CORRESPONDENCE

Restraint use for child passengers in South Africa

To the Editor: Motor vehicle accidents are a leading cause of death in children of all ages worldwide, and responsible for 32% of all childhood injury deaths.¹ When used correctly, restraint devices such as seat belts and child restraint systems significantly decrease mortality and serious injuries in children.^2,3 Many studies have been done on the use of seatbelts and car safety seats in America, Asia and Europe; however, none exist for African countries.

Red Cross War Memorial Children's Hospital, Cape Town, annually treats close to 300 children who were involved in motor vehicle accidents as passengers, of whom 87% were not restrained adequately within the vehicle. In order to correlate the rate of unrestrained children who presented after accidents with the general rate of restraints in children, Childsafe South Africa⁴ conducted an observational study at the main gate of Red Cross Hospital. We observed the use of restraints in all adult drivers, passengers and children passing through the main gate of the hospital from 26 to 30 March 2008.

A total of 1 269 cars entered the premises, with 2 080 people travelling in them; 313 were children. Those restrained were: drivers 50%, front adult passengers 30%, and adults travelling in the rear 10%. A total of 89% of the children observed entering the hospital were unrestrained in the vehicle. Of these 25% were sharing a seat with an adult. Only 8% of the children observed were sitting in a car seat and only 3% were adequately restrained.

As in the rest of the world, trauma related to motor vehicle crashes is a leading cause of childhood injuries and deaths in South Africa.

Our study demonstrates that a large majority of the children observed were not adequately restrained within the vehicles. It shows an alarming trend in restraint use in South Africa and demonstrates the need for promotion of and education in appropriate restraint use for children.

It is now almost 3 decades ago that paediatric trauma was identified as the number one killer of children globally.⁵ Since the efficacy of child restraint systems in preventing serious injuries and deaths in motor vehicle crashes is well established, we urge the medical fraternity to actively promote child safety restraints. It will definitely save many children's lives.

Julie Kling
Thomas Nicholls
Pumla Ntambeka
A B (Sebastian) van As

Childsafe South Africa
Red Cross War Memorial Children's Hospital, and
Department of Paediatric Surgery
University of Cape Town
Sebastian.vanas@uct.ac.za

1. Van As AB, Stein DJ. Child safety: a neglected priority. World J Pediatr 2010;6(4):293-295.         [ Links ]

2. Arbogast KB, Durbin DR, Cornej RA, Kallan MJ, Winston FK. An evaluation of the effectiveness of forward facing child restraint systems. Accid Anal Prev 2004;36(4):585-589.         [ Links ]

3. Zaza S, Sleet DA, Thompson RS, et al. Reviews of evidence regarding interventions to increase use of child safety seats. Am J Prev Med 2001;21:31-47.         [ Links ]

4. http://www.childsafe.org.za (accessed 5 January 2011).         [ Links ]

5. Haller JA. Pediatric trauma: the No. 1 killer of children. JAMA 1983;249:47.         [ Links ]