336 A multi-city study of helmet use in Africa

<h3>Background</h3> Rapid urbanization has resulted in increased use of powered two-wheelers in low and middle-income countries (LMICs). An increasing trend of motorcyclist injuries is seen in LMICs, often resulting from the lack of correct helmet use - an effective intervention that was found to reduce fatal injury risk by 42%. <h3>Objective</h3> Assess the prevalence of correct (i.e., standard, and strapped) helmet use among motorcyclists and the associated factors in five African cities. <h3>Methods</h3> Cross-sectional observation data was collected between 2021–2022 in Accra, Addis Ababa, Kampala, Kumasi, and Mombasa. Observation sites were randomly selected to represent city-wide prevalence. A pair of data collectors observed helmet use during five 90-minute intervals throughout the week. Descriptive analyses were done to present frequencies and percentages of correct helmet use and cross-tabulations with associated factors. <h3>Results</h3> A total of 225,542 helmet-use observations were conducted across the five cities. The prevalence of correct helmet use varied across the cities (Accra (60%), Addis Ababa (27%), Kampala (30%), Kumasi (36%), and Mombasa (19%)). Correct helmet use was much lower among passengers compared to drivers in all cities and was almost non-existent in some cities (e.g., 1% in Kampala, and 2% in Mombasa). Correct helmet use was higher on weekdays in Accra (62%), Addis Ababa (29%), Kampala (30%), Kumasi (39%) and Mombasa (22%) compared to weekends. More motorcyclists wore helmets correctly on arterial roads in Accra (70%), Addis Ababa (31%), and Kumasi (52%), while the prevalence remained the same on arterial and local roads for Kampala (30%) and Mombasa (19%). Correct helmet use was highest among ride-share motorcycles in Accra (78%) and Kampala (50%), among commercial ones in Mombasa (28%) and Kumasi (76%), and private and government motorcycles in Addis Ababa (38%). <h3>Conclusions</h3> Correct helmet use was low, particularly among passengers. The findings highlight the need for strengthening policies and enforcement around helmet use, particularly among passengers, and the factors discussed point to areas of prioritization for the implementation of interventions like enforcement and mass media campaigns, and the planning of city-wide road safety strategies.