1 Masters' Thesis Relationship Between The

MASTERS’ THESIS RELATIONSHIP BETWEEN THE LOCATION AND CAUSES OF MOTOR VEHICLE ACCIDENTS ON THE B1 ROAD, WINDHOEK TO REHOBOTH, NAMIBIA By Carolie Cloete (Student Number: 217132766) Thesis presented in fulfilment of the requirement for the Master of Health Sciences In the Faculty of Health and Applied Sciences, Namibia University of Science and Technology, Windhoek, Namibia Supervisor: Ms Andrit Lourens Co‐supervisor: Dr Adam Flowers 1 April 2019 1 DECLARATION I, Carolie Cisanne Cloete hereby declare that the work contained in the thesis entitled Relationship between the location and causes of motor vehicle accidents on the B1 road, Windhoek to Rehoboth is my own original work and that I have not previously in its entirety or in part submitted it at any university or other higher education institution for the award of a degree. Signature: ........................... Date: 1 April 2019 Retention and Use of Thesis I, Carolie Cisanne Cloete being a candidate for the degree of Master of Health Sciences accept the requirements of the Namibia University of Science and Technology relating to the retention and use of theses deposited in the Library and Information Services. In terms of these conditions, I agree that the original of my thesis deposited in the Library and Information Services will be accessible for purposes of study and research, in accordance with the normal conditions established by the Librarian for the care, loan or reproduction of theses. Signature: .............................. Date: 1 April 2019 2 AKNOWLEDGEMENTS Andrit Lourens and Adam Flowers, my supervisors, for the countless hours, valuable input and numerous corrections to make the thesis worthwhile. Susan Mwewa, my statistician, for doing and redoing all the calculations and your moral support. 3 DEDICATION This thesis is dedicated to my husband, Harry, and daughters, Chloe and Caitlyn, who believe in me and support me in everything I do. Also, to the growth and development of EMS in Namibia. 4 ABSTRACT PURPOSE OF THE RESEARCH: Motor Vehicle Accidents (MVAs) are fast becoming the leading cause of death globally. In 2010, one person died every 25 seconds due to an MVA. Namibia was highlighted in 2008 as the country with the highest accident‐related fatality rate in the world (45 deaths per 100 000) and in 2010, ranked 9th overall for fatality rate in Africa. The B1 road in the Hardap region (Rehoboth and its surrounding areas) was identified in 2009 as one of the top ten locations for MVAs and in 2014 as an area with high MVA associated fatality. Despite the identifiable causes of MVAs, accident rates continue to rise and have been recognised as a neglected epidemic due to poor data capturing and reporting. Despite the availability of data in Namibia there has been very little research performed to investigate the causes of these statistics and no research linking the cause to the location. Filling in these research gaps is important in beginning to remedy the high number of accidents and fatalities associated with MVAs in Namibia. OBJECTIVES: The study aimed to map the causes of MVAs in relation to the location (at 20km intervals) on the B1 road between Windhoek and Rehoboth. The objectives of the study were to identify clusters of causes per location interval and determine and describe the relationship between the causes and location of MVAs. The final objective is to formulate and propose endorsements for the erection of cause‐specific features at identified locations as a prevention strategy. PRINCIPAL RESULTS: The main cause of MVAs on the studied road was driver‐related causes (56.3%). Other common causes of MVAs included collision with an animal and mechanical failure. The greatest number of accidents occurred in the 0‐20km interval (29.3%), closest to Windhoek. The highest reported injuries (27.3%) and fatalities (32.9%) was in the 21‐40km interval. Clusters of causes identified revealed that driver‐related factors were the main cause of accidents across all location intervals, followed by a collision with an animal and vehicle mechanical failure. Weather/road conditions and pedestrian‐vehicle accidents played a role closer to Windhoek and closer to Rehoboth, respectively. There was a statistical relationship between the location and cause of accidents and a cluster of causes could be identified for each location interval. The odds of fatality increased with distance from Windhoek. Other contributing factors to accidents, injuries and fatalities included the type of accident, the day of the week and the time of day. MAJOR CONCLUSIONS: There is a relationship between the causes and location of MVAs on the studied road and a cluster of causes were identified. Driver causes are by far the leading cause of accidents. Updating existing laws combined with stricter law enforcement can address the key causes of MVAs on the B1 road and is thus the key to prevention. Other prevention strategies include improving data capturing to improve the quality of the data and for surveillance of implemented safety 5 strategies, improving public transport infrastructure to the number of vehicles on this road and making the roads safer for vulnerable road users. 6 Contents CHAPTER 1: INTRODUCTION 9 1.1 Background 9 1.2 Problem Statement 10 1.3 Research question, hypotheses, aim and objectives 11 1.3.1 Research Question 11 1.3.2 Hypotheses 11 1.3.3 Research Aim 11 1.3.4 Objectives 11 CHAPTER 2: LITERATURE REVIEW 13 2.1 Global burden of MVAs 13 2.2 Common causes of MVAs 16 2.3 MVAs in Namibia 18 CHAPTER 3: METHODOLOGY 20 3.1 Study Design 20 3.2 Study setting 20 3.3 Data collection and data management 21 3.4 Data Analysis 23 3.5 Study limitations 23 3.6 Ethical Considerations 24 CHAPTER 4: RESEARCH RESULTS 25 1. INTRODUCTION 26 2. MATERIALS AND METHODS 27 3. RESULTS 30 4. DISCUSSION 35 5. CONCLUSIONS 38 6. REFERENCES 39 CHAPTER 5: GENERAL DISCUSSION AND CONCLUSIONS 42 CHAPTER 6: RECOMMENDATIONS 45 REFERENCES 49 Appendix 1: MVAF Permission Letter 51 Appendix 2: Ethical Clearance 52 Appendix 3: Additional Figures 53 7 LIST OF FIGURES Figure 3.1: B1 road across Namibia ...................................................................................................... 20 Figure 4.1: B1 road across Namibia ...................................................................................................... 28 Figure 4.2: Number of accidents, injuries and fatalities vs location of accident from Windhoek ........ 31 Figure 4.3: Number of accidents, injuries and fatalities vs Causes of accidents .................................. 31 Figure 4.4: Mapping of accidents on a geographical map of the B1 road per Causes of accident ....... 33 LIST OF TABLES Table 3.1: Categories of causes for MVAs ............................................................................................. 22 Table 3.2: Types of MVAs ...................................................................................................................... 22 Table 4.1: Categories for causes of MVAs ............................................................................................. 29 Table 4.2: Types of MVAs ...................................................................................................................... 29 Table 4.3: Ranking of causes per location interval ............................................................................... 32 Glossary GPS: Global Positioning System GDP: Gross domestic product MVA: Motor vehicle accident MVAF: Motor Vehicle Accident Fund of Namibia N$: Namibian Dollars NRSC: National Road Safety Council PVA: Pedestrian‐vehicle accident SA: South Africa UN: United Nations USB: Universal Serial Bus WHO: World Health Organisation 8 CHAPTER 1: INTRODUCTION 1.1 Background The global impact of motor vehicle accidents (MVAs) on health care and economics are undeniable and evidenced by numerous publications in various international journals (Adeloye et al., 2016; Lagarde, 2007; Nantulya and Reich, 2002; Odero et al., 1997; Odero et al., 2003; Osoro et al., 2015; Peden et al., 2013; Prato et al., 2012; Rezaei et al., 2014; Sivak and Schoettle, 2014; WHO, 2015). In 2010, globally more than one million people died as a result of MVAs, which aggregates to one person dying every 25 seconds due to an MVA. It is estimated that there are a further 20 injured victims per MVA for every fatality, which translates to more than 20 million injured victims per year (WHO, 2015). Despite other pandemics such as HIV/AIDS and cardiovascular disease, MVAs are fast becoming the leading cause of death, globally. The most productive population, aged 15‐29 years, are most affected by MVAs (Nantulya and Reich, 2002; Odero et al, 2003; Sivak and Schoettle, 2014; WHO, 2015). The effects span much further than just the lives lost, and the injuries sustained by accident victims. National economies are affected by the higher incidence of MVAs amongst the working class, resulting in a change of demographics, loss of production, escalating medical expenses and damage to infrastructure and private property (Osoro et al., 2015; Rezaei et al., 2014). Fifty‐four percent of global vehicles are owned by people in developing countries, like African countries, yet these countries contribute to the vast majority (90%) of accidents and associated deaths worldwide (Bonnet et al., 2018; WHO, 2015). The United Nations (UN) instituted a safety policy, the Decade of Action in 2011 in a bid to decrease the global accident rate and associated deaths. Due to the identifiable causes of MVAs and safety

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