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Aluisio AR, Smith-Sreen J, Offorjebe A, Maina W, Pirirei S, Kinuthia J, Bukusi D, Waweru H, Bosire R, Ojuka DK, Eastment MC, Katz DA, Mello MJ, Farquhar C. Assessment of the HIV Enhanced Access Testing in the Emergency Department (HEATED) program in Nairobi, Kenya: a quasi-experimental prospective study. HIV Res Clin Pract 2024; 25:2403958. [PMID: 39290079 PMCID: PMC11443818 DOI: 10.1080/25787489.2024.2403958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/28/2024] [Accepted: 09/06/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND Persons seeking emergency injury care are often from higher-risk and underserved key populations (KPs) and priority populations (PPs) for HIV programming. While facility-based HIV Testing Services (HTS) in Kenya are effective, emergency department (ED) delivery is limited, despite the potential to reach underserved persons. METHODS This quasi-experimental prospective study evaluated implementation of the HIV Enhanced Access Testing in Emergency Departments (HEATED) at Kenyatta National Hospital ED in Nairobi, Kenya. The HEATED program was designed as a multi-component intervention employing setting appropriate strategies for HIV care sensitization and integration, task shifting, resource reorganization, linkage advocacy, skills development and education to promote ED-HTS with a focus on higher-risk persons. KPs included sex workers, gay men, men who have sex with men, transgender persons and persons who inject drugs. PPs included young persons (18-24 years), victims of interpersonal violence, persons with hazardous alcohol use and persons never HIV tested. Data were obtained from systems-level records, enrolled injured patient participants and healthcare providers. Systems and patient-level data were collected during a pre-implementation period (6 March - 16 April 2023) and post-implementation (period 1, 1 May - 26 June 2023). Additional, systems-level data were collected during a second post-implementation (period 2, 27 June - 20 August 2023). HTS data were evaluated as facility-based HIV testing (completed in the ED) and distribution of HIV self-tests independently, and aggregated as ED-HTS. Evaluation analyses were completed across reach, effectiveness, adoption, implementation and maintenance framework domains. RESULTS All 151 clinical staff were reached through trainings and sensitizations on the HEATED program. Systems-level ED-HTS among all presenting patients increased from 16.7% pre-implementation to 23.0% post-implementation periods 1 and 2 (RR = 1.31, 95% CI: 1.21-1.43; p < 0.001). Among 605 enrolled patient participants, facilities-based HTS increased from 5.7% pre-implementation to 62.3% post-implementation period 1 (RR = 11.2, 95%CI: 6.9-18.1; p < 0.001). There were 440 (72.7%) patient participants identified as KPs (5.6%) and/or PPs (65.3%). For enrolled KPs/PPs, facilities-based HTS increased from 4.6% pre-implementation to 72.3% post-implementation period 1 (RR = 13.8, 95%CI: 5.5-28.7, p < 0.001). Systems and participant level data demonstrated successful adoption and implementation of the HEATED program. Through 16 wk post-implementation a significant increase in ED-HTS delivery was maintained as compared to pre-implementation. CONCLUSIONS The HEATED program increased overall ED-HTS and augmented delivery to KPs/PPs, suggesting that broader implementation could improve HIV services for underserved persons already in contact with health systems.
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Affiliation(s)
- Adam R Aluisio
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Agatha Offorjebe
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Wamutitu Maina
- Accident and Emergency, Kenyatta National Hospital, Nairobi, Kenya
| | - Sankei Pirirei
- Accident and Emergency, Kenyatta National Hospital, Nairobi, Kenya
| | - John Kinuthia
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - David Bukusi
- Accident and Emergency, Kenyatta National Hospital, Nairobi, Kenya
| | - Harriet Waweru
- Accident and Emergency, Kenyatta National Hospital, Nairobi, Kenya
| | - Rose Bosire
- Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Daniel K Ojuka
- Department of Surgery, University of Nairobi Faculty of Health Sciences, Nairobi, Kenya
| | - McKenna C Eastment
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - David A Katz
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Michael J Mello
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
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Lovero KL, Stockton MA, Greene MC, Basaraba C, Khan S, Mabunda D, Mandlate F, Gouveia L, Fumo W, Wall MM, Duarte CS, Oquendo MA, Wainberg ML. Psychometric Evaluation of Screens for Common Mental Disorders, Severe Mental Disorders, Substance Use Disorders, and Suicide Risk in Mozambican Healthcare. MEDICAL RESEARCH ARCHIVES 2024; 12. [PMID: 39268201 PMCID: PMC11391859 DOI: 10.18103/mra.v12i8.5294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2024]
Abstract
Globally, mental and substance use disorders are a leading cause of disease burden. In low- and middle-income countries, where there is an extreme shortage of trained mental health specialists, validated, brief screening tools for mental and substance use disorders are required for non-specialists to efficiently identify patients in need of mental health care. Mozambique, one of the poorest countries in the world, has fewer than two mental health specialists for every 100,000 people. In the present study, we evaluated a comprehensive set of seven measures for depression, anxiety, somatization, alcohol use disorder, substance use disorder, psychosis and mania, and suicide risk among N=911 Mozambican adults in general healthcare settings. All instruments demonstrated acceptable internal consistency (α > 0.75). Compared to diagnoses made by the Mini International Neuropsychiatric Interview, all measures showed good criterion validity (AUC > 0.75), except the Psychosis Screening Questionnaire, which showed low sensitivity (0.58) for psychotic disorder. No substantial differences were observed in internal consistency when stratifying by gender, age, education level, primary language, facility-type, and patient status; criterion validity showed some variability when stratified by sub-population, particularly for education, primary language, and whether the participant was seeking care that day. Exploratory factor analyses indicated that the measures best differentiate categories of diagnoses (common mental disorder, severe mental disorders, substance use disorders, and suicide risk) rather than individual diagnoses, suggesting the utility of a transdiagnostic approach. Our findings support the use of these measures in Mozambique to identify common mental disorders, substance use disorders, and suicide risk, but indicate further research is needed to develop an adequate screen for severe mental disorders. Given the limited mental health specialists in this and other LMIC settings, these brief measures can support non-specialist provision of mental health services and promote closure of the treatment gap.
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Affiliation(s)
- Kathryn L Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, USA
| | - Melissa A Stockton
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - M Claire Greene
- Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, USA
| | - Cale Basaraba
- Department of Population Health, Grossman School of Medicine, New York University
| | - Saida Khan
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Dirceu Mabunda
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Flavio Mandlate
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Lidia Gouveia
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Wilza Fumo
- Department of Mental Health, Ministry of Health, Maputo, Mozambique
| | - Melanie M Wall
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, USA
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, USA
| | - Cristiane S Duarte
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - Maria A Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Milton L Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, New York, USA
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Quiroz Santos E, Stein LAR, Delaney DJ, Bassett SS, Rossi JS, van den Berg JJ. Screening, Brief Intervention and Referral to Treatment (SBIRT): An examination of health disparities. J Ethn Subst Abuse 2024:1-21. [PMID: 38967519 DOI: 10.1080/15332640.2024.2367234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
Risky substance use can lead to a variety of negative health outcomes, yet treatment is often underutilized by historically minoritized racial/ethnic groups. Screening, Brief Intervention and Referral to Treatment (SBIRT) is effective in changing substance use patterns across diverse settings and for diverse demographic groups. However, few studies have focused on whether individuals receive the appropriate level of care based on screening criteria. The purpose of this study was to investigate intervention match/mismatch and factors (e.g., service site, gender, race, ethnicity, age, socio-economic status) that predicted the likelihood of being matched/mismatched to an intervention. A sample of N = 3412 were available for analyses and logistic regressions were performed to examine the relationship between matching/mismatching to an intervention and other factors. Of participants, 2222 (65%) were matched to an intervention and 1190 (35%) were mismatched to an intervention. Being older, Hispanic, and receiving SBIRT by health-teams designed to reduce health disparities was related to increased odds of being mismatched. Exploratory results suggested that across predictors, individuals were more likely to receive a lesser intervention than their screening score indicated. Most clients were matched well to intervention as based on screening score. When mismatch occurred, a lower level of care was given. Staff may benefit from attending to more client engagement so that clients return for more intensive interventions; and agencies may need more resources to facilitate client access to services.
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Affiliation(s)
- Esther Quiroz Santos
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - L A R Stein
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
- Rhode Island Department of Behavioral Healthcare, Developmental Disabilities & Hospitals, Cranston, Rhode Island, USA
- Department of Behavioral & Social Sciences and Center for Alcohol & Addiction Studies, Brown University School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Daniel J Delaney
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Shayna S Bassett
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph S Rossi
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Jacob J van den Berg
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
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Van Wijk CH. Prevalence Estimate for Adjustment Disorders in the South African Navy. Clin Pract Epidemiol Ment Health 2024; 20:e17450179301661. [PMID: 39135946 PMCID: PMC11318156 DOI: 10.2174/0117450179301661240528064329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/06/2024] [Accepted: 05/15/2024] [Indexed: 08/15/2024]
Abstract
Introduction and Aim Adjustment Disorder is among the most commonly diagnosed mental disorders in the armed forces, with a mean prevalence estimated at 7.4% across military populations. The prevalence in South African military populations is not known. This study aimed to estimate the prevalence of Adjustment Disorders in the South African Navy and to explore potential risk factors. Methods In this cross-sectional study, a representative sample of 714 sailors completed the International Adjustment Disorder Questionnaire, and also provided information from their biennial occupational health assessment mental health screening, which included other clinical screeners of mental health and adjustment history. Results The estimated prevalence of Adjustment Disorders in the South African Navy was 6.9%, and was proportionally distributed across gender and age categories. Depression and PTSD were the main comorbid conditions. Risk factors included a) history of adjustment difficulties during military deployment or family adjustment difficulties, b) domestic discord (difficulties in relationship with spouse/partner or immediate family), and c) the experience of stress overload (i.e., that the demands of life are overwhelming available resources). Conclusion The estimated prevalence was similar to the expectation of military personnel generally, although the self-report data needs to be interpreted cautiously. The contributing risk factors offer possible direction for targeted intervention, e.g., skills training and relationship counselling to enhance coping with military service and family challenges, and cognitive behaviour therapy generally to address sailors' experience of stress overload.
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Affiliation(s)
- Charles H. Van Wijk
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
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Ayieko P, Kisanga E, Mshana G, Nkosi S, Hansen CH, Parry CDH, Weiss HA, Grosskurth H, Hayes RJ, Morojele NK, Kapiga S. Epidemiology of alcohol use and alcohol use disorders among people living with HIV on antiretroviral therapy in Northwest Tanzania: implications for ART adherence and case management. AIDS Care 2024; 36:652-660. [PMID: 38295268 DOI: 10.1080/09540121.2023.2299324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/18/2023] [Indexed: 02/02/2024]
Abstract
Alcohol use disorders (AUD) among people living with HIV (PLHIV) are associated with poor health outcomes. This cross-sectional study examined current alcohol use and AUD among 300 PLHIV on ART at four HIV care centres in Northwest Tanzania. Participants' data were collected using questionnaires. Alcohol use was assessed using Alcohol Use Disorders Identification Test (AUDIT). Logistic regression was used to examine associations between each outcome (current drinking and AUD) and sociodemographic and clinical factors. Association between alcohol use and ART adherence was also studied. The median age of participants was 43 years (IQR 19-71) and 41.3% were male. Twenty-two (7.3%) participants failed to take ART at least once in the last seven days. The prevalence of current drinking was 29.3% (95% CI 24.2-34.8%) and that of AUD was 11.3% (8.2%-15.5%). Males had higher odds of alcohol use (OR 3.03, 95% CI 1.79-5.14) and AUD (3.89, 1.76-8.60). Alcohol use was associated with ART non-adherence (OR = 2.78, 1.10-7.04). There was a trend towards an association between AUD and non-adherence (OR = 2.91, 0.92-9.21). Alcohol use and AUD were common among PLHIV and showed evidence of associations with ART non-adherence. Screening patients for alcohol use and AUD in HIV clinics may increase ART adherence.
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Affiliation(s)
- Philip Ayieko
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Gerry Mshana
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- National Institute for Medical Research, Mwanza, Tanzania
| | - Sebenzile Nkosi
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Psychology, Rhodes University, Makhanda, South Africa
| | - Christian Holm Hansen
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Charles D H Parry
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Helen A Weiss
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Heiner Grosskurth
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard J Hayes
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Neo K Morojele
- Mental Health, Alcohol, Substance Use and Tobacco Research Unit, South African Medical Research Council, Pretoria, South Africa
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Saidi Kapiga
- Mwanza Intervention Trials Unit, Mwanza, Tanzania
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Medical Research, Mwanza, Tanzania
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Aluisio AR, Smith-Sreen J, Offorjebe A, Maina W, Pirirei S, Kinuthia J, Bukusi D, Waweru H, Bosire R, Ojuka DK, Eastment MC, Katz DA, Mello MJ, Farquhar C. Implementation and Assessment of the HIV Enhanced Access Testing in the Emergency Department (HEATED) Program in Nairobi, Kenya: A Quasi-Experimental Prospective Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.03.24305277. [PMID: 38633813 PMCID: PMC11023650 DOI: 10.1101/2024.04.03.24305277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Background Persons seeking emergency injury care are often from underserved key populations (KPs) and priority populations (PPs) for HIV programming. While facility-based HIV Testing Services (HTS) in Kenya are effective, emergency department (ED) delivery is limited, despite the potential to reach underserved persons. Methods This quasi-experimental prospective study evaluated implementation of the HIV Enhanced Access Testing in Emergency Departments (HEATED) at Kenyatta National Hospital ED in Nairobi, Kenya. The HEATED program was designed using setting specific data and utilizes resource reorganization, services integration and HIV sensitization to promote ED-HTS. KPs included sex workers, gay men, men who have sex with men, transgender persons and persons who inject drugs. PPs included young persons (18-24 years), victims of interpersonal violence, persons with hazardous alcohol use and those never previously HIV tested. Data were obtained from systems-level records, enrolled injured patient participants and healthcare providers. Systems and patient-level data were collected during a pre-implementation period (6 March - 16 April 2023) and post-implementation (period 1, 1 May - 26 June 2023). Additional, systems-level data were collected during a second post-implementation (period 2, 27 June - 20 August 2023). Evaluation analyses were completed across reach, effectiveness, adoption, implementation and maintenance framework domains. Results All 151 clinical staff were reached through trainings and sensitizations on the HEATED program. Systems-level ED-HTS increased from 16.7% pre-implementation to 23.0% post-implementation periods 1 and 2 (RR=1.31, 95% CI:1.21-1.43; p<0.001) with a 62.9% relative increase in HIV self-test kit provision. Among 605 patient participants, facilities-based HTS increased from 5.7% pre-implementation to 62.3% post-implementation period 1 (RR=11.2, 95%CI:6.9-18.1; p<0.001). There were 440 (72.7%) patient participants identified as KPs (5.6%) and/or PPs (65.3%). For enrolled KPs/PPs, HTS increased from 4.6% pre-implementation to 72.3% post-implementation period 1 (RR=13.8, 95%CI:5.5-28.7, p<0.001). Systems and participant level data demonstrated successful adoption and implementation of the HEATED program. Through 16-weeks post-implementation a significant increase in ED-HTS delivery was maintained as compared to pre-implementation. Conclusions The HEATED program increased ED-HTS and augmented delivery to KPs/PPs, suggesting that broader implementation could improve HIV services for underserved persons, already in contact with health systems.
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Affiliation(s)
- Adam R. Aluisio
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, USA
| | | | - Agatha Offorjebe
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, USA
| | | | | | - John Kinuthia
- Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | | | - Rose Bosire
- Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Daniel K. Ojuka
- Department of Surgery, University of Nairobi Faculty of Health Sciences, Nairobi, Kenya
| | - McKenna C. Eastment
- Department of Global Health, University of Washington, Seattle, US
- Department of Medicine, University of Washington, Seattle, US
| | - David A. Katz
- Department of Global Health, University of Washington, Seattle, US
| | - Michael J. Mello
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, USA
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, US
- Department of Medicine, University of Washington, Seattle, US
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Lichtwarck HO, Mbotwa CH, Kazaura MR, Moen K, Mmbaga EJ. Early disengagement from HIV pre-exposure prophylaxis services and associated factors among female sex workers in Dar es Salaam, Tanzania: a socioecological approach. BMJ Glob Health 2023; 8:e013662. [PMID: 38154811 PMCID: PMC10759139 DOI: 10.1136/bmjgh-2023-013662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/25/2023] [Indexed: 12/30/2023] Open
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool when taken as prescribed. However, suboptimal use may challenge its real-life impact. To support female sex workers in their efforts to prevent themselves from HIV, it is essential to identify factors that contribute to early disengagement from PrEP care. In this study, we aimed to estimate the risk of early disengagement from PrEP services among female sex workers in Tanzania and associated factors using a socioecological model as a guiding framework. METHODS The study was conducted as part of a pragmatic mHealth trial for PrEP roll-out in Dar es Salaam in 2021. We estimated the risk of early disengagement, defined as not presenting for the first follow-up visit (within 56 days of enrolment), and its associations with individual, social, behavioural and structural factors (age, self-perceived HIV risk, mental distress, harmful alcohol use, condom use, number of sex work clients, female sex worker stigma and mobility) using multivariable logistic regression models, with marginal standardisation to obtain adjusted relative risks (aRR). RESULTS Of the 470 female sex workers enrolled in the study, 340 (74.6%) did not attend the first follow-up visit (disengaged). Mental distress (aRR=1.14; 95% CI 1.01 to 1.27) was associated with increased risk of disengagement. Participants who reported a higher number of clients per month (10-29 partners: aRR=0.87; 95% CI 0.76 to 0.98 and ≥30 partners: aRR=0.80; 95% CI 0.68 to 0.91) and older participants (≥35 years) (RR=0.75; 95% CI 0.56 to 0.95) had a lower risk of disengagement. CONCLUSIONS AND RECOMMENDATIONS Early disengagement with the PrEP programme was high. Mental distress, younger age and having fewer clients were risk factors for disengagement. We argue that PrEP programmes could benefit from including mental health screening and treatment, as well as directing attention to younger sex workers and those reporting fewer clients.
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Affiliation(s)
- Hanne Ochieng Lichtwarck
- Department of Community Medicine and Global Health, University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Christopher Hariri Mbotwa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- University of Dar es Salaam, Mbeya College of Health and Allied Sciences, Mbeya, Tanzania
| | | | - Kåre Moen
- Department of Community Medicine and Global Health, University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Elia John Mmbaga
- Department of Community Medicine and Global Health, University of Oslo, Faculty of Medicine, Oslo, Norway
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Pauley A, Buono M, Metcalf M, West K, Rent S, Nkenguye W, Sawe Y, Mikindo M, Kilasara J, Boshe J, Knettel BA, Mmbaga BT, Staton CA. " A Man Never Cries": A Mixed-Methods Analysis of Gender Differences in Depression and Alcohol Use in Moshi, Tanzania. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.14.23298216. [PMID: 38014016 PMCID: PMC10680871 DOI: 10.1101/2023.11.14.23298216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Background Unhealthy alcohol use negatively impacts many components of health and wellness, including mental health conditions like major depressive disorder (MDD). Globally, gender differences are common for both alcohol use behaviors and MDD, but these differences have not been studied within Moshi, Tanzania. To provide more effective and culturally appropriate mental health treatments, gender nuances around these conditions must be known. As such, this study aims to explore gender differences in MDD, alcohol use, and other aspects of mental well-being among patients at Kilimanjaro Christian Medical Center (KCMC) in Moshi. Methods Six hundred and seventy-six patients presenting for care at the KCMC Emergency Department (ED) and Reproductive Health Centre (RHC) were enrolled in this mixed-methods study between October 2021 and May 2022. Patients were selected through systematic random sampling and completed quantitative surveys including the Alcohol Use Disorder Identification Test (AUDIT) and the Patient Health Questionnaire 9 (PHQ-9). Nineteen patients were purposively chosen from the study population to participate in in-depth interviews (IDIs) exploring topics related to alcohol use, gender, and depression. Descriptive frequencies, univariate log-binomial regressions, and a linear regression model were used to analyze quantitative data, all of which were analyzed in RStudio. A grounded theory approach was used to analyze all IDIs in NVivo. Results Average [SD] PHQ-9 scores were 7.22 [5.07] for ED women, 4.91 [4.11] for RHC women, and 3.75 [4.38] among ED men. Similarly, ED women held the highest prevalence of MDD (25%) as compared to RHC women (11%) and ED men (7.9%) (p<0.001). Depressive symptoms were associated with higher AUDIT scores only for ED men (R2 = 0.11, p<0.001). Our qualitative analysis showed that while present for women, social support networks were notably absent for men in Moshi, the lack of which was seen to play a role in alcohol use. For men, alcohol was described as a coping mechanism for stress. Conclusion Intersectionality of gender, alcohol use, and depression is influenced by sociocultural and behavioral norms in Moshi. As such, multi-layered, gender-differentiated programming should be considered for the treatment of substance use and mental health conditions in this region.
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Affiliation(s)
- Alena Pauley
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Mia Buono
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | - Kirstin West
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Sharla Rent
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - William Nkenguye
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Yvonne Sawe
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | - Joseph Kilasara
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Department of Clinical Nursing, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Judith Boshe
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Brandon A Knettel
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke University School of Nursing, Durham, NC, USA
| | - Blandina T Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Catherine A Staton
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Department of Surgery, Duke University Medical Center, Durham, NC, USA
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Vissoci JRN, Friedman K, Caruzzo NM, de Oliveira LP, Pauley A, Zadey S, Menegassi V, Sakita F, Boshe J, Staton CA, Mmbaga B. Clinical evaluation of the alcohol use disorders identification test (AUDIT) in Moshi, Tanzania. PLoS One 2023; 18:e0287835. [PMID: 37939063 PMCID: PMC10631671 DOI: 10.1371/journal.pone.0287835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/14/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Alcohol use disorder is a major cause of morbidity and mortality in low- and middle-income countries. Alcohol screening using a validated tool is a useful way to capture high-risk patients and engage them in early harm reduction interventions. Our objectives were to 1) evaluate the psychometric evidence the Alcohol Use Disorders Identification Test (AUDIT) and its subscales in the general population of Moshi, Tanzania, and 2) evaluate the usefulness of the tool at predicting alcohol-related harms. METHODS Two hundred and fifty-nine adults living in Moshi, Tanzania were included in the study. We used the AUDIT and its subscales to determine the classification of harmful and hazardous drinking. To analyze the internal structure of AUDIT and the model adequacy we used Confirmatory Factor Analysis (CFA). The reliability of AUDIT was analyzed for Cronbach's alpha, Omega 6 and Composite Reliability. The optimal cut off point for the AUDIT was determined by the receiver operating characteristic (ROC) curve, using the Youden approach to maximize sensitivity and specificity. RESULTS The median score of the AUDIT was 1 (inter-quartile range: 0-7). The internal structure of the AUDIT showed factor loadings ranging from 0.420 to 0.873. Cronbach's alpha, Omega and Composite Reliability produced values above 0.70. The Average Variance Extracted was 0.530. For the AUDIT, a score of 8 was identified as the ideal cut-off value in our population. CONCLUSIONS This study validates AUDIT in the general population of Moshi and is one of the only studies in Africa to include measures of the internal structure of the AUDIT and its subscales.
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Affiliation(s)
- Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Duke Emergency Medicine, Duke University Medical Center, Durham, NC, United States of America
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University Durham, NC, United States of America
| | - Kaitlyn Friedman
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | | | | | - Alena Pauley
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University Durham, NC, United States of America
| | - Siddhesh Zadey
- Duke Emergency Medicine, Duke University Medical Center, Durham, NC, United States of America
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University Durham, NC, United States of America
| | | | | | - Judith Boshe
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Catherine A. Staton
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Duke Emergency Medicine, Duke University Medical Center, Durham, NC, United States of America
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University Durham, NC, United States of America
| | - Blandina Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Pauley A, Thatcher EC, Sarafian JT, Zadey S, Shayo F, Mmbaga BT, Sakita F, Boshe J, Vissoci JRN, Staton CA. Alcohol use among emergency medicine department patients in Tanzania: A comparative analysis of injury versus non-injury patients. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001900. [PMID: 37910469 PMCID: PMC10619788 DOI: 10.1371/journal.pgph.0001900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 09/19/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Alcohol is a leading behavioral risk factor for death and disability worldwide. Tanzania has few trained personnel and resources for treating unhealthy alcohol use. In Emergency Medicine Departments (EMDs), alcohol is a well-known risk factor for injury patients. At Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania, 30% of EMD injury patients (IP) test positive for alcohol upon arrival to the ED. While the IP population is prime for EMD-based interventions, there is limited data on if non-injury patients (NIP) have similar alcohol use behavior and potentially benefit from screening and intervention as well. METHODS This was a secondary analysis of a systematic random sampling of adult (≥18 years old), KiSwahili speaking, KCMC EMD patients surveyed between October 2021 and May 2022. When medically stable and clinically sober, participants provided informed consent. Information on demographics (sex, age, years of education, type of employment, income, marital status, tribe, and religion), injury status, self-reported alcohol use, and Alcohol Use Disorder (AUD) Identification Test (AUDIT) scores were collected. Descriptive statistics were analyzed in RStudio using frequencies and proportions. RESULTS Of the 376 patients enrolled, 59 (15.7%) presented with an injury. The IP and NIP groups did not differ in any demographics except sex, an expected difference as females were intentionally oversampled in the original study design. The mean [SD] AUDIT score (IP: 5.8 [6.6]; NIP: 3.9 [6.1]), drinks per week, and proportion of AUDIT ≥8 was higher for IP (IP:37%; NIP: 21%). However, alcohol preferences, drinking quantity, weekly expenditure on alcohol, perceptions of unhealthy alcohol use, attempts and reasons to quit, and treatment seeking were comparable between IPs and NIPs. CONCLUSION Our data suggests 37% of injury and 20% of non-injury patients screen positive for harmful or hazardous drinking in our setting. An EMD-based alcohol treatment and referral process could be beneficial to reduce this growing behavioral risk factor in non-injury as well as injury populations.
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Affiliation(s)
- Alena Pauley
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Emily C. Thatcher
- Duke Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Joshua T. Sarafian
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Siddhesh Zadey
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Frida Shayo
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Francis Sakita
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Judith Boshe
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - João Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Catherine A. Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
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11
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Pauley A, Buono M, West K, Metcalf M, Rent S, Kilasara J, Sawe Y, Mikindo M, Mmbaga BT, Boshe J, Vissoci JRN, Staton CA. A mixed-methods comparison of gender differences in alcohol consumption and drinking characteristics among patients in Moshi, Tanzania. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002009. [PMID: 37874782 PMCID: PMC10597514 DOI: 10.1371/journal.pgph.0002009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/05/2023] [Indexed: 10/26/2023]
Abstract
Excessive alcohol use stands as a serious threat to individual and community well-being, having been linked to a wide array of physical, social, mental, and economic harms. Alcohol consumption differs by gender, a trend seen both globally and in Moshi, Tanzania, a region with especially high rates of intake and few resources for alcohol-related care. To develop effective gender-appropriate treatment interventions, differences in drinking behaviors between men and women must be better understood. Our study aims to identify and explore gender-based discrepancies in alcohol consumption among Kilimanjaro Christian Medical Center (KCMC) patients. A systematic random sampling of adult patients presenting to KCMC's Emergency Department (ED) or Reproductive Health Center (RHC) was conducted from October 2021 until May 2022. Patients answered demographic and alcohol use-related questions and completed brief surveys, including the Alcohol Use Disorder Identification Test (AUDIT). Through purposeful sampling, 19 individuals also participated in in-depth interviews (IDIs) that focused on identifying gender differences in alcohol use. Quantitative data was analyzed in RStudio through descriptive frequencies, proportions, ANOVA, and Chi-squared tests, while IDIs were analyzed in Nvivo following a grounded theory approach. During the 8-month data collection timeline, 676 patients were enrolled. Men and women patients at KCMC's ED and RHC were found to have significant differences in their alcohol use behaviors. For our quantitative data, this included lower average AUDIT scores among women (average [SD] AUDIT scores were 6.76 [8.16] among ED men, 3.07 [4.76] among ED women, and 1.86 [3.46] among RHC women). A subsequent IDI analysis revealed greater social restrictions around women's drinking and more secretive alcohol use behaviors for where and when women would drink. For men, excess drinking was normalized within Moshi, tied to men's social interactions with other men, and generally motivated by stress, social pressure, and despair over lack of opportunity. Significant gender differences in drinking behaviors were found, primarily influenced by sociocultural norms. These dissimilarities in alcohol use suggest that future alcohol-related programs should incorporate gender in their conceptualization and implementation.
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Affiliation(s)
- Alena Pauley
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Mia Buono
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Kirstin West
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Madeline Metcalf
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Sharla Rent
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Joseph Kilasara
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Yvonne Sawe
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | | | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Judith Boshe
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - João Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Catherine A. Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
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Staton CA, Friedman K, Phillips AJ, Minnig MC, Sakita FM, Ngowi KM, Suffoletto B, Hirshon JM, Swahn M, Mmbaga BT, Vissoci JRN. Feasibility of a pragmatic randomized adaptive clinical trial to evaluate a brief negotiational interview for harmful and hazardous alcohol use in Moshi, Tanzania. PLoS One 2023; 18:e0288458. [PMID: 37535693 PMCID: PMC10399826 DOI: 10.1371/journal.pone.0288458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/26/2023] [Indexed: 08/05/2023] Open
Abstract
INTRODUCTION Low-resourced settings often lack personnel and infrastructure for alcohol use disorder treatment. We culturally adapted a Brief Negotiational Interview (BNI) for Emergency Department injury patients, the "Punguza Pombe Kwa Afya Yako (PPKAY)" ("Reduce Alcohol For Your Health") in Tanzania. This study aimed to evaluate the feasibility of a pragmatic randomized adaptive controlled trial of the PPKAY intervention. MATERIALS AND METHODS This feasibility trial piloted a single-blind, parallel, adaptive, and multi-stage, block-randomized controlled trial, which will subsequently be used to determine the most effective intervention, with or without text message booster, to reduce alcohol use among injury patients. We reported our feasibility pilot study using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, with recruitment and retention rates being our primary and secondary outcomes. We enrolled adult patients seeking care for an acute injury at the Kilimanjaro Christian Medical Center in Tanzania if they (1) exhibited an Alcohol Use Disorder Identification Test (AUDIT) ≥8, (2) disclosed alcohol use prior to injury, or (3) had a breathalyzer ≥0.0 on arrival. Intervention arms were usual care (UC), PPKAY, PPKAY with standard text booster, or a PPKAY with a personalized text booster. RESULTS Overall, 181 patients were screened and 75 enrolled with 80% 6-week, 82.7% 3-month and 84% 6-month follow-up rates showing appropriate Reach and retention. Adoption measures showed an overwhelmingly positive patient acceptance with 100% of patients perceiving a positive impact on their behavior. The Implementation and trial processes were performed with high rates of PPKAY fidelity (76%) and SMS delivery (74%). Intervention nurses believed Maintenance and sustainability of this 30-minute, low-cost intervention and adaptive clinical trial were feasible. CONCLUSIONS Our intervention and trial design are feasible and acceptable, have evidence of good fidelity, and did not show problematic deviations in protocol. Results suggest support for undertaking a full trial to evaluate the effectiveness of the PPKAY, a nurse-driven BNI in a low-income country. TRIAL REGISTRATION Trial registration number NCT02828267. https://classic.clinicaltrials.gov/ct2/show/NCT02828267.
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Affiliation(s)
- Catherine A. Staton
- Division of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Kaitlyn Friedman
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
| | - Ashley J. Phillips
- Division of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | | | | | | | - Brian Suffoletto
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittbsurgh, PA, United States of America
| | - Jon Mark Hirshon
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore MD, United States of America
| | - Monica Swahn
- Department of Epidemiology, Georgia State University School of Public Health, Atlanta, GA, United States of America
| | - Blandina T. Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Joao Ricardo Nickenig Vissoci
- Division of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States of America
- Duke Global Health Institute, Duke University, Durham, NC, United States of America
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Pauley A, Buono M, West K, Metcalf M, Rent S, Kilasara J, Sawe Y, Mikindo M, Mmbaga BT, Boshe J, Vissoci JRN, Staton CA. A Mixed-Methods Comparison of Gender Differences in Alcohol Consumption and Drinking Characteristics among Patients in Moshi, Tanzania. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.12.23289897. [PMID: 37292832 PMCID: PMC10246062 DOI: 10.1101/2023.05.12.23289897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Excessive alcohol use stands as a serious threat to individual and community well-being, having been linked to a wide array of physical, social, mental, and economic harms. Alcohol consumption differs by gender, a trend seen both globally and in Moshi, Tanzania, a region with especially high rates of intake and few resources for alcohol-related care. To develop effective gender-appropriate treatment interventions, differences in drinking behaviors between men and women must be better understood. Our study aims to identify and explore gender-based discrepancies in alcohol consumption among Kilimanjaro Christian Medical Center (KCMC) patients. Methods A systematic random sampling of adult patients presenting to KCMC's Emergency Department (ED) or Reproductive Health Center (RHC) was conducted from October 2020 until May 2021. Patients answered demographic and alcohol use-related questions and completed brief surveys including the Alcohol Use Disorder Identification Test (AUDIT). Through purposeful sampling, 19 subjects also participated in in-depth interviews (IDIs) focused on identifying gender differences in alcohol use. Results During the 8-month data collection timeline, 655 patients were enrolled. Men and women patients at KCMC's ED and RHC were found to have significant differences in their alcohol use behaviors including lower rates of consumption among women, (average [SD] AUDIT scores were 6.76 [8.16] among ED men, 3.07 [4.76] among ED women, and 1.86 [3.46] among RHC women), greater social restrictions around women's drinking, and more secretive alcohol use behaviors for where and when women would drink. For men, excess drinking was normalized within Moshi, tied to men's social interactions with other men, and generally motivated by stress, social pressure, and despair over lack of opportunity. Conclusion Significant gender differences in drinking behaviors were found, primarily influenced by sociocultural norms. These dissimilarities in alcohol use suggest that future alcohol-related programs should incorporate gender in their conceptualization and implementation.
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Affiliation(s)
- Alena Pauley
- Duke Global Health Institute, Duke University, Durham, NC USA
| | - Mia Buono
- Duke Global Health Institute, Duke University, Durham, NC USA
| | - Kirstin West
- Duke Global Health Institute, Duke University, Durham, NC USA
| | | | - Sharla Rent
- Duke Global Health Institute, Duke University, Durham, NC USA
- Duke Department of Pediatrics, Duke University Medical Center, Durham, NC USA
| | - Joseph Kilasara
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Yvonne Sawe
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | | | - Blandina T Mmbaga
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Judith Boshe
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - João Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, NC USA
- Duke Department of Surgery, Duke University Medical Center, Durham, NC USA
| | - Catherine A Staton
- Duke Global Health Institute, Duke University, Durham, NC USA
- Duke Department of Surgery, Duke University Medical Center, Durham, NC USA
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Lichtwarck HO, Kazaura MR, Moen K, Mmbaga EJ. Harmful Alcohol Use and Associated Socio-Structural Factors among Female Sex Workers Initiating HIV Pre-Exposure Prophylaxis in Dar es Salaam, Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:698. [PMID: 36613018 PMCID: PMC9819768 DOI: 10.3390/ijerph20010698] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/21/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
Harmful alcohol use is an important risk factor for premature mortality and morbidity and associated with increased HIV risk and lower uptake of and adherence to HIV interventions. This study aimed to assess the extent of harmful alcohol use and associated socio-structural vulnerability factors among female sex workers in Dar es Salaam, Tanzania, a key population in the HIV epidemic. Data from a study of female sex workers initiating pre-exposure prophylaxis (PrEP) recruited through respondent driven sampling were used. We assessed harmful alcohol use with the Alcohol Use Disorders Identification Test (AUDIT) defined as having an AUDIT score ≥ 16. Associations between harmful alcohol use and socio-structural factors were assessed using logistic regression with marginal standardization. Of the 470 women recruited, more than one third (37.3%) had a drinking pattern suggestive of harmful alcohol use. Such use was independently associated with sex work-related mobility (aPR: 1.36, 95% CI: 1.11-1.61), arrest/incarceration (aPR: 1.55, 95% CI: 1.27-1.84) and gender-based violence (aPR: 1.31, 95% CI: 1.06-1.56). The high prevalence of harmful alcohol use and the interconnectedness with socio-structural factors indicate a need for a holistic programmatic approach to health for female sex workers. Programming should not solely direct attention to individual behavior but also include strategies aiming to address socio-structural vulnerabilities.
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Affiliation(s)
- Hanne Ochieng Lichtwarck
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
| | - Method Rwelengera Kazaura
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam 11103, Tanzania
| | - Kåre Moen
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
| | - Elia John Mmbaga
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam 11103, Tanzania
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Staton CA, Minnig MC, Phillips AJ, Kozhumam AS, Pesambili M, Suffoletto B, Mmbaga BT, Ngowi K, Vissoci JRN. Feasibility of SMS booster for alcohol reduction in injury patients in Tanzania. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000410. [PMID: 36962731 PMCID: PMC10022354 DOI: 10.1371/journal.pgph.0000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 10/29/2022] [Indexed: 12/02/2022]
Abstract
Alcohol use is associated with 3 million annual deaths globally. Harmful alcohol use, which is associated with a high burden of disease in low- and middle-income countries (LMICs), often increases the probability of traumatic injury. Treatments for harmful alcohol use in LMICs, such as Tanzania, lack trained personnel and adequate infrastructure. The aim of this study was to assess the feasibility of using SMS boosters to augment a hospital based brief negotiational intervention (BNI) in this low resourced setting. We conducted a three stage, four arm feasibility trial of a culturally adapted BNI for injury patients with harmful and hazardous drinking admitted to Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. Post hospital discharge, two of the four arms included patients receiving either a standard or personalized short message service (SMS) booster to enhance and or perpetuate the effect of the in-hospital BNI. Text messages were sent weekly throughout a 3-month follow-up period. SMS feasibility was assessed according to the TIDier checklist evaluating what, when, how much, tailoring processes, modifications and how well (intervention fidelity). Data was collected with SMS logs and short answer surveys to participants. A total of 41 study participants were assigned to each receive 12 SMS over a three-month period; 38 received messages correctly, 3 did not receive intended messages, and 1 received a message who was not intended to. Of the 258 attempted texts, 73% were successfully sent through the messaging system. Of the messages that failed delivery, the majority were not able to be sent due to participants traveling out of cellular service range or turning off their phones. Participants interviewed in both booster arms reported that messages were appropriate, and that they would appreciate the continuation of such reminders. At 6-month follow-up, 100% (n = 11) of participants interviewed believed that the boosters had a positive impact on their behavior, with 90% reporting a large impact. This study demonstrated feasibility and acceptability of the integration of SMS mobile health technology to supplement this type of nurse-led BNI. SMS booster is a practical tool that can potentially prolong the impact of a brief hospital based intervention to enact behavioral change in injury patients with AUD.
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Affiliation(s)
- Catherine A. Staton
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Mary Catherine Minnig
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Ashley J. Phillips
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Arthi S. Kozhumam
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | | | - Brian Suffoletto
- Department of Emergency Medicine, Stanford University, California, United States of America
| | - Blandina T. Mmbaga
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Kennedy Ngowi
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Joao Ricardo Nickenig Vissoci
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
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16
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Kozhumam AS, Lovvorn C, O’Leary P, Minja L, Boshe J, Nickenig Vissoci JR, Mmbaga BT, Staton CA. Utility of Family Reports in Predicting Emergency Department Patient Alcohol Use in Tanzania. J Stud Alcohol Drugs 2022; 83:760-767. [PMID: 36136447 PMCID: PMC9523754 DOI: 10.15288/jsad.21-00141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 02/15/2022] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Myriad reasons, including stigma, may prevent patients from self-reporting harmful use of alcohol in Tanzania. Family members may be more forthright but might not know the extent of the patient's alcohol use or suffer alcohol-related stigma as well. Our study aims to compare the reporting of patient alcohol use by emergency department patients themselves and their family members in Tanzania in order to describe the potential use of family reports as a proxy for patient self-reports. METHOD We conducted a secondary descriptive analysis of a prospective cohort of adult patients seeking treatment for injury and their family members. We evaluated alcohol use behavior, alcohol-related consequences, and alcohol-related stigma reported by 231 patients and 231 family members (both majority male, ages 25-45 years), measured by the Alcohol Use Disorders Identification Test (AUDIT), Perceived Alcohol Stigma (PAS) scale, and the Drinker Inventory of Consequences (DrInC). Alcohol use behavior concordance/discordance between patients and families was established, and alcohol use and perceived stigma were analyzed. RESULTS More than 72% of patient-family pairs showed alcohol use (AUDIT) concordance. Receiver operating characteristic curve and regression analysis suggests family reports to be clinically relevant, significant, and potentially accurate markers of patient alcohol use (sensitivity: 95.10%, specificity: 69.77%). Findings support the existence of stigma toward alcohol in this context, with similar stigma levels of patients and family members. CONCLUSIONS Family-reported patient alcohol use may be an accurate proxy for patient self-reporting. Further research is needed into stigma toward alcohol that is culturally appropriate and adopted.
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Affiliation(s)
- Arthi S. Kozhumam
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Carter Lovvorn
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Paige O’Leary
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Linda Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Judith Boshe
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - João Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Duke Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina
| | - Blandina T. Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Catherine A. Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Duke Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina
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Mushi D, Moshiro C, Hanlon C, Francis JM, Teferra S. Missed opportunity for alcohol use disorder screening and management in primary health care facilities in northern rural Tanzania: a cross-sectional survey. Subst Abuse Treat Prev Policy 2022; 17:50. [PMID: 35794580 PMCID: PMC9258127 DOI: 10.1186/s13011-022-00479-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The study aimed to identify the missed opportunity for detection and management of alcohol use disorder by primary health care workers. DESIGN A cross-sectional survey SETTING: Outpatient services in the six governmental primary health care facilities in Moshi district council in Tanzania. PARTICIPANTS A total of 1604 adults were screened for alcohol use disorder (AUD) using the Alcohol Use Disorder Identification Test (AUDIT). Participants scoring 8 or above then provided details about their help-seeking behavior and barriers to seeking care. Participants' records were reviewed to assess the screening and management of AUD. RESULTS In the last 12 months, 60.7% reported alcohol use, and heavy episodic drinking (HED) was reported by 37.3%. AUD (AUDIT ≥ 8) was present in 23.9%. Males were more likely to have HED (aPR = 1.43;95% CI:1.3 to 1.4) or AUD (aPR = 2.9; 95% CI 1.9 to 4.2). Both HED and AUD increased with age. Only one participant (0.3%) had documented AUD screening and management. Only 5% of participants screening positive for AUD had sought help. Reasons for not seeking care were thinking that the problem would get better by itself (55.0%), wanting to handle the problem alone (42.0%), or not being bothered by the problem (40.0%). CONCLUSION While reported alcohol use, HED, and AUD are common among patients presenting to primary healthcare facilities in northern Tanzania, help-seeking behavior and detection are very low. Not screening for AUD in primary health care is a missed opportunity for early detection and management. There is an urgent need to develop interventions to increase the detection of AUD by health care providers, while also addressing help-seeking behavior and barriers to seeking care.
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Affiliation(s)
- Dorothy Mushi
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- Centre for Innovative Drug Development and Therapeutics Trial for Africa (CDT-Africa) College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Candida Moshiro
- Department of Epidemiology and Biostatistics Muhimbili, University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Charlotte Hanlon
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Joel M Francis
- Department of Epidemiology and Biostatistics Muhimbili, University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Family Medicine and Primary Care, Witwatersrand University, Faculty of Health Sciences, Johannesburg, South Africa
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Mbotwa C, Kazaura M, Moen K, Leshabari M, Metta E, Leyna G, Mmbaga EJ. Predictors of mHealth use in promoting adherence to pre-exposure prophylaxis among female sex workers: an evaluation of the Jichunge intervention in Dar es Salaam, Tanzania. BMC Health Serv Res 2022; 22:859. [PMID: 35787285 PMCID: PMC9254514 DOI: 10.1186/s12913-022-08245-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background There is evidence that pre-exposure prophylaxis (PrEP) is effective in preventing HIV transmission, and PrEP is recommended by the World Health organization (WHO) for use by individuals at high risk of HIV infection. However, low adherence has been reported to hamper its effectiveness. Some evidence indicates that mHealth interventions may be a promising way of promoting PrEP adherence. Nevertheless, evaluations of mHealth interventions in Africa, the region most affected by HIV, are scarce. This study aimed at identifying the extent of and predictors for use of a smartphone based mHealth application among female sex workers in Dar es Salaam, Tanzania. Methods As part of a quasi-experimental study in Tanzania, 470 female sex workers who were eligible for PrEP and who owned a smartphone were recruited using respondent driven sampling. All participants were provided with an mHealth application called Jichunge, a smartphone-based app designed to promote adherence to PrEP by offering users information, advise and support during start-up and use of PrEP. We collected data through structured interviews at baseline and extracted user data from the app for a period of 30 days. Modified Poisson regression model with robust standard errors was used to identify predictors for the optimal use of the Jichunge app. Results Overall, the optimal use of the Jichunge app was 46.4%. Optimal use was significantly higher among women who were older (aPR = 1.3, 95% CI: 1.10-1.65, p = 0.004 for age 25-34 years, and aPR = 1.6, 95% CI: 1.19-2.07, p = 0.001 for age at least 35 years), who had secondary education or higher (aPR = 1.8, 95% CI: 1.08-2.94, p = 0.023), who had suboptimal social support (aPR = 1.2, 95% CI: 1.02-1.48, p = 0.030), who had high awareness of PrEP (aPR = 1.3, 95% CI: 1.08-1.55, p = 0.005), and who had experience using common mainstream social media applications (aPR = 1.4, 95% CI: 1.08-1.71, p = 0.009). Conclusion Optimal use of the Jichunge app was substantially higher among women with higher age, higher education, higher PrEP awareness, less social support, and experience using common social media applications. Individual and interpersonal factors should be considered in planning mHealth interventions. Further studies to determine predictors of longer-term mHealth engagement are needed. Trial registration International Clinical Trials Registry Platform PACTR202003823226570; 04.03.2020.
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Affiliation(s)
- Christopher Mbotwa
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. .,Mbeya College of Health and Allied Sciences, University of Dar es Salaam, Mbeya, Tanzania.
| | - Method Kazaura
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kåre Moen
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Melkizedeck Leshabari
- Department of Behavioural sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Emmy Metta
- Department of Behavioural sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Germana Leyna
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
| | - Elia J Mmbaga
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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19
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Van Wijk CH, Martin JH, Meintjes WAJ. A Concise Occupational Mental Health Screening Tool for South African Workplaces. Front Psychol 2022; 13:895137. [PMID: 35707644 PMCID: PMC9190782 DOI: 10.3389/fpsyg.2022.895137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Mental health in the workplace is becoming of ever greater importance. General occupational health surveillance programmes are already in widespread use, with established referral systems for treatment and rehabilitation, and the same mechanisms could be expanded to include mental health screening and intervention. This study aimed to develop a concise composite mental health screening tool, based on analysis of existing data, for application in routine occupational health surveillance in South Africa. Data from workplace occupational health surveillance programs from 2,303 participants were analysed. Participants completed a number of questions/scaled items collated into a survey format, and partook in an interview with a psychologist. The data was analysed using frequency of positive self-reports, Chi square to calculate associations with outcomes, Receiver Operator Characteristic curve analysis to explore predictive ability, and binomial logistic regression to calculate the relative contribution of markers to outcomes. An exploratory factor analysis was further conducted on identified items. A general workplace model with 14 markers (and a maritime workplace model with 17 markers) were identified. The factor analysis suggested their organisation into five domains (similar for both models), namely neurocognitive health, common mental disorders, history of adaptation in occupational specific contexts, family-work interface, and stress overload. The study’s data-driven approach proposed a concise composite screener with less than 50 items, comprising five domains. This tool appears useful in identifying employees at risk for workplace injuries or poor mental health outcomes, and could be applied to related workplace settings in South Africa.
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Affiliation(s)
- Charles H Van Wijk
- Institute for Maritime Medicine, Simon's Town, South Africa.,Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Jarred H Martin
- Department of Psychology, Faculty of Humanities, University of Pretoria, Pretoria, South Africa
| | - W A J Meintjes
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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20
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Habtamu E, Madoro D. Psychometric properties of Alcohol Use Disorder Identification Test screening tool among medical outpatients in Dilla University Referral Hospital, southern Ethiopia, 2020. SAGE Open Med 2022; 10:20503121221077568. [PMID: 35186293 PMCID: PMC8855433 DOI: 10.1177/20503121221077568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/12/2022] [Indexed: 11/15/2022] Open
Abstract
Objective A quick, efficient, and flexible screening tool is essential for identifying alcohol use disorder in a busy clinical context. The Alcohol Use Disorders Identification Test is the most widely used and validated screening tool in the outpatient context. The psychometric features of the Alcohol Use Disorders Identification Test have yet to be confirmed for Ethiopians. As a result, the purpose of this study was to evaluate the Alcohol Use Disorders Identification Test screening tool's reliability and validity among medically ill patients in Ethiopia. Method A total of 325 patients who visited the internal medicine outpatient department were included in this study. To diagnose alcohol use disorder based on the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), the psychometric features of the Alcohol Use Disorders Identification Test were compared to the gold standard of Mini International Neuropsychiatry Interview. The reliability was determined by examining internal consistency. The receiver operating characteristic curve was established to calculate sensitivity and specificity of the screening tool. Construct validity was determined using confirmatory factor analysis. Result The translated version of Alcohol Use Disorders Identification Test showed language clarity. Internal consistency was excellent (Cronbach's α = 0.9). The Alcohol Use Disorders Identification Test provides an excellent receiver operating curve with cut-off point ⩾8 for females (sensitivity = 0.92, specificity = 0.87, positive predictive value = 70.2, negative predictive value = 96.9, likelihood ratio+ = 7.16, and likelihood ratio- = 0.1) and ⩾10 for males (sensitivity = 0.91, specificity = 0.84, positive predictive value = 72.6%, negative predictive value = 95.3%, likelihood ratio+ = 5.57, and likelihood ratio- = 0.10). Confirmatory factor analysis yielded good model fit indices for the two- and three-factor models, with the two-factor model outperforming the others. Conclusion The Alcohol Use Disorders Identification Test has been proven to be a reliable tool for detecting alcohol use in gedofa-speaking medical outpatients.
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Affiliation(s)
- Endashaw Habtamu
- Department of Psychiatry, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Derebe Madoro
- Department of Psychiatry, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
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21
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Kiwango G, Francis F, Moshiro C, Möller J, Hasselberg M. Association between alcohol consumption, marijuana use and road traffic injuries among commercial motorcycle riders: A population-based, case-control study in Dares Salaam, Tanzania. ACCIDENT; ANALYSIS AND PREVENTION 2021; 160:106325. [PMID: 34390892 DOI: 10.1016/j.aap.2021.106325] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 06/12/2021] [Accepted: 07/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Alcohol consumption and psychoactive drug use are well-recognised risk factors for road traffic injuries (RTIs). Both types of use may impair and affect drivers' performance. Yet, there is limited literature on their contribution to RTIs among commercial motorcycle riders, particularly in low- and middle-income settings. This study aimed to determine the association between alcohol consumption, marijuana use and RTIs among commercial motorcycle riders in the city of Dar es Salaam, Tanzania. METHODS We conducted a case-control study between July 2018 and March 2019. Cases (n = 164) were commercial motorcycle riders who had sustained an RTIs and attended at a hospital. Controls (n = 400) were commercial motorcycle riders who had not experienced an RTIs that led to hospital attendance during the past six months. Alcohol consumption was assessed using the Alcohol Use Disorder Identification (AUDIT) score, which classified participants as a non-drinker, normal drinker(1-7 scores) and risky drinker (scores ≥ 8). Marijuana use was assessed through self-reported use in the past year. We estimated odds ratios (ORs) using logistic regression adjusted for sociodemographic, driver-, and work-related factors. RESULTS Risky drinking was associated with close to six times the odds of RTIs compared to non-drinkers (OR = 5.98, 95% CI: 3.25 - 11.0). The association remained significant even after adjusting for sociodemographic, driving and work-related factors (OR = 2.41, 95% CI: 1.01 - 5.76). The crude odds ratios of RTIs were significantly higher among users of marijuana than non-users (OR = 2.33, 95% CI: 1.38 - 3.95). However, the association did not remain statistically significant after adjusting for confounders (OR = 1.11, 95% CI = 0.49-2.48). CONCLUSION Our findings confirm increased odds of RTIs among commercial motorcycle riders with risky drinking behaviour even after taking sociodemographic, driving and work-related factors into account. Unlike alcohol consumption the relationship between marijuana use and RTIs among commercial motorcycle riders was unclear. Since motorcycle riders are more susceptible to the effect of alcohol due to higher demands of balance and coordination and because commercial motorcyclist riders, in particular, they spend a considerable amount of time on the road, our results underscore the importance of addressing hazardous alcohol consumption and marijuana use in future prevention strategies to enhance road safety.
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Affiliation(s)
- George Kiwango
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Filbert Francis
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; National Institute of Medical Research, Tanga, Tanzania.
| | - Candida Moshiro
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jette Möller
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Marie Hasselberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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22
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van Wijk CH, Martin JH, Maree DJ. Clinical validation of brief mental health scales for use in South African occupational healthcare. SA JOURNAL OF INDUSTRIAL PSYCHOLOGY 2021. [DOI: 10.4102/sajip.v47i0.1895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Validity and item response theory properties of the Alcohol Use Disorders Identification Test for primary care alcohol use screening in Mozambique (AUDIT-MZ). J Subst Abuse Treat 2021; 127:108441. [PMID: 34134876 DOI: 10.1016/j.jsat.2021.108441] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 02/12/2021] [Accepted: 04/21/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND No validated tools exist to screen for substance use or dependence in Mozambique. The aim of this study was to validate the Alcohol Use Disorder Identification Test (AUDIT) for use in primary care settings in Mozambique. METHODS The study administered a final adapted Mozambican 10-item AUDIT (AUDIT-10-MZ) to 502 individuals from antenatal, postpartum, and general outpatient consultations in three Ministry of Health primary health care clinics in Sofala Province, Mozambique. The study evaluated the AUDIT-10-MZ against the MINI 5.0-MZ as a gold standard diagnostic tool. RESULTS Using the MINI 5.0-MZ, 16 (3.2%) of the sample tested positive for alcohol dependence and 3 (0.6%) tested positive for harmful alcohol use. The full AUDIT-10-MZ had acceptable internal consistency (α = 0.74); however, the shorter AUDIT-C-MZ had a higher alpha value than the full AUDIT screener (α = 0.79). The AUDIT-10-MZ performed well for screening in primary care, achieving areas under the receiver operating characteristic curves (AUROCs) of 0.94 (95% CI: 0.91, 0.96) for alcohol dependence. The AUDIT-C-MZ also performed well with an AUROC of 0.88 (95% CI: 0.80, 0.96) for alcohol dependence. Using a cut-off of ≥6, the AUDIT-10-MZ achieved a sensitivity of 68.8% and specificity of 92.0% for screening for alcohol dependence; a cut-off of ≥3 for the AUDIT-C-MZ achieved a sensitivity of 56.3% and specificity of 90.7%. CONCLUSIONS Both the AUDIT-10-MZ and AUDIT-C-MZ are valid instruments for screening for alcohol dependence in Mozambique. The AUDIT-C-MZ performed particularly well and providers could use it as a brief screener in primary care settings. Optimal cut-points will depend on weighing false positives and false negatives but could be employed at ≥ 6 or ≥ 7 for the AUDIT-10-MZ and at ≥ 2 or ≥ 3 for the AUDIT-C-MZ. Future implementation research is needed to examine how best to integrate screening for substance use or dependence in primary care settings in Mozambique and other similar LMICs.
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24
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Staton CA, Zhao D, Ginalis EE, Hirshon JM, Sakita F, Swahn MH, Mmbaga BT, Vissoci JRN. Alcohol Availability, Cost, Age of First Drink, and Its Association with At-Risk Alcohol Use in Moshi, Tanzania. Alcohol Clin Exp Res 2020; 44:2266-2274. [PMID: 32944986 PMCID: PMC7680393 DOI: 10.1111/acer.14457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Kilimanjaro region has one of the highest levels of reported alcohol intake per capita in Tanzania. Age at first drink has been found to be associated with alcohol problems in adulthood, but there is less information on the age of first drink in the Kilimanjaro region and its associations with alcohol-related consequences later in life. Furthermore, local alcohol cost and availability may influence the prevalence of alcohol use and alcohol use disorders. METHODS Data on the age of first drink, alcohol use disorder identification tool (AUDIT), number and type of alcohol consequences (DrInC), and perceived alcohol at low cost and high availability for children and adolescents were collected from an alcohol and health behavior survey of injury patients (N = 242) in Moshi, Tanzania. Generalized linear models were used to test age at first drink, perceived alcohol cost and availability, and their association with the AUDIT and DrInC scores, and current alcohol use, respectively. RESULTS Consuming alcohol before age 18 was significantly associated with higher AUDIT and DrInC scores, with odds ratios of 1.22 (CI: 1.004, 1.47) and 1.72 (CI: 1.11, 2.63), respectively. Female gender is strongly associated with less alcohol use and alcohol consequences, represented by an odds ratio of 3.70 (CI: 1.72, 8.33) for an AUDIT score above 8 and an odds ratio of 3.84 (CI: 2.13, 6.67) with the DrInC score. Perceived high availability of alcohol for children is significantly related to higher alcohol use quantity, with the odds ratio of 1.6 (CI: 1.17, 2.20). CONCLUSIONS The first use of alcohol before the age of 18 is associated with higher alcohol use and alcohol-related adverse consequences. In Tanzania, age at first drink is an important target for interventions aiming to prevent negative alcohol-related consequences later in life.
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Affiliation(s)
| | - Duan Zhao
- Duke Kunshan Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu China
| | | | - Jon Mark Hirshon
- University of Maryland School of Medicine, College Park, Maryland USA
| | | | | | - Blandina Theophil Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC USA
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Mushi DP, Hanlon C, Francis JM, Teferra S. Adaptation and piloting of an integrated intervention model for alcohol use disorders in primary healthcare in rural Tanzania: a study protocol. BMJ Open 2020; 10:e038615. [PMID: 33130566 PMCID: PMC7783617 DOI: 10.1136/bmjopen-2020-038615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Integration of evidence-based interventions for alcohol use disorders (AUDs) into primary healthcare has potential to increase coverage and reduce population burden. However, these interventions are rarely implemented in low- and middle-income countries and there is little existing guidance on how this could be achieved. The aim of the proposed study is to adapt and pilot an integrated model for AUDs in Tanzanian primary healthcare. METHODS AND ANALYSIS The study design will include a situational analysis, a qualitative study, a series of participatory Theory of Change (ToC) workshops and pilot intervention study. The evidence-based packages of care for AUD from the WHO mental health Gap Intervention Guide will form the basis of intervention. The situation analysis will use publicly available data to identify existing resources and system functioning. In-depth interviews will be conducted with key stakeholders (people with lived experience of substance use problems, health workers, health planners and community-based organisations) to identify barriers and facilitators to integration and recommended implementation strategies. Thematic analysis will be used. Triangulation of findings will inform the ToC map for the adapted model of integrated services for AUDs. This model will then be piloted. Change in knowledge, skills and attitudes of health workers will be measured pre-implementation and post-implementation. Interrupted time series analysis will be used to identify change in the rate of identification of AUDs beyond that observed due to secular trends or by chance. The integrated model will be finalised for future implementation and larger-scale evaluation. ETHICS AND DISSEMINATION Ethical approval was obtained from Addis Ababa University College of Health Science Institutional Review Board and Muhimbili University of Health and Allied Sciences Institutional Review Board. Findings will be disseminated to inform strategies for scale up of integrated interventions for people with AUDs in Tanzania and similar contexts.
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Affiliation(s)
- Dorothy Peter Mushi
- Department of Psychiatry and Mental Health, School of Medicine,Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutics Trial for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Innovative Drug Development and Therapeutics Trial for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Joel Msafiri Francis
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg South Africa, Johannesburg, South Africa
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Solomon Teferra
- Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Epidemiology, Harvard, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Zhao D, Nickenig Vissoci JR, Mmbaga BT, Abdullah AS, Staton CA. Alcohol-Related Risky Behavior Patterns and Their Association With Alcohol Use and Perceived Alcohol Stigma in Moshi, Tanzania. J Stud Alcohol Drugs 2020; 81:614-623. [PMID: 33028474 PMCID: PMC8076481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 04/12/2020] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE The Kilimanjaro region has one of the highest rates of reported alcohol use per capita in Tanzania. Alcohol-related risky behaviors pose substantial threats to the health and well-being of alcohol users and the people around them. This study seeks to understand how alcohol-related risky behaviors co-occur with other risky behaviors. METHOD Latent class analysis (LCA) was applied to examine alcohol-related risky behaviors. The optimal number of latent classes was confirmed by using model fit indices. Negative binomial models were used to test latent classes and their association with harmful and hazardous drinking and perceived alcohol stigma. With the model defined, we explored each class's drinking patterns and risky behavior patterns. RESULTS A total of 622 (60% male) of 841 participants were included in these analyses because they drank alcohol at least once in their lifetime. Three classes of risky behavior patterns were identified: Class 1, "Limited risk behaviors" (59.7%); Class 2, "Primarily foolish behaviors" (25.6%); and Class 3, "Pervasive risk behaviors" (13.1%). Class 3 had the most alcohol use quantity and frequency. No association between classes and alcohol stigma was found. Compared with males, females are less likely to be classified in Class 2 and 3. CONCLUSIONS Three different classes of risky behaviors became apparent and were distinguished by gender, age, and personal alcohol use. Our findings suggest a potential role for personalized interventions based on latent classes specifically to reduce risk behaviors.
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Affiliation(s)
- Duan Zhao
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Abu S. Abdullah
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Catherine A. Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina
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Zhao D, Nickenig Vissoci JR, Mmbaga BT, Abdullah AS, Staton CA. Alcohol-Related Risky Behavior Patterns and Their Association With Alcohol Use and Perceived Alcohol Stigma in Moshi, Tanzania. J Stud Alcohol Drugs 2020; 81:614-623. [PMID: 33028474 PMCID: PMC8076481 DOI: 10.15288/jsad.2020.81.614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 04/12/2020] [Indexed: 10/26/2023] Open
Abstract
OBJECTIVE The Kilimanjaro region has one of the highest rates of reported alcohol use per capita in Tanzania. Alcohol-related risky behaviors pose substantial threats to the health and well-being of alcohol users and the people around them. This study seeks to understand how alcohol-related risky behaviors co-occur with other risky behaviors. METHOD Latent class analysis (LCA) was applied to examine alcohol-related risky behaviors. The optimal number of latent classes was confirmed by using model fit indices. Negative binomial models were used to test latent classes and their association with harmful and hazardous drinking and perceived alcohol stigma. With the model defined, we explored each class's drinking patterns and risky behavior patterns. RESULTS A total of 622 (60% male) of 841 participants were included in these analyses because they drank alcohol at least once in their lifetime. Three classes of risky behavior patterns were identified: Class 1, "Limited risk behaviors" (59.7%); Class 2, "Primarily foolish behaviors" (25.6%); and Class 3, "Pervasive risk behaviors" (13.1%). Class 3 had the most alcohol use quantity and frequency. No association between classes and alcohol stigma was found. Compared with males, females are less likely to be classified in Class 2 and 3. CONCLUSIONS Three different classes of risky behaviors became apparent and were distinguished by gender, age, and personal alcohol use. Our findings suggest a potential role for personalized interventions based on latent classes specifically to reduce risk behaviors.
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Affiliation(s)
- Duan Zhao
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Abu S. Abdullah
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Catherine A. Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina
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Griffin SM, Karia FP, Zimmerman A, Minnig MCC, Swahn M, Makelarski J, T Mmbaga B, Vissoci JRN, A Staton C. A Mixed-Methods Study: Sex Differences in Experiences of Stigma Associated With Alcoholism and Alcohol Use Disorders Among Injury Patients in Tanzania. Alcohol Clin Exp Res 2020; 44:1700-1707. [PMID: 32583874 DOI: 10.1111/acer.14402] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 06/16/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Each year, alcohol use causes 3.3 million deaths globally and accounts for nearly 30% of injuries treated at Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania. Prior research found significant stigma toward patients reporting alcohol use in general and among healthcare providers for this population. METHODS This mixed-methods study aimed to identify sex-based perspectives of stigma among injury patients, family members, and local community advisory board (CAB) members. Injury patients from the emergency room at KCMC were asked to complete surveys capturing consumption of alcohol, perceived stigma, and consequences of drinking. Patients who completed the survey, their family members, and members of a CAB were also recruited to take part in focus groups led by a trained bilingual research nurse. Data were analyzed using multiple linear regression and Wilcoxon rank sum tests with alpha level set at 0.05. RESULTS Results showed that sex was a significant predictor of perceived discrimination (p = 0.037, Standard Error (SE) = 1.71 (0.81)) but not for perceived devaluation (p = 0.667, SE = -0.38 (0.89)). Focus groups revealed there were global negative perceptions of the amount of alcohol consumed as well as negative perceptions toward disclosure of alcohol use to healthcare providers. Sex differences in stigma emerged when participants were specifically asked about women and their alcohol consumption. CONCLUSIONS The findings of this study suggest there is an underlying sex difference, further stigmatizing women for alcohol use among the injury patient population at KCMC. Tanzanian women suffer from unequal access to health care, and the stigmatization of alcohol use likely increases this disparity.
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Affiliation(s)
- S Michelle Griffin
- University of New England, (SMG, JM), Biddeford, Maine.,Division of Emergency Medicine, Duke University Medical Center (SMG, JRNV, CS), Durham, North Carolina
| | - Francis P Karia
- Duke University School of Medicine (FPK), Durham, North Carolina
| | - Armand Zimmerman
- Duke Global Health Institute (SMG, AZ, MCCM, BM, JRNV, CS), Durham, North Carolina
| | | | - Monica Swahn
- Georgia State University School of Public Health (MS), Atlanta, Georgia
| | - Jennifer Makelarski
- University of New England, (SMG, JM), Biddeford, Maine.,Department of Obstetrics and Gynecology (JM), The University of Chicago, Chicago, Illinois
| | - Blandina T Mmbaga
- Duke Global Health Institute (SMG, AZ, MCCM, BM, JRNV, CS), Durham, North Carolina.,Kilimanjaro Christian Medical Center (BM), Moshi, Tanzania.,Kilimanjaro Clinical Research Institute (BM), Moshi, Tanzania.,Kilimanjaro Christian Medical University College (BM), Moshi, Tanzania
| | - João Ricardo Nickenig Vissoci
- Duke Global Health Institute (SMG, AZ, MCCM, BM, JRNV, CS), Durham, North Carolina.,Division of Emergency Medicine, Duke University Medical Center (SMG, JRNV, CS), Durham, North Carolina
| | - Catherine A Staton
- Duke Global Health Institute (SMG, AZ, MCCM, BM, JRNV, CS), Durham, North Carolina.,Division of Emergency Medicine, Duke University Medical Center (SMG, JRNV, CS), Durham, North Carolina
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van Amsterdam JG, Benschop A, van Binnendijk S, Snijder MB, Lok A, Schene AH, Derks EM, van den Brink W. A Comparison of Excessive Drinking, Binge Drinking and Alcohol Dependence in Ethnic Minority Groups in the Netherlands: The HELIUS Study. Eur Addict Res 2020; 26:66-76. [PMID: 31812961 PMCID: PMC7114898 DOI: 10.1159/000504881] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 11/18/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Dutch multi-ethnic Healthy Life in an Urban Setting study recently showed that alcohol consumption was lower in ethnic minority groups than those of Dutch origin, but that binge drinking in drinkers of Turkish and Moroccan origin was relatively high. The aim of the current study is to examine factors that may contribute to the differences in drinking patterns and how they relate to the relationship between drinking patterns and alcohol dependence (AD) across ethnic groups. METHODS The rate of last year alcohol use, alcohol use patterns and AD was assessed in 4,635 Dutch, 4,317 Moroccan, 4,036 Turkish, 2,459 Ghanaian, 4,426 African Surinamese and 3,357 South-Asian Surinamese participants (both men and women) born in Amsterdam, the Netherlands. RESULTS Compared to the Dutch, the prevalence of (regular) drinking is substantially lower in all ethnic minority groups and regular drinkers among most ethnic minority groups have a lower adjusted risk to develop binge drinking and AD than the Dutch. For the prevalence of regular drinking, the ethnic differences are bigger than for the prevalence of current drinking. However, regular drinkers of Moroccan origin have a risk similar to the Dutch to develop binge drinking and AD; a finding that could not be explained by group differences in age, sex, religiosity, perceived discrimination, depression or guilt feelings about drinking. DISCUSSION The prevalence data show that current drinking is lower and that regular drinking is much lower in ethnic minorities and - with the exception of those of Moroccan origin - ethnic minority regular drinkers also have a significant lower risk to develop binge drinking or AD than regular drinkers of Dutch origin. This implies that the magnitude of problematic alcohol use is substantially smaller in ethnic minorities than in the ethnic Dutch population of Amsterdam. Unfortunately, no explanation was found for the special risk situation of regular drinkers of Moroccan origin.
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Affiliation(s)
- Jan G.C. van Amsterdam
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,*Dr. Jan G.C. van Amsterdam, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, NL–1105 AZ Amsterdam (The Netherlands), E-Mail: ;
| | - Annemieke Benschop
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Simone van Binnendijk
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke B. Snijder
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anja Lok
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Aart H. Schene
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands,Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Eske M. Derks
- Translational Neurogenomics Group, QIMR Berghofer, Brisbane, Queensland, Australia
| | - Wim van den Brink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Zhao D, Staton CA, He Q, Mmbaga BT, Vissoci JRN. Cross-Culture Adaptation and Psychometric Properties of the DrInC Questionnaire in Tanzanian Swahili. Front Public Health 2018; 6:330. [PMID: 30515371 PMCID: PMC6255945 DOI: 10.3389/fpubh.2018.00330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/26/2018] [Indexed: 11/18/2022] Open
Abstract
Aims: To develop Swahili versions of the Drinker Inventory of Consequences (DrInC) and evaluate its psychometric properties among a mixed population in Tanzania. Methods: A Swahili version of the DrInC was developed by a panel of bilingual Swahili and English speakers through translation and back-translation. The translated DrInC was administered to a sample of Tanzanian injury patients and a sample of the general population. The validity and reliability of the scale were tested using standard statistical methods. Results: The translated version of the DrInC questionnaire was found to have outstanding domain coherence and language clarity. The tested scale and subscales have adequate reliability (>0.85). Confirmatory factor analysis (CFA) confirmed the five-factor solution by yielding adequate results. DrInC score is statistically significantly correlated with alcohol consumption quantity and the AUDIT score, suggesting that DrInC is able to predict alcohol use as well. Conclusions: This study presents the first validation of the DrInC questionnaire with injury patients and a general population and the first adaptations of the DrInC questionnaire in the Tanzanian and Swahili setting. DrInC instrument was found to have satisfactory psychometric properties, resulting in a new medical and social research tool in this setting.
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Affiliation(s)
- Duan Zhao
- Duke Kunshan Global Health Research Center, Duke Kunshan University, Kunshan, China
| | - Catherine A Staton
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Qing He
- Department of Linguistics, South China University of Technology, Guangzhou, China
| | - Blandina Theophil Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Research and Innovation, Kilimanjaro Clinical Research Institute, Moshi, Tanzania.,Research and Innovation and Paediatric and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
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