Road traffic injuries and alcohol use in the emergency department in Tanzania: a case-crossover study

Abstract Introduction: Alcohol is the leading risk factor for road traffic injury (RTI). Africa has the second-highest rate of alcohol dependence and the highest road traffic fatality rate. We describe the proportion of Tanzanian emergency department (ED) patients presenting with RTIs who are blood alcohol content (BAC) positive and determine the dose-response relationship between drinking and injury risk.Methods: Analysis of data from EDs in Tanzania from 2013 to 2014 was performed. Adults presenting to an ED within 6 hours of injury had BAC testing and were asked whether and how much alcohol was consumed prior to the injury. Data also included self-reported alcohol use during control periods 1 day and 1 week prior to the injury. Case-crossover analysis of injury risk used logistic regression to determine matched-pair odds ratios (ORs) and 95% confidence intervals (CIs).Results: Of 513 injury patients, 375 (73%) suffered RTIs. Overall, 29% of RTI patients were BAC-positive. Approximately 40% of those who reported using alcohol prior to RTI reported drinking more than 5 standard drinks. With any alcohol, drivers of both motorcycles and cars/trucks had increased odds of RTI (4.90 OR (CI 2.5-9.5) and 5.70 OR (CI 2.8-11.6) respectively). While the odds of RTI in car/truck drivers demonstrated a dose-dependent response, that in motorcyclists was highest after 3-4 drinks (5.60 OR, CI 2.22-14.10).Discussion: The RTI burden in Tanzania is high. Any alcohol can increase RTI risk. These findings should guide drunk-driving legislation.