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Journal of Primary Health Care & General Practice

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Research Article

Constraints Encountered in the Practice of Measures to Prevent the Occurrence of Motorbike Accidents by Riders in the Bamenda-ii Municipality of Cameroon

Bodzewan Emmanuel Fonyuy, Lange Innocent, Ngopewo Alphonsine

Correspondence Address :

Bodzewan Emmanuel Fonyuy
Ministry of Public Health of Cameroon National
Cameroon
Tel: (+237) 675 044 592
Email: ebodzewan@gmail.com

Received on: March 24, 2017, Accepted on: April 22, 2017, Published on: April 29, 2017

Citation: Bodzewan Emmanuel Fonyuy, Lange Innocent and Ngopewo Alphonsine (2017). Constraints Encountered in the Practice of Measures to Prevent the Occurrence of Motorbike Accidents by Riders in the Bamenda-ii Municipality of Cameroon

Copyright: 2017 Bodzewan Emmanuel Fonyuy. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract
According to the World Health Organization, motorbike related injuries killed an estimated 1.2 million people in Africa and injured more than 50 million others yearly. The number of people who die in bike related accidents will undergo a 144% increase between 2002 and 2020. Pedestrians and motorbike users get injured on the road more frequently and more severely than other road users. 
Motorcycle injuries constitute a major but neglected emerging public health problem in African countries and contribute significantly to the overall road traffic injuries. Motorcycle injuries are among the leading causes of disability and deaths and the main victims are the motorcyclists, passengers and pedestrians in the young reproductive age group.
The general objective of the study was to assess the knowledge of motorbike riders aged: 18-30 years on the causes and preventive measures put in place to prevent its occurrence in Bamenda-II Municipality. The study employed the descriptive cross sectional design with a sample size of 60 bike riders recruited for the study. 
A structured questionnaire comprising of both closed and open-ended questions was used to collect primary data for the study.
Results revealed that 30% said lack of road signs causes RTAs, 20% mentioned bad nature of the roads as the problem while 10% said tight traffic was their difficulty. On the tenable measures, 42.6% of the respondents said motorists should avoid being drunk when riding, 26% mentioned the control of speed of riders, 20.3% advocated for the regular maintenance of bikes, training of bike riders. The municipality staff should envisage organizing sensitization workshops with bike-riders so as to guarantee the security of the passengers they transport, the pedestrians and overall discipline in their activity.
Keywords: Road Traffic Accidents, Disability, Rehabilitation, Concussion, Motor-bike Injuries, Alcoholism, Over-speeding

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Introduction
An accident is defined as an event that is unplanned and undesirable that can be avoided if the circumstances leading up to its occurrences are identified and necessary precautions taken to prevent its occurrence. In the world today, accidents are very common and involve both the physical and non-physical aspects of life. Some physical examples of accidents include motor vehicle or bike collision, falls, touching hot and sharp items and ingestion of poisons. Some examples of non-physical accidents include unintentionally saying something incorrect and making a wrong decision [1].
Amongst the various types of accidents recorded in the world today, motorbike accidents have become very popular. The increase in the use of motorbikes in the continents of the world has also led to an increase in the number of accidents registered related to motorbikes. Across the world, motorbikes are used for recreational, personal and commercial activities. Motorcycles are mainly a luxury good in the developed world, while in developing countries; it has become a necessity due to its low cost and consumption. Economically, motorbikes have proven to be advantageous than vehicles, but despite the advantages of motorbikes over vehicles, they are known to have the worst records of all forms of traffic accidents in the world [2].
A report by the World Health Organization (WHO, 2005) [3] stated that, every year the lives of approximately 1.25 million people are cut short as a result of a road traffic crash. About 35% of the deaths result from motorbike accidents. Half of those dying on the world's roads are "vulnerable road users": pedestrians, cyclists and motorcyclists who all fall between the age 15 and 30 years. Without action, motorbike crashes are predicted to rise to become the 7th leading cause of death by 2030 [4].
Another World Health Organization study on the Americas concluded that in countries like Brazil, Mexico, Canada and the United States, motorcycle crashes are responsible for 20-30% of all deaths due to trauma. In the United Kingdom in 1998 motorcycle crashes were responsible for 15% of all deaths or serious injuries by traffic accidents. According to the U.S. National Highway Traffic Safety Administration (NHTSA), in 2006, motorcycle rider deaths were nearly 30 times more than drivers of other vehicles. The report further indicated that the rate of admission of patients in the hospital as a result of motorbike accidents and its consequences increases on a daily basis (Odelowo et al., 2007).
Globally, Road Traffic Injuries (RTIs) or Road Traffic Accidents (RTAs) are responsible for a significant proportion of overall injury morbidity and mortality; 90% of mortalities are seen in developing countries. Motorcycle users are more vulnerable on the road than any other group of road users. Even in developed countries with low morbidity and mortality rates from motorbike accidents, the risk of dying for every kilometer travelled from a motorcycle crash is 20 times higher than from a motor vehicle crash. It is observed that the human and economic costs of motorbike accidents are abnormally high. In every 2-4 accidents, motorbike accidents cause at least 2 deaths and one amputation [5].
A publication in 2006 showed that while the African Region possesses only 2% of the world's vehicles, it contributes 16% to the global deaths. Motorcycle injuries constitute a major but neglected emerging public health problem in African countries and contribute significantly to the overall road traffic injuries. Motorcycle injuries are among the leading causes of disability and deaths and the main victims are the motorcyclists, passengers and pedestrians in their young reproductive age group [6].
Commercial motorbikes have recently become increasingly popular in African countries as a means of commercial transport but their operation is characterized by non-helmet use by riders and their passengers, passenger overload, lack of certified driver training and valid licensing, over speed and reckless driving. The African continent records about a million motorbike accidents each year with a mortality rate of about 40%, with Nigeria and South Africa having the highest fatality rates (33.7 and 31.9 deaths per 100 000 population per year, respectively) in the region [7].
The case of Sub-Saharan Africa is not different from that of other regions of the world. This region alone, accounts for more than 75% of the total number of motorbike accidents in the African continent. The morbidity and mortality rates are also higher than those of other regions of the world and motorbike accidents were once considered a rare phenomenon in sub-Saharan Africa. But in 2008, over 4million cases of bike accidents were recorded in the region. About 1.5million individuals died between 2000 and 2008 related to bike accidents [8].
In Sub-Saharan African countries, motorbikes have emerged as a popular commercial mode of transportation without a corresponding improvement and adaptation of road infrastructures. This is particularly true for Cameroon where roads are generally considered very poor. Estimates show that, more than 500 people are killed every year as a result of motorbike accidents within the national territory. It is predicted that this region will have the highest growth in the number of bike accidents and people living with disabilities related to bike accidents than any other region in the world. The 2010 estimated number is predicted to almost double in 20years, reaching 8 million cases with a mortality rate of more than 44 % by 2030. The report laid emphasis on the point that, if necessary measures are not taken, motorbike accidents will one day become the leading cause of death in the sub region and also that, motorbike accidents are a public health epidemic that is growing unnoticed [9].
Cameroon being one of the countries in the sub region is not free from the consequences of motorbike accidents. Studies showed that 12% to 16% of adults in urban areas and 5% to 6% of adults in rural areas had been victims of bike clashes. The research revealed that this occurrence was because of four main factors namely: alcoholism, over speeding, overloading and bad roads, which are all common observable setbacks dominant in the transport sector in Cameroon [10].
Motorcycles are gradually becoming a major mode of transportation in Cameroon as is the case with other African countries in the absence of an organized public transport system. Consequently, the contribution of motorcycle crash to injury-related deaths seems to be on the rise. The importation of motorcycles into the country has experienced a considerable increase over the past decade with an average of about one hundred thousand bikes each year. Between the year 2005 and 2010, an average of 10000 people were involved in motorcycle accidents each year, with a considerable number of accidents not registered as well. Out of the 10000 victims of motorbike accidents, 16% died, the others suffered from serious after effects like amputations and disabilities [11].
A study carried out in the US has shown that motorbikes are a very special and severe problem. The fatalities due to motorbikes accidents are approaching five thousand per year and have the prospect of further increase unless effective counter measures are instituted. At present time motorbike accidents account for approximately ten percent of the total traffic accident fatalities, but the motorbike is only one to two percent of the vehicle population on the street in traffic [12].
In 2013, fatally injured motorbike drivers were 17% more likely to be operating without a valid driver's license than in 2011 (26% vs 21%). The rate of unlicensed fatally injured motorbike drivers during 2003-2013 was higher than the rate of unlicensed fatally injured passenger vehicle drivers (26% vs 15%) [5].
Statistics show that the situation in the world is worsening, and more so at an alarming rate. On an average, two persons in the world die every minute from motorbike accidents. A total of 3000 persons including 500 children die each day related to motorbike clashes and each day around the world, about 140000 people sustain injuries from bike accidents, while about 15000 of the injured individuals become handicapped for life, 20000 of the victims have amputations.
According to the WHO (2002) [3] motorbike related injuries killed an estimated 1.2 million people in Africa and injured more than 50 million others. The report further estimated that the number of people who die in bike related accidents will undergo a 144% increase between 2002 and 2020. According to the report, pedestrians and motorbike users get injured on the road more frequently and more severely than other road users. The study analysed that, 40% of traffic accidents involves bike riders [13].
As regards the situation in Africa, reports indicated that Africa has the worst record amongst all the 5 continents in the world when it comes to death related to motorbike accidents. In the report, death rates from motorbike accidents in Africa are four times more than that of European and Asian countries. Yet, there are far more bikes in the other continents than in Africa. 
In Cameroon, the president of the Association of Insurance Companies in Cameroon (ASAC); speaking during a press briefing in Douala, lamented that Cameroon unfortunately holds a sad record. He disclosed that the annual average of deaths rates from motorbike accidents in Cameroon is more than double that of any member country of the CEMAC zone which is comprised of Central African countries and some states in West African like Ivory Coast, Senegal and Mali. He indicated that in 2008, a total of 7020 bike accidents were registered in Cameroon, and caused the death of over 1500 people while about 11600 people sustained severe injuries (Dinga Pefok, 2011). The number of people who died in Cameroon related to motorbike clashes is 35 times more than that of America. One third of traffic injury victims in large cities of Cameroon (Yaounde, Douala, Bamenda) are motorbike riders.
Despite the stepping up of sensitization campaigns on road safety in the country by the government and other stakeholders, the rates of motorbike accidents and deaths being registered in the country are persistently on the rise. Figures released by president of ASAC revealed that, in 2010, insurance companies in Cameroon paid a total of FCFA 2.8 billion as insurance claims linked to motorbike accidents involving private and public transport vehicles. These claims were for the death of 300 persons and 1500 people who sustained injuries and material damage Dinga Pefok, 2011.
Research question
What are the constraints encountered by bike riders in Bamenda-II Municipality in practicing the preventives measures against motor bike accidents?
Study objectives
General objective: To find out the constraints encountered by bike riders in Bamenda-II Municipality in practicing the preventives measures against motor bike accidents
Specific objectives:
 To assess the knowledge of bike riders concerning measures to curb the occurrence of motor-bike accidents in the Bamenda-II municipality.
 To find out the causes of the motor bike accidents during the course of their business activities.
 To assess the measures put in place by bike riders to prevent the occurrence of motor-bike accidents
 To identify the problems/difficulties faced by bike riders in implementing measures to prevent motor bike accidents.
Methodology
Study design
The study design employed was the descriptive cross-sectional design in which the researcher collected primary data from a sample of bike riders in the municipality at a given point in time and the findings analysed as per study objectives.
Sample size
 The sample size was calculated using the formula below:
           N = (Z)2 X p(1-p)
________________________________________
                           (e)2
Where, 
 N= the required sample size
 Z= confidence interval of 95% (z=1.96)
 p = the population of bike riders (15%) 
 e = random error of 5% (type-1 value of 0.05) 
 N= 120 respondents.
A total of 120 commercial motorbike riders within the Bamenda II municipality were recruited for the study. 
Sampling method
The researchers used the systematic random sampling method to sample the bike riders in the various streets of the municipality till they attained the sample size.
Data collection instrument
The instrument used for the collection of primary data was a structured questionnaire that comprised of both closed and opened-ended questions. This instrument was designed to reflect the specific objectives of the study.
Data analysis tools
Data was coded using a coding guide developed for the study and entered in CsPro, cleaned and exported to SPSS windows version 16.0 for analysis.
-Descriptive statistics was employed to analyze the households' perceptions and practices.
-Bivariate analysis was used to evaluate the association between explanatory and outcome variables;
Data presentation method
Data collected was analyzed using the above software and presented in graphics and frequency tables. 
Presentation and Analysis of Findings
Socio-demographic data
Age distribution of respondents: From Figure 1, out of 120 respondents that were recruited for the study 3.40% were between the age range 18 -20years, 20% were between 21-23 years, 53.30% were between 24-26 years and 23.30% were age 27-30 years.
Respondents level of education: From Figure 2, 33.30% of the respondents have attended primary education, 31.70% attended secondary education, 20% attended college while 13.30% attended the university.
Respondents marital Status: From the pie chart, 56.70% were single, 43, 30% were married (Figure 3).
Causes of motorbike accidents
It can be observed in Table I above that 21.67% of the riders said motor-bike accidents is caused by drunkenness, 18.33% due to over speed, 15% said it is caused by poor nature of the road, 13.33% said it is caused by carelessness, 11.67% said it is caused by poor bike maintenance while 8.33% said it is caused by over loading.
Complications of motor bike accidents: In analyzing the data from the Figure 4, 40% of bike riders said physical disability is the major complication of motor-bike accidents, 25% said Traumatic Brain Injury (TBI) was the complication, 16.67% said loss of the limb is the complication, 10% said others (dead, chest pain) is complication from motor-bike accidents.
People responsible for the occurrence of accidents: From Figure 5, 31.67% of riders said motorist themselves are the root cause of bike accidents 28.33% said car drivers push motorists into accidents, 15% said pedestrians make motorist to have accidents (Figure 6).
Preventive measures
From Table 2, 42.6% said riders should avoid being drunk when riding will prevent them from having accidents, 26% said avoiding over-speeding reduces the chances of having accidents, 20.3% said ensuring maintenance of bikes, training bike-riders will reduce the occurrence of accidents while 11.10% said avoiding over-loading will prevent the occurrence of accidents.
Difficulties faced in the implementation of preventive measures
Viewpoints of respondents concerning difficulties encountered: Fifty percent of the respondents said they face difficulties to implement preventive measures while 40% respondents do not have difficulties to implement preventive measures. 
From the Table 3, out of 60 respondents who faced difficulties while implementing preventing measures 40% said other road users were obstacles, 30% said lack of road signs caused them problems, 20% said roads with pot holes were problems while 10% said too much traffic congestion was the cause of accidents.
Proposed solutions to salvage the encountered problems
From Figure 7, 29.6% said government should educate and train Bike-riders on precautionary measures; 27.7% said Government should repair the pot holes in the high-ways, 18.5% said road signs should be provided, 9.2% said all road users should be sensitized.
Discussion of Findings
Socio-demographic data
Following analysis of the socio-demographic data gotten from the respondents, it was observed that out of 120 participants recruited for the study, 56.7% were single while 43.3% were married. This shows that majority of bike riders do not have marital responsibility and are taking riding as part time job thus are never serious when riding.
Concerning their level of education, 33.3% of the sample attended primary education, 31.7% attended secondary education, this level of education amongst riders may be the reason for the high incidence of motor-bike accidents.
As per their age range, 53.3% were between (24 -26) years, 20% were between (21-23) years, 3.4% were between (18-20) years while 23.3% fell between 27-30 years age range. This shows that majority of respondents were aged less than 27 years. It is proven that lack of experience plays a lot in the occurrence of motor-bike accidents. Comparing these youths with older bike riders, research have shown that, older bike riders are more cautious when riding and the record less accidents than youths. Adults have been know be more experienced in riding than youths [8].
Causes of motorbike accidents
Responses gotten from the respondents indicate that everybody knew what causes motorbike accidents as illustrated in Table 1. All the respondents were aware of what causes motorbike accidents; which range from carelessness, drunkenness, over speeding, lack of experience, non-respect of high way code, bad nature of the roads (road with pot holes) but never put them into practice. A research conducted in Los Angeles (USA) by Hurt et al., (1998) on motorbike accidents, disclosed that speeding in heavy traffic and while negotiating sharp corners resulted in the rider colliding or sliding and falling off from the moving motor bike. According to a study by Hurts et al,(1998), out of 900 motorbike accidents cases recruited for the in the study in the USA, 22% of the riders involved had a Blood Alcohol Concentration of more the 0.04%. Alcohol is also known to be a leading cause of motorbike accidents in Sub-Saharan Africa [6].
The presence of traffic signs is a very important preventive measure for accidents in general. Well-constructed roads with these facilities minimize the risk of motorbike accidents. In contrary to this, most roads in the developing countries are without these facilities; hence, it is one of the reasons why these countries account for the greatest number of accidents in the world including motorbike accidents [2].
Respondents were knowledgeable of the complications that ensue following motorbike accidents as illustrated in Figure 4 where 40% said they lead to disability followed by Traumatic Brain Injury (TBI) which may occur in 25% of them. According to Elliott [14]. TBIs sometimes cause changes in personality, such as irritability or anger. TBI sufferers may act on impulse or they become easily frustrated. Physically, the challenges can include ongoing headaches, vision/hearing problems, inability to speak and imbalance. Cognitively, there may be impairments with attention, concentration and decision-making. 
In looking at the answers gotten from the respondents concerning the behaviour of the road users it is seen that majority that is 31.67% said that motorist themselves are the causes of bike accidents, 28.33% said car drivers push motorist into accidents, 15% said pedestrians make motorist to have accidents, 6.67% of respondents said they don't know. As such, from these responses, education and sensitization on how to use the road has to include all the road users in general.
Preventive measures
In assessing the practical measures implemented by the respondents in the prevention of bike accidents, 42.6% of the respondents said motorists should avoid being drunk when riding because this will prevent accidents, 26% mentioned that control of speed of riding, 20.3% advocated other responses such as maintenance of bikes, training of bike riders, 11.1% said they should avoid over load (Table 2). From these analyses, it is clear that the respondents have adequate knowledge in the prevention of bike accidents, but they don't practice. According to Soderstrom M, et al. [15]. leather jackets, gloves, trousers, proper foot wear, eye protection and helmets provide additional protection. Helmets are by far the riders' most important and simplest safety equipment because they protect against head injuries and brain trauma. 
Proposed solutions to salvage the encountered problems by riders
According to the respondents, 29.6% said the problems faced can be resolved through education and training, 27.70% said roads should be repaired by road maintenance authorities, 18.50% said road signs were needed along our highways, and that protective gadgets for motor bike riders 9.2% said sensitization of road users should be done [16-18].
Conclusion
No matter the age and the educational level of the motorbike riders, the researchers realized that each respondent knew at least more than one cause of motorbike accidents. Looking at the responses gotten from the participants it is seen that motorbike riders faced many difficulties when they are trying to prevent accidents, which is the reason why out of the 120 respondents who knew that accident from motorbike could be preventable, 40% of respondents faced diverse challenges in practicing these preventive measures [19,20]. 
Motorbike injuries cause considerable economic losses to victims, their families, and to the nation as a whole. These losses arise from the cost of treatment (including rehabilitation and incident investigation) as well as reduced/lost productivity (e.g. in wages) for those killed or disabled by their injuries, and for family members who need to take time off work (or school) to care for the injured.
In our society, bike accidents remain the cause of morbidity and mortality affecting all social groups. As such emphases have to be laid on the education and sensitization of all citizens on the application of preventive measures and taking it as a responsibility.
References
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4. Chalya PL, Mabula JB, Ngayomela IH, et al. Motorcycle injuries as an emerging public health problem in Mwanza City, north-western Tanzania. Tanzan J Health Res. 2010;12(4):214-221.
5. Ramli R, Abdul Rahman R, Abdul Rahman N.et al. Pattern of maxillofacial injuries in motorcyclists in Malaysia. J Craniofac Surg. 2008;19(2):316-321.
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17. Adebayo ET, Ajike OS, Adekeye EO. Analysis of the pattern of maxillofacial fractures in Kaduna, Nigeria. Br J Oral Maxillofac Surg. 2003;41(6):396-400.
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Tables & Figures
 
Figure 1. Distribution of respondents according to age

Figure 2. Distribution of respondents according to level of distribution

 Figure 3. Distribution of the respondents according to marital status 

Figure 4. Distribution of the respondents according to the complication of motor bike accident

Figure 5.  People responsible for the occurrence of these accidents

Figure 6. Distribution of respondents as to whether they encounter difficulties in preventing the occurrence of motorbike accidents

Figure 7. Perceived role of the Government to reduce the occurrence of motor-bike accidents 

Table 1.Distribution of the respondents according to the causes of motorbike accident  


Table 2. Distribution of respondents according to preventive measures to be employed by riders.



Table 3Distribution respondents according to the difficulty faced while preventing motor bike accidents. 

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