Nguyen Lan Huong GRSP Country Manager for Vietnam 9/11/2009, HCMC, Vietnam

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)

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Study location

2 hospitals of ViÖt §øc vµ Saint Paul – Hµ Néi

Viet Duc hospital

St Paul hospital

Interview

Training

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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

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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

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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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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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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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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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- 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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- High school and secondary school age have higher BACs than others

Graph 6: BACs distribution of study targets by education (%)

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- 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% .


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Graph 10: Percentage Distribution of road crash victims investigated who accept having drunk alcohol 8 hours before collision by sex (%)


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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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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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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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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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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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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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%

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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

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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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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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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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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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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

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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)

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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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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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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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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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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

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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

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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

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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

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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

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2 solutions closely combined:

Public Education + Enforcement

for behaviour change

“Drink – No Drive”

recommendation

60

Thank you!

[email protected]

Documents

Nguyen Lan Huong GRSP Country Manager for Vietnam 9/11/2009, HCMC, Vietnam