Bangalore Road Safety and Injury Prevention Program:
Results and Learning, 2007 - 2010
National Institute of Mental Health & Neuro Sciences Department of Epidemiology WHO Collaborating Centre for Injury Prevention and Safety Promotion Bangalore – 560 029, India
BANGALORE
ESTD 1980
Bangalore City Traffic Police
Sagar Hospitals Bangalore City Traffic Police Bengaluru Metropolitan Bowring & Lady Curzon Bruhat Bengaluru Bengaluru City Police Victoria Hospital Transport Corporation Hospital Mahanagara Palike
BANGALORE
ESTD 1980
Sanjay Gandhi Institute M. S. Ramaiah Kempegowda Institute Ambedkar Medical St. John’s Hospital of Trauma and Memorial Medical of Medical Sciences & College & Hospital Orthopaedics Hospital Research Centre
Rajarajeswari Medical Vydehi Medical MVJ Medical College & ESI Hospital Sri. Siddhartha Medical College & Hospital College & Hospital Research Hospital Rajajinagar College, Tumkur
Bangalore Road Safety and
St. Martha’s Hospital Injury Prevention Program: HOSMAT Hospital Results and Learning, 2007 - 2010
Chinmaya Mission St. Philomena’s Hospital Hospital
Sagar Hospitals
Sagar Hospital Bengaluru Baptist Hospital Columbia Asia Suguna Hospital Hospital
Command Hospital D.G.Hospital Mallige Medical Centre District Hospital, Ravi Kirloskar Memorial Tumkur Hospital
In Collaboration with
World Health Organization, Indian Council of Medical Ministry of Health & New Delhi Research, New Delhi Family Welfare, New Delhi Bangalore Road Safety and Injury Prevention Program: Results and Learning, 2007 - 2010
NATIONAL INSTITUTE OF MENTAL HEALTH & NEURO SCIENCES Department of Epidemiology WHO Collaborating Centre for Injury Prevention and Safety Promotion Bangalore – 560 029, India Title: Bangalore Road Safety and Injury Prevention Program: Results and learning, 2007 - 2010
Copyright: NIMHANS
ISBN no: 81-86432-00-X
NIMHANS publication No: 81
Year of publication: 2011
Key words:
Injury; surveillance; Data; Mortality; Morbidity; Disability; Road Traffic Injury; Suicide; Burns; Poisoning; Injury Prevention and Care: Capacity strengthening; policy and program
Suggested citation:
G Gururaj and Bangalore Road Safety and Injury Prevention Program Collaborators Group. Bangalore Road Safety and Injury Prevention Program: Results and learning 2007 - 2010, Publication No. 81, National Institute of Mental Health and Neuro Sciences, Bangalore, 2011
For further details about the program, contact any of the program nodal officers or –
Dr. G. Gururaj Program Coordinator Professor & Head Department of Epidemiology WHO Collaborating Centre for Injury Prevention and Safety Promotion NIMHANS, Bangalore - 29 Email: [email protected]; [email protected]
BRSIPP 2011 Nodal Officers
Sri. N.D. Birje (Bangalore city police-Traffic), Sri. Nitin Hegde and Sri. Jagadish (BMTC), Dr. Alfred C Roy and Dr. Niranjan (Bangalore Baptist Hospital), Dr. Bhanumurthy (Bowring & Lady Curzon Hospital), Dr. Rizwan Ali Khan (D.G. Hospital), Dr. Ajith Benedict Rayan (HOSMAT Hospital), Dr. K. Nagaraj (Jayanagar General Hospital), Dr. Devaraj and Dr. Ashwath Narayana (Kempegowda Institute of Medical Sciences), Dr. Mali Manjunath and Dr. S.P. Suryanarayana (M.S. Ramaiah Medical College and Teaching Hospital), Dr. Ramareddy and Dr. Sudharshini (Mallige Medical Centre), Dr. Rajeev Mathew (Sagar Hospital), Dr. Prabhakar and Dr. Shivalingaiah (Sanjay Gandhi Institute of Trauma and Orthopedics), Dr. Mabel Vasnaik and Dr. Varghese (St. John's Medical College & Hospital), Dr. Mallikarjun V. Abdulpur (St. Martha's Hospital), Dr. Riyaz Basha (Victoria Hospital), Dr. Salma Jabeen (Employee State Insurance Model Hospital, Rajajinagar), Dr. Murali Kumar (Chinmaya Mission Hospital), Dr. Nithya A (Suguna Hospital), Dr. Satish Kumar (Vydehi Institute of Medical Sciences), Dr. Srividya V (Rajarajeshwari Medical College and Hospital), Dr. Ceema Sam and Dr. Nischal (Columbia Asia Hospitals), Dr. Divakar SV (Ambedkar Medical College and Hospital), Dr. Ashok J and Dr. Venkatesh (Siddhartha Academy of Higher Education), Gp. Capt. M. Shukla (Command Hospital, Airforce), Dr. Nagaraj (MVJ Medical College and Research Hospital), Dr. Sateesh V.L, Dr. Chandrashekar and Dr. Girish .N.Rao (National Institute of Mental Health and Neuro Sciences). Partners in Program
STATE CRIME RECORDS BUREAU Sri. Sanjay Sahay, IPS, Inspector General of Police
Bangalore City Police E Sri. Shankar Bidari, Commissioner of Police Bengaluru City E Sri. Praveen Sood, Additional Commissioner of Police (Traffic and Road Safety) E Sri. N D Birje, Nodal Officer and Assistant Commissioner of Police (Traffic & Planning) E Sri. Panduranga Rane, Deputy Commissioner of Police (Traffic West) E Sri. B A Muthanna, Deputy Commissioner of Police (Traffic East) E Sri. Mohemmed Sajjad Khan, Inspector (Traffic Planning)
Traffic Training Institute, Bangalore E Sri. S A Pasha, Assistant Commissioner of Police E Sri. Byrappa, Sri. Kulkarni and Inspectors
Traffic Automation Centre E Sri. Sudheer, Inspector, Sri. Vijayakumar
City Crime Record Bureau E Sri. Vijaya Kumar, Assistant Commissioner of Police E Smt. Girija, Inspector of Police and Sri. Venkatarao Sub Inspector E Smt. Lalitha, Mr. Pradeepkumar, Mr. Ravi, Mr. Prasanna, Mr. Suresh
Transport Department Sri. Bhaskar Rao, IPS, Commissioner for Transport and Road safety Sri. Vijaya Vikram, Joint Commissioner for Transport (Enforcement) Sri. Muniveeregowda, Joint Commissioner for Transport, (Administration) Sri. Hemanth Kumar, Joint Commissioner for Transport, (E-Governance and Environment) Sri. R.V.D. Souza, Joint Commissioner for Transport, (Bangalore Rural and Urban)
Bangalore Metropolitan Transport Corporation Sri. Syed Zameer Pasha IAS, Managing Director Sri. J. Arun Chakravarthy IPS, Director (Security and Vigilance) Sri. K. S. Vishwanath, Chief Traffic Manager Sri. Jagadish, Assistant Traffic Manager, In-charge Divisional Traffic Officer Sri. Nitin Hegde, Nodal Officer and Divisional Traffic Officer (Accident) Sri. Shankara Bharathi, Assistant Traffic Superintendent Smt. Mahadevamma, Smt. Komala, Smt. Anitha and Smt. Vinutha, Assistants
Karnataka State Road Transport Corporation Sri. Gaurav Gupta, IAS, Managing Director Sri. M. A. Saleem, Security and Vigilance Officer Sri. K.A. Rajkumar Director (Operations) Sri. Dastagir Shariff, Chief Traffic Manager
Bruhat Bangalore Mahanagara Palike Sri. K.R. Niranjan, Special Commissioner Dr. Govindaraju, Former Special Commissioner, Health Sri. Govindaraju, Former Joint Commissioner, Health Dr. L. T. Gayathri, Chief Health Officer Sri. B. Shankarappa, Joint Director (Statistics) Mr. Narayanaswamy, Former Joint Director (Statistics) Sri. Srinivasamurthy, Asst Statistical Officer
BRSIPP 2011 Bangalore Baptist Hospital Dr. Alexander Thomas, Medical Superintendent Dr. Alfred C Roy, and Dr. Niranjan, Nodal Officers Dr. Norman Gift, Consultant,Community Health Casualty Medical Officers: Dr. Ahmed Iqbal Masood, Dr. Vishwas, Dr. Monika Sharma Medical Records Department: Mrs. Vimala, Mr. Vimal Raj
Bowring & Lady Curzon Hospital Dr. H. Satishchandra, Medical Superintendent Resident Medical Officer and Nodal Officers, Dr. Rajanna and Dr. Bhanumurthy Sri. Khaja Mohiddin, Public Relation Officer Casualty Medical Officers: Dr. Shankar K.N, Dr. Lokesh G, Dr. Aravind, Dr. Dhananjaya, Dr. G. Mohan Kumar, Dr. Shivashankar N.A, Dr. Keshavamurthy, Dr. Sashan Kumar, Dr. Nasrulla Babajan, Dr. Roopa B Govindagouder, Dr. Anilkumar K.C, Dr. Mohamad Mujthaba, Dr. H.M. Srikanth, Dr. Radha K.R Smt. Chomu Murthy, Nursing Superintendent Staff Nurses: Mrs. T. Selvi and Mrs. Prabhavathi Medical Records Department: Mr. Nagaraja and Mr. Narayana Department of Forensic Medicine and Toxicology: Dr. Beemappa Havanur, Professor Dr. Venkataraghava, Assistant Professor
Chinmaya Mission Hospital Dr. M.R. Chandrashekar, Director Dr. A.S. Ramachandraiah, Resident Medical Officer Dr. Murali Kumar, Nodal Officer Casualty Medical Officers: Dr. A. Sathya Devi, Dr. Karthik, Dr. Selvarasi Nursing staff: Ms. Shashikala, Ms. Suja, Ms. Rekha, Ms. Sony, Ms. Berly, Ms. Bincy, Ms. Geethu Medical Records Department: Smt. Devaki
Columbia Asia Hospital, Hebbal Dr. Ajoy, Chief of Medical Services Dr. Ceema Sam, Nodal Officer Mr. Yadunandana H.L. Executive officer of EMRD
Columbia Asia Hospitial, Yeshwanthapur Dr. Aravind Kasaragod, Chief of Medical Services Dr. Nischal, Nodal Officer Mr. Maria Das. P. Manager of EMRD
Command Hospital (Air Force) Air Cmde. H.S.Nanda Dr. A. K. Patra, Nodal officer. Casualty Medical Officers: Dr. Arijith Mukherjee and Dr. Lovneet Kaur
D.G. Hospital Dr. Ramesh H. D, Chairman Dr. Rizwan Ali Khan, Nodal Officer Dr. Vishvas, Casualty Medical Officer
Dr. B.R Ambedkar Medical College and Hospital Dr. S.V. Divakar, Medical Superintendent Casualty Medical Officers: Dr. Sathyaraj. Dr Bhanumathi, Dr. Raghunath, Dr. Mahesh, Dr.Gopalaiah Nursing staff: Smt. Prema, Smt. Shashirekha, Mr. Siddaraj Department of Forensic Medicine and Toxcicology: Dr. B.M. Nagaraj, Professor and Head Dr.Karthik, Associate Professor Employee State Insurance Model Hospital (ESI), Rajajinagar Dr. A.K. Khokhar, Medical Superintendent Dr. Malagi, Additional Medical Superintendent Sri. R. Kesavan, Registrar Dr. Salma Jabeen, Nodal Officer Casualty Medical Officers: Dr. P. Selvakumar, Dr. Raghavendra B, Dr. Ravishankar M, Dr. Roopa B.N, Dr. Sindhu, Dr. Suresh, Dr. Ravikumar Bellubbi, Dr. Rekha, Dr. Muralidharan K.A, Dr. Pankaj M Deshmane, Dr. Prashanth B, Dr. Raghvendra G Dr. Dhananjay S, Consultant Psychiatrist Nursing Staff: Mrs. Umamani, Mrs. Chandravathi, Mrs. Rajunnisa
HOSMAT Hospital Dr. Thomas Chandy, Medical Director Dr. Ajith Benidict Rayan, Nodal Officer Casualty Medical Officers: Dr. Chetan Ray, Dr. Karthik and Dr. Swaminath Mrs. Reena, Staff Nurse Mr. Surgirth Raj, Medical Records Officer
Jayanagar General Hospital Dr. Nagaraj K. Medical Superintendent Dr. Kishore C. Kumtakar, Resident Medical Officer Casualty Medical Officers: Dr. Kiran Kumar, Dr. Pushparaj, Dr. Pappu Vitalachar, Dr. Prameela, Dr. Sandya, Dr. Geetha, Dr. Revanna, Dr. Raghunandan, Dr. Rajkumar Naik, Dr. Sathya B. H, Dr. Sandhya, Dr. Vidya, Dr. Rajesh, Dr. Babu Rao, Dr. Divakar, Dr. Saroja, Dr. Lakshmi, Dr. Rathna, Dr. Ravindra Mohan, Dr. Prathima Devi, Dr. S.T. Sridhar, Dr. Jayamma, Dr. Prabhakar Nursing staff: Mr. Anil Kumar, Mr. Mohamad Rafiq, Mrs. Lalithamma, Mrs. Geetha Medical Records Department: Mrs. Pattar
Kempegowda Institute of Medical Sciences and Research Centre Dr. Capt. Venkatesh, Director Dr. M. K. Sudarshan, Dean and Principal Dr. Anjanappa T. H, Medical Superintendent Dr. Devaraj, Casualty Medical Officer and Nodal Officer Casualty Medical Officers: Dr. Ramesh, Dr. Shankar, Dr. Roopak, Dr. Prasanna Kumar, Dr. Dinesh Department of Community Medicine: Dr. Ashwath Narayana D. H. and Dr. Chitra Medical Records Department: Mr. E. Selwyn Jebasingh and Mr. Lingappa Dept of Forensic Medicine and Toxicology: Dr. Ananda K, Professor and Head, Dr. V.T. Venkatesha, Professor Dr. Shantha Kumar H.P, Associate Professor, Dr. Jagannath S.R and Dr. Naveen T, Assistant Professors Dr. Gopal B.K, Dr. Ramesh C. and Dr. Sridhar N.C. (Postgraduates)
M. S. Ramaiah Medical College and Hospitals Dr. S. Kumar, Dean and Principal Dr. Sundaresh, Medical Director, M S Ramaiah Medical Teaching Hospital Dr. Naresh Shetty, Medical Director, M S Ramaiah Memorial Hospital Dr.Narendranath, Joint Medical Director, M S Ramaiah Memorial Hospital Dr. Col. M.S. Murnal. Joint Administrator, MSRMTH Dr. Asha R. Executive Hospital Administrator Nodal Officers: Dr. Mali Manjunath and Dr. Suryanarayana S. P. Chief of Emergency Services: Dr. Aruna Ramesh Casualty Medical Officer: Dr. H.M. Gopalappa Prof. Pruthvish .S Professor and Head of Community Medicine Medical Records Department: Mrs. Wilbert Mary, Mrs. Margaret Rosy, Mrs. Shyamala, Mrs. Padma Dept of Forensic Medicine and Toxicology: Dr. Harish, Professor and Head, Dr. Girish Chandra, Associate Professor Dr. Satish N.T. Assistant Professor
BRSIPP 2011 MVJ Medical College and Research Hospital Dr. T. Rajeshwari, Dean and Director Ms. Dharini Mohan, Chief Administrative Officer Dr. Vivai, Medical Superintendent Dr. Nagaraj, Nodal Officer Department of Community Medicine: Dr. Sagorika Mullik, Professor and Head, Dr. T. Mahadevamurthy, Associate Professor, Dr. Lokesh, Assistant Professor Dr. Diwakar, Casualty Medical Officer Mr. Armugam, Medical Records Officer Department of Forensic Medicine and Toxicology: Dr. M. Somashekar, Professor and Head
Mallige Medical Centre Dr. Sriram, Medical Director Dr. Rama Reddy, Nodal Officer Mrs. Jessy. Y, Medical Records Department
National Institute of Mental Health and Neuro Sciences Dr. P. Satish Chandra, Director / Vice Chancellor Dr. S. K. Shankar, Former Director / Vice Chancellor Dr. Nagaraja D, Former Director / Vice Chancellor Dr. Ravi V, Registrar Dr. V. L. Sateesh, Medical Superintendent Dr. Chandrashekar V. S, Resident Medical Officer and Nodal Officer
Department of Neuro Surgery Dr. Sampath, Dr. Indira Devi, Dr. Chandramouli and all units staff
Casualty Medical Officers Dr. Muralidhara K, Dr. Neetha Nagaraj, Dr. Asgari Banu, Dr. Sridhara, Dr. Yashoda, Dr. Amit Acharya, Dr. Leena, Dr. Kasturi, Dr. Swathi, Dr. Lakshmi Rajamma
Medical Records Department Mr. Pulla Reddy, Mr. Nanjappachar and Mr. Vivekappa
Rajarajeshwari Medical College and Hospital Dr. Ramachandra, Director Dr. Govindaraju K. M, Medical Superintendent Dr. Srividya V, Nodal Officer Sri. Harihara Subramanian, S.S., Public Relation Officer Casualty Medical Officers: Dr. Nagaraj B S, Dr. Subramanya S.K, Dr. Gopalkrishna .K, Dr. K P Das, Department of Community Medicine: Dr. Shashikala M, Dr. K. Jayanthkumar Department of Forensic Medicine and Toxicology: Dr. Chandrashekaraiah, Professor and Head Dr. Pradeep Kumar, Associate Professor, Dr. Anand P. Ryamani, Assistant Professor
Sagar Hospital Dr. Hemachandra Sagar, Chairman Dr. Rajeev Mathew, Nodal Officer Casualty Medical Officers: Dr. Murali Mohan, Dr Radhika, Dr. Vetrivel Ramar, Dr. Fareeda U. R Raham Nursing Staff: Smt. Manjula, Mr. Manjunath and Mr. Kumar Medical Records Department: Mr. W. Wellesly Stephen
Sanjay Gandhi Institute of Trauma Care and Orthopaedics Dr. S.Prakash, Director Dr. K. Chandra Shekara Naik, Formerly Director Dr. Shivalingaiah, Resident Medical Officer and Nodal Officer Dr. Prabhakar, Fmr Resident Medical Officer Casualty Medical Officers: Dr Pavan, Dr. Girish, Dr. Suresh Medical Records Department: Mr. Agilasithan, Mr. Yashvanth, Mr. Dhananjaya Smt. Susheela, Nursing Superintendent, Smt. Meera, Staff Nurse St. John’s Medical College & Hospital Fr. Lawrence D'Souza, Director Dr. George A D'souza, Medical Superintendent Dr. Savio Pereria, Associate Medical Superintendent Dr. Prem Pais, Dean Dr. Mabel Vasnaik and Dr Varghese P. S, Nodal Officers Department of Emergency Medicine: Dr. Shakunthala Murthy, Professor and Head; Dr. Praveen Kumar and Dr. Srikanth, Department of Community Medicine: Dr. Arvind Kasthuri, Professor and Head, Dr. Dominic Misquith, Dr. Bobby Joseph Medical Records Department: Mrs. Irine Jacob and Mrs. Maria Joseph Department of Forensic Medicine and Toxicology: Dr. Varghees P. S, Professor and Head Dr. Betty and Dr. Babu Rao
St. Martha’s Hospital Dr. Surg. Comd. A J Moraes, Medical Superintendent Dr. Mallikarjun V. Abdulpur, Resident Medical Officer and Nodal Officer Dr. Shashikanth, Legal Consultant Casualty Medical Officers: Dr. Farid, Dr. Vidya, Dr. Kamini. H, Dr. Pai A G Medical Records Department: Mr. Anthony and Smt. Geetha
St. Philomena's Hospital Dr. Shankar Prasad, Medical Superintendent Casualty Medical Officers: Dr. Mansoor Pasha, Dr. Rajani, Dr. Subbalakshmi, Dr. Lakshmikantamma, D.K. Prasad Nursing staff: Ms. Mary Stella, Ms. Mini, Ms. Shashikala, Ms. Bincy, Ms. Honey, Ms. Tina, Ms. Monisha, Ms. Princy, Ms. Tintu, Ms. Rintu, Ms. Sumithra, Ms. Kathrine, Ms. Marcel Medical Records Department: Mr. George Pinto
Suguna Hospital Dr. Ravindra, Director Dr. Radhika Raveendran, Medical Superintendent Dr. Nithya A, Administrator Dr. Krishnaswamy, Nodal Officer Casualty Medical Officer: Dr. Shantha Kumar, Dr. Suraj Medical Records Officer: Mrs. Geetha
Victoria Hospital Dr. O.S. Siddappa, Dean and Director Dr. G.T. Subhash, Former Dean and Director Mr. Prabhakar, Chief Administrative Officer Dr. B.G.Tilak, Medical Superintendent Dr. Kantharaj J, Resident Medical Officer Dr. Riyaz Basha, Nodal Officer Casualty Medical Officers: Dr. A. Vishwanath, Dr. Cheluvanarayana, Dr. Rajareddy, Dr. Siddeshwar, Dr. B. Vishwanath, Dr. Vijayashri, Dr. Thyagaraj, Dr. H.V Shivakumar, Dr. Varalakshmi, Dr. R. Ramesh, Dr. Sathyanarayana, Dr. Manjula, Dr. Satheesh S.R. Vishwakarma, Dr. Madhusudan Das, Dr. Priyadarshini, Dr. Pradeep, Dr. Rashmi, Dr. Shivakumar, Dr. Shailaja, Dr. Santhosh and Dr. Jagadish. Mrs. Kunjumol, Nursing Superintendent Medical records department: Smt. S. Lakshmidevi, Mr. Sudhindra, Smt. Vasundara Department of Forensic Medicine and Toxicology: Dr. Devadass P.K, Professor and Head, Dr. K.V. Satish, Associate Professor, Dr. C.N. Sumangala, Assistant Professor, Dr. V. Suresh, Assistant Professor, Dr. Dileep Kumar K.B, Senior Resident, Dr. Yadukul .S, Dr. Murali Mohan M.C, Dr. Chandrakanth Kokatanur, Dr. Vinay H.N, Dr. Yogesh .G, Dr. Vinay Kautilya, Dr. Ravikumar, Postgraduates Dr. Vasantha Kamat, Professor and Head, Department of Medicine Dr. Shivaswamy, Professor and Head, Department of Surgery Dr. N. Vijay Kumar, Professor and Head, Department of Orthopaedics Dr. T.S. Ranganath, Professor and Head of Community Medicine
BRSIPP 2011 Vydehi Institute of Medical Sciences Mrs. Kalpaja D. A, Medical Director Maj. Gen. Dr. Anju Manchanda, Administrator Dr. (Mrs) Kantha S, Advisor Dr. Sandhya Belawadi, Principal and Dean Dr. G. Mohan. Medical Superintendent and Nodal Officer Casualty Medical Officers: Dr. Shivayogi, Dr. Murugan, Dr. Sripriya, Dr. S. Hemavarneshwari Medical Records Department: Mr. Pratap Department of Forensic Medicine and Toxicology: Dr. Sudhamshu Raj Sharma Khanal, Professor and Head Dr. Jagadish N, Professor, Dr. P. G. Bagli, Associate Professor, Dr. M.S. Kiran and Dr. Padmini Kannan Noone, Assistant Professors, Dr. Raviraj K.G, Dr. Shobhana S.S, Dr. Fairoz Khan, Tutors (PG.s)
RURAL CENTRE - Tumkur District
E Dr. Somashekara C, Deputy Commissioner and District Magistrate
Police E Dr. Harsha P S, IPS, Superintendent of Police E Sri. Nagarajaiah, Assistant Sub Inspector; Sri. Narasimhaiah and Sri. Chandrashekar, Ms. Bharathi, Head Constables; Deepa R, First Divisional Assistant
District Hospital Dr. Pratap Surya, District Surgeon Dr. Rangaswamy, Resident Medical Officer Casualty Medical Officers: Dr. Manjunatha Gupta, Dr. Srinivasamurthy, Dr. Nanjundappa, Dr. Chandan, Dr. Chandrashekhar, Dr. Sureshbabu, Dr. Veerabhadraiah, Dr. Muktamba, Dr. Eashwarappa, Dr. Govindaraju, Dr. Gowda V, Dr. Manjunatha K.R, Dr. Kallesh, Dr. Nagendrappa, Dr. Rekha, Dr. Rukmini, Dr. Srinivasmurthy, Dr. Sowmya Nursing staff: Ms. Sumitra C.S, Ms. Savitri H.B.
District Health and Family Welfare office Dr. Channamallaiah, District Health and Family Welfare Officer
Siddartha Academy of Higher Education (Deemed to be University) Dr. Shivaprasad G, Director and Chancellor Dr. Krishnamurthy K.A, Vice chancellor Dr. M. Z. Kurian, Registrar Dr. A. G. Srinivasamurthy, Principal Dr. C. R. Kodandaswamy, Medical Superintendent Dr. Ashok J and Dr. Venkatesh, Nodal Officers Dr. Rajanna M.S, Professor and Head, Dept of Community Medicine Casualty Medical Officers: Dr. K. R. Srinath, Dr. Muddukrishna, Dr. Anil Kumar, Dr. Sadananda Medical Records Department: Mr. Sridhar and Mr. Girish
Co-ordinating Centre at National Institute of Mental Health and Neuro Sciences Dr. P. Satish Chandra, Director / Vice Chancellor Dr. Gururaj G, Program Coordinator, Professor and Head of Epidemiology
Staff Department of Epidemiology Dr. Girish N Rao, Dr. Kavita R Mr. Manjunath D.P, Mr. Basavaraju K.S, Mr. Chandrashekara A. Mr. Lokesh M, Mr. Venkataramanappa G, Mr. Rajappa R, Mr. Chandrashekhara, Mr. S.L. Ramesh, Mr. Murali S.L, Mr. S.M. Amaresh, Mr. Mounesh Y, Mr. Saijan Cyriac, Smt. Rajani, Ms. Manjula, Mr. Girish B.G
All staff working in emergency rooms - medical record divisions of partner hospitals, Bangalore Metropolitan Transport Corporation and in all police stations of Bangalore city and Tumkur District Table of Contents
Foreword i Messages ii Executive Summary v
Section A: Injury and Violence in India A1. Introduction 1 A2. Scientific basis of injuries 2 A3. Injury and Violence as a Public Health problem in India 2 A4. Burden of injury and violence in India 3 A5. Burden of injury and violence in Karnataka 6 A6. Data mimitations 10 A7. Data requirements for road safety and injury prevention 10 A8. Injury surveillance 11 A9. Data sources for surveillance 12
Section B: The Program and Methods B1. Bangalore road safety and injury prevention program 14 B2. Methods 15 B3. Fatal injuries 15 B4. Non fatal injuries 16 B5. Population based observational surveys 17 B6. Data pooling 17 B7. Monitoring of activities 17 B8. Sharing and disseminating of information 18
Section C: Program and Results C1. Bangalore - A profile 19 C2. Motorisation and infrastructure development 21 C3. Mortality profile and patterns 22 C4. Non fatal injuries 23 C5. Young men and women are affected most 28 C6. Violence and injury occur all throughout the year 28 C7. Injury and violence in Bangalore 30 C8. Road traffic injuries 32 C9. Falls 55 C10. Burns 56 C11. Poisoning 59 C12. Assault and violence 61
Section D: Trauma Care Issues 63
Section E: Road Safety and Injury Prevention & Control E1. Current scenario 67 E2. RTI / injury surveillance: strengths, opportunities, barriers and limitations 69 E3. Sustainability issues 73
Section F: Activity Profile of 2010 75
Section G: Bangalore Road Safety and Injury Prevention Program - An Evaluation 82
References 84 Annexure I: Data capture format for road deaths 87 Annexure II: Data capture format for injury deaths excluding RTIs 89 Annexure III: Mortuary injury data capture format 91 Annexure IV: Emergency Trauma Care Record for non-fatal injuries in hospitals 93
BRSIPP 2011 List of Figures
Figure1: Causes of injury deaths in India in 2009 5 Figure 2: State wise distribution of RTIs in India, 2009 5 Figure 3: State wise distribution of suicides in India, 2009 6 Figure 4: Causes of injury deaths in Karnataka in 2009 6 Figure 5: Use of data for public health and safe system approaches 10 Figure 6: Designing and building a surveillance system 11 Figure 7: Sources of information for injuries 15 Figure 8: Vehicular growth in Bangalore 21 Figure 9: Motorisation trends in Bangalore, 2001 - 2010 21 Figure 10: Composition of vehicles in Bangalore 21 Figure 11: Major causes of death, 2009 22 Figure 12: Age - sex distribution of deaths in Bangalore, 2009 23 Figure 13: Distribution of injury deaths BBMP data, 2009 23 Figure 14: Age - sex distribution of injury deaths, 2009 (BBMP) 28 Figure 15: Age - sex distribution of fatal and non fatal injuries in 2010 28 Figure 16: Fatal and non-fatal injuries as per month of occurrence 29 Figure 17: Fatal and non-fatal injuries as per time of occurrence 29 Figure 18: Causes of fatal and nonfatal injuries in urban and rural areas, 2010 30 Figure 19: Intent of injury 31 Figure 20: Alcohol use in fatal and non-fatal injuries, Bangalore 31 Figure 21: Comparison of non-fatal RTIs registered with the police and hospitals 32 Figure 22: Bangalore RTI pyramid 32 Figure 23: Fatal RTIs in Bangalore city during 2001 to 2010 32 Figure 24: Nonfatal RTIs in Bangalore during 2001 to 2010 32 Figure 25: Age sex distribution of fatal and non fatal RTIs in urban and rural areas 33 Figure 26: Place of road traffic crashes 33 Figure 27a: Fatal crashes under different traffic police stations, 2010 35 Figure 27b:Conditions and characteristics of crash locations 35 Figure 28: Areas and roads with high fatal crashes, 2010 35 Figure 29: Road user catagories 36 Figure 30: Collision of vehicles with pedestrians 37 Figure 31: Pedestrian activity at the time of crash, 2010 37 Figure 32: Location of fatal pedestrian crashes, 2010 37 Figure 33: Pattern of two wheeler collision, areawise 38 Figure 34: Pattern of two wheeler collisions, 2010 37 Figure 35: Location of fatal two-wheeler crashes 37 Figure 36: Use of helmets among two wheeler riders 39 Figure 37: Cases booked by Bangalore city police for nonuse of helmets 40 Figure 38: Helmet use among two wheeler riders: results of an observational study 40 Figure 39: Seat belt use among car drivers in Bangalore city 41 Figure 40: Cases booked by the Bangalore city police for not wearing seat belts 41 Figure 41: Alcohol presence in road crashes in Bangalore 42 Figure 42: Trend of drink driving cases booked by the Bangalore city police 42 Figure 43: Persons driving under the influence of alcohol: Results from an observational study 43 Figure 44: Alcohol presence in injury cases 43 Figure 45: Alcohol involvement in various injury causes 43 Figure 46: Effect of speed 44 Figure 47: Trend of overspeeding cases booked by the Bangalore city police 44 Figure 48: Road crossing behaviour: Results of observational study 47 Figure 49: Number of deaths by involvement of BMTC buses 49 Figure 50: Number of serious injury by involvement of BMTC buses 49 Figure 51: Month wise distribution of fatal crashes, 2008 - 2010 50 Figure 52: Time of occurrence of BMTC crashes, 2010 50 Figure 53: Age of BMTC drivers involved in fatal crashes, 2010 50 Figure 54: Experience of drivers involved in fatal crashes, 2010 50 Figure 55: Age - sex distribution of fatally injured persons in BMTC crashes, 2010 50 Figure 56: Collision patterns in fatal BMTC crashes, 2010 51 Figure 57: Road user category of fatal bus crashes, 2008 - 10 51 Figure 58: Patterns of collision, 2010 51 Figure 59: Patterns of collision with other vehicle 51 Figure 60: Crash location of fatal bus crashes, 2010 51 Figure 61: Place of death among fatal crashes, 2010 51 Figure 62: Age - sex distribution of non-fatal fall injuries 55 Figure 63: Place of injury in non-fatal falls 55 Figure 64: Age - sex distribution of non-fatal burn injuries 57 Figure 65: Place of injury in non-fatal burns 57 Figure 66: Products involved in non-fatal poisoning cases 60 Figure 67: First aid in injury cases prior to reaching a definitive hospital 63 Figure 68: Mode of transportation in non-fatal injury cases 64 Figure 69: Time interval between injury and registration in the hospital for non-fatal injury cases 64 Figure 70: Time interval between injury and deaths in fatal injuries 64 Figure 71: Place of death 64 Figure 72: Pathways of research 69
BRSIPP 2011 List of Tables and Boxes
Table 1: Haddon's matrix as applied to two wheeler road traffic injury 2 Table 2: Deaths and injuries in India, Karnataka state and Bangalore city due to various causes, 2009 4 Table 3: Top 10 causes of death by age groups in India: Male 7 Table 4: Top 10 causes of death by age groups in India: Female 8 Table 5: Top 10 causes of death by age groups in India; Person 9 Table 6: Profile of Bangalore city 20 Table 7: Non-fatal injury registrations in ERs of participating hospitals, January-December 2010 24 Table 8: Leading causes of death in all age groups in Bangalore, 2009 25 Table 9: Leading causes of death among males in Bangalore, 2009 26 Table 10: Leading causes of death among females in Bangalore, 2009 27 Table 11: Injury related deaths in Bangalore during January - December 2010 29 Table 12: List of areas with high road deaths in Bangalore, 2010 34 Table 13: Highlights of BMTC services for Bangalore city 49
Box 1: Infrastructure projects completed till date in the city by 2010 22 Box 2: Cell phone use and road crashes 46
List of Abbreviations
BRSIPP : Bangalore Road Safety and Injury Prevetion Program BMTC : Bangalore Metropolitan Transport Corporation BBMP : Bruhat Bengaluru Mahanagara Palike CMO : Casualty Medical Officer CC : Co-ordinating Centre CCRB : City Crime Records Bureau CDs : Communicable Diseases ER : Emergency Room FIR : First Information Report HICs : High Income Countries ICD : International Classification of Diseases ICECI : International Classification of External Causes of Injuries ICMR : Indian Council of Medical Research IPC : Indian Penal Code LMICs : Low and Middle Income Countries MCCD : Medical Certification of Cause of Death MLC : Medico-Legal Case NCRB : National Crime Records Bureau NIMHANS : National Institute of Mental Health & Neuro Sciences NCDs : Non-Communicable Diseases NGO : Non-Governmental Organization OTC : Over The Counter RMO : Resident Medical Officer RTI : Road Traffic Injury WHO : World Health Organization Acknowledgements
Our sincere thanks to
E Prof. Satish Chandra P, Director/Vice-Chancellor, NIMHANS
E Dr. Bela Shah, Deputy Director General, Indian Council of Medical Research
E Dr. J.S. Thakur, Cluster focal person for NCDs, World Health Organization, India Office
E Dr. Margie Peden, Coordinator, Department of Violence and Injury Prevention, World Health Organization, Geneva
E Dr. Ann Dellinger, Epidemiology Division, Centre for Disease Control and Prevention, Atlanta, USA
E Sri. Shankar Bidari, Commissioner of Police, Bangalore City
E Sri. Praveen Sood, Additional Commissioner of Police (Traffic), Bangalore City
E Sri. Sunil Kumar, Additional Commissioner of Police (Law & Order), Bangalore City
E Sri. Sanjay Sahay, Inspector General of Police, State Crime Records Bureau, Karnataka
E Sri. Bhaskar Rao, Commissioner for Transport, Government of Karnataka
E Sri. Syed Zameer Pasha, Managing Director Banglaore Metropolitan Transport Corporation
E Sri. K.R. Niranjan, Special Commissioner, Bruhat Bangalore Mahanagara Palike
E Dr. C. Somashekhara, Deputy Commissioner, Tumkur
E Dr. P. S. Harsha, Superintendent of Police, Tumkur District
E National Informatics Centre, Bangalore
E All Non Governmental Organizations
E All partner hospitals in the program
E Dr. Girish N, Dr. Kavita Rajesh, Mr. D.P. Manjunath, Mr. Lokesh M and Mr. Basavaraju for involvement and support in all activities.
BRSIPP 2011 Foreword
As India progresses to greater economic growth and rapid motorization, the burden of injuries has been increasing significantly. The death of an estimated million people due to injuries has been a matter of great concern to all of us. Apart from those who report to the hospitals, daily, thousands more get injured either on the roads, at home or in their workplaces. Most of the injuries result in serious damage to the brain and many fail to recover completely and have residual morbidity, often leaving affected individuals and families in desperation and loss of hope. We can quote the numbers of injured and those dead, but it is important to realize the presence of a family behind every injury or death. The pain, suffering and the long term impact on the families and the society is indeed very significant, but difficult to measure.
The continually increasing Road Traffic Injuries and/or deaths, points to the need for making more systematic efforts to make our society safe. It is unfortunate that this modern epidemic affects mainly the young and productive members of our society. While we all seek development and progress, we need to ensure that this development happens with a human face. Often, we blame the individuals for the several mishaps. Global experience and scientific evidence shows that safe systems can be built and developed to overcome human failures. Even though we have the knowledge and technology, our combined efforts are still far from satisfactory in addressing this human disaster; several interventions, which, if properly implemented can save " lives and limbs".
Good quality data is often the first step in building sustainable and robust programs. I understand that the Bangalore Road safety and Injury Prevention Program (BRSIPP) has satisfactorily completed three years in this field. This unique public health endeavor undertaken as a collaborative activity with nearly 30 hospitals in Bangalore City, the Bangalore City Police, the Bangalore Metropolitan Transport Corporation has been co-ordinated by NIMHANS. During the three years, information from more than 1.5 lakh hospitalized and injured persons and nearly 15,000 injury deaths has been systematically collected and analyzed. Apart from the annual reports for the year 2008, 2009 and 2010, the program has also brought from these years, 10 fact sheets, 5 public alerts and 4 strategy papers. Collating the learnings from these years, a fact book about injury and violence in India and a framework document for implementing road safety programs with reference to a developing county like India are also being published this year. I take this opportunity to congratulate and compliment all the stake holders for their perseverance and commitment in this untiring effort.
Good decisions are possible only with reliable data; programs would be adhoc, crisis - ridden and importantly non - sustainable in the absence of data. BRSIPP has shown that it is possible to develop information systems which can guide and prioritize intervention activities. It has taken the first step in our country to develop a sustainable and replicable model for injury prevention and control. The collaborative program has laid the foundation to make a dent in the rising injury graph and, society will immensely reap the benefits over the years to come.
Greater political will and administrative determination is needed to develop programs which are contextual to our society and culture. I am sure that the lessons learnt would be very valuable to the policy makers and health managers, not just in India, but also across the globe. Prof. P. Satish Chandra Director / Vice-chancellor, NIMHANS, Bangalore. i Message
World Health Organization Country Office of India
At the outset, I would like to congratulate the Bangalore Road Safety and Injury Prevention Program for successfully completing three years. Apart from collecting data, the program undertook many capacity building programs, advocacy activities, campaigns and strengthened research using data generated from the program. This data was readily available to develop road safety and injury prevention program by the police, transport, health and all other involved sectors.
Worldwide, injuries account for over 1 million deaths and 50 million injuries every year. In India, more than 5,00,000 persons die due to different injury causes as per reports of the National Crime Records Bureau. Apart from deaths and hospitalizations, the pain and suffering of affected families are difficult to measure and quantify.
The reports developed under this program will provide useful and required information. I am hopeful that the policy makers, law enforcement agencies, Government departments, researchers, media & NGOs shall benefit from the available resource materials.
I take this opportunity to compliment all the partners in this initiative, particularly National Institute of Mental Health and Neuro Sciences, and the WHO Collaborating Centre for Injury Prevention and Safety promotion for coordinating respective activities. The lessons learnt will be helpful for all road safety initiatives in India and other parts of the world. I wish the programme its best in the coming years.
Dr Nata Menabde WHO Representative to India
ii BRSIPP 2011 Message
India has witnessed an unprecedented pace of motorization during the last two decades and Bangalore city leads with 90 lakh vehicle population; of which nearly 28 lakh are two wheelers. This growth has been impressive; it is rather unfortunate that nearly 1000 deaths and thousands of hospitalizations take place due to road traffic injuries every year. Most often, it is the pedestrians and two wheeler riders who get killed and injured in crashes on the roads of Bangalore. This consistent finding from the three years of the Bangalore Road safety and Injury Prevention Program has been a major worry for all interested in safe travel. The pain and suffering of the affected families are difficult to measure and needs to be understood by all policy makers and public at large.
We need to make our roads safe and also ensure that the vulnerable road users are protected. In this direction, Bangalore City Police are striving hard to change present scenario. Introduction of technology, increased manpower, training for police and greater penalties are helping in improving the scenario. Over speeding, drunken driving, risky behaviours on the road, not using helmets, using cell phone are some major issues to be addressed in all cities.
Simultaneously, there have been several initiatives at the city level by different agencies. Improving public transport, implementing safety rules, public awareness and other areas needs further strengthening. As policies and programs of all agencies in this direction have an impact on safety and mobility of people, it needs to be continuously monitored and evaluated. These learning's are helpful to many other cities for incorporating safety in day to day activities.
The Bangalore Road safety and Injury prevention program has been helpful by highlighting critical areas in enhancing road safety. The program with a major focus on strengthening and improving information systems will help in developing data led interventions over time. This year, for the first time in the country, data collection has been improved with electronic online transmission for developing a system and all our staff have been trained in this process.
Most significantly, it has brought all stake holders and different hospitals into network for collective thinking and developing activities. I would like to take this opportunity to compliment all the stakeholders who have come together to undertake this unique initiative. I very much hope that the policy makers and administrators would take serious note of the magnitude of the problem and important lessons learnt over the last three years of the Bangalore Road Safety Injury Prevention Program. I am also confident that the report for the year 2010 along with framework for implementing road safety programs in India and, Injury and Violence in India fact report will be helpful to all policy makers and professionals in various departments. I wish this program all the best.
Mr. Praveen Sood, IPS, Addl. Commissioner of Police, Traffic & Road Safety Bangalore City
iii Message
Road networks and mobility are the neural networks for growth and prosperity. The last two decades have witnessed an unprecedented growth of motor vehicles in India and Bangalore has been no exception to this change. India with a total road length of 3.34 million kms is the second largest in the world and this carries 65% of freight and 85% of passenger traffic. Nearly 80 million vehicles traverse the length and breadth of the country transporting people and goods on a regular basis. Transport systems are the nation’s building blocks which bring in economic gains, binds societies as well as people. This impressive growth has brought an unforgettable tragedy in terms of road deaths and injuries. It is imperative that we ensure that the road systems are safe and cause no or little harm to the users.
The transport department is vested with the responsibility of ensuring and co-coordinating road safety activities ranging from vehicle registration to ensuring its fitness to driver licensing and most importantly to make roads safer. This process of making roads and people safe requires good quality information that can drive good programs.
While information is needed to take action, it's essential and critical that various stake holders come together to undertake coordinated and concerted action. In this context, I would like to congratulate all partners in the Bangalore Road Safety and Injury Prevention Program (BRSIPP) for working together towards making our roads safe. NIMHANS has always been in the forefront of several road safety initiatives. I am happy that as co-coordinator's of the BRSIPP, they have continued to dialogue with multiple stake holders. I am sure that the third annual stake holders meet would be good opportunity to discuss and suggest a model for injury prevention and control for the country.
Bhaskar Rao, IPS, Commissioner for Transport & Road Safety, Government of Karnataka
iv BRSIPP 2011 Executive Summary
India with a population of 1.2 billion is witnessing a major shift in its health problems due to epidemiologic and sociodemographic transition. With marginal decline in communicable and infectious diseases, Noncommunicable Diseases and injuries have become the leading causes of deaths, disabilities and hospitalisations in the country. While vaccine preventable diseases are major problems in children, NCDs are a problem of middle aged and elderly. In the young population of 15 - 44 years, injuries have become leading killer diseases.
With an estimated million deaths, injury and violence is a major burden on health care systems. The younger age of occurrence and suddenness of the event makes injury and violence, an unbearable situation for families. Health systems are faced with major challenges of providing care and rehabilitation for millions of people. The affected families go through immense suffering, pain, grief and anxiety due to the loss of their near and dear ones. In recent times, injury and violence in Indian society has become extremely common that no single day passes without reading, hearing or witnessing these events. Injury and violence is a problem in both urban and rural parts of the country and is shifting from metros to grade B and C cities and into the rural areas as motorisation, urbanisation and impact of globalisation begin making inroads.
Despite huge increase in the burden of injuries, there are no systematic policies and programs in India. In recent times, some initiatives have begun to address road safety concerns. The injury surveillance pilot studies, training programs in police and transport sectors, computerisation of police stations across the country, revision of Indian Motor Vehicles Act, steps to constitute a National body for RTIs and efforts to address road concerns have all been initiated recently. Despite an increase in suicides and other types of violence, these problems remain unaddressed. Burns, poisoning, drowning, occupational injuries are not in the public domain as public health problems. Trauma care is more of an urban phenomenon and people in rural areas neither have access nor can afford good quality health care due to increasing costs and absence of social insurance systems.
In order to formulate sound policies and programs, strong and robust data is an essential prerequisite. In India, except police sources, all other data systems are in infantile stages. The police data have major limitations and health sector data is virtually absent. Without proper collection, analysis, interpretation and application of data, sound policies and programs cannot emerge to control the problem. Evidence led programs based on intersectoral approaches are key to injury prevention and control in India. Surveillance, registries, good reporting systems and systematic research in academic institutions are still not in vogue in the country.
The city of Bangalore is a living testimony to the impact of technological and socioeconomic changes. The city has many positive developments in terms of education, information technology, raising living standards, vibrancy and hope for millions. The dark side of this growth and development is also coming to the forefront due to absence of safety policies and programs. The Bangalore Road Safety and Injury Prevention Program
v was started as a collaborative activity between 25 hospitals, city police, city transport department, civic administration and NGO's in 2007 with the broad goals of developing scientific programs to reduce the burden of injuries. The program adapted a surveillance approach for information gathering and brought together all stake holders to develop integrated programs. Surveillance was developed with available resources and within existing systems along with appropriate strengthening at different levels. The program has been operational in both urban and rural areas and has been facilitated by WHO and ICMR and coordinated by the WHO Collaborating Centre for Injury Prevention and Safety Promotion at NIMHANS.
In 2010, nearly 6000 persons died due to acts of injury and violence in the city. Nearly 60,000 injured persons reached the study centres for care and more than half of survivors were discharged with disabilities of short or long term duration. In reality, more than a lakh would have reached hospitals as the coverage was from only 25 hospitals. Road traffic injuries and suicides were the leading injury causes. Majority (> 70%) of those killed and injured were in younger age groups of 15 to 44 years and predominantly men. Pedestrians, two wheeler riders and pillions, and pedal cyclists were involved in nearly 75% of road crashes. Consumption of insecticides, pesticides and drugs, occurring at a time when the person was alone at home was the common pattern for suicides. Burns, poisoning, falls were other major injuries responsible for deaths and hospitalisations. Trauma care was often found to be inadequate for the injured persons.
In 2010, data was used to provide inputs for policies and programs at national and state levels. Further, it was used to strengthen and support helmet use in the city, scaling up enforcement of drinking and driving, promoting seat belt use, and to increase awareness on hazards of speeding. The city police took the initiative of data collection and submission through online transmission with support from National Informatics Centre. Discussions with policymakers and professionals have indicated that the data developed has been useful to develop new activities as well as monitor existing programs.
After 3 years of systematic activities, it is time to seriously look at the sustainability and strengthening of the program. This will be taken up in consultation with all partners, WHO, ICMR and Ministry of Health and Family Welfare, Government of India in the coming days. Along with further strengthening of surveillance, there is need for capacity building, systematic training, advocacy, increasing public awareness, facilitating interventions, and monitoring of all activities. More research needs to be undertaken for risk factor delineation and finding solutions through both ongoing and new activities. Most importantly, there is need to build programs and interventions. This year, the program has also brought out the "India Injury and Violence Fact Report" and the "Framework document on Road Safety" along with this report. The earlier reports, fact sheets and public health alerts have been helpful to many and used by professionals and media.
Across the world, especially in HICs, research - knowledge - evidence and data changed the understanding of injuries. Political commitment, professional involvement and proactive media supported policies and programs. Today, it is well acknowledged that injuries are predictable and preventable. Preventing road crashes, suicides and other injuries requires a "proactive approach" rather than a "reactive approach". Action from police, transport, urban - rural development ministries, highway authorities, land development authorities, product and vehicle manufacturers, civic authorities, NGOs, public, media and others are required to save lives and limbs. If safety is given priority, injury and violence should not occur; even if it occurs, it should not lead to deaths and disabilities. It is our strong hope that India wakes up to this public health problem and initiates appropriate policies and programs. vi BRSIPP 2011 Section A: Injury and Violence in India
A1. Introduction
With a population of more than a billion, India is significant progress in NCD prevention and control facing many challenges to meet health needs of its programs along with expansion of trauma care people. The triple epidemics of Communicable and services. The augmentation of facilities and services, infectious diseases, Noncommunicable diseases though marked in urban areas and deficient in rural (NCDs) and injuries pose many challenges for health areas, has been receiving attention of policy makers systems and to our policy makers. Various policies and administrators. In recent years, increasing and programs by successive governments at both participation of the private health sector comprising central and state level have had some success in of specialty hospitals, corporate hospitals, teaching changing some vital indicators. Despite this hospitals, nursing homes and other family noticeable change, the consequences of globalisation, practitioners along with the public health sector has urbanization and motorization have emerged as been noticeable. Simultaneously, increasing costs of major challenges amidst existing social inequities health care, greater burden on individuals and and wide disparities in health systems between and families, and the limited and adverse impact of within states. Absence of efficient health systems as various policies and problems has also been a matter revealed by the inadequacies related to planning, of great concern. financing, human resources, infrastructure, supply systems, governance, information, and monitoring Recent data indicates that NCDs and injuries are some well known problems of our health care contribute for nearly three fourths of deaths and systems (Patel et al, 2011). disabilities in India (Patel et al, 2011). Even though recent years have witnessed some concerns from India has witnessed rapid and unprecedented changes policy makers on the growing incidence and burden in urbanization, motorization, industrialization and of injuries, the problem has not received major migration along with changing life styles, habits attention in terms of a unified approach to address and value systems of people. The ongoing the problem. While some of the recent programs epidemiological, demographic, economic and social are making systematic efforts to address the growing transition has resulted in the emergence of injury burden of NCDs, efforts for injury prevention and and violence as a major public health problem in control are totally lacking as they are not even the 21st century. India has been making small and recognized as public health problems in India.
1 A2. Scientific basis of injuries
Traditionally and for too long, injuries have been mechanisms at different time periods and at various considered as accidents. The term accident simply levels (Haddon, 1968). This concept that originated means that it just happens and nothing much can be in 1970s brought in a new understanding of injury done about it. Consequently and for a long time, the mechanisms by identifying the contributory factors fatalistic attitudes in our communities have persisted among people, vehicles or products, and the and continue even today. Injuries have been referred environment (Table 1). Within each of these three to as - acts of God, sins of past life, price one has to domains, factors that operate before, during or after pay, and several such understandings. Due to this the crash that influence the possible outcomes can be prevailing thinking by politicians, people and even delineated. Identifying and developing mechanisms professionals, the field of injury prevention and to address each of these for different injuries has helped control has not taken deeper grounding in India. in reducing RTIs and other injuries.
The epidemiological triad of agent, host and In recent years, the “Safe Systems approach” is an environment has been in practice for several extension of this model by identifying measures for years that evolved from the understanding of safe people, safe vehicles and safe roads for prevention communicable disease control. “Haddon Matrix” and control of RTIs. This approach considers different is a very scientific method to understand injury interactions between and within each component and is based on physiological tolerance of individuals. It Table 1: Example of Haddon’s matrix as is based on the understanding that human body is applied to two wheeler road traffic injury extremely vulnerable for injury and that people are Human Vehicle Environment likely to make mistakes. Hence, road crashes are the Pre-event Increase Increase Implement outcomes of different interactions among a number awareness visibility of safety features about helmet vehicle on roads of factors and interactions. Based on this wearing, drink understanding it is essential to address multiple driving, safe driving, etc. components that cause injuries by different partners Event Early transfer Better braking Crash (Mohan et al, 2006). This approach focusses on to hospital systems of two protective Safe people, Safe roads and Safe vehicles. This and required wheelers road side care stationary understanding has revolutionized the field of Road objects safety as well as injury prevention and control over Post- Rehabilitate Improve safety Facilities for time and it has been possible to identify injury event and improve technologies early rescue health care and compo- of injured prevention programs that can be effectively services nents persons implemented.
A3. Injury and violence as a public health problem in India
Commonly, injuries are classified as unintentional and custodial institutions. Another method of classifying intentional based on intent. Unintentional injuries injuries is based on the mechanism of injury as it include Road Traffic Injuries (RTIs), falls, burns, happens in road traffic injuries, poisoning, falls and poisoning, drowning, work related injuries, fall of others. The third method of classification is based on objects, injuries in disasters and animal bites. the place of occurrence like roads, home, play sites Intentional injuries include suicides and violence. or work places. The anatomical type and location of Violence includes a wide variety of conditions like injuries depending on the injured body organs like youth violence, violence against women, children and head injuries, intracranial injuries, fractures and elderly, communal violence and those occurring in dislocations are the fourth method of classification.
2 BRSIPP 2011 Several international frame works like the WHO The understanding that injury is damage to one or international classification of diseases (WHO, 1998), more body organs, which occur quite rapidly due International Classification of External Causes of to sudden energy transfer being the cause, Injuries (WHO, 2004a), and the International revolutionized the science of injury prevention and Classification of Functional Impairments are available control. The definitive interaction between agent, for more detailed understanding of injury process and host and environment along with energy transfer mechanisms (WHO, 2001a). results in injuries of varying nature and severity. The chances of repeated occurrence are also frequent. It is common to see, read, hear or witness injury Over time, moving from this concept, the safe deaths and events in our lives on a day to day basis. systems approach has evolved for prevention and Like any health condition, injury and violence also control. has the typical epidemiological understanding of agent (product), host (person) and environmental Any health problem is a public health problem, if it association. The term, injury, by definition means affects large sections of society, has identifiable and that – it is a body lesion due to an external cause, measurable risk factors, is amenable to prevention either intentional or unintentional, resulting from a and can be addressed through public health sudden exposure to energy through mechanical, approaches (Detels et al, 2009). Due to lack of good electrical, thermal, chemical or radiate sources that quality data on the burden, pattern and impact of is generated due to interaction between agent and injuries, the problem remains unrecognized and host (WHO, 1999). This definition has been consequently unaddressed in India. However, the expanded to include impairments and others. The death of nearly 5,00,000 persons as per official interaction of these elements results in transfer of reports every year indicates the enormous energy to the host, which when it exceeds the magnitude of the problem. Injuries predominantly physiological tolerance of the individual results in affect the young people in the society, primarily in damage to body organs. Depending on the product, the age group of 15-44 years and men, with majority the energy that is responsible can be mechanical (as belonging to lower and middle income strata of the in RTIs), chemical (as in poisoning), thermal society. International research and experience reveals (burns), electrical or radiant in nature. It is also that the risk factors of injuries are clearly discernable possible that injuries can occur due to sudden and are amenable for prevention as seen by a decline withdrawal of a vital requirement of the body as in in injury deaths and disabilities in recent decades in drowning due to lack of oxygen. many High Income Countries (HICs)(WHO, 2004b).
A4. Burden of injury and violence in India
The only major source of information on injury and In 2009, there were 4,76,576 accidental deaths in violence in India is the National Crime Records the country due to manmade causes (Table 2). Bureau (NCRB) under the Ministry of Home Affairs, A total of 6,47,904 unnatural accidents caused Government of India. NCRB publishes annually 4,76,576 deaths and injuries among 1.5 million ‘Accidental deaths & Suicides in India’ and ‘Crime in persons with a male to female ratio of 3: 1. A 4.3% India’.The reports of 2009, published in 2010, gives increase in accidental deaths has been reported, while salient findings on injury burden and patterns from a 7.2% decrease was noticed from deaths due to different states, union territories and the mega cities natural causes. Significant variations exist across of India (NCRB, 2009a & b). Despite limitations of the states due to population characteristics and levels reporting and timely publication, the report offers of motorisation and urbanisation. valuable insights into the current situation of injury and violence. Some of the salient observations are The major unnatural cause of death was road traffic also provided in the accompanying report entitled injuries, which resulted in death of 1, 26,876 persons “Injury and violence in India: facts and figures” in 2009. The share of accidents due to natural (Gururaj, 2011). causes decreased from 7% in 2008 to 6.2% in 2009. 3 Table 2 : Deaths and injuries in India, Karnataka state and Bangalore city due to various causes, 2009 Bangalore Karnataka India Sl. No Causes Injured Killed Injured Killed Injured Killed A Unintentional injuries I Air-Crash 0 0 0 1 0 12 II Collapse of Structure (Total) 0 9 9 282 556 2847 1 House 0 0 8 146 242 1091 2 Building 0 1 1 17 47 265 3 Dam 0 0 0 0 15 30 4 Bridge 0 0 0 0 32 44 5 Others 0 8 0 119 220 1417 III Drowning (Total) 5 43 6 2014 553 25911 1 Boat Capsize 0 0 0 51 33 984 2 Other Cases 5 43 6 1963 520 24927 IV Electrocution 4 29 11 365 453 8539 V Explosion (Total) 1 4 3 9 735 668 1 Bomb Explosion 0 0 0 0 491 261 2 Others (Boilers, Gas Cyld. etc.) 1 4 3 9 244 407 VI Fall (Total) 7 108 14 470 2416 10622 1 From Height 3 100 10 442 959 8796 2 Into Pit/Manhole 4 8 4 28 1457 1826 VII Factory 0 2 4 33 598 1467 1 Machine Accidents 0 2 4 32 552 1044 2 Mines or Quarry Disaster 0 0 0 1 46 423 VIII Fire (Total) 32 449 55 1625 3034 23268 1 Fireworks/Crackers 0 11 0 12 258 547 2 Short-Circuit 0 19 2 126 207 1328 3 Cooking Gas Cylinder/Stove Burst 13 89 34 341 241 4127 4 Other Fire Accidents 19 330 19 1146 2328 17266 IX Fire-Arms 0 15 0 18 671 1504 X Killed by Animals 1 1 5 50 198 962 XII Poisoning (Total) 20 388 25 2491 5269 26634 1 Food/Accidental intake of Insect. etc. 0 57 5 181 1662 8154 2 Spurious/Poisonous liquor 2 22 2 180 109 1450 3 Leakage of gases etc. 0 0 0 13 10 247 4 Snake Bite/Animal Bite 1 2 1 722 1900 8035 5 Other 17 307 17 1395 1588 8748 XIII Stampede 6 0 6 12 6 110 XIV Traffic Accidents (Total) 5705 742 61697 10163 470941 152689 1 Road Accidents 5705 742 61697 8714 466649 126896 2 Rail-Road Accidents 0 0 0 0 477 1516 3 Other Railway Accidents 0 0 0 1449 3815 24277 X V Other Causes 74 676 78 1022 4500 35906 XVI Causes Not Known 63 0 66 1125 1389 17534 Total of unintentional injuries 5918 2466 61979 19680 491319 308673 B Intentional Injuries XVII Intentional Injury Deaths 1 Homicides 0 256 0 1702 0 32369 2 Dowry deaths 0 50 0 264 0 8383 3 Suicides 0 2167 0 12195 0 127151 XVIII Other Intentional Injuries 1 Attempt to commit murder 338 0 1607 0 29038 0 2 Rape 65 0 509 0 21397 0 3 Kidnapping and abduction 270 0 892 0 33860 0 4 Molestation 251 0 2186 0 38711 0 5 Sexual harassment 35 0 64 0 11009 0 6 Cruelty by husband and relatives 367 0 3185 0 89546 0 7 Other IPC crimes 9992 0 61108 0 865541 0 Total of intentional injuries 11318 2473 69551 14161 1089102 167903 Grand Total (A+B) 17236 4939 131530 33841 1580421 476576 Source: NCRB report, 2009a & b
4 BRSIPP 2011 Under the broad category of traffic accidents, In the same year, several more died due to other 4,21,628 road accidents, 2080 rail-road accidents injury causes as shown in Figure 1. Nearly 1,27,151 and 27,575 other railway accidents were reported. persons ended their lives voluntarily in suicidal acts, RTIs and suicides were the major causes while 26,634 died due to accidental poisoning and contributing for 31% & 27% respectively. (Figure1). 23,268 due to burns. The data also shows the huge The report highlights an increase of road crashes extent of underreporting of injuries in official reports in the country by 7.3% during 2009 compared to as seen by the fact that injuries were less than deaths. 2008. Tamil Nadu reported highest rate of road As deaths are only the tip of iceberg, for every death, accidents contributing for nearly 21% of the nearly 30 – 50 reach hospitals and it is estimated national total (Figure 2). Road accidents in India that the actual number of hospitalised persons are increased by 1.4% during 2009 as comared to 2008. likely to be in the range of 30 – 40 million every In total, 4,15,855 road accidents were reported, year (Gururaj G, 2005a). that resulted in death of 1,26,896 persons with an accident severity index of 30%. The annual In 2009, 1,27,151 persons ended their lives in a mortality rate was 10.9/1,00,000 population. The suicidal act. The five states of West Bengal (11.5%), four states of Tamil nadu, Maharashtra, Karnataka Andhra Pradesh (11.4%), Tamil Nadu (11.3%), and Kerala accounted for 47% of total road Maharashtra (11.2%) and Karnataka (9.6%), accidents. The 32 mega cities contributed for 14% contributed for more than half of suicides in the of total road deaths. country (Figure 3). The five southern states registered 40% of total suicides in the country. The four cities of Bangalore (2,167), Chennai (1,412), Delhi Figure1: Causes of injury deaths in India in 2009 (1,215), and Mumbai (1,051) together reported nearly 44% of total suicides among the 35 mega cities of the country. Bangalore city had the highest rate: 38.1 per 1,00,000 population. In the total series, 1 out of every 3 suicides occurred in the age group of 15-44 years with an overall male to female ratio of 2:1. However, in young children less than 14 years, male to female ratio was almost equal. One out of every 5 suicides was registered among housewives.
The age sex distribution of the affected populations varied across the country. As per the national report, majority of the deaths due to injuries were in the
Figure 2: State wise distribution of RTIs in India, 2009 (National average 10.9/100,000 population)
State Rate State Rate Tamil Nadu 20.48 Jammu and Kashmir 9.07 Haryana 20.07 Punjab 8.87 Goa 19.17 Uttarakhand 8.80 Andhra Pradesh 17.43 Orissa 8.78 Himachal Pradesh 16.77 Uttar Pradesh 7.58 Karnataka 14.97 Meghalaya 7.48 Sikkim 14.50 Jharkhand 6.63 Rajasthan 13.69 Assam 6.50 Chhattisgarh 13.07 Tripura 6.41 Gujarat 12.04 Mizoram 6.30 Maharashtra 11.99 West Bengal 5.62 Delhi 11.80 Manipur 4.68 Madhya Pradesh 11.34 Bihar 4.60 Kerala 11.04 Nagaland 2.25 Arunachal Pradesh 10.25
5 Figure 3: State wise distribution of suicides in India, 2009 National average - 10.9/100,000 population
State Rate State Rate Sikkim 39.9 Arunachal Pradesh 9.0 Kerala 25.3 Himachal Pradesh 8.4 Chhattisgarh 24.4 Delhi 8.3 Tamil nadu 21.5 Rajasthan 7.7 Karnataka 21.0 Mizoram 6.9 Tripura 20.7 Meghalaya 4.3 Andhra pradesh 17.4 Jharkhand 3.6 Goa 16.4 Uttarakhand 3.5 West Bengal 16.4 Punjab 3.1 Maharashtra 13.2 Jammu and Kashmir 2.5 Madhya Pradesh 12.9 Uttar Pradesh 2.1 Orissa 10.8 Nagaland 1.4 Gujarat 10.7 Bihar 1.1 Haryana 10.3 Manipur 1.0 Assam 9.7
younger age groups of the population. Nearly 6.5% unintentional injuries and intentional self harm. of deaths were in children less than 14 years and Injuries were the leading cause of death in the 5 - 14 majority of deaths were in the age group 15-44 years. years age group. In total, motor vehicle injuries contributed to 3.7% of deaths in 5-14 years and 6.9% Data from the million death study identified in 15-24 years. Injuries were the 8th and the 9th cause unintentional and intentional injuries as a leading of death in 25-69 years of age group. The top 3 causes cause of death in younger age groups (RGI, 2009). of death in 15-24 years were due to other unintentional Most importantly, unintentional injuries were the injuries (14.7%), intentional self harm (14.3%), and 4th leading cause of death in 1 to 4 years, while it motor vehicle accidents to the extent of 12.4%. Injuries was the number one cause of death in 15-24 years were one among the top 10 leading causes of deaths with 11.8% and 15.6% for the two groups of in all the groups as shown in tables 3, 4 and 5.
A5. Burden of injury and violence in Karnataka
Karnataka with a population of 66 million is one of persons were injured as per police reports giving a the most progressive states in India. The state with a ratio of nearly 1:8 for deaths injuries. Considering motor vehicle population of 3.69 million is underreporting of injuries, the number hospitalized predominantly rural with an urbanization rate of could have both 1 – 1.2 million during the year. 37% (http://www.municipaladmn.gov.in/ dmaWebsite/urbanization.htm). With literacy rate Figure 4: Causes of injury deaths in Karnataka in of 66.7% and per capita income of Rs 40,998(RBI, 2009 2010), the state is an evolving knowledge and industrial hub of the country.
During 2009, 33,481 persons (19,680 accidental and 12,195 suicidal deaths) died due to injury and violence in the state (Figure 4). Among the major causes, road traffic crashes (8714) and suicides (12,195) topped the list, respectively. Among other causes for injury deaths, 2491 were due to poisoning and 2014 due to drowning. Intentional injury causes like homicide and dowry resulted in 1702 and 264, deaths respectively. In the same year, 1,31,350
6 BRSIPP 2011 (9.3) (6.7) (6.4) All Ages Ill-defined Respiratory Senility (4.0) Unintentional Cardiovascular diseases (20.3) infections (5.4) neoplasms (5.4) conditions (4.6) Tuberculosis (7.1) Tuberculosis Diarrheal diseases respiratory diseases Perinatal conditions Perinatal injuries: Other (5.2) Malignant and other COPD, asthma, other (7.3) 70+ (15.7) Ill-defined origin (2.8) Respiratory Unintentional Cardiovascular diseases (26.5) Senility (13.1) ever of unknown uberculosis (4.5) infections (3.4) conditions (4.4) neoplasms (4.6) F Diarrheal diseases T respiratory diseases injuries: Other (3.7) Malignant and other COPD, asthma, other (6.1) 25-69 (11.4) (10.1) Diarrheal Ill-defined Intentional Tuberculosis Unintentional diseases (4.0) Malaria (2.4) Cardiovascular diseases (26.3) self-harm (3.3) neoplasms (7.8) conditions (4.8) Digestive diseases respiratory diseases injuries: Other (5.0) Malignant and other COPD, asthma, other (5.2) (5.1) (6.0) (14.7) (12.4) 15-24 Maternal uberculosis Ill-defined Intentional T Unintentional Motor vehicle diseases (6.3) Malaria (4.8) conditions (-) injuries: Other accidents :; ;;, Cardiovascular self-harm (14.3) conditions (7.2) parasitic diseases Diarrheal diseases Other infectious and death by age groups in India: Male (2.9) 5-14 (19.4) (15.2) (13,5) Ill-defined Respiratory origin (2.5) Unintentional Malaria (8.1) Motor vehicle injuries: Other accidents (5.3) ever of unknown infections (8.4) neoplasms (3.8) conditions (5.4) parasitic diseases Digestive diseases F Diarrheal diseases Other infectious and Malignant and other 0-4 (9.8) Perinatal Diarrheal Ill-defined Congenital Nutritional origin (1.5) Respiratory Unintentional Malaria (2.4) diseases (12.3) ever of unknown anomalies (3.0) conditions (3.5) infections (20.7) parasitic diseases deficiencies (2.4) F conditions (36.9) Other infectious and injuries: Other (3.4) Table 3: Top 10 causes of Top 3: Table 1-4 (15.5) Diarrheal Digestive III defined Nutritional Congenital Respiratory Origin (3.1) Unintentional Malaria (6.6) Diseases (1.6) diseases (22.0) Infections 21.4) ever of Unknown conditions (5.3) Anomalies (1.9) parasitic diseases deficiencies (4.3) F Other infectious and injuries: Other (9.3) Ref: http://cghr.org/publications/FINAL%20REPORT-Millon% 20Death%20study%202001-2003%20-phase%201.pdf http://cghr.org/publications/FINAL%20REPORT-Millon% Ref: <1 (9.0) (7.9) Perinatal III defined Congenital Nutritional origin (0.9) Respiratory Unintentional Malaria (0.9) ever of unknown infection (20.5) anomalies (3.4) conditions (2.9) parasitic diseases F deficiencies (1.8) conditions (49.2) Diarrheal diseases injuries: Other (1.5) Other infectious and 1 2 3 4 5 6 7 8 9 10 Rank
7 (9.9) (8.0) (6.2) All Ages Ill-defined Respiratory Senility (6.5) Unintentional Cardiovascular diseases (16.9) infections (7.1) neoplasms (6.0) conditions (5.0) Diarrheal diseases Tuberculosis (4.7) Tuberculosis respiratory diseases Perinatal conditions Perinatal injuries: Other (4.5) Malignant and other COPD, asthma, other (9.8) 70+ (12.4) Ill-defined origin (3.9) Respiratory Unintentional Cardiovascular diseases (24.8) Senility (18.4) ever of unknown infections (3.4) neoplasms (3.5) conditions (4.5) F Tuberculosis (2.6) Tuberculosis Diarrheal diseases respiratory diseases injuries: Other (4.6) Malignant and other COPD, asthma, other (3.5) (6.6) 25-69 (10.4) male Ill-defined Intentional Unintentional Malaria (3.4) Cardiovascular diseases (22.5) self-harm (2.6) uberculosis (8.3) conditions (6.0) Digestive diseases neoplasms (11.8) Diarrheal diseases T respiratory diseases injuries: Other (4.1) Malignant and other COPD, asthma, other (4.4) (7.2) (7.2) 15-24 Maternal Intentional Motor vehicle Unintentional diseases (6.3) Malaria (4.6) Cardiovascular accidents (1.7) self-harm (16.9) parasitic diseases conditions (12.6) Tuberculosis (7.5) Tuberculosis Diarrheal diseases injuries: Other (9.1) Other infectious and Ill-defined conditions (2.8) 5-14 (19.6) (16.7) injuries: Ill-defined Respiratory origin (3.3) Other (12.0) Unintentional Motor vehicle Malaria (10.7) ever of unknown accidents (2.1) conditions (4.6) neoplasms (2.0) parasitic diseases infections (11.1) F Digestive diseases Diarrheal diseases Other infectious and Malignant and other 0-4 (15.3) (11.2) Perinatal Ill-defined Congenital Nutritional origin (1.6) Respiratory Malaria (3.0) Unintentional ever of unknown anomalies (2.3) conditions (3.4) infections (23.3) parasitic diseases deficiencies (3.2) F conditions (29.2) Diarrheal diseases Other infectious and injuries: Other (2.9) Table 4: Top 10 causes of death by age groups in India: Fe 4: Top Table 1-4 (1.8) (16.2) Diarrheal III defined Nutritional Congenital Respiratory Origin (3.1) Malaria (6.6) Unintentional diseases (25.2) ever of Unknown anomalies (1.3) conditions (3.9) Infections (23.3) parasitic diseases deficiencies (5.1) Digestive diseases F Other infectious and injuries: Other (6.2) Ref: http://cghr.org/publications/FINAL%20REPORT-Millon% 20Death%20study%202001-2003%20-phase%201.pdf http://cghr.org/publications/FINAL%20REPORT-Millon% Ref: <1 (8.8) Perinatal Diarrheal III defined Congenital Nutritional Respiratory origin (0.9) Unintentional Malaria (1.3) Diseases (10.6) ever of unknown infection (23.3) anomalies (2.8) conditions (3.2) parasitic diseases deficiencies (2.3) conditions (43.1) F Other infectious and injuries: Other (1.3) 1 2 3 4 5 6 7 8 9 10 Rank
8 BRSIPP 2011 (8.7) (8.1) Perinatal All Ages Ill-defined Respiratory Senility (5.1) Unintentional Cardiovascular diseases (18.8) infections (6.2) conditions (6.3) neoplasms (5.7) conditions (4.8) Diarrheal diseases Tuberculosis (6.0) Tuberculosis respiratory diseases injuries: Other (4.9) Malignant and other COPD, asthma, other (8.5) 70+ (14.1) Ill-defined origin (3.3) Respiratory Unintentional Cardiovascular diseases (25.7) Senility (15.7) ever of unknown infections (3.4) conditions (4.4) neoplasms (4.1) F Diarrheal diseases (3.6) Tuberculosis respiratory diseases injuries: Other (4.1) Malignant and other COPD, asthma, other (5.0) 25-69 (5'1> (10.2) Ill-defined erson Intentional Unintentional Malaria (2.8) Cardiovascular diseases (24.8) neoplasms (9.4) conditions (5.3) self-harm ' (3.0) uberculosis (10.1) Digestive diseases; Diarrheal diseases T respiratory diseases injuries: Other (4.6) Malignant and other COPD, asthma, other (11. 8) 15-24 Maternal Diarrheal Ill-defined Intentional and parasitic Unintentional Motor vehicle diseases (6.3) diseases (6.2) diseases (4.8) Malaria (4.7) injuries: Other Cardiovascular accidents (6.9) Other infectious self-harm (15.6) conditions (7.2) conditions (6.5) Tuberculosis (6.8) Tuberculosis death by age groups in India; P (2.9) 5-14 (15.7) (15.1) Diarrheal Ill-defined Respiratory origin (2.9) Unintentional Malaria (9.4) Motor vehicle injuries: Other diseases (17.4) accidents (3.7) ever of unknown infections (9.7) neoplasms (2.9) conditions (5.0) parasitic diseases Digestive diseases F Other infectious and Malignant and other 0-4 (10.5) Perinatal Diarrheal Ill-defined Nutritional Congenital origin (1.5) Respiratory Malaria (2.7) Unintentional diseases (13.8) ever of unknown anomalies (2.7) conditions (3.4) parasitic diseases infections (22.0) deficiencies (2.8) F conditions (33.1) Other infectious and injuries: Other (3.2) Table 5: Top 10 causes of Top 5: Table 1-4 (1.7) (15.9) Diarrheal III defined Nutritional Congenital Respiratory origin (3.1) Unintentional Malaria (6.6) diseases (23.8) ever of Unknown anomalies (1.5) conditions (4.5) Infections (22.5) parasitic diseases Deficiencies (4.8) Digestive diseases F Other infectious and injuries: Other (7.5) Ref: http://cghr.org/publications/FINAL%20REPORT-Millon% 20Death%20study%202001-2003%20-phase%201.pdf http://cghr.org/publications/FINAL%20REPORT-Millon% Ref: <1 (8.3) Perinatal Diarrheal III defined Congenital Nutritional origin (0.9) Respiratory Unintentional Malaria (1.1) diseases (9.7) ever of unknown infection (21.8) anomalies (3.1) conditions (3.0) parasitic diseases F deficiencies (2.0) conditions (46.3) injuries: Other (1.4) Other infectious and 1 2 3 4 5 6 7 8 9 10 Rank
9 A6. Data limitations
Data from NCRB report the total number of deaths official reported deaths were 22,000 in the same for the country and also for different states and 32 year. mega cities. Even in official reports, the number of injured are far less than deaths in some injuries. This Reflecting on the data further, it is observed that shows that many nonfatal injuries are not reported national reports provide gross numbers & trend data to police and reasons could be several. The reasons with additional information on age and gender, urban for underreporting lie in social, cultural, economic and rural, month and time, sociodemographic and administrative issues and vary from cause to correlates like education and occupation and broad cause. Three of the studies from India undertaken in causes for RTIs and suicides. Further, data is not readily Bangalore (Gururaj et al, 2000), Haryana (Varghese available for researchers & policy analysts in the public and Mohan, 2003) and Hyderabad (Dandona et al, domain for analysis & interpretation. This data is 2008) reveal that the actual burden of RTIs to be supplemented further with few research studies from higher than official figures. The Bangalore study different parts of the country on different injury causes. reported that RTI deaths and injuries were underreported by 5 – 10% and > 50%, respectively. In summary, comprehensive data required for policies Dandhona et al (2008) reported from Hyderabad and programs is not available in the country. It is that the RTI mortality rate was 38 / 1,00,000 time that national institutions like Department of population, much higher than officially reported Health Research (ICMR) and health professionals take figures. The ratio of deaths: critically injured: mild keen interest in developing good quality national level injuries was 1: 29: 65 among the surveyed villages data on injuries through a combination of quantitative of Haryana. NIMHANS study on suicides showed the and qualitative research methods. There is also need ratio of completed: attempted: suicidal ideations was for information from other disciplines like engineering, 1: 10: 100 based on data from hospitals and general transport, industry, law and other sources on different population survey (Gururaj et al, 2004). Sanghvi aspects of injuries. Information from all sources needs et al (2009) reported the number of deaths due to to be available to examine different aspects and to burns to be 1,63,000 based on estimates, while the provide inputs for policies and programs.
A7. Data requirements for road safety and injury prevention
Unlike communicable disease programs, there is and professionals to develop meaningful and evidence need for variety of data for road safety and injury based policies/programs and interventions. As per prevention. Primarily, good quality – reliable – and WHO (WHO, 2010a) reliable and accurate data can comprehensive data is required for policy makers help build political will to prioritise road safety by: E documenting the nature and magnitude of the Figure 5: Use of data for public health and safe road traffic injury problem; system approaches E demonstrating the effectiveness of interventions Set targets that prevent crashes and injuries; and monitor performance E providing information on reductions in socio- Formulate economic costs that can be achieved through strategy Identify risk effective prevention. factors, priorities Define Informative and good road crash data systems should problems provide information on (Figure 5)
10 BRSIPP 2011 E Magnitude of the problem in terms of deaths, in many areas of burden, characteristics and hospitalisations, disabilities and impact impact. At each level, different data is required E Characteristics of vehicle, the road user and and this has to be obtained from different sources the road/environment by varied methods. A comprehensive road safety E Situation – context – and circumstances of road data system would therefore encompass data crashes collection and analysis mechanisms that cover - E Risk factor identification for selection of deaths and serious injuries to road users, countermeasures characteristics of the crashes; exposure information: E Effectiveness of interventions in terms of speed, seat-belt and helmet use rates, drink driving, reduction and changes in the burden, and and vehicle and infrastructure safety ratings; and E Provide reliable output in a timely manner to impact data in terms of socioeconomic costs to the facilitate evidence-based decisions. society. As discussed in the earlier sections of this report, such data is not readily available in Using variety of data from different sources, India. indicators can be developed to measure progress
A8. Injury surveillance
Strong and robust data is an essential prerequisite prioritizing issues and provides a situation analysis to formulate effective road safety and injury of the current scenario. The data from surveillance prevention programs (WHO, 2010a). Information is programs needs to be essentially used for required on the number of fatal and non fatal injuries, prioritization of issues, capacity strengthening and characteristics of the affected people, the place and human resource development, identifying areas for time of injury occurrence, the various contributing interventions, and monitoring and evaluation of risk factors and causes, trauma care details and activities. Road safety and injury surveillance data other aspects. This type of comprehensive information and its availability and utilization will Figure 6: Designing and building a support development and implementation of policies surveillance system and programs. 1. Identify 2. Define system stakeholders objectives Surveillance is a very familiar concept in public 4. Identify 3. Define health research and refers to ongoing, continuous data sources “ a case ” and systematic collection, analysis, interpretation, dissemination, utilization and feed back of data for reducing the burden of any public health problem 5. Assess available 6. Inform and involve resources stakeholders (WHO, 2001b). A similar approach has been used for injury prevention and control as well in many 7. Define HICs. It includes gathering information on individual data needs cases or assembling information from different sources, analysing and interpreting information, 8. Collect data dissemination and providing feed back into programs (Figure 6). It is essential to note that 12. Monitor and surveillance is a continuous activity with an inbuilt evaluate 9. Establish a data processing system feedback mechanism and an action component.
Surveillance helps in recognizing the existing and 11. Train staff and 10. Design and activate system distribute reports changing burden of injuries, understanding various patterns, identifying new emerging problems, Source: WHO, 2001b
11 can be a meaningful input to several programs and Surveillance program can be built within existing activities of different ministries, government systems with minimal resources. These existing departments, health professionals and all others systems can be improved, strengthened and utilized involved in these activities. It is extremely important to develop the requisite information (Gururaj et al, to realize that surveillance moves beyond “just data 2010). collection” to “actually using data for policies and programs”(WHO, 2001b). Further, it is also essential For surveillance system to be effective, operational, to understand that surveillance alone will not be and sustainable, it should be simple, acceptable, an answer and needs to be supplemented with sensitive, reliable, representative, sustainable, timely, variety of different data to pinpoint selection of cost effective, and most importantly useful. The interventions. In India, due to absence of central essence of surveillance is to collect small amounts coordinating agency and data not being valued, most of good quality reliable information by scientific of the surveillance data remains underutilized, even approaches and utilize the information to develop in Communicable Diseases surveillance activities. policies programs and interventions. As surveillance is an ongoing activity the data would reveal the Many, including professionals believe that RTI/injury efficacy and effectiveness of interventions as seen by surveillance requires building entirely new systems change in the injury burden and patterns. that involve huge resources. This is not true.
A9. Data sources for surveillance
There are multiple sources of data for injuries in interpretation is not undertaken at state or local India. Each source collects different types and levels. quantum of data for its own purposes. The common E Similarly, information on transport injuries is sources of data are from vital registration systems, also collected by the transport department. police, transport, health, welfare, insurance, legal Apart from information on type and number sector and others. of registered vehicles, the department also collects and publishes data on deaths and E Injury deaths in India are considered medico injuries. The published reports are somewhat legal events since historical times. similar to NCRB reports with some additional Consequently, the police department undertakes information on highway deaths and few investigation on all accidental and unnatural established indicators of road safety. However, deaths and details are documented as per the periodicity of reports is not uniform and official procedures. Information on traffic there are delays in publication of these reports. deaths is collected by the traffic division, while E The vital registration system in every city and intentional injury deaths are documented by district collect and compiles data on births and the crime division. Information on few other deaths at local levels. Information on deaths is injury deaths is also collected by law and order collected (form no.4) and compiled regularly. ICD division of police department. The available 10 coding is used in few cities and districts for information varies from place to place and this purpose. The use of ICD 10 varies from place summary statistics are sent to NCRB which to place and depends on completion of death compiles and publishes national statistics. certificates in institutions and coding by However, the information collected is mainly physicians. The local level data is available on from an administrative, criminal and legal age, sex, place, cause while, ICD code details point of view and mechanisms to use are available in some situations. The accuracy information for policies and programs are of information is influenced by completeness of totally lacking. Further, data analysis and registration and quality of data at the local level.
12 BRSIPP 2011 E Information on injuries and related deaths is E Data on injury deaths are also available from also collected by mortuary centres of selected insurance sector. However, this data is not in institutions as per legal requirements. Mortuary the public domain and cannot be accessed data is collected by forensic medicine easily for policy or research purposes. professionals and stored for longer periods of In summary, time due to legal requirements. Information there are multiple sources of data on sociodemographic details, cause of death, depth and quality of information varies situation- context – circumstances of injury, from agency to agency description of injury details and cause of death no national or professional guidelines are documented for every case. However, no exist for data collection (except for MLC collective analysis is being done by any agency. summary formats) Currently, an ongoing study in Bangalore is no uniform format exists for reporting examining mechanisms to use autopsy data from hospitals for injury surveillance purposes (Gururaj, quality and nature of information has not 2010a). been examined E All hospitals document details of injury patients except NCRB, there is no national and deaths for care and administrative reasons. coordinating agency There is no uniformity and the practice varies no agency exists for analysis, from hospital to hospital. There are no national interpretation and dissemination, and or state level guidelines for documenting details data is rarely used for interventions, of injury patients or even other patients. policies and programs Unfortunately, hospitals do not even bring out summary statistics of their respective A major drawback of the current situation is that institutions. The MCCD system collects data total information on all aspects of injuries is not from specific institutions for national and state available in the public domain for planners, policy reporting systems (GOK, 2010). analysts and researchers as the existing information systems are fragmented, and piece meal in nature.
13 Section B: The Program and Methods
B1. Bangalore road safety and injury prevention program
The Bangalore Road Safety and Injury Prevention The overall goal of BRSIPP is to achieve a reduction Program (BRSIPP) was started in 2007 to develop in injury (RTIs, suicides and others) deaths, systematic activities for prevention and control of hospitalisations and disabilities in Bangalore along road traffic injuries and other injuries. At the national with strengthening injury information systems. level, information available from the National Crime Records Bureau through its annual reports of The specific objectives of Bangalore Road Safety and “Accidental deaths and Suicides in India” provides Injury Prevention Program were to: information on number of fatal and non fatal injuries, 1. Collect and analyse data from police sources, age – sex profiles, state and city wise distribution, selected participating health care institutions, education and occupation levels, road user categories and transport sector on specific aspects of RTIs for RTIs, time and period distribution, and a vague and other injuries through a surveillance distribution of causes for road traffic injuries, approach. suicides and all accidental deaths. While this 2. Use data for road safety and injury prevention information is definitely helpful from a national programs at the city level to facilitate perspective, local data is required for a number of development of road safety and injury activities. Hence, a surveillance approach was prevention through advocacy activities adopted to gather information from multiple sources 3. Facilitate application and utilization of data in the city. This demonstration program attempted for planning and implementing general and to develop systematic road safety and injury specific countermeasures through various prevention programs based on data and evidence programs. adopting comprehensive and multiple approaches.
14 BRSIPP 2011 B2. Methods
In Bangalore, under the program, attempts were undertaken during 3 years based on data collected made to generate data through specific mechanisms are discussed in later sections of this report. Some and pool data from different sources. The program salient aspects of data collection are highlighted below. has been strengthened during the last three years and attempts are in progress to develop an integrated Figure 7: Sources of information for injuries data collection system. The extent, type and nature of data to be collected were finalized in consultation with stakeholder’s at the beginning of program.
Details of data collection activities have been discussed in earlier reports of 2009 and 2010 (Gururaj et al, 2008 and 2010). The development phase focused on consultation with stake holders, sources of data, selection of centres, inventory of hospitals, pilot study, organizing logistics of data collection, training programs, testing validity and reliability of data collection methods, feedback mechanisms and data utilization aspects. The various sources of data in the program are shown in Figure 7. Activities
B3. Fatal injuries
Information on fatal injuries was collected from two The proforma has five sections of basic identification sources: city police and vital statistics division of details, injury details (intent, type, place of injury, the city administration. As all injury deaths are product involved etc), details of Road traffic injuries considered either unnatural or accidental, they (place of occurrence, collision patterns, risk factors are routinely reported to police. Investigations (alcohol), use of safety devices (helmet and seatbelts) are undertaken as per established norms and and trauma care details (first aid, mode of procedures. Under the program, information transportation etc) (Annexure 1). was initially collected (in 2008 and 2009) through paper based formats. Under the leadership of the Since it was not possible to collect detailed Additional Commissioner (Traffic and Road Safety), information on other non-traffic injury deaths Sri. Praveen Sood, the paper version has been (Annexure 2), primarily deaths due to intentional replaced with a web based format in 2010. The computerization support was provided by the staff of National Informatics Centre in the city. Since all police stations in the city have been computerized and there are identified writers and computer programrs in each station, it was considered timely and economical to shift to this method. Number of training programs has been conducted for writers and inspectors of traffic divisions in each police station during 2009 and 2010 to implement and improve the system. The writers complete a two page proforma for every road death soon after completing investigation formalities.
15 injuries, in the urban component of the program, in the city. In consultation with senior officials, a summary statistics was obtained from the office of procedure was introduced to document details of the City Crime Records Bureau. This was compiled each fatal crash involving buses. The proforma is for 2010 on different parameters and injury causes. completed by the designated trained staff of BMTC and transferred to Co-ordinating Centre (CC) on a A similar mechanism has been developed under the monthly basis. rural component of Bangalore Road Safety and Injury Prevention Program in Tumkur. Since there are no Information was also collected from city vital networked computer systems in the district, a paper statistics division and latest data available was for based format is being used and data is collected by the year 2009. Under the Births and Deaths the team of trained research officers from NIMHANS. Registration Act, each death has to be registered The designated staff from the coordinating centre using specific formats which include the cause of collect information from individual records of traffic death. In Bangalore, under the MCCD scheme, data and non-traffic deaths (primarily accidental and is collected from the different hospitals and is intentional injuries) from the police headquarters of compiled at the city level. This was also used to Tumkur District. With computerization process in examine injury deaths under the program. the offing, it is hoped that there will be a shift to a web based format in due course of time. This A feasibility study has been initiated in December mechanism is being strengthened through an ongoing 2010 to collect data from 9 mortuary centres in the District Road Safety and injury Prevention program city with support from WHO. Considering the with support from WHO and Ministry of Health advantages of small number of centres and the legal (Gururaj, 2010b). requirements of autopsy for all injury deaths, a mechanism has been developed to obtain accurate In addition, a separate program has been established and reliable data from all autopsies of injury deaths in the Bangalore Metropolitan Transport department (Gururaj, 2010a) (Annexure 3). (BMTC) to record information on all fatal bus crashes
B4. Nonfatal injuries
Information on non fatal injuries was collected in and it is expected to lead towards a sustainable long 2010 from hospital sources in both urban and rural term mechanism (ETCR, Anneure 4). components of the program. In Bangalore City, the program that was started in 2007 continued with The collection of data is done by the ER team (nurses all the hospitals (3 of the hospitals discontinued due or doctors) using Emergency Trauma Care Record. to variety of reasons). Based on the feasibility study During the last 3 years, a number of training and the practical difficulties encountered in 3 of the programs were conducted for ER staff at regularly. hospitals (Victoria hospital, Bowring hospital and The work in each hospital is supervised by a nodal St. Johns Hospital), data collection in these places is being done by the CC staff. In all other hospitals, data collection is undertaken by the hospital designated team in the emergency room division, which varies from institution to institution.
In rural areas, the information was collected by the Casualty Medical Officers (CMOs) in Sri Siddhartha Medical College Hospital. In the district hospital and three of the community health centres, this is undertaken by the hospital staff themselves from 2011
16 BRSIPP 2011 officer of the hospital and monitored on a weekly / E Details of other types of injury and deaths monthly basis by the CC staff. The focus of (intent, place, type), information collection was on E Pre-hospital care (first aid, transport, referral) E Basic identification and brief socio- E Management and outcome demographic details E Information on Injury and death (place, type, The research component of the program was activity, intent) approved by the institutional ethics committee of E Details of road traffic deaths (where, who, how NIMHANS in 2007. and selected risk factors)
B5. Population based observational surveys
In addition to the routinely collected data, special use patterns, drinking and driving issues, speed surveys were undertaken by the coordinating centre monitoring by police, seat belt use and pedestrian during January-February 2011 in focused areas. safety issues. Detailed survey procedures are given These population based surveys in the geographically in later sections of the report under individual defined boundaries of the city focused on helmet areas.
B6. Data pooling
Data pooling was done during the year from Further, data on infrastructural projects of the city information available with transport department was collected from Bruhat Bengaluru Mahangara especially with regard to motorization changes and Palike (BBMP) and Bangalore Development Authority patterns. Information available in the annual report (BDA) to identify completed projects during the year. was made use of for this purpose and remaining data was collected from individual RTOs in the In summary, different sources of data were identified city. and relevant information was collected to develop a comprehensive picture of fatal and nonfatal injuries Information on traffic violations was collected from for the city of Bangalore. Even though the major the Traffic Management Centre under Bangalore City focus was on road deaths and injuries, data was Police of the city to examine pattern and nature of collected for other injury causes as well. In addition, violations, fines collected and level of enforcement the collected data was used for number of activities in the city. as detailed in later sections of this report.
B7. Monitoring of activities
Inbuilt mechanisms have been developed to ensure Coordinating centre staff ensure uniformity and systematic monitoring of the program. completeness of data collection with random checks and independent monitoring of 5% cases. E At the hospital level, data collected from E A weekly meeting (Saturday) was held regularly casualty is cross checked with medical records to monitor progress, recognize problems, and statistics to ensure coverage of cases. identify solutions and review progress. E At the ER level, the nodal officers ensure E All received forms from different sources were inclusion of all cases, completeness of all forms, examined for coverage and completeness. transfer to a location in ER for storage and Missing information was filled up from other transfer to coordinating centre periodically. institutional records, wherever possible.
17 E Meeting with all nodal officers once in 3 months E The program coordinator and the team visit helped in reviewing progress, identifying police stations and hospital departments at remedial measures for problems, ensured periodical intervals and held discussions with better cooperation, and work out future nodal officers, ER staff, medical record staff steps. and hospital administrator. E Continuous contact of CC staff with all E All data received from different sources were institutions was an inbuilt activity under checked for coverage, completeness and quality the program. Periodical visits and by CC staff. Data was then entered into the communications on a regular basis was computer on a day to day basis. Data entry undertaken to ensure completion of all activities and check formats have been developed using as per time schedule. EPI - INFO package.
B8. Sharing and disseminating of information
E Surveillance is an ongoing continuous activity, Data was constantly reviewed in the nodal and the analysed data has to be shared with officers meeting and used in all training all the partners; hence, feedback becomes a programs. regular feature of the program. As discussed Specific detailed information has been in the stakeholders and nodal officer’s meeting, made available to member institutions as information was disseminated in number of and when required. ways. The primary reason for using so many In 2009 and 2010, the annual reports, set combined methods was to encourage people of 10 fact sheets (Injury, Child injury, to get actively involved and also to ensure that Injuries among elderly, road traffic injury, feedback becomes an inbuilt activity. two wheeler safety, pedestrian safety, E All reports have been developed, circulated and suicides, falls, burns, poisoning), 5 public disseminated under the title of “Bangalore Road health alerts (Helmets, Seatbelts, Drinking Safety and Injury Prevention Program” and driving, Speed management, trauma E Individual institutions were provided with care) and 4 injury prevention series their respective data (on a CD) on a regular (Education, Engineering, Enforcement basis. Member institutions were encouraged to and Emergency care) have been published examine, use and develop reports for their and disseminated under the program. institutional activities.
18 BRSIPP 2011 Section C: Program and Results
As discussed in the methods section of this report, highlight the injury burden and its characteristics with data was collected from multiple sources and data a focus on road traffic injuries and other injuries. pooling was done with available data from different Further analysis of data on different aspects and in sectors during 2010. The results in this section focused areas will be undertaken during the year.
C1. Bangalore – a profile
The city of Bangalore is the capital of Karnataka and its growth in the last few years has been phenomenal. is well known globally for its technological prowess The city is characterized for its cosmopolitan nature and economic growth. The city is vibrant and is host and has witnessed rapid growth in the past few years. to a number of educational and technology Some salient features of the city are given in institutions. Known as the “Silicon Valley” of India, Table 6.
19 Table 6: Profile of Bangalore City SI. No Parameters 2010 Source 1 Area 800 sq. kms 1 2 Population 7 million 1 3 Density 2980/sq.km 2 4 Contribution to Karnataka state population (%) 11 5 5 Sex Ratio (Females/1000 males) 915 3 6 Life expectancy at birth 64.2 years 5 7 Crude birth rate/1000 20.2 1 8 Crude death rate/1000 6.2 1 9 Decennial growth rate (%) 1.3 5 10 Literacy rate% 83.91 6 11 Total number of slums 733 4 12 Total population in slums 4,30,501 5 13 Slum population% 8 2 14 Socially disadvantaged population (%) 40 5 15 Total number of schools and colleges 7674 7 16 Total number of factories 3121 8 17 Total number of police stations 142 9 18 Total number of hospitals (including public, private hospitals & nursing homes) 583 10 19 Total number of Drug stores 4445 11 20 Total number of General practitioners 5000 10 21 Total number of registered vehicles 3.69 million 14 22 Total number of 2 wheelers 2.65 million 14 23 Total length of roads 5821.46 kms 1 24 Number of alcohol selling outlets (CL-2, 4, 5, 6, 6A, 7, 9, 14 & 15) Licensees 2400 13 25 Total number of police personnel (traffic) 2881 9 26 Total number of police personnel (law and order) 11,908 9 Source: 1 Bruhat Bangalore Mahanagara Palike 8 Small, Medium and Large scale industries Corporation 2 www.bangaloreit.com 9 BCP Bangalore City Police 3 http://www.experiencefestival.com/slum 10 KSPCB Karnataka State Pollution Control Board 4 http://www.hindu.com/2007/04/28/stories/2007042802250200.htm 11 Karnataka state Drugs control General 5 www.censusindia.com 12 Bangalore City Police 6 www.des.kar.nic.in 13 Karnataka State Beverages Corporation Limited 7 Karnataka Education Departments 14 RTO, Government of Karnataka
The City of Bangalore with a population of 7 million the country. The city has more than 200 health care spread over nearly 800 square kilometres has a institutions of different nature, facilities, and population density of 2980 per sq. km. The city has services. achieved significant progress over the decade with declining birth and growth rates and an increase in The global economic recession that impacted life expectancy at birth. The male to female ratio is India and its cities, appears to have eased and approximately 1000:915. Interestingly, despite a the economic growth has revived. However, the significant economic growth, the percent of socially surging inflation in the same period affected the disadvantaged communities in the city is 40%, with lives of many people. During the year, as per 8% of the population living in slums. The overall media reports, employment, travel, hotel, literacy rate in the city is considerably higher at 84%. entertainment and other industries seem to have The city has large number of educational institutions, recovered and also increased exposure of people to industrial units and is a hub of knowledge growth in traffic.
20 BRSIPP 2011 C2. Motorisation and infrastructure development
The motorization patterns in the city have changed city, the Bangalore City Police have nearly 2,881 significantly and, at present, nearly 3.7 million police personnel at different levels with large vehicles are registered in the city, up from 1.47 numbers being at lower and mid levels. Similarly, million in 2001 (Figure 8) During the year 2010, the city has nearly 12,000 police personnel for law 2,68,876 vehicles were added to the city roads (while and order management. 1,79,666 two wheelers and 62,717 cars came onto the city roads, 216 buses joined the existing fleet). The metro work continued in the city and the first Sixty nine percent of the vehicle population within phase is expected to be opened for the public by the city are two wheelers and the proportion of cars April 2011. Remaining phases of the metro work is has doubled in a matter of just two years (from 9% expected to be completed by 2013 – 14, thus opening in 2008 to 18% in 2010). Figures 9 & 10 show the up the possibility of mass public transportation increase in number of vehicles, percentage change facility for the first time in the city. However, the in different vehicles and also selective distribution ongoing metro construction itself was a major of different categories of vehicles. impediment and bottleneck for the traffic flow and resulted in few deaths of workers. The To accommodate the increasing number of vehicles, environmentalists, NGOs and public were up in arms the city has a total road net work of 5,821 kilo meters for the felling of hundreds of trees considered with 4,491 kms of asphalted roads and 590 kms of essential for metro works and new infrastructure major arterial roads. To manage the traffic in the projects and consequent loss of critical green
Figure 8: Vehicular growth in Bangalore
Figure 9: Motorisation trends in Bangalore, Figure 10: Composition of vehicles in Bangalore 2001 - 2010 total 34,91,000
21 cover in the city. To ease traffic congestion and Due to these changes, the travel patterns of people to accommodate the growing traffic, a few have changed and exposure to traffic might have infrastructure projects like subways (10) and flyovers come down considerably (the total km travelled data /skywalks (12) and construction of several rigid is not available) in some areas and increased in few concrete medians in few locations were undertaken areas. There have been no evaluations or monitoring by Bangalore Development Authority and Bruhat reports indicating effectiveness and usefulness of the Bangalore Mahanagara Palike. various infrastructure projects affecting the overall mobility and safety of people.
Box 1: Infrastructure projects completed till date in the city by 2010 Flyovers Pedestrian Subways 1. Sirsi circle flyover 1. Hebbala 2. Richmond circle flyover 2. CBI jucniton 3. Anand rao circle flyover 3. Sanjaynagar jucntion 4. Dairy circle flyover 4. Rajabhavan road 5. Jayadeva hospital flyover 5. Sheshadri road 6. Hebbal flyover 6. Dr. Ambedkar veedhi 7. Old airport flyover 7. KR circle (towards PWD Office) 8. Yeshwanthpura flyover 8. Nrupatunga road 3 9. H.S.R Road ORR Junciton 9. Old post office road 10. Sarjapura ORR junction 10. Town hall 11. Magadi road, ring road junction 12. National college at Basavangudi Underpasses using pre - cast elements Underpasses 1. BDA junction 1. Malleshwaram underpass 2. Cauvery junction underpass 2. Modi hospital underpass 3. CBI junction 3. Rajajinagar entrance underpass 4. Sanjaynagar 4. Marath halli outer ring road underpass 5. Anandnagar 5. ORR & Hennur Banaswadi road junction 6. Hosur road at Madiwala 6. Underpass at Rama Murthy nagar 7. Palace road Maharani college junction 7. Underpass at Tollgate Junction, West of Chord 8. K.R. circle Road 9. Yelahanka international airport road
C3. Mortality profile and patterns
During the year 2009, 33,601 persons died in the Figure 11: Major causes of death – 2009 (%) city with a death rate of 5.1 per 1,000 population. Communicable disease registered a decline from 19% to 16% of total deaths. Injuries accounted for 10% of total deaths in city (Figure 11). Cardiovascular diseases topped the list with 5,124 deaths, followed by 3,644 deaths due to neoplasm’s and cancers. Injury and violence occupied the 3rd position with 2,823 deaths. The injury mortality rate was 403 / million population in the city.
Injury and violence was the leading cause of death in the city
Among the total deaths in the city, two out of three deaths were among men. One out of three deaths
22 BRSIPP 2011 was among the elderly, while children <15 years emerging as one of the leading cause of death among accounted for 5.3% of total deaths. Nearly 20% of women. The nationally representative study of deaths were in 15 – 44 years and 30% among Million death study by the office of the Registrar 45 – 64 year age group with slight gender variations General of India also reported similar observations (Figure 12). Interestingly, more deaths (34%) were with regard to age groups (RGI, 2009). seen among elderly women as compared to men (27%). Among the various injury causes, transport injuries and burns topped the list accounting for 23% and Figure 12: Age – sex distribution of deaths in 28% of deaths, respectively (Figure 13). Suicides, Bangalore, 2009 primarily due to hanging were responsible for 12% of deaths. It is essential to note that majority of burns and poisoning could be suicidal in nature. As suicides occur due to poisoning, hanging, burns and drowning. The number of deaths was to be determined based on intent
Further, the pattern and nature of deaths is dependent on the cause of death as mentioned in death certificates.
Figure 13: Distribution of injury deaths as per Injuries have been a major cause of death in all age BBMP death data 2009 (%) groups and both sexes. Transport injuries and suicides were the leading cause of death in younger age groups of 15 – 44 years (Tables 8, 9 and 10). Among men, transport injuries were the leading cause of death in 15 – 44 years, while suicides (primarily due to burns) were the major cause among women. Male suicides were also common in this age group primarily due to poisoning. However, among women, suicides due to burns were the leading cause in same age group. With increasing mobility due to education and work, transport injuries are also
C4. Non fatal injuries
Data from the 3 years of BRSIPP indicate that nearly cases with more nonfatal injuries in falls and higher 6,000 persons died of injuries and violence in number of deaths in burns. Bangalore city. Pooled 3 years data indicate this ratio with regard to RTIs to be 1 : 18 (10-33) : 30 Nearly half of injury and violence deaths in (25-50)in the city of Bangalore. Data also indicate city are due to traffic crashes and suicides. the ratio of deaths : hospitalisations : minor injuries to vary from hospital to hospital and from injury to Injury and violence are the leading cause of injury. Information on distribution of injuries and death in both men and women in 15 – 44 RTIs across hospitals in Bangalore is shown in years Table 7. This ratio is likely to vary as per injury
23 deaths Total RTI RTI Total 20.2 37% Total injury injury deaths Total deaths in deaths in the Hospital Total RTI RTI Total admissions 6.7 51.7 Total injury injury Total admissions Total Hospital admissions RTI registrations Total Casualty Total Casualty 17.7 46.7 Total Injuries Casualty Casualty NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA NA 8057 632 393 9203 369 278 12 0 0 3330 2210 1480 3901 2377 9949 1006 1119 1153 28101 35 12 800 21 732 357 41 41 1717 2640 2467 1702 1848 1702 1686 2643 1372 1671 7991 324 23 856 22 234 23 50 3831 40 33 202 142 104 3 3 11708 2058 20236 2642 565 13504 4467 18344 975 18888 2118 13244 736 1822 23376 22444 1024 407 1234 447 2390 14802 154 727 280 409 571 1 8733 394 1376 138 41 2 330 45 384 25 14692 876 120 15 266 273 2 17851 199 310 80 35 92 234 5 4 11752 1901 83 13815 2642 10885 11888 1655 1368 195 26683 1343 17292 286 17 17435 505 718 56 12208 998 349 280 4599 1 30184 13069 481 542 767 2 18 5051 70 10022 1461 650 15 7257 450 27 106 11649 705 26 12958 528 166 195 17413 304 7 115 2680 10230 7 1 380 453 2 2050 40861 5612 233 246 263 798 17609 1107 12 3164 321 35 4 33302 284 33864 2873 7 634 643 18274 6 778 31306 14381 18261 415 463 14609 1030 674 196 3259 205 51 23 383 19464 597 134 11 35011 348 5010 4 2206 2 1291 3 233 3011 1154 280 104 70 56 Registrations Total Casualty Total Casualty Table 7 : Non-fatal injury registrations in ERs of participating hospitals, January-December 2010 Table Name of Hospital Hospital of Name V`HVJ :$V Ambedkar Medical College And Hospital Hospital And College Medical Ambedkar Hospital Baptist Bangalore Bowring & Lady Curzon Hospital Hospital Mission Chinmaya Columbia Asia Hospital Hebbal Columbia Asia Hospital Yeshwanthpur CommandHospital (Air Force) D.G. Hospital Rajajinagar Esi Hospital Total 392358 69480 32466 375300 25144 13004 10318 2080 770 General Hospital, Jayanagar Jayanagar Hospital, General Hospital Hosmat Kims Hospital Hospital Teaching Medical Ramaiah M.S. Hospital Memorial Ramaiah M.S. Centre Medical Mallige Hospital College & Research MVJ Medical Nimhans Rajarajeshwari Medical College& Hospital Sagar Hospital & Trauma of Institute Gandhi Sanjay Orthopaedics Hospital Sparsh College Medical John’S St. Hospital Martha’S St. St. Philomena’S Hospital Suguna Hospital Hospital Victoria Hospital And College Medical Vydehi
1 2 3 4 5 6 7 8 9 Sl 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 No
24 BRSIPP 2011 otal Burns 33601 crashes diseases diseases diseases diseases diseases disorders uberculosis Transport Other CNS Pulmonary Neoplasms Respiratory T Hypertensive Liver diseases erinatal deaths Miscellaneous heart diseases Urinary system P Cerebrovascular Ischaemic heart Diabetes Mellitus 13459 diseases diseases diseases diseases diseases diseases diseases disorders Neoplasms Pulmonary Other CNS Diarrhoeal Pneumonia Tuberculosis Hypertensive heart diseases Liver Diseases Miscellaneous Ischemic heart Urinary system Cerebrovascular Diabetes Mellitus Other circulatory Lower respiratory 5615 - 64 yrs Above 65 yrs T Other crashes diseases diseases diseases diseases diseases disorders uberculosis Transport Other CNS Neoplasms Pulmonary Pneumonia T Hypertensive Miscellaneous Liver Diseases heart diseases Ischemic heart Urinary system Cerebrovascular bacterial diseases Diabetes Mellitus Lower respiratory 4357 crashes diseases diseases diseases diseases diseases disorders disorders Transport Neoplasms Pulmonary Pneumonia Tuberculosis Hypertensive Liver Diseases heart diseases Haemopoeitic Miscellaneous Ischemic heart Urinary system Other bacterial Cerebrovascular Diabetes Mellitus Lower respiratory 2956 Burns crashes diseases diseases diseases diseases diseases disorders uberculosis Transport Diarrhoeal Neoplasms Pneumonia T Hypertensive Viral diseases Miscellaneous Liver Diseases Ischemic heart Urinary system Pulmonary heart Diabetes Mellitus Lower respiratory yrs 35 - 44yrs 45 - 54yrs 55 2249 Burns crashes Suicide disease diseases disorders Poisoning Transport uberculosis Neoplasms Pneumonia T Viral diseases Liver Diseases Miscellaneous Ischemic heart Urinary system CNS infections Rheumatic heart Diabetes Mellitus 1072 Burns deaths oisoning Suicide crashes diseases diseases disorders disorders Maternal P Table 8: LeadingTable causes of death in all age groups Bangalore, 2009 Transport Other CNS Diarrhoeal Rheumatic Neoplasms Tuberculosis Viral diseases heart diseases Haemopoeitic Miscellaneous CNS infections Other bacterial 255 Burns Suicide crashes diseases diseases diseases disorders disorders Transport uberculosis Neoplasms Other CNS Diarrhoeal Congenital Pneumonia T Viral diseases Haemopoeitic Miscellaneous CNS infections malformations Other bacterial Rheumatic heart 1491 Burns deaths crashes diseases diseases diseases Perinatal disorders disorders Transport Diarrhoeal Neoplasms Other CNS Congenital Pneumonia Tuberculosis Viral diseases Haemopoeitic Miscellaneous malformations CNS infections Other bacterial Rheumatic heart 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total SlNo. 0-4 yrs 5 - 14 yrs 15 - 24 yrs 25 - 34
25 otal Burns 21373 crashes diseases diseases diseases diseases disorders disorders uberculosis Transport Pulmonary Other CNS Neoplasms Respiratory T Hypertensive Liver diseases heart diseases Miscellaneous Urinary System Perinatal deaths Perinatal Ischaemic heart Cerebrovascular Diabetes mellitus 7970 crashes diseases diseases diseases diseases diseases diseases diseases disorders Transport Neoplasms Pneumonia Other CNS Tuberculosis Hypertensive Liver Diseases Miscellaneous Ischemic heart Urinary system Cerebrovascular Pulmonary heart Other circulatory Diabetes Mellitus Lower respiratory 3741 - 64 yrs Above 65 yrs T crashes diseases diseases diseases diseases diseases diseases disorders uberculosis Transport Pulmonary Pneumonia Other CNS Neoplasms T Hypertensive heart diseases Miscellaneous Liver Diseases Ischemic heart Urinary system Other bacterial Cerebrovascular Lower respiratory Diabetes Mellitus 2941 crashes diseases diseases diseases diseases diseases diseases disorders Transport Neoplasms Pneumonia Other CNS Tuberculosis Hypertensive Liver Diseases Miscellaneous Ischemic heart Urinary system CNS infections Cerebrovascular Pulmonary heart Diabetes Mellitus Lower respiratory 2071 Burns crashes Suicide diseases diseases diseases diseases disorders Transport uberculosis 35 - 44yrs 45 - 54yrs 55 Neoplasms Pneumonia Diarrhoeal T Hypertensive Viral diseases Liver Diseases Miscellaneous Ischemic heart Urinary system Pulmonary heart Diabetes Mellitus 1410 Burns crashes Suicide diseases disorders Poisoning Transport uberculosis Neoplasms Pneumonia Rheumatic Pulmonary T heart disease heart disease Liver Diseases Miscellaneous Ischemic heart Urinary system CNS infections Diabetes Mellitus 690 Burns Table 9: Leading causes of death among males in Bangalore , 2009 9: Leading Table Suicide crashes diseases diseases Malaria disorders disorders Poisoning uberculosis Transport Rheumatic Neoplasms Other CNS Diarrhoeal T Viral diseases heart diseases Miscellaneous Haemopoeitic CNS infections Other bacterial 144 crashes Suicide diseases diseases diseases disorders disorders Transport uberculosis 5 - 14 yrs 15 - 24 yrs 25 - 34 yrs Congenital Other CNS Diarrhoeal Pneumonia Neoplasms T Viral diseases Liver diseases Haemopoeitic Miscellaneous malformations CNS infections Other bacterial Rheumatic heart 959 Burns deaths crashes diseases diseases Perinatal disorders disorders disorders Transport uberculosis Congenital Diarrhoeal Neoplasms Other CNS Pneumonia T Viral diseases Haemopoeitic Miscellaneous malformations CNS infections Urinary system Rheumatic heart 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total SlNo. 0-4 yrs
26 BRSIPP 2011 otal Burns 12228 crashes diseases diseases diseases diseases disorders disorders uberculosis Transport Neoplasms Pulmonary Respiratory T Hypertensive Liver diseases Haemopoeitic Miscellaneous heart diseases Urinary system Perinatal deaths Perinatal Ischaemic heart Cerebrovascular Diabetes mellitus 5489 diseases diseases diseases diseases diseases diseases diseases diseases disorders Diarrhoeal Neoplasms Other CNS Pneumonia Tuberculosis Hypertensive Liver Diseases Miscellaneous Ischemic heart Urinary system Other bacterial Cerebrovascular Pulmonary heart Diabetes Mellitus Lower respiratory 1874 - 64 yrs Above 65 yrs T crashes diseases diseases diseases diseases diseases diseases disorders disorders Transport Neoplasms Pneumonia Tuberculosis Hypertensive Haemopoeitic Liver Diseases Miscellaneous Ischemic heart Urinary system Other bacterial Cerebrovascular Pulmonary heart Diabetes Mellitus Lower respiratory 1416 diseases diseases diseases diseases diseases disorders disorders Neoplasms Pulmonary Rheumatic Pneumonia Tuberculosis Hypertensive heart disease heart diseases Liver Diseases Haemopoeitic Miscellaneous Ischemic heart Urinary system Other bacterial Cerebrovascular Diabetes Mellitus Lower respiratory 885 Burns crashes diseases diseases diseases disorders disorders Transport Neoplasms Pulmonary Rheumatic Pneumonia Tuberculosis Hypertensive heart disease Liver Diseases heart diseases Haemopoeitic Miscellaneous Ischemic heart Urinary system Diabetes Mellitus Lower respiratory yrs 35 - 44yrs 45 - 54yrs 55 839 Burns Suicide crashes diseases diseases disorders Poisoning uberculosis Transport Rheumatic Neoplasms Pneumonia T heart disease Viral diseases Liver Diseases Miscellaneous Ischemic heart Urinary system Other bacterial Maternal deaths eading causes of death among females in Bangalore , 2009 382 Burns Suicide crashes diseases diseases diseases disorders Poisoning Table 10: L Table Transport Pulmonary Neoplasms Diarrhoeal Tuberculosis Heart disease Viral diseases Haemopoeitic Miscellaneous CNS infections Other bacterial Rheumatic heart Maternal deaths 111 Burns crashes Suicide diseases diseases diseases disorders Transport uberculosis Pulmonary Neoplasms Diarrhoeal Other CNS Pneumonia Congenital T Viral diseases heart diseases Miscellaneous CNS infections malformations Other bacterial Rheumatic heart 532 Burns deaths diseases diseases diseases Malaria Perinatal disorders disorders Diarrhoeal Neoplasms Other CNS Congenital Pneumonia Tuberculosis Viral diseases Haemopoeitic Miscellaneous malformations CNS infections Other bacterial Rheumatic heart 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Total SlNo. 0-4 yrs 5 - 14 yrs 15 - 24 yrs 25 - 34
27 C5. Young men and women are affected most
Injuries primarily affect the young people. Commonly, Figure 14: Age - sex distribution of communicable and infectious diseases are frequent injury deaths – 2009 (BBMP) in children and non-communicable diseases are seen beyond the age of 50 years. In the young population of 15 – 44 years injuries are a leading cause of deaths, hospitalisations and disabilities. Data from vital statistics division of BBMP and BRSIPP study findings confirm this observation as nearly 70% (65% of male and 74% of female) of deaths were in 15 – 44 years with a male to female ratio of 2:1 (Figure 14 and 15).
Figure 15: Age-sex distribution of fatal and non fatal injuries in 2010
Urban Rural
Urban Rural
C6. Violence and injury occur all throughout the year
Unlike many of the natural disasters that occur once though some months registered higher numbers in a while, injuries and RTIs are disasters of everyday. (Figure 16). In rural areas, 20% of fatal RTIs While natural disasters bring massive human occurred in July and reasons need to be ascertained suffering and property damage at one time and all for the same. This pattern of injury and violence of a sudden, injuries continue to kill and injure often obscures and hides the injury burden and people, and damage property, day after day and year highlights need for examination in a different after year (Table 11). Data from BRSIPP reveal that framework. Many policy makers tend to dismiss injuries were distributed across all months, even injuries as a major public health problem since a
28 BRSIPP 2011 few people are affected every day, and hence, a this has to be examined as per different injury causes, cumulative examination is crucial to understand the the distribution does not follow a classic and uniform distribution of injuries. pattern. Hence, because of its occurrence throughout different age groups, time periods and different Similarly, injuries continue to occur throughout the places, they are different as per compared to other day at different time points (Figure 17). Even though, problems.
Table 11 : Injury related deaths in Bangalore during January - December, 2010 (%)
Months Road Fire / Suicides- Other Accidents Falls Burns Poisoning Hanging Drowning Fall of Assualt / accidental Total Poisoning Objects Homicides deaths Others Jan 7.1 8.6 7.5 5.8 8.7 8.3 9.7 7.7 7.2 7.75 Feb 8.5 3.3 10.9 8 7.6 6.7 9.7 7.7 5.9 7.64 March 6.5 11.8 9.6 7.6 8.4 7.5 16.1 10.3 8.7 8.34 April 7 8.6 8.6 10.2 8.7 10.8 9.7 10.3 7.1 8.17 May 9.1 9.9 9.9 9.1 8.9 11.7 9.7 2.6 8.9 9.09 June 9.5 5.9 9 8 6 7.5 9.7 7.7 7.6 7.55 July 10.6 5.9 8.8 11.6 8.7 7.5 12.9 7.7 8.7 9.16 Aug 8.1 7.2 8.6 8.7 8.4 9.2 0 15.4 10.8 8.85 Sep 7.8 7.9 7.5 6.9 9.7 7.5 0 5.1 10.4 8.87 Oct 9.1 12.5 6.9 7.3 8.6 10 6.5 7.7 8.5 8.56 Nov 10.5 7.2 5.7 10.2 8.9 7.5 9.7 10.3 8.7 8.85 Dec 6.3 11.2 6.9 6.5 7.3 5.8 6.5 7.7 7.6 7.16
Figure 16: Fatal and non-fatal injuries as per month of occurrence (%) Urban Fatal RTI's Non-fatal all injuries Non fatal RTI's
Rural Fatal RTI's Fatal all injuries
Figure 17: Fatal and non-fatal injuries as per the time of occurrence (%) Fatal Non-Fatal
29 C7. Injury and violence in Bangalore
As per official police reports, during 2010, 4,542 RRR Nearly 500 persons die in Bangalore persons died in Bangalore due to one or more acts city every month of violence and injury. The number of deaths registered by police agencies was higher compared Among the various injury causes, Road traffic with vital statistics registration, probably due to injuries and suicides were the major causes, incomplete and improper registration of deaths. contributing for more than half of deaths in both Scientific studies from all over the world, including urban and rural areas and for both fatal and non- few from HICs, have documented underreporting in fatla injuries (Figure 18). One out of 5 deaths were official agencies, Studies from Bangalore (Gururaj due to RTIs, while one out of three deaths was G et al, 2000), Haryana (Varghese and Mohan, 2003) suicidal in nature. There could be possible and Hyderabad (Dandona et al, 2008) have revealed misclassifications for suicides and violence as this underreporting of RTIs. Deaths due to late is mainly based on intent and family members complications of injury and violence are not reported would like to conceal due to stigma, police enquiries with official agencies. Further, underreporting is and related issues. Burns due to self immolation – possible due to other injury causes like falls, accidental fires – and homicidal causes were drowning, burns and poisoning. responsible for nearly 500 deaths. In view of these issues, it is estimated that every year, nearly 6,000 deaths are likely to occur in the RRR Road traffic injuries and suicides city of Bangalore. This essentially means that nearly are the leading cause of deaths, 500 persons die every month due to an injury cause. hospitalisations and disabilities This estimate is also strongly supported with data from mortuary centers with autopsies done on more Road traffic injuries were the leading cause of death than 7,500 deaths in 2009. in both rural and urban areas for both fatal and non
Figure 18: Causes of fatal and nonfatal injuries in urban and rural areas, 2010 (%) Urban Fatal Non-Fatal
Rural Fatal Non-Fatal
30 BRSIPP 2011 Figure 19: Intent of injury (%) Urban Rural Fatal Non-Fatal Fatal Non-Fatal
fatal injuries. Nearly, 20% of deaths in urban areas RRR Alcohol consumption is a major risk and 32% of deaths in rural areas were due to road for deaths and injuries traffic injuries. Similarly among all non fatal injuries 47% in urban and 74% in rural were due to road Alcohol consumption is a major risk factor for traffic injuries. Remaining causes varied as per the injuries. Alcohol, even in small quantities, affects place. Among other causes, assaults due to violence vision, reflexes, judgement, coordination and was the second leading cause of hospitalizations in predisposes for occurrence of injuries. Data on both urban and rural areas. The 3rd leading cause alcohol is difficult to obtain from injury records in was mainly poisoning followed by falls. both hospitals and police due to medico legal problems. In our training programs, it was strongly RRR Majority of the injuries are emphasised about the need to document the unintentional in nature involvement of alcohol as it helps in recognition of the problem and taking corrective measures. Majority of the injuries were unintentional in nature in both fatal and non fatal categories. Unintentional Following these efforts, the recording of alcohol did injuries contributed for more than 2/3 of total non improve, even though this is far from ground reality. fatal injuries in Bangalore (70%) with fatal injuries Selective examination of alcohol use among men, in due to suicides and assault contributing for 28% of 16 + years and those injuries occurring between 6 pm injuries. In rural areas, intentional injuries accounted – 2 am, revealed that 7% of fatal and 20% of nonfatal for 25% of deaths with unintentional injuries injuries showed alcohol involvement (Figure 20). contributing for 1/3 of deaths (Figure 19). Alcohol not only predisposes, but also poses problems in care and management of individuals, especially those with brain injuries.
Figure 20: Alcohol in fatal and non-fatal injuries, Bangalore (%) Fatal Non-Fatal
31 C8. Road traffic injuries
In 2010, nearly 1000 persons died due to road crashes of the participating hospitals. In the same period in Bangalore. Apart from 858 registered deaths, there 13,004 persons were admitted for care with serious were 47 were UDRs (primarily crashes occurring with injuries. It is estimated that a minimum of 100,000 fixed objects which are documented separately) persons are likely to contact hospitals for emergency registered in the city. With an estimated 10% care. Based on data pooling for the period 2008-10 underreporting of late deaths, it is estimated that the it is estimated that, the ratio of fatal to hospitalized total number would be 1000 of deaths. As discussed to minor RTIs could be in the range of 1 : 40 : 70 in earlier, majority of these deaths occurred among young the city of Bangalore (Figure 22). men. The RTI mortality rate for 2010 was 14 / 1,00,000 population per year, which is much higher Due to increasing motorisation, industrialisation, than the national average of 11 / 1,00,000. migration and therby increasing exposure of people to vehicles and traffic, there has been a continuous The police agencies registered 5667 nonfatal injuries increase in road deaths in the city. The number during the same period in a ratio of 1 : 7 for fatal to of fatal RTIs has increased from 700 in 2001 to nonfatal injuries. There has been a gradual decline 858 by 2010, an increase of 25% over the decade of registered nonfatal injuries over time. This is due (Figure 23). Nonfatal injuries are also increasing to the fact that people register a case with police over time, even though many are not registered with only when there is requirement of an FIR for legal police and hospitals do not send any regular monthly or insurance purposes. or annual reports (Figure 24).
Data from 25 urban hospitals during the same period Figure 23: Fatal RTIs in Bangalore City saw a total of 32,466 nonfatal RTI registrations. during 2001 to 2010 8.3% of the total casualty registrations (Figure 21). For every 1 police registration, there were 6 hospital registrations. The number of nonfatal injuries could be much higher as data was collected from only 25
Figure 21: Comparison of non-fatal RTIs registered with the police and hospitals
Figure 24:Nonfatal RTIs in Bangalore during 2001 to 2010
Figure 22: Bangalore RTI pyramid
Deaths (1) 1000 A 25% increase in RTI deaths and a
40,000 phenomenal increase of nonfatal RTIs are Serious Injuries (40) seen during the last decade in Bangalore city. As shown in the figure 25, among the total deaths 84% were men. Nearly 5% of deaths occurred among Minor Injuries (70) 70,000 children < 15yrs and 13% among elderly. RTI deaths in the age group of 15 - 44 yrs contributed for 61 %
32 BRSIPP 2011 Figure 25: Age sex distribution of fatal and non fatal RTIs in urban and rural areas (%)
Urban Fatal Rural Fatal Urban Non-fatal
of total deaths. The pattern was similar for non fatal This analysis revealed that in each area one or two injuries. In rural areas, 86% of RTI deaths occurred roads accounted for large number of deaths. For among men and 50% of total were in 15 - 44 yrs. example, Tumkur road in Peenya limits registered 27 (42%) of the 64 deaths. Similarly, The Bangalore E Crash Locations - Bellary road contributed for 60% (38/63) of deaths. Generally, this analysis revealed that roads connecting The design and characteristics of roads plays a major to national / state highways and new peripheral ring role in RTI occurrence. The location of RTIs as per roads accounted for 3/4th of total crashes as shown different categories of roads helps in identifying major in Figure 28. and Table 12. Further, in all the areas, types of roads with high occurrence. One fourth of pedestrians and two wheeler riders were involved in urban fatal RTIs and half of rural RTIs occurred on 43.5% and 30.8% of fatal crashes respectively. The highways, highlighting the need to build safe analysis of road charecteristics revealed that crashes highways. The proportion of nonfatal RTIs in occured on stright roads, pucca roads and during both areas was around 12–15%, indicating the only nights. This type of information is useful for occurrence of severe crashes resulting in more number local area traffic and safety improvement programs of deaths (Figure 26). Every 3 out of 4 injuries in the for city planners. In particular, there is a need to city occurred on municipal roads, while rural roads improve and implement road safety programs on were responsible for one third of injuries in rural these roads. areas.
Urban and rural infrastructure has to be designed keeping safety of people.
In 2010, 858 road deaths registered with city police occurred in different locations. Information on crash location was also collected from police records. Among the 39 police stations, 503 (61%) took place in 13 police station limits as shown in Figure 27a.
Figure 26: Place of road traffic crashes (%) Urban Rural
33 Others Lorry Drivers Car Drivers Cyclists Two Wheelers 9 9 1 0 0 3 0 0 1 9 21 10 0 1 0 6 0 1 0 21 10 14 19 1 0 0 3 0 0 1 14 19 10 12 0 1 0 0 0 1 0 10 12 28 24 3 1 0 8 0 1 3 28 24 5 0 1 1 20 36 2 0 2 0 22 20 2 0 2 2 0 14 0 0 1 25 5 4 0 1 1 11 14 12 14 1 2 0 1 0 2 1 12 14 2 0 0 2 12 13 30 17 2 1 2 0 2 1 2 30 17 % Pedestrians % Pedestrians 4.3 13.2 40.5 20.6 25.8 29.0 36.4 21.2 s 5 7.8 1 1.6 9 26.5 3 6.5 2 5.3 4 12.9 8 36.4 14 26.9 11 23.9 18 58.1 17 56.7 27 51.9 31 81.6 38 60.3 26 56.5 22 59.5 23 74.2 20 87.0 27 42.2 No of Death Major Roads Major Roads Others 5 Others 15 Others 1 Tumkur Road Road Tumkur Hesaraghatta Road Ring Road 10 Bellary Road 15.6 Doddaballapur Road Ring Road 7 Hosur Road 11.1 Ring Road Mysore Road Ring Road Nice Road Hosur Road Nice Road Bellary Road Old Madras Road Ring Road 18 Bellary Road 52.9 Bellary Road Ring Road Ring Road Bannerghatta Road B T M Ring Road 17 Bellary Road 58.6 4 Doddaballapur Road 13.8 2 road Tumkur H M T Main road 8.7 C V Raman road 2 4 9.1 18.2 Others 22 34.4 Others 22 27 Others 17 Others 11 13.0 Others 6 Others 7 Others 8 Others 9 Others 13 43.3 27.6 Others 13 Others 8 Others 8 38 37 23 2010 Total Deaths Total 37 28 28 2009 Total Deaths Total Table 12: List of top areas with high road deaths in Bangalore, 2010 (n=500/858) Table ------50 25 64 50 25 63 45 39 52 56 55 46 48 56 34 98 39 31 18 14 31 22 15 32 24 30 32 24 29 26 24 22 49 30 2008 Total Deaths Total Name of the Area Peenya Peenya Yelahanka Madivala Byatarayanapura Electronic City Chikkajala K R Puram R T Nagar Hebbala Banasawadi Micolayout Devanahalli Yeshwanthpura 1 2 3 4 5 6 7 8 9 Sl 10 11 12 13 No
34 BRSIPP 2011 Figure 27 a: Fatal crashes under different traffic Figure 28: Area and roads with high fatal police stations, 2010 crashes, 2010
Figure 27b: Conditions and characteristics of crash Large numbers of pedestrians and two locations, (%) wheeler rider / pillion are killed and injured on the roads of Bangalore and in rural areas
Collision pattern varies in urban and rural areas and depends on number of factors. In urban areas, collision with pedestrians, hit from back and skid and, fall were the commonest types that resulted in nonfatal injuries. For fatal RTIs, colliding with pedestrians, hit from back and collision with a vehicle in front were frequent and seen among two wheeler riders and pillions. Hit and run was common C 8.1 Road user categories in rural areas, and especially on highways. Nearly 5% of crashes were due to collision with fixed objects In both urban and rural areas, pedestrians were most like medians, light poles, trees and other objects. frequently injured: for fatal injuries, varied from Colliding with a vehicle in front was seen in both 32 – 45% of total RTI deaths, and the numbers varied urban and rural areas to the extent of 10% and slightly from 24 – 30% for nonfatal injuries. Two commonly resulted in death due to high speeds in wheeler riders and pillions accounted for 42 - 56% such collisions. of nonfatal injuries in rural and urban areas, while 35 – 40% of deaths were in this group. Deaths and In fatal crashes, pedestrians were mainly hit by buses injuries among pedal cyclists varied from 2 – 5% in and trucks (25 – 28%), two wheelers (20 – 27%), the series. Car occupants ranged from 2 – 4% in cars (19-30%) in both urban and rural areas. The both urban and rural areas, except for the high heavy size of vehicle and impact of collision resulted numbers, primarily due to severe crashes occurring in higher number of deaths among pedestrians. on highways. The three wheeled auto rickshaws Collision between pedestrians and two wheelers was contributed to 10% of nonfatal injuries in rural areas extremely common in both urban and rural areas (Figure 29). resulting in nonfatal injuries. Pedestrians were mainly hit by two wheelers on the roads in nearly half of
35 Figure 29: Road user catagories (%) Urban Fatal Non-fatal
Rural Fatal Non-fatal
non fatal crashes. Cars had collided with pedestrians 6% at T junctions, 4% in round abouts and 4% at in 10-15% in both urban and rural areas. signal lights (Figure 32). Interestingly, in rural areas nearly 14% of collisions took place between pedestrians and buses while For two wheeler crashes, collision between two similar number in urban areas was 7% (Figure 30). wheelers was the commonest pattern for nonfatal injuries in both urban and rural areas. Nearly 50% Pedestrians were commonly injured while walking or of fatal in urban and 40% in rural were due to crossing roads in 20–40% of road crashes. collision with heavy vehicles (Figure 33). Most of Surprisingly, 10% of rural pedestrian deaths occurred the fatal two wheeler crashes (45%) took place in when they were hit by vehicles, as they were standing the middle of the road and one third of them while on road. Nearly 40% of pedestrians were killed while they were hit from the back (35%). The other walking on roads, indicating the unsafe environment common locations were road curves (7%), T junctions for walking in the city. Activity at the time of pedestrian (12%) and even on road humps (3-7%). Head on crash revealed that 2/3rds were crossing the road collisions were recorded in 10% of crashes, while and ¼th walking on the road. 8 children died while skid and fall was seen in 8% of deaths. Collision playing, 5 persons while working and 19 even when with a vehicle in front was documented in 18% of they were just standing in the road. (Figure 31). fatal crashes and 16 persons died due to crashes with fixed objects like concrete medians. (Figure 34 Nearly 38% of pedestrian deaths occured due to and 35). collisions in mid block areas, 6% near cross roads,
36 BRSIPP 2011 Figure 30: Collision of vehicles with pedestrians (%) Urban Fatal Non-fatal
Rural Fatal Non-fatal
Figure 31: Pedestrian activity at Figure 33 on next page the time of crash, 2010 (%)
Figure 34: Pattern of two wheeler collisions, 2010 (%)
Figure 32: Location of fatal pedestrian crashes, 2010 (%)
Figure 35: Location of fatal two wheeler crashes, 2010 (%)
37 Figure 33: Two - wheeler collison patterns (%) Urban Fatal Non-fatal
Rural Fatal Non-fatal
C 8.2. Risk factors for road crashes wheeler riders and pillions is the appropriate use of standard helmets. The helmet primarily reduces C 8.2.1 Helmet use impact of collision and consequent injury to the brain by - acting as a mechanical barrier between the The city is characterized by a phenomenal number skull and the impacting object; reducing the of two wheelers as shown in the previous sections of deceleration of the skull and hence the brain the report. The convenience of driving, easy movement; providing a cushioning effect through availability, rising income levels, media promotion, the padding thermocole lining which absorbs the inability to afford cars and lack of public impact ; spreading the force of the impact to a larger transportation have contributed for an increase of area so that energy is distributed through the outer two wheelers in the city. The distribution of injury patterns among two wheeler indicate that majority of them sustain injury to head and face in both fatal and non fatal injuries. Injury to a vital part of the body like brain, which controls all major activities of an individual, can have devastating effects on the life of affected individuals and their families. Injuries to the brain, spinal cord and facial structures can lead to instantaneous death and long term disabilities among two wheeler riders and pillions.
One of the recommended, proven and, cost effective interventions for reducing brain injuries among two
38 BRSIPP 2011 shell of a helmet. The shell also protects against done in this phase. A just completed study on penetration of the skull by any sharp pointed objects ‘prevalence of non-standard helmet use’ in Bangalore and by keeping the helmet on the head in a crash (www.rtirn.net) provides detailed interviews also. through chinstraps. (Gururaj 2005b and 2008a; WHO, 2006). E Examining helmet use among those killed and injured, though not a direct measure, indicates On November 6, 2006, Karnataka introduced partial the pattern of use and effectiveness of helmets helmet legislation (in select cities and only for riders) among those with different levels of injury as a safety strategy to reduce brain injuries based on severity. Data showed that 49% of urban and the directives from the High court of Karnataka. The 80% of rural injured motorcyclists had not worn Karnataka Motor Vehicle Rules, 1989, rule 230 makes helmets at the time of crash (Figure 36). Among it mandatory for motor cycle riders (covering urban fatal crashes only a third had worn motorcycles, scooters and mopeds) to wear protective helmets at the time of crash. The use of helmets head gear of such quality that will reduce impacts was totally deficient in rural areas as there is in crashes. The rule also highlights that helmets no legislation at present nor any awareness should confirm to standards and carry reflective tapes activities conducted in rural areas. Recently, of 2x13 centimetres to increase visibility. an independent study on prevalence of non
Figure 36: Use of helmets among two wheeler riders (%) Urban Rural Fatal Non-fatal Non-fatal
In 2010, data regarding helmets was collected from standard helmet use has been completed and multiple sources in the city. The use of helmets at report development is in progress. the time of crash was collected from patients in ER and also from the investigations by police in fatal E In recent times, enforcement by police for crashes. The level of enforcement was measured by helmet law has been stepped up and people the number of cases booked and fines collected by have been booked for violation of the law with the Bangalore City Police. In addition, focused a fine of Rs. 100. In 2010, nearly 2,57,072 2 population based observational surveys were wheeler riders were booked by Bangalore City undertaken by a team of trained research officers in Police for not wearing helmets. As shown in 78 traffic locations within the city. The observations figure 37, there has been an increase in number were made during both day and evening times on a of cases booked (1,98,651 in 2009 to 2,57,072 rotational basis at traffic intersections covering in 2010). different traffic movements and directions. During the period of 26th January 2011 to 8th February E The use was directly linked to the type of 2011, a total of 1,45,789 two wheeler riders were vehicle, time and location of observations. Our observed for helmet use. Two wheeler riders were observational surveys revealed that majority of observed at traffic intersections about helmet two wheeler riders were wearing helmets. wearing, type of helmets and whether they were Among the users, 53.7% were wearing full face appropriately strapped or not. No interviews were helmets, 11.1% half face and 31.8% open type
39 Figure 37: Cases booked by Bangalore city police E The survey was done during day time and during for non use of helmets working days, which showed greater one on the country our observations during other times and other days found lower helmet use among riders. Most of the pillions were not found wearing helmets as the present law does not cover these categories of riders.
or construction hat helmets (Figure 38). As open type helmets are not recommended, it can be inferred that the use of helmets was only 64% . It was also observed that many had not strapped their helmets properly as chin straps were not tied and helmets were likely to fall off any time. Further, many were also using damaged (cracked) helmets that are not likely to offer any protection. These observations indicate that (i) enforcement is more focused around day times and in central business Figure 38: Helmet use among two wheeler riders: parts of Bangalore, and (ii) public awareness on proper results of an observational study (%) use of helmets were extremely low.
Helmets reduce brain injury, related hospitalisation, consequent disabilities or deaths and accompanying economic costs significantly. Helmet laws should be expanded to the whole state and strictly implemented along with increasing awareness among public
Strategies to increase helmet use