Staton Catherine, Vissoci Joao, Gong Enying, Toomey Nicole, Wafula Rebeccah, Abdelgadir Jihad, Zhao Yi, Liu Chen, Pei Fengdi, Zick Brittany, Ratliff Camille D, Rotich Claire, Jadue Nicole, de Andrade Luciano, von Isenburg Megan, Hocker Michael
Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America.
Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
PLoS One. 2016 Jan 6;11(1):e0144971. doi: 10.1371/journal.pone.0144971. eCollection 2016.
Road traffic injuries (RTIs) are a growing but neglected global health crisis, requiring effective prevention to promote sustainable safety. Low- and middle-income countries (LMICs) share a disproportionately high burden with 90% of the world's road traffic deaths, and where RTIs are escalating due to rapid urbanization and motorization. Although several studies have assessed the effectiveness of a specific intervention, no systematic reviews have been conducted summarizing the effectiveness of RTI prevention initiatives specifically performed in LMIC settings; this study will help fill this gap.
In accordance with PRISMA guidelines we searched the electronic databases MEDLINE, EMBASE, Scopus, Web of Science, TRID, Lilacs, Scielo and Global Health. Articles were eligible if they considered RTI prevention in LMICs by evaluating a prevention-related intervention with outcome measures of crash, RTI, or death. In addition, a reference and citation analysis was conducted as well as a data quality assessment. A qualitative metasummary approach was used for data analysis and effect sizes were calculated to quantify the magnitude of emerging themes.
Of the 8560 articles from the literature search, 18 articles from 11 LMICs fit the eligibility and inclusion criteria. Of these studies, four were from Sub-Saharan Africa, ten from Latin America and the Caribbean, one from the Middle East, and three from Asia. Half of the studies focused specifically on legislation, while the others focused on speed control measures, educational interventions, enforcement, road improvement, community programs, or a multifaceted intervention.
Legislation was the most common intervention evaluated with the best outcomes when combined with strong enforcement initiatives or as part of a multifaceted approach. Because speed control is crucial to crash and injury prevention, road improvement interventions in LMIC settings should carefully consider how the impact of improvements will affect speed and traffic flow. Further road traffic injury prevention interventions should be performed in LMICs with patient-centered outcomes in order to guide injury prevention in these complex settings.
道路交通伤害（RTIs）是一个日益严重但被忽视的全球健康危机，需要有效的预防措施来促进可持续安全。低收入和中等收入国家（LMICs）承担着不成比例的高负担，全球90%的道路交通死亡发生在这些国家，而且由于快速城市化和机动化，道路交通伤害在这些国家呈上升趋势。尽管有几项研究评估了特定干预措施的有效性，但尚未进行系统综述来总结在低收入和中等收入国家背景下专门开展的道路交通伤害预防举措的有效性；本研究将有助于填补这一空白。
根据PRISMA指南，我们检索了电子数据库MEDLINE、EMBASE、Scopus、科学引文索引、TRID、Lilacs、Scielo和全球健康。如果文章通过评估与碰撞、道路交通伤害或死亡相关的预防干预措施来考虑低收入和中等收入国家的道路交通伤害预防，则符合入选标准。此外，还进行了参考文献和引文分析以及数据质量评估。采用定性元综述方法进行数据分析，并计算效应量以量化新出现主题的程度。
在文献检索得到的8560篇文章中，来自11个低收入和中等收入国家的18篇文章符合入选和纳入标准。在这些研究中，4篇来自撒哈拉以南非洲，10篇来自拉丁美洲和加勒比地区，1篇来自中东，3篇来自亚洲。一半的研究专门关注立法，而其他研究则关注速度控制措施、教育干预措施执法、道路改善、社区项目或多方面干预措施。
立法是评估最常见的干预措施，当与强有力的执法举措相结合或作为多方面方法的一部分时，效果最佳。由于速度控制对于预防碰撞和伤害至关重要，低收入和中等收入国家背景下的道路改善干预措施应仔细考虑改善措施的影响将如何影响速度和交通流量。应在低收入和中等收入国家开展进一步的道路交通伤害预防干预措施，并以患者为中心的结果为指导，以便在这些复杂环境中指导伤害预防工作。
