Traffic accidents constitute a global challenge that includes health, economic and societal aspects, as they claim the lives of approximately 1.25 million people each year and the injuries resulting from traffic accidents cause great economic losses for individuals and countries, due to the cost of treatment and the loss of people’s productivity [1-3]. Between 20 and 50 million other people suffer non-fatal injuries and many of them become disabled as a result, according to the World Health Organization in a study issued by Manikandan et al. [4].

Road traffic injuries cause significant economic losses to individuals, their families and entire countries and these losses arise from the cost of treatment and the loss of productivity of people who die or become disabled due to their injuries and family members who are forced to miss work or school to care for the injured. Traffic accidents in most countries cost 3% of GDP [5-6].

Males are more likely than girls to be involved in road accidents starting at a young age [7]. Young males under the age of 25 accounts for nearly three times as many road traffic fatalities as females (73%) and make up the majority of all fatalities [8].The likelihood of accidents and the gravity of the effects directly correlate with an increase in average speed [9]. For instance, the chance of a fatal accident rises by 4% and the risk of a major accident rises by 3% for every 1 km/h increase in average vehicle speed [10].

According to earlier research, RTAs occur on average in 8% of Brazilian cities [11], 30% of Vietnamese cities [12], 41.4% of Indian cities [13] and 51.50% of Iranian cities [14]. RTA prevalence varies among studies conducted in sub-Saharan Africa, ranging from 74.0% in one from Ghana to 87.5% in another [15-16]. 

The RTA ranges from 23.5 to 62.5% [17-18] in Ethiopian research. Due to a lack of information on the scope and elements that contribute from the driver's perspective, the government and other stakeholders have paid little attention to the issue even though road crashes are on the rise. This study aimed to identifying the potential causes and dealing with the rise in traffic accidents in Baghdad.

According to a report, there are many names for the same accident that happens on the roads when a car collides with a person, animal, building or another car, resulting in injuries as well as significant material losses and irreplaceable human losses [19-21]. The human factor, the road and the vehicle have been recognized as the three key components for each traffic accident and the World Health Organization estimates that 1.25 million people die as a result of traffic accidents each year [2,22].

Definition of a Traffic Accident

It is an incident where a vehicle or vehicles unexpectedly intercepts another vehicle, another vehicle, a facility, an animal or an object on a public or private road [23]. Damages from traffic accidents often range from minor ones that affect automobiles and property to major ones that cause death or permanent disability [24].

Types of Traffic Accidents [25-28]

• Collision accidents, which occur when two vehicles collide with each other or one with the other, which is the most common accident

• Run-over accidents, when a car collides with a person as he passes the road, which is one of the most common traffic accidents around the world

• Rollover accidents and this type means the change in the direction of the car, suddenly and it is difficult for the driver of the vehicle to control and control it

• Colliding accidents with an object, as a result of the car colliding with a fixed object on both sides of the road, such as a lamppost, a wall or an animal accidentally passing while the vehicle is in motion

Causes of Traffic Accidents

• Excessive speed, as a result of a vehicle driver driving his vehicle at an excessive speed and it has been proven that there is a direct relationship between the increase in the speed of the vehicle and the occurrence of the accident and the possibility of death increases whenever the car is traveling at a high speed and the injuries have severe consequences and most of them result in amputations or disabilities permanent [29-30]

• Driving under the influence of alcohol and taking natural or synthetic narcotic substances such as amphetamines, increases the risk of accidents that lead to death or serious injuries, due to lack of concentration in driving as a result of the effect of alcoholic and narcotic substances on the nervous and cognitive system of the driver [31,32]

• Non-compliance with safety and prevention measures. For example, most drivers of vehicles, motorcycles and motorcycles are victims without a protective helmet or seat belt and the car lacks the means of restraining children in seats [33]

• Inattention while driving, the presence of distractions leads to impaired driving and among these distractions is the use of a mobile phone and it has been proven that drivers who use mobile phones while driving are four times more likely than others to be exposed to road hazards, because the use of a mobile phone slows down their reactions when applying the vehicle's brakes [34]

• Non-compliance with traffic rules, as some drivers cross the red light and drive in the opposite direction [35]

• The driver's physical condition plays an important role in his safety and in causing accidents, as exhaustion and fatigue are the cause of some traffic accidents [36]

• Vehicles play an important role in avoiding accidents. Vehicles that do not have front and side impacts and an electronic stability control system and are devoid of airbags and seat belts, increases the risk of injuries resulting from traffic accidents for the occupants of the vehicle and outside it as well [37]

• The design of roads and their unsafeness for all users, the lack of adequate facilities for pedestrians and cyclists, the allocation of pedestrian paths and traffic lanes for bicycles and the creation of safe crossing points, increase the risk of traffic accidents [38]

Traffic Accidents can also be Classified According to their Consequences as Follows [39-40]

• Minor Accidents: These accidents do not lead to human injuries, which result in normal severe or medium damages but they often lead to wasting time, causing some pain and disrupting procedures

• Medium Accidents: These are accidents that have an economic impact, as they cause material losses in public and private funds and are represented by the damages that occur to vehicles and what they collide with

• Serious Accidents: This type of accident causes serious injuries represented in the exposure of thousands of people every year to death. It may cause some individuals to have permanent disabilities that prevent them from performing their natural role. This type is the most dangerous type of accident because it has an economic, social and psychological impact

Traffic Accidents in the Arab World and the World

Traffic safety is an important and major requirement to preserve the lives of road users and mitigate the resulting social, economic and psychological effects [41].

As a result of discovering the connection between traffic accidents and social and economic factors, many nations, particularly industrialized ones, have given attention to and prioritized traffic safety. In order to increase traffic safety, decrease economic and human losses and mitigate consequences and damages, precautionary plans and procedures have been put in place.

Where initiatives and projects for traffic safety received independent funding, including funding for performing studies. Additionally, the installation of engineering upgrades and the treatment of hazardous traffic accident sites had the biggest influence on the 10% decrease in road accident fatalities in Western Europe over the past ten years [42-44]. 

The situation deteriorated until the death rate in the Arab region reached roughly 20% during the past 10 years as a result of the Arab countries' insufficient efforts to increase the level of traffic safety on the roads. If the current trend continues and the appropriate steps are not done, it is predicted that traffic-related fatalities will rank third on the list of causes of death and serious injuries in the Arab region by 2030 [45-46].

Similar to other countries, Iraq struggles with the issue of a high number of traffic accidents and the consequences they have on both human and financial losses. As the number of traffic incidents in Iraq increased significantly. Accidents were one of the most significant rising problems facing the country's people because of the significant social and humanitarian catastrophes they cause in addition to material losses. This was accompanied by an increase in the number of fatalities and injuries [47-48].

Death Rates in Traffic Accidents

The continent of Africa is the highest in recording death rates resulting from accidents and the ages of deaths resulting from traffic accidents among youth and children range from 5 to 29 years old, while males cause road accidents at a higher rate than females and they account for 73% of deaths that result on traffic accidents among young people under the age of 25 [49-50].

Traffic Accident Results

Traffic accidents result in many injuries that differ and vary among themselves in terms of severity, which may reach the point of death and the injury varies according to the type of accident, as we will explain through the following points [51-54]:

• The first and most serious of these losses is the human loss of life and these losses cannot be compensated again

• Some may become permanently or temporarily disabled, depending on the type of injury

• The economic losses that occur to the roads that committed the accident and the other party, whether it is another car, facility or anything else and this type of loss may reach millions

• There are traffic accidents resulting from the front or rear collision of the car and the reason for this accident is due to not maintaining the legal distance or to the excessive speed of one of the cars or because the road is not completely paved for the passage of cars over it and this type of accident causes complete damage to the front or rear of the car, In addition to the possibility of car occupants and drivers with many injuries of varying severity

• There is another type of collision that occurs in one of the sides of the car, which is caused by many different factors, such as negligence, failure to estimate the distances well for the driver of the car and failure to adhere to traffic rules when exiting the intersections and this type of accident may lead to severe injuries in one side of the car. In addition to injuring the occupants of the car

• Run-over accidents, the causes of this type of accidents are due to the lack of clear visibility of pedestrians on the road, driving too fast or driving under the influence of a type of alcohol or drugs and leads to death

In addition to the financial and psychological toll they exact on the citizens, traffic accidents also entail a great deal of human and material loss, making them one of society's most pressing issues [55]. As a result, it is crucial to pay attention to traffic and make persistent efforts to decrease the number of accident victims and losses. additional follow-up from the traffic agencies calling for road improvements and the eradication of some undesirable phenomena that present among drivers, such as drug usage and its frequency [56].

Factors Affecting Traffic Accidents [57-58]

• Not addressing the topic of traffic culture in the various educational institutions and in the first place, human knowledge is a process that builds up over time and starts at home before encompassing other facets of life

• The ineffectiveness of instruction at driving education facilities, which lack the most basic educational tools for learning

• The absence of scientific curricula that driving education facilities can use to teach and refer to

• The lax standards of individuals in charge of administering the driving test and issuing licenses, as well as the fact that they are exempt from the rules of law

The Effects of Traffic Accidents [59-60]

The effects of traffic accidents can be divided into three sections related to material and human losses:

• Social Effects: When this person is productive and plays a significant part in society, it is symbolized by the loss of a family member or friend as well as the loss of the community

• Economic Effects: Traffic accidents have an impact on the economy of any nation since the ensuing losses in property, injuries and fatalities are hurdles to development in underdeveloped nations, particularly in Arab nations. Economic damage includes impairment to public assets and institutions, injuries to individuals that may result in death or disability and the amount of money spent by the state on medical bills for the injured

• Medical Effects: These are physical injuries that result in handicap and psychological consequences as a result of that disability

Methods of Prevention of Traffic Accidents [61-63]

In light of all the facts represented, which are considered one of the most important causes that lead to the occurrence of traffic accidents and what the statistics indicate, as well as the high rates of accidents over the years and can programs be developed to prevent or reduce traffic accidents in general and indicate that the experience of many countries in the field of prevention of traffic accidents and its ability to reduce the death rate and severe injuries and this is what encourages us to adopt an expanded program for the prevention of traffic accidents and is based on the intensification of the efforts of interested people from various disciplines, due to the high rate of traffic accidents to search for solutions that contribute effectively to reducing the continuous increase in traffic accidents. Which requires studying the psychological, social, economic and legal aspects and developing solutions that suit these causes in order to try to mitigate their effects or eliminate them completely if possible.

Programs to prevent traffic accidents require the support of all levels and a variety of sectors. All members of society should actively participate in these efforts, which should be coordinated by a center or an authority for accident prevention in order to maintain continuity, have adequate resources for training and research and be able to significantly alter accident prevention's course. When different authorities fail to fulfill their obligations in the area of accident prevention, this body will have the independence necessary to rationalize those failures.

Analytical cross-sectional study was carried out at the Directorate of Forensic Medicine in Baghdad for a three-month which is started from the first of January 2021 up-to March 2021 to address the rise in traffic accidents in Baghdad and to identify suitable remedies to their potential causes. All ages and both sexes of those killed in automobile accidents are included in this study. The deceased and the Statistics Department's statistics data were used to choose the sample. A 210-case sample was used. Age, accident type and percentages were used to classify and categorize the total number of deaths resulting from road accidents. Data on the quantity of traffic accidents, including run-over’s and vehicle collisions, was gathered. Additionally, each deceased person's age and sexual orientation were recorded. Through the use of the inferential statistical data analysis approach and the descriptive statistical (STATA) version 20 analysis approach that includes frequencies, percentages, mean of scores, SD and Fisher's exact test. Ethical approvals were obtained from the Ministry of Health prior to conducting this study.

Out of 210 RTA cases, there are 45.7% of male cases over the age of 35, followed by 22.3% of cases between the ages of 26 and 35 and 17.7% of cases between the ages of 16 and 25. Of them, 21.1% were employed while 69.1% were unemployed. While in female cases, 22.9% of patients were under the age of 15 and 42.9% were over the age of 35. 14.3% of them were students, while 74.3% were unemployed as shown in Table 1. Age, occupation and gender did not show any statistically significant differences when the p-value was less than 0.05 (Table 1).

Table 1: Characteristics of RTA Cases According to Age Groups, Occupation by Gender

*The result is not significant at p<0.05

According to the place of death, 53.8% of deaths occur at the scene, 40.5% occur in hospitals and 5.7% occur while transit to hospitals (Figure 1).

Figure 1: Place of Death Among RTA Cases

Figure 2 illustrates the increased prevalence of 67.6% run over, 23.3% clash and 9.1% wheel inversion.

Figure 2: Pie Chart of Accident Types Among RTA Cases

In RTA cases, direct hits accounted for 80% of fatalities, whereas complications after injuries accounted for 20% (Figure 3).

Figure 3: Causes of Death in RTA Cases

Figure 4 shows that accidents happened on Wednesday (20%), Monday (17.6%), Sunday (14.3%) and Saturday (13.8%).

Figure 4: Weekly Accident Rate Distribution from January to March 2021

In Figure 5 shows that 97.1% of people had never used alcohol, while 2.9% had.

Figure 5: Alcohol History Among RTA Cases from January to March 2021

Run over occurs most frequently in direct hits (76.8%), then clash (16.1%), then wheel inversion (7.1%). After an injury, 52.4% were involved in an accident, 31% were run over and 16.6% were wheel inversion as shown in Table 2.

Table 2: Relationship Between the Accident Type and Causes of Death 

Fisher's exact test = 32.8, p-value is <0.00001

 At the p-value of 0.05, statistical differences between accident types and causes of death have been discovered.

When a direct hit was the cause of death, the larger frequency of deaths was at the site, where they occurred 56.5% of the time, followed by hospital deaths, which happened 39.3% of the time and transportation-related deaths, which happened just 4.2% of the time. As demonstrated in Table 3, the highest frequency of death after injury was 42.9% at the scene and 45.2% in the hospital. Statistics show no statistically significant differences between death locations and causes at the p˂0.05.

Table 3: Relationship Between the Place of Death and Causes of Death

Fisher's exact test = 4.98, p-value is not significant at the 0.05

The RTAs were divided into three parts, i.e., (8.00 am-6.00 pm), (6.00 pm-12.00 am   ), (12.00 pm-8.00 am). It was seen that maximum (46.2%) of the RTAs occurred in between 8 am and 6 pm and the minimum (19.5%) occurred in between 12 am and 8 am as shown in Table 4.

Table 4: Frequency of Accident with Time

The incidence of accidents in the direct hit category was highest between the hours of 8 am and 6 pm, followed by 35.7% between 6 pm and 12 am and 13.7% between 12 am and 8 am. Injury-related accidents happened most frequently between the hours of 12 am and 8 am and 28.6% between the hours of 8 am and 12 am as shown in Table 5. There are statistical differences has been found in the time of occurrence and causes of death when the p-value ˂0.05.

Table 5: Relationship Between the Time of Occurrence and Causes of Death 

Fisher's exact test = 18.66, p-value is = 0.0000

The phenomenon of traffic accidents is complex. They are brought on by a variety of things, including as the road and its surroundings, other drivers, their behavior and certain aspects of the vehicles [64].

Age 

Age is a significant risk factor for injury, increasing both the frequency and severity of injury [65]. 42.9% of those in the current study were over 35 years old, while 17.1% were between the ages of 16 and 35. According to a study by Albayati and Lateef [66], 27% of RTAs are related to the 24 to 29 year-old age group, RTAs that occur between the ages of 18 and 23 account for 20% of RTAs, whereas RTAs that occur between the ages of 30 and 35 account for 22% of RTAs [66]. 

The authors of a cross-sectional study on 1306 elderly people who were injured in Iran discovered that their average age was 70.9±6.7 years [67]. In Sweden, a cross-sectional study of 4761 RTA victims revealed that the injured participants' average age was 46.2 [68]. According to Zuwairy et al. [69], 2020, 39% of the individuals were between the ages of 30 and 39, followed by 31.9% of those under the age of 29, 17.3% of those between the ages of 40 and 49 and 11.8% of those over the age of 50 [69]. In Tanzania, the majority (70.2%) of the population was between the ages of 18 and 45 [70]. The victims' average age in Ethiopia was 25.5. Ages 20 to 29 had the highest percentage of casualties (35.42%), followed by 10 to 19 years (26.04%) [71]. Al-Abdallat et al. [72] conducted a study in Jordan involving 311 cases and discovered that the young and active age group (19-29) was responsible for the majority of fatalities (n = 92, 29.6%), followed by the age group (18) (n = 70, 22.5%), the elderly (60) (n = 51, 16.4%) and finally the age group (30-39) (n = 6, 26.1%) [72].

Gender 

About 83.3% of participants in the current study were men, whereas 16.7% were women. Most of them (74.7%) were men, according to Etehad et al. [67]. In a survey of 959 RTA instances in Malaysia, the researchers discovered that 433 of them were men and 526 were women [69]. A cross-sectional hospital-based study was conducted in Ethiopia with 304 traumatized patients. The results showed that men were more frequently impacted than women (71.85% vs. 28.15%) [71]. In Tanzania, 4675 road traffic injury patients were seen in the hospitals under study and 76.6% of them were men [70]. A cross-sectional study of 384 trauma patients in Ethiopia found that 298 (77.6%) of the patients were men and 86 (22.4%) were women. 54 (17.4%) of the fatalities in Jordan were female, whereas 57 (82.6%) of the victims were male [73].

Occupation

About 74.3% of respondents polled for the current study were unemployed. Students, farmers and government employees accounted up 96 (31.27%), 81 (26.4%) and 38 (12.37%) of the total population in 2020, according to a study by Honelgn and Wuletaw [71].

Patient’s Outcome

About 40.5% of deaths take place in hospitals, whereas 53.8% happen at the scene. In Ethiopia, Hailemichael et al. [73] discovered that of all victims who reached hospitals, 23 (6%) died, 48 (12.5%) were discharged with long-term disabilities and 313 (81.5%) were discharged without long-term disabilities [73].

Accident Type

This result revealed that 23.3% of instances had clashed and 67.6% of cases had run over. Run-over made up roughly 53% of all RTAs, according to Albayati and Lateef's [66].

This makes them the most prevalent sort of RTA. Collisions, which made up about 39% of RTAs, were the second most typical category. 7% or so of RTAs were turnovers. Additionally, 1% of RTAs were classified as "others," which included RTAs such vehicle fires and collisions with rivers and hills.

Causes of Death 

In the current study found the direct hit at 80%. According to Singh et al. [74], injuries to the head and neck region of the body accounted for the bulk of fatalities (81.4%), followed by injuries to other body parts (10.9%), the abdomen (4.1%), the extremities (2.6%) and the chest (1.1%) [74]. In a 2015 study conducted in Iran, Entezami et al. [75] found that head injuries were the primary cause of death in 48.92% of cases [75].

Alcohol 

Only 2.9% of those in the current study were found to have used alcohol. According to a study conducted in Jordan, alcohol use was present in 37.1% of drivers and pedestrians [72].

Time of Occurrence 

In this study, it was shown that 46.2% of victims' incidents occurred between 8.00 am and 6.00 pm, while 34.3% occurred between 6.00 pm and 12.00 am. In 2020, the study was done it by Honelgn and Wuletaw [71], they discovered that during rush hour, there were the most traffic accidents: 55 (53.39%) happened in the afternoon, 26 (25.24%) in the morning and 22 (21.35%) at night [71]. According to Singh et al. (2016), the peak period for deaths in India was between 12.00 and 4.00 pm (29.9%), followed by 8.00 to 12.00 pm (21.5%). The fewest (2.5% of casualties) were recorded between 12.00 and 4.00 am [74].

According to this survey, the majority of victims were over 35, male, unemployed and half of them died at the scene. Higher run over rates were explained. Direct hits accounted for the majority of fatalities. A small number of victims used alcohol and more than a quarter of accidents happened between the hours of 8.00 am and 6.00 pm.

Recommendation 

Accident-related injuries can be avoided. To address road safety in a comprehensive way, governments must intervene. This requires the participation of numerous industries, including transportation, law enforcement, health and education, as well as initiatives that target road safety, cars and road users. Since the transport vehicle not the road is the cause of serious injuries, we advise redesigning the exterior of the vehicle to lessen the severity of pedestrian injuries. To instill a culture of public safety in the community, education is used in schools, universities, the media, social communication and posters, as well as civil society organizations. This education begins with traffic laws, vehicle use, road use and signals like the use of seat belts, setting special seats for children in cars and preventing children sit in the front seats and immediately ambulance services are terminated.

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