Introduction: Road crash fatalities have increased significantly in Low- and Middle- Income Countries (LMICs) between 2006 and 2016. This study presents how road safety characteristics have changed in LMICs by comparing data over time and relationships between the road crash fatality increase and a wide range of data from LMICs. Parametric and nonparametric methods are used to test significance. Method: There were 35 countries in the Latin America and Caribbean region, the Sub-Saharan Africa region, the East Asia and Pacific region, and the South Asia region, where the population rate of road crash fatalities consistently increased as per country reports, World Health Organization and Global Burden of Disease estimates. In these countries, the proportion of fatalities involving motorcycles (including powered two or three-wheelers) substantially increased (44%) over the same time (statistically significant). In these countries, the helmet-wearing rate was only 46% for all passengers. These patterns were not observed in LMICs with decreasing population fatality rates. Results: Motorcycle helmet usage rates strongly correlate with decreasing fatalities per 10,000 motorcycles in Low-Income Countries (LICs) and LMICs. Effective interventions (including increasing helmet usage) are urgently needed for motorcycle crash trauma in LMICs, especially where the economy and motorization rapidly grow. National strategies for motorcycle safety, conforming to the Safe System principles, are recommended. Conclusions: For evidence-based policy formulation, there is a need to continue strengthening data collection, sharing, and use.