“I feel good when I drink”—detecting childhood-onset alcohol abuse and dependence in a Ugandan community trial cohort

Abstract

Background Alcohol, substance use, and mental health disorders constitute major public health issues worldwide, including in low income and lower middle-income countries, and early initiation of use is an important predictor for developing substance use disorders in later life. This study reports on the existence of childhood alcohol abuse and dependence in a sub-study of a trial cohort in Eastern Uganda. Methods The project SeeTheChild—Mental Child Health in Uganda (STC) included a sub-study of the Ugandan site of the study PROMISE SB: Saving Brains in Uganda and Burkina Faso. PROMISE SB was a follow-up study of a trial birth cohort (PROMISE EBF) that estimated the effect that peer counselling for exclusive breast-feeding had on the children’s cognitive functioning and mental health once they reached 5–8 years of age. The STC sub-study (N = 148) used the diagnostic tool MINI-KID to assess mental health conditions in children who scored medium and high (≥ 14) on the Strengths and Difficulties Questionnaire (SDQ) in the PROMISE SB cohort N = (119/148; 80.4%). Another 29/148 (19.6%) were recruited from the PROMISE SB cohort as a comparator with low SDQ scores (< 14). Additionally, the open-ended questions in the diagnostic history were analysed. The MINI-KID comprised diagnostic questions on alcohol abuse and dependence, and descriptive data from the sub-study are presented in this paper. Results A total of 11/148 (7.4%) children scored positive for alcohol abuse and dependence in this study, 10 of whom had high SDQ scores (≥ 14). The 10 children with SDQ-scores ≥ 14 had a variety of mental health comorbidities of which suicidality 3/10 (30.0%) and separation anxiety disorder 5/10 (50.0%) were the most common. The one child with an SDQ score below 14 did not have any comorbidities. Access to homemade brew, carer’s knowledge of the drinking, and difficult household circumstances were issues expressed in the children’s diagnostic histories. Conclusions The discovery of alcohol abuse and dependence among 5–8 year olds in clinical interviews from a community based trial cohort was unexpected, and we recommend continued research and increased awareness of these conditions in this age group. Trial registration Trial registration for PROMISE SB: Saving Brains in Uganda and Burkina Faso: Clinicaltrials.gov (NCT01882335), 20 June 2013. Regrettably, there was a 1 month delay in the registration compared to the commenced re-inclusion in the follow-up study: https://clinicaltrials.gov/ct2/show/NCT01882335?term=saving+brains&draw=2&rank=1

Child alcohol use disorder in Eastern Uganda: screening, diagnostics, risk factors and management of children drinking alcohol in Uganda (TREAT C-AUD): a mixed-methods research protocol

“…11 In 2014, we identified a prevalence of 8.4% clinically defined harmful alcohol use or dependence in a sample of children aged 5–8 years (n=119) with a high mental health symptom load. 12 This prompted further qualitative investigation, which corroborated our finding.…”

Are we overlooking alcohol use by younger children?

“…In the aforementioned English birth cohort, drinking at age 10 had a weaker association with conduct problems compared with depression, but the relationship was stronger in adjusted analysis 26. In a small study from Uganda (n=148), 10 out of the 11 children aged 5–8 years diagnosed with harmful alcohol use and dependence had psychiatric comorbidities, including conduct disorder, suicidality, panic disorder and depression 24. In a study from the USA, investigating suicidal ideation among more than a thousand 8-year-olds at risk for or victims of maltreatment, 21% had used substances, including alcohol.…”

“…26 In a small study from Uganda (n=148), 10 out of the 11 children aged 5-8 years diagnosed with harmful alcohol use and dependence had psychiatric comorbidities, including conduct disorder, suicidality, panic disorder and depression. 24 In a study from the USA, investigating suicidal ideation among more than a thousand 8-year-olds at risk for or victims of maltreatment, 21% had used substances, including alcohol. Further, children that used substances were four times more likely to report suicidal ideation, and this association was stronger among maltreated children.…”

“…Recall in later adolescence is problematic, as ‘forward telescoping’, i.e., reporting something as more recent than it actually was, has resulted in older children consistently reporting a higher age of initiation compared to when being asked at an earlier age, potentially masking an actual earlier age of onset 6. While data is scarce, some reports of current use among younger children do exist, and examples include 5–8-year-olds in Uganda,24 8-year-olds in Argentina,25 10-year-olds in England,26 9–11-year-olds in Vietnam,14 27 elementary school students in the USA,15 and rural 5–12-year-olds in Peru 28. Street-connected children have been the focus in multiple studies of substance use, since this population live under exceptional conditions where substance use is rampant 16 Table 2.…”

Improving alcohol and substance use screening in school-age children: translation, adaptation and psychometric evaluation of the CRAFFT tool for Lumasaaba, Uganda

“…With about half of its population (49.3%) under the age of 15 years [ 3 ], Uganda is home to one of the world’s largest populations of children. Studies have detected alcohol consumption by children in Uganda, with some starting as young as 5 to 8 years old [ 4 – 6 ]. In addition, we found that primary school-age children in Mbale district, Uganda, reported easy access to alcohol, consuming it in various settings, including their homes, schools, and even classrooms during instructional sessions [ 6 ].…”