Do motorcycle helmets reduce road traffic injuries, hospitalizations and mortalities in low and lower-middle income countries in Africa? A systematic review and meta-analysis

Background Studies in Africa have examined the association between helmet use and injury prevention, however, there has been no systematic review to synthesize the literature within an African context nor has there been any meta-analysis examining the effect of helmet use on injury prevention. Methods The review was performed in accordance with the Joanna Briggs Institute for Systematic Reviews. Articles were searched using several databases (e.g. CINAHL, OVID Medline) and select gray literature (e.g. TRID) sources. Articles were included if they were quantitative studies published in English between 2000 and 2019 and examined the association between motorcycle helmet use with head injuries, hospitalizations, and deaths in low- and lower-middle income countries in Africa with comprehensive motorcycle helmet laws. A meta-analysis was performed using pooled effect sizes assessing the impact of helmet use on reducing head injuries. Results After screening 491 articles, eight studies met the inclusion criteria. Helmet use ranged from 0 to 43%. The mean age of being involved in a crash was 30 years with males being two times more likely to be involved in motorcycle crashes than females. Drivers (riders) were more likely to be involved in a crash, followed by passengers and then pedestrians. Helmet use reduced injury severity and provided an 88% reduction in serious head injuries (OR 0.118, 95% CI: 0.014-0.968, p = 0.049). Conclusions In our study, helmet usage significantly reduced the likelihood of fatal head injuries. African countries with no helmet laws should consider adopting helmet use policies to reduce severe head related injuries from motorcycle crashes.