title: Road Traffic Injury Prevention Initiatives: A Systematic Review and Metasummary of Effectiveness in Low and Middle Income Countries.
abstract: BACKGROUND
  Road traffic injuries (RTIs) are a growing but neglected global health crisis, requiring effective prevention to promote sustainable safety. Low- and middle-income countries (LMICs) share a disproportionately high burden with 90% of the world's road traffic deaths, and where RTIs are escalating due to rapid urbanization and motorization. Although several studies have assessed the effectiveness of a specific intervention, no systematic reviews have been conducted summarizing the effectiveness of RTI prevention initiatives specifically performed in LMIC settings; this study will help fill this gap.
  
  
  METHODS
  In accordance with PRISMA guidelines we searched the electronic databases MEDLINE, EMBASE, Scopus, Web of Science, TRID, Lilacs, Scielo and Global Health. Articles were eligible if they considered RTI prevention in LMICs by evaluating a prevention-related intervention with outcome measures of crash, RTI, or death. In addition, a reference and citation analysis was conducted as well as a data quality assessment. A qualitative metasummary approach was used for data analysis and effect sizes were calculated to quantify the magnitude of emerging themes.
  
  
  RESULTS
  Of the 8560 articles from the literature search, 18 articles from 11 LMICs fit the eligibility and inclusion criteria. Of these studies, four were from Sub-Saharan Africa, ten from Latin America and the Caribbean, one from the Middle East, and three from Asia. Half of the studies focused specifically on legislation, while the others focused on speed control measures, educational interventions, enforcement, road improvement, community programs, or a multifaceted intervention.
  
  
  CONCLUSIONS
  Legislation was the most common intervention evaluated with the best outcomes when combined with strong enforcement initiatives or as part of a multifaceted approach. Because speed control is crucial to crash and injury prevention, road improvement interventions in LMIC settings should carefully consider how the impact of improvements will affect speed and traffic flow. Further road traffic injury prevention interventions should be performed in LMICs with patient-centered outcomes in order to guide injury prevention in these complex settings.
authors.affiliation: Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America.|Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: Catherine
authors.initials: C
authors.lastname: Staton
authors.affiliation: Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: Joao
authors.initials: J
authors.lastname: Vissoci
authors.affiliation: Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: Enying
authors.initials: E
authors.lastname: Gong
authors.affiliation: Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: Nicole
authors.initials: N
authors.lastname: Toomey
authors.affiliation: Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: Rebeccah
authors.initials: R
authors.lastname: Wafula
authors.affiliation: Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: Jihad
authors.initials: J
authors.lastname: Abdelgadir
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: Chen
authors.initials: C
authors.lastname: Liu
authors.affiliation: Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: Fengdi
authors.initials: F
authors.lastname: Pei
authors.affiliation: Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: Brittany
authors.initials: B
authors.lastname: Zick
authors.affiliation: Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: Camille D
authors.initials: CD
authors.lastname: Ratliff
authors.affiliation: Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: Claire
authors.initials: C
authors.lastname: Rotich
authors.affiliation: Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: Nicole
authors.initials: N
authors.lastname: Jadue
authors.affiliation: Department of Nursing, State University of the West of Parana, Foz do Iguaçu, Parana, Brazil.
authors.forename: Luciano
authors.initials: L
authors.lastname: de Andrade
authors.affiliation: Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America.
authors.forename: Megan
authors.initials: M
authors.lastname: von Isenburg
authors.affiliation: Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America.
authors.forename: Michael
authors.initials: M
authors.lastname: Hocker
mesh_terms: D000063:Accidents, Traffic / Q000191:economics / Q000517:prevention & control*; D001364:Awareness; D016208:Databases, Factual; D003906:Developing Countries; D006801:Humans; D035846:Law Enforcement; D014507:Urbanization