Study

World Health Organization

Hanoi School of Public Health

Report: Study on Motorcycle Helmet Quality in Viet Nam

Content 1. Introduction..................................................................................................................... 3 2. Objectives ....................................................................................................................... 3 3. Method ............................................................................................................................ 4 3.1. Location................................................................................................................... 4 3.2. Time ........................................................................................................................ 4 3.3. Study design and implementation ........................................................................... 4 4. Results............................................................................................................................. 6 4.1. Exchange survey ..................................................................................................... 6 4.1.1. Demographic characteristics of the sample ...................................................... 6 4.1.2. Helmet characteristics....................................................................................... 8 4.1.3. Helmet quality................................................................................................. 17 4.2. Market survey........................................................................................................ 23 5. Discussion ................................................................................................................ 27 5.1. Exchange survey ................................................................................................... 27 5.2. Market survey........................................................................................................ 29 6. Conclusion and recommendation.................................................................................. 30 6.1. Conclusion............................................................................................................. 30 6.2. Recommendation................................................................................................... 31 7. References..................................................................................................................... 32 8. Appendices.................................................................................................................... 33 Appendix 1. STAMEQ list of qualified helmet (as of May 10th 2011)........................ 33 Appendix 2. Testing results – Exchange survey .......................................................... 44 Appendix 3. Testing results – Market survey .............................................................. 57

1. Introduction Since 2007, helmet wearing among motorcycle riders and passengers has been made mandatory.[1] In April 2010, Prime Minister signed an amendment to Resolution 32, Decree 34/2010/ND-CP. All drivers and passengers on motorcycles from the age of six must wear a helmet properly under penalty of a fine from 20 May 2010. Adults carrying children without a helmet or without it properly buckled will be fined 100,000 – 200,000 VND.[2] Following the regulation, helmet use among motorcycle riders and passengers improved significantly, from around 40% before the regulation to approximately 90% in 2010.[3-7] Helmet has been found to be as one of the most important measures to prevent head injury in motorcycle crashes. Evidence from many studies indicates that the death rate and incidence of lethal head injury have decreased among helmet riders compared with those non-helmeted motorcyclists. Besides, from four higher quality studies helmets were estimated to reduce the risk of death by 42% (OR 0.58, 95% CI 0.50 to 0.68) and from six higher quality studies helmets were estimated to reduce the risk of head injury by 69% (OR 0.31, 95% CI 0.25 to 0.38).[8]

In spite of the improvement in the helmet use, quality of the helmet appears to be another issue in controlling road traffic injuries in Vietnam. In April 2008, the Viet Nam Consumer Safety Association found that approximately 80% of the helmets on the market did not meet national standards. In November 2008, Viet Nam revised its national helmet standards to address this widespread market infiltration of substandard helmets. In particular, revisions were intended to strengthen the quality assurance and inspection of helmets to insure they met national standards.

2. Objectives •

To estimate the situation of helmets being used by motorcycle riders including the types, styles and quality,

•

To assess the quality of “qualified” labeled helmet in circulation,

•

To identify issues and recommendations for the assurance and control of helmet quality in circulation.

3. Method 3.1. Location The study was implemented in Hanoi and in three RS10 project provinces including Bac Giang, Ha Nam and Ninh Binh.

3.2. Time The study was conducted from July to December 2011.

3.3. Study design and implementation a) Exchange survey (helmet exchange component) This component employed a cross sectional design based on the sample of the road side study in the research project collaborated with Johns Hopkins University and World Health Organization Vietnam. The study was conducted in 3 RS10 project provinces including Bac Giang, Ha Nam and Ninh Binh provinces. The sample size in this component was based on the one for road side survey on road safety knowledge and drink-drive. In that survey, the sample size in each city/province is estimated by the following formulae: p×q × 110 % d2 Using SSize 2.0 software, a WHO software to calculate sample size for health studies, n = Z 12−α / 2 ×

with an alpha of 0.05 (z21- α/2 = 1.96), the anticipated proportion of alcohol uses in the male population of Vietnam of 45% (p = 0.45), an absolute precision of 7%. Rounding up the estimate, the final sample size was about 200 motorcyclists in each province.

Motorcyclists were asked to exchange their helmet with a new and qualified one. All exchanged helmets (used helmets) were then tested for quality in a certified laboratory, The Vietnam Safety Products and Equipment Company Laboratory. Helmets were made blind and uniquely coded before taking into the lab for testing by dark paint on the label

and brand. In addition to collecting used helmet from participants, they were also administered a pre-design questionnaires including questions on the helmet such as type, brand, time of use, location bought the helmet, questions on demographic information and knowledge on road safety.

b) Quality of “qualified” labeled helmet (market survey component) The cross sectional design was used in this component. According to the Directorate for standards, metrology and quality (STAMEQ), as of May 2011, there have been 444 helmets from approximately 80 manufacturers qualified for the national standard QCVN 2:2008/BKHCN. This list of 444 helmets was used as sampling frame for this component of the study. The sample size determination was based on the formula to estimate a proportion for simple random sampling. In this case, a proportion to be estimated is the proportion of unqualified helmet among “qualified” labeled helmets.

n=

z12−α / 2 P (1 − P ) N (ε × P ) 2 ( N − 1) + z12−α / 2 P (1 − P )

Using SSize 2.0 software, a WHO software to calculate sample size for health studies, with an alpha of 0.05 (z21- α/2 = 1.96), the anticipated proportion of unqualified helmet (P = 0.8, the proportion estimated by Viet Nam Consumer Safety Association in 2008), the relative precision (ε = 10%) and the population size (N = 444), the minimum sample required was 80.

Helmets selected into this component were selected by systematic random strategy from the STAMEQ list (Appendix 1). Exact series name and manufacturer of selected helmet were used to buy from helmet vendors in Hanoi. Since the STAMEQ list included all helmets that had met the quality, there were also ones which were no longer in circulation. Helmets which were not available were replaced by the next one on the STAMEQ list. These new helmets were then tested on impact protection at The Vietnam Safety Products and Equipment Company Laboratory. Similar to exchanged helmets, these new ones were also coded and blinded before taking into the lab for testing by dark paint on the label and brand,

4. Results 4.1. Exchange survey 4.1.1. Demographic characteristics of the sample Table 4.1. Demographic characteristics of participants in Bac Giang, Ha Nam and Ninh Binh province Bac Giang n % 193 100.0

Total Age group

Ha Nam n % 192 100.0

Ninh Binh n % 197 100.0

Total n 582

% 100.0

3 years Dont know Helmet price < 50k 50-100k 100-200k > 200k Dont know Place of buying Indoor shop Street vendor Other Dont know Reasons of using Avoid penalty Avoid dust Protect head * Legend for type of helmet

Tropical

Half head / Open face

Full face

Cap style

Characteristics of exchanged helmet are presented in Table 4.3. The most common type of helmet in use was tropical (over 65.0% in all three provinces). In addition to the

tropical type, it is important to note that the cap style helmet was also common. It was the type with the second largest proportion, 14.5% in Bac Giang, 16.1% in Ha Nam and 15.2% in Ninh Binh. However, the difference among province was not statistically significant (p=0.91). Other types include half-head/open face and full face, whose proportions were less than 10% in all three provinces. Regarding the age of helmet, around 50% of participants reported that they have used their helmet for 1-3 years. Specifically, proportion of 1-3 year old helmets was 64.2% in Bac Giang, 52.6% in Ha Nam and 49.7% in Ninh Binh. The proportion of participants reported that they have used their helmet for more than 3 years was relatively high, particularly in Ha Nam (30.7%) and in Ninh Binh (37.6%). When asking on the buying price of the helmet, generally, about 95% of participants provided the price range. Helmets bought in the price range of 50-100 thousand VND were the most prevalent, 61.1% in Ninh Binh, 54.2% in Ha Nam and 39.1% in Ninh Binh. The proportions of participants buying their helmet at the price of less than 50 thousand VND was highest in Bac Giang (20.2%), followed by Ninh Binh (16.8%) and lowest in Ha Nam (13.0%). Regarding the place where they got their helmets, indoor shop was the most place. It was 64.2% in Bac Giang, 56.8% in Ha Nam and 63.5% in Ninh Binh.

Responding to the question on the primary reason for wearing a helmet, nearly 48.0% of participant in Bac Giang and Ha Nam reported that it was to avoid police’s penalty. These figures was statistically significantly higher than that in Ninh Binh province (34.5%, p Dont 200k know

Ninh Binh

Figure 4.5 shows the proportion of helmet types by helmet price in three provinces. It can be seen that the most common helmet type, tropical helmet, had been bought at all price ranges from less than 50,000 VND to more than 200,000 VND. On the other hand, cap style helmet cap style helmet had been bought at all price range of less than 200,000 VND. Moreover, it accounted for the largest proportion all price range of less than 50,000 VND in all three provinces. For instance, in the less than 50,000 VND helmet group, the proportion was more than 60% in Bac Giang, more than 40% in Ha Nam and more than 30% in Ninh Binh.

100%

100%

100%

80%

80%

80%

60%

60%

60%

40%

40%

40%

20%

20%

20%

0%

0% Shop

Street vendor

Other

Dont know

Cap style

17

16

0

0

0

Full face

1

4

0

0

100

33

Half/Open face

9

9

0

0

0

67

Tropical

73

71

100

100

Shop

Street vendor

Other

Dont know

Cap style

6

34

0

0

Full face

4

2

0

Half/Open face

8

2

Tropical

82

63

Bac Giang Ha Nam Figure 4.6. Type of helmet by buying place in Bac Giang, Ha Nam and Ninh Binh

0% Shop

Street vendor

Other

Dont know

Cap style

10

Full face

8

25

0

22

0

0

0

Half/Open face

17

12

0

0

Tropical

65

63

100

78

Ninh Binh

Figure 4.6 illustrates the type of helmet by buying place in three provinces. Regarding the two most common buying places, indoor shop and street vendor, tropical helmets had been more likely bought from indoor shop while cap style ones had been more likely bought from street vendor. However, the trend for tropical helmets was statistically significant in Bac Giang (p 200k Dont know

39 118 34 0 2

17 113 34 0 2

43.6% 95.8% 100% 0 100%

25 103 50 4 9

15 97 48 3 7

60.0% 94.2% 96.0% 75.0% 77.8%

33 77 59 15 13

26 72 55 15 13

78.8% 93.5% 93.2% 100% 100%

39 118 34 0 2

13 102 34 0 2

33.3% 86.4% 100% 0 100%

25 103 50 4 9

11 89 43 3 7

44.0% 86.4% 86.0% 75.0% 77.8%

33 77 59 15 13

21 64 53 15 13

63.6% 83.1% 89.8% 100% 100%

39 118 34 0 2

3 29 6 0 0

7.7% 24.6% 17.6% 0 0.0%

25 103 50 4 9

3 17 17 0 2

12.0% 16.5% 34.0% 0.0% 22.2%

33 77 59 15 13

2 9 10 8 4

6.1% 11.7% 16.9% 53.3% 30.8%

39 118 34 0 2

3 29 6 0 0

7.7% 24.6% 17.6% 0 0.0%

25 103 50 4 9

3 17 17 0 2

12.0% 16.5% 34.0% 0.0% 22.2%

33 77 59 15 13

2 9 10 8 4

6.1% 11.7% 16.9% 53.3% 30.8%

Size

Table 4.5 presents numbers and proportions of helmets passing specific tests and overall quality by helmet buying place in three provinces. Comparing the two most common buying places, indoor shop and street vendor, it is obvious that the proportions of passing quality tests were higher among helmets buying from indoor shops than those buying from street vendors. However, these differences were statistically significant in Bac Giang for the first 3 tests, but not the impact absorption test and overall quality (p=0.36). In Ha Nam, all p-values were greater than 0.05. In other words, there was no statistically

significant difference in the proportions of qualified helmet on all quality tests. In Ninh Binh, on the other hand, difference in the proportions on all quality tests except the one on weight were statistically significant.

Table 4.5. Proportions of qualified helmets by buying place in Bac Giang, Ha Nam and Ninh Binh n Parts Indoor shop Street vendor Other Dont know Size Indoor shop Street vendor Other Dont know Weight Indoor shop Street vendor Other Dont know Impact Indoor shop Street vendor Other Dont know Overall Indoor shop Street vendor Other Dont know

Bac Giang qualified

%

n

Ha Nam qualified

%

n

Ninh Binh qualified

%

124 62 1 6

112 41 1 6

90.3% 66.1% 100% 100%

109 78 2 2

88 59 1 2

80.7% 75.6% 50.0% 100%

125 60 3 9

105 43 3 7

84.0% 71.7% 100% 77.8%

124 62 1 6

117 42 1 6

94.4% 67.7% 100% 100%

109 78 2 2

101 66 1 2

92.7% 84.6% 50.0% 100%

125 60 3 9

117 53 3 8

93.6% 88.3% 100% 88.9%

124 62 1 6

107 37 1 6

86.3% 59.7% 100% 100%

109 78 2 2

90 60 1 2

82.6% 76.9% 50.0% 100%

125 60 3 9

111 44 3 8

88.8% 73.3% 100% 88.9%

124 62 1 6

27 10 0 1

21.8% 16.1% 0.0% 16.7%

109 78 2 2

24 14 0 1

22.0% 17.9% 0.0% 50.0%

125 60 3 9

26 5 2 0

20.8% 8.3% 66.7% 0.0%

124 62 1 6

27 10 0 1

21.8% 16.1% 0.0% 16.7%

109 78 2 2

24 14 0 1

22.0% 17.9% 0.0% 50.0%

125 60 3 9

26 5 2 0

20.8% 8.3% 66.7% 0.0%

4.2. Market survey This section provides the results of quality tests for helmets in circulation. Systematic random selection was used to select 80 helmets from STAMEQ list. The list of selected helmets was then send to helmet vendors. Those helmets no longer in circulation were replaced by the next one in the STAMEQ list. They were all CR labeled helmets, indicating they met national standard QCVN2: 2008/BKHCN. For the objectivity of the

lab tests, all stamp, label, name and logo of the helmets were blinded by dark paint before taking to the lab.

Figure 4.10 shows the distribution of newly purchased helmets by type and buying price range. Most of them were tropical helmets (75.0%), followed by half-head/open face helmets (12.5%), full face helmets (10.0%) and cap style helmets (2.5%). Regarding the price, nearly 60.0% of the helmets was bought with prices of less than 200,000 VND, and only 20.0% of the helmets was bought with the higher prices of between 200,000VND and 300,000VND and 21.3% helmets with price of over 300,000 VND.

T

H/O

F

C

< 200k

2.5%

200-300k

>300k

21.3%

10.0% 12.5%

20.0% 58.8% 75.0%

Type of helmet Figure 4.10. New helmets by type and buying price

Buying price range

Table 4.6. Proportions of qualified helmets by type Tropical %

Total

n 60

Parts Weight Size Impact Overall

60 60 60 23 23

100.0% 100.0% 100.0% 38.3% 38.3%

Half-head/ Open face n % 10 9 10 10 6 6

Full face n

Cap style

%

n

8

90.0% 100.0% 100.0% 60.0% 60.0%

8 8 8 8 8

%

n 80

%

100.0% 100.0% 100.0% .0% .0%

79 80 80 37 37

98.8% 100.0% 100.0% 46.3% 46.3%

2 100.0% 100.0% 100.0% 100.0% 100.0%

2 2 2 0 0

Total

Table 4.6 shows the results of helmet quality tests based on four individual standards including required parts, weight, size and protection area, impact absorption and overall quality. Generally, almost all new helmets pass the test on required-part, weight and size and protection area. However, test result of impact absorption showed that only 46.3% of these new helmets were qualified. Therefore, for the overall quality, 46.3% of new helmets was considered as qualified. Looking at the test results by helmet type, the proportion of passing the impact absorption test was 38.3% among tropical helmets, 60% among half-head/open face helmet, 100% among full-face helmets and 0% among cap helmets. With p