FATIGUE OCCURRENCE, PERCEPTION, KNOWLEDGE AND THE UTILIZATION OF ITS COPING MECHANISMS BY COMMERCIAL AIRCREW IN NIGERIA SUBMITTED BY DR OSAGIE KENNETH COLE DEPARTMENT OF COMMUNITY HEALTH AND PRIMARY CARE ,LAGOS UNIVERSITY TEACHING HOSPITAL,IDI-ARABA LAGOS TO THE NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF THE FINAL FELLOWSHIP OF THE FACULTY OF PUBLIC HEALTH (FMCPH). NOVEMBER 2012 DECLARATION I hereby declare that this Research work titled “FATIGUE OCCURRENCE, PERCEPTION, KNOWLEDGE AND THE UTILIZATION OF ITS COPING MECHANISMS BY COMMERCIAL AIRCREW IN NIGERIA” is my original work and was done by me under appropriate supervision, and any assistance given has been duly acknowledged. I also declare that this dissertation has not been submitted anywhere else in part or in full for any other examination. ……………………………………….. ……………………….. Dr Osagie Kenneth Cole Date Department of Community Health and primary care , Lagos University Teaching Hospital Idi Araba ,Lagos state ii CERTIFICATION I hereby certify that this study titled “FATIGUE OCCURRENCE, PERCEPTION, KNOWLEDGE AND THE UTILIZATION OF ITS COPING MECHANISMS BY COMMERCIAL AIRCREW IN NIGERIA” was carried out by Dr Osagie Kenneth Cole under my direct supervision and to the best of my knowledge has not been submitted for any other examination or for publication in any journal. Prof A T Onajole …………………………….… (MPH,FMCPH) Signature and date Department of Community Health Lagos University Teaching Hospital Idi-Araba, Lagos Dr K A Odeyemi ………………………………… (MPH,FMCPH) Signature and date Head of Department, Department of Community Health Lagos University Teaching Hospital Idi-Araba, Lagos iii ACKNOWLEDGEMENTS I wish to most sincerely thank the Almighty God who strengthened me, gave exceedingly abundant grace and opened unbelievable windows of opportunity to make this project a reality. My Father, if not for your grace! I will also like to extend my profound gratitude to my vibrant and good natured supervisor, Professor AT Onajole for thoroughly supervising and guiding me through this work. Sir, you are an inspirational leader and an extraordinary mentor. God bless you. My appreciation also goes to our “mum in the house” and my Head of department Dr KA Odeyemi for her patience and guidance through my residency training. To Dr BE Ogunnowo, thank you for always being there. The three of you have molded me and made me so much better. May the Lord continue to increase you all in wisdom and understanding. My appreciation also goes to Dr Olufunlayo and other Lecturers/consultants in the department for their invaluable contribution to this dissertation and my residency training as a whole. My special thanks to Drs Abisoye Oyeyemi and Tomi Odugbemi for painstakingly reading through my work and making useful contributions. You both have remained my reliable “cousins”. I owe a debt of gratitude to the DG, NCAA Dr Harold Demuren for opening the doors of the aviation industry and providing very useful counsel. To the DGM, aero medicals, Dr T Haggai , thank you for sharing tons of research materials from your “treasure trove”. In addition, access to aircrew would have been a nightmare without your help. May God bless you abundantly. iv To the staff of KUPA medical centre and the in house research assistants, your contribution were invaluable. To my dear colleagues in the department and to the members of staff, thank you for making my residency a pleasant and rewarding experience. To my darling booh, Achere I cannot thank you enough for your Love, support, prayers and sacrifice throughout the course of the Residency programme and especially when putting this work together. May God bless you mightily. To my wonderful children, Esohe and Osaze, thanks for being patient and understanding when Daddy had to do his work. To my beloved parents Gp Capt (rtd) and Mrs Osaze Cole and my siblings, your remarkable support and encouragement helped in no small way. Thank you and may the good Lord bless you all. v TABLE OF CONTENTS Pages DECLARATION II CERTIFICATION III ACKNOWLEDGEMENTS IV TABLE OF CONTENTS VI ABBREVIATIONS VII LIST OF TABLES VIII LIST OF FIGURES IX SUMMARY x CHAPTER ONE: INTRODUCTION 1 Overview 1 Statement of the problem 3 Justification 5 Aim and Objectives 7 CHAPTER TWO: LITERATURE REVIEW 8 Introduction 8 Classification of fatigue 9 Indicators of fatigue 11 Factors responsible for pilot fatigue 12 Effect of fatigue on aircrew performance 17 Stress and fatigue in flying operations 19 Aircrew fatigue coping mechanisms 21 CHAPTER THREE: METHODOLOGY 32 Back ground to study area 31 Study design 32 vi Study population 33 Sample size estimation 33 Data collection tools and techniques 35 Data analysis 39 Ethical Consideration 40 Limitation of the study 41 CHAPTER FOUR: RESULTS 44 CHAPTER FIVE: DISCUSSION 78 Conclusion 89 Recommendations 91 References 92 Appendix A: Questionnaire 104 Appendix B: In-depth interview guide for regulators/management 111 Appendix C: In-depth interview guide for aircrew 114 Appendix D: Registered airlines in with AOC 117 vii ABBREVIATIONS AMSL Above mean sea level AOC Air Operators Certificate ATC Air traffic control ATPL Air transport pilot’s license CPL Commercial pilot’s license EEG Electro encephalogram FAA Federal Aviation Authority FAAN Federal airports authority of Nigeria FAST Fatigue avoidance scheduling tool FTL Flight time limitation ICAO International Civil Aviation Organization IFR Instrument flight rating MMIA Murtala Muhammed international Airport NASA National Aeronautics and Space Administration NCAA Nigerian Civil Aviation Authority NTSB National transport and Safety Board SAFE System for Aircrew Fatigue Evaluation UCL University College London UN United Nations viii LIST OF TABLES Tables Pages Table 1: Socio-demographic characteristic of respondents 43 Table 2: Social history of respondents 44 Table 3: Occupational characteristics of respondents 45 Table 4: Emotionally stressful issues reported by respondents 47 Table 5: Reported commuting time among respondents 48 Table 6: Time of last episode of fatigue experienced by respondents 51 Table 7: Levels of physical fatigue experienced by respondents 52 Table 8: Levels of mental fatigue experienced by respondents 54 Table 9: Graded fatigue level of respondents 56 Table 10: Percieved effect of fatigue on flying tasks among captains 57 and co pilots Table 11: Perception of performance on flight operations among captains 58 and co pilots in the last one month Table 12: Respondents knowledge of fatigue coping mechanisms 59 Table 13: Utilization of the various coping mechanisms 62 Table 14: Respondents’ perception of effectiveness of coping mechanisms 63 Table 15: Association between respondents’ socio demographics 64 characteristics and fatigue level experienced Table 16: Association between respondents’ occupational characteristics 66 and fatigue levels experienced Table 17: Association between respondents’ smoking and fatigue 68 ix Table 18: Association between respondents’ alcohol use and fatigue 69 Table 19: Association between respondents’ type of aircraft qualified on 70 and fatigue X LIST OF FIGURES Figures Pages Figure 1: Perception of respondents on the need for review of regulations to reduce flying hours 49 Figure 2: Distribution of respondents who reported ever being fatigued 50 Figure 3: Distribution of respondents who have had cause to utilize coping mechanisms 61 xi SUMMARY Introduction: Fatigue induced human error is a significant cause of accidents and incidents in the aviation industry with major consequences for public health safety. Fatigue is also the largest identifiable and preventable cause of accidents in air transport operations. This study was carried out to determine the level of fatigue being experienced by aircrew operating in Nigeria as well as their knowledge and utilization of fatigue coping mechanisms. Materials and methods: The study was a descriptive cross sectional study of aircrew fatigue and coping mechanisms in the Nigerian aviation industry. All consenting subjects were studied. Quantitative data were collected using a pre tested semi structured , self administered questionnaire and were analyzed using Epi info and winpepi statistical soft ware. In-depth interviews were also conducted on ten representatives from both aircrew and regulators of the industry. Results: A total of 190 respondents participated in the study and were made up of 86 captains, 50 co-pilots, 2 flight engineers and 52 flight attendants. Sixty nine percent of all aircrew were fatigued . A higher proportion of aircrew deployed to long haul duties were fatigued compared to those in short haul . Graded fatigue levels showed that 53.7% of aircrew were mildly fatigued, 26.1% moderately fatigued and 20.2% were severely fatigued. Respondents knowledge of fatigue coping mechanism was fair. Crew work rest/scheduling had the highest knowledge with 85.3% while cockpit naps had the least knowledge with 28.9%. xii Regarding the utilization of these mechanisms, scheduling was the most utilized (78.3%), followed by activity breaks (76.1%). The least utilized method was listening to music (35.1%). Conclusion: Fatigue levels were relatively high at 69% with a fair utilization rate of fatigue coping mechanisms ranging between 35.1%-78.3% . Recommendation: There is a need for regulations to establish appropriate flight time limits which will be based on total duty time (commencing when aircrew report for duty) and not based on number of sectors flown . In addition,