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Ebrahim J, Adams J, Demant D. Substance use among young people in sub-Saharan Africa: a systematic review and meta-analysis. Front Psychiatry 2024; 15:1328318. [PMID: 39323964 PMCID: PMC11422104 DOI: 10.3389/fpsyt.2024.1328318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 08/05/2024] [Indexed: 09/27/2024] Open
Abstract
Background The use of substances such as alcohol, tobacco, khat, or drugs among young people is becoming a public health concern globally, with particularly high prevalence rates in low and middle-income settings, where socio-cultural and economic factors contribute to distinct challenges in addressing this problem. This review aimed to summarize the current literature on the prevalence of substance use among young people in sub-Saharan Africa (SSA) and identify gaps in the current body of literature. Methods Seven databases and Google were searched for studies reporting on substance use prevalence among young people (aged 10-24 years) in SSA, published between January 2010 and May 2024. Observational studies were included, assessed for methodological quality, and checked for the presence of heterogeneity and publication bias using standard methods. A random effect model was used to estimate the pooled proportions for substance use among young people. Results The literature search identified 1,889 hits from the databases and Google. Among these 60 eligible studies involving 83,859 respondents were included in the review. The overall lifetime, 12-month, and current prevalence of any substance use among young people in SSA was found to be 21.0% (95% CI= 18.0, 24.0), 18% (95% CI=10,27), and 15% (95% CI=12,18), respectively. Among young people from SSA, alcohol use problem was the most prevalent (40%), followed by khat use (25%), stimulant use (20%), and cigarette smoking (16%). Other substances used by a smaller proportion of young people included cannabis, cocaine, inhalants, sedatives, shisha, hallucinogens, steroids, and mastics. The prevalence of substance use problems was higher among males compared to females, highest in the southern African region followed by Western and Eastern regions, and in community-based studies compared to institutional-based studies. Conclusions In SSA, over a fourth of young people use at least one substance in their lifetime, with higher rates among males than females and in community-based compared to institution-based studies. These results emphasize the need for interventions targeting the wider young population and those in specific subgroups identified as being at higher risk of substance use. This approach allows for the provision of tailored support and resources to those who need it most while also promoting positive health outcomes for the entire population of young people in the region. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022366774, identifier CRD42022366774.
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Affiliation(s)
- Jemal Ebrahim
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
- Department of Psychiatry, Faculty of Health Sciences, Madda Walabu University, Shashemene, Ethiopia
| | - Jon Adams
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Daniel Demant
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
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Nguata M, Orwa J, Kigen G, Kamaru E, Emonyi W, Kariuki S, Newton C, Ongeri L, Mwende R, Gichuru S, Atwoli L. Association between psychosis and substance use in Kenya. Findings from the NeuroGAP-Psychosis study. Front Psychiatry 2024; 15:1301976. [PMID: 38501084 PMCID: PMC10945606 DOI: 10.3389/fpsyt.2024.1301976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/06/2024] [Indexed: 03/20/2024] Open
Abstract
Background Substance use is prevalent among people with mental health issues, and patients with psychosis are more likely to use and misuse substances than the general population. Despite extensive research on substance abuse among the general public in Kenya, there is a scarcity of data comparing substance use among people with and without psychosis. This study investigates the association between psychosis and various substances in Kenya. Methods This study utilized data from the Neuro-GAP Psychosis Case-Control Study between April 2018 and December 2022. The KEMRI-Wellcome Trust Research Programme recruited participants from various sites in Kenya, including Kilifi County, Malindi Sub-County, Port Reitz and Coast General Provincial Hospitals, and Moi Teaching and Referral Hospital, as well as affiliated sites in Webuye, Kapenguria, Kitale, Kapsabet, and Iten Kakamega. The collected data included sociodemographic information, substance use, and clinical diagnosis. We used the summary measures of frequency (percentages) and median (interquartile range) to describe the categorical and continuous data, respectively. We examined the association between categorical variables related to psychosis using the chi-square test. Logistic regression models were used to assess the factors associated with the odds of substance use, considering all relevant sociodemographic variables. Results We assessed a total of 4,415 cases and 3,940 controls. Except for alcohol consumption (p-value=0.41), all forms of substance use showed statistically significant differences between the case and control groups. Cases had 16% higher odds of using any substance than controls (aOR: 1.16, 95%CI: 1.05-1.28, p=0.005). Moreover, males were 3.95 times more likely to use any substance than females (aOR:3.95; 95%CI: 3.43-4.56). All the categories of living arrangements were protective against substance use. Conclusion The findings of this study suggest that psychotic illnesses are associated with an increased likelihood of using various substances. These findings are consistent with those of previous studies; however, it is crucial to investigate further the potential for reverse causality between psychosis and substance abuse using genetically informed methods.
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Affiliation(s)
- Monica Nguata
- Department of Post Traumatic Stress Disorder (PTSD) Tnx, Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - James Orwa
- Department of Population Health, Medical College of East Africa Aga Khan University, Nairobi, Kenya
| | - Gabriel Kigen
- Department of Pharmacology and Toxicology, Moi University School of Medicine, Eldoret, Kenya
| | - Edith Kamaru
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Wilfred Emonyi
- Department of Immunology, Moi University School of Medicine, Eldoret, Kenya
| | - Symon Kariuki
- Neuroscience Unit, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Charles Newton
- Neuroscience Unit, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Linnet Ongeri
- Neuroscience Unit, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - Rehema Mwende
- Neuroscience Unit, Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Stella Gichuru
- Department of Medicine, Medical College East Africa, the Aga Khan University, Nairobi, Kenya
| | - Lukoye Atwoli
- Department of Medicine, Medical College East Africa, the Aga Khan University, Nairobi, Kenya
- Department of Mental Health and Behavioural Sciences, Moi University School of Medicine, Eldoret, Kenya
- Brain and Mind Institute, the Aga Khan University, Nairobi, Kenya
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Jaguga F, Ott MA, Kwobah EK, Apondi E, Giusto A, Barasa J, Kosgei G, Rono W, Korir M, Puffer ES. Adapting a substance use screening and brief intervention for peer-delivery and for youth in Kenya. SSM - MENTAL HEALTH 2023; 4:100254. [PMID: 38047062 PMCID: PMC10688596 DOI: 10.1016/j.ssmmh.2023.100254] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Background Substance use is a major problem among youth in sub-Saharan Africa, yet interventions that address this problem are scarce within the region. Screening and brief intervention is a cost-effective, efficacious, and easy to scale public health approach to addressing substance use problems. We conducted a pilot study to evaluate the feasibility of implementing a peer delivered screening and brief intervention program for youth in Kenya. The goal of this paper is to report on the process of adapting the Alcohol Smoking and Substance Involvement Screening Test for Youth- linked Brief Intervention (ASSIST-Y-linked BI) program for peer delivery and for the Kenyan context prior to the pilot. Methods The adaptation process was led by a multi-disciplinary team comprised of psychiatrists, pediatricians, and psychologists. We utilized the ADAPT-ITT framework to adapt the ASSIST-Y-linked BI. The ADAPT-ITT framework consists of 8 phases including Assessment, Decision making, Adaptation, Production, Topical Experts, Integration, Training, and Testing the evidence-based intervention. Here, we report on phases 1-7 of the framework. The results of the pilot testing have been published elsewhere. Results Overall, we made surface level adaptations to the ASSIST-Y-linked BI program such as simplifying the language to enhance understandability. We maintained the core components of the program i.e., Feedback, Responsibility, Advice, Menu of Options, Empathy, Self-efficacy (FRAMES). Conclusions Our paper provides information which other stakeholders planning to implement the ASSIST-Y-linked BI for youth in sub-Saharan Africa, could use to adapt the intervention.
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Affiliation(s)
- Florence Jaguga
- Moi Teaching & Referral Hospital Department of Mental Health, PO BOX 3-30100, Eldoret Kenya
| | - Mary A. Ott
- Division of Adolescent Medicine, Department of Pediatrics, Indiana University, Indiana, USA
| | - Edith Kamaru Kwobah
- Moi Teaching & Referral Hospital Department of Mental Health, PO BOX 3-30100, Eldoret Kenya
| | - Edith Apondi
- Moi Teaching & Referral Hospital Department of Mental Health, PO BOX 3-30100, Eldoret Kenya
| | - Ali Giusto
- Columbia University Medical Center/New York State Psychiatric Institute, New York, 40 Haven Ave., #171. New York, NY 10032. USA
| | - Julius Barasa
- Academic Model Providing Access to Healthcare. PO BOX 4606-30100, Eldoret, Kenya
| | - Gilliane Kosgei
- Academic Model Providing Access to Healthcare. PO BOX 4606-30100, Eldoret, Kenya
| | - Wilter Rono
- Academic Model Providing Access to Healthcare. PO BOX 4606-30100, Eldoret, Kenya
| | - Mercy Korir
- Academic Model Providing Access to Healthcare. PO BOX 4606-30100, Eldoret, Kenya
| | - Eve S. Puffer
- Department of Psychology & Neuroscience, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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Kiburi SK, Paruk S, Kwobah EK, Chiliza B. Exploring user experiences of a text message-delivered intervention among individuals on opioid use disorder treatment in Kenya: A qualitative study. PLOS DIGITAL HEALTH 2023; 2:e0000375. [PMID: 37930956 PMCID: PMC10627438 DOI: 10.1371/journal.pdig.0000375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/23/2023] [Indexed: 11/08/2023]
Abstract
Opioid use disorder causes significant burden of disease and treatment comprises pharmacotherapy and psychosocial treatment. Cognitive behavioral therapy is an effective psychosocial intervention used in substance use disorders treatment and can be delivered using digital approach. There is limited use of digital treatment among individuals with opioid use disorder in Kenya. This study aimed to describe the experiences and feedback from participants with opioid use disorder enrolled in a text-message intervention in Kenya. Qualitative data was collected from participants in the intervention arm of a feasibility trial testing a text-message intervention based on cognitive behavioral therapy. Data was collected using open-ended questions in a questionnaire and structured in-depth interviews amongst those who received the intervention. Framework method was applied for analysis. Twenty-four participants (83.3% males) were enrolled with a mean age of 32.5 years (SD9.5). Five themes were identified namely: (1) Gain of cognitive behavioral therapy skills which included: identification and change of substance use patterns; drug refusal skills; coping with craving and self-efficacy; (2) Therapeutic alliance which included: development of a bond and agreement on treatment goals; (3) Feedback on intervention components and delivery such as: frequency, and duration of the text message intervention; (4) Challenges experienced during the intervention such as: technical problems with phones; and barriers related to intervention delivery; (5) Recommendations for improvement of intervention in future implementations. The findings demonstrated participants' satisfaction with intervention, gain of skills to change substance use patterns, highlighted challenges experienced and suggestions on improving the intervention among individuals with opioid use disorder. The feedback and recommendations provided by the participants can guide implementation of such interventions to allow acceptability, effectiveness and sustainability. Trial registration: This study was part of a randomized feasibility trial. Clinical trial registration: Pan African Clinical Trial Registry: Registration number: PACTR202201736072847. Date of registration: 10th January 2022.
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Affiliation(s)
- Sarah Kanana Kiburi
- Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya
- Discipline of Psychiatry, University of KwaZulu Natal, Durban, South Africa
| | - Saeeda Paruk
- Discipline of Psychiatry, University of KwaZulu Natal, Durban, South Africa
| | - Edith Kamaru Kwobah
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Bonginkosi Chiliza
- Discipline of Psychiatry, University of KwaZulu Natal, Durban, South Africa
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Kiburi SK, Paruk S, Chiliza B. Mobile phone ownership, digital technology use and acceptability of digital interventions among individuals on opioid use disorder treatment in Kenya. Front Digit Health 2022; 4:975168. [PMID: 36093384 PMCID: PMC9452845 DOI: 10.3389/fdgth.2022.975168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background There is limited research on the use of digital interventions among individuals with opioid use disorders (OUD) in low-and-middle income countries. This study aimed to assess mobile phone ownership, digital technology use and acceptability of digital interventions for treatment among individuals on treatment for OUD in Nairobi, Kenya. Methods A cross-sectional study was conducted among individuals with OUD. Structured questionnaires were used to collect data on socio-demographic and clinical characteristics, use of mobile phones and other digital technology and acceptability of digital interventions for treatment. Results One hundred and eighty participants were enrolled comprising 83.3% males with mean age of 31.5 years (SD 8.6). Mobile phone ownership was reported by 77.2% of participants of which 59.7% used smartphones. One hundred and sixty-six (92.2%) used phones to call, 82.8 and 77.2% used phones to send and receive text messages respectively; 30% used the internet; 57.2% had replaced the phone in past year and 51.1% of participants reported use of at least one social media platform, of these 44.4% had searched social media for information on drug use. Acceptability to receive treatment by phone was 95% and computer 49.4% with majority (88.1%) preferring a text message-based intervention. The preferred approach of delivery of a text message-based intervention were: one text message per day once a week, message to be personalized and individuals allowed to choose time and day to receive the message. Factors associated with acceptability of digital interventions were education level, being single, smartphone ownership and employment. Conclusion Majority of individuals on treatment for OUD had access to mobile phones but with high device turnover and limited access to computers and internet. There was high acceptability of digital interventions to provide treatment for OUDs, mostly through phones. These findings highlight factors to consider in the design of a digital intervention for this population.
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Affiliation(s)
- Sarah Kanana Kiburi
- Discipline of psychiatry, Nelson Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
- Mbagathi Hospital, Nairobi Metropolitan Services, Nairobi, Kenya
- Correspondence: Sarah Kanana Kiburi
| | - Saeeda Paruk
- Discipline of psychiatry, Nelson Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Bonginkosi Chiliza
- Discipline of psychiatry, Nelson Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
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