Background 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.

Objective We examined the prevalence of sleepiness and sleep-related disorders among motor vehicle drivers in Fiji.

Method Using a two-stage cluster sampling study design, we recruited a representative sample of people driving four-wheeled motor vehicles at randomly selected times from 50 randomly selected roadside survey sites, on the island of Viti Levu, Fiji, over 12 months commencing July 2005. A structured interviewer-administered questionnaire sought self-report information on driver characteristics including sleep-related measures.

Results The 752 motor vehicle drivers recruited (84% response rate) were aged 17–75 years (mean 37 years), with most driving in Viti Levu undertaken by males (93%), and those identifying with Indian (70%) and Fijian (22%) ethnic groups. 18% of driving was undertaken by drivers who reported that they felt sleepy, had difficulty staying awake, or were not fully alert. Most driving while sleepy or less alert (25%) was undertaken by young drivers aged 15–24 years, with a similar proportion reporting less than five nights of adequate sleep per week. The prevalence of driving while experiencing acute or chronic sleep deprivation was generally higher among Fijians compared to Indians.

Significance Driving while not fully alert is relatively common in Fiji, suggesting driver sleepiness may be an important but under-estimated contributor to road traffic injuries in this and other less resourced Pacific countries.