Author: editor

Experts worldwide have said that child injuries are becoming a major public health issue that requires immediate attention. According to the World Health Organisation (WHO), in the developing and developed countries, traffic accidents involving children has become a serious epidemic problem. Road traffic accidents are now becoming more common with the advent of more vehicles on the roads. Like many other developing nations, Malaysia which has a fast-growing economy which makes private vehicles affordable for the majority of its people. As a result of these vehicles being on the road, Malaysia has a high rate of accidents for motor vehicles where these accidents are a common cause of disability and deaths. In an event of an accident, unrestrained children are more likely to be fatally injured compared to children who are correctly using appropriate child restraints. 

In certain Asian nations, children on motorcycles account for all child road traffic fatalities where motorcycle accidents are the main cause of fatality among teenagers. Accidents are in fact the manifestation of choices made by the parents, surrounding family, adults in charge and society at large which in turn determines the risk of injuries exposure of the children. Between 1999 to 2002, road traffic accidents are the main reason for more than half of the accidental injury instances admitted to Government hospitals in Malaysia. Male children and teenagers (ages 12 to 19) form the highest proportion of fatalities.

Children do not show the same signs or patterns of injuries to an adult due to the developing anatomical and physiological feature. Children with developing bodies have elastic type bodies where quick deceleration and acceleration of energy will be transferred causing internal energies without exhibition significant external signs. When a child is involved or injured in a road traffic accident, the child could end up mentally impaired with post-traumatic disorder. A child could also end up with profound psychological effects if the child ends up orphaned due to the accident. 

According to the World Health Organisation (WHO), child injuries and fatalities in road traffic accidents is becoming a major problem in the world. Malaysian accident data have shown a consistent pattern of motorcycle fatalities in children from the ages of 1 to 18 years. For the age group of 1 to 6 and 7 to 12 years, 88% fatality that occurred were the pillion riders.  Previous studies have shown that during road traffic accidents, compared to female children, there are twice the number of male children fatalities. The majority of these fatalities in childhood traffic injuries are attributable to trauma to the head and hence head injuries are important areas of research to look for ways to further protect the vulnerable heads of these children.

Motorcycles are a less safe mode of transport compared to other types of vehicles. Compared to every vehicle mile traveled motorcycle riders and their pillions have a higher chance of 34 times of dying in an accident compared to people in other different categories of vehicles. Motorcyclists are also eight times more likely to get injured. These high risks were associated with lack of protection afforded by motorcycles, the younger age of riders and poor visibility afforded by motorcycles and vehicles of the other road users. There are a lot of risk factors connected to childhood accidents. The risks are ecological factors, biological and psycho-social. These factors often work together which increases the risk of the accidents happens.

A very cost effective public health strategy is injury prevention. The prevention of injuries has been recognised as an important constituent in the approach of trauma in developed countries. The injuries preventable mechanisms in place are almost similar between the developing and developed countries. For motorcyclists, helmets are most important form of protection currently available as correct helmet usage reduces the incidence and severity of head injuries among motorcycle riders and pillion compared to non-helmeted riders. The helmet legislation and laws were formalised in order to prevent head injuries and the resultant death of motorcyclists. The resulting increased usage of helmets has managed to lessen the possibility of death, head injuries and the resulting medical cost. Other than head injuries, non-usage of helmet could also result in facial injuries and high-severity facial fractures. Other than the usage of helmets, protective clothing, protective boots, crash bars could also provide additional protection to motorcycle riders. 

On higher end and more expensive motorcycles, motorcycle airbags, back and leg protectors are also available. Protective clothing can reduce the risk of soft tissue injuries. Boots can provide protection against foot and ankle injuries. Crash bars protect the lower legs from side impacts.

While riding pillion on motorcycles, children can be susceptible to is exhaust system contact burns injuries. This is another area where there is a lack of data in Malaysia. Even though these burns only could be small, they were usually severe and possibly require surgery. Children with exhaust systems contact burns could be associated with considerable morbidity. Young children are in the high-risk group for exhaust burns due to their thinner skin which will burn more deeply at lower temperatures. Children are disproportionately affected by exhaust burns due to their small size, exposed limbs and thin dermis predispose them to these sort of injuries.

In order to reduce or prevent childhood morbidity and mortality road traffic accidents, child restraint systems were designed with the sole purpose of protecting and preventing and reducing childhood morbidity and mortality in traffic accidents.  and implemented in many countries. Different nations have different legislation mandating the usage of child restraint systems. There are many child restraint systems in the market currently. Among them are baby restraints (baby capsules) for new babies, car seat restraints for slightly older babies and kindergarten children, booster seat for preschool and early school going children and child safety harnesses. 

In other countries, legislations are in place mandating the use of child restraint systems. For instance, 90% of children below 5 years old in New Zealand currently use child restraint systems. It has been proven time and again that the children below 10 years old, will have to be restrained in an approved child restraints as the adult seatbelt will not be able to provide adequate protection and these adult seat belts could even inflict injuries on to the child if it is not properly aligned. Previous studies have shown the effectiveness of child restraintsbeing quite impressive. A study conducted in the USA for children restrained in a child seat compared to children using adult seat belts found when that there was a 60% reduction of risk of injury and 70% reduction in risk of head injury. The overall finding was that when the children were correctly restrained in the back/rear seat, the injuries sustained by the children were minor in nature.  Currently in Malaysia, there are no laws mandating the use of child safety seat. Child safety seat have been proven time and again as an effective tool in lowering the morbidity and mortality of child motor vehicle users. When used correctly, child safety seats have been shown to reduce the risk of death of children aged between 2 to 6 years by 28%. In order to prevent road traffic deaths among cars drivers and motorcyclists, seats belts and helmets had a profound effect in reducing the fatalities. The seat belt laws in Malaysia has been in place since the 1970s. The current seat belt rules requires the seat belt to be used by all the occupants of the vehicle.

Another solution could be the legislation of new laws. Legislation can help in ensuring that responsibilities are assigned for the safety of children on the road.  Enforcement of the law and legislation is very important as various countries have shown that correct implementation of the law not only reduces the number of fatalities and injuries from head trauma but it also increases the usage of motorcycle helmets. Parents, supervising adults, vehicle manufacturers, vehicle owners and even the government can be liable for the safety of children in vehicles where the well-being of children should be the utmost importance to ensure they are always safe on the roads. Another possible solution is to ensure that all motorcycle riders are properly licensed to ride the correct levels of motorcycle. Studies have shown that correctly and properly licensed motorcyclists tend to less likely involved in accidents compared to unlicensed motorcyclists. Similarly, previous studies have shown that effective rider education for reducing crashes and accidents have helped trained riders in having fewer and less severe crashes.

There have been a number of other measures undertaken to enhance the safety of children on the road. Public education on the need to ensure the safety of children in vehicles can be helpful in the short term as it is a relatively cheap measure to reach a large number of people in a short space of time. Among the measures that can be undertaken are advertisements in the newspaper, television, and radio and on social websites that a frequented by people. However, it be difficult the gauge the effectiveness of the adverts as there will be little opportunity for follow-up to see the effectiveness.

It is not the sole responsibility of teachers or parents to ensure the prevention of injuries in children. Interventions have to be started from the highest level of the policy makers and have to be translated all the way

to the private and civil sector. The joint UNICEF-WHO ‘World Report on Child Injury Prevention’ report recommends a wide range approach in tackling child injury prevention.

The report among other things recommends that governments are responsible for enacting and implementing multipronged strategies for child injury prevention. Most importantly though, the joint report also recommends product modification to better enable child safety and injury prevention. The United Nations declared the 2011–2020 decade as the ‘Decade of Action for Road Safety’ where the goal of the decade is to stabilise and then reduce global road fatalities by increasing national, regional and global activities. The steps being undertaken by various government agencies together with the new inventions and interventions for child road vehicle users in Malaysia can help achieve this United Nations vision.

Accidental injuries are the number one cause of disability and death among children. Motorcycle riders and vehicle drivers are influential in ensuring the safety of children in vehicles. In the Malaysian context, mandatory laws and educational programs addressing the proper and correct usage of child safety restraints could strongly influence its utilization by the drivers in Malaysia. Any legislation efforts or awareness should be thoroughly evaluated to make sure that they most effective in achieving the desired outcomes.

There is a pressing need to educate parents and adults on the urgent undertaking of child safety whilst going in vehicles on Malaysian roads. Children should be taught continuously from a young age on safety and the perils going in cars and whilst riding motorcycles as pillion. There is a pressing need to educate parents and adults alike on the urgent undertaking of child safety whilst in vehicles. A possible review of the Malaysian law pertaining suitability of children riding pillion with a set age limit of should be carried out for the benefit of this vulnerable group.  Another review should be undertaken with a view of mandating the use of child seats whilst ensuring the child seats are affordable to the masses. 

The usage of child safety systems can be potential tool for mitigating the ever increasing number of child road traffic accidents with the appropriate support utilising educational, research and legislative efforts. There is an urgent need to better protect our children while they are travelling in vehicles (motorcycles and cars included) on roads in Malaysia. Engineering countermeasures should be implemented to create a safer and more ‘crashworthy’ travel environment for child pillion riders. The creation and introduction of the correct type of protection systems, regulations and standards will go a long way towards realizing the vision for a safer traveling environment for the children in Malaysia. 

For motorcycles, a device capable of providing some sort of protection to the child whilst riding pillion should be designed and developed.  For vehicles, a possible enhancement to the existing car child restraint seat could be made to ensure that it is affordable for the masses while still providing the same sort of protection as a regular child restraint seat.  The safety of children in vehicles on Malaysian roads need to be urgently looked into and improved upon.

S. Sivasankar; K. Karmegam; M. T. Shamsul Bahri
Department of Environmental & Occupational Health
Faculty of Medicine and Health Science
43400 Universiti Putra Malaysia (UPM),
Serdang, Selangor, Malaysia.