The validity of self-reported helmet use among motorcyclists in India.

Background: Motorcyclists are the most vulnerable vehicle users in India. No published study has assessed the validity of self-reported estimates of helmet use in India. The objectives of this study were to assess helmet use by comparing observed and self-reported use and to identify factors influencing use among motorcyclists in Hyderabad, India. Methods: Population-based observations were recorded for 68 229 motorcyclists and 21 777 pillion riders (co-passengers). Concurrent roadside observations and interviews were conducted with 606 motorcyclists, who were asked whether they “always wear a helmet”. Multivariate logistic regression analyses were conducted to determine factors influencing helmet use. Results: In the population-based study, 22.6% (n = 15,426) of motorcyclists and 1.1% (n = 240) of pillion riders (co-passengers) were observed wearing helmets. In roadside interviews, 64.7% (n = 392) of the respondents reported always wearing a helmet, 2.2 times higher than the observed helmet use (29.4%, n = 178) in the same group. Compared with riders aged ≥40 years, riders in the age groups 30–39 years and 18–29 years had respectively 40% (95% confidence interval [CI]: 0.4 to 1.0, P < 0.05) and 70% (95% CI: 0.2 to 0.5, P < 0.001) lower odds of wearing a helmet after controlling for other covariates. Riders with postgraduate or higher education had higher odds of wearing a helmet (adjusted odds ratio [OR]: 4.1, 95% CI: 2.5 to 6.9, P < 0.001) than those with fewer than 12 grades of schooling. After adjusting for other covariates, younger riders also had 40% (95% CI: 0.3 to 0.9, P < 0.05) lower odds of self-reporting helmet use, while those with postgraduate or higher education had 2.1 times higher odds (95% CI: 1.3 to 3.3, P < 0.01) of reporting that they always wear a helmet. Police had stopped only 2.3% of respondents to check helmet use in the three months prior to the interview. Conclusion: Observed helmet use is low in Hyderabad, yet a larger proportion of motorcyclists claim to always wear a helmet, which suggests that observational studies can provide more valid estimates of helmet use. Interview findings suggest that a combination of increased enforcement, targeted social marketing and increased supply of standard helmets could be a strategy to increase helmet use in Hyderabad.

Injuries and violence in the Eastern Mediterranean Region: a review of the health, economic and social burden

We review current literature and data on the burden of injury and violence in the Eastern Mediterranean Region [EMR] of the World Health Organization [WHO], with a special focus on the health, economic and social burden they impose on individuals, families and society. Injury-associated mortality and disability is on the rise in EMR, especially among economically productive adults, young males and vulnerable road users. In particular, road traffic injuries, the leading cause of injuries, account for 27% of the total injury and violence mortality in EMR according to WHO. Violence including suicide, homicide and war-related injury has also been increasing over the past two decades for both females and males. There is need for greater interest and efforts in slowing and ultimately halting the trend through interventions, legislative actions, and research that examine the special needs and challenges in the Region

Emergency care in South Asia: challenges and opportunities

One of the striking deficiencies in the current health delivery structure is lack of focus on emergency care in primary health systems, which are ill-equipped to offer appropriate care in emergency situations resulting in a high burden of preventable deaths and disability. Emergency medical systems [EMS] encompass a much wider spectrum from recognition of the emergency, access to the system, provision of pre-hospital care, through definitive hospital care. The burden of death and disability resulting from lack of appropriate emergency care is very high in low- and middleincome countries. In South Asia, health services in general, and emergency care in particular, have failed to attract priority, investments and efforts for a variety of reasons. It has to be emphasized that integrating EMS with other health system components improves health care for the entire community, including children, the elderly, and other vulnerable groups with special needs. Out-of-facility care is an integral component of the health care system in South Asia. EMS focuses on out-of-facility care and also supports efforts to implement cost-effective community health care. There is a possibility of integration of other health services and programmes with an innovative, cost-effective EMS in the region

Road crashes: a modern plague on South Asia 's poor

South Asian nations are at the crossroads of economic and political progress but still face severe problems of underdevelopment. Available data illustrates that while some macroeconomic indicators have improved over the years, disparities between rich and poor have increased manifold. Although infectious diseases remain a formidable enemy, noncommunicable diseases and injuries are increasing the health challenges facing the countries of the region. While it is widely recognized and accepted that infectious diseases predominantly affect the poor, there is insufficient evidence documenting the burden of RTI on the lower socioeconomic groups in developing countries. Low educational level, poorly paid occupations and poverty have all been found to be risk factors for road traffic injuries. This paper reviews available data from South Asia to show that RTI disproportionately affect the poor in terms of mortality, morbidity and disability, and presents a persuasive argument to policy makers about the importance of road crashes as a public health problem in South Asia. It is hoped that this will provide further visibility to the increasing burden of RTI in South Asian countries and will attract more political and financial support from the national governments and the donor community to further scale up prevention and control

millennium development goals and road traffic injuries: Exploring the linkages in South Asia

In a major summit of the members of the United Nations [UN] in 2000, a Millennium Declaration was adopted which called for making the elimination of poverty and promotion of sustainable development a global priority. A road map was agreed upon to operationalize the declaration, and the Millennium Development Goals [MDG] were integrated within the document. The MDGs are now increasingly being used to assess the performance of countries, institutions and the global community. WHO declares that the MDGs provide "a set of outcomes that are relevant to the development of national health policy frameworks". It also states that although MDGs do not cover all the components of public health, when broadly interpreted "the goals provide an opportunity to address important cross-cutting issues and key constraints to health". Consistent with WHO's call for a broad interpretation of the MDGs, and building on the health linkages identified by WHO, this paper explores the linkages between the MDGs and the impact of road traffic injuries [RTI]. This is done in the context of South Asia, one of the poorest and populated regions of the developing world

Applying WHO's health systems performance assessment in Pakistan: Critical reflections

The World Health Organization [WHO] proposed a health systems performance assessment framework in 2000, which met with quick and often severe criticisms in terms of process, methods and utility. However, a country specific reflection for the potential application of this framework has not been published to-date from South Asia. This paper reviews the recent literature and critiques and analyzes the potential for applying the framework in Pakistan. Deconstruction of the framework into its five component parts ' health [level, distribution], responsiveness [level, distribution] and fair financing - allows an assessment of data needs for generation of specific indicators. This paper proposes that three of the five components may be attempted in Pakistan due to the availability of specific data; however the two components of responsiveness will require the collection of new primary data and present a considerable challenge. The conduct of a burden of disease study, assessment of health expenditures using household consumption surveys, and use of numerous national surveys will allow for optimal utilization of available information in Pakistan. The assimilation and analysis of available data will also be critical in informing national health decision-making