The role of driver sleepiness in motor vehicle crash injuries in Fiji
Despite its acknowledged relevance as a risk factor for road traffic injuries, few studies have quantified the prevalence of driver sleepiness in low and middle-income countries. A population-based case control study conducted in Viti Levu, Fiji, between July 2005 and December 2006, identified motor vehicles involved in crashes where at least one person died or was hospitalised (cases) and motor vehicles sampled from roadside surveys (controls). A structured interviewer-administered questionnaire sought information from drivers on driver and vehicle characteristics including sleep related measures. The driving population (131 cases, 752 controls) comprised mostly drivers who were male (93%), of Indian ethnicity (70%), and aged 25 to 44 years (61%). The motor vehicles driven by the driving population were cars (67%), vans/utility vehicles (30%), and trucks (3%). Shift work and working for more than 60 hours per week was reported in 15% and 6% of the driving population respectively. There was a six-fold increase in the odds of injury-related crashes among drivers reporting they were not fully alert, had difficulty staying awake, or were sleepy (OR 5.7, CI 2.7, 12.3). At least one third (34%) of injury crashes were attributed to driving while sleepy or less alert (CI 30.0, 37.4). Acute driver sleepiness is an important contributor to the burden of four-wheeled motor vehicle crashes in Fiji. The research highlights the need to design evidence-based strategies which reduce driver sleepiness-associated road crashes in less resourced settings. Interventions could include measures to limit work and driving (night) hours. This requires a collaborative approach by road safety stakeholders, ensuring road safety initiatives are integrated with the relevant legislature and wider social, occupational, and economic policy.