Child with Road traffi c injuries

Introduction
In many places the road network is constructed without
considering children. Children, though, use the roads as
pedestrians, bicyclists, motorcyclists and occupants of
vehicles. Th ey may live close to a road, play on a road, or
even work on the roads. All these interactions with roads,
together with a range of other risk factors associated with
childhood, increase the susceptibility of children to road
traffi c injury.
Th is chapter examines the extent and characteristics of
road traffi c injuries for diff erent types of road users among
children aged 0–17 years, as well as their risk factors.
Proven and promising interventions, for the diff erent types
of road user, are discussed, along with their eff ectiveness
and cost-eff ectiveness. Th e chapter concludes with some
recommendations for preventing the growing toll of road
traffi c injury.
For the purpose of this report, a road traffi c crash is
defi ned as “a collision or incident that may or may not lead
to injury, occurring on a public road and involving at least
one moving vehicle”. Road traffi c injuries are defi ned as
“fatal or non-fatal injuries incurred as a result of a road
traffi c crash” (1). Although other defi nitions exist, a road
traffi c fatality is considered to be a death occurring within
30 days of a road traffi c crash (2).
Th is chapter focuses on children aged 0–17 years.
Comprehensive data, however, are not always available
across the whole age range. In particular, information is
oft en limited for children aged between 15 and 17 years.
Th ere are also problems of under-reporting of road traffi c
deaths and injuries, particularly in low-income and
middle-income countries, limitations that need to be
taken into account when interpreting the data.
Th e road is a dangerous place for children and young
people. However, road traffi c injuries do not have to be
the price children and their families pay for the increasing
mobility and independence of children as they grow up.
Th ere are proven and eff ective measures that can be put
into place to reduce their risks to a minimum.


Epidemiology of road traffi c injuries
According to the WHO Global Burden of Disease project,
in 2004 nearly 1.3 million people of all ages were killed in
road traffi c crashes around the world and up to 50 million
more were injured or disabled. Th e South-East Asia and
the Western Pacifi c Regions of WHO together accounted
for two thirds of all road traffi c deaths. However, the
highest rates of road traffi c death were in the African and
Eastern Mediterranean Regions. Globally, 21% of road
traffi c deaths were among children.
Th ere have been downward trends in the numbers of
road traffi c deaths and injuries over the last couple of
decades in several developed countries. Globally, though,
the outlook is disturbing. By the year 2030, road traffi c
injuries are predicted to be the fi ft h leading cause of death
worldwide (3) and the seventh leading cause of disabilityadjusted
life years lost (4). Th e South-East Asia, African
and Western Pacifi c regions are expected to see the most
signifi cant increases in road traffi c injuries. Of particular
concern is the fact that in India and China – each with
more than a sixth of the world’s population – the number
of road traffi c deaths is predicted to increase, by 2020, by
approximately 147% and 97%, respectively (5).

Mortality
In 2004, road traffi c injuries accounted for approximately
262 000 child deaths among children and youth aged
0–19 years – almost 30% of all injury deaths among
children (see Statistical Annex, Table A.1). Road traffi c
injuries are the leading cause of death among young people
aged 15 to 19 years (see Table 1.1). Globally, these deaths
on the roads account for nearly 2% of all deaths among
children. Th ere are signifi cant geographic variations,
however. In the South-East Asia Region, the proportion
of childhood deaths due to road traffi c injuries is 1.3%,
while in the Americas it is as high as 4.7%. Some 93%
of child road deaths occur in low-income and middleincome
countries (see Statistical Annex, Table A.1). In
2004, the South-East Asia and African Regions and the
low-income and middle-income countries of the Western
Pacifi c Region accounted for two thirds of all road traffi c
deaths among children.
Data shows that globally, the road traffi c death rate
among children is 10.7 per 100 000 population (see
Figure 2.1). In South-East Asia, however, the rate is 7.4
per 100 000 population, while in the African Region it is
19.9 per 100 000 population. Although the mortality rate
is not as high in Europe, road traffi c injuries still account
for around a fi ft h of all childhood injury deaths across the
European Union (6).
In addition to regional diff erences, there are also
variations according to the type of road user. In 70
countries – mainly middle-income and high-income
countries – that provide suffi ciently detailed mortality
data to WHO, about 33% of all child deaths around the
world are pedestrians, while 65% are car occupants or
bicycle or motorcycle riders (7).

Age
Globally, road traffic injuries are the leading cause of
death among 15–19-year-olds and the second leading
cause among 5–14-year-olds (see Table 1.1). Global road
traffic fatality rates increase with age (see Figure 2.2),
reflecting the way children of different ages use the road.
Children up to the age of nine years are more likely to
be accompanied by parents when they travel, either in
vehicles or as pedestrians, while older children tend to
travel more independently, initially as pedestrians and
later as bicyclists, motorcyclists and finally drivers. The
higher rates of injury among children aged 10 years
and over is a result of this increased mobility as well
as of their increased tendency to exhibit risk-taking
behaviours.
For all age groups, except for the 15–19-year age
group, road traffic fatality rates are greater in lowincome
and middle-income countries than they are in
high-income countries.
Surveys in fi ve Asian countries showed that road traffi c
injuries are the second leading cause of child mortality (see
Statistical Annex, Table B.1). In Bangladesh, for instance,
road traffi c injuries were the second most common cause
of injury deaths in children aged 1–9 years, whereas in
children aged 10–14 years they were the leading cause,
accounting for 38% of all child deaths. In those aged 15–
17 years, road traffi c injuries accounted for 14% of injury

Gender
From a young age, boys are more likely to be involved in
road traffi c crashes than girls. Th e diff erence in incidence
rates between boys and girls increases with age until
children reach 18 or 19 years of age, when the gender gapis similar to that seen in adulthood (see Table 2.1). Overall,
the death rate for boys is 13.8 per 100 000 population,
compared to a rate for girls of 7.5 per 100 000 population. In
the high-income countries of the Eastern Mediterranean
Region the gender gap is greatest among young children
while in the regions of Europe, the Western Pacifi c and
the Americas the gap is more pronounced among older
children
Morbidity
Th e number of children injured or disabled each year as
a result of road traffi c crashes is not precisely known, but
has been estimated at around 10 million. Th is fi gure is
based on data from health-care institutions that suggest
that children make up between a fi ft h and a quarter of
those involved in a road traffi c crash and admitted to a
hospital (10 –12). However, community-based surveys
from Asia suggest that the fi gure could be much higher.
Th e surveys found that, for every child who died as a
result of a traffi c injury, 254 presented to a hospital facility
with injuries, four of whom where left with permanent
disabilities (13).
In children under the age of 15 years, road traffi c injures
rank as the eleventh cause of death and the tenth cause of
burden of disease among children (see Statistical Annex,
Table A.2). Globally, road traffi c injuries among this age
group account for 9482 disability-adjusted life years lost –
1.7% of the total disability-adjusted life years lost.
In general, there is a lack of data on morbidity,
particularly from low-income and middle-income
countries. Th is is partly because not all children injured
in road traffi c incidents are taken to hospital and partly as
a result of poor data collection systems.

Nature and severity of road traffi c injuries
Th e head and limbs are the most common parts of the body
injured in children involved in road traffi c crashes. Th e
severity of injuries will vary, depending on the age of the
child, the type of road user and whether protective devices
were used. A recent school-based survey conducted by
WHO looked at 13–15-year-olds in 26 countries. Of those
children reporting an injury involving a motor vehicle in
the previous 12 months, 10% had sustained a minor head
injury and 37% had fractured a limb.Th ese survey results are supported by a hospitalbased
study of injured children under the age of 12 years,
conducted in four low-income countries. Th e study found
that, among those suff ering road traffi c injuries, more
than a quarter had incurred a concussion or other head
injury, followed by various cuts, bruises, open wounds,
fractures and sprains
Source: World child prevention report