Background More than 33 people die on Uganda’s roads daily. The majority of the victims are vulnerable road users. In Kampala, motorcyclists contribute nearly half of the casualties of road traffic injuries. While helmets are effective in reducing serious injuries from a crash, and although they are available locally, their utilization in Kampala is poorly documented.

Objective To assess the prevalence of helmet use and associated factors in Kampala.

Methods We collected data from 16 randomly selected observations sites around Kampala between 2021 and 2023 in six rounds with the rounds being six months apart in a year. Data were collected using tablet-based checklists loaded on Kobo collect. Each site was observed for randomly selected 2 weekdays and one weekend. R software was used to conduct descriptive analyses, and run multivariable logistic regression.

Results We observed a total of 656,869 motorcyclists (67% riders and 33% passengers). Overall helmet use was 45% although correct helmet use was lower (38%). Helmet use was higher among drivers (98%) compared to passengers (2%). Half-head helmets were used most frequently (75%). Helmet use was highest among ride share users (60%) and private and government vehicles (54%). Being male (AOR – 2.26), using a ride share motorcycle (AOR – 4.05), riding during rains (AOR - 1.25) and riding on weekdays compared to weekends (AOR – 1.24) and being a driver (AOR – 71.8) were significantly associated with helmet use.

Conclusions Helmet use remains low in Kampala and is almost non-existent among passengers. Helmet use needs to be focused on all occupant types with specific focus on passengers.