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Official websites use. Share sensitive information only on official, secure websites. Licensee African Health Sciences. There is a rise in alcohol and other drug AOD abuse in the country but details of the practice are scanty. This paper provides characteristics of clients in the rehabilitation centres, their AOD related practices before and early months of COVID, and correlates of repeat treatment. The study was conducted in 10 rehabilitation centres in Kampala Metropolitan area. Modified Poisson regression model was used to analyse the repeat treatment. Intervention programs should target the educated, the unemployed, young men, their friends, street drug dealers and AOD hotspots. Keywords: Covid 19, substance use, rehabilitation centres, drugs, alcohol, interrupted time series, modified Poisson regression. The global burden of disease caused by harmful use of alcohol and other drugs AOD is enormous. AOD abuse is one of the leading risk factors for detrimental population health worldwide 1. Alcohol and other drug abuse are among the major contributors to the burden of disease in over health conditions. This exceeds those caused by many other risk factors and diseases high on the global health agenda 2. AOD abuse is linked to many non-communicable diseases like cardiovascular diseases, to road traffic injuries, violence and suicide 3 , to diseases associated with risky sexual behaviours 1 , and poor mental health 4. Globally this makes AOD abuse to be responsible for 7. People of younger ages were disproportionately affected by alcohol compared to older persons, and Although the highest levels of alcohol consumption are in Europe, Africa bears the heaviest burden of disease and injury attributed to alcohol. Alcohol per capita consumption per year in litres of pure alcohol is one of two indicators for SDG health target 3. According to the Global status report on Alcohol and health, the total Alcohol per capita for Uganda in the year was 9. AOD is on the rise in Uganda especially among young people 4. Alcohol use is among the top 10 risk factors that contribute to the country's burden of disease 8. This observation should compel major interest in the prevention of AOD abuse in Uganda but it does not get the attention it deserves. A review of literature shows there is evidence gap in relation to patterns, differentials and trends in AOD use. While there is some evidence on alcohol use information on other drugs is grossly lacking. In this work we characterise clients who reported at 10 rehabilitation centres in Kampala metropolitan area in a period of 8 months and assess patterns, differentials and trends of AOD practices covering 8 months of observation at the centres. The first case was reported on the 21 st March and as of 30 th June there were confirmed cases with no deaths as yet 9. Stringent measures against the pandemic were taken in March and from 1st of April there was a total nationwide lock down that was eased in June All forms of public transport were suspended during lockdown except for cargo planes, trucks and trains and restrictions on private vehicle movements were also instituted Ten facilities located in Kampala Metropolitan Area KMA involved in the treatment of alcohol and drug abuse were selected according to the following criteria: having established accommodation for clients and having record keeping facilities including a computer, storage for records and a staff to enter data. The study units were all clients of the rehabilitation centres. KMA has a population estimate of about 4,, Wakiso district, 2,, and Kampala, 1,, The area is served by several AOD related rehabilitation centres but most of them are small and not yet fully established. All clients of the 10 facilities in Kampala Metropolitan area seeking AOD treatment services in period of November to June were included in the study. Clinicians at the facilities were trained on how to identify persons with hazardous and harmful patterns of alcohol and drug consumption using the AUDIT tool Alcohol Use Disorders Identification Test The audit tool and a few more questions were added on the client screening form. Record Clerks were trained on how to abstract data from client files and enter it into a Microsoft access designed database. A standardized paper-based data collection tool to capture key components on the variables of interest extracted from patient files was developed and used. A database with in-built range and consistency checks was designed in Mcrosoft Access and installed on computers at each of the ten participating facilities. The data base had inbuilt range and consistency checks. The data were exported from Microsoft Access database to Excel from where they were exported to Stata Version 14 for cleaning and analysis. To characterize the clients to the rehabilitation facilities charts and cross-tabulations were used to show different patterns and differentials of the clients as well as trend for the 8 months. Key among variables examined weretype and source of drugs, and frequency of consumption, use of injecting drugs, reasons for starting and sustaining drug use. To get a statistical difference between before and after intervention instituting of lockdown an interrupted time series analysis was applied. It's a kind of analysis that compares the level and trend of the data before and after intervention. The time series refers to the data over the period, while the interruption is the intervention, which is a controlled external influence or set of influences Changes in level and trend are expected in a period subsequent to introduction of the intervention Interrupted time series ITS analysis is a strong quasi experimental design that can be used to evaluate the effectiveness of a population-level intervention that is clearly defined at a given time point Administrative clearance was also obtained from the participating facilities. The management team of each of the facilities was informed that their facilities could stop participating in the research at any time if they so wished. They were also given an opportunity to ask questions related to the study or the facility's rights as a participant. Other facilities recorded smaller numbers of Clients with some registering zero Clients in some months especially April Overall, a high number of Clients was registered in November followed by February while the least number was recoded in April In each of the months, alcohol use prevalence remained high among the new clients with higher percentages recorded in the months of January and February From Jan to June there was a gradual decline in proportion taking alcohol as a primary substance. For cannabis, the highest percentage was registered in the month of May For cocaine the highest percentage was in December Beside alcohol, none of the other substances was dominant throughout the 8 months figure 2. The source of primary drugs varied in each of the months although it consistently remained high for street dealers and friends compared to other categories Table 4. There was no observed significant change in source of primary drugs over the months. Figure 4 shows that the clients' median age at first use of the primary drug was about 20 years. The client's average age at first injection of drugs was A closer examination of source of payment for previous treatment by the prime substance used shows that family and friends were a dominant source of funding Figure 7. Strength and limitations of the study. The strength of the paper lies in the content, recency, focus on clients of rehabilitation centres, the length of data collection and data analysis. The content of the data is rich with information that includes characterization of the clients, AOD practices, kinds of drugs taken, expenditure, referrals, trend over time and analysis of treat treatment. The focus on clients of the rehabilitation centres is new. The authors are not aware of any similar work that has been done before. The data were collected over a period of 8 months and this allows some assessment of temporal changes. The limitations of the study lie in the kind of clients in then centres and the timing of the study. The people that seek care in rehabilitation centres may not represent the general population of people with addiction problems. These can pay the daily fees of the private centres which many will not afford. The only public facility in the study offers free services but there are costs of maintaining attendants of the patient and purchase of commodities that the government cannot provide. The 8-month duration of data collection is not long enough to allow analysis of full seasonality and trend analysis. The results show that clients of the rehabilitation centres in Kampala metropolitan area are largely youth, male, single, unemployed, urban and have attained secondary. There was a decline in number of clients from the month of November to December, The number of clients then rose to peak in February, but reduced with onset of the COVID pandemic, which later rose again after two months. The most commonly used drugs were alcohol, cannabis and cocaine and clients took them almost daily. The commonest source of drugs were street dealers and friends. The overall age at first use of primary drugs was 20 and it was lower among men and those who took cannabis. Peer pressure was a major reason for start and continued use of drugs. Other reason for continued use is a need for leisure or feeling better. Clients receive medical, psychological, prayer, traditional kinds of treatment. The characteristics of the clients of the rehabilitation centers appear similar to those in previous studies with a few variations. For example, one similar study in Pakistan found a high percent of illiterate clients in rehabilitation centres 16 while in this study majrity are educated. Reduction of clients in December may be attributed to Christmas holidays when workers in the rehabilitation centres break off and thus only a few can be admitted. The peak in February may be explained by lots of alcohol and drug intake during the Christmas and New Year festivities that can lead to relapse among those with history of drug abuse. Relatively high level of use of cocaine and opioids by women need further investigation. However, a systematic review study found that ratio of cannabis use prevalence between males and females has decreased significantly over time The type of drugs used in urban areas in Uganda such as cannabis, cocaine and opioids have been reported in several studies This paper adds details about changes over time and frequency of use of the drugs on existing amount of knowledge. Higher frequency of use of alcohol, cocaine compared to other drugs may be connected to availability and lower cost. Lower age at first use of drugs among cocaine users compared to users of other drugs needs further investigation. However, the mean age is not very different from studies in Australia Several studies have reported dearth of evidence on IDU in the country The national population level of injecting drug use is estimated at 10 per , inhabitants A study in in India found repeat treatment associated with unemployment, ever been marriage, higher age group A study published in in Pakistan showed that relapse is strongly associated with being female All the private facilities are much younger than the public facility and most of them are not even known. Clients in these facilities are mostly young, male, single, urban and educated. The main substance of abuse is alcohol followed by cannabis and cocaine. The drugs are commonly used daily and this is instigated largely by peer pressure, leisure as well as a need to feel better. Street dealers are the major source of drugs while sharing of equipment among injecting drug users was high. There is minimal access to Hepatitis C testing services. From the results in the study, we recommend the following: There is a need by the police and other relevant institutions to identify hotspots where the drugs are sold and design interventions to minimise or eliminate sales on these places. The program initiatives against substance use should target street drug dealers and friends of the AOD users. MOH and other players should provide target interventions for the male educated youth especially supporting their fight against peer pressure and unemployment. There is a need to identify and study those people in the communities who have AOD use disorders but don't go to the rehabilitation facilities. Information about them can be compared with that from the facilities and this will complete the whole picture of AOD abuse in the communities. One possible reason for failure to go the facilities is lack of funds and this could be factored in a probably case control study that can compare the two groups. We are very grateful to the Government of Uganda for providing these funds. We are also grateful for Makerere Research and Innovations Fund MakRIF staff for selecting our team and carrying out the oversight administration work for the project. RT contributed on the idea, proposal development, data management and analysis implementation and write up. As a library, NLM provides access to scientific literature. Afr Health Sci. Find articles by Nazarius Mbona Tumwesigye. Find articles by Ponsiano Ocama. Find articles by David Basangwa. Find articles by Flavia Matovu. Find articles by Catherine Abbo. Find articles by Twaibu Wamala. Find articles by Claire Biribawa. Find articles by Cissie Namanda. Find articles by Joshua Blessing. Find articles by Ronald Twesigomwe. Open in a new tab. Treatment Centre m11 m12 m1 m2 m3 m4 m5 m6 Butabika Nat. Ref Menta. Hosp 63 A modified Poisson Multivariable analysis for repeat visit to the rehabilitation centres. Similar articles. Add to Collections. 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The agency says Ugandans smuggle in expensive drugs such as methamphetamine and cocaine because of the huge amounts of money involved.
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The international airport in the city of Entebbe, meanwhile, has gained notoriety in recent years as a thriving conduit for the narcotics trade. In December , the death of a young and popular member of parliament, Cerinah Nebandah, after an overdose of cocaine sent reverberations throughout parliament. Private rehab facilities for affluent addicts have sprouted up in Uganda. Heroin is cheap enough to be an after-work routine for many in the slums who barely earn enough money for food. The Uganda Harm Reduction Network cares for drug users, advocating for their rights to health officials and offering needle exchanges. The NGO group is run by ex-drug users. By Michele Sibiloni. Published On 5 Nov 5 Nov
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It's surprising that the pattern of primary drugs used among clients of rehabilitation centres in the country (52% for alcohol, 19% cannabis and 14% cocaine) is.
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The study also examined the various types of substances consumed by the youth in Makerere Kikoni such as tobacco, oris, cocaine, hard liquor among others.
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