Marion Sinclair

Patterns of seatbelt use in different socioeconomic communities in the Cape Town Metropole, South Africa

UNLABELLED BACKGROUND; Road traffic injuries are a leading cause of death and may be related to social inequality. OBJECTIVE To establish whether patterns of seatbelt use vary between different socioeconomic communities in the Cape Town Metropole, South Africa. METHODS Vehicles and their occupants at 7 high-volume crossings (3 in high-income areas) were placed under surveillance for 2 hours each during November 2010. All occupants were eligible for inclusion except occupants of non-motorised vehicles, two-wheel motorised vehicles, buses, taxis, heavy goods vehicles and emergency vehicles. Child seatbelt use was recorded only for children who appeared older than 3 years. RESULTS A total of 4 651 vehicles with 6 848 occupants were surveyed. Rates of seatbelt use were 45.1% (n=3 090) for all occupants, 54.0% (n=2 513) for drivers, 33.1% (n=521) for front-seat passengers (adults 33.2%, n=452; children 32.7%, n=69) and 9.0% (n=56) for rear-seat passengers (adults 4.0%, n=13; children 14.4%, n=43). Occupants from high-income areas were more likely to wear seatbelts (odds ratio (OR) 4.35; 95% confidence interval (CI) 3.89 - 4.88). Use of child restraints was poor overall (22.3%, n=114), but also varied according to income areas (high income 40.9%, n=99; low income 0.03%, n=6; OR 26.77; 95% CI 11.44 - 62.63). DISCUSSION The impact of road traffic injuries is significant, but can be decreased by using appropriate restraining devices. Seatbelt use in South Africa, although compulsory, is neither strictly adhered to nor enforced. Their use is proportionally lower in lower-income areas. Specific interventions are required to target these communities directly.

Interventions to promote the use of seat belts

At a time in the world’s history when many of the health concerns of the past are showing some indication of improvement, traffic related health concerns are growing. Over 1.2 million people die each year as a result of traffic collisions and hundreds of thousands of others are permanently and seriously injured (WHO 2009). In 2002, road-traffic injuries ranked as the tenth leading cause of death in the world (WHO 2001). In 2004 that ranking rose to seventh, and it is expected that by 2030 road injuries will rank as the fifth leading cause of death (WHO 2009). The developing world bears the brunt of these injuries, over 90% of fatalities occur in low- and middle-income countries, where death rates can be up to twelve or thirteen times higher than in highincome countries (WHO 2009). Apart from the personal losses that these figures represent what is also clear is that these levels of injury represent huge cost burdens to countries with already limited resources (Nordberg 2000; Olukoga 2004; Chandran 2010; Juillard 2010; Mashreky 2010; Bhatti 2011). Work is needed to reduce the number of collisions that occur - through improved functionality of roads, vehicles and drivers themselves. Concurrently, we need to find cost-effective ways of reducing the severity of injuries sustained in the collisions that do occur (WHO 2004).