More than 1.25 million lives are cut short due to road traffic injuries. They are the 9th leading cause of death with 2.2% of all deaths globally for persons aged between 15 and 29 years. Developing countries have around 54% of the world’s vehicles, but have 90% of the world’s road fatalities. These crashes incur countries 3% of their gross domestic product (WHO, 2004). In Kenya, it incurs them 5.6% of GDP that approximately 300 billion Kenya Shillings (NTSA, 2016). Motorcycle injury is becoming one of the most serious problems in developing countries where motorcycle is used for transportation because it’s cheap and fast access to areas not accessible by motor vehicles. Motorcycle users are highly endangered on the road and should be a targeted group in order to reduce road traffic injuries (Solagrebu et al., 2006). Even in developed countries, the risk of dying from a motorcycle injury is 20 times higher when compared to motor vehicle injury (Peden, 2004; Solagrebuet al., 2006).
In Kenya motorcycle crashes, injuries and deaths are putting a heavy burden generally on communities and the health system since those affected by the accidents are mostly in their productive years (15-44) leading to a drain on the country’s human resources. When a head of household is injured or dies due to motorcycle injuries the family is forced into poverty and psychological torture. Motorcycle riders are endangered since they lack safety devices such safety belts and airbags as opposed to motor vehicles (Hurt HH et.al., 1981). Hence they are at risk of more serious and multiple injuries.
This study aims at determining injury patterns among commercial motorcycle users attending Thika Level V Hospital, Kiambu County, Kenya. A descriptive cross-sectional study will be sought to determine injury patterns among commercial motorcycle users attending Thika Level V Hospital, Kiambu County Kenya. 367 commercial motorcycle crash victims will be recruited into the study. Data will be collected using a semi-structured, interviewer-administered questionnaire, analyzed and presented in form of tables and charts.
BACKGROUND AND CONTEXT
More than 1.25 million lives are cut short due to road traffic injuries. They are among the leading causes of death (ranked at 9) with 2.2% of all deaths globally for persons aged between 15 and 29 years. Developing countries have around 54% of the world’s motor vehicles, but they have 90% of the world’s road fatalities. Countries suffer a loss of about 3% of their gross domestic product due to these crashes (WHO, 2004). In Kenya, it incurs them 5.6% of GDP that approximately 300 billion Kenya Shillings (NTSA, 2016). Motorcycle injury is becoming one of the most serious problems in developing countries where motorcycle is used for transportation because it’s cheap and fast access to areas not accessible by motor vehicles. Motorcycle users are highly endangered on the road and should be a targeted group in order to reduce road traffic injuries (Solagrebu et al., 2006). Injuries are the leading causes of death in all age groups and for both male and female (Krug, E., Gyanendra, K., & Lozano, R., 2000). Even in developed countries, the risk of dying from a motorcycle injury is 20 times higher when compared to motor vehicle injury (Peden, 2004; Solagrebuet al., 2006).
According to NHTSA, the U.S. Department of Transportation, there was a 5% decrease in motorcyclist injuries in 2013, from approximately 93,000 injured motorcyclists in 2012 to 88,000 injured motorcyclists. In the last decade in India, motorcycling has increased rapidly. The data maintained by the Ministry of Road Transport and Highways indicates that there is an almost 3 % increase in total road deaths since the previous year, the death percentage of motorcycle users being the highest at 33.9 % in the year 2014. It has also been approximated that the annual incidence for non-fatal road traffic due to motorcycle use to be 6.3% in Hyderabad for the age groups 5 ‘ 49. This shows the extent of burden of road traffic injuries amid motorcycle users (Dandona, R., et al., 2008).
Africa has the highest road fatality rates globally despite having 2% of the world’s vehicle at 24.1 deaths per 100,000 population (WHO, 2013). In Kenya motorcycle crashes, injuries and deaths are putting a heavy burden generally on communities and the health system since those affected by the accidents are mostly in their productive years (15-44) leading to a drain on the country’s human resources. When a head of household is injured or dies due to motorcycle injuries the family is forced into poverty and psychological torture (Hurt HH et.al., 1981). 3055 road traffic deaths was reported in 2010 about 7% were motorcyclists (NTSA, 2010). In the last 6 years, the number of registered motorcycles has increased. In 2011 70% of all newly registered vehicles were motorcycles. Between 2005 and 2010 there has been an increase, of about 5times, in motorcycle-related deaths (NTSA, 2010).
Injuries to motorcyclists are an important but neglected health concern. Motorcycle riders have the highest health burden expressed in disability adjusted life years lost. The prevalence of motorcycle injuries varies around the world according to the collected reports. Vietnam having 62%, Nigeria prevalence ranging from 12.8-60% have been reported (NHTSA, 2007), China having 22.8% (Zhang J Motorcycle, 2004) and in Kenya 39.4 %. Motorcycle riders are endangered since they lack safety devices such safety belts and airbags as opposed to motor vehicles (Hurt HH et.al., 1981). Hence they are at risk of more serious and multiple injuries. Wearing of safety gear such as helmets increases the chances of survival in case of an accident and jackets with reflectors significantly reduce incidence of crashes. Alcohol consumption, poor weather conditions leading to poor visibility, night riding and poor roads are associated with a higher incidence of crashes (Mullins B, Norton R, et al., 2004). Motorcyclists have a tendency of over-speeding and over loading their motorcycles in order to make several returns in a day. They are known to be undisciplined and most don’t wear protective gear such as helmets leading to aggravation of risks of getting severe head injuries (Crompton JG, Oyetunji TA et al., 2012).
Motorcycle injuries are underreported from developing countries especially injury patterns, demographic and host characteristics of the injured commercial motorcycle users. Road traffic injuries, globally, are accountable for a significant portion of all injury morbidity and mortality and 90% of the mortalities are seen in developing countries (Pedenet al., 2002). Therefore this study will be carried out so as to establish the injury pattern among commercial motorcycle users attending Thika Level V Hospital.
Injuries attributed to motorcycle account for a substantial number of road traffic injuries seen at Thika Level V Hospital. Compared to vehicle users, motorcycle riders and their passengers are relatively unprotected from accidents per kilometres travelled and have a higher chance of serious injuries or deaths. The emergent boom of commercial motorcycle use (commonly known as ‘bodaboda’) in the country raises serious safety concerns. The popularity of these commercial motorcycles are due to their fast means of transport particularly over short distances, their efficiency in dodging traffic jam in major cities and there are availability 24/7. Their operation is usually characterized with lack of valid licensing among riders, no use of helmets and passenger overload to enhance faster return for more passengers. The high number of Motorcycle crashes has put a strain on the health facilities in the rural areas that are ill equipped to deal with these crashes.
Prior researches have been based on crash and injury helmet use, limited geographic regions and majorly hospital based. Most hospital-based surveys report on motorcycle injuries in Kenya have been carried out in Nairobi as record reviews, but they don’t entail details on the severity of the injuries hence contributed to the lack of knowledge on the magnitude of the motorcycle road traffic injuries.
Justification of the study
Motorcycles operate efficiently compared to other transport means in terms of accessessibility and financial status hence they are a bridge in the transport system in Kenya. There has been a substantial increase in number of injuries caused by motorcycles. This is due to their lack of physical protection and other factors placing them in a vulnerable state that makes it easy for them to be injured once they are involved in a collision. Injuries affiliated to motorcycle use are among the road traffic injuries seen at Thika Level V Hospital. They lead to a substantial loss of lives and resources. At this rate, the motorcycle for quite a while will remain to be a key player as a means of transport and action needs to be taken to make it as safe as possible.
The lack of existing data demands a further investigations into the injury patterns and risk factors influencing the occurrence of commercial motorcycle injuries in this environment (Thika Town). This study will add on to existing documentation to make the motorcycle transport system safer by founding out on the injury patterns among motorcycle users attending Thika Level V Hospital. It also demonstrates the risk factors, incidence and knowledge on safety practice among commercial motorcycle users.
To determine the injury patterns among commercial motorcycle users attending Thika Level V Hospital, Thika, Kiambu County.
To determine incidences of injuries among commercial motorcycle users attending Thika Level V Hospital, Thika, Kiambu County.
To assess risk factors associated with injuries among commercial motorcycle users attending Thika Level V Hospital, Thika, Kiambu County.
To describe injury patterns among commercial motorcycle users attending Thika Level V Hospital, Thika, Kiambu County.
To explore the knowledge, practice safety measures and causes of motorcycle injury among commercial motorcycle users attending Thika Level V Hospital, Thika, Kiambu County.
What are the incidences of injuries among commercial motorcycle users attending Thika Level V Hospital, Thika, Kiambu County?
What are the risk factors associated with injuries among commercial motorcycle users attending Thika Level V Hospital, Thika, Kiambu County.
What are the injury patterns among commercial motorcycle users attending Thika Level V Hospital, Thika, Kiambu County?
What is the knowledge of safety practice and causes of motorcycle injury among Commercial motorcycle users attending Thika Level V Hospital, Thika, Kiambu County?
Independent Variable Intervening Variables Dependent Variable
Commercial Motorcycle User Motorcycle Injury
Motorcycle is a two wheeled vehicle at times three wheeled used for transporting one to two riders. One has to acquire a motorcycle license in order to ride a motorcycle on roads and special skills to ride them since braking and handling on wet or slick surfaces require extra caution in handling them. They provide a convenient, higher fuel economy, manoeuvrable and inexpensive alternative to automobiles. There are different variety of motorcycles for different purposes.
Incidences of motorcycle accidents
Motorcycles are a popular means of transport in low and middle income earning countries (WHO, 2006). Because they are cost effective compared to other vehicles in terms of sale and maintenance costs (Solagberu et al., 2006) and efficient in that they easily dodge traffic jam. In Thika, the commercial motorcycle as a means of employment is booming as evidenced by seeing the motorcyclists’ park at different locations as they await passengers. Some study done by in Nigeria (Solagberu et al., 2006) showed that commercial motorcycle was expanding in means of employment as one could earn sufficient money for daily living. Kenya in the last 6 has evidenced an increase in number of registered motorcycles. Regardless of the advantages of commercial motorcycles, a large part of those injured or killed on the roads are the motorcyclists as they are less visible compared to the other fast moving, heavier and bigger motor vehicles which they often share the traffic space with. They also lack physical protection making the motorcyclists and their passengers at high risk of being injured if involved in a collision (WHO, 2006). They are also at much higher risks of fatalities when involved in crashes as compared to other motor vehicles (Deutermann, 2004).
In 2011, 70% of all newly registered vehicles were motorcycles in Kenya (NTSA, 2010), 67% in Taiwan, 60% in Malaysia and 95% in Vietnam (Hung et al., 2006). In Malaysia and Taiwan motorcycle crash deaths were more than 50% of traffic deaths (Radin-Umar et al., 1996), 42% in Singapore and 80% in Thailand (Wong et al., 1990b). In the U.S. about 2% of all registered motor vehicles are motorcycles (NHTSA, 2007) because they are used for recreation most of the times and not commercial use. The difference in developing and developed countries motorcycle accidents include: most of the motorcycles in developed countries are scooters (Salatka et al., 1990) and scooter injuries differ from those for motorcycles (Salatka et al., 1990), the roads in developing countries are unique e.g. traffic is made up of a mixture of motor vehicles, rickshaws, bicycles, animal-driven vehicles, animals etc. (Sahdev et al., 1994) and finally, the incorrect use or absence of safety devices among motorcycle riders in developing countries. A study done in Indonesia and China showed that about a third of motorcycle riders had either incorrectly fastened helmet helmets or substandard helmets (Conrad et al., 1996). This is because of substandard knowledge and poor law enforcement (Liu et al., 2008).
Differences of motorcycle injuries incidences between the developed countries and developing countries is largely based on number of motorcycle riders, type of motorcycle, purpose of riding the motorcycle, the amount of riding exposure, road engineering and intervention programs provided (Forjuoh, 2003).Hence, if these differences are not taken into consideration it might not be practical for the use of commercial motorcycle in developing countries (Forjuoh, 2003).
Risk factors of motorcycle injuries
Helmet use among riders
Helmets are made of a rigid fiberglass, a foam liner and a chinstrap .Helmets reduced the risk of motorcycle deaths caused by head injuries. There was evidence of effectiveness increase up to 37% between the years 1993 to 2002 due to the upgrade of materials and design used in making helmets (Deutermann, 2004). Non helmeted riders were likely to sustain head injuries and skull fractures 2.4-times more compared to helmet users (Gabella et al., 1995). Types of helmets in existence; full face, full coverage, and half coverage (Tsai et al., 1995) but differences in their effectiveness have not been well explained.
Occasionally, injuries to neck and basal skull is found in helmeted riders hence rising speculations as to whether to its safe to use them (Konrad et al., 1996). Secondly, there has been raised concerns on the effects of helmet on the rider’s vision and hearing. Studies have shown that there is an effect on the lateral vision of the riders but it is small and is compensated by increased head rotation during turns hence hearing and visual acuity are not very majorly affected by the use of helmet (McKnight, 1995). Finally, another issue is whether the extra mass added on the head by helmet has an increased risk of a crash (Bishop et al., 1983).
Inexperience and training among riders
Inexperience among riders is affiliated with risk of motorcycle crashes (Wong et al., 1990a). However, there was no significant reduction of motorcycle crashes between riders who had partaken in formal training and those who didn’t receive a training course (Rutter and Quine, 1996). There are possible explanations as to the advantages of formal training on decreasing motorcycle crashes and injuries. A survey done in the United Kingdom showed that the youth played a major role than inexperienced riders in motorcycle crashes and injuries .This is due to a pattern of risk taking behaviours that include urge to violate laws governing the safety of riding motorcycle (Rutter and Quine, 1996). Risk homeostasis or risk compensation theory explains that trained riders have confidence in their operating skills to ride with more risk taking behaviours (Wilde, 1998). Nevertheless, there has been no study that directly examines the interpretability of this theory.
Alcohol and other drug use among motorcycle riders
Alcohol is mostly associated with all kinds of motor vehicle crashes (Villaveces et al., 2003). There has been a recent shift in the peak rate of alcohol in the United Stated to those aged 40 -44yrs from 15- 29years (Paulozzi and Patel, 2004). Motorcycle riders under the influence of alcohol involved in an accident are more likely to have not been wearing a helmet and lost control of their motorcycle leading to serious head injuries (Zambon & Hasselberg, 2006b). There has been a suggestion for a reduction in the legal limit of blood alcohol concentration for motorcycle riders since they are required to operate on an unstable vehicle due to the alcohol effect on their motor coordination, balance and judgement skills (Sun, Kahn, & Swan, 1998).
During 1990 to 1991, 32% of motorcycle riders treated in Maryland Trauma had consumed marijuana before they were involved in the crash, which was 2.7% higher than car drivers treated (Soderstrom et al., 1995). A combinations of alcohol and either cocaine, benzodiazepines, or cannabis was seen in about a third of the young aged injured motorcycle riders (Cimbura et al., 1990).
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