Prevalence of substance use and associated factors among secondary school adolescents in Kilimanjaro region, northern Tanzania

Substance use among young people in the West Arsi Zone, Ethiopia: A cross-sectional study

INTRODUCTION

Substance use is a pressing public health concern in young Ethiopians, impacting their physical, psychosocial, and emotional well-being and productivity. However, there is a limited understanding of the prevalence and factors associated with substance use in this population both across Ethiopia and in the West Arsi zone specifically. This study investigates the prevalence of substance use and associated factors among young people in the West Arsi Zone, Ethiopia.

METHODS

A community-based cross-sectional survey was conducted among 427 randomly selected young people aged 14-29 in the West Arsi zone of the Oromia region, Ethiopia. Data were collected using structured interviewer-administered questionnaires. Logistic regression analysis was performed to determine the association between the outcome and independent variables. Ethical approval was obtained from the University of Technology Sydney, Australia, and Madda Walabu University, Ethiopia.

RESULTS

A total of 424 participants were included in the analysis, giving a response rate of 99.3%. The overall lifetime prevalence of any substance use among the study participants was 48.1% (95% CI: 43.3%, 53.0%) and the prevalence of current substance use was 72.5% (95% CI: 65.9, 78.5). Among lifetime users, 76.5% reported chewing khat, 49.0% drinking alcohol, 33.3% using various forms of tobacco, and 23.0% using cannabis. Being male, having a single marital status, a family history of substance use, low perceived social support, and the presence of mental health conditions were associated with an increased likelihood of substance use.

CONCLUSIONS

About half of the study participants reported a history of use of at least one substance from alcohol, khat, tobacco, or cannabis in their lifetime, highlighting the need for appropriate focused interventions to help address the growing challenges of substance use amongst young people in Ethiopia.

The prevalence of tobacco, alcohol, stimulant, khat, and cannabis use among school-going students in African and Arab countries: a systematic review and meta-analysis

BACKGROUND

The objectives of this review and meta-analysis were twofold: first, to determine the prevalence of substance use among school-going children in Arab and African countries; and second, to highlight the considerable influence of variables such as the nation's region and the timeframe of the study on the prevalence of substance use.

METHODS

Research was sourced from Science Direct, Scopus, Web of Science, Google Scholar, and PubMed. Thirty-seven articles were incorporated in accordance with the PRISMA guidelines. This review included studies published from 2013 to 2023. The statistical meta-analysis was performed using Comprehensive Meta-Analysis ver. 3 software. Across 37 studies, the total number of study participants was 73,508.

RESULTS

The meta-analysis revealed that tobacco was the most commonly used substance, with a prevalence of 16% (95% confidence interval [CI], 12.7%-20.02%). This was closely followed by alcohol, which had a prevalence of 15% (95% CI, 10.5%-22.8%), stimulants at 11.4% (95% CI, 7.4%-17%), khat at 10% (95% CI, 5.7%-15%), and cannabis at 8% (95% CI, 3.3%-18.4%). Notably, alcohol was the only substance that showed an increasing trend in prevalence from before to after 2019, rising from 13.3% (95% CI, 6.2%-26.1%) to 17% (95% CI, 10.2%-27%) (p<0.001). Additionally, the prevalence of substance use varied significantly between Arab and African countries (p<0.001).

CONCLUSION

Although the prevalence of substance use among school-going populations has significantly decreased over time, with the exception of alcohol, it is imperative that both African and Arab countries implement comprehensive measures and stringent laws to address the production and marketing of substances.

Substance use among young people in sub-Saharan Africa: a systematic review and meta-analysis

Background

The use of substances such as alcohol, tobacco, khat, or drugs among young people is becoming a public health concern globally, with particularly high prevalence rates in low and middle-income settings, where socio-cultural and economic factors contribute to distinct challenges in addressing this problem. This review aimed to summarize the current literature on the prevalence of substance use among young people in sub-Saharan Africa (SSA) and identify gaps in the current body of literature.

Methods

Seven databases and Google were searched for studies reporting on substance use prevalence among young people (aged 10-24 years) in SSA, published between January 2010 and May 2024. Observational studies were included, assessed for methodological quality, and checked for the presence of heterogeneity and publication bias using standard methods. A random effect model was used to estimate the pooled proportions for substance use among young people.

Results

The literature search identified 1,889 hits from the databases and Google. Among these 60 eligible studies involving 83,859 respondents were included in the review. The overall lifetime, 12-month, and current prevalence of any substance use among young people in SSA was found to be 21.0% (95% CI= 18.0, 24.0), 18% (95% CI=10,27), and 15% (95% CI=12,18), respectively. Among young people from SSA, alcohol use problem was the most prevalent (40%), followed by khat use (25%), stimulant use (20%), and cigarette smoking (16%). Other substances used by a smaller proportion of young people included cannabis, cocaine, inhalants, sedatives, shisha, hallucinogens, steroids, and mastics. The prevalence of substance use problems was higher among males compared to females, highest in the southern African region followed by Western and Eastern regions, and in community-based studies compared to institutional-based studies.

Conclusions

In SSA, over a fourth of young people use at least one substance in their lifetime, with higher rates among males than females and in community-based compared to institution-based studies. These results emphasize the need for interventions targeting the wider young population and those in specific subgroups identified as being at higher risk of substance use. This approach allows for the provision of tailored support and resources to those who need it most while also promoting positive health outcomes for the entire population of young people in the region.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022366774, identifier CRD42022366774.

Prevalence and factors associated with illicit drug and high-risk alcohol use among adolescents living in urban slums of Kampala, Uganda

BACKGROUND

Illicit drug and high-risk alcohol use among adolescents leads to poor health outcomes. We enrolled adolescents from urban slums in Kampala, Uganda, to assess baseline prevalence and factors associated with illicit drug and high-risk alcohol consumption.

METHODS

We conducted a cross-sectional study using data collected in a cohort that enrolled 14-19-year-old male and female participants from 25 March 2019 to 30 March 2020. Data was collected on social demographics, sexual behavior, and reproductive health using interviewer-administered questionnaires. The main outcomes were illicit drug use and high-risk alcohol use. Data on alcohol use was collected using the Alcohol Use Disorder Identification Test (AUDIT); results were dichotomized. Factors associated with each outcome were analyzed using multivariable logistic regression.

RESULTS

We enrolled 490 participants (60.6% female) with a median age of 18 (IQR 17-18) years, 84.9% had less than secondary education, 48.4% had their sexual debut before 15 years, 47.1% reported paid sex in the past 3 months and 22.8% had a sexually transmitted infection (chlamydia, gonorrhea, and active syphilis) baseline characteristics associated with illicit drug use in the past 3 months were male gender (aOR 12.45; 95% CI 7.21-21.50) being married (aOR 2.26; 95%CI 1.03-4.94) 10 or more paying sexual partners (aOR 2.45; 95%CI 1.05-5.69) and high-risk alcohol use (aOR 3.94; 95%CI 2.10-7.40), baseline characteristics associated with high-risk alcohol use were male gender (aOR 0.29; 95% CI 0.13-0.63) emotional violence from sexual partners (aOR 2.35; 95%CI 1.32-418) illicit drug users com (aOR 3.94; 95% CI 2.10-7.40).

CONCLUSION

Illicit drug and high-risk alcohol use are prevalent among male adolescents and adolescents involved in high-risk sexual behavior living in the urban slums of Kampala.

The mediating role of self-control on the relations between adverse childhood experiences and substance use among adolescents in Uganda

Objective

Adverse childhood experiences (ACEs) are established risk factors for undesirable consequences in adolescence and early adulthood, including substance use and a lack of self-control. Based on the Social Bonds Theory (SBT), this study aims to expand our knowledge of the pathways from ACEs and self-control to substance use in adolescence and early adulthood.

Methods

The extent to which self-control mediates the association between ACEs and substance use was examined in a cross-sectional survey of 358 adolescents and young adults (N = 234, 65.5% girls, mean age 17.7, SD 0.58, range 15-18). Data were gathered using the Adverse Childhood Experiences (ACE-10) questionnaire, the Drug Abuse Screening Test (DAST-10), and the 10-item self-control scale to assess childhood adversity, substance use, and self-control, respectively.

Results

ACEs were widely reported and significantly associated with substance use and a lack of self-control. Self-control strongly predicted substance use, independent of ACEs. Among those reporting no ACEs, one to two, three to four, and five or more, there were significant variations in the respondents' substance use (F(3, 400) = 12.69, p = 0.001). Self-control explained 51.2% (95% confidence interval [CI]: 41, 61%) of the associations between ACEs and substance use as assessed by linear regression.

Conclusion

Self-control is key to understanding why adolescents and young adults with a history of childhood adversity indulge in substance use. Therefore, there is a need to advocate for psychological interventions such as cognitive and behavioural therapy that have demonstrated efficacy in promoting self-control in adolescents and young adults.

Prevalence, correlates, and reasons for substance use among adolescents aged 10-17 in Ghana: a cross-sectional convergent parallel mixed-method study

BACKGROUND

Substance use among adolescents poses significant risks to their health, wellbeing, and development, particularly in low- and middle-income countries, including Ghana. However, little is known about the outlets and reasons for substance use among Ghanaian adolescents. This study examined the prevalence, correlates, reasons for substance use, and outlets of these substances among adolescents aged 10-17 in Ghana.

METHODS

Data were obtained from the Department of Children, Ministry of Gender, Children, and Social Protection, Ghana, which employed a cross-sectional convergent parallel mixed-methods technique to collect quantitative and qualitative data from children aged 8-17, parents or legal guardians and officials of state institutions responsible for the promotion and protection of children's rights and wellbeing. Overall, 4144 adolescents aged 10-17 were interviewed for the quantitative data, while 92 adolescents participated in 10 focus group discussions. Descriptive statistics, Pearson's chi-square test, and multivariable binary logistic regression were used to analyse the quantitative data, while the qualitative data was analysed thematically.

RESULTS

The prevalence of substance use was 12.3%. Regarding the types of substance use, alcohol (56.9%) and cigarettes (26.4%) were the most common substances. Being a male and currently working are significant risk factors, whereas being aged 10-13, and residing in the Middle- and Northern-ecological belts of Ghana are significant protective factors of substance use. Peers, household members who use substances, drug stores, and drug peddlers are the major outlets. The reasons for substance use were fun, substance as an aphrodisiac, boosting self-confidence, dealing with anxiety, and improved social status.

CONCLUSIONS

There is a relatively high substance use among adolescents in Ghana, and this calls for a multi-sectoral approach to addressing substance use by providing risk-behaviour counselling, parental control, and effective implementation of substance use laws and regulations.

Common adolescent mental health disorders seen in Family Medicine Clinics in Ghana and Nigeria

BACKGROUND

Mental health disorders among adolescents is on the rise globally. Patients seldom present to mental health physicians, for fear of stigmatization, and due to the dearth of mental health physicians. They are mostly picked during consultations with Family Physicians. This study seeks to identify the common mental health disorders seen by family Physicians in Family Medicine Clinics in Nigeria and Ghana.

METHODS

A descriptive cross-sectional study involving 302 Physicians practicing in Family Medicine Clinics in Nigeria and Ghana, who were randomly selected for the study. Data were collected using self-administered semi-structured questionnaire, and were entered into excel spreadsheet before analysing with IBM-SPSS version 22. Descriptive statistics using frequencies and percentages was used to describe variables.

RESULTS

Of the 302 Physicians recruited for the study, only 233 completed the study, in which 168 (72.1%) practiced in Nigeria and 65 (27.9%) in Ghana. They were mostly in urban communities (77.3%) and tertiary health facilities (65.2%). Over 90% of Family Medicine practitioners attended to adolescents with mental health issues with over 70% of them seeing at least 2 adolescents with mental health issues every year. The burden of mental health disorder was 16% and the common mental health disorders seen were depression (59.2%), Bipolar Affective Disorder (55.8%), Epilepsy (51.9%) and Substance Abuse Disorder (44.2%).

CONCLUSION

Family Physicians in Nigeria and Ghana attend to a good number of adolescents with mental health disorders in their clinics. There is the need for Family Physicians to have specialized training and retraining to be able to recognize and treat adolescent mental health disorders. This will help to reduce stigmatization and improve the management of the disease thus, reducing the burden.

Suicidal Attempts among Secondary School-Going Adolescents in Kilimanjaro Region, Northern Tanzania

Suicide attempts among adolescents are common and can lead to death. The study aimed to determine the prevalence and factors associated with suicide attempts among secondary school-going adolescents in the Kilimanjaro region, northern Tanzania. The study used data from two repeated regional school-based student health surveys (RSHS), conducted in 2019 (Survey 1) and 2022 (Survey 2). Data were analyzed for secondary school students aged 13 to 17 years from four districts of the Kilimanjaro region. The study included 4188 secondary school-going adolescents: 3182 in Survey 1 and 1006 in Survey 2. The mean age in Survey 1 was 14 years and the median age in Survey 2 was 17 years (p < 0.001). The overall prevalence of suicide attempts was 3.3% (3.0% in Survey 1 and 4.2% in Survey 2). Female adolescents had higher odds of suicide attempts (aOR = 3.0, 95% CI 1.2–5.5), as did those who felt lonely (aOR = 2.0, 95% CI 1.0–3.6), had ever been worried (aOR = 1.9, 95% CI 1.0–3.5), or had ever been bullied (aOR = 2.2, 95% CI 1.2–4.1). Suicidal attempts are prevalent among secondary school-going adolescents in the Kilimanjaro region, northern Tanzania. In-school programs should be established to prevent such attempts.