The literature regarding the burden and risk factors in the Pacific region remains largely limited to descriptive studies in PNG with important limitations in their ability to examine the population-based burden of road crashes and investigate related risk factors. No RTI focused epidemiological studies have been published for over 15
years and few were conducted outside PNG. Notwithstanding these limitations, the published literature indicates that road crashes are a major public health problem. Studies from PNG reported that RTIs contributed to at least 40% of all deaths, 60% of trauma-related deaths, one third of trauma-related hospitalisations, and 40% of all head injuries. Most (two thirds) RTI-related deaths occurred prior to hospitalisation with related fatalities particularly high among pedestrians and passengers. Although head injuries were the most commonly reported RTI-related injury, chest injuries were reported to be particularly common among motor vehicle drivers. The available literature suggests that vehicle type (open-back utility), utility vehicle overloading, and alcohol are potentially important risk factors for RTI.
This review was limited to scientific publications and the English language. Therefore, it excluded the grey literature and routinely collected data such as police annual reports and national hospital and mortality statistics, most of which report events but provide little critique or analysis. The diverse methodological characteristics of the studies identified made it inappropriate to undertake a metaanalysis, or infer that the findings from these largely PNG focused studies can be generalised to Pacific countries more generally.
Nevertheless, this review adds to the evidence base of previous reviews on RTI in less resourced settings [7
], focusing in this case, on Pacific countries which are often absent or overwhelmed by statistics from countries with very large populations in the Western Pacific region. A defining feature of this review is the paucity of robust and contemporary epidemiological RTI studies from Pacific countries, suggesting research attention to RTIs in the region have not been a priority [45
] and long overdue. However, the evidence available indicates that, as in other less resourced settings, RTIs contribute significantly to the burden of RTIs in Pacific countries and poor data should not delay action [47
The review particularly reveals the need to undertake well-designed aetiological studies that can quantify the contribution of important context-specific risk factors associated with serious road crashes. Indicative findings from the review suggest a key area requiring focused attention in PNG is improved safety considerations relating to the use of utility type vehicles [48
]. While the approaches to address this must take into account the socio-economic and transportation implications for the communities involved [49
], it has been argued that restricting passenger numbers through vehicle occupancy capacity limits may have the potential to reduce crash fatalities by almost 30% [40
]. Other areas amenable to well-implemented legislative interventions in the region include the use of seatbelts [51
] and deterrents to drink driving [16
]. Given the high proportion of road deaths at the crash scene, greater attention is required to health system improvements including pre-hospital care and the training of first responders [2
The World Report on road traffic injury prevention identifies the need for a comprehensive multi-sectoral, integrated, systems approach that focuses on improved information systems, institutional capacity strengthening, research that quantifies common modifiable risks, and resources for targeting these [2
]. Reliable and sustainable injury data surveillance [52
] including secondary data routinely collected from hospital and police records, comprises an important foundation for monitoring and evaluating road safety strategies in the Pacific context [19
]. This would be strengthened by the standardisation of RTI case definitions, data collection processes, analysis and reporting from surveillance systems [56
], while ensuring dissemination approaches link findings to interventions, policies, context-specific research and funding mechanisms. As noted elsewhere [57
], a critical requirement for identifying and implementing effective road safety strategies is a skilled workforce integrated across relevant stakeholder agencies including legislation, economic policy, capital infrastructure, road engineering, vehicle design, and health care.