Affordability and Availability of Child Restraints in an Under-Served Population in South Africa

Knowledge and Attitude Toward Child Safety Seat Use in Saudi Arabia: A Cross-Sectional Study

Background Car safety seats (CSS) are a well-established strategy to reduce injuries and fatalities among children involved in road traffic accidents. However, the use of CSS is generally low globally due to limited knowledge of its benefits. This study assessed parents' knowledge and attitudes toward CSS in Saudi Arabia. Methods This cross-sectional study used an online self-administered survey distributed among residents in different regions of Saudi Arabia to assess their knowledge and attitude toward CSS. Data were analyzed using the statistical package for the social sciences (SPSS) version 23.0 (IBM Corp., Armonk, NY). Results A total of 383 Saudi residents participated in the study. The mean age was 37.14 ±9.10 years, with a female predominance (62.1%, n=238). One-third of the participants were from the western region of Saudi Arabia (30.3%, n=109). Non-use of CSS was reported by 25.8% of the participants, while 11.7% reported that they rarely used CSS. The mean total knowledge score was 2.15 (range 0 -3). A lower knowledge score was significantly associated with a lower educational level (p=0.008), not having information regarding CSS (p=0.005), none or rare use of CSS by the parent (p<0.001), and the use of media or self-education as a source of information regarding CSS (p=0.002). The mean attitude score was 12.52 (range 4 -20). The attitude score was significantly associated with gender (p=0.002), education (p=0.014), number of children (p=0.005), monthly family income (p=0.028), use of CSS by people other than the parent (p<0.001), information about CSS use in the car (p<0.002), source of information (p<0.001), and use of CSS by the parent (p<0.001). Conclusions The knowledge and attitude of the Suadi population toward CSS use are inadequate, highlighting the need to enhance awareness and understanding of the importance of CSS use.

Pediatric Traumatic Brain Injury in Malawi: A Propensity-Weighted Analysis of Outcomes and Trends Over Time

BACKGROUND

Pediatric injuries contribute to substantial mortality and morbidity worldwide, particularly in sub-Saharan Africa. We aim to identify predictors of mortality and time trends for pediatric traumatic brain injuries (TBIs) in Malawi.

METHODS

We performed a propensity-matched analysis of data from the trauma registry at Kamuzu Central Hospital in Malawi from 2008 to 2021. All children ≤16 years of age were included. Demographic and clinical data were collected. Outcomes were compared between patients with and without head injuries.

RESULTS

A cohort of 54,878 patients was included, with 1755 having TBI. The mean ages of patients with and without TBI were 7.8 ± 7.8 years and 7.1 ± 4.5 years, respectively. The most common mechanism for patients with and without TBI was road traffic injury and falls, respectively (48.2% vs. 47.8%, P < 0.01). The crude mortality rate for the TBI cohort was 20.9% compared to 2.0% in the non-TBI cohort (P < 0.01). After propensity matching, patients with TBI had 4.7 higher odds of mortality (95% confidence interval 1.9-11.8). Over time, patients with TBI had an increasing predicted probability of mortality for all age categories, with the most significant increase among children younger than 1 year.

CONCLUSIONS

TBI confers a greater than 4-fold higher likelihood of mortality in this pediatric trauma population in a low-resource setting. These trends have worsened over time.

Parents' knowledge and socio-demographic determinants toward child's restraint system use

BACKGROUND

Lack of protection or improper protection, is one of the most important reasons of child passenger's death and injury in traffic crashes. Based on what we see on the roads, Iranian children are unrestrained inside the car. The aim of this study was to investigate children restrained system (CRS) use rate, its socio-demographic determinants and parents' knowledge toward CRS use among Iranian parents.

METHODS

Using multi-stage cluster sampling and direct in filed method of observation, the behavior of 700 children in cars was observed in the current cross-sectional study. Socio-demographic determinants and parents' knowledge, toward using the CRS were evaluated using questionnaires. The study was performed from July to August 2019 in Tabriz city, northwestern Iran.

RESULTS

The rate of child safety seat (CSS) use was 15.1% CI 95%:(12.5%,18.0%), and the rate of booster use was 0.6%; CI 95%:(4.3%,8.0%). The majority of parents [e.g. 64.3%; CI 95%: (60.7%,67.9%)], had low knowledge about the use of CRS. The most important reasons for not using CRS was lack of laws and policies [e.g. 59.7%; CI 95%:(12.5%,18.0%)], lack of knowledge [e.g.59.6%; CI 95%:(57.9%, 63.3%)] and the high cost of CRS [e.g. 57.6%; CI 95%:(53.81%,61.2%)]. The most important predictors of not using CRS were the child's age, parental knowledge, and the socioeconomic status of the household (p < 0.05).

CONCLUSIONS

Most children did not have CRS. The parents with higher education and those with higher socioeconomic status had higher rate of CRS use. Based on the low rate of CRS use and poor parental knowledge about it, education of parents toward boosters use and benefits of using CRS, enforcing mandatory laws and ploicies for CRS use in Iran, and allocation of government subsidies to low-income families for purchasing CRS are suggeted as essential strategies to increase CRS use.

Dynamic frontal crash performance of old and used child restraint systems

OBJECTIVE

To examine the effect of age on the dynamic performance of child restraint systems in frontal crashes.

METHODS

A sample of used (3-269 months from manufacture) and newly purchased child restraints were subjected to frontal crash simulations of more than 56 km/h and peak deceleration approximately 33 g on a deceleration sled. Restraints were monitored for evidence of damage before and after each impact. Anthropometric test device (ATD) head and chest responses and peak head excursions were recorded for rearward facing restraints using the Q1 ATD and for forward facing restraints and booster seats using the Q6 ATD. The influence of restraint age on peak 3 ms head acceleration, HIC15, head excursion, peak 3 ms chest acceleration and restraint damage were analyzed.

RESULTS

In all impacts, the ATD remained within the restraint and secured to the test bench demonstrating the crash protection offered by the old and used restraints. There was no apparent relationship between ATD responses and restraint age for any restraint type. Older forward facing restraint systems had a very modest increase in forward head excursion (R² = 0.59, p = 0.001) of 0.27 mm for each month of age (95% CI, 0.13 mm - 0.42 mm). This equates to a 0.7% increase in the minimum measured excursion per year of restraint age. There was also a small increased likelihood of critical damage to the restraints in the simulated crashes per month of restraint age (OR 1.031, 95% CI 1.010-1.069).

CONCLUSIONS

Overall, degradation in restraint dynamic performance in older restraints, including some that are much older than the currently recommended 10-year lifetime, is minimal. However newer restraints may provide better protection due to marginal improvements in restraint design over time. Furthermore, the results of this study confirm previous recommendations that restraints should not be re-used after crash involvement.

Overloaded and Unrestrained: A Qualitative Study with Local Experts Exploring Factors Affecting Child Car Restraint Use in Cape Town, South Africa

(1) Background: Children in South Africa experience significant impacts from road injury due to the high frequency of road crashes and the low uptake of road safety measures (including the use of appropriate child restraints). The current study aimed to assess the feasibility of a child restraint program and to describe factors influencing child restraint use from the perspectives of clinicians, representatives of non-government agencies, and academics in Cape Town, South Africa. (2) Methods: Qualitative interviews were conducted with 13 experts from government, academic and clinical backgrounds. Findings were analyzed using the COM-B component of the Behaviour Change Wheel and were grouped by the layers of the social-ecological model (individual, relational, community and societal). (COM-B is a framework to explain behaviour change which has three key components; capability, opportunity and motivation), (3) Results: Experts believed that there was a need for a child restraint program that should be staged and multifactorial. Participants described knowledge gaps, perceptions of risk, mixed motivations and limited enforcement of child restraint legislation as key influences of restraint use. (4) Conclusions: The results demonstrate potential areas on which to focus interventions to increase child restraint use in Cape Town, South Africa. However, this will require a coordinated and consistent response across stakeholder groups.