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<p>Motorcycle crash related injuries and deaths are increasing rapidly in many African
nations. Utilizing conspicuity measures, such as wearing reflective, fluorescent safety
vests, are effective as crash prevention strategies. Furthermore, use of some conspicuity
measures is mandated by law among motorcycle-taxi drivers in Tanzania. Nonetheless,
uptake remains low. Locally appropriate strategies to improve crash preventative behaviors
are needed. </p><p>To explore whether use of conspicuity measures could be improved
through eliminating cost-barriers, we tested a distribution strategy involving the
provision of free motorcycle safety vests among a population of motorcycle-taxi drivers
in Moshi, Tanzania. We conducted a cluster randomized controlled trial among 180 motorcycle-taxi
drivers in which half of the participants (90) were randomized to the intervention
arm and received a free reflective vest. The other half of the participants (90) were
randomized to the control arm and did not receive free vests. Whether motorcycle taxi
drivers used the reflective vest was then unobtrusively observed on city streets over
a period of three months. </p><p>Mixed-effects logistic regression was used to estimate
differential uptake of the vests between trial arms. At baseline, 3.3% of individuals
in both arms used a reflective vest. In three months of follow-up, 79 drivers in the
intervention arm and 82 drivers in the control arm were able to be observed. In the
intervention arm the average proportion of observations during which drivers were
observed to be using a reflective vest was 9.5%, compared to 2.0% in the control arm
(odds ratio: 5.5, 95% confidence interval: 1.1-26.9, p-value: 0.04). Distribution
of free reflective vests did lead to an increase in vest usage, however, the increase
was minimal. Removing economic barriers alone appears insufficient to adequately improve
adherence to conspicuity measures.</p>
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