency Percentage

better headlight 2 2.8

maintenance 6 8.6

more careful 16 22.8

no overtaking 2 2.8

normal speed 11 15.7

not preventable 9 12.8

obey RTR 17 24.3

obey speed 3 4.3

patience 4 5.7

Total 70 100.0

FIG. 8.0

*RTR – road traffic regulation

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4.3 JOB ASSESSMENT

The category of workers involved in road traffic accidents, was divided into permanent or contract-

based, whether they are civil servants or are in the private sector. Thirty six of them had permanent jobs,

twenty-eight of the respondents had contract based jobs (40%), and it is important to note that six of

them were students (“missing” component of both tables).

These are summarized in two tables below;

TABLE 15.0 showing types of employment of the respondents

Frequency Percent

permanent 36 51.4

temporary/ contract based 28 40.0

Total 64 91.4

Missing System 6 7.2

Total 70 100.0

TABLE 16.0 showing the various job distributions of the respondents

Frequency Percent

civil service/ government

employed 31 44.0

private sector 33 47.1

Total 64 91.4

Missing System 6 8.5

Total 70 100.0

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The graph below represents the specific job descriptions of the RTA victims. (FIG. 9)

With the knowledge about their various occupations, the next was to find out their work-hours per week

and their number of working days per week. The table below shows the work hours per week. From the

data collected the mode for the total number of hours spent at work, on a weekly basis was 40hours/

week.

In comparison to the study of Julliard et al, on Socioeconomic impact of road traffic accidents in West

Africa, 107 out of a total of 127 were able to go to work, following varied duration of stay in hospital.

(28)

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The total number of hours wasted on a weekly basis, due to hospital admission was 3,686hours, for all

the working people interviewed.

TABLE 17.0 showing the frequencies of work hours per week

Hours Frequency fx

112 2 224

24 8 192

40 25 1000

42 2 84

48 2 96

50 7 350

54 2 108

60 3 180

70 12 840

72 2 144

84 1 84

90 1 90

98 3 294

Total 70 3686

The table below shows the number of days/ week of job work that was lost as a consequence of hospital

admission.

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TABLE 18.0 showing number of days per week lost to Road Traffic Accidents

Frequency Percent

three days/ week 8 11.4

five days/ week 17 24.2

six days/ week 21 30.0

Seven ays/ week 24 34.4

Total 70 100.0

Total 70 100.0

Majority of respondents (34%) lost full week off work on the average, implying they either had to obtain

financial support from their savings, company or from family & friends.

Based on the above information gathered, and in an attempt to determine the socioeconomic impact of

road traffic accidents, the questionnaire sought to find out salary being lost.

Majority of the respondents earned between GHc 100-500 (56.2%).

TABLE 19.0 showing the distribution of estimated salaries of respondents

Salary Frequency Percent

less than GHc 100.00 16 22.8

GHc 101.00 - GHc 500.00 38 56.2

GHc 501.00 - GHc 1000.00 10 14.2

GHc 1001.00 - GHc 1500.00 6 8.8

Total 70 100

Total 70 100.0

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TABLE 20.0 SHOWING THE DISTRIBUTION OF THE EXPENSES INCURRED BY

RESPONDENTS

Expenses Frequency Percent

less than GHc 100.00 10 14.3

GHc 101.00 - GHc 500.00 6 8.6

GHc 501.00 - GHc 1000.00 12 17.2

GHc 1001.00 - GHc 1500.00 40 45.7

more than GHc 2,000.00 2 2.9

Total

70

100.0

The second table below shows the expenses victims of road traffic accidents incurred for their treatment.

While majority of the respondents earned between Gh c 100-500, about 60% of the total 70 victims of

RTAs incurred costs up to Gh c 1500. Considering that 56.2% of the 70 victims earn about only one-

third of this cost, it clearly presents a huge financial challenge to patients admitted for various injuries at

the Accident Centre, Korle-Bu. A comparison between the budgetary allocation for road traffic

accidents and the amount lost in terms of services are almost on the same scale, showing that more has

to be done to control the spate of road traffic injuries in our country. It must be noted that GHc 97,821 –

GHc 163,200 is spent monthly to provide services for victims of vehicular accidents. (33)

2011 BUDGET AGAINST COST OF ROAD ACCIDENT ANNUALLY

FINANCIAL COST = $175,000,000 = GHC 241,000,000 EVERY YEAR

HUMAN LIVES = AVERAGE 1870 KILLED EVERY YEAR

SERIOUS INJURY = 15000 EVERY YEAR

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PHYSICAL DISABILITY = ABOUT 5000 EVERY YEAR (33)

The nature of injuries suffered by the victims and the duration of admission to date was also assessed.

The nature of injuries ranged from soft tissue injuries to fractures, with more than 90 respondents having

a fracture and more than 60 having an associated soft tissue injury.

--- Comparing, with O. Julliard’s article on the Burden of road injuries, 47% had fractures and soft

tissue injury, 21% having head and neck injuries. The least injury she reported was spinal injury (1.6%)

The graph below summarizes the distribution of injuries, among the interviewees.

(FIG. 10)

0

5

10

15

20

25

30

35

40

45

Graph showing distribution of the nature of injuries suffered by

victims

Frequency

58 | P a g e

With regards to duration of admission, it ranged from 1week to 16 weeks. This could be attributed to

varied or multiple reasons. From the table below, as many as six people had been on admission for

sixteen good weeks, away from work, family and friends. The impact of prolonged hospitalization on

the individual, the financial burden to the individual, the costs to the hospital and the country as a whole

cannot be overemphasized. This undoubtedly adds to the reason why road traffic accidents are assuming

a public health importance.

----- From the Socioeconomic impact of road traffic injuries article, 80% of the 107 victims stayed in

hospital for less than 4 weeks, whiles 19.6% stayed for over a month. This shows a similar pattern as

what is tabulated below. (9)

TABLE 21.0 SHOWING THE FREQUENCY DISTRIBUTION OF DURATION OF

ADMISSION AND THEIR PERCENTAGES

Frequency Percent

12wks 6 8.6

13wks 1 1.4

14wks 1 1.4

15wks 2 2.8

16wks 6 8.6

1wk 15 21.4

2wks 10 14.2

3wks 7 10.0

4wks 5 7.3

5wks 2 2.8

6wks 2 2.8

7wks 3 4.5

8wks 10 14.2

Total 70 100.0

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To make sense of the duration of stay, I went ahead to find out or better still rule out, those whose

admission in hospital had been prolonged on account of insufficient funds. The pie chart below,

describes this distribution.

FIGURE 11.0 SHOWING THE PERCENTAGE DISTRIBUTION OF RESPONSE TO

DURATION OF ADMISSION BEING INFLUENCED BY INSUFFICIENT

54% 46%

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4.4 IMPACT ON SOCIAL AND FAMILY LIFE

Following prolonged hospital admission, I decided to find out the extent, to which the ability of the in-

patients to provide for their families had been impaired. This was analyzed in consideration with the

number of interviewees, who were breadwinners.

--- From the studies conducted by the ODA, 67% out of a total of 89 respondents had no one wholly

dependent upon them in Ghana. (34)

The pie chart below, show the distribution of people who were breadwinners.

FIGURE 12.0 SHOWING PERCENTAGE DISTRIBUTION OF BREADWINNERS AMONG

THE

RESPONDENTS

The table below shows the extent to which the prolonged admission, has affected the ability of the

interviewees to provide for their families.

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TABLE 22 showing extent to which the injury affected respondent’s ability to provide

Frequency Percent

not significantly 20 28.6

significantly 23 32.4

very significantly 7 10.0

Total 50 71.4

Missing System 20 28.6

Total 70 100.0

From the above table, it is obvious the number of people who were unaccounted for, the missing data

represents the students and also some of the non-breadwinners, who were directly not responsible for

anyone.

The study also tried to ascertain, how the respondent’s financial situation had been affected, since some

were students, others had their medical expenses being catered for by insurance and others yet still were

being supported by their families.

--- From the study of Julliard O et al, 88.6% of the total 127 interviewees realized a reduction in their

earnings.(9)

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FIG.13 showing the extent to which hospitalization has affected their financial situation

The effect of hospitalization on their finances was marked, with 10 respondents complaining of very

significant reduction in their finances, twenty eight people complained of being affected moderately.

Twenty two respondents said their finances had not really been affected that much following the injury.

This could be attributed to recent admission, the coverage of insurance or a good social and family

support system. Some of these people may have also been students.

The study also sought to find out if their salaries had changed in anyway, and if it did, how it had

changed. The bar chart below shows the relationship between the two. Compare with above. (9)

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FIG. 14 Bar chart showing the changes in frequency of salary compared with nature of salary

change among the interviewees

0

10

20

30

40

50

60

Increased Decreased Not applicable

yes

no

Based on all the above information provided, the questionnaire sought to find out how their social lives

had been affected by the injury and also by prolonged hospitalization. Thirty four in patients declared

that they were limited to their beds, this was followed by 22 people complaining about their sports life

and these were all males. A total of 18 clients did not appreciate the fact of staying indoors. This in

comparison to the study of Julliard O et al on the “Socioeconomic impact of road traffic accidents”, she

found out that 37 people out of a total of 127 developed a permanent disability. Twelve respondents out

of the total 37 complained of inability to go about activities of daily living (ADL). (9)

Frequency

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The Pie chart below, pictures how the road traffic injury has influenced their daily functioning state.

This tells how the lives of a vast majority of accident victims change following injury, from disturbance

in activities such as, bathing, sex life and religious responsibilities.

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FIG. 16 SHOWING DISTRIBUTION OF LIMITATIONS TO FUNCTIONING, AS

EXPERIENCED BY THE INTERVIEWEES

From the Pie chart above, 57% of the people interviewed complained about their activities of daily

living, which for some was permanent and for others it was temporary. A minor 35% did not have any

limitations to their activities of daily living.

--- This in comparison with the study of Julliard O et al on the “Socioeconomic impact of road traffic

accidents”, revealed that 37 people out of a total of 127 developed a permanent disability. Twelve

respondents out of the total 37 complained of inability to go about activities of daily living (ADL). (20)

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CHAPTER 5: DISCUSSION, CONCLUSION AND RECOMMENDATIONS

5.1 THE TRENDS OF JOB LOSS AND WORK HOURS LOST AMONG DISABLED AND

NON-DISABLED PEOPLE.

From the study conducted, none of the people interviewed lost his or her job as a result of being

hospitalized following road traffic injury. This could be attributed to the fact that, employers may not be

aware of their functional capacity, that is, if they can still do the work they used to do, or possibly

something else, and might require a transfer. From the data collected thirty six respondents were

permanently employed and twenty-eight were working on contract basis, however thirty three of these

workers belonged to the private sector and thirty-one belonged to the civil service. It is also important to

note, that based on worker policy or employer- employee relationship, it would be inappropriate to lay

any worker off, on the basis of mere disability. With the work hours lost, this was varied depending on

the duration of admission, but out of the 64 employees, twenty eight of them were losing a total of

300hours per week, fourty five of them were losing a total of 340hours per week. This is significant,

considering the fact that Ghana has achieved middle income status.

--- A comparison with previous studies, by Juilliard O. on the Socioeconomic impact assessment of

road traffic injuries in West Africa (an exploratory data from Nigeria involving a study on 127

subjects) showed that among those who had the road traffic injury, seventeen percent were unable to

return to work, sixteen percent lost their job as a direct consequence of the road traffic injury related

disability and 88.6% sustained a reduction in their earnings. It is important to note that the most

common type of disability was difficulty in using a hand or arm for 24% of the respondents and

difficulty or inability to ambulate in 16% of the injured.

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5.2 THE CAUSE AND INCIDENCE OF ROAD TRAFFIC ACCIDENTS AND THE COMMON

AREAS IN ACCRA ASSOCIATED WITH THESE ACCIDENTS.

The study tried to find out the cause of most accidents on our streets; whether they were due to non-

compliance of traffic regulations, recklessness or carelessness among a range of other causes. Most of

the people interviewed felt that recklessness or carelessness was the main cause of the accidents, in

which they were involved in (35 people saying so). This was followed by overtaking by another vehicle

or by same vehicle and then over speeding. Non-compliance to road traffic regulations was the least

contributor to the causes of road traffic accidents, according to the study. This may have been due to

poor knowledge among respondents of the road traffic regulations, which was not one of the objectives

of this particular study.

--- An article entitled, “Another look into road accident in Ghana”, stated that the most common causes

of road accidents in Ghana include gross indiscipline on our roads, over- loading, fatigue driving, drunk

driving and over speeding. Statistics show that 60% of road accidents are caused by drunk driving and

over speeding. The latter alone constitutes about 50% of road accidents in the country. The poor nature

of some of our roads, poor maintenance of vehicles, disregard for traffic regulations by most drivers and

indiscriminate use of the road by some pedestrian are some of the other causes of motor accidents in the

country. (31)

--- A similar article entitled “150 Ghanaians die from road accident every month”, said that besides

other causes of transport accidents, fatigue contributes to 25% of road accidents globally. (32)

It is important to note that 88% of these road injuries occurred in Accra and 10% occurred in Tema; of

these 28 were pedestrians, 22 were passengers and 20 were drivers.

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This could be explained by the increase in influx of vehicles into the country over the past 12 years,

which is not commensurate with the road network we have currently. (33)

(Table 23) showing Motor Accident Returns from the MTTU Head-office for 01/11/11-31/03/2012

Location Total

No. of

cases

Commercial

Vehicles

involved

Private

Vehicle

involved

Motorbik

e

involved

Pedestrian

knocked

down

fatalities Persons

injured

Males

killed

Female

killed

Accra 1061 716 971 125 166 78 587 51 17

Tema 154 121 133 12 19 24 161 16 8

(Table 24) showing Motor Accident Returns from the MTTU Head office for 01/04/12- 31/05/2012

Location Total

No. of

cases

Commerci-

al Vehicles

involved

Private

Vehicle

involved

Motorbik

e

involved

Pedestrian

knocked

down

fatalities Persons

injured

Males

killed

Female

killed

Accra 1276 814 983 121 201 62 537 49 15

Tema 304 202 233 37 63 29 274 23 6

From the tables shown above, between the months of November 2011 to May 2012 there was an

increase in the total number of RTAs recorded in both Accra and Tema. My study conducted on the 70

accident victims revealed most of the accidents occurring in the Accra metropolis mainly, followed

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closely by Tema. Most accidents occurred with private vehicular involvement from the tables above, as

seen similarly in this study among the respondents at Accident Centre, Korle-Bu.

5.3 INFORMATION ON CARE SEEKING OPTION AND HOW COST OF TREATMENT

AFFECTS THE INTERVAL BETWEEN TEMPORARY AND DEFINITIVE TREATMENT

From the survey conducted, most of the patients were not actually involved in deciding which

healthcare option they should seek, (probably because of shock) however for those who were conscious

and alert, they preferred to seek medical care first and resorted to bone setters if they were not satisfied

with the hospital treatment.

In Ghana, victims of road traffic accidents, usually have no initial decision with regards to where to

seek medical care from, they usually wake-up to find themselves in hospital, usually the nearest one by.

(19)

--- From the study performed by Catherine Juilliard et al, on the “Socioeconomic impact of road traffic

injuries in West Africa; exploratory data from Nigeria”, of the 127 victims interviewed, 77% of study

subjects sought medical care. Hospital treatment and treatment by a private physician were the most

common types of initial care sought. Home treatment (22%) was the next most common, followed by

health post or clinic treatment (17%). Although only 6% of road traffic injured (RTI) people sought first

–line care from bone setters, herbalists and other traditional healers, 15 study subjects sought traditional

treatment after they had already been treated in a different setting. Traditional treatment was the most

common second treatment options chosen by road traffic injured people, comprising 39% of those study

subjects who sought more than one treatment, and 12% of all who had a RTI. Individual preferences was

the most common reason for a choice of first provider (42%), but proximity and cost of treatment were

also often quoted. (20)

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With regards to duration of admission, it ranged from 1week to 16 weeks. This could be attributed to

varied reasons. As many as six people had been on admission for sixteen good weeks, away from work,

family and friends. The impact of prolonged hospitalization on the individual and the financial burden to

the individuals were evident. It is therefore no surprise that RTAs are of a major public health concern.

From the “Socioeconomic impact of road traffic injuries” 80% of the 107 victims stayed in hospital for

less than 4 weeks, whiles 19.6% stayed for over a month. (9)

5.4 TO DETERMINE THE METHODS OF PREVENTION OF THESE ROAD TRAFFIC

ACCIDENTS

From the above, 83% of the victims thought the road accidents could have been avoided and this is

how; obeying the road traffic regulations, being more careful, maintenance of vehicles, no overtaking,

normal speed, patience, better headlights and obeying the speed limit. Sixteen out of the total 70 said

their accidents could have been prevented had the driver been more careful and diligent, seventeen

people said by obeying the road traffic regulations. However 9 people thought the accident was not

preventable.

Owing to the socio-economic impacts of road traffic accidents, it deserves to be given political

priority and commitment. Although some interventions are underway by the government of Ghana to

tackle this menace (such as Road Safety Commission’s mass education through advertisements on

television), a lot more work is needed in this aspect to minimize RTAs.

Examples of developed countries like the United States, Japan, Sweden and Finland are noteworthy;

where the personal commitment and interest of their heads of state have maintained the sanity on the

roads and culminated in a drastic decrease in road accidents and the adherence to road regulations. In

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Ghana, wearing of seat belts is yet to become mandatory, yet a lot more people are dying through

accidents when seat belts could have saved them. (14)

Four factors contribute to the vast majority of collisions. In descending order of importance they are:

Driver behavior, Poor roadway maintenance, Roadway design and Equipment failure.

Over 95% of motor vehicle accidents (MVAs, in the USA, or Road Traffic Accidents, RTAs, in Europe)

involve some degree of driver behavior combined with one of the other three factors. Drivers always try

to blame road conditions, equipment failure, or other drivers for those accidents. When the facts are

truthfully presented, however, the behavior of the implicated driver is usually the primary cause. Most

are caused by excessive speed or aggressive driver behavior.

Driver Behavior - Humans tend to blame somebody or something else when a mistake or accident

occurs. A recent European study concluded that 80% of drivers involved in motor vehicle accidents

believed that the other party could have done something to prevent the accident. A miniscule 5%

admitted that they were the only one at fault. Surveys consistently reveal that the majority consider

themselves more skillful and safer than the average driver. Some mistakes occur when a driver becomes

distracted, perhaps by a cell phone call or a spilled cup of coffee. Very few accidents result from an 'Act

of God,' like a tree falling on a vehicle.

Speed Kills - The faster the speed of a vehicle, the greater the risk of an accident. The forces

experienced by the human body in a collision increase exponentially as the speed increases. Smart

motorist recommends that drivers observe the 3 second rule in everyday traffic, no matter what the

speed may be. Most people agree that going 100 mph is foolhardy and will lead to disaster. The problem

is that exceeding the speed limit by only 5 mph in the wrong place can be just as dangerous. Traffic

engineers and local governments have determined the maximum speeds allowable for safe travel on the

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nation's roadways. Speeding is a deliberate and calculated behavior where the driver knows the risk but

ignores the danger. Fully 90% of all licensed drivers speed at some point in their driving career; 75%

admit to committing this offense regularly.

Who are the bad drivers? They are young, middle-aged, and old; men and women; they drive luxury

cars, sports cars, SUVs and family cars. Almost every qualified driver admits to some type of risky

driving behavior, most commonly over-speeding.

Aggressive Drivers - As we've described, modern cars are manufactured to very safe standards, and the

environment they're driven in is engineered to minimize the injuries suffered during an accident. The

most difficult area to change is aggressive driver behavior and selfish attitudes. (15). A 2004 study by the

Automobile Association in Great Britain found that 85% of the respondents reported aggressive

behavior as the 2nd common cause of Road Traffic Accidents.

5.5 THE USE OF PRIMARY ASSESSMENT / SURVEY AT THE ACCIDENT SCENE

From my study, none of the victims of the road traffic injury received any form of primary

assessment, before arrival at a health facility. This is surprising considering the fact that, two people

reported to the health facility via an ambulance.

This goes further to imply that, apart from the absence of emergency rapid response teams and

ambulances at various accident scenes, where these are present, they lack the necessary human resource

to run them.

To add to the above, the survey wanted also to find out if someone received any form of primary care,

and by whom. But unfortunately, since none received any form of primary care, it was not applicable.

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I went further to ascertain, where their primary survey was initially provided. Ninety five respondents

had some primary survey done at their first point of call (92.2%), while six people had the primary

survey at the referral site (5.8%). Two people said they didn’t have any form of primary survey either at

their referral site or destination.

In Benin, the police have the authority to require vehicles to transport accident victims; in Cote

d’Ivoire the fire brigade is responsible for the transport of road accident victims. This seems to be

working well in cities with fire brigades. Otherwise, injured people have to rely on the help of passing

“good Samaritans” for transport to hospital. Except for Cote d’Ivoire, where people seem to be reluctant

to be involved in helping out accidents, people seem to be helpful in providing transport to hospital.

Poor telecommunications is a problem in calling for help.

Though most countries have hospitals, spread out all over the country, not all hospitals have doctors on

call or the equipment needed to treat badly injured victims. (26)

5.6 CONCLUSION

On the whole, it has now been established that Ghana loses 1.6% of her Gross Domestic Product (GDP)

to Road Traffic Crashes (RTCs). The factors of the cost include loss of productive hours, property

damage, medical bills, human and administrative cost among many others. Even though my study did

not ascertain all the components of the socioeconomic impact determinants of road traffic accidents, I

was able to establish using patients of the Accident Centre, Korle- Bu Teaching Hospital as my sample

that huge amounts of money are lost to road traffic accidents as well as lives and property. I was able to

74 | P a g e

assess some of the interventions put in place and also determine that, Ghana as a nation has a long way

to go in order to curb this menace.

I must add that Ghana ranks in the top five countries of high incidence of road traffic accidents

globally(8).

5.7 RECOMMENDATION

It is expedient that long lasting solutions be found to these problems outlined in my study above;

mainly to reduce morbidity, mortality and the financial burden of road traffic injuries in Ghana.

Intensifying the national campaign against RTAs, empowering our Driver Vehicle and License authority

and enforcing existing road safety measures will prove key.

These will not only save the lives of our youth (future generation) but also our economy as a whole.

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5.8 REFERENCES

(1) http://www:ncbi-nim.nih.gov/pmc

(2) Ameratunga S, Hijar M, Norton R. Road-traffic injuries: confronting disparities to

address a global-health problem. Lancet 2006;367:1533e40.

(3) Blincoe L, Seay A, Zaloshnja E. The economic impact of motor vehicle crashes,

2000. Washington, DC: National Highway Traffic Safety Administration, 2002.

(4) The President of the United States. Budget of the United States government:

fiscal year 2000. 1999. http://www.gpoaccess.gov/usbudget/fy00/browse.html

(accessed 8 May 2010).

(5) Peden M, Scurfield R, Sleet D, et al. World report on road traffic injury prevention.

Geneva: World Health Organization, 2004.

(6) http://answers.yahoo.com/question/index?qid=20080316075336AAByhQH

(7 )http://www.thefreedictionary.com/disabled

(8) World Health Organization – Disabilities

(9) Catherine J, Mariam L, Olive k, Adnan A. Socioeconomic impact of road traffic injuries in West Africa:

exploratory data from Nigeria. BMJ Volume 16 issue 6

(10) Mock CN, Gloyd S, Adjei S, et al. Economic consequences of injury and resulting family coping strategies in

Ghana. Accid Anal Prev 2003;35:81–90. [CrossRef] [Medline] [Web of Science]

(11) http://www.ghanaweb.com/GhanaHomePage/features/artikel.php?ID=177453

76 | P a g e

(12) http://www.modernghana.com/news/42956/1/150-ghanaians-die-from-road-accident-every-month.html

(13) http://www.modernghana.com/news/178039/50/another-look-into-road-accidents-in-ghana.html

(14) http://www.ghanaweb.com/GhanaHomePage/features/artikel.php?ID=90849

(15) http://www.smartmotorist.com/traffic-and-safety-guideline/what-causes-car-accidents.html

(16) Blincoe L, Seay A, Zaloshnja E. The economic impact of motor vehicle crashes, 2000. Washington, DC:

National Highway Traffic Safety Administration, 2002.

(17)http://www.sixwise.com/newsletters/05/07/20/the_6_most_common_causes_of_automobile_crashes.htm

(18) http://www.amend.org/docs/TL_West%20Africa_Amend.pdf

(19) Personal communiqué by Dr. P. K. Amooh , Occupational Health Physician of the Korle- Bu Teaching

Hospital.

(20) Catherine J, Mariam L, Olive k, Adnan A. Socioeconomic impact of road traffic injuries in West Africa:

exploratory data from Nigeria. BMJ Volume 16 issue 6

(21)http://www.who.int/violence_injury_prevention/road_traffic/activities/roadsafetytraining_manual_unit_4.pdf

(22) Peden M et al. World report on road traffic injury prevention. Geneva, World Health Organization, 2004.

(23) Ker K et al. Post-license driver education for the prevention of road traffic crashes: a

Systematic review of randomized controlled trials. Accident Analysis & Prevention, 2005, 37: 305–313.

(24) http://www.evidencebased.net/ce/case1/primarytext.html

(25) http://www.nrsc.gov.gh/assets/2007%20annual%20report%20dav%20adom%20ruddy.pdf

77 | P a g e

(26) http://www4.worldbank.org/afr/ssatp/Resources/SSATP-WorkingPapers/SSATPWP33.pdf

(27) Mock CN, Adzotor E, Denno D, et al. Admissions for injury at a rural hospital in Ghana: implications for

prevention in the developing world. Am J Public Health 1995; 85:927e31.

(28) Catherine J, Mariam L, Olive k, Hyder A. The burden of road traffic injuries in Nigeria: results of a

population – based survey BMJ volume 15 issue 6, page 157-162.

(29)Motor transport and traffic Union-Ghana; Motor accident returns for the 1st quarter ending 31/03/2011,

nationwide.

(30) Kobusingye O, Guwatudde D, Lett R. Injury patterns in rural and urban Uganda; Lancet 1997; 349: 1269-76.

(31) http://www.modernghana.com/news/178039/50/another-look-into-road-accidents-in-ghana.html

(32) http://www.modernghana.com/news/42956/1/150-ghanaians-die-from-road-accident-every-month.html

(33) http://www.ghanaweb.com/GhanaHomePage/features/artikel.php?ID=177453

(34) Ghee C, Astrop A, Silcock D, Jacobs G, Socio-economic aspects of road accidents in developing countries;

TRL

Report 247

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5.9 APPENDIX: QUESTIONNAIRE

NAME OF INSTITUTION: UNIVERSITY OF GHANA MEDICAL SCHOOL, DEPARTMENT OF

COMMUNITY HEALTH

NAME OF SUPERVISOR: PROF. BIRITWUM

PROJECT TITLE: SOCIO-ECONOMIC IMPACT OF ROAD TRAFFIC ACCIDENTS

IN A SECTION OF PATIENTS AT THE ACCIDENT CENTRE,

KORLE-BU TEACHING HOSPITAL.

MY NAME IS MICHAEL A. ADU-DARKO, FINAL YEAR MEDICAL STUDENT

UNDERTAKING THIS DISSERTATION IN PARTIAL FULFILLMENT OF THE REQUIREMENT

FOR THE AWARD OF MB ChB DEGREE.

INFORMATION PROVIDED IN THIS QUESTIONNAIRE WILL SEEK TO DESCRIBE THE

DEMOGRAPHIC CHARACTERISTICS OF PARTICIPANTS, IDENTIFY THE ECONOMIC AND

SOCIAL IMPACT OF ROAD TRAFFIC ACCIDENTS ON PARTICIPANTS, TO COMPARE

RESULTS OBTAINED WITH SIMILAR STUDIES ELSEWHERE AND TO PROVIDE

RECOMMENDATIONS TO THAT EFFECT.

THIS INFORMATION WILL BE KEPT STRICTLY CONFIDENTIAL.

YOU ARE AT LIBERTY TO WITHDRAW YOUR PARTICIPATION AT ANY POINT IN THE

STUDY.

THANK YOU FOR PARTICIPATING

INITIALS OF PARTICIPANT:

DATE:

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SERIAL NUMBER:

INSTRUCTIONS: Please circle or fill as appropriate

DEMOGRAPHY

1. Age……………………yrs Sex: MALE ….. FEMALE …..

2. Ethinicity: a) Akan b) Ga c) Ewe d) Northern e) Other (specify) …………

3. Religion: a) Christian b) Islam c) Traditional d) Other (specify)…………

4. Marital status: a) Single b) Married c) Divorced d) Widowed

5. Educational Level: a) Primary b) Secondary/Vocational c) Tertiary

6. Occupation: a) Student b) Formal Sector c) Informal Sector d) Unemployed

NATURE OF ROAD TRAFFIC ACCIDENT:

7. Could you kindly identify or state the road on which is occurred? Eg. Tema Motorway

……………………………………………………………

8. Where the accident occurred, if in Accra or other (indicate) ………………………………….

9. Were you a: a) Pedestrian b) Passenger c) Driver

10. If you were a passenger, what vehicle were you in?

a) Bicycle c) Car

b) Motorcycle d) Truck e) Other, please specify …………………

11. Were you the only one involved? a) Yes b) No

12. If no, was there any mortality involved? a) Yes b) No

13. Do you have a fair idea of how many? If so please state …………………….

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14. What was the nature of the road like? a) Rough road b) Tarred road c) Other

(specify)……………………

15. What time of the day was it? a) Morning b) Afternoon c) Night d) Dawn

16. Do you have an idea as to the cause of the accident?

a) Over-speeding b) Over-taking by another vehicle or by your vehicle

c) Bad Road d) Non-compliance of traffic signs or non-compliance of road

regulations

e) Mechanical fault or failure f) Poor road lighting

g) Poor vehicle headlights h) Crossing animal or pedestrian

i) Recklessness or carelessness on the part of the driver

17. How did you get to the nearest hospital?

a) Ambulance b) Good Samaritan c) Relatives d) Public transport d) Other (please

specify) ………………………

18. Did you receive any primary assessment/survey before arriving at the hospital?

a) Yes b) No

If YES, by whom? ………………………………………….

19. Where was the primary assessment conducted?

a) At the accident site b) The first point of call c) At the referral site

20. Was the accident preventable? a)Yes b) No

21. How could it have been prevented (If yes to the question above)?

a) Better headlights g) Not preventable

b) Better maintenance of vehicle h) Patience

c) More careful i) obey speed limits

d) No over-taking j) other………………………….

e) Normal speed

f) Obey traffic regulations

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JOB ASSESSMENT

22. If employed, please specify …………………………..

23. Is the employment a) Permanent b) Temporary/contract based

24. Nature of job

a) In the civil service/ government employed

b) Private sector

25. Could you please specify;

a. The work hours in a week …………………….

b. Number of days in a week …………………….

26. Could you please provide an estimation of your salary/ wages

a) Less than GHc 100 b) GHc 101 – GHc 500 c) GHc 501 – GHc

1,000

d) GHc 1001 – GHc 1500 e) GHc 1501 – GHc 2500 f) GHc 2501 – GHc

5,000

g) GHc 5001 – GHc 10,000 h) GHc 10,001 – GHc 20,000 i) >/ More than GHc

20,000

27. If there has been additional remuneration please indicate below

………………………………………………………………………

28. What was the nature of the injury? Please tick more than one if applicable.

a. Soft tissue injury b) Fracture c) Head injury

ii) Penetrating injury d) Spinal injury e) Other (please

specify)……………………………

29. Duration of admission (till date if applicable) (in weeks/days)………………………………..

30. Any identified morbidities / impairment………………………………………………

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31. Has your duration of admission been influenced by cost of treatment?

a) Yes b) No c) Other, please specify…………………………………….

32. Estimated expenses/ cost of treatment (up till date if applicable).

a. < GHc 100.00 b) GHc 101.00 – GHc 500.00 c) GHc 501.00 – GHc 1,000.00

d) GHc 1,001.00 – GHc 2,000.00 e) > GHc 2,000.00

IMPACT ON SOCIAL AND FAMILY LIFE

33. Are you the bread-winner for your family? a) Yes b) No

34. If yes, how has your injury affected your ability to provide for your family?

a) Very significantly b) Significantly c) Not significantly

35. If no, how has it affected your personal financial situation?

…………………………………………………………………………………………

36. Has there been a change in your current salary/ wages following the injury?

a) Yes b) No

--- If yes, has it a) increased b) decreased, following the injury?

37. Has your social life been influenced in anyway by the injury? If yes, please specify

………………………………………………………………………………………………………

……………….

38. Have there been any limitations to your daily functioning state? If yes, please specify

………………………………………………………………………………………………

Thank you for your co-operation

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