Objective: To estimate the prevalence of helmet use among riders and pillion riders of motorcycles in the Tamale Metropolis of Ghana.

Methods: Cross-sectional observations of helmet use were made at locations where traffic generally slowed down. Statistical analysis was carried out for variables by calculating chi-square (?2) tests to assess statistical significance.

Results: A total of 3115 riders and 1058 pillion riders (passengers) were observed at 10 different sites. The overall helmet use for riders was 34.2 percent and that for pillion riders was 1.9 percent. Riders’ helmet use rate was highest among the elderly (49.6%), followed by adults (34.3%) and lowest for young people (21.9%) and the observed percentage differences were significant (?2 (2)= 67.1; p < .001). A marked difference (?2 (1)= 6.7; p = .0096) in helmet use was observed between riders riding within the central business district (CBD; 36.5%) and those outside the CBD (32.1%). Riders with at least one pillion rider (27.4%) were less likely to wear a helmet compared to riders riding alone without passengers (37.3%; ?2 (1)= 29.347; p < .001).

Conclusion: Helmet use by motorcyclists in Ghana is generally low. There is a need for public awareness campaigns on the safety benefits of helmets to increase its prevalence in Ghana. The education on helmet use must be accompanied by sustained enforcement of the road traffic law by the traffic police to ensure compliance and change in attitudes.