Identifying contributing factors to fatal and serious injury motorcycle collisions involving children in Malaysia

Abstract

In Malaysia, motorcycle crashes constitute approximately 60 percent of all road trauma, and a substantial proportion involve children 16 years and younger. There are, however, many gaps in our knowledge on contributing factors to crashes and injury patterns amongst children killed and seriously injured in motorcycle crashes. The aim of this study was to examine fatal and serious injury motorcycle-related collisions to identify contributing factors and injury patterns amongst child motorcyclists. All identified motorcyclist fatal crashes between 2007 and 2011 (inclusive) were extracted from the national Police-reported crash database (M-ROADS) and a range of variables were selected for examination. A total of 17,677 crashes were extracted where a rider or pillion was killed and of these crashes 2,038 involved children, equating to 12 percent. Examination of crashes involving children revealed that some crashes involved more than two children on the motorcycle, therefore, overall children constituted 9.5% of fatal and 18.4% of serious injury collisions. A high proportion of child fatal or serious injury collisions involved the child as the rider (62%), and this was most common for children aged between 10 and 16 years. The majority of collisions occurred on rural roads, in speed limit zones of 50–70km/h, and approximately one-third occurred at an intersection. Collisions involving another motorcycle or a passenger vehicle contributed to 41% and 53% of the total fatalities and severe injuries, respectively. A high proportion (43.9%) of the children (25.5% riders and 18.8% pillion) sustained head injuries with 37.7% being in the 10–16 age group. Furthermore, 52.4% of the children sustaining head injuries did not wear a helmet. The implications of these findings for countermeasures within a Safe System framework, particularly interventions aimed at reducing the rate of unlicensed riding and helmet wearing, and infrastructure countermeasures are discussed.

INTRODUCTION

Injuries to children represent a significant global public health concern. Each year, hundreds of thousands of children up to ages 16 to 18 years die from injuries and millions more suffer long-term consequences of non-fatal injuries (World Health Organisation [WHO], 2008a). Indeed, unintentional injuries are one of the leading causes of death, hospitalisation and disability amongst children up to the age of 16 years and traffic-related injuries make up a substantial proportion (22%) of these injuries (WHO, 2008a; Norlen, Wong, Hanis & Iihamah, 2011). Moreover, the evidence suggests that the burden of injury on children is unequal, being heaviest amongst the poor and in developing and middle income countries, compared with more affluent communities and high income countries (WHO, 2008b). Childhood injury represents a significant global concern, accounting for three of the top fifteen causes of death in the 0–4 year age group, and six of the top fifteen causes of death in the 5–14 year age group ([WHO, 2008b).

Roads are dangerous places for children – they are vulnerable, and as their world extends from the home to school and other social activities, children increase their use of the road as pedestrians, bicyclists, motorcyclists and vehicle passengers (WHO), 2008b). Unfortunately, the transport system is rarely designed with the vulnerability of children in mind, thus, children are reported to be ‘at risk’ vulnerable road users. Motorcyclists account for approximately 60 percent of all road fatalities in Malaysia, with vehicle occupants comprising approximately 22 percent of all fatalities (Ministry of Transport, 2006). Child motorcyclists especially are at risk as they lack protection and carry a high risk of injury in the event of a crash. In their examination of road traffic injuries among children, Norlen and his colleagues (2011) noted that child road traffic deaths (children aged 18 years and younger) accounted for approximately 15 percent of all fatalities in Malaysia. They also showed that 49.5 percent of children killed on Malaysian roads were motorcycle riders and 18.1 percent were pillion passengers, and a further 15.6 percent were car occupants. Similar proportions were also noted for all casualty collisions.

The motorcycle is a highly used mode of transport and especially for families in Malaysia, primarily because of its convenience, cost and ease of mobility, and it is common to see a number of children travelling as pillion passengers with their parents and older siblings (often without wearing a helmet) (WHO, 2009). Moreover, there is some suggestion that unlicensed riding, particularly amongst young riders, is common (Norlen et al., 2011). Given the popularity of the motorcycle, continued high collision rates, and a continuing trend of unlicensed riding and non helmet use among child riders and pillions, this is a significant road safety issue that requires targeted initiatives. These issues are recognized in the Malaysian Road Safety Strategy which aims to reduce road fatalities by 50 percent and emphasizes behavioural, engineering and enforcement measures to improve motorcyclist safety (Malaysian Ministry of Transport, 2006),

Currently, however, there are many gaps in our knowledge on contributing factors to crashes involving child riders and pillions, injury patterns and outcomes.

Given the high trauma associated with motorcycle-related crashes and the substantial involvement of children in fatal and serious injury outcomes, any effort to address motorcycle-related trauma is a high priority for Malaysia. However, in order to develop and implement the most effective and targeted interventions, a good understanding of the contributing factors is required. This paper sets out to address some of the gaps in our knowledge of contributing factors to motorcycle-related fatal collisions involving children.

METHODS

An analysis was conducted of all Police-reported motorcycle crashes that resulted in at least one motorcyclist death for a five year period from 2007 to 2011, inclusive.

Data

The motorcyclist crash data were obtained from the the Malaysian Institute of Road Safety Research (MIROS) Road Accident Analysis and Database System (M-ROADS). The M-ROADS database is populated by Police-reported collision information and managed by MIROS.

All identified motorcyclist fatal crashes between 2007 and 2011 (inclusive) were extracted from the database and a range of data variables were selected for examination and included: rider variables (a ‘rider’ is defined as the operator of the motorcycle and a ‘pillion’ is defined as any passenger on the motorcycle), site and crash characteristics, and broad injury outcome. From this dataset, a ‘child motorcyclist’ dataset was created specifically including all records where the age of the rider or pillion was identified to be 16 years or under and were on a motorcycle (not an occupant of a car or other vehicle).

Data analysis

Descriptive statistics are provided for all summary data of the selected variables. In addition, Chi-square tests were conducted to determine if there were any statistically significant differences between the data variables.

The analyses were predominantly crash-based, however, demographic, behavioural and injury outcome variables were person-based as is the conventional practice for examining these factors.

RESULTS

The crash database created consisted of 17,677 crashes over the five-year period where at least one motorcyclist (rider or pillion) was killed. Of these, 2,038 crashes (11.5%) involved at least one child riding on the motorcycle (as either rider or pillion). A high proportion (59.6%) of these involved a fatal outcome, and 13.3 percent with a serious injury outcome to the child. The analysis also revealed that over a quarter (26.2%) of these motorcycles had more than one child on the motorcycle, These data reveal that 9.5 percent of all fatalities and 18.4 percent of all serious injuries sustained in motorcycle collisions involved children.

Child motorcyclist characteristics

A number of road user variables were examined using the ‘child motorcyclist’ dataset and a summary of these characteristics are presented in Table 1.

Table 1.

Demographic characteristics of participants by group.

Characteristics	All child motorcyclists (%) (n=2,557)	All Riders (%) (n=1,586)	Killed Riders (%) (n=992)	All Pillions (%) (n=971)	Killed Pillions (%) (n=544)
Age Group:
0–4 years	5.4	0.3	0.2	13.9	16.3
5–9 years	5.7	0.3	0.2	14.6	13.6
10–16 years	88.9	99.5	99.5	71.5	70.0
Gender:
Male	82.9	89.5	90.0	72.1	71.3
Female	16.9	10.3	9.9	27.5	28.1
Unknown	0.3	0.2	0.1	0.4	0.6
Helmet wearing:
Worn	41.5	41.6	40.3	45.1	44.5
Not worn	42.4	40.7	43.3	49.2	50.9
Not fastened	2.7	2.5	3.0	3.23	3.5
Religious cap	0	0.1	0.1	0.1	0
Unknown	13.4	15.1	13.3	2.4	11.6

The majority of riders were male (89.5%) and aged between 10 and 16 years of age and 40.7 percent overall were not wearing a helmet. In comparison, higher proportions of pillion riders were younger (28.5%), i.e., aged 9 years and younger, female (27.5%), and almost half did not wear a helmet. Characteristics of killed riders and pillions were similar to all riders and pillions. However, slightly higher proportion of killed riders and pillions did not wear a helmet (43.3% and 50.9%, respectively).

Given that 1,586 (62 percent of all children involved in a collision) were riders, information regarding the type of errors made by them was also analysed. Overall, there was no fault attributed to the majority of collisions, with 87.2 percent reported to be innocent, therefore, rider errors were only available for 46 riders. Figure 1 shows that careless riding, riding too fast, cutting in, incorrect turning and ‘other’ were frequent errors (Figure 1).

Figure 1.

Frequency of rider errors (excluding innocent).

Unfortunately, license status was not available in this dataset, however, age of motorcycle licensure is 16 years in Malaysia, therefore it can be assumed that none of these riders were licensed.

Collision Characteristics

Characteristics of collisions were analysed using factors such as vehicles involved in collisions, collision type, number of vehicles involved and type of road user.

Figure 2 presents the collision partners for all collisions involving a child motorcyclist fatality and shows that the majority of collisions (involved the target motorcycle and another vehicle (59.2%). These either with another motorcycle (20.3%), a passeneger vehicle or 4WD (24.1%), or a van/bus/truck (14.3%). A substantial proportion (23.5%) were single vehicle collisions, and a further 13.8 percent involved multiple vehicles (i.e., more than two vehicles including the target motorcycle).

Figure 2.

Type of vehicle involved in collision.

In addition, collision type was examined. The analysis revealed that head-on collisions, angular or side hit and loss of control were the most common types of collision overall (22.6%, 20.2% & 16.2%, respecticely). Figure 3 shows collision type by rider characteristic (rider or pillion). Given collision involvement, riders were more likely to be injured in most collision types, compared with pillion passengers, however, pillions were more likely to be injured in rear end collisions and ‘unknown’ collision types, χ²₍₆₎=28.1, p<0.001.

Figure 3.

Collision type by rider characteristic

In addition, collision partner was examined by collision type. For single vehicle collisions, out of control crashes contributed to 58.3 percent of these collisions. For collisions with other motorcyles, head on collisions were the most common (37.9%), followed by angular/side impacts (17.5%) and side swipes (13.8%). Collisions with other vehicles (passenger cars, trucks, vans, etc), generally involved angular/side impacts (approximately 30%) and head on collisions (apprximately 25%).

Collision location and environmental characteristics

A number of location and environmental characteristics were examined, including road geometry, type of road, speed limit of road, time of collision, weather, location type, and road condition.

Generally, collisions occurred during good weather conditions, on flat and straight roads, and were relatively evenly distributed across all days of the week, with slightly higher proportions occurring between Friday and Sunday compared with weekdays (an increase of approximately 3%). Almost one-third (30.1%) of collisions occurred during early evening (6–9pm). An additional 17.4 percent occurred between 3 and 6pm and 13.8 percent during early afternoon hours (12–3pm).

By far, the majority of collisions occurred on rural roads (75.6%). Only 9.1 percent of collisions occurred in major and small cities. Location of collision was associated with rider characteristic and age group (Figure 4). Given collision involvement, riders were more likely to be involved in collisions on rural roads, compared with pillions, χ²₍₅₎=131.9, p<0.001, and older children (10–16 years) were more likely to be involved in collision on rural road compared with younger children, who were more likely to be involved in collision on ‘other’ roads, χ²₍₁₀₎=25.7, p<0.01.

Figure 4.

location of collision by rider characteristic

Last, the speed limit of roads was examined. Despite the fact that the majority of collisions occurred on rural roads, it was surprising to find that the majority of collisions occurred in relatively low speed zones of 50km/h and 70km/h (25% and 20.9%, respectively). This suggests that many of the collisions occurred on more local roads and not on major highways and expressways.

Injury Outcome

Last, some information on injury outcome for child motorcyclists (both riders and pillions) was examined. Figure 5 shows body region injured by rider characteristic.

Figure 5.

Body region injured by rider characteristic.

The most frequently injured body region was the head, accounting for 44 percent of all injuries, and riders were more likely to sustain a head injury, compared with pillion passengers. Multiple injuries also comprised a substantial proportion of injuries, accounting for 17 percent of injuries.

Location of injury was examined by a number of additional variables including rider age group, helmet wearing status and injury severity, and all were significantly associated with body region injured.

• Younger children aged 9 years and under were more likely to sustain a head injury compared with older children aged 10–16 years, (55.9% vs 42.4%, respectively), χ²₍₁₈₎=37.8, p<0.01.

• A head injury was more likely to be associated with a fatal outcome, compared with a severe injury, (59.8% vs 31.1%, respectively). Injuries to upper or lower extremities, and multiple injuries were more likely to be associated with a severe or light injury, χ²₍₃₆₎=2301.6, p<0.001.

• Children not wearing a helmet were more likely than those wearing a helmet to sustain a head injury (54.3% vs 44.0%, respectively), χ²₍₂₇₎=1880.9, p<0.001.

DISCUSSION

Motorcyclists, and especially children, are at high risk of injury, largely due their small stature, their vulnerability, lack of protection and limited biomechanical tolerance to violent forces if involved in a motorcycle collision (WHO, 2008b; Nolen et al., 2011).

This paper presents the findings from an examination of the motorcyclist fatal and serious injury crash data in Malaysia. The overall aim of the study was to improve our understanding of the nature and extent of child motorcyclist collisions by identifying contributing factors to collision involvement and injury outcomes. There were some significant findings of this study, both expected and unexpected, which may have implications for the development of effective and targeted measures to reduce the frequency and severity of motorcycle collisions in which children are killed or seriously injured.

Overall, there was a substantial proportion of children travelling on motorcycles and a substantial level of death and serious injury among riders and their pillions. This was a somewhat unexpected finding, and contrary to the general trend in many developed countries where fatality and serious injury rates/numbers are generally significantly lower than minor injury rates/numbers (WHO, 2009).

However, it is also noted that motorcyclists (and particularly child motorcyclists) are an extremely vulnerable road user group due to their lack of protection against impacts with other vehicles, the ground and roadside objects (National Highway Traffic safety Administration [NHTSA] (2007; European Transport Safety Council [ETSC], 2008). For this reason, rider injuries are often more severe than those of other road users and motorcycle riding carries a high risk of death. Per vehicle mile travelled, motorcycle riders have approximately 30 times the relative risk of death in a crash than people driving other types of motor vehicles, and they are also approximately eight times more likely to be injured (ETSC, 2008).

A significant and unexpected finding was that a large proportion of children injured in motorcycle collision were riders, and not, as expected pillions. This is a concerning finding, given that the age of motorcycle licensure in Malaysia is 16 years, therefore clearly these children are riding at very young ages and most likely without a licence. Unlicensed drivers/riders have been shown to pose an increased crash risk compared to the general licensed driving/riding population in many developed countries, with an estimated crash risk of eleven times that of licensed drivers/riders (Scopatz, Hatch, DeLucia & Tays, 2003). While the risks associated with unlicensed driving/riding have long been recognised within the road safety field, they remain a difficult group to identify and detect and so current estimates regarding exposure and crash involvement are assumed to be an underrepresentation of the true extent of this behaviour. The finding that many crash-involved child riders are unlicensed in Malaysia is of concern and has clear implications for enhancements to the licensing system and procedures, enhanced enforcement of unlicensed riding and targeted education initiatives in schools.

A further significant finding of this analysis is the high level of head injuries, particularly amongst younger children, amongst fatal outcome collisions, pillions, and children who did not wear a helmet. Previous research has found that motorcycle riders often sustain multiple injuries in a crash, with head injuries the most frequent in fatal crashes, contributing to about one-half of all motorcycle deaths. Chest and abdominal injuries are the second most common cause of fatality, followed by spinal injuries (Lin & Kraus, 2009). These findings confirm previous studies showing that wearing a helmet significantly reduces risk of head and brain injury and reduces severity of injury, however, it was of concern that a relatively high proportion of children were injured even when they were reported to have been wearing a helmet. It is important to note that there are many other factors to consider especially in Asian countries including helmet wearing behaviour, particularly the lack of proper securing of the helmet, the type of helmet worn, and the size of the helmet, all of which can affect the effectiveness of the helmet. Recent studies (e.g., Yu, Chen, Chiu & Lin, 2011; Ramli, 2013) have demonstrated varying levels of protection offered by different helmet types, with half-head helmets (common in Asian countries) providing the least protection from head injuries, that wearing a loosely fastened or loosely fitting helmet may compromise any potential protection. This information is difficult to obtain from mass crash data analyses, but further research is warranted.

One of the most effective ways of reducing fatalities and serious injuries and improve outcome amongst motorcyclists (particularly as a result of head injuries) is to increase helmet wearing (Rowland, Rivara, et al., 1998; Brandt, Ahrns, Corpron et al 2002). Helmets significantly reduce the probability of head and neck injuries by 53 percent and lead to a 72 percent reduction in the probability of death (Keng, 2005). In contrast, unhelmeted motorcyclists sustained substantially higher rate of facial and brain injuries compared to helmeted riders (Eastridge, Shafi, Minei et al., 2006).

Helmet laws were introduced in Malaysia in 1973 and it is compulsory for all motorcycle users (both riders and pillion passengers) to wear them whenever they are riding on the road. In addition to legislation, standards for helmet type were also introduced and set by the Standards and Industrial Research Institute of Malaysia (SIRIM). To date, SIRIM has issued two certifications for helmets, the MS.1:1969 in 1969 and MS.1:1996 in 1996, and are currently updating test criteria. Since the introduction of these initiatives, helmet usage increased tremendously and a reduction of 30 percent in number of motorcycle fatalities from time of legislation to 1980 was reported (Supramaniam, Bell & Sung, 1984).

In addition, a helmet is only effective if it is fitted and worn properly. Non-helmeted riders usually sustain more serious forms of head injury and three times more likely to sustain craniofacial soft tissue injuries compared with helmeted riders (Johnson, McCarthy, Miller & Peoples, 1984). Moreover, there is previous evidence to suggest that many Malaysian riders and pillions do not wear a helmet, and for those who do wear a helmet, there is a high proportion of non-buckling of the strap (Kulanthayan, Radin Umar, et al, 2000).

Implications

It is evident from these analyses that there is a high use of motorcycles by families and children, and that child motorcyclist injuries (as both pillions and riders) account for a substantial proportion of motorcycle deaths and serious injuries. The significant findings of these analyses were that i) the majority of collisions are severe in nature and there is a high proportion of fatal outcome, mainly as a result of head injury, ii) older children are over-involved in collisions as (unlicensed) riders, ii) younger children are over-involved in collisions as pillions, and iii) helmet wearing rates are relatively low, especially amongst younger children.

The safety of child motorcyclists can be addressed within the Safe System approach, with a focus on two major components, that is, by ensuring that they (and their parents) are adopting safe riding practices, and that the road and infrastructure is designed to provide a crashworthy environment.

First is the need to adopt safe riding practices. Education, information, practical training and an appropriate licensing system are essential for acquiring the attitudes, skills and knowledge necessary for safe road use. Targeted initiatives that aim to raise the awareness of motorcycle safety among parents and children, especially in rural areas should be implemented. School-based road safety education programs could be enhanced to include targeted motorcycle safety education, with a focus on licensure, helmet wearing, and adoption of safe riding practices. In addition, enhanced enforcement efforts to increase helmet wearing rates are essential, particularly among young children.

With regard to engineering countermeasures, efforts should focus on rural roads and roads in small towns. These roads in Malaysia are often of low design, are undivided, with little or no shoulder and few barrier systems to address run-off-road collisions. Moreover, speeds are often relatively high for the environment. Engineering countermeasures have the potential to quickly and effectively create a safer and more ‘crashworthy’ travel environment for vulnerable road users. The improvements that may provide most benefit to child (and all-aged) motorcyclists on rural roads include: i) measures to reduce travel speeds (including lower speed zones and traffic-calming measures), and ii) improvements to roads and roadsides to provide a much higher standard of road, particularly on federal and state roads – these improvements may include improved shoulder areas, provision of clear zones, provision of barrier systems, conversion of undivided roads to divided roads, and provision (and maintenance) of separate motorcycle lanes.

Limitations

There are some limitations in drawing comprehensive conclusions about trauma and collision risk from Police-reported data, particularly when addressing vulnerable road users. For example, there is potential for biased reporting, given the high likelihood of the pedestrian being injured (and not the driver). It should also be noted that, due to the way Police-reported data are collected and collated, non injury and minor injury collision rates may be underestimated, and can be better understood by validating against hospital data. Furthermore, in-depth information regarding collision and injury causation is lacking in these data sources. Nevertheless, it is important to analyse Police-reported data sources to highlight important features of casualty collisions.

CONCLUSION

The present study has highlighted some important contributing factors to fatal and serious injury motorcycle collision amongst children in Malaysia. There is clearly a need to focus on improvements to some rider behaviours, including efforts to increase helmet wearing rates and reduction of risky riding behaviours such riding unlicensed, riding without a helmet and not securing helmets. Provision of educational and training programs aimed at improving road user behaviour would be beneficial, as well improved licensing procedures and enhanced enforcement techniques and technologies. Engineering countermeasures also have great potential to reduce collisions, particularly single vehicle run off road and side impact collisions.