South Africa has double the world average child road fatality rate, with at least 1 300 children killed every year. A leading contributor to this public health challenge is the lack of safe public transport that enables children to reach schools easily. Minibus Taxis (MBTs), South Africa's incarnation of paratransit services, have aimed to fill this gap by providing transport at a reasonably priced fare and a relatively higher frequency, compared with other modes of public transport. However, the informal nature of MBTs means that this form of transport places passengers at a relatively higher risk of road accidents due to the use of unroadworthy vehicles, reckless driving and speeding. This paper provides an overview of the Safe Travel To School (STTS) programme, which was initiated in 2014 with a view to providing a localised intervention that would potentially strengthen the safety of MBTs for scholar transport in South Africa. The programme aims to provide safer travel for child passengers by monitoring driver performance through a tracking device installed in each vehicle and rewarding good driver performance each quarter. A driver recruited into the programme also undergoes health tests and training that covers first aid, defensive driving and road safety training. The literature review that each of these components improves driver performance. A previous evaluation of the programme found that since inception, drivers in the programme have shown better driving performance than general motorists. Thus, the STTS programme potentially provides an implementable practice model for safe scholar transport that is oriented towards a developing country like South Africa.

The need for stronger child restraint laws To the Editor: Children are vulnerable road users in South Africa (SA), with road traffic crashes being the second leading cause of death for children aged 5-14 years. [1] Two road-user groups, child pedestrians and child passengers, are particularly vulnerable, constituting 62% and 36% of child road fatalities, respectively. [2] Several interventions have been proposed to reduce this preventable burden, including the appropriate use of child restraints. Evidence shows that, when installed correctly, child restraints can reduce the likelihood of a road traffic fatality by between 54% and 80%, depending on the child's age. [3] Two observational studies conducted at Red Cross War Memorial Children's Hospital, Cape Town, in 2008 and 2019 found that a concerning number of children arriving at the hospital by car were not restrained-in an age-appropriate child restraint system or by a seatbelt. [4,5] While the findings in 2008 were expected because SA had no child restraint law at that time, the 2019 results are disappointing because of the 2014 amendment to the road safety law, which requires the use of a child restraint. The amendment to regulation 213, section 6A of National Road Traffic Act No. 93 of 1996 [6] mandates the use of a South African Bureau of Standards-approved child restraint for all child passengers under the age of 3 years and also requires children aged 3 years and older to sit in the rear and use a seatbelt. Child restraint use can be increased significantly by applying a systems approach that includes adequate enforcement of the law. [5] We decided to review the SA Road Traffic Act and associated regulations, to determine whether the existing legislation and associated penalties are comprehensive without any ambiguity or loopholes that might enable road users to escape the consequences of breaking the law. Our review identified three main issues. Firstly, the law remains ambiguous on the type of restraint that should be used for children older than 3 years, and does not comply with international best practice as defined by the United Nations Economic Commission for Europe regulation 44 or the latest version, regulation 129. [7] Furthermore, the SA law in its current state gives no indication as to the best position for a child under the age of 3 to sit in a car with his/her child restraint, i.e. the back seat or the front seat. The bestpractice law categorises restraints suitable for a child up to the age of 12 years based on three factors: age, height and weight. Furthermore, older children who are above the height and weight specification must wear a seatbelt. International law further states that a child must be restrained in the back seat [7] in order to minimise injury during a road crash. Our second finding was that the age specification in the SA law imposes the challenging task of age estimation on law enforcement officials, which results in low restraint use. A study in 2002 found that 87% of observers were able to estimate the age of a child co...

No abstract

Background: Child road traffic injuries are a major global public health problem and the issue is particularly burdensome in middle-income countries such as South Africa where injury death rates are 41 per 100,000 for under 5′s and 24.5 per 100,000 for 5–14-year-old. Despite their known effectiveness in reducing injuries amongst children, the rates of use of child restraint systems (CRS) remains low in South Africa. Little is known about barriers to child restraint use especially in low- and middle-income countries. Methods: We carried out observation studies and parent/carer surveys in 7 suburbs of Cape Town over a three month period to assess usage rates and explore the knowledge and perceptions of parents towards child restraint legislation, ownership and cost; Results: Only 7.8% of child passengers were observed to be properly restrained in a CRS with driver seatbelt use and single child occupancy being associated with higher child restraint use. 92% of survey respondents claimed to have knowledge of current child restraint legislation, however, only 32% of those parents/carers were able to correctly identify the age requirements and penalty. Reasons given for not owning a child seat included high cost and the belief that seatbelts were a suitable alternative. Conclusions: These findings indicate the need for a tighter legislation with an increased fine paired with enhanced enforcement of both adult seatbelt and child restraint use. The provision of low-cost/subsidised CRS or borrowing schemes and targeted social marketing through online fora, well baby clinics, early learning centres would be beneficial in increasing ownership and use of CRS.

No abstract