Rev. bras. ortop. vol.49 número4

w w w . r b o . o r g . b r

Original

Article

Correct

use

of

safety

belts

and

child

restraint

devices

in

cars

among

children

in

Goiânia

夽

,

夽夽

Roberto

Medeiros

de

Sousa,

Pedro

Felisbino

Júnior,

Felipe

de

Moura

Braga,

Sílvio

Dias

da

Costa

Neto,

Felipe

Marques

Belo,

Sandro

da

Silva

Reginaldo,

Frederico

Barra

de

Moraes

SchoolofMedicine,UniversidadeFederaldeGoiás,Goiânia,GO,Brazil

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e

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n

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o

Articlehistory:

Received23April2013 Accepted10September2013 Availableonline25April2014

Keywords:

Trafficaccidents Children

Accidentprevention Childprotectionsystems Physicalrestraint

a

b

s

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t

Objective:toconductanobservationalstudy,bymeansofcampaigns,regardingtheuseof childrestraintdevicesincarsinGoiânia.

Methods:thiswasa cross-sectionalstudyusinga conveniencesamplebuiltupascases arose.ThedataweregatheredintoanExcelspreadsheetandwereanalyzeddescriptively andstatistically(SPSS16.0),usingchi-squareandtakingp<0.05assignificant.

Results:in2006,410carswereevaluated,andin2010,544carswereevaluated.Around85% oftheoccupantswereusingseatbeltscorrectlyatbothtimes(p=0.650).In2006,itwas observedthatatotalof273passengerswereoccupyingtherearseats,whilein2010there were226.Amongthese,178and170wereusingseatbelts,respectively,i.e.65.2%and75.22% (p=0.001).In2006,fivechildrenwereoccupyingthefrontseatwithoutusingtheseatbelt, whilein2010,thisnumberwas42(p<0.001).In2010,itwasobservedthat458vehicleswere transportingchildrenontherearseats,andthiswasbeingdonecorrectlyin214vehicles, i.e.46.72%.In2006,ofthe410vehiclesanalyzed,only90ofthem(21.95%)weretransporting childrencorrectly(p<0.001).Inaddition,therewasadifferenceinthevariableswithinthe yearevaluated,inwhichtransportationdonecorrectlyinthefrontseatwasmuchmore frequentthantransportationdonecorrectlyintherearseats,inbothyears(p<0.001).Cars transportedonetofourchildren,whilevanstransportedonetoninechildren.In2006,one vantransportingchildrenirregularlywasobserved,whilein2010itwasdonecorrectlyin allcases.

Conclusion:comparingthesetwoyears(2006and2010)inwhichdataweregathered,we canconcludethatchangesinbehavioramongdriversinGoiâniahavebegun,withregard tosafetywhentransportingchildreninvehicles,withanimprovementof25%(p<0.001). Alargepartofthishascomethroughchangesinknowledgeamongthissegmentofthe population,throughcampaignsthathavebeencarriedout,includingthroughthemedia, andbecauseoflegalobligations.

©2014SociedadeBrasileiradeOrtopediaeTraumatologia.PublishedbyElsevierEditora Ltda.Allrightsreserved.

夽_{Pleasecitethisarticleas:deSousaRM,FelisbinoJúniorP,BragaFM,daCostaNetoSD,BeloFM,ReginaldoSS,etal.Usocorretodo}

cintodeseguranc¸aedosdispositivosderestric¸ãoinfantilemautomóveisdeGoiânia.RevBrasOrtop.2014;49:340–344.

夽夽_{WorkperformedintheDepartmentofOrthopedicsandTraumatology,HospitaldasClínicas,UniversidadeFederaldeGoiás,Goiânia,}

GO,Brazil. ∗

Correspondingauthor.

E-mail:[email protected](F.B.deMoraes).

Uso

correto

do

cinto

de

seguranc¸a

e

dos

dispositivos

de

restric¸ão

infantil

em

automóveis

de

Goiânia

Palavras-chave:

Acidentesdetrânsito Crianc¸as

Prevenc¸ãodeacidentes Sistemasdeprotec¸ãopara crianc¸as

Restric¸ãofísica

r

e

s

u

m

o

Objetivo: fazerumestudoobservacional,pormeiodecampanhas,sobreousodos disposi-tivosderestric¸ãoinfantilemautomóveisdeGoiânia.

Métodos: estudotransversalporamostradeconveniênciaconformesurgimentodoscasos. OsdadosforamcoletadosemumatabelaExcel,analisadosdeformadescritivaeestatística (SPSS16.0),comousodoqui-quadrado,comp<0,05comosignificativo.

Resultados: em2006,foramavaliados410automóveis,enquantoqueem2010foram avali-ados544,nosquaiscercade85%daspessoasusavamocintodeformacorretanosdois períodos(p=0,650).Em2006,foramobservados273passageirosnobancodianteiroeem 2010,226.Usavamcintodeseguranc¸a178e170,respectivamente,ou65,2e75,22%(p=0,001). Em2006,cincocrianc¸asocupavamobancodafrentesemousodocintodeseguranc¸a. Em2010,essenúmerofoide42(p<0,001).Em2010,foramobservados458veículosque transportavamcrianc¸asnobancotraseiro,214demaneiracorreta,ou46,72%.Em2006, dos410veículosanalisados,apenas90(21,95%)transportavamcrianc¸asdemaneira cor-reta(p<0,001).Alémdisso,houvediferenc¸aentreasvariáveisdentrodoanoavaliado,no qualotransportecorretonobancodafrentefoibemmaisfrequentedoqueonobancode trás,nosdoisanos(p<0,001).Carrostransportavamdeumaaquatrocrianc¸aseasvans,de umaanovecrianc¸as.Em2006foiobservadaumavanquetransportavacrianc¸asdemaneira irregular,enquantoqueem2010todasestavamcorretas.

Conclusão: nacomparac¸ãodessesdoisperíodos,podemosavaliarquehouveuminíciode mudanc¸anocomportamentodomotoristagoianiensenoquetangeàseguranc¸ano trans-portede crianc¸asem automóveis,commelhoriade25%(p<0,001).Grandepartedisso decorreudamudanc¸adeatitudedapopulac¸ãoapósascampanhasfeitas,atépelamídia,e daobrigatoriedadedalei.

©2014SociedadeBrasileiradeOrtopediaeTraumatologia.PublicadoporElsevier EditoraLtda.Todososdireitosreservados.

Introduction

Accordingtothe National TrafficDepartment(DENATRAN), trafficaccidentsarethemaincauseofdeathsamongchildren agedonetofourteenyearsinBrazil.In2008,22,472casesof injuriesamongchildrenuptothe ageof12years,and802 deathsin the same age group, were recorded.1 _TheWorld

HealthOrganization(WHO)hasestimatedthatin2015traffic accidentswillbethe maincauseofmorbidityand mortal-ityamongchildren.This situationgenerates highcosts for thehealthcaresystem,especiallyfordevelopingcountries.2

Accordingtothemortalityinformationsystem(SIM)of DATA-SUS(InformaticsDepartmentoftheNationalHealthSystem, SUS),therewere5309deathsduetoexternalcauses(asthe maincauseofdeath)intheagegroupfromonetofourteen yearsin2010, thusrepresenting 31.5%ofthe totalforthat year.3

With the aim of diminishing these high accident rates amongtheyoungestagegroups,campaignshavebeen con-ducted overrecent years.Special attentionhas been given tothe use of child restraint devices (CRDs) invehicles. In Brazil,inconformitywithwhathasalreadybecomethe real-ity in other countries, a law regulating the use of these CRDswascreated.Resolutionno.277oftheNationalTraffic Council(CONTRAN),ofMay28,2008,4_{establishedminimum}

safetyconditionsfortransportingpassengersundertheage

of10 years in vehiclesand clarified the use ofCRDs. This law cameinto force inits year ofpublication, onan edu-cationalbasis,andcompliancebecameobligatoryfrom2010 onwards.

CRDsarepopularlyknownas“childseats”and,according totheCONTRANresolution,theyinclude“babycomfortseats” or“convertibleseats”,whichareuseduptotheageofoneyear, “childseats”fortheagesofonetofouryears,“boosterseats” fortheagesoffourtosevenandahalfyears,andfinally,the vehicle’sownseatbeltforchildrenovertheageofsevenanda halfyears.4_{Theaimofthisstudywastoconductobservations,}

throughcampaigns,regardingCRDuseincarsinthecityof Goiânia.

Material

and

methods

StudentTraumaAssociationoftheSchoolofMedicine,Federal UniversityofGoiás.

AnewcampaignwasconductedinMay2010,inexactlythe sameformatatthefirstsurvey.Itsaimwastoassesswhether, afterthelawbecameanobligationandsafetyconceptshad beenintroducedthrougheducational campaignson correct andnecessaryuseofCRDs,therehadbeenany changesin behavioramongdriversinGoiânia.

ThedataweregatheredandstoredinanExcel2007 spread-sheet,andwereanalyzeddescriptivelyandbymeansofthe SPSSsoftware,version 16.0,using thechi-squarestatistical test.Differenceswithp≤0.05wereconsideredtobe

signifi-cant.

Results

In2006,410carswereassessedandin2010,544.Therewasno significantdifferenceregardingthedrivers’useofseatbelts (p=0.650).Around85%wereusingtheseatbeltcorrectlyon bothoccasions(Fig.1).

In2006,therewere273front-seatpassengersandin2010, 226.Ofthese,178and170,respectively,wereusingtheseat belt,i.e.65.2and75.22%(Fig.2).Thisdifferencewassignificant (p=0.001).Itisimportanttohighlightthatin2006,fivechildren wereusingthefrontseatwithoutusingtheseatbelt,whilein 2010,42weredoingso(p<0.001).

In2010,458vehicleswereseentobetransportingchildren ontherearseats,ofwhich214weredoingthiscorrectly,i.e. 46.72%.In2006,ofthe410vehiclesanalyzed,only90(21.95%) weretransportingchildrencorrectly(Fig.3).Thisimprovement wassignificant(p<0.001).Inaddition,therewasadifference betweenthevariableswithintheyearevaluatedsuchthat cor-recttransportationonthefrontseatwasmuchmorefrequent thanontherearseats,inbothyears(p<0.001).

Amongthesevehicles,carstransportedonetofour chil-dren and vans, one to nine children. In 2006, one van transportingchildreninanirregularmannerwasobserved, whilein2010,allofthemwerecorrectlylicensed(Fig.4).There wasnosignificantdifference.

350 (85.36%)

470 (86.4%)

60 (14.63%) 74 (13.6%)

0 50 100 150 200 250 300 350 400 450 500

2006 (410) 2010 (544)

Correct Incorrect

Fig.1–Driverswhousedseatbeltsinthetwoevaluations in2006and2010,withoutanysignificantchange.

178 (65.2%)

170 (75.22%)

89 (34.8%)

56 (24.78%)

0 20 40 60 80 100 120 140 160 180 200

0 1 0 2 )

3 7 2 ( 6 0 0

2 (226)

Correct Incorrect

Fig.2–Front-seatpassengerswhousedseatbelts,witha significantimprovement(p=0.001).

90 (21.95%)

214 (46.72%) 320 (78.05%)

244 (53.27%)

0 50 100 150 200 250 300 350

2006 (410) 2010 (458)

Correct Incorrect

Fig.3–Childrenintherearseatofthecarusingabeltor CRDcorrectly.

394

530

16 14

0 100 200 300 400 500 600

0 1 0 2 6

0 0 2

Cars School vans

Fig.4–Typesofvehicleanalyzed.

Discussion

Fig.5–Informationcampaignamongthepopulation,at schoolgates,withtrafficagents,whonotedandgave adviceregardingthecorrectuseofCRDsandseatbelts.

2011–2020astheDecadeofActionforRoadSafety,withthe aimofavoiding increasesand then achieving decreases in thenumbersofdeathsintrafficaccidentsaroundtheworld. AccordingtoWHO,1.3millionpeopledieeveryyearintraffic accidents,i.e.morethan3000perday,and90%oftheminpoor ordevelopingcountries. Morethan30millionpeoplesuffer injuriesandhavesequelaeandincreasedexpenditureon recu-perationeveryyear,whichmayreach3%ofthesecountries’ grossdomesticproduct(GDP).2

Correctuseofseatbeltsdecreasestheriskofdeathincases ofcaraccidentsbyupto40%.5,6_{However,thisdoesnot}

ade-quatelypreventinjuriesamongchildrenundertheageof10 years,whosufferabdominalandhighthoracicinjuriescaused byincorrectpositioningoftheseatbelt,andalsoincreased mortality.7–9

Inothercountries,compulsoryuseofCRDsdatesfromthe 1980s,andtheeffectrelatingtoreductionsindeathsand seri-ousinjuriesisalreadyknown.Thisplacesthesedevicesasthe mostefficientmethodforreducing mortality.Astudy con-ducted inthe stateofNorth Carolina,USA, wherethe law making use of CRDscompulsory datesfrom 1985, showed thattherewasa42%reductionindeathsandseriousinjuries amongchildrenagedfourto15yearsfrom1985to1994,in comparisonwiththefiveyearsjustbeforethelawcameinto force.10

Tomonitortrafficaccidentsrelating tochildren,studies needtobeconductedfrequently, inaddition tocampaigns, sincethe strategies that havean impact on adultsdo not haveasimilareffectamongchildren(Fig.5).Whenchildren areundertheageofsixyears,theydependonadultsusing CRDsintheircarsandmakingthechildrenusethem.After reachingthisage,theybecomecapableoffasteningtheirseat belts alone, but the adult driving the car does notalways set an example and,in such situations,the child remains unprotected.11–13

Studiesontheimpactofusingsafetydevicesonchildren insidecarshaveonlyrecentlybeenconductedinBrazil,inthe samewaythatthelawregulatingthisisrecent.Itisnot pos-sibletocalculatetheimpactthatthesemeasureswillhave onBrazilianpublichealth.Apreliminarystudyconductedby

theInstituteofAppliedEconomicResearch(IPEA)showedthat therewasa23%reductionintheabsolutenumberofdeaths, comparingthefirstyearinwhichthelawwasinforcewith pre-viousyears.However,itwasemphasizedthatthelawwould needtobeinforceforalongerperiod,withgreatermonitoring ofcompliance,fordataofgreatersignificancetobeobtained inthefuture.14

Foroursurvey,westartedfromtheideathatdriverswho were awareofthe potentialrisksthat theirpassengersrun would takesafety measurestominimize theserisks. How-ever,large-scalemeasurescanonlybeimplementedifthere areeducationalcampaignsandlawsinthisregard.Theeffects thatseatbeltuseprovides,withregardtopreventionoffatal injuriesorevenimportantsequelae,havelongbeenknown.In oursurvey,onbothoccasions,thereseemedtobehighratesof seatbeltuseamongdrivers(85%in2006and86%in2010)and amongfront-seatpassengers(65%in2006and75%in2010). Nonetheless,eventhoughthesenumbersmaydemonstrate thatthepopulationisawareoftheimportanceofusingseat belts,theyarenotidealandarereflectedinthedegreeof con-cernthattheseparentshaveregardingtransportationoftheir childrenandwhethertheyadheretousingCRDs.

In2006,weobservedthecorrectuseofCRDsinonly90of the410vehiclesanalyzed,andin2010,in214ofthe458 vehi-clesthatweretransportingchildrenontherearseats.This showedthattherehadbeenanincreaseinCRDuseof25.3%. However,westillobservedthat132childrenwerebeing trans-portedonthefrontseatand42withoutusingtheseatbelt. Inrelationtoschooltransportvans,wenotedahighconcern forsafety,evenbeforetheadventofthelawandthe educa-tionalcampaigns.Asimilarchangeoccurreddecadesearlier withtheapplicationofseatbeltuseamongdriversand pas-sengers,withcampaignsinthemediathatarenowknownby thepopulation.Untilthen,muchhadbeensaidaboutseatbelt useandlittleabouttheimportanceofCRDs.

WetaketheviewthattheadherencetoCRDusewillbe high,partlybecause ofthecompulsionofthelaw.Evenso, therewillalwaysbetheneedforeducationalcampaigns,given that thesedevices arenotan integralpartofvehicles, like seatbelts,andtheyplaceanadditionalfinancialburdenon thepopulation.Theimpactrelatingtoreductionofmorbidity andmortalityisdirectlyproportionaltothe adherencerate andawarenessofthebenefitofusingCRDs.Evidenceforthis, intheBraziliancontext,willhavetoawaitalongertimeof applicationofthesedevices.

hospital,emergencyservices,operatingtheaters,orthopedists andrehabilitationcenterstocareforsomanyinjuries.Brazil isallowingagenerationofvictimswithsequelaefromtraffic violencetoappearandourfutureasadevelopednationmay becompromised.

Conclusion

Incomparingthetwoperiods(2006and2010)duringwhich dataweregathered,wecanmaketheassessmentthatthere werethebeginningsofchangesinthebehaviorofdriversin Goiânia,withregardtosafetyintransportingchildreninside cars,withanimprovementof25%(p<0.001).Alargepartof thiswasduetochangesinthepopulation’sknowledge, com-ingfromthecampaignsconducted,includinginthemedia, andbecauseoftheobligatorynatureofthelaw.Webelieve thatgreatermonitoringoftrafficbytheauthorities,alongwith bettereducationandexplanationsforthepopulationthrough campaigns,mayfurtherimprovetheratesofuseofCRDsand seatbelts.

Conflicts

of

interest

Theauthorsdeclarenoconflictsofinterest.

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