ACKNOWLEDGEMENT
I am grateful to God for providing me with sustenance during my endeavors. I also want to express appreciation to Dr. Isaac Owusu, my supervisor, as well as the facilitators of the course and management at KATH and LSTM for their valuable contributions that made this project possible. Special thanks go to Miss Felicia Agbenorwu, a Research Assistant at the Trauma and Orthopaedics Directorate at KATH, who administered the questionnaires. To all respondents, ‘Ayeeko.’ Congratulations are in order for my husband, family, and friends for their unwavering support. Lastly, I acknowledge the productive interactions, suggestions, and criticisms from my course mates. THANK YOU ALL.
ABSTRACT
Background: Many accident victims often experience a disruption in their social life and inability to return to work, which affects their social and economic status. Objectives: The purpose of this study is to assess the socio-economic impact on road traffic accident victims at KATH.
The study methodology involved a descriptive cross sectional study with 82 patients who received treatment for injuries from road traffic accidents. The study took place from May 1st to September 31st, 2012. Patients who were discharged and came for review were included in the study after giving consent. Questionnaires were used to gather information on the socio-economic impact of the accidents. Data on the types of injuries and levels of incapacitation were obtained from patients’ folders and final medical reports.
The results showed that accidents were most common among individuals aged 20-40, with an average age of 38.78 years (s.d = 9.64). The age range of patients in the study was between 18 and 60 years.
62.20% of the respondents were below 40 years old and 58.50% experienced long bone injuries as victims in this study. Despite having a good relationship with their families (60% of the victims), the restricted movement caused by the RTA made them rely on their families for social gatherings, becoming burdens on them. In terms of economic impact, before the accident, 93.90% of the victims were employed and served as primary earners for their families at a rate of 85.53%. However, after the accident, 88.64% lost their jobs which affected them economically and left them unable to fulfill their breadwinning responsibilities. Additionally, approximately only 5% of the victims faced higher levels of incapacitation reaching around 40%.
In this study, it was found that road traffic accidents (RTA) were prevalent among individuals under 40 years old. Additionally, a large portion of the victims served as the main financial providers for their families, resulting in job loss and causing economic and social difficulties for their households. Moreover, over half of the victims experienced limitations in their social activities.
Chapter 1
1.1 Introduction
Road Traffic Accident (RTA) is a global concern, especially in developing countries, where it is a leading cause of disability and death. According to the World Health Organization (WHO), there are over 1.2 million annual fatalities and more than 50 million serious injuries caused by RTAs worldwide. Without immediate and coordinated action at both global and national levels, the WHO predicts that RTA deaths could reach two million per year by 2020. While high-income countries expect a 30% reduction in road crashes in the next decade, low and middle-income countries like Ghana are projected to experience an 80% increase.
In Ghana, RTAs have become a significant public concern due to frequent fatal accidents that result in loss of life and disabilities for individuals and their families. These accidents have substantial social and economic consequences for the country, contributing to its overall mortality rates.
The Accident and Emergency Center, Komfo Anokye Teaching Hospital, serves as a referral center for the northern sector. Since its establishment, it has witnessed numerous accident cases that have resulted in loss of life and various injuries with potential effects on daily activities. Some victims have experienced significant social and economic repercussions due to these accidents. This study aims to evaluate the socioeconomic impact of road traffic accidents (RTA) on victims by examining their social and economic consequences. The results will serve as a wake-up call for leaders, policymakers, and individual road users regarding the importance of implementing and adhering to road safety measures in order to reduce RTAs in the country. 1.2 Main objective
The study aims to assess the socio-economic impact on victims of road traffic accidents. It specifically seeks to determine the types of injury, level of incapacitation, social impact, and economic impact on victims after the accident. The study also includes a definition of terms for clarity.
An RTA, or Road Traffic Accident, occurs when a vehicle collides with another vehicle, pedestrians, animals, road debris, or stationary obstructions. Socio-economic factors are the social and economic aspects that accident victims may experience due to the incident. Impact refers to the effect that the RTA can have on these victims. Victims are individuals who were involved in the accident. Pelvic Injury refers to harm inflicted on the bones of the pelvic region. Long Bone Injury involves specific bones like the humerus, ulner, radius, femur, tibia, and fibula being injured.
Chapter 2
2.1 Literature review
Road Traffic Accident (RTAs) refers to a situation where a vehicle collides with another vehicle, pedestrians, animals, road debris, or any other stationary obstruction. This type of accident is a global catastrophe that leads to loss of lives and livelihoods, hampers development, and puts millions of people at risk. The incidence of casualties resulting from road traffic accidents is particularly prevalent in low and middle-income countries, with rates often surpassing twenty deaths per 100,000 individuals annually or around 500,000 deaths each year. In India, the number of fatalities on the roads is eighteen times greater than that in Japan, amounting to 60,000 deaths annually. Ghana also faces an alarmingly high rate of RTAs as one of the developing African nations.
According to statistics from the Ghana National Road Safety Commission, Ghana experiences 11,400 road crashes annually, resulting in 1,400 injuries and 1,800 deaths. Despite efforts by the Motor and Traffic Unit Ghana Police Service to address this issue, there is growing concern about the rising number of road traffic accidents (RTAs) in the country.
A study by Samuel Obour reveals a consistent increase in road traffic accidents over time. In 2007 alone, Ghana witnessed 1,346 deaths due to road accidents. This number rose by 13 percent in 2008 to reach 1,520 deaths. Comparing the figures from 2007 to those of 2009 shows an additional loss of 1,587 lives; representing a significant increase of19 percent. Furthermore, this number further escalated by another30 percent in2010with a total of1,760deathsreported.
In terms of transportation methods within Ghana’s borders,r oad travel remains dominant with it accounting for96%of national freight tonnage and97%of passenger traffic. Amongst six West African countries surveyed in2010,Ghana ranked as thesecond highest accident-prone nation with arateof73deaths per10 ,000accidents.Many survivors of these accidentsin thenorthern sectorreceived care atKATH medical facility.
Komfo Anokye Teaching Hospital, located in the Ashanti Region of Ghana, serves as a referral center to the Northern Sector. In May 2009, the hospital was inaugurated and recorded 1,862 cases from May to December of that year. The following years saw an increase in cases with 3,548 and 3,678 respectively. These figures include an accident involving President Atta Mills’ convoy during their presidential election congress from Sunyani to Accra. Fortunately, there were only injuries and no lives lost in this incident. Unfortunately, other leaders’ convoys have not been as fortunate and have resulted in painful loss of life. During ex-President John Agyekum Kuffour’s tenure, his convoy was involved in at least three serious accidents resulting in the deaths of three security personnel and two members of parliament. These examples highlight the significant impact road traffic accidents (RTAs) have on individuals, families, society, and the country as a whole. RTAs in Ghana are caused by various factors including equipment failure, poor maintenance, roadway design, and driver behavior.
Equipment failure, such as brake loss, tire blowouts or tread separation, is a contributing factor to road traffic accidents (RTAs). Additionally, poor road maintenance, including potholes, faded road signs, road construction, and unmarked obstacles, also contributes to some RTAs.
2 The Highway Authorities sometimes fail to rectify these problems in a timely manner, which occasionally contributes to road traffic accidents (RTAs). Additionally, driver behaviors such as overspeeding, overtaking, poor car maintenance, fatigue driving, and drunk driving are also considered to be causes of RTAs.
According to a study in Europe, 80% of drivers involved in road traffic accidents (RTAs) believed that the other party could have taken action to avoid the accident, while only 5% admitted their own fault.
Both the lack of discipline in the Mottor and Traffic Unit (MTTU) and the corruption within the Driver and Vehicle licensing Authority (DVLA) in Ghana pose significant dangers to road users. Drivers who are unfit or have inadequate vehicles have been able to obtain legitimate licenses and documents by falsely declaring themselves and their vehicles as roadworthy. Unfortunately, police officials responsible for enforcing road laws often ignore these vehicular crimes, unintentionally contributing to accidents. The consequences of these accidents are severe, affecting individuals, society, and the nation as a whole. There are socio-economic impacts such as a high dependency burden caused by disabilities, which may result in unemployment. Furthermore, with men accounting for 67% of national casualties, there is a worrying increase in the number of widows and female-headed households.
The most common injuries in road traffic accidents (RTA) are long bone and pelvic injuries. In Pakistan, a study found that fractures of bones, known as long bone injuries, were the most prevalent among survivors. Out of 150 survivors, there were 90 cases of long bone injury. Furthermore, accident victims’ level of incapacitation is determined using the workman’s compensation law from 1897 (PNDC 187), regardless of whether they were injured during official duties. This law assigns a specific rating to each type of injury. For example, if a victim loses two or more parts of their hand, their level of incapacitation will not exceed that for the loss of the entire hand.
Ten individuals impacted by road traffic accidents (RTA) suffer economic consequences as their ability to work and earn income is hindered. While they may receive some compensation based on their vehicle insurance, it may not be sufficient to support them throughout their lives. With the victims being the main breadwinners, the responsibility of providing for the family falls upon them. Consequently, dependents of these victims end up dropping out of school, facing social disadvantages, and potentially getting involved in criminal activities. Moreover, funeral expenses for any deceased victims further burden the family financially. Apart from financial repercussions, the victims also encounter limitations in engaging in social events like church services, funerals, parties, and more.
The burden of assisting social gathering victims falls on families and society, as well as restricts the movement of the victims. While the National Health Insurance Scheme covers some hospital bills, it does not cover all care deliveries, resulting in the inability to pay for non-insured bills after long-term hospitalization. Hospitals are responsible for caring for various individuals in need of healthcare, including victims of road traffic accidents (RTAs), who require urgent assistance. The initial healthcare provided to these victims is free, causing hospitals to incur losses. Healthcare providers must prioritize caring for RTA victims, putting additional strain on them. Some victims are unable to settle their non-insured bills after being hospitalized for an extended period, leading to waived bills and financial losses for the hospital. Insurance companies also bear significant costs in compensating RTA victims each year, posing a burden on their budgets. Furthermore, RTAs have a negative impact on the nation as a whole, resulting in the loss of lives, productivity, and contributions from highly talented and educated individuals essential for national development.If road crashes continue to frighten potential domestic and international tourists, tourism development will not be achieved.
CHAPTER 3
METHODOLOGY
3.1 Study Type and Design:
The methodology used in this study was a descriptive cross-sectional approach. The study was carried out at the Trauma Unit of Accident and Emergency Center at KATH over a five-month period from May 1st to September 30th, 2012. The primary aim of the study was to assess the socioeconomic effects on individuals affected by road traffic accidents during this time frame.
3.2 Study site:
The Komfo Anokye Teaching Hospital is the second largest Teaching Hospital in Ghana. It serves as the main tertiary and referral health facility for the northern sector of the country, including the Ashanti, Brong Ahafo, Northern, Upper East, and Upper West regions. Additionally, patients from the Sefwi area of Western region and the Kwahu areas of Eastern region also receive care here.
The accident and emergency center at Komfo Anokye Teaching Hospital admits approximately 3,500 to 4,000 accident victims each year. The center is staffed by 6 specialists, along with resident and house officers divided into 3 teams. Nurses and healthcare assistants are also part of the team.
Between January and September 2012, the accident and emergency center admitted 2,255 accident cases. The center operates 24 hours a day. Minor injuries are treated and discharged, while patients with more severe injuries are admitted to wards C1 and C2, as well as the ICU, for further medical care.
3.3 Ethical Clearance:
The study obtained ethical clearance from the Committee on Human Research, Publications and Ethics of the Kwame Nkrumah University of Science and Technology, Kumasi. The clearance was given after the committee reviewed the study protocol. Every study patient provided consent, which was documented through signed or thumb-printed consent forms. These forms were kept separately in an envelope with no particular order before the administration of questionnaires. To maintain anonymity, the questionnaires were not matched with the consent forms and were not labeled with names. Respondents were assured of the confidentiality of their responses and that the study findings would be published without identification.
3.4 Study population:
The study population consisted of all road traffic accident (RTA) victims who were discharged and returned for review at KATH. The inclusion criteria were as follows:
1. Patients with a history of RTA
2. Patients who had been discharged and returned for review.
3. Consent for participation in the study.
4. Age group of 18-60 years.
3.6 Exclusion Criteria:
1. Patients who were on admission.
2. Patients whose incidents do not have any insurance cover.
3. Patients below 18 and above 60 years.
3.7 Sampling:
A convenient sampling method was used. The research assistant went to the consulting room to screen the accident victims and select the most eligible cases. Questionnaires were administered to those victims who had been discharged from admission and were coming for review. The research assistant also went through the folders to retrieve the needed information. Additionally, she reviewed their final medical reports to gather information concerning their level of incapacitation.
3.8 Sample Size:
The survey was conducted with a sample size determined by specific assumptions. These assumptions included a confident limit of 95%, an estimated emerging error of 10%, and an assumed proportion of accident victims with socio-economic problems of 70%. Thus, a minimum of 81 accident victims were required for the study. In total, 82 respondents were interviewed during the study period.
3.9 Data Collection:
The data collection utilized the services of a research assistant who was responsible for screening accident victims and recruiting eligible individuals into the study. Those who were able to read were given a consent form to read and provide consent. For those who were unable to read, the consent form was explained in the local language in order to obtain their consent. The signed or thumb-printed consent forms were placed in separate envelopes. The research assistant administered a structured questionnaire, which covered socio-demographic information, social status, and economic status, to the participants. Additionally, the research assistant retrieved information on types of injuries from the participants’ folders. Lastly, the same research assistant gathered information from the insurance company using the last question on the questionnaire.
3.10 Data Management and Analysis:
The data entry for Epidata was carried out and then exported to Stata Corporation’s 4905 software (located at Lakeway Drive College Station, Texas 77845 USA) for analysis. Age was analyzed by calculating the mean and standard deviation. Frequencies, percentages, figures, and tables were also generated using this software.
CHAPTER 4
RESULT AND DATA ANALYSIS
During the five-month study period, a total of 82 respondents were interviewed. The sociodemographic characteristics of the respondents are presented in Table I below:
Table I
Factor n(%)
Age n = 82
20-40: 51 (62.20)
>40: 31 (37.80)
Mean(SD): 38.78 years (9.64 years)
Sex n = 82
Male: 48 (58.54)
Female: 34 (41.46)
Marital Status n = 82
Married: 45 (54.88)
Single: 27 (32.93)
Divorce: 8 (9.76)
Separated:2(2•44) < br/>< br/>
Educational level n =82 < br/ >
Non-formal :15(18•29) < br/ >
Primary :38(46·34) < br/ >
Secondary :20(24·39) < br/ >
Tertiary :9(ll·98) < br/ >< br/ >
Religion
n=82
Christianity
76 {92·68}
Muslim
6 {7•32}< br / >
Occupation
n=81
Trader
36 {44•44}
Artisan
19{23•46}
Farmer
10{12•35}
Civil servant
7{8•64}
Driver
6 {7 •41}
Menial work
2{2 •47}
Unemployed
1{l .23}
62.20% of the victims in this study are aged between 20 and 40, with an average age of 38.78 years. There were more males (58.54%) than females involved in road traffic accidents (RTA). The majority (54.88%) of the respondents were married, while only 2.44% were separated. Around 46.34% of the victims had primary education, and approximately 10.98% had tertiary education. Most of them identified as Christians (92.68%), while the remaining 7.32% were Muslims.
Among the respondents, trading was the most common economic activity, accounting for 44.44%, whereas only 1.23% were unemployed.
The study also examined various types of injuries which will be further discussed.
Table II: Types of Injury
Factor
n(%)
Type of injury
n = 82
Pelvic injury
Long bone injury 34(41.5)
48(58.5)
Table 2 shows that approximately 58.5% of the victims suffered from long bone injuries, whereas 41.5% had pelvic injuries.
The social impact of victims involved in road traffic accidents is illustrated in Figure 1. It shows the distribution of how families assisted these victims in facilitating their movements after the accident.
Following the accident, 77% of the victims required support from their families to navigate, whereas only 23% could do so independently.
Figure 2 depicts the dispersion of aid given by friends and families to those affected after the accidents.
The data reveals that a majority of victims (60%) had positive relationships with their friends and family, but approximately one-third experienced difficulties or strained relations with their loved ones after the accident. Only 10% of the victims reported having an excellent relationship.
4.4 Economic Impact on RTA Victims
The working status of the victims before and after the accidents was compared in fig. 3 below.
Fig. III: Distribution by Comparing Working Status before and After the Accident
Before the accident, the majority of victims (93.90%) were employed while a small fraction (6.10%) were unemployed.
After the incident, most of these individuals (88.46%) were unable to go back to their previous jobs, but a few (11.54%) managed to return to work.
Fig. IV: The distribution of breadwinner responsibilities before and after the accident.
Fig. 4 above illustrates the shift in breadwinning responsibilities pre- and post-accident. Initially, a significant majority (85.53%) of individuals were accountable for financially supporting their families. Nevertheless, following the accident, the majority (92.96%) found themselves unable to fulfill this obligation. Merely a small fraction (7.04%) of victims retained the capacity to provide economic support to their families after the accident.
The distribution of the level of incapacitation is depicted in Figure V.
The distribution of the level of incapacitation is shown in Figure 5 above. Around 48% of victims had an incapacitation level ranging from 20% to 40%, while only 5% had a level between 41% and 65%. The remaining 47% had an incapacitation level below 20%.
CHAPTER 5
5.1 DISCUSSION
Road traffic accidents (RTAs) are a global issue that affects every nation in the world. The frequency of news about RTAs remains constant, and it is crucial to analyze this hazard critically to prevent loss of life. The socio-economic impact on accident victims, especially among young individuals aged 20 to 40 years, is a common concern. According to a study conducted by The World Health Organization (WHO), more than half of the deaths resulting from RTAs occur in the age range of 15–44 years, which includes a significant portion of the working population. This highlights the necessity for greater attention and support from all members of communities worldwide.
The study also revealed that males accounted for 58.54% of RTA victims, aligning with Mr. Noble John Appiah’s findings stating that males were involved in 67% of accident cases. Regarding education level, primary education was most prevalent among the victims, representing 46.34% of cases.
Various studies have shown similar patterns.For example, research conducted in Bangkok, Thailand found that lower-educated patients comprised the majority in both rural areas (46.3%) and urban areas (17.1%). Another study conducted in Mwanza, Tanzania showed that self-employed individuals made up 59.5% of patients with little or no formal education accounting for 57.9%.
The findings of the study conducted at the Komfo Anokye Teaching Hospital in Ghana align with global trends regarding injury types.
In the study, it was found that 58.5% of accident victims suffered from long bone injuries, which is similar to a study conducted in Pakistan where 60% of victims had the same type of injury. From a social perspective, it was discovered that 60% of victims received positive assistance from their relatives after the accident, while only 30% had strained relationships with their families. However, Asmaa Hassan Abu Hassan’s study yielded contrasting results, indicating varying levels of distress among family members and its impact on the interaction between victims and their families. This often resulted in interpersonal difficulties such as family friction and poor tolerance due to sudden changes in family dynamics and living/working conditions (9). Nevertheless, the current study suggests that Ghanaian victims maintained a positive relationship with their families due to strong social cohesion and family values. This finding aligns with the traditional Ghanaian proverb emphasizing hospitality (9). In terms of mobility, approximately 70% of previously mobile victims experienced restricted movement after the accident.This hindered their participation in social gatherings, either making them dependent on assistance or confining them to their homes due to discomfort caused by disabilities (9). A study revealed that road traffic accidents (RTA) have a severe economic impact on victims’ lives and negatively affect their social lives (9). Prior to the accident, almost all victims were employed and earning income, with a significant portion serving as breadwinners for their families. Unfortunately, the majority of these victims are unable to return to work, resulting in an inability to support their families. These findings align with previous research highlighting that RTA victims are often the main providers for their families. The sudden loss of these breadwinners creates financial hardship for dependents. In situations where male breadwinners die in an RTA, female-headed households may emerge, while the loss of female caretakers leaves men solely responsible for caring for the children alone. Consequently, dependents of RTA victims frequently experience negative consequences such as dropping out from school, facing social destitution, and potentially engaging in delinquency later on (9).
