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Traffic Fatalities in Nepal
To the Editor: Road traffic injuries are one of the leading causes of death in the world.1 Each year more than 1 million people die and about 10 million people are seriously injured or disabled on the world's roads.2 Nearly three quarters of deaths resulting from motor vehicle crashes occur in developing countries.3 Although the problem appears to be increasing rapidly in developing countries,4 detailed data are lacking.
In Nepal, the population increased from 15 022 839 in 1981 to 22 367 048 in 20015; the number of registered vehicles increased from 76 378 in 1989-1990 to 354 955 in 2001-2002 (Department of Transport Management, unpublished data, 2002). The conditions of road infrastructure, including widening and paving of roads, appear to have been improved in the past few decades. These factors, coupled with a limited number of pedestrian crossings, traffic lights, symbols, street lights, and sidewalks, may contribute to high exposure of pedestrians as well as vehicle occupants to motor vehicle crashes. We assessed traffic-related deaths in Kathmandu, Nepal.
Methods
We obtained the traffic-related mortality data between Nepali fiscal year 1981-1982 and 2002-2003 from the Kathmandu Valley Traffic Police Office, which is responsible for the Kathmandu valley and up to 70 km west, to Kathmandu in Kathmandu-Pokhara highway.
The police data included fatalities at crash scenes or at hospitals. Deaths at crash scenes are reported by attending police officers; deaths at hospitals are reported by officers collecting information from major hospitals in Kathmandu valley based on reports from emergency department staff. It is compulsory for hospital staff to report road traffic injuries to the police authority. Those hospitalized are under police supervision until the time of discharge or death. Thus, deaths after 30 days from the time of the crashes are also included. We performed trend analysis using linear regression with SPSS version 11.0 (SPSS Inc, Chicago, Ill).
Results
Traffic-related deaths in Kathmandu steadily increased during the study period of 1981-2003 (Figure 1). The annual increase of the number of traffic-related deaths was 3.88 (95% confidence interval, 2.76-5.00).
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Figure. Trend of Road Traffic–Related Deaths in Kathmandu, 1981-2003
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Comment
We found an increasing number of traffic-related deaths in Kathmandu, Nepal. We believe that our results are unlikely to be influenced by reporting bias. Nepali law requires that all road-traffic crashes resulting in injury or death must be reported to police authorities; in the event of death, legal actions, such as postmortem examinations, compensation, and punishment, require the involvement of police officers. Thus, police data are more likely to cover the fatal cases of road traffic injuries. Furthermore, underreporting in police data, if it exists, would not affect our result because the police authorities are following similar reporting procedures during the study period.
The increase in traffic-related deaths might have resulted from the increase in population size, rapid growth of traffic volume, and increases in speed that accompany economic development. Since Nepal is still in an early phase of economic development, its pace of installation of safety facilities may not be able to keep up with the rapid increase of traffic volume and speed.6
Kalpana Poudel-Tandukar, MPH, MPHC;
Shinji Nakahara, MD, MS
shinji{at}m.u-tokyo.ac.jp
Krishna C. Poudel, MHSc, MA;
Masao Ichikawa, PhD, MPH;
Susumu Wakai, MD, PhD
Department of International Community Health
Graduate School of Medicine
University of Tokyo
Tokyo, Japan
1. Peden M, ed, McGee K, ed, Krug E, ed. Injury: A Leading Cause of the Global Burden of Disease, 2000. Geneva, Switzerland: World Health Organization; 2002.
2. Murray CJL, Lopez AD. Global Health Statistics: A Compendium of Incidence, Prevalence and Mortality Estimates for Over 200 Conditions. Geneva, Switzerland: World Health Organization; 1996.
3. Odero W, Garner P, Zwi A. Road traffic injuries in developing countries: a comparative review of epidemiological studies. Trop Med Int Health. 1997;2:445-460.
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4. Jacobs G, Aeron-Thomas A, Astrop A. Estimating Global Road Fatalities. London, England: Transport Research Laboratory, 2000. Report 445.
5. Central Bureau of Statistics. Statistical Year Book of Nepal 2001. Kathmandu, Nepal: Central Bureau of Statistics; 2001.
6. van Beeck EF, Borsboom GJJ, Mackenbach JP. Economic development and traffic accident mortality in the industrialized world, 1962-1990. Int J Epidemiol. 2000;29:503-509.
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Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.
JAMA. 2004;291:2542.
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