Prognostic study, level II.
The need for stronger child restraint laws To the Editor: Children are vulnerable road users in South Africa (SA), with road traffic crashes being the second leading cause of death for children aged 5-14 years. [1] Two road-user groups, child pedestrians and child passengers, are particularly vulnerable, constituting 62% and 36% of child road fatalities, respectively. [2] Several interventions have been proposed to reduce this preventable burden, including the appropriate use of child restraints. Evidence shows that, when installed correctly, child restraints can reduce the likelihood of a road traffic fatality by between 54% and 80%, depending on the child's age. [3] Two observational studies conducted at Red Cross War Memorial Children's Hospital, Cape Town, in 2008 and 2019 found that a concerning number of children arriving at the hospital by car were not restrained-in an age-appropriate child restraint system or by a seatbelt. [4,5] While the findings in 2008 were expected because SA had no child restraint law at that time, the 2019 results are disappointing because of the 2014 amendment to the road safety law, which requires the use of a child restraint. The amendment to regulation 213, section 6A of National Road Traffic Act No. 93 of 1996 [6] mandates the use of a South African Bureau of Standards-approved child restraint for all child passengers under the age of 3 years and also requires children aged 3 years and older to sit in the rear and use a seatbelt. Child restraint use can be increased significantly by applying a systems approach that includes adequate enforcement of the law. [5] We decided to review the SA Road Traffic Act and associated regulations, to determine whether the existing legislation and associated penalties are comprehensive without any ambiguity or loopholes that might enable road users to escape the consequences of breaking the law. Our review identified three main issues. Firstly, the law remains ambiguous on the type of restraint that should be used for children older than 3 years, and does not comply with international best practice as defined by the United Nations Economic Commission for Europe regulation 44 or the latest version, regulation 129. [7] Furthermore, the SA law in its current state gives no indication as to the best position for a child under the age of 3 to sit in a car with his/her child restraint, i.e. the back seat or the front seat. The bestpractice law categorises restraints suitable for a child up to the age of 12 years based on three factors: age, height and weight. Furthermore, older children who are above the height and weight specification must wear a seatbelt. International law further states that a child must be restrained in the back seat [7] in order to minimise injury during a road crash. Our second finding was that the age specification in the SA law imposes the challenging task of age estimation on law enforcement officials, which results in low restraint use. A study in 2002 found that 87% of observers were able to estimate the age of a child co...
Background There are two main causes of shack fires in South Africa: Fallen candles and paraffin-related burns. These fires lead to devastating consequences and huge economic losses. Aim/Goal The goal of this project is to facilitate and promote safer use of candles in a glass jar, with the ultimate aim to prevent fires, burn injuries and deaths caused by fallen candles, targeting individuals and families who live in informal homes. Material and Methods Childsafe South Africa personnel conducted a number of trials to test the “Candle in a glass jar” concept. In 2006, the project was piloted in an informal area that exclusively uses candles as source of light. Further demonstration and educational sessions have taken place and over 100,000 jar units have been distributed to various communities to date. Results The Safer Candle Project is six years old, and has become one of Childsafe's established programmes. It has been widely accepted and been approved by World Wide Fund for Nature SA (WWF) for Earth Hour 2011& 2012. Significance The idea of candle in the glass jar is recommended as its very simple and preventative measure to reduce fires mainly caused by candles tipping. One of its advantages is that it places no financial burden on families, as there are virtually no costs involved.
BackgroundHead injuries represent the most common and most serious injury occurring in childhood. We analysed the profile of childhood head injury patients treated in a Paediatric Trauma Unit over a 25 years period.MethodsA retrospective record-based study was performed at the Trauma Unit of the Red Cross War Memorial Children’s Hospital in Cape Town, South Africa. The Childsafe South Africa Childhood Injury Surveillance System was data-mined for the information. Inclusion criteria were children under the age of 13 years and presenting with a head injury during the period between January 1991 and July 2025.Results10205 children presented after a sustaining a head injury. There were 6457 boys and 3745 girls. In 281 (2.75%) of cases the children were injured as a result of physical violence. The majority of children presented with superficial lacerations and abrasions, mostly affecting the scalp and skull. Injuries were mainly caused by falls from a variety of heights or were traffic-related. Almost two-thirds of traffic-related injuries involved children as victims of a motor vehicle crash. The majority of head injuries in young children occurred in the vicinity or within the child’s own home. In 56 cases the severity of the injury was not recorded. From the remaining 10146, 6864 (67.3%) were classified as minor; 2918 (28.6%) as moderate; 225 (2.2%) as severe and 135 (1.3%) children died within 24 hours after admission.ConclusionsHead injuries are a significant and ongoing cause of morbidity in particular of young children and represent the most important component of childhood injuries. Protection of young children, especially in their own home and on the streets requires urgent attention.
BackgroundSince 1991, Childsafe South Africa has gathered available statistics on childhood injuries and deaths presenting at Red Cross War Memorial Children’s Hospital Trauma Unit in Cape Town, South Africa. This database serves as a surveillance system on childhood injuries and it is considered to be one of the biggest paediatric injury databases. The database has been systematically analysed for a large number of clinical and epidemiological studies as they relate to childhood injuries.Childsafe South Africa collaborated with relevant stakeholders and developed educational posters that convey universal safety information and recommendations for families, crèches, and care givers, based on the statistics from the database.MethodsA series of three educational posters (1) “Growing Safely” (2008), (2) “Living Safely” (2010), and (3) “Travelling Safely” (2011) were developed encompassing the various characteristics of children throughout their development and providing corresponding harm reduction principles.These posters identify the early developmental limitations of the children; recognise typical injuries within specified age groups (from the database); illustrate the best practice scenario and best prevention are organised by age and are coloured with detailed pictures of accident precautions and suggestions.Results“Growing Safely” is an international award winning poster and depicts the child from birth until age six. It raises crucial awareness by providing safety recommendations, by age, for fall prevention, drowning risks, car safety, and the dangers of common household items.The “Living Safely” poster was designed in response to a growing number of hot water burns and flame burns. Thus, “Living Safely” is formatted in the same award winning design and addresses burn risks and fire safety. The topics portrayed in “Living Safely” include; sunburn protection, hot water burn prevention, electrical cord/outlet recommendations, and proper fire extinguishing directions.The most recently developed poster, “Travelling Safely” illustrates age appropriate vehicle restraints, helmet and safety guard suggestions, street crossing advisory, and tips for proper bicycling. To provide such imperative information, the three posters have been translated into local languages.ConclusionThe Childsafe South Africa posters have been well received and regarded as best educational tool not only in South Africa but around the world. People are able to connect with messages as it’s extracted from simple situations that take place on daily basis. Images of real people (children) are being used and the pictorial depictions overcome literacy levels.
BackgroundThe World health Organisation indicates that child pedestrian injuries are highest in African countries with a continental mortality rate that is twice the global world (WHO 2011). In South Africa it is noted that the majority of children walk to and from school, placing them at particular risk to road traffic crashes resulting in injury, disability or death(Stats SA 2013) Child pedestrians are particular vulnerable to road crashes due to their physical and cognitive limitations.MethodsThe Safe School project aimed to reduce child pedestrian injuries and deaths in South Africa by introducing the iRAP star rating concept, which provides tools and training to help countries make roads safe by inspecting high-risk roads and developing star ratings for those roads, with the ultimate goal of eliminating one- and two-star rated roads from the world’s road network. 3 primary schools were selected in South Africa where intervention took place and 1 school served as a control for monitoring and evaluation purposes.ResultsThe pilot project has developed an innovative model combining education for the school children, training for teachers and advocacy action to catalyse the introduction of safe road infrastructure. It has also enabled creation of a multi-stakeholder partnership and further contributed to development of educational tool kit by Takalani Sesame (Sesame Street).The project has been successful in one of its primary objectives to encourage the government to ensure sustained investments for safer roads thorough collaboration with City of Cape Town road engineers.ConclusionThe project has been effective as a model for catalysing sustainable investment in interventions aimed to improve road safety for school children. This model has the potential to be replicated on a wider basis across other schools in South Africa and other countries. With its outcomes and potential long term impact, it has already made valuable contribution to the Decade of Action for Road Safety and has the potential to do so.
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