title: Helmet wearing in Kenya: prevalence, knowledge, attitude, practice and implications.
abstract: OBJECTIVE
  In light of the increasing prevalence of motorcycles on Kenyan roads, there is a need to address the safety of individuals using this mode of transport. Helmet use has been proven to be effective in preventing head injuries and fatalities in the event of a crash. This study aims to understand the prevalence of helmet use as well as knowledge, attitudes, and practices in two districts in Kenya over a 5-year period (2010-2014).
  
  
  METHODS
  Observational studies on helmet use at randomly selected locations throughout each district were done every quarter to estimate the prevalence of helmet use. Roadside knowledge, attitude, and practice (KAP) surveys were done two times a year in each district.
  
  
  METHODS
  Helmet use among motorcycle drivers and passengers in Thika and Naivasha was assessed through systematic observations at randomly selected locations in the two districts between August 2010 and December 2014. Roadside KAP surveys were administered in both sites to motorcyclists in areas where they stopped, including motorcycle bays, petrol stations and rest areas near the helmet observation sites. Secondary analysis of trauma registries was also used. Negative binomial regressions were used to assess trends of helmet wearing among motorcyclists over time, and logistic regressions were used to analyze associated risk factors as well as association with health outcomes among those admitted to the four hospitals.
  
  
  RESULTS
  A total of 256,851 motorcycles were observed in the two target districts during the study period. Overall, prevalence of helmet use among motorcycle drivers in Thika and Naivasha across all periods was 35.12% (95% confidence interval [CI]: 34.87%-35.38%) and 37.42% (95% CI: 37.15%-37.69%) respectively. Prevalence of helmet wearing remained similar after the passage of a traffic amendment bill. These results were not statistically significant in either Thika or in Naivasha. Data from the KAP survey showed that respondents recognized the life-saving effect of wearing a helmet, but many did not always wear a helmet because they found it inconvenient/uncomfortable. Analysis of trauma registry data showed that helmet wearing was associated with a significant reduction in head injuries among motorcyclists (adjusted odds ratio: 0.472, 95% CI: 0.327-0.684).
  
  
  CONCLUSIONS
  This study highlights the low prevalence of helmet use and documents the potential reduction in the risk of head injuries to motorcyclists if this risk factor was addressed. The passage of a traffic amendment bill showed negligible impact on helmet use. This highlights the need for a multi-faceted strategy that includes media campaigns and widespread enforcement in addition to legislative change for improving helmet use.
authors.affiliation: Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: abachani@jhu.edu.
authors.forename: A M
authors.initials: AM
authors.lastname: Bachani
authors.affiliation: Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Y W
authors.initials: YW
authors.lastname: Hung
authors.affiliation: Roless Media Management Institute, Nairobi, Kenya.
authors.forename: S
authors.initials: S
authors.lastname: Mogere
authors.affiliation: Department of Public Health, Kenyatta University, Nairobi, Kenya.
authors.forename: D
authors.initials: D
authors.lastname: Akunga
authors.affiliation: Department of Public Health, Kenyatta University, Nairobi, Kenya.
authors.forename: J
authors.initials: J
authors.lastname: Nyamari
authors.affiliation: Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Hyder
mesh_terms: D000063:Accidents, Traffic / Q000517:prevention & control / Q000706:statistics & numerical data*; D000328:Adult; D006259:Craniocerebral Trauma / Q000517:prevention & control*; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D009049:Motorcycles / Q000706:statistics & numerical data; D016017:Odds Ratio; D015995:Prevalence; D012042:Registries; D012307:Risk Factors; D012449:Safety; D011795:Surveys and Questionnaires
keywords: Helmet; Kenya; Low- and middle-income countries; Road safety; Road traffic injuries