253 Child restraint use in Latin America from 2020 to 2022: a multi-round observational study

<h3>Background</h3> Road traffic deaths (RTDs) are a significant global issue, particularly affecting young people. In 2016, 1.35 million RTDs occurred globally, with children and young adults aged 5–29 being the most vulnerable.¹Low- and middle-income countries (LMICs) account for 93% of RTDs.¹ In Latin America and the Caribbean, where almost half of the population is under 25, the mortality rate related to RTDs among 5- to 14-year-olds is nearly twice the world’s mean rate.² Children are more susceptible to RTDs due to physical differences.^{3 4} Effective safety measures, like child-specific restraints, significantly reduce RTIs and RTDs among children,⁵ yet only 33 countries have laws aligning with WHO’s best practices for child restraints.¹ <h3>Objective</h3> This study aims to assess using and implementing child restraint systems (CRS) in Latin American countries. <h3>Methods</h3> Employing data from the third phase of The Bloomberg Philanthropies Initiative for Global Road Safety (BIGRS), this study conducted observations across 12 Latin American cities from 2020 to 2022. Sites were randomly selected to capture the prevalence of risk factors that could be attributed to targeted interventions or secular trends. The study utilized a standardized data collection protocol, focusing on vehicle-based observations conducted in a systematic quasi-random fixed sequence. Observations were performed between 7:15 a.m. and 7:00 p.m. on weekdays and weekends. Descriptive statistics were used to show the prevalence of correct child restraint system use. Logistic regression was performed to adjust for sex, type of road, and age, while accounting for clustering at the city level. <h3>Results</h3> Out of 481,266 individuals observed, 16,629 were under 18 years old (3.5%). Only 45% of children under 5 and 15% of children aged 5 to 11 used CRS. The use of CRS was lowest in the 5 to 11 age group across all cities. For children aged 12 to 17, 37% were appropriately secured. Focusing on visible compliance, only 13% of children under 11 years old were using CRS on expressways and 20% on local roads. The multilevel logistic regression analysis revealed that compared to arterial roads, the odds of CRS use were higher on collector roads (OR 1.17, 95% CI 1.03–1.34, p=0.019) and lower on local roads (OR 0.82, 95% CI 0.68–0.99, p=0.044), while expressways did not show a significant difference (OR 0.87, 95% CI 0.40–1.94, p=0.742). Regarding age, children aged 5–11 years had significantly lower odds of using CRS than children below five years old (OR 0.29, 95% CI 0.26–0.32, p&lt;0.001). There were no differences between males and females. The model accounted for clustering at the city level, with a residual intraclass correlation (ICC) of 0.13 (95% CI 0.06–0.26), indicating that 13% of the variability in CRS use is attributable to differences between cities. <h3>Conclusions</h3> The study reveals a strikingly low usage of CRS in Latin American countries, particularly among children aged 5 to 11, who remain one of the most vulnerable groups to RTDs. This highlights a critical need for enhanced safety measures and stronger implementation of child restraint laws to mitigate one of the leading causes of child fatalities in the region. <h3>References</h3> WHO. Global Status Report on Road Safety 2018; WHO: Geneva, Switzerland, 2018. Draisin N, Silverman A, González F, Lambrosquini F, Silva M, Zugarramurdi F. Calles para la vida: trayectos seguros y saludables para los niños de américa latina y el caribe. UNICEF. 2018. Available online: https://www.unicef.org/lac/media/2166/file/PDF%20Street%20for%20life.pdf (accessed on 29 November 2023). Li Q, Alonge O, Hyder AA. Children and road traffic injuries: can’t the world do better? <i>Arch Dis Child</i> 2016;<b>101</b>:1063–70.doi:10.1136/archdischild-2015-309586 Huelke DF. An overview of anatomical considerations of infants and children in the adult world of automobile safety design. <i>Annu Proc Assoc Adv Automot Med</i> 1998;<b>42</b>:93–113. Johns Hopkins International Injury Research Unit. Evidence Synthesis on Interventions Targeting Child Restraint Systems Use. July 2023. Baltimore, MD.