Factors behind not using child restrain(t) among hospital employees and general population: A case control study

doi:10.5847/wjem.j.1920-8642.2017.04.004

Abstract

Abstract:

BACKGROUND: Motor vehicle crash (MVC) related injury has been identified as a major public health concern. Child restrain (CR) seat belts can minimize the mortality and morbidity from MVC. The use for seat belts is substantially low in developing countries like Pakistan even though its use has been shown to decrease morbidity and mortality by a significant extent.

METHODS: This was a case control study with cases from the general population (GP) and controls from the Aga Khan University (AKU) employees in a 3:1 ratio. The study questionnaire was based on parameters like gender, education level, awareness and presence of CR and also assessed the frequency of usage, reasons for not using CR and the source of knowledge regarding CR use.

RESULTS: Out of 848 respondents, 212 were from AKU and 636 were from the GP. 96.7% from AKU had at least a bachelor's degree while less than half (42.6%) of those from the GP were graduate or above (P<0.001). A statistically significant difference was found between the two groups with drivers from AKU being generally more aware about CR and its use. 81.1% of the group from AKU compared to 59.7% from the general population were found to be aware of child restraint use (P<0.001). Media (40.6%) was found to be the most common source of information amongst the AKU employees.

CONCLUSION: Most motor vehicle related injuries in children can be prevented or their severity may be reduced by the use of appropriate child restraint seat belts.

Key words: Child restrain, Seat belt, Injury, Pakistan

Emad Siddiqui, Badar Afzal, Ghazala Kazi, Asher Feroz, Rubaba Naeem, Tarab Mansoor, Ahreen Allana, Saif Siddiqui, Zain Siddiqui. Factors behind not using child restrain(t) among hospital employees and general population: A case control study[J]. World Journal of Emergency Medicine, 2017, 8(4): 269-275.

Figures/Tables 5

Table 1

Table 2

Table 3

Table 4

Table 5

References 24

1	Forjuoh SN, Gyebi-Ofosu E. Injury surveillance: should it be a concern to developing countries? J Public Health Policy. 1993; 14(3):355-9. pmid: 8254009
2	WHO. Health statistics and health information systems-Projections of mortality and burden of disease to 2030 Geneva2006. Available from: http://www.int/healthinfo/statistics/bodprojections20.
3	Vital Statistics, Mortality: summary list of causes. Ottawa, Canada: 1978. doi: 10.1007/BF03022879 pmid: 27771910
4	Ma X, Layde P, Zhu S. Association between child restraint systems use and injury in motor vehicle crashes. Acad Emerg Med. 2012; 19(8):916-23. doi: 10.1111/j.1553-2712.2012.01403.x pmid: 22849710
5	Mohan D, Bawa P. An analysis of road traffic fatalities in Delhi, India. Accid Anal Prev. 1985; 17(1):33-45. doi: 10.1016/0001-4575(85)90006-5 pmid: 4091931
6	Manciaux M, Romer CJ. Accidents in children, adolescents and young adults: a major public health problem. World Health Stat Q. 1986; 39(3):227-31. pmid: 3788200
7	Hertz E. Revised estimates of child restraint effectiveness. NHTSA Research Note. 1996.
8	Rice TM, Anderson CL. The effectiveness of child restraint systems for children aged 3 years or younger during motor vehicle collisions: 1996 to 2005. Am J Public Health. 2009; 99(2):252-7. doi: 10.2105/AJPH.2007.131128 pmid: 19059860
9	Berg MD, Cook L, Corneli HM, Vernon DD, Dean JM. Effect of seating position and restraint use on injuries to children in motor vehicle crashes. Pediatrics. 2000; 105(4):831-5.
10	Elliott MR, Kallan MJ, Durbin DR, Winston FK. Effectiveness of child safety seats vs seat belts in reducing risk for death in children in passenger vehicle crashes. Arch Pediatr Adolesc Med. 2006; 160(6):617-21. doi: 10.1001/archpedi.160.6.617 pmid: 16754824
11	Snowdon AW, Hussein A, Ahmed E, Kolga C, Howard A. Technical Report: Canadian National Survey on Child Restraint use 2010 Completed for Transport Canada, in partnership with AUTO21.
12	Pérez-Núñez R, Chandran A, Híjar M, Celis A, Carmona-Lozano MS, Lunnen JC, et al. The use of seatbelts and child restraints in three Mexican cities. Int J Inj Contr Saf Promot. 2013; 20(4):385-93. doi: 10.1080/17457300.2012.754477 pmid: 23316999
13	Williams AF. Observed child restraint use in automobiles. Inj Prev. 1998; 4(2):155-60. pmid: 9666374
14	Wikipedia, the free encyclopedia: List of countries by vehicles per capita. 2016.
15	WHO. Pakistan Statistics Summary. Global Health Observatory Data Repository 2012.
16	Pakistan Bureau of statistics - Government of Pakistan: Pakistan Statistical Year Book 2011 2011. Available from: http://www.pbs.gov.pk/content/pakistan-statistical-year-book-2011.
17	Razzak JA, Luby S, Laflamme L, Chotani H. Injuries among children in Karachi, Pakistan—what, where and how. Public Health. 2004; 118(2):114-20. doi: 10.1016/S0033-3506(03)00147-1 pmid: 15037041
18	Siddiqui E, Ejaz K, Waheed S, Kazi GI, Khursheed M. Attitudes towards child restrains and seat belts usage in the learned population of Karachi, Pakistan. World J Emerg Med. 2014; 5(3):223. doi: 10.5847/wjem.j.issn.1920-8642.2014.03.012 pmid: 25225589
19	Peden M, Scurfield R, Sleet D, Mohan D, Hyder AA, Jarawan E, et al. World report on road traffic injury prevention. World Health Organization Geneva; 2004.
20	Hassan HM, Abdel-Aty MA. Exploring the safety implications of young drivers' behavior, attitudes and perceptions. Accid Anal Prev. 2013; 50:361-70. doi: 10.1016/j.aap.2012.05.003 pmid: 22658949
21	Trevino-Siller S, Pacheco-Magana LE, Bonilla-Fernandez P, Rueda-Neria C, Arenas-Monreal L. An educational intervention in road safety among children and teenagers in Mexico. Traffic Inj Prev. 2016: 1-7. pmid: 33119415
22	Handbook TDs. Your Road Safety Responsibilities South Australia: My Licence; Available from: http://mylicence.sa.gov.au/data/assets/pdf_file/0009/152874/MR200_p1-40_Mar_2016_v1.pdf.
23	National Highway & Motorway Police Pakistan Rules. downloaded on May 10, 2017 https://headfastco.wordpress.com/2011/03/24/national-highway-motorway-police-pakistan-rules
24	Ghaffar A, Hyder AA, Mastoor MI, Shaikh I. Injuries in Pakistan: directions for future health policy. Health Policy Plan. 1999; 14(1):11-7. doi: 10.1093/heapol/14.1.11 pmid: 10351465

Variables	Control (AKU) (n=212)	Case (GP) (n=636)	P value
Gender			0.005
Male	126 (59.4)	444 (69.8)
Female	86 (40.6)	192 (30.2)
Total	212	636	848
Educational status
Intermediate & below	7 (3.3)	365 (57.4)	<0.001
Graduate & above	205 (96.7)	271 (42.6)	<0.001
Total	212	636	848
Possess a valid driving license
Yes	154 (72.6)	494 (77.7)	0.135
No	58 (27.4)	142 (22.3)	0.135
Total	212	636	848
Aware of child restraints
Yes	172 (81.1)	380 (59.7)	<0.001
No	40 (18.9)	256 (40.3)	<0.001
Total	212	636	848
Knowledge of child restraints
Driving school	9 (4.2)	50 (7.9)	<0.001
Car manufactures	6 (2.8)	45 (7.1)
Media	86 (40.6)	153 (24.1)
Friends	21 (9.9)	67 (10.5)
Others	50 (23.6)	65 (10.2)
Not aware	40 (18.9)	256 (40.3)
Total	212	636	848

Variables	Control (AKU)(n=212)	Case (GP) (n=636)	P value
Car has child restraints
Yes	65 (30.7)	63 (9.9)	<0.001
No	147 (69.3)	573 (90.1)	<0.001
Total	212	636	848
Child restraints works properly
Yes	62 (95.4)	57 (90.5)	0.278
No	3 (4.6)	6 (9.5)	0.278
Total	65	63	128
Type of child restraints
Front facing	48 (73.8)	46 (73.0)	0.915
Rear facing	17 (26.2)	17 (27.0)
Total	65	63	128
Use while driving
Present and working	49 (75.4)	57 (90.5)	<0.001
Present but not working	16 (24.6)	6 (9.5)	<0.001
Total	65	63	128
Who used CR regularly while driving
Father	16 (24.6)	45 (72.6)	<0.001
Mother	5 (7.7)	9 (14.5)
Both/driver/other	42 (64.6)	1 (1.6)
Not using	2 (3.1)	7 (11.3)
Total	65	62	127
How often used CR
Always	31 (51.7)	38 (61.3)	0.309
Most of the time	14 (23.3)	8 (12.9)
Less Frequent	15 (25.0)	16 (25.8)
Total	60	62	122
Who cares for the child while driving
No one	16 (7.5)	70 (11)	<0.001
Mother	72 (34)	290 (45.6)
Elder siblings	20 (9.4)	93 (14.6)
Others	104 (49.1)	183 (28.8)
Total	212	636	848
Child remains unattended while restrained
Yes	17 (26.4)	53 (89.8)	<0.001
No	47 (73.4)	6 (10.2)	<0.001
Total	64	59	123

Variables	Control (AKU)(n=212)	Case (GP) (n=636)	P value
Availability of seat belt
Present and working	153 (72.2)	195 (30.7)	<0.001
Present but not working	28 (13.2)	14 (2.2)
Not present at all	31 (14.6)	427 (67.1)
Total	212	636	848
Use seatbelts while driving
Regularly	32 (17.7)	81 (38.8)	<0.001
Irregularly	70 (38.7)	74 (35.4)
Not at all	79 (43.6)	54 (25.8)
Total	181	209	390
Type of seat belt
Lap belt	10 (5.5)	48 (23.0)	<0.001
Shoulder	55 (30.4)	55 (26.3)
Lap/shoulder	115 (63.5)	91 (43.5)
Don't know	1 (0.6)	15 (7.2)
Total	181	209	390
Usual speed limit while driving
20-30 km/hour	1 (0.5)	68 (10.7)	<0.001
30-40 km/hour	20 (9.4)	141 (22.2)
40-50 km/hour	92 (43.4)	223 (35.1)
50-60 km/hour	60 (28.3)	162 (25.5)
60-70 km/hour	31 (14.6)	42 (6.6)
>70 km/hour	8 (3.8)	0 (0)
Total	212	636	848

Variables	Control (AKU)(n=212)	Case (GP) (n=636)	P value
Any misfortune car accident
Yes	59 (27.8)	143 (22.5)	0.114
No	153 (72.2)	493 (77.5)
Total	212	636	848
Who drove the car (at the time of accident)
Father	20 (33.9)	120 (83.9)	<0.001
Mother	30 (50.8)	7 (4.9)
Driver/both	3 (5.1)	4 (2.8)
Others	6 (10.2)	12 (8.4)
Total	59	143	202
Was the driver belted (at the time of accident)
Yes	33 (62.3)	22 (48.9)	0.184
No	20 (37.7)	23 (51.1)
Total	53	45	98
Child restrained at the time of accident
Yes	12 (66.7)	1 (11.1)	0.015
No	2 (11.1)	1 (11.1)
Don't know	4 (22.2)	7 (77.8)
Total	18	9	27
Using CR now (after accident)
Yes	14 (23.7)	3 (2.1)	<0.001
No	9 (15.3)	98 (68.5)
Don't know	36 (61)	42 (29.4)
Total	59	143	202
How often do you drive with your family
≤1/week	51 (24.1)	256 (40.3)	<0.001
>1/week	117 (55.2)	301 (47.3)
Daily	44 (20.8)	79 (12.4)
Total	212	636	848
How often you use highway
Not at all	143 (67.5)	399 (62.7)	0.03
Often	54 (25.5)	212 (33.3)
Most of the time	15 (7.1)	25 (3.9)
Total	212	636	848
Reason for not using CR (who had CR in car)
Did not know how to use	2 (3.1)	21 (33.3)	<0.001
Difficult to use	11 (16.9)	8 (12.7)
Discomfort for child/ Parental casual attitude	5 (7.7)	3 (4.8)
Feel unnecessary	2 (3.1)	1 (1.6)
Expensive	3 (4.6)	7 (11.1)
Use CR	42 (64.6)	23 (36.5)
Total	65	63	128

Variables	Availability of CR, n (%)	Odds Ratio with 95%CI	P value	Adjusted Odds Ratio with 95%CI	P value
Gender
Male	77 (13.5)	Ref.		Ref.
Female	51 (18.3)	1.44 (0.98-2.12)	0.065	1.2 (0.7-2.04)	0.511
Educational status
Intermediate & below	37 (9.9)	Ref.		Ref.
Graduate & above	91 (19.1)	2.14 (1.42-3.22)	<0.001	1.24 (0.26-5.95)	0.785
Possess a valid driving license
Yes	105 (16.2)	1.49 (0.92-2.41)	0.104	2.05 (1-4.18)	0.050
No	23 (11.5)	Ref.		Ref.
Type of user
AKU	65 (30.7)	4.02 (2.72-5.95)	<0.001	4.20 (2.43-7.26)	<0.001
General	63 (9.9)	Ref.		Ref.
Frequency of Driving with family
≤1/week	37 (12.1)	Ref.		Ref.
>1/week	66 (15.8)	1.37 (0.89-2.11)	0.155	1.49 (0.79-2.83)	0.219
Daily	25 (20.3)	1.86 (1.06-3.25)	0.029	1.51 (0.7-3.26)	0.298
Using highway
Not at all	76 (14.0)	Ref.		Ref.
Often/most of the time	52 (17.0)	1.26 (0.86-1.84)	0.246	1.83 (1.09-3.07)	0.023
Used sticker "child on board"
Yes	9 (36.0)	2.27 (0.97-5.33)	0.054	2.46 (1.0-6.10)	0.051
No	79 (19.8)	Ref.		Ref.