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Road safety has come a long way in our lifetimes, and there are steps in this progress that mark their place in history. Many of these were technical innovations, such as seat belts, electronic stability control, and geofencing for vehicle speed control. Also important, though perhaps fewer in number, were innovations in strategies to achieve change. These include the public health model of Dr. William Haddon, the introduction of Vision Zero, the World Report on Road Traffic Injury Prevention from WHO and the World Bank, and more recently, the Decade of Action 2011–2020. I am sure that the work and recommendations presented in this report will deserve their place in a “Hall of Fame” for strategic innovation in saving lives across the globe.

Statement of purpose Globally, thousands of children lose their lives to unintentional injuries every year. Injuries occurring at home to under 5s (burns, falls, poisoning) can be prevented through providing safety equipment e.g. barriers and childproof containers. Although a number of studies have shown significant reductions in child injuries most have been conducted in high-income countries. This research aims to reduce unintentional home injuries among under 5s in Jinja, Uganda through the provision of a toolkit. Methods/Approach This study is guided by a community-based participatory research approach utilizing mixed methods. A quantitative retrospective review of hospital data was combined with a community- based household survey and risk assessment tool to provide incidence and risk factor data. An exploration of perceptions of injuries, risky behaviours and practices in the home was provided through focus-group discussions and Photovoice. Results Preliminary analysis of ongoing data collection has been done. Hospital record review of 225 cases revealed that 34% of injuries were due to burns, 45% were seen in outpatients and 39% admitted to the wards. The survey of 615 households indicated that there had been 879 injury events amongst under 5s in the preceding 12 months. The majority occurred within the compound of the home (57% fall-related ; 23% burn injuries). From the qualitative exploration, falling in pits, open fireplaces and off beds were the major causes of injuries. Conclusion This formative research contextualises the problem and looks to propose an intervention toolkit including educational material, parent training workshops, awareness campaigns, home visits and environmental modifications. The findings will inform the development of a culturally appropriate/affordable set of interventions and provide accurate incidence rates for a future intervention trial. Significance The results will have significant implications for low-income countries in terms of research methodology and effective information in mitigating injuries among under 5s.

Statement of purpose The purpose of this presentation is to evaluate progress towards achieving the Decade of Action for Road Safety by analyzing the results of three Global Status Reports on Road Safety. Methods/Approach The analysis was based on the data from the three Global Status Reports on Road Safety with global level data from 2010, 2013, and 2016. Descriptive analyses and t-tests were conducted to evaluate the past and current trends in road traffic deaths and countries’ progress in achieving key road safety indicators. Data from 160 countries that consistently reported their statistics for all three global status reports were included in the analysis. Results A slight decline in road traffic deaths during the past decade was observed, however, current global deaths were found to be unacceptably high standing at a rate of 16.4/100,000. This decline considerably varied between countries and was highly dependent on the income level of the country, with deaths significantly high in low- and middle-income countries (LMICs) when compared to high- income countries (HICs). In terms of progress on countries’ progress in achieving key road safety indicators, the same pattern was observed where HICs having emplaced most of the recommended rules, while low rates of achievement were observed in LMICs. Conclusion Despite the global efforts, RTIs remain disproportionately high in LMICs and progress in achieving global road safety indicators is slow. Significance This analysis highlights the need for continued efforts towards promoting road safety especially in LMICs and identifies areas for improvement that must be addressed for the new Decade of Action for Road Safety from 2021–2030.

In May 2020, the High Volume Transport (HVT) Applied Research Programme which is funded by UKAid through the Foreign, Commonwealth & Development Office (FCDO), published an insight paper by the Road Traffic Injury Research Network’s RTIRN Chair and Deputy Chair (Drs Kobusingye and Peden) on the nexus between transport and health during the COVID-19 pandemic. The report looks at the five interacting dimensions between transport and public health – safety, active transport, clean air, connectivity/access, and equity – during COVID-19. It highlights the positive unintended effects of the pandemic – reductions in road crashes and improvements in air quality - and questions what can be done to maintain some of these gains. The report emphasises the gaps in current knowledge, particularly in low- and middle-income countries, such as the effectiveness of masks in crowded public transport, and the impact of severe transport restrictions on vulnerable populations, especially older people, adolescents, pregnant women, and persons with disabilities. It argues that COVID-19 offers an opportunity for an inter-sectoral response from the health and transport sectors to build safer, more equitable, and resilient transport systems. Transport systems were responsible for converting a local epidemic into a pandemic, and they have been central to the pandemic response – transporting patients, essential workers, goods, and services – and will continue to be critical in the recovery phase as countries restructure ‘COVID safe’ transport systems and revamp their economies. The report concludes by identifying areas that require urgent additional research, policy, and regulation development.

The central objective of the Road Traffic Injury Research Network (RTIRN) is to support the development and strengthening of research agendas and research capacity on road traffic injury in low- and middle-income countries. Specifically, the network advocates for research to reduce the burden of road traffic injuries in low- and middle-income countries; develops capacity for road traffic injury research in low- and middle-income countries; promotes investments for road traffic injury prevention; facilitates communication between partners involved in road traffic injury research; conducts strategic road safety research, and promotes the application and utilization of research for policy and intervention development in order to reduce the burden of road traffic injury in low- and middle-income countries. The RTIRN has worked mainly in Africa, Latin America, and Asia to build capacity through training and mentoring, and the funding of strategic research in a number of countries. Through linkages facilitated by RTIRN, partners from both low- and high-income countries were able to successfully build research capacity with limited resources. The Network plans to use various platforms to engage its membership in discussions that highlight research gaps for the road safety field, in order to identify what research is critical where. We intend to interrogate the role of Implementation Research in the face of increasing pressure for Low- and Middle-Income Countries to meet global targets, and adopt recommended road safety interventions, many of them developed in HICs. We invite new and existing partners to join the discussions on www.rtirn.net.

Injury is a significant cause of death and morbidity among children from the age of one, increasing to become the leading cause of death among children aged 10 to 19 years. Adolescents, particularly girls and young women, are increasingly seen as driving forces in global health and yet are a neglected cohort. There is a growing consensus on the need for investments in adolescent health if the UN’s Sustainable Development Goals and the Global Strategy for Women’s, Children’s and Adolescents’ Health are to be achieved. Increasing globalization has resulted in shifting patterns of exposure to injury-related risk factors. These trends, particularly the impact on reshaping the role of girls and women have not been fully explored in LMIC mainly due to lack of suitable data. Increasingly girls/women are entering the workforce, suggesting that traditional injury patterns and risk-factor exposures are changing. The Young Lives study provides unique longitudinal household cohort data over a 15 year period (2002–2017) in four developing countries (Vietnam, Peru, Ethiopia and India) recruiting ˜2000 children per country in the younger cohort (0–15 years) and 1000 in the older cohort (8–22 years). Data pertaining to injuries incorporates a wealth of information on risk factors such as age, gender, education, cause, activity at time of injury and on household risk factors pertaining to maternal/caretaker health, education and income. This research provides an analysis of childhood injuries across the lifespan of the cohort examining cross-country differences and the changing trends/impact of injuries on girls/women over their lifespan (risk-taking, rough play, employment, health-seeking behaviour after injury). It examines links between chronic maternal health (including mental health) and risk of child injury. Such an analysis will identify gender inequalities during adolescence and examine what causes such inequalities to shift or persist in different ways within and between countries.

Background Pediatric injuries are associated with significant morbidity and mortality, especially in low- and middle-income countries. Data to characterize the cause and risk factors associated with childhood injuries in these countries are, however, very scarce. The aim of this study is to describe the injuries sustained among children, and possible sex disparities, between 1991 and 2017 (27 years) using hospital-based data in Cape Town, South Africa. Methods Data from injured children Results In total, over 200 000 children with injuries presented to the Children’s Hospital from 1991 to 2017. Preliminary analysis shows that the mean age was 6 years and over 60% were male. Common mechanisms of injury included falls (40%), road traffic injuries (13%), burns (12%), and assault (4%). Comparing years from 1991 to 2017 the preponderance of boys to girls was a consistent finding for almost all types of injuries. Further analysis on type of injuries and severity, as well as injury incidence related to the implementation of certain policies, e.g. child restraint law, is still being undertaken. Conclusion Although these epidemiologic findings suggest there is a stronger need for data that are population-based and not hospital-based, a more accurate description of childhood injuries will strengthen the need for targeted interventions to address the specific risk factors for pediatric injuries in both boys and girls. In the light of the paucity of population-based data, hospital-based data currently remain the most powerful tool to study sex differences in injuries in South Africa.

Background: This study reports dose?response estimates for the odds ratio (OR) and population attributable risk of acute alcohol use and road traffic injury (RTI). Methods: Data were analyzed on 1,119 RTI patients arriving at 16 emergency departments (EDs) in Argentina, Brazil, Costa Rica, Dominican Republic, Guatemala, Guyana, Mexico, Nicaragua, Panama, and Trinidad and Tobago. Case-crossover analysis, pair-matching the number of standard drinks consumed within the 6 hours prior to the RTI with 2 control periods (prior d/wk), was performed using fractional polynomial analysis for dose?response. Results: About 1 in 6 RTI patients in EDs were positive for self-reported alcohol 6 hours prior to the injury (country range 8.6 to 24.1%). The likelihood of an RTI with any drinking prior (compared to not drinking) was 5 times higher (country range OR 2.50 to 15.00) and the more a person drinks the higher the risk. Every drink (12.8 g alcohol) increased the risk of an RTI by 13%, even 1 to 2 drinks were associated with a sizable increase in risk of an RTI and a dose?response was found. Differences in ORs for drivers (OR = 3.51; 95% CI = 2.25 to 5.45), passengers (OR = 8.12; 95% CI = 4.22 to 15.61), and pedestrians (OR = 6.30; 95% CI = 3.14 to 12.64) and attributable fractions were noted. Acute use of alcohol was attributable to 14% of all RTIs, varying from 7% for females to 19% for being injured as a passenger. Conclusions: The finding that the presence of alcohol increases risk among drivers and nondrivers alike may further help to urge interventions targeting passengers and pedestrians. Routine screening and brief interventions in all health services could also have a beneficial impact in decreasing rates of RTIs. Higher priority should be given to alcohol as a risk factor for RTIs, particularly in Latin America and the Caribbean. Fil: Borges, Guilherme. Instituto Nacional de Psiquiatria Ramon de la Fuente; México Fil: Monteiro, Maristela. Pan American Health Organization (paho); México Fil: Cherpitel, Cheryl J.. Alcohol Research Group; México Fil: Orozco, Ricardo. Instituto Nacional de Psiquiatria Ramon de la Fuente; México Fil: Ye, Yu. Alcohol Research Group; México Fil: Poznyak, Vladimir. Organizacion Mundial de la Salud; Argentina Fil: Peden, Margie. Organizacion Mundial de la Salud; Argentina Fil: Pechansky, Flavio. Universidade Federal do Rio Grande do Sul; Brasil Fil: Cremonte, Mariana. Universidad Nacional de Mar del Plata; Argentina Fil: Reid, Sandra D.. Caribbean Institute On Alcoholism And Other Drug Problems; Fil: Mendez, Jesus. Instituto Sobre Alcoholismo y Farmacodependencia; Costa Rica

Background The use of non-standard motorcycle helmets has the potential to undermine multinational efforts aimed at reducing the burden of road traffic injuries associated with motorcycle crashes. However, little is known about the prevalence or factors associated with their use. Methods Collaborating institutions in nine low- and middle-income countries undertook cross-sectional surveys, markets surveys, and reviewed legislation and enforcement practices around non-standard helmets. Findings 5563 helmet-wearing motorcyclists were observed; 54% of the helmets did not appear to have a marker/sticker indicating that the helmet met required standards and interviewers judged that 49% of the helmets were likely to be non-standard helmets. 5088 (91%) of the motorcyclists agreed to be interviewed; those who had spent less than US$10 on their helmet were found to be at the greatest risk of wearing a non-standard helmet. Data were collected across 126 different retail outlets; across all countries, regardless of outlet type, standard helmets were generally 2–3 times more expensive than non-standard helmets. While seven of the nine countries had legislation prohibiting the use of non-standard helmets, only four had legislation prohibiting their manufacture or sale and only three had legislation prohibiting their import. Enforcement of any legislation appeared to be minimal. Interpretation Our findings suggest that the widespread use of non-standard helmets in low- and middle-income countries may limit the potential gains of helmet use programmes. Strategies aimed at reducing the costs of standard helmets, combined with both legislation and enforcement, will be required to maximise the effects of existing campaigns.

Urban and regional planning has a contribution to make toward improving pedestrian safety, particularly in view of the fact that about 273,000 pedestrians were killed in road traffic crashes in 2010. The road is a built environments that should enhance safety and security for pedestrians, but this ideal is not always the case. This article presents an overview of the evidence on the risks that pedestrians face in the built environment. This article shows that design of the roadway and development of different land uses can either increase or reduce pedestrian road traffic injury. Planners need to design or modify the built environment to minimize risk for pedestrians.

A survey of medical superintendents revealed that an estimated 1.5 million trauma cases presented to South Africa's 356 secondary and tertiary level hospitals in 1999. Injury rates for traffic, violence and other injuries showed considerable inter-provincial variation, with violence accounting for more than half of the trauma caseload. This type of survey is a simple low cost alternative for monitoring injury patterns and supplementing burden of disease and injury costing studies.

Background To support country work to improve national regulation on road traffic injury prevention, we developed various approaches and tools to enhance the capacity of staff in government and civil society organisations, mainly lawyers, to assess and develop evidence-based regulations. We use the term “regulation” in this presentation broadly to include laws that are enacted by national parliament and regulations issued by national or subnational ministerial or other executive branches of government. Methods This presentation describes the approaches used to improve the skills, access to and use of evidence-based interventions to assess and improve regulations on road traffic injury prevention for lawyers and others involved in regulatory processes in public health or road traffic. Results Since 2010, WHO has supported the improvement of road safely legislation in 12 countries with support from Bloomberg Philanthropies. In the early years of the capacity development programme (2012–2014), participants from 9 countries (Brazil, Cambodia, China, India, Kenya, Mexico, Turkey, Russian Federation, Viet Nam) were selected through a nomination process from WHO Regional and Country Offices. This phase focused primarily on providing face-to-face periodic training on skills and information on evidence-based road safety interventions. Starting in 2015 we launched a Legal Development Programme in 4 countries (China, Philippines, Thailand, United Republic of Tanzania) with the objectives of providing a range of learning opportunities for lawyers and other individuals involved in developing regulations and of improving their skills, access to and use of resources on evidence interventions to assess and develop evidence-based regulation. Participants were selected through a semi-competitive process taking into consideration their background, interest in the topic, the nature and extent of their involvement in public health or road safety regulation, and commitment to play an active role in improving legislation in public health or road safety in their country. The level of engagement of the Legal Development Programme members in regulatory mechanisms on the topic in country has also been enhanced. Conclusions During 2012–2014 participants who regularly took part in face-to-face workshops showed longer-term and active involvement in improving road safety regulation in their country. Countries supported also showed better improvement in evidence-based regulation (either in the number of changes or in the extent to which the changes are in line with evidence). Although the impact of the Legal Development Programme has not yet been assessed, it has so far generated greater interest than the previous capacity development programme (through an increase in number of participating members since the launch) as well as more active involvement in various aspects of the road safety regulatory process.

Increasing motorization leads to bleak projections for the future of road safety in many low- and middle-income countries. World Bank extrapolations suggest that between 2000 and 2020, road traffic deaths will decline by nearly 30% in high-income countries but will increase by upto 87% in low- and middle-income countries. The World report on road traffic injury prevention aims to raise awareness about the issue of road safety, and contribute to a shift in thinking about the nature of the problem of road traffic injury prevention, and appreciate the importance of road traffic injuries as a public health issue. South Asia currently faces an enormous challenge in this regard. However, Asian governments and stakeholders are now taking positive steps as they are aware that urgent action is needed. The responsibility for this problem needs to be shared among sectors, with public health taking an active role to end the carnage. The time for action is now. Partnerships and a systematic approach to this problem will save lives.

Injury has become a major cause of death and disability world-wide. Systematic approaches to its prevention and treatment are needed. In terms of treatment, there are many low-cost improvements that could be made particularly in low- and middle-income countries to strengthen their trauma systems. These can be formalised under "Essential Trauma Care" programme, similar to other global programmes for major public health problems. World Health Organisation (WHO), leading the initiative in this direction, convened a meeting at Geneva in June 2002, involving Injuries and Violence Prevention Department of the WHO, the Working Group for Essential Trauma Care of the International Association for Trauma and Surgical Intensive Care (IATSIC), representatives of other organisations and trauma care clinicians representing Africa, Asia, and Latin America. The meeting developed a preliminary list of Essential Trauma Care services and a model template for the skills and equipment needed to assure them. It is intended to be used to assist individual countries in planning their own trauma care services.