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Road traffic injuries (RTIs) are an important cause of death and injury in Colombia and Brazil. This burden is not uniform across countries and cities. Understanding these differences and similarities in road traffic behaviors is key in designing effective RTI interventions. This study is aimed to assess such differences by comparing observed road safety behaviors in three South American cities, Bogota (Colombia), and Sao Paulo and Fortaleza (Brazil). As part of the Bloomberg Initiative for Global Road Safety (BIGRS), observational studies were conducted in Bogota, Fortaleza, and Sao Paulo. Trained observers recorded road safety behavior (speeding, helmet use, seatbelt use and drink driving) every six months between August 2015 and September 2017. Around 1.5 million observations in these risk factors have been collected throughout six rounds of data collection. It was found that Bogota and Sao Paulo had varying rates of speeding, very dependent on changes in policy and enforcement circumstances, whereas Fortaleza maintained relatively high and stables rates. Rates of seatbelt and correct helmet use among all passengers were higher in Sao Paulo than Bogota and Fortaleza. Drink driving prevalence was higher in Sao Paulo than Fortaleza and Bogota. Fortaleza has experienced a reducing trend in drink driving prevalence throughout the project. In Sao Paulo, refusal rates reached 76%. Important regional differences in road safety risk factors highlight the need for tailored interventions in South American cities. Speeding is a priority for Bogota and Fortaleza. Sao Paulo’s alcohol results illustrate the urgency for drink driving-based interventions and correct helmet use is an increasingly important need in Bogota and Fortaleza. These results are being used to develop specific interventions for BIGRS. These results are of interest for policy makers in Latin American cities and other middle-income countries where these interventions can be piloted and if effective, scaled up and replicated.

Background Sao Paulo is one of the world’s largest urban areas and it was selected as one of the ten cities for the Bloomberg Initiative for Global Road Safety (BIGRS) project. With nearly 12 million inhabitants and 8 million vehicles, the city has reached a significant decline in road traffic mortality during the last decade (7 deaths per 1 00 000 inhabitants in 2016). Objective To evaluate the performance of interventions aiming to reduce the prevalence of four key road safety risk factors (speeding, drink and driving, seatbelt and helmet use) during 2015–2017 in the city of Sao Paulo, Brazil. Methods Following a baseline study performed in 2015, observational studies monitoring these risk factors were performed twice a year. Six to eight different locations were randomly selected to represent the main regions of the city, where drivers’ behaviors were observed during all days of the week using an internationally validated protocol. Findings The prevalence of speeding at baseline (10%) decreased substantially to 5% in 2016 following citywide speed limit reduction interventions, but increased again (9%) by the end of 2017 after interventions were reverted. Drivers testing above the legal blood alcohol concentration (BAC) limit (0.01%) presented a decreasing trend (from 4.1% to 1.2%); however, more than half of drivers currently refuse breathalyzer tests. Driver’s seatbelt use rate has kept constant at approximately 90%, as well as rear’s passengers usage rate, but at a much smaller proportion (22%). Helmet use among drivers and passengers presented a highly consistent percentage, with nearly all motorcycle drivers wearing helmets correctly. Conclusion and policy implications Speeding and drink driving are the most prevalent risk factors observed among drivers, but interventions addressing these behaviors have demonstrated a positive association with their reduction. Future strategies addressing rear seatbelt use and correct helmet wearing should also be promoted.

The Sustainable Development Goals (SDG) aim to halve road traffic deaths and provide safe, affordable, accessible and sustainable transport systems for all. Achieving these targets will be challenging if multi-sectoral evidence-based interventions are not implemented and scaled up, particularly in low- and middle-income countries (LMIC) where 90% of all deaths due to road traffic injuries (RTI) take place and the poorest billion live. The objective of this study is to (1) review the literature for effective evidence-based interventions for RTI, and (2) conduct estimations on the number of lives potentially saved by each intervention in LMIC. We conducted a systematic review of all evidence available on interventions on RTI. Furthermore, we estimated the potential effect that these interventions would have if implemented in each country. We obtained parameters from the GBD2015 study and the GSRRS2015. We estimated the number of lives saved using a Monte Carlo simulation and a triangular distribution with 10 000 iterations for each intervention and country. We obtained values for the point estimates and standard deviations of the lives saved by each intervention for each type of injury and country. Statistically significant results on mortality were presented by only six interventions for road injures and three for drowning. The most effective interventions are speed and drinking and driving enforcement for RTI and formal swimming lessons and the use of creches for drowning. In this study, we provide evidence on the lives saved by different road safety intervention and highlight the scarcity of data on the effectiveness and mortality impacts of injury interventions. These results will be of interest for policy makers in LMIC as well as funders committed to road safety. This work has been published in: Lancet Global Health 6 (5):523–534. 2018.