Characteristics of road traffic injuries and potential risk factors in Oman

Background: Globally, road traffic injuries have increased by almost 46% in the twenty years prior to 2010. This makes road traffic crashes (RTC) the tenth leading cause of death in the world and the leading cause of death of young people. Oman, a wealthy country where motorising is increasing rapidly, has a very high road traffic mortality. In Oman, road traffic deaths and injuries are the main external cause of morbidity in young adults and have a direct effect on the economic and health resources of the country. Road traffic crash research has only recently begun in Oman. The modifiable causes of this problem and most effective response have not yet been well-explored. Aims: The main aims of the research described in this thesis were: - To describe the distribution of road traffic crashes in Oman by time, person and place using the data collected by the Royal Oman Police and examine their assessment of reasons for crashes, from 1985-2010. - To collect data in order to estimate the prevalence and distribution of known risk factors in road traffic crashes in Oman, focusing specifically on Sohar. Methods: Two studies were conducted to achieve the aims of this thesis. Firstly, a retrospective case series used the Royal Oman Police data from 1985-2010. This examined trends in the police data on road traffic crashes across the whole time period and then summarised the most recent available year of data (2010) in more detail. Secondly, a prospective case series of injured drivers admitted to Sohar Hospital Emergency Department was carried out. Between 20 February 2012 and 20 March 2012, consecutive injured drivers admitted to Sohar Emergency Department were recruited to the study. Questionnaire-based face-to-face interviews were held to collect data on socio-demographics, circumstances of the crash, and known risk factors for road traffic injuries, including risk behaviours at the time of the crash and usual behaviours. All admitted injured drivers were recruited apart from the most seriously injured drivers who were taken by ambulance to the capital city Muscat for further investigations, and those who died from their injures. Results: According to Royal Oman Police data (1985-2010), total deaths and injuries from RTCs have increased by almost 300% in Oman since 1985. An element of speeding was reported for all the crashes since 1992. The victims of road traffic crashes were mostly the young age group (21-30 years). More drivers have been killed than any other road user group, constituting 43.8% of total road traffic deaths, and passengers have been the most injured, constituting 48.2% of total road traffic injuries. In the Sohar study, 250 injured drivers, 75% males and 25% females, were interviewed with a 100% response rate. Interviewed injured drivers were found to have spent long hours on the roads and had driven for long distances. Overall, less than 5% of injured drivers were over the age of 35 years. There was a marked difference in the age distribution of male and female injured drivers. Among men almost half (49.5%) of the injured drivers were 18-25 years old and 45.7% were 25-35. Among women, 95% of injured drivers were 25-35 years old. Generally, male drivers had more traffic violations than female drivers with 83% of males reporting at least three traffic violations over the past five years, whereas almost half of the females reported one or no, traffic violation over the same period. The highest frequency of crashes occurred on Saturdays and Thursdays (18.8% and 17.6% respectively) and the majority of the injured drivers were either familiar or very familiar with the roads on which they crashed. It was clear that the injured drivers in Sohar routinely ignored the traffic laws and reported risky driving behaviours. For instance, less than 10% of injured male drivers and only 56% of female drivers were wearing their seatbelts at the time of the crash. Also, a high proportion of both male and female drivers were travelling at a speed of 100-140 km/hour at the time of their crash (65.4% male and 58% female drivers). Moreover, 31.4% of injured male drivers and 24% of injured female drivers were using their cell phones at the time of their crash. When describing their usual driving behaviour, 52.8% of all interviewed drivers reported that they never or almost never wear seatbelts while driving. Conclusions: Overall, the incidence of road traffic crash injuries and deaths is high and increasing in Oman with a high prevalence of known risk factors for road traffic injuries even where protective legislation exists. Even though this case series cannot establish that these risk factors cause road traffic injuries in this population, experience from other countries suggests that appropriate legislation and increased enforcement could reduce road traffic injuries in Oman