Buses account for a disproportionate number of road traffic accident fatali
ties in Karachi, Pakistan and other developing countries. Potentially dange
rous bus driving and commuting practices that increase risk of road acciden
ts and the effect of traffic police on bus behavior are evaluated. A total
of 250 episodes each of disembarking and embarking commuters, buses stoppin
g and moving on the road at ten of Karachi's highest risk intersections for
traffic injuries were observed. Of the disembarking passengers, 33% did no
t wait for the bus to stop; 54% stepped off in the center of the road and 8
4% 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 ju
mp 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 awa
y from the stop and 79% stopped in the center of the road. Where traffic po
lice were present buses were more likely to race (9% versus 3%, P = 0.05) a
nd to cut off other vehicles (13% versus 2%, P = 0.001) than where police w
ere 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. (C) 1999 Elsevier Science Ltd. All rights reserved.