Drug and alcohol use in Tanzanian road traffic collision drivers

Abstract

Introduction Road traffic collisions (RTCs) are an important public health problem in low and middle-income countries (LMIC), where 90% of RTC deaths occur. The World Health Organization has suggested strategies to address excess mortality from RTCs including efforts to combat driving after using alcohol or drugs. Data on the impact of drug and alcohol use on RTCs is limited in many low-resource settings including Tanzania. We sought to examine the prevalence of drug and alcohol use in Tanzanian RTC drivers. Methods This prospective, observational study was conducted in the emergency centre (EC) of Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania. We enrolled adult drivers presenting within 24 h of an RTC. We collected a saliva test of blood alcohol content (BAC) and a urine drug screen (UDS) and administered a validated substance use disorder screening tool, the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Patients were excluded from individual analyses if they could not produce saliva or urine or answer questions. Primary outcomes were rates of positive BAC, UDS and self-reported risky alcohol and drug use patterns. Results We screened 5264 trauma patients and enrolled 418, in whom 190 had a BAC, 364 had a UDS, and 410 had a complete ASSIST. 15 of 190 patients (7.9%) had a positive BAC, and 67/361 (18.7%) had a positive UDS for at least one drug. ASSIST scores showed 75/410 (18.3%) patients were at moderate or high risk for alcohol use disorder. Few were at risk for disordered use of other non-tobacco substances. Discussion In our population of RTC drivers, positive BAC and UDS tests were rare but many patients were at risk for an alcohol use disorder. Ideal screening for substance use in Tanzanian trauma populations may involve a combination of objective testing and a verbal screening tool.

Helping Women Suffering from Drug Addiction: Needs, Barriers, and Challenges

“…The extreme marginalization of this group is both a barrier for women suffering from drug abuse to make any attempt at treatment and a severe challenge for policymakers [ 29 ]. The same is true, by the way, in African countries, including Tanzania, where fear of social consequences, violence against women, and low access to prevention and treatment services seem to be more of a challenge than a need [ 38 ], especially since research and prevention initiatives seem to be rare in that country [ 41 ]. In addition, drug abuse and HIV risks are a “pressing problem” that should not be ignored [ 42 ].…”

“…At the same time, therapists’ high level of training and egalitarianism are advocated, especially by African-American women suffering from addiction [ 25 ]. For women with addiction problems serving prison sentences, challenges related to their lowered self-esteem and sometimes harsh economic conditions include avoidance of seeking help in public institutions (hospitals, schools) due to fears of mistreatment for having been incarcerated in the past, and poor mental health as a consequence of their overall life experiences [ 41 ]. In addition, for women living in poorer neighborhoods, an indicated challenge is the so-called “domino effect,” i.e., despite the favorable completion of therapy, recurring difficulties in returning to fulfilling social roles related to past experiences [ 23 ].…”