Perceived susceptibility to and perceived causes of road traffic injuries in an urban and rural area of Tanzania

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Abstract

The aim of the study was to investigate social and behavioral correlates of perceived vulnerability to traffic injuries in an urban and rural setting in Tanzania. In 2002, a sample of 494 adults aged 15 years and above participated in household interviews in Dar es Salaam (urban) and Hai District (rural). The study was part of a population-based survey that collected self-report data on non-fatal injuries. In Dar es Salaam 75 and 82% of males and females, respectively, perceived it as likely that they would experience a traffic injury in general. The corresponding figures in Hai were 63 and 64%. Men rated their road traffic vulnerability similarly to women (OR = 0.8, 95% CI 0.5–1.3). Factors associated with high perceived vulnerability as a pedestrian or being injured by a bicycle were amount of road safety information received from health workers and friends, having caused a car to swerve and having crossed a road while talking. Respondents perceived driver recklessness and driver drunkenness as the leading causes of traffic injuries in both areas. Differences were found between the urban and rural setting with respect to perceived risk for traffic injury. The implications of these findings in the context of traffic injury prevention are discussed.

Introduction

Road traffic injuries are the leading cause of injury-related deaths worldwide. In 2000, an estimated 1.26 million people worldwide died as a result of road traffic injuries. About 90% of all road traffic injury deaths occurred in the low and middle-income countries. Over 50% of the global mortality due to road traffic injury occurs among young people between the ages of 15 and 44 years (Peden et al., 2002). The epidemiology of injuries shows clear patterns allowing injury rates to be predicted at the aggregate level of the population, with prevention achieved through environmental modification and educational interventions. Reducing the burden of traffic injuries requires interdisciplinary approaches with behavioral and social science theory and methods being essential components of the preventive efforts (Liller and Sleet, 2004).

Whether people take steps to protect themselves against diseases and injuries, might depend on their perceived susceptibility of experiencing adverse health outcomes (Harris and Middleton, 1994, van der Pligt, 1996). Programs to make people aware of their susceptibility to health and safety risks reflect the assumption that risk perceptions encourage people to take precautions and that such perceptions can be influenced by exposure to relevant risk information (Harris and Middleton, 1994, van der Pligt, 1996). In models of health protective behavior, such as the health belief model, perceived susceptibility is recognized as an important early link in a causal chain of factors leading to the adoption of health promoting behaviors (Rosenstock, 1974). Considerable evidence has confirmed the relationship between risk perceptions and preventive behavior (van der Pligt, 1996). Adult smokers take into consideration the smoking risks when deciding whether or not to continue to smoke and adolescents consider their vulnerability to oral health hazards when deciding whether or not to engage in oral health protective behaviors (Astrom and Rise, 1996, Sutton, 1998). There is, however, equivocal evidence when it comes to the accuracy of people's vulnerability judgements (Millstein and Halpern-Felsher, 2002, van der Pligt, 1996). British smokers tended to substantially overestimate their perceived personal lifetime risk of experiencing lung cancer and heart disease (Sutton, 1999). In a study of adolescents’ injury vulnerability perceptions, Caucasian adolescents inaccurately perceived that they were at greater risk for motor vehicle injuries than their African–American peers (Ey et al., 2000). There is a notion that people do not draw personal implications from risk information because of the tendency to perceive negative events as less likely and positive events as more likely to oneself than to others (Weinstein, 1987). In addition, they seem to be more likely to underestimate their vulnerability if the disease/injury is something they perceive to have control over or are not yet familiar with (Weinstein, 1987).

Health behavior models including perceived vulnerability do not provide an explanation on how risk perceptions accrue. Studies suggest, however, that people take account of objective medical risk factors when assessing perceived susceptibility to health hazards (Gerend et al., 2004, Kreuter and Strecher, 1995, Weinstein, 1987). A recent study of women's perceived risk to various chronic diseases revealed that psychological factors such as perceived similarity to women who contract disease predicted women's perceived susceptibility above and beyond several medical risk factors (Weinstein, 1984). It has been argued that people seem to be able to incorporate knowledge about their family health history, personality and physical and psychological conditions into their risk perceptions but do not easily recognize the relationship between their own actions and the risk they run (Weinstein, 1987). It is evident, however, from a number of studies that those who confirm engagement in risk taking behaviors, such as dangerous driving and excessive alcohol consumption, rate themselves as more vulnerable to health hazards than their peers (Gerrard et al., 1996, Quadrel et al., 1993).

Whilst the role of attitudes and beliefs has long been considered crucial in the prevention and control of infectious and non-communicable diseases, to date there are few qualitative investigations of injuries (Astrom et al., 1999, Butchart et al., 2000). Population-based studies focusing on perceived risk of road traffic injuries have yet to be conducted in sub-Saharan Africa. This study extends an analysis of people's perceived susceptibility and perceived causes and solutions for road traffic injuries into the developing country context of Tanzania. The study is part of a community based household survey in Tanzanian adults, that provides epidemiological and risk factor information with respect to various causes of non-fatal injuries generally. As injury causes and severity were found to be unequally distributed by socio-demographic characteristics (Moshiro et al., 2005a), one goal of this paper was to assess the accuracy of perceived vulnerability for road traffic injury by comparing its socio-demographic distribution with that concerning the actual road traffic injury rates. Moreover, this study investigated demographic and behavioral correlates of vulnerability perceptions to road traffic related injuries in adults living in an urban and rural area of Tanzania. The relationship between vicarious risk experience, in terms of exposure to road safety information from different sources, and perceived vulnerability was also investigated. Finally, this study explored perceived causes of and solutions to road traffic injuries through qualitative interviews.

Section snippets

Study area

This study was conducted in Dar es Salaam, the largest city of Tanzania, and Hai District, a rural area of the country. Estimated annual mortality rates due to transport injuries amount to 44 and 32 per 100,000 population for males in Dar es Salaam and Hai, respectively, while for females figures are 13 and 8, respectively (Moshiro et al., 2001). The Ministry of Health through the Adult Morbidity and Mortality project (AMMP) established a health and demographic surveillance system in 1992 in

Results

Four hundred and ninety four respondents were included in the study. The respondents in Dar es Salaam were younger, had a higher proportion of females and a higher level of education than respondents in Hai (Table 1). Seventy-four and 28% (p < 0.001) of the respondents in Hai and Dar es Salaam, respectively, confirmed having had an injury during the past one year. Of these, 10 and 52% (p < 0.001) had experienced a road traffic injury, respectively.

Table 2 shows the distribution of road traffic

Discussion

The present study adds to existing evidence on vulnerability perceptions of health risks by expanding the scope to include perceived risk to road traffic injuries of adults living in a non-western socio-cultural context. At odds with studies that have confirmed an optimistic bias in people's assessments of several health and safety risks (Ey et al., 2000, Millstein and Halpern-Felsher, 2002, van der Pligt, 1996), substantial proportions of the Tanzanian participants did consider it likely or

Acknowledgements

This research was carried out by the Centre for International Health in University of Bergen in collaboration with the Adult Morbidity and Mortality Project (AMMP) of the Tanzanian Ministry of Health. The authors are thankful to those who participated in collecting the data.

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