A study exploring the impact of motor vehicle injuries in Pakistan has found
that as many as 61 percent to 86 percent of such injuries may go uncounted in
official police statistics, causing public health officials in Pakistan to
underestimate the problem's seriousness. The investigation shows that the total
number of motor vehicle crashes increased 14-fold between 1956 and 1996, while
the number of lives lost in crashes increased 16 times. The scientists also
discovered that buses and public service vehicles, which in Pakistan account for
just 12 to 35 percent of the total number of registered vehicles in any given
year, are involved in over 60 percent of motor vehicle crashes and 90 percent of
First author Adnan A. Hyder, MD, MPH, PhD, assistant scientist, International
Health, Johns Hopkins School of Public Health, said, "Since the numbers of motor
vehicle injuries and deaths may be seriously underreported in Pakistan's
official statistics, the public health sector there has not fully appreciated
the burden these injuries are imposing on the population." The study appeared in
the September 2000 issue of Injury Prevention.
Currently ranked ninth among the world's disease burdens, motor vehicle crashes
are projected to rank third by 2020. Developing countries are the site of nearly
three quarters of the ten million motor vehicle crashes annually. "And yet,"
says Hyder, "in the absence of accurate and detailed epidemiological and
economic data for injuries, there is limited understanding of this issue in the
To measure the risk of traffic injuries in Pakistan, Hyder teamed up with Abdul
Ghaffar, PhD, in Pakistan's Ministry of Health. They gathered data on the
numbers of registered vehicles and motor vehicle crashes, as well as on injuries
and deaths in Pakistan during the years 1956 to 1996. They also interviewed 35
crash survivors between May and August, to ask whether the police had been on
the scene to register the crashes.
The study's results indicate that the numbers of motor vehicle crashes, injuries
and fatalities in the country have increased steadily during the 40-year period
after 1956, and that commercial vehicles contribute disproportionately to these
The in-depth interviews of motor vehicle crash survivors revealed that only 14
percent of the crashes were investigated and registered by the police. (A
previous study found that 39 percent of road traffic injuries had been
investigated by the local city police.)
The authors said that since commercial vehicles travel many more kilometers
annually than do cars, their risk for crashes is heightened. Equally important,
according to the authors, is that commercial vehicle production has not kept
pace with population growth, so that existing vehicles in this category are
increasingly likely to be overloaded, further contributing to increased injury
and fatality rates per crash.
Hyder said there is little evidence that the health sector in general is
responding to this challenge. "Pakistan's focus has traditionally been on
providing hospital treatment once a crash has occurred and the injured party has
reached a facility," he said, "not on developing and coordinating emergency
medical services and prevention strategies."
The authors say that policy makers in developing nations must first fully
appreciate the problem of crash injuries and then perform epidemiologic studies
to demonstrate the need for prevention programs.