Rear seat belt use as an indicator of safe road behaviour in a rapidly developing country.

Injuries from road traffic accidents are set to become the second highest cause of disability-adjusted life years lost in developing countries by 2020. The number of injuries and deaths are disproportionately high in low income countries, which account for only 40% of all motor vehicles. Human behaviour is thought to be a major factor in most accidents. In Oman wearing a seat belt is compulsory in the front seats but not in the rear. Wearing a seat belt can reduce the severity of injuries when sitting in rear seats. This study examines the use of seat belts in cars entering a university and hospital campus in Oman to determine the degree of seat belt wearing in the rear. At peak times on a selected day, cars were stopped at the university's entrance barrier. The type of driver was identified - student, employee, hospital patient or visitor - and the degree of seat belt wearing among driver and passengers was noted. A total of 1,066 cars were stopped. Of this total, 90.1% of drivers and 80.9% of front seat passengers were wearing a restraint complying with Local traffic regulations. However, only 1.4% of back seat passengers wore a seat belt. Only 3.7% of children under the age of five were restrained in a child seat and only 16.7% of five- to 12-year-olds were strapped in. A third (34.6%) of under-fives were sitting in the front seat. In cars with child occupants, 40% of the time parents wore seat belts but the children did not. Occupants conformed to the law but behaviour indicated a lack of awareness of the dangers of not wearing seat belts, especially towards children. Traffic regulations need to be updated and the public educated about the need to wear seat belts. Health agencies could be more active in educating the public about road safety behaviour and should also be involved in the overall strategy to reduce injuries and deaths.