This document summarizes a systematic review of interventions to prevent injuries and fatalities among motorcyclists in low- and middle-income countries. The review examined the effects of regulatory interventions like mandatory helmet laws and daytime running headlights, as well as road engineering projects. The results showed that mandatory helmet laws were associated with a 6% reduction in fatalities and 26% reduction in injuries. Exclusive motorcycle lanes were linked to an 11% decline in accidents. The review concluded that well-enforced traffic laws and separating motorcycles from other vehicles can help reduce crashes, but injury surveillance also needs improving in these countries.

1. Washington DC
January 12, 2016

2. THE IMPACT OF INTERVENTIONS
FOR PREVENTING INJURIES AND
FATALITIES AMONG
MOTORCYCLISTS IN LOW- AND
MIDDLE-INCOME COUNTRIES
Results from Systematic Review: Regulatory and Road
Engineering Interventions for Preventing Road Traffic
Injuries and Fatalities among Vulnerable Road Users in
Low- and Middle-Income Countries

3. The Impact of Interventions for Preventing Injuries and Fatalities
among Motorcyclists in Low- and Middle- Income Countries
AGENDA
 METHODS
 STUDY RESULTS
 DATA ANALYSIS
 OUTLINE OF EVIDENCE
 CONCLUSION

4. The Impact of Interventions for Preventing Injuries and Fatalities
among Motorcyclists in Low- and Middle- Income Countries
POPULATION
 Vulnerable Road Users:
- Non-motorised road users: Pedestrians, cyclists, rickshaws etc
- Motorised two-wheel road users (motorcycles, mopeds, and light
mopeds) of all ages
 Low- and Middle-income Countries
COMPARATOR
 Compared changes in outcomes before and after the
intervention with or without a control group

5. The Impact of Interventions for Preventing Injuries and Fatalities
among Motorcyclists in Low- and Middle- Income Countries
STUDY DESIGN
 Randomized Control Trials
 Non-randomized: Uncontrolled before and after, Controlled
before and after, Time series, Controlled cohort,
Uncontrolled cohort, and Case control
 Road safety audits were considered if a qualifying
intervention study met the inclusion criteria

6. The Impact of Interventions for Preventing Injuries and Fatalities
among Motorcyclists in Low- and Middle-Income Countries
INTERVENTIONS
Population level interventions:
 Traffic Law Enforcement & Regulatory
 Road Engineering
This review did not look at
 Education, Information and Media Advocacy
 Vehicle design and Post crash/trauma care

7. The Impact of Interventions for Preventing Injuries and Fatalities
among Motorcyclists in Low- and Middle- Income Countries
OUTCOMES
 Mortality measures
- Road traffic death counts/death rates
 Morbidity measures
- Number of proportion of severe injuries
- Number or proportion of moderate injuries
- Number or proportion of road traffic accidents
 Secondary outcomes
- Compliance
- Mean vehicular speed
- Mean vehicular conflict

8. The Impact of Interventions for Preventing Injuries and Fatalities
among Motorcyclists in Low- and Middle- Income Countries
Description of Studies
Bastos 2005
Bhatti 2011
Chiu 2000
Ichikawa 2002
Liberatti 2001
Nguyen 2013
Panichaphongse
1995
Espitia-Hardeman
2008
Radin Umar 1995a
Radin Umar 2005
Mulyadi 2013
Radin Umar 1995b
Time Series Uncontrolled Before and After
RoadEngineering
Conspicuity-Useof
DaytimeHeadlight
MandatoryHelmet
Use
Study Sample size
Bastos 2005 6298 motorcyclists
Bhatti 2011
742 motorcyclists and 295
pillion riders
Chiu 2000
8795 cases of motorcycle
related head injuries
Ichikawa 2002 12,002 injured motorcyclists
Liberatti 2001 1837 motorcycle victims
Nguyen 2013 665,428 motorcycle riders
Panichaphongse 1995
4035 injured motorcycle
accidents
Espitia-Hardeman 2008 Not available
Radin Umar 1995a
3662 motorcycle accidents
Radin Umar 2005 4319 motorcycle accidents
Mulyadi 2013
4700 vehicles per 30 green
lights
Radin Umar 1995b 4865 motorcycle accidents

9. DATA ANALYSIS
Traffic Law Enforcement & Regulatory Interventions
Outcome changes without a control group before and after
Fatalities among Motorcycle Riders – Mandatory Helmet Use
Fatalities declined by 6%, absence of substantial heterogeneity

10. DATA ANALYSIS
Traffic Law Enforcement & Regulatory Interventions
Outcome changes without a control group before and after
Injuries among Motorcycle Riders – Mandatory Helmet Use
Injuries (moderate and severe) declined by 26%

11. Traffic Law Enforcement & Regulatory Interventions
Outcome changes without a control group before and after
Severe injuries among Motorcycle Riders – Mandatory Helmet Use
Severe injuries declined by 9%, statistically significant

12. Traffic Law Enforcement & Regulatory Interventions
Outcome changes without a control group before and after
Compliance among Motorcycle Riders – Mandatory Helmet Use
Compliance to mandatory helmet enforcement resulted in eight time more
compliance. Statistically significant presence of heterogeneity

13. Traffic Law Enforcement & Regulatory Interventions
Outcome changes in time series before and after
Road Traffic Accidents among Motorcycle Riders – Day time
Running Headlights
The number of accidents declined post intervention period. Mean
percent change in accident declined by 38%.
A study Espitia-Hardeman 2008 reported fatalities, Log RR -1.79 (CI -
2.60, -0.98). Percent change in accidents -500.65 (CI -1248.43, -165.55)
51%
62%
68%

14. DATA ANALYSIS
Road Engineering Interventions
Effect of Exclusive Motorcycle Lanes Intervention
 A time-series study, Radin Umar 1995b analysed motorcycle
accident outcomes
 Road traffic accidents declined by 11%, percent change -
111.80 (CI -492.9, 24.34)
Effect of Red Motorcycle Box at Intersection Intervention
 A before and after study, Mulyadi 2013 analysed traffic-
conflicts and traffic flow at intersections
 Traffic conflicts (per 1000 vehicle) declined marginally,
standard mean difference -0.23 (CI -0.32, -0.15)
 Traffic volume (pce/green light) increased marginally,
standard mean difference 0.30 (CI 0.25, 0.35)

15. The Impact of Interventions for Preventing Injuries and Fatalities
among Motorcyclists in Low- and Middle- Income Countries
OUTLINE OF EVIDENCE
Traffic Law Enforcement & Regulatory Interventions
 Road traffic crashes resulting in fatalities declined by 6%
 Road traffic injuries resulting in injuries declined by 26%
 Mandatory helmet law enforcement resulted in eighth times
more compliance among motorcyclists.
 Conspicuity related road accidents dropped by 38%
Road Engineering Interventions
 In percent change, accidents declined by 11% as a result of
exclusive motorcycle lanes

16. The Impact of Interventions for Preventing Injuries and Fatalities
among Motorcyclists in Low- and Middle- Income Countries
CONCLUSION AND RECOMMENDATIONS
 The effect of interventions being implemented by LMICs
demonstrate the initial stages of positive developments
 Stringent enforcement of traffic laws & regulatory
interventions
 In road engineering, segregation of motorcycle riders from
motorised vehicles can potentially reduce traffic conflicts
 Improved injury surveillance systems on road traffic injuries
are required

17. The Impact of Interventions for Preventing Injuries and Fatalities
among Motorcyclists in Low- and Middle- Income Countries
 The protocol is registered with the Cochrane
Public Health Group and published in Cochrane
Liberary
 The Systematic Review is funded by the
Department for International Development

18. Washington DC
January 12, 2016