Burden of road traffic injuries and related risk factors in low and middle-income Pacific Island countries and territories: a systematic review of the scientific literature (TRIP 5)

BACKGROUND: In Pacific Island countries and territories, the burden of road traffic injuries and their attendant risks are considered significant but are poorly quantified. As with other low and middle-income countries, understanding the epidemiology of road traffic injuries in Pacific countries is critical to informing sustainable research and policy initiatives aimed at reducing this burden. METHODS: We undertook a systematic review and critical appraisal of the relevant epidemiological literature between January 1980 and December 2010, using key search strings for incidence and aetiological studies focusing on RTIs in less resourced Pacific countries. RESULTS: Nineteen studies were identified. The majority were descriptive and were unable to provide population-based estimates of the burden of road crash injury, or reliable information on risk factors using well-designed aetiological research methods. All studies were published more than 10 years ago, and all but three reported on data from Papua New Guinea, thereby limiting the generalisability of findings to the current status in the region. Studies undertaken in Papua New Guinea suggested that RTIs were more frequent among young males, with head injuries the most common cause of death or hospital admission. Two thirds of fatalities occurred at the crash site or soon after admission. Most road crash victims were passengers or pedestrians. Factors postulated to influence the risk of RTIs were travel in open-back utility vehicles, utility vehicle overcrowding, and alcohol. CONCLUSIONS: This review suggests that, despite increasing awareness of the importance of addressing road safety among stakeholders in less resourced Pacific Island countries, road traffic injuries have not been a research priority with little relevant current evidence from the region to inform policy. Robust epidemiological research that can assess the magnitude and key determinants of road traffic injuries in these settings is essential to determine context-specific road safety initiatives that are relevant and affordable. Greater attention to harnessing routinely collected data (e.g., hospital information systems and police crash statistics) to inform policy is also required.