Child motorcycle helmet project in Thailand Background and origin of the initiative Since 1996, the motorcycle helmet law for drivers and passengers has been enforced nation-wide in Thailand. However, the injury surveillance reports from the MOPH repeated continuously that motorcycle riders still had the largest proportion among deaths of all road users (approximately 70- 80 % of road death each year). Children were not exempted, as motorcycles were used as family vehicles and as major mode for transporting children to schools. Among children less than 15 years, 68 % of deaths from transport crashes were of vehicle users and 72% of the child vehicle users died from riding on motorcycles in 2002. As per estimation from death registry and Thailand National Injury Surveillance of 2003, approximately 12,000 children were admitted to provincial hospitals for treatment (average of 33 per day or 1.4 persons per hour). There were 1.5 child deaths every day, approximately four times the numbers of DHF deaths. According to the National Injury Surveillance report, 99.9% of the child motorcyclists who got severely injured did not wear motorcycle helmet. Head injuries in the admitted children due to transport injuries increased significantly at 2 years old and again from 10 to 14 years old. (Figure1) In 2003, the information was presented in the meeting of the National Road Safety Directing Center (RSDC), chaired by the Deputy Prime Minister together with the proposal to prohibit children from riding on motorcycles. After a three - month consideration, the RSDC Board decided not to prohibit but to seek for protection of the child motorcycle riders instead. Wearing of a motorcycle helmet is an important safety behavior for motorcycle riders. If a 90% helmet wearing rate among motorcycle riders on the road is achieved, deaths and severe head injuries among motorcycle riders would be decreased by 30%. The causes of not wearing helmet were inadequate knowledge and lack of enforcement. This resulted in the helmet industry not producing motorcycle helmets for 2-5 year old children, and helmets for 6-14 years old (smallest size of the standard helmet) were difficult to find outside of Bangkok. (Children of less than 2 years old can not wear standard motorcycle helmet due to weak neck muscle.) The child motorcycle helmet project aimed to catalyze the manufacturing of standard motorcycle helmet for 2-5 year-old child and promote helmet wearing in children < 15years old, of which will decrease deaths and serious head injuries in children. Detail of the initiative 1. To have the 2-4 year-old child helmet manufactured – The manufacturers required certainty in the sales, which depends on the enforcement on this age group and the first purchase order which is large enough to cover the cost for the new mold. The cost only for the new mold was about 100,000 Baht (USD 2,500). Fund raising from the private sector was tried but received no actual contribution. Finally, 3 million Baht (approximately 75,000 USD at that time) from government budget of the RSDC‘s secretary office (Department of Disaster Prevention and Mitigation), was mobilized from the saved budget in purchasing alcohol breath analyzers, to purchase the first lot of 15,000 child (2-5 years old) helmet through open bidding. o The Subcommittee on child helmet, under the RSDC, organized a workshop for all helmet manufacturers to inform the policy of the RSDC and provide opportunity to the manufacturers to discuss technical issues of the new standard and production of child (2-5 years old) motorcycle helmet with the experts. o The standard of motorcycle helmet for children 2-5 years old was announced by the Industrial Ministry. The specification to purchase the child helmet was announced accordingly, with major features to be half shell, weight of less than 0.5 kg and head circumference 500 – 520 mm, to be suitable to the small child. ( full standard- Annex1 ) 2. To distribute the purchased child helmets, raise awareness and promote wearing at local and national level - A call for 15 pilot provinces application was circulated to all governors, together with the concept paper of the project. A contract was signed by the governors, the chief police, and the education chief of each pilot province with the RSDC Chair (Dep. PM) stating that each pilot province would receive 1,000 child MC helmet but would also have to mobilize local resources for purchasing another 1,000 additional helmets to be used all together as educational tools in own province; technical support would be provided from the RSDC (by a technical coordinator as the project manager) through meetings with the multisectoral core team of each province to discuss the project concept and planning for activities, at the beginning and again at the middle of the project to exchange experience and lessons learned; empowering visit to each province by the project manager and through day to day communications. Each province would receive 350,000 Baht (US $ 8,750) to organize educational campaign at central district of each province; stringent enforcement should follow after the educational campaign. The 15 provinces would be evaluated on helmet wearing rate against the target, among 2-14 years old after 1 year. The provincial project started in March 2005. National and local TV / radio spots, newspaper scoops/ campaigns for central were also implemented. The Thaihealth (The Thai health promotion foundation has revenue derived from 2 percent of the excise taxes on tobacco and alcohol) supported 14.9 million Baht (USD 372,500) for all implementation and another 3 million Baht (USD 75,000) for external evaluation. According to the evaluation done by the Public health faculty, Thammasart University, the standard child motorcycle helmet had achieved 74% reduction of head injuries by wearing helmet when riding on motorcycle. The child helmet wearing rate raise from 0% before the project to the average of 9.8% in the pilot and 7.6 % in the non-pilot provinces (television and radio spot covered the whole country). The evaluation report revealed that enforcement was the key for higher helmet wearing rate. This was evident from wearing rate by each pilot province of which the leading provinces Bureerum (17.2%) had the chief police as project manager. However, by the end of the project, there were 6 manufacturers producing the 2-5 year old and more than 5 year old child motorcycle helmets for local market and exporting to other countries. Replicability Each country that allows children to be transported by motorcycle should have the standard of child motorcycle helmet, especially for 2-5 year, who can not use the smallest size of adult motorcycle helmet. Whether to manufacture within the country depends on the production cost and the demand. The initial investment by the government to catalyze the manufacturing in Thailand was as low as 75,000 USD. Thailand needed the extra budget for promotion program due to the rather low motorcycle helmet law enforcement. According to the 1st global road safety survey in 2009, self scoring from consensus professional opinion of Thailand was 4/ 10, while other SEAR countries had higher score, such as Nepal (score 9), Indonesia (score 7), Sri Lanka (score 7), Myanmar (score 6). Hence these countries with more effective enforcement may not need budget in promoting child motorcycle helmet wearing. Only the standard and clarification that children are not exempted in the helmet law through mass media may be adequate for the start. In 2007, Ministry of Transport, Indonesia started the child motorcycle project helmet. At present, the child Motorcycle helmets are manufactured within the countries and also exporting to other countries. Catalyzing the manufacturing of standardized child motorcycle helmet will not only provide more safety to children who rides on motorcycles in the countries but will also be an investment of good opportunity for exporting. Let’s save the kids! Head injuries in child motorcycle riders, by age National Injury Surveillance,Thailand, 2003 number 800 700 600 500 400 300 200 100 0 <1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 age(yr) Figure1 Source : 27 hosp.National Injury Surveillance,Ministry of Public Health,Thailand 2003 Figure 2 Educational campaign Figure 3 Real life situation in Thailand, 2011 children wearing helmets on motorcycles Annex 1 Specification of child Motorcycle helmet (Thailand since 2004) 1) General Figures Use for children when riding of motorcycle and bicycle for safety, if crashes 2) Detail Specification following are required: 2.1 Half shell, weight – Less than 0.5 kg, head circumference – 500 – 520 mm 2.2 Properties are according to standard ISO/R 1511 – 1970 or standard JIS T 8133 – 1982 or standard BS 6658: 1985 in following list: 1) Shock Absorption 2) Resistance to Penetration 3) Rigidity 4) Chinstrap Strength I. Resistance to Deformation II. Resistance of Harness to detachment from Shell 2.3 Width of chinstrap is 20 mm or more 2.4 Ventilating hole (if available) can not be more than 4 (2 front 2 back), size not more than 1.00 x 2.5 cm each 2.5 Reflective Sticker seen from front, sides (2 sides) and backside Width – 1.5 cm total length at least – 30 cm. Note: This specification has been discussed with the manufacturers and agreed by them to the Industrial Standard Ministry. Remarks: 1. This specification had field evaluations done by 3 rd party- Dr. Nitaya Vajanapoom (nvajanapoom@yahoo.com) and team in Thammasart University public health faculty. Paper presented in an injury conference in Vietnam. The result showed 74% effectiveness in protecting head and brain injuries. 2. Thailand is now (2011) working for a new standard that will use newer reference than standard ISO/R 1511 – 1970 or standard JIS T 8133 – 1982 or standard BS 6658: 1985 . 3. For more information, interested member countries can contact directly to DR. Adisak Plitponkarnpim copying to Thailand MOH FP (raapp@mahidol.ac.th;) Ms Nongnuch Tantidhama nongnuch Tantidhama and WHO CO FP Kimhy@SEARO.WHO.INT)