The prevalence of alcohol and illicit drug use among injured patients presenting to the emergency department of a national hospital in Tanzania: a prospective cohort study

Abstract

BackgroundAlcohol and illicit drugs have been found to be major contributing factors leading to severe injuries in a variety of settings. In Tanzania, the use of these substances among injured patients has not been studied. We investigated the prevalence of positive tests for alcohol and illicit drug use among injured patients presenting to the emergency medicine department (ED) of Muhimbili National Hospital (MNH).MethodsThis was a prospective cohort study of a consecutive sample of patients > 18 years of age presenting to the ED-MNH with injury related complaints in October and November 2015. A structured data sheet was used to record demographic information, mechanism of injury, clinical presentation, alcohol and illicit drug test results, and ED disposition. Alcohol levels and illicit drug use were tested by breathalyser device or swab stick alcohol test and multidrug urine panel, respectively. Patients were followed up for 24 h and 30 days using medical chart reviews and phone calls. Descriptive statistics and relative risk were used to describe the results.ResultsWe screened 1011 patients and we enrolled all 143 (14.1%) patients who met inclusion criteria. 123 (86.0%) were male, the median age was 30 years (IQR: 23–36 years). The most frequent mechanism of injury was road traffic accidents (84.6%). 67/143 (46.9%) patients tested positive for alcohol and 44/122 (36.1%) patients tested positive for drugs. 29 (26.1%) tested positive for alcohol and drugs. The most frequently detected illicit drug was marijuana in 30/122 (24.5%) injured patients. 23/53 (43.4%) patients with positive alcohol testing self-reported alcohol use. 3/25 patients with positive illicit drug tests who were able to provide self-reports, self-reported drug use. At 30-day followup, 43 (64.2%) injured patients who tested positive for alcohol had undergone major surgery, 6 (9.0%) had died, and 36 (53.7%) had not yet returned to their baseline.ConclusionsThe prevalence of alcohol and illicit drugs is very high in patients presenting to the ED-MNH with injury. Further studies are needed to generalise the results in Tanzania. Public health initiatives to decrease drinking and/or illicit drug use and driving should be implemented.Electronic supplementary materialThe online version of this article (10.1186/s12873-019-0222-9) contains supplementary material, which is available to authorized users.

Drug use detection in medical occurrences involving physical trauma

“…The association of alcohol and others drugs use and accidents was observed in brazilian and worldwide studies (Mundenga et al, 2019;Andrecceutti et al, 2018;Bakke, Normann, Ekeberg & Bachs, 2016;Lasebikan & Adebayo, 2013;Legrand, Silverans, Paepe, Buylaert & Verstraete, 2013), which corroborate to those found in this study.…”

“…While many studies worldwide use the patient's verbal report or a screening tool to detect the use of alcohol and illicit drugs in patients with physical trauma, our study and other studies have shown that the analytical toxicological test is more accurate and provides the evidence for psychoactive substances abuse, allowing information when patients are unable to do so and avoiding an incorrect estimate of drug and alcohol use. However, one of the main limitations of using toxicological tests is their high cost, a reality in most low-and middle-income countries (Mundenga et al, 2019;UNODC, 2019;WHO, 2018b).…”

“…United Nations Office on Drugs and Crime [UNODC] (2019); World Health Organization [WHO] (2018a), there is insufficient data on non-fatal trauma and little has been done to understand the complex "scenario of drug use and its connection with injuries". In lowand middle-income countries, little is known about the use of alcohol and other drugs among patients who had physical trauma, although the World Health Organization (WHO) estimates that 90% of injury-related deaths worldwide take place in these countries (Mundenga et al, 2019;World Health Organization [WHO] (2009). Thus, it is essential to collect data on substance use among victims of physical trauma, especially in the Latin American region, where both traffic accidents and interpersonal violence have taken epidemic proportions in recent years (Andrecceutti et al, 2018;(WHO, 2018a)).…”

Drug and alcohol use in Tanzanian road traffic collision drivers

“…We calculated our sample size to determine the number of patients needed to report a proportion of positive screens with a 5% margin of error. Based on data from Mundenga et al, we assumed a positive screening rate of roughly 50% in our study population [8] . We calculated that assessment of 385 subjects would provide a confidence level of 95% that our point estimate of the positive screening rate would fall within ±5% of the actual value.…”

“…In Tanzania, intoxication among drivers has been poorly studied but appears to be common, with some noting, “it is an open secret that drivers drink and drive with impunity.” [7] Preliminary work by Mundenga et al (2019) assessed for objective evidence of drug and alcohol use in trauma patients presenting to the EC of Muhimbili National Hospital (MNH) within 12 h of injury. They found that 49% of patients tested positive for alcohol and 36% of patients tested positive for illicit drugs [8] . While this study included all trauma patients, data on drug and alcohol use in drivers can help inform targeted interventions.…”