On-site personal protective equipment signage and use by road construction workers in Ghana: a comparative study of foreign- and locally-owned companies.

BACKGROUND: Road construction work has specific risks and safety issues which have not been adequately addressed in most low- and middle-income countries, especially Africa. The objective of this study was to determine the prevalence of personal protective equipment (PPE) use during road construction activities by workers in foreign- owned against locally-owned road construction companies in Ghana. METHODS: An institution-based cross-sectional survey was undertaken during January - March, 2020 to study 389 road construction workers who were actively working on site. They were unobtrusively observed to capture whether or not they wore the appropriate PPE at the time of the survey. The PPE of interest were: hard hat, goggles, shoes, nose masks, hearing protection, gloves and reflective vests/apparel. On-site posted PPE signage was also checked. RESULTS: Majority of workers were males (96.9%) and labourers (53.5%). Similar numbers of workers in locally-owned (195) and foreign-owned (194) companies were studied. Use of PPE varied considerably by type: shoes (78.7%), reflective vest (44.5%), gloves (30.6%), hard hat (27.0%), nose mask (17.2%), goggles (11.3%) and hearing protection (10.8%). For all types of PPE, use was higher for workers in foreign-owned companies compared with locally-owned companies: goggles (Odds ratio [OR] 55.2), hearing protection (OR 52.0), gloves (OR 23.7), hard hat (OR 20.2), nose mask (OR 17.8), reflective vest (OR 5.3) and shoes (OR 4.1), (p<0.001 for all ORs). No site had any signage to promote PPE use. CONCLUSIONS: Majority of workers used shoes. Less than half of workers used other types of PPE and use of some types (goggles and hearing protection) was minimal. Workers in foreign-owned companies were significantly more likely to use all the seven types of PPE than locally-owned companies. Although there is still room for improvement in foreign-owned companies, locally-owned companies should be able to attain similar PPE use to that in foreign-owned companies. Necessary PPE should be provided and site supervisors should encourage workers to wear PPE when on site.

Road traffic crashes at night-time: characteristics and risk factors.

The study was to examine the nature and risk factors associated with road traffic crashes at night in Ghana and identify potential measures to control them. Crash and injury data for the period 2013-2017 were analyzed. The fatality index and fatal crash ratio measures were employed to assess the severity of injuries among traffic participants. Statistical analysis was carried out for the variables using contingency tables and the chi-square (χ2) tests to assess statistical significance. Generally, night-time traffic crashes resulted in severer injury outcomes than crashes in the hours of daylight (χ2(2)=292.7, p < 0.001). The relative risk of death in a night traffic crash was 1.3 times that during the daytime. The risk of death was highest among pedestrians (44%) and motorcyclist (18%) compared to bus/mini-bus occupants (16%) and car occupants (11%) and the observed percentage differences were significant (χ2(14)=2303.2, p < 0.001). Most of the collisions (67%) occurred at the early hours of the night, between 18:00 and 22:00 hours. Poor night visibility coupled with poor visual guidance on roads are the key contributory risk factors associated with night travels. Policies must be geared towards provision of functioning street lights in built-up areas, road line markings, delineators and signage for the highways and arterial roads.

Pedestrian risky behavior and safety at zebra crossings in a Ghanaian metropolitan area.

OBJECTIVE: This article assesses pedestrian behavior and safety at zebra crossings in the Cape Coast Metropolis. METHOD: A mix of a naturalistic exploratory and descriptive study was conducted using both primary and secondary data. The primary data included an observational study of over 6,000 pedestrians using zebra crossings in the metropolis. The secondary data were obtained from the national road traffic crashes (RTCs) database at the Building and Road Research Institute covering information on pedestrian crashes between 2007 and 2016 in the metropolis. Analyses were conducted using frequencies and percentages with Pearson's chi-square correlation used to establish the relationship between independent and dependent variables. RESULTS: The findings showed that the majority of the 328 pedestrian crashes between 2007 and 2016 resulted in either fatalities or serious injuries and occurred at locations away from a junction. Most of the pedestrians observed used the zebra crossing were alone and engaged in talking or using mobile phone. Age group, pedestrian status, and the location of the zebra crossings influenced pedestrians' risky behaviors. CONCLUSION: The majority of the pedestrian crashes in the metropolis resulted in injuries resulting in hospitalization or fatalities and occurred at a midblock. Pedestrians largely exhibited risky behaviors predisposing the occurrence of RTCs at zebra crossings despite the fact that they are a pedestrian right-of-way. There is therefore the need for the National Road Safety Commission to carry out campaigns to educate pedestrians on the safer use of zebra crossings.

Evaluation of the effectiveness of traffic calming measures on vehicle speeds and pedestrian injury severity in Ghana.

Objectives: Each year, pedestrian injuries constitute over 40% of all road casualty deaths and up to 60% of all urban road casualty deaths in Ghana. This is as a result of the overwhelming dependence on walking as a mode of transport in an environment where there are high vehicular speeds and inadequate pedestrian facilities. The objectives of this research were to establish the (1) impact of traffic calming measures on vehicle speeds and (2) association between traffic calming measures and pedestrian injury severity in built-up areas in Ghana. Method: Vehicle speeds were unobtrusively measured in 38 selected settlements, including 19 with traffic calming schemes and 19 without. The study design used in this research was a matched case-control. A regression analysis compared case and control casualties using a conditional logistic regression. Results: Generally, the mean vehicle speeds and the proportion of vehicles exceeding the 50 km/h speed limit were significantly lower in settlements that have traffic calming measures compared to towns without any traffic calming measures. Additionally, the proportion of motorists who exceeded the speed limit was 30% or less in settlements that have traffic calming devices and the proportion who exceeded the speed limit was 60% or more in towns without any traffic calming measures. The odds of pedestrian fatality was significantly higher in settlements that have no traffic calming devices compared to those that have (odds ratio [OR] = 1.98; 95% confidence interval, 1.09-4.43). The protective effects of a traffic calming scheme that has a speed table was notably higher than those where there were no speed tables. Conclusion: It was clearly evident that traffic calming devices reduce vehicular speeds and, thus, the incidence and severity of pedestrian injuries in built-up areas in Ghana. However, the fact that they are deployed on arterial roads is increasingly becoming a road safety concern. Given the emerging safety challenges associated with speed calming measures, we recommend that their use be restricted to residential streets but not on arterial roads. Long-term solutions for improving pedestrian safety proposed herein include bypassing settlements along the highways to reduce pedestrians' exposure to traffic collisions and adopting a modern way of enforcement such as evidence-based laser monitoring in conjunction with a punishment regime that utilizes the demerit points system.

Road Traffic and Other Unintentional Injuries Among Travelers to Developing Countries.

Injuries result in nearly 6 million deaths and incur 52 million disability-adjusted life-years annually, making up 15% of the global disease burden. More than 90% of this burden occurs in low- and middle-income countries. Given this burden, it is not unexpected that injuries are the leading cause of death among travelers to low- and middle-income countries, namely, from road traffic crashes and drowning. Therefore, pretravel advice regarding foreseeable dangers and how to avoid them may significantly mitigate injury risk, such as wearing seatbelts, helmets, and personal flotation devices when appropriate; responsibly consuming alcohol; and closely supervising children.

The use of non-standard motorcycle helmets in low- and middle-income countries: a multicentre study.

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.

Observed seat belt use in Kumasi Metropolis, Ghana.

We conducted an observational survey of seat belt use to determine the use rate of drivers and front-right passengers of vehicles in Kumasi, Ghana. Unobtrusive observations of seat belt use were made at 41 locations composed of signalized intersections and roundabouts where vehicles come to a halt or slow down considerably. The overall driver seat belt use rate was 17.6% compared to 4.9% for front-right passengers. Driver belt use was 33.2% for private cars, 9.0% for taxis, 8.3% for minibus (trotro), 13.1% for large buses and 9.7% for trucks. Overall seat belt use was higher for female drivers than for male drivers (44.8% versus 16.4%, p < .001), was lowest within the Central Business District (CBD) compared to the outskirts of the city (16.3% versus 21.0%, p < .001) and seat belt use rate increased with age. Passengers belted more often if drivers were belted, but about three-quarters of male passengers and 70-80% of female passengers were unbelted even when drivers were belted. In conclusion, the seat belt use rate was generally low in Kumasi, Ghana, and it is a function of occupant seating position, gender, vehicle type and usage, age group, and location setting. The results provide important preliminary data about seat belt use, particularly among male drivers and commercial vehicle occupant population. The study also suggests the need to develop effective strategies and programs that address low seat belt use in Ghana.

Prevalence of helmet use among motorcycle users in Tamale Metropolis, Ghana: an observational study.

OBJECTIVE: To estimate the prevalence of helmet use among riders and pillion riders of motorcycles in the Tamale Metropolis of Ghana. METHODS: Cross-sectional observations of helmet use were made at locations where traffic generally slowed down. Statistical analysis was carried out for variables by calculating chi-square (χ(2)) tests to assess statistical significance. RESULTS: A total of 3115 riders and 1058 pillion riders (passengers) were observed at 10 different sites. The overall helmet use for riders was 34.2 percent and that for pillion riders was 1.9 percent. Riders' helmet use rate was highest among the elderly (49.6%), followed by adults (34.3%) and lowest for young people (21.9%) and the observed percentage differences were significant (χ(2)((2))= 67.1; p < .001). A marked difference (χ(2)((1))= 6.7; p = .0096) in helmet use was observed between riders riding within the central business district (CBD; 36.5%) and those outside the CBD (32.1%). Riders with at least one pillion rider (27.4%) were less likely to wear a helmet compared to riders riding alone without passengers (37.3%; χ(2)((1))= 29.347; p < .001). CONCLUSION: Helmet use by motorcyclists in Ghana is generally low. There is a need for public awareness campaigns on the safety benefits of helmets to increase its prevalence in Ghana. The education on helmet use must be accompanied by sustained enforcement of the road traffic law by the traffic police to ensure compliance and change in attitudes.

Sustainable improvements in injury surveillance in Ghana.

The mortuary is an important foundation for injury surveillance. However, mortuary data are incomplete in many developing countries. The Komfo Anokye Teaching Hospital (KATH) mortuary handles most injury deaths for Kumasi, Ghana. During 1994-1995, many cases in KATH's mortuary logbooks had missing information deaths. A low-cost pilot programme was adopted to improve recording of injury deaths. During 1996-1999, 633 deaths per year were recorded. Project sustainability assessment in 2006 showed that reporting was high, with 773 cases per year. Data quality was standard with similar per cents of missing values for key variables compared with the pilot period. Supplemental data constituting 20% was obtained from the intensive care unit, for which data recording in the mortuary was incomplete. Low-cost improvements can lead to improved mortuary reporting of injury deaths. Collation of data from multiple sources remains a problem at KATH. Improved organisation and training could remedy the situation.

Pedestrians' injury patterns in Ghana.

OBJECTIVE: To establish the associations between pedestrian injury and explanatory variables such as vehicular characteristics, temporal trends, and road environment. METHODS: A retrospective analysis of de-identified pedestrian crash data between 2002 and 2006 was conducted using the Building & Road Research Institute's crash data bank. We estimated the odds ratios associated with casualty fatalities using a multinomial logistic regression. RESULTS: There were 812 pedestrian casualties reported, out of which 33% were fatal, 45% sustained serious injuries requiring hospitalization, and 22% were slightly injured but were not hospitalized. Crossing the roadway accounted for over 70% of all pedestrians' deaths. Whereas fatalities in 2002 and 2003 were statistically indistinguishable from those of 2004 (p>0.05), in comparison with 2004, there were significantly fewer fatalities in 2005 and 2006 (78% and 65% reduction respectively). According to police report, the probability that a pedestrian fatality occurring in Ghana attributable to excessive speeding is 65%. The adjusted odds ratio of pedestrian fatality associated with speeding compared with driver inattentiveness was 3.6 (95% CI: 2.5-5.2). It was also observed that generally, lighter vehicular masses were associated with lower pedestrian fatalities. Compared with buses, pedestrians were less likely to die when struck by private cars (52%), pick-up trucks (57%), and motorcycles (86%). CONCLUSION: Pedestrian death remains the leading cause of fatality among urban road users in Ghana. Risk factors associated with pedestrian fatality include being hit by heavy vehicles, speeding, and roadside activities such as street hawking, jaywalking and nighttime walking. Steps which may contribute to reducing pedestrian fatalities include measures to reduce vehicles speeds in settlements, providing traffic medians and lighting streets in settlements, and discouraging street and roadside activities such as hawking.

Assessment of vehicle speeds on different categories of roadways in Ghana.

Empirical evidence from road safety literature suggests that vehicular speed is an important risk factor in the incidence and severity of road traffic crashes globally. Speed studies are at rudimentary stages in developing countries, thus making vehicular speed research imperative. The main aim of the study was to establish two major speed parameters, namely, the mean and dispersion, and their implications for more extensive and long-term speed monitoring in Ghana. Research workers stationed themselves in a parked car and used a radar gun to unobtrusively measure the travelling speeds of 28,489 vehicles at 15 different inter-urban locations on three highway categories. Excessive speeding is very pervasive on all highway categories in Ghana. Travelling speeds through settlements where a speed limit of 50 km/hour is mandatory were particularly excessive. Generally, 98%, 90% and 97% of vehicles exceeded the posted speed limit of 50 km/hour on national, inter-regional and regional roads respectively. Mean speeds and speed dispersions (as assessed by the standard deviations) through built-up areas were 81.3 +/- 17.3 km/hour on national roads, 64.7 +/- 12.3 km/hour on inter-regional roads and 72.6 +/- 13.4, km/hour on regional roads. On rural undivided highways with an 80 km/hour speed limit, mean and speed dispersions were 90 +/- 18.9 km/hour on national roads, 80.1 +/- 16 km/hour on inter-regional roads and 84.4 +/- 15.6 on regional roads; also translating into 66%, 47% and 60% of vehicles exceeding recommended speeds. In all cases, speed dispersions were notably higher than the value of 10 km/hour generally found in developed countries. Excessive speeding and wide speed dispersions are highly prevalent on Ghana's highways. These factors likely account for the high incidence of traffic crashes and fatalities in Ghana. An integrated speed monitoring and control programme and by-passing small and medium settlements would be required for the reduction of speed-related crashes, fatalities and injuries.

Study of vehicle speeds on a major highway in Ghana: implication for monitoring and control.

OBJECTIVE: Vehicular speeds have been identified to be at the core of road accident severity and frequency globally. Whereas speed control is a fundamental priority and the cornerstone of road safety in the developed world, the subject is at rudimentary stages in most developing countries thus making research into vehicle speeds in developing nations imperative. The main aim of the study was to establish two major speed parameters, namely the mean speed and dispersion, and their implications for more extensive and long-term speed monitoring in Ghana. METHODS: Research workers stationed themselves in a parked car and used a radar gun to unobtrusively measure the travelling speeds of 4,163 vehicles over two 24-hour periods at two separate sites on one of the main inter-urban roads (Accra-Kumasi). Both sites were settled areas with posted speed limits of 50 km/hr. RESULTS: Over 95% of vehicles travelled above the posted speed limit of 50 km/hr. Vehicles on an average travelled at 87 km/hr, (95% CI=87, 88). Variation in speeds was wide, with a standard deviation of 18 km/hr for all classes of vehicles, and with a range of 40 to 187 km/hr. The highest vehicular speed was associated with the private car (97.6+/-18.3 km/hr) followed by large buses (93.6+/-13.3 km/hr) and the least was with heavy trucks (73.8+/-12.9 km/hr). CONCLUSION: The excessive vehicular speeds coupled with the wide speed variations explain in part the high incidence of traffic crashes and fatalities on the Accra-Kumasi highway. An integrated speed monitoring and control program, and realigning the highway to by-pass small and medium settlements would be required as a long-term measure for the reduction of speed-related road traffic crashes, fatalities, and injuries in Ghana.

Human resources for the control of road traffic injury.

The definition of the ideal numbers and distribution of human resources required for control of road traffic injury (RTI) is not as advanced as for other health problems. We can nonetheless identify functions that need to be addressed across the spectrum of injury control: surveillance; road safety (including infrastructure, vehicle design, and behaviour); and trauma care. Many low-cost strategies to improve these functions in low- or middle-income countries can be identified. For all these strategies, there is need for adequate institutional capacity, including funding, legal authority, and human resources. Several categories of human resources need to be developed: epidemiologists who can handle injury data, design surveillance systems, and undertake research; engineers and planners versed in safety aspects of road design, traffic flow, urban planning, and vehicle design; police and lawyers who understand the health impact of traffic law; clinicians who can develop cost-effective improvements in the entire system of trauma treatment; media experts to undertake effective behaviour change and social marketing; and economists to assist with cost-effectiveness evaluations. RTI control can be strengthened by enhancing such training in these disciplines, as well as encouraging retention of those who have the needed skills. Mechanisms to enhance collaboration between these different fields need to be promoted. Finally, the burden of RTI is borne disproportionately by the poor; in addition to technical issues, more profound equity issues must be addressed. This mandates that people from all professional backgrounds who work for RTI control should develop skills in advocacy and politics.

Pattern of road traffic injuries in Ghana: implications for control.

Road traffic injuries and fatalities are increasing in Ghana. Police-collected crash and injury data for the period 1994-1998 were aggregated and analyzed using the MAAP5 accident analysis package developed by the Transport Research Laboratory, U.K. Published results of recent transport-related epidemiological and other surveys provided an additional data source. According to the 1994-1998 police data, road traffic crashes were a leading cause of death and injuries in Ghana. The other leading causes of death and injuries are occupational injuries which involve non-mechanized farming and tribal conflicts. The majority of road traffic fatalities (61.2%) and injuries (52.3%) occurred on roads in rural areas. About 58% more people died on roads in the rural areas than in urban areas, and generally more severe crashes occurred on rural roads compared with urban areas. Pedestrians accounted for 46.2% of all road traffic fatalities. The majority of these (66.8%) occurred in urban areas. The second leading population of road users affected was riders in passenger-ferrying buses, minibuses and trucks. The majority of these (42.8%) were killed on roads that pass through rural areas. Pedestrian casualties were overrepresented (nearly 90%) in five regions located in the southern half of the country. Efforts to tackle pedestrian safety should focus on the five regions of the country where most pedestrian fatalities occur in urban areas. Policies are also needed to protect passengers in commercially operated passenger-ferrying buses, minibuses and trucks because these vehicles carry a higher risk of being involved in fatal crashes.

Speed control in developing countries: issues, challenges and opportunities in reducing road traffic injuries.

Speed has been determined to be one of the most common contributing factors in vehicle crashes. This study explores vehicle speed as a factor in the causation of road traffic crashes, using the example of Ghana. It examines the effectiveness of various speed control measures, based on police-reported traffic crashes in Ghana and published works on speed control measures in both industrialized and developing countries. In Ghana, pedestrians were the main victims of road traffic injuries. The dominant driver error assigned by traffic police was loss of control, with the underlying factor being excessive vehicle speeds. The 'speed factor' alone accounted for more than 50% of all Ghanaian road traffic crashes between 1998 and 2000. While the enforcement of speed limits by traffic police may not be affordable for most developing countries, rumble strips and speed humps were found to be effective on Ghanaian roads. Rumble strips installed on the main Accra-Kumasi highway reduced crashes by about 35% and fatalities by about 55%. Reducing vehicle speeds may be one of the most effective interventions to stem traffic crashes in low-income countries. However, setting lower speed limits is not an effective intervention without the traffic law enforcement resources to ensure that limits are followed. Developing countries must also look to other speed reduction measures such as speed bumps and rumble strips, roads that segregate high- and low-speed users, and technological solutions such as speed governors, as well as greater public awareness of the problem.