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Keywords:

  • injury;
  • motorcycle rider education;
  • Thailand

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References

A community-based programme for motorcycle rider education was provided for motorcyclists in all villages of 3 randomly selected subdistricts in Mae Sot District, Tak Province, northern Thailand, between January and March 1995. To determine the extent of changes in risk-taking behaviours, we conducted an interview survey of motorcyclists in 3 villages selected by systematic sampling from the 3 intervention subdistricts and in 3 control (without intervention) villages for comparison in March 1997, 2 years after the programme. Motorcyclists in the intervention villages (69.7%) were significantly more likely to have valid licences than those in the control villages (46.5%). The proportion of motorcyclists who always or often wore helmets was significantly greater in the intervention sample (46.0%) than in the control sample (20.5%). In 1994, the annual incidence rate of motorcycle-related injuries was slightly higher in the intervention areas than in the control areas. Following the education programme, the injury rates for 1995 and 1996 were significantly lower in the intervention than in the control population. The annual number and rate of fatal motorcycle injuries decreased after the intervention although there was no significant difference between the two populations. Motorcycle rider education may be a promising intervention for prevention of motorcycle-related injuries in rural areas where road safety measures, particularly enforcement activities, are commonly limited.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References

In many developing countries, road traffic-related injuries are among the major causes of mortality, especially among economically active men (Zwi 1993; Söderlund & Zwi 1995). A variety of road safety interventions have been shown to be effective in reducing morbidity, mortality, and disability from traffic vehicle crashes in several countries (National Committee for Injury Prevention & Control 1989; WHO 1989; Söderlund & Zwi 1995). While in developed countries road safety measures have been widely implemented for injury prevention and control, road traffic injuries in developing countries tend to be under-recognized as a major public health problem (WHO 1989; Zwi 1993).

In Thailand, injuries of all aetiologies are among the first three leading causes of death, with road traffic injuries constituting the majority of injury morbidity and mortality (Division of Epidemiology 1997). Since motorcycles are in widespread use, they have become the most common type of vehicle involved in traffic-related crashes in most areas of the country (Division of Epidemiology 1997). This paper reports on the effect of a community-based education programme on changes in risk behaviours of motorcyclists and on the incidence of motorcycle-related injuries in rural communities in northern Thailand.

The study was conducted in Mae Sot District, Tak Province, located 500 km north of Bangkok. Motorcycles were the most commonly used vehicles, accounting for 78.8% (13138/16680) of registered motor vehicles in the district in 1996. Injury surveillance data show that motorcycles were the vehicles most frequently involved in traffic-related crashes and that they accounted for the majority of injuries and deaths in this area (Swaddiwudhipong et al. 1994). Driver risk factors for traffic injuries, such as alcohol consumption and lack of a valid driving licence, were more common in motorcyclists than in other motorists. The rare use of motorcycle helmets contributed to the high incidence of preventable head and neck injuries and deaths (Swaddiwudhipong et al. 1994).

Materials and methods

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References

Study population and health care setting

The total population of the district in 1996 was 77263. In 1997, the district was served by 20 public health centres and one general hospital with 280 beds. The hospital was located in the municipal area, whereas the health centres were distributed among the rural villages of 9 subdistricts. Each health centre employed two or three health personnel (one nurse, one midwife, and/or one sanitation worker). The health centre could only provide simple treatment of minor injuries; the more severely injured required proper management in hospital.

According to the Thailand Primary Health Care Programme, each rural village in Mae Sot had 5–30 village health communicators (VHCs), each of whom was responsible for about 10–20 households. The VHCs were residents of the village they served and were trained primarily to educate their neighbours and assist health personnel in matters of preventive and promotive health care.

Community-based education programme

Of the 9 subdistricts outside the municipality, 3 were located in the remote hilly areas and not included in the study. We conducted a community-based education programme free of charge for prevention of motorcycle-related injuries in all villages of the 3 subdistricts selected by simple random sampling from the remaining 6 subdistricts between January and March 1995. The target group for education included the VHCs and the motorcyclists, particularly those without a motorcycle licence. These target riders in each village were identified by the VHCs and the health centre workers. The education team comprised personnel from both the hospital (a physician and health educators) and the Tak Department of Land Transport. The hospital personnel gave health education on the epidemiology of motorcycle crash injury in the area, motorcycle-related risk, and the effective protection of helmet use; the officials of the Department of Land Transport provided motorcycle rider education, including traffic laws, vehicle regulations, traffic signs, and written and skill tests for a driving licence. The VHCs were asked to deliver the handbook covering these topics to the motorcyclists who could not attend the programme. A total of 1626 motorcyclists participated in the education programme. Most of them were daily drivers.

To determine the effect of the education programme on changes of risk-taking behaviours, we conducted an interview survey of motorcyclists in 3 villages selected by systematic sampling from the 16 villages of the intervention areas ordered by village size in March 1997, 2 years after the programme. For comparison, an identical interview was conducted in March 1997 by the same group of interviewers in 3 villages systematically selected from the 18 villages of the control areas. The questionnaires had 2 parts. The first part contained questions on the characteristics of the motorcyclists including age, sex, frequency of driving, motorcycle licence status, frequency of helmet use, and history of alcohol intake within 2 h before driving in the month prior to the interview. The second part contained questions about characteristics of the motorcycles including conditions of brakes, lights, and mirrors. In each household, all motorcyclists were identified and interviewed by trained health workers who had never worked in the areas. We attempted to survey the entire target population by conducting interviews in the late afternoon and early evening to reach those who worked during the day.

To evaluate the ultimate impact of the education intervention, we compared the incidence rates of motorcycle-related injuries and deaths in these 3 intervention subdistricts with the rates in the remaining 3 control subdistricts for 1994 (preintervention) and 1995–96 (postintervention). Hospital records were reviewed for motorcycle-related injuries and deaths. Information on victims transferred to another institution was also collected to assess the outcome of treatment. We added police reports and postmortem examinations on those injured persons who died before or did not reach the hospital to our surveillance data.

Between 1994 and 1996, health education about injury prevention and control through mass media (mostly radios and televisions) was sometimes disseminated similarly to people in both intervention and control areas, whereas traffic safety regulations, including motorcycle helmet use laws, were poorly enforced in the district.

The χ2-test was used for comparison of proportions between the 2 samples.

Results

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References

1141 (97.5%) of the 1170 motorcyclists in the intervention villages and 1297 (97.0%) of the 1337 in the control villages participated in the interview survey in March 1997, 2 years after the education programme. Nine persons in the intervention villages and 7 in the control villages refused to be interviewed. The remainder were absent and could not be contacted at the time of the interviews. The distributions of age and sex of the respondents in both samples were similar.

Table 1 presents driver behaviours of the motorcyclists in each sample. About half in both samples were daily drivers. Motorcyclists in the intervention villages (69.7%) were significantly more likely to have valid licences than those in the control villages (46.5%). The proportion of motorcyclists who always or often wore helmets was significantly greater in the intervention sample (46.0%) than in the control sample (20.5%). However, there was no significant difference between the 2 samples in the proportion who had consumed alcohol within 2 h before driving. About 92.3% (430/466) of the motorcycles in the intervention sample and 89.3% (465/521) in the control sample had brakes, lights, and mirrors in good condition. The proportion of good motorcycles was not statistically different (P= 0.13) between the 2 samples.

Table 1.   Driver behaviours among motorcyclists in the intervention and control villages, March 1997 Thumbnail image of

In 1994, before the education intervention, the annual incidence rate of motorcycle-related injuries was slightly higher in the intervention areas than in the control areas (Table 2). Following the education programme in early 1995, the injury rate in the intervention areas for 1995 was 10.5/1000 population compared with 16.9/1000 for the control population. The difference between the 2 populations in the incidence rates was less evident in 1996, 2 years after the intervention. Although the annual number and rate of fatal motorcycle injuries decreased after the intervention, there was no significant difference between the 2 populations.

Table 2.   Motorcycle-related injuries and deaths in the intervention and control subdistricts 1994–96 Thumbnail image of

Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References

The behaviour of road users is an important contributory factor in the majority of traffic-related injuries and deaths. Several studies have provided data on the effectiveness of motorcycle helmets in reducing the severity of injuries and the likelihood of deaths (McSwain & Petrucelli 1984; Murdock & Waxman 1991; Rutledge & Stutts 1993; Council on Scientific Affairs, American Medical Association 1994; Kraus et al. 1994). Motorcyclists wearing helmets tended to have fewer and less severe head and facial injuries than those not wearing helmets (Bachulis et al. 1988; Murdock & Waxman 1991; Rutledge & Stutts 1993). Kraus et al. (1991) found that owners of motorcycles in crashes were more likely to have invalid licences than motorcycle owners not involved in accidents. Earlier injury surveillance data in the study area also indicate that the majority of motorcyclists in crashes were not validly licensed and rarely wore helmets (Swaddiwudhipong et al. 1994).

Our study demonstrates that the education programme could significantly increase the licensure and use of helmets among motorcyclists in the intervention areas compared with the control areas. The greater proportions of validly licensed and helmeted riders after the education programme in the intervention areas might contribute to the lower incidence of motorcycle-related injuries compared to control areas. Such education programmes should therefore be continued for new motorcyclists.

Although our education intervention appeared to increase the driving licensure and use of helmets, there remained some riders who were licensed invalidly and/or did not frequently use helmets. Moreover, the programme could not influence risk behaviour on drinking and driving. The results of our survey also indicate that the brakes, lights, and/or mirrors of about 10% of the motorcycles in the study area were not in good condition. Since the processes that cause road traffic injuries are, by nature, multifactorial, other safety measures such as enforcement of traffic rules and regulations, and public information campaigns may help to counteract these problems.

Road traffic injuries are rapidly becoming one of the leading causes of morbidity and mortality in many developing countries. Injuries involving motorcycles are a major problem in most of the areas where such means of conveyance are in widespread use. A community-based programme for motorcycle rider education may be one promising intervention for prevention of motorcycle-related injuries in rural areas where road safety measures, particularly enforcement activities, may remain limited. Good cooperation between the health care centres and the Department of Land Transport is needed for the operation of such a programme.

Acknowledgements

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References

We thank Dr Alan F. Geater of the Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Thailand, for his assistance in editing the manuscript.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Materials and methods
  5. Results
  6. Discussion
  7. Acknowledgements
  8. References
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