Enhancing Road Safety in Ghana: Crash Analysis, an Innovative Religion-Based Organisation Survey and Helmet Assessment

Introduction: Road traffic injuries are a major public health crisis in Ghana, with motorcycle-related fatalities rising sharply alongside increased motorcycle use. Yet policy responses remain inadequate: injury data are sparse and underreported, there is no national helmet standard, and road safety laws fail to define helmet quality. This thesis addresses these gaps by quantifying the crash burden, developing innovative data collection methods, and assessing motorcycle helmet quality in Ghana. Methods: This thesis applies a pragmatic, multi-method approach across four studies in Ghana; 1) systematic review and meta-analysis reporting the burden of unintentional injuries, 2) secondary analysis of national crash data quantifying the burden of road traffic fatalities and the epidemiology of fatal motorcycle crashes, 3) a faith-based injury surveillance pilot assessing acceptability and feasibility for routine data collection and 4) observational and qualitative inquiries examining motorcycle safety, including helmet use and quality, and identifying determinants for access to quality helmets. Results: The systematic review identified a pooled prevalence of 18% (95% CI: 11–26%) and mortality of 17% (95% CI: 11–24%) from unintentional injuries, with road traffic injuries contributing the highest burden. Also, there is limited data on the economic burden and disabilities associated with injuries in Ghana. The crash data analysis reveals age-standardised road fatality rate (ASFR) increased between 2000 and 2022, with an average annual percentage increase of 0.52%. The average age-standardised road fatality rate was higher among males (rate=13.27) than among females (rate=3.91). At the same time, fatal motorcycle crashes were high, with 22.85% (95% CI: 22.44–23.26%) of motorcycle crashes being fatal. Fatal motorcycle crashes increased with an average annual percentage change of 4.71% between 2000 and 2022. Fatality ratios were higher in the northern parts of Ghana and during the last three months of the year. There was strong acceptance of religious-based organisations as platforms for collecting injury data by members and leaders. The estimated standardised mean acceptability score (75.60) was high and did not differ between members and leaders. The injury incidence rate from the religious-based organisations injury survey was estimated at 15.7 per 1,000 member-years (95% CI: 14.1–17.3). Mortality rate was 72.0 per 1,000 injuries, higher than what been reported in previous studies. Traffic injuries caused the highest rates of severe and fatal injuries. The thesis found a low helmet use rate, estimated 24.4% (95% CI: 23.6–25.2%). The rate was 31.7% among riders and 6.9% among pillions. Quality helmets were low, estimated at 34.7% (95% CI: 31.0-38.5%) of the over 600 helmets assessed. Helmets purchased from general shopping centres (OR=3.04), street vendors (OR=1.89), and friends or colleagues (OR=4.66) were of better quality than those included with the motorcycle purchase. The qualitative analysis identified four interconnected system gaps that limit access to quality helmets: lack of knowledge and awareness of helmet quality, limited availability of quality helmets, economic constraints, and the absence of regulations and enforcement. Potential enablers included public education and awareness on quality helmets, improved market availability, price controls and incentives, and enhanced regulation and enforcement. Conclusion: This thesis generates evidence on the burden of road injuries in Ghana, such as the increasing trend of road fatalities and the sharp rise in motorcycle fatalities. It demonstrates that religious‑based organisations offer an acceptable and feasible alternative platform for injury data collection in contexts where national injury surveillance systems are limited. The thesis also found a low helmet use rate, which was even lower among pillion riders. As Ghana has passed a law allowing motorcycles to be used for commercial passenger transport, it is important that the mandatory helmet law is enforced and that offenders are severely punished. But also ensure that motorcyclists use quality helmets that provide maximum protection. Most helmets I accessed were of poor quality, and riders face systemic gaps in accessing quality helmets, such as the absence of helmet standards and enforcement. Highlighting the need for Ghana to develop and implement helmet standards to regulate the helmet market.