ROAD TRAFFIC ACCIDENTS: A DESCRIPTIVE STUDY OF …

International Journal of Public Health and Clinical Sciences e-ISSN : 2289-7577. Vol. 7:No. 1

January/February 2020

M. Syazmin Zuwairy, Abdul Aziz Harith, Hamajima Nobuyaki, Nuraini M. Naim, Rohaizat Yon

https://doi.org/10.32827/ijphcs.7.1.58 58

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Open Access: e-Journal

ROAD TRAFFIC ACCIDENTS: A DESCRIPTIVE STUDY OF

COMMUTING INJURY AMONG HEALTHCARE WORKERS

IN MALAYSIA 2014-2016

M. Syazmin Zuwairy1, Abdul Aziz Harith.2*, Hamajima Nobuyaki3, Nuraini M.

Naim4, Rohaizat Yon4,

¹ Occupational Safety and Health Units, Medical Development Division, Ministry of Health

Malaysia

² Occupational Health Research Centre, Institute for Public Health Malaysia

³ Department of Healthcare Administrations, Nagoya University, Japan

⁴ Medical Development Division, Ministry of Health Malaysia

*Corresponding author: Abdul Aziz Harith, Occupational Health Research Centre, Institute

for Public Health Malaysia, No. 1, Block E5-E6, Jalan Setia Murni U13/52 Seksyen U13,

Setia Alam, 40170 Shah Alam, Selangor, email:[email protected]

https://doi.org/10.32827/ijphcs.7.1.58

ABSTRACT

Background: In recent years, traffic accidents in Malaysia have resulted in an alarming

increase of injuries and deaths, hence resulting in a broad range of negative impacts to the

society and economy. Thus, the objective of this study is to identify the demographics and

injury risks of MOH healthcare workers involved in traffic accident.

Materials and Methods: This study was based on data collected from the Workers

Environment Health Unit (WEHU) notification form from 2014 to 2016. The information

obtained from the WEHU form comprises sociodemographic data, occupational data, accident

specific data and classification of injuries. Odds ratio (OR) and 95% confidence interval (CI)

were estimated with a logistic model.

Result: 959 cases were reported to MOH during 2014 - 2016. Statistics review showed age

group of 50 years old and above, environmental health assistant, male gender, and travelling

from residence to workplace have the highest annual incident of road traffic accidents. Males

gender contribute to a majority numbers of fatalities (71.4%), while as in job post prospective,

health assistants showed the greatest risk of sustaining an injury (OR=9.34, 95% CI 4.12-

21.36).

Conclusion: More focus and attention should be given on effective interventional strategies

which could reduce the risk of road traffic accidents among MOH healthcare workers,

especially among the older age group and specific occupational groups, where frequent

traveling are the main principal. We recommend that the WEHU reporting system can be

improved and be made mandatory for a more accurate perspective of the issue in hand.

Keywords: commuting accident, road traffic accident, workplace accident, healthcare workers,

Malaysia







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1.0 Introduction

According to World Health Organization (WHO) Global Road Safety Report, the number of

road traffic fatality worldwide has reached 1.35 million in 2018 compare 1.25 million in 2015

[1]. In addition to that, 90% of the road traffic accident occurred in low and middle income

countries including Malaysia. Three out of four road traffic fatalities worldwide occur among

males [1]. In recent years, road traffic accidents in Malaysia have caused a substantial number

of injuries and deaths, hence resulting in a broad range of negative impact to the society and

economy. In 2015, there were a total of more than half a million (521,466) road traffic accidents

recorded by the Malaysian Institute of Road Safety Research. Malaysia recorded an average of

24 deaths per 100,000 populations, which is five times number recorded in Japan despite having

an almost similar total land area [1; 2].

Malaysia has a well-developed asphalt road network system consisting of 61,420 km of state

roads and municipality roads, 18,904 km of federal roads and 1,820 km of expressways [3]. A

study in 1996 has shown that Malaysia has the highest road traffic fatality risk in the world [4].

In 2014, according to a research by the Transportation Research Institute, University of

Michigan, Malaysia was the 17th most dangerous place for drivers in the world [5]. Out of half

a million accident cases recorded in Malaysia in 2015, 28,579 or 5.5% were reported as work

related commuting accident cases by the Malaysia Social Security Organization (SOCSO) [6].

Major concerns have been placed by the government on the proportion of commuting accidents

that contributed to the statistics. Work-related road accident consists of two types of accidents:

commuting accidents and accidents during working period. The International Labour

Organization (ILO) defines commuting accident as “…an accident occurring on the habitual

route, in either direction, between the place of work or work-related training and: (i) the

worker’s principal or secondary residence; (ii) the place where the worker usually takes his or

her meals; or (iii) the place where he or she usually receives his or her remuneration; which

results in death or personal injury” [6; 7].

The causes of road traffic accidents are multifactorial. 94% of these collisions were due to driver

error and reckless driver behaviour such as recognition error (driver’s inattention, internal and

external distractions and inadequate surveillance), decision error (speeding, false assumptions

of other actions, misjudgement of gap and illegal manoeuvre), performance error

(overcompensation and poor directional control) and non-performance error (sleep). On the

other hand, only 6% of these accidents were contributed to other reasons includes mechanical

errors and environmental factors such as weather and road conditions [8]. Anything that shifts

a driver’s attention away can be considered as a distraction. As a result, visual distraction

(taking eyes off the road), manual distraction (taking hands off the wheel) and cognitive

distraction (taking mind off driving) occurs more frequently during driving - a complacency

which kills [1, 8-11].

The percentage of mobile phone users in Malaysia continue to rise from 94.2% in 2013 to 97.5%

in 2015 [12]. It was shown that mobile phone use while driving may seriously affect traffic

safety. Serious injuries due to texting while driving may occur even with few seconds of visual

distraction. As a guide, texting usually involves 5 seconds of visual distraction. At 90 km/hour

(the general speed limit of a federal road in Malaysia), a car could have travelled the length of

a football field blindfolded [3; 8; 10; 11]. In a study conducted by the Malaysian Institute of






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Road Safety Research, 43.4% Malaysian drivers were found to use their mobile phone while

driving. Among them, 53% drivers admitted to texting 1-3 times a week when driving while

13.4% drivers did it about 4-6 times a week and 4.8% drivers did it more than 7 times a week

[10].

It is well established that males who are in the most economically active age group make up the

largest proportion of road traffic accidents victim [6, 13, and 14]. However, female’s

involvement in road traffic accidents appears to be on the rise. This occurred perhaps due to

increasing number of female employment in Malaysia. The percentage of female civil servants

has risen from 39% in 1995 to 56% in 2014. In 2017, there were a total of 243,666 active civil

servants under MOH, of which 69.2% were females [15; 16]. Despite the increasing number of

working females, the general perception towards women and their roles have not changed much

over the years. Apart from official works, women are given more responsibilities with regards

to domestic matters such as looking after the children and doing house chores which increases

the tendency for female to be more tired [17].

Various researchers have found that drowsy driving is one of the contributing factors in motor

vehicle accidents [18-22]. It is because lack of sleep leads to attention lapses and poor decision

making. Healthcare workers in MOH Malaysia are frequently exposed to shift working hours

and on call duties which may range from 24 hours to 36 hours of non-stop duty. Long working

hours also contribute to occupational burnout, poor work-life balance, circadian

resynchronisation and drowsy driving during way back from the workplace. Workers who are

sleep deprived may experience micro sleep, a short burst of sleep which may last for a fraction

of second or more. This may result in fatalities situations that demand alertness [19-21].

A higher speed increases the likelihood of an accident. Speed limits have been set on all the

national roads but it may not be heeded by every road user. It was reported that the highest rate

of road traffic deaths per kilometre occurs on expressways (maximum speed limit of 110km/h),

followed by federal roads and state roads (maximum speed limit of 90 km/h) in Malaysia [1;

22; 23]. Therefore, this study aims to analyse the road traffic accident among healthcare workers

particularly with regards to the demographics and injury risks of MOH healthcare workers. The

authors hope this study will lead to an enhanced awareness and knowledge on commuting safety

management and road safety.

2.0 Materials and Methods

2.2 Study subjects

This study was conducted among healthcare workers in all facilities which consist of doctors,

medical assistants, nurses, assistant health officers, health attendants, administrative officers

and drivers. The original dataset contained 2,661 occupational accidents and dangerous

occurring in 2014 to 2016. Out of 2,661 subjects, a total of 1,702 were excluded from the study

for any of the following reasons; 1) subjects with missing or unknown data, 2) subjects who

were involved in other type of workplace injuries apart from road traffic accidents (such as

being hit by falling objects, exposure to loud noise, slips, trips and falls) and 3) subjects in






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occupational groups that were not included in the study. The final number of eligible subjects

for the study was 959.

The following variables associated with the registered road traffic accidents among MOH staff

were examined: 1) sociodemographic data: age and gender, 2) occupational data: professional

position and workplace (hospital, health clinic and health administrative office), 3) accident

specific data: direction of the route (residence to workplace, workplace to residence and during

working hours), 4) type of injuries: soft tissue injuries, fractures & dislocations, internal organ

injuries, multiple injuries and death.

2.3 Data sources

The dataset for this study was collected from the Occupational Safety and Environmental

Health Department, MOH Malaysia. The source of data was primarily obtained from the

Workers Environment Health Unit Notification (WEHU) form that is stipulated under the

Notification of Accident, Dangerous Occurrence, Occupational Poisoning and Occupational

Disease (NADOPOD) Regulation 2004 and its parent act, the Occupational Safety and Health

Act (OSHA) 1994. All healthcare workers in MOH Malaysia are legally required to report any

occupational accident and dangerous occurrence through WEHU form based on the OSHA

1994.

2.4 Data analysis

Descriptive analysis is done on the trend of accidents over the period of 3 years according to

age group and gender distribution. Subsequent analyses involving variables such as age group,

gender and occupational group was done based on the mean number of accidents per year. They

are presented as the rate of annual accident per 10,000 workers.

Odds ratio (OR) and 95% confidence interval (CI) were estimated using a multivariate logistic

regression model to investigate the associations between variables and injury risk due to a road

accident. The difference was considered as significant if p-value was less than 0.05. Data were

analysed using Statistical Package for the Social Sciences (SPSS) version 20 Mac (IBM SPSS

Inc.).

2.5 Ethical considerations

This study was approved by the Medical Development Division of Ministry of Health Malaysia.

It was reviewed and approved by the National Medical Research Registry, National Institute of

Health, Malaysia (NMRR-18-686-41451 (IIR). The confidentiality of personal information and

reported contents were handled appropriately at every stage of data analysis.

3.0 Result






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3.1 Distribution of road traffic accidents among healthcare workers from 2014 to 2016

according to age group, gender and occupations.

Age group (years) n (%) Gender, n (%) Total

N 29 30-39 40-49 50 Male Female

Total 306(31.9) 354(39.0) 166(17.3) 113(11.8) 433(45.2) 526(54.8) 959

Accident year

2014 71(30.3) 83(35.5) 52(22.2) 28(12) 11(47.9) 122(52.1) 234

2015 101(31.3) 128(39.8) 53(16.5) 40(12.4) 14(45.3) 176(54.7) 322

2016 134(33.3) 163(40.4) 61(15.1) 45(11.2) 175(43.4) 228(56.6) 403

Occupation

Doctor 28(54.9) 15(29.4) 6(11.8) 2(3.9) 20(39.2) 31(60.8) 51

Nurse 150(36.7) 172(42.0) 60(14.7) 27(6.6) 12(2.9) 397(97.1) 409

AMO1 23(51.1) 13(28.9) 7(15.6) 2(4.4) 43(95.6) 2(4.4) 45

HA2 14(11.7) 53(44.2) 25(20.8) 28(23.3) 58(48.3) 62(51.7) 120

EHA3 59(56.7) 19(18.3) 12(11.5) 14(13.5) 96(92.3) 8(7.7) 104

Driver 6(5.0) 44(37.0) 40(33.6) 29(24.4) 119(100) 0(0) 119

AO4 26(23.4) 58(52.3) 16(14.4) 11(9.9) 85(76.6) 26(23.4) 111

¹Assistant Medical Officer, ² Health Attendants, ³ Environmental Health Assistant,

⁴Administrative Officer

There were total of 959 road traffic accidents recorded within 3 years of study period which

234 of the road traffic accidents occurred in 2014 while 322 occurred in 2015 and 403 occurred

in 2016. Among the subjects, 433 of them were male and 526 were female. About 39% of the

subjects were in the age group of 30-39 years old followed by 31.9% in the age group of 29

years old and below, 17.3% in the age group of 40-49 years old and 11.8% in the age group of

50 years old and above. According to the occupational groups, the study subjects were

dominated by nurses (409 subjects) followed by health attendants (120 subjects), drivers (119

subjects), administrative officers (111 subjects), environmental health assistants (104 subjects),

doctors (51 subjects) and assistant medical officers (45 subjects).

3.2 Incidence rate of road traffic accidents per 10,000 workers according to age, gender and

occupations during 2014 to 2016






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Age (years) Gender Total

29 30-39 40-49 50 Male Female

Workers 58,848 81,637 31,805 13,368 52,002 133,656 185,657

n (rate) 306(17.3) 374(15.3) 166(17.4) 113(28.2) 433(27.7) 526(13.1) 959(17.2)

Occupation

Doctor 12,561 13,002 2,975 956 11,163 18,331 11,163

n (rate) 28(7.4) 15(3.8) 6(6.7) 2(7.0) 20(6.0) 31(5.6) 51(15.2)

Nurse 31,960 37,974 15,614 4,997 2,404 88,141 90,544

n (rate) 150(15.6) 172(15.1) 60 (12.8) 27 (18.0) 12 (16.6) 397(15.0) 409(15.1)

AMO1 5,736 4,712 2,052 705 11,716 1,489 13,205

n (rate) 23 (13.4) 13(9.2) 7(11.4) 2(9.5) 43 (12.2) 2(4.5) 45(11.4)

HA2 2,998 12,446 5,860 3,775 11,638 13,441 25,079

n (rate) 14(15.6) 53(14.2) 25(14.2) 28(24.7) 58(16.6) 62(15.4) 120(15.9)

EHA3 2,158 1,818 548 359 3,635 1,248 4,883

n (rate) 59 (91.1) 19 (34.8) 12 (73.0) 14 (130.0) 96(88.0) 8(21.4) 104(71.0)

Driver 477 2,948 2,448 1,515 7,388 0 7,388

n (rate) 6(41.9) 44 (49.8) 40 (54.5) 29(63.8) 119(53.7) 0 (0) 119(53.7)

AO4 2,958 8,737 2,308 1,061 4,058 11,006 15,064

n (rate) 26(29.3) 58(22.1) 16(23.1) 11 (34.6) 85(69.8) 26(7.9) 111(24.6)



Based on the data, the rate of road traffic accidents was double in males (27.7 per 10,000

workers) as compared to females (13.1 per 10,000 workers). It was found that the age group of

50 years old and above had the highest rate of road traffic accidents (28.2 per 10,000 workers)

and the lowest rate was found in the age group of 30-39 years old (15.3 per 10,000 workers).

Focusing on occupational groups, environment health assistant had the highest incident of road

traffic accident followed by drivers, at 71.0 per 10,000 workers and 53.7 per 10,000 workers.

It was also found that among the environmental health assistants, those in the age group of 50

years and above had the highest rates of road traffic accidents (130.0 per 10,000 workers).

3.3 Incidence rate of road traffic accidents per 10,000 workers according to type of injuries

during 2014 to 2016






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Characteristic

s

Total

worker

s

Type of injuries

N during (rate, per 10,000 workers)

Soft

Tissue

Injury

Fractur

e

Death

Interna

l organ

injury

Multipl

e injury

No

injury

Gender

Male 52,002 111(7.1

)

81 (5.2) 5 (0.3) 13 (0.8) 135

(8.7)

88(5.6)

Female 133,656 157(3.9

)

87 (2.2) 2

(0.05)

12 (0.3) 156

(3.9)

112(2.8

)

Age Groups

29 years 58,848 100(5.7

)

46 (2.6) 5 (0.3) 11 (0.6) 91(5.2) 53(3.0)

30-39 years 81,637 103(4.2

)

61 (2.5) 1

(0.04)

7(0.3) 111(4.5) 91(3.7)

40-49 years 31,805 46(4.8) 34 (3.6) 0 (0) 3(0.3) 49 (5.1) 34(3.6)

50 years 13,368 19(4.7) 27(6.7) 1 (0.2) 4 (1.0) 40(10.0) 22(5.5)

Occupations

Doctor 29,494 6 (0.7) 7(0.8) 1(0.1) 1(0.1) 21(2.4) 15(1.7)

Nurse 90,544 133(4.9

)

64(2.4) 1(0.04

)

10 (0.4) 121

(4.5)

80(2.9)

AMO1 13,205 14(3.5) 5(1.3) 2(0.5) 1(0.3) 15 (3.8) 8(2.0)

HA2 25,079 31 (4.1) 30(4.0) 1(0.1) 1(0.1) 42 (5.6) 15(2.0)

EHA3 4,883 32(21.8

)

24(16.4) 1(0.7) 2(1.4) 27

(18.4)

18(12.3

)

Driver 7,388 20 (9.0) 15(6.8) 0(0) 1(0.5) 27

(12.2)

56(25.3

)

AO4 15,064 32 (7.1) 23(5.1) 1(0.2) 9(2.0) 38 (8.4) 8(1.8)



This study finds that incidence rate of injury is higher in males, regardless of the category of

injuries. The highest incidence of fractures and multiple injuries are among the subjects in the

age group of 50 years old and above, at 6.7 per 10,000 workers and 10.0 per 10,000 workers

respectively. However, the age group of 29 years old and below sustained more internal organ

injuries (0.6 per 10,000 workers) which may lead to a higher probability of fatality as compared

to others. It was also found that environmental health assistants recorded high rates of injuries

in all the categories. Drivers recorded the highest rate of no injury at 25.3 per 10,000 workers

as compared to other occupational groups.






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3.4 Multivariate analysis of predictors of injury (consists of fracture, dislocation, soft tissue

injury, internal organ injury and multiple injury)

Characteristics

Unadjusted Adjusted

OR (95%CI) p-value OR (95%CI) p-

value

Occupation

Doctor 1 reference 1 reference

Nurse 1.85 0.98-3.51 0.06 2.57 1.09-5.86 0.31

AMO*3 1.60 0.64-4.01 0.31 4.66 2.29-9.50 <0.001

HA*4 2.97 1.35-6.56 0.007 9.34 4.12-21.36 <0.001

EHA*5 2.04 0.94-4.43 0.70 1.47 0.70-3.15 0.31

Driver 0.51 0.26-1.03 0.06 3.78 1.92-7.42 <0.001

AO*6 5.18 2.10-12.77 <0.001 3.14 1.88-4.93 <0.001



Administrative officers were more likely to sustain an injury from road traffic accidents

(OR=5.18, 95% CI 2.10-12.77) prior to adjustment. However, after adjustment to gender, age,

route direction, occupation and place of practice were made, health assistants showed the

greatest risk of sustaining an injury when involved in road traffic accident (OR=9.34, 95% CI

4.12-21.36), followed by assistant medical officers (OR=4.66, 95% CI 2.29-9.50).

3.5 Annual incident of road traffic accidents according to route (per 10,000 workers) for

different gender

Route of accidents Gender n(rate)ª All workers

N (rate)ª Male Female

Residence to workplace 225 (14.4) 277 (6.9) 502 (9.0)

During working hours 120 (7.7) 139 (3.5) 259 (4.7)

Workplace to residence 88 (5.6) 110 (2.7) 198 (3.5)

ª per 10,000 workers

Road traffic accidents occur with greater frequency when traveling from residence to workplace

(9.0 per 10,000 workers) rather than from workplace to residence (3.5 per 10,000 workers).






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4.0 Discussion

Driving is a complex activity of daily living, where drivers are required to concentrate and

interact with the vehicles on the road as well as the surrounding environment. Various studies

worldwide have shown that young and inexperienced drivers have a higher risk of accidents [1;

3; 5; 24]. However, according to our study, healthcare workers of the elderly age of 50 years

old and above recorded the highest rate of road traffic accidents.

Senior drivers may experience a delay in making a decision, thus increased their reaction time

and subsequently affecting their ability to drive safely [26; 27]. Yee et al. in his study has shown

that road traffic injuries among the elderly would result in a higher rate of chest injuries and

double the rate of mortality compared to younger patients [28]. The present study also

demonstrated that men are more likely to suffer from injuries and death as compared to females.

This finding corresponds to various other studies that reported higher incidences of injuries and

deaths in males [1; 4; 7; 13; 29; 30].

It was found in our study that road traffic accidents occur with greater frequency when

healthcare workers were traveling to work rather than on their way home. It is a common

practice in Malaysia where parents will send their children to nursery or school before

proceeding to the workplace. Drivers, especially young females have a higher tendency to look

at their child passengers and become distracted while driving as reported in Curry et al. [31].

This may have contributed the higher incidence of accidents from residence to the workplace

in this study.

Apart from that, with the escalating cost of living in Malaysia, more than half (57%) of parents

are still financially supporting their children until adulthood [32]. In urban areas where the cost

of renting a house is exceptionally high, workers with low and moderate income whose monthly

income average was MYR 2,334, have no other choice other than staying at their parents’ house

which may be far from their workplace and this resulted in extended exposure of long-distance

driving [6; 33] As a result, spending long hours behind the wheel may cause mental and physical

exhaustion affecting driving behaviours [20; 24; 25; 34].

Our study has also found that environmental health assistants have the highest rate of road

traffic accidents followed by drivers. This may be attributed to the nature of their jobs which

involved a lot of traveling. Generally, environment health assistants spend a large amount of

their working time visiting properties such as factories, restaurants, offices, schools, shops and

hospitals for inspection of various health-related quality standards as well as enforcement of

health regulations.

Drivers especially ambulance drivers are also at higher risk of road accidents due to the urgent

nature of patient transfers. They often work at irregular hours and under timed pressure. These

may be harmful to their wellbeing and may cause psychological stress and sleep deprivation.

Retrospective secondary data analysis study by Institute for Health System Research, MOH

Malaysia in 2017 shown that on average, 129 number of ambulance accident happened per year

[35; 36].






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Results of environmental health officers and drivers had a higher incidence of road traffic

accidents compared to other occupational groups contradict the current public perception that

the most accident prone occupational groups are doctors and nurses [37-40]. However, a cross-

check between the individual names in the database and several newspapers articles reporting

specific accidents involving doctors and nurse revealed that many of these accidents and deaths

were never reported through WEHU form (as it is a self-reporting system) and this could be

considered as the major limitation of this study [41-45].

Secondly, this study only involves data from 2014 to 2016 which limits the scope of the

analysis. Lack of prior research regarding road traffic accidents involving healthcare workers

in Malaysia also limits the scope of comparison in this study. Our study does not provide

detailed data on the mode of transportation involved and other specific occupational risk factors,

such as the duration of working hours, on-call schedule, post-call, shift working hours or

workplace stress. Further studies may be carried out to focus on a more detailed analysis of

behavioural, cognitive and emotional risk factors of road traffic accidents, especially with

regard to the workplace environment, work burden such as total hours per week and also its

relationship between travel distances to workplace. Such studies may be very beneficial in

drafting policies related to accident prevention.

5.0 Conclusion and recommendation

In conclusion, senior drivers have a higher tendency to be involved in road traffic accidents.

More focus should be given on effective interventional strategies that would reduce the risk of

road traffic accidents among MOH healthcare workers, especially among the elderly age group

and occupational groups which require frequent traveling. We recommend that the WEHU

reporting system be strengthened and be made mandatory for a more accurate perspective of

the issue at hand.

Acknowledgement

The authors would like to offer their appreciation to the Director General of Health Malaysia

for permitting this paper to be published. In addition, the author is grateful to Prof. Nobuyuki

Hamajima, and academic staff of Department of Healthcare Administration, Nagoya University

Graduate School of Medicine for your continuous support.

Declaration

Author(s) declare that there are no potential conflicts of interest relevant to this article that was

reported.






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Author’s contribution

Author 1: Substantial contributions to the concepts and design, acquisition, analysis and

interpretation of data, drafting the work, final approval of the article, Author 2: Acquisition of

data, revising it critically for important intellectual content and final approval of the article,

Author 3: Acquisition of data, revising it critically for important intellectual content and final

approval of the article and Author 4: Substantial contributions to the concepts and design,

revising it critically for important intellectual content and final approval of the article.

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