Risky behavior of bus commuters and bus drivers in Karachi, Pakistan.

Buses account for a disproportionate number of road traffic accident fatalities in Karachi, Pakistan and other developing countries. Potentially dangerous bus driving and commuting practices that increase risk of road accidents and the effect of traffic police on bus behavior are evaluated. A total of 250 episodes each of disembarking and embarking commuters, buses stopping and moving on the road at ten of Karachi's highest risk intersections for traffic injuries were observed. Of the disembarking passengers, 33% did not wait for the bus to stop; 54% stepped off in the center of the road and 84% did not look out for traffic. Among the embarking commuters, 38% got on moving buses; 73% climbed on buses filled to their outer foot boards and 83% waited for buses on the street. Males were more likely than females to jump off a moving bus (43% versus 1.6%, P < 0.001), get on a moving bus (49% versus 12%, P < 0.001), and run to catch a bus (45% versus 8%, P < 0.001). At the bus stops, 30% of the buses did not stop completely; 46% stopped away from the stop and 79% stopped in the center of the road. Where traffic police were present buses were more likely to race (9% versus 3%, P = 0.05) and to cut off other vehicles (13% versus 2%, P = 0.001) than where police were absent. Risky behavior is common among both Karachi bus drivers and bus commuters. The traditional efforts to regulate bus traffic through traffic police is ineffective.