Trends and Distributions of Road Tra � c Crashes and Injuries , Nigeria , 2013 – 2016


 BackgroundAfrica accounts for one-fifth of low- and middle-income countries’ contributions to the global road traffic mortality, and Nigeria reported > 25% of this. Over the years, the trends in road traffic crashes (RTCs) in Nigeria have a slow decline. This study describes the magnitude and distribution of RTCs and injuries in Nigeria and determines if the sustainable development goal (SDG 3.6) target set in 2011 was achieved in 2016. MethodsRTCs surveillance data from the Federal Road Safety Corps (FRSC) 2013 - 2016 was analyzed. Variables like date of the crash, route of the crash, location of the crash, the probable cause of the crash, age and sex of people involved, injured, or killed, road users type and make of vehicles were anonymized and abstracted on Microsoft Excel worksheet. RTCs outcome were classified as minor, moderate, and fatal. The road traffic injury (RTI) fatality rate is the proportion of persons killed in RTC per 100,000 population. Data analyzed for frequency, proportions, and ratio but presented in tables, trend, and charts.ResultsThere were 42,813 RTCs involving 56,331 vehicles and 283,949 persons. Fatal RTCs were 12,031 (28.1%) and 23,412 (8.2%) persons died. Male to female ratio was 3:1. North-Central zone (NCZ) reported 16,097 (37.6%) of the RTCs while South-West zone (SWZ) had the highest proportion of RTCs that were fatal 2,474/6,902 (35.8%). RTI fatality rate was highest in NCZ followed by SWZ with 23.8 and 12.7 deaths per 100,000 population, respectively. The States with the highest fatal RTCs were Oyo 631/1209 (52.0%), Yobe 114/269 (42.4%), Ondo 446/1073 (41.6%) and Kogi 566/1368 (41.4%). The commonest causes of RTCs were speed violation and loss of vehicle control. From 2011 to 2016, reduction in RTC and Fatal RTC were 27.4% and 7.8%, respectively and SDG 3.6 target not met.ConclusionsRTCs remains a major public health in Nigeria where fatal RTCs, injuries, and RTI fatality rate are differentially distributed in states and geo-political zones. RTI fatality rate was highest in NCZ and SWZ, and SDG 3.6 target was not met. Therefore, a context-specific RTCs preventive strategies should be designed and implemented in Nigeria.


Background
Road tra c injury (RTI) is a common cause of unintentional injury [1]. Globally, it is the eighth leading cause of death for all age groups and resulted in 1.35 million deaths and 50 million people injured in 2018 [2]. Low and middle-income countries account for 90% of global RTI mortality but had a fewer number of vehicles compared to developed nations [2,3]. The African region of the World Health Organization had one-fth of global road tra c deaths in 2018 [4]. But Nigeria accounts for more than 25% of RTI deaths in this region [5,6] with 20.5 road tra c deaths per 100,000 population [4,7].
Although, the trend and magnitude of road tra c crashes or injuries have a slow decline over the years in Nigeria [8]. But the level of fatality remained high and has been worrisome considering the socioeconomic burden to the individual and the nation [6]. Historically, road safety measures in Nigeria dated back to 1913 [9]. But on February 18, 1988, the Federal Road Safety Commission (FRSC) was established when Nigeria was second globally to Ethiopia as the most affected country with road tra c crashes and injuries [10]. For effective delivery of their services as a lead agency on road safety matters, FRSC was strengthened with the FRSC Act (CAP 141) and FRSC (Establishment) Act 2007 [11,12].
The FRSC is responsible for road safety and RTI surveillance in Nigeria. It has 12 zonal commands that oversee 37 sectoral commands in 36 Nigerian States and the Federal Capital Territory (FCT). These are further divided into 205 commands with 257 formations serving as a source of RTI surveillance data in Nigeria. These formations cover 87 routes, which were divided into 24 corridors. They collate RTI data and send same to National Headquarters through the 12 Zonal Commands. In 2014, FRSC created National Crash Report Information System (NACRIS) to uni ed road tra c crash data by collaborating with other stakeholders on RTI, yet to be fully in operation [13]. To align with a Sustainable Development Goal (SDG) 3.6 target [14], FRSC in the year 2012-2016 strategic plan aimed to halve the road tra c crash fatalities in 2016 using the year 2011 as the baseline [8] using a quality RTI surveillance.
In 2009 rst global ministerial conference on road safety i.e., Moscow Declaration, it was resolved that national RTI surveillance systems should be improved to a quality standard and comparable internationally [15]. This will encourage countries to monitor their progress to achieve the SDG 3.6 target.
The frequent monitoring and evaluation of interventions to reduce RTI is one of the key elements of a Safe System approach to identifying gaps and target resource allocation more effectively [15]. Since the establishment of FRSC, studies have shown an overall decline in the magnitude of RTI [6,8,12] but is lagging meeting the SDG 3.6 target. There is a need for sub-national information to effectively plan a context-based intervention to drive actions to meet the SDG 3.6 target in Nigeria.
This study aimed to describe the magnitude, characteristics, trends, and distribution of road tra c crashes, injuries, and fatality rate per 100,000 population in Nigeria. It also assessed if the 50% reduction in road tra c crash fatalities (SDG 3.6 target) set in 2011 was achieved in 2016. We anticipate that this will generate information, in uence policy formulations that will be used for local interventions in areas with poor RTI outcomes.

Methods
The study setting Nigeria with a total area of 923,768 km2 was ranked the seventh most populous country in the world [16]. It has 36 states with Federal Capital Territory, Abuja as the seat of government. The national road network is approximately 200,000 km and classi ed as Trunk A, B, and C. Trunk A roads account for 16.5% of the road network. It is a Federal Government supported road [13]. Due to poor or total lack of rail and marine transportation, 54% of Trunk A roads are responsible for 80% of national vehicular movement [17]. Trunk B roads constitute of 27.5% of the national road network and supported by the State Government. The 774 local district governments supported 56% of the national road networks classi ed as Trunk C roads and usually not made of concrete or asphalt [17].

Study Design
This study was a record review of RTI data from 2013 to 2016.

Data Collection
RTI data from 2013 to 2016 at the FRSC headquarters were abstracted electronically on Microsoft Excel spreadsheets by trained data abstractors. RTI surveillance variables like unit or sector reporting, date of the crash, time of the crash, reporting time, route of the crash, location of the crash, probable cause of the crash, number of people involved, the severity of RTI, age, sex or gender, type, and make of the vehicles involved in road tra c crash and injury. Each of the FRSC Sector and Zonal commands collect and verify road tra c crashes and injuries data every month and send it to the National Headquarters for further veri cation, validation and they are archived for future use. This was the data released for this study.

Data Variables And Data Tool
The outcome or dependent variables are road tra c crash and road tra c injury. Variables such as date of the crash, time of the crash, route of the crash, location of the crash, the probable cause of the crash, number of people involved, age group, sex, and type/make of vehicles involved are independent variables.
All vehicles involved in the crash were assigned to one crash. One or more probable causes of the crash is assigned to the crash and vehicles involved. RTI fatality rate was de ned as persons killed in RTC per 100,000 population for each locality and was used to rank the risk of RTI fatality among the 36 states in Nigeria. The severity of RTI was de ned as minor injury when persons involved in road tra c crash has bruises, minor laceration, and no extended hospital admission beyond 48 hours. Serious or moderate injury is when persons involved in a road tra c crash and sustained moderate to severe injury without death but some disabilities with extended hospitalization beyond 48 hours. Fatal injury is injuries that led to the death of persons involved in RTC. However, fatal RTC is road tra c crash that involved a death of at least one person among people involved in RTC for example, vehicle occupants and pedestrians. A road tra c crash is "a collision or incident involving at least one road vehicle in motion, on a public road or private road to which the public has right of access [15]". The age was classi ed into adults as anyone aged 18 years or more, otherwise, the individual is a child.

Data Validation For Analysis
At each data collection point, the o cer in charge of RTI data, the unit head and the head of the command veri ed and certi ed the data before forwarding it to the next level. Therefore, there are 3 levels of data veri cation and validation inherent with FRSC RTI surveillance data, i.e., at the collection point (FRSC formations), the state command, and at the FRSC Headquarters. Data abstracted were anonymized and cleaned for analysis with Microsoft Excel and Epi Info 7 statistical software. Descriptive or univariate analysis, like frequency, proportions, and the ratio was calculated, and information presented in tables, trend and charts or graphs.

Characteristics of RTC, age and sex distributions of the injured
The characteristics of road tra c crashes (RTCs), severity, and number of vehicles involved from 2013-2016 were shown in Table 1    In terms of RTI fatality rate as shown in Fig. 1, North Central geopolitical zone reported 23.8 deaths per 100,000 population, South-West zone 12.7, North West 11.7, South East 9.5, South-South 9.1, and North East 8.6.
Among the 36 Nigeria States as shown in Table 3 Table 4. There were 1,950 RTCs involving the collision between the motor vehicle and motorcycle with 8.8% (877/10,007) persons involved killed.   Of the 42, 813 RTCs, no probable cause of RTCs was reported for 2,826 (6.6%). Speed violation 24.8%, was the commonest probable cause of RTCs, loss of vehicular control 23.5%, dangerous driving 11.1%, violation of sign light 10.0%, wrongful and dangerous overtaking 7.8%, tire burst 6.9%, brake and mechanical failure 6.2%, route violation 4.4%, road obstruction 1.6%, and overloading 0.8%. Others were, driving under the in uence of alcohol 0.7%, and fatigue or sleeping on steering while driving 0.5, pedestrian crossing 0.4%, and using phone while driving 0.2%. Among 8,561 jointly reported probable causes of RTCs, speed violation and loss of vehicular control were the two most commonly reported, accounted for 2,068 (24%), followed by sign light violation and loss control 765 Sub-nationally as shown in Fig. 3

Discussion
Nigeria is one of the countries that report high rates of road tra c crashes and fatalities in the world [18]. RTC and injuries are one of the major public health concerns [2,4,19] as shown in this study with a monthly average of 892 RTCs reported in Nigeria. Three out ten RTCs were fatal and 8% of persons involved died. These high fatality rates could be a reason why Nigeria is leading other countries in RTC's fatality reported from WHO Afro region [5,6]. This study revealed that male gender and adults are mostly affected with RTCs [19][20][21] and could cause severe economic effects on household productivity because male genders are the usual breadwinners for households in Nigeria [22]. The proportion of fatal crashes in this study was similar to 28.6% reported in a study that analyzed RTCs between 1990 and 2012 [6]. This re ected no change in the proportion of fatal crashes from 2013 to 2016 compared to pre-2013.
There is a wide variation among the 36 states and FCT in the six geopolitical zones with the occurrence of RTCs [6,22,23], proportion of persons killed in RTCs, fatal RTCs, and RTCs fatality rate per 100,000 population. The North Central geopolitical zone with 15% of Nigeria population accounted for every fourth out of ten RTCs in Nigeria, but only one-fth were fatal RTC, North-West geo-political zones with 25% of Nigeria's population had one-tenth of persons involved in RTCs killed, and South-West geo-political zones with approximately 20% of Nigeria population had 16% of RTCs in Nigeria but reported the highest proportion of fatal RTCs. Also, the South-South geopolitical zone was second to South West as zones with the highest proportion of fatal RTCs. This clearly shows that RTCs has differential effects on each geo-political zone as well as the states.
Five states in the North-West geopolitical zone namely, Jigawa, Katsina, Kebbi, Sokoto, and the Kaduna States were among the ten leading states with high proportions of persons involved in RTCs killed. Yobe and Cross River states were leading the rank. Other states in these ranks were Oyo, Akwa Ibom and Niger. Although this study reported lower road tra c deaths per 100,000 population of 3.2 compared to 20.5 reported by WHO in 2018 [4]. But North Central and South-West geopolitical zones were mostly affected with each zone having four of its states among the ten leading states with high RTI deaths per 100,000 population. The states were FCT, Nasarawa, Kogi and Niger states in the North Central zone, and Ogun, Ondo, Osun, and the Oyo States in South-West geopolitical zone. Other states among this league were Kaduna and Edo. These high-risk states were similar to what had been reported in previous studies [6,23].
The impact of RTCs on vulnerable road users was high in this study as 13% of those involved in crashes that occurred in a collision between motor vehicles and bicycles died. It also revealed that 9% of those involved in a collision between motor vehicles and motorcycles, and 7% of those involved in a collision between motorcycles died. The use of motorcycles in Nigeria has increased recently as it is easier to purchase, maintain, popularly used for transportation, and has been associated with vulnerability [21]. Common causes of RTCs in Nigeria were similar to previous studies [12,21],. Speed violation and loss of vehicle control, as well as sign light violation and loss of vehicle control, were the most common joint causes of RTC. Other common probable causes of RTCs are dangerous driving, violation of sign lights, wrongful and dangerous overtaking, burst tires, brake and mechanical failure, route violation, road obstruction, and overloading. The use of fairly-used imported tires has been seen to cause RTCs in Nigeria [21].
There has been a declining trend in the number of RTCs in Nigeria [23,24], but the number of persons per RTC increases. This might be attributable to vehicular overloading and a more improved road condition [6]. The number of people who are killed or seriously injured in RTCs is a key performance indicator to measure the safety of a nation's transport system [24]. To measure the progress to achieve SDG 3.6 target, the proportional reductions in the persons involved and killed in RTCs, and fatal RTCs in 2016 compare to 2011 was < 30% and 8%, respectively. This was far lower to the national target set from 2011 to be achieved in 2016. Therefore, the SDG 3.6 target was not met nationally in 2016, as this might be linked to the weakness in the enforcement of safety elements like seat belts and helmets, despite high awareness that did not translate to practice [21,25],. Some of the 36 states and FCT were able to halve the road crash fatality rate (SDG 3. showing that data analyzed was merged with other sources or RTI like police motor tra c division, insurance, and public and private health facilities. Though the data covered all the states and FCT in Nigeria but must be interpreted with cautions. However, it is reliable in providing programmatic decisions to inform effective interventions to reduce RTI in Nigeria.

Conclusions
RTC with associated injuries and deaths is still a public health concern in Nigeria affecting the young age group. Though there is a decline in some indicators between 2011 to 2016, Nigeria did not meet the SDG 3.6 target. There are differential distributions among the geo-political zones and states in Nigeria, concerning the number of RTCs, fatal RTCs, number of persons killed in RTCs, fatality rate, deaths per 100,000 population, and meeting the SDG 3.6 target. The peculiarity with each location will be useful in the planning and implementation of context-based interventions among the states and FCT rather than a one-size-ts-all approach. Trend of the proportion of fatal RTC, person killed and fatality rate (person killed in RTC per 100,000 population) Figure 3 Annual RTI fatality rate and RTCs reported by Nigeria states and Federal Capital Territory, 2013 to 2016.