عنوان

Road Traffic Crashes in Federal Capital Territory, Nigeria: Explanatory Factors in Statistical, Geospatial, and Qualitative Analyses

Number

TL50913

.Language of Text, Soundtrack etc

انگلیسی

Title Proper

Road Traffic Crashes in Federal Capital Territory, Nigeria: Explanatory Factors in Statistical, Geospatial, and Qualitative Analyses

General Material Designation

[Thesis]

First Statement of Responsibility

Holmes, Benjamin D.

Subsequent Statement of Responsibility

Cassidy, Laura D.

Name of Publisher, Distributor, etc.

The Medical College of Wisconsin

Date of Publication, Distribution, etc.

2019

Text of Note

157 p.

Dissertation or thesis details and type of degree

Ph.D.

Body granting the degree

The Medical College of Wisconsin

Text preceding or following the note

2019

Text of Note

BACKGROUND: Road traffic crashes and sequelae are reaching pandemic proportions globally and have currently achieved disproportionately high levels in Nigeria. Crashes can result in death, disability, and injuries, which can cause economic, workforce, and quality of life strain. Explanatory factors of crashes and sequelae in Nigeria are incompletely understood and are rarely evaluated using geospatial or qualitative methods. METHODS: This mixed-methods study evaluates explanatory factors of crashes, injuries, and mortality in Federal Capital Territory, Nigeria using statistical, geospatial, and qualitative techniques. Quantitative crash patient data were collected from National Hospital Abuja's trauma registry from records between 2014 and 2018, and qualitative data were collected via semi-structured interviews with individual crash patients in 2018. Data were analyzed using multiple logistic regression, cluster analysis, and qualitative content analysis. RESULTS: More than 60% (1879) of all trauma patients were injured in a road traffic crash. Crashes were a significantly greater cause of spinal (77.4%) than nonspinal (59.4%) injuries (p<.0001). Pedestrians were involved in 19% (356) of total crashes, occupying a significantly larger proportion of spinal (18.6%) than nonspinal (10.6%) injuries (p<.0001). Involvement in a crash as a pedestrian was a risk factor of crash-related spinal injury, with an adjusted odds ratio of 1.38 (95% confidence interval: 1.03 - 1.85, p=0.0329). Involvement in a crash as a pedestrian was also a risk of mortality (odds ratio: 2.61, 95% confidence interval: 1.78 - 3.81, p<.0001), as was whether the crash occurred on an expressway or in a transition zone between expressways and local roads (i.e., junction, bridge, or roundabout) as compared to local roads (odds ratio: 1.84, 95% confidence interval: 1.25 - 2.72, p=0.0045). Cluster analysis further isolated significant hotspots of mortality (Moran's I=0.31), pedestrian injury (Moran's I=0.34), and expressway/transition zone injury rates per population (Moran's I=0.18) to the same five wards in Federal Capital Territory: Dutse Alhaji, Wuse, Garki, City Centre, and Nyanya. Qualitative units of analysis were structured by Haddon's four etiologic categories (human-, vehicle-, physical environment-, and socioeconomic environment-related) and developed into subcategories. Human-related subcategories included reckless behavior and drivers' limited technical knowledge and skill. Vehicle-related subcategories included vehicular disrepair and lack of safety equipment. Physical environment-related subcategories included road disrepair, infrastructural inadequacy, and weather. Socioeconomic environment-related subcategories included government, prehospital care, and money. Subcategories were organized temporally within pre-event, event, and post-event phases, with most units of analysis in each category allocated to the pre-event phase. CONCLUSION: Road traffic crashes are a significant cause of injury and mortality for patients seen at National Hospital Abuja. The patient's status as a pedestrian is an explanatory factor of both spinal injury and death. The location of a patient's crash was another explanatory factor of death, with a higher risk of mortality for patients whose crashes occurred on expressways/transition zones. Five wards clustered significantly as hotspots of mortality, pedestrian injury, and expressway/transition zone injury rates. Qualitative findings highlight the perceived etiologies of crashes, injuries, and death, which frequently included reckless behavior and infrastructural inadequacy leading up to the crash (such as traffic congestion in transition zones); vehicular disrepair at the time of the crash; and a lack of post-crash, prehospital care. Results from this dissertation can guide future research along community-aligned priorities. This and subsequent studies can help direct both the development of road traffic injury practice guidelines and interventional and preventative measures, and the allocation of limited resources.

Subject Term

Epidemiology

Subject Term

Public health

Holmes, Benjamin D.

Cassidy, Laura D.

The Medical College of Wisconsin

Electronic name

p

[Thesis]

276903

a

Y