title: Effect of free distribution of safety equipment on usage among motorcycle-taxi drivers in Tanzania--A cluster randomised controlled trial.
abstract: BACKGROUND
  Deaths due to road traffic injuries, particularly motorcycle crashes, have increased rapidly in many African nations and context-specific strategies to improve preventative behaviours are needed. Although adhering to conspicuity measures by wearing reflective safety vests is a highly effective crash prevention strategy and mandated by law among motorcycle-taxi drivers in some African countries, actual use is currently low. We aimed to test whether eliminating cost-barriers through the provision of free reflective, fluorescent motorcycle safety vests would lead to increased utilisation among a high-risk population of motorcycle-taxi drivers in Tanzania.
  
  
  METHODS
  A cluster randomised controlled trial was conducted among 180 motorcycle-taxi drivers. Participants randomised to the intervention arm (90) received free, reflective, fluorescent vests; participants randomised to the control arm (90) did not receive free vests. Participants' use of reflective vests was then observed on city streets over a three month period and differential uptake was estimated using mixed-effects logistic regression.
  
  
  RESULTS
  Baseline use of reflective vests was 3.3% in both arms. Seventy-nine drivers in the intervention arm and 82 drivers in the control arm were observed during follow-up. The average proportion of observations during which motorcycle drivers were using a reflective vest was 9.5% in the intervention arm, compared to 2.0% in the control arm (odds ratio: 5.5, 95% confidence interval: 1.1-26.9, p-value: 0.04).
  
  
  CONCLUSIONS
  Although distribution of free reflective vests led to a statistically significant increase in vest usage, the absolute increase was modest. Additional strategies beyond removing economic barriers are important to augment adherence to road safety behaviours for injury prevention.
authors.affiliation: Duke University, Hubert Yeargan Center for Global Health, Durham, United States. Electronic address: steven.sumner@duke.edu.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Sumner
authors.affiliation: Kilimanjaro Christian Medical Centre, Orthopaedics Department, Moshi, Tanzania.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Pallangyo
authors.affiliation: Duke University, Department of Infectious Diseases and International Health, Durham, United States.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Reddy
authors.affiliation: Kilimanjaro Christian Medical Centre, Department of Medicine, Moshi, Tanzania.
authors.forename: Venance
authors.initials: V
authors.lastname: Maro
authors.affiliation: Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, United States.
authors.forename: Brian W
authors.initials: BW
authors.lastname: Pence
authors.affiliation: Duke University, Division of Emergency Medicine and Duke Global Health Institute, Durham, United States.
authors.forename: Catherine
authors.initials: C
authors.lastname: Lynch
authors.affiliation: Duke University, Duke Global Health Institute, Durham, United States.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Turner
authors.affiliation: Duke University, Duke Global Health Institute, Durham, United States.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Egger
authors.affiliation: Duke University, Department of Infectious Diseases and International Health, Durham, United States.
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Thielman
mesh_terms: D000063:Accidents, Traffic / Q000517:prevention & control* / Q000706:statistics & numerical data; D000328:Adult; D001336:Automobiles / Q000706:statistics & numerical data; D005260:Female; D006293:Health Promotion; D006801:Humans; D008297:Male; D009049:Motorcycles / Q000706:statistics & numerical data; D011482:Protective Devices / Q000191:economics / Q000706:statistics & numerical data* / Q000600:supply & distribution; D017751:Safety Management; D013636:Tanzania / Q000453:epidemiology
keywords: Conspicuity; Conspicuity measures; Crash; Injury; Motorcycle; Prevention