Background The non-use of helmets is a specific factor leading to head injuries resulting from motorcycle crashes.

Purpose The study's purpose was to explore the commercial motorcyclists' attitude and their practices of helmet wearing.

Methods A cross-sectional survey was conducted in urban and peri-urban areas of Dar es Salaam region in May, 2011 at 40 randomly selected commercial motorcycle parking points. A total of 273 commercial motorcyclists participated. Face-to-face interviews were performed using a standard questionnaire while observations were conducted using adapted WHO checklist. Data was analysed using SPSS V.16.0.

Results The majority of respondents (81.3%) reported that they wear helmets; few of them (32.4%) wearing a helmet consistently. Predictors of helmet use were having a positive attitude, towards helmet use for passengers (p=0.005), protective ability of helmets against head injury (p=0.003), wearing of helmets during the night (p=0.001) and the necessity of wearing helmets even by experienced riders (p=0.000).Commercial motorcyclists who had primary education were more likely to wear helmets than those who had no formal education (AOR 6.146; 95% CI 1.345 to 28.097). No significant difference in helmet wearing between urban and peri-urban areas (p=0.109). Observations showed that 52.7% were observed wearing helmets and 91.8% of them had no passenger's helmet.

Significance Despite a generally positive attitude towards helmet use, most commercial motorcyclists do not wear helmet consistently. This highlights the need for exploring the factors behind inconsistent helmet use.