Knowledge, mobility and the built environment: assessing risk factors for road traffic incidents during children's school journeys in urban Blantyre, Malawi - an observational study.

INTRODUCTION: Road injuries are a leading cause of death in the 5-19 age group and pedestrian school children are a key vulnerable group. However, the road crash risks faced by school children in Malawi remain understudied. This study aims to describe and quantify the prevalence. METHODS: We performed an observational study from July to December 2022. Data were collected through a knowledge, attitudes and practices survey, mobility survey, school-zone speed and pedestrian observations and star ratings for schools' assessments in six schools in Blantyre. RESULTS: We surveyed 2466 students aged 12-16 and conducted safety assessments in the areas around these schools. Among surveyed children, 134 (5.4%) and 732 (29.7%) had been involved in a crash or 'near-miss' in the last 6 months. Receipt of road safety education in the past was not associated with involvement in a crash. 63.4% of vehicle observations were above the standard 30 km/hour safe speed limit, and star ratings from 2 to 5 stars. DISCUSSION: Despite receipt of road-safety education, road crashes continue to affect students walking to school. Improvement of road markings, signs and pedestrian crossings is a key intervention to improve safety across all schools. Modest infrastructural improvements are required to raise star ratings to at least three in study sites. CONCLUSIONS: Improving road safety for school children in Malawi requires targeted action focusing on ground truth assessments. Enhanced road safety awareness and practices at designated crossings, reduced speeds and improved infrastructure are potential targets.