TITLE:
Prevalence, Sociodemographic and Traffic Factors Associated with Fatal Pedestrian Road Accidents in Nairobi, Kenya: An Autopsy Study
AUTHORS:
Kiama Wangai
KEYWORDS:
Pedestrians Road Traffic, Fatality, Alcohol, Kenya
JOURNAL NAME:
Open Access Library Journal,
Vol.12 No.11,
November
10,
2025
ABSTRACT: Background: Globally pedestrians account for nearly a quarter of all road crash deaths, with the number of pedestrian victims rising at nearly twice the rate of all other road crash fatalities. The proportion of pedestrians killed compared with other road users is highest in the African Region, at 40%. Increasing incidence of road traffic accidents in Low and Middle Income Countries like Kenya calls for region and country specific interventions. There is, however, inadequate data to inform such context-appropriate interventions. Objective: The objective of this study was to determine the prevalence, sociodemographic and traffic factors associated with fatal pedestrian road traffic accidents as well as their association with alcohol intoxication in Nairobi City, Kenya. Materials and Methods: This was a prospective, descriptive autopsy-based study conducted at Nairobi City Mortuary over a 12-month period from June 1, 2009, to May 31, 2010. The study received ethical approval from the University of Nairobi-Kenyatta National Hospital Ethics and Review Committee. Nairobi City Mortuary, located at the intersection of Mbagathi Way and Ngong Road, serves as the primary public mortuary in Nairobi for medicolegal autopsies. A total of 2,566 violent death cases were autopsied during the study period, all road traffic fatalities received complete postmortem examinations a systematic subsample of 400 cases was selected for alcohol testing, this is by consecutively selecting every fifth autopsy. Vitreous humor samples were analyzed using gas chromatography to determine ethanol concentration. Of the 400 cases tested, 96 were positive for alcohol. These included 50 cases due to accidents, 38 due to homicide, and 8 suicides. Of the 50 alcohol-positive accident cases, 43 were attributed to road traffic accidents and 7 to other types of accidents. Crude prevalence was calculated using a denominator of 3.7 million inhabitants, based on the 2009 Kenya National Census population for Nairobi City. Data on sociodemographic variables (age and sex), circumstances of the accident (e.g., road type, pedestrian action), and vehicle types involved were obtained from next of kin and attending police officers. Roads were categorized as follows: Highways: Major multi-lane roads connecting Nairobi to other towns, such as Thika Road and Mombasa Road, Market Roads: Roads in or near open-air market areas with heavy pedestrian and informal traffic. City Roads: Primary roads within the central business district (CBD) and surrounding urban core, Estate Roads: Minor roads within residential neighborhoods, typically with lower speed limits, Town Roads: Roads within outlying urban centers or informal settlements within Nairobi and; Other Roads: Roads that did not clearly fall into the above categories, including access or industrial roads. Data were analyzed using SPSS version 11.5 (SPSS Inc., Chicago, IL). Descriptive statistics were generated and presented in tables. Pearson correlation tests were used to assess associations between variables, including alcohol intoxication and pedestrian fatality characteristics. Results: During the 12-month study period, a total of 929 fatal road traffic accidents were recorded at Nairobi City Mortuary. Of these, 436 cases (46.9%) involved pedestrians, corresponding to a crude fatality rate of 11.8 per 100,000 population, based on the 2009 Nairobi City census figure of 3.7 million. The mean age of pedestrian victims was 30 years, with a range of 10 to 59 years. The age group most affected was 30 - 39 years, accounting for 211 cases (48.4%), followed by the 20 - 29 age group with 117 cases (26.8%). There was a striking male predominance, with a male-to-female ratio of 12.6:1. Most pedestrian fatalities (75.5%) occurred while victims were crossing the road. Regarding accident locations, highways accounted for the highest proportion of incidents (25.5%), followed by market roads (22.9%), city center roads (17.2%), town roads (10.8%), and residential areas (14.6%). In 16.5% of cases, vehicles had veered off the road before striking the pedestrian. Analysis of the types of vehicles involved showed that light passenger vans (matatus) were responsible for the majority of pedestrian fatalities (35.6%), followed by buses (24.8%), trucks (21%), private cars (10.6%), and motorbikes (8%).Among the 43 alcohol-intoxicated victims of road traffic accidents sampled from the study population, 22 (51.2%) were pedestrians. The presence of alcohol was found to be significantly associated with pedestrian fatalities (p = 0.03; 95% CI). Conclusion: Fatal pedestrian crashes are a major contributor to road traffic deaths in Nairobi, accounting for nearly half of all such fatalities. The victims are predominantly young males, with most incidents occurring during road-crossing attempts. Alcohol intoxication was found to be a significant associated factor, further increasing the vulnerability of this demographic. These findings highlight the urgent need to prioritize pedestrian safety through comprehensive urban road planning, improved engineering design of pedestrian walkways and crossings, and implementation of targeted road safety campaigns. In addition, stricter enforcement of traffic regulations and effective control of alcohol consumption—particularly among young men—are critical to reducing the burden of pedestrian fatalities. A multi-sectoral approach involving policymakers, urban planners, law enforcement, and public health stakeholders is essential to address the root causes and prevent these avoidable deaths.