The Global Road Safety Programme: work in progress.

Every year over 1.2 million people are killed in road traffic crashes around the world, while an additional 20 to 50 million are injured.1 According to the Global Burden of Disease Study 2010, road traffic injuries (RTIs) are responsible for over a third of the world injury burden and resulted in the loss of 76 million Disability-Adjusted Life Years (DALYs).2 If no action is taken, road traffic injuries are predicted to become the fifth leading cause of death globally by 2030. Lowand middle-income countries (LMICs) experience 90% of all road traffic fatalities, but have only 52% of the world’s registered vehicles suggesting that these countries suffer a higher proportion of the global burden.1 This gap between LMICs and high income countries (HICs) is set to widen further. Between 2004 and 2020, these rates are predicted to increase by 27% in LMICs while decreasing in HICs by 83% (World Health Organization Department of Violence and Injury Prevention and Disability, 2009). The amount of research on road safety in LMICs is not proportional to the burden borne by these countries. Only 6 of the 236 trials utilized as part of a recent Cochrane review on road safety interventions were conducted in LMIC and all 6 focused on helmet wearing.3 The World Health Organization (WHO) Global Status Report on Road Safety clearly highlights what interventions can be utilized in road safety prevention efforts; seatbelts, helmets, reducing drink driving, reducing excessive speeding and child restraints. However there is a noticeable gap in the literature surrounding the effectiveness of road safety interventions particularly in LMICs. It is vital that road safety programmes, specifically in LMICs, are evaluated if economically and socially acceptable injury prevention policies are to be implemented. The Bloomberg Global Road Safety Programme is a multicountry initiative that was launched in 2010. Involving a consortium of six partners (WHO, Global Road Safety Partnership, Johns Hopkins International Injury Research Unit, Association for Safe International Road Travel, Embarq and the World Bank Global Road Safety Facility), focusing on ten countries that account of 48% of all road traffic fatalities globally (Brazil, Cambodia, China, Egypt, India, Kenya, Mexico, Russia, Turkey and Vietnam). The programme also incorporates a trauma component focusing on improving trauma systems in Kenya. The remit of the programme in each country is to promote the use of evidence-based interventions in order to reduce the death and serious injury caused by RTIs. Specific details of the programme in each country (including geographical sites, risk factors and interventions employed) can be found elsewhere.4,5 An integral component of the programme in each country has been monitoring and evaluation of risk factors and health outcomes. The framework for evaluation employs a real world approach with mixed methods; details of which can be found in previous publications.5-8 This supplement issue presents findings from the ongoing monitoring and evaluation activities in each of the ten countries, including the evaluation of the trauma component of the programme. It highlights the mixed methods approach of data collection (e.g. quantitative observation studies, road side interviews, qualitative focus group discussions and indepth interviews), showcasing the successes and challenges of collecting such data in real world settings. The spectrum of analytic methods employed in the evaluation framework are also demonstrated through these papers. In “The prevalence of speeding and drink driving in two cities in China: a mid-project evaluation of ongoing road safety interventions”, roadside interviews, observation data and crash statistics are utilized to assess interventions in two cities. Authors discuss the challenges of police underreporting and confounding interventions in one site employed by local authorities. Legislation surrounding drink-driving and inadequate enforcement is explored in Brazil and India. “Challenges associated with drink driving measurement: combining policeand selfreported data to estimate an accurate prevalence in Brazil” looks at the effects of legislative loopholes and insufficient capacity to adequately enforce existing legislation on the prevalence of drink-driving in Brazil. Similarly, in “Qualitative study to explore stakeholder perceptions related to road safety in Hyderabad, India” authors use qualitative methods to investigate opinions surrounding lack of adequate authority, appropriate laws and ineffective enforcement. A two-pronged approach of primary data collection through police enforcement checkpoints coupled with knowledge, attitude and practice (KAP) surveys of road users forms the basis of “Drinking and driving in Viet Nam: prevalence knowledge, attitudes and practices in two provinces”. Results show that although there has been some reduction in drinkdriving prevalence in the intervention sites to-date, incorrect knowledge surrounding legislation appears to be an impediment to greater gains. The realities of working in real-world settings and dealing with challenges in data collection are highlighted in the short paper entitled “Seatbelt use and speeding on three major roads in Egypt: a brief report”. Data on speeding and seatbelt use, particularly with regards to child occupancy of front passenger seats, provides interesting insight into road safety in Egypt. “Trends in prevalence, knowledge, attitudes and practices of helmet use in Cambodia: results from a two year study” describes the results of a mixed methods approach to evaluation combining The Global Road Safety Programme: work in progress