Dr.munir baghdad road traffic injuries,Epidemiological Characteristics, 2010-2011

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Health & Medicine

Published on March 30, 2014

Author: munirsalman1

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Analysis of RTI data is crucial for controlling its highly mortality and morbidity, especially in our country Iraq

Epidemiological Characteristics of Road Traffic Injuries in Baghdad, Iraq, 2010-2011 Dr. Munir T. Salman IFETP student Cohort 2 A.S. Sultan FETP Mentor F. Al Lami PhD, Resident Advisor

Injury : A bodily lesion at the organic level, resulting from acute exposure to energy, in amounts that exceed the threshold of physiological tolerance. Accident: is an unexpected occurrence which happens by chance. Injury: is a definable, correctable event, with specific and identifiable risks for occurrence.

Injuries killing more than 5 million people worldwide each year and causing more cases of disability. Neuropsychiatric disorders 12% Respiratory infections 6% Cardiovascular diseases 10% Source: World Health Report, 1999 WHO

Neuropsychiatric disorders 12% Respiratory infections 6% Cardiovascular diseases 10%

Neuropsychiatric disorders 12% Respiratory infections 6% Cardiovascular diseases 10%

Road traffic injuries RTI Globally; Constitute a major public health. killed more than 1.2 million, and injured more than 50 million. The vast majority – 90% – of road traffic deaths were in low-income and middle-income countries, including Iraq, (Despite it has only 48% vehicles of world).

1 Lower respiratory infections 2 Diarrhoeal diseases 3 Perinatal conditions 4 Unipolar major depression 5 Ischaemic heart disease 6 Cerebrovascular disease 7 Tuberculosis 8 Measles 9 Road traffic injuries 10 Congenital abnormalities 1 Ischaemic heart disease 2 Unipolar major depression 3 Road traffic injuries 4 Cerebrovascular disease 5 COPD 6 Lower respiratory infections 7 Tuberculosis 8 War 9 Diarrhoeal diseases 10 HIV Change in rank order of the 10 leading causes of the global burden of disease 1990 2020 Source; Mathers C, Loncar D. Updated projections of global mortality and burden of disease, 2002-2030: data sources, methods and results. Geneva, World Health Organization, 2005.

1 Lower respiratory infections 2 Diarrhoeal diseases 3 Perinatal conditions 4 Unipolar major depression 5 Ischaemic heart disease 6 Cerebrovascular disease 7 Tuberculosis 8 Measles 9 Road traffic injuries 10 Congenital abnormalities 1 Ischaemic heart disease 2 Unipolar major depression 3 Road traffic injuries 4 Cerebrovascular disease 5 COPD 6 Lower respiratory infections 7 Tuberculosis 8 War 9 Diarrhoeal diseases 10 HIV Source; Mathers C, Loncar D. Updated projections of global mortality and burden of disease, 2002-2030: data sources, methods and results. Geneva, World Health Organization, 2005. Change in rank order of the 10 leading causes of the global burden of disease 1990 2020

Objectives: 1- determines RTI vulnerable groups and risk factors. 2- Characterize RTI in term of person, time and place. 3- Calculate the reclaim cost.

A cross sectional study of RTI from three sources For two years 2010 – 2011: 1 – Iraq Sentinel Injury Surveillance System (ISISS). 2 - Iraq Road Traffic Police(IRTP) Annual Reports. 3 - Iraqi National Insurance Company(INIC) archives. Methods

Iraq Sentinel Injury Surveillance System (ISISS) 6.6% 16.3% 18% 19.6% 39.3% 0 5 10 15 20 25 30 35 40 45 Explosions Domestic incidents RTI Out side Incidents Others Injuries by circumstances, Total cases 128 844 2010 – 2011

Iraq Sentinel Injury Surveillance System (ISISS) 6.6% 16.3% 18% 19.6% 39.3% 0 5 10 15 20 25 30 35 40 45 Explosions Domestic incidents RTI Out side Incidents Others Injuries by circumstances, Total cases 128 844 2010 – 2011

20% 80% Total CO ER cases 23 192 4 638 18 554 ISISS: RTI registered cases 8 governorates CO: coroner, dead cases. ER: emergency cases. * * * * year 2010 - 2011

20% 80% Total CO ER cases 23 192 4 638 18 554 CO: coroner, dead cases. ER: emergency cases. * * * * Baghdad share was 5900 case ISISS: RTI registered cases 8 governorates year 2010 - 2011

CO ER Baghdad 5900 RTI cases By Reporting Site year 2010 - 2011 74%26%

Governorate No. Of deaths Population MR 1- Baghdad 749 7647482 9.7 2- Al-Basra 61 2032495 3 3- Anbar 166 1660123 10 4- Erbil 276 1707260 16 5- Karballa 125 1000546 12.4 6- Misan 114 889440 12.8 7- Mousel 198 3090611 6.4 8- Sulaimaniya 278 2088018 13.3 2010 RTI Mortality rate in Baghdad and other sentinel governorates for the year 2010 -2011 No. of deaths/105

Governorate No. Of deaths Population MR 1- Baghdad 749 7647482 9.7 2- Al-Basra 61 2032495 3 3- Anbar 166 1660123 10 4- Erbil 276 1707260 16 5- Karballa 125 1000546 12.4 6- Misan 114 889440 12.8 7- Mousel 198 3090611 6.4 8- Sulaimaniya 278 2088018 13.3 No. of deaths/1052010 RTI Mortality rate in Baghdad and other sentinel governorates for the year 2010 -2011

2010 Governorate No. Of deaths Population MR 1- Baghdad 749 7647482 9.7 2- Al-Basra 61 2032495 3 3- Anbar 166 1660123 10 4- Erbil 276 1707260 16 5- Karballa 125 1000546 12.4 6- Misan 114 889440 12.8 7- Mousel 198 3090611 6.4 8- Sulaimaniya 278 2088018 13.3 No. of deaths/105 RTI Mortality rate in Baghdad and other sentinel governorates for the year 2010 -2011

2010 Governorate No. Of deaths Population MR 1- Baghdad 749 7647482 9.7 2- Al-Basra 61 2032495 3 3- Anbar 166 1660123 10 4- Erbil 276 1707260 16 5- Karballa 125 1000546 12.4 6- Misan 114 889440 12.8 7- Mousel 198 3090611 6.4 8- Sulaimaniya 278 2088018 13.3 No. of deaths/105 The average of MR = 10.45/105 RTI Mortality rate in Baghdad and other sentinel governorates for the year 2010 -2011

Governorate No. Of deaths Population MR 1- Baghdad 789 7046029 11 2- Al-Basra 98 2526957 4 3- Anbar 187 1553320 12 4- Erbil NA 1609937 NA 5- Karballa 178 1062934 17 6- Misan 168 968801 17 7- Mousel 231 3258180 7 8- Sulaimaniya 306 1875893 16 2011 No. of deaths/105 RTI Mortality rate in Baghdad and other sentinel governorates for the year 2010 -2011

2011 Governorate No. Of deaths Population MR 1- Baghdad 789 7046029 11 2- Al-Basra 98 2526957 4 3- Anbar 187 1553320 12 4- Erbil NA 1609937 NA 5- Karballa 178 1062934 17 6- Misan 168 968801 17 7- Mousel 231 3258180 7 8- Sulaimaniya 306 1875893 16 No. of deaths/105 RTI Mortality rate in Baghdad and other sentinel governorates for the year 2010 -2011

2011 Governorate No. Of deaths Population MR 1- Baghdad 789 7046029 11 2- Al-Basra 98 2526957 4 3- Anbar 187 1553320 12 4- Erbil NA 1609937 NA 5- Karballa 178 1062934 17 6- Misan 168 968801 17 7- Mousel 231 3258180 7 8- Sulaimaniya 306 1875893 16 No. of deaths/105 RTI Mortality rate in Baghdad and other sentinel governorates for the year 2010 -2011

The average of MR = 12/105 2011 Governorate No. Of deaths Population MR 1- Baghdad 789 7046029 11 2- Al-Basra 98 2526957 4 3- Anbar 187 1553320 12 4- Erbil NA 1609937 NA 5- Karballa 178 1062934 17 6- Misan 168 968801 17 7- Mousel 231 3258180 7 8- Sulaimaniya 306 1875893 16 No. of deaths/105 RTI Mortality rate in Baghdad and other sentinel governorates for the year 2010 -2011

The average of RTI MR for the 8 sentinel governorate for the tow years 2010 – 2011 = 11.45/105 The average of RTI MR for the Baghdad governorate for the two years 2010 – 2011 = 10.3/105

Female Male Baghdad 5900 RTI case Gender distribution year 2010 - 2011 19% 81% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Female Male ER COCO ER

Female Male Baghdad 5900 RTI case Gender distribution year 2010 - 2011 19% 81% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Female Male ER COCO ER

1 139 178 86 135 145 110 126 83 65 1 262 422 423 1337 984 512 315 218 162 0 200 400 600 800 1000 1200 1400 1600 0-0 01-04 05-09 10-14 15-24 25-34 35-44 45-54 55-64 65-100 female male Baghdad RTI cases distributed by Age groups and gender, year 2010 - 2011

1 139 178 86 135 145 110 126 83 65 1 262 422 423 1337 984 512 315 218 162 0 200 400 600 800 1000 1200 1400 1600 0-0 01-04 05-09 10-14 15-24 25-34 35-44 45-54 55-64 65-100 female male 45.6% 15 - 34 Baghdad RTI cases distributed by Age groups and gender, year 2010 - 2011

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 01-04 05-09 10-14 15-24 25-34 35-44 45-54 55-64 65-100 ER CO Baghdad RTI cases by death or injury percent and age group, year 2010-2011

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 01-04 05-09 10-14 15-24 25-34 35-44 45-54 55-64 65-100 ER CO Baghdad RTI cases by death or injury percent and age group, year 2010-2011

0 50 100 150 200 250 300 350 400 450 500 c 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Baghdad RTI cases by daily hours, Year 2010 - 2011

0 50 100 150 200 250 300 350 400 450 500 c 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 10 am 2 pm Baghdad RTI cases by daily hours, Year 2010 - 2011

DAY CO ER TOTAL Sunday 201 698 899 Monday 200 709 909 Tuesday 195 646 841 Wednesday 218 669 887 Thursday 223 573 796 Friday 219 541 760 Saturday 214 518 732 Total 1470 4354 5824 Baghdad RTI cases (CO and ER) by DAYS of the week

DAY CO ER TOTAL Sunday 201 698 899 Monday 200 709 909 Tuesday 195 646 841 Wednesday 218 669 887 Thursday 223 573 796 Friday 219 541 760 Saturday 214 518 732 Total 1470 4354 5824 p-value=0.003 Baghdad RTI cases (CO and ER) by DAYS of the week

CO% 22.4 22.0 23.2 24.6 28.0 28.8 29.2 DAY CO ER TOTAL Sunday 201 698 899 Monday 200 709 909 Tuesday 195 646 841 Wednesday 218 669 887 Thursday 223 573 796 Friday 219 541 760 Saturday 214 518 732 Total 1470 4354 5824 p-value=0.003 Baghdad RTI cases (CO and ER) by DAYS of the week

p-value=0.003 Baghdad RTI cases (CO and ER) by DAYS of the week CO% 22.4 22.0 23.2 24.6 28.0 28.8 29.2 DAY CO ER TOTAL Sunday 201 698 899 Monday 200 709 909 Tuesday 195 646 841 Wednesday 218 669 887 Thursday 223 573 796 Friday 219 541 760 Saturday 214 518 732 Total 1470 4354 5824

115 110 116 106 159 123 135 116 116 144 132 166 320 399 340 392 335 285 239 419 457 458 362 356 1 2 3 4 5 6 7 8 9 10 11 12 CO ER Baghdad RTI cases (ER vs. CO) by monthly distribution, Year 2010 - 2011 Months 20102011

3 32 349 868 2082 2568 0 500 1000 1500 2000 2500 3000 Unknown Others Bicycle Motorcycle Car Pedestrain Baghdad RTI cases by accident’s circumstance 2010 - 2011 43.5%

Baghdad RTI cases By Circumstance and CO Vs. ER 2010 - 2011 0 500 1000 1500 2000 2500 3000 Others Bicycle Motorcycle Car Pedestrain CO ER

Ambulance 3% Other Vehicle 96% Others 1% Unknown 0% Baghdad RTI cases Mode of arrival to health facilities 2010 - 2011

Ambulance 3% Other Vehicle 96% Others 1% Unknown 0% Baghdad RTI cases Mode of arrival to health facilities 2010 - 2011

6 6 7 9 38 62 190 5584 0 1000 2000 3000 4000 5000 6000 Unknown Farm and countryside Others Market Public gathering Workplace Home Street/high way/road Baghdad RTI cases by place of occurrence 2010 - 2011

6 6 7 9 38 62 190 5584 0 1000 2000 3000 4000 5000 6000 Unknown Farm and countryside Others Market Public gathering Workplace Home Street/high way/road Include 20 coroner cases (deaths) 16 male 4 female Baghdad RTI cases by place of occurrence 2010 - 2011

0 100 200 300 400 500 600 700 800 900 other upturned Collision Run over 2010 2011 Baghdad RTI Types of crashes 2010 - 2011

0 100 200 300 400 500 600 700 800 900 other upturned Collision Run over 2010 2011 Baghdad RTI Types of crashes 2010 - 2011

0 200 400 600 800 1000 1200 other passengers road pedestrian car drivers 2010 2011 Baghdad RTI by offender Year 2010 - 2011

0 200 400 600 800 1000 1200 other passengers road pedestrian car drivers 2010 2011 71.3% Baghdad RTI by offender Year 2010 - 2011

0 200 400 600 800 1000 2010 2011 Baghdad RTI by type of vehicle 2010 - 2011 Saloon Station Tractor Bus Pickup Trailer Motorcycles Others Vans Agricultural equipments

0 200 400 600 800 1000 2010 2011 More than tow fold increase in bus Crashes this might explain the raise in deaths Due to RTI ; 749 deaths 2010 789 deaths 2011 Saloon Station Tractor Bus Pickup Trailer Motorcycles Others Vans Agricultural equipments Baghdad RTI by type of vehicle 2010 - 2011

Case No. of finished file Reclaim cost (Iraqi dinar) Deaths 66 326 585 000 Disabilities 45 143 100 000 Total 111 469, 685, 000 ~ 375 000 000 US $ Source ; INIC (Iraq National Insurance Company data ) We obtain data and reclaim cost of 111 file out of 188 case ( 77 file not finished ) Baghdad RTI Reclaim Expenditure : 2010- 2011

The average of death reclaim ~ 5 000 000 ID ~ 4000 US $ The average of disability reclaim ~ 3 500 000 ID ~ 2900 US $  The INIC reclaim less than 6% of the 5600 RTI incidents occurred in Baghdad.

Conclusions Although the RTI mortality rate was increasing in Baghdad, it is far below the WHO estimate. Surveillance database lacks information on risk factors. Insurance compensation shows a big deficit. Multisectoral collaboration is recommended. More in depth study at national level are indicated.

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