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A perspective on road fatalities in Jeddah, Saudi Arabia
Accrd. Anal. a; Prev. Vol. 24. No. 2. pp. 143-148. 1992 Printed in Great Bntam.
ow)l4575/~2 $5.00 + .(Xl 0 1992 Pergamon Press Ltd.
A PERSPECTIVE ON ROAD FATALITIES JEDDAH, SAUDI ARABIA
IN
A. BENER* Dept.of Community Medicine. Faculty of Medicine, Kuwait University. P.O. Box 24923, Safat 131lo, Kuwait, State of Kuwait and K. S. JADAAN Dept. of Civil Engineering, Faculty of Engineering. Kuwait University, P.O. Box 5969, Safat 13060, Kuwait. State of Kuwait
(Received 4Juiy1990) Abstract-The aim of this paper is to study an epidemiological aspect of fatalities from motor vehicle accidents in Jeddah. Saudi Arabia. All fatal accidents that occurred in Jeddah between 1 January and 31 December 1987 are analvzed. The death rates oer hundred million vehicle kilometers of travel, per 100,000 registered motor vehicles, and per’100.000 resident population in 1987 were about 1.87, 19.7, and 26.5, respectively. An attempt is made to use international death rates to compare Jeddah with other countries. The figures reveal higher death rates per vehicle travel and per resident population but lower rate per registered vehicle than in some industrialized countries. An additional attempt was made to estimate the cost of road traffic fatalities in Jeddah, which is an extremely difficult task due to lack of reliable data. This study shows that the cost of 1987 road fatalities in Jeddah is estimated to be 648.7 million Saudi Riyals (US$172.5 million).
INTRODUCTION
Road fatalities constitute a major health problem in Saudi Arabia. Road traffic fatalities have been a major leading cause of morbidity and mortality in developed and developing countries. Various research carried out on traffic accidents in developing countries (Jacobs 1982), and in rich developing countries (Bayoumi 1981; Jadaan 1983; Mekky 1985; Bener and EESayyad 1985; Bener, Abouammoh, and El-Kahlout 1988; Ergun 1987; Weddell and McDougall 1981; Jadaan 1983,1988,1989a; and Ofosu, Abouammoh, and Bener 1988) has revealed that, compared with many western industrialized countries, developing countries have a secular increase in mortality rates due to road injuries. Jacobs and Cutting (1986)) in their study of accidents in a number of developing countries, showed that the traffic safety situation is worsening in many of these countries. The fatality rates are generally decreasing in Europe and North America, while relatively little attention has been paid to the magnitude of the problem in developing countries. Road traffic injuries are becoming a public health epidemic in Saudi Arabia. Yet, relative to other causes of mortality and morbidity, the amount of attention they have received from public health professionals and the scientific community is minuscule. This could be the situation in a number of countries and has been reported to be partly due to the absence of comprehensive documentation of the situation (Langley and McLaughlin 1989). In the oil-rich Arabian Gulf countries, many aspects of life changed shortly after the discovery of oil. There was an explosion both in populations and in number of vehicles, accompanied by rapidly expanding road construction. Unfortunately, patterns of behavior did not change so rapidly. The result is a large and growing number of casualties caused by traffic accidents. The World Health Organization, in the report of a conference on the epidemiology of road traffic accidents, (WHO 1976), observed that public health authorities should *Current address: Dept. of Community Medicine, Faculty of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al-Ain, United Arab Emirates. 143
A. BENERand K. S. JADAAN
144
be aware of the extent of permanent incapacity from road accidents and reported that there was evidence that this incapacity was increasing. Among factors associated with this increase were thought to be the greater power of the vehicles involved, and an increasing number of heavy goods vehicles. Also, advances in techniques of medical resuscitation mean that even the most seriously injured may survive. The role of the epidemiologist in this context includes the provision of data essential to the planning, implementation, and evaluation of services for the control of road accidents and management of casualties, and to the correct assignment of priorities among those services (WHO 1976). The object of this paper is to discuss the magnitude of road traffic fatalities in Jeddah and to compare the situation with that of some developed countries. This study is concerned with fatal motor vehicle accidents and their resulting casualties. We use international death rates to ascertain both the ranking of this health problem in Jeddah and how it compares to other countries. and we offer some specific recommendations as to how the risk can be reduced. METHOD
The data used for this study were taken from the Ministry of Interior’s Yearly Statistical Report and in collaboration with the Traffic Department, Kingdom of Saudi Arabia. The study is based on the collection of data about all fatal motor vehicle accidents that had occurred in Jeddah during the period 1 January to 31 December 1987. The annual statistical report contains information such as number of registered vehicles, number and nature of accidents, number of casualties and fatalities, age of drivers, and frequency of accidents. Additional data were obtained from various sources, including Government censuses (1963 and 1974), Sebai (1969), Nutfaji (1981), United Nations (1981, 1985); Tawfig, Bakhatma, and Sulaiman (1985); Al-Qasabi et al. (1989); International Road Federation (1983); and World Bank (1985). An attempt was made to estimate road traffic fatalities’ cost in Jeddah, an extremely difficult task due to lack of reliable data. Two attempts were made to cost traffic accidents in Saudi Arabia. The first study was carried out by Khawashki (1980) and the second by Mufti (1983). The above methods were used to estimate the costs of traffic fatalities accidents that occurred in 1987 in Jeddah. We considered three aspects of costs: human loss (death), personal injury, and property damage. RESULTS
Data on fatality rates per 1,000 vehicles and per 100 accidents in Jeddah for the period between 1980 and 1987 are given in Table 1. There was a decrease in the number of fatalities per 1,000 vehicles and per 100 traffic accidents. Table 2 shows the motor vehicle fatalities and mortality rates by age using the population in 1987. The overall motor vehicle mortality rate per 100,000 population was Table 1. Fatality rates from motor vehicle accidents in Jeddah (1980-19871 Jeddah Years
Vehicle per person
Fatalities/ 10,000 vehicles
Fatalities/ 100 traffic accidents
1980 1981 1982 1983 1984 1985 1986 1987
0.903 0.997 1.182 1.504 1.847 1.885 1.657 1.349
5.6 4.7 5.6 2.7 2.3 2.4 2.3 2.0
12.5 12.8 13.2 12.2 11.6 11.2 11.2 10.9
Road fatalities in Jeddah, Saudi Arabia
145
Table 2. Motor vehicle fatalities and mortality rate by age in Jeddah during 1987 Motor vehicle fatalities
Age group in years
Mortality rate/ 100,000 population
Population
o-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+
19 23 20 28 22 25 31 24 26 23 20 17 30
283020 243874 164735 92881 75580 61010 50083 41887 34603 28229 23676 19123 41886
6.7 9.4 12.1 30.0 29.1 41.0 62.0 57.3 75.0 81.5 122.0 89.0 74.0
All ages
308
1160597
26.5
26.5. The lowest mortality rate was in the age group O-4, 6.7 per 100,000 population. The highest mortality rate was in the age group 50-54 years, which was 122.0 per 100,000 population. All age groups above 40 years have mortality rates much higher than younger groups indicating loss of resources that are needed for the development of the country. One of the important epidemiological parameters used in relation to disease mortality is the potential years of life lost (PYLL) as an indicator of premature mortality for health planning. Table 3 calculates PYLL between ages 1 and 70 due to fatal motor vehicle accidents that occurred in Jeddah during 1987. The rate of PYLL in 1987 was found to be 9.9 per 1,000 population. Much of the work done to study the costs of road accidents has aimed at the development of aggregate cost figures. Whilst it is difficult to attribute monetary values to the losses arising from road traffic accidents, estimates of accident costs are essential to satisfactory decision-making in road safety. The different approaches to accident costing generated substantially different costs and it was shown that the cost of accidents involving a fatality may vary in the United Kingdom and the United States from 3,000 to 2 million U.S. dollars, depending on which method is used (Hills and Jones-Lee 1983). Some authors studied the socioeconomic impact of road traffic accidents, injuries, and fatalities in Saudi Arabia (Khawashki 1980; Mufti 1983). They concluded that Saudi Table 3. Potential Years of Life Lost (PYLL) between age l-70 due to motor vehicle accidents in Jeddah during 1987 Age group in years
Remaining years
l-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 so-54 55-59 60-64 65-69 70+
67.0 62.5 57.5 52.5 47.5 42.5 37.5 32.5 27.5 22.5 17.5 12.5 7.5 2.5 0
Total ( l-70) Rate of PYLL = s AAP24:2-o
Number of deaths
PYLL
19 23 20 28 22 25 31 24 26 23 20 17 8 13 9
1273.0 1437.5 1150.0 1470.0 1045.0 1062.5 1162.5 780.0 715.0 742.5 350.0 212.5 60.0 32.5
308
11493
x 1000 = 9.9/1000.
A. BENFR and K. S. JADAAN
146
4. Estimates of cost of fatalities in Jeddah (1987)
Table
road
Fatality cost (‘000 SR)
Cost item Human loss (death) Personal injury Property damage
42 1800 78600 I‘W300
Total
64X700 $1 U.S. = 3.76 Saudi Rival (S.R.) I S.R. = U.S. 27 cents.
Arabia was losing approximately 4,777.836 S.R. (U.S. $1,085,644) per day due to road traffic accidents and the management of their victims. The above methods were used as a base to estimate the costs of road fatalities that occurred in 1987 in Jeddah. We consider three aspects of costs: human loss (deaths), personal injury, and property damage. Table 4 shows the estimates of road fatality costs per item, such as human loss (death), personal injury, and property damage. This study showed that the 1987 road fatality costs in Jeddah are estimated to be SR 354.905 million, (U.S. $172.5 million). DISCUSSION
Road fatalities in Saudi Arabia as well as in other Arab Gulf states constitute a major health problem second only to infectious diseases as a medical problem. It is an epidemic as serious as plague or smallpox were to earlier generations (Mufti 1983). The authors are well aware of the deficiencies involved in retrospective study and the lack of standardized record-keeping. At least. it gives an idea about the magnitude of the problem. Fatal accidents are usually all reported, and it is unlikely that a death will not be reported. However, a difficulty for international comparability has been the variation in definition of road death from country to country and from time to time. Three fatality rates are often used. which allow comparisons to be made between different countries: the fatality rate per 100,000 population, the fatality rate per 100,000 registered vehicles, and the fatality rate per million vehicle kilometers traveled. For comparison purposes. the last rate is the most meaningful. However, comparing a number of epidemiological variables relevant to fatal motor vehicle fatalities between Jeddah, U.S.A.. Great Britain. and Kuwait is instructive. Table 5 shows that death rates per hundred million vehicle kilometers of travel. per 100,000 registered motor vehicles, and per 100,000 resident population of Jeddah in 1987 were about 1.87. 19.7, and 26.5, respectively. Jeddah has the highest fatality rate per 100,000 persons, the lowest rate per 100,000 vehicles, and a fatality rate per hundred million vehicle km higher than developed countries but lower than Kuwait. Jeddah enjoys the highest car ownership and this is reflected in its low fatality rate as related to the number of registered vehicles. Table 5. Statistical Item
Jeddah
Motor vehicle deaths Vehicle travel (million kms) Registered vehicle (100,000) Resident population (100.000) Death rates per hundred million vehicle kms per 100,000 registered vehicle per 100,000 resident population Vehicle ownership Ratios of vehicle
comparison
to population
of motor
vehicle
Great
deaths
Britain
30X I6503 15.70
510X 3 IS800 314.7
11.60
552
in 1987 U.S.A.
Kuwait
48317 3060803 1932.6 2420.8
273 13577 5.6 IX.7
1.87 19.70 26.55
1.62 23.79 9.2s
1.58 25.00 19.96
2.01 48.75 14.60
I .35
0.38
0.80
0.30
Road fatalities in Jeddah, Saudi Arabia
147
Table 6. Causes of death for all age groups in Saudi Arabia Causes of death Road traffic accidents Cerebrovascular accident Malignancy Heart disease Gastrointestinal tract disease Others
Percentage 15.2 14.3 14.1 13.8 12.8 29.8
The major causes of death for all age groups in the Saudi Arabia during the year 1986 are shown in Table 6. The present study shows that road traffic fatalities is at the top of the list of major causes of death. Similar observations have been found in other studies (Kreis, Plasencia, and Augenstein 1986; Baker, Oppenheimer, and Stephens 1980; Somers 1980). A similar study in the United States ranked road traffic fatalities as the third most common cause of death in all age groups. Road traffic accidents generally cause more serious trauma than other accidents. This is reflected in the high number of fatal and serious injuries. In order to gain meaningful information on the total cost of fatalities caused by traffic accidents, an investigation should start from the moment of impact until rehabilitation is complete. However, this is not always possible, but it is particularly important to quantify the medical cost in a more precise way than using haphazard guesses (Jadaan 1989b). The attempt made in this paper to evaluate 1987 cost of road fatalities in Jeddah shows it to be 648.7 million Saudi Riyals ($172.5 million U.S.). RECOMMENDATIONS
In conclusion, road injuries, besides being a major health hazard leading to a high rate of morbidity, disability, and death, have a great socioeconomic impact on the victim, his family, and the nation as a whole. The problem is tractable, and the toll could be greatly reduced if appropriate measures were taken. The present study suggests that motor vehicle accidents are probably the most common single cause of death in Jeddah. Motor vehicle accidents are a preventable disease like other epidemic diseases. However, as for many other public health problems, the solution to road injuries and fatalities does not lie in one magic procedure but rather in a series of concomitant actions, the most important of which are listed below. 1. Traffic rules and safety measures should be taught in the schools and through media: i.e. newspapers and television programs. Therefore, traffic education that aims at changing the attitudes and behavior of road users is urgently needed. 2. Speed limits should be reinforced by law and monitored regularly. 3. Safety seat belts should be monitored and their use should be legislated. 4. Implement child restraining systems. 5. Health education in accident prevention should be provided. 6. Require vehicle insurance that should suit Islamic culture and values. Since insurance coverage is not compulsory, parties involved in such accidents tend to settle their financial losses without reporting these accidents to the Traffic Police Department. 7. Rehabilitation and trauma centers are needed. 8. Another factor contributing to the high fatality rate is the lack of maintenance of vehicles. Therefore, strict vehicle testing by road random checks of vehicles by Police Patrols is recommended. 9. There is a real need to conduct accident cost analysis in association with accident analysis to help in identifying appropriate remedial measures and road safety. 10. More research is needed to study the etiology and epidemiology of road injuries and fatalities and to devise measures to control the problem.
148
A. BENER and K. S. JADAAN
Acknowledgements-We would like to thank improved the presentation of this paper.
K. Rumar
and the referees
for their useful comments
which have
REFERENCES Al-Qabasi, 0. D.; Al-Mofarreh. M. A.; Al-Bunyan, A. R.; Al-Karion. A. A.; Haque. M. M. Road traffic fatalities in Rivadh Central Hosnital. Annals of Saudi Medicine 9:237-40; 1989. Baker. C. C.: Oppenheimer, L.; Stephens, B. Epidemiology of trauma deaths. Am. J. Surg. 140:149-SO; 1980. Bayoumi. A. The Epidemiology of fatal motor vehicle accidents in Kuwait. Accid. Anal. Prev. 13:339-34X; 1981, Bener. A.: El-Sayyad, G. M. Epidemiology of motor vehicle accidents in Jeddah. J. R. Sot. Health 105:200201; 1985. Bener, A.; Abouammoh. A. M.; El-Kahlout, G. R. Road traffic accidents in Riyadh. J. R. Sot. Health 108:34-36: 1988. Ergun, G. Condition of vehicles in Saudi Arabia. Accid. Anal. Prev. 19:343-358; 1987. Hills, P. J.; Jones-Lee. M. W. The costs of traffic accidents and the valuation of accident-prevention in developing countries. Highway Investment in Developing Countries; 1983. International Road Federation. World road statistics 1980-1983. Jacobs, G. D. The potential for road accident reduction in developing countries. Transport Reviews 2:213224; 1982. Jacobs, G. D.; Cutting, C. A. Road accidents in developing countries. TRRL Report SR 807. Crowthorne. Berks. U.K.: Transport and Road Research Laboratory; 1986. Jadaan. K. S. A comparison of traffic accidents in the Arabian Gulf countries. Paper presented at 9th International Congress on Accidents and Traffic Medicine, Mexico; 1983. Jadaan. K. S. Traffic safety in Gulf countries with special reference to Kuwait. Transport Review 8:249-265; 1988. Jadaan, K. S. The epidemiology of road traffic accidents in Jordan. J. R. Sot. Health 109:141-146; 1989a. Jadaan, K. S. Road accidents costs in Jordan. J. R. Sot. Health 109:144-146; 1989b. Khawashki, E. Socioeconomic impact of R.T.A. in Saudi Arabia. Saudi Medical Journal 1(5):246; 1980. Kreis, D. J. Jr.; Plasencia. G.; Augenstein, D. Preventable trauma deaths. Dade county, Florida J. Trauma; 261649-53: 1986. Langley, J. D.: McLaughlin. E. Injury mortality and morbidity in New Zealand. Accid. Anal. Prev. 21:243254; 1989. Mekky, A. Effects of rapid increase in motorization levels on road fatality rates in rich developing countries. Accid. Anal. Prev. 17:101-109; 1985. Mufti. M. H. Road traffic accidents as a public health problem in Riyadh. Saudi Arabia. Int. Assoc. for Accident and Traffic Medicine 11:65-69: 1983. Nutfaji, M. A. H. Projection of Saudi population by sex and age. Riyadh. Saudi Arabia: Research Centre. College of Administrative Sciences, King Saud University; 1981, Qfosu. J. B.; Abouammoh. A. M.: Bener, A. A study of road traffic accidents in Saudi Arabia. Accid. Anal. Prev. 20:95-101; 1988. Sebai, 2. The health of the Bedouin family in a changing Arabia. Unpublished doctoral dissertation. Baltimore, MD: The John Hopkins University; 1969. Somers, A. R. Life-style and health. In: Last. J. M., ed. Maxcy-Rosenau public health and preventive medicine. 1lth ed. New York; Appleton-Century-Crofts; 1990. Tawfiq, 0. M.: Bakhatma. M. A.; Sulaiman. S. I. Head injuries in Jeddah: An analytical study of 200 cases. Saudi Medical Journal 6:25-34; 1985. United Nations. Population policy compendium: Saudi Arabia. New York: United Nations; 1981. United Nations. Population and vital statistics: Latest available data for Western Asia. New York: United Nations; 1985. Weddell, J. M.; McDougall. A. Road traffic accidents in Sharjah. Saudi Medical Journal 2: 137-142; 19X1. World Health Organization. The epidemiology of road traffic accidents. Report of a Conference. Vienna 47 November 1975. WHO, Regional Publications European Series No. 2. WHO Regional Office for Europe; Copenhagen; 1976. World Bank. World development report; 1985.
ow)l4575/~2 $5.00 + .(Xl 0 1992 Pergamon Press Ltd.
A PERSPECTIVE ON ROAD FATALITIES JEDDAH, SAUDI ARABIA
IN
A. BENER* Dept.of Community Medicine. Faculty of Medicine, Kuwait University. P.O. Box 24923, Safat 131lo, Kuwait, State of Kuwait and K. S. JADAAN Dept. of Civil Engineering, Faculty of Engineering. Kuwait University, P.O. Box 5969, Safat 13060, Kuwait. State of Kuwait
(Received 4Juiy1990) Abstract-The aim of this paper is to study an epidemiological aspect of fatalities from motor vehicle accidents in Jeddah. Saudi Arabia. All fatal accidents that occurred in Jeddah between 1 January and 31 December 1987 are analvzed. The death rates oer hundred million vehicle kilometers of travel, per 100,000 registered motor vehicles, and per’100.000 resident population in 1987 were about 1.87, 19.7, and 26.5, respectively. An attempt is made to use international death rates to compare Jeddah with other countries. The figures reveal higher death rates per vehicle travel and per resident population but lower rate per registered vehicle than in some industrialized countries. An additional attempt was made to estimate the cost of road traffic fatalities in Jeddah, which is an extremely difficult task due to lack of reliable data. This study shows that the cost of 1987 road fatalities in Jeddah is estimated to be 648.7 million Saudi Riyals (US$172.5 million).
INTRODUCTION
Road fatalities constitute a major health problem in Saudi Arabia. Road traffic fatalities have been a major leading cause of morbidity and mortality in developed and developing countries. Various research carried out on traffic accidents in developing countries (Jacobs 1982), and in rich developing countries (Bayoumi 1981; Jadaan 1983; Mekky 1985; Bener and EESayyad 1985; Bener, Abouammoh, and El-Kahlout 1988; Ergun 1987; Weddell and McDougall 1981; Jadaan 1983,1988,1989a; and Ofosu, Abouammoh, and Bener 1988) has revealed that, compared with many western industrialized countries, developing countries have a secular increase in mortality rates due to road injuries. Jacobs and Cutting (1986)) in their study of accidents in a number of developing countries, showed that the traffic safety situation is worsening in many of these countries. The fatality rates are generally decreasing in Europe and North America, while relatively little attention has been paid to the magnitude of the problem in developing countries. Road traffic injuries are becoming a public health epidemic in Saudi Arabia. Yet, relative to other causes of mortality and morbidity, the amount of attention they have received from public health professionals and the scientific community is minuscule. This could be the situation in a number of countries and has been reported to be partly due to the absence of comprehensive documentation of the situation (Langley and McLaughlin 1989). In the oil-rich Arabian Gulf countries, many aspects of life changed shortly after the discovery of oil. There was an explosion both in populations and in number of vehicles, accompanied by rapidly expanding road construction. Unfortunately, patterns of behavior did not change so rapidly. The result is a large and growing number of casualties caused by traffic accidents. The World Health Organization, in the report of a conference on the epidemiology of road traffic accidents, (WHO 1976), observed that public health authorities should *Current address: Dept. of Community Medicine, Faculty of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al-Ain, United Arab Emirates. 143
A. BENERand K. S. JADAAN
144
be aware of the extent of permanent incapacity from road accidents and reported that there was evidence that this incapacity was increasing. Among factors associated with this increase were thought to be the greater power of the vehicles involved, and an increasing number of heavy goods vehicles. Also, advances in techniques of medical resuscitation mean that even the most seriously injured may survive. The role of the epidemiologist in this context includes the provision of data essential to the planning, implementation, and evaluation of services for the control of road accidents and management of casualties, and to the correct assignment of priorities among those services (WHO 1976). The object of this paper is to discuss the magnitude of road traffic fatalities in Jeddah and to compare the situation with that of some developed countries. This study is concerned with fatal motor vehicle accidents and their resulting casualties. We use international death rates to ascertain both the ranking of this health problem in Jeddah and how it compares to other countries. and we offer some specific recommendations as to how the risk can be reduced. METHOD
The data used for this study were taken from the Ministry of Interior’s Yearly Statistical Report and in collaboration with the Traffic Department, Kingdom of Saudi Arabia. The study is based on the collection of data about all fatal motor vehicle accidents that had occurred in Jeddah during the period 1 January to 31 December 1987. The annual statistical report contains information such as number of registered vehicles, number and nature of accidents, number of casualties and fatalities, age of drivers, and frequency of accidents. Additional data were obtained from various sources, including Government censuses (1963 and 1974), Sebai (1969), Nutfaji (1981), United Nations (1981, 1985); Tawfig, Bakhatma, and Sulaiman (1985); Al-Qasabi et al. (1989); International Road Federation (1983); and World Bank (1985). An attempt was made to estimate road traffic fatalities’ cost in Jeddah, an extremely difficult task due to lack of reliable data. Two attempts were made to cost traffic accidents in Saudi Arabia. The first study was carried out by Khawashki (1980) and the second by Mufti (1983). The above methods were used to estimate the costs of traffic fatalities accidents that occurred in 1987 in Jeddah. We considered three aspects of costs: human loss (death), personal injury, and property damage. RESULTS
Data on fatality rates per 1,000 vehicles and per 100 accidents in Jeddah for the period between 1980 and 1987 are given in Table 1. There was a decrease in the number of fatalities per 1,000 vehicles and per 100 traffic accidents. Table 2 shows the motor vehicle fatalities and mortality rates by age using the population in 1987. The overall motor vehicle mortality rate per 100,000 population was Table 1. Fatality rates from motor vehicle accidents in Jeddah (1980-19871 Jeddah Years
Vehicle per person
Fatalities/ 10,000 vehicles
Fatalities/ 100 traffic accidents
1980 1981 1982 1983 1984 1985 1986 1987
0.903 0.997 1.182 1.504 1.847 1.885 1.657 1.349
5.6 4.7 5.6 2.7 2.3 2.4 2.3 2.0
12.5 12.8 13.2 12.2 11.6 11.2 11.2 10.9
Road fatalities in Jeddah, Saudi Arabia
145
Table 2. Motor vehicle fatalities and mortality rate by age in Jeddah during 1987 Motor vehicle fatalities
Age group in years
Mortality rate/ 100,000 population
Population
o-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60+
19 23 20 28 22 25 31 24 26 23 20 17 30
283020 243874 164735 92881 75580 61010 50083 41887 34603 28229 23676 19123 41886
6.7 9.4 12.1 30.0 29.1 41.0 62.0 57.3 75.0 81.5 122.0 89.0 74.0
All ages
308
1160597
26.5
26.5. The lowest mortality rate was in the age group O-4, 6.7 per 100,000 population. The highest mortality rate was in the age group 50-54 years, which was 122.0 per 100,000 population. All age groups above 40 years have mortality rates much higher than younger groups indicating loss of resources that are needed for the development of the country. One of the important epidemiological parameters used in relation to disease mortality is the potential years of life lost (PYLL) as an indicator of premature mortality for health planning. Table 3 calculates PYLL between ages 1 and 70 due to fatal motor vehicle accidents that occurred in Jeddah during 1987. The rate of PYLL in 1987 was found to be 9.9 per 1,000 population. Much of the work done to study the costs of road accidents has aimed at the development of aggregate cost figures. Whilst it is difficult to attribute monetary values to the losses arising from road traffic accidents, estimates of accident costs are essential to satisfactory decision-making in road safety. The different approaches to accident costing generated substantially different costs and it was shown that the cost of accidents involving a fatality may vary in the United Kingdom and the United States from 3,000 to 2 million U.S. dollars, depending on which method is used (Hills and Jones-Lee 1983). Some authors studied the socioeconomic impact of road traffic accidents, injuries, and fatalities in Saudi Arabia (Khawashki 1980; Mufti 1983). They concluded that Saudi Table 3. Potential Years of Life Lost (PYLL) between age l-70 due to motor vehicle accidents in Jeddah during 1987 Age group in years
Remaining years
l-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 so-54 55-59 60-64 65-69 70+
67.0 62.5 57.5 52.5 47.5 42.5 37.5 32.5 27.5 22.5 17.5 12.5 7.5 2.5 0
Total ( l-70) Rate of PYLL = s AAP24:2-o
Number of deaths
PYLL
19 23 20 28 22 25 31 24 26 23 20 17 8 13 9
1273.0 1437.5 1150.0 1470.0 1045.0 1062.5 1162.5 780.0 715.0 742.5 350.0 212.5 60.0 32.5
308
11493
x 1000 = 9.9/1000.
A. BENFR and K. S. JADAAN
146
4. Estimates of cost of fatalities in Jeddah (1987)
Table
road
Fatality cost (‘000 SR)
Cost item Human loss (death) Personal injury Property damage
42 1800 78600 I‘W300
Total
64X700 $1 U.S. = 3.76 Saudi Rival (S.R.) I S.R. = U.S. 27 cents.
Arabia was losing approximately 4,777.836 S.R. (U.S. $1,085,644) per day due to road traffic accidents and the management of their victims. The above methods were used as a base to estimate the costs of road fatalities that occurred in 1987 in Jeddah. We consider three aspects of costs: human loss (deaths), personal injury, and property damage. Table 4 shows the estimates of road fatality costs per item, such as human loss (death), personal injury, and property damage. This study showed that the 1987 road fatality costs in Jeddah are estimated to be SR 354.905 million, (U.S. $172.5 million). DISCUSSION
Road fatalities in Saudi Arabia as well as in other Arab Gulf states constitute a major health problem second only to infectious diseases as a medical problem. It is an epidemic as serious as plague or smallpox were to earlier generations (Mufti 1983). The authors are well aware of the deficiencies involved in retrospective study and the lack of standardized record-keeping. At least. it gives an idea about the magnitude of the problem. Fatal accidents are usually all reported, and it is unlikely that a death will not be reported. However, a difficulty for international comparability has been the variation in definition of road death from country to country and from time to time. Three fatality rates are often used. which allow comparisons to be made between different countries: the fatality rate per 100,000 population, the fatality rate per 100,000 registered vehicles, and the fatality rate per million vehicle kilometers traveled. For comparison purposes. the last rate is the most meaningful. However, comparing a number of epidemiological variables relevant to fatal motor vehicle fatalities between Jeddah, U.S.A.. Great Britain. and Kuwait is instructive. Table 5 shows that death rates per hundred million vehicle kilometers of travel. per 100,000 registered motor vehicles, and per 100,000 resident population of Jeddah in 1987 were about 1.87. 19.7, and 26.5, respectively. Jeddah has the highest fatality rate per 100,000 persons, the lowest rate per 100,000 vehicles, and a fatality rate per hundred million vehicle km higher than developed countries but lower than Kuwait. Jeddah enjoys the highest car ownership and this is reflected in its low fatality rate as related to the number of registered vehicles. Table 5. Statistical Item
Jeddah
Motor vehicle deaths Vehicle travel (million kms) Registered vehicle (100,000) Resident population (100.000) Death rates per hundred million vehicle kms per 100,000 registered vehicle per 100,000 resident population Vehicle ownership Ratios of vehicle
comparison
to population
of motor
vehicle
Great
deaths
Britain
30X I6503 15.70
510X 3 IS800 314.7
11.60
552
in 1987 U.S.A.
Kuwait
48317 3060803 1932.6 2420.8
273 13577 5.6 IX.7
1.87 19.70 26.55
1.62 23.79 9.2s
1.58 25.00 19.96
2.01 48.75 14.60
I .35
0.38
0.80
0.30
Road fatalities in Jeddah, Saudi Arabia
147
Table 6. Causes of death for all age groups in Saudi Arabia Causes of death Road traffic accidents Cerebrovascular accident Malignancy Heart disease Gastrointestinal tract disease Others
Percentage 15.2 14.3 14.1 13.8 12.8 29.8
The major causes of death for all age groups in the Saudi Arabia during the year 1986 are shown in Table 6. The present study shows that road traffic fatalities is at the top of the list of major causes of death. Similar observations have been found in other studies (Kreis, Plasencia, and Augenstein 1986; Baker, Oppenheimer, and Stephens 1980; Somers 1980). A similar study in the United States ranked road traffic fatalities as the third most common cause of death in all age groups. Road traffic accidents generally cause more serious trauma than other accidents. This is reflected in the high number of fatal and serious injuries. In order to gain meaningful information on the total cost of fatalities caused by traffic accidents, an investigation should start from the moment of impact until rehabilitation is complete. However, this is not always possible, but it is particularly important to quantify the medical cost in a more precise way than using haphazard guesses (Jadaan 1989b). The attempt made in this paper to evaluate 1987 cost of road fatalities in Jeddah shows it to be 648.7 million Saudi Riyals ($172.5 million U.S.). RECOMMENDATIONS
In conclusion, road injuries, besides being a major health hazard leading to a high rate of morbidity, disability, and death, have a great socioeconomic impact on the victim, his family, and the nation as a whole. The problem is tractable, and the toll could be greatly reduced if appropriate measures were taken. The present study suggests that motor vehicle accidents are probably the most common single cause of death in Jeddah. Motor vehicle accidents are a preventable disease like other epidemic diseases. However, as for many other public health problems, the solution to road injuries and fatalities does not lie in one magic procedure but rather in a series of concomitant actions, the most important of which are listed below. 1. Traffic rules and safety measures should be taught in the schools and through media: i.e. newspapers and television programs. Therefore, traffic education that aims at changing the attitudes and behavior of road users is urgently needed. 2. Speed limits should be reinforced by law and monitored regularly. 3. Safety seat belts should be monitored and their use should be legislated. 4. Implement child restraining systems. 5. Health education in accident prevention should be provided. 6. Require vehicle insurance that should suit Islamic culture and values. Since insurance coverage is not compulsory, parties involved in such accidents tend to settle their financial losses without reporting these accidents to the Traffic Police Department. 7. Rehabilitation and trauma centers are needed. 8. Another factor contributing to the high fatality rate is the lack of maintenance of vehicles. Therefore, strict vehicle testing by road random checks of vehicles by Police Patrols is recommended. 9. There is a real need to conduct accident cost analysis in association with accident analysis to help in identifying appropriate remedial measures and road safety. 10. More research is needed to study the etiology and epidemiology of road injuries and fatalities and to devise measures to control the problem.
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A. BENER and K. S. JADAAN
Acknowledgements-We would like to thank improved the presentation of this paper.
K. Rumar
and the referees
for their useful comments
which have
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