Research Article

Evaluation of the impact of the month of Ramadan on
traffic accidents
Utku Murat Kalafat1, Hakan Topacoglu1, Ozlem Dikme2, Ozgur Dikme1, Sila Sadillioglu1,
Mustafa Orfi Erdede1
1

Emergency Department, Istanbul Training and Research Hospital, Istanbul, Turkey.
Emergency Department, Haseki Training and Research Hospital, Istanbul, Turkey.
Correspondence to: Utku Murat Kalafat, E-mail: utkumuratk@yahoo.com

2

Received November 5, 2015. Accepted November 16, 2015

Abstract
Background: In the Muslim society, long periods of hunger in the month of Ramadan affect physiological and psychological
performance of fasting practitioners. Most of the traffic accidents are due to human factors.
Objective: To investigate the effects of the month of Ramadan on traffic accidents.
Materials and Methods: The study was carried out based on the traffic accident reports in a period of 1 year using theTurkish Statistical Institute data. In accordance with this report, the data were analyzed with respect to Ramadan andnon-Ramadan months.
Result: In 2011, total of 3,835 persons were found dead and 238,074 injured in 312,878 traffic accidents. Total number oftraffic accidents in Ramadan month was found to be 28,447 and that during non-Ramadan month’s average was 25,857(p < 0.001). Statistical analysis of the number of traffic accidents within the 12 months of 2011, when used c2-test for goodness of fit, showed that the observed number of accidents was significantly higher (p < 0.001) than the expected number
in June, July, August (Ramadan), and September. Death rate in Ramadan was found to be 1.5% and that in non-Ramadan
months was 1.2% (p = 0.001).
Conclusion: The average number of traffic accidents was slightly higher in Ramadan than in non-Ramadan months. Also
traffic accidents involving death and injury were slightly high and traffic accidents involving material damage was less.
Total number of dead and injured persons was also found to be slightly high. Also, as expected, penalties due to drunk
driving were found less in Ramadan.
KEY WORDS: Ramadan, traffic accident, traffic penalty

Introduction
Traffic accident can be described as an event that resultsin death, injury, and material loss due to the crash of one ormore vehicles moving on roads. Traffic accidents are oneof the most pressing international health and development
Access this article online
Website: http://www.ijmsph.com
DOI: 10.5455/ijmsph.2016.05112015173

Quick Response Code:concerns in the world. The main cause of traffic accidents may
be human factors and individual performance. The highway
traffic law is issued in order to maintain traffic order withrespect to security of life and property in highways and to
specify the precautions to be taken for all aspects of traffic
safety.[1]Ramadan is the ninth month of the lunar calendar andlasts 30 days. The dates of Ramadan show variation becauseof the moving backward approximately 10 days each year
depending on the moon. In 2011, Ramadan occurred between
August 1 and August 30. Approximately one billion Muslims
around the world are fasting and they refrain from eating,drinking, smoking, and sex between sunrise and sunset.
Depending on the season, duration of fasting may change
from 13 to 18 hours. Although, Ramadan fasting is one ofInternational Journal of Medical Science and Public Health Online 2016. © 2016 Utku Murat Kalafat. This is an Open Access article distributed under the terms of theCreative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium
or format and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license.
International Journal of Medical Science and Public Health | 2016 | Vol 5 | Issue 03543

Kalafat et al.: Impact of Ramadan on traffic accidents

the five pillars of Islam, unhealthy and weak individuals are
not allowed to fast. Effect on daily diet intake and metabolism was known of Ramadan might affect both cognitive andphysical functions. For most people, if hunger occurs atnight 8–10 hours is acceptable as normal.[2] Biochemical andphysiological parameters, sleep pattern, and eating habits ofthe fasting person change in the month of Ramadan. Somechronobiological studies showed that Ramadan fasting affects
circadian distribution related to body temperature, cortisol,
melatonin, and glucose. Night sleep, day alertness, and psychomotor performance decrease.[3,4]. People under medical
treatment do not use their drugs regularly to be able to fast.
Existing chronic diseases of fasting people are affected in
Ramadan. Topacoglu et al.[5] observed that the number ofcases presented to the emergency department for diabetes,
hypertension, and uncomplicated headache-related complaints increases during Ramadan. Ramadan affects animportant portion of the world population and there are manystudies related to its impacts on health. But there are fewerstudies on its effects on forensic cases and traffic accidents.
The aim of this study was to investigate the effect of the monthof Ramadan on traffic accidents.

Materials and Methods
This study was conducted by evaluation of the data published by the Turkish Statistical Institute (TurkStat) reporting on traffic accidents in Turkey between January 1 andDecember 31, 2011. Ramadan is the ninth month of thelunar calendar. When it is adapted according to the Gregoriancalendar, every year Ramadan comes 10 days earlier. Dueto the Ramadan in 2011 was started at August 1th and it wasended at August 30th, only 2011 statistical data was chosen
and we can comment all 2011 August data’s as Ramadan.
According to the TurkStat reports, the accidents wereclassified as urban and rural depending on where it was
occurred. In this study, these two data were analyzed together.
All traffic accidents were classified by month and analyzed
in three subgroups as accident number according to damage,injury, and death. Also, all accidents with regard to total numberof dead or injured persons were analyzed into two subgroups.
Statistical analysis especially death ratio was performed
separately with total accident groups and total injury groups.
All of the traffic accidents data were analyzed separately bymonth and according to the Ramadan (August)/non-Ramadan
months, before and after the Ramadan subgroups. The
penalties for drunk driving were provided from the “T.R.
Security General Directorate Department of Traffic Services.”
The penalties for drunk driving were classified by month andanalyzed in subgroups, Ramadan and non-Ramadan months.
Statistical analysis was carried out using Microsoft Excel
2010 program with 95% confidence intervals (CIs) and p-value<0.05 was considered statistically significant. All subgroups’
data were presented as total number and percentage. Also
histogram was performed. c2-Test was used in the statisticalanalysis of categorical data and odds ratio was calculated.
544

International Journal of Medical Science and Public Health | 2016 | Vol 5 | Issue 03

Results
According to the TurkStat reports total number of the traffic
accidents involving death or injury in 2011 was reported as
131,846. Monthly distribution of the traffic accidents in 2011
was showed that the highest number of traffic accidents wasin July (30,935) and the lowest number of traffic accidents
was in February (20,548). The average number of traffic accidents was found to be 26,073 within 12 months. The numberof traffic accidents in the month of Ramadan (August) was
reported as 28,447; and when evaluated in terms of total
number of traffic accidents, September was second (29,425)
and Ramadan (August) was third. In addition, when we
examined the monthly distribution of the traffic accidents withregard to death and injury, we found that the highest number
was in July. The total number of dead persons was reported
as 3,845 and 430 (11.2%) in the month of Ramadan, whereas
the total number of injured persons was reported as 238,074
and 24,523 (10.3%) in the month of Ramadan. According to
the T.R. Security General Directorate Department of Traffic
Services reports in 2011, total numbers of driving licensesuspension penalties due to drunk driving were reported as
108,211. Monthly distribution of these penalties was showedthat the highest number was found in October as 10,436 andthe lowest number was in August (Ramadan) as 3,631. Table 1
shows the monthly distribution of traffic accidents in 2011 byproperties (involving in death and injury), total numbers of
traffic accidents, death persons, injured persons, and monthly
distribution of the numbers of driving license suspension
penalties due to drunk driving.
Analysis of the Accidents in Ramadan

In non-Ramadan period total number of the traffic accidents was found to be 284,431 and monthly average of traffic
accidents was found to be 25,857 (8.3%). The number oftraffic accidents in the month of Ramadan (August) was
reported as 28,447 (9.1%) and it was slightly higher thanthe other months’ average (c2, p < 0.001, OR: 1.11, 95% CI:
1.09–1.13). Also, statistical analysis of the number of traffic
accidents within 12 months of 2011, when used the chi-square
test for goodness of fit, showed that the observed number ofaccidents was significantly higher (p < 0.001) than the expected
number during summer holiday months in Turkey, which wereJune (8.8%), July (9.9%), August (9.1%), and September(9.4%).
When Ramadan and non-Ramadan months were comparedwith statistically by subgroups, traffic accidents involving deathand injury were found slightly higher in Ramadan and material
damage was found less. In Ramadan month 339 (1.2%) andin non-Ramadan months 2735 (1.0%) traffic accidents wereinvolving death (c2, p < 0.001; OR: 1.24, 95% CI: 1.11–1.39);
whereas, 12,838 (45.1%) traffic accidents were involving injury
in Ramadan month and 115,913 (40.8%) were in nonRamadan months (c2, p < 0.001; OR: 1.20, 95% CI: 1.17–1.23).
About involving material damage, 15,270 (53.7%) traffic accidents were in Ramadan month and 164,762 (57.9%) were

Kalafat et al.: Impact of Ramadan on traffic accidents

Table 1: Monthly distribution of 2011 traffic accidents properties and total numbers
Monthly
distribution
January

February
March
April
May

June

July

AugustTraffic accidents count involving

Material
damageInjuryDeath

Traffic accidents

15,546

13,574

8,170

192

23,908

14,531

6,832
8,281

159

22,971

14,773

9,110

14,617

10,44815,896

14,642

14,827

15,27012,524

12,838

142
206
234

313

397

339

20,54824,089Total countInjuredpersonDeathperson12,258190

14,71914,552
16,218242

10,126

177

8,925

244

298

10,10730,93528,873498

9,346

27,66428,447

23,33824,523404

430

13,430325

29,42525,639376

November

14,915

10,802267

25,984

20,516338

December

Total

16,106

181,032

11,387

10,287

128,751

308

213

3,095

in non-Ramadan months (c2, p < 0.001; OR: 0.84, 95% CI:
0.82–0.86). Also when Ramadan and non-Ramadan months
were compared with statistically by the number of deathand injured persons, it was found slightly higher in Ramadan.
The total number of death persons was reported as 430 (1.5%)
in Ramadan and 3405 (1.2%) in non-Ramadan months(c2, p = 0.001; OR: 1.19, 95% CI: 1.08–1.32), and the total
number of injured persons was reported as 24,392 (10.3%)
in Ramadan and 19,319 (8.2%) in non-Ramadan months
average (c2, p = 0.001; OR: 1.19, 95% CI: 1.08–1.32). The
total number of driving license suspension penalties due todrunk driving was 3631 (3.4%) in Ramadan month and themonthly average number was 9507 (8.8%) in non-Ramadan
months (c2, p < 0.001; OR: 0.36, 95% CI: 0.35–0.38).

Discussion
According to the TurkStat reports, in 2011 Turkey population
was 74.7 billion people and the number of vehicles registered
to traffic was 16 billion. Also the number of persons with driving
license was 22.8 billion. In 2011, total number of accidents
was 1.2 billion but only 3,095 accidents were involving deathand 128,751 accidents were involving injury. In 2011, 3835
persons were died and 238,074 persons were injured in traffic
accidents.[1] Our study findings showed that the number traffic
accidents in the month of Ramadan (August) was slightly
higher than the other months’ average and also the observed
number of accidents was significantly higher than the expected
number in June, July, August (Ramadan), and September,and an increase was observed in total numbers comparedto other months. The number of accidents in the month of
Ramadan was high with respect to some other months, but
this seems to be due to an effect of the summer season itself.
This may be due to the fact that people prefer summer season

9,382

19,41915,67015,307

7,979

25,299September
OctoberNumber of penalties
due to drunk driving

27,002

26,606

312,878

20,17017,849238,074

377

261

3,835

9,863

3,631

10,297

10,436

8,375

9,744

108,211

for their vacations, and also it may be a result of the increasein number of vehicles in traffic, especially in high-populated
cities; social activities of the people; and intercity trips.
There are some studies in literature, which reported a
relationship between Ramadan and forensic cases. In a 4-year
study in Turkey, Hussein et al.[6] analyzed all forensic cases
including traffic accidents, assaults, and suicides, and foundthat there was no significant difference between forensic cases
presented in Ramadan and non-Ramadan periods. Likewise,
Küçüker and Aksu[7] found a similar ratio for injuries in traffic
accidents. In this 1-year retrospective study, the number ofaccidents in the month of Ramadan was high with respect tosome other months, but these increases were not separated
from due to an effect of the summer season itself or effect ofRamadan. However, in United Arab Emirates, a 1-year
retrospective study carried out by Bener et al.[8] found thatthe number of persons who were injured by traffic accidents
during Ramadan, which was at a non-summer season (March
28–April 26), was slightly higher than during other months.
Unlike, Khammash and Al-Shouha[9] found that the rate of theroad traffic accidents during the Ramadan was significantly
less. But in their study only two winter months (October andNovember), as Ramadan, were analyzed and 15 days ago
and 15 days later periods were taken as control groups.
In our study, we studied all months in a year and found thatin Ramadan month traffic accidents were slightly higher thanthe other months’ average. Also our study showed that, whencompared to other months, the number of deaths and injuries
in traffic accidents during the Ramadan month was significantly higher. Tahir et al.[10] conducted a study about road trafficcrashes in the Ramadan 2011 at Pakistan. They reported
that 12,969 road traffic crashes were occurred and, like ourstudy, they compared these with an average of non-Ramadan
10 months (11,573 road traffic crashes per month fromJanuary to August 2011) and they found that the number ofInternational Journal of Medical Science and Public Health | 2016 | Vol 5 | Issue 03545

Kalafat et al.: Impact of Ramadan on traffic accidents

road traffic crashes in Ramadan month was statistically significantly higher than the non-Ramadan months’ average.
Ramadan and fasting have lots of physiological changes
on human body. When evaluated in terms of psychomotor
performance we think that it can be decreased. There aresome studies on human psychomotor performance in theliterature. Al Suwaidi et al.[11] state that external factors forfasting, food intake, and/or sleep time changes can affectcircadian rhythm. Similarly in other studies, it has been shownthat the sudden change in meal times in Ramadan effects
sleep time and circadian rhythm.[12] Night sleep, day alertness,and psychomotor performance decrease.[13] As the literaturesuggests that Ramadan has an impact on personal performance, it is expected that an increase in traffic accidents may
be observed during this period. Throughout this expectation,
our study was showed that slightly statistically significant
increase in the number of traffic accidents in Ramadan compared to non-Ramadan months. But we cannot separate tothese increases from due to an effect of the summer season
itself or effect of Ramadan. Also summer season seems tohave a stronger effect on total number of accidents.
TurkStat reported that 339 traffic accidents involving deathand 430 persons were died in Ramadan, and these numbers
were considered statistically significant. Lots of factors canaffect to the traffic accidents involving death, and drunk driving
is one of them. Shih et al.[14] found that morbidity due to traffic
accidents was found to be higher in drunk drivers than inothers. In our study in Ramadan, there was a decrease in
drunk driving but death persons and injured persons rates
were similar in non-Ramadan months. Although the month of
Ramadan reduced reported alcohol intake in traffic, it had no
positive or negative effect on the number of accidents and thenumber of accidents resulting in death. Although Ramadan
seems to affect physiological parameters of fasting people, itdoes not seem to have an impact regarding traffic accidents.
Limitations
This study has several limitations. First of all, the nonMuslim drivers were not excluded from the study. Because of
our country statistical storage status and ethical issues, wecannot access the religion statements of patients with accident.
Religion is a private situation and not routinely questioned inpatients. In addition, in Ramadan month we had no private
information about his/her fasting situation. This is the second
limitation of this study. As Turkey is a Muslim country, we
accept that all the traffic accident victims were fasting.

Conclusion
The average number of traffic accidents was slightly highin Ramadan than in non-Ramadan months. Also traffic accidents involving death and injury were slightly high and traffic
accidents involving material damage was less. The number of546International Journal of Medical Science and Public Health | 2016 | Vol 5 | Issue 03

dead and injured persons was also found to be slightly high.
Also, as expected, penalties due to drunk driving were foundless in Ramadan.

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How to cite this article: Kalafat UM, Topacoglu H, Dikme O,
Dikme O, Sadillioglu S, Erdede MO. Evaluation of the impact ofthe month of Ramadan on traffic accidents. Int J Med Sci Public
Health 2016;5:543-546
Source of Support: Nil, Conflict of Interest: None declared.