Background Road traffic injuries (RTI) are a significant cause of morbidity and mortality in low and middle income countries (LMIC). Further investigations of the high risk areas for RTIs in LMIC are needed to guide improvements in road safety planning. This study aims to provide a built environmental analysis of road traffic crash hotspots within Moshi, Tanzania.

Methods After ethical and police permission, Moshi police data was collected and descriptive statistics were tabulated. Hotspots were identified through spatial analysis and relevant patterns in environmental characteristics determined using Qualitative Comparative Analysis (QCA).

Results 36 Hotspots were identified. QCA revealed 40% of crash sites were found on local roads, without night lighting and had increased motorcycle density. A further 26% of hotspots were located on paved narrow roads and 13% of hotspots were described as unpaved roads with uneven roadside areas. Roadside unevenness was more predominate in low risk sites, (High risk n = 7 (46.7%), Low risk n = 19, 90.5%, p = 0.01). Both low and high risk sites had minimal signage (High risk n = 1 (6.7%), low risk n = 6 (28.6%) and all had informal pedestrian pathways (High risk n = 15 (100%), low risk n = 21 (100%) .

Conclusions In Moshi, Tanzania hotspots were associated with roadside dangers, lack of night lighting, informal pedestrian pathways, and increased traffic density but overall there was little variability between the low and high risk sites suggesting hazardous road conditions exist throughout the area. Our findings suggest overall improvement in municipal infrastructure, including structural improvements, signage and enforcement are needed to help reduce road traffic injury burden.