Uptake of visibility materials for injury prevention and associated factors among commercial motorcycle riders: a cross-sectional study in Cameroon

BACKGROUND: Commercial motorcycle riders are among the most vulnerable road users in low- and middle-income countries, with poor visibility contributing significantly to road traffic injuries, particularly under low-light conditions. While visibility materials such as reflective jackets and functional lighting systems are effective, low-cost safety measures, their use remains inconsistent in many settings. In addition to individual behaviors, structural factors such as enforcement, access to safety equipment, and road conditions may influence their uptake. This study assessed the use of visibility materials and factors associated with their uptake among commercial motorcycle riders in the Limbe and Tiko Health Districts of Cameroon. METHODS: A community-based cross-sectional study was conducted among 499 commercial motorcycle riders aged 18 years and above in the Limbe and Tiko Health Districts. Riders were recruited at selected motorcycle pick-up points using a multistage sampling approach. Data were collected using structured interviewer-administered questionnaires and an observational checklist. Descriptive statistics were used to summarize the uptake of visibility materials. Multivariable logistic regression analysis was performed to identify factors independently associated with reflective jacket use, guided by theoretical and contextual relevance. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. RESULTS: The mean age of riders was 32.2 ± 7.6 years, and all participants were male. The most commonly observed visibility feature was a functional headlamp (85.8%), followed by backlights (57.3%) and brake lights (57.3%). Approximately half of the riders were observed wearing reflective jackets (50.9%), while reflective strips were present on only 19.0% of motorcycles. In adjusted analysis, riders who reported obeying traffic regulations were more likely to wear reflective jackets (AOR = 1.52; 95% CI: 1.10-2.30), as were those willing to allocate a budget for visibility materials (AOR = 2.20; 95% CI: 1.30-3.60). Knowledge and attitudes toward visibility materials were also positively associated with reflective jacket use. Each one-point increase in knowledge score was associated with an 18% increase in the odds of reflective jacket use (AOR = 1.18; 95% CI: 1.10-1.26), while each one-point increase in attitude score increased the odds by 14% (AOR = 1.14; 95% CI: 1.07-1.21). Riders reporting safer visibility-related practices were also more likely to wear reflective jackets (AOR = 2.16; 95% CI: 1.36-3.44). CONCLUSION: The uptake of visibility materials, particularly reflective jackets and reflective strips, remains suboptimal among commercial motorcycle riders despite widespread availability of basic lighting systems. Both behavioral and contextual factors appear to influence their use. Interventions that combine improved awareness with strategies addressing structural barriers-such as affordability, accessibility, and enforcement-may enhance rider visibility and contribute to reducing road traffic injuries in this population.