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

Abstract

Background: Child road traffic injuries are a major global public health problem and the issue is particularly burdensome in middle-income countries such as South Africa where injury death rates are 41 per 100,000 for under 5′s and 24.5 per 100,000 for 5–14-year-old. Despite their known effectiveness in reducing injuries amongst children, the rates of use of child restraint systems (CRS) remains low in South Africa. Little is known about barriers to child restraint use especially in low- and middle-income countries. Methods: We carried out observation studies and parent/carer surveys in 7 suburbs of Cape Town over a three month period to assess usage rates and explore the knowledge and perceptions of parents towards child restraint legislation, ownership and cost; Results: Only 7.8% of child passengers were observed to be properly restrained in a CRS with driver seatbelt use and single child occupancy being associated with higher child restraint use. 92% of survey respondents claimed to have knowledge of current child restraint legislation, however, only 32% of those parents/carers were able to correctly identify the age requirements and penalty. Reasons given for not owning a child seat included high cost and the belief that seatbelts were a suitable alternative. Conclusions: These findings indicate the need for a tighter legislation with an increased fine paired with enhanced enforcement of both adult seatbelt and child restraint use. The provision of low-cost/subsidised CRS or borrowing schemes and targeted social marketing through online fora, well baby clinics, early learning centres would be beneficial in increasing ownership and use of CRS.

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

“…For instance, a study conducted in Nigeria revealed that 26% of parents surveyed considered CSSs unnecessary [ 9 ]. Similar reports from Turkey [ 11 ], South Africa [ 12 ], Singapore [ 10 ], and Romania [ 13 ]. Studies have also found that a lack of knowledge regarding the proper use of CSS is a barrier to their usage.…”

“…Previous studies showed that common reasons mentioned for the non-use of CSS included insufficient space and high cost [ 11 , 26 ]. It was seen in South Africa, where the affordability of CSS caused financial burdens on families, especially those with more than one kid who needs CSS [ 12 ]. These findings have practical implications for policymakers to increase the use of CSS among the local population by reviewing the cost of CSS and encouraging more healthcare workers to educate parents regarding the importance of using CSS for their children [ 27 ].…”

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

“…Child restraint use is a core factor of road safety strategies globally and is a listed priority in the South African Road Safety Strategy 2011-2020 [12]. While a law mandating the use of South African Bureau of Standards-approved child restraints for all children under the age of three years exists in South Africa [13], data indicate widespread low rates of use [14,15]. For example, an analysis of specific types of road traffic injuries in Cape Town found that unrestrained passenger injuries were the most common mechanism of road traffic injury for children aged 0-12 months and the second most common for children between 0 and 4 years following pedestrian injuries [16].…”