Trauma Secondary to Road Traffic Injuries: A Paediatric Neglected Disease

The term ‘neglected diseases’ was added as a Medical Subject Heading (MeSH) to PubMed in 2011, and it was defined as ‘Diseases that are underfunded and have low name recognition but are major burdens in less developed countries’. A quick search for ‘neglected diseases’ either in PubMed, web databases, or the World Health Organization (WHO) portal shows that this term overwhelmingly yields manuscripts about tropical or communicable diseases. It seems ‘neglected’ has become a synonym for ‘infectious’ within academia. This narrow framing excludes a critical and overlooked category: non-tropical neglected diseases. Paediatric trauma, the leading global cause of death and disability among children and young adults 1, is excluded from the very definition of ‘neglected diseases’. This omission generates a troubling paradox when the major killer in childhood gets excluded from the conversation. By definition, a neglected disease is one that lacks recognition and places its heaviest burden on low- and middle-income countries (LMICs). This is the case for paediatric trauma, a complex disease which encompasses various forms, including falls, drowning, and abusive trauma, which is notably prevalent in LMICs and associated with higher mortality 2. The most prevalent and severe form is road traffic injuries, which claim 1.2 million lives annually and leave 20–50 million individuals injured. Nine out of 10 of those deaths occur in LMICs, where the risk of death per population is three times higher than in high-income countries (HICs). This disparity exists despite only 1% of the world's motor vehicles being in circulation in poor nations 3. Most of this burden of disease is preventable. Proven safety measures, such as child restraint systems, can significantly reduce the risk of injury 4. Yet, only 33 countries worldwide have enacted laws that align with WHO's best practices on child restraint use, leaving vast populations unprotected. The rapid growth in motorcycle use—more than doubling between 2010 and 2021 to over 1 billion—exacerbates the problem 3. In poor nations, motorcycles (often with multiple pillion riders and without correct helmet use) are often the primary means of transport and employment. Paediatric trauma is clearly a neglected topic in public health discourse, its research underfunded and usually overlooked in policy implementation. This crisis is real. In September 2020, the UN General Assembly adopted the resolution ‘Improving global road safety’, proclaiming the Decade of Action for Road Safety 2021–2030, with the ambitious target of preventing at least 50% of road traffic deaths and injuries by 2030 5. These initiatives were aligned with some of the Sustainable Development Goals (SDGs), which aimed to reduce road traffic deaths by half and to provide access to safe, affordable, and sustainable transportation by 2030 6. The Safe System approach addresses road safety by emphasising shared responsibility among designers, manufacturers, policymakers, and users to prevent fatalities and reduce crash severity. It prioritises protecting vulnerable users, especially children, through safe roads, speeds, vehicles, and post-crash care. The WHO's Global Status Report on Road Safety 2023 highlights four priorities: multimodal transport systems, safer infrastructure, safer vehicles, and improved governance 3. Paediatricians play a vital role in this effort. We are often the first witnesses to the catastrophic consequences of paediatric trauma—facing the devastation of preventable injuries and deaths in their daily practice. Yet, we have to assume that we largely remain silent. Paediatric trauma is far from monopolising academic activities and discussions as other paediatric diseases do. We think it is time for paediatricians to rise as academic advocates, placing road safety firmly on national and global health and research agendas. If we do not advocate for children's right to safer roads and vehicles, who will? Advocacy starts by assuming our negligence. We must break the silence and speak up. Paediatricians can champion this cause by engaging in policy dialogues and collaborating with policymakers, engineers, and public health experts to achieve safer transportation systems. The fight for road safety is, at its core, a fight for equity and justice for children. Every life saved represents not only a brighter present and future for the child but for the whole society. Paediatric trauma is not an inevitable consequence of modern mobility but a preventable tragedy. We should not neglect it anymore. The authors have nothing to report. The authors declare that the research presented in this manuscript adheres to the ethical principles outlined by Johns Hopkins University IRB. All procedures involving human participants were conducted in accordance with the ethical standards of the Johns Hopkins Bloomberg School of Public Health and the Declaration of Helsinki (1964), as revised in 2013. The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.