Occupational and behavioral factors associated with fatigue among long-distance truck drivers on the Kenya–Uganda transport corridor

Objectives This study aimed to identify occupational and behavioral factors associated with fatigue among long-distance truck drivers along the Kenya–Uganda transport corridor. A secondary objective was to assess the robustness of identified associations by applying LASSO penalized regression as a sensitivity check. Methods A cross-sectional analytical study was conducted among 207 long-distance truck drivers at the Busia and Malaba border crossings. Fatigue was assessed using the Chalder Fatigue Questionnaire (CFQ-11) with binary scoring. Missing data were addressed using multiple imputation by chained equations (MICE; m = 20). Factors associated with fatigue were examined using multivariable logistic regression with predictors selected on theoretical grounds from the occupational fatigue literature. LASSO logistic regression was applied as a secondary analysis to confirm that associations were stable under coefficient penalization. Firth penalized logistic regression was conducted as a sensitivity analysis to evaluate the stability of findings. Results The prevalence of occupational fatigue was 52.2% (95% CI : 44.8–58.6%). Substance use (adjusted OR = 8.64; 95% CI : 4.30–17.33; p < 0.001) and longer daily driving hours (adjusted OR = 1.23 per additional hour; 95% CI : 1.10–1.37; p < 0.001) were independently associated with fatigue. Both associations were retained under LASSO penalization, supporting their robustness. Conclusions Occupational fatigue affects a substantial proportion of long-distance truck drivers and is strongly associated with substance use and extended daily driving hours. Public health and transport-sector interventions should prioritize fatigue prevention through substance-use reduction strategies, driver wellness programmes, and enforcement of regulations limiting excessive driving hours to improve driver health and road safety.