1
GRSP Viet Duc Hospital & St Paul Hospital NEU
Alcohol Consumption of Road Traffic Victims
at Viet Duc and Saint-Paul Hospitals
Nguyen Lan Huong
GRSP Country Manager for Vietnam
9/11/2009, HCMC, Vietnam
2
background
2000: GRSP started our plan of long term collaboration with GOVN in order to sustainably reduce road traffic fatalities and injuries
2006: successful collaboration in helmet, on going
3/2009: DD GPM, Nat’l DD Seminar,NTSC, GRSP, WHO, MOH
Data and analysis on DD was limited
Is alcohol consumption in Vietnam a key contributor to traffic accident?
Future priority projects? A national DD action plan to be developed and submitted to
GOVN office.
3
objectives
To synthesize activities and projects related to alcohol overuse and intervention implemented in Vietnam from 2002 up to now
To input data on drink-driving crashes at Viet Duc and Saint Paul Hospitals in Hanoi
To evaluate the alcohol consumption situation of crash victims admitted to the hospitals
To evaluate consequent factors between drink-driving and victims’ health and hospital costs
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Target groupTarget of study
Situation, attitude and behavior of road traffic victims towards alcohol consumption
Target group Road traffic victims:Over 16 years oldRoad crash victims within 8 hours since collision happenedHospitalized, stayed for monitoring at clinic, minor operation, including deaths caused in the hospital and clinic
(The study is not applicable for victims returning home after check-up or death before arriving at hospital and clinic).
Sample size: 775
5
methodology
Study on available documentation
- Road Traffic Law- Previous studies, projects, researches Qualitative data
- In depth interviews with representatives of GOVN agencies (NTSC, C26, MOH’s PMD)
- In depth interviews with representatives of int’l and NGOs (WHO, JICA…)
Quantitative data
- Questionaire, refering to MOH’s questionaire- Interview, and collection of data from different faculties
of the hospital- BAC testing results provided by Viet Duc Hospital.
6
Methodology
Timeframe From 11/08 – 01/09: TOR, proposal and study plan From 02/09 – 05/09: Implementation, data collection and analysis,
report
Interviewers: NEU researchers Doctors, medical staff of Viet Duc and St Paul hospitals 2 trainings at each hospitals: pilot then actual interview
(questionaire revised after the pilot)
7
Study location
2 hospitals of ViÖt §øc vµ Saint Paul – Hµ Néi
Viet Duc hospital
St Paul hospital
Interview
Training
8
MORAL OF THE STUDY
Epidemical study with multi-implementing agencies (IPSI- NEU, Viet Duc Hospital, and Saint Paul Hospital in Hanoi) + carried out after having approval from relevant agencies
Personal information of victims: respected and kept confidential as a principle, recorded under bar codes stipulated by study guideline
The study results serve to improve the drink-driving situation
9
RESTRICTION
At hospital, with injured victims: difficult to collect all required data
Victims admitted to different faculties, under supervision of different doctors. Q’naire must go through several faculties. Time consuming, missing data, interuption in interviews.
Samples: Victims over 16 yrs, no death before arriving hospital, within 8 hours from the accident.
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KEY FINDINGS
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SYNTHESIS OF ACTIVITIES, INTERVENTION PROJECTS AND RESEARCHES
implemented in Vietnam from 2002 to present
• Penal Code Number 15/1999 QH 10 (Article 202 – drunk term, not yet legal BAC)
• Traffic Law in 2001
( Article 8, para 8 – over 80 miligam/100 mililit blood or 40 miligam/1 liter of breath (BAC and BrAC not consistant, no difference btw riders and drivers)
• Traffic Law in 2008 (effective from 1/7/2009)
(Article 8 para 8- over 50 miligam/100 mililit blood or 0.25 miligam/1 liter of breath” to MC riders; and O to drivers
12
SYNTHESIS OF ACTIVITIES, INTERVENTION PROJECTS AND RESEARCHES
implemented in Vietnam from 2002 to present
GOVN agencies
+ NTSC and provincial TSCs Traffic safety PE in collaboration with social and economic orgs.
Leaflets – Things that Drivers and Riders need to know Collaboration with NGOs Not yet separated PE on DD
- C26: enforcement + behavior change education
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SYNTHESIS OF ACTIVITIES, INTERVENTION PROJECTS AND RESEARCHES
implemented in Vietnam from 2002 to present
Hanoi DOT• Enforcement: not much, only in combination
with riders/ drivers’s traffic• PE: leaflets- Things that Riders and Drivers need to
know, MOET curriculum participation, road traffic law competitions
- Not yet separated PE on DD
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SYNTHESIS OF ACTIVITIES, INTERVENTION PROJECTS AND RESEARCHES
implemented in Vietnam from 2002 to present
MOET- Traffic safety and Road Traffic Law curriculum at all
levels of school.- Collaborated with C26, NTSC to develop teacher ‘s
manual and student’s workbooj on traffic safety- Drink no Drive is one of the themes
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SYNTHESIS OF ACTIVITIES, INTERVENTION PROJECTS AND RESEARCHES
implemented in Vietnam from 2002 to present
MOH’s GDPMEH• “Statistics on fatalities due to injuries and accidents” every 2 year• Research of accidents relating to DD situation and awareness on Hanoi 2
districts and Hung Yen. Initial study, stopped due to shortage of fund. • HSPH, Medical University of Hanoi, of Hue etc.
Projects: WHO, JICA, Honda, VIA, TCTRBNGK…
Scientific researches / studies on DD
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RESULTS FROM FOCUS INTERVIEWS AT 2 THE HOSPITALS
Per age and sex Most are male
Graph 1.1: Percentage distribution of study targets by age and sex (%)
Demographic specifications of study targets
24.5
10.3
33.4
8.512.4
4.1 4.1 2.6
74.5
25.5
0
10
20
30
40
50
60
70
80
16-24 25-44 45-59 60+ Chung
Nam
Nữ
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Demographic specifications of study targets
Graph 2: Percentage distribution of study targets by education (%)
Trung học c ơ sở 27,6%
Phổ thông trung học 38,1 %
Cao Đẳng đại học 18,8 %
Không trả lời11,5%
Tiểu học3 %
Không đi học0,9%
Per education level
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Demographic specification s of study targets
Per occupations: Free labourers 27,7%, farmers 15,6%, Blue collars 15,5%
Graph 1.3: Percentage distribution of study targets divided by occupation (%)
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Evaluation of drink-driving situation
- Alcohol positive is very high 56,4%. - 29,4% exceed legal BAC regulated in RTL 2001 - Per RTL 2008: 33,4% exceed BAC
Graph 4: Percentage distribution of study targets related to BACs and exceeding legal limit regulated by traffic law (%)
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Evaluation of drink-driving situation
- At all ages, male has higher BACs than female
Graph 5: BACs distribution of study targets divided by sex and age group (%)
76.368.2
53.1
75.0
59.4
69.762.1
73.4
58.365.3
37.9
26.6
41.7 34.740.6
23.831.8
25.030.3
46.9
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
Nữ Nam Nữ Nam Nữ Nam Nữ Nam Nữ Nam
16-24 25-44 45-59 60+ Chung
Không Có
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Evaluation of drink-driving situation
- High school and secondary school age have higher BACs than others
Graph 6: BACs distribution of study targets by education (%)
22
Evaluation of drink-driving situation
- Drivers has the highest BACs
Graph 7: Distribution of BACs of study targets by occupation (%).
47.4 47.4
61.7
72.7
62.8
52.1
33.3
100.0
66.7
71.7
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Pupil-Student
Officer Worker Soldier-Poilice
Farmer Free labour
Retired people
Driver Other Indistinguishable
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Graph 8: Percentage Distribution of study targets regarding alcohol use habits (%)
Only 38,1% always use non alcohol. Often use different types of alcohol is over 50%
G9: Percentage Distribution of study targets regarding alcohol use frequency: daily or weekly (%)
3,9% drink everydayAt least once/ week is 3,7%. 1 – 3 days / mth: Highest, 26,6% .
Evaluation of drink-driving situation
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Graph 10: Percentage Distribution of road crash victims investigated who accept having drunk alcohol 8 hours before collision by sex (%)
Evaluation of drink-driving situation
Over one third accept having drunk alcohol within 8 hours prior to collition, mainly male37,2% in general. 47,3% in male
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Evaluation of drink-driving situation
In 288 samples who accept having drunk within 8 hours prior to collision, 94,8% is male
“Did not remember” (the quantity of drinks) is very high 36,3%.
G11: Percentage Distribution of investigated males regarding alcohol consumption level within 8 hours before collision (cup for wine/glass for beer) (%)
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Evaluation of relevant factors to road crash, health and alcohol use
Weekends have higher percentage of accidents. Fri 17%, Sun 17.7%
G12: Percentage Distribution of road crash hours by days (%)
02468
1012141618
Monday Tues Wed Thurs Friday Satuday Sunday
16.0
10.613.5
10.5
17.014.7
17.7
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Evaluation of relevant factors to road crash, health and alcohol use
Going out hours have the highest of accident percentages: 31.2%.
Total sum of accidents within working hours are high, 28.8%
G13: Percentage Distribution of involving road crash by hours (%).
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Evaluation of relevant factors to road crash, health and alcohol use
Table 1: Percentage Distribution of period having road crash by hours and with BACs
Time period that accidents happenAlcohol Negative
Alcohol Positive Average
6h30-8h_Go for work 5,9 2,5 4,0
8h-11h30_Working hours 21,3 9,4 14,6
11h30-13h30_Lunch break 8,0 6,9 7,4
13h30-16h30_Working hours 14,2 14,2 14,2
16h30-18h30_Leave for home 8,6 6,4 7,4
18h30-19h30_Dinner time 6,5 7,6 7,1
19h30-23h30_going out 21,9 38,4 31,2
23h30-6h30_Bed time 7,4 6,6 7,0
Not known 6,2 8,0 7,2
Total % 100,0 100,0 100,0
Total sample 338 437 775
Highest alcohol positive: going out time. Followed by in working hours
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Evaluation of relevant factors to road crash, health and alcohol use
G 14: Percentage Distribution of type of vehicle used by road crash victim (%)
.
82.8%victims use MCs, in which more than ½ of victims are alcohol positive
G15: Percentage Distribution of study targets by type of vehicles and with BACs (%)
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Evaluation of relevant factors to road crash, health and alcohol use
G16: Percentage Distribution of the type of vehicles that had collision with victims (%).
Most of the collisions are with motorbikes (52,8%). 14,8% self falling
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Evaluation of relevant factors to road crash, health and alcohol use
G17: Percentage Distribution of vehicle drivers/riders that had collions with victims due to BACs (%)
In all collisions, BACs of the drivers/ riders are high, from 52,9% to 65,2%
In self, falling, BACs exceed 65%
32
Evaluation of relevant factors to road crash, health and alcohol use
G18: Percentage Distribution of interviewees by their position on
vehicles when in the collision (%)
73% of the victims are drivers/ riders
G19: Distribution of interviewees by their position on vehicles and with BACs
(%).
Approx 60% victims are riders/drivers with BACs
33
Evaluation of relevant factors to road crash, health and alcohol use
G20: Percentage Distribution of victims using safety devices – Helmet (%)
Helmeted motorcyclists are 65,5%.
- BAC victims have higher % of not using safety devices than no BAC victims
- % of not using safety devices reduces per age groups: 16-24, 25-44, 45-59, 60+ are accordingly 19,4%, 16,1%, 15,2% và 7,4%.
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Evaluation of relevant factors to road crash, health and alcohol use
G 21: Percentage Distribution of study targets by injured parts of their bodies and having BACs (%)
Head injuries in BAC victims are 61,1%, vs 38,9% in no BAC victims
Similarly, face injuries:70,5% vs 29,5%
Multi injuries: 68,0% vs 32,0%.
Especially, there is close connection btwn BAC and injured parts of bodies. Equiv in head and face (Equiv. P value = 0.004 và 0.003)
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Evaluation of relevant factors to road crash, health and alcohol use
Table 2: Percentage Distribution and the risk of having injured parts of victims with BACs
Risk of injuries increases when victims are alcohol positive.
Risk of head injuries in the BAC victims is 1.5 times higher than no BAC victims. Face: 2 times higher; multiple injuries is approx 1,7 times.
Injured partAlcohol
%Non alcohol
%P value
Risk OR
HeadInjured 61,1 38,9
0.004 1,53No 50,7 49,3
FaceInjured 70,5 29,5
0.003 2,0No 54,4 45,6
Multiple injuriesInjured 68,0 32,0
0.234 1,67No 56,0 44,0
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Evaluation of relevant factors to road crash, health and alcohol use
Table 3: The risk of having injured parts of victims with lower and higher BACs level than legal limit in Traffic Law 2001 and 2008
Road Traffic Law obbeydiance will reduce credibly injury risks.
Head injuries reduce from 2.5 times to 2.1
Face injuries reduce from 1.8 times to 1.6 times
Injured parts
BACs level from1-
80mg/100ml%
Above 80mg/100ml
%
BAC level from 1-
50mg/100ml%
Above 50mg/100ml
%
Head
injured 38,6 61,4 33,2 66,8
No 61,2 38,8 51,7 48,3
P value 0.000 0.000
OR risk 2,511 2,125
Face
Injured 35,8 64,2 31,3 68,7
No 50,0 50,0 42,4 57,6
P value 0.089 0.033
OR risk 1,792 1,615
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Evaluation of relevant factors to road crash, health and alcohol use
G 22: Study targets distribution by injuries mechanism and having BACs (%)
BAC victims have higher % of internal injury/ wound or internal injury/ wound than no BAC victims
42,1 40,2 43,8
56,359,857,9
0
10
20
30
40
50
60
70
Internal injury Wound InternalInjury/wound
Non Alcohol Alcohol
38
Evaluation of relevant factors to road crash, health and alcohol use
G 23: Percentage Distribution of interviewee by Glasgow point and having BACs
BAC victims have higher Glasgow points than no BAC victims
(G<=8 is dangerous)
39
Evaluation of relevant factors to road crash, health and alcohol use
G 24: Percentage Distribution of victims having treatment at clinic and/or emergency room (%)
Over 50% of victims are hospitalised from having treatment at clinic, emergency room
% of victims being examined, treated and discharged home (slight injuries) is
only 14,7%.
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Traffic accidents and Drink drive
Graph 25: Percentage Distribution by final injury (%)
379 victims hospitalised and diagnosed with final injury. 2 main injuries are head trauma 42.3% & extremities fractured 38.1%.
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Traffic accidents and Drink drive
Graph 26: Percentage Distribution of interviewees by final injury and having BACs (%)
victims with BACs often have higher risks of being injured than non BACs victims; spinal injury is an exception
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Traffic accidents and Drink drive
Graph 27: Percentage Distribution of investigated group by further treatment and having BACs (%)
Significant differences in further treatment among the BACs victim group and non BACs (31.4% compared to 19.3%, respectively).
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Awareness / Knowledge of the investigated group
Knowledge at alarming level: 81.3% do not know about the legal BACs and BrACs
Graph 28: Percentage distribution of interviewees that know about the legal BACs level for drivers as stipulated in the Traffic Law (%)
0102030405060708090
Do not answer No Yes
18,1
81,3
0,6
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Awareness / Knowledge of the investigated group
47.8% of the interviewed victims had travelled as passengers with drinking drivers with varied frequencies (34.5% under 10 times/ year & 13.3% over 10 times/ year), indicating that victims do not have the right behaviors on DD
Graph 29:Percentage distribution of interviewees that had travelled as passengers with drinking drivers
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Awareness / Knowledge of the investigated group
Most victims know the bad influences of drinking then driving
Graph 30: Ratio of interviewees who supported solutions for limiting alcohol use when driving
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Treatment expenses
Most victims do not obtain health insurance (61.9%)
Note: Victims with BACs not to receive allowance as stipulated in Health Insurance Law 2008, Article 23
Graph 31: Percentage distribution of victims obtaining health insurance (%)
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Treatment expenses
25% victims pay 617.000 đ and below, 25% victims pay 3.574.000 đ and above (6 times of the minimum salary)
Table 4: Hospital treatment fee
Victims with BAC pay more than those without BAC
Amount (1000 VND)
Criteria
Alcohol
Non alcohol
General
Inter quartile range 25 700 535 617
50 1,550 1,335 1,497
75 3,629 3,455 3,574
Average amount/treatment case 2,873 2,758 2,823
Total hospital fee 1,255,401 932,346 2,187,747
Number of victims 437 388 775
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Treatment expensesTendency of treatment costs to increase sharply if the legal BACs increases:
50% of road crash victims with the legal BACs level stipulated in Traffic Law 2008 (up to 50mg/100ml blood), have to pay hospital fees higher than those non BACs - an amount of 113% above the minimum stipulated salary.
Graph 32: The different rate of treatment costs for victims with BACs and those without BACs, based on the inter quartile range (to be counted per the
minimum stipulated salary of VND 540,000/month)
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Treatment expenses
Average (VNĐ) 2.823.000
Total (775 victims) (VNĐ) 2.187.747.000
• Average treatment expenses per victim is approx. 2.823.000 VND • Excluding caretaker expenses and other losses caused by the work disability, opportunity costs of victims and caretaker• Excluding state economic and social costs as well as of the victims
Hospital treatment exp = 23,000 victims (per MOH
statistics) x 2,823,000 = 65 billionVNĐ Trend not statistics.
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Opportunity costs
Graph 33: Distribution of target group based on the disclosed opportunity cost of victims and the main caretakers (%)
1. Loss of biz development and expansion is highest (both victims and mian caretakers): 48,4% & 41,9%
2. Loss of taking care of children follows at 31,5% & 35,7%
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Conclusion and Recommendation
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Alcohol use limits for drivers was integrated into the Criminal Law of Vietnam in 1999. No BAC, term “drunk”
The legal level of BACs was clearly stipulated in the Traffic Law 2001 but slow implementation of adjudication sanctions (administrative punishment or legalization for traffic policemen to test BACs on drivers) had limited effect.
Ordinance regulations have been revised 5 times by GOVN
In the Traffic Law 2008, the legal BACs have been lowered –guidance has been being drafted for implementation.
conclusion
53
Most of the traffic victims (75.7%) are under 45 years old (they are in the labor age group and the bread-earner of families
Most of the traffic victims (82.8%) used motorcycles and 70% of them were drivers.
Half of the vehicles having collisions with victims were motorcycles.
The percentage of road crash victims with excess BACs is high (56.4%), of which men occupy the majority of cases (86.3%).
conclusion
54
Consumption of alcohol was recorded to be higher for people with junior and senior school education
Permanent drivers’s & freelance laborers’s BACs level was higher than for other occupations. Lives of passengers?
Fri, Sat, Sun, Mon: more accidents
Rush hours: less accidents than working hours and leisure time in the evenings
conclusion
55
Victims having the habit of alcohol beverage consumption: pretty high (> 50%). Men as majority.
60% of the traffic crash victims = drivers and motorcyclists with high BACs levels. Wearing helmets accounted for only 65.5%. Behavior?
Drivers and motorcyclists with positive BACs had a much higher risk of being injured or higher rates of having injuries on the head and face than those without BACs.
conclusion
56
More than 50% of the traffic victims had to be hospitalized after treatment at clinics. Head trauma and leg-bone fractures were mainly the longest lasting injuries which accounted for 42.3% and 38.1% of the total.
Approximately 50% of the victims have travelled as a passenger with the DD driver and motorcyclist
Crash victims who did not know about the legal BACs and BrACs limits were extremely high (81.3%) - This is a gap in traffic law propaganda.
conclusion
57
61.9% of crash victims did not have health insurance. The hospital treatment cost for traffic victims with BACs was often higher than non BACs victims.
Average treatment cost for a hospitalized victims was 5 times higher than the current minimum salary regulated by the Government (VND2,900,000 compared to VND540,000).
Annually 23,000 traffic victims (per MOH) = VND65 billion for traffic injury treatment nationwide.
conclusion
58
Opportunity cost: (1) Loss of biz development & expansion (Vicitms =48,4% main care
takers = 41,9%). (2) Loss of taking care of children (Victims = 31,5%; main caretakers =
35,7%) (3) Loss of taking care of old parents (43,9% & 27,4) From 16 to 24 years old: loss of study opportunities, some permanent disabled –
loss of vocational training, job opportunities.
Most of the crash victims had the same opinion that drinking and driving will increase the risk of having a traffic accident.
The percentage of supporters to drinking-not driving is extremely high (85%);
most of the victims said that drinking drivers should be strictly punished and alcohol abuse prevention propaganda should be disseminated widely. ( big awareness – behaviour gap)
conclusion
59
2 solutions closely combined:
Public Education + Enforcement
for behaviour change
“Drink – No Drive”
recommendation