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The use of non-standard motorcycle helmets in low- and middle-income countries: a multicentre study
  1. Road Traffic Injuries Research Network Multicenter Study Collaborators,
  2. Williams Ackaah1,
  3. Francis Afukaar1,
  4. Williams Agyemang1,
  5. Trinh Thuy Anh18,
  6. A R Hejar2,
  7. Ghaffar Abdul3,
  8. Gopalkrishna Gururaj4,
  9. Hidalgo-Solórzano Elisa5,
  10. Híjar Martha5,6,
  11. Adnan A Hyder7,
  12. Cristina Inclán-Valadez8,
  13. Subramaniam Kulanthayan9,2,
  14. Robyn Norton10,
  15. Wilson Odero11,
  16. Eme T Owoaje12,
  17. Margie Peden13,
  18. Krishnan Rajam14,
  19. Junaid Abdul Razzak15,
  20. Adesola Oluwafunmilola Sangowawa16,
  21. Jawaid Shah17,
  22. Pham Le Tuan18,
  23. Radin Umar RS19,
  24. Nguyen Thi Van Anh18,
  25. Marc Van der Putten20,
  26. Nitaya Vajanapoom20,
  27. Nuntavarn Vichit-Vadakan20,
  28. Kaviyarasu Yellappan2,
  29. James Yu21
  1. 1CSIR-Building & Road Research Institute, Kumasi, Ghana
  2. 2Road Safety Research Centre, Faculty of Engineering, Universiti Putra Malaysia, Malaysia
  3. 3Global Forum for Health Research, Geneva
  4. 4Department of Epidemiology National Institute of Mental Health and Neuro Sciences, Bangalore, India
  5. 5Centro de Investigación en Sistemas de Salud del Instituto Nacional de Salud Pública, Cuernavaca, México
  6. 6Fundación Entornos, A. C
  7. 7Johns Hopkins International Injury Research Unit. Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
  8. 8Cities & Development Research Department, the London School of Economics and Political Science
  9. 9Department of Community Health, Faculty of Medicine & Health Sciences, University Putra Malaysia
  10. 10The George Institute for Global Health, The University of Sydney, Sydney, Australia
  11. 11Moi University, Kenya
  12. 12Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan Oyo State, Nigeria
  13. 13Department of Violence, Injury Prevention and Disability, WHO, Geneva
  14. 14Department of Primary Care Medicine, University Malaya, Malaysia
  15. 15Department of Emergency Medicine, and Community Health Sciences, Aga Khan University, Karachi, Pakistan
  16. 16Institute of Child Health, College of Medicine, University of Ibadan, Nigeria
  17. 17Aga Khan University, Pakistan
  18. 18Hanoi Department of Public Health, Vietnam
  19. 19Malaysian Institute of Road Safety Research, Malaysia
  20. 20Thammasat University, Thailand
  21. 21Research and Development, The George Institute for Global Health, Beijing, China
  1. Correspondence to Road Traffic Injuries Research Network, Office of the Secretariat. Address: Calle 3 No. 1, Col. Lomas de Atzingo, C.P. 62180. Cuernavaca, Morelos, Mexico; secretariat{at}


Background The use of non-standard motorcycle helmets has the potential to undermine multinational efforts aimed at reducing the burden of road traffic injuries associated with motorcycle crashes. However, little is known about the prevalence or factors associated with their use.

Methods Collaborating institutions in nine low- and middle-income countries undertook cross-sectional surveys, markets surveys, and reviewed legislation and enforcement practices around non-standard helmets.

Findings 5563 helmet-wearing motorcyclists were observed; 54% of the helmets did not appear to have a marker/sticker indicating that the helmet met required standards and interviewers judged that 49% of the helmets were likely to be non-standard helmets. 5088 (91%) of the motorcyclists agreed to be interviewed; those who had spent less than US$10 on their helmet were found to be at the greatest risk of wearing a non-standard helmet. Data were collected across 126 different retail outlets; across all countries, regardless of outlet type, standard helmets were generally 2–3 times more expensive than non-standard helmets. While seven of the nine countries had legislation prohibiting the use of non-standard helmets, only four had legislation prohibiting their manufacture or sale and only three had legislation prohibiting their import. Enforcement of any legislation appeared to be minimal.

Interpretation Our findings suggest that the widespread use of non-standard helmets in low- and middle-income countries may limit the potential gains of helmet use programmes. Strategies aimed at reducing the costs of standard helmets, combined with both legislation and enforcement, will be required to maximise the effects of existing campaigns.

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