Road safety and road traffic accidents in Saudi Arabia
The burden of road traffic accidents (RTA) is a leading cause of all trauma admissions in hospitals worldwide.1 According to the World Health Report (WHR) in 2010,2 road traffic injuries (RTI) have been identified as the ninth most common cause of disability adjusted life years (DALYs) lost for all age and gender categories. The World Health Organization (WHO) reported that 1.24 million people were killed on the road, and up to 50 million people were injured worldwide, and the number of road traffic deaths is expected to increase further by 2020.3,4 Nearly three-quarters of overall road deaths occur in developing countries, although road deaths are common in developed countries. Road traffic fatality in the Kingdom of Saudi Arabia (KSA) accounts for 4.7% of all mortalities, while road traffic fatalities do not exceed 1.7% in Australia, United Kingdom (UK), or United States of America (USA).5 Similarly, road fatalities in KSA have increased over the last decade from 17.4-24 per 100,000 population compared with 10 in USA, and 5 in UK, where road safety has been taken seriously, and all primary and secondary preventive measures are implemented appropriately.6 Saudi Arabia was found to have higher number of deaths from RTAs among high income states (accident to death ratio is 32:1 versus 283:1 in USA), and is considered to be the country’s main cause of death for 16-30-year-old males.7 Road injuries are reported to be the most serious in this country with an accident to injury ratio of 8:6, compared with the international ratio of 8:1.8 The rate of RTA caused by 4-wheeled vehicles is the highest of all worldwide accidents.9
Saudi Arabia is a vast country of 2,149,690 km2, and is the largest Arab state in Western Asia. The Kingdom has been categorized as a high-income nation, and is part of the “Group of Twenty” (G-20) of major economies. It has a total population of approximately 27 million, one-fourth of whom are expatriates, with the highest population density (per km2) of 101 in Jizan, and 38 in Makkah, and the lowest of 2.8 in Najran, and 3.6 in Al Jawf.10 In KSA, motor vehicles are the main means of transportation within, and in-between cities. According to a recent estimate, more than 6 million cars are found on the roads of KSA.11 According to the morbidity and mortality records in the Ministry of Health (MOH) hospitals, 20% of beds are occupied by RTA victims, and 81% of deaths in the hospitals are due to RTIs.8 Over the past 2 decades, KSA has recorded 86,000 deaths, and 611,000 injuries in RTAs with 7% resulting in permanent disabilities.12 The economic implications of RTAs estimated in terms of potential productive years life lost (PPYLL) were examined in a study that reported a 31.6% increase in deaths due to RTA among males in 1997-2002 compared with a 1.3% increase in deaths due to RTA among females.13,14 Road traffic accidents are a major health hazard with 19 killed daily, and 4 injured every hour in KSA. The young and economically productive age groups are the most affected.9 In industrialized countries, the gross loss due to accidents is 1 ± 2% of the national income, while for KSA, this loss has been estimated to be between 2.2 and 9%.8,15 The accident or injury reporting system in KSA has been much improved over the last couple of decades. Legislation on seat belt use has been put into practice, along with fully operational speed camera systems in large cities under the control of police departments, and police department record keeping of road mortalities and collisions.16 This improved reporting system shows a paradoxical rise in the magnitude of the problem over the years. The WHO has identified 5 Road Safety Pillars, namely: road safety management or policy; road infrastructure; safe vehicles; road users’ safe behavior; and post-crash care.17 Driver errors has been mostly reported in different regions of KSA as a cause of RTAs, in addition to some deplorable vehicles, and road conditions. However, post-crash care is largely ignored in all possible direct, or indirect evidence on the subject. There is scarcity of local standardized information on RTAs; therefore, measures for injury related mortality and disability are mostly available, either in popular press articles, police records, or WHO projected estimates. The aim of this study was to identify the changing trends and crucial preventive approaches to RTAs adopted in KSA over the last 2.5 decades, and to analyze aspects previously overlooked. This systematic review was planned to propose a standardized surveillance system for RTAs in KSA. This analysis aims to provide helpful information in limiting the overall incidence of RTAs, and the severity of the resultant injuries in KSA.