title: The use of non-standard motorcycle helmets in low- and middle-income countries: a multicentre study.
abstract: BACKGROUND
  The use of non-standard motorcycle helmets has the potential to undermine multinational efforts aimed at reducing the burden of road traffic injuries associated with motorcycle crashes. However, little is known about the prevalence or factors associated with their use.
  
  
  METHODS
  Collaborating institutions in nine low- and middle-income countries undertook cross-sectional surveys, markets surveys, and reviewed legislation and enforcement practices around non-standard helmets.
  
  
  RESULTS
  5563 helmet-wearing motorcyclists were observed; 54% of the helmets did not appear to have a marker/sticker indicating that the helmet met required standards and interviewers judged that 49% of the helmets were likely to be non-standard helmets. 5088 (91%) of the motorcyclists agreed to be interviewed; those who had spent less than US$10 on their helmet were found to be at the greatest risk of wearing a non-standard helmet. Data were collected across 126 different retail outlets; across all countries, regardless of outlet type, standard helmets were generally 2-3 times more expensive than non-standard helmets. While seven of the nine countries had legislation prohibiting the use of non-standard helmets, only four had legislation prohibiting their manufacture or sale and only three had legislation prohibiting their import. Enforcement of any legislation appeared to be minimal.
  
  
  CONCLUSIONS
  Our findings suggest that the widespread use of non-standard helmets in low- and middle-income countries may limit the potential gains of helmet use programmes. Strategies aimed at reducing the costs of standard helmets, combined with both legislation and enforcement, will be required to maximise the effects of existing campaigns.
authors.affiliation: CSIR-Building & Road Research Institute, Kumasi, Ghana.
authors.forename: Williams
authors.initials: W
authors.lastname: Ackaah
authors.forename: Francis
authors.initials: F
authors.lastname: Afukaar
authors.forename: Williams
authors.initials: W
authors.lastname: Agyemang
authors.forename: Trinh
authors.initials: T
authors.lastname: Thuy Anh
authors.forename: A R
authors.initials: AR
authors.lastname: Hejar
authors.forename: Ghaffar
authors.initials: G
authors.lastname: Abdul
authors.forename: Gopalkrishna
authors.initials: G
authors.lastname: Gururaj
authors.forename: Hidalgo-Solórzano
authors.initials: HS
authors.lastname: Elisa
authors.forename: Híjar
authors.initials: H
authors.lastname: Martha
authors.forename: Adnan A
authors.initials: AA
authors.lastname: Hyder
authors.forename: Cristina
authors.initials: C
authors.lastname: Inclán-Valadez
authors.forename: Subramaniam
authors.initials: S
authors.lastname: Kulanthayan
authors.forename: Robyn
authors.initials: R
authors.lastname: Norton
authors.forename: Wilson
authors.initials: W
authors.lastname: Odero
authors.forename: Eme T
authors.initials: ET
authors.lastname: Owoaje
authors.forename: Margie
authors.initials: M
authors.lastname: Peden
authors.forename: Krishnan
authors.initials: K
authors.lastname: Rajam
authors.forename: Junaid
authors.initials: J
authors.lastname: Abdul Razzak
authors.forename: Adesola
authors.initials: A
authors.lastname: Oluwafunmilola Sangowawa
authors.forename: Jawaid
authors.initials: J
authors.lastname: Shah
authors.forename: Pham
authors.initials: P
authors.lastname: Le Tuan
authors.forename: Radin
authors.initials: R
authors.lastname: Umar Rs
authors.forename: Nguyen
authors.initials: N
authors.lastname: Thi Van Anh
authors.forename: Marc
authors.initials: M
authors.lastname: Van der Putten
authors.forename: Nitaya
authors.initials: N
authors.lastname: Vajanapoom
authors.forename: Nuntavarn
authors.initials: N
authors.lastname: Vichit-Vadakan
authors.forename: Kaviyarasu
authors.initials: K
authors.lastname: Yellappan
authors.forename: James
authors.initials: J
authors.lastname: Yu
mesh_terms: D000328:Adult; D000354:Africa, Western; D001208:Asia; D003430:Cross-Sectional Studies; D005260:Female; D006260:Head Protective Devices / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008800:Mexico; D008875:Middle Aged; D009049:Motorcycles / Q000331:legislation & jurisprudence*; D011203:Poverty