Prevalence and issues in non-use of safety belts and child restraints in a high-income developing country: lessons for the future

Child maltreatment and protection in the Arab Gulf Cooperation Council countries: A scoping review

BACKGROUND

Research on child maltreatment and protection in the Arab Gulf Cooperation Council countries-Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates (UAE)-is limited but growing, as is child protection as a sector.

OBJECTIVES

We aimed to identify themes and gaps in existing research on child maltreatment and protection, identify opportunities for building capacity in research and practice.

PARTICIPANTS AND SETTING

N/A.

METHODS

We conducted a scoping review of empirical studies published in peer-reviewed journals in English and Arabic and reported methods and findings according to the PRISMA-ScR reporting protocol. Articles were coded by country, topic of research, and type of abuse studied, if any.

RESULTS

Our database search returned 6109 articles and 160 articles were included in our review. Themes included (1) prevalence, incidence, and characteristics of maltreatment, (2) outcomes associated with maltreatment, (3) attitudes, awareness, and reporting, (4) accidental injury and death potentially associated with neglect, (5) policy and practice. Eighty-seven articles studied Saudi Arabia, while 28 studied the UAE, 21 Kuwait, 13 Qatar, 12 Oman, and 11 Bahrain. Physical abuse was studied in 77 articles, followed by sexual abuse in 54 articles and emotional abuse in 54.

CONCLUSION

Although the medical community produces an encouraging volume of child maltreatment research, gaps remain. Intervention research is lacking, and further inquiry into family dynamics, culture, and spirituality could inform the development of effective interventions. Cross-sectoral collaboration among education, social work, law enforcement, and healthcare is also needed to safeguard children's rights in the GCC.

Restraint Use for Child Occupants in Dubai, United Arab Emirates

The overall objective of the current study was to investigate the behaviours and knowledge of parents/carers in relation to safe child occupant travel in the Emirate of Dubai in the United Arab Emirates (UAE). A community survey was completed by 786 participants who were responsible for the safety of 1614 children (aged 10 years and younger). The survey included questions related to the type, frequency and appropriateness of restraint use for their eldest child. Overall, 24 percent of participants reported that they ‘never/almost never’ restrained their eldest child while travelling in a motor vehicle, with this proportion increasing with child age. For example, though 89 percent of participants reported that they restrained their infants (<1 year) in an ‘appropriate’ restraint for their age, this rate was much lower for children aged between 5 and 7 years (10%). Overall, these findings suggest that a large proportion of child occupants, especially those aged five years and older, are not appropriately restrained in vehicles, and therefore are at an increased risk of death or serious injury in the event of a crash. Future research will validate this self-reported child restraint use data with objective data from observations of real-world child restraint use behaviour in the UAE.

Prevalence of and factors associated with self-reported noncompliance with mandatory seatbelt-use law while driving among adults in Kuwait

Objectives

This cross-sectional study assessed the prevalence of self-reported noncompliance with mandatory seatbelt-use law and examined the factors associated with noncompliance with seatbelt-use while driving in adult working population in Kuwait.

Methods

During October 2017, 822 adults aged 21–60 years from 11 government ministries and departments were enrolled in this study. Data were collected using a pre-tested, structured, and self-administered questionnaire. We computed the prevalence of self-reported noncompliance with mandatory seatbelt-use law while driving and evaluated the factors associated with noncompliance with seatbelt-use law while driving using a multivariable log-binomial regression model. The adjusted prevalence ratios (PR) and corresponding 95% confidence intervals (CI) were computed using model’s parameters’ estimates.

Results

Of 822 participants, 64.4% were females, 56.6% were 21 to 30 years old, 86.5% were Kuwaitis, and 70.3% had college and/or university level education. The prevalence of self-reported noncompliance with mandatory seatbelt-use law while driving was 55.5%, whereas the prevalence of noncompliance with self-reported mandatory use seatbelt as a passenger was 80.9%. Multivariable log-binomial regression model showed that after adjusting for the influence of other variables in the model, participants were more likely to be noncompliers with mandatory seatbelt law while driving, if they believed that seatbelt does not protect against injuries during road traffic crashes (RTC) (adjusted PR = 1.20; 95% CI: 1.06–1.37; p = 0.004) or if they were ever fined for not wearing seatbelt (adjusted PR = 1.34; 95% CI: 1.24–1.47; p <  0.001). Furthermore, participants were significantly more likely to be noncompliers with mandatory seatbelt law while driving, if they were unaware of implemented mandatory seatbelt law in Kuwait (adjusted PR = 1.11; 95% CI: 1.04–1.19; p = 0.003).

Conclusions

The prevalence of noncompliance with mandatory seatbelt-use law in the adult working population of Kuwait is considerably high. Being unaware of mandatory seatbelt use law, belief that seatbelt does not protect during RTC, and having ever been fined in the past for not having seatbelt on while driving were significant predictors of noncompliance with seatbelt-use law. These results warrant the focused mass education and rigorous enforcement of seatbelt-use law while driving. These strategies are likely to enhance the adherence to seatbelt-use law and minimize RTCs related injuries and mortality among adult drivers in this and other similar settings in the region. If implemented, future studies may look at the impact of such interventions on RTCs related frequency and severity of injuries in this and other similar settings.

A bivariate probit analysis of child passenger's sitting behaviour and restraint use in motor vehicle

Motor vehicle injuries are a leading cause of death among children worldwide, though many of these deaths are preventable. Buckling young children in age- and size-appropriate car seats, booster seats, or seat belts and also seating them in appropriate position can lead to a significant reduction of serious and fatal injuries. This study investigated sitting behaviour and restraint use among child passengers through cross-sectional observational surveys conducted in Kumasi, Ghana. A bivariate probit model was developed for simultaneous determination of the contributing factors influencing child passenger's sitting behaviour and restraint use. The results showed that 26% of the child passengers observed were occupying the front seat and the prevalence rate of restraint use was 4.5%. The developed bivariate probit model clearly highlights the existence of interrelationship between child passenger's sitting position and restraint use. The key factors simultaneously influencing child passenger's sitting position and restraint use include vehicle type, driver's gender, driver's belt use, child's age, and the presence of other child or adult passenger. Furthermore, time of day and day of week also influence child passenger sitting behaviour but not their restraint use. These findings provide insight for better understanding of child transporting practices and the contributing factors influencing their sitting behaviour and restraint use. The findings also highlight the need for policy makers to design effective countermeasures to promote rear sitting and restraint use among child passengers.

The prevalence of seatbelt and mobile phone use among drivers in Riyadh, Saudi Arabia: An observational study

INTRODUCTION

Road traffic injuries (RTIs) are the third leading cause of death in Saudi Arabia. Numerous factors may increase the likelihood of RTIs. The prevalence of risk factors associated with RTIs may vary due to several reasons. Because little is known about these risk factors locally, we examined the prevalence of mobile phone and seatbelt use and their association with spatial locations.

METHODS

This is an observational study conducted at major highways and inner intersections throughout Riyadh, the country's capital. Two observers captured seatbelt and mobile phone use among drivers. Logistic regression models were constructed to examine the association between real estate prices and mobile phone or seatbelt use. Observations were categorized as taken place in an affluent neighborhood if the average price per square meter was above 2500 Saudi Riyal.

RESULTS

A total of 1700 drivers were observed in 13 sites citywide. 13.8% of drivers were seen using mobile while driving and only a third of drivers (34%) were wearing seatbelts. Being at an affluent neighborhood was associated with close to three times higher odds of wearing seatbelts (OR = 2.7, 95% CI = 1.9-3.7) and also associated with 42% lower odds of mobile phone use among drivers (OR = 0.58, 95% CI = 0.36-0.92).

DISCUSSION

This study found a high prevalence of traffic violations among drivers in Riyadh. Based on our estimate, 660,000 drivers are roaming the street during daytime while using their phones and they are less likely to wear seatbelts. Unfortunately, this estimate might contribute to increasing RTIs. Despite existing regulations, seatbelt use among drivers is significantly lower than in developed countries (i.e. USA 94%).

CONCLUSION

Our study found a high prevalence of traffic violations represented by lack of compliance with seatbelt and mobile phone use laws. These findings provide a basis for their underlying prevalence in SA. Practical applications: Public health prevention programs may use these findings to facilitate support to increasing investment in awareness campaigns and further enforcement by the traffic police to reduce RITs and improve population health.

Youth traffic-related injuries: a prospective study

Background

Traffic-related injuries are the most common cause of morbidity and mortality of the youth. Our aim was to study epidemiology, risk factors and outcome of hospitalized youth patients injured in road traffic collisions in order to give recommendations for prevention.

Methods

We prospectively studied all youth (15–24 years) patients having traffic-related injuries who were admitted to Al Ain or Tawam Hospitals, Al Ain City, or who died after arrival to these hospitals during an 18 months period. Demography, location and time of injury, injured body regions, severity, hospital and intensive care unit (ICU) stay and outcome were analyzed.

Results

Three hundred thirty-three patients having a mean age (SD) of 20 years (2.5) were studied. 87% were males and 72% were UAE nationals. Majority of injured patients were drivers or front-seat passengers (70%), followed by back seat passengers (16%), motorcyclists (5%) and pedestrians (4%). Rollover was the most common crash mechanism (35%), followed by front crash (34%). Twenty seven patients (8%) were ejected during the crash, 14 during roll-over, 7 from quadribikes and three during front crash. 20% of the patients were admitted to the ICU. Median Glasgow Coma Scale was 15 (range 3–15), median Injury Severity Score was 5 (range 1–41), and median total hospital stay was 3 days (range 1–73). Nine (3%) patients died.

Conclusions

Young UAE-national males are at a higher risk of being injured at traffic. Rollover crash was frequent with high risk of ejection. Promotion of traffic safety and enforcement of safety legislation is necessary.

Seat belt and mobile phone use among vehicle drivers in the city of Doha, Qatar: an observational study

BACKGROUND

In Qatar traffic injuries and fatalities are of serious concern. Mobile phone use whilst driving has been associated with increased risk of vehicular collisions and injuries. Seat belt use has been demonstrated to save lives and reduce the severity of road traffic injuries. Whereas previously published studies may have looked at all front passengers, this study aims to obtain reliable estimates of the prevalence of seat belt and mobile phone use among vehicle drivers in the city of Doha, Qatar. Additionally, we aim to investigate the association of these behaviors with other variables namely gender, time of the day and type of vehicle.

METHODS

An observational study on 2,011 vehicles was conducted in 2013. Data were collected at ten sites within Doha city over a two-week period. Two trained observers surveyed each car and recorded observations on a data collection form adapted from a form used in a 2012 Oklahoma observational study. Associations were assessed using the Chi-squared test or Fisher's exact test. A p-value of .05 or less was considered statistically significant.

RESULTS

Overall, 1,463 (72.7 %) drivers were found using a seat belt (95 % CI: 70.8-74.7 %) and 150 (7.5 %) their mobile phones (95 % CI: 6.3-8.6 %) during the observation period. Mobile phone use was significantly associated with not using a seat belt and driving a sport utility vehicle. Significantly lower rates of seat belt use were observed in the early morning and late afternoon. No gender differences were observed.

DISCUSSION

Seatbelt use in Doha was found to be similar to countries in the region but lower than those in western countries. Also, studies from other high-income locations, reported lower rates of mobile phone use while driving than in Doha.

CONCLUSIONS

Despite road traffic crashes being one of the leading causes of death in Qatar, three out of 10 drivers in Doha, Qatar, do not use a seat belt and about one in 12 use a mobile phone while driving. More efforts, in the form of awareness campaigns and increased law enforcement, are needed to improve compliance with laws requiring seat belt use and prohibiting mobile phone use while driving.

Arab Adolescents: Health, Gender, and Social Context

This article reviews the evidence about adolescent health in the Arab world, against the background of social, economic, and political change in the region, and with a particular focus on gender. For the literature review, searches were conducted for relevant articles, and data were drawn from national population- and school-based surveys and from the Global Burden of Disease project. In some parts of the Arab world, adolescents experience a greater burden of ill health due to overweight/obesity, transport injuries, cardiovascular and metabolic conditions, and mental health disorders than those in other regions of the world. Poor diets, insufficient physical activity, tobacco use, road traffic injuries, and exposure to violence are major risk factors. Young men have higher risks of unsafe driving and tobacco use and young women have greater ill-health due to depression. Several features of the social context that affect adolescent health are discussed, including changing life trajectories and gender roles, the mismatch between education and job opportunities, and armed conflict and interpersonal violence. Policy makers need to address risk factors behind noncommunicable disease among adolescents in the Arab region, including tobacco use, unhealthy diets, sedentary lifestyles, unsafe driving, and exposure to violence. More broadly, adolescents need economic opportunity, safe communities, and a chance to have a voice in their future.

Epidemiology of spinal injuries in the United Arab Emirates

Aim

To assess the risk factors, mechanism of injury, and clinical outcome of hospitalized patients with spinal injuries in order to recommend preventive measures.

Methods

Patients with spinal injuries admitted to Al Ain Hospital, United Arab Emirates (UAE) for more than 24 h or who died after arrival to the hospital were studied over 3 years. Demography, location and time of injury, affected body regions, hospital and ICU stay, and outcome were analyzed.

Results

239 patients were studied, 90 % were males, and 84 % were in the productive years of 25–54. Majority were from the Indian subcontinent (56 %). Road was the most common location for spinal injury (47 %), followed by work (39 %). The most common mechanism of injury was traffic collisions (48 %) followed by fall from height (39 %) and fall from the same level (9 %). UAE nationals were often injured at road and home compared with non-UAE nationals, who were more injured at work (p < 0.0001). Patients falling from the same level were older (p = 0.001) and predominantly females (p < 0.0001) when compared with other mechanisms. Spinal fractures were more common in the lumbar region (57 %). Eleven patients (5 %) sustained paraplegia and five (4 %) patients died.

Interpretation

Traffic injuries and falls were the leading causes for spinal injuries in the UAE. Expatriate males are at high risk for fall from height, UAE national males for traffic injuries and females for falls at the same level at homes. Prevention should focus on traffic and home injuries for UAE nationals and occupational safety for expatriate workers.

Vehicle occupant restraint systems impact on eye injuries: a review

Vehicle occupant trauma to the eyes and associated facial structures has evolved rapidly in conjunction with safety-oriented vehicle design, including restraint systems. Trends vary worldwide with culture, personal factors, vehicle safety equipment, and the traffic environment-including physical, legislative, and enforcement. Wearing safety belts is essential to occupant protection. Airbags were designed as a supplement to protect the head from hard surfaces in frontal crashes, not as a primary countermeasure. Even where vehicle fleets are new with high airbag prevalence, but safety culture and knowledge of restraints is less than robust, injury attributable to not wearing seatbelts is frequent, especially in countries where high-powered vehicles are prevalent. Upper bodies of rapidly forward-moving unrestrained occupants collide with rearward-accelerating airbags. Airbag deployment produces injuries such as corneal abrasions, alkali burns, and the effects of globe compression.

Seat-belt use still low in Kuwait: self-reported driving behaviours among adult drivers

Kuwait mandated seat-belt use by drivers in 1976 and by front seat passengers in 1994. The study objectives were to identify and estimate current factors associated with seat-belt use and levels of potentially unsafe driving behaviours in Kuwait. In 2010, 741 adults were surveyed regarding driving habits and history. Only 41.6% of drivers reported always using a seat belt. Front seat passenger belt use was more common (30.5%) than rear seat belt use (6.5%). Distracted driving behaviours were common, including mobile phone use ('always' or 'almost always': 51.1%) and texting/SMS (32.4%). Logistic regression indicated that drivers who were young (18-19 years), male, Kuwaiti nationals or non-Kuwaiti Arabs, drove over the speed limit, had traffic violation tickets or >1 car crashes in the last year, were less likely to use seat belts. Targeted initiatives to increase public awareness and to enforce car-safety legislation, including use of seat belts, are necessary to decrease the health burden of car crashes in Kuwait.

Pediatric and youth traffic-collision injuries in Al Ain, United Arab Emirates: a prospective study

Aim

To study the mechanism of road traffic collisions (RTC), use of safety devices, and outcome of hospitalized pediatric and youth RTC injured patients so as to give recommendations regarding prevention of pediatric RTC injuries.

Methods

All RTC injured children and youth (0–19-year-olds) who were admitted to Al Ain City’s two major trauma centers or who died after arrival to these centers were prospectively studied from April 2006 to October 2007. Demography of patients, road-user and vehicle types, crash mechanism, usage of safety devices, injured body regions, injury severity, Revised Trauma Score, Glasgow Coma Scale, intensive care unit admissions, hospital stay and mortality were analyzed.

Results

245 patients were studied, 69% were vehicle occupants, 15% pedestrians, 9% motorcyclists and 5% bicyclists. 79% were males and 67% UAE citizens. The most common mechanism of RTC was rollover of vehicle (37%) followed by front impact collision (32%). 32 (13%) of vehicle occupants were ejected from car. 63% of ejected occupants and 70% of motorcyclists sustained head injuries. Only 2% (3/170) vehicle passengers used seatbelts and 13% (3/23) motorcyclists a helmet.

Conclusions

Male drivers and UAE nationals were at high risk of RTC as drivers and as motorcyclists. Ejection rate was high because safety restraint use was extremely low in our community. More education and law enforcement focusing especially on car/booster seat use is needed.

Child and youth traffic-related injuries: use of a trauma registry to identify priorities for prevention in the United Arab Emirates

OBJECTIVE

Traffic-related injuries are the main cause of death during childhood and youth in the United Arab Emirates (UAE), use of safety restraints by citizens is uncommon, rollovers are frequent, and current legislation does not protect rear-seat occupants. Because little was known about the circumstances of hospitalizations for traffic injuries to guide prevention, a trauma registry was used to assess causes and determinants for traffic-related injuries during childhood and youth (<19 years) and its value for prevention.

METHODS

One hundred ninety-three children and youth with traffic injuries were admitted for more than 24 h at surgical wards of the main trauma hospital in the Al-Ain region during a 36-month period (2003-2006). Injuries were analyzed by age, nationality, road user and vehicle types, severity, anatomical region, and the presence of head injury using Injury Severity Scores (ISS) and the Abbreviated Injury Scale (AIS).

RESULTS

Traffic injuries represented 40 percent (n = 193) of injuries to 0- to 19-year-olds, followed by falls (39 percent). Among 15- to 19-year-olds, who accounted for 46 percent of child and youth victims, the incidence was 150/100,000 person years, compared to an incidence of 15 to 51 for younger age groups. Overall, 53 percent were vehicle occupants, 23 percent were pedestrians, 14 percent were bicyclists, 6 percent were motorcyclists, with 4 percent other. The ratio of male-to-female victims was 6.7:1; for drivers it was 33:0; and for pedestrians, bicyclists, and motorcyclists it was between 10:1 and 12:1; injured females were mainly rear-seat passengers and the male: female ratio was 1.4:1. Seventy-one percent of pedestrians were ≤9 years old. Although the ratio of UAE children to foreign children was estimated at 0.7:1 in the community, 58 percent of the injured were UAE citizens. The ratio of injured UAE: non-UAE citizens was 1.4:1 overall but 5.6:1 for drivers and 4.5:1 for motorcyclists. Forty-one percent of citizens were injured in 4-wheel drive sport utility vehicles compared to 13 percent of non-citizens. Head injuries occurred in 68 percent of vehicle occupants and 51 percent of nonoccupants, with AIS ≥ 3 injuries in 23 percent of occupants and 26 percent of nonoccupants. Sixty-seven percent of rear occupants had head injuries.

CONCLUSIONS

Male drivers and vulnerable road users were at an unusually high risk relative to females. A relatively high frequency of traffic-related head injuries among UAE children and youth, including rear-seat passengers and other vehicle occupants, suggests that considerable preventable morbidity is associated with nonuse of safety restraints and/or other factors such as excess speed and rollovers of 4-wheel drive vehicles. Trauma registries can be useful for prevention; inclusion of data on safety restraints and helmet use by road user type is essential.

The legal framework and initiatives for promoting safety in the United Arab Emirates

Injury is a leading cause of morbidity and mortality in the United Arab Emirates (UAE). The UAE is a rapidly developing country with fast economic growth, demographical and environmental changes that are associated with new hazards emerging at a similar pace. The UAE as a federal entity has federal and local systems responsible for safety policy, regulations and enforcement. To set priorities for safety promotion and injury prevention, it is necessary to have data on the most frequent external causes of injury and the main individual, equipment and environmental risk factors that contribute to injury. However good quality data for injury prevention are scarce. The aim of this paper is to describe the scale of injury as a public health problem in the UAE, and the development of safety policies, regulations and promotion efforts with special emphasis on traffic, occupational and child safety.

Pediatric trauma research in the Gulf Cooperation Council countries

BACKGROUND/OBJECTIVE

To review published pediatric trauma research from the Gulf Cooperation Council (GCC) countries so as to identify research fields that need to be enhanced.

METHODS

A MEDLINE search for articles on pediatric trauma from GCC countries during the period 1960 to 2010 was performed. The content of articles was analyzed, classified and summarized.

RESULTS

Fifty-three articles were found and retrieved of which 18 (34%) were published in the last 5 years, 42 (79.2%) were original articles. The first author was affiliated to a university in 29 reports (54.7%), to a community hospital in 13 (24.5%) and to a military hospital in 10 (18.9%). All articles were observational studies that included 18 (34%) case-control studies, 18 (34%) case reports/case series studies, 8 (15.1%) prospective studies, and 7 (13.2%) cross sectional studies. The median (range) impact factor of the journals was 1.3 (0.5-3.72). No meta-analysis studies were found.

CONCLUSION

A strategic plan is required to support pediatric trauma research in GCC countries so as to address unmet needs. Areas of deficiency include pre-hospital care, post-traumatic psychological effects and post-traumatic rehabilitation, interventional studies focused on a safe child environment and attitude changes, and the socioeconomic impact of pediatric trauma.

Effects of seat belt usage on injury pattern and outcome of vehicle occupants after road traffic collisions: prospective study

BACKGROUND

Injury and death from road traffic collisions (RTCs) is a major health problem worldwide. The seat belt is the most important RTC safety innovation to reduce injury severity and death from RTCs. We aimed to study the effects of seat belt usage on injury patterns and outcomes of restrained vehicle occupants compared with unrestrained occupants after RTCs.

METHODS

RTC trauma patients who were vehicle occupants and admitted to Al-Ain and Tawam Hospitals, or who died after arrival at the emergency departments were prospectively studied during the period of April 2006 to October 2007. Demography of patients, position in the vehicle, usage of seat belts, injury severity markers, Glasgow Coma Scale (GCS), hospital stay, need for surgery, injured body regions, and mortality were analyzed.

RESULTS

Of 783 vehicle occupants, 766 (98%) patients with known seat belt status were studied. Among them, the 631 (82.4%) who were unrestrained were significantly younger than the restrained patients (P < 0.0001). The Abbreviated Injury Scale (AIS) scores for the thorax, back, and lower extremity were significantly higher in unrestrained than in restrained patients (P = 0.001, P = 0.036, and P = 0.045 respectively). The GCS was significantly lower in unrestrained than in restrained patients (P = 0.006). More surgical operations were performed in the unrestrained patients (P = 0.027).

CONCLUSIONS

Seat belt usage reduces the severity of injury, hospital stay, and number of operations in injured patients. Seat belt compliance is low in our community. More legal enforcement of seat belt usage is mandatory to reduce the severity of injury caused by RTCs.

Profiling genitourinary injuries in United Arab Emirates

Background:

The epidemiology of genitourinary (GU) organ injury following general trauma is not well-studied especially in the Middle East.

Patients and Methods:

All patients with GU injuries from the Trauma Registry of Al-Ain Hospital were studied. The registry data was prospectively collected from March 2003 to March 2006.

Results:

Out of 2573 patients in the registry, 22 had GU injuries (incidence: 0.9%, 2.0 per 100,000 inhabitants per year). Road traffic collision was the most frequent mechanism of injury (50% of all cases). 41% of injuries were renal. In 73% of patients, GU injuries were associated with other organ injuries, the most frequent of which were injuries to the other abdominal and pelvic organs (94%). The mean Injury Severity Score, mean total hospital stay, the percentage of patients who required intensive care unit (ICU) admission were higher in patients with GU injuries compared to non-GU patients (17.1 vs. 5.5 (P 0.001), 15.4 vs. 9.2 days (P 0.040) and 43% vs. 8%, (P 0.0001), respectively.

Conclusions:

The incidence of trauma-related GU injuries in the current study appears to be comparable to those reported from the West. Patients with GU organ injuries tend to have more severe trauma compared to other patients. Road traffic collision was the most common mechanism of injury and the kidney was the most frequently injured organ.

Seatbelt compliance and mortality in the Gulf Cooperation Council countries in comparison with other high-income countries

BACKGROUND AND OBJECTIVES

Mortality from road traffic collisions (RTC) is a major problem in the Gulf Cooperation Council (GCC) countries. Low compliance with seatbelt usage can be a contributing factor for increased mortality. The present study aimed to ascertain the presence of a relationship between seatbelt non-compliance of vehicle occupants and mortality rates in the GCC countries versus other high-income countries.

DESIGN AND SETTING

Observational and descriptive study using information published by the World Health Organization.

METHODS

Data for all GCC countries (n=6) and other high-income countries (n=37) were retrieved and compared with regard to population, gross national income, number of vehicles, seatbelt non-compliance and road traffic death rates. Univariate and multivariate analysis were used to define factors affecting the mortality rates.

RESULTS

The median road traffic death rates, occupant death rates, and the percentage of seatbelt non-compliance were significantly higher in the GCC countries (P<.0001, P=.02, P<.001, respectively). There was a strong correlation between occupant death rates and seatbelt non-compliance (R=.52, P=.008). Seatbelt non-compliance percentage was the only significant factor predicting mortality in the multiple linear regression model (P=.015).

CONCLUSIONS

Seatbelt non-compliance percentages in the GCC countries are significantly higher than in other high-income countries. This is a contributing factor in the increased road traffic collision mortality rate in these countries. Enforcement of seatbelt usage by law should be mandatory so as to reduce the toll of death of RTC in the GCC countries.

Seatbelts and road traffic collision injuries

Modification of seatbelts and their legislation played an important role in reducing morbidity and mortality of occupants in road traffic collisions. We aimed to review seatbelt development, its mechanism of action and its effects. Seatbelts reduce injury by preventing the occupant from hitting the interior parts of the vehicle or being ejected from the car. We have made a linear regression correlation between the overall seatbelt compliance and road traffic death rates in 46 high income countries to study the relationship between seatbelt use and mortality. There was a very highly significant negative correlation between the seatbelt compliance and road traffic death rates (R = - 0.77, F = 65.5, p < 0.00001). Seatbelt-related injuries include spinal, abdominal or pelvic injuries. The presence of a seatbelt sign must raise the suspicion of an intra-abdominal injury. These injuries can be reduced if seatbelts were applied correctly. Although seatbelts were recognized as an important safety measure, it still remains underused in many countries. Enforcement of seatbelt usage by law is mandatory so as to reduce the toll of death of road traffic collisions.

Vascular injuries following road traffic collisions in a high-income developing country: a prospective cohort study

BACKGROUND

The mechanism and pattern of vascular injury vary between different populations. The commonest mechanism of vascular injury in civilian practice is road traffic collisions. We aimed to prospectively study the incidence, detailed mechanism and anatomical distribution of hospitalized vascular trauma patients following road traffic collisions in a high-income developing country.

METHODS

Data were collected prospectively on road traffic collision injuries in the whole city of Al-Ain, United Arab Emirates, from April 2006 to October 2007 with full details of mechanism of injury and its relation to sustained injuries.

RESULTS

Out of 1008 patients in the registry, 13 patients had vascular injury, a calculated incidence of 1.87 cases/100 000 inhabitants per year. There were eight car occupants, four pedestrians, and one motorcyclist. Upper limb vascular injuries were the most common anatomical site (n = 4) followed by thoracic aorta (n = 3). All thoracic aortic injuries were acceleration injuries (pedestrians hit by a moving vehicle). None of the eight car occupants was wearing a seatbelt and the majority sustained a front impact deceleration injuries. The median injury severity score, hospital stay, and ICU stay were significantly higher in the vascular injury group compared with nonvascular group (P < 0.0001). Three patients died (23%); two due to severe liver trauma and one due to rupture thoracic aorta.

CONCLUSIONS

The incidence of hospitalized vascular injury due to road traffic collisions in Al-Ain city is 1.87 cases/100 000 inhabitants. These injuries occurred mainly in the upper part of the body. Seatbelt compliance of car occupants having vascular injuries was very low. Compliance with safety measures needs more enforcement in our community.

Relative benefits of population-level interventions targeting restraint-use in child car passengers

OBJECTIVES

Because public health resources for injury prevention are limited, methods for comparing competing strategies are needed. We aimed to estimate potential injury reductions for 4 population-level interventions that target restraint practices for child car passengers aged 0 to 12 years.

METHODS

Population-attributable risk fraction (PARF) is a population-level estimate of excess risk from exposure to a risk factor. PARFs were calculated for each intervention scenario by using published age-specific mortality/injury relative-risk estimates; restraint practices among injured child car passengers from police-collected data; and observational data for correctness of restraint use in New South Wales, Australia. PARF reductions were estimated for population uptakes of 25%, 50%, and 75%.

RESULTS

Assuming a 50% population uptake, (1) promoting age-appropriate restraint use could prevent additional fatalities (5.1%, infants; 3.4%, 1- to 6-year-olds) and nonfatal injuries (3.2%, infants; 16.2%, 1- to 6-year-olds) compared with promoting any restraint use; (2) further encouraging correct age-appropriate restraint use could also prevent additional fatalities (9.1%, infants; 14.3%, 1- to 6-year-olds) and nonfatal injuries (9.2%, infants; 10.7%, 1- to 6-year-olds); and (3) for children aged 7 to 12 years, promoting correct use of restraints could prevent an additional 3.4% fatalities and 3.1% nonfatal injuries compared with promoting any restraint use.

CONCLUSIONS

Interventions that target child passenger-restraint practices offer population-level benefits in terms of reduction in fatalities and injuries. These tangible benefits call for action internationally, not only to promote restraint use but correct age-appropriate restraint use for child car passengers.

Factors affecting anatomical region of injury, severity, and mortality for road trauma in a high-income developing country: lessons for prevention

OBJECTIVES

To study the factors affecting anatomical region of injury, severity, and mortality among road users in United Arab Emirates so as to improve preventive measures.

METHODS

Data of the Trauma Registry of Al Ain city were collected prospectively over 3 years (2003-2006) at the main trauma hospital. For traffic injuries, the following were assessed: gender, nationality, road user type, anatomical region(s) of injury, systolic blood pressure on admission, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), and mortality. Analysis included frequencies, cross-tabulations, and logistic regression.

RESULTS

There were 1070 patients, 89% male, 25% UAE nationals, and with a mean age of 31 years. Expatriates, mainly from non-Arabic speaking, low-income countries, accounted for 88% of injured pedestrians, whilst nationals were overrepresented among vehicle occupants (29%), and motorcyclists 37%. Injuries of the extremities and head were frequent among pedestrians, motorcyclists, and bicyclists, whilst head and spine injuries were most common among front and rear vehicle occupants and drivers. The median ISS was five for pedestrians and four for all other road user types, including rear vehicle occupants. The mean hospitalisation was 9.7 days; 13% of patients were admitted to ICU with mean stay of 6.5 days. Overall mortality was 4%; pedestrians accounted for 61% of deaths. Predictors of mortality were GCS (p<0.001), ISS (p<0.01) and systolic blood pressure on admission (p<0.03).

CONCLUSIONS

Head injury was a major factor affecting mortality, followed by injury severity and hypotension. To reduce injury incidence and severity, legislation and education are needed to ensure use of seat belts by all vehicle occupants including rear passengers, high-visibility devices by other road users, helmets by motorcyclists and bicyclists, protective clothing and boots for motorcyclists, and traffic engineering for pedestrians.

Availability, functionality, and use of seat belts in Beijing taxis prior to the 2008 Beijing Olympic Games

Use of driver seat belts and availability and functionality of passenger seat belts in a convenience sample of 231 Beijing taxis were examined in the months prior to the 2008 Beijing Olympic Games. Driver and front passenger seat belt use was mandated in China from 2004 to help address the growing public health crisis of road trauma. Results from observations made by in-vehicle passengers revealed that 21.2% of drivers were correctly wearing a belt, approximately half were not, and one third were using the belt in a non-functional way. Over 3/4 of this sample of taxi drivers were unrestrained while working. The percentage of functionally available belts was higher for front than rear passengers (88.3% and 22.9%, respectively). This low rate of belt availability in rear seats calls into question the preparedness of the fleet to cater for the safety needs of foreign visitors to China, particularly those from countries with high levels of restraint use. Factors influencing the use/misuse of seat belts in China remain largely unexplored. Results of this pilot study support further investigations of barriers to using injury prevention mechanisms such as seat belts in less motorised countries.