Thesis RTA Thailand
Thesis RTA Thailand
Thesis RTA Thailand
BY
Dr Ehsanullah Niazi
Roll No.1603535110013
Mph-Batch 2016-18
Supervisors
Dr Najibullah Rafiqi
MD,MRH,MSR
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Certificate
Certified that the dissertation “Risk factors of road traffic accident in Kandahar” is a record
of the research work undertaken by Dr Ehsanullah Niazi in partial fulfillment of the
requirements for the award of the degree of Master of Public Health under my guidance and
supervision.
Dr Najibullah Rafiqi
MD,MRH,MSR
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Declaration
I hereby declare that this dissertation “Risk factors of road traffic accident in Kandahar,Afg”
is the bonafide record of my original field research. It has not been submitted to any other
university or institution for the award of any degree or diploma. Information derived from the
published or unpublished work of others has been duly acknowledged in the text.
Dr Ehsanullah Niazi
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Abstract
Background: Road transportation is the major system of transportation in Kandahar
Afghanistan, which uses various kinds of vehicles as means of transport. According to the
Ministry of Transport report MRT (2008), most people in the province rely on road transport for
their daily commutation, as well as the conveyance of raw materials and food commodities The
statistical profile reflects a global estimate of 5.1 million deaths in 2000, which was due to
injuries that accounted for 10% of deaths due to all causes. Out of this a quarter of injury-related
deaths occurred in the South-asian and Central Asian region. Currently Road traffic accident is
ranked as ninth leading cause for died in world
Deaths due to RTIs in Afghanistan are 2.5 per 10, 000 vehicles (EMRO Report status on Road
safety). Afghanistan is third highest country for RTAs in EMRO region after Egypt and Libyan
(EMRO Report status on Road safety). Kandahar is the second-largest city in Afghanistan, with a
population of about 557,118 (CSO 2017-2018). Kandahar is located in the south of the country,
it has 15 districts.
Method: Cross-sectional study design was used for this study and purposive sampling method
was used, we interviewed with only 150 injured one, attendants, drivers, and traffic officers who
have a road traffic accident and are admitted and enrolled in the study only in Mirwais Regional
Hospital Kandahar between 1st February and 30 June 2018. A semi structured questionnaire was
used to interview injured person or their attendants in emergency room to collect data on the risk
factors of RTAs.
Result: This study revealed that 73 percent of the participants were in almost middle age (21-40
years) while participants economically active were highly prone to road traffic accidents.
This study showed that 63 had illiterate. This study shown that 54% of drivers got driving
training and 46% did not get any driving training. This study indicates 77 percent of the
participants had an accident in speed (41-120/km/hour).52 percent had an accident in sunny
weather and 35 percent had an accident in rainy and snowy weather. 41 percent of accident
happened in narrow and asphalt roads and 17 percent of accident occurred in Asphalt roads. 96%
percent of drivers said that there are no traffic signs in these roads.
Most commonly affected road users are pedestrians, passengers and cyclists as opposed to
drivers who are involved in most of the deaths and disabilities
Generally lack of driving licenses, poor condition of city roads and highway roads, drivers
smoking, failure to follow traffic signs, and driving over speed limits contributes the Major risk
factors of Road traffic injuries in Mirwais regional hospital. In Kandahar most accidents
occurred on Thursday/Friday.
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1. Improving road safety in the region should be a matter of all inclusive involving road
users, policy makers and the mass media. The mass media should be used for publicity to
raise the awareness in support of road safety campaigns.
2. The Kandahar Education Service should design appropriate curriculum for all levels of
education to conscientise the students from the beginning so that they become aware of
the consequences of road safety which would result in improved driver attitudes.
3. The theory test for applicants seeking driver license should be comprehensive to include
basic knowledge in vehicle systems.
4. Traffic rule and regulation have to consider the age limitation on drivers and over 40
years’ people can drive in high and main roads.
5. Traffic department of MOIA should prepare and implement speed limitation policy and
have to organize drivers training and orientation sessions to them.
6. As known that all high way roads are asphalt, but it is still narrow, all the roads should be
wide and double in order to reduce the risk of an accident.
7. Specific sign boards in curve areas must be installed to reduce accident in curve area.
8. Traffic department must install traffic sign board and monitor drivers for following the
traffic rule and regulations.
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Acknowledgements
Thanks to Allah Almighty who enabled me to research on such a hot issue of these days. I, the
author of this paper, express my gratitude to my supervisors at Department of Public Health,
Maulana Azad University, Dr. Latika Nath Sinha, Ms. Bhawana Sathi, Dr. Abhishek Lohra, Dr.
Nitin Joshi and Dr. Pramila Vivek and all guest professors who taught the conduct of research
and provided their valuable comments while writing up this paper. Likewise, I acknowledge the
support of my co-supervisor and friend, Dr. Najibullah Rafiqi, Academic and medical Staff,
Department of Surgery, Faculty of Medicine, Kandahar University, Afghanistan. And his team
for reviewing the report and valuable assistance.
I revere the patronage and moral support extended with love, by my parents, brothers and sisters
whose passionate encouragement made it possible for me to complete this project, they are
ultimate role models. Most importantly I wish to thank my loving and supportive wife, who
provides unending inspiration.
My joy knows no bounds in expressing my cordial gratitude to my best friend Dr. Sadullah Amin
.his keen interest and encouragement were a great help throughout the course of this research
work. Last but not least, I would like to thank all the men who eagerly participated in the
research.
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Table of Content
Contents
Abstract……………….…………………………………………………………………………4
Acknowledgements .................................................................................................................... 6
Chapter 1: Introduction .............................................................................................................. 11
1.1. Geography…………. ......................................................................................................... 11
1.2. Population………. ............................................................................................................. 11
1.3. Political and Socioeconomic Situation .............................................................................. 11
1.4. Health System .................................................................................................................... 12
Chapter 2: Review of Literature ................................................................................................ 13
2.1. Background ........................................................................................................................ 13
2.2.Rationale……………………………………………………………………….…..…...…13
2.3.Research question ................................................................................................................ 13
2.4.Main Objective..................................................................................................................... 13
2.5.Specific objectives ............................................................................................................... 13
2.6.LITERATURE REVIEW on RTAs ..................................................................................... 14
2.6.1.Global Accident Situation ................................................................................................. 14
2.6.2.RTAs in Kandahar and Afghanistan ................................................................................. 15
Chapter 3: Methodology ............................................................................................................ 17
3.1.Study and sampling design .................................................................................................. 17
3.2.Study Site……………………………………………………….…………………………17
3.3.Study Subjects ...................................................................................................................... 17
3.4.Data Collection tool and Processing .................................................................................... 17
Chapter 4: Results, Discussions, Conclusion and Recommendations ....................................... 19
4.1.Result……………………………………………………………………..………………..19
a.Socio-demographic characteristics.......................................................................................... 19
4.2.Discussion…………………………………………………………………………..……...37
4.3.Conclusion and Recommendations ...................................................................................... 39
Chapter 5: Public Health benefits, Ethical consideration, Funding and Work .......................... 40
5.1. Potential public health benefits .......................................................................................... 40
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Tables:
Table 1:…………………………………………………………………………………………………………………………..15
Table 2: ………………………………………………………………………………………………………………………….22
Table 3: ………………………………………………………………………………………………………………………….23
Table 4: ………………………………………………………………………………………………………………………….25
Table 5: ………………………………………………………………………………………………………………………….25
Table 6: ………………………………………………………………………………………………………………………….26
Table 7: ………………………………………………………………………………………………………………………….27
Table 8: ………………………………………………………………………………………………………………………….28
Table 9: ………………………………………………………………………………………………………………………….29
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Graphs:
Graph 1: Region of the World……………………………………………………………………………………….14
Graph 2: Sex…………………………………………………………………….………………………………………….19
Graph 3: Age……………………………………………………………………………………………………………….20
Graph 4: Education……………………………………………………………………………………………………..20
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Chapter 1: Introduction
1.1. Geography:
Kandahār is the second-largest city in Afghanistan, Formerly called Alexandria Arachosia, the
city is named after Alexander the Great, who founded it in 329 BC around an
ancient Arachosian town. Kandahar is located in the south of the country on the Arghandab
River, at an elevation of 1,010 m (3,310 ft). Sixty-five percent (65%) of the province
mountainous or semi-mountainous and 35% flat or semi-flat It is the capital of Kandahar
Province (UNFPA 2004), and also the center of the larger cultural region called Loy Kandahar.
Many empires have long fought over the city due to its strategic location along the trade routes
of southern, central and western Asia. Kandahar has extensive road links with Lashkar
Gah and Herat to the west, Ghazni and Kabul to the northeast, Tarinkot to the north,
and Quetta in neighboring Balochistan to the south.The city has 15 districts and a total land area
of 27,337 hectares. The total number of dwellings in Kandahar is 61,902. Kandahar is the
Regional Hub in southern Afghanistan, close to the border with Pakistan. Non-built up land use
accounts for 59% of the total land area. Within the built-up area, vacant plots occupy a slightly
higher percentage of land (36%) than residential land (34%). There is a significant commercial
cluster along the road to Pakistan in District 5. India, Iran and Pakistan operate their consulate
here for trade, military and political links.
1.2. Population:
The estimated population of Kandahar is 557,118 (CSO 2017-2018) of which 51 percent are
males and 49 percent females. According to official national data, annual population growth rate
is 2.7 and population density is about 41 people per square kilometer land (CSO, 2016). An
estimated 76.1% population live in rural areas including 5.1% nomads while 23.9% population
resided in urban areas of the province. The total fertility is 5.3 children per mother in the country
(Afghanistan Demographic Health Survey 2015). Traditionally people live in extended families
and average household size is estimated 7.8 persons (APHI, 2010). In accordance with estimated
population of 2017, almost half the population is below 15 years of age (47.5%) (CSO 2017).
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improved after the establishment of new government in 2002 with the support of international
community. National development and reconstruction strategies and plan have been endorsed by
the new government. According to constitution of Afghanistan, health care services and
education (from primary to university level) is free for all population (Islamic Republic of
Afghanistan, 2004). 36 percent of the province population is unemployed and living below
poverty line where many people are suffering from basic life needs like housing, access to safe
drinking water, electricity, gas and other source of heating. (World Bank, 2010).
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2.2. Rationale:
Road traffic accidents which are generally unintended and preventable are a common risk every
day to life that can happen to almost every one, anywhere. The problem of road traffic accident
is increasingly becoming a threat to public health and national development in many developing
countries. Road traffic accidents contribute to poverty by causing deaths, injuries, disabilities,
grief loss of productivity and material damages. The British Medical Journal of 11th May 2002
indicated that more people die on the road traffic accident than from malaria worldwide; and that
traffic accident cause about 1.2 million deaths and injury 10 to 15 million people a year in the
world. Many people do not know that road traffic accidents are preventable. (Krug, 2002) Road
traffic accidents are the most frequent causes of injury-related deaths worldwide (Astrom, et al.
2006). According to the World Report on Road Traffic Injury Prevention (World report on road
traffic injury prevention, Peden et al., 2004) traffic accidents account for about 3000 daily
fatalities worldwide.
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In economic terms, the cost of road crash injuries is estimated at roughly 1% of gross national
product (GNP) in low-income countries, 1.5% in middle-income countries and 2% in high-
income countries (Global road safety crisis).
The direct economic costs of global road crashes have been estimated at US$ 518 billion, with
the costs in low-income countries – estimated at US$ 65 billion – exceeding the total annual
amount received in development assistance (Global road safety crisis). Furthermore, the costs
estimated for low-income and middle-income countries are probably significant underestimates.
Using more comprehensive data and measurement techniques, the estimated annual costs (both
direct and indirect) of road crash injury in European Union (EU) countries alone.
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Table 1: Change in rank order of DALYs for the 10 leading causes of the global burden of disease
1990 2020
Rank Disease or injury Rank Disease or injury
1 Lower respiratory infections 1 Ischemic heart disease
2 Diarrheal diseases 2 Unipolar major depression
3 Perinatal conditions 3 Road traffic injuries
4 Unipolar major depression 4 Cerebrovascular disease
Chronic obstructive pulmonary
5 Ischemic heart disease 5
disease
6 Cerebrovascular disease 6 Lower respiratory infections
7 Tuberculosis 7 Tuberculosis
8 Measles 8 War
9 Road traffic injuries 9 Diarrheal diseases
10 Congenital abnormalities 10 HIV
DALY: Disability-adjusted life year. A health-gap measure that combines information on the number of years lost from premature death with the loss of health
from disability.
Kandahar has experienced rapid social and economic modernization within the last fifteen years.
This development included an increase in the motorization rate and a growing road network.
There is no any complete data to the registered and non-registered vehicles and as well as to
show the number of driving licenses distribution in Kandahar .This growth was supplemented by
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an increase in the number of RTA related fatalities. Deaths due to RTIs in Afghanistan are 2.5
per 10, 000 vehicles (EMRO Report status on Road safety).
The statistic data on Road traffic injuries of Kandahar public health directorate shows that total
of (6013) RTAs registered in Mirwais Regional Hospital (MRH), from which (2588) injured and
(208) died in 2016 in Kandahar province boundaries. (HMIS department Afghanistan 2016).
They surveyed 1514 injured and 283 drivers. Apparently the proportion of smokers among
drivers were 51% (144) while it was 16.5% (247) among injured. Similarly, hashish use was
11% (31) among driver and 1.6% (24) among injured. Cars and motorbikes were involved in
56.4% and 28.3% of cases. Of the injured, 45.3% were pedestrians, 25.7% were passengers,
18.1% were cyclists, and 10.9% were drivers. The reasons for accidents from the injured
patients’ standpoint were 1.9% due to overloads, 2.8% due to failure to follow traffic signs,
71.6% due to driving over speed limits, 5.6% due to pedestrians on the street, 1.4% due to bad
weathers, 7.7% due to bad roads, 8.6% due to poor driving skills and 0.5 % due to poorly
maintained vehicles. Lower limb injuries were most common (39.6 %) followed by head injuries
(25.1 %). Of all injured, 63.6% were hospitalized, 31.5% were discharged from emergency
department, and 4.9% died in the emergency department. The average speed of the vehicles
involved in accidents was 59.5 ± 22.10 km/hours. 13% vehicle occupants used seat belts or
helmets, and 23.7% vehicles were right-side steering wheel. (Epidemiologic Pattern of Road
Traffic Injuries in Afghanistan, 2013).
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Chapter 3: Methodology
3.1. Study and Sampling Design:
Cross-sectional study design was used for this study and purposive sampling method was used,
we interviewed with only 150 injured one, attendants, drivers, and traffic officers who have a
road traffic accident and are admitted and enrolled in the study only in Mirwais Regional
Hospital Kandahar between 1st February and 30 June 2018. A semi structured questionnaire was
used to interview injured person or their attendants in emergency room to collect data on the risk
factors of RTAs.
As there is no any comprehensive survey to show the prevalence of RTAs in Afghanistan, for
sample size in this study we used the highest possible prevalence of RTIs; 95% confidence
interval and 5% band of error. By correction of 10% un-response rate.
Inclusion Criteria:
Exclusion Criteria:
Non-RTIs injuries
Fall down from a stopped vehicle
Lack of consent for interview
RTIs from other hospitals and trauma centers will not be included.
Specific objective-based questionnaire was used. Each question was followed by pretested and
most related hints and probes during interview with different respondents to have required data.
Thematic analysis carried out by using a Stata and Excel spread sheets according to the
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definition and inclusion and exclusion criteria. For validity and consistency of the findings and
data, triangulation technique was undertaken by using information from Key information
interview. Stata and excel spread sheet were used for the analysis of the collected data.
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a. Socio-demographic characteristics.
b. Analysis of risk factors of RTAs in Kandahar, Afg.
a. Socio-demographic characteristics
The present study revealed most victims were young, unmarried, pedestrians and drunk drivers.
On socio-educational front, majority of them were educated up to school and belonged to middle
and lower socioeconomic classes.
This situation can be improved by educating public through the mass media and initiating road
safety training campaign in schools. This should highlight the socioeconomic and other problems
of RTA and the role of individuals in its prevention.
Medical conditions, personal problems and psychosocial conflicts were found to be significantly
association with RTA.
The socio-demographic characteristics were gender, age, and education level of participant in
this study.
Sex: A total of 150 participants were interviewed which include both male and female.
(Graph.2)
Sex
Female
Male
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Age: Given local context of the country in terms of access to education and employment, more
than 73 percent of the participants were in almost middle age(21-40 years) while participants
above 50 years make up only 10 percent of the study size, and participants’ age profile is
reflected in the table given below. (Age with site of accident) (Graph 3)
Age
140 120.00%
120
120 100.00%100.00%
100
80.00%
80
60.00%
60 50
38 41.67% 40.00%
40 31.67%
18
20 9 20.00%
2 15.00% 3
7.50%
0 1.67% 2.50% 0.00%
10=20 21-30 31- 40 41- 50 51- 60 60+
Freq Percent
Education: Education has important role in routine live of people and as the literacy level of
Afghans are low, so majority of people select the task which doesn’t need education, one of the
task which doesn’t education is driving, almost two third of the study participants did not have
any formal education or literacy at all while 37 percent of the participants have certain level of
the education.
(Graph 4)
Education
44, 37%
Yes
76, 63%
No
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Among 44 participants who had certain level of education, 43 percent of participants had
secondary level education, followed by high school level education 41%, participant’s and only
14 percent of participants had bachelor level education and 2 percent had only primary education
level.
(Graph 5)
EDUCATION LEVEL
University Primary
14% 2%
Secondary
43%
High School
41%
The previous scenario of Afghan population, those who had education should have formal
employment in governmental or non-governmental entities so far it is almost applicable here and
now a day it is going to be changed and some educated people are involved in their personal
businesses including driving in cities and main roads.
This study indicates that 31 percent of drivers had education and their main job is driving and 69
percent of participants who had no education and their main jobs were driving and had an
accident experience.
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Table 2
Employment
Education
Driver Formal Employee Student Personal Retired Total
33 3 4 3 1 44
Yes 30.56% 100.00% 100.00% 75.00% 100.00% 36.67%
75 0 0 1 0 76
No 69.44% 0.00% 0.00% 25.00% 0.00% 63.33%
Total 108 3 4 4 1 120
100.00% 100.00% 100.00% 100.00% 100.00% 100.00%
Graph 6
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This study showed that only (25.00%) were snuff users and (75.00%) were not snuff users.
This study showed that only 17 percent of respondents were hashish user and 83 percent of
respondents were hashish non-user.
8 percent of the drivers were using hashish1 during the driving in this main road which highly
risky. Graph 7
Yes, 8, 38%
1
Opening cigarette pack, removing cigarette stick, using lighter/match stick for burning cigarette stick and placing
back the cigarette pack in pocket/switch board during driving.
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This study showed that only 4 percent of participant were alcohol user and 96 percent of
participants were not alcohol users and 60 percent of the drivers were using alcohol before an
accident and 40 percent participants were alcohol user.
Graph 8
No, 2, 40%
Yes, 3, 60%
Driving License:
Having driving license is essential for all drivers who are planning to drive in cities and main
roads, this study showed that 93 percent of participants had driving license and only 7 percent of
participants didn’t have any license at all which is an obligatory requirement by the law forcing
agencies and traffic authorities but were still driving on certain main roads. (Graph 9)
Driving license
Yes No
93% 7%
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Although there is no exception for any driver regarding regular participation in formal driving
licensing training but almost half of the study population (43% drivers) had not attended 2
weeks’ obligatory driving training. But interestingly all these drives without having formal
driving training had their licenses for their vehicles and driving.
This study showed that 57 percent of participants attended a formal driving training course and
they had driving licenses too, 88 percent of had no driving licenses and had no formal driving
training too.
12 percent of participants had formal driving training, but didn’t have driving license. Table 4
Driving License
Formal Driving Training
Yes No
Yes 64 (57.14%) 1 (12.50%)
No 48 (42.86%) 7 (87.50%)
Total 112 (100.00%) 8 (100.00%)
Using Seatbelt:
As use of seatbelts remain very important for live saving during driving and all respondents
reported that their vehicles have seatbelts but the study figures indicate that only 20 percent of
the drivers regularly use seatbelts during driving on the main roads, 69 percent of respondents
didn’t use seatbelt during driving and finally 11 percent of respondents said that sometimes they
used seatbelt. Table 5
Site of Accident:
As daily thousands of people are driving inside the city and many more are traveling from
Kandahar city to nearby districts and surrounding provinces, the study site is very important
component of this study and to find out the risky site of the above mentioned main roads and will
appropriate recommendation to road construction department and public traffic department for
installing traffic sign in specific areas.
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1. Kabul
This study indicates that 20 percent of accident happened in Moqor and 20 percent of accident
occurred in Salar and 13 percent of accidents take place in Maidan area of Kandahar to Kabul
main road. Table 6
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2. Helmand (Lashkargah)
This study revealed that 33 percent of accident happened in Dorahi,20 percent of accident
occurred in Malang Kariz and 13 percent of an accident take place in Sanzeri Jan and 13
percent of accident occurred in Yakhchal area of Kandahar to Lashkargah main road. Table 7
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3. Urozgan
This study revealed that 40 percent of accident happened in Wayand,16 percent of accident
occurred in Lond Bakhto and 10 percent of an accident take place in Wach Bakhto, Saagai and
Bazargai area of Kandahar to Urozgan main road. Table 8
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4. Zabul (Qalat)
This study indicates that 30 percent of accident happened in Shaar Safa area and 17 percent of
accident occurred in Daman of Kandahar to Zabul main road. Table 9
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Type of Vehicle:
Based on the type of vehicle, this study showed that majority of accident happened by
Motorbikes 40 (33.33%), followed by Zeranges bikes and Taxi cabs, 23 (19.17%) and 21
(17.50%). Table 10
Vehicle Speed:
This study indicates that 77 percent of the participants speed were in(41-120/km/hour) while
participants below 20 percent speed were 0-40 km/hour and only 3 percent of the study size, and
participants’ speed were 120+ in these main road.
Graph 10
SPEED ESTIMATION
120+, 4, 3%
0-40, 24, 20%
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This study showed that 35 percent of Motorbikes had an accident in estimated speed of 61-80
km/hour, 48 percent of Zeranges had an accident in estimated speed of 81-100 km/hour, 35
percent of Taxi cabs had an accident in estimated speed of 61-80 km/hour, 43 percent of bus 303
had an accident in estimated speed of 101-120 km/hour, 83 percent of bus 404 had an accident
on estimated speed of 81-100 km/hour and finally 47 percent of Rekshaw had an accident on
estimated speed of 41-60 km/hour. Table 11
Type of Speed
Vehicle Remar
0-20 21-40 41-60 61-80- 81-100 101-120 120+ Total k
Motorbik
es 10 20 1 35 18 10 0 100
4 % 3 8% 8 % 4 % 7 % 4 % 0 % 40 %
Zeranges 19 1 48 19 5 100
1 5% 4 % 1 5% 0 0% 0 % 4 % 1 % 21 %
Taxi cabs 17 13 26 35 4 100
4 % 3 % 6 % 8 % 1 4% 0 0% 1 % 23 %
Bus 303 14 14 29 43 0 100
0 0% 1 % 1 % 0 0% 2 % 3 % 0 % 7 %
Bus 404 1 83 17 0 100
0 0% 0 0% 0 0% 0 0% 0 % 2 % 0 % 12 %
Saracha 12 12 47 0 100
2 % 2 % 2 % 8 4% 3 0% 0 0% 0 % 17 %
1 1 11 1 15 3 25 3 28 1 11 2 12 100
Total 1 9% 3 % 8 % 0 % 3 % 3 % 2 % 0 %
Angle of Accident:
This study showed that majority of vehicle had an accident from the front angle of the vehicle,
which were 68 respondents (57.14%) and followed by right angle 27 respondents (22.69%).
Graph 11:
Accident Angle
140 119
120
100
80 68
60
40 27
18
20 6
0
Front Back Right Left Total
Freq 68 18 27 6 119
Percentage 57.14% 15.13% 22.69% 5.04% 100.00%
Freq Percentage
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Weather Condition:
Driver’s perception regarding the weather condition and an accident, 62 respondents (51.67%)
had an accident in sunny weather, 25 respondents (20.83) had an accident in rainy weather, 14
respondents (11.67%) had an accident in snowy weather and followed by dark, windy, foggy and
cloudy weather.
Graph 12
Weather Condition
70
62
60
50
40
30 25
20 14
10 6 5 7
51.67% 20.83% 5.00% 4.17% 5.83% 11.67% 1 0.83%
0
Sunny Rainy Windy Foggy Dark Snowing Cloudy
Freq Percentage
Road Condition:
Road condition is one major cause of Road Traffic Accident, we observed in this study that 41
percent of accident happened in narrow and asphalt roads and 17 percent of accident occurred in
Asphalt roads and followed by broken, Narrow and narrow and broken and clay roads in main
roads of Kandahar. Graph 13:
Road Condition
Freq Percentage
60 45.00%
49 40.83% 40.00%
50
35.00%
40 30.00%
25.00%
30
20 20.00%
20 16.67% 15 15.00%
14 14
11.67% 11.67% 12.50%
7 10.00%
10
5.83% 1 5.00%
0 32 0.83% 0.00%
Clay Esphalt Broken Narrow Narrow and Narrow and Other
Esphalt Broken
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Reasons of Accident:
Main reasons of accident are that majority of accident 35 respondents (29.17%) occurred in bad
weather condition, 30 respondents (25%) had other causes of an accidents, 18 respondents
(15.00%) said their reason of an accident was bad road condition, 16 respondents (13.33%)
expressed that their accidents reason was high speed, 5 respondents (4.17%) said their accident
reason was low experience of driving.
Graph 14:
Reason of Accident
40 35.00%
35
35 30.00%
29.17% 30
30
25.00%
25
25.00% 20.00%
20 18
16
15.00% 15.00%
15 13.33% 13
10.83% 10.00%
10
5
5 4.17% 5.00%
0 1 1 1
0 0.00% 0.83% 0.83% 0.83% 0.00%
Over load No Traffic High People on Animal on Bad Bad Road Low Vehicle Other
Traffic Sign Speed Road Road Weather Experience related
condition
Freq Percentage
Vehicle Problem:
Speeding vehicle and long distance travel were found to be associated with high percentage of
RTA. Accidents were also high in the present series at the start of journey as well as at the fag
end of the journey. An effective speed policies for different zones along with scanning for
speedy and rash driving through speed detecting camera at strategic and accident black spots
together with timely refresher courses for the drivers are some of the activities where the
government and local bodies should focus upon
Vehicle condition is one cause of RTAs in world, this study showed that there is no problem in
vehicle before an accident, 107 participants (89%) said there was no vehicle problem and only 13
participants (11%) said that their vehicle had problem. Out 13 vehicles which had problem, the
majority had 8 (61.54%) brake defect.
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Graph 15:
Vehicle condition
120
107
100
80
60
40
20 13
10.83% 89.17%
0
Yes No
Freq Percentage
Graph 16:
Vehicle problem
Headlight 15.38%
2
0 1 2 3 4 5 6 7 8 9
Area of Accident:
Helmand, 67 percent of accidents happened in curve area of road and 33 percent of an accident
occurred in straight road.
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Kabul, 27percent of an accidents happened in curve area of road and 73 percent of accident
occurred in in straight road.
Urozgan, 37 percent of an accidents happened in curve area of road and 63 percent of accident
occurred in in straight road
City roads, 30 percent of accidents happened in curve area of road and 70 percent of accident occurred
in straight road. Table 12
Time of Accident:
Due to multiple reason movement from Kandahar to districts and provinces and verse versa are
from day and morning time and consider this movement habit of the people the accident pick is
62 percent in 6:00 AM-11:59 AM, 46 percent accident occurred in 12:00 PM-5:59 PM and this
table shows time of accident:
Graph 17:
Accident Time
70 60.00%
62
60 51.67% 50.00%
50 46
38.33% 40.00%
40
30.00%
30
20.00%
20
9 7.50%
10 10.00%
3 2.50%
0 0.00%
6:00AM- 11:59 AM 12:00 PM- 5:59 PM 6:00 PM- 11:59 PM 12:00 PM- 5:59 AM
Freq Percentage
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Day of Accident:
Most of the accidents regarding the day of an accident, 23 percent had accidents in Friday, 20
percent had an accident in Thursday, 17 percent had an accident in Wednesday, 13 percent had
accidents on Tuesday and 9 percent had no information regarding the day of their accidents.
Graph 18:
Thursday
20% Tuesday
13%
Wednesday
17%
Traffic Signs:
The study demonstrated that the presence of traffic police and traffic light had a significant
impact on the number and severity of accident. In fact, presence of functioning traffic light
showed better accident control than the presence of traffic police alone. In our series we did not
find any single instance where the accident dynamic was studied to evaluate the impact and
extent of the damage.
Availability of traffic signs in roads has an important role in reduction of accidents in city road
and as well as in high way and this study indicates that traffic sign installation in these main
roads, 115 respondents (96%) expressed that there is no traffic sign in these high way and only 4
respondents (5%) expressed that there is traffic sign in these roads.
Graph 19:
Traffic Signs
No, 5, 4%
36Yes No
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4.2. Discussion:
In Kandahar most accidents occurred on Thursday/Friday. Everyday many people are killed and
injured on our roads. Men, women or children walking, biking or riding to school or work,
playing in the streets or setting out on long trips, are never having guarantee to reach destinations
or to return home safely. hundreds of people each year are spending many weeks in hospital after
severe crashes with many of them not being able to live, work or play as they used to do.
Road Traffic Accidents in Kandahar are one of the main causes of death and they have imposed
a very heavy burden on the health of Kandahar population. Afghanistan is ranked third highest in
EMRO region after Egypt and Libyan.
Generally lack of driving licenses, poor condition of city roads and highway roads, drivers
smoking’s, failure to follow traffic signs, and driving over speed limits contributes the major
risk factors of Road Traffic Injuries in Mirwais regional Hospital.
One main reason to conduct this study is to know the Major risk factors of RTAs in Kandahar,
Afghanistan which has high experience of road traffic accidents incidence in last decade.
This study revealed that young generation age between 31-40 (41.67%) and followed by 21-30
(31.67%) years that are economically active were highly prone to road traffic accidents.
This study showed that illiteracy 76 (63.33%) has highest contribution to RTAs in main roads of
Kandahar, and despite those who had education, most of them are secondary and high school
graduated and university had only 6 (14%)respondents.
This study shown that 55 (54%) of drivers got driving training and 55 (46%) did not get any
training which had enormous contribution to RTAs in Kandahar, because they didn’t know the
traffic rule and regulations.
This research revealed that 112 (93%) of drivers had driving license and 8 (7%) of drivers didn’t
have driving license and despite not having license they are regularly driving in roads of
Kandahar.
This study showed that 112 participants having the driving license, 64 participants (57.14%) got
driving training and 48 participants (42.86%) didn’t get any professional driving training but had
training license.
The study figures indicate that only 20 percent of the drivers regularly use seatbelts during
driving on the main roads, 69 percent of respondents didn’t use seatbelt during driving and
finally 11 percent of respondents said that sometimes they used seatbelt.
This study indicates that 20 percent of accident happened in Moqor and 20 percent of accident
occurred in Salar and 13 percent of accidents take place in Maidan area of Kandahar to Kabul
main road
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This study revealed that 33 percent of accident happened in Dorahi,20 percent of accident
occurred in Malang Kariz and 13 percent of an accident take place in Sanzeri Jan and 13 percent
of accident occurred in Yakhchal area of Kandahar to Lashkargah main road.
This study revealed that 40 percent of accident happened in Wayand,16 percent of accident
occurred in Lond Bakhto and 10 percent of an accident take place in Wach Bakhto, Saagai and
Bazargai area of Kandahar to Urozgan main road.
This study indicates that 30 percent of accident happened in Shaar Safa area and 17 percent of
accident occurred in Daman of Kandahar to Zabul main road.
Main reasons of accident, 29 percent of accident occurred in bad weather condition, 25 percent
had other causes of accidents, 15 percent said their reason of an accident was bad road condition
and 13 percent expressed that their accidents reason was high speed.
52 percent had an accident in sunny weather and 35 percent had an accident in rainy and snowy
weather.
This study indicates that 77 percent of the participants speed were in(41-120/km/hour) while
participants below 20 percent speed were 0-40 km/hour and only 3 percent of the study size, and
participants’ speed were 120+ in these main road
Road condition is one major cause of Road Traffic Accident, we observed in this study that 41
percent of accident happened in narrow and asphalt roads and 17 percent of accident occurred in
Asphalt roads and followed by broken, Narrow and narrow and broken and clay roads in main
roads of Kandahar.
Helmand, 67 percent of accidents happen in curve area of road and 33 percent of an accident
occurred in straight road, but Kabul, Urozgan provinces and Kandahar city roads majority of
accident occurred in straight road.
Due to multiple reason movement from Kandahar to districts and provinces and verse versa are
from day and morning time and consider this movement habit of the people the accident pick is
62 percent in 6:00 AM-11:59 AM, 46 percent accident occurred in 12:00 PM-5:59 PM
Most of the accidents regarding the day of an accident, 23 percent had accidents in Friday, 20
percent had an accident in Thursday, 17 percent had an accident in Wednesday, 13 percent had
accidents on Tuesday and 9 percent had no information regarding the day of their accidents
Availability of traffic signs in roads has an important role in reduction of accidents in city road
and as well as in high way and this study indicates that traffic sign installation in these main
roads, 115 respondents (96%) expressed that there is no traffic sign in these high way and only 4
respondents (5%) expressed that there is traffic sign in these roads.
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1. Improving road safety in the region should be a matter of all inclusive involving road
users, policy makers and the mass media. The mass media should be used for publicity to
raise the awareness in support of road safety campaigns.
2. The Kandahar Education Service should design appropriate curriculum for all levels of
education to conscientise the students from the beginning so that they become aware of
the consequences of road safety which would result in improved driver attitudes.
3. The theory test for applicants seeking driver license should be comprehensive to include
basic knowledge in vehicle systems.
4. Traffic rule and regulation have to consider the age limitation on drivers and over 40
years’ people can drive in high and main roads.
5. Traffic department of MOIA should prepare and implement speed limitation policy and
have to organize drivers training and orientation sessions to them.
6. As known that all high way roads are asphalt, but it is still narrow, all the road should be
wide and double in order to reduce the risk of an accident.
7. Specific sign boards in curve areas must be installed to reduce accident in curve area.
8. Traffic department must install traffic sign board and monitor drivers for following the
traffic rule and regulations.
9. Ministry of Education have to increase equal access to education capital city and
provinces and have to initiate special literacy courses to drivers.
10. Driving professional training must obligatory for getting driving license at least for 15
days
11. Traffic department must conduct awareness program and explain the rule of seatbelts and
how much seatbelt safe their live and there should be punishment for not using seatbelts.
12. Traffic department of MOIA have to investigate more regarding accident area, Majority
of accident in Kandahar to Kabul road are occurred in Moqor and Salar, Majority of
accident in Kandahar to Helmand road are occurred in Dorahi and Malang Kariz,
Majority of accident in Kandahar to Urozgan road are occurred in Wayand and Lond
Bakhto and finally Majority of accident in Kandahar to Zabul road are occurred in Shaar
Safa and Daman.
13. 52 percent had an accident in sunny weather and 35 percent had an accident in rainy and
snowy weather.
14. Reason 29 percent of accident occurred in bad weather condition, 25 percent had other
causes of an accidents, 15 percent said their reason of an accident was bad road
condition.
15. 62 percent of accident occurred in 6:00 AM-11:59 AM, 46 percent of accident occurred
in 12:00 PM-5:59 PM.
16. 23 percent had accidents in Friday, 20 percent had an accident in Thursday, 17 percent
had an accident in Wednesday, 13 percent had accidents on Tuesday and 9 percent had no
information regarding the day of their accidents.
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The research has considered all ethical codes and norms of local society during the study and
during publishing/preparing the report of findings. No personal information had been disclosed
to any third party nor it is published in the report in a way which could reflect a personal image
of a person, village or society. As the study involves human subject as interviewees therefore a
formal permission was taken from the Directorate of Public Health.
A proper informed consent was signed with every individual who were interviewed throughout
the study. All questions were articulated in such a way which were considered as unethical in the
Afghan context.
In this study most female victims of RTAs were not allowed by their attendants to participate in
the study, due to social and cultural issue of the region.
As some of drivers had serious accident and they were not alive to interview and got correct
information regarding the risk factors of RTAs.
As some of the injured ones were brought to emergency room of Mirwais regional hospital by
strangers who were not present at the time of RTA, so we face low reliability of the accident
history.
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Reference
1. Epidemiologic Pattern of Road Traffic Injuries in Afghanistan, 2013
2. Kandahar Directorate of Transport report (2016)
3. Kandahar public health directorate statistics report
4. Krug prevention injuries
5. Survey Reports of Bangladesh’ RTAs by International Agencies
6. WHO, 2009
7. Afukaar, F. K. (2003), Speed control in developing countries: issues, challenges and
opportunities in reducing road traffic injuries, Injury Control and Safety Promotion,
vol.
10, No. 1-2 pp. 77-81
8. Andreassen, D (1991), Population and Registered Vehicle Data vs Road Deaths,
Accident Analysis and Prevention, vol. 23, pp.343-351
9. Traffic department ministry of internal affairs
10. Driver and Vehicle Licensing agency (DVLA, 2008),
11. World report on road traffic injury prevention, Peden et al.,2004
12. Gaber, Gen M.A. and Yarrell, J.S (1983), road safety research in Egypt, in IAATM
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9 International Conference, Mexico, September, 1983. (International Association for
Accident and Traffic Medicine)
13. Drinking, driving, and crashing: a traffic flow model of alcohol related motor vehicle
accident.
14. James, L and Nahl, D (2000), Road rage and aggressive driving: steering clear of
highway warfare, Amherst NY: Prometheus Books.
15. WHO, Geneva, April 2004
16. USA (Peek-Asa et al., 1999) study
17. EMRO report status on Road safety
18. National Road Safety Commission (NRSC)(2009), Road traffic Crashes in Ghana,
Statistics 2009, Ministry of Transport, Accra
19. Road Traffic Deaths Index 2009 Country Rankings, Available from
http://www.photius.com/rankings/roadtrafficdeathscountryrankings.2009.html
[Accessed February 2, 2010]
20. HMIS department Afghanistan 2016
21. Global road safety protocol
22. Road Accidents with Casualties in Developing-Developed Countries
23. Transport Research Laboratory (2006), Development of National Road Safety
Strategy
for the United Kingdom of Bahrain, Interim report
24. World Health Organization (WHO, 2009) World Report on Road Traffic Injury
Prevention, Geneva, Switzerland
25. World Health Organization (WHO,2002) cited in
http://www.worldbank.org/html/pdf/transport/road/safety.html
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26. International statistical classification of diseases and related health problems, tenth
revision. Volume 1: Tabular list. Geneva, World Health Organization, 1992.
27. World Health Organization. Injury: A leading cause of global burden of disease. World
Health Organization. Available at
http://www.who.int/violence_injury_prevention/index.html. Accessed 26 May 2002
28. Abhishek Singh A, Bhardwaj A, Pathak R, Ahluwalia SK. An epidemiological study of
road traffic accident cases at a tertiary care hospital in rural haryana. Indian Journal of
Community Health. 2011; 23 (2): 53-55
29. Ghaffar A, Alihyder A, David B. New papers reports as a source for injury data in
developing countries. Health policy and planning. 2001; 16(3): 322-325
30. International Campaign to Ban Landmines. Landmine monitor report 2003. New York:
Human Rights Watch, 2002.
31. Oleg B, Muireann B. Injuries and deaths caused by unexploded ordnance in Afghanistan:
review of surveillance data, 1997-2002.BMJ. 2005; 330:127–8
32. Ministry of Public Health. Afghan National Public Health Institute, Surveillance
Department, Annual data analysis, Kabul-Afghanistan, March, 2012
33. Shrivastava SR, Pandian P, Shrivastava PS. Pre-hospital care among victims of road
traffic accident in a rural area of Tamil Nadu: A cross-sectional descriptive study. J
Neurosci Rural Pract. 2014; 5 (Suppl 1): S33-8.
34. Afghanistan Mortality Survey. 2010. ANPHI, CSO, IIHMR, WHO ICF Macro, 2011
35. NilambarJha, Srinivasa DK, Gautam R, Jagdish. Epidemiological Study of Road Traffic
Accident Cases S. a Study from South India. Indian Journal of Community Medicine.
2004; XXIX (1): 20- 24
36. Soheil S, Hamid S. Epidemiology of traffic injuries and motor vehicles utilization in the
Capital of Iran: A population based study. BMC Public Health. 2011; 11:488
37. Central Statistic Organization, population estimation. Islamic State of Afghanistan.
Accessed: 10/02/2015
[http://cso.gov.af/Content/files/Settled%20Population%20by%20Civil%20Division,.pdf]
38. Paravar M, Hosseinpour M, Salehi S, et al. Pre-Hospital Trauma Care in Road Traffic
Accidents in Kashan, Iran. Archives of Trauma Research. 2013;1(4):166-171.
39. Cummings P. Association of seat belt use with death: a comparison of estimates based on
data from police and estimates based on data from trained crash investigators. Inj Prev.
2002, 8:338- 341
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traffic accidents from an industrial town in India. Int J CritIlln Inj Sci. 2013; 3(1):8-11.
41. Adeloye D. Pre-hospital trauma care systems: potential role toward reducing morbidities
and mortalities from road traffic injuries in Nigeria. Prehosp Disaster Med. 2012;
27(6):536-42.
42. Jones AP, Bentham. Emergency medical service accessibility and outcome from road
traffic accidents. Public Health. 1995;109(3):169-77
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Timeline-2018
S/N Place Remarks
Feb March April May June July
3 Data compiling
4 Data analysis
5 Report Writing
6 Final Report
Unit
Activities Total Cost afs
Cost Afs
Subtotal 18000
Subtotal 33000
Stationery, Communication
3000 18000
& other
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Hello!
I am going to give you information and invite you to participate in this research entirely
voluntary. You do not have to decide just now, whether or not you agree that you may participate
in the research. Before you decide, you can talk to anyone you feel comfortable with.
If you choose not to consent, all the services you receive at this hospital will continue and
nothing will change. You may also choose to change your mind later and stop participating, even
if you agreed earlier, and the services you receive at the hospital will continue.)
There may be some words that you do not understand. Please ask me to stop as we go through
the information and I will take time to explain. If you have questions later, you can ask them of
me, the study doctor or the staff.)
The purpose of this research is to identify the very most common risk factors of RTAs in order to
make preventive strategy for them in the future.
The information that we collect from this research project will be kept confidential. and it will
not be used for any other purpose.
Contact Number:
45
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رضایت لیک:
زه ډاکټر احسان هللا نیازی می او د هندوس تان هیواد د موالان ازاد پوهنتون د MPHد پروګرام غړی می،غواړم د
کندهار په والیت یک د ترافیکی واقعاتو د خطر پر فکتورونو ابندی یو علمی څیړنه ای حتقیق تررسه کړم.
زه به اتسو ته ددی څیړین په هلکه پوره معلومات درکړم او اتسو ته دعوت در کوم چه پدی حتقیق کښی په خپهل خوښه
او رضایت بیهل کوم فشاره برخه واخیل ،او د ګډون تر خمه اتسو د هر چا رسه مشهوره کوالی یس.که چریی اتسو ددی
څیړین دپاره اماده نه ایست نو بیا مه موږ اتسو ته اطمنان در کوو چه پدی روغتون کښی به ټول خدمات س تاسو دپاره
د پخوا په شلک وی او کوم تغری به پکښی را نیس.اماکن لری ځین لکامت س تاسو د پاره ان اش نا وی نو اتسو پوره حق
لری چه پوښتنه وکړی او اتسو ته به معلومات درکول یس.
ددی څیړین هدف په کندهار والیت کښی د ترافیکی واقعاتو د خطری فکتورونو پژیندل دی تر څو په راتلونکی کښی
ددی څیړین څخه په اس تفاده الزمه تدابری او تګالره جوړه یس.او س تاسو ټول حمرم معلومات به په ډیر اطمناین ډول رسه
وساتل یس او د بل کوم هدف دپاره به ونه اکرول یس.
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ANNEX 4: Questionnaire
Sex: M / F
House Number or
Location:
Date/Time of Accident
Place of accident:
Q1 Sex 1. Male
2. Female
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Q4 Education 3. Primary
4. Secondary
5. High School
6. University
7. Master
8. PhD
9. Other specify…………..
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1. Other specify:…………..
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ابتدایه .۱
ثانوی .۲
لیسه .۳
پوهنتون تر کومه کچه مو زده کړی کړی .۴
۴پوښتنه
ماستری .۵ دی؟
دوکتورا .۶
.۸کو بل څه وی مشخص یی
کړی...............
متاهل .۱
مجرد .۲
کونډ یا کونډه .۳ ستاسو مدنی حالت څنکه دی؟ ۵پوښتنه
.۴کو بل څه وی مشخص یی
کړی...............
دریور .۱
کارکوونکی رسمی .۲
کوونکی زده .۳
تجارت .۴
بزکر .۵ اصلی دنده مو ځه ده؟ ۶پوښتنه
ښځه کور د .۶
متقاعد .۷
.۸کو بل څه وی مشخص یی
کړی...............
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.۱کروال موټر
۲۱۱۱ .۲موټر
کیشتم سوپر ..۳
بس .۴
کوم نوع موټر مو چلوه؟ ۲۴پوښتنه
الری .۵
رینجر .۶
.۷کو بل څه وی مشخص یی
کړی..............
۱.۱-۲۱
۲.۲۱-۴۱
۳.۴۱-۶۱
د ترافیکی پیښی په وخت کی مو ۴.۶۱-۸۱
۲۵پوښتنه
۵.۸۱-۱۱۱ د موټر سرعت ځو وه؟
۶.۱۱۱-۱۲۱
۷.۱۲۱زیات
.۸نه پوهیږم
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۱.۱-۱۲میاشت
۲.۱-۲کال
ځومره وخت کیږی چی تاسو په
۳.۳-۴کال ۳۷پوښتنه
دی الر کی دریوری کوی؟
۴.۵-۶کال
از ۷کال زیات .۵
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Paper:
59