RESUMEN
BACKGROUND: Globally, there is a concerning surge in the prevalence of substance use among adolescents and children, creating a substantial public health problem. Despite the magnitude of this issue, accessing healthcare explicitly for substance use remains challenging, even though many substance users frequently visit healthcare institutions for other health-related issues. To address this gap, proactive screening for substance use disorders has emerged as a critical strategy for identifying and engaging patients at risk of substance use. The purpose of this study was to investigate the prevalence of probable alcohol and other substance use disorders, and associated factors, among children aged 6 to 17 years old attending health facilities in Mbale, Uganda. METHODS: We conducted a health facility cross-sectional study, involving 854 children aged 6-17 years. The prevalence of probable alcohol and other substance use disorders was assessed using a validated Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT) screening tool. Univariable and multivariable modified Poisson regression analyses were performed using STATA 15 software. RESULTS: The overall prevalence of probable alcohol use disorders (AUD) and other substance use disorders (SUD) was 27.8% (95% CI 1.24-1.31) while that of probable AUD alone was 25.3% (95% CI 1.22-1.28). Peer substance use (APR = 1.24, 95% CI 1.10-1.32), sibling substance use (APR = 1.14, 95% CI 1.06-1.23), catholic caregiver religion (APR = 1.07 95% CI 1.01-1.13), caregiver income of more than $128 (APR = 0.90, 95% CI 0.82-0.98), having no parental reprimand for substance use (APR = 1.05, 95% CI 1.01-1.10) and having no knowledge of how to decline an offer to use substances (APR = 1.06, 95% CI 1.01-1.12) were found to be significantly associated with probable AUD/SUD. CONCLUSIONS: Our findings suggest a high prevalence of probable AUD and SUD among children and adolescents visiting healthcare facilities for other conditions, along with a strong link between AUD and SUD prevalence and social factors. The implication for our healthcare system is to actively screen for and treat these conditions at primary healthcare facilities.
Asunto(s)
Alcoholismo , Trastornos Relacionados con Sustancias , Niño , Adolescente , Humanos , Uganda/epidemiología , Alcoholismo/epidemiología , Prevalencia , Estudios Transversales , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/diagnóstico , EtanolRESUMEN
BACKGROUND: Substance use disorders (SUD) pose a significant public health problem in Uganda. Studies indicate that integrating mental health services into Primary Health Care can play a crucial role in alleviating the impact of SUD. However, despite ongoing efforts to integrate these services in Uganda, there is a lack of evidence regarding the preparedness of health facilities to effectively screen and manage SUD. Therefore, this study aimed to assess the readiness of health facilities at all levels of the health system in Mbale, Uganda, to carry out screening, diagnosis, and management of SUD. METHODS: A health facility-based cross-sectional study was carried out among all the 54 facilities in Mbale district. A composite variable adapted from the WHO Service Availability and Readiness Assessment manual (2015) with 14 tracer indicators were used to measure readiness. A cut-off threshold of having at least half the criteria fulfilled (higher than the cutoff of 7) was classified as having met the readiness criteria. Descriptive analyses were performed to describe readiness scores across various facility characteristics and a linear regression model was used to identify the predictors of readiness. RESULTS: Among all health facilities assessed, only 35% met the readiness criteria for managing Substance Use Disorders (SUD). Out of the 54 facilities, 42 (77.8%) had guidelines in place for managing SUD, but less than half, 26 (48%), reported following these guidelines. Only 8 out of 54 (14.5%) facilities had staff who had received training in the diagnosis and management of SUD within the past two years. Diagnostic tests for SUD, specifically the Uri stick, were available in the majority of facilities, (46/54, 83.6%). A higher number of clinical officers working at the health centres was associated with higher readiness scores (score coefficient 4.0,95% CI 1.5-6.5). CONCLUSIONS: In this setting, a low level of health facility readiness to provide screening, diagnosis, and management for substance use disorders was found. To improve health facility readiness for delivery of care for substance use disorders, a frequent inventory of human resources in terms of numbers, skills, and other resources are required in this resource-limited setting.