The RTrT Partnership: Reducing Traffic-related TraumA - A community-based prevention and first-response programme intervention for Malawi and beyond.

道路交通碰撞造成的伤害是撒哈拉以南非洲可预防死亡的一个主要和日益增长的原因。在低收入和中等收入非洲国家，道路交通碰撞造成约169 000人死亡，并使残疾人损失约600万健康寿命年。道路交通碰撞还影响人们的工作能力和社区福祉。由于处于工作年龄的男性发生道路交通碰撞的可能性是女性的三倍，低收入和中等收入国家的收入潜力损失最高可达3%。因此，改善道路交通碰撞后果将有助于实现联合国可持续发展目标中的四项：消除贫困；健康和福祉；维持城市和社区以及合作伙伴关系。马拉维是世界上道路交通相关死亡率最高、车辆拥有率最低、人均收入水平最低的国家之一。因此，马拉维政府已确定，与道路交通有关的创伤是改善国家健康和财政状况的主要障碍。然而，它在改进方面面临着相当大的挑战。马拉维没有正式的院前护理系统，没有通用的紧急电话号码，几乎没有救护车服务。对受伤人员的护理是随意的，通常是由很少或没有基本急救培训的路人提供的。因此，那些有存活能力的人往往会死亡。这导致马拉维最大医院的医生最近发布了一份行动呼吁，强调需要改善创伤护理。所有的创伤护理都将受益于进一步的研究和发展。然而，《行动呼吁》表示，改善院前创伤护理的研究应该是一个特别的优先事项。因此院前创伤护理是合作伙伴关系的特别重点。2017年9月，应Chokotho博士和Mulwafu博士的邀请，Duncan博士和Uny博士对马拉维进行了为期9天的研究访问，随后制定了这项建议。在这次访问中，我们与不同的组织、学者和社区成员讨论了当地道路交通相关创伤的挑战。普遍一致认为，第一步应该是发展以社区为基础的方案干预措施，这种干预措施由不同但相互联系的干预措施组成，以预防和应对冲突。将预防和应对结合起来处理，可能比单独处理任何一个都能给社区带来更大的改善。我们的道路交通相关创伤伙伴关系汇集了应用卫生科学、公共卫生、全球卫生、艺术和人文学科、院前和紧急卫生保健服务、社区参与以及当地社区成员方面的专家。我们将使用我们所代表的不同学科的各种方法。这些可能包括收集、分享和讨论不同人对道路碰撞挑战的看法和想法的创造性方式，包括使用视觉方法和戏剧来参与和交流研究团队、更广泛的利益相关者和公众。我们将在马拉维工作，并在会议间隙制定一项干预措施，以改善受道路交通碰撞严重影响的当地社区的社区预防和第一反应。在项目结束时，我们将研究如何将我们的工作转移到其他撒哈拉以南国家。然后，我们将申请资金来实施和测试我们的干预措施。我们将在本地、全国和国际上分享我们的工作。我们将确保与学术界、政府决策者、道路交通和创伤护理组织以及当地社区成员分享我们的研究结果。在适当情况下，将与当地居民共同制订这些产出，并将其翻译成主要的当地语文。

Injuries resulting from road traffic collisions are a major and growing cause of preventable death in sub-Saharan Africa. Road traffic collisions in low and middle income African countries account for approximately 169,000 deaths and about 6 million healthy years of life lost due to disabilities people are left with. Road traffic collisions also impact on people's ability to work and on community wellbeing. As working aged men are three times more likely than women to be involved in a road traffic collision low and middle income countries lose up to 3% of their earning potential. As a result improving outcomes from road traffic collisions will contribute to the delivery of four of the United National Sustainable Development Goals: no poverty; health and well-being; sustaining cities and communities and partnership working.Malawi has one of the highest rates of road traffic related death, lowest rates of vehicle ownership, and lowest income levels per person in the world. Consequently the Malawian Government have identified road traffic related trauma as a major barrier to improving the health and finances of the nation. However it faces considerable challenges in making improvements. Malawi has no formal prehospital care system, no universal emergency telephone number, and almost no ambulance service. Care of injured people is haphazard and often provided by passers-by who have very little or no training in basic first aid. As a result people who have survivable injuries often die. This has led to doctors from the largest Malawian hospitals recently publishing a Call to Action that highlighted the need to improve trauma care. All of trauma care would benefit from further research and development. However the Call to Action says that research to improve pre-hospital trauma care should be a specific priority. So pre-hospital trauma care is the Partnership's specific focus. This proposal was developed following a 9 day study visit to Malawi by Dr's Duncan and Uny in September 2017, at the invitation of Dr's Chokotho and Mulwafu. During this visit local challenges of road traffic related trauma were discussed with a wide range of different organisations, academics and community members. There was a broad consensus that the first step should be the development of community based programme intervention that is made up of different, but linked, interventions to prevent and respond to collisions. Tackling prevention and response together is likely to lead to bigger improvements in communities than dealing with either separately.Our Road Traffic Related Trauma (RTrT) Partnership brings together experts in applied health science, public health, global health, arts and humanities, pre-hospital and emergency healthcare delivery, community engagement, and local community members. We will use a variety of methods from the different disciplines we represent. These are likely to include creative ways of gathering, sharing and discussing different people's views and ideas on the challenge of road collision, including the use of visual methods and theatre to engage and communicate within the research team, wider stakeholders and the public. Working in Malawi and at a distance between meetings we will develop an intervention to improve community prevention and first-response within local communities highly affected by road traffic collisions. Towards the end of the project we will will look at ways our work can be transferred to other sub-Saharan countries. We will then apply for funding to implement and test our interventions. We will share our work locally, nationally and internationally. We will ensure that our findings are shared with with academics, Government policy makers, organisations involved in road traffic and trauma care, and local community members. Where appropriate these outputs will be developed with local residents and translated into key local languages.