Study Finds Silent Epidemic of Motor Vehicle Crashes in Pakistan

A study exploring the impact of motor vehicle injuries in Pakistan has found that as many as 61 percent to 86 percent of such injuries may go uncounted in official police statistics, causing public health officials in Pakistan to underestimate the problem's seriousness. The investigation shows that the total number of motor vehicle crashes increased 14-fold between 1956 and 1996, while the number of lives lost in crashes increased 16 times. The scientists also discovered that buses and public service vehicles, which in Pakistan account for just 12 to 35 percent of the total number of registered vehicles in any given year, are involved in over 60 percent of motor vehicle crashes and 90 percent of crash deaths.

First author Adnan A. Hyder, MD, MPH, PhD, assistant scientist, International Health, Johns Hopkins School of Public Health, said, "Since the numbers of motor vehicle injuries and deaths may be seriously underreported in Pakistan's official statistics, the public health sector there has not fully appreciated the burden these injuries are imposing on the population." The study appeared in the September 2000 issue of Injury Prevention.

Currently ranked ninth among the world's disease burdens, motor vehicle crashes are projected to rank third by 2020. Developing countries are the site of nearly three quarters of the ten million motor vehicle crashes annually. "And yet," says Hyder, "in the absence of accurate and detailed epidemiological and economic data for injuries, there is limited understanding of this issue in the developing world."

To measure the risk of traffic injuries in Pakistan, Hyder teamed up with Abdul Ghaffar, PhD, in Pakistan's Ministry of Health. They gathered data on the numbers of registered vehicles and motor vehicle crashes, as well as on injuries and deaths in Pakistan during the years 1956 to 1996. They also interviewed 35 crash survivors between May and August, to ask whether the police had been on the scene to register the crashes.

The study's results indicate that the numbers of motor vehicle crashes, injuries and fatalities in the country have increased steadily during the 40-year period after 1956, and that commercial vehicles contribute disproportionately to these injuries.

The in-depth interviews of motor vehicle crash survivors revealed that only 14 percent of the crashes were investigated and registered by the police. (A previous study found that 39 percent of road traffic injuries had been investigated by the local city police.)

The authors said that since commercial vehicles travel many more kilometers annually than do cars, their risk for crashes is heightened. Equally important, according to the authors, is that commercial vehicle production has not kept pace with population growth, so that existing vehicles in this category are increasingly likely to be overloaded, further contributing to increased injury and fatality rates per crash.

Hyder said there is little evidence that the health sector in general is responding to this challenge. "Pakistan's focus has traditionally been on providing hospital treatment once a crash has occurred and the injured party has reached a facility," he said, "not on developing and coordinating emergency medical services and prevention strategies."

The authors say that policy makers in developing nations must first fully appreciate the problem of crash injuries and then perform epidemiologic studies to demonstrate the need for prevention programs.

Support for this study was provided in part by the Global Forum for Health Research, Geneva.