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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 21  |  Issue : 2  |  Page : 165-169

Epidemiological assessment of road traffic accidents among the naval population


1 O/o DGMS (Navy), IHQ MoD (Navy), New Delhi, India
2 Headquarters, Southern Naval Command, Kochi, Kerala, India
3 O/o DGMS (Army), IHQ MoD (Army), New Delhi, India

Date of Submission13-Apr-2019
Date of Acceptance23-Jul-2019
Date of Web Publication07-Oct-2019

Correspondence Address:
Surg Cdr (Dr) Saurabh Bobdey
O/o DGMS (Navy), IHQ MoD (Navy), Sena Bhawan, New Delhi - 110 011
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmms.jmms_20_19

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  Abstract 


Introduction: Road traffic accidents (RTAs) are one of the leading causes of mortality and morbidity globally. The problem is more critical and increasing in developing countries due to rapid motorization and poor conditions of the road. In Indian Navy too, there is serious concern regarding injuries and deaths due to RTAs. Therefore, the present study was conducted to study and document the factors involved in RTAs as well as elucidate major modifiable risk factors for RTA among the naval population. Materials and Methods: Medicolegal case records pertaining to RTAs in the naval population for the period January 1, 2016–December 31, 2017, from all Naval Hospitals and major base units of Indian Navy were obtained and analyzed. Results: During the study, a total of 1608 cases of RTA were documented. More than half of the cases (n = 841; 52%) involved personnel between the ages of 21 and 30 years. Maximum number of cases (n = 179; 11.1%) occurred in July and in terms of hours of the day, maximum cases were documented as occurring between 1200 and 1600 h (n = 394; 24.5%), whereas another 24.4% of cases happened in the night starting at 2000 h. Age <40 years (odds ratio [OR] 2.37, 95% confidence interval [CI] 1.67–3.38), history of consumption of alcohol (OR 1.77, 95% CI 1.27–2.47), and involvement of another vehicle in the accident (OR 1.55, 95% CI 1.16–2.08) were found to be independent risk factors for grievous injury. Conclusion: Morbidity and mortality of trained and professional workforce due to RTAs is a major cause of concern for the Indian Navy. The present study highlights the factors associated with RTAs among the naval population and emphasizes the need to take decisive steps to reduce RTA's and prevent the loss of precious lives of naval personnel.

Keywords: Alcohol, helmet, medicolegal case record, road traffic accidents


How to cite this article:
Singh M V, Bobdey S, Narayan S, Ilankumaran M, Chatterjee J, Vishwanath G, Pawar A A, Banerji A. Epidemiological assessment of road traffic accidents among the naval population. J Mar Med Soc 2019;21:165-9

How to cite this URL:
Singh M V, Bobdey S, Narayan S, Ilankumaran M, Chatterjee J, Vishwanath G, Pawar A A, Banerji A. Epidemiological assessment of road traffic accidents among the naval population. J Mar Med Soc [serial online] 2019 [cited 2019 Oct 17];21:165-9. Available from: http://www.marinemedicalsociety.in/text.asp?2019/21/2/165/268615




  Introduction Top


Road traffic accidents (RTAs) are defined by the World Health Organization as “fatal or nonfatal injury incurred as a result of a collision involving at least one moving vehicle.”[1] However, this definition does not cover the entire spectrum of RTA, for example, accidents/injuries sustained due to falling from a two-wheeler. The United Nations Economic Commission for Europe provides a more comprehensive definition, i.e., “an accident which occurred or originated on a way or street open to public traffic; resulted in one or more persons being killed or injured, and at least one moving vehicle was involved.” This definition, therefore, includes collisions between vehicles, between vehicles and pedestrians, and between vehicles and animals or fixed obstacles. It further divides RTAs into two categories, i.e., “single-vehicle accidents in which one vehicle alone (and no other road user) was involved are included. Multivehicle collisions are counted only as one accident provided that the successive collisions happened at very short intervals.”[2] Every year, more than 1.25 million lives are lost worldwide to RTAs and 20–50 million individuals suffer nonfatal injuries, leaving many disabled. Globally, RTAs are the leading cause of death among young individuals between the ages of 15 and 29 years.[3]

In India, RTA is one of the four leading causes of death and disability among persons in the age group of 15–49 years. As per available Indian figures, in 2016, RTA accounted for a total of 150,785 fatalities, and 494,624 individuals were injured. This translates to an average of 17 deaths every hour.[4] Equally alarming is the finding that fatalities due to RTA in India are steeply increasing over the years.[5]

Personnel of the Indian Navy too are not immune from the risk of the growing epidemic of RTA in the country. Injuries, nonenemy action, which include injuries due to RTA form one of the leading causes of hospitalization in the Indian Navy. There is no existing mechanism that captures data on RTA among Indian Navy personnel and their dependants. Therefore, the present study was undertaken with the aim to study the factors involved in RTAs as well as to elucidate major modifiable risk factors for suffering grievous injuries due to RTA among Naval population and thereby enable evidence-based preventive strategies to be implemented.


  Materials and Methods Top


This records-based cross-sectional study was conducted by abstracting data from medicolegal case (MLC) records pertaining to RTAs among the naval population. All RTA cases recorded in MLC registers of all naval hospitals and major bases/units during the period January 1, 2016–December 31, 2017 (24 months) were taken into consideration (100% sample). All serving and retired naval personnel and their dependants who were brought/reported a naval hospital after an RTA and their MLC were raised were included in the study. Civilians and personnel, including families of other services (army, airforce, etc.), were excluded from the study. Data were entered from MLC records into an electronic spreadsheet (Microsoft Excel ®) and analyzed using an electronic statistical package SPSS software version 17.0 (SPSS, IBM, Chicago, IL, USA).

For the purpose of analysis of risk factors in this study, injuries were categorized as grievous or nongrievous as per the Section 320 of Indian Penal Code which defines grievous injury as” an injury which is extensive or serious, does not heal rapidly and causes permanent disfigurement and deformity if allowed to follow the natural cause of disease, it includes eight clauses, namely emasculation, permanent privation of sight of either eye, permanent privation of hearing of either ear, privation of any member or joint, destruction or permanent impairing of the power of any member or joint, fracture or dislocation of a bone or tooth, and any hurt which endangers life or which causes the victim to be in severe bodily pain or unable to follow his ordinary pursuits for a period of 20 days. Thereafter, the risk factors for grievous injury were identified from factors under the study, namely age, month of accident, time of accident, involvement of other vehicles, use of helmet, and alcohol intake before RTA. Odds ratio (OR) and the 95% confidence intervals (CIs) for each risk factor were derived using logistic regression. Statistical significance was considered to be represented by P < 0.05.


  Results Top


During the study (January 1, 2016–December 31, 2017), a total of 1608 cases of injuries due to RTA were recorded in the naval population. Demographic and other baseline features of this study population are depicted in [Table 1]. These accidents accounted for 26 deaths (case fatality rate 16.16/1000 cases of RTA) with 713 (44.3%) of the 1608 cases resulting in grievous injuries.
Table 1: Baseline characteristics

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More than half of the cases (n = 841; 52%) involved individuals between the ages of 21 and 30 years followed by those aged 31–40 years. A maximum number of cases (n = 179; 11.1%) occurred in July and more than a quarter of all cases occurred in monsoon months, i.e., from June to August. The distribution is graphically represented in [Figure 1].
Figure 1: Month-wise distribution of road traffic accidents

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In terms of day of the week, there was a clustering of RTAs during the weekend with maximum cases (n = 304; 18.9%) occurring on Saturdays followed by 16.9% (n = 273) on Fridays. Distribution in terms of hours of the day revealed a peak between 1200 and 1600 h (n = 395; 24.5%), whereas another 24.4% of cases happened in the night starting at 2000 h. Further, narrowing the time intervals revealed two peaks during the day, the first between 1200 and 1400 h (n = 212, 13.1%), and the second peak was between 2000 and 2200 h (n = 197; 12.2%) [Figure 2].
Figure 2: Distribution of road traffic accident as per the time of accident (2 hourly interval)

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Of the 1305 individuals involved in two-wheeler accidents (81.2% of total), 294 (18.3%) had a documented history of not wearing a helmet; while overall, in 275 (17%) individuals, there was a documented history of consumption of alcohol in the time frame proximate to the current episode of driving. Actual alcohol levels were not documented. A second vehicle was involved in 1034 (64.3%) accidents, which resulted in 487 (68.3%) grievous injuries.

To further identify risk factors for grievous injury following RTA, variables such as age, use of helmet, history of consumption of alcohol in the time frame proximate to the current episode of driving, involvement of other vehicle, month of accident (monsoon/nonmonsoon months), and day of the week (weekdays/weekends) were considered in univariate analysis. Age, history of consumption of alcohol, and involvement of other vehicle were found to be statistically significant (P < 0.05) risk factors for grievous injury and were subsequently included in multivariate analysis. However, month of accident (monsoon/nonmonsoon months) and day of the week (weekdays/weekends) failed to achieve statistical significance in univariate analysis. On multivariate analysis, age <40 years (OR 2.37, 95% CI 1.67–3.38), history of consumption of alcohol (OR 1.77, 95% CI 1.27–2.47), and involvement of another vehicle in the accident (OR 1.55, 95% CI 1.16–2.08) emerged as independent risk factors for grievous injury following RTA. While the use of helmet with two-wheelers (OR 0.471; 95% CI 0.34–0.64) was found to offer protection against grievous injuries [Table 2].
Table 2: Univariate and multivariate analysis of risk factors for grievous injury

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  Discussion Top


RTAs are a major public health problem in India. The first step to develop and implement preventive interventions is to determine the magnitude, scope, and characteristics of the problem and the second step is to identify the factors that increase the risk of injury or disability and to determine which factors are potentially modifiable. Thus, the first step looks at “who, when, where, what, and how,” and the second step looks at “why.”[6] Based on the foregoing principle, the present study was conducted to analyze RTAs reported in the Indian Navy establishments, identify risk factors for grievous injuries, and to recommend practical-specific interventions. The study is one of its kinds to document not only accidents leading to admission in the hospital, but also all minor injuries, including those not admitted for treatment.

Out of the total 1608 RTA cases analyzed, individuals of the age group 20–40 years were found to be most involved in the accidents (841 [52.3%]). This figure is similar to that documented in “Road Accidents in India-2016” report released by the Ministry of Road and Surface Transport, Government of India; according to which 46.3% of accident deaths were in the age bracket 18–35 years. Similarly, Pathak et al.[7] in their study of RTAs conducted at a tertiary care Armed Forces Hospital found that the majority of patients were aged between 20 and 30 years. However, in Armed Forces scenario, this aggregation of cases in 20–40 years age bracket can also be because the majority of personnel belong to the younger age group.

The present study found that there was an increase in a number of accidents in the monsoon months (June–August) with maximum cases occurring in July. This increase can be attributed to impaired visibility, wet roads, and skidding of two-wheelers observed during monsoon months. Similar, the increase in RTAs in monsoon months have been reported by a number of studies both in the service and civilian population.[7],[8] Most accidents in this study occurred between 1200 and 1400 h followed by 1800–2200 h. The first peak (1200–1400 h) could be due to people going home for lunch or while rushing back to office postlunch. The second peak (1800–2200 h) can be attributed to relatively lower visibility and high rush hour traffic during this period. Kiran et al. in their study found that 33.5% of the RTAs occurred in the evening from 1800 to 2359 h,[9] which is very similar to our study where we found 34.26% of RTAs occurred between 1800 and 2359 h. Another study conducted in Mangalore also found that the majority of accidents occurred between 1700 and 2100 h.[10] In terms of day of the week, maximum cases occurred on Saturday (19%) followed by Friday (17%). Similarly, other studies too have found that the highest number of RTAs took place on weekends.[11],[12] One solution to this problem can be the provision of means of mass transport such as buses which would help in the reduction of accidents by reducing traffic congestion, reducing fatigued driving, and offering an alternative to drunk driving.[13],[14]

Majority of cases in the present study were riding motorized two-wheelers (81%). The similar predominance of two-wheelers has been reported by number of Indian studies.[7],[9],[10] However, in spite of strict rules and regulations in Armed Forces regarding the use of helmet, in 18% of cases, helmets were not worn at the time of the accident. Nonuse of protective gear has been documented by many studies, Jha et al. in their study of 726 road traffic victims from South India found that not even one was using any kind of protective gear including helmet.[11] Use of headgear was found to be protective against grievous injury in the present study,[7] and this protective efficacy of helmet has been reported to positively impact in reducing mortality, as well as incidence of head, face, and neck injuries, following two-wheeler crashes.[15],[16]

Another important aspect observed in the present study was that 17% of the individuals involved in the RTA's were found to have consumed alcohol in the time frame proximate to the RTA, and it was also found to be a risk factor for grievous injury (OR 1.77 [95% CI 1.27–2.47]). Alcohol has long been implicated as a major risk factor for causation of RTA, and etiological relation between alcohol and causation of vehicular crashes both fatal and nonfatal is well established.[17] Moreover, studies from different parts of the world have reported a reduction in fatal and nonfatal accidents poststrict implementation of the law against driving under the influence of alcohol.[18],[19],[20] The prevalence of alcohol intake before RTA is quite variable in different reports published in India, “Road Accidents in India – 2016” report released by Ministry of Road and Surface Transport, Government of India has reported that intake of alcohol/drugs by drivers resulted in 14,894 road accidents (3.7%) and 6131 fatalities (5.1%) in 2016.[4] Kiran et al.[9] found evidence of alcohol in only in 13% of the RTA cases which greatly differs from the observations made by Kochar et al. in their study, where evidence of alcohol was found in all their 160 cases.[21] Involvement of another vehicle, i.e., collision accidents were found to be risk factor for grievous injury as compared to noncollision accidents. A review of RTA studies published by Rolison et al. found that inexperience, lack of skill, risk-taking behaviors, and consumption of alcohol in young male drivers were major contributing factors for collision accidents.[22] In our study also, majority of the accidents were collision accidents (64%) involving young males.

The present study, despite having the distinction of being one of the largest studies with Navy-wide representation, it is not devoid of limitations. First, the study is based on the retrospective medicolegal data not primarily collected for the purpose of the study; hence, certain dynamics such as experience of the driver, use of pavements by pedestrians, wide variety of users with varying speeds, and use of cheaper version of helmet have not been accounted for and only those variables/aspects that were recorded in the MLC records have been taken into consideration. Second, some of the smaller units in Indian Navy have been missed out due to the remoteness of their location; however, data from all major units of all major naval bases have been included in the study. Finally, accidents occurring while personnel are on leave and those cases which were recorded as MLC in nonnaval hospitals have not been taken into consideration.


  Conclusion Top


Morbidity and mortality of trained and professional workforce due to RTAs is a major cause of concern for the Indian Navy. The factors highlighted in the present study are not new, but they continue to play a major role. Based on the findings of the study, remedial actions such provision of bus service for ferrying to and fro from place of duty, major social gatherings, and naval institutes, especially on weekends, ensuring of use of helmets, including punitive action against defaulters, and strict enforcement of zero-tolerance laws against drunk driving, are suggested for implementation and sensitization of the naval population.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Road Traffic Accidents in Developing Countries. Report Number: Technical Report Series No. 73. World Health Organization; 1984.  Back to cited text no. 1
    
2.
The United Nations Economic Commission for Europe (UNECE), Statistics of Road Traffic Accidents in Europe and North America. OECD Health Statistics 2018 Definitions, Sources and Methods. Available from: http://w3.unece.org/PXWeb2015/pxweb/en/STAT/STAT__40-TRTRANS__01-TRACCIDENTS. [Last accessed on 12 May 19].  Back to cited text no. 2
    
3.
World Health Organization. Global Status Report on Road Safety 2015. Geneva, Switzerland: WHO Press, World Health Organization; 2015.  Back to cited text no. 3
    
4.
Road Accidents in India – 2016, Government of India Ministry of Road Transport & Highways Transport Research Wing, New Delhi-110001: Available from: shttp://www.morth.nic.in. [Last accessed on 12 May 19].  Back to cited text no. 4
    
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Singh SK. RTA in India: Issues and challenges. Trans Res Procedia 2017;25:4708-19.  Back to cited text no. 5
    
6.
Mohan D, Tiwari G, Khayesi M, Nafukho FM, editors. Road Traffic Injury Prevention Training Manual. Geneva, Switzerland: World Health Organization; 2006.  Back to cited text no. 6
    
7.
Pathak SM, Jindal AK, Verma AK, Mahen A. An epidemiological study of road traffic accident cases admitted in a tertiary care hospital. Med J Armed Forces India 2014;70:32-5.  Back to cited text no. 7
    
8.
Jha N, Agrawal CS. Epidemiological study of road traffic accident cases: A study from Eastern Nepal. Road safety. Reg Health Forum 2008;1:15-22.  Back to cited text no. 8
    
9.
Kiran ER, Saralaya KM, Vijaya K. Prospective study on road traffic accidents. J Punjab Acad Forensic Med Toxicol 2004;4:12-16.  Back to cited text no. 9
    
10.
Pawan BC, Meghna N, Rodrigues D, Shailendra Z, Pattnaik D, Muendi Anand D. Understanding some factors associated with road traffic accidents: Analysis of data for the year 2003 available from major hospitals in Mangalore. Indian J Prev Soc Med 2005;36:87-93.  Back to cited text no. 10
    
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Liu BC, Ivers R, Norton R, Boufous S, Blows S, Lo SK. Helmets for preventing injury in motorcycle riders. Cochrane Database Syst Rev 2008;(1):CD004333.  Back to cited text no. 15
    
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21.
Kochar A, Sharma GK, Murari A, Rehan HS. Road traffic accidents and alcohol: A prospective study. Int J Med Toxicol Legal Med 2002;5:22-4.  Back to cited text no. 21
    
22.
Rolison JJ, Regev S, Moutari S, Feeney A. What are the factors that contribute to road accidents? An assessment of law enforcement views, ordinary drivers' opinions, and road accident records. Accid Anal Prev 2018;115:11-24.  Back to cited text no. 22
    


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