To ascertain the prevalence and pattern of alcohol impaired driving in an African nation, we conducted a random, roadside, breathalyzer survey of drivers in Ghana. A total of 149 (21%) of 722 drivers tested had a detectable blood alcohol concentration (BAC). In addition, 7.3% of drivers had a BAC ≥ 80 mg/dl. The prevalence of impaired driving (BAC ≥ 80) was higher among private drivers (9.8%) than commercial drivers (6.4%). However, due to a higher volume, the majority (64%) of impaired drivers were commercial drivers. Alcohol use was higher among uneducated (11%) compared to educated drivers (5.4%) and was higher among middle aged drivers (30 - 49 years, 9.1% impaired) compared with younger (< 30 years;​ 5.0%) or older drivers (≥ 50 years;​ 0%). Alcohol impaired driving is a significant problem in this African nation. Anti-drunk driving measures should be an important component of road safety efforts. Such measures may need to be different than industrialized nations and will need to target less educated drivers, middle aged drivers, and commercial drivers.