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Introduction Recently, cases of clothing-related entanglement in motorcycles have been increasingly reported from India and Pakistan but no epidemiological studies are available for such crashes. Objective To assess the injury burden and severity of clothing-related two-wheeler crashes in Pakistan. Methods The study setting was Karachi, Pakistan. Cases were defined as riders and pillion riders of motorised two-wheelers involved in a crash as a result of entangling of clothing in parts of the vehicle. Cases were selected from an ongoing traffic injury surveillance study. For each case, Abbreviated Injury Scale (AIS) of involved body parts was recorded and used in computation of New Injury Severity Score (NISS). Results A total of 986 injuries were reported from January 2007 to December 2009. Most were females (73.9%) and pillion riders (80.6%). These crashes were mostly single vehicle (98.5%) and involved head (41.5%), face (35.9%), limbs (51.0%), and external body that is, skin (60.3%). As per NISS, one-third of injuries were moderate (26.7%) to severe (10.2%). A total of 10 deaths were reported and head and face injuries were reported in nine of them. Female gender, age≥45 years (21.5%), pillion riders (80.6%) and crashes occurring at intersections (34.3%) were more likely to result in severe NISS than other users (p Significance Clothing-related motorised two-wheeler injuries are common in Karachi indicating the risks associated with wearing traditional clothing when riding motorcycles. Promotion of appropriate, conspicuous clothing by both riders and pillion riders might prevent such injuries.

Introduction Despite the importance of a helmet in prevention of head injuries among motorcyclists, there is limited use of helmet both by drivers and female pillion riders in Pakistan. Objective The objective of the study is to explore perceptions, barriers, and strategies of women pillion riders regarding the use of motorcycle helmets. Methods Data was collected from five focus group discussions (FGDs) held with women pillion riders working at the Aga Khan University (AKU). Interviews and focus groups were transcribed verbatim and checked for accuracy before being imported into NVivo2. Written informed consent was taken from each participant before the beginning of each discussion. Results Some major themes included (1) motorcycles are a risky transport (2) all participants never wore a helmet or never thought about wearing a helmet (3) did not know about the helmet law (4) the most important benefit of helmet use expressed was ‘safety’ Possible barriers to helmet use included (1) a lack of awareness regarding helmet law (2) uninvited attention from people from wearing a helmet (3) the saddle-sided sitting style of women (4) concerns about their looks and discomfort from wearing a helmet. Suggested strategies for implementing helmet use included (1) awareness campaigns through media (2) use of helmets by women police (3) strict law enforcement in the form of fine/ticket. Significance Publicising and awareness on the helmet law for pillion riders should be the first step towards initiating helmet use among women pillion riders in Pakistan.

Background More than 9 in 10 children deaths in the road traffic environment occur in low and middle countries. Little is known about the demographic distribution of those deaths and the categories of road users at risk by age and gender. This study sheds light on those issues in one large urban setting of Pakistan. Methods This is register-based cross-sectional study in which we extracted all injuries sustained by children aged 1–19 years (n=32 814) from hospital based injury surveillance system (five participating hospitals) in the city during 2007–2010. The injury distributions by category of road users was examined considering age group (1–4, 5–9, 10–14 and 15–19 years), gender and injury outcome (discharge, admission and death). We considered both vulnerable road users (pedestrians, drivers and passengers of two wheelers, drivers) and protected one (passengers of three or more wheelers). Results Whereas RTIs among boys increased with age, they peaked among girls at age 5–9 years, for a global male to female ratio of 6 : 1. Children were most often injured as vulnerable road users. In early age groups, children were injured mostly as pillion riders (1–4 years) and as pedestrians (5–9 and 10–14 years) while in older age group (15–19 years), girls as motorcycle passengers and boys, as motorcycle drivers. Pedestrians9 injuries had highest admissions (38%) and deaths (46%) in children. Conclusion At all ages, boys are more injured in road traffic crashes than girls. Both genders are at higher risk as vulnerable road users.