Substance use among adolescents in sub-Saharan Africa: a systematic review and meta-analysis

Abstract

Substance use has become one of the growing major public health and socioeconomic issues worldwide; it has dramatically increased, particularly in developing countries. [1-3] The analysis of substance use is complex, due in part to its varieties, degree of secrecy, health challenges and different legal connotations surrounding its use globally. The use of khat (Catha edulis), cigarettes, heroine, alcohol and other substances is a worldwide threat which especially affects young people. The World Health Organization (WHO) estimates that there are about 2 billion people worldwide who consume alcoholic beverages, of whom 76.3 million are affected by alcohol-related disorders. [4-8] It is estimated that 9% of the global population aged ≥12 years are classified as dependent on psychoactive substances. [9] Studies have confirmed that there is a growing epidemic of tobacco, heroine and alcohol use among adolescents in the developing world, especially in southern Africa and in sub-Saharan Africa as a whole. [6,10-12] Khat has been used in African countries for centuries as a mild stimulant. For most youths, chewing khat is considered a method for increasing energy and elevating mood in order to improve work performance. [13] The WHO report on substance use in southern Africa showed that negative consequences are common traits of substance use. [3,14] These include sexual violence (e.g. rape), physical violence, criminal activity, neglect of social responsibilities, disease, injury and loss of life. Harmful effects occur with any psychoactive substance use and early initiation has been found to be associated with an increased risk of developing addiction and adulthood dependence. [3,15] In general, it has been shown that the use of cigarettes, alcohol and other substances is a worldwide threat that affects young people. [3,16] In some parts of Ethiopia, such as Bale and Harar, khat chewing in communities in which smoking is common is seen as a social custom that dates back thousands of years. Many students also consider khat chewing as a method of improving their reading ability. However, no activity has been seen in the reduction of substance use. [17,18] While substance use is not new in research parlance, [1] the high level of ingenuity among young people (especially adolescents) that has resulted in numerous complex mixtures, experimentation and discoveries of new materials and volatile solvents (or inhalants) that can be drunk or inhaled with immediate intoxicating effect or other diverse consequences, [11] could make continuous research on this menace relevant. The prevalence of substance use varies from country to country and time to time. Regular updates on substance use and its associated factors could therefore hold significant input regarding appropriate and dynamic interventions towards reduction or eradication of substance use among adolescents, not only in southern Africa but also worldwide. [19,20] The present study therefore aims to assess the prevalence of substance use among adolescent in sub-Saharan Afri...

Determinants and Effects of Adolescent Substance Use in Africa: A Systematic Review Protocol

“…An accurate understanding of the drivers of substance use among adolescents is essential for the prevention and treatment of substance use and harmful use of alcohol, as enshrined in the Sustainable Development Goals (SDG3.5). The recent systematic review of substance use among adolescents in sub-Saharan Africa highlighted a prevalence of 41.6% [11]. Our study will build on this review with a focus on determinants, risk and protective factors in Africa [8].…”

“…A recently published systematic review found that the overall prevalence of 'any substance use' among adolescents in sub-Saharan African of 41.6%, with alcohol and tobacco being the highest prevailing substances (i.e. 40.8% and 45.6%, respectively) across the continent compared to any other substance use [11]. More interestingly, a few region-speci c patterns of substance use were identi ed, highlighting the need for region (or country) speci c and culturally appropriate interventions and policies.…”

“…More interestingly, a few region-speci c patterns of substance use were identi ed, highlighting the need for region (or country) speci c and culturally appropriate interventions and policies. For example, khat use only in East Africa [12] and using tranquilisers in South Africa [11]. Overall this review provides detailed holistic and regional understanding of the determinants of substance use among adolescents in sub-Saharan Africa.…”

“…The role of other study level variables like gender, (mental) health status as potential risk and protective factors will also be explored with regional comparisons where possible. Understanding the determinants of substance use among adolescent in Africa will ll a gap in literature, and strengthen prevention and treatment of harmful substance use, enhancing achievement of SDGs 3.5 and 3.4 in the region of Africa [11].…”

Patterns And Correlates Of Substance Use: Cross Sectional Exploratory Study Among Health Care Workers In Bungoma County, Kenya

“…Substance use is defined as the practice of using at least one of the substances such as alcohol, cigarettes, and licit or illicit drugs with the aim of enjoying the pleasurable effects of the psychoactive properties which comes with associated risks of addiction [1] Substance abuse on the other hand is defined as the harmful or hazardous use of psychoactive substances, including alcohol and/or illicit drugs in a manner that jeopardizes ones health despite knowledge of its dangers. Abuse, may be for both licit and illicit substances and may lead to substance use disorder (SUD) such as dependence which is a compulsive craving behaviour that persists despite known consequences [2] Substance use is a global problem causing 39 deaths per 100 000 population out of which 35 deaths are attributable to alcohol use while four are attributable to illicit drug [3] There is an emergent epidemic of tobacco, heroine and alchohol use among adoloscent in Sub-Saharan Africa (Olawole-Isaac, et al, 2018) with illegal substance consumption responsible for 37,000 people dying annually from illegal drug consumption related illnesses [4] The estimate of substance use among adolescents in Sub-Saharan Africa was found to be 41.6% (55 CI 31.3-51.9) with Central Africa taking the lead with 55.5% (95%-CI-53-58) followed by East Africa with 48.99%(95%-CI-28.8-69.2) and the least in Southern Africa at 37% (95% CI 16.1-57.8) [5] The Government of Kenya acknowledged substance abuse as a matter of national concern, and through a Legal Notice established the National Agency for Coordination of Drug & Substance abuse tasked with the responsibility to spearhead the campaign against substance use (NACADA, 2009). The Ministry of health indicate that the most commonly used drugs in Kenya are nicotine,alchohol and cannabis.…”