Effect of road safety-conscious motorcycle taxi programs on riding behaviors and risk of road traffic crash among motorcycle taxi drivers in Kampala, Uganda

Background: SafeBoda is a private transportation company that started providing motorcycle taxi services in Kampala in 2015. Prior to the introduction of SafeBoda, motorcycle taxi services in Kampala were entirely provided by independent motorcycle taxi drivers with limited formal training on road safety and proclivity for risky riding behaviors (e.g., driving without protective gear and against traffic). SafeBoda introduced an Uber-like model of motorcycle taxi services where it provides road safety training, protective gear, and vehicle maintenance to its drivers. In addition, its drivers are expected to adhere to a code of conduct (e.g., respect for traffic regulations such as stopping at traffic stops). Penalties for breaking the code of conduct include re-training, suspension, or dismissal. We sought to determine whether helmet use, risk of road traffic crash (RTC), and riding behaviors differed between SafeBoda and regular (i.e., those not enrolled in SafeBoda) motorcycle taxi drivers in Kampala, Uganda. Method: We collected demographic and behavioral data from SafeBoda and regular drivers using: a) computer-assisted personal interview (CAPI), where 400 drivers were asked about their riding behaviors (e.g., helmet and mobile phone use); b) roadside observation questionnaire, where riding behaviors were observed in 3000 boda-boda drivers and their passengers along major roads in Kampala; c) text-based/SMS and telephone interview questionnaires where occurrence of road traffic crash data was collected from 342 drivers every two months for a period of six months; and d) Global Positioning System (GPS) devices where movement patterns and riding data were collected from 60 drivers for a period of 24 hours. Baseline characteristics were compared between SafeBoda and regular drivers using chi-square and t-tests. In addition, we used Poisson and generalized estimating equation models with robust standard errors to model the effect of the SafeBoda program on helmet use and risk of road traffic crash respectively. Results: Across all studies, a higher proportion of SafeBoda drivers than regular drivers engaged in safe riding behaviors. For instance, helmet use among SafeBoda compared to regular drivers was 21 percent points higher (95% CI: 0.15-0.27; p<0.001) based on the CAPI and 45 percent points higher (95% CI: 0.43-0.47; p<0.001) based on roadside observation. Furthermore, compared to regular drivers, SafeBoda drivers were more likely to report having a driver’s license (66.3% vs 33.5%; p<0.001) and a reflective jacket (99.5% vs 50.5%; p<0.001) and were less likely to report driving against traffic (4% vs 45.7%; p<0.001) in the past 30 days. From the follow-up study of 342 drivers for 6 months, there were 85 crashes (31 in SafeBoda and 54 in regular drivers) that occurred during the follow-up. The majority of the 85 crashes (31 in SafeBoda vs 54 in regular drivers) involved either a collision with another motorcycle (27.1%) or a car (63.5%). Speeding (10.6%), faulty brakes (7.1%), and distracted driving (4.7%) were the most frequently reported causes of the crashes. Sixty-nine (81.2%) of the crashes resulted in injury to the driver and 56 (81.2%) of these driver injuries required a visit to a health facility. Of the injuries that required a visit to a health facility, 13 (23.2%) required in-patient care (admission). The median hospitalization time for injuries requiring in-patient care (as of the time of follow-up) was 3 days with a range from 1 day to 30 days. Over the six-month follow-up period, SafeBoda drivers were 39% less likely to be involved in a RTC than regular drivers after adjusting for age, possession of a driver’s license, and education (RR: 0.61, 95% CI: 0.39-0.97, p=0.04). From the GPS study, we found that GPS devices are acceptable and feasible for measuring boda-boda driver movements without any major measurement (e.g., missing data and device failure) and logistical (e.g., installation and retrieval of the devices) issues. The GPS data showed that boda-boda drivers in the study made an average of 31 trips per day (SD = 10.4). The median trip was 3.5 km and lasted on average 9.0 minutes (range 3 minutes to 13.8 minutes). The mean farthest Euclidean distance from the driver’s stage or taxi stand was 5.8 km. The mean speed on a trip was 22.5 km/h. Driving movements within the city did not seem to differ significantly between SafeBoda and regular drivers (they shared similar activity spaces). Even where there were differences, these seem to be quite modest. Conclusion: The SafeBoda program is associated with increased safe riding behaviors and reudced risk of road traffic crash among motorcycle taxi drivers in Kampala. Therefore, the promotion and expansion of such programs may lead to a reduction in morbidity and mortality due to road injuries.