Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 43-49

Road traffic accidents among commercial motorcyclists: Relationship with substance use and psychosocial factors


1 Department of Psychiatry, College of Medicine, Ekiti State University; Department of Psychiatry, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
2 Department of Psychiatry, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
3 Department of Community Medicine and Primary Care, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria

Date of Submission27-Jan-2020
Date of Decision06-Mar-2020
Date of Acceptance13-Mar-2020
Date of Web Publication9-Jun-2020

Correspondence Address:
Dr. Adetunji Obadeji
Department of Psychiatry, Ekiti State University Teaching Hospital, PMB 5535, Ado-Ekiti, Ekiti State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/SHB.SHB_9_20

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  Abstract 


Introduction: Road traffic accidents (RTAs) constitute a major source of death, morbidity, and disability, with a disproportionate number occurring in developing nations. This study was aimed at evaluating the rate of RTA among commercial motorcyclists and identified psycho-social as well as substance use variables associated with it. Methods: This was a cross-sectional study among commercial motorcyclists in Ado-Ekiti, Nigeria. Participants were assessed with sociodemographic questionnaire, the condensed Alcohol, Smoking and Substance Involvement Screening Test and Patient Health Questionnaire, the 9-item version. Chi-square tests and the odds of developing RTA were calculated for current substance use variables and other variables of interest. Results: Two hundred and thirty-four (51.3%) reported to have experienced one form of accident or the other, of which majority reported major injuries that necessitated hospital in-patient care and 3.0% had fatality. No significant association between history of RTA and sociodemographic characteristics (P > 0.05). Participants with a history of current marijuana use (odds ratio [OR] = 1.77 [95% confidence interval (CI) = 0.89–3.51]) tobacco use (OR = 1.45 [95% CI = 0.90–2.34]), alcohol use (OR = 1.49 [95% CI = 1.02–2.17]), and depression (OR = 1.50 [95%CI = 0.97–2.33]) had a higher risk of experiencing RTA compared to those without such history. Significantly, those with a history of current use any substance (OR = 1.55 [95% CI = 1.07–2.24]) (P = 0.04) and alcohol (OR = 1.49 [95% CI = 1.02–2.17]) (P = 0.02) were more likely to have had RTA compared to those without history of current use of any substance. Conclusion: There is a high rate of RTA among motorcyclists studied, with most reporting a major accident that required some form of hospital care, thus increasing the burden on the already over-burdened health systems. Among other factors, effort at reducing RTA among motorcyclists should also focus on reducing substance use.

Keywords: Alcohol, commercial motorcyclists, Nigeria, psychosocial factors, road traffic accidents, substance use


How to cite this article:
Obadeji A, Kumolalo BF, Bamidele JO, Olasehinde TF. Road traffic accidents among commercial motorcyclists: Relationship with substance use and psychosocial factors. Soc Health Behav 2020;3:43-9

How to cite this URL:
Obadeji A, Kumolalo BF, Bamidele JO, Olasehinde TF. Road traffic accidents among commercial motorcyclists: Relationship with substance use and psychosocial factors. Soc Health Behav [serial online] 2020 [cited 2021 Dec 2];3:43-9. Available from: https://www.shbonweb.com/text.asp?2020/3/2/43/286263




  Introduction Top


Globally, road traffic accidents (RTAs) constitute a major source of death, morbidity, and disability, with a disproportionate number occurring in developing nations.[1] Currently, injuries from RTAs rank ninth globally among the leading causes of disability-adjusted life years lost, and this is projected to rise to third by 2020.[2],[3] About 90% of the disability-adjusted life years lost worldwide is attributable to road traffic injuries from developing countries.[1],[3] Each year, an estimated 1.2–1.35 million people died from road accidents, with about 50 million injured, occupying nearly 70% of beds in the orthopedic wards in developing countries hospitals.[4],[5] In low- and middle-income countries, death rates from road traffic injuries were reported to be high in 2015, with 34/100,000 in the countries studied,[6] and over half of all road traffic deaths from vulnerable road users.[3]

Several factors contributed to RTAs, including human errors, reckless behavior of most road users, bad road, unsafe vehicles, inadequate enforcement of traffic laws, inexperience, risky use of substances among commuters and other road users,[3],[7],[8],[9],[10] fatigue, overload, the terrain, and the effect of large vehicles are other significant factors.[11]

The aforementioned significant factors have been reported among the commercial motorcyclists (i.e., individuals who use motorcycles for commercial transportion). Indeed, over speeding, wrong overtaking, bad roads, sudden mechanical defects, alcoholic intake, and smoking of cigarettes have been reported to be associated with RTA in the commercial motorcyclists.[9],[12] Of these factors, the use of alcohol and other psychoactive substances has been repeatedly implicated.

Although most studies did not report the rate of RTA among commercial motorcyclists, studies looking at RTA among motorcycle riders in Nigeria had reported high accident among motorcyclists with a history of substance use, most especially alcohol.[12],[13],[14] The use of alcohol and other drugs increases risk-taking behavior, which has been shown to increase the risk of an accident by over 80% among commercial motorcyclists.[9] Moreover, the risk of RTA has been reported to be at least twice among drivers with depression compared to those without such.[15],[16]

RTAs adversely affect individuals, their family members, as well as create a heavy burden on the health-care system that is already stretched in most developing countries.[3],[6],[10] This study thus evaluated the rate and patterns of RTA among commercial motorcyclists and identified potential psycho-social as well as substance use variables associated with RTA.


  Methods Top


Study designs and setting

This was a cross-sectional study among commercial motorcyclists in Ado-Ekiti, Nigeria. Ado-Ekiti is the capital city of the Ekiti State, with a population of over 500,000 based on 2019 estimates. Commercial motorcycle otherwise called “Okada” is a major source of transportation in the town with over 7000 commercial motorcyclists going by the information from the Okada riders' association.

Study population and sample size

The sample size (n) was calculated using the formula (n = Z2pq/d2) for a cross-sectional survey.[17] Considering 95% confidence interval (CI) with 5% margin of error, an estimated sample size of 400 was determined, which includes 10% attrition. Nevertheless, a total of 456 participants were interviewed from an entire study population of commercial motorcyclists in Ado-Ekiti, Metropolis. As a result of the dynamic nature of the riders, participants were selected by convenience sampling method across the major commercial motorcyclists' terminals in Ado-Ekiti, interviewing riders as they arrived at the motorcycles' terminals, i.e., where motorcyclists converge to pick passengers or relax during the off-pick period.

Inclusion and exclusion criteria

Inclusion criteria include being a commercial motorcyclist, aged 16 and above and have been engaging in the job for at least of 6 months. Commercial motorcyclists who were younger than 16 years and those who only engage either in the mornings or the evenings were excluded from the study.

Measures

Participants were assessed with sociodemographic questionnaire incorporating participants' characteristics such as age, level of education, marital status, duration of riding motorcycle, involvement in RTA traffic accidents and the extent injury or loss of life, and other engagement or jobs apart from riding motorcycles. Substance use was assessed with the condensed Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), and significant depressive symptoms with the Patient Health Questionnaire, the 9-item version (PHQ-9). Detail information on PHQ-9 can be found in our previous study.[18] The instruments were administered by clinical psychology interns who had earlier been trained on the administration of such. In this study, current substance use was defined as the use of substances under investigation in the past 3 months.

The condensed ASSIST by the World Health Organization was used to assess substance use in this study. It contains eight screening questions that cover alcohol, amphetamine-type stimulants (including ecstasy) cannabis, cocaine, inhalants, sedatives, hallucinogens, opioids, tobacco, and other drugs.[19] The risk score was calculated for alcohol and subsequently grouped into high risk (scores 27 or higher), moderate risk (scores 11–26), and low risk (scores 0–10). The ASSIST had low sensitivity and high specificity, with a diagnostic accuracy >95%.[20]

The PHQ-9 is the 9-item module that assesses depression. A person is said to have significant depressive symptoms if 5 or more of the 9 depressive symptom criteria have been present at least “more than half the days” in the past 2 weeks.[21] The PHQ-9 scores range from 0 to 27, each of the 9 items is scored on a Likert scale of 0 (not at all) to 3 (nearly every day). As a measure of severity, a score of 0–4 is rated none or minimal depressive symptoms, 5–9 mild depression, 10–19 moderate, and 20–27 severe depression. The total score was dichotomized into two, and those scoring between 0 and 4 were adjudged as having no depression and those with a score of 5 and above were said to be having significant depressive symptoms. The PHQ-9 has good concurrent validity with the Beck's Depressive Inventory and a sensitivity of 0.897, specificity of 0.989 at a cutoff point of 5.[22]

Ethical considerations

Research and Ethics Committee of the Ekiti State University Hospital, Ado-Ekiti approved the research protocol (EKSUTH/A67/2019/09/010). Permission to carry out the study was obtained from the Chairman of the State Association of Okada riders and written informed consent was obtained from all participants.

Statistical analysis

Data were analyzed with the Statistical Package for the Social Sciences version 25 (IBM Inc.) The distribution of the characteristics of variables of interest was calculated using descriptive statistics. Chi-square test was used to determine the relationship between categorical variables. Odds ratio (OR) and its 95% CI of associated factors were determined. A P = 0.05 or less was set to indicate significance.


  Results Top


Sociodemographics variables

The mean age of the participants was 31.9 years (standard deviation [SD] = 9.0). As shown in [Table 1], 327 (70.7%) participants had secondary education or below, 286 (62.7%) were married, 275 (60.3%) had no other job apart from being a commercial motorcyclist, 153 (33.6%) were artisans. Reasons for engaging in the job include no other job (n = 212; 46.5%), augment other source of income (n = 243; 53.2%), and one person was doing it because of interests.
Table 1: Sociodemographic variables

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Rates and severity of accidents

As shown in [Table 2], two hundred and thirty-four (51.3%) (95% CI = 46.6–56.0) reported having experienced one form of accidents or the other. Of these majority, 115 (49.1%) reported major injuries that need hospital in-patient care and 7 (3.0%) had a fatality. On an average, the respondents have been riding for 6.14 years (SD = 5.08 years). The mean duration of riding for those with a history of RTA was 6.34 years and 5.39 years for those without a history of RTA. The mean duration of riding was non-significatly higher for those with RTA compared with those without RTA (P = 0.43)
Table 2: Rates and severity of accidents

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Frequencies of road traffic accident among motorcyclists

[Figure 1] shows the frequencies of accidents among the participants. Most of the participants had had RTA, 93 (40%) had RTA once, followed by those with multiple histories.
Figure 1: Frequencies of road traffic accident

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Relationship between sociodemographic variables and history of motorcycles' accident

[Table 3] shows the relationship between psychosocial, demographic variables, and history of RTA among the recruited commercial motorcyclists. Although a higher proportion of those with primary school or lower reported a higher rate of accident compared with those with secondary school and above, there was no significant association between sociodemographic characteristics and history of RTA (P > 0.05). Those with a history of significant depressive symptoms also had a higher rate and at higher risk of RTA; however, it was marginally significant (P = 0.07).
Table 3: Relationship between psychosocial, demographic variables and history of motorcycles' accident

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Relationship between substance use variables and history of motorcycles' accident

The relationship between substance use variables and history of motorcycles' accident is shown in [Table 4]. Except for current tramadol use, current sedative use and current amphetamine use, participants with a history of the current use of marijuana OR = 1.77 (95% CI = 0.89–3.51) tobacco use OR = 1.45 (95% CI = 0.90–2.34) and alcohol use OR = 1.49 (95% CI = 1.02–2.17) had a higher risk of experiencing RTA compared with those without such history. Significantly, those with a history of the current use of any substance OR = 1.55 (95% CI = 1.07–2.24) (P = 0.04) and alcohol use 1.49 (1.02–2.17) (P = 0.02) were more likely to have had RTA compared to those who were not using any substance. The proportion of RTA increases as the risk of alcohol increase with 48.2%, 61.6% and 63.2% of those with mild, moderate, high-risk use reporting RTA (not in the table).
Table 4: Relationship between substance use variables and history of motorcycles' road traffic accident

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  Discussion Top


The rate of RTA among commercial motorcyclists was quite substantial, over half of the participants had experienced various degrees of RTA in the course of their business. The rate reported in this study is relatively higher than what was reported by Owoaje et al. in 2005,[23] but lower than what was reported by Lawal et al. in 2019 in Sokoto town, Nigeria.[24] The timing and level of urbanization may explain these variations. Of the population studied, nearly half described the extent of the accident as none to mild, i.e., with a minimal injury that does not require in-patient care. Again, about half described the injuries sustained as a major, necessitating some level of inpatient care and about 3% had life lost in their encounters. The extent injury depends on the severity of impart, which is oftentimes with other motorcycles or with motor vehicles in most cases.[24]

The proportion of commercial motorcyclists with RTA is quite substantial, particularly when considering the number of people in this business and the strain on the health system in developing economies like ours with a huge burden from other health challenges such as communicable and other noncommunicable diseases. An effort at ensuring a reduction in the burden of RTA and the economic losses due to morbidity and mortality from this preventable cause will in no doubt improve the nation's economy as well as reduce the burden on the overstressed health care system.

Although most drug use variables did not show any significant relationship with the history of RTA, most participants with a history of one substance use or the other, had a higher risk of experiencing RTA compared with their counterparts without a history of substance use. In addition, those with a history of alcohol use or those with current use of any substance were significantly more likely to have a history of RTA than those without such history. Studies have shown that drivers or riders who drink alcohol are more likely to experience RTA compared to those who do not.[11],[12],[13],[14],[25] This may be because alcohol increases the risk-taking behavior, impairs judgment[9],[13],[26] and allows speed standard deviation, and lane position standard deviation.[27] Although not significant, marijuana also constitutes a significant risk. Studies have indicated the risk of accidents associated with marijuana use persisted after adjusting for confounding variables.[28] Drivers under the influence of cannabis are prone to fatal accidents and preventable accidents compared to if such drivers ever drove under the influence of cannabis.[28],[29]

In this study, there was no significant association between demographic, psychosocial variables and RTA. However, a higher proportion of those with primary education or lower compared with those with secondary education had RTA. This may also be associated with the ability to use road signs, the ability to engage in risky behaviours or the use of substances. Riders with lower education were more likely to use substance, including alcohol compared with those with higher education.[12],[30] Similarly, compared with those without significant depressive symptoms, a higher proportion of those with significant depressive symptoms were more likely to have RTA. Impaired psychomotor activities along with impaired attention in people with depression, may affect their effective coordination and judgment on the road. The risk of RTA has been reported to be amplified by at least two-fold among vehicle drivers with depression.[15],[16] As noted in this study, as the severity increases, the rates of RTA increases. The relationship between depression and RTA may also be due to the strong association between substance use and depression, particularly alcohol.[31],[32]

Findings from this study show that the majority of the commercial motorcyclists were young, a dynamic segment of the population with nearly three-quarter under the age of 35 or with secondary education or lower. This is similar to findings from other regions of the country.[12],[14],[24],[33] The lower education coupled with the absence of other skills may have necessitated many young people engaging in such occupation despite the risks associated with it. This may also account for the recklessness of the riders on the road. The high proportion of young people with secondary education or lower, emphasizes the need for the government to develop programs aimed at equipping secondary school leavers with skills or skills acquisition training incorporated into secondary education. This may reduce the number of young adults going into a risky vocation with little or no training, and the same time stemming down the tide of substance use among this population and possibly among the youth nationally.

Limitations

The rate of RTA among commercial motorcyclists reported in this study may be lower than the actual rate. Riders who were dead or had major impairment were not captured in this study. Nevertheless, this provides a likely rate among those who are active road users. Future studies may also consider records from hospitals as well as from the police, particularly in estimating the level of fatality among commercial motorcyclists. Again, this is a cross-sectional study and where the exposure and outcome were simultaneously assessed, therefore, making it difficult to ascertain causality between substance use and the occurrence of RTA. As with self-reported survey, data were subjected to biases, some participants may have provided socially acceptable answer rather than being truthful about their experiences. However, biases were limited by explaining the purpose of survey to each participant and by assuring each participant of the confidentiality of every information given.


  Conclusion Top


There is a high rate of RTA among commercial motorcyclists studied, with most reporting a major accident that required some form of hospital care and fatality. The study also identified alcohol and other substances to increase the risk of RTA among commercial motorcyclists. In addition to other factors, an effort aimed at reducing RTA among commercial motorcyclists should also focus on reducing substance use among this segment of the population. This will also go a long way in reducing the burden on already over-burdened healthcare system and at the same time reducing years lost to disability.

Acknowledgments

We appreciate the leadership of commercial motorcyclists' association of Ado-Ekiti for their support during data collection. Our appreciation also goes to clinical psychology interns who assisted in data collection.

Financial support

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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