252966 Descriptive epidemiology of bicycle helmet usage in central and southern Malawi

Sunday, October 30, 2011

John D. Kraemer , Department of Health Systems Administration, Georgetown University, Washington, DC
Brian J. Honermann , O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC
Jason S. Roffenbender , Department of Human Science, Georgetown University, Washington, DC

Road traffic accidents comprise a substantial portion of the burden of injury and illness in developing countries. Because a high percentage of many sub-Saharan African populations ride bicycles, safe cycling interventions could have a large public health benefit. However, very little data exist on baseline levels of safe cycling interventions, such as helmet wearing.


During four days of driving in central and southern Malawi, we recorded the helmet status and relevant characteristics (sex, approximate age, and bicycle operator/passenger) of observed cyclists. We sought a representative sample of road conditions, including paved and unpaved, low- and high-volume, and rural and urban, roads.


1900 cyclists were observed. Of these, 91.5% were male and 87.7% were operating the bicycle. The sizable majority of male cyclists were classified as young adults from adolescence to 25 years old (47.2%) or adults over age 25 (44.9%); only 7.9% of male cyclists were preadolescent. Passengers were more likely to be female than operators (39.1% versus 4.2%), though, even for passengers, a higher proportion were males than females (p=0.0005).

No cyclist was identified as wearing a helmet (exact 95% CI: 0.0% - 0.2%). There was no variation by age, sex, or operator/passenger status.


In what we believe to be the largest assessment of helmet usage ever conducted in sub-Saharan Africa, helmet usage is so rare as to be non-existent. This suggests that an opportunity exists for significant improvement. Based on observed cyclists' demographics, interventions should be targeted to adult and young adult male cyclists.

Learning Areas:
Public health or related research

Learning Objectives:
1. Describe the level of bicycle helmet usage in Malawi. 2. Articulate a simple methodology for assessing bicycle and motorcycle helmet usage in settings that currently lack data.

Keywords: Bike Helmets, International Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: was involved in the design of the study, acquisition of data, and writing of the abstract and teach epidemiology at Georgetown University.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.