• Josephine Herman, Berlin Kafoa, Iris Wainiqolo, Elizabeth Robinson, Eddie McCaig, Jennie Connor, Rod Jackson, and Shanthi Ameratunga.
• Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand. Electronic address: j.herman@auckland.ac.nz.
• Injury. 2014 Mar 1; 45 (3): 586591586-91.

IntroductionPublished studies investigating the role of driver sleepiness in road crashes in low and middle-income countries have largely focused on heavy vehicles. We investigated the contribution of driver sleepiness to four-wheel motor vehicle crashes in Fiji, a middle-income Pacific Island country.MethodThe population-based case control study included 131 motor vehicles involved in crashes where at least one person died or was hospitalised (cases) and 752 motor vehicles identified in roadside surveys (controls). An interviewer-administered questionnaire completed by drivers or proxies collected information on potential risks for crashes including sleepiness while driving, and factors that may influence the quantity or quality of sleep.ResultsFollowing adjustment for confounders, there was an almost six-fold increase in the odds of injury-involved crashes for vehicles driven by people who were not fully alert or sleepy (OR 5.7, 95%CI: 2.7, 12.3), or those who reported less than 6 h of sleep during the previous 24 h (OR 5.9, 95%CI: 1.7, 20.9). The population attributable risk for crashes associated with driving while not fully alert or sleepy was 34%, and driving after less than 6 h sleep in the previous 24 h was 9%. Driving by people reporting symptoms suggestive of obstructive sleep apnoea was not significantly associated with crash risk.ConclusionDriver sleepiness is an important contributor to injury-involved four-wheel motor vehicle crashes in Fiji, highlighting the need for evidence-based strategies to address this poorly characterised risk factor for car crashes in less resourced settings.Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

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