Fig 1
Data collection sheet. * Age appropriate child restraint. Gender: M = male; F = female. Age group: Y = young; M = middle aged; E = elderly. Y = Yes; N = no.
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Unlabelled:
BACKGROUND; Road traffic injuries are a leading cause of death and may be related to social inequality.
Objective:
To establish whether patterns of seatbelt use vary between different socioeconomic communities in the Cape Town Metropole, South Africa.
Methods:
Vehicles and their occupants at 7 high-volume crossings (3 in high-incom...
Context in source publication
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Objectives
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Methods
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The protection of children in motor vehicle crashes has improved since the introduction of child restraint systems. However, motor vehicle crashes remain one of the top leading causes of death for children. Today, computer-aided engineering is an essential part of vehicle development and it is anticipated that safety assessments will increasingly r...
Citations
... Even in countries with high use rate, correct and appropriate restraint use can still be a problem [15]. Observational data show that children and young adults are less likely to use seatbelts than adults [16]. According to statistics from the Child Accident Prevention Foundation of South Africa, 84% of children in vehicles are not restrained and 80% of children who had been injured in collisions were not restrained [17]. ...
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.
... High-speed traffic is disproportionately found in poorer neighbourhoods, where fewer people own or use cars, thus people from these groups are exposed to more danger and likelihood of being involved in crashes (Cairns et al, 2015). In both LMICs and HICs, higher levels of seatbelt use have been shown to be associated with having higher levels of education and socioeconomic status, with income level being the strongest predictor of mortality and morbidity (Van Hoving et al, 2013). This indicates that if involved in crashes those from lower socio-economic groups are more likely to have adverse consequences (Van Hoving et al, 2013). ...
... In both LMICs and HICs, higher levels of seatbelt use have been shown to be associated with having higher levels of education and socioeconomic status, with income level being the strongest predictor of mortality and morbidity (Van Hoving et al, 2013). This indicates that if involved in crashes those from lower socio-economic groups are more likely to have adverse consequences (Van Hoving et al, 2013). The lower socio-economic groups, who are worse affected by RTIs, also have limited access to emergency health care when crashes occur (Nantulya and Reich, 2003). ...
Background: Road traffic injuries (RTIs) are a major problem worldwide. In this mixedmethods thesis I investigated the trend of RTIs in Namibia, which is one of the worst affected countries globally. I also investigated the long-term impacts of RTIs and the role of a fuel levy fund - The Motor Vehicle Accident Fund (MVAF) - in enhancing the availability of rehabilitation and counselling services to RTI survivors in Namibia. Methods: Using quantitative methods, I conducted analysis of data sets on RTIs from 2012 to 2014. Descriptive analysis was used to characterise crashes, injuries and deaths, and people affected. Further to this, I conducted multinomial logistic regression in order to investigate the likelihood of having been injured or killed. Using qualitative methods, I conducted semi-structured interviews with RTI survivors in Namibia, and healthcare workers involved in caring for them, in order to investigate the long-term impacts of RTIs and the availability of rehabilitation and counselling services to road injury survivors in Namibia and the role played by the MVAF. Results: The quantitative analysis showed over 2012-2014, the rates of injury and death had risen by 3.9% and 1.1%. Logistic regression identified the road user group had the greatest influence on the risk of being injured and killed. The method of transportation to hospital had the greatest influence on the risk of dying among those admitted to hospital. The qualitative analysis showed that RTIs are associated with long-term physical and mental health sequalae, financial hardships, and various social problems. The analysis also showed the MVAF is effectively helping to enhance access to rehabilitation and other health services for RTI survivors. Conclusion: The present study adds to the knowledge of the long-term impact of RTIs and presents new information from Namibia, where no previous studies of this kind have been done.
... For the association of GPP (Gross provincial product) and rate of seat belt usage Van Hoving, et al, [2012] showed the usage of seat belt was proportionally lower in lower-income areas of South Africa despite it already had law legislation (33) . Scuffham, et al, showed GDP was one of the significant factors in explaining the number of crashes. ...
Objective:
The aims of this research were to cross-sectional survey the basic characteristics of the seat belts usage and use rate among drivers and passengers in Thailand. And, study the relationship between seat belt use rate and gross provincial product (GPP), literacy levels, percent under the poverty line and police density, relationships between literacy levels and penalties rate.
Materials and Methods:
A nationwide cross-sectional study was conducted by a collaboration of police department, injury surveillance of the Ministry of Public Health, Thai Road Safety Survey, and National Pediatric Injury and Trauma Registry of Thailand (NPIRT) database from 2010 to 2011.The rates of seat belt usage were recorded. All baseline characteristic variables (regions, provinces, population density, police density, literacy level, under poverty line, and conviction rate) were collected, and compared with interested outcome, seat belt usage rate by univariate analysis, linear regression and multiple regression analysis.
Results:
The average of seat belt usage rate across the country was 37.8 %+15.3 %. The highest rate of usage (mean±SD) were demonstrated in Bangkok (78.9 %), follow by North-east region (46.2 %+12.5 %), Central region (44.0 %+11.9 %), Northern region (28.2 %+9.7 %), and lowest in Southern region (24.2 %+11.1 %), respectively. The univariate regression analyses, GPP (coefficient 0.303;95%CI :0.109-0.497), literacy (coefficient 0.044;95%CI:0.020-0.068), police density (coefficient 0.038;95%CI: 0.0170-0.060) and conviction rate (coefficient 0.008;95%CI:0.003-0.012) showed statistically significances with seat belt usage rate (p-value=0.003, 0.010, <0.001, 0.001, respectively). The level of literacy not significant correlated to decrease of conviction rate (coefficient 0.001;95% CI: -1.15-1.38, p-value=0.86). Multiple regression analyses, results showed the final three significantly correlated factors with usage rate were GPP, level of literacy, and conviction rate (p-value < 0.001, adjusted R-square 0.33). GPP showed a highest impact on seat-belt usage rate. 19.5 % (coefficient 0.195; 95%CI:0.025-0.366, p-value = 0.03). The level of literacy of the population enhance the rate of seat-belt usage approximately 3.9 %(coefficient 0.039; 95 % CI :0.019-0.060, p-value <0.001), and conviction rate can increase seat belt usage rate 0.64 %(coefficient 0.006; 95 % CI 0.003-0.010, p-value< 0.01).
Conclusion:
Only one third of people use a seat belt when they drive in Thailand. The seat belt usage rate has a trend of increasing in urban more than rural area, and the highest rate in the metropolitan’s area. Finally, three significantly factors were GPP, level of literacy, and conviction rate had significant effect with rate seat belt usage. Improving of GPP, Level of Literacy and law penalty will be enhancing of seat belt usage rate and their engagement in immediate and long term.
Keywords:
Seat Belt, Road Traffic Collision, Seat belt Compliance, Seat Belt Law legislation
... For the association of GPP (Gross provincial product) and rate of seat belt usage Van Hoving, et al, [2012] showed the usage of seat belt was proportionally lower in lower-income areas of South Africa despite it already had law legislation (33) . Scuffham, et al, showed GDP was one of the significant factors in explaining the number of crashes. ...
Objective: The aims of this research were to cross-sectional survey the basic characteristics of the seat belts usage and use rate among drivers and passengers in Thailand. And, study the relationship between seat belt use rate and gross provincial product (GPP), literacy levels, percent under the poverty line and police density, relationships between literacy levels and penalties rate. Materials and Methods: A nationwide cross-sectional study was conducted by a collaboration of police department, injury surveillance of the Ministry of Public Health, Thai Road Safety Survey, and National Pediatric Injury and Trauma Registry of Thailand (NPIRT) database from 2010 to 2011.The rates of seat belt usage were recorded. All baseline characteristic variables (regions, provinces, population density, police density, literacy level, under poverty line, and conviction rate) were collected, and compared with interested outcome, seat belt usage rate by univariate analysis, linear regression and multiple regression analysis. Results: The average of seat belt usage rate across the country was 37.8 %+15.3 %. The highest rate of usage (mean+SD) were demonstrated in Bangkok (78.9 %), follow by North-east region (46.2 %+12.5 %), Central region (44.0 %+11.9 %), Northern region (28.2 %+9.7 %), and lowest in Southern region (24.2 %+11.1 %), respectively. The univariate regression analyses, GPP (coefficient 0.303;95%CI:0.109-0.497), literacy (coefficient 0.044;95%CI:0.020-0.068), police density (coefficient 0.038;95%CI: 0.0170-0.060) and conviction rate (coefficient 0.008;95%CI:0.003-0.012) showed statistically significances with seat belt usage rate (p-value= 0.003, 0.010, <0.001, 0.001, respectively). The level of literacy not significant correlated to decrease of conviction rate (coefficient 0.001;95% CI:-1.15-1.38, p-value=0.86). Multiple regression analyses, results showed the final three significantly correlated factors with usage rate were GPP, level of literacy, and conviction rate (p-value < 0.001, adjusted R-square 0.33). GPP showed a highest impact on seat-belt usage rate. 19.5 % (coefficient 0.195; 95%CI:0.025-0.366, p-value = 0.03). The level of literacy of the population enhance the rate of seat-belt usage approximately 3.9 %(coefficient 0.039; 95 % CI:0.019-0.060, p-value <0.001), and conviction rate can increase seat belt usage rate 0.64 %(coefficient 0.006; 95 % CI 0.003-0.010, p-value< 0.01) Conclusion: Only one third of people use a seat belt when they drive in Thailand. The seat belt usage rate has a trend of increasing in urban more than rural area, and the highest rate in the metropolitan’s area. Finally, three significantly factors were GPP, level of literacy, and conviction rate had significant effect with rate seat belt usage. Improving of GPP, Level of Literacy and law penalty will be enhancing of seat belt usage rate and their engagement in immediate and long term.
... 3 Socioeconomic status may also be an important predictor of seatbelt use; South Africa and Nigeria have higher gross domestic product (GDP)than Uganda and Tanzania, and in our study, those from Nigeria and South Africa had higher educational attainment than those from Uganda. 16 17 The prevalence of helmet use was lower than reported in other studies in Uganda and Ghana. 18 19 Motorcycle use is becoming an increasingly important form of mobility in both urban and rural Africa, and given the predicted rise in transport-related injuries, the low prevalence of helmet use is particularly concerning. ...
Introduction
Injury-related morbidity is a neglected health concern in many low-income and middle-income countries. Most injury data in Africa have been collected from hospital-based studies, and few studies have occurred across multiple countries. Using data from a novel cohort, we examined the prevalence and incidence of serious injuries and associated risk factors across five sites in sub-Saharan Africa (SSA).
Methods
A common baseline and follow-up survey was administered to participants. The study population included 1316 persons at baseline and 904 persons at follow-up. Frequencies were calculated, and logistic regression models were used to assess risk factors for injury.
Results
A total of 233 (17.7%) persons reported a serious injury at baseline and 60 (6.6%) reported a serious injury 6 months later at follow-up. Sixty-nine per cent of participants responded to the follow-up questionnaire. At baseline and follow-up, the most common cause of serious injury at urban sites was transport related, followed by poison/overdose. In rural Uganda, sharp instruments injuries were most common, followed by transport-related injuries. Living at an urban site was associated with an increased odds for serious injury compared with those at the rural site (OR: 1.83, 95% CI 1.15 to 2.90). Participants who consumed above a moderate amount of alcohol were at a higher risk of serious injury compared with those who did not consume alcohol (OR: 1.86, 95% CI 1.02 to 3.41). High level of education was an important risk factor for injury.
Conclusion
At baseline and follow-up, common causes of serious injury were transport related, sharp instrument and poison/overdose. Alcohol consumption, urban location and education are important risk factors for injury. It is feasible to collect longitudinal injury data using a standardised questionnaire across multiples sites in SSA. Longitudinal data collection should be leveraged to obtain robust data on risk factors for injury in SSA.
... Data from a survey study of parents and children seeking emergency care found that racial disparities persisted after adjusting for education, income, source of general child passenger safety knowledge (e.g., online) and CRS-specific knowledge (e.g., their child's CRS instruction manual), with parents from minority racial groups reporting lower ageappropriate CRS use than white parents [9]. Our study was conducted in the United States, but racial and ethnic, cultural and socioeconomic disparities in child occupant protection knowledge, beliefs, and behaviors have been noted in other countries as well [26][27][28][29][30]. Qualitatively different models of intervention and outreach may be needed, especially for hard-to-reach and at-risk populations, although the factors that make certain populations hard-to-reach may vary globally. ...
Objectives: Child Restraint System (CRS) misuse is common. We characterized caregivers’ use of child passenger safety informational and instructional resources and determined whether there were differences in the quality of CRS installations associated with prior exposure to specific resources as evaluated in a standardized CRS installation environment. Methods: Caregivers completed self-report surveys and installed a forward-facing CRS in a controlled environment. Installations were evaluated for security (tightness) and accuracy (no errors) by a child passenger safety technician (CPST). Results: CRS manuals were the most common way caregivers learned to install a CRS. Primary care providers (PCP)s were the most frequently endorsed source of CRS safety information. There was no strong pattern of associations between prior exposure to resources and installation quality (security or accuracy), although some evidence supports protective effects of learning from CPSTs; 13% (19 out of 151) installations were secure and 57% (86 out of 151) installations were accurate. Conclusions: A focus on developing effective and lasting behavioral interventions is needed.
... In South Africa, RTIs are a leading cause of injuryrelated deaths, accounting for 27 deaths per 100,000 people compared to the global average of 10 deaths per 100,000 use in South Africa is estimated to be 50%, at best, for front seat occupants, and 8% for rear-seated passengers (2). Seatbelt use is proportionally lower in lower-income areas within South Africa (8). ...
Introduction:
Given the burden of road traffic injuries (RTIs) in South Africa, economic evaluations of prevention interventions are necessary for informing and prioritising public health planning and policy with regard to road safety.
Methods:
In view of the dearth of RTI cost analysis, and in order to understand the extent to which RTI-related costs in South Africa compare with those in other low- and middle-income countries (LMICs), we reviewed published economic evaluations of RTI-related prevention in LMICs.
Results:
Thirteen articles were identified, including cost-of-illness and cost-effectiveness studies. Although RTI-related risk factors in South Africa are well described, costing studies are limited. There is minimal information, most of which is not recent, with nothing at all on societal costs. Cost-effective interventions for RTIs in LMICs include bicycle and motorcycle helmet enforcement, traffic enforcement, and the construction of speed bumps.
Discussion:
Policy recommendations from studies conducted in LMICs suggest a number of cost-effective interventions for consideration in South Africa. They include speed bumps for pedestrian safety, strategically positioned speed cameras, traffic enforcement such as the monitoring of seatbelt use, and breathalyzer interventions. However, interventions introduced in South Africa will need to be based either on South African cost-effectiveness data or on findings adapted from similar middle-income country settings.
... However, lack of compliance on the part of the community is not uncommon, causing increased implications for more severe injury. 12,13 This chapter aims to demonstrate the extensive burden of trauma in We also identify some good practices and hindrances to policy implementation, while noting possible implications for policy reform in terms of cost and human resource requirements. ...
... The major units in KZN have achieved good results in the peer-review process in this regard, with IALCH achieving almost 90% compliance. 12 One of the aims of the National Health Insurance (NHI) White Paper 104 is to provide a mechanism for cross-subsidisation across the entire health system, while meeting acceptable standards of care and achieving positive health outcomes. This aim is similar to that of trauma care and as such is unfortunately a cost driver for curative care in a poorly resourced and poorly structured health system. ...
... This finding is probably explained by the proportionally larger head/thoracic ratio in children and their higher incidence of injury in pedestrian MVCs. Children travelling as passengers also remain a vulnerable group: in a recent study, Van Hoving et al. [16] showed a very low rate of seatbelt use among child passengers in the Cape Town metropole, with compliance as low as 14.4%. ...
Background.
Trauma is a leading cause of death in the developing world. Blunt thoracic trauma represents a major burden of disease in both adults and children. Few studies have investigated the differences between these two patient groups.
Objective.
To compare mechanism of injury, presentation, management and outcome in children and adults with blunt thoracic trauma. Methods. Patients were identified from the database of the trauma intensive care unit at Inkosi Albert Luthuli Central Hospital, Durban, South Africa. Demographics and relevant data were extracted from a pre-existing database.
Results.
Of 415 patients admitted to the unit, 331 (79.7%) were adults and 84 (20.2%) children aged <18 years. The median injury severity score (ISS) was similar for both age groups (32 v. 34; p=0.812). Adults had a higher lactate level at presentation (3.94 v. 2.60 mmol/L; p=0.001). Of the children, 96.4% were injured in motor vehicle collisions, 75.0% as pedestrians. Compared with adults, children had significantly fewer rib fractures (20.2% v. 42.0%; p<0.001), flail chests (2.4% v. 26.3%; p<0.001) and blunt cardiac injuries (BCIs) (9.5% v. 23.6%; p=0.004), but sustained more lung contusions (79.8% v. 65.6%; p=0.013). Mortality in children was significantly lower than in adults (16.7% v. 27.8%; p=0.037).
Conclusion.
Thoracic injuries in children are the result of pedestrian collisions more often than in adults. They suffer fewer rib fractures and BCIs, but more lung contusions. Despite similar ISSs, children have significantly lower mortality than adults. More effort needs to be concentrated on child safety and preventing pedestrian injury.
... In South Africa, lower-income families are more likely to drive older vehicles, many of which may not have rear seatbelts, the installation of which is prohibitive. With such families, the free distribution of age-appropriate child restraints combined with education regarding their use has been reported as beneficial (Van Hoving, Sinclair, & Wallis, 2013). The use of age-appropriate child restraints is however still not compulsory in South African law; in addition, legislation emphasising driver responsibility for passenger restraint use, including those for children, has also been recommended (Van Hoving, Sinclair, & Wallis, 2013). ...
... With such families, the free distribution of age-appropriate child restraints combined with education regarding their use has been reported as beneficial (Van Hoving, Sinclair, & Wallis, 2013). The use of age-appropriate child restraints is however still not compulsory in South African law; in addition, legislation emphasising driver responsibility for passenger restraint use, including those for children, has also been recommended (Van Hoving, Sinclair, & Wallis, 2013). ...
Road traffic crashes are a significant cause of the disease burden among children, with the highest mortality in low- and middle-income countries. This observational study explores such injuries in Cape Town, South Africa through an analysis of data for cases in 1992, 2002 and 2012 at the Red Cross War Memorial Children's Hospital, a referral paediatric hospital for children younger than 13 years. Descriptive and time trend analysis of demographic data as well as of the causes, severity and place of injury was conducted. Logistic regression and generalised linear models described factors influencing hospital admission. In the years 1992, 2002 and 2012, a total of 4690 patients presented with injuries sustained as a result of a road traffic crash. Nearly 50% (n = 2201) of them were between five and nine years of age, with 1.7 males for every female. Three-quarters of those who got injured were pedestrians while the second most commonly injured ones were unrestrained passengers. The majority had minor injuries (58%), but with notably higher proportions with moderate to severe injuries in the years 2002 and 2012. Forty per cent were admitted for inpatient treatment, with the highest proportion (50%) in 2002. Admission was related to mechanism and severity. The epidemiological factors assessed remain largely unchanged over the assessment points calling into question the impact of local safety strategies.
