There is a feeling of freedom cruising through Kigali on the back of a motorcycle taxi (commonly known as a taxi moto or boda boda), the wind whipping my hair as scratches on the face shield of the government required helmet partly obscure my view.
But motorcycle taxis are not only the most efficient means of transportation in East Africa’s metropolitan areas, they also tend to be among the most dangerous. That’s because motos recklessly weave between traffic on streets that rarely have proper lanes and where drivers of cars, trucks, and buses are also impatiently attempting to split lanes.
According to a study conducted in Kampala last year, 75% of all trauma patients at Mulago National Hospital are related to boda boda accidents. As a result, the hospital estimated that it spent 1.5 billion UGX (~$600,000 USD) treating boda boda accident victims. This is around 63% of the surgery department’s budget.
This week, I personally had a near miss, as a large passenger bus nearly ran the moto I was riding off the road, all because the bus driver was too busy on his cell phone to notice us.
In honor of the moto driver who saved my life (and his own) through his skill at maneuvering his bike out of the way in time, this edition of Graphic Monday looks at the WHO’s data on road traffic fatalities.
World Health Organization’s Statistics on Road Traffic Fatalities
The World Health Organization publishes data on traffic fatalities worldwide. These data include total deaths per 100,000 in the population, as well as, a breakdown of fatalities by type of transportation.
The WHO data reveal that for every 100,000 residents, Africa has the highest average rate of road traffic fatalities. For 2010-2011, the region averaged 21.78 traffic accident fatalities per 100,000 in the population. This compares to an average of 14.14 deaths for all other regions. Meanwhile, Europe had the lowest rate of fatalities, at 9.4 deaths per 100,000.
Looking at the data by accident type, cars are by far the most dangerous mode of transportation, accounting for 42.25% of all road fatalities. Pedestrians are the second most common fatality (27.2%). Meanwhile, the culprit of interest for this piece – motorcycles – account for only 15.77% of deaths. The two least deadly forms of transportation are a catchall “other vehicle” category (9.93%) and bicycles (4.14).
Of course, these are only crude estimates. They fail to take into account the volume of each form of transportation on the roadways. Thus, cars may account for the highest rate of fatalities simply because there are more cars than anything else on the road. Similarly, pedestrians might come in second because of their high volume in certain areas where there tend to be few pedestrian walkways.
Unfortunately, such numbers are extremely difficult to come by. While some countries, such as the United States, survey citizens on their primary means of transportation to work, these statistics do not span enough countries to make for meaningful global averages.
The World Bank’s World Development Indicators do include a count of the number of passenger vehicles (4-wheeled) and number of 2-wheeled vehicles per 1000 inhabitants. Data for motorcycles (2-wheeled) are only available through 2005, whereas data on passenger vehicles is available for direct comparison with 2011. Based on these data, on average in 2005, there were 34 motorcycles per 1000 inhabitants in the world. This compares to 284 cars per 1000 persons in 2011.
Cars outpace motorcycles in all regions of the world except South-East Asia. According to estimates by WorldMapper (University of Scheffield), on average there are 8 cars for every motorcycle in the world. In South-East Asia, there are an estimated 4 motorcycles for every one car. Africa is not far behind in its motorcycle density, with 2.8 cars to every one motorcycle. Meanwhile, the Americans and Eastern Mediterranean represent the global average, and Europe has slightly more than average cars to motorcycles (12:1).
It is also important to note that cars may produce more fatalities because they carry more passengers. It is unclear the passenger load referred to by the WHO in their data, which simply defines cars as 4-wheeled passenger vehicles. According to the World Bank definition, a passenger vehicle holds up to 9 people. Using this definition, the capacity ratio of a car to a motorcycle could be as much as 9:1. The same can be said for a bicycle. Likewise, pedestrians involved in a collision typically are solo victims.
Traffic Fatalities on the Most Unsafe Roads in the World
The WHO estimates that Africa has the highest rates of traffic fatalities, making its roads the “most unsafe” in world. According to the World Bank, Africa also has the fewest roads (per 100 square-km of land), the lowest percentage of paved roads, and the lowest vehicle count (per km of road) in the world. This adds further evidence to the claim that African roadways, in general, are simply unsafe. What explains Africa’s high rate of fatalities on its few, (largely) uncongested and unpaved roadways?
Looking closer at the type of fatalities by region, cars tend to dominate every region, except Africa. The largest share of traffic-related fatalities for Africa comes from pedestrian deaths (38.88%). Car-related deaths comes in second with 35.23%. Africa actually has the lowest rate of motorcycle-related fatalities, standing at 11.49% of all traffic related deaths. This should make the avid boda boda rider feel much better about her transportation choices.
Traffic Fatalities and Gaps in Medical Care Provision in Africa
One possible explanation for Africa’s high roadway fatality rate could be its underdeveloped healthcare sector. According to WHO estimates, on average, less than 29% of “seriously injured” patients are transported by ambulance to the hospital. This is the lowest in the world, followed by Western Pacific with 30% and South-East Asia with 34%.
Generally medical coverage is quite low in the region. On average, African countries have 1.2 doctors to every 100,000 inhabitants and 1.6 hospital beds for every 1,000 inhabitants. Even South Africa, the country in the region with the highest ratio of doctors to inhabitants, has only 7.5 physicians for every 100,000 people. This is well below the world average of 171 physicians per 100,000. This means that even if trauma patients, like traffic accident victims, do somehow have access to an ambulance for transportation, physicians and hospital beds are few and far between.
Despite low ambulance services, physicians, and hospital beds, Africa does outrank Western Pacific and South-East Asia in terms of emergency medical training for its doctors. Among African countries 64% have some form of emergency medical training for doctors and 39% have this training for nurses.
Traffic Fatalities and Government Policies
Aside from medical care, another potential explanation for the high volume of roadway fatalities in Africa could be related to government policy. In particular, laws governing road safety could have a major impact on traffic fatalities. In general, Africa lags behind in requiring all vehicle occupants to wear a seatbelt, but is outpaced only by Europe in terms of helmet requirements for motocyclists.
The two problematic areas for the region appear to be drunk driving and a limited policies regarding pedestrians and bicyclists. Africa has both the highest rate of drunk driving fatalities (36% of all traffic fatalities) and the highest admissible blood alcohol content levels for drivers (0.07).
Africa’s high levels of pedestrian deaths may be attributable to the region’s overall lack of policy regarding pedestrians and cyclists. Only 4 of the 44 African countries covered by the WHO data had some form of national or subnational policy regarding pedestrians and cyclists.
Based on anecdotal experience living in several Africa countries, I can attest to the informal “vehicle hierarchy” that dominates African roadways. The bigger vehicle almost always has the right of way. This means that pedestrians must yield to bicycles, motorcycles, cars, trucks, and buses. Drivers of these vehicles will not slow down or swerve to avoid a pedestrian until the last possible moment, or perhaps not at all. This hierarchy based on vehicle size means that the most vulnerable travelers – those walking, cycling, or on motorcycles – also lack basic protections under informal norms or even formal legislation.
What does this casual analysis really tell us about the causes of traffic fatalities in the world, and particularly on the world’s “most unsafe” roads? Not much in terms of causal (or statistical) significance. However, these crude eyeball correlations using graphics may help us to qualitatively understand the road conditions and policies that may (or may not) have contributed to traffic fatalities worldwide.
Despite being relatively underdeveloped and having a low volume of vehicles, African roadways stand out as particularly deadly. African pedestrians are the most at risk, followed by car users. Surprisingly, despite local reports of “deathtrap” motorcycles, Africa’s rate of motorcycle fatalities is the lowest in the world.
The danger in Africa’s roadways could be tied to a mixture of underdevelopment and lax government policies. While African doctors are typically trained in emergency medicine, Africa has limited medical facilities and emergency transport services for trauma patients. The region’s lenient drunk driving laws may explain why it has the highest rate of drunk driving fatalities in the world. Lastly, the region’s lack of policies regarding pedestrians and cyclists may have resulted in high rates of pedestrian fatalities.
A logical next step in this analysis would be to run statistical models to test for the significance of these various factors in determining rates of traffic fatalities. Unfortunately, the data presently available present serious concerns regarding missing observations, making such analysis problematic. Perhaps future research using more complete data can tackle this challenge.
Replication & Sources
If you would like to replicate the graphics produced in this blog, replication data is here: 2014.07.28 Graphic Monday Data. A replication instruction file is here: 2014.07.28 Do File. Because WordPress does not support Stata files, the replication data are stored in Excel and will need to be migrated to Stata (typically copy and paste, selecting “variable names”, works just fine). The replication instructions are stored in PDF format, but can be pasted into the command menu or a Do file in Stata.
Sources for data are:
– World Health Organization. 2014. Indicator and Metadata Registry. Available here.
– World Bank. 2014. World Development Indicators. Available here.
– WorldMapper. 2014. “Map No.32: Mopeds and Motorcycles”. Available here.