Background Approximately 300 children die through traffic injuries annually in Ghana and school children are the majority.

Objective To observe the road use behaviour of urban public primary school pupils in the Ablekuma South Education Circuit of Metropolitan Accra.

Methods This unobtrusive observational study targeted Primary 1–6 pupils. Five behaviours were graded: Walking while crossing the road; Stopping at the kerb; Looking left-right-left before crossing; Keep looking left-right-left while crossing and Facing traffic while walking along the road. Eight public primary schools were randomly selected from the Ablekuma South Circuit of Accra. Minimum of 100 pupils were observed from each school. All 882 pupils were observed while on their way to or from school.

Results/Outcome A little over two in three children stopped at the kerb before crossing the road while almost three in four children looked for cars before stepping off the kerb. A little over three in four children walked while crossing as against less than one in four children who kept looking while crossing. Not looking for cars before crossing, not facing on-coming traffic and not keeping looking for cars while crossing the road, were more associated with boys than girls (p<0.001 in all cases). This suggests that girls behaved significantly more safely than boys. In stopping at the kerb, there was no difference in gender behaviour (p<0.135).

Child Road Safety Education in Schools and Communities is recommended.

Significance/Contribution to the Field The study will inform policy direction in helping to reduce childhood road traffic injuries in Ghana.