Are child passenger fatalities and child passenger severe injuries equally affected by child restraint legislation? The case of Chile

The objective of this study is to determine the contribution of Chile's 2005 child restraint legislation to the reduction of child passenger fatalities and severe injuries. We analysed motor vehicle injury and fatality data from Chile's National Road Safety Commission of the Ministry of Transport from 2000 to 2012 to determine the effect of Chile's 2005 mandatory child restraint legislation. Using interrupted time-series Poisson regression models, we assessed the effect of the law on two dependent variables: (1) number of child fatalities in car and (2) number of children severely injured. The independent variable was the 2005 enactment of Chile's mandatory child restraint legislation. Coefficients from the interrupted time-series Poisson regression models indicate that Chile's enactment of child restraint legislation in 2005 is significantly associated with a total of 35% reduction in child passenger severely injured but only three years after its enactment, and significant associations between this policy and child fatalities were less evident.     

Child motor vehicle occupant and pedestrian casualties before and after enactment of Child Restraint Seats Legislation in Japan

Problem. Prevention of injuries to child passengers is a significant public health priority, as motor vehicle-related injuries remain a leading cause of death for children in Japan. The purpose of compulsory child restraint seats legislation in April 2000 was to reduce the number of child passengers killed or injured in motor vehicle crashes.

Methods. The objectives of this preliminary evaluation are to measure the effectiveness, benefits and usage of safety seats for child passengers aged 1–5 years by analysing the child casualty data for the period of 1997–2002. Population and vehicle miles travelled based injury and fatality rates were used to compare before and after legislation trends in child casualties.

Results. Despite overall increases in the use of child restraint seats (as observed by different national surveys), overall casualty rates in motor vehicle occupants in the 1–5 year age group did not change (fatalities and serious injuries) or even increased (minor injuries).

Conclusions. Casualties among restrained children have not decreased since the law came to effect in the year 2000, perhaps because of incorrect usage of the seats. Given that exposure to crash environments is increasing, traffic safety advocates and public health community need to be aware of the importance of child restraints as a means of reducing the likelihood of injury. It is necessary to implement effective community-based child safety seat campaigns to disseminate the information on appropriate restraint use and to increase efforts to enforce the existing legislation.     

A contemporary analysis of road traffic crashes,fatalities and injuries in Trinidad and Tobago

Road safety, in particular pedestrian safety, is a problem in Trinidad and Tobago. Data were derived from the database of the Traffic and Highway Patrol Unit of the Trinidad and Tobago Police Service. Road traffic crashes in Trinidad and Tobago are largely an urban problem. Four urban areas accounted for nearly three-quarters of reported road traffic crashes, fatalities and injuries. Pedestrians, passengers and drivers accounted for 93% of fatalities and 95% of injuries due to road traffic crashes in 2000. Pedestrians alone accounted for 42% of fatalities and 34% of injuries in 2000. Trends over time show that there has been a decline in fatality rates from 17 deaths per 100,000 population in 1960 to 10 deaths per 100,000 population in 2000, despite rapid motorization. Motorization increased four-fold from 63 registered vehicles per 1000 population in 1960 to 250 vehicles per 1000 population in 2000. In conclusion, effort should be intensified to ensure safety for all road users and, in particular, pedestrians, passengers and drivers. Improved data collection and operational research would improve monitoring and evaluation of policy interventions.     

Seating position and patterns of severely injured body parts among child passengers in motor vehicle crashes: Japan as a distinct case

ABSTRACT

This study describes injury patterns and outcomes related to the seating position of child passengers involved in motor vehicle crashes in Japan. Using data obtained from a national trauma registry database, we compared the occurrence of injuries by body parts, length of hospital stay and in-hospital deaths between front-seating and rear-seating among children. We analysed 166 children aged 0–5 years and 205 children aged 6–12 years. No significant differences were observed between front- and rear-seating for injured body parts, length of hospital stay or in-hospital deaths in the 0–5-year-old victims. Among those aged 6–12 years, rear-seating was associated with a higher incidence of head and chest injuries but the length of stay or in-hospital deaths did not differ. These findings contrast those of previous studies, which found that rear-seating reduces injury risk, possibly attributed to low age-appropriate restraint use among school-aged children in Japan.     

Parental perceptions of child placement within vehicles: a focus group study

Although rear-seating children in motor vehicles results in fewer injuries and fatalities in motor vehicle crashes, many children continue to be front-seated. This study seeks to identify parental barriers to rear-seating children in motor vehicles and strategies to increase child rear seat placement. Focus groups were conducted with parents of children 12 or younger to determine barriers to rear seating and strategies to increase child rear seat placement. Barriers to rear seat placement identified include the logistics of transporting multiple children with limited rear seat availability, the potential of children to harm themselves if rear-seated, and peer pressure. Parents felt there should be no option to sit elsewhere within the vehicle to help normalize rear-seating. Successful interventions to increase child rear seat placement should focus on parental barriers to rear-seat their children in vehicles, including normalizing rear seat placement, and determining approaches to make rear-seat placement with multiple children uncomplicated.     

The influence of licence status on Kansas child fatalities due to motor vehicle crashes

The influence of driver licensure on child motor vehicle crash (MVC) deaths in Kansas was investigated. Fatalities from 1994-2000 due to MVCs were extracted from the Kansas State Child Death Review Board and the Fatality Analysis Reporting Systems databases. It was found that 14% (52 of 363) of child fatalities from MVCs in Kansas occurred in vehicles where the driver was not licensed. Driver licence status was associated with use of safety restraints, the victim's age and race, weekend driving and rural county location. All child deaths involving unlicensed drivers were preventable. New legislation on vehicle sanctions may be required to assist law enforcement. Safety restraint laws should be enforced and promoted to the public. Transportation options are necessary for unlicensed drivers, particularly if they have young children and live in a rural community. Thus, a multi-system approach involving law enforcement, accident prevention strategies and transportation options will save the lives of children.     

Trends in road traffic crashes and associated injury and fatality in the People’s Republic of China, 1951–1999

The burden of road traffic injuries in the People’s Republic of China is increasing as evidenced by trends since 1951. Data from the National Statistical Office, Ministry of Communications and the Traffic Administration Bureau were analyzed. Absolute numbers of crashes, fatalities, and injuries, as well as fatalities per 100,000 population and motorization (number of vehicles per 1000 population) were used as indices to measure trends. Regional variations in trends and the characteristics of people injured or killed were also analyzed. Road traffic crashes increased 68- fold, from around 6000 in 1951 to 413,000 in 1999. Excessive speed was the main reported cause of the crashes. The injuries increased 56-fold – from around 5000 to 286,000 – and fatalities 97-fold – from 852 to around 84,000 – over the same period. The crash, fatality and injury rates also increased after 1985, due to increased motorization spurred by rapid economic growth. The number of four-wheel motor vehicles increased from 60,000 in 1951 to just under a million four-wheel motor vehicles in 1975 and to 10 million in 1987. The number of four-wheel motor vehicles then rose to 50 million in 1999, with an additional 30 million motorcycles. The increase in motorization and fatalities affected all the provinces. Road traffic injuries are the leading cause of death for populations up to the age of 45 years and the leading cause of working-life years lost in China.     

Keeping our children safe in motor vehicles: knowledge,attitudes and practice among parents in Kuwait regarding child car safety

Child safety restraints can reduce risk of death and decrease injury severity from road traffic crashes; however, knowledge about restraints and their use in Kuwait is limited. A cross-sectional, self-administered survey about child car safety was used among a convenience sample of parents of children aged 18 years or younger at five Kuwaiti university campuses. Of 552 respondents, over 44% have seated a child in the front seat and 41.5% have seated a child in their lap while driving. Few parents are aware of and fewer report using the appropriate child restraint; e.g., 36% of parents of infants recognised an infant seat and 26% reported using one. Over 70% reported wearing seat belts either “all of the time” (33%) or “most of the time” (41%). This new information about parents' knowledge and practice regarding child car seat use in Kuwait can inform interventions to prevent child occupant injury and death.     

Global collaboration on road traffic injury prevention

Worldwide, nearly 1.2 million people are killed in road traffic crashes every year and 20 million to 50 million more are injured or disabled. These injuries account for 2.1% of global mortality and 2.6% of all disability-adjusted life years (DALYs) lost. Low- and middle-income countries account for about 85% of the deaths and 90% of the DALYs lost annually. Without appropriate action, by 2020, road traffic injuries are predicted to be the third leading contributor to the global burden of disease. The economic cost of road traffic crashes is enormous. Globally it is estimated that US$518 billion is spent on road traffic crashes with low- and middle-income countries accounting for US$65 billion--more than these countries receive in development assistance. But these costs are just the tip of the iceberg. For everyone killed, injured or disabled by a road traffic crash there are countless others deeply affected. Many families are driven into poverty by the expenses of prolonged medical care, loss of a family breadwinner or the added burden of caring for the disabled. There is an urgent need for global collaboration on road traffic injury prevention. Since 2000, WHO has stepped up its response to the road safety crisis by firstly developing a 5-year strategy for road traffic injury prevention and following this by dedicating World Health Day 2004 to road safety and launching the WHO/World Bank World Report on Road Traffic Injury Prevention at the global World Health Day event in Paris, France. This short article highlights the main messages from the World Report and the six recommendations for action on road safety at a national and international level. It goes on to briefly discuss other international achievements since World Health Day and calls for countries to take up the challenge of implementing the recommendations of the World Report.     

Road traffic mortality in Estonia: alcohol as the main contributing factor

Traffic fatalities are the leading cause of death among the young and middle-aged population in Estonia. The objective of this study was to reveal the pattern of traffic fatalities among the population aged 15 - 64 years and to determine the role of alcohol in their fatalities. The data were collected from post-mortem reports at the Estonian Bureau of Forensic Medicine from 2000 to 2002. Alcohol-related deaths were those with a blood alcohol concentration (BAC) equal or above 0.05 g/100 ml. Out of 512 victims, 401 were males and 111 were females. The greatest group were car occupants (58%) followed by pedestrians (31%). The portion of alcohol-related deaths was 70% among men and 44% among women. The mean BAC and percentage of alcohol-related deaths was significantly higher in pedestrian than in driver fatalities. Alcohol intoxication was identified as the most powerful contributing factor to traffic fatalities. The results provide more evidence for politicians to tackle alcohol abuse and unsafe traffic environments.     

The neglected epidemic: road traffic accidents in a developing country, State of Qatar

The objective of the study is to explore the pattern of road traffic accidents (RTA) and their causes in the State of Qatar. A total of 52,160 RTA, 1130 injuries and 85 fatalities were registered during the year 2000. The data on RTA, injuries and fatalities was obtained from the Traffic Department of the Ministry of Interior, Supreme Council for Planning and Ministry of Public Health. The major cause of traffic accidents in Qatar was careless driving (71%). Relatively there was a more rapid increase in the number of registered vehicles (155%), but accidents were only (61%) in 2000 compared to the year 1983. The majority of victims (53%) were in the age group (10-40) "the most productive class in Society". Forty-three per cent of the total drivers who died due to RTA were in the age group (10-19) who were unlicensed drivers. In 2000, deaths due to RTA were the third leading cause of death after the diseases of the circulatory system and cancer. In conclusion, it is possible to control the epidemic of road traffic injuries through strict policy interventions, mass media and a national traffic campaign to increase the use of seat belts.     

Road traffic injuries in Thailand: Trends,selected underlying determinants and status of intervention

Injuries and deaths from traffic crashes have become a major public health and socio-economic problem in Thailand. Injuries, fatalities and economic losses due to traffic crashes have increased with the rising level of motorization. This study analyzes hospital-based data compiled by the Ministry of Public Health, data compiled by the National Police Office and data compiled by the traffic engineering division of the Department of Highways, Ministry of Transport and Communications. Analysis reveals that 70% of the people injured or killed in traffic crashes are aged 10-39. Men are at four to five times higher risk of death and injury due to traffic crashes than women. The number and rate of traffic injury in Thailand swung from a record low during the economic recovery in the 1980’s to record a high during the bubble economy, then declined with the economic crisis in 1997. The economic costs were estimated at U.S.$1.6 billion in 1995. An urban-rural difference in traffic injuries has been recorded with a higher rural case-fatality rate. A number of known behavioral risk factors have been identified, i.e., drunk driving, speeding, substance abuse and failure to use helmets and seat belts. However, determinants of behavior need further investigation. Hazardous road locations have also been mapped. Trends of traffic injuries seem to follow trends of economic growth. Without effective policy and implementation programs to control the determinants, it is expected that traffic injuries will increase as the country recovers from economic crisis. A major pitfall to many current government programs is that they incorporate no systematic evaluation. The fragmented structure of road safety authorities further complicates collaboration and coordination. A broad coalition of stakeholders is needed to catalyze policy action.     

Road traffic crashes with fatal and non-fatal injuries in Arkhangelsk,Russia in 2005–2010

The study investigated trends in traffic crashes with fatal and non-fatal injuries in Arkhangelsk, Russia in 2005–2010. Data were obtained from the road police. Negative binomial regression with time regressor was used to investigate trends in monthly incidence rates (IRs) of crashes, fatalities, and non-fatal injuries. During the six-year period, the police registered 4955 crashes with fatal and non-fatal injuries, which resulted in 217 fatalities and 5964 non-fatal injury cases. The IR of crashes with fatal and non-fatal injuries per total population showed no evident change, while the IR per increasing total number of motor vehicles decreased on average by 0.6% per month. Pedestrian crashes constituted 51.8% of studied crashes, and pedestrians constituted 54.6% of fatalities and 44.5% of non-fatal injuries. The IRs of pedestrian crashes and non-fatal pedestrian injuries per total population decreased on average by 0.3% per month, and these were the major trends in the data.     

Investigation of pedestrian crashes using multiple correspondence analysis in India

Abstract

Pedestrian safety is of growing concern with an increasing number of traffic accidents, especially in developing economies like India. In 2017, there were 20,457 pedestrian fatalities in India. Pedestrian crashes have also become a key concern in the state of Tamilnadu, India, due to the high percentage of deaths. If the available datasets are large and complex, identifying key factors is a challenging task. In this study, Multiple Correspondence Analysis (MCA), an exploratory data analysis technique was used to explore the roadway, traffic, crash, and pedestrian-related variables influencing pedestrian crashes. This study used the data from Government of Tamilnadu Road Accident Traffic Management System (RADMS) database, to analyse accident data of nine years (2009–2017) related to pedestrian crashes. The results of the study show that crashes occurring on the express highways on a multilane road are often associated with hit-and-run behaviour among drivers. Factors such as lighting conditions, location, pedestrian behaviour, crossings, and physical separation are also significantly contributing to pedestrian crashes. The key advantage of MCA is that it identifies a possible association between various contributing factors. The findings from this study will be useful for state transport authorities to improve countermeasures for mitigating pedestrian crashes and fatalities.     

Pedestrian traffic injuries in Mexico: A country update

Road traffic injuries in general and pedestrian injuries in particular are a major public health problem in Mexico, especially in large urban areas. Analysis of mortality and road crashes at the national level was done using routine data recorded on death certificates. Fatality rates for different age groups were estimated by region for the year 2000. These data were supplemented by a cross-sectional study of pedestrian injuries in Mexico City based on death certificates information for pedestrians who lived and died in Mexico City between 1994 and 1997. Participant observation of physical spaces where crashes occurred was carried out. The spaces were filmed and in-depth interviews of survivors conducted. Road traffic crashes were responsible for approximately 17,500 deaths in Mexico during 2000. The mean age of the victims was 37 years. Mexico lost an average of 30 years of productive life for each individual who died in a traffic crash – 525,000 years in 2000. An estimated 9500 (54.3%) of all fatalities were pedestrians, and for every pedestrian death there were 13 others who sustained nonfatal injuries requiring medical care. The overall crude mortality rate for pedestrian injuries in Mexico City was 7.14 per 100,000 (CI 6.85-7.42). A concentration of deaths was observed in 10 neighborhoods at specific types of street environments. The underlying factors included dangerous crossings and the absence or inadequacy of pedestrian bridges, as well as negative perceptions of road safety by pedestrians. In conclusion, this study demonstrates the importance of elucidating the underlying contextual determinants of pedestrian injuries.     

Pattern of deaths and injuries in road crashes on three main entrance roads in Kerman,Iran

Road traffic injuries and fatalities are increasing in Kerman, Iran. The study included all road traffic crashes recorded by traffic police forces located in west, northwest and south rural roads between 2005 and 2007 in Kerman city. According to the data, road traffic crashes were the main causes of injuries and deaths in Kerman. The results of this study indicated that significant differences were found between male and the female drivers. Results obtained on the driver's age indicated that higher male crashes were in age groups 26–34 years. Statistical testing of the results at the 5% significant level reveals that rate differences are significant under sunny, foggy, rainy, storm and lighting conditions of driving. The analysis results indicated that a majority of male drivers and only 0.23% of female drivers travelled unbelted while driving on rural roads in Kerman.     

Road traffic injuries in Mozambique

Road traffic injuries affect the economy, health and quality of life of the people of Mozambique. Current road safety programmes are inadequate and inefficient given the magnitude of the problem. Data reported on road traffic crashes in the period 1990 to 2000 from the National Institute for Road Safety, the traffic police and the Central Hospital of Maputo were reviewed. The burden of road traffic injuries in Mozambique is rising, with at least three people killed daily. The age group most affected is 25-38 (39.35%), followed by 16-24 (20.79%). The main causes of crashes include reckless driving, drunken driving, roads with potholes, inadequate signs, lack of protection for pedestrians, and inadequate traffic law enforcement. However, the data are not adequate to reveal the true magnitude of the problem. Data collected by different sources are incomplete and not coordinated with other sources and databases. In urban areas, however, better response to crashes, treatment of the injured, reporting and data collection is attributable to a greater concentration of police and medical facilities. Road traffic safety programmes in Mozambique are inadequate and inefficient, starting with the data collection system. Improvement of injury surveillance systems is needed to help make road traffic safety a national development agenda priority and for developing and implementing road safety policies. For road safety programmes to be effective, government must facilitate stakeholders’ involvement, and the clear definition of government activities, civil society activities and public-private partnerships need to be established.     

Parents' perceptions, attitudes and behaviours towards child safety: a study in 14 European countries

Injury is the leading cause of death for children 0- 19 years of age in Europe, accounting for 3.1 deaths per 10 000 children per year. The youngest children of the ages 0-4 years require the most protection in this age group, with 2.5 injury-related deaths per 10 000 children in Europe annually. As parents are the primary caregivers of children, it is necessary to learn more about parents' perceptions, attitudes and behaviours towards child safety. This study presents the findings of a 14-country study in Europe on this theme. A quantitative survey of parents of children aged 5 years or under was performed in 14 EU member states in order to enable better targeting of prevention efforts aimed at educating parents. The total sample size was 2088. The results show that 95% of parents reported that they personally take measures to avoid accidental injury to their children. Their top concern with regard to safety of their children was children being hit by a car. The most common response, when asked why some parents find it difficult to protect their children from accidental injury, was not being able to watch their children constantly. Lack of awareness or knowledge about the causes of accidents was the second response. Two-thirds of parents would like to see more help from the government to prevent childhood injuries. Three-quarters of parents agreed that child injuries can be avoided. It was concluded that parents want to be better informed about the causes of child accidents and about actions they and society can take to reduce injury-related risks to children.     

Traffic death trends in children aged 0-14 years in Lithuania: patterns by age group

The aim of the study was to analyse traffic-injury mortality trends in children aged 0-14 years in Lithuania between 1971 and 2005. The data was derived from Statistics Lithuania. Trends were estimated by the use of cubic regression. In addition, data from 'tail' years was compared, and the t-test was used. The significance level p?≤0.05 was considered statistically significant. In the age groups 1-4 and 5-9 years, traffic injury mortality showed significantly decreasing trends, but in the age group 10-14 years, no significant tendencies have been observed. Traffic deaths as a proportion of injury deaths and as a proportion of all deaths have risen significantly in the age groups 1-4 and 10-14 years. In children aged 5-9 years, for traffic deaths percentage of injury deaths, no significance change was observed, and significant decrease was shown for traffic deaths percentage of all deaths. The study showed that in road safety work, more attention should be given to young adolescents aged 10-14 years and to children aged 1-4 years. A public health approach, effective law enforcements and community involvement are recommended for road safety management.