Browsing by Subject "Alcohol"

Background: Harmful alcohol use and violence are both major contributors to global mortality and morbidity rates, despite being both predictable and preventable. This study seeks to quantitatively determine the scope of violence-related injury and Alcohol Use Disorders in a referral hospital in Moshi, and qualitatively determine 1) how violence-related injury patients perceive alcohol use influences the occurrence of violence and 2) how experiencing a violence-related injury influences patients’ subsequent alcohol use behavior.

Methods: This study was conducted at Kilimanjaro Christian Medical Center (KCMC). Survey data was obtained from a trauma registry including all injury patients ≥ 18 years admitted to the emergency room. Interview participants were included if they reported their injury was due to violence, tested positive for alcohol (by breathalyzer) upon admittance, medically stable, able to communicate and provide informed consent in Swahili or English, and clinically sober at the time of enrollment.

Results: From the 500 injury patients enrolled in the trauma registry from April 17, 2018 to January 12, 2019, 84 (16.8%) reported that their injury was due to violence. Patients with violent injuries were 2.21 times more likely to have a positive alcohol status compared to non-violent injuries (95% CI 1.36, 3.60, p<0.01). Among violent injuries, those with a positive alcohol status were 6.26 times more likely to have an Alcohol Use Disorder compared to those with a negative alcohol status (95% CI 2.13, 18.39, p<0.001). Interview respondents reported a perception that violent injuries were worse from other injuries, that the perpetrator was also under the influence of alcohol, that alcohol contributes to violence, and a desire to change alcohol use behavior following their injury.

Conclusion: Alcohol use and violence-related injury pose a significant threat to health and well-being globally. In Moshi, Tanzania, both issues are prevalent and contribute to a sufficient disease burden. This study has added to the data on alcohol-attributable harm, contributing to expanding information available on this issue from LMICs. To adequately reduce violence-related injuries in this setting, it is necessary to address harmful alcohol use as well.

Background: Alcohol consumption is a major risk factor for several adverse health effects globally and is associated with a high disease burden of malnutrition in Tanzania. This study aims to: 1) assess the practicality and effectiveness of mid-upper arm circumference (MUAC) as a feasible bedside measure to detect malnutrition among adult and pediatric patients, 2) evaluate the association between alcohol use and nutritional status among adult injury patients and 3) qualitatively identify social determinants of malnutrition in Tanzania. Methods: This mixed-method study was conducted in Kilimanjaro Christian Medical Centre. Receiver Operating Characteristic (ROC) curves and logistic regression were used for quantitative data on alcohol use, body mass index (BMI), MUAC. Thematic approach was used for qualitative data on perspectives on alcohol use and its interactions with malnutrition. Results: MUAC cut-offs were determined at < 25.5 cm (BMI < 16 kg/m2) for severely underweight, < 28 cm (BMI < 18.5 kg/m2) for underweight, ≥ 30.5 cm (BMI ≥ 25 kg/m2) for overweight, ≥ 33 cm (BMI ≥ 30 kg/m2) for obese. The association between alcohol use and malnutrition (MUAC < 25.5 cm) was statistically significant. Qualitative results helped explain the association between alcohol use and malnutrition. Conclusions: MUAC is an effective tool to detect adult malnutrition to inform clinical practice in Tanzania. Polarizing attitudes towards drinking revealed by qualitative data suggested the need for alcohol awareness campaigns. Food assistance programs are needed to reduce the risk of malnutrition among vulnerable populations.

Background: The Western Cape Province of South Africa has one of the highest documented rates of FASD globally. In order to establish FASD prevention interventions that can effectively reach women in this high-risk population, it is important to understand the attitudes that women hold towards alcohol use during pregnancy and examine reasons why positive attitudes may not necessarily translate to behavior in this setting. Study aims: The aims of this secondary analysis were to: describe the attitudes towards alcohol use during pregnancy, compare attitudes with alcohol use behaviors during past pregnancies, and build a logistic regression model to examine predictors of harmful attitudes toward alcohol use during pregnancy. These quantitative aims then set the stage for a qualitative exploration of reasons for harmful behaviors, in spite of attitudes that would support drinking cessation during pregnancy. Methods: This study is based on cross-sectional data from 200 women who were recruited from alcohol-serving venues in a single township in Cape Town, South Africa. A sub-set of 24 was selected to participate in-depth qualitative interviews. Measures of interest included: demographics, attitudes about alcohol use during pregnancy, history of abuse, depression, current drinking behavior, drinking during past pregnancy, and pregnancy intentions and attitudes. Quantitative analysis was conducted in three steps. First, descriptive statistics were used to describe the sample. Second, drinking behaviors in past pregnancies and attitudes toward alcohol use during pregnancy were examined separately and then together in order to describe any potential attitude/behavior gap in this population. Third, logistic regression models were built to examine predictors of attitudes toward alcohol use during pregnancy. Interviews were reviewed and coded for emergent themes under categories that were identified a priori: knowledge about risks of alcohol use during pregnancy, contributors to alcohol use during pregnancy, and contributors to resiliency against alcohol use during pregnancy. Results: The sample of 200 women ranged in age from 18 to 43, were all of Coloured (mixed-race) ancestry, and most had not completed secondary school. Most were not intending to become pregnant and most reported a history of abuse. Though approximately 83% (n=164) of women with a history of pregnancy did not report having harmful attitudes toward alcohol use during pregnancy, more than half of these women (n=84, 51.2%) still reported alcohol use during a previous pregnancy. This discrepancy revealed the existence of a stark attitude-behavior gap in which the holding of harmful attitudes toward alcohol use during pregnancy is not entirely predictive of alcohol use during pregnancy. The strongest predictors of holding harmful attitudes were a history of abuse (AOR=3.33, 95% CI 1.06-10.50) and drinking during a previous pregnancy (AOR=6.87, 95% CI 1.79-26.33). Qualitative data analysis revealed several factors that contributed to alcohol use during pregnancy: 1) Having an unplanned pregnancy; 2) Drinking because of stress or to cope; 3) History of abuse or trauma; 4) Reliance on the venue space for solace; 5) Recreation; and 6) Feelings of invincibility. Conclusions: These data further define the existence of an attitude-behavior gap in this population and highlight that in this setting, having non-harmful attitudes might not be enough to elicit healthy behavior. This points to a need for identification and implementation of policies or interventions that go beyond education to build intrinsic motivation to refrain from alcohol use during pregnancy.

Alcohol Use Disorder (AUD) and Major Depressive Disorder (MDD) account for millions of deaths and disabilities each year with many theories on the interaction between the two disorders. Tanzania has a high rate of harmful alcohol use, depression, and alcohol-related injuries. To address the growing burden, a nurse-led Brief Negotiational Intervention (BNI) was implemented in the Kilimanjaro Christian Medical Centre Emergency Department in 2020. Three-month outcomes from this study have shown that AUDIT scores are not significantly reduced by the intervention. Thus, this study aims to explore the relationship and potential mediating effects of depression within the context of the BNI at KCMC ED. For quantitative aims, we used secondary data from the PRACT 6-month outcomes. We compared demographic characteristics between AUDIT/PHQ-9 categories using median, IQR, Kruskal-Wallis, and Fisher’s Exact Test. We then specified two cross-sectional structural equation models at 3 and 6 months to explore depression as a mediator between BNI and AUDIT scores. For our qualitative aim, we conducted 15 semi-structured interviews and analyzed data using a thematic coding approach. Out of our 282 participants, demographic characteristics differed between AUDIT/PHQ-9 groups on gender and education. Additionally, depression does not mediate the relationship between BNI and AUDIT scores at 3 or 6 months. However, BNI is reducing AUDIT and PHQ-9 scores at 6 months. Our qualitative data highlights the association between AUD and MDD and explores the importance of social communities for both disorders. More research is needed to determine the temporality between AUD and MDD in this context. Yet, this study has provided evidence that an alcohol-based BNI has provided benefits for AUD and MDD. Thus, it’s imperative to capitalize on this unintended intervention effect and modify the intervention to include a mental health component.

Background: Self Determination Theory (SDT) conceptualizes human motivation in terms of a spectrum. However, literature is scarce on how to measure self-determination in different languages or how self-determination can influence the effectiveness of healthcare interventions. The aim of this study was to translate and culturally adapt a psychometric questionnaire on self-determination (TSRQ) as well as SMS booster messages for a Brief Intervention (BI) aimed at reducing harmful alcohol use among injury patients presenting at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania.

Methods: A mixed-methods approach was used to evaluate the psychometric properties of the TSRQ and SMS booster messages. Likert-scale surveys were administered on expert panels to assess translation quality and adherence to theory.

Results: Quantitative analyses confirmed that the Swahili translation of the TSRQ accurately reflected SDT constructs. Exploratory Factor Analysis (EFA) revealed a two-domain model had a better fit than the original three-domain TSRQ. Expert panel surveys indicated that the SMS booster messages maintained strong connections to tenets of SDT.

Conclusion: This was the first study to conduct a cross-cultural validation of the TSRQ in Tanzania and the first to implement and assess motivational constructs in SMS booster messages for a BI to promote safe alcohol use. The TSRQ is a valid, clinically useful scale but could be improved with more items. SMS booster messages touch on many SDT constructs, affirming their motivational utility.

Alcohol is a leading risk factor for injury. Road traffic injuries are a leading killer, but perceptions of drinking and drink driving in Tanzania are unclear. This research aims to define how perceptions of drinking influence risky driving behavior at Kilimanjaro Christian Medical Center in Moshi, Tanzania. This mixed methods study incorporated the Alcohol Adapted Perceived Discrimination-Devaluation scale (PDD) and the Alcohol Use Disorders Identification Test (AUDIT) among 96 injury patients regardless of their alcohol use prior to injury. Results were reported as medians and IQRs with Kurskal Wallis tests. Additionally, focus groups with injury patients, their families, and community members (n = 63) were conducted and analyzed in parallel using an inductive thematic content analysis approach. Of the 96 injury patients surveyed, 53 used alcohol and 17%(n=9) of those self-reported driving after ingesting 3 or more alcoholic drinks (SRDD). SRDD’s average AUDIT score (median=11) was significantly different from those who denied drink driving (median=6, p= 0.03). The PDD showed a high overall stigma, particularly discrimination, against those who use alcohol; but, the PDD was similar for drinkers and abstainers from alcohol (median=2.7 and 3.1, respectively). Thematic content analysis highlighted an ‘inability to change those that drink drive, ‘disapproving of drink driving’, and a ‘necessary police enforcement on drink driving.’ While stigma is present in Tanzania against those who use alcohol, it does not impact the choice to drink and drive, and was not stronger in drinkers or abstainers. Overall, there appears to be a community-wide disapproval of drinking and driving coupled with feeling unable to change this risky behavior.

Alcohol use is one of the leading risk factors worldwide for death and disability-adjusted life years. The WHO Africa region consumes on average 20% more alcohol per day than the global average, with Tanzania ingesting especially large quantities. However, resources, trained personnel, and services for treating unhealthy alcohol use and users in this region are scarce. Women’s drinking behavior in particular has been historically understudied, and the existing resources in this area have not been equitably accessed and utilized by women. This research seeks to fill this gap in understanding women’s drinking behaviors and the impact of gender on alcohol use, with the long-term goal of informing future women-focused alcohol reduction programs. This is a sequential explanatory mixed-methods study that used quantitative survey responses to guide qualitative semi-structured in-depth interviews (IDIs). The methods and results compiled here are based on preliminary data (300 survey responses and 8 IDIs) as collection is still ongoing at the time of this defense. The results of this thesis have indicated that men and women in Moshi have distinct patterns of alcohol use, an outcome that is mediated by multiple socio-cultural factors and likewise produces unique consequences for each gender. This data indicates that future alcohol-focused programs may need to be differentiated by gender if they are to effectively minimize the burden caused by alcohol in this region.