Assessing the impact of road safety agencies and health systems in traffic outcomes across 146 countries, 1994-2012.

BACKGROUND: Road safety policies (RSPs) have emerged worldwide. Yet, while an important group of RSPs have been regarded as necessary to reduce traffic crashes and their consequences, the impact of others remain inconclusive. To advance knowledge on this debate, this article focuses on the potential effects of two RSPs: i) road safety agencies (RSAs) and ii) health systems (HS). METHODS AND DATA SOURCES: Cross-sectional longitudinal data corresponding to 146 countries from 1994 to 2012 are analyzed using regression models to account for the endogeneity of RSA formation, including instrumental variable and fixed effects designs. A global dataset compiling information from multiple sources, including the World Bank, and the World Health Organization is built. RESULTS: RSAs are associated with a decrease of traffic injuries in the long-term. This trend is observed in Organisation for Economic Co-operation and Development (OECD) countries only. Potential data reporting differences between countries could not be accounted for, and therefore it is unclear whether the observation for non-OECD countries is due to an actual difference or due to these reporting differences. HSs decrease traffic fatalities by 5% (95% Confidence interval (CI) 3% to 7%). Across (OECD) countries, HS is not associated with traffic injury variation. CONCLUSION: While some authors have theorised that RSA institutions may fail to reduce either traffic injuries or fatalities, our work however captured a long-term effect in RSAs performance when targeting traffic injury outcomes. That well-developed HSs have been effective in decreasing traffic fatalities, and ineffective in decreasing injuries, is consistent with the overall function that this type of policies fulfils. Results call for revisiting the specific mechanisms which explain why RSAs and HSs seem effective in decreasing different traffic outcomes.

Associations between household air pollution and early child development among children aged 36-59 months in Bangladesh.

BACKGROUND: Household air pollution (HAP) from solid fuel use (SFU) for cooking may impact child health in low-resources countries. This study examined the associations between HAP and early childhood development (ECD) outcomes among children under 5 years of age in Bangladesh and explored potential effect modification by sex and urbanicity. METHODS: The study sample consisted of 9395 children aged 36-59 months in the households from the Bangladesh Multiple Indicator Cluster Survey 2019. SFU and levels of exposure to SFU (unexposed, moderately exposed and highly exposed) were used as proxies of HAP exposure. We estimated the covariate-adjusted prevalence ratios (aPRs) and 95% CIs for the associations between HAP and ECD outcomes using multilevel mixed-effects Poisson regression models with a robust variance estimator. RESULTS: 81.4% of children were exposed to SFU, and the prevalence of developmental delay (in Early Childhood Development Index) was 25.3%. Children exposed to SFU were 1.47 times more likely to have developmental delays (95% CI: 1.25, 1.73; p<0.001) compared with children with no SFU exposure. SFU was significantly associated with developmental delay in socioemotional (aPR: 1.17; 95% CI: 1.01, 1.36; p=0.035) and learning-cognitive (aPR: 1.90; 95% CI: 1.39, 2.60; p<0.001) domains. Similarly, children moderately exposed and highly exposed to HAP had higher prevalence of developmental delays than unexposed children. We did not observe effect modification by sex or urbanicity. CONCLUSION: Public health policies should promote the use of clean cooking fuels and cookstoves to reduce the high burden of HAP exposure in low-resource countries for helping younger children to meet their developmental milestones.

Impact of child restraint policies on child occupant fatalities and injuries in Chile and its regions: An interrupted time-series study.

OBJECTIVES: We assessed the effectiveness of the child restraint legislation (CRL) introduced in Chile in December 2005 and the National Decree enacted in February 2007, which regulated the technical characteristics of child restraint devices with the goal of reducing child occupant fatalities and severe injuries nationally and within Chile's regions. METHODS: An interrupted time-series design was used to measure the effect of CRL and the National Decree on two dependent variables-number of child occupant deaths in traffic collisions and number of child occupants severely injured in traffic collisions per vehicle fleet from 2002 to 2014 (police data). Our analyses compared the incidence of these outcomes in the post-intervention period (2006 to 2014) with the period prior to these interventions (2002-2005) nationally and by region, controlling for several confounders. RESULTS: Nationally, the child restraint policies were associated with a 39.3% (95% CI: 4.7; 73.9) reduction in child occupant fatalities, but no significant decrease was observed in child severe injuries. These interventions were associated with a 75.3% (95% CI: 15.6; 135.1) reduction in the rate of child occupant fatalities in the southern regions, and a 32.9% (95% CI: 1.1; 67.0) reduction in the rate of children severely injured in the northern regions. CONCLUSION: In the short term, the CRL and the National Decree were associated with fewer child occupant fatalities, at the national level and in the southern regions, and severely injured child occupants in traffic collisions in Chile's northern regions. These results demonstrate a limited temporal and territorial impact. This suggests that to effectively protect vulnerable populations across all territories, efforts should be expanded more consistently and sustained over time.