A recent accident in June 2004, claimed the life of the attorney general of Uganda. There is a growing concern about the rising trend in mortality and morbidity from road traffic accidents in developing countries due to their effect on health care resources and budgets. Traffic accident injuries account for high medical care costs and loss of productivity (Murray, et al., 1996). This paper first, examines traffic accident mortality and trends in injuries in Uganda. Second, it seeks to understand the spatial variations in traffic accidents from 1997 to 2002. The role of urbanization and transport changes in causing a shift in the relative importance of various sources of mortality are central to the discussion in this paper. Improvement in road conditions is often promoted, in part, as tool to improve traffic safety. The study analysis, based on Uganda data, suggests that tarmac improvements are associated with fatal accidents and that urbanization and transport policy changes are associated with increases in serious accident rates. This paper contributes to the scant literature on the epidemiology of road traffic accidents in Africa, and to the growing debate on lack of an effective transport policy in developing countries.