title: High road utilizers surveys compared to police data for road traffic crash hotspot localization in Rwanda and Sri Lanka.
abstract: BACKGROUND
  Road traffic crashes (RTCs) are a leading cause of death. In low and middle income countries (LMIC) data to conduct hotspot analyses and safety audits are usually incomplete, poor quality, and not computerized. Police data are often limited, but there are no alternative gold standards. This project evaluates high road utilizer surveys as an alternative to police data to identify RTC hotspots.
  
  
  METHODS
  Retrospective police RTC data was compared to prospective data from high road utilizer surveys regarding dangerous road locations. Spatial analysis using geographic information systems was used to map dangerous locations and identify RTC hotspots. We assessed agreement (Cohen's Kappa), sensitivity/specificity, and cost differences.
  
  
  RESULTS
  In Rwanda police data identified 1866 RTC locations from 2589 records while surveys identified 1264 locations from 602 surveys. In Sri Lanka, police data identified 721 RTC locations from 752 records while survey data found 3000 locations from 300 surveys. There was high agreement (97 %, 83 %) and kappa (0.60, 0.60) for Rwanda and Sri Lanka respectively. Sensitivity and specificity are 92 % and 95 % for Rwanda and 74 % and 93 % for Sri Lanka. The cost per crash location identified was $2.88 for police and $2.75 for survey data in Rwanda and $2.75 for police and $1.21 for survey data in Sri Lanka.
  
  
  CONCLUSIONS
  Surveys to locate RTC hotspots have high sensitivity and specificity compared to police data. Therefore, surveys can be a viable, inexpensive, and rapid alternative to the use of police data in LMIC.
authors.affiliation: Division of Emergency Medicine, Duke University Medicine Center, Durham, USA. catherine.staton@duke.edu.|Duke Global Health Institute, Durham, NC, USA. catherine.staton@duke.edu.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Staton
authors.affiliation: Duke Global Health Institute, Durham, NC, USA. pvdesilva@gmail.com.|Department of Community Medicine; Faculty of Medicine, University of Ruhuna, Matara, Sri Lanka. pvdesilva@gmail.com.
authors.forename: Vijitha
authors.initials: V
authors.lastname: De Silva
authors.affiliation: Division of Emergency Medicine, Duke University Medicine Center, Durham, USA. krebse@gmail.com.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Krebs
authors.affiliation: State University of West of Parana / Unioeste, Foz do Iguaçu, Brazil. luc.and1973@gmail.com.|Public Health Research Group, Unioeste, Toledo, Brazil. luc.and1973@gmail.com.
authors.forename: Luciano
authors.initials: L
authors.lastname: Andrade
authors.affiliation: College of Medicine and Health Sciences, University of Rwanda, Butare, Rwanda. s.rulisa@gmail.com.|University Teaching Hospital of Kigali, Kigali, Rwanda. s.rulisa@gmail.com.
authors.forename: Stephen
authors.initials: S
authors.lastname: Rulisa
authors.affiliation: Southern Provincial Director of Health Services Office, Galle, Sri Lanka. chandipushpa@yahoo.com.
authors.forename: Badra Chandanie
authors.initials: BC
authors.lastname: Mallawaarachchi
authors.affiliation: Department of Occupational Health; School of Public Health, Fudan University, Shanghai, China. zhkjin@fudan.edu.cn.
authors.forename: Kezhi
authors.initials: K
authors.lastname: Jin
authors.affiliation: Duke Global Health Institute, Durham, NC, USA. joaovissoci@gmail.com.|Faculty of Medicine, Faculdade de INGA, Maringa, Brazil. joaovissoci@gmail.com.
authors.forename: Joao
authors.initials: J
authors.lastname: RicardoVissoci
authors.affiliation: Department of Community Medicine; Faculty of Medicine, University of Ruhuna, Matara, Sri Lanka. Truls.ostbye@dm.duke.edu.
authors.forename: Truls
authors.initials: T
authors.lastname: Østbye
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D003625:Data Collection / Q000379:methods*; D040362:Geographic Information Systems; D006801:Humans; D016495:Police; D015203:Reproducibility of Results; D012432:Rwanda / Q000453:epidemiology; D012449:Safety; D062206:Spatial Analysis; D013188:Sri Lanka / Q000453:epidemiology