Project Summary Johns Hopkins International Injury Research Unit partnered with collaborators from Ethiopia, Ghana, Kenya, and Uganda to conduct roadside observations of risk factors for road safety, namely, speed, lack of helmet use and lack of seatbelt and child restraint use, as a part of the Bloomberg Initiative for Global Road Safety project. These observations aim to assess the prevalence of risk factors and their associated factors.

Background Road traffic injuries are a leading cause of death worldwide, particularly in Africa, which records nearly 18 deaths per 100,000 people. Despite the known benefits of seat-belt use, there’s a gap in data regarding its prevalence in Africa.

Objective Determine the prevalence and predictors of seatbelt and child restraints use across five selected African cities: Accra (Ghana), Addis Ababa (Ethiopia), Kampala (Uganda), Kumasi (Ghana), and Mombasa (Kenya).

Methods Between 2020 and 2022, one round of roadside observations was conducted at 10 to 15 systematically selected representative sites in each city. Observations took place in five daily 90-minute sessions covering both weekdays and weekends. Descriptive analyses and multivariable logistic regression were performed to report on seat-belt use (over 12 years old) and child restraint use (under 12 years old).

Results Results from 202,001 vehicles and 349,615 occupants showed varying seat-belt use: 85% in Addis Ababa, 41% in Kampala and Accra, 28% in Mombasa, and 15% in Kumasi; child restraint use was extremely rare, with the highest 6% in Kumasi. In all five cities, seat-belt use was more common among drivers than passengers (66% vs 11% in Accra, 99% vs. 61% in Addis Ababa, 51% vs. 19% in Kampala, 25% vs. 5% in Kumasi, and 28% vs. 16% in Mombasa) and among front-seat passengers than rear-seat passengers (18% vs.2%, 85% vs.8%, 22% vs. 6%, 8% vs. 1%, and 26% vs. 6%, respectively). Multivariable logistic regression showed a significant (p<0.05) 30–50% lower likelihood of wearing seatbelts among males than females for all cities except Addis Ababa. Across all the cities except Kampala, seatbelt use on arterial roads was significantly less likely, 10%-40% (p<0.05), compared to local and collector roads. Other factors like road type, time, vehicle type, ownership type, and law enforcement presence showed varied influence across cities.

Conclusions Although the prevalence of seatbelt use varies across selected African cities, there is a need to implement targeted strategies to improve seatbelt use with a specific focus on males and passengers, especially rear-seat passengers, along with the use of child restraint seats. Tailored, context-specific strategies are also recommended.