Essay: INJURY PATTERNS AMONG COMMERCIAL MOTORCYCLE USERS ATTENDING THIKA LEVEL V HOSPITAL, THIKA, KIAMBU COUNTY

ABSTRACT
More than 1.25 million lives are cut short due to road traffic injuries. They are the 9th leading cause of death with 2.2% of all deaths globally for persons aged between 15 and 29 years. Developing countries have around 54% of the world’s vehicles, but have 90% of the world’s road fatalities. These crashes incur countries 3% of their gross domestic product (WHO, 2004). In Kenya, it incurs them 5.6% of GDP that approximately 300 billion Kenya Shillings (NTSA, 2016). Motorcycle injury is becoming one of the most serious problems in developing countries where motorcycle is used for transportation because it’s cheap and fast access to areas not accessible by motor vehicles. Motorcycle users are highly endangered on the road and should be a targeted group in order to reduce road traffic injuries (Solagrebu et al., 2006). Even in developed countries, the risk of dying from a motorcycle injury is 20 times higher when compared to motor vehicle injury (Peden, 2004; Solagrebuet al., 2006).
In Kenya motorcycle crashes, injuries and deaths are putting a heavy burden generally on communities and the health system since those affected by the accidents are mostly in their productive years (15-44) leading to a drain on the country’s human resources. When a head of household is injured or dies due to motorcycle injuries the family is forced into poverty and psychological torture. Motorcycle riders are endangered since they lack safety devices such safety belts and airbags as opposed to motor vehicles (Hurt HH et.al., 1981). Hence they are at risk of more serious and multiple injuries.
This study aims at determining injury patterns among commercial motorcycle users attending Thika Level V Hospital, Kiambu County, Kenya. A descriptive cross-sectional study will be sought to determine injury patterns among commercial motorcycle users attending Thika Level V Hospital, Kiambu County Kenya. 367 commercial motorcycle crash victims will be recruited into the study. Data will be collected using a semi-structured, interviewer-administered questionnaire, analyzed and presented in form of tables and charts.
CHAPTER ONE
BACKGROUND AND CONTEXT
Study background
More than 1.25 million lives are cut short due to road traffic injuries. They are among the leading causes of death (ranked at 9) with 2.2% of all deaths globally for persons aged between 15 and 29 years. Developing countries have around 54% of the world’s motor vehicles, but they have 90% of the world’s road fatalities. Countries suffer a loss of about 3% of their gross domestic product due to these crashes (WHO, 2004). In Kenya, it incurs them 5.6% of GDP that approximately 300 billion Kenya Shillings (NTSA, 2016). Motorcycle injury is becoming one of the most serious problems in developing countries where motorcycle is used for transportation because it’s cheap and fast access to areas not accessible by motor vehicles. Motorcycle users are highly endangered on the road and should be a targeted group in order to reduce road traffic injuries (Solagrebu et al., 2006). Injuries are the leading causes of death in all age groups and for both male and female (Krug, E., Gyanendra, K., & Lozano, R., 2000). Even in developed countries, the risk of dying from a motorcycle injury is 20 times higher when compared to motor vehicle injury (Peden, 2004; Solagrebuet al., 2006).
According to NHTSA, the U.S. Department of Transportation, there was a 5% decrease in motorcyclist injuries in 2013, from approximately 93,000 injured motorcyclists in 2012 to 88,000 injured motorcyclists. In the last decade in India, motorcycling has increased rapidly. The data maintained by the Ministry of Road Transport and Highways indicates that there is an almost 3 % increase in total road deaths since the previous year, the death percentage of motorcycle users being the highest at 33.9 % in the year 2014. It has also been approximated that the annual incidence for non-fatal road traffic due to motorcycle use to be 6.3% in Hyderabad for the age groups 5 ‘ 49. This shows the extent of burden of road traffic injuries amid motorcycle users (Dandona, R., et al., 2008).
Africa has the highest road fatality rates globally despite having 2% of the world’s vehicle at 24.1 deaths per 100,000 population (WHO, 2013). In Kenya motorcycle crashes, injuries and deaths are putting a heavy burden generally on communities and the health system since those affected by the accidents are mostly in their productive years (15-44) leading to a drain on the country’s human resources. When a head of household is injured or dies due to motorcycle injuries the family is forced into poverty and psychological torture (Hurt HH et.al., 1981). 3055 road traffic deaths was reported in 2010 about 7% were motorcyclists (NTSA, 2010). In the last 6 years, the number of registered motorcycles has increased. In 2011 70% of all newly registered vehicles were motorcycles. Between 2005 and 2010 there has been an increase, of about 5times, in motorcycle-related deaths (NTSA, 2010).
Injuries to motorcyclists are an important but neglected health concern. Motorcycle riders have the highest health burden expressed in disability adjusted life years lost. The prevalence of motorcycle injuries varies around the world according to the collected reports. Vietnam having 62%, Nigeria prevalence ranging from 12.8-60% have been reported (NHTSA, 2007), China having 22.8% (Zhang J Motorcycle, 2004) and in Kenya 39.4 %. Motorcycle riders are endangered since they lack safety devices such safety belts and airbags as opposed to motor vehicles (Hurt HH et.al., 1981). Hence they are at risk of more serious and multiple injuries. Wearing of safety gear such as helmets increases the chances of survival in case of an accident and jackets with reflectors significantly reduce incidence of crashes. Alcohol consumption, poor weather conditions leading to poor visibility, night riding and poor roads are associated with a higher incidence of crashes (Mullins B, Norton R, et al., 2004). Motorcyclists have a tendency of over-speeding and over loading their motorcycles in order to make several returns in a day. They are known to be undisciplined and most don’t wear protective gear such as helmets leading to aggravation of risks of getting severe head injuries (Crompton JG, Oyetunji TA et al., 2012).
Motorcycle injuries are underreported from developing countries especially injury patterns, demographic and host characteristics of the injured commercial motorcycle users. Road traffic injuries, globally, are accountable for a significant portion of all injury morbidity and mortality and 90% of the mortalities are seen in developing countries (Pedenet al., 2002). Therefore this study will be carried out so as to establish the injury pattern among commercial motorcycle users attending Thika Level V Hospital.
Problem Statement
Injuries attributed to motorcycle account for a substantial number of road traffic injuries seen at Thika Level V Hospital. Compared to vehicle users, motorcycle riders and their passengers are relatively unprotected from accidents per kilometres travelled and have a higher chance of serious injuries or deaths. The emergent boom of commercial motorcycle use (commonly known as ‘bodaboda’) in the country raises serious safety concerns. The popularity of these commercial motorcycles are due to their fast means of transport particularly over short distances, their efficiency in dodging traffic jam in major cities and there are availability 24/7. Their operation is usually characterized with lack of valid licensing among riders, no use of helmets and passenger overload to enhance faster return for more passengers. The high number of Motorcycle crashes has put a strain on the health facilities in the rural areas that are ill equipped to deal with these crashes.
Prior researches have been based on crash and injury helmet use, limited geographic regions and majorly hospital based. Most hospital-based surveys report on motorcycle injuries in Kenya have been carried out in Nairobi as record reviews, but they don’t entail details on the severity of the injuries hence contributed to the lack of knowledge on the magnitude of the motorcycle road traffic injuries.
Justification of the study
Motorcycles operate efficiently compared to other transport means in terms of accessessibility and financial status hence they are a bridge in the transport system in Kenya. There has been a substantial increase in number of injuries caused by motorcycles. This is due to their lack of physical protection and other factors placing them in a vulnerable state that makes it easy for them to be injured once they are involved in a collision. Injuries affiliated to motorcycle use are among the road traffic injuries seen at Thika Level V Hospital. They lead to a substantial loss of lives and resources. At this rate, the motorcycle for quite a while will remain to be a key player as a means of transport and action needs to be taken to make it as safe as possible.
The lack of existing data demands a further investigations into the injury patterns and risk factors influencing the occurrence of commercial motorcycle injuries in this environment (Thika Town). This study will add on to existing documentation to make the motorcycle transport system safer by founding out on the injury patterns among motorcycle users attending Thika Level V Hospital. It also demonstrates the risk factors, incidence and knowledge on safety practice among commercial motorcycle users.
Research Objectives
General Objective
To determine the injury patterns among commercial motorcycle users attending Thika Level V Hospital, Thika, Kiambu County.
Specific Objectives
To determine incidences of injuries among commercial motorcycle users attending Thika Level V Hospital, Thika, Kiambu County.
To assess risk factors associated with injuries among commercial motorcycle users attending Thika Level V Hospital, Thika, Kiambu County.
To describe injury patterns among commercial motorcycle users attending Thika Level V Hospital, Thika, Kiambu County.
To explore the knowledge, practice safety measures and causes of motorcycle injury among commercial motorcycle users attending Thika Level V Hospital, Thika, Kiambu County.
Research Questions
What are the incidences of injuries among commercial motorcycle users attending Thika Level V Hospital, Thika, Kiambu County?
What are the risk factors associated with injuries among commercial motorcycle users attending Thika Level V Hospital, Thika, Kiambu County.
What are the injury patterns among commercial motorcycle users attending Thika Level V Hospital, Thika, Kiambu County?
What is the knowledge of safety practice and causes of motorcycle injury among Commercial motorcycle users attending Thika Level V Hospital, Thika, Kiambu County?
Conceptual Framework
Independent Variable Intervening Variables Dependent Variable
Commercial Motorcycle User Motorcycle Injury
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CHAPTER TWO
LITERATURE REVIEW
Introduction
Motorcycle is a two wheeled vehicle at times three wheeled used for transporting one to two riders. One has to acquire a motorcycle license in order to ride a motorcycle on roads and special skills to ride them since braking and handling on wet or slick surfaces require extra caution in handling them. They provide a convenient, higher fuel economy, manoeuvrable and inexpensive alternative to automobiles. There are different variety of motorcycles for different purposes.
Incidences of motorcycle accidents
Motorcycles are a popular means of transport in low and middle income earning countries (WHO, 2006). Because they are cost effective compared to other vehicles in terms of sale and maintenance costs (Solagberu et al., 2006) and efficient in that they easily dodge traffic jam. In Thika, the commercial motorcycle as a means of employment is booming as evidenced by seeing the motorcyclists’ park at different locations as they await passengers. Some study done by in Nigeria (Solagberu et al., 2006) showed that commercial motorcycle was expanding in means of employment as one could earn sufficient money for daily living. Kenya in the last 6 has evidenced an increase in number of registered motorcycles. Regardless of the advantages of commercial motorcycles, a large part of those injured or killed on the roads are the motorcyclists as they are less visible compared to the other fast moving, heavier and bigger motor vehicles which they often share the traffic space with. They also lack physical protection making the motorcyclists and their passengers at high risk of being injured if involved in a collision (WHO, 2006). They are also at much higher risks of fatalities when involved in crashes as compared to other motor vehicles (Deutermann, 2004).
In 2011, 70% of all newly registered vehicles were motorcycles in Kenya (NTSA, 2010), 67% in Taiwan, 60% in Malaysia and 95% in Vietnam (Hung et al., 2006). In Malaysia and Taiwan motorcycle crash deaths were more than 50% of traffic deaths (Radin-Umar et al., 1996), 42% in Singapore and 80% in Thailand (Wong et al., 1990b). In the U.S. about 2% of all registered motor vehicles are motorcycles (NHTSA, 2007) because they are used for recreation most of the times and not commercial use. The difference in developing and developed countries motorcycle accidents include: most of the motorcycles in developed countries are scooters (Salatka et al., 1990) and scooter injuries differ from those for motorcycles (Salatka et al., 1990), the roads in developing countries are unique e.g. traffic is made up of a mixture of motor vehicles, rickshaws, bicycles, animal-driven vehicles, animals etc. (Sahdev et al., 1994) and finally, the incorrect use or absence of safety devices among motorcycle riders in developing countries. A study done in Indonesia and China showed that about a third of motorcycle riders had either incorrectly fastened helmet helmets or substandard helmets (Conrad et al., 1996). This is because of substandard knowledge and poor law enforcement (Liu et al., 2008).
Differences of motorcycle injuries incidences between the developed countries and developing countries is largely based on number of motorcycle riders, type of motorcycle, purpose of riding the motorcycle, the amount of riding exposure, road engineering and intervention programs provided (Forjuoh, 2003).Hence, if these differences are not taken into consideration it might not be practical for the use of commercial motorcycle in developing countries (Forjuoh, 2003).
Risk factors of motorcycle injuries
Helmet use among riders
Helmets are made of a rigid fiberglass, a foam liner and a chinstrap .Helmets reduced the risk of motorcycle deaths caused by head injuries. There was evidence of effectiveness increase up to 37% between the years 1993 to 2002 due to the upgrade of materials and design used in making helmets (Deutermann, 2004). Non helmeted riders were likely to sustain head injuries and skull fractures 2.4-times more compared to helmet users (Gabella et al., 1995). Types of helmets in existence; full face, full coverage, and half coverage (Tsai et al., 1995) but differences in their effectiveness have not been well explained.
Occasionally, injuries to neck and basal skull is found in helmeted riders hence rising speculations as to whether to its safe to use them (Konrad et al., 1996). Secondly, there has been raised concerns on the effects of helmet on the rider’s vision and hearing. Studies have shown that there is an effect on the lateral vision of the riders but it is small and is compensated by increased head rotation during turns hence hearing and visual acuity are not very majorly affected by the use of helmet (McKnight, 1995). Finally, another issue is whether the extra mass added on the head by helmet has an increased risk of a crash (Bishop et al., 1983).
Inexperience and training among riders
Inexperience among riders is affiliated with risk of motorcycle crashes (Wong et al., 1990a). However, there was no significant reduction of motorcycle crashes between riders who had partaken in formal training and those who didn’t receive a training course (Rutter and Quine, 1996). There are possible explanations as to the advantages of formal training on decreasing motorcycle crashes and injuries. A survey done in the United Kingdom showed that the youth played a major role than inexperienced riders in motorcycle crashes and injuries .This is due to a pattern of risk taking behaviours that include urge to violate laws governing the safety of riding motorcycle (Rutter and Quine, 1996). Risk homeostasis or risk compensation theory explains that trained riders have confidence in their operating skills to ride with more risk taking behaviours (Wilde, 1998). Nevertheless, there has been no study that directly examines the interpretability of this theory.
Alcohol and other drug use among motorcycle riders
Alcohol is mostly associated with all kinds of motor vehicle crashes (Villaveces et al., 2003). There has been a recent shift in the peak rate of alcohol in the United Stated to those aged 40 -44yrs from 15- 29years (Paulozzi and Patel, 2004). Motorcycle riders under the influence of alcohol involved in an accident are more likely to have not been wearing a helmet and lost control of their motorcycle leading to serious head injuries (Zambon & Hasselberg, 2006b). There has been a suggestion for a reduction in the legal limit of blood alcohol concentration for motorcycle riders since they are required to operate on an unstable vehicle due to the alcohol effect on their motor coordination, balance and judgement skills (Sun, Kahn, & Swan, 1998).
During 1990 to 1991, 32% of motorcycle riders treated in Maryland Trauma had consumed marijuana before they were involved in the crash, which was 2.7% higher than car drivers treated (Soderstrom et al., 1995). A combinations of alcohol and either cocaine, benzodiazepines, or cannabis was seen in about a third of the young aged injured motorcycle riders (Cimbura et al., 1990).
Licensure and ownership among motorcyclists
Only 75% of fatally injured motorcycle riders had a valid license (NHTSA, 2007). Younger riders aged 20 years are among the lowest rate licensure (Kraus et al., 1991). Proof of valid license before purchase of a motorcycle, increasing the age in obtaining a motorcycle license and heavy penalties for motorcycle riders without license are among the countermeasures for lack of a valid license (Reeder et al., 1995). For riders between 15 and 19years in the United States, graduated rider licensing systems were significantly effective in decreasing motorcycle injuries and deaths (McGwin et al., 2004).
Risk-taking behaviour among motorcyclists
The risk-taking behaviour of young riders such as not using helmet, driving under the influence, speeding, unlicensed riding, driving on stop signs and riding with too little headway between vehicles contribute to risk of motorcycle injuries (Rutter and Quine, 1996). Young aged riders tend to overestimate the chance of them being killed in and underestimate the chance of being involved in a crash (Leaman and Fitch, 1986). Even after being involved in a crash, the risk perception of adolescent riders neither reduce nor modify their risk-taking behaviours (Mangus et al., 2004). These behaviours among young person’s usually an expression of freedom, relieving stress and aggression and impressing there peers (Hodgdon et al., 1981).
Conspicuity and daytime headlight laws among motorcycles
Two-thirds of car drivers involved in car ‘ motorcycle collision claimed to have seen the motorcycle too late or not have seen it at all (Hodgdon et al., 1981). During daytime the use of high/ low beam headlights has improved the conspicuity of motorcycle riders than devices such as wind fairing and reflective jackets (Olson et al., 1981). Daytime use of headlights has been recommended to increase motorcycle riders safety; however, this have not been found to reduce motorcycle crash injuries (Yuan, 2000).
Riding speed among motorcyclists
High speeds during the time of crash has very serious motorcycle injuries (Kraus et al., 1975). Studies done in Los Angeles County involving 900 motorcycle crashes, 40% happened at speeds of 0’20 mph with a crash fatality of 17%, 30% at crash speed of 21’30mph with a crash fatality of 21%, 14% at crash speed of 30’40mphwith crash fatality of 37% and 16% at crash speed of 41mph and crash fatality of 25% (Kraus et al., 1975; NHTSA, 2008b). Fatal crashes by speeding motorcyclists in the United States was almost twice the rate for drivers of other motor vehicles (NHTSA, 2008a). At high speeds injuries can occur (Feliciano and Wall, 1991) due to deceleration. Slow speeds and inappropriate speeding in traffic initiate two vehicle collisions (Lardelli-Claret et al., 2005). It was evaluated that riding on highways with speeds greater than 55 mph, they were more likely to die in crashes 3-7 times more compared to those driving at low speeds (NHTSA, 1993). Existence of police patrol, checkpoints, speed limits and speed control camera can control the road user’s behaviors hence decreasing accidents (J”rgensen and Abane, 1999).
Environmental factors
Contributors to road accidents including road design, its geographic location, visibility, weather, time of the day and traffic regulations (Bjornskau et al, 2000). Well-constructed roads with different lanes for cyclists and with all important signs are much safer. These road signs should be clear, visible and convey the intended message to the driver. Barriers to discourage pedestrians and cyclists to motor roads reduces the rate of injuries.
General motorcycle injury patterns
Multiple injuries are sustained in a motorcycle crash (Bachulis et al., 1988).The most frequent is head injuries (Kraus, 1989). The second commonest is chest injuries comprising of 7% and abdominal injuries comprising of 25% (Ankarath et al., 2002). Cervical and spinal injuries occur mostly in fatal crashes (Wyatt et al., 1999). The commonest site of injury in all non-fatal motorcycle crashes is the lower extremity (Wladis et al., 2002). The most injured spinal region is the thoracic spine in motorcycle crashes (Ankarath et al., 2002).
Head injuries
They are the leading cause of mortality in motorcycle crashes particularly in head on collision and helmeted riders (Ankarath et al., 2002). 53% of motorcycle deaths in the United States between 1979 and 1986 were an outcome of head injuries (Sosin et al., 1990). Concussions, contusions, skull fractures, facial fractures and haemorrhage are the most common head injuries (Kraus and Peek, 1995a). Deceleration forces cause brain injuries for example vascular, diffuse axonal or concussive brain injuries especially with rotational kinetics (Feliciano and Wall, 1991). Basal skull fractures and intracranial hematomas are the most frequent brain injuries noted in persons with cervical injury.
Lower-extremity injuries
The commonest injuries in non-fatal motorcycle crashes are lower extremity injuries and they affect about 30 to 70% of injured riders and they have poor outcomes in aspects of disability, financial costs and the return to full functionality (Shankar Ramzy, & Soderstrom 1992; Peek et al., 1994). Tibia is the commonest site of lower extremity injury then the femur, foot, and patella (Peek et al., 1994).
Protection devices
Daytime running lights (DRLs).
A study done to examine the effectiveness of DRLs on crashes involving company buses showed that there was decrease rate of crashes occurring during daytime by 40% compared to the year prior to implementation (Allen, M.J., 1970). In the Franklin Institute Report the author and colleagues concluded that there is increased conspicuity of motorcycles when high and low beam headlights were used as evidenced by their decreased crash involvement (Janoff, M.S., Cassel, A., Fertner, K. S., & Smierciak, E. S., 1970). A couple of studies provide supporting proof that the use of DRLs during daytime hours decreases the chances of being involved in a crash compared to those who don’t use them (Cairney, P., & Styles, T., 2003).
Headlight modulators
There are possibilities in increase in conspicuity of a motorcycle by the use of headlight modulators (Levine, M.W., 2000). The use of low or high beam headlights and modulating headlights during daytime and night-time significantly improves the conspicuity of a motorcycle (Olson, P.L., & Sivak, M., 1981). Research on effects of headlights on conspicuity of motorcycle is severely lacking (Janan, A.S., & Lorenzo, I. T., 2010).
Helmet
Helmets are made of a rigid fiberglass, a foam liner and a chinstrap .Helmets reduced the risk of motorcycle deaths caused by head injuries. There was evidence of effectiveness increase up to 37% between the years 1993 to 2002 due to the upgrade of materials and design used in making helmets (Deutermann, 2004). Non helmeted riders were likely to sustain head injuries and skull fractures 2.4-times more compared to helmet users (Gabella et al., 1995). Types of helmets in existence; full face, full coverage, and half coverage (Tsai et al., 1995) but differences in their effectiveness have not been well explained.
Occasionally, injuries to neck and basal skull is found in helmeted riders hence rising speculations as to whether to its safe to use them (Konrad et al., 1996). Secondly, there has been raised concerns on the effects of helmet on the rider’s vision and hearing. Studies have shown that there is an effect on the lateral vision of the riders but it is small and is compensated by increased head rotation during turns hence hearing and visual acuity are not very majorly affected by the use of helmet (McKnight, 1995). Finally, another issue is whether the extra mass added on the head by helmet has an increased risk of a crash (Bishop et al., 1983).
Causes of motorcycle injuries
Behaviors’ and skill of the driver determines the good control of vehicles (Muhlrad et al., 2005). Human errors such as misjudgment, ignorance, carelessness, incompetence and rule violation are a major contributor to road traffic accidents (Leeming, 1969). (Jorgensen and Abane, 1999) noted that one can differentiate between driving skills and driving style which are reflectors of attitudes and traffic risk perception. Training increases driver’s skills. (Asongwa, 1992) revealed that a large proportion of drivers who owned driving licenses bought their licenses. They never attended any driving school or undergone a driving test. Stopping distance in emergency conditions is crucial and it’s determined by the driver’s reaction time, skills of the driver, speed of the motor vehicles, tyre quality and condition of the road (Lemming, 1969). The following factors are contributors to motorcycle crashes; lack of certified driver training, lack of valid licensing, over speeding and reckless driving, poor law enforcement and regulation, not using helmets by riders and their passengers, poor use of conspicuity measures such as reflectors, daytime headlights, overloading, and use of alcohol and drugs when driving (Odero, 2009).
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CHAPTER THREE
METHODOLOGY
Study Area
The study will be carried out at Thika Level V Hospital. Thika Level V Hospital is a teaching and referral hospital located in Thika Town, Kiambu County. From just a simple health centre with basically essential services, it has grown to a leading public health institutions in the country, serving about 60-70% referral cases from the neighbouringGatundu, Ruiru and Juja Sub-counties, Murang’a, Machakos and Nairobi Counties and the Northern Frontier County of Garissa. It provides health services to about 20,000 inpatients and 350,000 outpatient annually.
Study design
This study will adopt a descriptive cross-sectional study of patients with commercial motorcycle crash injuries of all age groups and gender presenting at the Accident and Emergency department and those admitted to the surgical wards of Thika Level V Hospital.
Study variables
The study develops its independent variables as commercial motorcycle users and dependent variable as motorcycle injuries. The interrelationship can be explained by the Haddon matrix which comprises of three time phases of an event that is pre-event, event, and post-event together with the areas influencing each of the crash phases, human, vehicle, and environment. Some risk factors such as age, gender, a low socioeconomic status, time of the day and seasons cannot directly be modified to reduce severity of motorcycle injuries or prevent their occurrence. But their influence can be seen through the amount of riding exposure and modifiable factors such as helmet wearing, driver training and skills, driver’s license and ownership, risk taking behaviours of the motorcyclists, use of conspicuity devices such as headlights and reflecting jacket, alcohol and other drug use and riding speed.
Study population
The study population will comprise of victims of commercial motorcycle crashes that will present at the Accident and Emergency department and those that have been admitted to the surgical wards of Thika Level V Hospital between 9th March 2018 and 13th April 2018.
Inclusion criteria
Victims of commercial motorcycle crashes that present to the accident and emergency department within 24hours of the motorcycle crash injury and are admitted to the surgical wards and that will give an informed consent.
Exclusion criteria
Victims less than 18years that present to the emergency and accident department and those who are admitted to the surgical wards without guardians to give informed consent will be excluded from the study. Also patients that are unwilling to consent to the study will be excluded.
Victims that present to the accident and emergency department after 24hours of the motorcycle crash injury.
Sample size determination
The standard statistical approach to determination of a sample size uses the fisher’s formula.
n=Z^2 P(1-P)/d^2
n= minimum sample size
z= constant, normal standard deviation (1.96 for 95% confidence level)
p= expected prevalence. Since there is no other study that has been conducted in the area, the prevalence used was from NTSA which puts motorcycle injury at 39.4%.
d- Accepted margin of error
z= 1.96
p= 0.394
1-p= 0.74
D= 0.05
n= 1.96^2 *0.394(1-0.394) /0.05^2
=367
The minimum sample size will be 367.
Sampling techniques
The Sampling Size will be obtained through stratified random sampling of commercial motorcycle crash injury patients who will present at the accident and emergency department and those who have been admitted to the surgical wards at Thika Level V Hospital.
Data collection tools
This study will be undertaken through the use of open ended structured questionnaires. The questionnaire is comprised of three sections. The first part includes the respondents’ demographic information. The second part describes the knowledge, safety, practice and risk factors regarding motorcycle injuries. The last section gives an estimate of the prevalence rate of accidents and injuries pattern among the respondents.
Pre testing of data collection tool
Validity
Content and face validity of the instruments will be determined before deployment. To check on the validity of the instruments the questionnaires as per the study objectives will be presented to the research supervisor who will scrutinize and advise on them. His input will be used to improve them through expert judgment (Borg and Gall, 1985).
Reliability
Reliability of research instruments is the extent to which results are consistent over time and are an accurate representation of the population under study (Joppe, 2000). The consistency of this study instruments will ascertain through pretest of the questionnaire at Mama Lucy Hospital, Nairobi County two weeks prior to the study, with a sample size of 20 injury victims to remove ambiguity and clarify response categories
Data Collection
Two trained researchers will be stationed at the accident and emergency department and surgical wards and they will apply the structured questionnaires and do data entry after they have obtained an informed consent. Data collected will be compiles all as charted in the questionnaires after they have completed.
Data management and analysis
Variables obtained will be organized into nominal, ordinal and ratio measurements. They will then be coded and filled in to frequency tables. Quantitative data will be summarized and analyzed. After cross tabulation of values for analysis, data will be presented in form of charts, graphs, tables, photographs and also in prose form.
Ethical Consideration
Before proceeding for data collection, the researcher will seek official consent from the administration of Mount Kenya University Ethical Research Committee. Once the go ahead will be given consent to carry out the study will be sought from the hospital administration. The researcher will also give the respondents adequate information about the study before issuing them questionnaires to allow them make an informed consent in giving out their information. The respondent’s individual rights and integrity will be safeguarded before, during and after data collection. The researcher will ensure confidentiality of all information obtained until authorized to disclose it.
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