CHAPTER ONE

INTRODUCTION About 3000 people die from Road Traffic Injuries (RTIs) daily in the world. Eighty five percent of the deaths and 90% of health years of life lost due to RTIs are from the low income and middle income countries (Peden et al, 2004). Mostly passengers and pedestrians are affected (ibid). One of the top three causes of deaths for 5-44 years age group in many countries is RTIs (World Bank, 2011). This has enormous implications for development. The Road Transport and Safety Agency was established by an Act of Parliament in 2002 to promote road safety through education, regulation and law enforcement. The Agency has since 2006 been promoting road safety through several activities aimed at reducing injuries and deaths related to road traffic crashes. The Agency further has been implementing the road transport policy in order to provide an efficient and effective road transport system. In 2011, a total of 22, 570 road traffic crashes were reported as compared to 15, 186 road traffic accidents reported in the year 2010 representing a 49 percent increase in absolute terms. Lusaka and Copperbelt provinces continued to record the highest number of road traffic crashes due to the continued increase in motor vehicle population. Currently, a total of over 52,000 motor vehicles were imported in 2011 bringing the cumulative total to 381,948 motor vehicles in the country (RTSA,2012:2). During 2011, a total of 212 fatalities involving children aged 16 years and below were reported. This represented 13 per cent of the total fatalities. Road traffic crashes are the leading cause of death among people aged between 10 and 24 years old. In Zambia, road traffic injuries have become one of the significant causes of childhood morbidity and mortality. The bulk of the crashes amongst these children are predictable and preventable. Many involve children playing on the streets, young pedestrians, cyclists, novice drivers and passengers of public service vehicles.

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Due to this alarming situation where so many young lives are being lost to avoidable road traffic crashes, the United Nations (UN) General Assembly unanimously passed a resolution proclaiming the years 2011 to 2020 as the DECADE OF ACTION FOR ROAD SAFETY. In recognising the importance of this UN declaration, on behalf of the country,the Agency joined the rest of the world in launching the DECADE OF ACTION FOR ROAD SAFETY in May 2011 where a government commitment to ensure the reduction of road traffic crashes was made. This declaration is a challenge to all of us not just as RTSA but all Zambians because it implores us to reduce road traffic crashes by 50 per cent by 2020. RTIs strongly contribute to mortality, morbidity and increased inequality among the productive age group and their dependants in Zambia. Fatal road traffic accidents top all the risks and threats of life in the country (Andrews, 2011). The estimated road traffic death rate in the country is 27.5 per 100 000 population per year and the modelled number of road traffic deaths is 3,669 per year (WHO, 2011). However this number does not include those that die after 24 hours which implies under estimation (ibid). An estimation of 30% of patients at St Giles Rehabilitation Centre and 60% of people who need artificial limbs are a result of RTIs (RTSA, undated). RTIs contribute to loss of productive life due to death or due to disability. In Zambia the 26-45 years age group is the most affected (RTSA, undated). RTIs cost about 2% of gross domestic product (GDP) in the country (ibid). Public holidays have been heavily associated with loss of life due to road traffic accidents in Zambia (Towindo and Bulla, 2011). Mutore and Nyambuya (2011) in their article Dont be a stat this holiday cites Easter, heroes and festive season holidays as holidays that RTIs are particularly encountered. This is the time when most people have ample time to travel for social gatherings such as church gatherings and visiting friends and relatives thereby increasing traffic volume on roads. Occurrence of accidents is also related to time, most accidents occur from 0600-1800 hours (RTSA, undated) though fatal accident occurs at night with greater frequency than during the day due to reduced visibility (Parirenyatwa, 2004).
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1.2 Statement of the problem Having gone through these worrying problems of RTIs one can conclude that RTIs are a huge public health and development problem in Zambia. The majority of RTIs affects young males who are bread winners. Reducing RTIs and fatalities will reduce suffering and free resources for development and more productive uses. This leads me to the research questions that I intend to answer in my study. 1.3 Research questions 1. What are the burden, contributing factors and trends of RTIs in Zambia? 2. What are the circumstances that lead to road traffic accidents? 3. What are the strategies that can be used to reduce road traffic injuries? 4. What can be done to strengthen the road transport sector legislation and policies in Zambia? 1.4 Main Objective To analyse the situation on road traffic injuries in Zambia in order to make recommendations towards reduction of the burden of road traffic injuries. 1.4.1. Specific objectives 1. To describe and analyse road traffic injuries and their trends in Zambia. 2. To critically analyse causes and contributing factors related to road users, road and road sides, vehicles factors and road safety decision making. 3. To describe and discuss consequences of road traffic accidents in Zambia. 4. To review current strategies in Zambia. 5.To identify and discuss good practices from other countries. 6. To formulate recommendations based on findings. 2.4. Methodology
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This study is based on both peer reviewed and grey literature. An active search for informal and formal information about RTIs in the country was done to analyse the RTI problem. An internet search was done to search for information on RTIs through Google scholar, Google search, Science direct, Cochrane library and Pub med. African development Bank, World Bank, World Health Organisation and Road Traffic and Safety Agency (RTSA) websites were also used to identify papers related to the topic as well as other international organisations. Analysis of available RTI statistics was done. Efforts to get updates of the situation in Zambia were made by listening to news, reading online newspapers and emails from colleagues and the Ministry of Transport. Current strategies which are being implemented were looked into and analysis of the gap between discourse and practice as well as gap in reducing health inequities has been made. Below is the adopted conceptual framework from a systems approach and some components from commission of social determinants of health framework (Australian Transport Council, 2008) (WHO, 2007). 2.5 Conceptual framework To analyse contributing factors for RTI in Zambia the social political country contextual factors has been considered as basic contributing factors to RTIs. The systems approach model has been adopted (Australian Transport Council, 2008), to consider the system as whole, interaction between elements (vehicles, roads, road users and their physical, social and economic environments). Some components from the social determinants of health framework have been used in the block with country contextual factors and the block with socio economic position (WHO, 2007). The systems approach model for prevention did not include what happens when the road traffic injury occurs so this block has also been added. RTIs affect the poor more than the wealthy in developing countries especially pedestrians (Nantulya and Reich, 2003). This framework does not separate behaviour
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from its context for example the intermediary determinants are linked to transport policy, land use policy and values of the society. From the left column the first box shows contextual factors that bring influence on social stratification leading to socioeconomic position. For example transport policy influences the transport infrastructure, land use influence distance to be travelled. Socioeconomic positions influences susceptibility to RTI; for instance the means of transport most frequently used by poor people in Zambia is walking (pedestrian), bus, minibuses and cycling and these are more vulnerable to RTIs. Poor people can only afford second hand vehicles. Poor people cannot afford trauma care hence this may lead to inequalities increasing severity of the problem. Zambians cultural and social values put men at more risk of RTI; men are expected to provide for the family hence end up working more hours causing drivers exhaustion. Anxiety, stress, use of sedative drugs and sleeping problems also contributes to loss of concentration. Education, occupation and income are linked together. Incorporating road safety education at schools reduces number of RTIs and improves crossing behaviour (Duperex et al, 2002). Awareness of risks and ability to deal with information about risks shapes the behaviour and attitudes of an individual. Some occupations such as truck driving also place individuals at more risk. Income has been seen to influence a lot of accidents in roads for example commercial drivers are given a target that determines their salary, hence competing for passengers, leads to speeding. Demands for income at home forces people to work overtime. Socioeconomic position influences exposure to RTIs by acting through intermediary determinants. These include material factors such as vehicles conditions, roads conditions and working conditions, psychological factors and behavioural factors. These factors are interlinked for example lack of material affects living and working conditions and this may lead to psychological problems resulting in bad behavioural acts such as speeding, drinking and driving. The health system is also influenced by the countrys economy. Road environment factors, human factors and vehicle factors are interrelated
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factors that result in road traffic injuries or safe journeys travelled. They are also influenced by material circumstances, behavioural factors and psychological factors. Health systems determine the trauma care of the victims of RTI. One can conclude that the determinants of RTI are multifactorial. Structural determinants of health form the basis of the RTI outcome. The framework explains how social inequities determine risk for RTI morbidity, mortality and differentials in socioeconomic groups. 2.6. Limitations of the thesis The researcher faced a lot of problems trying to get updated RTI information from Zambia. It is very difficult. Statistics from the RTSA website were used and the World Health Organisation (WHO) Zambia profile has 2007 statistics for injury surveillance. Data reported and quoted by different entities were often conflicting, which may be related to differences in reporting (quality and completeness).The researcher used personnel experiences and newspapers articles in some situation which at times may not be valid.

CHAPTER TWO LITERETURE REVIEW 2.1. Understanding road traffic injuries in Zambia

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Severe injuries and mortality in road traffic accidents are a public health problem with consequences such as long term disabilities which are similar to any other public health problem such as tuberculosis, HIV/AIDS and cancer, but they are not mentioned in the Millennium Development Goals (MDGs). Road injuries continue to increase in many countries, around 1.2 million die in road accidents annually, 65% being pedestrians and 35% of pedestrian deaths are children (UNECA et al, 2011). Low and middle-income nations account for 85% for all road traffic deaths (Arumugam, 2007). The top cause of death by injury is road traffic injuries (UNECA et al, 2011). Disability due to road traffic injuries account for about 3050million people (ibid). The traumas involved account for lot of costs, about 1 to 3 % of GDP in most countries which implies that road injuries result in a lot of expenditure (UNECA et al, 2011). Road Traffic Accidents in Zambia In Zambia, Road traffic accidents and the deaths that follow have always been a major public concern. Each year thousands of Zambians fall victim to road traffic accidents. Each month, tens of Zambians are killed on our roads. Between April 18 th and July 30th 1988, 30 road traffic accidents were reported in one of the daily newspaper. 1 This was in a midst a serious economic crisis and a time when Zambias motor vehicle number was still very small. On November 25th 2009, it was reported that 44 deaths occurred in just one month.2 In 2002, there were 8 855 road traffic accidents and 1 000 dead. In 2003, there were 21 692 road traffic accidents through which 1 046 people were killed and 2 696 seriously injured.3 In 2005/2006, a total of 33 165 road traffic cases were recorded by the Zambia Police. 14 075 of the accidents occurred in 2005 resulting in 1 075 killed and 3 397 injured. In 2006, there were 19 095 recorded cases of road traffic accidents in which 1 170 people killed and 3 963 seriously injured. 12 171 individuals were slightly injured. In
1 2

Zambia Daily, April-July, 1988. Post newspapers, 12th November 2009. 3 Mercy Mwila, New countrys highway code to lessen road traffic accidents, Times of Zambia. 30th January 2010.

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2006/7 the Zambia Police recorded a total of 33 165 cases of road traffic accidents. 4 The number of those killed on Zambian roads increased from 892 victims in 2004 to 1 170 in 2006 to 1 266 people in 2007.5 According to the Road Transport Safety agency (RTSA) Annual Report for the year 2008, about 1 238 people were killed on Zambian roads from 19 727 road traffic accidents. Passenger deaths constituted 30% of the total number of accident victims while pedestrian deaths accounted for 48% of the total. 75% of the accidents occurred in urban areas, or 14 850 accidents compared to rural areas which recorded a total of 4 877 accidents.6 There were 852 deaths recorded in the year 2009 out of a total of 16 531 accidents while 2 740 people were seriously injured7. The above accidents were attributed to an increase in second hand vehicle on the Zambian roads and careless driving by some drivers. Even though there is a general belief that accidents are unavoidable, on the contrary, experts are of the view that 95% of the accidents in Zambia are due to human error while motor vehicle malfunction accounts for only 3% of the total. Poor transportation infrastructure accounts for remaining 2%.8

The major causes of road traffic accidents have been linked to poor public service driving and a dilapidated road infrastructure, most of it built in the 1970s. Most of the roads have large potholes that are often the cause of accidents as motorists try to avoid them. Roads do no have street lights, therefore making it difficult for motorists to see pedestrians. Most road users, especially the young and elderly have no knowledge on proper road use, drivers do not go to driving schools or get their licenses before they could gain adequate competence in driving and there are no alcohol tests.9 These factors are compounded by corruption over licenses, road worthiness of motor vehicles, overloading, speeding and alcohol
4 5

Times of Zambia, Tuesday, 19th February, 2008. Joseph Schatz, On the road in Zambia, 2008. 6 Mercy Mwila, New countrys highway code. 30th January 2010. 7 http://www.znbc.co.zm/media/news/cgi? 8 Mercy Mwila, New countrys highway code. 30th January 2010. 9 Mercy Mwila, New countrys highway code, 30th January 2010.

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abuse among drivers. Like elsewhere in the developing world, most of the road traffic victims are young people. School going children are most vulnerable.10 Road traffic accidents rank as the third largest killer in the country after Malaria and HIV/AIDS.11 Even though this appears to be the official appreciation of the gravity of deaths from road traffic accidents, I find it difficult to accept such a ranking. An average death toll of about 1 200 individuals per annum, appears too low to constitute the third highest cause of death in Zambia. There is need therefore to come up with comparative statistics on the causes of death in the country before the above ranking could be affirmed. However, apart from loss of human lives, the road carnage also causes damage to property, results in serious injury and ends in temporal or permanent disability. The cost arising from road traffic accidents in Zambia has been estimated at 1.3 trillion Zambian Kwacha (about 282 million US dollars) or about 3% of the GDP, each year.12 This is besides the grief and suffering that come with each accident. 3.1. Country contextual factors contributing to road traffic injuries The conditions in which people live and work determine their health status (ICSU, 2011). These conditions have an influence on the severity of RTIs and cause disparities among peoples chances of leading healthy lives. Cultural and social values also influence the road users perception on the impact of RTIs. Gordon Chavhunduka, a traditionalist, argues that cleansing ceremonies could help in treating the black spots through consultation with the spirit medium of the respective places where RTIs are common (Mukarati, 2011). Some also argues that African countries have faced many disasters such as war, famine and fatal diseases so they perceive RTIs as killing a relatively few people because they have witnessed many people dying in a massacre (Assum, 1998). Interpretations of sudden death in Zambia: A tentative discussion

10 11

Mercy Mwila, New countrys highway code, 30th January 2010. Times of Zambia, 16th November 2007. http://allafrica.com/stories/200711160013.html 12 Mercy Mwila, New country highway code, 30th January 2010, Radio Phoenix News, 31st March 2010.

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In his doctoral work Mwewa, a Catholic priest devoted some space to the discussion of various aspects of death in Zambia. He noted that except for sudden death, normally, nobody dies unattended to. He also distinguished between natural and unnatural deaths. Whereas natural death was easily accepted and often came about on account of old age, unnatural or bad death in contrast, was invariably problematic. The latter death was usually associated with evil men, witches, curses and aggrieved spirits. The deaths which this paper is concerned with and highlights fall in the category of unnatural or bad deaths. These are deaths that are occasioned by road traffic accidents, are sudden and therefore difficult to deal with. As Eyetsemitan noted;

Whereas the grieving process begins before death occurs in the case of a dying person, it begins after death has occurred in the case of sudden or unexpected death. In the case of dying there is anticipation that death will ultimately result. Therefore, the loved ones have time to prepare both emotionally and cognitively for death when it occurs. Here, coping after death is easier for the survivors and the dying person has time to take care of unfinished business such as preparing a Will. However, in the case of sudden death, because such preparation is absent, coping by loved ones is difficult

It is the difficulties associated with sudden death and in the case of road traffic accidents, the gruesome nature of such deaths, which lends them open to many interpretations

Tradition views

Traditionally, most road traffic accidents are caused by spirits or supernatural powers. How such an interpretation is arrived at depends on a number of factors such as; the
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nature of the accident, the purpose of the trip, the means of travel or the spot on which the accident occurred. A few years ago, a colleague lost a brother in-law . After burial, relatives of the deceased decided to exhume the body for reburial without informing the husband or relatives of the deceased husband. On their way back from the village they were involved in an accident in which some members of the family died while others were injured. How could such deaths be explained? I discuss this story more fully below. There is also a generally held view that a road traffic accident could be caused by a chisomo, usually sent by someone to cause death.

My account starts with the death of a Minister of Home Affairs Luckson Mapushi who died in a road traffic accident a few months after he was appointed and was elevated to a cabinet post in December 2002. On the day he died he had gone back to his Keembe constituency. Whilst addressing a meeting a bolt of lightning struck his brother and left him unconscious. Suspicion over the incident led to the cancellation of the meeting. Still horning his driving skills, the Minister and his wife decided to drive back to his rural base in Chibombo. On the way, he lost control of his vehicle, hit into a tree and died instantly.

The Home Affairs Ministers sudden death, created a furole. There were bitter recriminations among members of his family and between his family and that of a former Minister of Finance. Among those suspected of having being behind the death was a close member of the deceased family and a former Minister of Finance. The late Ministers sister who happened to be the then presidents wife openly accused the former government officials family of having killed his brother and called upon them to eat his body.

The Ministers death occurred at a time when the accused government official was on the run for alleged corrupt activities and was therefore being sought after by the police.
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The accused came from a part of Zambia that is noted for being a den of witches, Chiengi district and was he himself considered a powerful wizard who was able to evade capture by invoking his supernatural powers which made him invisible to his pursuers. The accused was said to be hiding in the bush in his native Luapula Province and it was claimed that he was able to communicate with the rest of the world using a laptop computer even though he was in an area without electricity or internet connection.

It was reported that while driving, the Minister had seen someone in the middle of the road and had, in the process of trying to avoid hitting into a human figure, swerved off the road and hit into a tree. The man in the middle of the road was not real but a shadow sent by the wizard to provoke the accident.

It was on account of the above beliefs that when the man who was the Minister in charge of the police died, fingers were immediately and directly pointed at the individual on the run. Taking the lead was the deceased sister who as already noted was the then Presidents wife. A bitter exchange of words ensued between the sister to the deceased Minister and the wife to the accused man. The matter was widely covered in the national media.

A sober analysis of what caused the accident revealed that the Minister in question, who had just been elevated to cabinet level, was still learning how to drive what was a powerful 4X4 motor vehicle which may have proved difficult to handle in a bush track. However, given the incident that had led to the cancellation of a political meeting in Keembe earlier, and the acrimonious relationship that had emerged between government and the family of the former Minister of Finance, Mapushis sudden death was immediately looked at with suspicion and considered unnatural.

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The above saga was not strange to most Zambians. Like everywhere else on the African continent, there are hundreds of myths concerning death and its causes and in particular, sudden death. It is explained in many ways. It may be caused by sorcery, witchcraft, magic, spirits or a curse among others. Magesa noted that in the African mentality, everything wrong or bad in society and in the world, and, most particularly, various afflictions and I add, or sudden death, originates in witchcraft.

Mapushis death was sudden and traumatic. It was difficult to accept or deal with. It broke in the words of Zahan, the natural and regular progression of things. It was a distressful event which was striking because of the suddenness with which it shattered order by brutally destroying the continuum of time. Under such difficult circumstances relatives were compelled to seek answers on the cause of the accident by recourse to the supernatural.

Traditional beliefs have remained persuasive and continue to hold sway despite increased recourse to modern science and apparent westernization of the Zambian society. Accidents in Zambia are a daily occurrence. However, the fact that the death of the Home Affairs Minister occurred at a time when the police were after an alleged wizard and suspect on the run, resulted in many accusations and counter accusations. Those involved were well educated and therefore part of the modern Zambian elite. However, faced with a sudden and accidental death, they fell back on traditional beliefs to explain its cause.

Witchcraft was immediately suspected because for sometime before the accident, a bitter and acrimonious exchange of words had ensued between the wife of the alleged wizard (the former Minister of finance) and suspect on the run and government officials in particular, the then President, his wife and the Minister of Home Affairs. Government was accused of using false accusations of corruption against certain former government
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officials and in this particular case, the former Minister of finance, to wage war against people who were deemed close to the former President, Chiluba. It appeared logical therefore to consider the Ministers death as having been brought about by witchcraft. How anyone got to know about what the deceased saw in front of the bush track he was driving along, remains within the realm of African traditional beliefs and cannot therefore be explained through logic or modern science. Accident Black Spots as Haunted Places There is a common Africans traditional belief that a spot where road Traffic accidents occur for more than once, even if it is only twice must have a particular significance, mostly, a supernatural one. Dixon wrote of one such a spot in Chivhu in Zimbabwe; the road is scarred with skid marks, others pencil straight. They shriek the fate of unlucky travelers who lost their lives; they mark near-missed. Frequent road traffic accidents on the spot led Zimbabweans to the conclusion that the cause of such accidents was not natural but supernatural. Ancestral spirits were involved and performance of appropriate rituals to propitiate the spirits of the dead ancestors was deemed the only possible remedy. Why that particular part of the highway had become a black spot was traced back to Zimbabwes first contact with the white men who arrived in what later became Southern Rhodesia as members of the pioneer column in 1890. The pioneers established a camp at Fort Charter near the current highway. Local Africans believe that many of their ancestors were thrown into a burning pit by the foreigners. In the past, there were no accidents on the spot. This was because local people remembered their ancestors through performance of religious rituals which were characterized by the slaughter of cattle. The animals blood and meat would then be shared with the ancestors. In this way, the spirits of the living dead would be appeased and they in turn ensured the safety of their still living kinsmen and women. However, in the last 10-15 years, such local religious practices have been neglected. Non observance of traditional rituals can probably be partly explained by the economic crisis the country has been passing through but is most likely also due to the influence and impact that evangelical and fundamentalist Christianity has had on African traditional

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religious practices. In most parts of Africa it is believed that when ancestral spirits are neglected or angered, they can cause affliction and even death. There are indications that South Africa may have its own black spots. A newly arrived pastor from South Africa told me of a recent spate of terrible road traffic accidents that happened on Mabopane Highway. The first occurred on the 16th and the second on the 17th March 2010. A taxi (known as mini bus in Zambia) hit into a barrier before plunging 8 metres down the bridge. A total of 24 people died, some on the spot, others in hospital. Newspapers reported a total death toll of only 8. In the second taxi incident, 3 people were killed. This was within 36 hours of the first accident. My informant noted that an accident such as the first one had never happened before and was considered possible given the way the bridge was constructed. The cause of the accident was traced to a rear tyre burst. However, in spite of expert views, many people believe that a snake had crossed that stretch of the road. The snake represented a spirit and was the likely cause of the two accidents. When an accident occurred on a particular stretch of a road, relatives would collect the spirit of the dead as a way of cleansing the spot. It is believed that if someone dies on the road and his spirit is not taken are, the victim would haunt that place leading to more accidents. In Namibia, I was informed that accidents frequently occur at a place known as Okakalala, which is near a hill where Satanists are believed to perform their rituals. 2.4 Consequences of road traffic injuries It is of great importance to note that road traffic accidents happen in a fraction of a second but their consequences take a long time (ETSC, 2007). Besides loss of life or reduced quality of life due to road traffic accident, consequences attributed to RTI include costs such as: Replacement and repair of property damaged Medical treatment

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 Home renovations, for example, toilet or bathroom to accommodate wheelchairs as well as vehicle adaptation physical pain, grief and suffering Permanent disability and disfigurement as well as travel anxiety (ETSC, 2007). Furthermore RTIs affect household income and national economy through cost of prolonged medical care, together with funeral costs and loss of income due to disability. Involvement of a breadwinner pushes the household affected into poverty (Odero et al 1997). 3.4.1 Socio-economic impact of road traffic injuries in Zambia Globally the estimated cost of RTI is 518 billion USD in low income countries the cost of RTI is around 65-100 billion USD which exceeds the total amount of assistance that the countries received for development (WHO, 2006b). Although no cost study was done in Zambia it is estimated that around 1-2% of GDP is spent on road traffic injuries (AfDB, undated). RTIs affect males in their active period of life, when they are socially important economic as heads of household. In 2006, 71% of deaths due to RTIs were males (WHO, 2012). While women are less victims of RTIs they suffer as secondary victims; loss of their husband exposes them to socially, financially insecurity and likewise children also are impacted by the social and economic of the loss of their parent (Odero et al, 1997) (WHO, 2004). WHO noted that the impact of RTI on poor people is greater than the rich and they represent the higher risk group such as pedestrians, passengers and motorcyclists. Although not all pedestrians are poor, it is assumed that the poor cannot afford buying a vehicle hence will be pedestrians or passengers. Low socio economic group of people have less access to medical services and this results in disparities of recovery and survival (Sharma, 2008). 3.5. Health systems response to RTIs
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The health systems response to RTIs influences the degree of recovery as well as survival chances (Chen, 2010). Zambias health care system has been characterised with delays in attending to the victims. Shortages of resources and delays in detecting the scene of crash have been the hiccup of the health system. Presence of fire resulting from collision has also been a contributing factor to worsen the situation (ZBC, 2012). Hospital care has also been affected by lack of appropriate emergency care mainly due to lack of necessary resources (Biti, 2009); for example, lack of suture materials. Health care systems have also been affected with brain drain; many experienced human resources have moved out of country for greener pastures hence the poor economy has also lead to poor hospital care (IOM, 2012)(Zambia Health Workforce Observatory, 2009). Accessibility to services is also influenced by the economic status of the individuals so that those who afford to pay for the services are better cared for.

CHAPTER THREE RESEARCH FINDINGS 3.0 Background Information of Zambia Officially the Republic of Zambia, is a landlocked country in southern Africa. The neighbouring countries are the Democratic Republic of the Congo to the north, Tanzania to the north-east, Malawi to the east, Mozambique, Zimbabwe, Botswana and Namibia to the south, and Angola to the west. The capital city is Lusaka, located in the southcentral part of the country. The population is concentrated mainly around Lusaka in the south and the Copperbelt Province to the northwest. Location: Zambia is located in Southern Africa, east of Angola and north of Botswana and Zimbabwe; see map below.
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CHAPTER FOUR DATA ANALYSIS

Figure 1: Map of Zambia 3.1 Background information about the research setting The research was done in Lusaka, which is the capital city of Zambia. Lusaka is the capital and largest city of Zambia. One of the fastest-developing cities in Southern Africa, Lusaka is located in the southern part of the central plateau at an elevation of about 1,300 metres (4,265 feet). As of 2010, the city's population is about 1.7 million. Lusaka is the centre of both commerce and government in Zambia and connects to the country's four main highways heading north, south, east and west. English is the official language of the city, but Nyanja, and Bemba are also common. 3.2 Background information about the respondents The researcher interviewed 50 respondents, which comprised of road users and Road Traffic Agency Officers. The following chart shows the respondents profile.

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Profile of respondents

20% 30%

50%

Driv ers Genera l public R T S A

Figure 2: Information about the respondents As shown on Figure 2 above, 50 respondents representing 100% were involved in the study in which 25 comprised of drivers (road users, that included public transport drivers of Taxis and Busses). 15 respondents comprised of the general public who were sampled from Lusaka main trading area representing 30% above. The study was comprised of 10 Road Traffic Safety Agency (RTSA) Officers) representing 20% in Figure 2 above.

3.3

RESEARCH

FINDINGS

IN

RELATION

TO

THE

RESEARCH

OBJECTIVES 3.3.1 To analyse the situation on road traffic injuries in Zambia in order to make recommendations towards reduction of the burden of road traffic injuries.

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From the secondary sources obtained at RTSA Headoffice . In 2011, a total of 22, 570 road traffic crashes were reported as compared to 15, 186 road traffic accidents reported in the year 2010 representing a 49 percent increase in absolute terms. Figure 3: Road traffic accidents fatality and injuries between 2010 and 2011

RT I between 2010 and 2011 12000 10000 8000 6000 4000 2000 0 Lusaka Central C/belt Southern 2010 Eastern 2011 Western N/Western Northen Luapula

As shown above, Lusaka and Copperbelt provinces continued to record the highest number of road traffic crashes due to the continued increase in motor vehicle population between 2010 and 2011.Lusaka provinces alone in 2010 had 8217 and in 2011 it had recorded 11,498.In the copper belt in 2010, accidents were at 3116 and in 2011 they were 11, 498. It was followed by Central province and the lowest province for accidents was Luapula province. Currently, a total of over 52,000 motor vehicles were imported in 2011 bringing the cumulative total to 381,948 motor vehicles in the country. 3.3 To describe and analyse road traffic injuries and their trends in Zambia. The researcher interviewed 50 (100%) on the trends of traffic accidents and injuries in Zambia.23 respondents representing 46 % indicated that road traffic injuries is human error i.e. dangerous driving, over speeding and failure to follow traffic rules.

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Economical 24% Spiritual 30%

Human error 46%

Hum an error S piritual Econom ical

Figure 4: causes of road traffic injuries 12 respondents representing 24 % attributed road traffic injuries to economical challenges. 15 respondentss representing 30 % said that, accidents in Zambia most of them are as a result of spiritual explanation, in which it was attributed that Satanists are causing major accidents in Zambia in their plea to getting rich.

3.4 To critically analyse causes and contributing factors related to road users, road and road sides, vehicles factors and road safety decision making. A survey on the causes of sudden accidents in Zambia revealed that, human error is the major contributing factor followed by spiritual practices such as Satanism practices.(See Appendix 2).

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17 die in Kabwe Lusaka Road when the bus collided with a Track, on 1 st May 2013

The wreckage of the bus that collided with a Kabwe-bound Sabot Zambia truck in Liteta area on 31st May 2013. 3. 5 Strategies to prevent Road Traffic Injuries The research findings showed five good practices to be developed so as to prevent road traffic injuries in Zambia as shown on the table below Strategies Road safety management Prayerful lifestyle amongst road users Restriction of
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Frequency 50

Percentage 100%

Safety

education

for

pedestrians Enforcement to reduce

alcohol impaired driving Total 50 100%

Table 1: strategies to prevent road traffic injuries

CHAPTER FOUR DATA ANALYSIS 4.1 To analyse the situation on road traffic injuries in Zambia in order to make recommendations towards reduction of the burden of road traffic injuries. What the paper does therefore is to take a look at the occurrence of sudden death, in particular sudden death through road traffic accidents that are more numerous and more frequent. What meanings do Zambians attach to such deaths and how have these meanings changed over time? Consideration of the nature and causes of road traffic accidents in Zambia and their explanations will cover a twenty- year period; 1980-2010.
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This period has been chosen in that it covers two specific eras in Zambias history. The period 1980-1991 was characterized by a serious economic decline and a critical shortage of almost everything. During this period the existing basic transportation infrastructure deteriorated significantly and motor vehicle owners could not get spare parts for their vehicles. After 1991, the economy was liberalized. Purchase of motor vehicles became easier and spare parts became more readily available. It would be important to see what impact these developments had on the nature, causes and rate of road traffic accidents in Zambia and the meanings Zambians attached to them. Even though road traffic accidents have been a major source of concern and a subject of a Commission of enquiry at one time, no historical study has ever been carried out to try and better appreciate the nature of the problem, its causes and how those affected by consequent deaths dealt with sudden tragedy. Each year, thousands of Zambians are killed or maimed through road traffic accidents at great material, financial and emotional cost to the nation. What has been the Zambians attitude and reaction towards such loss of life?

Apart from seeking to better appreciate the nature, causes and reactions to sudden death, the paper will also examine how Zambians have tended to explain deaths occurring through road traffic accidents and how this has evolved over time. Deaths from road traffic accidents are often explained on the basis of traditional systems of beliefs and practices. This usually depends on how the accident occurred, the reason for travel, mode of transportation and in more recent times, whether or not a public service vehicle was involved. For example, currently, most deaths from road traffic accidents involving public service vehicles are increasingly attributed to the practices of Satanism. The first part of the paper presents a general overview of the subject of research. This will be followed by a discussion of occurrence and nature of road traffic accidents in Zambia and the last part will focus on the various interpretations that have been proffered to explain sudden death through road traffic accidents. Road Traffic Accidents an Overview
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Road traffic accidents and road traffic injuries are a major and growing public health problem that impacts on all sectors of society. They remain are major cause of death and disability in developing countries. According to the World Health Organization estimates, worldwide deaths from road traffic accidents increased from about 999 000 in 1990 to about 1.2 in 2002 . The number is projected to rise to 2 million deaths per year by 2020. The number of such deaths is expected to continue to rise as societies become more motorised. Although developing countries have fewer vehicles, accounting for only about 40% of the worlds total, they bear the heaviest burden. 85% of the total road traffic fatalities Like in Zimbabwe and elsewhere, Zambia has its own black spots scattered across the country. The history of these spots varies from place to place. Mostly they are linked to some unappeased spirit. The deaths are usually of a criminal natural in which an innocent life is brutally lost or a person is killed in a hit and run accident. These are also cases in which those involved are never known or brought to justice. The spirits of the dead are therefore said to haunt these places and the road traffic accidents and the deaths that occur are invariably linked to the spirits of those who were killed on that spot. Among a large number of places that are considered as black spots, is a spot in Munali Hills on the road to Mazabuka. I was informed that each time there was an accident in those hills it occurred on one particular spot and vehicles fell on the same side of the road and in the same ravine. The other was a spot on the Great North Road when crossing it from the Railway club to the town centre. I was told that many people have died on the spot and that last year alone, three people died while trying to cross the road. Other areas indicated as black spots were; Kapiri Ngozi along the Lusaka Chirundu road, the area around Shimabala on the Lusaka Kafue road, Landless corner on the Lusaka Kabwe road, a stretch on the same road near Zambia National Service, a corner near Mulungushi Textiles in Kabwe, the area between Chainama and Mumana Pleasure resort in Lusaka and Mubanga-Chipoya Basic School in Kasama. Each district and province has its own black spots.

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Accident black spots have been central in the interpretations of sudden deaths on our roads. They are generally considered as haunted places or an abode of malevolent spirits. The black spot at Mubanga-Chipoya Basic School in Kasama was haunted by the first person to die on spot. Five accidents have been recorded on the spot since 1998. At the black spot near Chainama, drivers have reported sudden appearances of human figures in the middle of the road at night. In other instances, drivers are said to have seen a hump, an animal or some obstacle ahead of them or found themselves caught in the glare of headlamps of a vehicle that was not there. An attempt to avoid such a figure would result in an accident and certain death of the driver. All deaths that occur on black spots are as a consequence, invariably deemed unnatural and therefore as caused by a malevolent spirit, a curse, black magic or more increasingly by satanic practices. Up to sometime in the early 1990s, accidental deaths through road traffic accidents were attributed to witchcraft, curses or black magic. They were associated with ghosts, a woman who was not properly cleansed or simply jealousy. Today, most of these deaths are increasingly explained by satanic ritual practices. The need for blood is said to be behind the spate of accidents occurring on Zambian roads. Blood is considered to be a source of strength and it is used in sacrificial rituals. I was informed that initiates into Satanism are made to drink blood in order to enter into a covenant with Satan. However, spilling of blood, especially through road traffic accidents ensures continued success and growth of a business. Accidents bring wealth, a new fleet of buses or taxis. The issue of blood is central to many belief systems. In Christianity, we learn from the bible that blood cleanses, heals and is life itself. Even though in most cases accidents on particular black spots can be explained by technical means, once a spot has earned the tag of a haunted place, the tag remains and is generally believed to be so by both Christians and non Christians alike. Satanism or satanic practices are increasingly brought in to explain what is happening on Zambian roads. Unlike conventional explanations that tend to link recourse to the supernatural in times of increasing distress, in Zambia, it would appear that it is the apparent affluence of a few in societies and the dramatic increase in the number of
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evangelical churches that has fuelled current theories on the nature and causes of deaths on our roads. Apparent affluence is mostly picked on to explain road traffic accidents and ensuing deaths. This has been the case in the rural towns and urban areas of Zambian. The general account is that young men sell their years in order to acquire material wealth. This is usually in form of a well stocked grocery shop, or means of transportation such as trucks, buses, mini-buses or taxis for ferrying goods or passengers. How one could sell years to live a shorter but prosperous life before dying has never been explained. It therefore follows that for the apparent level of wealth to be maintained and built upon, blood has to spill and some rituals performed at regular intervals. This occurs through road traffic accidents. Zambia like elsewhere in the world has been marked by a sharp rise Christian fundamentalism. Since the mid 1990s the country has seen a dramatic multiplication of born again churches which like in the case of Kinshasa in the Democratic Republic of Congo as de Boeck noted, have become the norm rather the exception. Thousands of Zambians have been drawn to these new churches. The quick development and spread of these evangelical or pentecostal churches can be largely attributed to a mix of factors such as; political change in 1991, the declaration of Zambia as a Christian Nation by the Chiluba regime, liberalization of the economy and the resultant increased social and economic indigence, HIV/AIDS, a general increase in the countrys disease burden and a quest for quick riches among men of God. The teachings of these relatively new churches have had a deep and at times an unsettling influence on their members. One of the areas in which these churches have had the greatest influence is over the interpretation of causes of death, including road traffic accidents

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CHAPTER FIVE: DISCUSSION CONCLUSION AND RECOMMENDATIONS 5.1. Conclusion The objective of this thesis was to analyse the situation on road traffic injuries in Zambia in order to make recommendations towards reduction of the burden. A conclusion was drawn based on a review of the RTI information in Zambia and on experiences from other countries. The analysis shows that the country has basic legislation in place for road safety, but the laws are not comprehensive in their relevance. Speed limits are above the global recommendation, seat belt laws do not apply to all vehicle occupants, and the BAC limits level is higher than the WHO recommendation. Above all the country does not have a well-publicised road safety strategic plan or national road safety policy which is a huge gap in all road safety activities. Absence of the policy documents compromise coordination of activities. Road safety activities are said to be implemented but with no target and funding to support the activities are
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limited. RTIs data lack accuracy. There is negligence of road safety regulations by road users, poor law enforcement, and corruption. RTIs are a safety problem as well as an equity public health issue in Zambia. Fatal road traffic accidents are the greatest existing threat among all risks in the country. The country has a road traffic deaths rate of 27.5 deaths per 100,000 populations per year. The most affected age group is 26-42 year and majority of the affected are passengers and pedestrians. Males have more risk than females. Reckless driving and violation of traffic laws are the human behaviours that influence RTIs occurrence. However alcohol impaired and over speeding have been identified as the worst human behaviour resulting in accidents in Zambia. Road users include motorists, passengers, pedestrians and cyclists. Inadequate and corrupted law enforcement coupled with public acceptance has resulted in the increase of unworthy overloaded damaged vehicles and unregistered vehicles on the road. Vehicle fleets have increased considerably in the country. However the majority of these vehicles are not roadworthy. Zambian roads have been found lacking in terms of safety measures, which are associated with a lot of road traffic injury risks such as poor technical design of the highway construction, narrow roads that cannot accommodate high traffic volumes, potholes, poor signage, bushes surrounding the roads and stray animals found in the road environment. There is no traffic separation such as cyclist lanes, pedestrian lanes and all these factors contribute significantly to risk of road traffic injury occurrence in the country. Those injured face challenges in order to access health care, due to lack of adequate post trauma care. RTIs cause suffering within families such as school drop outs and poverty due to involvement of the breadwinner. Universal national health insurance is needed to improve accessibility to health care services. Majority of the RTI victims are passengers and pedestrians. This implies public transport system needs improvement, proper pedestrian paths needs to be established and improvement in road traffic law enforcement. A sense of responsibility is required to share the road with others
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A main challenge to road safety in Zambia is the lack of accurate data. Comprehensive data is essential for drawing attention from law makers, setting targets, designing and evaluating strategies and prioritizing activities. In order to improve understanding and awareness of road traffic injuries determinants and consequences among decision makers, researchers, practitioners and people, I will give the following recommendations based on analysis of the study and proven good practices from other countries as well as feasibility.

6.2. Recommendations Governments capacity, commitment and support to the established lead agency (RTSA) are needed in order to reduce RTI in Zambia. A number of interventions were analyzed as to their applicability for Zambia. Road safety management The Ministry of Transport and Infrastructure Development should finalize the national road transport safety policy in order to have an authenticated guiding document in all road safety activities. Public transport should be improved to address the road transport safety needs of vulnerable population (passengers), e.g., setting standards on minibuses and to enforce their compliance. RTIs data collection and recording by Zambia Republic Police, RTSA and MOH&CW should be done accurately. RTIs data is essential for explaining the burden, prioritizing activities, setting targets and designing strategies.
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Safer road users Drinking and driving law, speed limit law should be reviewed and changed to meet the WHO recommendation. Seat belt use should be mandatory to all vehicle occupants. This can be done gradually to allow those cars with no seat belts to be fitted. Improve on regular, consistent and comprehensive enforcement of road rules to improve road user behaviours especially on drinking and driving, speeding, use of seat belts and helmet use. Place speed cameras on busy intersections and black spots to enforce speed limit. Defensive driving should be incorporated in driver licensing training. This involves training on knowing how to avoid traffic crashes and recognize potential hazards before its too late. Establish graduated drivers licensing system for novice drivers. This gives novice drivers time to gain experience, with some restrictions, e.g., on night driving or carrying passengers. Education and encouragement to improve alertness and obedience to road rules as well as regular and consistent anti-corruption campaigns. NGOs and RTSA should advocate for policies such as public transport policy, policy to promote walking and cycling this helps in drawing policy makers attention to road safety. Safer vehicles All new cars should have seat belts. A period of time can be given for the old cars to have seat belts fitted. Enforcement of regular vehicle services and proper inspection periodically. Collaborate with Environmental Management Agency in tracking unworthy vehicles on road
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 Mandatory daytime running lights usage and headlight usage for motorcyclists. Safer roads and road sides Establish policy on routine road maintenance Involve engineers in road accident investigation to detect road engineering problems Instant remedial action on black spots with traffic calming measures such as roundabout, speed humps with good signaling. This may help to reduce traffic accidents especially at intersections and at areas with repeated accidents. REFERENCES AfDB (2011). Infrastructure and growth in Zambia. An action plan for sustained strong economic growth. IRIN Africa, Southern Africa. Special Report on Road Traffic Injury Prevention. Friday 12th March, 2010: htpp://irinnews.org/report.aspx?reportd=50251 Joseph Schatz, On the road in Zambia. The Lancet, Vol. 372, issue 1637, 9th August 2008. http://www.the lancet.com/journals/lancet/article/p1150140-6736(08)611794/fulltext Mercy Mwila, New countrys highway code to lessen road traffic accidents, Times of Zambia. 30th January 2010. World Bank. (2006). Zambia Infrastructure Assessment Note for Roads, Railways, and Water Sectors: Africa Transport Sector (AFTTR) Report No. 36978-ZW. World Bank. (2008). Zambia infrastructure dialogue in roads, railways, water, energy and telecommunication sub-sectors. Report no. 43855-zw. Lusaka.

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APPENDIX A INTERVIEW GUIDE TO ROAD USERS

1. For how long have you stayed in this area? 2. How do you define, road traffic injuries? 3. What do you think are the causes of road traffic injuries in Zambia 4. What do you think should be done to prevent road traffic injuries in Zambia? 5. In your own opinion, what strategies can be put in place in road safety management? 6. What is role of road transport safety Agency (RTSA) and the Zambian police in accident prevention?

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APPENDIX B CAUSES OF SUDDEN ROAD ACCIDENTS DEATHS IN ZAMBIA

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