Injury risks for different road users in Nepal: a secondary analysis of routinely collected crash data

Background Road traffic injuries are the 12th leading cause of mortality globally. Nepal, one of the least developed countries in the world, has a rapidly rising rate of road traffic-related morbidity and mortality. There is incomplete reporting of traffic crashes in Nepal in the last three World Health Organization global status reports on road safety. Together with poor-quality coding of crashes, essential information to inform prevention interventions or make international comparisons is lacking. Objectives The study aimed to critically analyse routinely collected traffic police data in Makwanpur district, Nepal, to identify the road user groups most likely to be involved and injured in traffic crashes in this part of the country. Design Secondary data analysis. Setting Makwanpur district, Nepal. Data sources Road traffic crash records from the District Traffic Police Office, Makwanpur, over 2 years (April 2017–March 2018 and May 2019–April 2020). Data were extracted from paper-based records onto an electronic database, and the data were analysed descriptively using the Statistical Package for the Social Sciences version 24.0 (IBM Corporation, USA). Results There were 291 crashes recorded in 2017–8 and 435 crashes in 2019–20. Two-wheeled vehicles (motorcycles/scooters) were the most frequently involved in police-reported crashes (35.5%). For most crashes (419/726, 58%), no cause was documented in the police record. Road users involved in crashes were mostly riders or passengers of motorised two-/three-wheelers (33.4%), four-wheeled vehicles (19.9%) or buses (16.7%). Of fatal injuries, 31.2% were riders or passengers of motorised two-/three-wheelers, and 24.8% were pedestrians. Limitations The data used represent crashes reported to the traffic police and therefore underestimate the true number of crashes and injuries. At the end of the second period of study, local movement restrictions associated with the COVID-19 pandemic lockdown limited the traffic on the roads, resulting in fewer crashes in March and April 2020. In most crash records, there were missing data, limiting the ability to determine contributory factors with confidence. Conclusion This study contributes to the evidence gap by describing crashes and mortality data by vehicle type and road user category. The findings suggest that the number and rates of crashes may be increasing over time. Action to improve the quality and completeness of data routinely collected by the traffic police is needed; a piloted web-based Road Accident Information Management System has the potential to support improved routine data collection. Future work The data indicate crashes occurring in one district over 2 years. To better understand the apparent increase in crashes, an analysis over a longer period, and over multiple districts, would be necessary. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Global Health Research programme as award number 16/137/49.