{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:14:58Z","timestamp":1758845698305,"version":"3.44.0"},"reference-count":36,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Inj Prev"],"accepted":{"date-parts":[[2024,1,18]]},"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Although motorcycle helmets can save lives in case of a crash, no helmet use data are available for many countries. When data is available, it is often only analysed as a global average, preventing targeted road safety education and legislative action. In this study, we conducted a detailed analysis of motorcycle helmet use in the capital of Madagascar.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Using a cross-sectional observational field survey framework, we observed 17\u2009230 individual motorcycles. We systematically recorded motorcycle riders\u2019 helmet use, position on the motorcycle, rider numbers and gender.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We found a general helmet use of 76.1%. Observed <jats:italic>drivers<\/jats:italic> had a significantly higher helmet use (84.6%) than <jats:italic>passengers<\/jats:italic> (47.7%), and subsequently helmet use per motorcycle decreased significantly when the number of riders per motorcycle increased. Female drivers had significantly higher helmet use than male drivers, and female passengers had significantly higher helmet use than male passengers. That is, on the same position of the motorcycle, female riders behaved safer than male riders. However, since female riders were more often passengers than drivers, their average helmet use was lower than that of male riders overall. Contrary to findings from other countries, motorcycle helmet use did not differ significantly throughout the day but was relatively constant.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Our results show the potential for injury and fatality prevention in Madagascar through increased passenger helmet use. This increase would also proportionally benefit female riders more than male riders. Findings regarding road safety legislation\u2019s applied impact, education, enforcement and future research needs are discussed.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/ip-2023-044995","type":"journal-article","created":{"date-parts":[[2024,2,2]],"date-time":"2024-02-02T13:21:16Z","timestamp":1706880076000},"page":"387-392","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Gender disparities in observed motorcycle helmet use in Madagascar: female motorcyclists behave safer but have lower overall protection"],"prefix":"10.1136","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5082-1419","authenticated-orcid":false,"given":"Felix Wilhelm","family":"Siebert","sequence":"first","affiliation":[{"name":"Department of Technology, Management, and Economics, Technical University of Denmark, Kongens Lyngby, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4740-4163","authenticated-orcid":false,"given":"Francois","family":"Brambati","sequence":"additional","affiliation":[{"name":"Deep Blue consulting and research, Roma, Lazio, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana Lu\u00edsa","family":"Silva","sequence":"additional","affiliation":[{"name":"Centre for African and Development Studies (CEsA), Universidade de Lisboa, Lisboa, Portugal"},{"name":"ONG Lalana, Antananarivo, Madagascar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jess\u00e9","family":"Randrianarisoa","sequence":"additional","affiliation":[{"name":"ONG Lalana, Antananarivo, Madagascar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1638-0496","authenticated-orcid":false,"given":"Paolo","family":"Perego","sequence":"additional","affiliation":[{"name":"Universit\u00e0 Cattolica del Sacro Cuore, Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,2,2]]},"reference":[{"key":"2025092503235461000_30.5.387.1","unstructured":"World Health Organization . 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Directive 2010\/40\/EU of the European Parliament and of the Council of 7 July 2010 on the framework for the deployment of Intelligent Transport Systems in the field of road transport and for interfaces with other modes of transport (Text with EEA relevance) (Official Journal of the European Union, L 207, Volume 53, 6 August 2010). 2010."},{"key":"2025092503235461000_30.5.387.4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2021\/6336517","article-title":"Understanding the factors that are associated with motorcycle crash severity in rural and urban areas of Ghana","volume":"2021","author":"Agyemang","year":"2021","journal-title":"J Adv Transport"},{"key":"2025092503235461000_30.5.387.5","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.aap.2013.05.028","article-title":"A mixed logit analysis of two-vehicle crash severities involving A motorcycle","volume":"61","author":"Shaheed","year":"2013","journal-title":"Accid Anal Prev"},{"key":"2025092503235461000_30.5.387.6","unstructured":"World Health Organization . Helmets: a road safety manual for decision-makers and practitioners. World Health Organization; 2006."},{"key":"2025092503235461000_30.5.387.7","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.aap.2010.12.006","article-title":"Injury protection and accident causation parameters for vulnerable road users based on German In-Depth Accident Study GIDAS","volume":"44","author":"Otte","year":"2012","journal-title":"Accid Anal Prev"},{"key":"2025092503235461000_30.5.387.8","doi-asserted-by":"publisher","DOI":"10.1136\/injuryprev-2012-040348"},{"key":"2025092503235461000_30.5.387.9","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1080\/17457300.2013.877937","article-title":"Motorcycle helmet use in Mar del Plata, Argentina: prevalence and associated factors","volume":"22","author":"Ledesma","year":"2015","journal-title":"Int J Inj Contr Saf Promot"},{"key":"2025092503235461000_30.5.387.10","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1080\/15389588.2018.1509072","article-title":"Prevalence rate of helmet use among motorcycle riders in Kumasi, Ghana","volume":"19","author":"Nimako Aidoo","year":"2018","journal-title":"Traffic Inj Prev"},{"key":"2025092503235461000_30.5.387.11","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.iatssr.2020.08.004","article-title":"Safety of child passengers who ride to school on a motorcycle: An observational study in two Argentine cities","volume":"45","author":"Tosi","year":"2021","journal-title":"IATSS Research"},{"key":"2025092503235461000_30.5.387.12","doi-asserted-by":"crossref","first-page":"1434031","DOI":"10.1080\/2331205X.2018.1434031","article-title":"Helmets and traffic injury outcomes: findings from a setting lacking legislation on proper wearing and quality assessment","volume":"5","author":"Bhatti","year":"2018","journal-title":"Cogent Medicine"},{"key":"2025092503235461000_30.5.387.13","doi-asserted-by":"crossref","unstructured":"Souto R , Corassa RB , Lima C de , et al . Helmet use and injury severity among crashed motorcyclists in Brazilian state capitals: an analysis of the violence an accidents survey 2017. Rev Bras Epidemiol 2020;23.(Suppl 1) doi:10.1590\/1980-549720200011.supl.1","DOI":"10.1590\/1980-549720200011.supl.1"},{"key":"2025092503235461000_30.5.387.14","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.aap.2010.08.012","article-title":"Prevalence rates of helmet use among motorcycle riders in a developed region in China","volume":"43","author":"Xuequn","year":"2011","journal-title":"Accid Anal Prev"},{"key":"2025092503235461000_30.5.387.15","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1080\/10286580108902568","article-title":"Modeling of compliance behavior of motorcyclists to proper usage of safety helmets in Malaysia","volume":"2","author":"Kulanthayan\u2217","year":"2001","journal-title":"J Crash Prev Injury Control"},{"key":"2025092503235461000_30.5.387.16","doi-asserted-by":"crossref","unstructured":"Kumar A . Understanding the emerging role of motorcycles in African cities: a political economy perspective. World Bank report 66941; 2011.","DOI":"10.1596\/17804"},{"key":"2025092503235461000_30.5.387.17","unstructured":"Unites Nations . General Assembly resolution 70\/1, transforming our world: The 2030 agenda for sustainable development. A\/70\/L.1; 2015. Available: http:\/\/undocs.org\/A\/RES\/70\/1"},{"key":"2025092503235461000_30.5.387.18","unstructured":"Wei Y , Soames Job RF . Road crashes affect women and men differently\u2014here's why. ending poverty in South Asia: ideas that work. Washington, DC: World Bank, 2021."},{"key":"2025092503235461000_30.5.387.19","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1136\/ip.5.4.264","article-title":"Factors affecting motorcycle helmet use in the population of Greater Athens, Greece","volume":"5","author":"Skalkidou","year":"1999","journal-title":"Inj Prev"},{"key":"2025092503235461000_30.5.387.20","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.trf.2013.01.002","article-title":"Barriers and facilitators of helmet use in a Greek sample of motorcycle riders: Which evidence?","volume":"18","author":"Papadakaki","year":"2013","journal-title":"Transportation Research Part F: Traffic Psychol Behav"},{"key":"2025092503235461000_30.5.387.21","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.aap.2019.01.011","article-title":"Patterns of motorcycle helmet use - a naturalistic observation study in Myanmar","volume":"124","author":"Siebert","year":"2019","journal-title":"Accid Anal Prev"},{"key":"2025092503235461000_30.5.387.22","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.trf.2021.04.005","article-title":"Disparity of motorcycle helmet use in Nepal \u2013 Weak law enforcement or riders\u2019 reluctance?","volume":"79","author":"Siebert","year":"2021","journal-title":"Transport Res Part F: Traffic Psychol Behav"},{"key":"2025092503235461000_30.5.387.23","unstructured":"World Health Organization . 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Available: https:\/\/midi-madagasikara.mg\/2022\/03\/22\/accident-de-la-circulation-les-motards-premieres-victimes-de-la-route [Accessed 19 Feb 2023]."},{"key":"2025092503235461000_30.5.387.27","unstructured":"La G . Bilan de la brigade des accidents: 121 accidents de la circulation Depuis Mars. 2022. Available: http:\/\/www.lagazette-dgi.com\/?p=71968 [Accessed 19 Feb 2023]."},{"key":"2025092503235461000_30.5.387.28","doi-asserted-by":"crossref","unstructured":"Eby DW . Naturalistic observational field techniques for traffic psychology research. In: Handbook of Traffic Psychology. Cambridge: Academic Press, 2011: 61\u201372.","DOI":"10.1016\/B978-0-12-381984-0.10005-0"},{"key":"2025092503235461000_30.5.387.29","doi-asserted-by":"publisher","DOI":"10.1111\/2041-210X.12584"},{"key":"2025092503235461000_30.5.387.30","unstructured":"Cohen J . Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum, 1988: 567."},{"key":"2025092503235461000_30.5.387.31","doi-asserted-by":"crossref","DOI":"10.11604\/pamj.2014.19.296.4885","article-title":"Crash characteristics and injury patterns among commercial motorcycle users attending Kitale level IV district hospital, Kenya","volume":"19","author":"Sisimwo","year":"2014","journal-title":"Pan Afr Med J"},{"key":"2025092503235461000_30.5.387.32","doi-asserted-by":"crossref","DOI":"10.11604\/pamj.2018.31.70.16988","article-title":"Epidemiology of head injuries and helmet use among motorcycle crash injury: a quantitative analysis from a local hospital in Western Kenya","volume":"31","author":"Sisimwo","year":"2018","journal-title":"Pan Afr Med J"},{"key":"2025092503235461000_30.5.387.33","doi-asserted-by":"crossref","DOI":"10.11604\/pamj.2015.20.438.5659","article-title":"Prevalence of helmet use among motorcycle users in Dar Es Salaam, Tanzania","volume":"20","author":"Kauky","year":"2015","journal-title":"Pan Afr Med J"},{"key":"2025092503235461000_30.5.387.34","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1080\/15389588.2014.973491","article-title":"Road traffic injury on rural roads in Tanzania: measuring the effectiveness of a road safety program","volume":"16","author":"Zimmerman","year":"2015","journal-title":"Traffic Inj Prev"},{"key":"2025092503235461000_30.5.387.35","unstructured":"World Health Organization . Global status report on road safety 2015. 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