P2B167: A Comparative Analysis of Global Child Restraint Use in Nine Cities

Background: Over 90% of road traffic deaths occur in low- and middle-income countries (LMICs). Such deaths are the leading cause of mortality in children over five. Although the most vulnerable children are pedestrians, cyclists, and motorcycle passengers, child passenger safety in vehicles is a growing problem as LMICs urbanize and increase vehicle use. Infants and children should be restrained in a rear seat using specific child restraints, which reduce the risk of death by 60%. Unfortunately, child restraint use is extremely low in LMICs, with rates below 10% in some Latin American countries. Moreover, the WHO has no child restraint use data in major regions including Africa, Eastern Mediterranean, and South-East Asia. Using data from the Bloomberg Philanthropies Initiative for Global Road Safety, the purpose of this project was to examine child restraint use in nine global cities.

Methods: Eight rounds of roadside observational data were collected from February 2015 to March 2019. The nine cities included in the analysis were Accra, Addis Ababa, Bandung, Bangkok, Bogota, Fortaleza, Ho Chi Minh City, Mumbai, and Sao Paulo. Examiners observed the child’s age, whether they were in a child restraint, their seat position, vehicle type, day of the week, and road type.

Results: In total, the dataset contained 43,619 child passenger restraint observations. Of this, 13,727 were children under five and 29,892 were children between five and eleven. After accounting for missing data, the overall prevalence of child restraint use was 16.23% for children under five and 3.24% for children over five. Sao Paulo had the highest prevalence of child restraint use under five (53.54%), while Bandung had the lowest (2.23%). Four cities had prevalence rates below 10%. For children aged five to eleven, Bangkok (16.90%) and Sao Paulo (16.56%) had the highest prevalence of child restraint use. All other cities were below 10% for this age category (Table 1). For all ages, there was a higher prevalence of restraint use in sedans and SUVs compared to other vehicles, and a lower prevalence of restraint use on Fridays and on local roads compared to arterial roads. 15.65% of children under five and 27.84% of children over five were in the vehicle’s front seat.

Conclusion: The prevalence of correct utilization of child passenger restraints is concerningly low and shows large variation globally. There may be misperceptions about restraints, they may not be readily available, and older vehicles in LMICs may not have seatbelts to secure the restraints in rear seats. Further analysis of this dataset will explore factors associated with child restraint use and changes in restraint use over time. The goal of this project is to highlight this significant global problem in child road safety to advocate for enhanced vehicle standards and policy strengthening.