1. DEPARTMENT OF COMMUNITY MEDICINE
FACULTY OF CLINICAL SCIENCES
COLLEGE OF HEALTH SCIENCES
ABUTH, ZARIA.

2. OUTLINE
• Case Presentation
• Home Visit
• Literature Review
• Epidemiology
• Prevention and control
• Conclusion
• References

3. Case Presentation
by:
Maryam Shehu Ingawa
U17MD2009

4. BIODATA
• I am presenting I.S, a 31yr old Muslim, Hausa, male driver,
who is married and reside at Ban zazzau, Zaria Kaduna state.
2

5. PRESENTING COMPLAIN
• He presented 1/52 ago with history of crushed left upper limb(fore
arm).
3

6. HISTORY OF PRESENTING COMPLAIN(HPC)
• He was apparently healthy until 1hr prior to presentation when
the propeller of the dump truck he was driving failed which led
him to loose control.
• The truck collided with an abandoned concrete structure by the
road side which led to the crushing of his left upper limb (fore
arm) with only a small flesh still holding it to the arm .
• There is pain on the remaining part of the arm which was
stabbing in nature, not radiating to any part of the body,
aggravated by depending on left side of the body, relieved by
lying in supine position.
4

7. HPC CON’T
• He also sustained minor bruises on other parts of his body
• There was associated loss of consciousness however he
regained consciousness spontaneously after 40mins, there
was no associated bleeding from craniofacial orifices or
convulsion.
• There was no history of headache or vomiting.
• No associated muscle pain, joint pain or swelling.
5

8. SYSTEMIC REVIEW(SR)
• CNS: no headache, fever, syncopal attacks, seizures, blurring of
vision , hearing impairment, or tremor.
• GUS: no change in urine frequency, color or quantity, difficulty
or pain on passing urine, hesitancy or urgency.
• CVS: no chest pain, no undue awareness of heartbeat, no
orthopnea, no PND.
• RS: no breathlessness, no wheezing, no cough.
• GIT: no dysphagia, odynophagia, nausea, vomiting, abdominal
pain or distention, change in bowel habit.
6

9. PAST MEDICAL HISTORY
• He is a known PUD patient, diagnosed 10yrs ago following
presentation with burning epigastric pain at peripheral
hospital, Zaria.
• Not a known hypertensive or diabetic.
• No history of surgery.
• There was history of blood transfusion when he was young
but indication and details not known to the patient.
7

10. FAMILY HISTORY
• No family history of hypertension or diabetes mellitus.

11. SOCIAL HISTORY
• He is a dump trunk driver.
• He smokes cigarette averaging 10 sticks per day.
• He ingest alcohol averaging 3 bottles per week.
• Doesn’t use recreational drugs.

12. HISTORY OF HOSPITAL STAY
• Following presentation, many investigations were done,
however details were not known to the patient.
• I.V fluids and injections were given.
• The patient is now stable and feeling better.
10

13. SUMMARY
• I have presented a 41yr old male dump truck driver who
presented with 1hr history of loss of left upper limb
associated with LOC, with no associated bleeding from
craniofacial orifices, headache or vomiting.
11

14. EXAMINATION
• I found a worried man who is in painful distress but not in
obvious respiratory distress.
• Anicteric, not pale, acyanosed, well hydrated, with no
significant palpable lymphadenopathy.
• No palmer erythema, leukonychia, koilonychia, or digital
clubbing.
• No pedal edema.
12

15. EXAMINATION CON’T
CNS:
• GCS is 15/15.
• No sign of meningeal irritation.
• The cranial nerves are intact.
• Motor system:
-normal attitude, muscle bulk, and no fasciculation.
-normal tone and power in both upper and lower limbs
but left upper limb (fore arm) is missing.
13

16. EXAMINATION CON’T
CNS CON’T
• Normal sensation.
• Coordination and gait were normal.
14

17. EXAMINATION CON’T
CVS:
• Pulse rate was 86bpm and was regular, full volume,
synchronous radiofemorally.
• Blood pressure was 120/60mmHg.
• No elevated JVP.
• Apex beat was at left 5thth intercostal space, mid-clavicular
line.
• Heart sounds S1 and S2 were heard with no added sound.
15

18. EXAMINATION CON’T
RS:
• Respiratory rate was 20cpm.
• Chest was bilaterally symmetrical.
• No scarification marks on chest.
• Chest movement and expansion was normal.
• Trachea was central.
• Normal percussion notes.
• Normal tactile fremitus.
• Vocal resonance and vesicular breath sounds.
16

19. EXAMINATION CON’T
ABDOMEN:
• Was symmetrical, not distended, moves with respiration, no
scars and no distended veins.
• No area of tenderness.
• Liver span was 14cm.
• Percussion note was tympanic.
• Bowel sounds were normal.
17

20. DIAGNOSIS
• Traumatic forearm amputation of left upper limb secondary
to road traffic accident.
18

21. DIFFERENTIAL DIAGNOSIS
• Amputation due to diabetic vasculopathy.
• Amputation due to osteosarcoma.
19

22. MANAGEMENT
• Primary survey and resuscitation:
-A,B&C of resuscitation.
• Secondary survey and evaluation:
-Detailed History, Examination & Investigation.
• Definitive treatment:
-Wound dressing, bandage wrapping, pain control,
exercise, and psychological support.
20

23. HOME VISIT
Maryam Shehu Ingawa
U17MD2009
21

24. AIM
• To assess the patients home and environment for risk factors
associated with road traffic accidents.
• To identify other problems in the environment that can affect patients
health.
• Counselling.
• To offer health education.
22

27. FINDINGS
• Road factors
• Poor functional road and maintenance
• Improperly planned road
25

28. FINDINGS
• VEHICLE FACTORS
• Bad vehicle/motor maintenance
• Crash protective design
• Overcrowding in the vehicle
26

29. FINDINGS
• DRIVERS FACTORS
• Distracted driving
• Drunk driving
• Teenage drivers
• Driving under influence of drug
• Drowsy driving
27

30. COUNSELLING
• Good functional road
• Good driving behavior
• Good vehicle/Motor maintenance
• Proper driving education
• Avoid use of mobile devices and gadgets while driving
• Avoid over-speeding

31. HEALTH EDUCATION
• Regular sleeping
• Improvement of general hygiene
• Wearing of seatbelts
• Avoid over crowing in the vehicle
• Importance of seeking awareness on RTA
• Importance of good occupational practices
28

32. LITERATURE REVIEW
U17MD2012
10/7/2021 32

33. OUTLINE
• Introduction
• Definition
• Phases of RTA
• Causes
• Road Accident Studies on Critical Factors
• Studies on Various Road Safety Models
• Conclusion
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34. INTRODUCTION
• Road traffic accidents (RTAs) are a common cause of disability and also a
leading cause of injury-related death all over the world (Krug, Sharma, and
Lozano, 2000).
• According to data recently released by the World Health Organization (WHO,
2013), an estimated 55 million people died worldwide in the year 2011. Of
these, 1.3 million were due to road injuries, equating to roughly 3500 each
day from road traffic injuries.
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35. • Transport is a critical sector of the Nigerian economy, whose effect, particularly
on socio-economic development, cannot be overemphasized. Over 80% of
transportation in Nigeria is done by road (Afolabi and Gbadamosi, 2017).
• According to The Economist (2013), this makes the situation especially
problematic in Nigeria because of poor traffic infrastructure, poor road design,
poor enforcement of traffic rules and regulations, a rapidly growing population,
and subsequent number of people driving cars (The Economist, 2013) .
10/7/2021 35

36. DEFINITIONS
• The WHO (1979) defines Road Traffic Accident, or motor vehicle
crash, as an event occurring on a street, road or highway, in which at
least one motor vehicle in motion is involved by collision or losing
control, and which causes physical injury or damage to property.
• While Jha et al (2004) define RTA as accident which took place on the
road between two or more objects, one of which must be any kind of
a moving vehicle.
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37. DEFINITION CONT’D
• Fatalities are deaths that occur within 30 days as a result of a motor
vehicle crash. This is the standard definition recommended by the
Economic Commission for Europe and the World Health Organization
(WHO, 1979).
10/7/2021 37

38. DEFINITION CONT’D
• Furthermore, Odero, Garner, and Zwi (1997) define injuries as number of
persons who sustain tissue damage, which may be slight or serious, in a
motor vehicle crash.
• And lastly, Casualties are the total number of fatalities and injuries resulting
from a motor vehicle crash (Odero, Garner, and Zwi, 1997)
10/7/2021 38

39. PHASES OF RTA
• Afolabi and Gbadamasi (2017) argued that the critical evaluation of accident
indicates three specific phases. These are;
• Pre-Accident Phase:- it implies all situations and circumstances preceding
the occurrence of an accident. Under this phase, falls all the contributory
factors like the environment, the vehicle, the road users/persons, and the
preventive or precautionary measures taken to normally avert accident.
10/7/2021 39

40. PHASES OF RTA
• The Accident Phase:-Once the pre-crash phase cannot be averted,
the crash phase is the actual occurrence of the accident, when the
mechanical device is involved in actual collision resulting in an
accident. The type of outcome from the accident to the victim also
belongs to this phase. The focus of this second phase, therefore, is on
injury prevention.
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41. PHASES OF RTA
• Post-Accident Phase:- This can be described as the process of evaluating or
assessing the consequences of road accidents. Such evaluation is based on
socio-economic, environmental and political effects, using quantifiable and
qualitative analytical tools.
10/7/2021 41

42. CAUSES OF RTA
• According to AUSTROADS (1994), road accidents occur as a result of one, or more
than one of the following factors: human factors; vehicle factors; road and
environmental factors.
• The factors of traffic accidents are driver, the highway and motor vehicles
(Balogun and Abereoje, 1992).
• Most traffic accidents often involve the three elements. While most RTAs involve
motor vehicles, bicycles or pedestrians accidents can occur without vehicles(Stutts
and Hunter, 1999)
• A high proportion of RTA can be apportioned to unsafe human acts. The drunk
drivers of motor vehicles make the clearest example(Hijar et al, 2000).
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43. CAUSES OF RTA CONT’D
• Reckless and dangerous driving, alcoholism, faulty pedestrian attitude, etc
constitute the major causes in Nigeria(Ezenwa, 1986)
• Eke, Etebu, and Nwosu (2000) using the data collected from the University
of Port Harcourt Teaching Hospital from January 1986 to December 1995
found that 70% of total accidents in Port Harcourt, Nigeria occurred during
the rainy seasons and that most accidents occurred during the weekends.
10/7/2021 43

44. CAUSES OF RTA CONT’D
• Mechanical faults and road defects which can be grouped under vehicle
and road and environments factors respectively are also significant cause
of RTA. This is in agreement with AUSTROADS (1994) that says that one
or more of human, vehicle and road and environmental factors must be
involved for RTA to occur.
10/7/2021 44

45. CAUSES OF RTA CONT’D
• Afolabi and Gbadamosi (2017) noted that amongst the three categories, the
human factors is responsible for over 80 percent of all traffic crashes because
the drivers’ operational ability is very critical to the causes and prevention of
traffic accidents.
• Almost to the point of indisputability is the fact that, of virtually all the
significant factors contributing to the alarming proportion of accidents on
Nigeria roads, the human factor tops the list.(Afolabi and Gbadamosi, 2017).
10/7/2021 45

46. CAUSES OF RTA CONT’D
• Indicators to verify the claim are evident:
• (a) Prevalent disregard of road traffic signs by road users;
• (b) Lack of proper training of drivers;
• (c) Irresponsible driving habit particularly among teenage drivers;
• (d) Inexperience and incompetent drivers;
• (e) Over speeding, dangerous driving and total disrespect of traffic regulations
especially concerning speed limits;
10/7/2021 46

47. CAUSES OF RTA CONT’D
• (f) Drink driving and/ or driving under the influence of drugs including herbal
concoctions laced with spirit;
• (g) Lack of respect / consideration for other road users;
• (h) Impatience and negligence
• (i) Overloading of vehicles;
• (j) Fatigue;
• (k) Poor vision (Afolabi and Gbadamosi, 2017).
10/7/2021 47

48. Road Accident Studies on Critical Factors
• The critical factors affecting accident severity were featured in various
reports.
• Kristle and Regan (2007) reviewed the aspects on in-vehicle driver
distraction, focusing on mobile phone use in particular, stated that this device
has received the greatest attention in the driver distraction literature. The
paper also discussed the effect of in-vehicle devices on driving performance.
10/7/2021 48

49. Studies on Various Road Safety Models
• Kasimani et al (2015) illustrated road safety statistical models to predict injury
accidents. Two accident prediction models one associated with two-lane rural
roads and the other with multilane roadways were calibrated using procedure
based on least squares method with a confidence level of 95%.
• Traffic flow, lane width, vertical slope and curvature change rate and roadways
segments length were the explanatory variables.
10/7/2021 49

50. Studies on Various Road Safety Models
• Haigney and Westerman (2000) studied the possible effects of
mobile phone usage on driving performance with thirty
participants using stimulators and reported. The results disclosed
decrease in mean speed and the standard of the participants
during conversation on the mobile phone.
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51. Studies on Various Road Safety Models
• Accident Analysis and prevention by Taimur, Liping, Luis (2010)
presented a modelling approach that associated accident frequency
with road surface conditions, visibility and other influencing factors
during a snow storm event. The paper explained the empirical
relationship between safety and road surface conditions, and made
quantification of safety benefits easier.
10/7/2021 51

52. Studies on Various Road Safety Models
• Eke, Etebu, and Nwosu (2000) using data collected form University of Port
Harcourt Teaching Hospital (UPTH) from January 1986 to December 1995
found that 70% of total accidents in Port Harcourt, Nigeria occurred during
the rainy seasons and that most accidents occurred during the weekends.
• This study follows the same path and analyses data on the reported
number of RTAs for the period 2000-2008 along (Obinze/Ihegwa/Nekede)
road in Owerri West Local Government Area (LGA) (Ohakwe, Iwueze, and
Chikezie, 2011) .
10/7/2021 52

53. Studies on Various Road Safety Models
• The research by Hindle and Hindle (2011) reported the rates of
personal injury collisions (PIC). A significant difference in
improvement rate was observed between urban and rural dimension
and was very much depended on prior PIC risk levels. The study
featured the accident scenario of sites under the continual
surveillance of camera and its impact on accidents.
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54. CONCLUSION
• Road traffic accident in Nigeria has not received the attention warranted
considering the magnitude of the problem(Ezenwa, 1986).
• According to Rafindadi (2000), vehicular factor can be improved through
better vehicle design and maintenance; roadway factors through better road
design and maintenance.
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55. EPIDEMIOLOGY
U17MD2010
5/29/2023

56. Distribution....
• Global
• Approximately 1.3 million people die each year as a result of road
traffic crashes.
• Road traffic crashes cost most countries 3% of their gross domestic
product.
• More than 93% of the world's fatalities on the roads occur in low-
and middle-income countries, even though these countries have
approximately 60% of the world's vehicles.
5/29/2023 56

57. Distribution......cont.
• Fig. 1
5/29/2023 57

58. Distribution......cont.
• More than half of all road traffic deaths are among vulnerable road
users: pedestrians, cyclists, and motorcyclists.
• Road traffic injuries are the leading cause of death for children and
young adults aged 5-29 years.
• About three quarters (73%) of all road traffic deaths occur among young
males under the age of 25 years who are almost 3 times as likely to be
killed in a road traffic crash as young females.
5/29/2023 58

59. Distribution......cont.
• IN SUBSAHARAN AFRICA
• In Sub-Saharan Africa, RTA have increased from 41 to 93 per 100,000
population over a fifteen-year period up to 2015
• RTA account for one third of trauma cases admitted to health facilities
• RTA case fatality rates for the Africa region in 2013 were estimated at 27
per 100,000 population
5/29/2023 59

60. Distribution......cont.
IN NIGERIA
• Nigeria is ranked second-highest in the rate of road accidents among
193 countries of the world.
• Nigeria has the highest rate of fatalities from motor accidents in
Africa according to statistics.
• Nigeria leads 43 other nations with 230 deaths in 10,000 vehicle
crashes followed by Ethiopia, Malawi and Ghana with 219, 183 and
178 deaths per 10,000 vehicles respectively (Daramola, 2015).
• International comparison indicates that the chance of a vehicle killing
someone in Nigeria is 47 times higher than in Britain.
5/29/2023 60

61. Distribution......cont.
• Fig. 2
5/29/2023 Presentation on HIV/AIDS 61

62. Distribution......cont.
• Based on Medical Records Office and Casualty ward of Ahmadu Bello
University (A.B.U) Teaching Hospital, Zaria.
• It was found that there were more RTA on Tuesdays(16.10%) and
Wednesdays (16.63%) than Fridays(11.52%) and Saturdays(11.87%)
• More cases of RTA were witnessed in the months of September(9.48%) and
October(11.20%) than in February(6.82%) and June(2.82%).
• Recklessness and negligence of drivers account for(23.58%) and was found
mostly to be responsible cause of RTA while intoxication account
for(0.59%)
5/29/2023 62

63. Risk Factors
• Over speeding
• Driving under the influence of alcohol and other psychoactive
substances
• Nonuse of motorcycle helmets, seat-belts, and child restraints
• Distracted driving
• Unsafe road infrastructure
• Unsafe vehicles
• Inadequate post-crash care
• Inadequate law enforcement of traffic laws
5/29/2023 63

64. PREVENTION AND CONTROL
BY IBRAHIM AISHA MACHIKA
U17MD2013
59

65. LEVELS OF PREVENTION
• Primordial
• Primary
• Secondary
• Tertiary

66. RISK FACTORS
• Over Speeding.
• Alcohol intake.
• Nonuse Motor cycle helmets.
• Disregard use of seat belt and child restraint.
• Mobile phone usage.
• Widespread disregard of traffic rules
• Defective roads, poor street lighting, defective layout of cross roads and
cross beakers.
• Sudden mechanical defects.

68. PRIMORDIAL PREVENTION
• Entails actions and measures that prevent emergence of risk factors in
form of environmental, social, behavioral and vehicle factors in
population group in which they have not appear.

69. Primordial prevention
• Government policies, laws and legislation that includes;
• Enacting and enforcing legislations on key risk factors
• Government legislation on improvement of road infrastructure

70. PRIMARY PREVENTION
• Involves actions taken prior to onset of accident to remove possibility
that the accident will occur
• Achieved through safety education and promotion of safety
measures.

71. Primary prevention
• Safety education;
• Driver should be educated on:
• Proper maintenance of vehicles and safe driving
• Traffic rules and road signs
• Promotion of safety measures
• All drivers should be properly trained and should possess a valid driving license
• Use of helmets
• Drivers should avoid alcohol and drugs
• Avoid distraction while driving
• Carryout periodic medical checkup especially vision and hearing of the driver
• Indiscriminate honking should be avoided

73. Secondary Prevention
• Many deaths and impacts of injury can be prevented with first aid if
casualties are treated immediately
The basic aims of first aid are;
• To save life
• To protect the casualty from getting more harm
• To reduce pain and priorities of casualty treatment

74. Secondary prevention cont’d
• Immediate management in a RTA situation is based on ATLS protocol
• Primary survey;
initial assessment and management of a trauma patient, it is
conducted to detect and treat actual or imminent life threats and prevent
complications from these injuries, a systemic approach using ABCDE is used
• Secondary survey;
entails detailed history and examination of the patient with the
objective of identifying all injuries sustained, also monitor and review the
success of primary survey and establish a diagnosis

75. Tertiary prevention
• Aimed at treatment and limitation of complication following injuries
• effective first aid
• appropriate hospital care
• Rehabilitation services .
• Palliative care.

76. CONTROL
• The control of RTA is based on;
• The review of key risk factors
• Making progress in improving key road safety laws, making infrastructure
safer adopting vehicle standards and improving access to post crash care

77. Control cont’d
• International Agencies/Programs
• Drivers and vehicle standards agency (DVSA); Responsible for
annual testing of vehicles and enforcement checks on the maintenance
standards of vehicle
• Driver and vehicle licensing agency (DVLA); promotes road safety
and general law enforcement ,registers of drivers and vehicles

78. • Federal road safety commission (FRSC): conducts road safety audit on
Nigerian roads for road crash prevention
• Federal roads maintenance agency (FERMA): Monitoring and
maintenance of all federal roads in Nigeria

79. CONTROL CONT’D
Local Agencies/programs
• State ambulance services
• State road maintenance agencies
• State traffic management such as;
• Kaduna state traffic and environmental law enforcement agency (KASTELEA)
• Kano state road and traffic agency (KAROTA) responsible for educating and
enlightening road users and members of the public on the proper use of roads as
well as to enhance and designate bus stops and bus terminal

80. REFERENCES
• Afolabi, J. and Gbadamosi, K. (2017) ‘Road traffic crashes in Nigeria: causes and consequences,’ Transport & Logistics: the
International Journal, 17.
• Asogwa, S.E. (1992) ‘Road traffic accidents in Nigeria: a review and a reappraisal’, Accident; analysis and prevention, 24(2),
pp. 149–155.
• AUSTROADS (1994) Road Safety Audit. AUSTROADS Publication, Sydney, Australia.
• Balogun, J.A. and O.K. Abereoje, 1992. Pattern of road traffic accidents cases in a Nigerian university teaching hospital
between 1987 and 1990. J. Trop. Med. Hyg., 95: 23-29.
• Eke, N., Etebu, E., and Nwosu, S. (2000) ‘Road traffic accident mortalities in port harcourt, Nigeria’, Anil Aggrawals Internet J.
Forensic Med. Toxicol., 1(2).
• Ezenwa, A.O. (1986) ‘Trends and characteristics of road traffic accidents in Nigeria’, J. R. Soc. Health, 106, pp. 27-29.
• Haigney, D.E. and Westerman, S. J. (2001) ‘Mobile (cell) phone use and driving: A critical review of research methodology’,
Ergonomics, 44, pp. 132– 143.
• Hindle, G. and Hindle, T. (2011) ‘Safety Cameras and Road Accidents: Effectiveness in Local Authority Areas in
England’, J. of the Op. Res. Soc. 62, pp. 1181-1188.
• Jha, N., Srinivasa, D., Roy, G., and Jagdish, S. (2004) ‘Epidemiological study of road traffic accident cases: A study from
South India’, Indian J. Community Med, 29, pp. 20-24.
• Kasimani, R., Muthusamy, P., Rajendran, M., and Sivaprakash, P. (2015). ‘A Review on Road Traffic Accident and Related
Factors’, International Journal of Applied Engineering Research.
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81. REFERENCES
• Kristle, Y. and Regan, M. (2007) ‘Driver distraction: A review of the literature’, In: Faulks, I., Regan, M. Stevenson,
J. Brown, A. Porter & J.D. Irwin (Eds.). Distracted driving. Sydney, NSW: Aust. College of Road Safety, pp. 379-
405.
• Krug, E.G., Sharma, G.K., and Lozano, R. (2000) ‘The global burden of injuries’, Am J Public Health, 90, pp. 523–6.
• Odero, W., Garner, P., and Zwi, A. (1997) ‘Road traffic injuries in developing countries: a comprehensive review of
epidemiological studies’, Tropical Medicine and International Health, 2(5).
• Ohakwe, J., Iwueze. S., and Chikezie, C. (2011) ‘Analysis of Road Traffic Accidents in Nigeria: A Case Study of
Obinze/Nekede/Iheagwa Road in Imo State, Southeastern, Nigeria’, Asian Journal of Applied Sciences, 4, pp. 166-
175.
• Rafindadi, A.H. (2000) ‘A Review of Types of Injuries Sustained Following Road Traffic Accidents and their Prevention’,
Nigerian Journal of Surgical Research, 2(3).
• Taimur, U., Liping, F., and Luis, F. (2010) ‘Miranda-Moreno,(2010).Quantifying safety benefit of winter road
maintenance: Accident frequency modeling’, Accident Analysis and Prevention, 42(6), pp. 1878-1887.
• The Economist (2013) Driving in Nigeria, Time for a Test. Available from: http://www.economist.com/news/middle-east-
and-africa/21579057-why-nigerias-roads-can-be-terrifying-time-test. (Accessed: 06, September, 2021).
• World Health Organization (WHO) (1979) Road traffic Accidents statistics. Copenhagen: The Economic Commission
for Europe and the WHO.
• World Health Organisation (WHO) The 10 Leading Causes of Death in the World, 2000 and 2012 (2013). Available
from: http://www.who.int/mediacentre/factsheets/fs310/en/index.html. (Accessed: 10th March, 2021).
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