Chitetezo: Improving adolescent road safety and reducing road traffic collisions.

Up to 1.4 million people are killed each year as a result of road traffic collisions. Over 90% of these collisions happen in low and middle-income countries. Between 20 to 50 million people are injured but survive, often with life-changing disabilities. Young people are particularly vulnerable road users. In fact, young people are more likely to die from a road collision in Africa than any other single cause. Within Africa, Malawi has one of the highest rates of road traffic collision in the region.

Current approaches to dealing with road traffic safety are not working. To date, almost no research has been undertaken looking at community-based ways of reducing road traffic collision with young people in low and middle-income countries.

We have been working to improve road safety in Malawi. In this study we will assess whether an intervention called Chitetezo (a Malawian phrase meaning "Protected") improves young people's road safety and reduces the number of road traffic collisions. We co-developed Chitetezo in collaboration with two young Malawian artists and the school management of one school in Blantyre, Malawi. Chitetezo involves young leaders working with other young people to improve understanding about road safety and their human right to live in a safe environment. The young people create large picture murals as part of this process: one which depicts the current road environment in their local community and its dangers; and another mural that shows the personal and environmental changes they would like to occur and believe would lead to reductions in road traffic collisions. The young people then host an exhibition to which they invite members of the local community and local government. During the exhibition, the young people present their murals and lead the adults in a discussion of the problems they have observed, as well as some potential solutions. The idea is that the discussions between young people and adults will lead to decisions being made to improve their local road safety infrastructure. We tested Chitetezo in one school in Blantyre, and found that young people enjoyed taking part and found it fully acceptable. Furthermore, there is some evidence that road safety infrastructural changes to improve road safety occurred 3 months later, as a direct result of the intervention being delivered.

This study Chitetezo will be run in 10 other schools around Blantyre. We will collect data to measure whether or not it makes a difference to the road safety behaviour of young people and the local road safety infrastructure. We will speak to young people about their experience of taking part in the intervention, or learning about it happening in their school. We will work together with young people collecting information on the environmental impact of the road infrastructure and young people's road safety behavior, both before and after the intervention takes place. We will also carry out an analysis of all the data on road collisions that are routinely collected by the Malawian Road Traffic Safety Service. This data will help us understand whether or not the intervention has made a difference to the number of road traffic collision over time.

Current approaches to prevent road traffic collisions (RTC) among adolescents are not working. We have developed and feasibility tested a novel peer-led prevention intervention (Chitetezo) to improve adolescent road safety, through changing behaviours and reducing RTC around schools in Malawi. Our overall study objective is to investigate if Chitetezo can reduce RTC around schools in Malawi. The study has an explanatory mixed-methods design. It incorporates both process evaluation and quasi-experimental elements across 10 schools. We will conducted four interconnected work packages (WP). In WP1 we will use participatory co-design methods to refine intervention components and hypothesised programme theory using recently gathered feasibility data. We will co-develop intervention materials for WP2. Schools will be purposively selected based on geographical dispersion, proximity to tarmacked roads, high traffic density and frequent collisions. Participants (n=8 per school) will be purposively selected using maximum diversity sampling. A mixed-method multiple case study process evaluation, informed by realist evaluation methods, will be undertaken, with each school being a case. In WP3 we will investigate Chitetezo's impact on behaviour, road safety infrastructure, and RTC. Three complementary data collection approaches will be used: i) a citizen science project with adolescents to evaluate the level of non-reported RTC; ii) participatory mapping activities to capture local knowledge about road traffic risks, and road safety behaviours; and iii) an interrupted time series (ITS) to analyse RTC around participating schools using an ongoing routine dataset (from 2003). The effectiveness of Chitetezo will be evaluated using a comparative interrupted time series (ITS) analysis. Data from each WP will be combined in a triangulation matrix to investigate convergence and divergence to answer the overall research objective. WP4 will focus on dissemination and legacy planning.

KEY BENEFICIARIES
This study will deliver a variety of key impacts for a range of beneficiaries including:

- Adolescents and other members of the public in Malawi and other low- and middle-income countries (LMIC), many of whom are classified as vulnerable road users (i.e. pedestrians, cyclists and motorbike users). In the short-term this will occur with the adolescents who are engaged in the study. In the medium term this impact will be extended to schools across Malawi and in the longer term to other LMIC.
- Schools and their local communities (again, initially those taking part in the research and then further afield in Malawi and other LMIC).
- The 35 Malawian local government authorities and relevant Malawian Government ministries (Health, Education, Science and Technology, and Transport and Public Works).
- Non-governmental international agencies (including The World Bank; The United Nations Road Safety Collaboration; UNICEF; College of Surgeons of East, Central and Southern Africa).
- The international interdisciplinary academic community working to understand the most effective ways to prevent and respond to road traffic collisions and their consequences.

KEY IMPACTS
1. Reduced road traffic collisions as a consequence of:

i. Increased adolescent awareness of positive road safety behaviour:

In the short-term there will be increased awareness of positive road safety behaviours among adolescents in the participating schools and local communities, and affordable improvements made to the road infrastructure. This will lead to improved road safety behaviour adcn safer and therefore reduced incidence of collisions involving adolescents (and other road users), resultant injuries and fatalities over the intermediate- to long-term in LMIC. This will facilitate an enhancement of economic productivity by reducing income lost due to unemployment as a result of road trauma injuries.

ii. Improved infrastructure and policy:

We envisage that the study will lead to road infrastructure safety improvements around school communities where there are high densities of adolescents and children. Our study will inform and influence Malawian government ministries as well as the policies of international agencies that have a focus on road safety and reducing road traffic collisions effecting adolescents and the wider community.

2. Increased capacity:

We will build research capacity and capability of Malawian early career researchers (the study researcher and a local co-investigator) who are part of the study team. Both young leaders who will deliver the intervention will develop skills in team leadership, teaching and communication of adolescents. We will also develop capacity and capability in leadership, communication skills and citizen science expertise among young people who participate in the citizen science data collection exercises described in work package 3.

Up to 80 young people will directly participate in the intervention, through which they will develop an increased understanding of the challenges of road safety in Malawi, analytical skills as they consider what road infrastructure improvement is required in their local environment. A further 80 young people will gain training and experience as citizen scientists through which they will develop capability in understanding road traffic issues, data gathering and reporting. Collectively, these adolescent-focused impacts will enhance the life and management skill capacity of young leaders and improve their future employability.

3. Partnership building:

The research will facilitate an increased engagement between adolescents and both their local communities and local government. The young people that participate in the research will develop an increased capability to engage in intergenerational decision-making, thereby developing inclusive and sustainable rights-based partnerships between adolescents and civic and political leaders