Distance, transport mode, and road safety on school journeys in urban India

Background: A third of a billion children travel to school every day in India, yet little is known about this journey. Increasing motorisation in India is likely to have implications for road safety of children. This thesis develops methods to measure distance to school, transport modes, and risk of road traffic injury, on journeys to school in Hyderabad. Methods: Following a systematic review, a self-completion questionnaire was developed to estimate the distance and modes of travel to school in India. Its validity and reliability was assessed using the kappa statistic. A cross-sectional survey using a two-stage stratified cluster sampling design was conducted in government funded, government aided, and private schools in Hyderabad. The relationship between modes of travel and distance to school was analysed using logistic regression, adjusting for confounders. The prevalence of road traffic injury in the previous 12 months during school journeys was estimated, and the impacts of alternative transport scenarios on road injury was modelled. Results: The questionnaire provided reliable information on the usual mode of travel to school, and road injury. Distance to school measured by asking for the nearest landmark to a child’s home was found to be a valid measure of distance compared to a method based on in-depth interviews with children. Forty five schools including 5,842 children aged 11-14 years participated in the survey, with a response rate of 99%. Most children in Hyderabad walked or cycled to school. Others travelled by motorised 2-wheelers, auto-rickshaw, school bus, public transport bus, and car. Greater distance to school was strongly associated with the use of motorised transport. A sixth of all children reported a road injury during school journeys, which was strongly associated with travel mode and distance to school. The overall risk of road injury was 25/100,000 child km per year. Relative to school bus occupants, bicyclists, pedestrians and motorcycle passengers were more likely to be injured, for the same distance travelled. The model showed that road injuries can be prevented under transportation scenarios that restrict distance and motorised vehicles near schools. Conclusions: The questionnaire reliably measured mode of travel to school and estimated distances to school in Hyderabad. Most children walked or cycled to school and if these levels are to be maintained, there is an urgent need to ensure that walking and cycling may be done sa