International Journal of Injury Control and Safety Promotion Vol. 17, No.

4, December 2010, 257265

SHORT REPORT Fatigue and the road users: travellers account!

Gerryshom Munala* and Kiambigi Maina
Department of Construction Management, Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62000-00200, Nairobi, Kenya (Received 4 June 2009; nal version received 28 May 2010)

Introduction Road safety continues to be an intractable problem for Kenyas transport system despite many years of initiatives to reduce the carnage. With the number of drivers on the increase, it is clear that extra care must be taken while driving. In 2001, the World Health Organisation rated Kenya at the top for the highest accident rate in the world. There were 510 fatal accidents for every 100,000 vehicles, followed by South Africa with 260 and Zimbabwe with 205 (Kenya ranks top, 2001). This terrible toll reects the culture of road use in Kenya, which appears to be characterised by a lack of understanding of, or respect for, dangerous driving. What is indisputable is that the roads in Kenya have a serious ongoing road safety problem. In view of this high crash toll and accident rate, it is presumed that drivers and other road users alike are supposed to take extra care while driving, i.e. by being extremely alert and cautious. However, the abovementioned statistical accident data do not support this. Besides lives being cut short tragically, debilitating injuries due to accidents cause pain, grief and suering that have lifelong impacts on victims, families and communities. The world report on road trac injury and prevention describes that the economic cost of road crashes and injuries is estimated to be at 1% of the gross national product in low-income countries, 1.5% in middle-income countries and 2% in high-income countries. The global cost is estimated to be US$ 518 billion per year. Low- and middle-income countries account for US$ 65 billion, which is more than they receive for development assistance (Peden et al., 2004). As a country, Kenya has lost a substantial amount of resources, both in terms of man power and nance, in trying to stem and deal with this road carnage. Odero,

Khayesi and Heda (2003) suggest that the fatality rates in Kenya are extremely high with 7 deaths from 35 road crashes every day, and that the impact of the prevailing interventions is dismal. According to a Ministry of Health Report, in 1996 trac accidents were the third leading cause of death after malaria and HIV/AIDS (Government of Kenya, 1996). On its part, the Ministry of Transport and Communication (MoTC, 2004) estimates that the current total annual average cost to the Kenyan economy is KShs 14 billion or approximately 5% of the gross domestic product. This is not to say that eorts including improved safety features and enforcement of road laws are not being put in place. For instance, in February 2004, the socalled michuki rules were enforced in an attempt to improve Kenyas appalling record. The government obliged the owners of the countrys 25,000 matatus (minibuses), the backbone of public transportation, to install new safety equipment on their vehicles. Even after this, social and economic demands continue to exert pressure on consumers of the road transport system. Increased competition in the commercial road transport industry has further escalated the problem. While transporters strive for lower costs and an improvement in eciency, best practices in safety are being compromised. Recommended international practice stipulates that drivers should take 2030-min breaks after every 1.52 h of driving (www.drowsydriving.org; www. landtransport.govt.nz). This also presents an important opportunity for everyone in the vehicle to use the restroom, stretch their legs and get a little exercise. Breaks during long drives give the opportunity to reenergise, regain alertness and press on for everyone. Despite this, many drivers still believe that they can

*Corresponding author. Email: gerryshom@yahoo.co.uk

ISSN 1745-7300 print/ISSN 1745-7319 online 2010 Taylor & Francis DOI: 10.1080/17457300.2010.498641 http://www.informaworld.com

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G. Munala and K. Maina Data collection was done between October 2008 and January 2009 at three major points on the Mombasa road: Voi, Mtito Andei and Mombasa, between 6 am and 6 pm for three consecutive days at each location. Night time was avoided due to security reasons. The Mombasa road belongs to class A and is marked as A109. The distance of this road from Mombasa to Nairobi is approximately 467 km. It is one of the busiest roads in Kenya today. This road connects Kenyas principal seaport of Mombasa to its capital city, Nairobi. As such, it is Kenyas primary transport artery, and more importantly a principal access to the seaport of Mombasa for hinterland countries and regions of east and central Africa (Uganda, Rwanda, Burundi, eastern Democratic Republic of Congo, southern Sudan and northern Tanzania). Non-probability (convenience/accidental/choicebased) sampling was used to select the interviewees on the basis of their availability or ease of inclusion at each location. It was important that purposive sampling/judgement sampling was done in an eort to get detailed information of central signicance to the study from strategic informants. The fatigue questionnaires developed were administered to dierent categories of drivers and passengers. Table 1 gives a summary of the drivers proles. A total of 100 private car drivers, 115 PSV drivers and 100 truck drivers was sampled for the administered questionnaires. Out of which 87, 110 and 85 private car, PSV and truck drivers, respectively responded to the questionnaires; an 89% response rate. Table 2 gives the summary of the trac count. Descriptive cross-tabulation statistics were developed to draw initial insights about the various factors that seem to inuence fatigue and later translated into various graphs for display. Prevalence of fatigue Travelling is an age-long activity. Eliminating the need or desire to travel is not possible. Therefore, it follows that fatigue is inevitable and the only possible remedy is the reduction of the eects that come with it. Moreover, fatigue has many facets and its eects can be manifested

ignore the signs of fatigue and continue on the journey until they reach their destination without any rest, even if the journey is long. Crashes due to driver fatigue are the most common on the roads. And because of the lack of adequate understanding of this phenomenon, accidents related to fatigue are almost always indicated as accidents caused by loss of control. These types of crashes generally occur when the driver has actually fallen asleep, albeit momentarily, and as a result was unable to apply the brake or avoid an impending crash. As a result, loss of control and head on crashes are recorded as being the most common types of fatal crashes involving fatigue (NRSC, 2007). The aim of this article is to help understand the dierent view sets of three dierent categories of drivers private car drivers, passengers service vehicle (PSV) drivers and truck drivers with regard to fatigue and its management on the roads of Kenya. Their opinions expressed in this article are an indicator to the seriousness of the problem and the need to put immediate management measures in place. Methodology The primary consumers of road transport are passengers and drivers. This study endeavours to capture the opinions of the drivers through empirical and exploratory eld survey methods. A conscious focus on drivers was made for a number of reasons: (i) for some, driving is their daily occupation; (ii) drivers are likely to experience some symptoms that are not experienced by passengers; and (iii) drivers are active road users unlike passengers who are passive road users. The rsthand accounts of these users experience and their perceptions of road crashes have helped the study to focus on the meaning of human experience, obtained through elucidation of respondents perspectives, process and situational details. The study has made use of multiple methods, such as administered questionnaires, semi- and unstructured interviews and participant observation. In doing so, the respondents views were explored while according respect for the individual.
Table 1. Summary of respondent prole. Age Median PSV drivers TRUCK drivers PRIVATE car drivers 40 39 33 Mean 38.8 40.3 34.1

Gender Male (%) 97 100 91 Female (%) 3 0 9

Driving experience (years) Median 7 8 6 Mean 8.4 9.1 8.5

International Journal of Injury Control and Safety Promotion

Table 2. Summary of trac count on Mombasa road. From Mombasa PSV vehicles Trucks Private cars 565 256 566 To Mombasa 339 258 648 Sampled population 100 115 100

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Weighting (sampled/ vehicle count) 0.11 0.22 0.10

as either physical or psychological. Fatigue as a phenomenon can be caused by a single variable or a combination of several of these variables. In an eort to understand this, various actors were interviewed and their responses are highlighted in this report. Fatigue as experienced by drivers was sought through various variables. A few symptoms of fatigue as variables were used and the respondents were asked to state the frequency of occurrence of these indicators. The respondents were to rate the frequency using the terms: often, sometimes, rarely and never. Often and sometimes were used to indicate that the respondents experienced fatigue while travelling while rarely and never were used to indicate that the respondents had not experienced fatigue while travelling but if they had it was on very few occasions. The data in Table 3 show the extent to which drivers experience fatigue as they carry out their duties on roads. Drivers were asked to respond to the question, How often do you notice the following symptoms during your journey? In each category, less than 10% experience fatigue on every trip. Interestingly, the response to fatigue causing delays in braking received a high response never from 34%, 25% and 49% of PSV, truck and private car drivers, respectively. This can be attributed to a fear that they could be accused of deliberately causing accidents. In comparison, the response on every trip is low. The low frequency of the symptoms on every trip is a likely indication of the development of inbuilt body inertia to the eects of fatigue for PSV and truck drivers, given that they are on the roads most of the time. However, the same cannot be said of private car drivers. They too have low response rate to fatigue on every trip but this could be attributed to the exibility they enjoy to deal with fatigue when it sets in during the journey. Physical fatigue factors, i.e. sore eyes, stiness or cramps and headaches or backaches elicited a high response rate 52%, 52% and 34%, respectively by private car drivers who indicated that these do not occur to them at all. The commercial-oriented drivers, i.e. truck and PSV drivers, indicate that the same factors occur to them most on few trips. As for the rest of the factors, which are psychological in nature, boredom on few trips and loss of concentration on some trips take a heavy toll on drivers across board.

Table 4 shows the computed values of Chi Square across all the variables for the three groups of drivers. We can conclude that drivers across board experience signs of fatigue on their journey, although at varying levels. Socio-economic contributors to road fatigue Pressure to enhance capital utilisation Economic pressure has rapidly taken its toll on drivers as they strive to t into the 24-h working environment. This study has revealed that in pursuit of increased prots, vehicle owners frequently force their drivers to drive at excessive speeds, to work for unduly long hours and to work even when exhausted. Apart from this, the study has also revealed that employers take advantage of the poor enforcement of employment procedures to recklessly misuse the unemployed. When asked about the nature of their operations, PSV and truck drivers responded that they are hired under the following three categories: (i) regularly employed (87%); (ii) hired on seasonal basis (during high season holidays and school holidays) (9%); and (iii) hired on an ad hoc basis mainly to deal with emergency cases (for instance when the regular driver is absent) (4%). Owing to this, the drivers, especially those who are employed on, an ad hoc basis, drive for long hours to make additional money during the short periods that they have to work for. Figure 1 shows the details of the time the drivers spend on the road everyday. Figure 2 shows another interesting trend between employee-drivers and owner-drivers. Employee-commercial drivers reported that they had to drive long hours a day as they were under nancial crisis, and had to meet deadlines and earn more money. Apart from long working hours, the payment mode was noted to compromise the need for resting as shown in Figure 3. Drivers tend to drive longer when there is a motivation for more pay. On average, drivers employed tended to drive for 8.7 h daily as compared to 11.3 h for those that are paid on an hourly basis. It was also observed that a driver pooling system has become favourable with commercial vehicle owners where drivers are being used by several owners and are paid per trip. This is fast catching on in the PSV transport industry where bus and coach drivers work for more than one transport company, and it is

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Table 3. Symptoms Boredom while driving Sore eyes Loss of concentration Stiness or muscle cramps Yawning Delayed or poor gear changing Delays in applying brakes Poor overtaking decisions Headaches and backaches Mood changes or increased irritability Occurrence of fatigue signs on drivers. Drivers PSV Truck Private PSV Truck Private PSV Truck Private PSV Truck Private PSV Truck Private PSV Truck Private PSV Truck Private PSV Truck Private PSV Truck Private PSV Truck Private

G. Munala and K. Maina

Never (%) 10 16 11 25 15 52 14 12 12 30 18 52 9 8 12 25 25 40 34 25 49 20 24 28 15 8 34 23 11 46

Few trips (%) 34 34 23 30 28 17 29 29 26 26 22 14 16 18 35 30 22 29 26 16 25 26 20 20 32 16 34 25 15 18

Some trips (%) 21 7 30 16 15 10 26 15 35 22 14 12 22 12 18 14 9 8 12 11 5 21 18 16 22 18 12 16 11 11

Most trips (%) 14 12 17 8 9 4 11 12 10 12 14 3 19 24 14 7 12 4 6 12 2 12 6 16 7 14 2 8 13 4

Every trip (%) 4 6 4 2 7 0 2 5 0 2 3 0 11 7 1 1 1 0 2 4 0 2 4 1 4 11 1 3 7 0

Table 4.

Test of statistical signicance for response to occurrence of fatigue signs by the three categories of drivers. Pearson Chi square Degree of freedom (df) 10 10 10 10 10 10 10 10 10 10 Level of alpha (p) 0.000 0.000 0.003 0.000 0.000 0.000 0.000 0.001 0.000 0.000

Boredom while driving Sore eyes Loss of concentration Stiness or muscle cramps Yawning Delayed or poor gear changing Delays in applying brakes Poor overtaking decisions Headaches or backaches Mood changes or increased irritability

40.249 74.455 26.708 52.406 70.115 35.857 54.832 30.513 89.574 90.162

understood that some are engaged in other types of work such as taxi/private hire vehicle-driving or nightshift work. It is clear that drivers who struggle to remain commercially viable expose the travellers and indeed themselves to great risks. Pressure to reach a destination Commercial drivers were further asked to indicate whether they had been involved in any kind of accident (including collision, roll-over, hitting an object, etc.)

during the past year. Fifty-eight per cent responded in the armative. The follow-up question required them to indicate in which section of the journey this occurred. Twenty-one per cent indicated that the incidents occurred towards the end of long journeys when they were rushing to try and make up for the lost time. Only 7% indicated that the incidents occurred at the start of the journey. The above can be attributed to poor scheduling or lack thereof. Seventy-seven per cent of the drivers indicated that they worked under some schedule while 23% said that they operate

International Journal of Injury Control and Safety Promotion under no schedule at all. Figure 4 shows the details of drivers working with or without a schedule against the average time they drive everyday. Pressure to drive for longer periods

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Figure 1. Nature of employment status of PSV drivers (n 105).

The time spent driving everyday is an indicator of the following: (i) how sleep is taken for granted; and (ii) how the pressure to make money plays a major role in determining human activities. On average, the study has revealed that PSV drivers spent 8.94 h on roads everyday. This is more than the recommended 8 h within the Trac Act (chap. 403), Part V section 66A (1) of the Kenyan law (Government of Kenya, 1954). This section states that No person shall drive a public service vehicle or a commercial vehicle for more than a total of eight hours in any period of twenty-four hours. Owing to pressure of time, there is always the urge to push-on beyond comfortable driving levels. The International Labour Organization (ILO) on its part, through its convention, The ILO Hours of Work and Rest Periods (Road Transport) Convention, 1979 (No. 153), provides more specication on working and rest periods in road transport. It is the only ILO Convention which deals exclusively with conditions of work in road transport. The main clauses of the Convention state that: (1) every driver is entitled to a break after four hours of continuous driving or after ve hours of continuous work; (2) the maximum daily total driving time should not exceed nine hours; (3) the maximum weekly total driving time should not exceed 48 hours; (4) the daily rest period must never be less than eight consecutive hours.

Figure 2. Time spent driving for owner/employed for PSV drivers (n 105).

Unfortunately, as of August 2005, only eight ILO member States (Ecuador, Iraq, Mexico, Spain,

Figure 3.

Payment mode for the time driven for PSV drivers (n 102).

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G. Munala and K. Maina Time fatigue aects the most The survey revealed that drivers showed increased fatigue signs at two periods as shown in Figure 5: (1) between 10 pm and midnight: this coincides with the time that the body generally responds to the rst requirements to rest (sleep). (2) from midday to early evening: this includes the time between the post-lunch dip period to the time when the body is tired after a whole days work. The dangers are that drivers lose concentration and alertness during these times. Additionally, during late afternoons many drivers will be eager to reach their destinations quickly.

Switzerland, Turkey, Uruguay and Venezuela) had ratied this instrument (http://www.ilo.org/public/ english/dialogue/sector/papers/transport/wp232.pdf). Numerous studies have conrmed that an average person needs about 8 h of sleep to sustain alertness (e.g. Roehrs, Timms, Zwyghuizen-Doorenbos, & Roth, 1989; Roehrs, Shore, Papineau, Rosenthal, & Roth 1996). If this minimum sleep need is not met, then alertness and performance levels are reduced (Bonnett, 1994; Dinges & Kribbs, 1991; Dinges et al., 1997). This study further arms the conclusions that these long working hours, reduced sleep and built-up sleep debt may increase the risk of being involved in a fatigue-related crash.

Figure 4.

PSV drivers operation under some schedule (n 105).

Figure 5.

Eects of fatigue on PSV drivers over 24-h period (n 106).

International Journal of Injury Control and Safety Promotion The increased likelihood of micro-sleeps at these times is due to the circadian rhythm, the 24-h cycle of sleeping and waking. Humans are designed for daytime activity and night-time rest. Mid-day also poses a postlunch dip in performance that naturally increases sleepiness (occasioned by digestive activities from mid-day meals) which corresponds with both an increased occurrence of micro-sleeps and an increase in fatigue crashes. These trends are echoed in other studies, e.g. the study carried out by Lisper, Eriksson, Fagerstrom and Lindholm (1979) (Sweden). Forty-one per cent of the PSV drivers indicated that they had no problem driving at night as it did not have an impact on their driving abilities. Perception of management of fatigue Fatigue in transport probably cannot always be avoided, but it can be managed. Figures 6 and 7 show how the road users perception of management of fatigue is being handled by authorities and how they acquired knowledge of dealing with it while travelling. The general perception from PSV drivers (86%) indicates that the management of fatigue is quite bad or worse. Only 2% think it is well done. The key issues raised by the drivers were as follows: (i) no training, (ii) no access to information and (iii) authorities disregard for fatigue. Despite this poor management, 67% of the PSV drivers indicate learning how to handle fatigue through on-job experience. They argue that the longer one is in the job, the better he/she gets experience in identifying fatigue situations. A sizeable number, 7% and 12%, reported getting some company training or reading from booklets, respectively regarding the

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issues related to fatigue. This is a positive sign. It shows that fatigue issues have come to the attention of some vehicle owners and eorts are being put in place to enlighten their drivers on the ways to manage the phenomenon. However, 14% indicate of having no knowledge whatsoever on fatigue issues. This number is a cause of worry because without the knowledge of the identication of the signs, cause and eects of fatigue, one cannot start to mange it eectively. Most of the road users lack formal training on fatigue management. Frequent road users, especially commercial drivers learn through trial and error on how to handle and manage fatigue. Formal training on fatigue would improve the decision-making process especially on issues of scheduling, rest-stops and generally to know what to do when one feels fatigued. Training should be encouraged after the formal acquisition of a licence as it could improve the drivers behaviour; brochures could be circulated freely to drivers through campaign eorts by authorities and workshops and seminars for drivers should be made mandatory on the subject of fatigue. Despite all these, there is no doubt that fatigue is present in road users. Road users are exposed and experience dierent levels of fatigue. It is interesting to note that the road users who were interviewed did allude to the fact that fatigue could be a major factor in road crashes in the country. Overall, the study can condently conclude that road users are aware of the signs of fatigue. Even with this knowledge many take conscious decisions to proceed on with their journeys without making a stop to rest (for some this becomes a fatal decision). The reasons behind their decision are as follows: (i) nearness to the end of the trip; (ii) pressing appointments; (iii) the wish to arrive at a reasonable hour; and (iv) need to go for another trip.

Figure 6. Perception of management of fatigue by PSV drivers (n 108).

Figure 7. Means of knowledge acquisition by PSV drivers (n 105).

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G. Munala and K. Maina ability, rest stops can also provide drivers a break from driving under other hazardous conditions including bad weather. The identication of the possible stopping opportunities along the route is important. The possible locations for consideration include: (1) Locations of black spots. In determining the priority for providing roadside rest stops, the locations of fatigue black spots and other road safety issues should receive primary consideration. Rest stops should be located just before black spots for the drivers to be most alert as they approach these dangerous areas on the road. (2) Locations with scenic views. The need to rest should also give the traveller a chance to enjoy the scenic views of the landscape along the road. Good views and an attractive setting will encourage road users to stop. Therefore, locations should be able to maximise site uses by considering other amenities such as scenic views, points-of-interest or historic sites. (3) Proximity to towns. Proximity to urban and commercial services centres gives another opportunity for siting rest stops. Close proximity to public utilities such as water, sewerage connections and electricity is desirable, as this reduces the cost of building and operating the rest area, as well as improving the quality. These centres can also oer an opportunity for the travellers to refuel, enjoy meals and even buy items needed for the journey. Closeness to settlements also enhances the security of the rest stops. (4) At intersections and junctions. Road intersections and junctions (existing and future) do oer another excellent opportunity for rest stops. Finally, because the data provided in this study are subjective in nature, they may underestimate the extent of the problem. However, they do provide useful insights into public perceptions about fatigue that will be useful to build upon for the development of eective fatigue intervention campaigns. The challenge is to reconstruct the mindset of the Kenyan travellers and in the process, save lives. This change of behaviour can be achieved in part through education campaign eorts and a collective revival of the nations conscientiousness towards safe driving. The role of the media in this aspect cannot be over-emphasised. Management of fatigue on roads can only bring a positive change through the transformation of the attitude of the road users themselves. Ideally to be successful, all stakeholders must join together through participation,

Figure 8.

Integrative tri-management strategy.

Conclusions Kenyas vehicle population is on the rise. With it will be the fatality rate unless the above-mentioned measures are implemented. As this study on the Mombasa road has demonstrated, fatigue is in existence in the road transport system. The results reveal concerns on drivers behaviours, perception of accident causes and socio-economical pressures on road users. Drivers at times make conscience decisions to continue on their journey despite clearly being fatigued. It may be that those who persist in driving are either unaware of the risk they are taking, or underestimate the risk posed by fatigue or even just ignore the risk. One practical solution for the above problem would be to introduce rest-stops at strategic locations along the highway. These locations could oer a number of benecial remedies to both drivers and passengers, such as: (i) they could provide safety breaks for travelling motorists during longdistance travelling, (ii) they could provide a place for travellers to relax and take a break from highway travel, (iii) they could provide comfort stations, and in some cases, food and beverage services and (iv) they also could provide safety and convenience on the roads where travellers can pause and refresh themselves before proceeding on the journey. The concept of introducing rest stops is based upon the premise that traveller fatigue, and the boredom and monotony associated with travelling can be reduced if road users break their journey regularly. Rest stops could further oer an additional opportunity to safely pull-over and give the travellers time to relieve, re-energise and enjoy the special character of the regions through which they travel. Apart from this very useful health-restoring

International Journal of Injury Control and Safety Promotion ownership and support of management strategies as shown in Figure 8. The roles to be played by the enforcement authorities should not be just sporadic and symbolic during major accident incidences but should be sustained. Importantly, safety policy on roads should be guided by research that gives a detailed understanding of the circumstances that lead to crashes. Acknowledgements
The authors gratefully acknowledge the nancial support from the division of Research, Production and Extension (RPE) at Jomo Kenyatta University of Agriculture and Technology that made this research possible. They also want to thank the sta of the Department of Construction Management that supported them during the research and their students who helped them with eld data collection. All errors of omission and commission are that of the authors.

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