Objectives: Each year, pedestrian injuries constitute over 40% of all road casualty deaths and up to 60% of all urban road casualty deaths in Ghana. This is as a result of the overwhelming dependence on walking as a mode of transport in an environment where there are high vehicular speeds and inadequate pedestrian facilities. The objectives of this research were to establish the (1) impact of traffic calming measures on vehicle speeds and (2) association between traffic calming measures and pedestrian injury severity in built-up areas in Ghana. Method: Vehicle speeds were unobtrusively measured in 38 selected settlements, including 19 with traffic calming schemes and 19 without. The study design used in this research was a matched case-control. A regression analysis compared case and control casualties using a conditional logistic regression. Results: Generally, the mean vehicle speeds and the proportion of vehicles exceeding the 50 km/h speed limit were significantly lower in settlements that have traffic calming measures compared to towns without any traffic calming measures. Additionally, the proportion of motorists who exceeded the speed limit was 30% or less in settlements that have traffic calming devices and the proportion who exceeded the speed limit was 60% or more in towns without any traffic calming measures. The odds of pedestrian fatality was significantly higher in settlements that have no traffic calming devices compared to those that have (odds ratio [OR] = 1.98; 95% confidence interval, 1.09-4.43). The protective effects of a traffic calming scheme that has a speed table was notably higher than those where there were no speed tables. Conclusion: It was clearly evident that traffic calming devices reduce vehicular speeds and, thus, the incidence and severity of pedestrian injuries in built-up areas in Ghana. However, the fact that they are deployed on arterial roads is increasingly becoming a road safety concern. Given the emerging safety challenges associated with speed calming measures, we recommend that their use be restricted to residential streets but not on arterial roads. Long-term solutions for improving pedestrian safety proposed herein include bypassing settlements along the highways to reduce pedestrians' exposure to traffic collisions and adopting a modern way of enforcement such as evidence-based laser monitoring in conjunction with a punishment regime that utilizes the demerit points system.
Keywords: Traffic calming measures; bypass; demerit points; enforcement; pedestrian injuries; speeding.