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Addressing discrepancies in estimates of road traffic deaths and injuries in Ethiopia
  1. Kazuyuki Neki1,
  2. Hialy Gutierrez2,
  3. Sudeshna Mitra1,
  4. Awoke M Temesgen3,
  5. Leah Watetu Mbugua1,
  6. Ramshankar Balasubramaniyan2,
  7. Mercer Winer2,
  8. Jaeda Roberts2,
  9. Theo Vos3,
  10. Erin Hamilton3,
  11. Mohsen Naghavi3,
  12. James E Harrison4,
  13. Soames Job1,
  14. Kavi Bhalla2
  1. 1World Bank Global Road Safety Facility, Washington, DC, USA
  2. 2Public Health Sciences, University of Chicago, Chicago, Illinois, USA
  3. 3Institute for Health Metrics and Evaluation, Seattle, Washington, USA
  4. 4Research Center for Injury Studies, Flinders University, Bedford Park, South Australia, Australia
  1. Correspondence to Dr Kavi Bhalla, Public Health Sciences, University of Chicago, Chicago, IL 60637, USA; kavibhalla{at}gmail.com

Abstract

Background There are large discrepancies between official statistics of traffic injuries in African countries and estimates from the Global Burden of Disease (GBD) study and WHO’s Global Status Reports on Road Safety (GSRRS). We sought to assess the magnitude of the discrepancy in Ethiopia, its implications and how it can be addressed.

Methods We systematically searched for nationally representative epidemiological data sources for road traffic injuries and vehicle ownership in Ethiopia and compared estimates with those from GBD and GSRRS.

Findings GBD and GSRRS estimates vary substantially across revisions and across projects. GSRRS-2018 estimates of deaths (27 326 in 2016) are more than three times GBD-2019 estimates (8718), and these estimates have non-overlapping uncertainty ranges. GSRRS estimates align well with the 2016 Demographic and Health Survey (DHS-2016; 27 838 deaths, 95th CI: 15 938 to 39 738). Official statistics are much lower (5118 deaths in 2018) than all estimates. GBD-2019 estimates of serious non-fatal injuries are consistent with DHS-2016 estimates (106 050 injuries, 95th CI: 81 728 to 130 372) and older estimates from the 2003 World Health Survey. Data from five surveys confirm that vehicle ownership levels in Ethiopia are much lower than in other countries in the region.

Interpretation Inclusion of data from national health surveys in GBD and GSRRS can help reduce discrepancies in estimates of deaths and support their use in highlighting under-reporting in official statistics and advocating for better prioritisation of road safety in the national policy agenda. GBD methods for estimating serious non-fatal injuries should be strengthened to allow monitoring progress towards Sustainable Development Goal target 3.6.

  • Epidemiology
  • Low-Middle Income Country
  • Public Health

Data availability statement

Data are available in a public, open access repository. Data may be obtained from a third party and are not publicly available. DHS data analysed in this manuscript are available to researchers via request from USAID’s DHS Program. WHS data are available via request from the WHO. GBD estimates are available to the public from the IHME’s Global Health Data Exchange (GHDx) website.

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Data availability statement

Data are available in a public, open access repository. Data may be obtained from a third party and are not publicly available. DHS data analysed in this manuscript are available to researchers via request from USAID’s DHS Program. WHS data are available via request from the WHO. GBD estimates are available to the public from the IHME’s Global Health Data Exchange (GHDx) website.

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Footnotes

  • Contributors SM and KB contributed to the study design and jointly led all aspects of the study. JR and SM initiated the research into the issue. KN, LWM, HG, MW, RB and JR searched for data sources, reviewed questionnaires and conducted data analysis. KN and KB wrote the first draft of the article. All authors contributed to the discussion and interpretation of the results and to the writing of the manuscript. All authors have read and approved the final manuscript. KB is the guarantor of the manuscript.

  • Funding This investigation was conducted by researchers from the University of Chicago and the World Bank Global Road Safety Facility and supported by funding from UKAID (Award/Grant Number: 7197082). UKAID had no role in data analysis, data interpretation or writing of the article. The corresponding author had full access to all the data in the study and had the final responsibility for the decision to submit for publication. We thank our project advisory group for feedback on preliminary results.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.