Injury prevalence and safety habits of boda boda drivers in Moshi, Tanzania: A mixed methods study

BackgroundTraffic crashes are a major cause of global morbidity and mortality disproportionately affecting low- and middle-income countries (LMICs). Motorcycle taxi (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 LMICs.MethodsA cross-sectional mixed methods study was conducted with 300 boda boda drivers between 24 March and 3 April 2014 in urban Moshi, Tanzania. A convenience sample of participants was drawn from 25 of 58 registered boda boda stands and 2 of 31 unregistered stands. Data were analyzed using R, and content thematic analysis was performed and agreed upon by three investigators. Logistic regression models were used to evaluate the association between boda boda characteristics and injury risk.ResultsIn total, 300 drivers participated, of whom 148 (49.3%) had experienced a crash during their lifetime, and 114 (77.0%) sustained at least one injury. Only 27 of those injured (23.4%) were hospitalized. Of all participants, 220 (73.3%) reported consistent helmet usage, despite 285 participants (95.0%) agreeing that helmet usage reduces injury severity. From the 280 helmets observed, 231 (82.5%) were either damaged or fit improperly. Having a cracked helmet was associated with higher risk of being involved in a traffic crash. Owning a helmet with a proper fit was associated with reduced risk for a traffic crash (OR = 0.06) and road traffic injuries (OR = 0.07). 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.ConclusionOur study demonstrates boda boda drivers’ safety behaviors and 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.背景 道路交通事故是全球发病与死亡的主要诱因之一，对中低收入国家（low- and middle-income countries, LMICs）的影响尤为不成比例。摩的（boda boda）驾驶员群体尤为脆弱，他们在暴露于交通风险的同时仅配备有限的安全防护装备。本研究旨在阐明摩的驾驶员的损伤患病率与安全习惯现状，并探索改善中低收入国家道路交通安全的可行路径。 方法 本研究于2014年3月24日至4月3日在坦桑尼亚莫希市开展，针对300名摩的驾驶员采用横断面混合方法研究设计。研究通过便利抽样，从58个注册摩的停靠点中选取25个、31个非注册停靠点中选取2个作为抽样范围。数据采用R语言进行分析，同时开展内容主题分析，并由三名研究者共同确认分析结果。通过逻辑回归模型评估摩的驾驶员特征与损伤风险之间的关联。 结果 总计300名驾驶员参与本研究，其中148名（49.3%）在从业生涯中曾遭遇交通事故，114名（77.0%）至少遭受过一处损伤。在受伤的驾驶员中，仅27名（23.4%）接受过住院治疗。全体参与者中，220名（73.3%）表示会坚持佩戴头盔，尽管有285名（95.0%）受访者认同佩戴头盔可降低损伤严重程度。本次研究共观察到280顶头盔，其中231顶（82.5%）存在破损或佩戴不合规的情况。头盔存在裂纹与交通事故卷入风险升高呈显著相关。佩戴尺寸合规的头盔则与交通事故风险（OR=0.06）及道路交通损伤风险（OR=0.07）降低相关。对摩的驾驶员提出的道路安全改进建议开展主题分析后，共识别出四大干预领域：1）道路基础设施与交通规制；2）道路使用者态度与安全驾驶行为；3）教育与培训；4）执法监管。 结论 本研究明确了摩的驾驶员的安全行为现状，并识别出四大可用于提升整体道路交通安全的干预领域。值得注意的是，尽管摩的驾驶员已知晓提升交通安全的可行方式，但其安全习惯的依从性仍处于较低水平。因此，亟需开展多部门协同的干预措施，以改善坦桑尼亚摩的驾驶员的道路交通安全状况。