Child alcohol use disorder in Eastern Uganda: screening, diagnostics, risk factors and management of children drinking alcohol in Uganda (TREAT C-AUD): a mixed-methods research protocol

Skylstad, Vilde; Aber, Harriet; Bakken, Victoria; Dierkes, Jutta; Iversen, Silje Akselberg; Kisaakye, Esther; Kühl, Melf-Jakob; Nalugya, Joyce; Rayamajhi, Divya; Sebuwufu, Deogratious; Skar, Ane‐Marthe Solheim; Skokauskas, Norbert; Valeckaite, Neda; Wamani, Henry; Engebretsen, Ingunn Marie S.; Babirye, Juliet N.

doi:10.1136/bmjpo-2021-001214

Cited by 7 publications

(6 citation statements)

References 33 publications

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“…Mbale district hosted the TREAT-CAUD project (33), which resulted from an earlier study that found clinically significant alcohol use by children [4]. At the time of data collection Mbale city was within the district and was categorized as urban while the town councils outside Mbale town were categorized as peri-urban.…”

Section: Rationale For Age Range Selectionmentioning

confidence: 99%

“…The aim of this study was to translate and adapt the CRAFFT tool into the Lumasaaba language and evaluate its psychometric properties in school-age children aged 6 to 13 years who were at risk for alcohol and other substance use disorders. It was part of the larger Child Alcohol Use Disorder (TREAT C-AUD) project in the Mbale district, Eastern Uganda [ 33 ], that followed the detection of alcohol use by young children [ 4 ]. Specifically, the study aimed to improve the tool’s ability to screen for alcohol and other substances for this vulnerable population in the Ugandan setting.…”

Section: Introductionmentioning

confidence: 99%

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Improving alcohol and substance use screening in school-age children: translation, adaptation and psychometric evaluation of the CRAFFT tool for Lumasaaba, Uganda

Nalugya,

Engebretsen,

Nakasujja

et al. 2024

Addict Sci Clin Pract

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Background Children at risk of substance use disorders (SUD) should be detected using brief structured tools for early intervention. This study sought to translate and adapt the Car, Relax, Alone, Forget, Family/Friends, Trouble (CRAFFT) tool to determine its diagnostic accuracy, and the optimum cut-point to identify substance use disorders (SUD) risk in Ugandan children aged 6 to 13 years. Methods This was a sequential mixed-methods study conducted in two phases. In the first qualitative phase, in Kampala and Mbale, the clinician-administered CRAFFT tool version 2.1 was translated into the local Lumasaaba dialect and culturally adapted through focus group discussions (FGDs) and in-depth interviews, in collaboration with the tool’s authors. Expert reviews and translations by bilingual experts provided insights on linguistic comprehensibility and cultural appropriateness, while pilot testing with the target population evaluated the tool’s preliminary effectiveness. In the second phase, the CRAFFT tool, adapted to Lumasaaba, was quantitatively validated against the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) for diagnosing SUD in Mbale district, through a survey. Participants, chosen randomly from schools stratified according to ownership, location, and school size, were assessed for the tool’s reliability and validity, including comparisons to the MINI KID as the Gold Standard for diagnosing SUD. Data were analyzed using STATA-15. Receiver-operating-characteristic analysis was performed to determine the sensitivity, specificity, and criterion validity of the CRAFFT with the MINI-KID. Results Of the 470 children enrolled, 2.1% (n = 10) had missing data on key variables, leaving 460 for analysis. The median age and interquartile range (IQR) was 11 (9–12) years and 56.6% were girls. A total of 116 (25.2%) children had consumed alcohol in the last twelve-month period and 7 (1.5%) had used other substances. The mean CRAFFT score for all the children (n = 460) was 0.32 (SD 0.95). The prevalence of any alcohol use disorder (2 or more positive answers on the MINI KID) in the last 12 months was 7.2% (n = 32). The Lumasaaba version of the CRAFFT tool demonstrated good internal consistency (Cronbach’s α = 0.86) and inter-item correlation (Spearman correlation coefficient of 0.84 (p < 0.001). At a cut-off score of 1.00, the CRAFFT had optimal sensitivity (91%) and specificity (92%) (Area Under the Curve (AUC) 0.91; 95% CI 0.86–0.97) to screen for SUD. A total of 62 (13.5%) had CRAFFT scores of > 1. Conclusion The Lumasaaba version of the CRAFFT tool has sufficient sensitivity and specificity to identify school-age children at risk of SUD.

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Section: Rationale For Age Range Selectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Improving alcohol and substance use screening in school-age children: translation, adaptation and psychometric evaluation of the CRAFFT tool for Lumasaaba, Uganda

Nalugya,

Engebretsen,

Nakasujja

et al. 2024

Addict Sci Clin Pract

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“…Overall, the use of zero tolerance and danger rhetoric approaches do not re ect the realities the Ugandan children face daily and do not equip them with tools to prevent harm from alcohol consumption (53). The legal drinking age in Uganda is 18, but many children consume earlier (11,13,27,62). The schools could prepare learners with more nuanced and age-appropriate information and contribute to reduced harm.…”

Section: Danger Focused Rhetoricmentioning

confidence: 99%

“…To our knowledge, only few school-based interventions focusing on alcohol have been conducted and assessed in Africa (14,25,26). Previous qualitative studies have described the child and adult perspectives on alcohol use, and some studies have explored the teaching of the standard primary curriculum in Uganda (11,13,(27)(28)(29)(30). The perspectives and experiences with the current standard primary school curriculum on health and alcohol has not yet been fully explored.…”

Section: Introductionmentioning

confidence: 99%

“We talk about the dangers”: exploring teachers’ and learners’ perspectives on alcohol education in Ugandan primary schools

Valeckaite,

Kühl,

Babirye

et al. 2024

Preprint

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adolescents are affected through own or other’s drinking. Schools have an opportunity to address this issue. While curriculum-based alcohol education is a widely used educational approach, there is limited research on its delivery and effectiveness in Ugandan primary schools. This study aimed to explore the teachers’ and learners’ perspectives and teaching methods on alcohol education used in Ugandan primary schools. Methods: This was a qualitative study which enrolled six schools from Mbale, Eastern Uganda. We conducted twelve key informant interviews with teachers and twelve focus group discussions with the learners aged 11-13 years. The data was coded in NVivo and analysed using reflexive thematic analysis. Results: Alcohol as a topic was taught during science classes in Ugandan primary schools. Four main topics were covered during the lessons: what alcohol is and how it is made; the effects of alcohol use; why people drink; and, how to avoid it. The dangers of alcohol use were strongly emphasized by the teachers and the children were advised to avoid places and people including children that use alcohol. Teachers often used moralising and didactic methods of teaching to underline their message against alcohol use. Conclusion: To our knowledge this is the first study to describe alcohol education in primary schools in Mbale district, Uganda. This study shows that teachers considered alcohol education as an important topic aiming to teach children about the dangers and negative effects of alcohol use.

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“…The study was conducted in Mbale district, eastern Uganda, from February to March 2020 just before school closure due to the COVID-19 pandemic. The district hosted the TREAT C-AUD project that investigated the magnitude of alcohol and other drug use among 6-13-year-old children in the health, school and community contexts [31]. At the time of the study Mbale city was a municipal council consisting of three divisions.…”

Section: Design and Settingmentioning

confidence: 99%

“She gives it to her child who doesn’t even talk”: a qualitative exploration of alcohol and drug use among primary school-age children in Uganda

Nalugya,

Skylstad,

Babirye

et al. 2023

BMC Public Health

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Background There is little research on alcohol and other drugs (AOD) use by school-age children in low-resource settings like Uganda. Including the voices of children in research can inform prevention and early intervention efforts for those at risk of AOD use. The aim of this study was to understand the perspectives of children aged 6 to 13 years regarding AOD in Uganda. Methods This qualitative study was conducted in Mbale district, Uganda from February to March 2020. Eight focus group discussions (FGDs) were conducted with 56 primary school-age children, stratified by age (6–9 and 10–13 years), sex (male and female), and school status (in school and out of school). All FGDs were conducted in either Lumasaaba or Luganda. The FGDs were audio-recorded, transcribed verbatim, and translated into English. Data were coded, and overarching themes were identified using thematic framework analysis. Results Two themes identified were (1) Children’s perceptions and experiences with AODs. The participants understood alcohol by its consistency, colour, odour, and by brand/logo. They described the types and quantities of AOD consumed by school-age children, brewing processes for homemade alcoholic drinks, and short and long-term consequences of the use of alcohol. (2) Contributing factors to childhood drinking included: Stress relief for children who experienced multiple adversities (orphaned, poverty-stricken, and hailing from broken homes), fitting in with friends, influence from families, and media exposure that made alcohol look cool. Children would start drinking at an early age) or were given alcohol by their parents, sometimes before they could start talking. In the community, alcohol and other drugs were cheap and available and children could drink from anywhere, including in the classroom. Conclusions Children eligible for primary education in Uganda can easily access and use AOD. Several factors were identified as contributing to alcohol and other drug use among children, including availability and accessibility, advertising, lack of parental awareness and supervision, peer influence, adverse childhood experiences, socioeconomic factors, and cultural norms. There is a need for multi-sectoral action for awareness of childhood AOD use and deliberate consideration of children in the planning, design, and implementation of research, policies, and programs for prevention and early intervention.

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Child alcohol use disorder in Eastern Uganda: screening, diagnostics, risk factors and management of children drinking alcohol in Uganda (TREAT C-AUD): a mixed-methods research protocol

Cited by 7 publications

References 33 publications

Improving alcohol and substance use screening in school-age children: translation, adaptation and psychometric evaluation of the CRAFFT tool for Lumasaaba, Uganda

Improving alcohol and substance use screening in school-age children: translation, adaptation and psychometric evaluation of the CRAFFT tool for Lumasaaba, Uganda

“We talk about the dangers”: exploring teachers’ and learners’ perspectives on alcohol education in Ugandan primary schools

“She gives it to her child who doesn’t even talk”: a qualitative exploration of alcohol and drug use among primary school-age children in Uganda

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