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Road traffic injuries in Baghdad from 2003 to 2014: results of a randomised household cluster survey
  1. Barclay T Stewart1,2,3,17,
  2. Riyadh Lafta4,5,
  3. Megan Cherewick6,
  4. Sahar A Esa Al Shatari7,
  5. Abraham D Flaxman5,8,
  6. Amy Hagopian5,9,
  7. Lindsay P Galway10,
  8. Tim K Takaro11,12,
  9. Gilbert Burnham13,
  10. Adam L Kushner6,14,15,
  11. Charles Mock1,16
  1. 1Department of Surgery, University of Washington, Seattle, Washington, USA
  2. 2School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
  3. 3Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
  4. 4Department of Community Medicine, Al Munstansiriya University, Baghdad, Iraq
  5. 5Department of Global Health, University of Washington, Seattle, Washington, USA
  6. 6Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  7. 7Human Resources Development and Training Center, Iraq Ministry of Health, Baghdad, Iraq
  8. 8Institute for Health Metrics and Evaluation, Seattle, Washington, USA
  9. 9Department of Health Services, University of Washington, Seattle, Washington, USA
  10. 10Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
  11. 11Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
  12. 12Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA
  13. 13Department of International Health, Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  14. 14Surgeons OverSeas (SOS), New York, New York, USA
  15. 15Department of Surgery, Columbia University, New York, New York, USA
  16. 16Department of Global Health, University of Washington, Seattle, Washington, USA
  17. 17Surgeons OverSeas (SOS) and Fogarty International Center (R25-TW009345; D43-TW007267)
  1. Correspondence to Dr Barclay T Stewart, Department of Surgery, University of Washington, 1959 NE Pacific St., Suite BB-487, P. O. Box 356410, Seattle, WA 98195-6410, USA; stewarb{at}


Introduction Around 50 million people are killed or left disabled on the world's roads each year; most are in middle-income cities. In addition to this background risk, Baghdad has been plagued by decades of insecurity that undermine injury prevention strategies. This study aimed to determine death and disability and household consequences of road traffic injuries (RTIs) in postinvasion Baghdad.

Methods A two-stage, cluster-randomised, community-based household survey was performed in May 2014 to determine the civilian burden of injury from 2003 to 2014 in Baghdad. In addition to questions about household member death, households were interviewed regarding crash specifics, healthcare required, disability, relatedness to conflict and resultant financial hardship.

Results Nine hundred households, totalling 5148 individuals, were interviewed. There were 86 RTIs (16% of all reported injuries) that resulted in 8 deaths (9% of RTIs). Serious RTIs increased in the decade postinvasion and were estimated to be 26 341 in 2013 (350 per 100 000 persons). 53% of RTIs involved pedestrians, motorcyclists or bicyclists. 51% of families directly affected by a RTI reported a significant decline in household income or suffered food insecurity.

Conclusions RTIs were extremely common and have increased in Baghdad. Young adults, pedestrians, motorcyclists and bicyclists were the most frequently injured or killed by RTCs. There is a large burden of road injury, and the families of road injury victims suffered considerably from lost wages, often resulting in household food insecurity. Ongoing conflict may worsen RTI risk and undermine efforts to reduce road traffic death and disability.

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