Forensic Assessment of Alcohol-Related Deaths among Road Users in Nairobi: Implications for Public Safety and Policy

Abstract

Background: Road traffic accidents (RTAs) are a significant public health challenge globally, especially in low- and middle-income countries, where they contribute to high rates of injury and death. Alcohol consumption is a major risk factor for RTAs, impairing driving skills like judgment and reaction time. While much of the research has focused on drivers, other vulnerable road users such as passengers, pedestrians, and cyclists remain underexplored. This study investigates the prevalence of alcohol in RTA fatalities across different road user categories in Nairobi, Kenya, using forensic postmortem toxicological analysis.
Methods: A cross-sectional study analyzed 100 RTA fatalities from the City Mortuary in Nairobi between January and March 2007. Postmortem vitreous humour samples were tested for alcohol using standard forensic techniques. After excluding five cases with potential postmortem ethanol formation, 95 valid samples were analyzed. Victims were categorized into four road user groups: drivers, passengers, pedestrians, and cyclists. Alcohol presence and demographic factors were examined to assess prevalence patterns.
Results: Among the 95 valid cases, 15 (15.8%) tested positive for alcohol. Males comprised 66.7% (n = 10) of alcohol-positive victims. A Chi-square test showed a significant gender difference in alcohol positivity (χ² = 4.45, p = 0.035), with males more likely to test positive. Passengers had the highest alcohol positivity rate (46.7%), followed by pedestrians and cyclists (20% each), and drivers (13.3%). ANOVA revealed a significant difference in alcohol prevalence across road user groups (F = 6.81, p = 0.001). Among intoxicated individuals, 57% of passengers and all alcohol-positive pedestrians showed severe intoxication. The highest blood alcohol concentration was 0.52 g% in a pedestrian. Logistic regression found that age was not a significant predictor (p = 0.267), but gender remained significant.