Article Text

Download PDFPDF
Effect of different helmet types in head injuries: a case–control study in northern Ghana
  1. Anthony Baffour Appiah1,2,
  2. Patricia Akweongo3,
  3. Samuel Oko Sackey1,
  4. Martin Tangnaa Morna4,
  5. Ernest Kenu1,5,
  6. Alexis Dun Bo-ib Buunaaim6,
  7. Samual Akobour Yaw Debrah4,
  8. Thomas K Ojo7,
  9. Peter Donkor8,
  10. Charles N Mock9
  1. 1 Ghana Field Epidemiology and Laboratory Training Programme, School of Public Health, University of Ghana, Legon, Ghana
  2. 2 Injury Epidemiology and Prevention Unit, Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
  3. 3 Department of Health Policy, Planning, and Management, University of Ghana, Legon, Ghana
  4. 4 Department of Surgery, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
  5. 5 Department of Applied Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
  6. 6 Department of Surgery, Tamale Teaching Hospital, Tamale, Ghana
  7. 7 Department of Geography and Regional Planning, University of Cape Coast College of Humanities and Legal Studies, Cape Coast, Ghana
  8. 8 Department of Surgery, School of Medical Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
  9. 9 Harborview Injury Prevention & Research Center, Seattle, Washington, USA
  1. Correspondence to Anthony Baffour Appiah, Ghana Field Epidemiology and Laboratory Training Programme, University of Ghana, Legon LG 1181, Ghana; anthonybaffourappiah{at}


Background Motorcycle helmet use is low in Ghana and many helmets are non-standard. There are limited data on the effectiveness of the different helmet types in use in the real-world circumstances of low-income and middle-income countries. This study assessed the effect of different helmet types on risk of head injury among motorcycle crash victims in northern Ghana.

Methods A prospective unmatched case–control study was conducted at the Tamale Teaching Hospital (TTH). All persons who had injuries from a motorcycle crash within 2 weeks of presentation to TTH were consecutively sampled. A total of 349 cases, persons who sustained minor to severe head injury, and 363 controls, persons without head injury, were enrolled. A semistructured questionnaire was used to interview patients and review their medical records. Multivariable logistic regression was used to estimate odds for head injury.

Results After adjusting for confounders, the odds of head injuries were 93% less in motorcyclists with full-face helmet (FFH) (adjusted OR, AOR 0.07, 95% CI 0.04 to 0.15) or open-face helmet (OFH) (AOR 0.07, 95% CI 0.04, 0.13), compared with unhelmeted motorcyclists. Half-coverage helmets (HCH) were less effective (AOR 0.41, 95% CI 0.18 to 0.92). With exception of HCH, the AORs of head injury for the different types of helmets were lower in riders (FFH=0.06, OFH=0.05 and HCH=0.47) than in pillion riders (FFH=0.11, OFH=0.12 and HCH=0.35).

Conclusion Even in this environment where there is a high proportion of non-standard helmets, the available helmets provided significant protection against head injury, but with considerably less protection provided by HCHs.

  • Motorcycle
  • Helmet
  • Traumatic Brain Injury
  • Health Education

Data availability statement

All data relevant to the study are included in the article.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

All data relevant to the study are included in the article.

View Full Text


  • Contributors ABA: conceptualisation, methodology, resources, investigation, data curation, visualisation, drafting, reviewing and editing. PA, SOS and EK: supervision, methodology, drafting, reviewing and editing. MTM and SAYD: resources, reviewing and editing. ADB-iB: data curation, writing-reviewing and editing. TKO: reviewing and editing. PD and CNM: conceptualisation, methodology, funding acquisition, reviewing and editing. All the authors have read and agreed to the final revised manuscript. ABA: responsible for the overall content as the guarantor.

  • Funding This study was supported by grants from the Fogarty International Center at the US National Institutes of Health (D43 TW007267) and from the AO Alliance Paediatric Fracture Solution Project.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. The funder played no role in the gathering or interpretation of the data, nor the writing of the manuscript.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.