Effectiveness of interventions for preventing road traffic injuries: A systematic review in low-, middle- and high-income countries.

Background: Road traffic collisions (RTCs) are the primary cause of death, which usually occur during the most crucial years of life, resulting in significant damage to health, society, and the economy. A wide variety of strategies and policies have been implemented around the world to minimize injuries and fatalities resulting from RTCs. This study aimed to systematically evaluate the effectiveness of interventions to reduce road traffic injuries (RTIs) in low-, middle-, and high-income countries.

Methods: The researchers looked for articles in many databases (PubMed, Web of Science, Google Scholar, Scopus, Embase, PsycInfo, OpenGrey, EconLit, IMEMR, AIM, Cochrane Injuries Group's specialized register, Transport Research International Documentation (TRID), Transportation Research Information Services (TRIS) Database and the OECD's Joint Transport Research Centre's International Transport Research Documentation (ITRD)) about ways to reduce RTIs and included articles published up to December 2023. The study area did not matter; only RTI reduction methods were considered. Two people checked the articles to ensure being relevant and qualified and summarized what they found in the articles.

Results: A total of 852 articles were included in this systematic review. Most interventions were related to legislation (26.4%) and enforcement (17.0%), and the minor interventions were related to social marketing (4.9%) and traffic user safety (2.2%). Regarding income level (based on the latest classification of the World Bank-2020), more than half of the interventions (83.7%) took place in developed and high-income countries. Regarding intervention types, legislative and road safety interventions effectively reduced road traffic crashes by 26% and 16.7%, respectively. The results indicated that interventions in high-income countries were more likely to minimize RTCs than other countries. However, this difference was not statistically significant (p-value = 0.982). Most effective interventions (36.1%) were reported during the Decade of Action for Road Safety (2011-2020).

Conclusion: Current road safety efforts prioritize changing how people behave on the roads (training, laws, enforcement) over making the roads safer. Focusing on fixing the entire system rather than blaming drivers ("system repair") is necessary for a complete picture.