Abstract
Background: Child road traffic injuries are a major global public health problem and the issue is particularly burdensome in middle-income countries such as South Africa where injury death rates are 41 per 100,000 for under 5′s and 24.5 per 100,000 for 5–14-year-old. Despite their known effectiveness in reducing injuries amongst children, the rates of use of child restraint systems (CRS) remains low in South Africa. Little is known about barriers to child restraint use especially in low- and middle-income countries. Methods: We carried out observation studies and parent/carer surveys in 7 suburbs of Cape Town over a three month period to assess usage rates and explore the knowledge and perceptions of parents towards child restraint legislation, ownership and cost; Results: Only 7.8% of child passengers were observed to be properly restrained in a CRS with driver seatbelt use and single child occupancy being associated with higher child restraint use. 92% of survey respondents claimed to have knowledge of current child restraint legislation, however, only 32% of those parents/carers were able to correctly identify the age requirements and penalty. Reasons given for not owning a child seat included high cost and the belief that seatbelts were a suitable alternative. Conclusions: These findings indicate the need for a tighter legislation with an increased fine paired with enhanced enforcement of both adult seatbelt and child restraint use. The provision of low-cost/subsidised CRS or borrowing schemes and targeted social marketing through online fora, well baby clinics, early learning centres would be beneficial in increasing ownership and use of CRS.
Highlights
21% of road traffic deaths occur among children aged 0–19 year [1]
Of those seated in the backseat, the majority (n = 269) were unrestrained (87.9% 95% CI 83.7–91.3%) whilst only 28 of all children seated in the back seat (9% 95% CI 6.2–13%) were observed in a formal child restraint systems (CRS)
Eleven of the 67 children who were observed to be seated in the front seat of the car were restrained with just one child using a dedicated child restraint (16.4% 95% CI 8.5–27.5%) (Figure 1)
Summary
Road traffic injuries (RTIs) are the leading cause of death amongst children aged 1–19 years with global rates being estimated at 10.7 per 100,000 population [2,3] Of these, 93% occur in low- and middle-income countries (LMIC). Child road traffic injuries are a major global public health problem and the issue is burdensome in middle-income countries such as South Africa where injury death rates are 41 per 100,000 for under 50 s and 24.5 per 100,000 for 5–14-year-old. Despite their known effectiveness in reducing injuries amongst children, the rates of use of child restraint systems (CRS) remains low in South Africa. The provision of low-cost/subsidised CRS or borrowing schemes and targeted social marketing through online fora, well baby clinics, early learning centres would be beneficial in increasing ownership and use of CRS
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