Road traffic injuries (RTIs) have become a major public health challenge in many low- and middle-income countries (LMICs). About 90 percent of the 1.3 million deaths and 50 million injuries from road traffic crashes worldwide each year occur in LMICs, although these countries have only 48 percent of the world's registered vehicles. Increasing motorization and urbanization in LMICs could double this toll by 2030. The difference in road crashes between LMICs and high-income countries (where many road deaths still occur), is stunning. ECA countries have experienced rapid growth in the number of passenger cars on the roads over the last two decades. In the Commonwealth of Independent States (CIS), there was a 120 percent increase in passenger cars per 1,000 persons from 64 in 1990 to 141 in 2003. Similar trends were observed in countries in southeastern Europe. Vehicles in many Europe and Central Asia (ECA) countries tend to be old and have sub-standard safety features. Length of roads and highways (in km.) has also increased since the 1990s by 18 percent and 157 percent in the CIS, 21 percent and 75 percent in European Union (EU)-10 countries, and 46 percent and 144 in southeastern Europe, respectively. In spite of significant investments in road infrastructure since the 1990s, in some ECA countries the roads still suffer from poor maintenance and under-investment.