Pedestrian Safety in Developing Countries: A Systematic Literature Review and Gap Analysis

Pedestrian safety remains a pressing challenge in low- and middle-income countries (LMICs), where global predictive models often misrepresent local realities. This study tests the hypothesis that global predictive models, such as the International Road Assessment Programme (iRAP), overestimate countermeasure effectiveness in LMICs because key contextual factors are omitted. The two-phase research combined a PRISMA-based systematic literature review (SLR) with a quantitative iRAP performance gap analysis of the countermeasures implemented in the candidate studies of the SLR. The review systematically evaluated the effectiveness of pedestrian safety countermeasures, with an emphasis on their application in LMIC contexts. Following PRISMA 2020 guidelines, 14 longitudinal before–after studies were selected from 1911 records and screened with EPPI-Reviewer 4 software. The analysis identified 33 contextual factors shaping countermeasure performance across both high- and low-income settings; of these, 23 were specific to LMICs, and 13 are not accounted for in the iRAP model. The findings show that iRAP systematically overestimates countermeasure effectiveness in LMICs due to weak enforcement, poor maintenance, and informal road use. Transverse rumble strips were the only intervention consistently effective across diverse LMIC settings. A novel performance gap analysis of five LMIC case studies revealed an average discrepancy of 30.9% (SD = 29.7%) between predicted and observed outcomes. A risk of bias assessment showed that most LMIC studies were of moderate to serious risk, reflecting systemic data limitations and a frequent reliance on proxy outcomes. These findings highlight the urgent need for recalibrated, context-sensitive frameworks that incorporate enforcement, maintenance, and socio-economic variables. Policy implications include prioritising affordable and scalable countermeasures, pairing infrastructure with enforcement and education, and strengthening crash data systems to support more realistic, evidence-based road safety planning.