Background Uganda loses about 33 people per day to road traffic injuries. Seatbelts and child restraints are effective in reducing injury severity in a crash. However, the use of these car safety features and the associated factors in Kampala remain scanty.

Objective To assess the prevalence of seatbelt and child restraint use and the associated factors in Kampala.

Methods We conducted roadside observations at 16 randomly selected sites in Kampala between March and April 2021. Data were collected using KoboToolbox installed on android tablets. Each site was observed for 2 weekdays and one weekend, and each of the observation days was randomly selected. We used logistic regression to assess the factors associated with use and report the results at 95% confidence intervals.

Results Overall, 36,174 drivers and 18,889 passengers were observed. Seatbelt use was at 42% (22,947/55,063) while child restraint use was at 1% (19/1531). Seatbelt use was higher among drivers (53%) compared to passengers (18%). Most of the drivers were males (85%) and over 95% estimated to be 25–59 years. Seatbelt use was higher among female drivers compared to male drivers (74% vs 50%). Overall, seatbelt use was highest among private and government vehicles (44%) and lowest among commercial vehicles (28%). Among drivers, seatbelt use was highest among Sedan/SUV drivers (62%) and lowest among minivan/minibus drivers (20%). There was no significant difference in seatbelt use between weekdays and weekends. The majority of the vehicles had one to two people with majority of the observed passengers being front seat occupants. Adjusting all other variables, male car occupants were less likely to use seatbelts compared to females (AOR 0.6, CI (0.5 - 0.6)) and passengers were less likely to use seatbelts compared to drivers (AOR 0.2 CI (0.2 - 0.2)). There was no association between time of day, weather, and age with seatbelt use.

Conclusions Less than half of the observed adult car occupants used seatbelts, while child restraints were barely used. Multi-stakeholder engagement is needed to design targeted interventions to improve seatbelt and child restraint use in Kampala.