Abstract
BackgroundRoad traffic injuries are among the top ten causes of death globally, with the highest burden in low and middle-income countries, where over a third of deaths occur among pedestrians and cyclists. Several interventions to mitigate the burden among pedestrians have been widely implemented, however, the effectiveness has not been systematically examined.ObjectivesTo assess the effectiveness of interventions to reduce road traffic crashes, injuries, hospitalizations and deaths among pedestrians.MethodsWe considered studies that evaluated interventions to reduce road traffic crashes, injuries, hospitalizations and/or deaths among pedestrians. We considered randomized controlled trials, interrupted time-series studies, and controlled before-after studies. We searched MEDLINE, EMBASE, Web of Science, WHO Global Health Index, Health Evidence, Transport Research International Documentation and ClinicalTrials.gov through 31 August 2020, and the reference lists of all included studies. Two reviewers independently screened titles and abstracts and full texts, extracted data and assessed the risk of bias. We summarized findings narratively with text and tables.ResultsA total of 69123 unique records were identified through the searches, with 26 of these meeting our eligibility criteria. All except two of these were conducted in high-income countries and most were from urban settings. The majority of studies observed either a clear effect favoring the intervention or an unclear effect potentially favoring the intervention and these included: changes to the road environment (19/27); changes to legislation and enforcement (12/12); and road user behavior/education combined with either changes to the road environment (3/3) or with legislation and enforcement (1/1). A small number of studies observed either a null effect or an effect favoring the control.ConclusionsAlthough the highest burden of road traffic injuries exists in LMICs, very few studies have examined the effectiveness of available interventions in these settings. Studies indicate that road environment, legislation and enforcement interventions alone produce positive effects on pedestrian safety. In combination with or with road user behavior/education interventions they are particularly effective in improving pedestrian safety.
Highlights
Road traffic injuries (RTIs) are among the top ten causes of death for people of all ages across all regions [1]
All except two of these were conducted in high-income countries and most were from urban settings
The highest burden of road traffic injuries exists in low- and middle-income countries (LMICs), very few studies have examined the effectiveness of available interventions in these settings
Summary
Road traffic injuries (RTIs) are among the top ten causes of death for people of all ages across all regions [1]. Between 2013 and 2016, reductions in the number of road traffic deaths were recorded among 48 middle- and high-income countries [1]. The road traffic burden remains predominant among pedestrians in low- and middle-income countries (LMICs), especially in the African, Eastern Mediterranean, and Western Pacific regions. Pedestrians in the African region account for 38% of the road traffic deaths, which is higher than their global contribution of 22%. Road traffic injuries are among the top ten causes of death globally, with the highest burden in low and middle-income countries, where over a third of deaths occur among pedestrians and cyclists. Several interventions to mitigate the burden among pedestrians have been widely implemented, the effectiveness has not been systematically examined
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