Motor Vehicle Crashes in Fiji: An Epidemiological Investigation

Abstract

Aims The overall goal of this research was to explore a cause and consequences of serious injuryinvolved four-wheeled motor vehicle crashes (MVCs) in Fiji. The specific aims were: • To quantify the contribution of kava use to MVCs; and • To investigate the longer term health outcomes of MVC involvement in Fiji Methods Role of kava use in MVCs: Following a review of the relevant literature, secondary analysis of data collected in a population-based case-control study, a component of the Traffic Related Injury in the Pacific (TRIP) project, was undertaken to investigate the contribution of kava use to MVCs in Fiji. Consequences of MVCs: A review of the literature examining instruments used in the assessment of health-related quality of life (HRQoL) or health outcomes following injury in low-and middle-income countries informed the design of the Fiji Car Crash Disability (FCCD) Study which followed up TRIP ‘crash’ drivers (10 years later) to assess the longterm health impacts of the MVC (Study 2). The study questionnaire was pilot-tested as part of this process (Study 1). Results Role of kava use in MVCs: Driving following kava use was associated with a four-fold increase in the odds of crash involvement (OR: 4.70; 95% CI: 1.90-11.63). The related population attributable risk was 18.37% (95% CI: 13.77-22.72). Consequences of MVCs (Studies 1 and 2): Twelve adults aged 26 to 78 years participated in the pilot of the questionnaire (Study 1). ‘Cognitive interviewing’ revealed respondents’ issues with comprehension, time-related items, definitions, response options, recall and questions perceived as being similar, complex, or ambiguous. ‘Conventional pre-testing’ highlighted the need to have open-ended questions to capture cultural and contextual perceptions that would otherwise be missed in quantitative enquiry. These findings informed revisions to the questionnaire and contextual aspects of the methods for Study 2. The European Quality of Life Five Dimensions (EQ-5D) and WHO Disability Assessment Schedule – 12 item (WHODAS-12) assessments identified pain, being emotionally affected, difficulty with standing up for long periods and walking long distances as common problems. While constrained by a small sample size, pre-injury characteristics of being older, reporting poorer health and depressive symptoms before the MVC appeared to predict poorer longer-term HRQoL and significant disability. Open-ended enquiry revealed physical, psycho-social and financial problems persisting for variable periods of time. Spirituality, soporific substances (alcohol, kava) and cigarette smoking were reported as coping strategies. The family and peers within the driver’s social network (‘internal’ system) and government hospital care and police crash investigations (‘external’ system) were identified as significant supports. Drivers’ perceptions of better care strongly reflected the need for counselling to support psycho-social well-being, for them and their caregivers. Conclusions The findings of this research affirm the need to strengthen road safety efforts in lessresourced Pacific countries such as Fiji, including enforcement of legislative policies to discourage driving following kava use. In addition, the persistence of physical and psychological problems up to 10 years following a MVC highlights the need for culturally appropriate psychosocial interventions.