Current Substances Use Among Students in Ethiopia: A Systematic Review and Meta-analysis of 20-years Evidence

Abstract

Background: The use of psychoactive substances is the main cause of morbidity and becomes important public health and socio-economic issue worldwide. However, there is a lack of evidence on the magnitude of current use substances among students in Ethiopia. Therefore, this review and meta-analysis aimed to provide comprehensive views of the current prevalence of substance use among students in Ethiopia.Methods: Literature searches were done from electronic biomedical databases; PubMed/Medline, HINARI, AJOL, Google Scholar, Science Direct and manully seared master thesis and dissertation done until 31/12/2019. Two authors autonomously selected studies, extracted data, and evaluated the quality of studies. The prevalence of current substances with 95% confidence interval (95%) estimated using the random-effects model. The results were displayed using forest plots, and Cochrane Q-test and I2 use to measure the extents of between-study variations.Results: A total of 1543 study articles were identified from electronic databases, and 32 of them were included in the meta-analysis. The prevalence of current use of at least one substance was 37.63% (95% CI: 33.66, 41.69; I2=91.2%, P<0.00), alcohol 27.61% (95%CI: 22.10, 33.48; I2=98.08%, P<0.00), khat 17.20% (95%CI: 14.03, 20.62; I2=97.2%, p<0.00) and smoking 9.74% (95%CI: 7.17, 12.64; I2=95.06%, P<0.00). Subgroup analysis revealed that the prevalence of any substance by high school students versus university/college students was 41.55% (95% CI: 38.83, 44.29) vs 36.24% (95% CI: 32.37, 40.20), alcohol 24.21% (95% CI: 14.05, 36.11) vs 25.27% (95% CI: 19.76, 31.20), khat 13.82% (95% CI: 8.61, 20.02) vs 17.30% (95%CI:13.75, 21.16), and cigarette 8.30% (95% CI: 1.89, 18.60) vs 9.80% (95% CI: 7.32, 12.58). Meta-regression analysis revealed publication year, sample size, female proportion, and age was not significantly associated with the current use of substances.Conclusion: The prevalence of the current use of substances was high and highlights the extent the problem among students in Ethiopia. Overall currrent substance use was high for all substances use categories; any substance, alcohol, chewing khat and smoking cigarettes. Comparable to university/college students a significant propoartion of high school students were already using susbstances before joining teritiary education. Caution is needed while interpreting the findings due to significant heterogeneity between studies. Policymakers should formulate and implement strictly binding regulations to control the pervasive use of substances around educational institution sites at the national level. Protocol registration: The protocol has been registered on 19 Auguest 2019 on PROSPERO (the International Prospective Register of Systematic Reviews) with ID: CDR42019130560.