The impact of alcohol among injury patients in Moshi, Tanzania: a nested case-crossover study

Abstract

BackgroundGlobally, alcohol is responsible for 3.3 million deaths annually and contributes to 5.9% of the overall global burden of disease. In Sub-Saharan Africa, alcohol is the leading avoidable risk factor accounting for a substantial portion of death and disability. This project aimed to determine the proportion of injuries related to alcohol and the increased risk of injury due to alcohol among injury patients seeking care at the emergency department (ED) of Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania.MethodsA representative cross-sectional sample of adult patients presenting to the KCMC ED with acute injury were enrolled in this study with a nested case-crossover design. Patient demographics, injury characteristics, and severity as well as alcohol use behaviors were collected. Alcohol breathalyzers were administered to the enrolled patients. Data on activities and alcohol use were collected for the time period 6 h prior to injury and two control periods: 24–30 h prior to injury and 1 week prior to injury.ResultsDuring 47 weeks of data collection, 24,070 patients were screened, of which 2164 suffered injuries, and 516 met the inclusion and exclusion criteria, consented to participate, and had complete data. Of the study participants, 76% were male, and 30% tested positive for alcohol on arrival to the ED. Alcohol use was associated with being male and being employed. Alcohol use was associated with an increased risk of injury (OR 5.71; 95% CI 3.84–8.50), and specifically road traffic injuries were associated with the highest odds of injury with alcohol use (OR 6.53, 95% CI 3.98–10.71). For all injuries and road traffic injuries specifically, we found an increase in the odds of injury with an incremental increase in the dose of alcohol.ConclusionsAt KCMC in Moshi, Tanzania, 3 of 10 injury patients tested positive for alcohol on presentation for care. Similarly, alcohol use conveys an increased risk for injury in this setting. Evidence-based prevention strategies for alcohol-related injuries need to be implemented to reduce alcohol misuse and alcohol-related injuries.

Physical Trauma and Its Consequences in Rural and Semi-Urban Regions of Low and Middle Income Countries

“…There are other factors to road traffic accidents and trauma predominantly in the rural and semi-urban regions. Excessive alcohol consumption increases not only the odds of RTA but also assaults and falls which altogether accounts for incidents of physical trauma [4,11]. Drunk-driving is one of the known major factors of RTAs, especially among youths in the rural and semi-urban regions of LMICs [12][13][14].…”

“…Drunk-driving is one of the known major factors of RTAs, especially among youths in the rural and semi-urban regions of LMICs [12][13][14]. In one of the studies carried out in Tanzania, in which all injured drivers were tested for alcohol use it was found that up to 30% had exceeded the allowed levels [11]. This situation can be explained by the fact that there is quite a few number of road traffic police officers in these regions to monitor drivers behavior including alcohol consumption.…”

Injury patients’ perceptions of drink-driving: A qualitative assessment of drink-driving behavior in Moshi, Tanzania

“…High rates of alcohol attributable RTIs in many countries indicate that they either do not have proper policies in place, or they are not being implemented and enforced strongly enough [1]. With RTIs contributing to around 70% of all alcohol-related injuries, Tanzania falls into the second category [7]. Current policies in place include blood alcohol concentration limits of 0.08g/dl for the general population and 0g/dl for commercial drivers, which can be enforced through random breath testing or police check points [8].…”

Cross-Culture Adaptation and Psychometric Properties of the DrInC Questionnaire in Tanzanian Swahili

“…Kilimanjaro Christian Medical Center (KCMC) Emergency Department (ED) data show ~30% of the injury patients consumed alcohol at the time of injury ( 10 ). Compared with patients present at a primary health care facility, those presenting in ED are more common to report higher problem drinking rate and alcohol dependence ( 11 ).…”