Abstract

Africa has the second highest rate of alcohol dependence and road traffic fatality rate despite the lowest number of vehicles. Sub-Saharan Africa (SSA) is particularly vulnerable to the growing global burden of alcohol-related injury. Therefore, we aimed to describe and compare the proportion of emergency department (ED) patients presenting with RTIs who are breathalyzer (BAC) positive in three African countries and determine the alcohol dose-response.

Secondary data analysis on RTI patients from the International Collaborative Alcohol and Injury Study in EDs used data from Mozambique (Moz, 2001), South Africa (SA, 2001) and Tanzania (Tz, 2014). Patients, 18 years or older, presenting to an ED within 6 hours of an injury had BAC testing and were asked whether they had been drinking prior to injury and the amount consumed. In Tanzania, self-reported alcohol use prior to the injury was collected for case-crossover analysis.

Of 1433 patients, 38% (581) suffered RTIs (25% Moz, 21% SA, 73% Tz). Overall 28% of RTI patients were BAC positive (21% Moz, 34% SA, 29% Tz). In Tanzania, we found a 5.26 (CI 3.42 to 8.53) increased odds of RTI with any alcohol with a dose-dependent response. Both motorcycles and cars/trucks have an increased odds of RTI with any alcohol, 4.90 OR (CI 2.54 to 9.45) and 5.70 OR (CI 3.81 to 11.64) respectively; while cars/trucks had a dose dependent response, motorcyclists had their highest odds of injury at 3–4 drinks (5.60 OR, CI 2.22 to 14.10).

The burden of road traffic injuries and particularly alcohol-associated road traffic injury is high in sub-Saharan Africa. All motorists have a six times higher odds of road traffic injury due to alcohol with a dose-dependent response while motorcyclists have a high odds of injury with even low doses of alcohol.