Cyclists’ Helmet Usage and Characteristics in Central and Southern Malawi: A Cross-Sectional Study

Abstract

The objective of this study was to determine the prevalence of, and factors associated with, bicycle helmet usage in southern and central Malawi. This study was across-sectional observation of public behaviour. Urban and rural roadways in southern and central Malawi were studied during the dry season. In total, 1900 bicyclists were observed over a four-day period. Observer ascertainment of cyclists' helmet status, approximate age, sex and bicycle operator or passenger status were measured. Of the 1900 cyclists observed, 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. Nearly, 91.5% of observed cyclists were males and 87.7% were operating the bicycle. The sizeable majority of male cyclists were classified as young adults from adolescence to 25 years old (47.2%) or adults over age 25 (44.9%); 7.9% of male cyclists were pre-adolescent. 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 < 0.001). In Malawi, helmet usage is so rare as to be non-existent. This suggests an opportunity for significant improvement. Based on the observed cyclists' characteristics, interventions should be targeted to adult and young adult males.

Keywords: road safety, helmets, injury prevention