Determinants of knowledge and attitudes toward personal protective equipment use among commercial motorcycle riders in a conflict-affected region of Cameroon: implications for road safety in Sub-Saharan Africa

Background Road traffic injuries are a leading cause of death globally, disproportionately affecting motorcyclists in low- and middle-income countries (LMICs). Personal protective equipment (PPE) such as helmets and visibility materials substantially reduce injury severity, yet their consistent use remains suboptimal in many African settings. In conflict-affected areas, where displacement and informal transport systems are common, safety behaviors may be further compromised. This study examined the determinants of knowledge and attitudes toward PPE use among commercial motorcycle riders in the Limbe and Tiko Health Districts of Cameroon to inform regional road safety interventions. Methods A community-based cross-sectional study was conducted among 499 commercial motorcycle riders aged ≥18 years between May and August 2024. Participants were selected using a multistage sampling approach, and data were collected by trained research assistants through interviewer-administered structured questionnaires at randomly selected motorcycle pick-up points. The questionnaire captured sociodemographic characteristics, riding experience, and PPE knowledge (13 items) and attitudes (9 Likert-scale items). Knowledge and attitude scores were categorized using a 60% threshold. Multivariable logistic regression was applied to identify factors independently associated with good knowledge and positive attitudes. Results The mean age of participants was 32.2 ± 7.6 years; all were male. Overall, 66.1% had good knowledge and 45.9% had positive attitudes toward PPE use. License ownership (AOR = 1.7; 95% CI: 1.1–2.6) and prior PPE training (AOR = 2.0; 95% CI: 1.4–3.0) were positively associated with knowledge, while internal displacement reduced the odds (AOR = 0.6; 95% CI: 0.4–0.9). Predictors of positive attitudes included license ownership (AOR = 1.8; 95% CI: 1.1–2.8), PPE training (AOR = 1.7; 95% CI: 1.1–2.6), and good knowledge (AOR = 10.4; 95% CI: 6.3–17.3). Internal displacement again reduced the likelihood of positive attitudes (AOR = 0.6; 95% CI: 0.4–0.9). Conclusion Although knowledge of PPE was relatively high, attitudes remained inadequate, particularly among internally displaced riders. Strengthening motorcycle licensing systems, integrating PPE training into road safety programs, and addressing displacement-related vulnerabilities could improve safety behaviors. Findings from this conflict-affected region of Cameroon provide valuable insights for designing community-based interventions to enhance PPE use and reduce motorcycle-related injuries across Sub-Saharan Africa.