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Nalugya JS, Engebretsen IMS, Nakasujja N, Ndeezi G, Babirye JN, Bakken V, Skar AMS, Tumwine JK, Skokauskas N. Improving alcohol and substance use screening in school-age children: translation, adaptation and psychometric evaluation of the CRAFFT tool for Lumasaaba, Uganda. Addict Sci Clin Pract 2024; 19:38. [PMID: 38745244 PMCID: PMC11095024 DOI: 10.1186/s13722-024-00465-7] [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: 04/11/2023] [Accepted: 04/22/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Children at risk of substance use disorders (SUD) should be detected using brief structured tools for early intervention. This study sought to translate and adapt the Car, Relax, Alone, Forget, Family/Friends, Trouble (CRAFFT) tool to determine its diagnostic accuracy, and the optimum cut-point to identify substance use disorders (SUD) risk in Ugandan children aged 6 to 13 years. METHODS This was a sequential mixed-methods study conducted in two phases. In the first qualitative phase, in Kampala and Mbale, the clinician-administered CRAFFT tool version 2.1 was translated into the local Lumasaaba dialect and culturally adapted through focus group discussions (FGDs) and in-depth interviews, in collaboration with the tool's authors. Expert reviews and translations by bilingual experts provided insights on linguistic comprehensibility and cultural appropriateness, while pilot testing with the target population evaluated the tool's preliminary effectiveness. In the second phase, the CRAFFT tool, adapted to Lumasaaba, was quantitatively validated against the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) for diagnosing SUD in Mbale district, through a survey. Participants, chosen randomly from schools stratified according to ownership, location, and school size, were assessed for the tool's reliability and validity, including comparisons to the MINI KID as the Gold Standard for diagnosing SUD. Data were analyzed using STATA-15. Receiver-operating-characteristic analysis was performed to determine the sensitivity, specificity, and criterion validity of the CRAFFT with the MINI-KID. RESULTS Of the 470 children enrolled, 2.1% (n = 10) had missing data on key variables, leaving 460 for analysis. The median age and interquartile range (IQR) was 11 (9-12) years and 56.6% were girls. A total of 116 (25.2%) children had consumed alcohol in the last twelve-month period and 7 (1.5%) had used other substances. The mean CRAFFT score for all the children (n = 460) was 0.32 (SD 0.95). The prevalence of any alcohol use disorder (2 or more positive answers on the MINI KID) in the last 12 months was 7.2% (n = 32). The Lumasaaba version of the CRAFFT tool demonstrated good internal consistency (Cronbach's α = 0.86) and inter-item correlation (Spearman correlation coefficient of 0.84 (p < 0.001). At a cut-off score of 1.00, the CRAFFT had optimal sensitivity (91%) and specificity (92%) (Area Under the Curve (AUC) 0.91; 95% CI 0.86-0.97) to screen for SUD. A total of 62 (13.5%) had CRAFFT scores of > 1. CONCLUSION The Lumasaaba version of the CRAFFT tool has sufficient sensitivity and specificity to identify school-age children at risk of SUD.
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Affiliation(s)
- Joyce Sserunjogi Nalugya
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
- Department of Psychiatry, Mulago National Referral and Teaching Hospital, Ministry of Health, Kampala, Uganda.
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - Ingunn Marie Stadskleiv Engebretsen
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Noeline Nakasujja
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grace Ndeezi
- Department of Pediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Juliet N Babirye
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Victoria Bakken
- Centre for Child and Adolescent Mental Health and Child Protection, Institute of Psychiatry, Faculty of Medicine, NTNU, Trondheim, Norway
| | - Ane-Marthe Solheim Skar
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - James K Tumwine
- Department of Pediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Pediatrics and Child Health, School of Medicine, Kabale University, Kabale, Uganda
| | - Norbert Skokauskas
- Centre for Child and Adolescent Mental Health and Child Protection, Institute of Psychiatry, Faculty of Medicine, NTNU, Trondheim, Norway
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Namusoke J, Amone-P’Olak K, Nakanwagi CC, Kibedi H, Mayengo N, Ssenyonga J, Omech B. The mediating role of self-control on the relations between adverse childhood experiences and substance use among adolescents in Uganda. Front Psychol 2024; 15:1297565. [PMID: 38807955 PMCID: PMC11132265 DOI: 10.3389/fpsyg.2024.1297565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 04/09/2024] [Indexed: 05/30/2024] Open
Abstract
Objective Adverse childhood experiences (ACEs) are established risk factors for undesirable consequences in adolescence and early adulthood, including substance use and a lack of self-control. Based on the Social Bonds Theory (SBT), this study aims to expand our knowledge of the pathways from ACEs and self-control to substance use in adolescence and early adulthood. Methods The extent to which self-control mediates the association between ACEs and substance use was examined in a cross-sectional survey of 358 adolescents and young adults (N = 234, 65.5% girls, mean age 17.7, SD 0.58, range 15-18). Data were gathered using the Adverse Childhood Experiences (ACE-10) questionnaire, the Drug Abuse Screening Test (DAST-10), and the 10-item self-control scale to assess childhood adversity, substance use, and self-control, respectively. Results ACEs were widely reported and significantly associated with substance use and a lack of self-control. Self-control strongly predicted substance use, independent of ACEs. Among those reporting no ACEs, one to two, three to four, and five or more, there were significant variations in the respondents' substance use (F(3, 400) = 12.69, p = 0.001). Self-control explained 51.2% (95% confidence interval [CI]: 41, 61%) of the associations between ACEs and substance use as assessed by linear regression. Conclusion Self-control is key to understanding why adolescents and young adults with a history of childhood adversity indulge in substance use. Therefore, there is a need to advocate for psychological interventions such as cognitive and behavioural therapy that have demonstrated efficacy in promoting self-control in adolescents and young adults.
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Affiliation(s)
- Jane Namusoke
- Department of Psychology, Kyambogo University, Kampala, Uganda
| | | | | | - Henry Kibedi
- Department of Psychology, Kyambogo University, Kampala, Uganda
| | - Nathaniel Mayengo
- Department of Foundations of Education and Educational Psychology, Kyambogo University, Kampala, Uganda
| | - Joseph Ssenyonga
- Department of Foundations of Education and Educational Psychology, Kyambogo University, Kampala, Uganda
| | - Bernard Omech
- Directorate of Graduate Training and Research, Lira University, Lira, Uganda
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Odokonyero RF, Fatch R, Emenyonu NI, Cheng DM, Ngabirano C, Adong J, Muyindike WR, Nakasujja N, Camlin CS, Kamya M, Hahn JA. The Relationship between Age at Initiation of Regular Drinking of Alcohol and Viral Suppression Status, and Depression Symptoms Among People Living with HIV in South-Western Uganda. AIDS Behav 2024; 28:1415-1422. [PMID: 38060110 PMCID: PMC10940472 DOI: 10.1007/s10461-023-04228-4] [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] [Accepted: 11/20/2023] [Indexed: 12/08/2023]
Abstract
Alcohol use is an important factor in achieving and maintaining viral suppression and optimal mental health among persons with HIV (PWH), however, the effect of age at first regular drinking on viral suppression and depression remains poorly understood. Here, using secondary data from the Alcohol Drinkers' Exposure to Preventive Therapy for Tuberculosis (ADEPT-T) study, we used logistic regression analyses to explore whether there is an association between age at first regular drinking and viral suppression (< 40 copies/ml), or presence of depressive symptoms (Center for Epidemiologic Studies Depression, CES-D ≥ 16) among 262 PWH. The median age at first regular drinking was 20.5 years (IQR: 10), with high proportions starting under age 12 (12.2%) and as teens (13.4%). The majority had an undetectable viral load (91.7%) and 11% had symptoms of probable depression. We found no significant association between age at first regular drinking and viral suppression (i.e., child (aOR = 0.76 95%CI: 0.18, 3.26), adolescent (aOR = 0.74 95%CI: 0.18, 2.97) and young adult (aOR = 1.27 95%CI: 0.40, 3.97)) nor with depressive symptoms (i.e., child (aOR = 0.72 95%CI: 0.19, 2.83), adolescent (aOR = 0.59 95%CI: 0.14, 2.50) and young adult (aOR = 0.57 95%CI: 0.22, 1.53)). Age at first regular drinking among PWH did not appear to be associated with either viral suppression or the presence of depressive symptoms, suggesting interventions may best be focused on the harmful effects of current alcohol use.
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Affiliation(s)
- Raymond Felix Odokonyero
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Robin Fatch
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Nneka I Emenyonu
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Debbie M Cheng
- School of Public Health, Boston University, Boston, MA, USA
| | | | - Julian Adong
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Winnie R Muyindike
- Mbarara University of Science and Technology, Mbarara, Uganda
- Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Noeline Nakasujja
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Carol S Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Moses Kamya
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Judith A Hahn
- Department of Medicine, University of California, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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Rudenstrand H, Bäärnhielm S. A qualitative study about explanatory models of alcohol use disorder among patients and relatives in a Ugandan mental hospital. BMC Psychiatry 2024; 24:222. [PMID: 38515058 PMCID: PMC10958892 DOI: 10.1186/s12888-024-05677-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/12/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Alcohol use disorder (AUD) is a major clinical problem in Uganda. Explanatory models (EMs) of illness are important as they have consequences for treatment. Clinicians´ knowledge about patients´ EMs can improve understanding of the latter´s perspectives and adapting treatments. There is a lack of African studies about EMs of AUD. The aim of this study was to explore EMs for AUD among hospitalized patients and their relatives at the alcohol and drug unit (ADU) at Butabika hospital in Uganda. METHODS An adapted version of the Explanatory Model Interview Catalogue (EMIC) was used for interviews with ten patients and five relatives to investigate how both hospitalized patients with AUD and their relatives understand the disease. Data were analysed for themes with a qualitative content analysis and support of the software program, OpenCode 4.03. RESULTS Five major themes were identified from the patient interviews: "Context promotes AUD"; "Alcohol is part of culture"; "Spiritual causes of AUD in the community"; "Help through Western medicine and religious sources is preferred" and "Social problems and stigmatization". Six major themes identified from the interviews with relatives were: "Numerous causes of drinking alcohol"; "Devastating consequences of drinking alcohol"; "Exploiting persons with AUD"; "Others' suffering"; "Relatives struggling for help" and "Suggested solutions". CONCLUSIONS Patients' EMs of AUD included social and spiritual explanations. Alcohol is seen as an important part of the Ugandan culture among both patients and their relatives. The results indicate it is important in clinical contexts to investigate the EMs of the patients and relatives to individually tailor treatment interventions.
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Affiliation(s)
| | - Sofie Bäärnhielm
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Transcultural Centre, Region Stockholm, Stockholm, Sweden.
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Aber-Odonga H, Babirye JN, Engebretsen IMS, Nuwaha F. Prevalence of probable substance use disorders among children in Ugandan health facilities. BMC Public Health 2024; 24:314. [PMID: 38287328 PMCID: PMC10823678 DOI: 10.1186/s12889-024-17732-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/10/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Globally, there is a concerning surge in the prevalence of substance use among adolescents and children, creating a substantial public health problem. Despite the magnitude of this issue, accessing healthcare explicitly for substance use remains challenging, even though many substance users frequently visit healthcare institutions for other health-related issues. To address this gap, proactive screening for substance use disorders has emerged as a critical strategy for identifying and engaging patients at risk of substance use. The purpose of this study was to investigate the prevalence of probable alcohol and other substance use disorders, and associated factors, among children aged 6 to 17 years old attending health facilities in Mbale, Uganda. METHODS We conducted a health facility cross-sectional study, involving 854 children aged 6-17 years. The prevalence of probable alcohol and other substance use disorders was assessed using a validated Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) screening tool. Univariable and multivariable modified Poisson regression analyses were performed using STATA 15 software. RESULTS The overall prevalence of probable alcohol use disorders (AUD) and other substance use disorders (SUD) was 27.8% (95% CI 1.24-1.31) while that of probable AUD alone was 25.3% (95% CI 1.22-1.28). Peer substance use (APR = 1.24, 95% CI 1.10-1.32), sibling substance use (APR = 1.14, 95% CI 1.06-1.23), catholic caregiver religion (APR = 1.07 95% CI 1.01-1.13), caregiver income of more than $128 (APR = 0.90, 95% CI 0.82-0.98), having no parental reprimand for substance use (APR = 1.05, 95% CI 1.01-1.10) and having no knowledge of how to decline an offer to use substances (APR = 1.06, 95% CI 1.01-1.12) were found to be significantly associated with probable AUD/SUD. CONCLUSIONS Our findings suggest a high prevalence of probable AUD and SUD among children and adolescents visiting healthcare facilities for other conditions, along with a strong link between AUD and SUD prevalence and social factors. The implication for our healthcare system is to actively screen for and treat these conditions at primary healthcare facilities.
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Affiliation(s)
- Harriet Aber-Odonga
- Makerere University College of Health Sciences School of Public Health, Kampala, P.O Box 7072, Uganda.
| | - Juliet Ndimwibo Babirye
- Makerere University College of Health Sciences School of Public Health, Kampala, P.O Box 7072, Uganda
| | - Ingunn Marie S Engebretsen
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Fred Nuwaha
- Makerere University College of Health Sciences School of Public Health, Kampala, P.O Box 7072, Uganda
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Nalugya JS, Skylstad V, Babirye JN, Ssemata AS, Ndeezi G, Bangirana P, Engebretsen IMS, Nakasujja N. "She gives it to her child who doesn't even talk": a qualitative exploration of alcohol and drug use among primary school-age children in Uganda. BMC Public Health 2023; 23:2114. [PMID: 37891544 PMCID: PMC10605311 DOI: 10.1186/s12889-023-17016-5] [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: 04/19/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND There is little research on alcohol and other drugs (AOD) use by school-age children in low-resource settings like Uganda. Including the voices of children in research can inform prevention and early intervention efforts for those at risk of AOD use. The aim of this study was to understand the perspectives of children aged 6 to 13 years regarding AOD in Uganda. METHODS This qualitative study was conducted in Mbale district, Uganda from February to March 2020. Eight focus group discussions (FGDs) were conducted with 56 primary school-age children, stratified by age (6-9 and 10-13 years), sex (male and female), and school status (in school and out of school). All FGDs were conducted in either Lumasaaba or Luganda. The FGDs were audio-recorded, transcribed verbatim, and translated into English. Data were coded, and overarching themes were identified using thematic framework analysis. RESULTS Two themes identified were (1) Children's perceptions and experiences with AODs. The participants understood alcohol by its consistency, colour, odour, and by brand/logo. They described the types and quantities of AOD consumed by school-age children, brewing processes for homemade alcoholic drinks, and short and long-term consequences of the use of alcohol. (2) Contributing factors to childhood drinking included: Stress relief for children who experienced multiple adversities (orphaned, poverty-stricken, and hailing from broken homes), fitting in with friends, influence from families, and media exposure that made alcohol look cool. Children would start drinking at an early age) or were given alcohol by their parents, sometimes before they could start talking. In the community, alcohol and other drugs were cheap and available and children could drink from anywhere, including in the classroom. CONCLUSIONS Children eligible for primary education in Uganda can easily access and use AOD. Several factors were identified as contributing to alcohol and other drug use among children, including availability and accessibility, advertising, lack of parental awareness and supervision, peer influence, adverse childhood experiences, socioeconomic factors, and cultural norms. There is a need for multi-sectoral action for awareness of childhood AOD use and deliberate consideration of children in the planning, design, and implementation of research, policies, and programs for prevention and early intervention.
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Affiliation(s)
- Joyce Sserunjogi Nalugya
- Department of Psychiatry, Mulago National Referral and Teaching Hospital, Ministry of Health, Kampala, Uganda.
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - Vilde Skylstad
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Juliet N Babirye
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Andrew Sentoogo Ssemata
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Paul Bangirana
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ingunn M S Engebretsen
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Noeline Nakasujja
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Skylstad V, Engebretsen IMS, Nalugya SJ, Opesen C, Ndeezi G, Okello ES, Moland KM, Tumwine JK, Skar AMS. 'There is nowhere to take the child': a qualitative study of community members' views on managing early childhood substance use in Mbale, Uganda. BMC Public Health 2022; 22:1192. [PMID: 35705928 PMCID: PMC9198618 DOI: 10.1186/s12889-022-13548-4] [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: 02/14/2022] [Accepted: 05/26/2022] [Indexed: 11/20/2022] Open
Abstract
Background Harmful alcohol use by 5–8-year-old children has been identified in Mbale District, Uganda. To further examine this finding, the present study explores the experiences and perceptions of community members regarding how childhood substance use (before age 10) is managed in this area. Methods We conducted eight focus group discussions with 48 parents of children aged < 10 years and 26 key informant interviews with teachers, health workers, child protection workers, police, local stakeholders, brewers, and others. Thematic content analysis was performed. Results Three main themes were identified: ‘We don’t talk about it’: Despite concern, childhood substance use was not addressed in the community. Participants attributed this to three main factors related to a lack of leadership in addressing it, changing acceptability for peer parental interference, and uncertainty about repercussions related to children’s rights. ‘There is nowhere to take the child’: Schools, police, and remand homes were intuitively considered appropriate arenas for managing childhood substance use but were considered inaccessible, unresponsive, and inadequate due to insufficient resources, competence, and training. Since substance use was not considered a medical problem, help from the health sector was only sought for adverse consequences, such as injury. This left the participants with the experience that there was in effect nowhere to take the child. ‘The government has not done so much’: The participants called for government action and clear laws that would regulate the availability of alcohol and other substances to children, but they had limited trust in the capacity and commitment of the government to act. Conclusions The participants were concerned about childhood alcohol and substance use, but the complexity and magnitude of the problem left them feeling incapacitated in responding. Relevant factors were identified on the community, institutional, and the government level, such as a lack of leadership in addressing it, a loss of mandate to interfere in child-rearing, inadequate services, weak legal structures, and missing government action. A strengthening of collective agency and public policy is necessary to prevent and address childhood alcohol and substance use. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13548-4.
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Affiliation(s)
- V Skylstad
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - I M S Engebretsen
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - S J Nalugya
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Psychiatry, Mulago National Referral and Teaching Hospital, Ministry of Health, Kampala, Uganda
| | - C Opesen
- Department of Sociology and Anthropology, School of Social Sciences, Makerere University, Kampala, Uganda
| | - G Ndeezi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - E S Okello
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza Campus, Mwanza, Tanzania
| | - K M Moland
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - J K Tumwine
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Paediatrics and Child Health, Kabale University School of Medicine, Kabale, Uganda
| | - A M S Skar
- Global Health Cluster, Norwegian Institute of Public Health, Oslo, Norway.,Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
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Skylstad V, Nalugya JS, Skar A, Opesen C, Ndeezi G, Okello ES, Moland KM, Engebretsen I, Tumwine JK. 'As soon as they can hold a glass, they begin taking alcohol': a qualitative study on early childhood substance use in Mbale District, Uganda. BMC Public Health 2022; 22:812. [PMID: 35459136 PMCID: PMC9033416 DOI: 10.1186/s12889-022-13140-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 03/31/2022] [Indexed: 11/14/2022] Open
Abstract
Background Globally, substance use is a leading contributor to the burden of disease among young people, with far reaching social, economic and health effects. Following a finding of harmful alcohol use among 5-8-year-old children in Mbale District, Uganda, this study aims to investigate community members’ views on early childhood substance use among children below the age of 10 years. Methods In 2016, we conducted eight focus group discussions with 48 parents and 26 key informant interviews with teachers, health workers, alcohol distributors, traditional healers, religious leaders, community leaders and youth workers. We used thematic content analysis. Four participants and two research assistants reviewed and confirmed the findings. Results Alcohol in everyday life: ‘Even children on laps taste alcohol’: Almost all participants confirmed the existence of and concern for substance use before age 10. They described a context where substance use was widespread in the community, especially intake of local alcoholic brews. Children would access substances in the home or buy it themselves. Those living in poor neighbourhoods or slums and children of brewers were described as particularly exposed. Using substances to cope: ‘We don’t want them to drink’: Participants explained that some used substances to cope with a lack of food and resources for childcare, as well as traumatic experiences. This made children in deprived families and street-connected children especially vulnerable to substance use. Participants believed this was a result of seeing no alternative solution. Conclusions To our knowledge, this is the first study to describe the context and conditions of childhood substance use before age 10 in Mbale District, Uganda. The study shows that community members attributed early childhood substance use to a social context of widespread use in the community, which was exacerbated by conditions of material and emotional deprivation. These social determinants for this practice deserve public health attention and intervention.
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Affiliation(s)
- V Skylstad
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - J S Nalugya
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Psychiatry, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Ams Skar
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.,Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - C Opesen
- Department of Sociology and Anthropology, School of Social Sciences, Makerere University, Kampala, Uganda
| | - G Ndeezi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - E S Okello
- Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza Campus, Mwanza, Tanzania
| | - K M Moland
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Ims Engebretsen
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - J K Tumwine
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda.,Kabale University School of Medicine, Kabale, Uganda
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Skylstad V, Babirye JN, Kiguli J, Skar AMS, Kühl MJ, Nalugya JS, Engebretsen IMS. Are we overlooking alcohol use by younger children? BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2021-001242. [PMID: 36053657 PMCID: PMC8905875 DOI: 10.1136/bmjpo-2021-001242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 02/13/2022] [Indexed: 11/04/2022] Open
Abstract
Alcohol use is a leading contributor to the burden of disease among youth. Early-onset use is associated with later life dependency, ill health and poor social functioning. Yet, research on and treatment opportunities for alcohol use among younger children are scarce. Despite knowledge that alcohol intake occurs in childhood, and the fact that children understand alcohol related norms and develop alcohol expectancies from age 4, younger children are rarely included in studies on alcohol use.Patterns of early alcohol use vary greatly across the globe and are part of complex interplays between sociocultural, economic and health-related factors. Family influence has proven important, but genetic factors do not seem to play a crucial role at this age. Stressful circumstances, including mental health problems and sociocultural factors can entice alcohol use to cope with difficult situations. The World Health Organization has developed guidelines for effective strategies to reduce the harmful use of alcohol, including preventative and treatment interventions, but important gaps in implementation remain. An increased focus on research, policy and implementation strategies related to early alcohol use is warranted, granted its wide-ranging implications for public health and social functioning. In this summary of literature on alcohol use among younger children and adolescents, we show that younger children (aged 10 and younger) tend to be systematically overlooked. However, research, interventions and policy implementation strategies need to include younger children to mitigate the global burden of harmful alcohol use more effectively.
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Affiliation(s)
- Vilde Skylstad
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | | | - Juliet Kiguli
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ane-Marthe Solheim Skar
- Global Health Cluster, Norwegian Institute of Public Health, Oslo, Norway.,Section for Implementation and Treatment Research, Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Melf-Jakob Kühl
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Joyce Sserunjogi Nalugya
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Psychiatry, Ministry of Health, Mulago National Referral Hospital, Kampala, Uganda
| | - Ingunn Marie Stadskleiv Engebretsen
- Centre for International Health, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
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Mugisha J, Van Damme T, Vancampfort D. Associations between mild depression and anxiety and physical inactivity among school-going Ugandan adolescents aged 14 to 17 years. J Child Adolesc Ment Health 2022; 34:115-125. [PMID: 38632955 DOI: 10.2989/17280583.2023.2288969] [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: 04/19/2024]
Abstract
Objective: The aim of this cross-sectional study was to investigate associations between physical activity levels and emotional and behavioural problems in school-going adolescents aged 14 to 17 years in Uganda.Methods: Two-hundred and five adolescents [median (interquartile range) age = 16.0 (1.0) years; female = 61.9%] completed the interviewer-administered Strengths and Difficulties Questionnaire (SDQ), Patient Health Questionnaire-9 (PHQ-9), the Generalised Anxiety Disorder-7 questionnaire (GAD-7), and the Physical Activity Vital Sign (PAVS) measure. Spearman's rho correlations and Mann-Whitney U-tests were applied.Results: Among 205 adolescents, 97.1% were physically inactive (PAVS < 420min/week), while 64.4% reported either mild depressive (PHQ-9 ≥ 5) or anxiety (GAD-7 ≥ 5) symptoms. Higher PAVS scores correlated significantly with lower SDQ emotional problems (ρ = -0.23, p < 0.001), lower PHQ-9 (ρ = -0.26, p < 0.001), and lower GAD-7 (ρ = -0.22, p < 0.001) scores. Those with emotional problems (SDQ ≥ 5) (n = 86) were significantly less physically active than those without (n = 119) [30.0 (62.5) versus 60.0 (105.0) min/week, p < 0.001]. Those with depressive symptoms (PHQ-9 ≥ 5) were significantly less physically active than those without [35.0 (70.0) versus 60.0 (120.0) min/week, p < 0.001].Conclusion: Physical inactivity and mental health problems are related important public health concerns in school-going adolescents in low-income countries such as Uganda. The efficacy and effectiveness of school-based mental health literacy programs, including physical activity promotion, should be explored in these low-resource settings.
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Affiliation(s)
- James Mugisha
- Department of Sociology and Social Administration, Kyambogo University, Kampala, Uganda
| | - Tine Van Damme
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Centre, KU Leuven, Leuven, Belgium
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Centre, KU Leuven, Leuven, Belgium
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Skylstad V, Aber H, Bakken V, Dierkes J, Iversen SA, Kisaakye E, Kühl MJ, Nalugya JS, Rayamajhi D, Sebuwufu D, Skar AMS, Skokauskas N, Valeckaite N, Wamani H, S Engebretsen IM, Babirye JN. Child alcohol use disorder in Eastern Uganda: screening, diagnostics, risk factors and management of children drinking alcohol in Uganda (TREAT C-AUD): a mixed-methods research protocol. BMJ Paediatr Open 2021; 5:e001214. [PMID: 34345718 PMCID: PMC8322685 DOI: 10.1136/bmjpo-2021-001214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/13/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Following a finding of alcohol use among children aged 5-8 years old in Mbale, Uganda, this project investigates the magnitude of alcohol and substance use among children ged 6-13 years old and related household, community, school, health system and clinical factors. METHODS The project includes four larger work packages (WPs). WP1 comprises management, WP2 and 3 include the scientific components and WP4 includes integration of results, dissemination, policy and implementation advice. This protocol presents the planned research work in WP 2 and 3. WP2 comprises the adaptation and validation of the alcohol use screening tool Car-Relax-Alone-Forget-Family and Friends-Trouble (CRAFFT) to the age group and setting. WP3 comprises four substudies (SS). SS1 is a cross-sectional community household survey with an estimated sample size of 3500 children aged 6-13 years and their caregivers. We apply cluster sampling and systematic sampling within the clusters. Data collection includes a structured questionnaire for caregiver and child, measuring social and demographic factors, mental health status, alcohol and substance use, nutrition history and anthropometry. Urine samples from children will be collected to measure ethyl glucuronide (EtG), a biological marker of alcohol intake. Further, facilitators, barriers and response mechanisms in the health system (SS2) and the school system (SS3) is explored with surveys and qualitative assessments. SS4 includes qualitative interviews with children. Analysis will apply descriptive statistics for the primary outcome of establishing the magnitude of alcohol drinking and substance use, and associated factors will be assessed using appropriate regression models. The substudies will be analysed independently, as well as inform each other through mixed methods strategies at the stages of design, analysis, and dissemination. ETHICS AND DISSEMINATION Data protection and ethical approvals have been obtained in Uganda and Norway, and referral procedures developed. Dissemination comprises peer-reviewed, open access research papers, policy recommendations and intersectoral dialogues.Trial registration numberClinicaltrials.gov 29.10.2020 (NCT04743024).
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Affiliation(s)
- Vilde Skylstad
- Faculty of Medicine, Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Harriet Aber
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Victoria Bakken
- Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jutta Dierkes
- Department of Clinical Medicine, Centre for Nutrition, Mohn Nutrition Research Laboratory, University of Bergen, Bergen, Norway.,Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Silje Akselberg Iversen
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Esther Kisaakye
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Melf-Jakob Kühl
- Faculty of Medicine, Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Joyce Sserunjogi Nalugya
- School of Public Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Psychiatry, Mulago National Referral Hospital, Kampala, Uganda
| | - Divya Rayamajhi
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Deogratious Sebuwufu
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ane-Marthe Solheim Skar
- Faculty of Medicine, Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway.,Section for Implementation and Treatment Research, Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Norbert Skokauskas
- Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Neda Valeckaite
- Faculty of Medicine, Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Henry Wamani
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ingunn Marie S Engebretsen
- Faculty of Medicine, Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
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