PREVALENCE AND FACTORS ASSOCIATED WITH ROAD TRAFFIC CRASH AMONG BAJAJ AND MOTOR BICYCLE DRIVERS IN NEGELLE ARSI TOWN, OROMIA REGIONAL STATE, SOUTH EAST ETHIOPIA

1. Department of Anesthesia, Negelle Arsi General Hospital and Medical College, Negelle Arsi, Ethiopia. 2. Department of Surgery, Negelle Arsi General Hospital and Medical College, Negelle Arsi, Ethiopia. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 23 November 2019 Final Accepted: 25 December 2019 Published: January 2020

The study population included in the study was randomly selected Bajaj and Motor bicycle drivers found and working in Negele Arsi Woreda, Negelle Arsi town from March 2016 to April 2019.
Exclusion criteria -Those working at night time, come from nearby town and unavailable during study period.

Sampling procedure and sample size determination:
The sample size was calculated using the single population proportion formula, n = Z (1- Thus, the actual sample size for the study was 330. We obtained the list of the two kinds of vehicles in the area for sampling frame from April 10-20, 2019 at Negelle Arsi town. The study was done among a sample of 330 drivers of Bajaj (three tier vehicles) and Motorcycle drivers. After proportion to size allocation for Bajaj (206) and Motorcycle (124) drivers, we used simple random sampling method to identify illegible study subjects who meet the inclusion criteria.

Data collection tools and procedure:
Face to face interviews using pre-tested and structured questionnaires were used to collect data. Questionnaires were adapted from different literatures and modified to the current aim of the study which consisting of 43 questions used to measured road traffic accident as a collision between vehicles; between vehicles and pedestrians; between vehicles and animals; or between vehicles and fixed obstacle within three years period of time. The data collectors translate the English questionnaires for him/her self and interview the participants by their language. Motorcycle and Bajaj drivers identified with simple random sampling technique and the trained data collectors approached for the interview at their stations based on the information given from transport office of the town, taxi and Bajaj associations. Data was collected by one Nurse degree and one Anesthesia degree holders and supervised by principal investigator.

Data Quality Assurance
Data collectors were trained on each items included in the study tools, objective, right of respondents, confidentiality of information obtained and technique of interview. During data collection, regular supervision and follow up was made. Investigator was cross checked for completeness and consistency of data on daily basis. Once the data was collected and checked for completeness, consistency and accuracy, it was sorted, categorized and summarized. Then, we enter the data into the computer using developed data entry. Incomplete questionnaires were discarded and considered as none response rate.

Data Analyzing and processing
Data was checked manually for completeness and then coded and entered by investigators to SPSS version 20 computer program for cleaning and analysis. Descriptive statistics was used to determine the frequency of dependent and independent variables. Variables which show significant association on bivariate analyses were fitted in to multivariate logistic regression model to determine the independent predicators for RTC. Bivariate and multivariate 148 analysis was used to identify associated factors of RTA and the strength of association was measured by 95% confidence interval and P-value of 0.05 was used as a cut of point.

Ethical Consideration:
Ethical clearance was obtained from Ethical Review Committee of NAGHMC and was produce for Negelle Arsi town Road and transport Authority Office and their official permission was taken. Informed Verbal consent was secured from every study participants before the start of interview. Confidentiality and anonymity were ensured.

Socio-demographic and Drivers characteristics
A total of 322 participants completed the study questionnaires from the planned 330, giving a response rate of 97.6 %. Eight respondents were excluded from the study as a result of not availed during data collection or incomplete response to the survey. The mean age of the respondents was 26.5. All of the respondents 322 (100.0%) were males. More than half 164 (50.9%) were single in marital status, Muslim (n=197, 61.2%), Have no own Residency (n=204, 63.4%), and Monthly income from2000.00-4000.00ETB (n=203, 63.0%). Less than half of the respondents' educational status were secondary school 137 (42.5%) followed by elementary school 126 (39.1%). Almost half of the drivers were self-employed (n = 163, 50.6%) meaning that they own their own taxi vehicles (Table 1).

Factors related to road traffic accident condition, Environmental, Seasonal and Geographical factors of the respondent:
Generally, among 322 total respondents, 92 (28.6%) of the Bajaj and Motorcycle drivers ever had experience of road traffic accident in the last three years. Out of the total drivers who were experienced road traffic accident, 70 (76.1%) and 22(23.9%) were Bajaj and Motorcycle drivers respectively. More than half, 203 (63.0%) of the respondents were following the recommended speed limit of driving in the town. From the total respondents, 119 (36.9%) of them were drive over the limited speed. 88(73.9%) of them occasionally drive more than the limited speed. The reasons given for why they do not follow the speed limit and drive more than the limited speed was because of to shorten the line77 (64.7%) and to increase income 38 (31.9%).
High proportions, 271 (84.2%) of the respondents were not chewing chat while driving. Only 51(15.8%) of them were used chewing chat. Out of these, 43(84.3%) of them used sometimes, 6(11.8%) of them used most of the time and only 2(3.9%) used always while driving. The explanations given by the participants were; they said that they were feel free in driving 29(56.9%), it give them energy 16(31.4%) and for pleasure while driving 6 (11.8%).
Twenty-one accidents (22.8%) were happened in rainy weather condition while 73(79.3%) and 29(31.5%)of the accidents happened in non-asphalt road and at commercial center respectively. The most common cause of RTA were quality of road 28(30.4%) followed by over speed driving 18(19.6%) and pedestrians carelessness 17(18.5%).
After applying both bivariate and multivariate logistic regression, four variables were found to be associated with road traffic accident. This includes, speedy driving, history of alcohol use, khat chewing and mechanical problems were found to increase the odds of Road traffic accident involvement. But, respond to mobile phone and Listening FM radio were not significantly associated with road traffic accident.

Discussions:-
This study concentrated on 2 and 3 wheeled vehicle drivers, clarifying that about (28.6%) of them had been involved in a Road traffic accident in the past three years. It is comparable to the prevalence described among different vehicles drivers in Vietnam (La, Lee, Meuleners, & Van Duong, 2013).
In this study, even though use of mobile phone has insignificant association with RTA, 81% (n= 261) of the study participants were used mobile phone while driving. Similarly in other study, mobile phone use is constantly a risk factor for road traffic crash and 35% of the participants reported as using their mobile phones while driving (Al-Aseeri & Oghuehi, 2013).
This study identified as 119, 36.9% of the respondents were not following the limited speed of driving. It identified as speedy driving and Road traffic accident had a significant association. Comparable to our findings, speedy driving was associated with Road traffic accident in China (Zhang et al., 2013), Oman (Islam & Al Hadhrami, 2012), and Nepal (Mishra, Sinha, Sukhla, & Sinha, 2010). But, study in Australia speedy driving was not associated with road traffic accident (Lam, 2004).

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Previous studies in the USA have indicated that alcohol are highly related with road traffic accident (Harrison & Fillmore, 2011), similar to this findings, our study detect as alcohol usage have significant association with RTA and result shows 57(17.7%) of the respondents were used alcoholic beverage. From these, 23(40.3%) of them never drive within three hours of drinking alcohol.
Approximately 38.7% of drivers reporting road traffic accident association in our study had a history of at least one to two traffic punishments, and over 124 (38.5%) of the total study participants had received a punishment. This shows as there is high level of risky driving behavior between the study populations(Asefa, Ingale, Shumey, & Yang, 2016).
In contrast with previous studies in Ethiopia and other studies in low and middle income countries, our studies finding shown that Pedestrians accounted for higher percentage (22.8%) of road traffic accident injury followed by vehicle drivers (21.7%) [ (Getachew et al., 2016), (Chalya et al., 2012)]. This might be due to inadequate footways and road signals in the town for pedestrian. Others may be public awareness on road traffic rules and behavior of drivers.
Different studies confirmed that young drivers are commonly involved in highest proportion of risk behaviors and traffic accidents than other age groups [ (Beenstock & Gafni, 2000), (Hassen, Godesso, Abebe, & Girma, 2011)].Unlike to the above studies, in this particular study (n= 174, 54.0%) of the drivers from 18-24 years old were involved to RTA than (n=131,40.7%) drivers from 25-31 years old.
Similar to previous study (Males, 2009), our study, even if educational status had no significant association with RTA, it shown that drivers with elementary and secondary school educational status (n=81, 88%) had higher risky of road traffic accident than drivers with Diploma and above educational status (n=10, 10.9%).This may be because of drivers with lower educational status are not educated and less opportunities of occupation in other field.
In our study even though monthly income was a risk factor, it was not significantly associated with road traffic accident. Unlike this study, other research identified that high income was associated with high risky driving behavior [ (Males, 2009), (Castle, Yi, Hingson, & White, 2014)]. This might be defined as average monthly income increases, the ability to pay for vehicles and likely punishments increases.
Previous study showed as Alcohol consumption and abusing drugs with sedative properties lead drivers at a higher risk of road traffic accident by dropping their awareness and response time. In addition amphetamine can increases the self-confidence of the drivers and make them susceptible to more hazardous driving behaviors. Our study revealed that among drivers who consumed alcohol during work hours, 28(30.4%) of them result in RTA and 27(29.3%) of drivers who used chat chewing during driving was involved to road traffic accident in the last three years (de Carvalho Ponce, Muñoz, Andreuccetti, de Carvalho, & Leyton, 2011).

Limitations:
1. Recall bias and survival bias may lead the prevalence to under-estimation. 2. Some of Bajaj and motorcycle drivers were not willing to participate. 3. Lack of comparable studies makes the comparison difficult because most of the literatures were hospital based.

Conclusions:-
Generally, among 322 total respondents, 92 (28.6%) of the Bajaj and Motorcycle drivers ever had experience of road traffic accident in the last three years. Out of the total drivers who were experienced road traffic accident, 70 (76.1%) and 22(23.9%) were Bajaj and Motorcycle drivers respectively. The risk factors that were identified and associated with road traffic accident were Mechanical problems, Speedy driving, Drinking alcohol and Khatchewing.

Recommendations:-
Negelle Arsi town transport bureau should give training for drivers on rules related with speedy driving and avoiding of other risky driving behaviors.