Research Letter - (2022) Volume 9, Issue 5
Received: Mar 08, 2022, Manuscript No. JEBMH-21-46770; Editor assigned: Mar 11, 2022, Pre QC No. JEBMH-21-46770 (PQ); Reviewed: Mar 25, 2022, QC No. JEBMH-21-46770 ; Revised: Mar 30, 2022, Manuscript No. JEBMH-21-46770(r); Published: Apr 05, 2022, DOI: 10.18410/jebmh/2022/9.5.2
Citation: Sosengo T. Substance Abuse among Community in Harar Town, Eastern Ethiopia; a Cross Sectional Study J Evid Based Med Healthc 2022;9(05):02.
Background: Substances are anything, that is, when taken inappropriately disturbs the normal function of the body. When substances are used appropriately, they are useful for various functions. Substance abuse is the inappropriate use of substances in a manner that leads to various deleterious problems. Self-administration of drugs for nonmedical reasons is a basic feature of substance abuse. Substance abuse is posing deleterious consequences to society. Currently, about 275 million people worldwide are exposed to substance abuse at least once during their lifetime.
Objective: To assess prevalence, knowledge and reasons about substance abuse abuse among the community of Harar town, Eastern Ethiopia, from December 10, 2020 – February 1, 2021.
Methodology: Cross - sectional study was done from December 10, 2020 to February 01, 2021. Simple random sampling technique was used to collect responses from 379 respondents of Harar town. The data was collected using self-administered questionnaires and then entered and analyzed by using the statistical package for Social Science version 24.
Result: In this study, 379 respondents were included. 206 (54.4 %) of the respondents were abused to drink alcohol, while 61.5 %, 32.7 %, and 13.7 % of the respondents were abused to chew khat, smoking cigarettes and hashish respectively. The 201 (53 %), 55 (14.5 %), 48 (12.7 %),30 (7.9 %), 32 (8.4 %) of participants responded that smoking causes heart attack, diabetic ulcer, impotency, bladder cancer and poor wound healing respectively. The health risks of khat chewing reported by the participants were constipation 58 (24.1 %), loss of appetite 34 (14.1 %), gastritis 33 (13.7 %) and tooth problem 22 (9.1 %) respectively. In multivariate logistic regression, respondents with an age of less than 45 years were 19 times more likely to have adequate knowledge about substance abuse [AOR = 19, 95 % CI: 2.46 - 19.46] compared to respondents whose age is above 45 years and respondents who are literate are 43 times more likely to have adequate knowledge about substance abuse [AOR = 43.19, 95 % CI: 8.42 - 187.84].
Harar, Knowledge, Prevalence, Reason
Substances are anything, that is, when taken inappropriately disturbs the normal function of the body. When substances are used appropriately, they are useful for various functions.1 Substance abusers is the inappropriate use of substances in a manner that leads to various deleterious problems. Self-administration of drugs for nonmedical reasons is a basic feature of substance abuse.2-4 Substance abuse is posing deleterious consequences to society. Currently, about 275 million people worldwide are exposed to substance abuse at least once during their life time.5,6
Social drug use is a worldwide problem, particularly among African populations. Common substances abused in the region are alcohol, khat, and tobacco.7-9
Substance abuse causes various health problems such as hypertension, heart rhythm disorders, insomnia, liver toxicity, oral cancer, hypertension, spermatorrhoea and hemorrhoids, loss of appetite and gastrointestinal effects and psychiatric problems such as schizophrenia and psychosis.10,11 Abuse of social drugs like chat chewing is associated with medical problems like anxiety, tension, restlessness, hypnogogic hallucinations, hypomania, and aggressive behavior or psychosis among chewers. In addition, the combined use of alcohol and khat is associated with sexual risky behaviors contributing to the spread of Human Immunodeficiency Virus (HIV) infection.12,13
The deleterious impacts of substance abuse are not limited to individuals who abuse substances but also affect families, friends, various businesses, and government resources. Substance abuse and dependence have complicated the existing society problems, increasing crime rates, hospitalizations, child abuse and neglect, and rapidly consuming public funds.14
Despite such deleterious effects of substance abuse, still no study has assessed the knowledge and reasons of substance abuse among residents of Harar town.
Study Setting and Period
The study was conducted in Harar town, east Ethopia. Harar town is found 526 kms east from Addis Ababa, the capital of Ethiopia. The study was conducted from December 10, 2020 – February 1, 2021.
Study Design
Cross-sectional study was conducted among Shenkore Wereda Kebele 08 residents to assess knowledge and reasons towards substance abuse.
Population
Source and study population
• All residents of kebele.
Study population
• Individuals aged greater than 15 years and lived for at least six months in the kebele.
Sample size determination
Sample size was calculated using the formula:
Ni = (Zα / 2)2P (1-P)
d2
Where;
Ni = sample size
P = Prevalence of substance abuse among the community (50 %)
Zα / 2 = critical value at 95 % C.I (1.96)
D = margin of error (5 %)
n = (〖 (1.96)^2 x 0.5 (1 - 0.5)) / (0.05)^2 =384
Since of the population size of the kebele is 8330, which is less than 10000, the final sample size to be analyzed in the study was determined using the following equation:
Nf = ni x N / ni + N, which results in a sample size of 367. With the addition of 10 % of contingency for nonresponse, the final sample size becomes 403.
Sampling Procedures
The samples were selected by using a simple random sampling method.
Data Collection Methods
Data was collected using self-administered questionnaires. Data collectors were trained by the principal investigators (researchers) about interviewing data, study participants, and questioner filling.
Data Processing and Analysis
The collected data was coded, entered, and analyzed with SPSS version 20 program and the result is presented by Tables and Figures.
Ethical Considerations
The study was carried out after a letter of permission was obtained from School of Pharmacy, Haramaya University College of Health and Medical Science. Respondent’s data confidentiality was assured and full written informed consent was obtained from all participants before actual data collection started.
Operational definitions
Illicit (illegal) drugs: Drugs which are forbidden by law and include cocaine, heroin, hashish, cannabis, ganja, and marijuana.
Knowledge: Information and skills acquired through experience or education. The participants will be categorized depending on their level of knowledge as per the level of correct answers to 10 questions to assess knowledge.
Highly knowledgeable; if he / she answers out of 10 questions.
Fairly knowledgeable; if he / she answered out of 10 questions.
Not knowledgeable; if he / she answers (less than 3 or 3) out of 10 questions
Substance abuse: A condition in which the person uses a drug repeatedly, in ways that hurt their health.
Socio-demographic Characteristics
379 subjects were willing to be included in the study. The 55.7 % and 44.3 % respondents were male and female, respectively. Most of the respondents belong to an age range of 15 - 24 (32.5 %) and 25 - 34 (25.6 %). 10.8 % of the participants were illiterate and 26.6 % have completed primary education (Table 1).
| Variable | Frequency | Percentage (%) |
|---|---|---|
| Sex | ||
| Male | 211 | 55.7 |
| Female | 168 | 44.3 |
| Age(in years) | ||
| 15-24 | 123 | 32.5 |
| 25-34 | 97 | 25.6 |
| 35-44 | 61 | 16.1 |
| 45-54 | 56 | 14.8 |
| >55 | 42 | 11 |
| Educational status | ||
| Illiterate | 41 | 10.8 |
| Read and write | 82 | 21.6 |
| Primary school | 101 | 26 |
| Secondary school | 83 | 21.9 |
| Collage/University | 72 | 19 |
| Occupation | ||
| Government | 89 | 23.5 |
| Private sector | 67 | 17.7 |
| Self employed | 81 | 21.4 |
| Daily labor | 32 | 8.4 |
| I have no work | 110 | 29 |
| Religion | ||
| Orthodox | 172 | 45.4 |
| Muslim | 158 | 41.7 |
| Protestant | 40 | 10.6 |
| Catholic | 5 | 1.3 |
| Other* | 4 | 1.1 |
| Marital status | ||
| Single | 167 | 44.1 |
| Married | 166 | 43.8 |
| Divorced | 28 | 7.4 |
| Widowed | 18 | 4.7 |
| Monthly income | ||
| < 1000 Et Br* | ||
| 1000-5000 Et Br* | 227 | 59.9 |
| 5000-10000 Et Br* | 117 | 30.9 |
| >10000 Et Br* | 23 | 6.1 |
| 12 | 3.2 | |
Other*: No religion ; Br*: Ethiopian Birr
Practice of substance abuse
The majority, 206 (54.4 %) of the respondents were abused with alcohol. 233 (61.5 %) and 135 (35.6 %) of the respondents were abused with chew chat and cigarette smoking, respectively. Significant proportion (13.7 %) of the study participants were abused by smoking of marijuana / hashish (Table 2).15
| Variable | Frequency | Percentage (%) |
|---|---|---|
| Abuse of alcoholic | ||
| Yes | 206 | 54.4 |
| No | 173 | 45.6 |
| Abuse of khat chewing | ||
| Yes | 233 | 61.5 |
| No | 146 | 38.5 |
| Abuse of cigarette smoking | ||
| Yes | 135 | 35.6 |
| No | 244 | 64.4 |
| Abuse of marijuana /hashish | ||
| Yes | 52 | 13.7 |
| No | 327 | 86.3 |
Reasons of Substance Abuse
Various reasons were forwarded by the study participants about the causes of substance abuse. The most common reasons mentioned for the abuse of chat chewing were to increase work or academic performance 73 (31.3 %), followed by to stay awake 50 (21.5 %). The majority of the respondents replied that they abuse alcohol to get personal pleasure 101 (49 %) and due to peer influence (24.3 %) (Table 3).
| Variable | Reason for abuse | Frequency | Freq* | (%)* |
|---|---|---|---|---|
| Khat Chewing | To increase work or academic performance | To increase work or academic performance | 73 | 31.3 |
| Due to family chewing habit | Due to family chewing habit | 20 | 8.6 | |
| To stay awake | To stay awake | 50 | 21.5 | |
| Peer pressure | Peer pressure | 26 | 11.2 | |
| To get personal pleasure | To get personal pleasure | 32 | 13.7 | |
| To increase work or academic performance | To increase work or academic performance | 12 | 5.2 | |
| +family chewing habit + to stay awake | ||||
| To stay awake +peer pressure to get | To stay awake +peer pressure to get | 15 | 6.4 | |
| Personal pleasure | ||||
| All | 5 | 1.3 | ||
| Alcohol drinking | To get personal pleasure | To get personal pleasure | 101 | 49 |
| Peer influence | Peer influence | 50 | 24.3 | |
| Due to academic work dissatisfaction | Due to academic work dissatisfaction | 16 | 7.8 | |
| To be sociable | To be sociable | 25 | 12.1 | |
| To increase pleasure during sexual practice | To increase pleasure during sexual practice | 2 | 1 | |
| To get personal pleasure + | To get personal pleasure + | 12 | 5.8 | |
| peer influence + academic work | peer influence + academic work | |||
| dissatisfaction + to be sociable | dissatisfaction + to be sociable | |||
| Freq*: Frequency | %: Percentage | |||
Knowledge on Substance Abuse
324 (85.8 %) of the respondents were adequately knowledgeable and 54 (14.2 %) inadequately knowledgeable effects of substance abuse (Figure 1).
Figure 1. Study participant's knowledge about substance abuse,February, 2021.
Knowledge towards Health Problems Caused Substance Abuse
The health risks of khat chewing reported by the participants were constipation 58 (24.1 %), loss of appetite 34 (16 %), gastritis 33 (13.7 %) and tooth problem 22 (9.1 %) respectively (Table 4).
| Variable | Frequency | Percentage (%) |
|---|---|---|
| Health risks caused by khat chewing | ||
| Constipation | 58 | 24.2 |
| Loss of appetite | 34 | 14.1 |
| Gastritis | 33 | 13.7 |
| Teeth problem | 22 | 9.1 |
| Decrease in sexual desire | 15 | 6.2 |
| Constipation + loss of appetite + | 30 | 12.4 |
| Gastritis + teeth problem | ||
| All | 31 | 12.9 |
| No problem | 18 | 7.5 |
The 201 (53 %), 55 (14.5 %), 48 (12.7 %),30 (7.9 %), and 32 (8.4 %) of participants responded that smoking causes heart attack, diabetic ulcer, impotency, bladder cancer and poor wound healing respectively (Figure 2).
Figure 2. Health risks of cigarette smoking mentioned by study participant,February 2021.
Determinants of Treatment Outcomes
In the bivariate logistic regression, the association of sex, educational status, and age towards knowledge about substance abuse was assessed. Accordingly, sex, educational status, and age were significantly associated with knowledge about substance abuse [p < 0.05]. In multivariate logistic regression, respondents with an age of less than 45 years were 19 times more likely to have adequate knowledge about substance abuse [AOR = 19, 95 % CI: 2.46 - 19.46] compared to respondents whose age is above 45 years and respondents who are literate are 43 times more likely to have adequate knowledge about substance abuse [AOR = 43.19, 95 % CI: 8.42 - 187.84] (Table 5).16
| Variable | Odd ratio (95% CI) | P-value | |||
|---|---|---|---|---|---|
| Adequate knowledge | Inadequate knowledge | COR | AOR | ||
| Sex | |||||
| Male | 181 | 30 | 2.76 (1.4 - 6.57) | 0.381(0.147-1.654) | 0.03* |
| Female | 144 | 24 | 1 | 1 | |
| Age | |||||
| 15-45 | 270 | 11 | 0.063(0.017-0.253) | 19(2.46-19.46) | 0.002* |
| > 45 | 55 | 43 | 1 | 1 | |
| Educational Status | |||||
| Illiterate | 6 | 35 | 0.101(0.020-0.507) | 43.19(8.42-187.84) | 0.003* |
| Literate | 319 | 19 | 1 | 1 | |
COR-Crude Odds Ratio, AOR-Adjusted Odds Ratio, * statistically significant, CI-Confidence Interval
In the current study, 61.5 % of the respondents were abused for chewing khat. This result is higher than a report of Sebata town, Ethiopia (52.3 %),15 Jazan region of Saudi Arabia (21.46 %),16 and Gondar, Ethiopia (42 %).17The discrepancy in the results may be due to differences in sample sizes and culture among the respondents.
In the present study, the major reasons given by the study participants for chewing khat were to increase academic (work) performance (31.3 %) and to stay awake (21.55 %). This in opposite to the report of a study done in Gondar, Ethiopia, which revealed that the majority of the respondents replied that they chew khat for entertainment (62.3 %) and relaxation (36.9 %).16,17 This finding is significantly higher than the result of a study done in Meru, Kenya, among secondary students in which 58 (28.9 %), 16 (8 %), 5 (2.5 %) and 5 (2.5 %) respondents reported that they chew Khat for reasons getting concentration, entertainment, get good health and relief from stress respectively.18
54.4 % of the study participants were abused to alcohol consumption. The finding is significantly higher than the study reports of a study done in Jimma town, Ethiopia (11.5 %) and in Iran (33 %).19,20This difference could be due the difference in sample size, geographical location, and culture of the study respondents. The present study finding is lower than the study report of a study done in Mekelle town, Ethiopia, in which 64.9 % of the study participants were addicted to alcohol consumption.13
The prevalence of cigarette smoking in this study is 35.6 %. This result is significantly higher than the study done in Mekelle University, Ethiopia, and the study conducted among Shahroud University students in which 29.5 % and 20 % of the respondents were addicted to cigarette smoking.13,20 This variation may be due to a difference in the cultural and educational status of the study participants.
In this study, 85.8 % and 14.2 % of participants were adequately and inadequately knowledgeable about substance abuse and its harmful effects on health. This result is almost in line with the result of another study done in India, in which 84 % of the respondents had knowledge regarding the harmfulness of substance abuse. The current finding is higher than the result of a study carried out in International Islamic University of Malaysia, in which 63.5 % of the respondents had good knowledge about the consequences of substance abuse.14 This variation in the results could be due to the socio-demographic and cultural variation.
In this study, the majority of the respondents reported that constipation 59 (24.2 %) and loss of appetite 39 (16 %) were health risks of khat chewing. This result is in concordance with the study done in Sebata, Ethiopia, and Kaffa Zone, Ethiopia.15 The current result is in opposite to a study report of a study done in Meru, Kenya, in which 37.8 % and 20.9 % respondents reported harmful effects of Chewing Khat on teeth and other body systems.18
Despite the high levels of knowledge regarding substance abuse, the prevalence of substance abuse among the community remains high. Thus, concerned bodies like health bureaus and nongovernmental organizations should take measures to decrease the prevalence of substance abuse among the community.
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