My gratitude first goes to the Almighty God for his sustenance throughout my endeavours. I wish to express my profound gratitude to Dr. Isaac Owusu, my supervisor; and to all facilitators of the course and management of KATH and LSTM for the various contributions they made to make this project a reality. Special thanks go to Miss Felicia Agbenorwu, a Research Assistant at the Trauma and Orthopaedics Directorate, KATH who administered the questionnaires. To all the respondents I say ‘Ayeeko.’ My husband, family and friends deserve congratulations for their untiring support. Last but not the least, I acknowledge the healthy and fruitful interactions, suggestions and criticisms from my course mates. THANK YOU ALL.
Background: Most accident victims have their social and economic status being affected. This fact cannot be denied in the sense that most of the victims are deprived of their social life as well as going back to their various jobs after the accident. Objectives: To assess the Socio-Economic Impact on Road Traffic Accident Victims in KATH.
Methodology: A cross sectional descriptive study of 82 patients who were managed for various injuries of road traffic accident was carried out between 1st May and 31st September, 2012. Consents were given by patients who were involved in accident and were discharged from admission and came for review. Questionnaires were administered to them to assess the socio-economic impact on them. Types of injury were retrieved from their folders as well as their levels of incapacitation which were collected from their final medical reports. Results: Result from this study indicates that, accident is commonly found between the ages of 20 and 40 with the mean age of 38.78 years (s.d = 9.64). The range is 18-60 years.
More than half of the respondents (62.20%) were below 40 years of age. Types of injury was commonly (58.50%) found to be long bone injury among the victims. Although 60% of the victims had good relationship with their families, they were burden on their families. This is because 77% had their movement restricted by the RTA and had to depend on the family whenever there is the need to attend any social gathering. Victims were much affected economically in this study. This study shows that 93.90% were working before the accident and 85.53% were breadwinners of their families. More than 80% (88.64%) of the victims also lost their job after the accident hence their inability to take up their breadwinning responsibilities. Only 5% of the victims were found to have higher level incapacitation of about 40%.
Conclusion: In this study RTA was common among the under 40 years old. Majority of the victims were breadwinners of their families and lost their jobs after the accidents, thereby imposing economic and social hardship on their families. More than half of the victims also had their social life restricted.
Road Traffic Accident has become a disease responsible for most avoidable and quickest way one dies or hears of the death of a relative, loved one or friend few minutes after seeing or hearing from that person. Though RTA is said to be a global concern it is most especially known to be particularly high and as well as a major cause of disability and death in the developing countries. The World health Organization (WHO) estimates that over 1.2 million people are killed on roads every year with over 50 million more seriously injured. The organisation again predicts that by 2020, the number of people killed each year can reach two million if swift and coordinated action is not taken both at global and national levels. 1 It is further predicted that in the next decade road crash in high income (developed) countries will decline by 30 percent but will increase by 80 percent in low as well as middle income (especially developing African) countries like Ghana. 1 It has come to light that RTA is becoming a major public concern in Ghana. There has not been a single day passing by without the hearing of RTA in the Country; some could be very fatal claiming many lives and causing disabilities to loved ones, families, friends and many more which tends to have a lot of impacts on the society socially and economically. It is therefore known to be one of the causes of mortality in the Country.
Accident and Emergency Center, Komfo AnokyeTeaching Hospital which serves as a referral center in the northern sector has seen many accident cases since its establishment. Many lives were claimed and others too sustained different types of injury that might deprive them from being active as they use to be. Some of these accident victims had their social and economic lives affected significantly. Does road traffic accident have Socio-Economic impact on accident victims is a question that could be asked? This study is to assess the socio-economic impact of RTA on accident victims. It will find out how RTA has socially and economically affected the victims. The information provided at the end of this study would be used to serve as a wakeup call to the leaders, policy makers and individual road users to ensure that road safety measures are put in place and observed as to reduce the occurrence of road traffic accident in the country. 1.2 Main objective
To assess the socio-economic impact on road traffic accident victims. 1.3 Specific objectives
1. To determine the types of injury
2. To determine the level of incapacitation of victims
3. To determine how the victims are socially affected after the accident 4. To determine how the victims are economically affected after the accident 1.4 Definition of terms:
Road Traffic Accident – Is defined as a vehicle colliding with another vehicle, pedestrians, animal, road debris, or other stationary obstruction. Socio-economic – Is the social and economic aspect that the accident victim might encounter as a result of the accident. Impact – Is the effect that the RTA might have on the victim. Victims – They are the persons who are involved in the accident. Pelvic Injury – An injury to any part of the bones constituting the pelvic of the individual. Long Bone Injury – An injury involving any of the following: Humerus, Ulner, Radius Femur, tibia and fibula.
2.1 Literature review
Road Traffic Accident (RTAs) could be defined as a vehicle colliding with another vehicle, pedestrians, animal, road debris, or other stationary obstruction.2 RTA is a global disaster which destroys lives and livelihood. It also hampers development and leaves millions of people in vulnerability. The rates of casualties from road traffic accident are particularly high in low and middle-income countries with rates typically being over twenty deaths per 100,000 people per year, or around 500,000 per annum in total. 3 In India for example, roadway death rates are 18 times higher than those in Japan, amounting to 60, 000 fatalities per year. 3 Ghana, one of the developing African countries has no exemption in the alarming high rate of RTA prone countries.
According to the Ghana National Road Safety Commission statistics, 11, 400 road crashes occur annually resulting in 1, 400 injuries and 1,800 deaths. 4 Despite the constant sweet talk by the Motor and Traffic Unit Ghana Police Service, several observers are still worried that RTAs are increasing by year in the country. In a study conducted by Samuel Obour, there has been an increase in road traffic accident as the year goes by. In 2007, 1346 died in road accident across the country. In 2008 that figure increased by 13 percent to stand at 1,520. A further 1,587 people lost their lives in 2009, representing a 19 percent increase on the 2007 figures. This figure again increased by 30 percent in 2010 to stand at 1,760. 5 Road Transport is a sub-sector in Ghana which has the highest means of transportation and currently accounts for 96 percent of national freight tonnage and 97 percent of passenger traffic.1 Among six West African Countries, Ghana was rated second highest accident prone country with 73 deaths per 10,000 accidents in the year 2010. 1 Many more of the survivors of these accidents especially in the Northern sector were catered for in KATH.
Komfo Anokye Teaching Hospital is located in the Ashanti Region of Ghana and serves as a referral center to the Northern Sector. This center was inaugurated in May, 2009. During that year the cases recorded were 1,862 (May-December, 2009). In the second and the third year of its establishment, it recorded 3, 548 and 3,678 respectively. 6 These records include an accident which involved the President Atta Mills’ convoy when returning from Sunyani to Accra after their presidential election congress. Though no life was lost people were injured. There are so many instances of which convoy of some other leaders of the country were involved in RTAs. Some lives were painfully lost. During the tenure of the Ex-President John Agyekum Kuffour, his convoy was involved in at least three very serious accidents of which at least three security persons died.7 Two members of parliament also died as a result of RTA.7 Aside these examples of RTAs involving these prominent people in our society, many more people are killed or maimed through RTAs in the country. The effect of these RTAs on the individuals, families, societies and country at large is enormous. RTA which has become a dominating issue in the country could be attributed to many factors. Some of these factors could be named as equipment failure, poor maintenance, roadway design, driver behaviour and many more.
Equipment failure as one of the contributing factors to RTAs includes loss of brakes, tire blowouts or tread separation and many more. 2 Poor road maintenance is also one of the factors of some RTAs. This includes potholes, faded road signs, road way constructions and unmoveable obstacles without road signs.
2 These problems are sometimes not rectified at the right time by the Highway Authorities hence occasionally contributing to RTAs. Driver behaviour such as overspeeding, overtaking, poor car maintenance fatigue driving and drunk driving are also considered as cause of RTAs.
2 Many of these factors are avoidable. A study conducted in Europe concluded that 80% of drivers involved in RTAs believed that the other party could have done something to prevent the accident. Only 5% admitted that they were at fault.
2 In a country like Ghana where there is not much discipline in the Mottor and Traffic Unit (MTTU) and also the Driver and Vehicle licensing Authority (DVLA) is causing a major harm to road users. Corrupt officials in the DVLA have made it possible for unfit drivers with equally unfit vehicles acquired legitimate driver’s licenses and documents that declare them and their vehicles fit for the road. The attitude exhibited by the police officials on the road is also killing us. They are supposed to ruthlessly enforce the country’s road laws but they rather continue to close their eyes to vehicular criminality on the roads, thereby inadvertently contributing to accidents. These accidents have very serious impact on the individual, society and the nation as a whole. Some of the socio-economic impacts include disability and therefore a high dependency burden; the gravity of their disability could render some of them jobless. With men representing 67 percent of national casualties, it has serious implications of increasing number of widows and female headed households.
8 Long bone and pelvic injuries are regarded as types of injuries of RTA. Although long bone injury was describe as a partial injury (fractures of bones) in one of the studies conducted in Pakistan, it revealed that long bone injury was the most common survivors which showed in 90 cases from a total of 150 survivors. 9 Although the workman’s compensation law, 1897 (PNDC 187) is for employers who find themselves injured during the discharge of official duties, it is the same law that is being used to calculate the level of incapacitation for accident victims. This law clearly spells out as to what each and every type of injury should be rated for. In cases where the victim loses two or parts of the hand the percentage of the incapacitation shall not be more than for the loss of the whole hand.
10 RTA victims are economically affected in the sense that prior to the accident they might be working and earning an income which will no more be forthcoming because of the their inability to go back to work after the accident. Depending on the type of insurance the vehicle might have, the victims might be compensated with some amount of money but might not be sufficient to cater for the victims for the rest of their lives. As breadwinners the victims might be, such responsibility will be shifted onto the family. The dependants of such victims become school dropouts, social destitutes and eventual delinquents. Performing the funerals of those who might pass away too becomes a financial drain on the family. The victims will be deprived of involving themselves in any social activities. Some of them might completely not be able to attend any social gathering like church services, funerals, parties and many more.
Some of them might need the assistance of other capable people before they can be at any social gathering hence the burden of assisting those victims are shifted on to the families and the society as well as the victims movement been restricted. Although there is National Health Insurance Scheme that caters for part of the hospital bills, some of the care deliveries are not covered by the NHIS hence the inability to settle non-insured bills after a long term hospitalization. Hospitals are made to take care of different dimension of sick people who need health care delivery. RTA victims are one of those who need an urgent assistance from the hospital. The initial healthcare given to these victims are for free and run the hospital into a loss. The health care providers need to suspend attending to other patients to assist in taking care of the RTA victims. This puts extra burden on the healthcare providers. As some victims are not able to settle their non-insured bills after a long term hospitalization they are made to go home with a waived bill leading to the hospital incurring lost. Insurance companies have to pay huge sum of monies in compensation to victims annually. This constitutes a drain on their budgets. RTA impact negatively on the nation as a whole. The nation in the first place loses the lives, productivity and contributions of her highly talented and educated people whose talent, knowledge and experience are required by the country for national development. Tourism development will also not be realised if road crashes continue to scare away potential domestic and international tourists.
3.1 Study Type and Design:
This study used a descriptive cross-sectional method and was conducted in the Trauma Unit of Accident and Emergency Center at KATH over a period of five months. This study assessed the socio-economic impact on road traffic accident victims from 1st May to 30th September, 2012. 3.2 Study site:
Komfo Anokye Teaching Hospital is the second largest Teaching Hospital in Ghana. It is the main tertiary and referral health facility in the northern sector of the country. The catchment area of the hospital includes Ashanti, Brong Ahafo, Northern, Upper East and Upper West regions. Patients are also seen from the Sefwi area of Western region as well as the Kwahu areas of Eastern region. The accident and emergency center has been admitting between 3,500 and 4,000 accident victims annually. The directorate has 6 specialists with a number of resident and house officers divided into 3 teams, nurses and healthcare assistant. The center admitted 2,255 accident cases between the month of January and September, 2012. The directorate provides 24 hour services. Minor injuries are treated and discharged whilst patients with major injuries are admitted into ward C1 and C2 and ICU for further medical care.
3.3 Ethical Clearance:
Ethical clearance for the study was sought from the Committee on Human Research, Publications and Ethics of the Kwame Nkrumah University of Science and Technology, Kumasi. Ethical clearance was obtained after the review of the study protocol by the committee. Consent was administered and obtained from every study patient. The consent forms were signed or thumb- printed by the respondents and kept in a separate envelope in no particular order before questionnaires were administered. The questionnaire bears no name in order to keep it anonymous. There was no matching of the questionnaire with the consent form to ensure confidentiality. They are assured of their anonymity of the responses. The respondents were assured that the findings of the study would be published without identification. 3.4 Study population:
The Study population contained all RTA victims who have been discharged and come back for review in KATH. 3.5 Inclusion Criteria:
1. Patients with history of RTA
2. Patients who had been discharged and come for review.
3. Consent for the study.
4. Age group of 18-60 years inclusive.
3.6 Exclusion Criteria:
1. Patient who were on admission.
2. Patients whose incident do not have any insurance cover
3. Patient below 18 and above 60 years.
A convenient sampling method was used. The research assistant goes to the consulting room to screen the accident victims to select the most eligible cases. Questionnaires are administered to those victims who have been discharged from admission and coming for review. She also goes through the folders to retrieve the needed information. Again she goes through their final medical reports to pick information concerning their level of incapacitation. 3.8 Sample Size:
The sample size for the survey was determined using the following assumptions. Confident limit of 95%, estimated emerging error of 10% and an assumed proportion of accident victims with socio-economic problems of 70%. A minimum of 81 accident victims were therefore required for the study. 82 respondents were interviewed during the period of study.
3.9 Data Collection:
The services of a research assistant were employed for the data collection. She screened the accident victims and recruited those who were eligible into the study. Those who could read were made to read the consent form and gave their consent. The consent was explained in the local language to those who could not read to obtain their consent. The consent forms were separately signed or thumb-printed and packed in a separate envelope. The structured questionnaire which includes: socio-demography, social status, and economic status were administered to the respondents by the research assistant. The
information on types of injuries, etc. were retrieved from their folders by the research assistant. The last question on the questionnaire was administered to the insurance company by the same research assistant. 3.10 Data Management and Analysis:
Epidata was used for the data entry and exported to Stata Corporation, 4905 software (Lakeway Drive College Station, Texas 77845 USA) for analysis. Mean and standard deviation were calculated for age. This software was used to calculate frequencies and percentages as well as to draw figures and tables.
RESULT AND DATA ANALYSIS
During the period of five months study, 82 respondents were interviewed. 4.1 Sociodemographic Characteristics of Respondents
Table one below describes the sociodemographic characteristics of the respondents. Table I
n = 82
Mean(SD) 38.78years (9.64years) Sex
n = 82
n = 82
n = 82
n = 82
n = 81
More than half (62.20%) of the victims fall between the ages of 20 and 40 inclusive. The mean age of the victims is 38.78years. More males (58.54%) than females were involved in RTA in this study. A little over half (54.88%) of the respondents were married whilst only 2.44 were separated. Close to half (46.34%) of the victims had primary education and about a tenth (10.98%) of them had tertiary education. Majority (92.68%) of them were Christians whilst the remaining 7.32% were muslims. The commonest economic activity among the respondents is trading, accounting for 44.44% whiles only 1.23% of them were unemployed. 4.2 Types of Injury
Table II: Types of Injury
Type of injury
n = 82
Long bone injury 34(41.5)
Table 2 indicates that about little over half (58.5%) of the victims had long bone injuries whiles (41.5%) had pelvic injuries.
4.3 Social Impact of RTA Victims
The figure below shows the distribution of how families assisted victims to facilitate their movements after the accident. Fig. 1: Victims ability to Facilitate Their Movement without Assistance from Families after the Accident.
More than three-quarters of the victims (77%) were not able to move around without assistance from families after the accident and only (23%) were able to facilitate their movement without assistance.
The fig. 2 below shows how friends and families related to the victims interms of rendering the victims the needed assistance. Fig. II: Distribution of How Friends and Families Related to Victims by Rendering Them the Needed Assistance after the Accidents.
More than half (60%) of the victims enjoyed good relationship from friends and family members. About a third of them experienced poor/bad relationship from friends and family members after their accident. Only 10% of them had enjoyed very good 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
Almost all the victims (93.90) were working before the accident and only (6.10%) were not working. Majority of the victims (88.46) were not able to go back to their various jobs after the accident. Only a few (11.54%) of them were able to return to work.
Fig. IV: Distribution by Bread Winner Responsibilities before and after the Accident
Fig. 4 above shows the comparism of bread winning responsibilities before and after the accident. More than four-fifth (85.53%) were breadwinners for their families before the accidents. After the accident, majority (92.96%) of the victims were not able to fend for their families. Only7.04% of the victims were capable of discharging their responsibility of fending for their families after the accident.
4.5 LEVEL OF INCAPACITATION
Fig V: Distribution of Level of Incapacitation
Fig 5 above shows the distribution of the level of incapacitation of the victims. Almost half (48%) of the victims had their level of incapacitation
estimated to be between 20 and 40%. Only 5% of the victims had their level of incapacitation estimated to be between 41 and 65% whilst the remaining 47% had less than 20% level of incapacitation.
Road traffic accident is a global issue as well as a big concern to every nation in the world. There has not been a single day passing by without the news of RTAs. This is a hazard that cannot be overlooked rather a critical look needs to be taken to avoid losing our dear ones each and everyday. RTA has impacted immensely on the socio-economic status of accident victims. This study shows that socio-economic impact on accident victims is common (62.20%) among the youth between the ages of 20 and 40 years. As reported by The WHO, a study conducted shows that over 50% of deaths are among young adults in the age range of 15–44 years. 9 Most of the working force falls under this group hence their engagement in various business activities which involve their usage of the road transport all the time. WHO believes majority of RTA victims are young. Therefore, the issue needs more attention and support from every individual in all communities around the world. The study also shows that more than half of the males 58.54% are involved in RTAs. This finding is similar to the findings of Mr. Noble John Appiah who reported 67% of accident cases being males.8 The commonest level of education among victims in this study was found to be primary (46.34%). This is similar to the findings in the following studies: a study conducted by Department of Emergency Medicine, Lerdsin General Hospital, Bangkok, Thailand, the patients with a lower education level accounted for the largest number of cases, both in the provinces (46.3%) and Bangkok (17.1%).11 Another study conducted by the Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania in collaboration with the Department of Orthopaedic and Traumatology, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania also shows that vast majority of patients, 998 (59.5%) were self-employed and most of them, 972 (57.9%) had either primary or no formal education.12 In respect to the types of injury, what this study depicted is not different from what happens in the other parts of the world. This study in the Komfo
Anokye Teaching Hospital shows that 58.5% of the accident victims had long bone injuries which is similar to a study conducted by Asmaa Hassan Abu Hassan in the year 2010 in Pakistan. In that study 60% had long bone injury.9 Socially, this study shows that 60% percent of the victims who had a good relationship with their relatives in terms of assistance after the accident. Only 30% of the victims had a bad relationship with their families. This finding is in contrast to the finding of Asmaa Hassan Abu Hassan whose study revealed that the distress on the family members which was either temporary or permanent depending on how closed they were to the victims affected the social interaction between the victims and the families. Families experienced several interpersonal difficulties such as family friction or poor tolerance. It also suggested that the reason for this is related to the sudden change in family life which threatens living or working conditions. 9 The findings in this study show that victims had a good relationship with their families. This could be explained by the social cohesion and family values of the Ghanaian society. The findings re-affirm the values of the aged proverbial Ghanaian hospitality. According to this study 70% of the victims who were capable of moving around freely had their movement restricted after the accident. They either had to be assisted to go for social gatherings or keep to their homes because of being uncomfortable to be at public gatherings with their disabilities. This restriction in their social life undoubtedly would affect their emotions negatively Economically, this study was able to determine the rate at which RTA affects the lives of victims. The economic impact of RTA on victims in this study is indeed grave. Almost all the victims (93.9%) were working and earning some income before the accident. Many (85.53%0 were breadwinners. As many as 88.46% of them were not able to go back to their various works hence their inability to continue to take the bread winning responsibilities. The findings from this study is not different from that of Yiadom, Joseph Boakye which states that most victims of RTAs are the breadwinners of their families and their sudden departure throws their dependants into economic hardship. The death of male bread winners through RTAs creates female-headed households. In the same vein the loss of female caretakers of households leaves the men alone to take care of the children. Dependants of RTA victims usually become school dropouts, social destitute and eventually delinquents.