Background Motorcycle taxis are an emerging mode of urban mobility in lower- and middle-income countries (LMICs) especially in Asia and sub-Saharan Africa. The epidemiology of injuries associated with motorcycle taxi use is unclear, and there is limited information about safe motorcycle taxi systems.

Objective To systematically gather published reports about motorcycle taxi systems and synthesise evidence to inform regulation and policy development in LMICs.

Methods We searched PubMed, SafetyLit, and TRID databases for studies reporting injuries and deaths associated with motorcycle taxi systems in LMICs or the management of such systems. We included two-wheeled taxis, including but not restricted to those provided through ride-sharing apps. Articles were screened by two researchers to identify those meeting all inclusion criteria, and data were extracted into a piloted data extraction spreadsheet. A narrative synthesis reported taxi system management interventions using a framework of Rider, Operator, Regulatory, and Environmental factors.

Results The searches identified 412 articles. After removing duplicate records, screening of titles and abstracts, and a review of full texts, 52 articles met our inclusion criteria with 63% from Sub-Saharan African countries and 15% from Southeast Asian countries. Only 13 publications reported crashes and injuries. Of these, most described the experience of motorcycle taxi riders, who reported having crashed or been injured whilst riding, often without a helmet or undertaking risky behaviour. Of publications reporting taxi system management interventions, mostly rider factors were reported, particularly behavioural issues such as helmet, alcohol, or drug use, how vehicles were maintained or used, or regulatory factors (e.g. licensing, insurance, and use of safety equipment). Operator and environmental factors were reported infrequently.

Conclusion The epidemiology of injuries associated with motorcycle taxi use is poorly reported. Interventions to promote motorcycle helmet use is the most common strategy reported to increase the safety of motorcycle taxi systems. There is scope to significantly broaden the evidence base regarding the safe management of this form of public transport.