Context In Antananarivo, Madagascar’s capital city, motorcycle and scooter traffic is increasing, and newspapers frequently report on crashes that injure or kill motorcycle riders. Despite this, no detailed data on the share of motorcyclists on overall traffic is available. Furthermore, no data is collected on motorcycle helmet use, leaving policy makers without an evidence base for road safety related policy decisions.

Methods An in-traffic naturalistic observation study was conducted in Antananarivo, Madagascar, to collect data on motorcyclists’ helmet use and to assess the share of motorcyclists on overall traffic. A traffic observation camera was set-up at one of the main roads in the city (Route Circulaire), where traffic was recorded every day for one week. The observations were carried out from 7am to 5pm. The software BORIS was used to register the observations on the video recordings.

Results Two-wheeled vehicles account for 23.5% of the vehicles in circulation observed, of which powered two-wheelers (PTW – scooters and motorcycles) represent 90%. Overall, 70.3% of PTW riders registered during this observation used a motorcycle helmet. But while drivers’ helmet use was relatively high (76.4%), less than half of the observed motorcycle passengers (47.7%) used a helmet.

Conclusion and Learning Outcomes This first naturalistic observation study revealed a disparity of motorcycle helmet use in Antananarivo. Road policy adjustment is necessary to increase motorcycle passenger helmet use, through educational/enforcement campaigns, or direct adjustment of traffic fines. More data collection is needed to provide a comprehensive evidence base for motorcyclists’ safety related behaviour in Madagascar.