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Table of Contents
Year : 2022  |  Volume : 13  |  Issue : 1  |  Page : 29-32

Road traffic injuries among schoolchildren from Rural and Urban Districts of South India: A cross-sectional study

Department of Public Health, Rajiv Gandhi Institute of Public Health and Centre for Disease Control, Rajiv Gandhi University of Health Sciences, Bengaluru, Karnataka, India

Date of Submission11-Jun-2021
Date of Decision31-Jul-2021
Date of Acceptance21-Sep-2021
Date of Web Publication24-Jan-2022

Correspondence Address:
Dr. Pallavi Sarji Uthkarsh
Department of Public Health, Rajiv Gandhi Institute of Public Health and Centre for Disease Control, Rajiv Gandhi University of Health Sciences, 4th T Block East, Jayanagar, Bengaluru - 560 041, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/injms.injms_71_21

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Introduction: Children are prone to road traffic injuries (RTIs) while commuting to school as pedestrians, bicyclists, motorcyclists, and occupants of vehicles. Understanding these injuries is crucial for planning injury prevention programs. There is not much data available regarding RTIs among schoolchildren during commute to schools in the urban and rural areas of South India, and the current study is an attempt to explore the burden of RTIs among schoolchildren. Objectives: The aim of the study was (1) to assess the magnitude of RTIs among rural and urban school children while commuting to schools and (2) to determine factors affecting RTIs among school children. Materials and Methods: A cross-sectional study was conducted in urban and rural districts of a state in South India, a pretested, semi-structured, self-administered questionnaire was used to collect data and analyzed using SPSS version 20. Results: Magnitude of RTIs reported was similar in urban and rural districts. Children going to Government (public schools) reported more compared to the ones going to private schools. Male children and those accompanying other schoolchildren during commute to schools reported more injuries. Conclusion: Nearly one-fourth of the schoolchildren from Bangalore urban and rural districts reported RTIs during the past 12 months.

Keywords: Accident, injury, road behavior, road traffic injuries, schoolchildren, vulnerable road users

How to cite this article:
Babu Y R, Uthkarsh PS, Gangaboraiah A. Road traffic injuries among schoolchildren from Rural and Urban Districts of South India: A cross-sectional study. Indian J Med Spec 2022;13:29-32

How to cite this URL:
Babu Y R, Uthkarsh PS, Gangaboraiah A. Road traffic injuries among schoolchildren from Rural and Urban Districts of South India: A cross-sectional study. Indian J Med Spec [serial online] 2022 [cited 2023 Mar 31];13:29-32. Available from: http://www.ijms.in/text.asp?2022/13/1/29/336427

  Introduction Top

Road traffic injuries (RTIs) occupy 6th place in the top ten leading causes of death in India in the age group of 5–15 years,[1] it is quite alarming to know that nearly 13,270 people were injured in India near educational institutions due to road traffic accidents in the year 2015.[2] Karnataka stands second in place out of 13 states which contribute to the 87.2% of RTIs in India,[3] with 56,971 (11.4%) RTIs and more than 10,000 deaths every year due to road accident.[4] Children in India use road as pedestrians, cyclists, and two-wheeler occupants or might live close to the roads or even play or work on the roads, all these activities and other associated factors increase the risk of children to RTIs.[5]

So far, no study has been done in the state of Karnataka to understand RTIs among school children and hence, the current study has been undertaken to comprehend the burden of RTIs among schoolchildren in urban and rural districts of Karnataka.

  Materials and Methods Top

Study setting and sampling method

The study was done in two districts (Bangalore urban and rural) out of 28 districts of Karnataka state,[6] which have a population of nearly 10 million[7] and nearly 7159 schools which were divided into three divisions by Department of Education for administrative reasons as - Bangalore urban North, Bangalore urban South, and Bangalore rural.

Bangalore urban North was further divided into four subdivisions, Bangalore urban South was divided into five subdivisions, and Bangalore rural district was divided into four subdivisions. From each division, one subdivision was randomly chosen using a lottery method. From each subdivision, two government and two private schools, i.e., 12 schools were randomly selected by a lottery method.

Sample size of 627 students was calculated using the formula n = (4pq/d2) with the prevalence of RTI's in schoolchildren during school commute based on previous studies, i.e., P = 0.17, at 95% CI and precision d = 0.03.

Ethical clearance

Ethical clearance was obtained from the Institutional Ethical Committee of Rajiv Gandhi Institute of Public Health and Centre for Disease control, Rajiv Gandhi University of Health Sciences and necessary permission and parental consent obtained.

Method of collection of data

Data were collected in person by visiting the selected schools from students of 6th, 7th, 8th, and 9th standards. Schoolchildren from 6th to 9th standard (11–14 years age group) were selected for the study because this is typically an age when children may be expected to travel independently.[8] Students who were not willing to participate, students whose parents had not given consent, and students who were absent during data collection period were excluded from the study.

Information regarding RTIs, travel pattern, and travel behavior was collected through a pretested, semi-structured questionnaire in a local language prepared by a review of literature[8],[9],[10] was pilot tested, and distributed to children after briefing the purpose of the study and explaining each variable in the questionnaire. Questionnaire was sent home to be filled with the help of parents after the consent and collected next day morning. Nearly 780 students were given questionnaires, among them 675 students returned the filled forms with consent.

Statistical analysis

Data were analyzed using SPSS version 20 IBM SPSS Statistics Version 2020. Descriptive variables were presented in the form of frequency and percentages. Z-test and Pearson's Chi-square tests were used to test significance of the association. Logistic regression analysis was done to find out the factors associated with RTI's.

  Results Top

More than one-fourth of the schoolchildren reported RTIs while commuting to schools in both urban and rural settings [Table 1]. Injuries to the extremities (>60%) were the most common [Table 2]. Nearly half of the injured children in both urban and rural setting reported that they were admitted to a hospital for a day or more [Table 2].
Table 1: Urban and rural: Road traffic injuries

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Table 2: Road traffic injury characteristics among schoolchildren of Bangalore

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Factors affecting road traffic injuries

Univariate binary logistic regression was done to know the impact of exposure variables such as type of the district (rural/urban), gender, type of school (private or government), crossing main roads to reach school, type of accompaniment, mode of travel to school, distance of school from home, and duration taken to reach school, in relation to RTIs [Table 3]. The variables such as district, mode of travel to school, distance, and duration did not show significance in the univariate binary logistic regression.
Table 3: Univariate binary logistic regression for selecting significant variables

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With females as reference category, males had 1.59 times higher risk of exposure to RTIs which is statistically significant [Table 4]. With private schoolchildren as reference category, Government schoolchildren had 1.50 times higher risk of exposure to RTIs which is statistically significant [Table 4]. With schoolchildren who never crossed main roads to reach schools as reference category, schoolchildren who always crossed main roads to reach their schools had 1.93 times higher risk of exposure to RTIs and schoolchildren who sometimes/rarely crossed main roads to reach their schools had 1.98 times higher risk of exposure to RTIs, which is statistically significant [Table 4]. With children accompanied by a family member to reach their schools as reference category, children travelling with other schoolchildren had 2.3 times higher risk of exposure to RTIs which is statistically significant [Table 4].
Table 4: Binary logistic regression to determine factors affecting road traffic injuries

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  Discussion Top

Change in lifestyle and infrastructure has made RTIs a major public health problem,[1],[2] especially among young lives. Clear understanding of the RTIs among school-going children is need of the hour to plan effective interventions.

In this study, it was observed that the magnitude of RTIs which occurred in the past 12 months during school commute was 26.2% (25.8% in Bangalore urban district and 27.1% in Bangalore rural district). From these two Bangalore districts, the magnitude of RTIs occurred during the past 12 months was 31% and 21.5% among government and private schools, respectively. Government schoolchildren were found to be 1.5 times more at risk for RTIs than private schoolchildren in Bangalore, it might be due to private schools having school buses for the commute while none of the government schools have that facility. A study conducted by Shailaja et al. found that the overall prevalence of self-reported road injury in the past 12 months during school journeys among schoolchildren studying from 6th to 9th standard was 17% (95% CI 12.9% to 21.7%) and higher proportion of boys (25%) reported a road injury than girls (11%).[11] A retrospective study was conducted at the casualty services of the hospital in two parts in the Trauma Center at NIMHANS, Bangalore by Pruthi et al., in which 529 consecutive pedestrians who sustained injury in a road traffic accident were studied and retrospectively analyzed and found to be pediatric and elderly age groups constituted 47.6% (252/529) of all casualty admissions.[12] In the study conducted by Posner et al., it was found that, out of the total sample of children who were treated at the emergency department for pedestrian injuries, 15% (21/139; 95% CI 10% to 22%) were hit while walking enroute to or from school.[13]

In this study, it was observed that extremities were the most common body parts to be injured (74.6% in Bangalore urban district and 67.8% in Bangalore rural district), followed by head-and-neck region and then face. The study undertaken by Menon et al. in 2007, by the Department of Epidemiology, NIMHANS, Bangalore, and the Department of PSM, BJMC, Pune regarding prospective data on morbidity and mortality due to injuries showed that, among the road traffic victims, 42.1% of the injuries affected the lower limbs, upper limb injuries were reported by 33.7% victims, followed by head injuries and then face injuries. The upper and lower limbs and head injuries were the most frequent among the two-wheeler riders.[14] A cross-sectional study conducted at Nagpur, a city in central India, by Ganveer and Tiwari among 423 nonfatal cases of road traffic accidents reporting for the treatment to Indira Gandhi Medical College, Nagpur during 1999–2000 showed that lower extremity was involved in 192 (45.39%) cases, while multiple sites were affected in 114 (26.95%) cases.[15]

It was observed in the present study that male schoolchildren were 1.59 times at more risk for RTIs than female schoolchildren. Even in the study conducted by Kumar et al., it was found that, out of 366 RTA cases, 362 (98.9) were males and the remaining 4 were females indicating a large majority of male predominance in victims.[16] Burden, pattern, and outcomes of RTIs in a rural district of India, by Gururaj et al. showed that young males were affected most by RTIs,[17] even the study done by Uthkarsh et al. in a South Indian district showed the risky road usage behavior associated with the male gender.[18] The reason for this need more in-depth understanding in the gender behavior of the road user.

Limitations of the study

As data on RTIs experienced in the past 12 months were collected through a questionnaire which was filled by students with the help of their parents/guardians, chances of recall bias might be a limitation.

  Conclusion Top

Nearly one-fourth of the schoolchildren irrespective of the urban or rural districts reported RTIs while commuting to the school. Male gender, government schools, and not being accompanied by elder were found to be strongly associated with RTIs.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Mohan D, Tiwari G, Bhalla K. Road safety in India:Status Report 2017. New Delhi:Transportation Research and injury prevention programme, IIT Delhi; 2015. p. 93.  Back to cited text no. 1
NCRB, Ministry of Home Affairs I. Accidental Deaths and Suicides in India 2015. NCRB, Ministry of Home Affairs; 2016. p. 342. Available from: http://ncrb.nic.in/StatPublications/ADSI/ADSI2015/adsi-2015-full-report.pdf. [Last accessed on 20 Dec 2019].  Back to cited text no. 2
Road accidents in India 2015. IATSS Res 2009;33:75-9. Government of India, Ministry of road transport and highways. Available from: www.morth.nic.in. [Last accessed on 2017 Jul 15].   Back to cited text no. 3
Karnataka Government Secretariat; 2015. p. 8. Available from: http://www.karnataka.gov.in/roadsafetycell/Policies/Karnataka StateRoadSafetyPolicy2015.pdf. [Last accessed on 2020 Sep 18].  Back to cited text no. 4
WHO UNICEF. World Report on Child Injury Prevention. Vol. 14. World Health Organisation, Geneva; 2008. p. 203. Available from: http://apps.who.int/iris/bitstream/10665/43851/1/9789241563574_eng.pdf. [Last accessed on 2020 Sep 18].  Back to cited text no. 5
Karnataka. Available from: https://en.wikipedia.org/wiki/Karnataka. [Last accessed on 2020 Sep 22].  Back to cited text no. 6
Bangalore. Available from: https://en.wikipedia.org/wiki/Bangalore. [Last accessed on 2019 Apr 15].  Back to cited text no. 7
Hillman M, Adams J, Whitelegg J. One False Move. Study of Children's Independent Mobility. PSI publications, London; 1990. p. 187. Available from: http://john-adams.co.uk/wp-content/uploads/2007/11/one false move.pdf. [Last accessed on 2018 Jun 06].  Back to cited text no. 8
Tetali S, Edwards P, Murthy GV, Roberts I. Development and validation of a self-administered questionnaire to estimate the distance and mode of children's travel to school in urban India. BMC Med Res Methodol 2015;15:1-7.  Back to cited text no. 9
Mendoza JA, Watson K, Baranowski T, Nicklas TA, Uscanga DK, Hanfling MJ. Validity of instruments to assess students' travel and pedestrian safety. BMC Public Health 2010;10:257.  Back to cited text no. 10
Tetali S, Edwards P, Murthy GV, Roberts I. Road traffic injuries to children during the school commute in Hyderabad, India: Cross-sectional survey. Inj Prev 2016;22:171-5.  Back to cited text no. 11
Pruthi N, Ashok M, Shiva KV, Jhavar K, Sampath S, Devi BI. Magnitude of pedestrian head injuries and fatalities in Bangalore, South India: A retrospective study from an apex neurotrauma center. Indian J Med Res 2012;136:1039-43.  Back to cited text no. 12
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Posner JC, Liao E, Winston FK, Cnaan A, Shaw KN, Durbin DR. Exposure to traffic among urban children injured as pedestrians. Inj Prev 2002;8:231-5.  Back to cited text no. 13
Menon GR, Gururaj G, Tambe MP, Shah B. A Multi-sectoral approach to capture information on road traffic injuries. Indian J Community Med 2010;35:10.  Back to cited text no. 14
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Ganveer GB, Tiwari RR. Injury pattern among non-fatal road traffic accident cases: A cross-sectional study in central India. Indian J Med Sci 2005;59:9-12.  Back to cited text no. 15
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Srinivasa Kumar PV, Srinivasanan K. To study the socio demographic profile of road traffic accident victims in district. IJRDH 2013;1:136-40.  Back to cited text no. 16
Gururaj G, Uthkarsh PS, Rao GN, Jayaram AN, Panduranganath V. Burden, pattern and outcomes of road traffic injuries in a rural district of India. Int J Inj Contr Saf Promot 2016;23:64-71.  Back to cited text no. 17
Uthkarsh PS, Kraft T, Merode FV. Young road users in a district of south India: Gender differences in behaviour and perceptions. Int J Community Med Public Health (Gujarat) 2020;7:2393-9.  Back to cited text no. 18


  [Table 1], [Table 2], [Table 3], [Table 4]


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