Road traffic accidents in Bangladesh: Why people have poor knowledge and awareness about traffic rules?

Abstract

Purpose:

The study aimed to identify the characteristics of road traffic accident (RTA) and to determine the role of different socioeconomic and demographic factors on the knowledge and awareness about traffic rules among people in Bangladesh.

Study Design:

This was a cross-sectional study.

Methods:

To conduct this study, 700 primary data were collected from respondents who were involved in RTA by interviewing in medical college hospitals and several private clinics of Dhaka, Rajshahi, and Khulna division in Bangladesh. For the achievement of the objective, the Chi-square test, Cramer's V correlation, and the logistic regression model have been applied in this study.

Results:

Traffic rules violation was identified as the second-most important reason behind RTA. Respondent's age, gender, residence, education, occupation, awareness about RTA, etc., were significantly associated with having knowledge and awareness about traffic rules. The result of multivariate analysis showed that respondent's age (<30: odds ratio [OR] = 2.019, confidence interval [CI]: 1.377–2.960); residence (rural: OR = 0.288, CI: 0.193–0.431); education (literate: OR = 5.064, CI: 3.332–7.698); and categories of victims (driver: OR = 2.731, CI: 1.676–4.450 and passenger: 1.869, CI: 1.198–2.916) were the vital predictors of having knowledge and awareness about traffic rules.

Conclusions:

By imposing strict traffic act, increasing public awareness through various types of education and awareness/outreach about traffic rules-related program, especially in rural areas, by strictly prohibiting the license giving to unskilled drivers or unfit vehicles, RTA can be minimized.

INTRODUCTION

Road traffic accident (RTA) is a global health, economic, and social crisis. It is the 9^th major cause of death and around 1.25 million people die and 20–50 million people suffer from nonfatal injuries annually in RTA.[1] According to a statistics, in road accident, an average of 3287 people dies per day and 2.2% of all deaths worldwide and the main cause of death among adolescents aged 15–29 years and the 2^nd for children from 5 to 14 years, cost $518 billion globally, especially in LMICs costing individually 1%–2% of their annual GDP.[2] Without taking action predicted to be the 5^th leading cause of death[1] and 3^rd leading cause of lost disability-adjusted life years[3] by 2030, respectively.

Bangladesh is the 12^th most densely populated country in the world with a density of 1251.5/km²⁴ and has been identified as one of the countries with excessive RTA over the past 5 years.[5] Furthermore, RTA is the 2^nd leading cause of death, fatal and nonfatal injuries in the country.[5] In this study, an overview of literature regarding RTA by the road user group in this region is provided based on the findings of different studies. However, the annual urban growth rate in Bangladesh is 3.3%[6] and motor vehicle growth is 8.8%.[7] According to Bangladesh Road Transport Authority, there are 2750333 registered motor vehicles in Bangladesh and 1,030,864 in Dhaka until September in 2017.[8,9]

Reviewing various literature from different countries, it significantly showed that in developing countries, people in the age group of 15–44 years, especially the males are carrying out a greater share of the burden of RTA across different times.[10,11,12,13] The motorcycle is the most vulnerable vehicle along with bus and truck, and pedestrians and passengers are the main sufferers[14,15] in RTA. Various studies have previously demonstrated that there are many reasons that affect RTA, such as violating traffic laws and signals, novice drivers, excessive speed, faulty road and management, and lack of knowledge.[14,16] Among all these factors, lack of knowledge and awareness, and violation of traffic law were identified as the most important cause behind RTA in Bangladesh as well as the world.[5,17]

Therefore, this study is important for the development of the road safety situation in our country. The objective of this study is to identify the characteristics of RTA and to determine the role of different socioeconomic and demographic factors on the knowledge and awareness of traffic rules among people in Bangladesh.

METHODS

Sources of data

To conduct this study, primary data were collected from Medical College Hospitals, Sadar Hospitals, and Dhaka, Khulna and Rajshahi Division using purposive sampling technique by interviewing using questionnaire and duration January to May 2017. The information related to injury, treatment, and awareness was collected from 700 respondents who have recently experienced RTA in the selected study area.

Statistical techniques

Setting at P < 0.05 level of significance, the association between knowledge and awareness about traffic rules and various background characteristics were assessed by Chi-square test. Further, Cramer's V correlation formula was used to measure the association. The response variable of this study was knowledge and awareness about traffic laws, which is binary in nature. Hence, the binary logistic regression model was fitted to assess the net effect of background characteristics. Here, the dependent variable knowledge and awareness about traffic laws are addressed as follows:

On the other hand, respondent's age, gender, residence, education, occupation, economic status, categories of victims, aware of RTA was treated as explanatory variables. Data were analyzed using SPSS 23.0 (SPSS Inc., Chicago, IL, USA) in the window's version.

RESULTS

Knowledge and awareness about traffic rules

Traffic laws are the laws governing traffic and control of vehicles, and the rules of the road are the informal laws and rules that may be developed over time to facilitate timely and orderly traffic flow. Table 1 illustrates the bivariate distribution of respondents who were involved in RTA and their knowledge and awareness about traffic rules according to different explanatory variables. This demonstration pursued the factors that might be related to having knowledge and awareness about traffic rules using the Chi-square-test and Cramer's V correlation test where a significant association and correlation between knowledge and awareness about traffic rules and some selected explanatory variables such as respondent's age, gender, residence, education, occupation, economic status, categories of victims, and aware of RTA were found. However, in this observation, there were 62% of respondents had knowledge and awareness about traffic rules. There were 58.1% of the respondents was aged 30 or less, whereas 43.2% of these respondents had no knowledge and awareness about traffic rules which is proportionately higher than the respondents aged >30 years (30.7%). This study observed a higher percentage of victims were male (81.9%), but unfortunately, 34.4% of males had no knowledge and awareness about traffic rules. In this observation, most of the respondents were rural people (55.1%), but miserably, 52.8% of them had no knowledge and awareness about traffic rules as compared to the urban people (80.3%). Although 79% of the respondents in this study area were literate, a respectable amount of them (29.7%) had no knowledge and awareness about traffic rules. According to our demonstration, 69.9% of the respondents were occupied in a profession such as a businessman and labor. but lamentably only 49% of them had knowledge and awareness about traffic rules. Expectedly, 75.3% of people with higher economic status had knowledge and awareness about traffic rules, whereas only 56.1% of lower-income people had knowledge and awareness about traffic rules. The survey observed that the main victims of RTA were the passengers (44.6%) with a respectable amount of drivers (28.3%). Moreover, 73.7% of the drivers had knowledge and awareness about traffic rules compared to pedestrians (44.7%). If it was observed particularly, the drivers of public transport (75.7%) had higher knowledge and awareness about traffic rules but the motorcyclist (57.8%) had poorest knowledge and awareness about traffic rules [Figure 1]. Besides, a better part of respondents with awareness about RTA (72.8%) had knowledge and awareness about traffic rules. Cramer's V correlation shows that respondent's education, residence, occupation, categories of victims, and awareness about RTA is highly correlated with having knowledge and awareness about traffic rules.

Table 1.

Bivariate distribution of knowledge and awareness about road traffic laws according to some background characteristics of the respondents

Variables	Frequency, n (%)	Knowledge and awareness about road traffic laws		Calculated chi-squa re value (χ2)	Level of significance (P value)	Cramer’s value
		No (n=266), n (%)	Yes (n=434), n (%)
Age
≤30	407 (58.1)	176 (43.2)	231 (56.8)	11.346	0.001	0.127
>30	293 (41.9)	90 (30.7)	203 (69.3)
Gender
Male	573 (81.9)	197 (34.4)	376 (65.6)	17.562	<0.0001	0.158
Female	127 (18.1)	69 (54.3)	58 (45.7)
Residence
Urban	314 (44.9)	62 (19.7)	252 (80.3)	80.541	<0.0001	0.339
Rural	386 (55.1)	204 (52.8)	182 (47.2)
Education
Illiterate	147 (21.0)	102 (69.4)	45 (30.6)	77.810	<0.0001	0.333
Literate	553 (79.0)	164 (29.7)	389 (70.3)
Occupation
Job	211 (30.1)	21 (10.0)	190 (90.0)	100.851	<0.0001	0.380
Others	489 (69.9)	245 (50.1)	244 (49.9)
Economic status
Low	369 (56.6)	174 (43.9)	222 (56.1)	15.020	0.001	0.146
Middle	227 (32.4)	73 (32.2)	154 (61.8)
High	77 (11.0)	19 (24.7)	58 (75.3)
Categories of victims
Passerby	190 (27.1)	105 (55.3)	85 (44.7)	36.855	<0.0001	0.229
Driver	198 (28.3)	52 (32.2)	146 (73.7)
Passenger	312 (44.6)	109 (34.9)	203 (65.1)
Aware about RTA
No	284 (40.6)	153 (53.9)	131 (46.1)	51.107	<0.0001	0.270
Yes	416 (59.4)	113 (27.2)	303 (72.8)

RTA: Road traffic accident

Figure 1.

Knowledge and awareness about traffic rules among drivers

Respondent's source of knowledge about traffic rules

According to Figure 2, it was identified that television (38.8%) is the most common and effective source of knowledge about traffic rules alongside with other sources (36.9%) like the Internet, mobile, etc. There were 17.7% of the respondents know about traffic rules by reading the newspaper and a very few amounts of respondents know about traffic rules from radio (6.6%) programs.

Figure 2.

Respondent's source of knowledge about road traffic laws

Determinants of knowledge and awareness about traffic rules

Table 2 represents the result of multivariate logistic regression analysis for having knowledge and awareness about traffic rules according to selected background characteristics. The likelihood of having knowledge and awareness about traffic laws was increased among respondents aged over 30 (Odds ratio [OR] = 2.019, confidence interval [CI]: 1.377–2.960) than the respondents aged ≤30 years. Again, the probability of having knowledge and awareness about traffic laws was decreased among females (OR = 0.583, CI: 0.348–0.975) respondents than the males. Besides, the OR for the rural resident was 0.288 (CI: 0.193–0.431) which indicated that the rural participants had 0.288 times fewer chances of having knowledge and awareness about traffic laws than the respondents from urban areas. In this study, the possibilities of having knowledge and awareness about traffic rules were increased among literate (OR = 5.064, CI: 3.332–7.698) victims of RTA than the illiterate respondents. However, the likelihood of having knowledge and awareness about traffic laws was increased among drivers (OR = 2.731, CI: 1.676–4.450) and passenger (OR = 1.869, CI: 1.198–2.916) than the respondents who were a passer-by. The participants with awareness about RTA had 2.523 (CI: 1.737–3.666) times more probable of having knowledge and awareness about traffic laws than who was not aware of RTA.

Table 2.

Adjusted odds ratio for having knowledge and awareness about road traffic laws according to some background characteristics of the respondents

Background characteristics	Adjusted OR	95% CI		ρ
		Lower	Upper
Age
≤30(RC)	1.00	…	…	…
>30	2.019	1.377	2.960	0.000
Gender
Male(RC)	1.00	…	…	…
Female	0.583	0.348	0.975	0.040
Residence
Urban(RC)	1.00	…	…	…
Rural	0.288	0.193	0.431	0.000
Education
Illiterate(RC)	1.00	…	…	…
Literate	5.064	3.332	7.698	0.000
Occupation
Job(RC)	1.00	…	…	…
Others	0.202	0.130	0.315	0.000
Economic status
Low(RC)	1.00	…	…	0.639
Middle	0.894	0.583	1.371	0.606
High	1.256	0.644	2.451	0.504
Categories of victims
Passerby(RC)	1.00	…	…	0.000
Driver	2.731	1.676	4.450	0.000
Passenger	1.869	1.198	2.916	0.006
Aware about RTA
No(RC)	1.00	…	…	…
Yes	2.523	1.737	3.666	0.000
Model summary	Model Summary Of This Logistics Analysis
Model χ2 (ρ)	315.908 (<0.0001)
−2 log likelihood	654.498
Cox and Snell R2	0.363
Hosmer and Lemeshow test χ2 (ρ)	5.30 (0.725)
ρ2cv	0.3472
λ	0.0158
Stability of R2	0.9842

OR: Odds ratio, CI: Confidence interval, RTA: Road traffic accident

In the fitted model in Table 2, the Cox and Snell R² was 36.3% and that was calculated from the linear relationship between the independent variables and the overall model was significant when all explanatory variables were entered in the model. Besides, the stability of the model was 34.72%, the shrinkage coefficient was 0.0158, and the stability of R² was 0.9842. Besides, the Hosmer and Lemeshow test P-value was 0.725. The smaller shrinkage coefficient and higher P-value tend to 1 are indicating that the regression model was a better fit.

DISCUSSION

In this study, it was tried to investigate the background characteristics of RTA and factors that affect the knowledge and awareness of traffic rules in Bangladesh. Our findings concerning the main reasons behind RTA are the unskilled driver, faulty vehicle, carrying an excessive passenger, violation of traffic rules, damaged road, and lack of footpath which is similar to the findings of several previous studies.[18,19,20,21,22,23,24] Besides, supporting our findings, few earlier attempts have identified that lack of knowledge and violation of traffic rules and signals is the most important reason behind RTA in Saudi Arabia, Poland, and Canada.[18,20,23] In Bangladesh, violation of traffic rules mainly occurs due to the poor knowledge and lack of awareness about traffic rules which are putting an immense impact on RTA.

The study result regarding higher involvedness in RTA of people aged ≤30 years and the male is most vulnerable to RTA is showing consistency with the findings of Sango et al.[25] and also closer estimation is found in many other endeavors.[5,10,26,27,28,29,30] In Pune city of India, a cross-sectional study has observed the high prevalence of RTA among males aged 15–30 in the year 2014.[12] In Bangladesh, the depiction is very similar to India, but unfortunately, a good amount of these young people have no knowledge and awareness about traffic rules according to our findings. As a result, these people are violating the traffic rules now and again. Hence, to reduce RTA among male young people, urgent initiatives are needed to increase the knowledge and awareness about traffic rules among them.

However, most of the victims in this study were from the rural area and literate people that is consistent with the hypothesis of Mishra et al.[31] As expected, a higher percentage of rural and illiterate people have no knowledge and awareness of traffic rules. This is because, in a rural area, there is no such program related to increasing knowledge and awareness in traffic rules as well as RTA is held. Hence, the initiatives are badly needed to improve the situation to make the people aware of traffic rules. Moreover, this demonstration shows that the respondents from profession like businessman, labor, etc., and from low-economic status are the main victims of RTA in Bangladesh. Normally, professionals like businessman, labor, etc., have to travel more than the serviceman. However, their knowledge and awareness of traffic rules are very poor in Bangladesh.

The present study examines that most of RTA victims were passengers with a respectable amount of drivers and pedestrians in Bangladesh, which shows similarities with the result of a study in developing countries[32] but shows a contradiction with several previous demonstrations.[33,34,35] In Bangladesh, the drivers have almost three time's higher knowledge and awareness of traffic rules than pedestrians. In addition, earlier endeavors have mentioned Bangladesh as a low middle-income country and the pedestrians are at high risk of getting involved in RTA.[33,34,35] Some studies have identified motorcyclists are at high risk of getting involved in RTA;[10,11,15,36,37] perhaps, the situation is similar in Bangladesh. However unfortunately, the knowledge and awareness about traffic rules among the motorcyclists are very poor in Bangladesh and the commercial vehicle drivers are in the second position of the row.

There are various sources of knowledge about traffic rules were identified in Bangladesh. Among them, TV, Internet, mobile, etc., are the most effective source to increase knowledge and awareness about traffic rules than the radio. Hopefully, by broadcasting different knowledge and awareness-related programs regarding traffic rules in TV and spreading them through Internet, especially with the help of social media, the Bangladeshi people could be more aware of the country's traffic rules.

Limitations and strengths of the study

There were some limitations on this study. The cost was not sufficient as there was no funding source, some respondents could not remember exact answers such as age, income, and expenses and some respondents expect some incentives, but it was not possible due to lack of budget. Although of these obstacles, we tried to discover the factors that are influencing the knowledge and awareness about traffic rules among people. To our knowledge, there is no such study that described the knowledge and awareness about traffic rules among people. Perhaps, this work will enrich the available information and helps in further investigations.

CONCLUSIONS

In this study, particular attention was paid to the general characteristics of RTA in the present traffic stream of Bangladesh and contributing factors of knowledge and awareness about traffic rules. With the growing population and urbanization, a sustainable transportation system with proper knowledge and awareness about traffic rules and regulations is needed for Bangladesh which will meet both present and future demand. Hence, it can be advised based on the study that the young and male people are at a most vulnerable position in RTA. Raising public awareness about RTA as well as traffic rules gets vital importance to reduce RTA. People can know the country's traffic rules and be more conscious about the traffic rules through education, different training, and awareness program, especially in rural areas. If it can be added to the primary textbook that would be more beneficial. Besides, traffic laws must be strictly complied with and must have to follow. The government should not give license to unskilled drivers and to prohibit unfit vehicles. In addition, “Safety of road safety” must be a social movement. This circumstance intimates the necessity of immediate attention from a public health standpoint or educational awareness program.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Research quality and ethics statement

This study was approved by the Institutional Review Board / Ethics Committee. The authors followed applicable EQUATOR Network (http://www.equator-network.org/) guidelines during the conduct of this research project.