Background Road traffic crashes are a major cause of global morbidity and mortality, disproportionately affecting low- and middle-income countries. Motorcycle taxi (boda-boda) drivers are particularly vulnerable because they have limited protection and safety equipment. This study characterises injury prevalence and safety habits amongst boda-boda drivers, and identifies intervention points to improve road safety.

Methods A prospective mixed methods interview and safety assessment was administered to 300 boda-boda drivers in urban Moshi, Tanzania. Participants were chosen randomly from 25 of 58 registered boda-boda stands and 2 of 31 unregistered stands. The survey was administered using a computerised, internet based survey tool (REDCAPS) and tablet computers. Data were analysed using R, and a thematic analysis was performed and agreed upon by three investigators (MP, TN, CS).

Results Of the 148 participants (49.3%) who had experienced a crash, 114 (77.0%) sustained at least one injury. Only 27 of those injured (23.4%) were hospitalised. 220 participants (73.3%) reported consistent helmet usage despite the fact that 285 participants (95.0%) agree that helmet usage reduces injury severity. Of the 280 helmets observed, 231 (82.5%) were either damaged or fit improperly. A thematic analysis of boda-boda drivers’ suggestions to increase road safety identified four intervention points: 1) roadway infrastructure and traffic regulation, 2) road user attitudes and safe driving behaviours, 3) education and training, and 4) law enforcement.

Conclusions The present study demonstrates the high prevalence of road traffic injuries amongst boda-boda drivers. The study identifies four intervention points that can be leveraged to increase overall road traffic safety. Unfortunately, while boda-boda drivers are aware of ways to improve safety, adherence to safety habits remains low. Successful interventions will bridge the gap between knowledge and practice of safety habits.