Injury Prevalence and Safety Habits of Boda Bodas in Moshi Tanzania: A Mixed Methods Study

Background: Road traffic crashes are a major cause of global morbidity and mortality disproportionately affecting low- and middle-income countries (LMIC). Motorcycle taxi, or boda boda drivers are particularly vulnerable because they are exposed to traffic risks with limited safety equipment. This study aims to characterize injury prevalence and safety habits among boda boda drivers, as well as ways to improve road traffic safety in a LMIC. Methods: A prospective mixed methods interview and safety assessment was administered to 300 boda boda drivers between 24 March and 3 April 2014 in urban Moshi, Tanzania. Participants were chosen randomly from 25 of 58 registered boda boda stands and 2 of 31 unregistered stands. The survey was administered using a computerized and internet based survey tool and tablet computers. Data were analyzed using R, and a thematic analysis was performed and agreed upon by three investigators (MP, TN, CAS). A network analysis was performed to evaluate the association between boda boda characteristics and injury risk. Results: In total, 300 drivers participated of which 148 (49.3%) experienced a lifetime crash, and 114 (77.0%) sustained at least one injury. Only 27 of those injured (23.4%) were hospitalized. 220 participants (73.3%) reported consistent helmet usage despite the fact that 285 participants (95.0%) agree that helmet usage reduces injury severity. Of the 280 helmets observed, 231 (82.5%) were either damaged or fit improperly. A thematic analysis of boda boda drivers’ suggestions to increase road safety identified four intervention areas: 1) roadway infrastructure and traffic regulation, 2) road user attitudes and safe driving behaviors, 3) education and training, and 4) law enforcement.<br>Conclusion: Our study demonstrates a high prevalence of road traffic crashes and injuries amongst boda boda drivers. The study identifies four intervention areas that can be leveraged to increase overall road traffic safety. Unfortunately, while boda boda drivers are aware of ways to improve safety, adherence to safety habits remains low. Successful multi-sectoral interventions are needed to improve road safety for boda boda drivers in Tanzania.