Descriptive epidemiology of bicycle helmet usage in central and southern Malawi

Background

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.

Methods

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.

Results

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.

Conclusions

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.