Don׳t learn safety by accident: A survey of child safety restraint usage among drivers in Dansoman, Accra

Highlights

• The study revealed low child restraints use among drivers in Dansoman, Accra.

• Children in new vehicles are more likely to be restrained.

• Children seated in the back seat are more likely to be unrestrained.

• Children are more likely to be unrestrained where there are other occupants.

Abstract

Objective

The study surveyed child safety restraints use among drivers transporting children to school in Dansoman, Accra.

Method

Employing a naturalistic observational method, the following were observed: sex of the driver, vehicle model, child characteristics, child location in the vehicle, whether child was restrained and how they were restrained, whether the driver was belted and the presence of other vehicle occupants. In total 126 vehicles were observed.

Results

The study revealed low child restraints use among the observed drivers; children in new vehicles were more likely to be restrained; children seated in the back seat were more likely to be unrestrained; and child occupants were more likely to be unrestrained where there were other vehicle occupants.

Conclusion

The study maintained that a collaborated effort by road safety stakeholders in terms of education/awareness creation and subsequent strict enforcement of child restraints use laws were required.

Introduction

An estimated 30 million people have been killed in road crashes since the invention of the motor vehicle over a century ago. From the statistics, it is evident that road crashes are associated with 1.3 million deaths annually (i.e. one death every 30 s resulting in about 3000 deaths per day). Additionally these crashes result in an estimated 50 million injuries per year. Ironically, with about 40% of the world׳s motor vehicles, developing countries seem to be the major problem as they contribute to about 90% of these casualties. It has been projected that by 2020, annual deaths resulting from road crashes would increase to 1.9 million if no effective countermeasures are implemented. Based on this projection fatalities are expected to increase by more than 80% in developing countries, but decrease by close to 30% in developed countries (Rizavi, 2011).

“Children are especially susceptible to road traffic injury, and morbidity and mortality rates throughout the world reflect this vulnerability” [2, p. 301]. One-fifth of all road traffic deaths are among children. Each year an estimated 262,000 of the world׳s children are killed aside the 10 million others who are injured in these crashes (Peden et al., 2008). Globally, traffic injuries are among the top three causes of death for children older than age 5 years. For those aged 1–4 years, traffic injuries are among the top ten causes of death and it is projected that by 2015, traffic injuries would be the number one cause of death and disability for all children older than 4 years old (World Health Organization, 2009, Toroyan and Peden, 2007, Mathers and Loncar, 2005).

Accidents involving children cause significant harm and damage physically, emotionally and psychologically and often result in serious but unnecessary damage. Children possess a number of unique developmental characteristics that contribute to their vulnerability to traffic injuries (Toroyan and Peden, 2007). A possible reason could be the fact that children have “small and still developing” bodies which are less resistant to crash forces. “Furthermore, their disproportionately large head size leads to greater number of head injuries given their higher center of gravity” (Will, 2011, p. 301). Toroyan and Peden (2007) have revealed that children׳s traffic-related injuries tend most commonly to be head and limb injuries, which often than not result in death or long-term disability. Children in developing countries for instance face a huge risk of deaths or injuries on the road due to poor implementation of road safety measures and underutilization of safety devices such as child restraints (Will, 2011).

Like other developing countries, Ghana is witnessing steady increases in vehicle ownership and use. Associated with this increase in vehicle ownership and use are road safety implications. An estimated 1.5 million vehicles currently run the streets of the country with close to 60% of these vehicles in the capital city of Accra alone (United Nations Environment Programme, 2013). Statistics from the National Road Safety Commission (NRSC) indicate that in the year 2010 alone, 6.8% (136 out of 1986) of persons killed as well as 2.6% (389 out of 14918) of those injured nationwide were in the age bracket of 0–5 years. Moreover, in the same year, 10.9% (217 out of 1986) of those killed and 6.4% (962 out of 14918) of those injured were between the ages of 6–15 years. These figures represent an increase over the previous years׳ (National Road Safety Commission (NRSC), 2010). Currently it is reported that 23% of all crashes in the country involve children below 16 years of age (Modern Ghana, 2013). Although the statistics did not indicate data on child safety restraints use or non-use, presumably many of these children passengers were not safely restrained in their respective vehicles at the time of these crashes. For the purposes of this study, child safety restraints as broadly used refers to the rear- and forward-facing car seats and booster seats used in restraining children in vehicles.

Arising from the necessity to protect children passengers, the study sought to survey child safety restraint usage among private vehicle drivers transporting/dropping children at some selected schools in Dansoman, a suburb of Accra. On the basis of previous research findings from the literature (e.g. Monteiro et al., 2013, Pan et al., 2012, Greenspan et al., 2010, Lee et al., 2008, Snowdon et al., 2008) and the need to ascertain how these findings manifest in this area, the following hypotheses were posited: (1) There would be low rate of child safety restraint use among drivers in Dansoman community; (2) Children in new or partly new vehicles would more likely be restrained than children in older vehicle models; (3) Children seated in the back seat would more likely be unrestrained than those at the front seat; (4) Male drivers would more likely have unrestrained child occupants and (5) Child occupants would more likely be unrestrained where there are other adult occupants (aside the driver) on board. The study intends to either confirm or refute the previous reported findings in the light of the study findings.

There is no doubt that properly restraining children (i.e. securely fastening them in child safety seats or other devices meant to protect and ensure their safety and that are appropriate for their weight and age) is an easy way to prevent road traffic deaths and serious injuries (Safe Kids, 2013). There are age- and weight-dependent child restraints designed to help restrain children safely in vehicles. Child safety restraints designed for use in vehicles are to either bear crash forces or distribute the crash forces over the strongest parts of a child׳s body in the event of a crash (National Highway Traffic Safety Administration, 2007). The use of the restraint is to reduce injury to the child passenger in a collision. It is been reported that failure to wear a safety restraint increases a child׳s odd of injury or death in a crash by 45–74%, depending on the type of restraint and seating position (National Highway Traffic Safety Administration, 2010).

Arbogast et al. (2009) for instance have argued that “properly fitted safety restraints prevent injury by keeping occupants in the vehicle, contacting the strongest parts of the body, spreading forces over a wide area of the body, helping the body slow down, and protecting the brain and spinal cord. Chief among these is the prevention of ejection from the vehicle because an occupant is four times more likely to be killed if thrown from the vehicle during a crash. Proper fit of a safety restraint is essential for maximum protection. It has been established that the primary reasons for injuries to children who are restrained at the time of motor vehicle crashes relate to premature graduation from child safety seats to booster seats, premature graduation from booster seats to adult safety belts, prematurely turning a child forward, misuse of safety restraints and children seated in the front seat of the vehicle” (Arbogast et al, 2009, p. 1284).

The effectiveness of these restraints depends on appropriate and correct use. Will (2011) observed that use of child safety restraints is only one aspect of child passenger safety; the other aspect of importance is seat positioning. According to him children are safest sitting in the back seat of the car, as opposed to the front seat. Buttressing the need for child safety restraint, Rice and Anderson (2009) claim that when correctly installed and used, child safety seats reduce the risk of fatal injury by as much as 74% for infants and 59% for toddlers. Other writers have observed that compared to appropriately restrained children, unrestrained children are greater than three times more likely to sustain injury in a crash (Durbin et al., 2005, O’Neil et al., 2009).

A number of factors seem to correlate with use and non-use of appropriate child restraints. For example socio-economic characteristics of countries have been linked to child restraint use in the literature. For instance Olufunlayo et al. (2012) found a significant correlation between child restraints use among drivers in developed countries compared with those in developing countries. The study reported among other things that child safety restraints were regarded as luxury in developing countries and this seem to culminate in the low and incorrect use as well as lack of knowledge about the device.

Other studies (Lee et al., 2003, McIlvenny et al., 2004) have reported lack of awareness about the importance of child safety restraint as another factor associated with child restraints use. In situations such as this it is commonplace to see children standing, playing or jumping around in the back seat or at best sitting on the laps of adult occupants.

Moreover, Monteiro et al. (2013) identified other factors (dispositional and contextual) which they claim to correlate with child safety restraint use. According to them the dispositional factors are peculiar characteristics of the drivers such as age, education, gender whereas the contextual/situational variables may be the type of car, location of the car, and time of the day. Snowdon et al. (2008) in a study revealed that correct use of car seats has been associated with female gender, higher level of education and individuals who reported having difficulty in obtaining information about the correct use of child safety seats. Confirming earlier studies, Pan et al. (2012) observed that in China the more educated the mother was the more likely her child would be seated appropriately in the vehicle. Other studies have revealed that appropriate child restraint use is decreased among older children; where there are other vehicle occupants; in older vehicles, pickup trucks or large vans; as well as with unbelted and young drivers (Greenspan et al., 2010, Lee et al., 2008).