title: Driver sleepiness and risk of motor vehicle crash injuries: a population-based case control study in Fiji (TRIP 12).
abstract: BACKGROUND
  Published 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.
  
  
  METHODS
  The 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.
  
  
  RESULTS
  Following 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.
  
  
  CONCLUSIONS
  Driver 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.
authors.affiliation: Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand. Electronic address: j.herman@auckland.ac.nz.
authors.forename: Josephine
authors.initials: J
authors.lastname: Herman
authors.affiliation: Department of Public Health, College of Medicine, Nursing and Health Sciences Fiji National University, Suva, Fiji.
authors.forename: Berlin
authors.initials: B
authors.lastname: Kafoa
authors.affiliation: Department of Public Health, College of Medicine, Nursing and Health Sciences Fiji National University, Suva, Fiji.
authors.forename: Iris
authors.initials: I
authors.lastname: Wainiqolo
authors.affiliation: Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Robinson
authors.affiliation: Department of Public Health, College of Medicine, Nursing and Health Sciences Fiji National University, Suva, Fiji.
authors.forename: Eddie
authors.initials: E
authors.lastname: McCaig
authors.affiliation: Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Jennie
authors.initials: J
authors.lastname: Connor
authors.affiliation: Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: Rod
authors.initials: R
authors.lastname: Jackson
authors.affiliation: Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand.
authors.forename: Shanthi
authors.initials: S
authors.lastname: Ameratunga
mesh_terms: D000062:Accidents, Occupational / Q000517:prevention & control* / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000517:prevention & control* / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D001334:Automobile Driving / Q000331:legislation & jurisprudence; D016022:Case-Control Studies; D016000:Cluster Analysis; D005221:Fatigue / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005367:Fiji / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018986:Motor Vehicles; D016272:Occupational Health; D016017:Odds Ratio; D011050:Policy Making; D015995:Prevalence; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000453:epidemiology; D012892:Sleep Deprivation / Q000150:complications* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014940:Work Schedule Tolerance; D016526:Workload; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
keywords: Accidents; Automobile driving; Developing countries; Pacific Islands; Sleep; Traffic