Disability has become an important issue in health care, but still insufficiently considered in public policies. According to the World Health Organization (WHO), disability is not linked to the individual but results from the interaction between a health problem and personal and environmental factors. It can be experienced very differently by each individual and therefore reflects an individual perception of capabilities [1] [2] . People with disabilities are exposed to social inequality and disability has a direct impact on development as it can increase the risk of poverty [2] . This requires targeted interventions to meet their specific needs, which may include disabled seating on public transport, access to public buildings, disabled-friendly pavements and traffic lights. Road crashes are one of the leading causes of injury and years of life lost due to disability worldwide and in sub-Saharan Africa [3] . Disability prevalence is estimated to be around 16% of the world’s population [1] and related factors commonly identified for post-crash disabilities are factors such as age, sex, injury severity, injury location, and referral conditions [4] [5] [6] [7] [8] . In Africa, motorbikes are more exposed to crashes (28% of road crash deaths worldwide), due to their vulnerability and their importance in the transport and in the general population [9] [10] [11] . They represent about more 75% of road crashes victims in hospital in Benin [12] . Research on the disability consequences of road crashes is relevant for complementing mortality and morbidity data or for developing road safety policies. It is also useful for planning rehabilitation needs and monitoring the Sustainable Development Goals (SDGs) at the country level [13] . An estimation of the prevalence of disability and the identification of its related factors could help to have a better understanding of the specific needs of motorcyclists and contribute to the development of a better road safety policy. Therefore, this study aims to provide data on disabilities resulting from road traffic crashes by estimating its prevalence and associated factors 12 months after the crash among road traffic victims in Benin.

Our study suggests that active male adults are more exposed to disabilities resulting from road traffic crashes. This profile is consistent with the common profile of most literature review studies, regardless of the context [7] [17] [18] [19] [20] [21] . This predominance of young males among road crash victims can be explained in Beninese settings by the fact that these young men (more than women or older people) engage in activities that require a lot of travel with most of the time risky behaviors such as speeding, non-compliance with traffic regulations, use of psychoactive substances and other driving habits that are more risky in traffic (passing between several vehicles, risky overtaking, aggressive driving in search of thrills). The assumption, entirely plausible in the Beninese context, is confirmed by recent work in China, in which male drivers were found to be more likely to take extreme risks while driving, explaining their preponderance among the victims [22] . Setting up policies to prevent accidents and consequently post-accident disability must therefore integrate this profile as being particularly high-risk and more vulnerable to the phenomenon.

The prevalence of disability in the present study was 12.5%. The main types of disability observed were walking difficulties (75%), memory difficulties (43%) and body care difficulties (30%). Regarding disability prevalence, there are very large variations depending on the context (close to 15% in Africa, around 30 - 50% Iran and Brazil) and the comparison remains difficult and not necessarily relevant [4] [19] [23] [24] [25] [26] . Indeed, integrating differences between contexts, used assessment tools, patient’s specific clinical profiles, follow-up times, defining outcomes, and data sources as well as evaluation times makes it difficult to have proper objective comparisons [25] [26] . For example, regarding assessment tools, the United Nations Washington Group on Disability Statistics questionnaire used in this study is internationally recommended for the assessment of disability in general. It explores the main types of disability according to the recommendations of the International Classification of Disability, Functioning and Health (ICF), taking into account the interaction of disabled people with their environments by proposing an exploration on the six (06) functions with a self-report of the patient. This self-reporting which remains for its part subjective can be discussed, as well as the definition of the six functions or the levels of scale used and these reservations justify the exploration through other tools like the WHODAS, developed by WHO [27] , or Barthel Index, which is a 10-item tool that assesses disability on a scale of 0 to 20 [28] . Furthermore, the results of the studies could differ according to the data sources as in population studies offers precise data [24] and that hospital surveys suffer from selection bias and may be an issue for representativeness. Thus, according to what is recommended, it is necessary to standardize methodological approaches and tools [26] .

As far as type of disability is concerned, the disability is more related to mobility with a focus on walking difficulties (76%) in this study and likewise in reviews [8] [29] . Lower body injuries are the most common, and some authors have established a greater risk of disability in patients with lower extremity injuries [27] . Also, when motor function is affected, the person is more reliant on others than on other functions. The self-reporting of the tool might influence the diagnosis.

Age was the first associated factor with disability plausible due to the great fragility of older peoples. They got a longer recovery process than younger people who have more resistant bodies. Our findings fit those of the literature review [4] [8] [24] .

No other socio-demographic variables were associated with the risk of disability in this study whereas sex was linked in other studies [4] , as well as the level of education and incomes [6] [8] . Variations in populations, sampling and the availability of some variables that have not been studied account for the differences. On the one hand, wider-scale explorations are necessary to better investigate the problem, but the need for standardization of approaches recommended by some authors is confirmed here [26] .

In this study, the severity of the initial injury and the hospitalization of the patient were also factors that influenced the occurrence of disability as logical consequences. Similar findings have been made in studies where the length of hospital stay and injury severity were risk factors for post-crash disability [5] [27] [28] [29] at 6 and 12 months after a road crash. This result also explains the other paradoxal findings related to the fact that ambulance transport to the hospital was significantly associated with disability. Although this variable is not significant in the final model, it can be explained regarding the fact that most serious injuries are transported by ambulance, which usually takes a long time to reach the site of the accident. The quality of pre-hospital care on site can help reduce the initial severity of the injuries (whose evaluation, recall, is done in the context of the first reception and management structure) and probably the length of hospitalization. In fact, improving the quality of pre-hospital care is a relevant and potentially effective area of intervention to be considered in implementing strategies to prevent disabilities after road crashes [19] .

Besides, due to the link with technological evolution and the impacts on individual and family life with significant socio-economic consequences, disability is thus a problem of public health for which, a better knowledge of the extent and the identification of the associated factors will allow to better target the most relevant interventions.

This study has some limitations due to the restriction of the 12-month follow-up to patients living in the south of the country. The health barrier put in place during the pandemic period at COVID-19 did not allow for the inclusion of all initial collection sites, some of which were located in the northern part of the country. However, this did not significantly influence the quality of the data as few patients were recruited in hospitals in this area. In order to limit the number of missing data, eligible victims were sufficiently reassured about the measures taken to prevent contamination by COVID-19 in the collection hospitals. This may have improved the adherence of victims. In addition, they were informed that the data collected is not part of any legal proceedings relating to their crash. Nevertheless, some behavioral or clinical variables could not be collected from certain victims, which explain the missing data. In addition, some bias could have been introduced into the study due to the likely false answers given by the victims for certain non-verifiable behavioral variables.

Age over 45 years, severity of initial injury and hospitalization of the victim were risk factors for the occurrence of disability in the motorcyclist victims. Campaigns against road crashes (awareness raising and enforcement of the road safety law), holistic and early management of seriously injured people over 45 years of age, could contribute to reducing the prevalence of disability among victims in Benin.

The authors are sincerely grateful to the data collectors and all respondents for their willingness to participate in the study.

The authors declare no conflicts of interest regarding the publication of this paper.

Glèlè-Ahanhanzo, Y., Kpozèhouen, A., Daddah, D., Santos, B.H.-D., Salami, L. and Paraïso, M.N. (2023) Disability to Admit as a Change of Life after a Road Crash: Estimates and Related Factors in Benin for Prevention. Open Journal of Epidemiology, 13, 83-96. https://doi.org/10.4236/ojepi.2023.131007