Epidemiology of road traffic injuries and fatalities among children in Ethiopia: a systematic review and meta-analysis

BACKGROUND: Road traffic injuries are a global public-health challenge, causing substantial morbidity and mortality, especially among children in low- and middle-income countries such as Ethiopia. Despite this impact, research on child road traffic injuries is often under-represented and often masked within the general population. Effective injury prevention requires context-specific evidence to support implementation and scale-up interventions. This study aimed to address these gaps by investigating epidemiological evidence and injury patterns among paediatric populations. METHODS: A systematic literature search was conducted across major databases, including Medline, Embase, Scopus, PubMed, CINAHL Complete, and Ovid Transport to identify published studies reporting on child traffic injuries. Data were extracted using a standard Microsoft Excel format, and the quality of the included studies was assessed using the JBI checklists. Statistical analysis was conducted using Stata version 18. Random-effects models were used to estimate the pooled prevalence of child traffic injuries and fatalities. RESULTS: A total of 36 articles were included in this review. The random-effects models indicated that the pooled prevalence of child traffic injuries and fatalities was estimated at 23% (95% CI: 21%-25%) and 17% (95% CI: 11%-24%), respectively. Regarding the pattern of injuries, 81.5% of all reported injuries involved pedestrians; 40.6% of injury cases involved individuals aged between 13 and 18 years; 37% of injuries were classified as serious; nearly 50% of incidents occurred on streets or highways; and 34.1% of incidents occurred in school-zone areas. Head trauma was the most frequently injured region and a leading contributor to death. The key causes of incidents were failure to prioritise pedestrians, speeding, incorrect lane use, alcohol impairment, and unsafe following distances. CONCLUSIONS: This study highlights child road traffic injury as a substantial public health burden in Ethiopia, with disproportionate impacts on school-aged children, males, adolescents, and those living in urban areas. These findings underscore the need for targeted public health strategies for child injury prevention. Enhancing community-level road safety education, strengthening enforcement of traffic laws, and promoting effective child supervision are essential for evidence-informed policy interventions. Implementation of these measures could meaningfully reduce child injuries and fatalities.