Seatbelt and child restraint use in Accra, Ghana: results from multi-round observational studies (2015-2020)

Seatbelt and child restraint use are cost-effective ways of reducing the severity of road traffic injuries among vehicle occupants and children, respectively. The study aimed to determine the prevalence and associated factors of seatbelt and child restraint use in Accra, Ghana, using a multi-round cross-sectional observation design spanning the period 2015 - 2020. Between 6 and 15 sites were randomly selected in areas where traffic slowed down considerably or completely stopped. Nine observational rounds were undertaken during the period with a gap of six months between each round. The overall seatbelt usage was 48.7% (n = 481,585), with a significant difference among drivers' (78.9%, n = 258,996), front-seat passengers' (14.4%, n = 206,578) and rear-seat passengers' use (2.2%, n = 16,011) (p < 0.001). Child seat usage was far lower at 5.9%. The observed driver seatbelt use, passenger seatbelt usage and child seat usage generally declined significantly between August 2015 and November 2020. Both seatbelt and child restraint use were lowest among males, truck vehicles, on weekends and in presence of camera enforcement, among other specific factors. Policy reforms should prohibit young children from occupying front seats and place clear legal responsibility on drivers to secure all passengers.