Annals of the Royal College of Surgeons of England (I978) vol 6o
A comparative study of road traffic accidents in West Malaysia J Francis Silva MD FRCS FRACS FACS Professor of Orthopaedic Surgery, University of Malaysia, Kuala Lumpur
Summary The problem of road traffic accidents in developing countries is now becoming a cause for concern. This is more so as preventive measures have not kept pace with economic progress and development. This paper reviews the present situation in West Malaysia, one of the better developed countries of the East, during the period I970 to 1975. A comparative study has been made between the United States and Malaysia. To enable the urgency of the problem in developing countries to be appreciated the increases in the country's population and in the number of vehicles in use and their relation to the lesser increase in road mileage over the period of study have been discussed. The study has considered every aspect of the causative factors leading to traffic accidents, such as the effects of weather, seasonal variation, and road and lighting conditions. The common human errors leading to accidents have been discussed. Other factors, such as the ethnic distribution in Malaysia, and their relation to road accidents have shown the effect of the social structure on the problems. The data evaluated in this study make it clear that preventive measures are very necessary in underdeveloped as well as in developed countries.
Introduction The tragedy of road traffic accidents is an unfortunate circumstance with which the human race has to contend in this modern age. The rapid progress of civilisation has made speed in transport an integral part of human life. There is no halt to this ever-increasing desire for speed; hence the inevitable consequence of increasing frequency of accidents on our roads. That this modern killer robs mankind of its flower of youth is well appreciated in the
Western world and every effort is being made to cope with the preventive aspects of the problem. In developing countries the preventive measures that should be taken are equally important, if not more so. These countries can ill afford the loss of useful manpower or damage to property. Social welfare services are so heavily taxed by the many other demands made on them that they are hard put to bear the added burden of providing assistance to victims of accidents with permanent physical disability.
Magnitude of the problem In 1958 38 ooo people were killed in the United States and I 400 000 injured'. These figures increased to 55 ooo dead and 2 000 000 injured in I9732. The year I975 saw 473 automobile accidents, 95 persons injured, and one killed every io minutes. This unfortunate pattern of the steady rise of accidents over the years in a country like the United States has taken place in spite of a great awareness of the problem and organised preventive programmes. In developing countries the tragic problem, though not of the same magnitude, is nevertheless a serious one. In contrast to the United States, in Malaysia 1975 saw I32 automobile accidents, 47 persons injured, and 6 killed each day. These are figures that cause concern when taken into consideration with the economic and developmental differences between the two countries. Thus it would seem that tne provision of better preventive measures with regard to road accidents should be given serious consideration in Malaysia. In 1975 Malaysia had a population of IO 438 I37, while it was 2I3 540 000 in the United States. In the same year road traffic acci(lents caused 2324 deaths or 0.022 per
The 2nd Grayton Brown Memorial Lecture delivered at the 5ist General Scientific Meeting of the Royal Australasian College of Surgeons in Kuala Lumpur in AMay 1978.
1 Francis Silva
458
I00 population in Malaysia, whereas in the United States it was 4 6oo or 0.02I per I00 population. On the other hand, non-fatal injuries in Malaysia amounted to only I 7 Io6, while in the United States the figure was I8oo ooo. However, the numbers of registered vehicles on the road were I 267 II9 (I2.1 per Ioo population) and I35 700000 (63.6 per Ioo population) respectively. Although the Malaysian proportion of fatal to non-fatal accidents is somewhat higher, one might tend to treat this difference as of no significance owing to the larger discrepancy in the number of registered vehicles. However, this would be misleading as the road mileage in the two countries is different, that in Malaysia being very low. The high figure is therefore significant.
Population and traffic increase and accident rates The population of West Malaysia increased
in I970 and 75 633 in 1975, an increase of 289.27o. The increase in the number of casualties on the roads compared with I970 rose from II.370 in I97I to 155.970 in I975. However, during this time the increase in road mileage was limited, being 3.2 7o in 197I and only I2.4% in 1975. This low increase in road mileage compared with that in vehicular traffic must of necessity have led to increasing congestion on the roads and a greater liability to accidents (Fig. I).
Accidents by states West Malaysia is a peninsula divided into iI states with greatly varying accident rates. In 1976 the state of Selangor, including the Federal Territory, led with a rate of 6.2 accidents per ioo motor vehicles, while the island of Penang came a close second with 5.0 per i00 vehicles. These two states are the most densely populated and industrialised areas in the country and their roads the most heavily congested with vehicles. Of the remaining 9 states, only 2 had rates exceeding 3 per i oo vehicles.
from 8 8oI 399 in I970 to I0 438 I37 in 1975. The increase in the number of vehicles on the road compared with 1970 has risen from 9.i% in 197I to 89.370 in 1975. Ethnic distribution Corresponding with this increase in the The population of West Malaysia is made up number of vehicles the number of those in- of approximately 5370 Malays, 3570 Chinese, volved in accidents has also risen, being 19 433 i i o Indians, and i 7o other races. This study has revealed that members of PERCENTAGE INCREASE SINCE 1970 the Chinese community are the most com300 r monly involved in road accidents. There were ,CCIDENTS 3837 Chinese casualties in I970 and the figure has gradually risen to 8779 in 1975. The Malays are the next most involved race, with 200 2393 casualties in 1970 and 7923 in I975. The Indian community is less affected, with only I236 casualties in I970 and 2690 in /- - ' ' ," I975. Casualties among the other communities 100 are insignificant. These figures reflect the relative affluence of the three principal racial communities in the country.
,"
0
d
Sex and age distribution Study of the sex distribution shows a considerFIG. I Percentage inc rease in casualties, able male preponderance that has increased road mileage, vehicles on the road, and over the years. There were 6227 males invehicles involved in acc-idents since I970 in volved in accidents in 1970, while in I973 there were I 2 7I8 male victims. The year I974 West Malaysia. 1970
1971
1972
YEAR
1973
1974
1975
A comparative study of road traffic accidents in West Malaysia
was more encouraging as there was a drop in the figure to IO 703, but unfortunately it rose again to I5 996 in I975. This was probably due to the greater increase of vehicles during the period I974-75. The pattern for female casualties has been similar, though the numbers were much smaller, there being only I 394 casualtics in I97O and 3444 in 1975. The age distribution of casualties during the whole period I970-75 shows a steady increase from 5598 between 5 and io years to I4 i8i at the age of 2I. After this peak there is a decline to 7043 casualties between the ages of 5I and 6o. Over the age of 6o there were 5372 casualties.
459
NO, OF CASUALTIES _
6,000
5,000
-
4,000 -
3.000 -
2,000
1,000
r
1970
1971
1972
1973
1974
1975
YEAR
Vehicles and victims The type of vehicle most commonly involved in accidents was the private car, accidents to which increased steadily in numbers from 7927 in I970 to 36 9I9 in I975 (Fig. 2). The motorcycle was the next most commonly involved vehicle, accounting for about half as many accidents as the car. Accidents involving lorries and vans were much less frequent, the numbers being only 2I34 in I97O and 8043 in 1975, while the contribution of buses and taxis was not significant. Even though motor-cycles were less frequently involved than cars in accidents, the largest number of casualties was among NO. OF ACCIDENTS
40.000 r
30,000
FIG. 3 Casualties among different types of road user. motor-cyclists (Fig. 3), there being I870 such casualties in I970 and 5994 in I975. (Pillion riders were much less often injured, probably because they were fewer in numbers.) Pedestrians were the next most unfortunate victims, their figures going up from I586 in I970 to 3910.in I975. Cyclists were more frequently injured than the drivers of motor vehicles, who in turn were slightly more often injured than their passengers; this is probably due to the fact that seat belts have come into use only in recent times. There were I 322 drivers injured compared with I035 passengers in 1970, while in I975 these figures had increased to 2439 and 2157 respectively. Lack of protection probably accounts for the higher casualty rates among motor-cyclists, pedestrians, and cyclists than among the occupants of motor vehicles despite their high accidentproneness.
20,000
10,000
,'
--
LORRIES
-'
8
VANS
Comparative traffic fatality rates Comparison of the traffic fatality rate per ioo million vehicle miles in Malaysia in I973 (as calculated by the Royal Malaysia Police) with
the corresponding rates for a number of developed countries (compiled by the Motor '70 Vehicle Manufacturers Association of the United States) shows that the Malaysian figure A nalysis of f vehicles commonly in- (i8.5) was higher than those of Belgium (I7.4) volved in accidents. and France (I3.7), which had the highest rates _@ -
0
_
t-:
'71
'72
2
*
--
'73
YEAR
FIG.
-
BUSES TAX S
-
'74
'75
460
J Franzcis Silva
of the developed countries listed, the United States (4.2) and the United Kingdom (5.2) having the lowest rates. Moreover, in all the developed countries the figures had steadily improved from I970 to I973, whereas in Malaysia the rate rose in 197I and thereafter remained virtually unchanged. A fall in I975 to 15.3 per IOO million vehicle miles is, however, encouraging.
States. This indicates the misconception that arises from direct comparison of accident incidence between two countries without due consideration being given to differences in population, size of the countries, and the number of vehicles. In the United States there is a definite seasonal variation in the number of deaths and of accidents, the months of June, July, and August showing a definite rise.
Accidents related to time of day and month Analysis of the proportion of accidents occurring at different times of the day in Malaysia during I975 showed that during the daylight hours there was no particular period in which accidents were specially liable to happen. From 6 to 8 a.m. there was a steady rise in the number of accidents and this remained as a plateau until 6 p.m., when it began to decline quite rapidly. Between io p.m. and 6 a.m. the figure remained low. This would imply that during the night most road users in Malaysia possibly exert greater care than during the day. Another factor may well be the fewer number of vehicles on the roads at night. As only the main urban roads are well lit the need for greater caution in poor conditions in rural areas is clear. In contrast in the United States in the same year there was a sudden rise starting at 6 a.m. and continuing until it reached a peak, amounting to i6.3%go of the total number of accidents, at the rush hour between 4 and 6 p.m., when most people were anxious to get home quickly. The figure then fell steadily, but by i o p.m. it was still around 7.2 % and from midnight to 2 a.m. it remained at 5.8%, then rapidly dropping to i.6% between 4 and 6 a.m. This pattern is different from that in Malaysia, where the figure had fallen to 4.3% by io p.m. and remained between 2 and 3 % from midnight to 6 a.m. In the same year a monthly analysis of accidents in Malaysia showed a fairly steady distribution throughout the year; there was a slight fall in January and a slight increase in July. On average, the monthly number of accidents in Malaysia approximates closely to the mnonthly number of deaths in the United
Causative factors of road accidents In I970 73.6% of accidents were due to faults of drivers, a figure which in I975 increased to 85.o0. Pedestrians were responsible for 8.i% of accidents in I975. This figure was much the same throughout the period except in I970 and I974, when it increased to 9.2 o and 9.6%To respectively. As would be expected in a developing country 2.3% of the accidents in I975 were caused by animals; these were probably unattended. Accidents attributable to road conditions made up i.9To, while other factors were of minor significance. WEATHER CONDITIONS
With clear weather conditions the number of accidents was greater. In I970 there were 10 538 accidents during clear weather conditions. This figure rose to 40 925 in I975, whereas during wet Conditions it was 1432 and during misty conditions, poor light, and heavy rain the numbers were 2968, 2677, and I093 respectively. This suggests that, contrary to expectation, bad weather does not increase accidents in a country subjected to heavy monsoonal rains. On the contrary, the accident rate is remarkably low at such times, suggesting the possibility of greater care exercised during these periods and slower speeds of travel. In the United States 75.8% of accidents occurred in dry weather, I8.2% in wet conditions, and 6% in icy conditions. ROAD SURFACE
The road surface, too, had a bearing on the frequency of accidents; the better the road conditions, the higher was the accident rate. In I975 there were 36 879 accidents on metalled
A comparative study of road traffic accidents in West Malaysia
46I
roads (76.46%), while it dropped to 10 402 much higher than ever before. It may well (21.57%) on gravel roads and 952 (1.97%) be that certain areas hitherto classified as builton laterite roads.
up were included among the rural areas in
Two factors possibly play a role here. Firstly, the better roads are more congested with vehicular traffic, being in urban areas. Secondly, their better condition allows faster speeds. The less developed roads, from the point of view of their state of construction as well as being in rural areas, are less crowded and do not permit high speeds. LOCALITY
In towns and built-up areas there were 6926 casualties in I970, while in rural areas there were only 695. These figures gradually rose and there were I4 270 casualties in towns and built-up areas in I973, while in rural areas the figure still remained much lower than in urban areas, though higher than in the preceding years. The following years saw an improvement in urban areas in that there were only I2 299 casualties in 1974 and 10 394 in I975. In rural areas, however, although there was a fall in the number of casualties in 1974, there was a dramatic rise, to 9064, in I975 (Fig. 4). This was the first time in the period under review that there was a greater number of fatal casualties in rural areas (890) than in towns and built-up areas (62 i). These facts are hard to explain as the numbers both of total casualties and deaths in rural areas were so CAS ALT:ES
I975.
The fact that even though, in I975, the total number of casualties was higher in towns and built-up areas fatalities were more frequent in the rural areas may be due to the fact that in remote areas greater speeds of travel are possible on good roads as crowding is less. In addition, it may also be possible that in these remote areas, owing to the lack of adequate traffic control, there is less care and concern for safety. Another explanation may be delay in or absence of resuscitation at the scene of the accident and the late arrival of transport for the injured. In the United States there were i6 500 deaths in built-up areas and 29 500 in unbuilt areas in 1975, the pattern thus being the same as it was in Malaysia in the same year. In the United States accidents were more frequent in rural than in urban areas throughout the period under review, the pattern thus differing from that in Malaysia.
Discussion The mounting toll of road accidents, with 2334 fatalities in 1975 compared with 579 in 1970, makes continuing studies of the problem of road accidents in Malaysia an urgent matter.
14 000
Preventive measures are needed both to reduce the incidence of accidents and to UNBUILT minimise the fatality and morbidity rates .This 10 000 can be achieved in two ways. Firstly, by introducing preventive measures to reduce incidence 10000 by organisation of passive programmes3. Secondly, by education of young doctors so that 4600 they understand the mechanism of accidents and the changing forces produced by them. Such knowledge will help in the better anticipation of the injuries to be expected in a given accident and in appreciating even more the 1974 1975 1q7' 1973 1970 1972 need for better and more thorough clinical examination4. A full application of such FIG. 4 Traffic accident casualties by location knowledge and clinical data will help in better management. in West Malaysia. D
TOWN & BUILT-UP AREAS
AREAS
F EAR
462
J Francis Silva
Of the many steps needed to curb the incidence of accidents, proper control of the design and structure of motor vehicles from the point of view of strength of construction and installation of safety measures is the most important. The slower rate of increase of road mileage in the country may be the cause of the high percentage of fatalities when compared with the United States, even though the size of the countries, their populations, and the numbers of vehicles on the roads are not comparable. An increase in road mileage would certainly reduce the congestion on the roads. That this is an urgent need is shown by the fact that accident rates in Malaysia have no seasonal variation or even variation at weekends, there having been a steady increase throughout each year over the period of study. This is very different from the United States or Australia, where the incidence rises each year in the summer months and during weekends5. The statistics obtained in this study show only the fatalities that occurred at the scene of the accident. Delayed mortality figures are not included as they are not available. Hence to reduce these figures urgent care must be given to traffic accident victims by the prompt availability of transport from the scene of the accident to the emergency department and ambulances must be provided with properly trained crews capable of resuscitating the victims. They should have at their disposal all the modern equipment for providing this facility. In this way not only could the mortality rates be reduced but also prolonged morbidity could be curtailed. Accident casualties should be transported to well-equipped accident centres, which should be alerted and ready to receive such victims. Regional services are essential6. In Florida, even though traffic accidents increased by 417o between I968 and I97I, deaths due to trauma fell by I 3 7o as a result of improved organisation of emergency services7. That these are the services needed and not higher-speed ambulances has been stressed by Curry et al8. This need was further emphasised in a study of road accidents conducted in the Birmingham area9 in which it was found that one-third of the 63%70 ped-
estrians and 23% drivers and passengers of vehicles in road accidents died within half an hour, while in New York an even higher immediate fatality rate was found by McCarrol and Haddon"0. The lethal nature of these accidents is further stressed by Gissane and Bull11, who reported that in 55% of 6i deaths in accidents on a motorway the patient arrived dead at hospital, and by Perry and McClellan'2, who found that 6 i o of victims of main-road accidents arrived dead. That there are more early deaths in rural areas has been shown by Smeed'5, 55% arriving dead in rural accidents as opposed to 36% in urban accidents. The magnitude of the problem even where organised services exist further supports the contention that there is a need for study and planning in Malaysia. It also further emphasises the need for resuscitation at the scene of the accident and continuing care during transportation. Other causative factors that could be eliminated in all countries are poor roads and highways'4; the room for improvement here is even greater in developing countries like Malaysia. The lack of at least yearly vehicle inspection is yet another aspect that needs to be rectified, since old and neglected vehicles are more liable to cause injury to their passengers'5. Education of the public on courtesy on the roads can also prevent tragedies and this is yet another urgent long-term measure that is needed. It is even more so when the majority of the injured are either drivers of vehicles or pedestrians; this has been found to be so by others'6. Regular testing of drivers for blood alcohol, particularly in the evenings, and the taking of necessary action when it is high would be a further help. High levels of blood alcohol have been shown to increase errors of judgment7' 18. There cannot be enough emphasis placed on the urgency of the need for these measures to prevent this tragic cause of disablement, death, and damage to property. The need becomes more apparent when it is realised that the age group most affected is that between 20 and 30 years, a fact stressed by other observers".
A comparative study of road traffic accidents in West Malaysia '[he assistance so kindly extended to me by YB Tan Sri Dato' Sri Mohd Haniff b. Omar, Inspector General of Police, and ACP Mohd Noor Khamis, Assistant Director, Traffic Branch, of the Royal Malaysian Police, is gratefully appreciated. My thanks also go to Mr F Weston Fenhagen, Counsellor of Foreign Affairs of the United States Information Service of the American Embassy, Kuala Lumpur, for making available the road traffic accident data for the United States. I also wish to thank Mr Ng Lik Lin for his invaluable assistance with the statistical work and for drawing the charts to illustrate this paper.
References Wade, P A (I96I) Journal of Bone and Joint Surgery, 43B, 634. 2 National Safety Council of USA. Traffic Accident Facts, 1974 edition. 3 Haddon, W, jr (I974) Journal of Trauma, 14, 353. 4 London, P S (I975) Acta orthopaedica Scandinavica, 46, 460. 5 Tonge, J I, et al (I977) Medicine, Science and the Law, I7, 9. I
6 Silva, J F
463
(I973) Medical Journal of Malaysia,
28, I.
7 Waters, J M jr, et al (I973) Journal of Trauma, 13, 645. 8 Curry, C J, and Lyttle, S N (I958) American Journal of Surgery, 95, 507. 9 Sevitt, S (I972) Injury, 4, 28I. IO McCarroll, J R, and Haddon, W A (I962) Journal of Chronic Diseases, 15, 8II. i IGissane, W, and Bull, J (I962) Practitioner, I88, 489. 12 Perry, J F, and McClellan, R J (I964) Surgery, Gynecology and Obstetrics, 19, 586. I3 Smeed, R J (I953) International Road Safety and Traffic Review, I, i6. 14 Braunstein, P W, Moore, J 0, and Wade, P A (I957) Surgery, Gynecology and Obstetrics, I05, 257. I5 Braunstein, P W (I957) Journal of the American Medical Association, 163, 249. i6 Edwards, G E, et al (I973) Journal of the Irish Medical Association, 66, 65i. I7 Havard, J D J (I962) Practitioner, I88, 498. I8 McFarland, R A (i962) Practitioner, I88, 457. I9 Zollinger, R W (I955) Archives of Surgery, 70, 694
A comparative study of road traffic accidents in West Malaysia J Francis Silva MD FRCS FRACS FACS Professor of Orthopaedic Surgery, University of Malaysia, Kuala Lumpur
Summary The problem of road traffic accidents in developing countries is now becoming a cause for concern. This is more so as preventive measures have not kept pace with economic progress and development. This paper reviews the present situation in West Malaysia, one of the better developed countries of the East, during the period I970 to 1975. A comparative study has been made between the United States and Malaysia. To enable the urgency of the problem in developing countries to be appreciated the increases in the country's population and in the number of vehicles in use and their relation to the lesser increase in road mileage over the period of study have been discussed. The study has considered every aspect of the causative factors leading to traffic accidents, such as the effects of weather, seasonal variation, and road and lighting conditions. The common human errors leading to accidents have been discussed. Other factors, such as the ethnic distribution in Malaysia, and their relation to road accidents have shown the effect of the social structure on the problems. The data evaluated in this study make it clear that preventive measures are very necessary in underdeveloped as well as in developed countries.
Introduction The tragedy of road traffic accidents is an unfortunate circumstance with which the human race has to contend in this modern age. The rapid progress of civilisation has made speed in transport an integral part of human life. There is no halt to this ever-increasing desire for speed; hence the inevitable consequence of increasing frequency of accidents on our roads. That this modern killer robs mankind of its flower of youth is well appreciated in the
Western world and every effort is being made to cope with the preventive aspects of the problem. In developing countries the preventive measures that should be taken are equally important, if not more so. These countries can ill afford the loss of useful manpower or damage to property. Social welfare services are so heavily taxed by the many other demands made on them that they are hard put to bear the added burden of providing assistance to victims of accidents with permanent physical disability.
Magnitude of the problem In 1958 38 ooo people were killed in the United States and I 400 000 injured'. These figures increased to 55 ooo dead and 2 000 000 injured in I9732. The year I975 saw 473 automobile accidents, 95 persons injured, and one killed every io minutes. This unfortunate pattern of the steady rise of accidents over the years in a country like the United States has taken place in spite of a great awareness of the problem and organised preventive programmes. In developing countries the tragic problem, though not of the same magnitude, is nevertheless a serious one. In contrast to the United States, in Malaysia 1975 saw I32 automobile accidents, 47 persons injured, and 6 killed each day. These are figures that cause concern when taken into consideration with the economic and developmental differences between the two countries. Thus it would seem that tne provision of better preventive measures with regard to road accidents should be given serious consideration in Malaysia. In 1975 Malaysia had a population of IO 438 I37, while it was 2I3 540 000 in the United States. In the same year road traffic acci(lents caused 2324 deaths or 0.022 per
The 2nd Grayton Brown Memorial Lecture delivered at the 5ist General Scientific Meeting of the Royal Australasian College of Surgeons in Kuala Lumpur in AMay 1978.
1 Francis Silva
458
I00 population in Malaysia, whereas in the United States it was 4 6oo or 0.02I per I00 population. On the other hand, non-fatal injuries in Malaysia amounted to only I 7 Io6, while in the United States the figure was I8oo ooo. However, the numbers of registered vehicles on the road were I 267 II9 (I2.1 per Ioo population) and I35 700000 (63.6 per Ioo population) respectively. Although the Malaysian proportion of fatal to non-fatal accidents is somewhat higher, one might tend to treat this difference as of no significance owing to the larger discrepancy in the number of registered vehicles. However, this would be misleading as the road mileage in the two countries is different, that in Malaysia being very low. The high figure is therefore significant.
Population and traffic increase and accident rates The population of West Malaysia increased
in I970 and 75 633 in 1975, an increase of 289.27o. The increase in the number of casualties on the roads compared with I970 rose from II.370 in I97I to 155.970 in I975. However, during this time the increase in road mileage was limited, being 3.2 7o in 197I and only I2.4% in 1975. This low increase in road mileage compared with that in vehicular traffic must of necessity have led to increasing congestion on the roads and a greater liability to accidents (Fig. I).
Accidents by states West Malaysia is a peninsula divided into iI states with greatly varying accident rates. In 1976 the state of Selangor, including the Federal Territory, led with a rate of 6.2 accidents per ioo motor vehicles, while the island of Penang came a close second with 5.0 per i00 vehicles. These two states are the most densely populated and industrialised areas in the country and their roads the most heavily congested with vehicles. Of the remaining 9 states, only 2 had rates exceeding 3 per i oo vehicles.
from 8 8oI 399 in I970 to I0 438 I37 in 1975. The increase in the number of vehicles on the road compared with 1970 has risen from 9.i% in 197I to 89.370 in 1975. Ethnic distribution Corresponding with this increase in the The population of West Malaysia is made up number of vehicles the number of those in- of approximately 5370 Malays, 3570 Chinese, volved in accidents has also risen, being 19 433 i i o Indians, and i 7o other races. This study has revealed that members of PERCENTAGE INCREASE SINCE 1970 the Chinese community are the most com300 r monly involved in road accidents. There were ,CCIDENTS 3837 Chinese casualties in I970 and the figure has gradually risen to 8779 in 1975. The Malays are the next most involved race, with 200 2393 casualties in 1970 and 7923 in I975. The Indian community is less affected, with only I236 casualties in I970 and 2690 in /- - ' ' ," I975. Casualties among the other communities 100 are insignificant. These figures reflect the relative affluence of the three principal racial communities in the country.
,"
0
d
Sex and age distribution Study of the sex distribution shows a considerFIG. I Percentage inc rease in casualties, able male preponderance that has increased road mileage, vehicles on the road, and over the years. There were 6227 males invehicles involved in acc-idents since I970 in volved in accidents in 1970, while in I973 there were I 2 7I8 male victims. The year I974 West Malaysia. 1970
1971
1972
YEAR
1973
1974
1975
A comparative study of road traffic accidents in West Malaysia
was more encouraging as there was a drop in the figure to IO 703, but unfortunately it rose again to I5 996 in I975. This was probably due to the greater increase of vehicles during the period I974-75. The pattern for female casualties has been similar, though the numbers were much smaller, there being only I 394 casualtics in I97O and 3444 in 1975. The age distribution of casualties during the whole period I970-75 shows a steady increase from 5598 between 5 and io years to I4 i8i at the age of 2I. After this peak there is a decline to 7043 casualties between the ages of 5I and 6o. Over the age of 6o there were 5372 casualties.
459
NO, OF CASUALTIES _
6,000
5,000
-
4,000 -
3.000 -
2,000
1,000
r
1970
1971
1972
1973
1974
1975
YEAR
Vehicles and victims The type of vehicle most commonly involved in accidents was the private car, accidents to which increased steadily in numbers from 7927 in I970 to 36 9I9 in I975 (Fig. 2). The motorcycle was the next most commonly involved vehicle, accounting for about half as many accidents as the car. Accidents involving lorries and vans were much less frequent, the numbers being only 2I34 in I97O and 8043 in 1975, while the contribution of buses and taxis was not significant. Even though motor-cycles were less frequently involved than cars in accidents, the largest number of casualties was among NO. OF ACCIDENTS
40.000 r
30,000
FIG. 3 Casualties among different types of road user. motor-cyclists (Fig. 3), there being I870 such casualties in I970 and 5994 in I975. (Pillion riders were much less often injured, probably because they were fewer in numbers.) Pedestrians were the next most unfortunate victims, their figures going up from I586 in I970 to 3910.in I975. Cyclists were more frequently injured than the drivers of motor vehicles, who in turn were slightly more often injured than their passengers; this is probably due to the fact that seat belts have come into use only in recent times. There were I 322 drivers injured compared with I035 passengers in 1970, while in I975 these figures had increased to 2439 and 2157 respectively. Lack of protection probably accounts for the higher casualty rates among motor-cyclists, pedestrians, and cyclists than among the occupants of motor vehicles despite their high accidentproneness.
20,000
10,000
,'
--
LORRIES
-'
8
VANS
Comparative traffic fatality rates Comparison of the traffic fatality rate per ioo million vehicle miles in Malaysia in I973 (as calculated by the Royal Malaysia Police) with
the corresponding rates for a number of developed countries (compiled by the Motor '70 Vehicle Manufacturers Association of the United States) shows that the Malaysian figure A nalysis of f vehicles commonly in- (i8.5) was higher than those of Belgium (I7.4) volved in accidents. and France (I3.7), which had the highest rates _@ -
0
_
t-:
'71
'72
2
*
--
'73
YEAR
FIG.
-
BUSES TAX S
-
'74
'75
460
J Franzcis Silva
of the developed countries listed, the United States (4.2) and the United Kingdom (5.2) having the lowest rates. Moreover, in all the developed countries the figures had steadily improved from I970 to I973, whereas in Malaysia the rate rose in 197I and thereafter remained virtually unchanged. A fall in I975 to 15.3 per IOO million vehicle miles is, however, encouraging.
States. This indicates the misconception that arises from direct comparison of accident incidence between two countries without due consideration being given to differences in population, size of the countries, and the number of vehicles. In the United States there is a definite seasonal variation in the number of deaths and of accidents, the months of June, July, and August showing a definite rise.
Accidents related to time of day and month Analysis of the proportion of accidents occurring at different times of the day in Malaysia during I975 showed that during the daylight hours there was no particular period in which accidents were specially liable to happen. From 6 to 8 a.m. there was a steady rise in the number of accidents and this remained as a plateau until 6 p.m., when it began to decline quite rapidly. Between io p.m. and 6 a.m. the figure remained low. This would imply that during the night most road users in Malaysia possibly exert greater care than during the day. Another factor may well be the fewer number of vehicles on the roads at night. As only the main urban roads are well lit the need for greater caution in poor conditions in rural areas is clear. In contrast in the United States in the same year there was a sudden rise starting at 6 a.m. and continuing until it reached a peak, amounting to i6.3%go of the total number of accidents, at the rush hour between 4 and 6 p.m., when most people were anxious to get home quickly. The figure then fell steadily, but by i o p.m. it was still around 7.2 % and from midnight to 2 a.m. it remained at 5.8%, then rapidly dropping to i.6% between 4 and 6 a.m. This pattern is different from that in Malaysia, where the figure had fallen to 4.3% by io p.m. and remained between 2 and 3 % from midnight to 6 a.m. In the same year a monthly analysis of accidents in Malaysia showed a fairly steady distribution throughout the year; there was a slight fall in January and a slight increase in July. On average, the monthly number of accidents in Malaysia approximates closely to the mnonthly number of deaths in the United
Causative factors of road accidents In I970 73.6% of accidents were due to faults of drivers, a figure which in I975 increased to 85.o0. Pedestrians were responsible for 8.i% of accidents in I975. This figure was much the same throughout the period except in I970 and I974, when it increased to 9.2 o and 9.6%To respectively. As would be expected in a developing country 2.3% of the accidents in I975 were caused by animals; these were probably unattended. Accidents attributable to road conditions made up i.9To, while other factors were of minor significance. WEATHER CONDITIONS
With clear weather conditions the number of accidents was greater. In I970 there were 10 538 accidents during clear weather conditions. This figure rose to 40 925 in I975, whereas during wet Conditions it was 1432 and during misty conditions, poor light, and heavy rain the numbers were 2968, 2677, and I093 respectively. This suggests that, contrary to expectation, bad weather does not increase accidents in a country subjected to heavy monsoonal rains. On the contrary, the accident rate is remarkably low at such times, suggesting the possibility of greater care exercised during these periods and slower speeds of travel. In the United States 75.8% of accidents occurred in dry weather, I8.2% in wet conditions, and 6% in icy conditions. ROAD SURFACE
The road surface, too, had a bearing on the frequency of accidents; the better the road conditions, the higher was the accident rate. In I975 there were 36 879 accidents on metalled
A comparative study of road traffic accidents in West Malaysia
46I
roads (76.46%), while it dropped to 10 402 much higher than ever before. It may well (21.57%) on gravel roads and 952 (1.97%) be that certain areas hitherto classified as builton laterite roads.
up were included among the rural areas in
Two factors possibly play a role here. Firstly, the better roads are more congested with vehicular traffic, being in urban areas. Secondly, their better condition allows faster speeds. The less developed roads, from the point of view of their state of construction as well as being in rural areas, are less crowded and do not permit high speeds. LOCALITY
In towns and built-up areas there were 6926 casualties in I970, while in rural areas there were only 695. These figures gradually rose and there were I4 270 casualties in towns and built-up areas in I973, while in rural areas the figure still remained much lower than in urban areas, though higher than in the preceding years. The following years saw an improvement in urban areas in that there were only I2 299 casualties in 1974 and 10 394 in I975. In rural areas, however, although there was a fall in the number of casualties in 1974, there was a dramatic rise, to 9064, in I975 (Fig. 4). This was the first time in the period under review that there was a greater number of fatal casualties in rural areas (890) than in towns and built-up areas (62 i). These facts are hard to explain as the numbers both of total casualties and deaths in rural areas were so CAS ALT:ES
I975.
The fact that even though, in I975, the total number of casualties was higher in towns and built-up areas fatalities were more frequent in the rural areas may be due to the fact that in remote areas greater speeds of travel are possible on good roads as crowding is less. In addition, it may also be possible that in these remote areas, owing to the lack of adequate traffic control, there is less care and concern for safety. Another explanation may be delay in or absence of resuscitation at the scene of the accident and the late arrival of transport for the injured. In the United States there were i6 500 deaths in built-up areas and 29 500 in unbuilt areas in 1975, the pattern thus being the same as it was in Malaysia in the same year. In the United States accidents were more frequent in rural than in urban areas throughout the period under review, the pattern thus differing from that in Malaysia.
Discussion The mounting toll of road accidents, with 2334 fatalities in 1975 compared with 579 in 1970, makes continuing studies of the problem of road accidents in Malaysia an urgent matter.
14 000
Preventive measures are needed both to reduce the incidence of accidents and to UNBUILT minimise the fatality and morbidity rates .This 10 000 can be achieved in two ways. Firstly, by introducing preventive measures to reduce incidence 10000 by organisation of passive programmes3. Secondly, by education of young doctors so that 4600 they understand the mechanism of accidents and the changing forces produced by them. Such knowledge will help in the better anticipation of the injuries to be expected in a given accident and in appreciating even more the 1974 1975 1q7' 1973 1970 1972 need for better and more thorough clinical examination4. A full application of such FIG. 4 Traffic accident casualties by location knowledge and clinical data will help in better management. in West Malaysia. D
TOWN & BUILT-UP AREAS
AREAS
F EAR
462
J Francis Silva
Of the many steps needed to curb the incidence of accidents, proper control of the design and structure of motor vehicles from the point of view of strength of construction and installation of safety measures is the most important. The slower rate of increase of road mileage in the country may be the cause of the high percentage of fatalities when compared with the United States, even though the size of the countries, their populations, and the numbers of vehicles on the roads are not comparable. An increase in road mileage would certainly reduce the congestion on the roads. That this is an urgent need is shown by the fact that accident rates in Malaysia have no seasonal variation or even variation at weekends, there having been a steady increase throughout each year over the period of study. This is very different from the United States or Australia, where the incidence rises each year in the summer months and during weekends5. The statistics obtained in this study show only the fatalities that occurred at the scene of the accident. Delayed mortality figures are not included as they are not available. Hence to reduce these figures urgent care must be given to traffic accident victims by the prompt availability of transport from the scene of the accident to the emergency department and ambulances must be provided with properly trained crews capable of resuscitating the victims. They should have at their disposal all the modern equipment for providing this facility. In this way not only could the mortality rates be reduced but also prolonged morbidity could be curtailed. Accident casualties should be transported to well-equipped accident centres, which should be alerted and ready to receive such victims. Regional services are essential6. In Florida, even though traffic accidents increased by 417o between I968 and I97I, deaths due to trauma fell by I 3 7o as a result of improved organisation of emergency services7. That these are the services needed and not higher-speed ambulances has been stressed by Curry et al8. This need was further emphasised in a study of road accidents conducted in the Birmingham area9 in which it was found that one-third of the 63%70 ped-
estrians and 23% drivers and passengers of vehicles in road accidents died within half an hour, while in New York an even higher immediate fatality rate was found by McCarrol and Haddon"0. The lethal nature of these accidents is further stressed by Gissane and Bull11, who reported that in 55% of 6i deaths in accidents on a motorway the patient arrived dead at hospital, and by Perry and McClellan'2, who found that 6 i o of victims of main-road accidents arrived dead. That there are more early deaths in rural areas has been shown by Smeed'5, 55% arriving dead in rural accidents as opposed to 36% in urban accidents. The magnitude of the problem even where organised services exist further supports the contention that there is a need for study and planning in Malaysia. It also further emphasises the need for resuscitation at the scene of the accident and continuing care during transportation. Other causative factors that could be eliminated in all countries are poor roads and highways'4; the room for improvement here is even greater in developing countries like Malaysia. The lack of at least yearly vehicle inspection is yet another aspect that needs to be rectified, since old and neglected vehicles are more liable to cause injury to their passengers'5. Education of the public on courtesy on the roads can also prevent tragedies and this is yet another urgent long-term measure that is needed. It is even more so when the majority of the injured are either drivers of vehicles or pedestrians; this has been found to be so by others'6. Regular testing of drivers for blood alcohol, particularly in the evenings, and the taking of necessary action when it is high would be a further help. High levels of blood alcohol have been shown to increase errors of judgment7' 18. There cannot be enough emphasis placed on the urgency of the need for these measures to prevent this tragic cause of disablement, death, and damage to property. The need becomes more apparent when it is realised that the age group most affected is that between 20 and 30 years, a fact stressed by other observers".
A comparative study of road traffic accidents in West Malaysia '[he assistance so kindly extended to me by YB Tan Sri Dato' Sri Mohd Haniff b. Omar, Inspector General of Police, and ACP Mohd Noor Khamis, Assistant Director, Traffic Branch, of the Royal Malaysian Police, is gratefully appreciated. My thanks also go to Mr F Weston Fenhagen, Counsellor of Foreign Affairs of the United States Information Service of the American Embassy, Kuala Lumpur, for making available the road traffic accident data for the United States. I also wish to thank Mr Ng Lik Lin for his invaluable assistance with the statistical work and for drawing the charts to illustrate this paper.
References Wade, P A (I96I) Journal of Bone and Joint Surgery, 43B, 634. 2 National Safety Council of USA. Traffic Accident Facts, 1974 edition. 3 Haddon, W, jr (I974) Journal of Trauma, 14, 353. 4 London, P S (I975) Acta orthopaedica Scandinavica, 46, 460. 5 Tonge, J I, et al (I977) Medicine, Science and the Law, I7, 9. I
6 Silva, J F
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(I973) Medical Journal of Malaysia,
28, I.
7 Waters, J M jr, et al (I973) Journal of Trauma, 13, 645. 8 Curry, C J, and Lyttle, S N (I958) American Journal of Surgery, 95, 507. 9 Sevitt, S (I972) Injury, 4, 28I. IO McCarroll, J R, and Haddon, W A (I962) Journal of Chronic Diseases, 15, 8II. i IGissane, W, and Bull, J (I962) Practitioner, I88, 489. 12 Perry, J F, and McClellan, R J (I964) Surgery, Gynecology and Obstetrics, 19, 586. I3 Smeed, R J (I953) International Road Safety and Traffic Review, I, i6. 14 Braunstein, P W, Moore, J 0, and Wade, P A (I957) Surgery, Gynecology and Obstetrics, I05, 257. I5 Braunstein, P W (I957) Journal of the American Medical Association, 163, 249. i6 Edwards, G E, et al (I973) Journal of the Irish Medical Association, 66, 65i. I7 Havard, J D J (I962) Practitioner, I88, 498. I8 McFarland, R A (i962) Practitioner, I88, 457. I9 Zollinger, R W (I955) Archives of Surgery, 70, 694
