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| ORIGINAL ARTICLE |
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| Ahead of print publication |
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Awareness about road safety and factors associated with self-reported road traffic injury while commuting to school in India
Nikunj K Kansara, Arun K Yadav
Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
| Date of Submission | 20-Dec-2021 |
| Date of Decision | 21-Mar-2022 |
| Date of Acceptance | 21-Mar-2022 |
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Correspondence Address:
Arun K Yadav,
Department of Community Medicine, Armed Forces Medical College, Pune - 411 040, Maharashtra
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/mjdrdypu.mjdrdypu_1013_21
Background: India is the home to almost 30% of total children aged 13 to 19 years. Road traffic injury dominates over all causes of unintentional injuries. Children's road safety is neglected issue in the planning and designing of roads in the urban towns of India where a third of a billion children travel to school every day. As India is motorizing rapidly, road traffic injuries are projected to increase in near future. In the present study, awareness regarding road safety issues and prevalence of self-reported road traffic injury incurred while commute to school was estimated in the school going children aged 14 to 18 years. Methods: A Cross-sectional questionnaire-based survey was conducted among three schools in Pune, Maharashtra India. The information was collected about mode of commute to/from school including distance from home and understanding about road safety issues. The data was also collected about any road traffic injury incurred during commute to school in the past 12 months. Results: Total 398 children participated in the study of which 212 (53.3%) respondents were male. The mean age of the respondents was 15.5years (SD 1.1 years). The overall prevalence of self-reported road injury during journey to school in the last 12 months was 17.3% (95% CI, 13.75-21.42). A higher proportion of boys (18.9%) reported road injury than girls(15.6%).Children who walk (OR =2.79;95%CI1.04-7.52) or travelled by autorickshaw (OR=2.37;95%CI 0.78 - 7.24) to school were more likely to report road injury than those who travelled by school bus/school van. Conclusions: A sixth of the children reported a road traffic injury in the past 12 months during school journeys in Pune district, Maharashtra. Road safety education may be made part of the syllabus of school going children. Children's road safety should be given utmost priority in any urban planning of roads, schools and streets in India.
Keywords: Children, cross-sectional survey, public health, road safety, road traffic injury
How to cite this URL:
Kansara NK, Yadav AK. Awareness about road safety and factors associated with self-reported road traffic injury while commuting to school in India. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2023 Mar 20]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=345004 |
| Introduction | |  |
Road traffic injury is the eighth leading cause of death in the world. There are a total of 13.5 lakh road traffic deaths that occur every year in the world, out of which 7.3 lakh deaths are of pedestrians, cyclists, and motorcyclists.[1] Road traffic injury remains a major public health issue in children for a few decades and is projected to increase the severity if not addressed adequately.[2] Over 1.5 million pediatric trauma cases befall annually in the United States (US), which results in around 600,000 hospitalizations, and 15,000–20,000 childhood deaths every year.[3] Road traffic injury cases were steadily found to be among the top three causes of childhood death from 2004 to 2011 in China.[4]
As per the number, total road traffic accidents (RTA) in India were 4,37,369 in the year 2019.[5] Almost one-third of the young population was affected by these road traffic accidents.[6] India is owning one of the largest education systems in the world with more than 1.5 million schools, 8.5 million teachers, and 250 million children.[7] School-going children need to commute to school. There are various means of commuting. While in the developed country the majority of students commute by private cars and school buses, in developing countries like India students commute by walking.[8],[9] This combined with the condition of roads in developing countries makes the students vulnerable to road traffic injury while commuting. The injury during the commutation to the school leads to loss of educational opportunity to the very child who is going to school for education. However, there is a lack of data on road traffic injury while commuting to school and there is less understanding of the factors associated with RTA during commuting, hence the present study was undertaken.
| Methodology | | |
The study was conducted in the western state of Maharashtra. It is the second-most populous state in India. Pune, a city located in the western part, is the second most populous city of Maharashtra and the eighth most populous state in India. Pune is also known as oxford of India as there are many educational institutes located in Pune. The study population consists of all school children between 14-18 years of age. In India there are three main types of school management; Government, Government aided private schools (semi-private), and private schools (unaided). Government schools, which are run by the Central or State Government provide free education to lower-income groups, Government aided private schools receiving a grant from the government, provide education to the middle-income groups. Private schools (unaided) totally run by parents' fees, provide education to the higher income groups' families. Out of these types of schools, one school was randomly selected for the study. Each class in a school has four or more sections. From each school, one section was randomly chosen and within the section, all participants were included in the study. Each section comprised 50-60 students in Government and semi-private schools whereas private schools comprised 30-40 students. Any child with special needs was excluded from the study. The study was implemented between the months of September to November 2019.
The sample size was calculated assuming the cluster effect of 1.2, the estimated prevalence of road traffic accidents as 0.2 (based on a previous study),[9] 95% confidence interval and with a 5% margin of error, the calculated sample size was 300. However, a total of 398 students were enrolled in the study.
Data collection
A questionnaire was developed with the help of experts, epidemiologists, and biostatisticians. It was made in two languages; Marathi (Local) and English. It was pilot tested among 30 students. The Cronbach's alpha of the questionnaire was 0.8. The data was collected during the weekly parent-teacher meeting. The data collection was done by a single investigator and the average time taken for data collection from each student was 8 minutes. Self-reported understanding of road traffic issues of students was measured on a Likert scale. Data was also collected from records on absenteeism followed by road injury and other socio-economic variables.
Operational definitions
The operational definition of road traffic injury in our study was taken as “Any non-fatal injury sustained in the past 12 months, on the road while going to, or coming from school, due to collision with another vehicle, or due to fall or skid from a bicycle or two-wheeler, or while standing or walking on the road which has resulted in at least 1 day of their usual activities missed from the school or which required treatment from a doctor or nurse.”[10]
Ethics
The study was approved by the Institutional Ethical Committee. The assent of the students and consent from a parent were taken as per Institutional ethics guidelines. The permission from the school administration was also taken to conduct the study.
Statistical analysis
Prevalence of self-reported road traffic injury in the previous 12 months during the commute to school by mode of commute and distance from the house was estimated. The Chi-square test for the degree of independence between the self-reported level of understanding regarding road safety issues and road traffic injury was applied. Two-wheeler and bicycle, car, and autorickshaw, and school bus and school van were combined due to similarity of travel and for the ease in statistical analysis. Logistic regression was used to estimate the ORs with 95% CIs of road traffic injury for each mode of travel after adjusting for potential confounding variables. Statistical analysis was done using IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. P value of more than 0.05 was considered significant.
| Results | | |
A total of 399 children participated in the study from three schools. One child was excluded due to a physical disability. The mean age of the children in the sample was 15.5 years (SD = 1.1 years) with a higher proportion of boys (55%) than girls (45%). A total 140 (35.2%) children were enrolled in private schools, 137 (34.4%) in semi-private, and 121 (30.4%) from the government school.
The prevalence of self-reported road traffic injury in the last 12 months during the commute to school was 17.3% (95% CI, 13.75-21.42). A higher proportion of boys (40,18.9%) reported injury than girls (29,15.6%) [Table 1]. | Table 1: Demographic characteristics and association with road traffic injury
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Self-reported awareness level was high to above average in 61.5% (245) children. There was a statistically significant association between the level of understanding of road safety issues and self-reported road traffic injury incurred while commuting to school (P < 0.001). Students with limited understanding reported road traffic injuries in a higher proportion (39.6%) than any other self-reported level of understanding [Figure 1]. | Figure 1: Distribution of self-reported road traffic injury among selfreported levels of understanding regarding road safety issues
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According to the mode of commute, children who traveled by walk reported the highest prevalence (30%), followed by children who traveled by autorickshaw (28%). The lowest prevalence was reported by children who commuted via school bus and school van (13%). The prevalence of road injury was highest among the children who traveled 2-3 Km (21%) lowest (9.5%) among children who traveled a distance less than 1 Km. The prevalence of road traffic injury increases with the distance for the children who commute to school by walking or coming by bicycle or two-wheeler [Table 2]. | Table 2: Prevalence of Self-reported road traffic injury by mode and distance to school
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A total of 152 (38.2%) students did not prefer walking or cycling to school, because of heavy traffic 39 (25.7%), rash driving 29 (19%), and long-distance 29 (19%). A total of 282 (71%) children responded that road safety is very important while 8 (2%) children replied that road safety is not important to them. Children were also asked about their perception regarding the safety of the roads they are traveling, in the response, 271 (68%) children replied that our roads are safe, 47 (12%) replied to be fairly unsafe, and 24 (6%) replied roads to be very unsafe.
Children who studied in semi-private (OR 1.21; 95% CI 0.53 to 2.77) and Government (OR 2.97; 95% CI1.10 to 8.00) schools were more likely to report road traffic injuries. Children who traveled by walk (OR 2.79; 95% CI 1.04 to 7.52) were more likely to report an injury than those who traveled by school bus/school van even after adjusting for gender, school type, and distance to school [Table 1].
| Discussion | | |
Self-reported level of understanding of road safety issues and prevalence of road traffic injury while commuting to school by mode of travel and distance to school was estimated in Pune district, Maharashtra. The main findings suggest that students who reported limited understanding of road safety issues were more likely to report road traffic injuries. Walking is the most unsafe mode of commute to school, however, school buses and school vans were the safest mode of travel.
In the study, we found that the prevalence of self-reported road traffic injuries in the study was 17.3%. A study conducted in Hyderabad, another Metropolitan city of India, by Tetali et al.[10] had estimated the prevalence of 17% for road traffic injuries in the children of age group 11-14 years by using the same operational definition for road traffic injury. In another study by Hyder AA, et al.[11] has also estimated the burden of road traffic injuries among children and adolescents by reviewing 24 articles and using 1505 published articles. In his study, the percentage of children and adolescents with road traffic injury out of all injured children and adolescents in medical facilities did not vary with the different studies. Weighted Mean for road traffic injury in his study was 24%. Hence, our findings are in conformity with the findings of other studies done elsewhere.
Based on the previous studies on road safety awareness, the level of awareness ranges from 20-60%.[12],[13] In the present study also self-reported awareness level was 61.5%. A total of 18% of children marked as roads are not safe, while in the other studies 60% of students said that defect in the roads is the biggest factor causing crash on the roads.[14]
Walking was the most unsafe mode of travel, followed by autorickshaw. Our study estimates of self-reported road traffic injuries by walking (30%) and by autorickshaw (25%) were higher than those reported by Tetali et al.[10] (by walk 17% and by autorickshaw 13%). Estimates of walk-road injuries were lower than those reported by another study on-road use by Indian children (42% for walking) by Dandona et al.[15] These differences may be due to differences in the operational definition of road traffic injuries or the destination of the trips. Another study from Andhra Pradesh by Kataoka et al.[16] used 3 year recall period to record severe non-fatal injuries and found that cyclists (52%) and children who walk (20%) got the maximum injury.
Traveling by school bus and school van was safer than walking as it is usually a door-to-door facility. Every parent cannot afford a school bus or school van for their children due to financial constraints. Pune Mahanagar Parivahan Mahamandal Ltd. (PMPML) is a public transport bus service provider for the city of Pune and per day more than 9 Lac passengers are travelling via PMPML city buses. It provides a safe, secure, and affordable transport facility for the people of Pune. Our results show that it is a safer mode of travel than walking or autorickshaw.
A higher proportion of boys were injured than girls, which is consistent with the results from similar studies in India.[14] Studies conducted in Europe show that the majority of the children with road traffic injuries were pedestrians and mortality was highest among the children aged 7 to 14 years. Children who commute to school by walk or by bicycle constituted a major risk group.[17] Similar results were found in our study as well. Almost half of child bicyclists or motorcyclists who were involved in the accidents did not admire the basic principle of road safety.[17] In our study, it was found that a higher proportion of children suffered from road traffic injuries, and had limited self-reported understanding of road safety. Children in the age group of 15 to 17 years are more vulnerable as they move independently on the road, both as pedestrians and bicycle and two-wheeler drivers.
The results of our study emphasized that behavioral change communications regarding road safety awareness may play a crucial role in the prevention of road traffic injuries.[18] Hence, it is recommended that an awareness drive about road traffic safety may be taken up in all the schools at the national and local levels. In this sense first-ever “Decade of Action for Road Safety” 2011–2020 proclaimed in the UN general assembly in March 2010 is a right step in the direction of creating awareness. In India, the mascot “Pappu the Road Sense Zebra” promoted campaigns in Orissa and Rajasthan in which children were educated children on the value of using pedestrian crossings to safely cross the road.[12] However, there is a requirement to implement the program at a more granular level. School management and public health planner should plan for activities like observing road safety awareness week to increase awareness among school children. Road safety may also form a part of the curriculum in secondary school. This will inculcate the importance and relevance in the student's mind.
Secondly, Measures such as special affordable public transport buses dedicated for school going children will be a good option to control road injuries. The government schools may also explore providing transport for commutation either under government funds or public-private partnerships. All road traffic accidents are preventable and a multi-pronged approach with the help of civic bodies, school management, public health planner, ministry of road and transport may mitigate the scourge of road traffic injury among students. The present study estimates the prevalence of road traffic injury present by self-reporting, which is inclined towards recall bias. Distance of travel from/to school was estimated based upon the self-reported distance by the children, which may have led to misclassification. Minor injuries are difficult to recall and may have gone unnoticed.[19] children were also not asked about the total number of injuries, location, and severity of the injuries.
As a part of public health action arising from the research, the investigator did an awareness campaign about road safety in all three schools. Also, school administrators were made aware of the findings and were told measures to reduce road traffic injuries among the students.
| Conclusions | | |
One in six children reported road injury in the past 12 months during the commute to school in Pune, Maharashtra state, India. The majority of children commute via walk-in India and considering the results of the study walking is not safe for children on the roads of the country. Since the understanding of road safety is associated with injuries while commuting, school management and public health planner should plan for activities like observing road safety awareness week to increase awareness among school children. All road traffic injuries are preventable and a multi-pronged approach is needed to averting road traffic injuries.
Acknowledgements
We acknowledge school principals and teachers for their great efforts for making this study useful for the betterment of planning and design of roads and policies for the children's road safety.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1]
[Table 1], [Table 2]
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