Dataset Information

Differences in outcomes of mandatory motorcycle helmet legislation by country income level: A systematic review and meta-analysis.

ABSTRACT:

Background

The recent Lancet Commission on Legal Determinants of Global Health argues that governance can provide the framework for achieving sustainable development goals. Even though over 90% of fatal road traffic injuries occur in low- and middle-income countries (LMICs) primarily affecting motorcyclists, the utility of helmet laws outside of high-income settings has not been well characterized. We sought to evaluate the differences in outcomes of mandatory motorcycle helmet legislation and determine whether these varied across country income levels.

Methods and findings

A systematic review and meta-analysis were completed using the PRISMA checklist. A search for relevant articles was conducted using the PubMed, Embase, and Web of Science databases from January 1, 1990 to August 8, 2021. Studies were included if they evaluated helmet usage, mortality from motorcycle crash, or traumatic brain injury (TBI) incidence, with and without enactment of a mandatory helmet law as the intervention. The Newcastle-Ottawa Scale (NOS) was used to rate study quality and funnel plots, and Begg's and Egger's tests were used to assess for small study bias. Pooled odds ratios (ORs) and their 95% confidence intervals (CIs) were stratified by high-income countries (HICs) versus LMICs using the random-effects model. Twenty-five articles were included in the final analysis encompassing a total study population of 31,949,418 people. There were 17 retrospective cohort studies, 2 prospective cohort studies, 1 case-control study, and 5 pre-post design studies. There were 16 studies from HICs and 9 from LMICs. The median NOS score was 6 with a range of 4 to 9. All studies demonstrated higher odds of helmet usage after implementation of helmet law; however, the results were statistically significantly greater in HICs (OR: 53.5; 95% CI: 28.4; 100.7) than in LMICs (OR: 4.82; 95% CI: 3.58; 6.49), p-value comparing both strata < 0.0001. There were significantly lower odds of motorcycle fatalities after enactment of helmet legislation (OR: 0.71; 95% CI: 0.61; 0.83) with no significant difference by income classification, p-value: 0.27. Odds of TBI were statistically significantly lower in HICs (OR: 0.61, 95% CI 0.54 to 0.69) than in LMICs (0.79, 95% CI 0.72 to 0.86) after enactment of law (p-value: 0.0001). Limitations of this study include variability in the methodologies and data sources in the studies included in the meta-analysis as well as the lack of available literature from the lowest income countries or from the African WHO region, in which helmet laws are least commonly present.

Conclusions

In this study, we observed that mandatory helmet laws had substantial public health benefits in all income contexts, but some outcomes were diminished in LMIC settings where additional measures such as public education and law enforcement might play critical roles.

SUBMITTER: Lepard JR

PROVIDER: S-EPMC8486090 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background Morbidity and mortality from road traffic crashes are steadily increasing globally and they remain a major public health challenge. This burden is disproportionately borne by low-and middle-income countries, especially Sub-Saharan Africa where motorcycle helmet use is low and where there are challenges of affordability and availability of standard helmets. We sought to assess the availability and cost of helmets in retail outlets in northern Ghana. Methods A market survey of 408 randomly sampled automobile-related retail outlets in Tamale, northern Ghana was conducted. Multivariable logistic regression was used to identify factors associated with helmet availability and gamma regression was used to identify factors associated with their cost. Results Helmets were available in 233 (57.1%) of surveyed retail outlets. On multivariable logistic regression, street vendors were 48% less likely and motorcycle repair shops 86% less likely to sell helmets than automobile/motorcycle shops. Outlets outside the Central Business District were 46% less likely to sell helmets than outlets inside that district. Nigerian retailers were five times more likely to sell helmets than Ghanaian retailers. Median helmet cost was 8.50 USD. Helmet cost decreased by 16% at street vendors, 21% at motorcycle repair shops, and 25% at outlets run by the owner. The cost increased by older age of retailer (1% per year of age), education level of retailer (12% higher for secondary education, 56% higher for tertiary education, compared to basic education), and sex (14% higher for male retailer). Conclusion Motorcycle helmets were available in some retail outlets in northern Ghana. Efforts to improve helmet availability should address outlets in which they are less commonly sold, including street vendors, motorcycle repair shops, outlets run by Ghanaians, and outlets outside the Central Business District. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-023-15695-8.

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