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Accid. Anal. and Prev., Vol. 29, No. 5, pp.

695697, 1997
1997 Elsevier Science Ltd
All rights reserved. Printed in Great Britain
0001-4575/97 $17.00 + 0.00

PII: S000145759700004-3



M H*
University of New Mexico, School of Medicine, Department of Emergency Medicine, Albuquerque,
NM 87131-5246, U.S.A.
(Received 19 July 1996; in revised form 8 January 1997)

AbstractMalaysia has strict laws requiring seat belt use by all vehicle occupants. However, neither passive
devices nor inertial reel belts are mandated. Seat belt usage was investigated among 60 taxicab drivers in Kuala
Lumpur, Malaysia, in 1993. Although all drivers appeared to be restrained during an initial curb-side inspection,
60% did not fasten the latch. There was no statistical difference between ethnic groups.
Curb-side estimates of restraint use may overestimate actual usage, resulting in falsely low estimates of
effectiveness. Requiring inertial reel belts, which would retract if not latched, could greatly increase actual
restraint use. This may be cost effective for developing nations. 1997 Elsevier Science Ltd.

KeywordsAccidents, Traffic, Protective devices, Seat belts


increase the compliance rate ( Escobedo et al., 1992;

Streff et al., 1992).
Malaysia, like other developing countries
(Swaddiwudhipong et al., 1994; Jacobs and Cutting,
1986), has a high rate of motor vehicle accidents,
and these accidents are a common cause of death
and disability ( Krishnan, 1992; Arokiasamy and
Krishnan, 1994; Vital Statistics, 1990). This is partly
due to a rapidly expanding economy which makes
purchase of private vehicles possible for much of the
population. Road development lags behind, however,
and roads tend to be narrow with inadequate shoulders, barriers and signage. Malaysia has a primary
enforcement law, the Traffic Act of 1958, with a fine
of up to 100 MR (approximately $40 U.S.) for each
unbelted rider. All vehicles sold in Malaysia must be
equipped with three-point shoulder harnesses and lap
belts for the middle passengers. A brief curb-side
survey of drivers in the Malaysian capital city of
Kuala Lumpur showed extremely high rates of compliance (all of 165 consecutive drivers). However,
when riding in taxicabs it was noted that many drivers
did not latch the belt. This finding would greatly alter
statistics for restraint use and efficacy, particularly in
areas which do not require inertial reel belts. This
study attempted to confirm and quantify this finding.

Motor vehicle accidents are a major cause of death

and injury in both developed and developing countries (National Safety Council, 1993; Shanks et al.,
1994 ). Seat belts significantly decrease morbidity and
mortality from motor vehicle accidents, provided that
they are fastened correctly ( U.S. Department of
Transportation NHTSA, 1992; Orsay et al., 1988,
1990; Kaplan and Cowley, 1991 ). Unfortunately, not
all occupants do this. Passive belts, airbags, and semipassive devices such as passive shoulder harnesses
with manual lap belts are used to minimize the
number of unrestrained occupants ( Hendey and
Votey, 1994; Williams et al., 1992; Reinfurt et al.,
1991 ). Passive devices tend to be cumbersome or
expensive. Even in developed countries, many passengers and drivers of specialized or older vehicles are
not protected by passive devices. In developing countries, the problem is even more difficult. One way to
increase restraint use is to mandate it by law
(Johnston et al., 1994; Thomas, 1990). Primary
enforcement per se laws which allow police to pull
over and cite unbelted drivers have been shown to
*Author for correspondence. Tel. 505-272-5062;
505-272-6503; e-mail



M. H


Three trained observers took a total of 60 taxicab
rides in and about Kuala Lumpur during 1993.
Taxicabs were chosen for study as they are among
the few vehicles in which strangers are routinely given
rides. An attempt was made to sample all shifts and
parts of the city. Most rides were taken during peak
usage times of 68 .. and 46 .., although a few
samples were deliberately obtained during mid-day
and at night. Approximately half of the rides were
from residential areas, and half from the city core.
More formalized sampling would have been difficult
because records of the total number of vehicles available and fares collected by time or site are not
available. The observers noted whether the drivers
shoulder harness appeared to be in use prior to
entering the vehicle. After entering the vehicle, the
belt latch was checked to determine if it was connected. Almost all Malaysian citizens are legally
classified into one of three ethnic groups: Malay,
Indian, or Chinese. This information is entered on
the individuals national identity card, and must be
visible in all taxicabs.
Data was analyzed using a personal computer.
Standard error of proportion was calculated for population statistics. Ethnic groups were compared using
Prior to entering the taxicab, all shoulder harnesses appeared to be in place. Closer examination
revealed that 36 of the belts were not latched.
Proportion belted=0.4 SE 0.063. There was no significant difference between ethnic groups. Chi-square:
0.66 with 2 degrees of freedom; p=0.7 (see Table 1 ).
Seat belt use is an important means of reducing
morbidity and mortality in both developed and developing nations. Mandatory compliance and per se
laws allowing unbelted subjects to be pulled over and
ticketed have been shown to increase the compliance
rate. Compliance can be estimated by questioning
drivers, victims of accidents (Orsay et al., 1988, 1990),
Table 1. Number and percentage of subjects belted
% belted SE
All subjects



medical providers ( Kaplan and Cowley, 1991 ) or

police. These sources are likely to overestimate usage.
Direct roadside observation studies demonstrate
lower compliance rates ( Wagenaar and Margolis,
1990) than do surveys, and hence estimate more
accurately actual usage (Streff et al., 1992 ). Direct
observation has become the standard technique for
comparative studies, and is used as the basis for
population surveys. ( Phillips, 1983) Although our
data is only directly applicable to a limited group, it
indicates that under certain conditions even direct
observation from the roadside can greatly overestimate belt usage.
Overestimation of compliance decreases the estimated efficacy of a device, because some unprotected
nonusers are counted as users. Restraints are likely
to be more effective than would be indicated by
studies which derive population statistics from curbside surveys.
Primary enforcement laws must be difficult to
circumvent to be effective. Requiring inertial reel
belts, with appropriate penalties for sabotage, should
greatly increase belt use in countries which do not
currently require them. This would be much less
expensive than requiring sophisticated passive
restraint devices such as airbags, which are estimated
to cost $300 U.S. per vehicle (Ramirez, 1994; Warner,
1983). In developing countries such as Malaysia,
which have adequate police resources to enforce the
use of belts but must carefully assess the cost of
public health interventions, this may be an attractive
Arokiasamy, J.T. and Krishnan, R. ( 1994) Some epidemiological aspects and economic costs of injuries in Malaysia. AsiaPacific Journal of Public Health 7, 1, 1620.
Escobedo, L.G., Chorba, T.L. and Remington, P.L. (1992)
The influence of safety belt laws on self-reported safety
belt use in the United States. Accident Analysis and Prevention 24, 6, 643653.
Hendey, G.W. and Votey, S.R. ( 1994) Injuries in restrained
motor vehicle accident victims. Annals of Emergency
Medicine 24, 1, 7784.
Jacobs, G.D. and Cutting, C.A. ( 1986) Further research on
accident rates in developing countries. Accident Analysis
and Prevention 18, 2, 119127.
Johnston, J.J., Hendricks, S.A. and Fike, J.M. (1994)
Effectiveness of behavioral safety belt interventions.
Accident Analysis and Prevention 26, 3, 315323.
Kaplan, B.H. and Cowley, R.A. (1991) Seatbelt effectiveness and cost of noncompliance among drivers
admitted to a trauma center. American Journal of Emergency Medicine 9, 410.
Krishnan, R. (1992 ) Safe travela worthwhile destination.
World Health Forum 13, 163164.
National Safety Council: Accident Facts: 1993 Edition,
Itasca, Illinois, National Safety Council, 1993.

Seat belt use in Malaysia

Orsay, E.M., Turnbull, T.L. and Dunne, M. ( 1988) Prospective study of the effect of safety belts on morbidity
and health care costs in motor-vehicle accidents. Journal
of the American Medical Association 260, 35983603.
Orsay, E.M., Dunne, M. and Turnbull, T. (1990 ) Prospective study of the effect of safety belts in motor vehicle
crashes. Annals of Emergency Medicine 19, 258261.
Phillips, B.M. (1983) Restraint system usage in the traffic
population. I Automobile safety belts. II Child restraint
seats. III Motorcycle helmets ( Final report to National
Highway Traffic Safety Administration, DOT
HS-806-424). National Technical Information Service,
Springfield, VA.
Ramirez, C.E. (1994) R.I.P. passive belts: airbags rise in
popularity, federal law dooms automatic seat belt
system. Automotive News, 5546, p. 7I(1 ).
Reinfurt, D.W., St. Cyr, C.L. and Hunter, W.W. ( 1991)
Usage patterns and misuse rates of automatic seat belts
by system type. Accident Analysis and Prevention 23, 6,
Shanks, N.J., Ansari, M. and al-Kalai, D. (1994 ) Road
traffic accidents in Saudi Arabia. Public Health 108, 1,
Streff, F.M., Molnar, L.J. and Christoff, C. ( 1992) Increasing safety belt use in a secondary enforcement state: eval-


uation of a three-county special enforcement program.

Accident Analysis and Prevention 24, 4, 369383.
Swaddiwudhipong, W., Nguntra, P. and Mahasakpan,
P. ( 1994) Epidemiologic characteristics of drivers,
vehicles, pedestrians and road environments involved in
road traffic injuries in rural Thailand.. Southeast Asian
Journal of Tropical Medicine and Public Health 25, 1,
Thomas, J. (1990) Road traffic accidents before and after
seatbelt legislationstudy in a district general hospital.
Journal of the Royal Society of Medicine 83, 2, 7981.
U.S. Department of Transportation, National Highway
Traffic Safety Administration (1992 ) 1991 Occupant
Protection Facts.: NHTSA, Washington, DC.
Vital Statistics (1990 ) Peninsular Malaysia. : Department of
Statistics, Kuala Lumpur, Malaysia.
Wagenaar, A.C. and Margolis, L.H. ( 1990) Effects of a
mandatory safety belt law on hospital admissions. Accident Analysis and Prevention 22, 3, 253261.
Warner, K.E. (1983) Bags, buckles, and belts: The debate
over mandatory passive restraints in automobiles. Journal of Health Politics, Policy, and Law 8, 1, 4475.
Williams, A.F., Wells, J.K. and Lund, A.K. (1992) Use of
seatbelts in cars with automatic belts. Public Health
Reports 107, 2, 182188.