They have been dubbed Uganda's silent killers. Boda-bodas, the country's ubiquitous motorbike taxis, snake through gridlocked traffic, navigate potholed roads and provide much-needed employment for young people. They are also maiming and killing thousands every year, monopolising hospital budgets and wiping out livelihoods. Since they appeared on the streets of Uganda in the 1960s, the number of boda-bodas has swelled. One recent news report estimated there were more than 300,000 bikes operating in the capital, Kampala. The number of motorbike accidents has increased exponentially. According to the Injury Control Centre, there are up to 20 boda-related cases at Mulago National Referral hospital in Kampala every day. The strain on the country's limited health budget is growing. According to a report by Makerere University College of Health Sciences and the department of orthopedics at Mulago, about 40% of trauma cases at the hospital are from boda-boda accidents (pdf). The treatment of injured passengers and pedestrians accounts for almost two-thirds of the hospital's annual surgery budget.

Dr Michael Edgar Muhumuza, head of Mulago's neurosurgery unit, believes the boda-bodas are deathtraps. "These are young people, the youth of tomorrow," he says as he examines x-rays. "It's a big problem [for] this nation. The last two, three years the number of these accidents has become much greater. It's now very bad." As well as those who are injured or die in accidents, Muhumuza is seeing an increasing number of riders who have been beaten and left for dead after being robbed of their vehicles. While boda-bodas are helping to reduce youth unemployment – one recent study estimated that 62% of young people in Uganda are jobless – the impact of a serious injury can prove catastrophic for riders and their families. Ali Niwamanya, 25, a boda-boda driver, spent three months in Mulago hospital and another five at home recovering after a collision with a car in the capital in September. "I had a broken leg. It was too painful," he recalls. "It was hard for me to get money because I could not work, and so my family had to suffer during that time."

Niwamanya is now in debt after taking out a 3m Ugandan shilling loan (£765) for a new bike. While the human impact of the boda-boda craze is evident in the packed hospital wards, the strain that spiralling road fatalities could have on the economy is worrying politicians. The death toll on Uganda's roads is twice the average across Africa. motorbike store red deerThe Ugandan annual crime and traffic/road safety report showed 3,343 road deaths were registered in 2011 (pdf) although the World Health Organisation has estimated the figure to be more than double that. hid motorcycle conversion kits h4Some are warning that, if action is not taken, the death toll from Uganda's roads could top that from diseases such as malaria – and be second only to HIV and Aids as the leading cause of death in the country.predator mask motorcycle helmet

"This translates into a monetary loss to the country," says Winstone Katushabe, secretary of the transport licensing board at the transport ministry. "It's about 1 trillion shillings [£255m] in terms of loss to the economy, [with] investigations of accidents, post-trauma care, families you have to look after." Kampala's metropolitan traffic police director, Lawrence Nuwabiine, agrees. best motorcycle pagerHe says Uganda must "fight this road carnage" with the same commitment it used to tackle HIV and Aids a decade ago.daytona winner motorcycle boots "When we started [with] the issue of Aids, the president … said: 'We are dying, every person must talk about Aids'," Nuwabiine says. "wholesale motorcycle gear melbourne

And people started talking about Aids in churches, in schools. We managed to reach somewhere. But [with] this one, people are not talking about death as a result of these boda-bodas." Some measures are being taken to try to stem the problem. Last month, the government announced that the works and transport sector would be allocated one of the biggest chunks – about 15% – of the 2013-14 budget to improve and maintain roads.bulletproof motorcycle helmet Even though road safety measures were not specifically included within the budget, the government is establishing a national agency to run advocacy campaigns and manage roads. In Kampala, the Capital City Authority is attempting to introduce regulations, including mandatory registration of drivers, first-aid training, reflector jackets and helmets, and a monthly fee of 20,000 Ugandan shillings paid by the city's 250,000 motorbike taxis.

Other initiatives are also springing up. The Global Helmet Vaccine Initiative is holding a one-day workshop for 100 riders, part of a national scheme under which it has trained 1,800 boda-boda riders in basic road safety. On completion, each participant receives a yellow helmet bearing the slogan: "Your life is your wealth". It is a message that seems to be getting through. Ronald Katetemera, 27, says he will not be taking his new headgear off. "Every day it's going to be the first thing I put on," Katetemera says. "They say life has no money value. I have my children. I don't want to die."Cambodia has recently experienced dramatic growth in its motorized vehicle traffic.  The Road Crash and Victim Information System (RCVIS), a monitoring system put into place by the National Road Safety Committee in Cambodia and supported by Handicap International, recently released details of how this rapid motorization of Cambodia has led to an increase of road traffic casualties.  According to the RCVIS 2011 report, the number of registered motor vehicles increased 231% over the preceding 6 years, with the majority of this increase (84%) being from motorbikes. 

Conservative estimates report a total of 16,654 casualties with over 1,900 fatalities.  Motorbike riders in Cambodia account for two thirds of all traffic related fatalities with 70% of these fatalities being related to head injury. Helmets are effective in reducing both mortality and head injury with studies showing a reduction in risk of head injury by 69% and death by 42%.  In 2009, Cambodia instituted a mandatory helmet law for all motorbike drivers.  This led to an increase of helmet use in drivers from 21% (2007) to 84% (2011).  Unfortunately, helmet use by passengers remained dismal at 8% (2011). This implies that mandating helmets for drivers did not influence passengers at all. With one motorbike commonly carrying multiple passengers, expanding the mandatory helmet law to include ALL riders could potentially protect thousands of crash victims.  Supported by numerous groups from local biker clubs to multinational partnerships, expansion of the Cambodian helmet law to include passengers should be the next step in road safety legislation.