Background Around 90% of the world’s road traffic deaths occur in low and middle income countries (LMIC). Bangladesh has over 100 road traffic deaths per 10,000 motor vehicles, one of the highest rates in the world. Most of the crashes occurring at ‘black spots’ and about 70% of crash fatalities occur in rural areas. A pilot project has been implemented on the Dhaka-Sylhet (N2) highway of Bangladesh. This road has many black spots and a high number of pedestrian fatalities. The pilot is innovative in both the selection of implemented interventions (a combination of effective and relatively low-cost measures) and in the approach to monitor pre- and post-intervention data.

Methods The intervention program combines small-scale infrastructural measures for traffic calming (e.g., using speed humps, signs, and marking) with practical training (e.g., to school children) and active community involvement. Three methods are used for monitoring: development of own crash database with local record keepers, speed analysis, and conflict observation study using video (DOCTOR).

Results We understand now the precise causes of crashes and conflicts. Buses are involved in 71% of dangerous road situations. Speeding and overtaking are the main risk-enhancing factors. After implementation of the pilot, the crash database showed a 63% reduction in the number of crashes and a reduction of over 70% in the number of people killed and injured.

Conclusions The selected combinations of interventions is very effective to reduce road deaths and injuries at relatively low-cost. The selected methodologies for monitoring crash data and crash patterns provided a thorough overview and analysis of the causes of crashes and the impact of the selected interventions. Both the interventions and the monitoring methods are suitable for use in other LMICs.