Understanding the wider determinants of child road fatalities in England and opportunities for prevention: protocol for a mixed-methods study of the national child mortality database

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INTRODUCTION: In Great Britain, an estimated 4% of road deaths occur among children under 16 years-old. Previous research has often focused on individual-level risk factors, with less attention to the broader social, environmental and system-level determinants shaping child road safety. Emerging systematic reviews highlight the need for integrated approaches that consider inequalities, built environment characteristics and transport systems in understanding child injury risk. The establishment of the National Child Mortality Database (NCMD) in 2019 provides a unique opportunity to comprehensively analyse child road fatalities in England. This study adopts a systems-based approach, using Dahlgren and Whitehead's (1991) Social Determinants of Health model to explore the interplay of modifiable risk factors and inform evidence-based interventions. METHODS AND ANALYSIS: A sequential mixed-methods design will analyse all child road traffic fatalities (0-17 years) recorded in the NCMD between 2019 and 2024 (estimated n ≈ 262). Cases will be identified using NCMD cause of death classifications and child death review panel determinations.Quantitative analysis will describe patterns in child road deaths across individual, family, social and environmental factors, identifying variations by mode of transport, age, gender, deprivation and geographic region. A qualitative template analysis of child death review narratives will provide deeper insight into the systemic conditions contributing to child road deaths. Context-Mechanism-Outcome models will be developed to explore how different risk factors interact to increase vulnerability. Recommendations for policy and practice will be coproduced with stakeholders, including caregivers, using the study findings. ETHICS AND DISSEMINATION: Ethics approval has been obtained through the University College London, Civil, Environmental and Geomatic Engineering Local Ethics Board (28815/001). Findings will be disseminated through peer-reviewed publications, policy briefings, stakeholder workshops and practitioner guidance, with the aim of informing national road safety policy and cross-sector prevention strategies.

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