A Silent Tsunami on Indian Road: A Comprehensive Analysis of Epidemiological Aspects of Road Traffic Accidents

This paper aims to critically analyze the epidemiology of road traffic accident in India. It is noteworthy to mention that India already accounts for about 9.5% of the total 1.2 million fatal accidents in the world. In 2009, for every 4.14 minute and 1.13 minute one death and one injury took place in India from road accident, respectively. Between 1970 and 2009 the number of accidents has quadrupled (1.1 lakh in 1970 to 4.22 lakh in 2009) with nearly 6.5 fold increase in injuries (0.7 lakh in 1970 to 4.67 lakh in 2009) and nearly 9.5 fold increase in fatalities (0.14 lakh in 1970 to 1.27 lakh in 2009). During the period of 2004 to 2009, road accident rate, injury rate and casualty rate per 10 5 population have been increased by 8.5%, 4.7% and 29.8%, respectively. In 2009, total 1,08,409 male and 18,487 female died in road accident. It was also observed that in last five years (2005 to 2009) average 84.9% male and 15.1 % female died in road accident. In 2009, total 90,298 people, out of total 1,26,896 accident victims died from age group of (5-44 Yrs), which is the most productive age group for nation. Average percentage share of last five years (2005-2009) for the age groups (Up to 14 Yrs), (15–29 Yrs), (30–44 Yrs), (45–59 Yrs), and (Above 60 Yrs) were 6.35, 29.84, 35.05, 20.97 and 7.79, respectively. The month-wise distribution of ‘Road Accidents’ has also shown more accidents during May (38,928) and June (36,234) sharing 9.2% and 8.6% respectively. Maximum ‘Road Accidents’ (68,835) were reported during 3 p.m. to 6 p.m (16.3%), 64,191 cases during 9 a.m. to 12 noon (15.2%), and least number (28,984) of these accidents (6.9%) was reported during 1200 to 3 AM in the night. The cause-wise number of persons killed in road accidents indicates that almost three-fourths of the accidents were due to driver’s fault.


INTRODUCTION
Tsunami in the Indian Ocean on December 26 th , 2004 had a devastating effect on India. According to the Indian government, almost 11,000 people died in the tsunami and over 5,000 are missing and feared dead (Ministry of Home Affairs). It is estimated that 3,80,000 Indians have been displaced by the disaster and reconstruction is expected to cost more than 1.2 billion dollars (approx. 5,500 crore Indian rupees) (World Bank). In 2009 only, 1.27 lakh people died in road accident in India resulting a financial cost of approximately 1,36,000 crore Indian rupees (Mondal et al, 2011). Therefore, road accidents can be easily compared with gigantic infamous tsunami. Road crashes deserve to be a strategic issue for any country's public health and can lead to overall growth crisis, if not addressed properly. Road traffic injuries are the leading cause of death globally among 15-19 year-olds, while for those in the 10-14 years and 20-24 years age brackets they are the second leading cause of death (WHO, 2007 a ). The projected 40% increase in global deaths resulting from injury between 2002 and 2030 is predominantly due to the increasing number of deaths from road traffic accidents (WHO, 2007 b ). Road traffic crashes kill 1.2 million people each year and injure 50 millions. It is estimated that road traffic deaths will increase worldwide, from 0.99 million in 1990 to 2.34 million in 2020 (representing 3.4% of all deaths). India already accounts for about 9.5% of the total 1.2 million fatal accidents in the world. In 2009, 1.27 lakh people in India lost their lives in road mishaps (Mondal et al., 2011). In 2009, for every 4.14 minute and 1.13 minute one death and one injury took place in India from road accident, respectively. Figure 1 reveals that 35.5% of total accidental death (natural and un-natural) was caused by road accidents (GoI, 2010). The Planning Commission of India had assessed the social cost at Rs. 55,000 crore (Rs. 550 billion) on account of road accidents in India (Mondal et al., 2008). A huge number of researches have been conducted to analyze road crashes. This paper aims to critically analyze the epidemiology of road traffic accident in India.

ROAD ACCIDENT PROFILE IN INDIA
A high prevalence of old vehicles that often carry many more people than they are designed to carry, lack of safety belt and helmet use, poor road design and maintenance and the traffic mix on roads are other factors that contribute to the high rate of crashes in India. Figure 2 gives the year wise road accident and fatality distribution from 1970 to 2009(GoI, 2010. In 2009, 348 deaths per day and 1278 injuries per day took place in India. Road accident share (%) in total un-natural death road accidents in India, the number of injuries reported appears to be underestimated. Various studies indicate that the actual number of injuries could be 15 to 20 times the number of deaths. The discrepancies in the number of deaths and injuries are a result of the application of different methodologies for the derivation of estimates (Sundar, 2007). An estimated 2 million people have a disability that results from a road traffic crash (Gururaj, 2006, WHO, 2009

STATE WISE ROAD ACCIDENT DISTRIBUTION IN INDIA
In 2008, the 'Accidental Deaths' due to Un-Natural Causes were mainly on account of 'Road Accidents' (37.1%). The road accidental death details of States and UTs categorized as high prone areas (percentage share exceeding the All-India share) on the basis of the percentage share of deaths on these counts are presented in figure 3. The cause-wise analysis of un-natural deaths revealed that 72.5% deaths in Sikkim (highest) was due to 'Road Accidents' (GoI, 2009).

CRITICAL ANALYSIS OF EPIDEMIOLOGY OF ROAD ACCIDENTS IN INDIA
In order to establish what is known from available research, prior to conducting further research or promoting particular public health policies on road safety, it is important to examine the public domain literature for available evidence concerning the epidemiology of traffic injuries, with the objective of identifying and summarizing available information about the epidemiology of motor vehicle crashes in India. During search, it has been found that very less number of research reports/papers are available in the area of epidemiological research of road accidents in India. It was also found that most of the available researches are based on regional or even city specific data.

AGE GROUP WISE DISTRIBUTION OF ACCIDENTAL DEATHS
In 2009, total 90,298 people, out of total 1,26,896 accident victims died from age group of (5-44 Yrs), which is the most productive age group for nation. In figure 6,

TRAFFIC INCIDENCE BY TIME AND MONTH
The month-wise distribution of 'Road Accidents' has also shown more accidents during May (38,928) and June (36,234) sharing 9.2% and 8.6% respectively. Tamil Nadu and Maharashtra, which accounted for the maximum (14.4%) and (11.6%) of 'Road Accidents' in the country have also reported the maximum number of 'Road Accidents' during each month of the year at national level. Delhi has reported the maximum number of 'Road Accidents' among UTs which is 1.8% at the National level. Maximum 'Road Accidents' (68,835) were reported during 3 p.m. to 6 p.m. (16.3%), 64,191 cases during 9 a.m. to 12 noon (15.2%), and least number (28,984) of these accidents (6.9%) was reported during 1200 to 3 AM in the night.

ACCIDENT CATEGORIZATION AS PER TYPES OF CAUSES
The cause-wise number of persons killed in road accidents indicates that almost three-fourths of the accidents were due to driver's fault during the period in 2004 for the reporting States/UTs. Accidents attributed to mechanical fault were only 2% amongst the causes. The pedestrian's fault works out to 1 to 2. The number of persons killed in the road accidents cause-wise are given in the table 4 (Planning Commission, 2006).

REQUIREMENT OF STRATEGIC PLANNING FOR ROAD ACCIDENT MITIGATION
Road crashes deserve to be a strategic issue for any country's public health and can lead to overall growth crisis, if not addressed properly. Thus, there is an urgent need to recognize the worsening road safety situation in order to take appropriate action. Road traffic injury prevention and mitigation should be given the same attention and scale of resources that are currently being channeled towards other predominant health issues, if increasing human loss and injury on the roads, with their devastating human impact and large economic cost to society are to be avoided. There is no organized programme to combat morbidity and mortality on Indian roads while there are structured programmes to combat communicable diseases, with substantive allocation of plan funds. Table 5 indicates the number of fatalities reported from a few select communicable diseases and the plan allocation for combating these diseases as compared to the allocation for road safety (Sundar, 2007).

CONCLUSIONS
The analyzed data show that men are more at risk than women of being injured in crashes. The preponderance of males may be attributed to their greater exposure to traffic and other associated factors. Similar evidence is well documented in several studies in industrialized countries (Odero et al., 1997). While most motor-vehicle drivers are men, a high proportion of males involved as pedestrians, passengers or cyclists, suggests the co-existence of other social and behavioural factors contributing to their vulnerability. However, no study is available which has attempted to investigate specific potential factors that would explain the observed gender differences. Such a study is desirable and would need to assess and correct for levels of exposure by gender.
The findings, that the age group of (5-44 Yrs), are at high risk of traffic injury is well documented in this paper. This has important economic impacts as these are people in their most economically productive years. It also has implications for the design and implementation of more targeted interventions.
This paper produced sufficient evidence in support of a high incidence of day-time casualties. This can be explained by greater traffic volume during the day resulting in greater risk of accident involvement as people travel to work, children go to school, and commercial enterprises are open for business. The relative decline in traffic casualties at night may be explained by less night-time activity and travel. Simple interventions, such as painting bicycles yellow instead of black or wearing reflector bands may be costeffective and decrease traffic injuries. Such easy but seems to be effective interventions need to be tested.
Considering the gigantic social and economic impact of road accidents, more planned allocation Govt. fund and initiatives for accident research and subsequent policy development and implementation is required.