Background In low- and middle-income countries (LMICs), most road traffic injury victims are vulnerable road users. Injuries and deaths are frequent, as walking, cycling, and traveling on motorized two and three-wheelers are the most common modes of transportation in LMICs, emphasizing the intersection of mobility and equity in transportation planning. Approximately 88% of the world’s powered two- and three-wheelers are in LMICs, with an increasing fleet due to the availability of low-cost motorcycles, lower fuel consumption, rising traffic volumes, and unmet transportation needs. Further, road safety policies often overlook VRUs, perpetuating inequities in transportation planning and underscoring the urgency of inclusive approaches to meet the mobility needs of all.

Objective We retrospectively evaluated police-reported data on each road traffic injury, severe injury, and death in Ghana between 2016 to 2020 to determine the impact of human, vehicle, and environmental factors on severity.

Methods Using a partial proportional odds model, we compare factors affecting severe injury and mortality odds among VRUs and non-VRUs. Subgroup analyses were conducted on the main VRU types commonly found in Ghana: 1) powered-two-wheeler occupants, 2) powered three-wheeler occupants, 3) cyclists, and 4) pedestrians.

Results The analysis covers 51,033 injured road users: 18,892 minor injuries, 24,200 severe injuries, and 7,450 deaths. Significant factors affecting severity across groups included collisions that are head on collisions (VRU OR: 2.03, 95% Confidence Interval [CI]: 1.88, 2.20, non-VRU OR: 2.14, 95% CI: 2.01–2.27), rural collisions (VRU OR: 1.81, 95% CI: 1.71, 1.91, non-VRU: 1.30, 95% CI: 1.24, 1.37), and nighttime collisions with limited lighting (VRU OR: 1.54, 95% CI: 1.33, 1.77, non-VRU OR: 1.36, 95% CI: 1.22, 1.51). We found variability in factors associated with severity by road user type. Commercial bus-involved collisions and nighttime collisions with limited lights increased the risk for powered two-wheelers and pedestrians. Powered three-wheeler passengers were at higher severity risk compared to drivers (OR: 1.62, 95% CI: 1.62, 1.97). Pedestrians were more likely to be injured on gravel or earth roads (OR: 1.43, 95% CI: 1.11, 1.84).

Conclusions The findings underscore the importance of tailoring injury prevention efforts to the specific context and road user type.