P0252 - Child Passenger Helmet and Restraint Use: A comparative analysis from 10 cities

Background:
Globally, there are 1.35 million road traffic deaths annually, with 90% of these deaths occurring in low- and middle-income countries (LMICs). Road traffic injury is now the leading cause of death in children older than five years of age. To achieve the Stockholm Declaration of halving the number of road traffic deaths by 2030, and Sustainable Development Goal 11.7 to provide safe transport systems, particularly for vulnerable individuals, drastic action needs to be taken in LMICs. In 2007, Bloomberg Philanthropies launched the Initiative for Global Road Safety. The second phase of the project, which started in 2015, focused on addressing road safety in 10 cities. The purpose of this study is to examine child passenger helmet use and child restraint data from the project.

Methods:
The 10 cities selected were Accra, Addis Ababa, Bandung, Bangkok, Bogota, Fortaleza, Ho Chi Minh City, Mumbai, Sao Paulo, and Shanghai. Eight rounds of roadside observational data were collected from February 2015 to March 2019. For motorcycles, observers noted child passenger helmet use (under 18 years of age) with a strapped helmet, no helmet use, and unstrapped helmet use. For vehicles, examiners observed whether the child was in an age-appropriate, properly secured child restraint. Data was collected at between 5-8 different time points in each city. Due to differences in methodology, Shanghai was not included in the child restraint analysis.

Results:
In this dataset, 106,923 child passenger helmet and 29,212 child passenger restraint observations were recorded. The overall prevalence of child passenger helmet use with a strapped helmet ranged from 1.78% in Mumbai to 97.35% in Sao Paulo. With the exception of Sao Paulo, all other cities had more than 20% of the child passenger population without any helmet or with an unstrapped helmet. For properly utilized child passenger restraints in vehicles, Sao Paulo had the highest prevalence at 53.54% in children under 5 years of age and Bangkok demonstrated the highest prevalence for children aged 5-11 at 18.99%. Children were properly restrained less than 20% of the time in 6 out of 9 cities for the under five years age group and in all of the cities for the 5-11 years age group.

Conclusion:
The prevalence of correct utilization of child passenger helmets and child restraints shows large variation globally and is concerningly low overall. Further analysis of this dataset will examine changes in helmet and restraint use over time, as well as driver, passenger, and road traffic factors that are associated with child helmet and restraint use. This data will be used as part of the larger project to decrease road traffic deaths through behavioral interventions, improvements in infrastructure, sustainable urban transport, enhanced vehicle standards, and policy strengthening.