Burden of motorcycle-related injury in Malaysia
© Rahman et al. 2015
Received: 26 November 2014
Accepted: 20 May 2015
Published: 4 June 2015
Road traffic injury (RTI) contributes to major morbidity and mortality in both developed and developing countries. Most of the injuries are caused by road-related injuries that specifically relate to motorcycle crash. We attempted to conduct a short survey to determine the magnitude of burden related to motorcycle-related RTIs in Malaysia. We hypothesize that motorcycle-related RTI in Malaysia contributes significantly to the health burden in the country.
The cross-sectional survey involves data searching related to RTI in Malaysia from the relevant agencies such as the Ministry of Health Malaysia, Royal Police Force, and Malaysia Institute of Road Safety Research (MIROS) through their official websites and PubMed search. The three agencies are well established and recognized by the Malaysian government in dealing with data collection for the injury nationwide. The primary aim is to determine the prevalence of motorcycle-related RTI, and secondary outcomes are the overall mortality and the contributing factors.
Of the cause of trauma, 80 % is due to RTI, and the most vulnerable road users such as pedestrians and motorcyclists are affected the most. Of all RTI, 70 % is contributed by the motorcycle crash, and there are a significant number of deaths for both rider and pillion rider of the motorcycle than for other types of vehicles. Human error is the main reason to be blamed, specifically the attitude of the riders on the road.
Trauma is one of the common reasons for death and hospitalization in Malaysia. Motorcycle-related RTI in Malaysia contributes significantly to the health burden in Malaysia. The Malaysian government and non-government agencies have worked together seriously in implementing a preventive measure to reduce the incidence and aftermath of motorcycle-related RTI. However, data is still lacking, and every effort is made to increase the amount of research in the field.
Latest alarming data on motorcycle-related injuries in the developing country.
The data is collected from multi-agencies recognized by ministries in the country.
Very limited publication specifically on motorcycle-related injuries is available.
The data is only from one country.
The statistical data is gathered from a variety of sources, i.e., relevant agencies and authorities and website of the involved ministries.
MOH statistics on the top 10 causes of hospital admission in Malaysia
Ten principal causes of hospitalization in Malaysian hospitals, 2012
Pregnancy, childbirth, and the puerperium
Diseases of the respiratory system
Injury, poisoning, and certain other consequences of external causes
Diseases of the circulatory system
Certain conditions originating in the perinatal period
Certain infectious and parasitic diseases
Diseases of the digestive system
Diseases of the genitourinary system
Factors influencing health status and contact with health services
The cross-sectional survey involves data searching related to RTI in Malaysia from the relevant agencies such as the Ministry of Health Malaysia, Royal Police Force, and Malaysia Institute of Road Safety Research (MIROS) through their official websites and PubMed search. The primary aim is to determine the prevalence of the motorcycle-related RTI, and secondary outcomes are the overall mortality and the contributing factors. The fatality cases include those who died immediately at the scene and late death in hospitals after sustaining motorcycle-related RTI.
This article does not require ethical approval because it is a brief review report article and does not involve data collection from patients.
Total casualties and damages caused by RTA in Malaysia, 2002–2011
Total number of accidents
The total number of vehicles involved in RTA in Malaysia, 2002–2011
Deaths by type of road users in various regions 2012
Registered motorcycle (2012)
Reported fatalities (2012)
Road fatalities per 100,000 population
Motorcycle fatalities per 10,000 registered motorcycles
Pattern of injuries sustained by motorcyclists in 2012 in ED of two tertiary centers
AIS body regions
Head and neck
Preventive efforts and research
There are many ways to tackle this serious issue, one of which is the implementation of preventive and road traffic safety programs. Malaysia has also experienced significant change in ways to tackle road safety. Few important organizations start to integrate and work on the same issue in promoting road safety. Those include the Malaysian Police Force (PDRM), Ministry of Transportation, Malaysian Institute of Research on Road Safety (MIROS), Department of Road Safety (JKJR), Department of Road and Transportation (JPJ), Ministry of Work, and Ministry of Health [11, 12].
Despite a lot of advancement in the modern engineering of the motorcycle, man has failed to put effective protective equipment and measures to protect the rider in the motorcycle itself. The initiative of any protection is concentrated on the rider himself rather than on the motorcycle. Thus, the rider needs to utilize protective equipments such as helmet, leather protective gears, boots and gloves, and conspicuous clothing. An essential checking of the brake light and wheel pressure besides keeping the front light switch on all the time may ensure further protection for the rider . Legislation in Malaysia mandates the rider to switch on the light at daylight in order to make the rider more visible and reduce fatalities among motorcycle users [14, 15]. In Malaysia, wearing a crash helmet or a safety helmet is compulsory and mandatory by law. The helmet has its own standard for its manufacturing and its safety regulation, and in Malaysia, the bodies that ensure helmets safety is the Standards and Industrial Research Institute of Malaysia (SIRIM) .
A preventive measure requires considerable amount of data to elicit the current problem. Data obtained from robust studies can be used to create preventive measures and hence reduces the incidence of motorcycle-related RTI. Unfortunately, due to the limited number of prospective studies conducted in Malaysia and the lack of an integrated sustainable injury registry, neither the accurate morbidity nor the mortality of road-related motorcycle injuries has been recorded nationally. Ambak et al. conducted a cross-sectional study in Selangor, Malaysia, in 2011 to examine the percentage of compliance rate regarding helmet use and to identify its characteristics . The observations among 1150 motorcyclists show that only 46.6 % used helmets properly, 10.6 % untied helmet, and 42.8 % did not wear a helmet. The percentage of improper helmet usage in the locations of study was considered high, and it seems those helmet initiative programs are insufficient to overcome the problem. Therefore, there is a serious need to introduce a new mechanism or method that can be utilized to incorporate behavior adaptation toward safety concern among motorcycle users. In 2006, Law et al. conducted an interesting cross-sectional analysis among motorcyclists who are labelled as red light runners in Kuala Lumpur, Malaysia . Interestingly, they found that most of the red light running violations occurred at the signalized intersections with high-motorcycle volume, shorter change interval time, shorter amber time, and longer cycle length. The findings can be used to evaluate the effectiveness of specific countermeasures, such as providing a longer change interval time and amber time, shorter cycle length, less number of signal phase, or all of them, for different traffic volumes at signalized intersections.
In 2005, a group of researchers from MIROS analyzed all motorcyclists injured who sustained cervical spine injuries in Kuala Lumpur . The types of injuries sustained were acquired from medical reports. Information on the crash scene and crash mode was obtained from police reports, and interview sessions were arranged with the motorcyclists involved in the crash. Generally, a high count was noted for injuries to the lower cervical vertebrae, especially at vertebrae C5, intervertebral C5-C6, and vertebrae C6. The upper cervical spine was observed to have a high frequency of injury at C2, especially the odontoid process. Neck flexion and extension movements are the most frequent neck injury mechanisms, especially in frontal- and rear-end-impacted motorcycles. This has proven that the mechanism of impact during the crash greatly influenced the clinical finding, and every paramedic and doctor involved in treating the victims should be made aware of the biomechanics of the injury so that they do not miss the serious injury.
There are many more ongoing researches in the same field such as the geo-mapping of the RTA, the development of the electronic road traffic injury surveillance system, and the biomechanics of injury. The research effort must involve multi-agencies, and grant support from the government must be made available continuously for the sustainable preventive projects in the future. Another area that requires more attention by the law maker is the development of a sustainable and funded nationwide data collection system such as a trauma registry. At present, unfortunately, this database system is not available nationwide but more of the regional collection which is either a manually or electronically hospital-based system. However, the police force has established a nationwide and centralized data collection on all motor vehicle crashes that are reported to them. The dataset includes the prehospital data, mechanism of crashes, severity of injury (based on body parts injured), and clinical outcome. Effort has been made to integrate data collection between agencies such as hospitals, MIROS, and the police force which has a uniform dataset definition. Even though the data mentioned above came from various sources, these published data represent prevalence among population of Malaysia and can be considered accurate enough since they were extracted from established and recognized agencies such as MIROS, the Ministry of Health, and the Royal Police Force of Malaysia. Unfortunately, we do not have the exact figure on the economic impact of trauma care on the RTI victims. This is probably another aspect that can be looked upon seriously by the government in tackling the burden of motorcycle-related injury holistically.
The survey obtained the data mainly from official websites and previous publication through PubMed. There is a tendency for missing data of the actual incidence of the motorcycle-related RTI and the underreporting of the factors contributing to the crash. The data is only up to the year 2012. However, the data published is from reliable and well-maintained sources and still reflects the present situation in the country.
Trauma is one of the common reasons for death and hospitalization in Malaysia. Motorcycle-related RTI in Malaysia contributes significantly to the health burden in Malaysia. The Malaysian government and non-government agencies have worked together and seriously in implementing the preventive measure to reduce the incidence and the aftermath of the motorcycle-related RTI. However, data is still lacking, and every suitable effort is taken to increase the amount of research in the field.
Ministry of Health Malaysia at http://www.moh.gov.my/images/gallery/stats/heal_fact/health_fact_2012_page_by_page.pdf
Ministry of Transport at http://www.jpj.gov.my/web/eng/statistic
We acknowledge the financial support from a Research University (RUI) grant (1001/PPSP/812099) for the pilot project of the electronic road traffic injury surveillance (eRTIs) development in the Universiti Sains Malaysia.
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