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Francis, JM (2015) Epidemiology of alcohol use and alcohol use disor PDF

178 Pages·2017·6.28 MB·English
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LSHTM Research Online Francis, JM; (2015) Epidemiology of alcohol use and alcohol use disorders (AUD) among young people in Northern Tanzania. PhD thesis, London School of Hygiene & Tropical Medicine. DOI: https://doi.org/10.17037/PUBS.02374475 Downloaded from: https://researchonline.lshtm.ac.uk/id/eprint/2374475/ DOI: https://doi.org/10.17037/PUBS.02374475 Usage Guidelines: Please refer to usage guidelines at https://researchonline.lshtm.ac.uk/policies.html or alternatively contact [email protected]. Available under license. To note, 3rd party material is not necessarily covered under this li- cense: http://creativecommons.org/licenses/by-nc-nd/3.0/ honline.lshtm.ac.ukhttps://researc EPIDEMIOLOGY OF ALCOHOL USE AND ALCOHOL USE DISORDERS (AUD) AMONG YOUNG PEOPLE IN NORTHERN TANZANIA Joel Msafiri Francis Thesis submitted in accordance with the requirements for the degree of Doctor of Philosophy University of London AUGUST 2015 Department of Infectious Disease Epidemiology Faculty of Epidemiology and Population Health LONDON SCHOOL OF HYGIENE & TROPICAL MEDICINE Funded by STRIVE RPC, an international research consortium funded by the UK Department for International Development (DFID) to investigate structural drivers of HIV. 1 I, Joel Msafiri Francis, confirm that the work presented in this thesis is my own. Where information has been derived from other sources, I confirm that this has been indicated in the thesis. Date: 31st July 2015 2 Acknowledgement I must admit PhD work involves a lot of sacrifice and commitments, it has been a very demanding undertaking but extremely useful journey for my research and academic career. In this engagement, I developed research concepts, designed, implemented, analyzed the data and prepared reports on the research findings. I have attained this milestone with support of the Almighty Lord and individuals described below. I am extremely grateful to my supervisors Professor Heiner Grosskurth and Professor Helen Weiss for continuous guidance and support in this training. My supervisors made things look simpler and meaningful even in the moments where I thought it was impossible. I extend my sincere thanks to the PhD advisory committee (Dr Saidi Kapiga, Prof David Ross and Prof Jim McCambridge) for their valuable inputs that shaped PhD research ideas and Ms Kathy Baisley for her immense support during the data analysis for the cross- sectional study among young people in Mwanza and Kilimanjaro. I thank the PhD upgrading examiners (Prof Liam Smeeth and Ms Kathy Baisley) and the chairperson, Prof Suzanne Filteau for their valuable advice to consider an evaluation of alcohol screening tools using biomarkers in African young people. I greatly appreciate support of Mr John Changalucha, director of the National Institute for Medical research, Mwanza centre and Dr Saidi Kapiga, scientific director of Mwanza Intervention Trials Unit (MITU) for the opportunity and the resources to pursue this training through a research consortium funded by the UK Department for International Development (DFID) to investigate structural drivers of HIV (STRIVE RPC). 3 I am very thankful to the STRIVE RPC teams in Mwanza and London, specifically to Dr Gerry Mshana, Prof Charlotte Watts and Dr Lori Heise for their support in funding of the studies and critical comments on the implementation plans. Studies conducted in this PhD training contributed to the objectives and outputs of the STRIVE RPC. Lastly but not least, I thank all study participants, heads of local institutions and work places in Tanzania for their permission to conduct the research. I am also grateful for the contribution of the fieldworkers who helped me to collect the data, and of the data management team at MITU/NIMR in Mwanza who entered the data. 4 List of Abbreviations AUD Alcohol Use Disorders AUDIT Alcohol Use Disorders Identification Test AUROC Area Under Receiver Operating Characteristics Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers - CAGE screening test for problem drinking and potential alcohol problems CDT Carbohydrate-Deficient Transferrin CI Confidence Interval DALY Disability-Adjusted Life Year DFID UK Department for International Development DSM IV Diagnostic and Statistical Manual of Mental Disorders GGT Gamma-Glutamyl Transferase HIV Human Immunodeficiency Virus IQR Interquartile range MINI Mini International Neuropsychiatric Interview questionnaire MITU Mwanza Intervention Trials Unit NIMR National Institute for Medical Research PEth Alcohol biomarker Phosphatidylethanol PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses QATSO Quality Assessment Tool for Systematic reviews of Observational studies SSA Sub Saharan Africa STIs Sexually Transmitted Infections acronym of a Research Programme Consortium (RPC) to investigate STRIVE RPC Structural Drivers of HIV Infection STROBE Strengthening the Reporting of Observational studies in Epidemiology TB Tuberculosis TFLB Time Line Follow Back calendar WHO World Health Organisation 5 Abstract Excessive alcohol use is a significant public health problem globally. Alcohol use typically begins in adolescence or early adult life, and effective prevention strategies focused on this age group are needed to avoid initiation of harmful drinking. The aims of this PhD are to understand the epidemiology of alcohol use and alcohol use disorders (AUD) in East Africa, to validate self-reported alcohol use among young people in Tanzania, and to use the findings to recommend strategies for the prevention or reduction of harmful alcohol use among young people. Specific objectives include (1) to systematically review the evidence on alcohol use among young people in eastern Africa; (2) to estimate the prevalence of alcohol use, AUD and associated risk factors among different groups of young-people in northern Tanzania; (3) to assess the validity of self- reported alcohol use against the blood biomarker phosphatidylethanol (PEth); and (4) to assess the validity of the Mini International Neuropsychiatric Interview questionnaire (MINI) for the diagnosis of alcohol dependence against PEth, in Mwanza (northern Tanzania). The main findings are a high prevalence of reported alcohol use among diverse groups of young people in eastern Africa, especially among university students and sex workers, but that few studies used standardised alcohol screening questionnaires. In our survey of almost 2000 young people in northern Tanzania, the prevalence of reported alcohol use was higher among males (20-45% for current use) than females (12-47% for current use). Alcohol use was also associated with being in a relationship, greater disposable income, and a higher number of sexual partners. 6 There were significant positive correlations between reported total alcohol intake and PEth concentration in males (Spearman correlation (r )=0.65 among college students and s r =0.57 among casual labourers; p<0.001). Self-reported alcohol use in the past month s was also a sensitive marker of having a positive PEth result (overall sensitivity 89%, 95%CI 81-94%), and was similar in all groups. The MINI dependence criteria (positive responses to ≥3 questions) were met by 79/202 (39%) casual workers and college students. The high prevalence was mainly due to two non-specific questions (on tolerance and compulsion to drink). Both sensitivity and specificity of the MINI were low when compared to PEth, raising questions about the validity of the tool for this population. This thesis finds that alcohol use is a significant problem among young people in northern Tanzania, and the Timeline Followback calendar (TLFB) and Alcohol Use Disorders Identification Test (AUDIT) are sensitive measures of alcohol use. Most affected groups are college students and casual labourers. These two groups need urgent interventions addressing both individual and societal risks to reduce hazardous/harmful alcohol use. 7 Table of Contents Acknowledgement .......................................................................................................................... 3 List of Abbreviations ....................................................................................................................... 5 Abstract ........................................................................................................................................... 6 Chapter 1. Introduction and background ..................................................................................... 10 Alcohol use as a global health problem .................................................................................... 10 Alcohol use as a public health problem among young people ................................................. 11 Alcohol use among young people in Africa............................................................................... 12 Screening tools for alcohol use disorders ................................................................................. 12 Biomarkers for alcohol intake ................................................................................................... 13 Outline of the thesis.................................................................................................................. 14 References ................................................................................................................................ 15 Chapter 2. Methods ..................................................................................................................... 20 References ................................................................................................................................ 26 Chapter 3. Systematic review and meta-analysis: prevalence of alcohol use among young people in eastern Africa ............................................................................................................................ 27 Chapter 4. The epidemiology of alcohol use and alcohol use disorders among young people in northern Tanzania ......................................................................................................................... 43 Abstract ..................................................................................................................................... 46 Introduction .............................................................................................................................. 48 Methods .................................................................................................................................... 50 Results ....................................................................................................................................... 57 Discussion ................................................................................................................................. 61 Acknowledgements................................................................................................................... 64 Author’s contribution ............................................................................................................... 65 References ................................................................................................................................ 66 Supporting information ............................................................................................................ 69 Tables of results ........................................................................................................................ 71 Chapter 5. The validity of self-reported alcohol use compared with the alcohol biomarker phosphatidylethanol among young people in northern Tanzania ............................................... 86 Abstract ..................................................................................................................................... 89 Introduction .............................................................................................................................. 91 Material and methods .............................................................................................................. 93 Results ....................................................................................................................................... 97 Discussion ................................................................................................................................. 99 Acknowledgements................................................................................................................. 101 8 Author’s contribution ............................................................................................................. 101 Supplementary Information ................................................................................................... 102 Figure legends ......................................................................................................................... 103 References .............................................................................................................................. 106 Tables of results ...................................................................................................................... 109 Chapter 6. Validation of the MINI (DSM IV) tool for the assessment of alcohol dependence among young people in northern Tanzania using the alcohol biomarker Phosphatidylethanol (PEth)........................................................................................................................................... 115 Abstract ................................................................................................................................... 118 Introduction ............................................................................................................................ 120 Experimental section .............................................................................................................. 122 Results ..................................................................................................................................... 126 Discussion ............................................................................................................................... 128 Supplementary material ......................................................................................................... 130 Acknowledgements................................................................................................................. 130 Author’s contribution ............................................................................................................. 130 References .............................................................................................................................. 131 Tables of results ...................................................................................................................... 134 Chapter 7. Discussion .................................................................................................................. 138 Epidemiology of alcohol use and AUD among young people ................................................. 138 Alcohol screening tools ........................................................................................................... 139 A need for targeted alcohol interventions ............................................................................. 142 References .............................................................................................................................. 144 Chapter 8. Conclusion and recommendations ........................................................................... 146 Appendix 1. Systematic review and meta-analysis detailed search strategies .......................... 147 Appendix 2. Survey questionnaire and additional information to determine total alcohol intake in a drinking event ...................................................................................................................... 156 Appendix3. Pictorial display of beers with standard drinks ....................................................... 175 Appendix 4. Additional information to determine total amount of alcohol intake in each drinking event as identified in the TFLB .................................................................................................... 176 Appendix 5. Mini international neuropsychiatric interview (MINI) ........................................... 177 9

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ders (AUD) among young people in Northern Tanzania. Systematic review and meta-analysis: prevalence of alcohol use among young people Employed young people were selected from soft drink plants located in adverse effects of alcohol use on school or work performance, and on smoking
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