Trends in Helmet Use Among Motorcycle Drivers and Passengers in Addis Ababa: A Six-Year Observational Study (2015–2020)

Motorcycle use is rising in low- and middle-income countries, leading to more crashes. Many deaths from these crashes are preventable with correct helmet use. This study examined correct helmet use trends and factors influencing it. A roadside cross-sectional observational study was conducted in 10 randomly selected locations across 10 sub-cities of Addis Ababa from 2015 to 2020 twice a year. Binary logistic regression analysis was performed to identify predictors of correct helmet use. Out of 39,246 drivers and 12,950 passengers observed, 75% of drivers and 26.2% of passengers wore helmets. However, according to the Ethiopian helmet law (which requires the strapped use of any helmet type), only 34.2% of observed drivers (n = 39,246) and 9.1% of observed passengers (n = 12,950) wore helmets correctly. Under the global best-practice standard (strapped use of approved helmets excluding cap helmets) was even lower at 29.6% among drivers and 6.6% among passengers. Correct use declined over six years until the 2019 reinitiation of helmet law enforcement. Among drivers, correct use was linked to full-face helmets (AOR = 1. 90, 95% CI: 1.77–2.04), police enforcement (AOR = 1.08, 95%CI: 1.02–1.14), rain (AOR = 1.26, 95% CI: 1.14–1.40), and riding on arterial roads (AOR = 1.89, 95% CI: 1.78–2.00). For passengers, being female (AOR = 1.55, 95% CI: 1.09–2.19), aged ≥18 (AOR = 2.16, 95% CI: 1.34–3.46), and riding with correctly helmeted drivers (AOR = 3.37, 95% CI: 2.88–3.95) increased correct use. The findings indicate a need for a combination of interventions, including awareness-raising campaigns, sustained enforcement, and preparing helmet standards.