Background 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%. Objective Assess the prevalence of correct (i.e., standard, and strapped) helmet use among motorcyclists and the associated factors in five African cities. Methods 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. Results 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%). Conclusions 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.

Background Uganda loses about 33 people per day to road traffic injuries. Seatbelts and child restraints are effective in reducing injury severity in a crash. However, the use of these car safety features and the associated factors in Kampala remain scanty. Objective To assess the prevalence of seatbelt and child restraint use and the associated factors in Kampala. Methods We conducted roadside observations at 16 randomly selected sites in Kampala between March and April 2021. Data were collected using KoboToolbox installed on android tablets. Each site was observed for 2 weekdays and one weekend, and each of the observation days was randomly selected. We used logistic regression to assess the factors associated with use and report the results at 95% confidence intervals. Results Overall, 36,174 drivers and 18,889 passengers were observed. Seatbelt use was at 42% (22,947/55,063) while child restraint use was at 1% (19/1531). Seatbelt use was higher among drivers (53%) compared to passengers (18%). Most of the drivers were males (85%) and over 95% estimated to be 25–59 years. Seatbelt use was higher among female drivers compared to male drivers (74% vs 50%). Overall, seatbelt use was highest among private and government vehicles (44%) and lowest among commercial vehicles (28%). Among drivers, seatbelt use was highest among Sedan/SUV drivers (62%) and lowest among minivan/minibus drivers (20%). There was no significant difference in seatbelt use between weekdays and weekends. The majority of the vehicles had one to two people with majority of the observed passengers being front seat occupants. Adjusting all other variables, male car occupants were less likely to use seatbelts compared to females (AOR 0.6, CI (0.5 - 0.6)) and passengers were less likely to use seatbelts compared to drivers (AOR 0.2 CI (0.2 - 0.2)). There was no association between time of day, weather, and age with seatbelt use. Conclusions Less than half of the observed adult car occupants used seatbelts, while child restraints were barely used. Multi-stakeholder engagement is needed to design targeted interventions to improve seatbelt and child restraint use in Kampala.

Background More than 33 people die on Uganda's roads daily. The majority of the victims are vulnerable road users. In Kampala, motorcyclists contribute nearly half of the casualties of road traffic injuries. While helmets are effective in reducing serious injuries from a crash, and although they are available locally, their utilization in Kampala is poorly documented. Objective To assess the prevalence of helmet use and associated factors in Kampala. Methods We collected data from 16 randomly selected observations sites around Kampala between 2021 and 2023 in six rounds with the rounds being six months apart in a year. Data were collected using tablet-based checklists loaded on Kobo collect. Each site was observed for randomly selected 2 weekdays and one weekend. R software was used to conduct descriptive analyses, and run multivariable logistic regression. Results We observed a total of 656,869 motorcyclists (67% riders and 33% passengers). Overall helmet use was 45% although correct helmet use was lower (38%). Helmet use was higher among drivers (98%) compared to passengers (2%). Half-head helmets were used most frequently (75%). Helmet use was highest among ride share users (60%) and private and government vehicles (54%). Being male (AOR – 2.26), using a ride share motorcycle (AOR – 4.05), riding during rains (AOR - 1.25) and riding on weekdays compared to weekends (AOR – 1.24) and being a driver (AOR – 71.8) were significantly associated with helmet use. Conclusions Helmet use remains low in Kampala and is almost non-existent among passengers. Helmet use needs to be focused on all occupant types with specific focus on passengers.

Project Summary Johns Hopkins International Injury Research Unit partnered with collaborators from Ethiopia, Ghana, Kenya, and Uganda to conduct roadside observations of risk factors for road safety, namely, speed, lack of helmet use and lack of seatbelt and child restraint use, as a part of the Bloomberg Initiative for Global Road Safety project. These observations aim to assess the prevalence of risk factors and their associated factors. Background Road traffic injuries are a leading cause of death worldwide, particularly in Africa, which records nearly 18 deaths per 100,000 people. Despite the known benefits of seat-belt use, there's a gap in data regarding its prevalence in Africa. Objective Determine the prevalence and predictors of seatbelt and child restraints use across five selected African cities: Accra (Ghana), Addis Ababa (Ethiopia), Kampala (Uganda), Kumasi (Ghana), and Mombasa (Kenya). Methods Between 2020 and 2022, one round of roadside observations was conducted at 10 to 15 systematically selected representative sites in each city. Observations took place in five daily 90-minute sessions covering both weekdays and weekends. Descriptive analyses and multivariable logistic regression were performed to report on seat-belt use (over 12 years old) and child restraint use (under 12 years old). Results Results from 202,001 vehicles and 349,615 occupants showed varying seat-belt use: 85% in Addis Ababa, 41% in Kampala and Accra, 28% in Mombasa, and 15% in Kumasi; child restraint use was extremely rare, with the highest 6% in Kumasi. In all five cities, seat-belt use was more common among drivers than passengers (66% vs 11% in Accra, 99% vs. 61% in Addis Ababa, 51% vs. 19% in Kampala, 25% vs. 5% in Kumasi, and 28% vs. 16% in Mombasa) and among front-seat passengers than rear-seat passengers (18% vs.2%, 85% vs.8%, 22% vs. 6%, 8% vs. 1%, and 26% vs. 6%, respectively). Multivariable logistic regression showed a significant (p<0.05) 30–50% lower likelihood of wearing seatbelts among males than females for all cities except Addis Ababa. Across all the cities except Kampala, seatbelt use on arterial roads was significantly less likely, 10%-40% (p<0.05), compared to local and collector roads. Other factors like road type, time, vehicle type, ownership type, and law enforcement presence showed varied influence across cities. Conclusions Although the prevalence of seatbelt use varies across selected African cities, there is a need to implement targeted strategies to improve seatbelt use with a specific focus on males and passengers, especially rear-seat passengers, along with the use of child restraint seats. Tailored, context-specific strategies are also recommended.

Objectives. Upon immersion in water, a cascade of human physiological responses is evoked, which may result in drowning death. Although lifejackets are over 80% effective in preventing drowning, many people in lakeside fishing communities in Uganda shy away from wearing them because of active distrust in the quality of the lifejackets on the local market. No study has determined the veracity of these claims. This study determined the seaworthiness of lifejackets sold at landing sites of Lake Albert, Uganda. Methods. Using a within-person repeated assessment design, we tested 22 new lifejacket samples obtained from landing sites of Lake Albert, Uganda. We conducted water entry, righting, floatation stability and minimum buoyancy performance tests. Results. All the lifejacket samples failed the minimum buoyancy functional requirements test; the average buoyancy was 80 N (SD 13). Only 4% of the lifejackets passed the righting test within 5 s. For floatation stability, 45% of the lifejackets sank earlier than 48 h of placement in water and also failed water entry tests by getting dislodged from the wearer. Conclusion. The lifejackets sold at the landing sites of Lake Albert do not meet minimum seaworthiness functional requirements. The government should regulate the quality of lifejackets on the local market.