Introduction:
A Road Traffic Accident (RTA) can be defined as, ‘An event that occurs on a way or street open to public traffic; resulting in one or more persons being injured or killed, where at least one moving vehicle is involved. Thus RTA is a collision between vehicles;
between vehicles and pedestrians; between vehicles and animals; or between vehicles and geographical or architectural obstacles.(1) Road traffic injuries are estimated to be the eighth leading cause of death globally, with an impact similar to that caused by many communicable diseases, such as malaria (2). They are the leading cause of death for young people aged 15–29 years, and as a result take a heavy toll on those entering their most productive years(3). Economically disadvantaged families are hardest hit by both direct medical costs and indirect costs such as lost wages that result from these injuries. At the national level, road traffic injuries result in considerable financial costs, particularly to developing economies. Indeed, road traffic injuries are estimated to cost low- and middle-income countries between 1–2 % of their Gross Domestic Product (GDP), an estimate of about US$ 100 billion a year.(2)
India has the highest number of Road Traffic Deaths in the world overtaking China.(2) It has the worst road traffic accident rate worldwide. India reported a total number of 499628 Road Traffic Accidents with 134513 deaths due to Road Traffic Accidents in 2010(85%M, 15%F). The estimated GDP lost due to these Road Traffic Accident was 3%.(4) Research from Bangalore, India, had found that mortality from Road traffic Injuries was 13.1 & 48.1 per 100000 in the poorer socio-economic groups of urban & rural population respectively, to 7.8 & 26.1 per 100000 among their more affluent counterparts.(5)
Although studies have been carried out to illustrate the losses caused due to Road Traffic Accidents in metropolitan cities, limited researches are available to demonstrate the factors affecting Road Traffic Accidents and to determine the out of pocket expenditure due to Road traffic Accidents in rural areas in small town and cities. So the present study has been carried out with the following objectives:
- To study the epidemiological profile of Road Traffic Injuries among the patients admitted in a tertiary care centre.
- To find out the various out of pocket expenditure in the patients of Road Traffic Accidents.
Materials and Methods
Study Design and study Period: Hospital based Descriptive Prospective Study carried out for a period of two months from April to May 2014.
Study Area: Orthopedic Ward of UP Rural Institute of Medical Sciences & Research, Saifai, Etawah(UP)
Study Universe: All patients admitted to Orthopedic Department following Road Traffic Accident.
Sampling Technique: The sampling technique used was Consecutive Sampling. Out of the 2 months assigned for data collection, patients were included in the study for first month; remaining month was kept for the follow-up and data analysis of the patients. Two days per week was kept for data collection.
Inclusion Criteria:
- Patients brought directly from the site of injury or those who had not consulted any other health care provider were included in the study.
- Patients of Road traffic accidents attending Department of Orthopedic Department who were the resident of District Etawah.
Methodology: A list of all the patients admitted due to Road Traffic Accident was obtained from the ward sisters of Orthopedic Department per week for one month. The list was sorted to find out the eligible participants using inclusion criteria. Patient Stability and Seriousness was also considered during the inclusion of the study participants. All the selected participants were interviewed on the two fixed days of the week (i.e Tuesdays and Thursdays) provided they gave the consent for the participation in the study. They were told about the aims and objectives of the study and option of withdrawal from the study at any stage was always available to them.
A pre tested structured open ended questionnaire was used for data collection. The information was collected under four broad headings namely - General Information, Details of accident, Details of out of pocket expenditures due to Road Traffic Accident.
- General Information: It gathered information related Sociodemographic profile of the study participants
- Details of Accident: It gathered information on day and date of accident, time of accident, role of victim, collision with, type of the road.
- Details of Out of Pocket Expenditure: The amount spent in the admission process if any and amount spent on treatment under different heads in the first week of admission and the amount lost due to absence of work.
Data Analysis: Data analysis was done using appropriate Statistical Tool.
Results
A total of eligible 52 participants were contacted for an interview, or which 48 gave the verbal consent for the participation in the study. Thus the final sample size was limited to 48 only. Of the 48 participants interviewed, 34(70.8%) were male and 14 (29.2%)were females.
Socio Demographic Profile: The most common age group affected was 21-25 years followed by 16-20 years. The rate of accident was more common among literate especially among graduates and belonging to Socio Economic class III according to modified BJ Prasad Classification. (Table 1)
Table 1: Distribution of the participants on the basis of Socio Demographic Determinants |
No. |
Socio Demographic Determinants |
Male (34) |
Female (14) |
Total (48) |
No |
% |
No |
% |
No |
% |
1 |
Age |
11-15 Years |
6 |
17.64 |
0 |
0 |
6 |
12.5 |
16- 20 Years |
16 |
47.05 |
4 |
28.57 |
20 |
41.66 |
21-25 Years |
11 |
32.35 |
8 |
57.14 |
19 |
39.5 |
26- 30 Years |
1 |
2.94 |
1 |
7.14 |
2 |
4.16 |
>30 Years |
0 |
0 |
1 |
7.14 |
1 |
2.08 |
Total |
34 |
100 |
14 |
100 |
48 |
100 |
2 |
Religion |
Hindu |
24 |
70.58 |
8 |
57.14 |
32 |
66.66 |
Muslim |
6 |
17.64 |
3 |
21.42 |
9 |
18.75 |
Others |
4 |
11.76 |
3 |
21.42 |
7 |
14.58 |
Total |
34 |
100 |
14 |
100 |
48 |
100 |
3 |
Occupation |
Labor/ Unskilled workers |
5 |
14.70 |
1 |
7.14 |
6 |
12.5 |
Students/Unemployed /Housewife |
11 |
32.35 |
13 |
92.85 |
24 |
50 |
Skilled workers |
8 |
23.52 |
0 |
0 |
8 |
16.66 |
Businessmen/ shopkeeper |
8 |
23.52 |
0 |
0 |
8 |
16.66 |
Professionals |
2 |
5.88 |
0 |
0 |
2 |
4.166 |
Total |
34 |
100 |
14 |
100 |
48 |
100 |
4 |
Literacy |
Illiterate |
0 |
0 |
1 |
7.14 |
1 |
2.08 |
Primary |
4 |
11.76 |
3 |
21.42 |
7 |
14.58 |
Secondary |
3 |
8.82 |
0 |
0 |
3 |
6.25 |
Graduate |
22 |
64.70 |
9 |
64.28 |
31 |
64.58 |
Post Graduate |
5 |
14.70 |
1 |
7.14 |
6 |
12.5 |
Total |
34 |
100 |
14 |
100 |
48 |
100 |
5 |
Socio economic class |
Class I |
2 |
5.88 |
0 |
0 |
2 |
4.16 |
Class II |
2 |
5.88 |
0 |
0 |
2 |
4.16 |
Class III |
8 |
23.52 |
2 |
14.28 |
10 |
20.83 |
Class IV |
9 |
26.47 |
6 |
42.85 |
15 |
31.25 |
BPL |
13 |
38.23 |
6 |
42.85 |
19 |
39.58 |
Total |
34 |
100 |
14 |
|
48 |
100 |
Day of Accident: The rate of accidents was most common on the weekends i.e Saturday and Sundays as compared to other days of the week. (Table 2)
Table 2: Distribution on the basis of days of accidents |
S.No |
Day |
Number |
% |
1 |
Sunday |
12 |
25.0 |
2 |
Monday |
3 |
6.2 |
3 |
Tuesday |
2 |
4.2 |
4 |
Wednesday |
6 |
12.5 |
5 |
Thursday |
4 |
8.3 |
6 |
Friday |
8 |
16.6 |
7 |
Saturday |
13 |
27.1 |
|
Total |
48 |
100 |
Role of Victim: The rate of accidents was most common among the users of two wheelers motorized or non motorized as compared other modes of transportation. (Table 3)
Table 3: Distribution of the participants on the basis of Role of Victims |
S.No |
Role of Victim |
No. |
% |
1 |
Pedestrian |
8 |
16.7 |
2 |
Pedal cyclist rider/occupant |
11 |
22.9 |
3 |
Motor cycle driver/occupant |
16 |
33.4 |
4 |
Car driver/occupant |
8 |
16.7 |
5 |
Driver of pickup truck/van/occupant |
1 |
2.1 |
6 |
Bus driver/occupant |
4 |
8.4 |
|
Total |
48 |
100 |
Collision: Majority of the accidents took place on collusion with other motorized two or three wheelers followed by four wheelers at a high speed leading to grievous injuries. (Table 4)
Table 4: Distribution of the participants on the basis of Collision with |
| S. No |
Collision with |
No. |
% |
1 |
Pedestrian/animal |
2 |
4.2 |
2 |
Pedal cyclist |
6 |
12.5 |
3 |
2/3 wheeled motor vehicle |
19 |
39.6 |
4 |
Car, pick up van/truck |
11 |
22.9 |
5 |
Heavy transport vehicle/bus |
2 |
4.2 |
6 |
fixed/stationary object |
8 |
16.7 |
|
Total |
48 |
100 |
Protective Gear used at the time of accident and the type of Road: Majority of the study participants were not wearing any protective gears like helmet, seat belt etc. at the time of accident. The most common site of accident was city road followed by National high ways. (Table 5)
Table 5: Distribution on the basis of use of protective gears at the time of accident |
| S.No |
Parameter |
No. |
% |
1 |
Whether any Protective Gear used at the time of accident |
|
Yes |
9 |
18.7 |
|
No |
|
|
|
Total |
48 |
100 |
2 |
Type of Road |
|
National highway |
8 |
37.5 |
|
State /Village |
4 |
16.7 |
|
City road |
|
|
|
Total |
48 |
100 |
Mode of transportation of victims: The most common mode of transportation of victim from the site of injury to the hospital was Private vehicle/ ambulance followed by own vehicle.(Table 6).
Table 6: Distribution on the basis of vehicle used in the transportation victim. |
| S. No |
Mode of transportation |
Number |
% |
1 |
Private Vehicle/ Ambulance |
36 |
75 |
2 |
Own Vehicle |
9 |
18.7 |
3 |
Govt. ambulance |
3 |
6.3 |
|
Total |
48 |
100 |
The average out of pocket expenditure in the transportation of victims is Rs 1564 ±275.
Table 7: Distribution on the basis of the Money spent in first week of admission. |
| S. No |
Heads |
Amount (Rs.) |
1 |
Medicine |
19800± 2800 |
2 |
Diagnosis |
5014± 780 |
3 |
Prosthesis |
2500± 624 |
4 |
Surgical Procedure |
3012± 562 |
5 |
Transportation |
1564 ±275 |
6 |
Daily Care |
2016 ±1185 |
7 |
Miscellaneous |
1020 ±182 |
|
Total |
334926 ±915 |
Amount spent on Admission: More than 50% of the participants reported to have spent some money in the process of admission. Most of the participant who reported to had spent money had given it as registration fee. It average money spent was Rs.158 ± 25 only.
Amount spent for treatment in the first week of admission: Majority of the expenditure in the first week of admission was on the purchase of medicines which were not available in the hospital followed by on the diagnosis. A significant amount was also spent on the overall day care of the patients that includes bringing of the relatives and caretakers from home to hospital etc., per day.
Amount lost due to absence of work: Half of the participants interviewed were either students/unemployed/ housewife so they did not incurred any financial losses due to absence of work. However the remaining participants were occupied in some jobs and suffered major financial loss in the first week of admission. The average financial loss was Rs.7060± 1084 (Range from Rs 10400- 3500). Majority of losses was due to loss of salary, closure of shop, loss due to daily wages etc.
Discussion
In the present study a total of 48 participants were interviewed. Majority of the participants interviewed who were the victims of Road Traffic Accidents were Male (70.8%) and were in the age a group of 16-25 years (56%). The ratio of male : female in the present study was 2.5: 1 This is lower than the ratio quoted by Jha N et al.(6) This difference in the risk factor for male and female for Road Traffic Accident could be attributed to the fact that males are more mobile due to their job profiles. The other reasons could be that male are more aggressive and careless then their female counterparts and this difference is more prevalent in the younger age group as exemplified in the present study. Various studies from India and across the globe has also noted similar finding in their studies.(6-9) Even the Global Status Report on Road Safety, 2013 has also stated that younger males are more prone to road traffic accident then any other age group member.(2)
It has been noted in the present study that majority of the victims were belonging to the lower socio economic (SE) status i.e. SE III, SE IV and Below Poverty Line (BPL).This could be due to the fact that our hospital is a government hospital and mostly caters the poorer section of the society. Studies carried out by Jha N et al(6) and Jolly MF et al (10) has also pointed out that Road Traffic Accidents are more common in persons belonging to the lower socioeconomic status.
In line with the above finding majority of the victims were laborers, unskilled workers, unemployed or housewife in case of female victims. It was observed in the present study that majority of the victims were literate and had done graduation. Theses findings fit well with the fact that most of the victims belongs to younger age group from 16-25 years. The present study had also shown that education status does not affect much as a risk factor for Road Traffic Accident. However, the authors were of opinion that a bigger study with much larger sample size should be carried out to comment on it.
On evaluation of data related to the day of accident, it was noted that majority of the accident took place on weekends i.e Saturdays and Sundays. This could be attributed to the fact that many people leave home and go out for various purpose including recreation activities etc. This make them more careless and less attentive making them prone to accidents. Various studies had also noted higher accidents rate on Saturdays and Sundays. (6,9,11,12)
It was observed in the present study that majority of the victims of Road Traffic accidents were either rider or occupants of two wheelers which may be either motorized or non motorized. Further it was observed that majority of the accidents took place with two or three wheeled motorized vehicle. Global status report on Road Safety 2013 had also stated that nearly one third (36%)of all the deaths due to Road Traffic Accidents are among the motorcyclist and the percentage is even higher in the South East Asia Region.(2) The high incident of Road Traffic Accidents among the two wheelers could be attributed to the fact that majority of the riders of two or three wheeled are young people who prefer rush driving with out following any road safety rules and not wearing any protective gears. The findings of the study coincide well with the findings of other researchers from India.(6,9,12-15)
It was observed in the present study that majority of the victims were not wearing any protective gear like helmet or seat belt at the time of accident. Majority of the victims of the Road Traffic Accident have a false belief that wearing protective gears like helmets or seat belt often have a deleterious effect on their personality. Wearing protective gears often decreases the impact of Road Traffic Accidents which not only decreases the severity of the Road Traffic Accident; it also decreases the length of hospital stay and has a less economic impact of Road traffic Accidents. Studies carried out by researchers like Eastride R at al(16), Heldti A et al(17) and hundley C et al(18), has also stated these finding in their studies.
It was noted in the present study that majority of the accident reported in the present study took place on the city Road followed by National high ways. City road are more prone to accidents as they are more congested and narrow as per the growing rates of auto mobilization. Highways are also more prone to Road Traffic Accidents because of the rush driving that took place on these roads.
Majority of the victims were directly transferred from the site of accidents to the tertiary care hospital mostly by a private vehicle or private ambulance (75%) or by their own vehicle (18.7%). Only 6.3% were transferred by the government ambulances. This is because government ambulances take lot of the time to reach the accident site and private vehicle or ambulances are easily available or the transportation of the victims. However transportation of the victim by private vehicle/ ambulance cost heavily to the family of the victims adding to the out of pocket expenditure on the family. In the present study Rs 1564±275 was required for the transportation of the victims from various areas of Etawah District.
It was noticed in the present study that majority of the participants reported that they have spent money during the process of admission. However the amount spent was Rs.158 ± 25. This is the minimum amount required as admission fee for different class of patients. Persons bellow the poverty lines were admitted free of charge.
It was found in the present study that the maximum out of pocket expenditure was made on the purchase of medicine during the First week of admission followed amount spent on the Diagnosis and Surgical procedures. In the present study the out of pocket expenditure on the purchase of medicine is Rs.19800± 2800. The amount spent of the Diagnosis and surgical procedures are 5014± 780 and 3012± 562 respectively. A significant out of pocket expenditure is also made on the daycare of the care takers & patents including food, communication etc. A detail study on the burden of Out of Pocket expenditure for the road traffic Accident in urban India was carried out by Kumar GA et(19) al has also found that the maximum out of pocket expenditure is made on the purchase of Medicine followed by that of diagnosis.
It was observed in the present study that a significant financial loss has took place due to absence from work among the victims who were employed in any from of work. The amount lost due to indirect loss in the present study is Rs.7060± 1084 per month. This is an indirect financial loss that was due to non working and will continue till the victims are fit to resume their duties. Majority of the times these indirect loss are underestimated but they causes financial losses not only to the victims but also to the other family members. Kumar GA et al (19) has also stated that these direct losses have a huge financial impact not only on the victims but also on their family members.
Conclusion:
The present study hereby concludes that there is an urgent need for creating awareness about Road Traffic Accident as it not only causes agony and pain to the victim it also causes huge financial losses to the victim and their families.
The study also concludes that majority of the out of pocket expenditure in the first week of admission is on the medication. Thus the policy maker should take into consideration the drugs used into the management of Road Traffic Accidents. This will lessen the financial impact of Road Traffic Accidents on the victims and their families.
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