The prevalence and correlates of alcohol use and alcohol use disorders among young people (15 – 24 years) and adults in eSwatini, Malawi and Zambia

Msibi, Zethu Sandrah
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Introduction Globally, excessive alcohol use is a remarkable substantial risk for poor public health outcomes. It is escalating in Sub Saharan Africa due to marketing aggressively and lack of individual and policy level interventions. We used the national representative population-based HIV Impact Assessment (PHIA) data to determine the prevalence and correlates of ‘alcohol use’ (AU) and ‘alcohol use disorders’ (AUD) in young people and adults in Eswatini, Malawi and Zambia. Methods PHIA surveys 2015 – 2017 data was analyzed. The surveys employed a multistage sampling strategy to recruit study participants at household level. The sample in each country dataset were as follows Eswatini (n=9885) Malawi (n=19405), and Zambia (n=27,382). The analysis utilized multivariate logistic regression models that identify the correlates of AU and AUD. Analyses were adjusted for weights, stratification, and clustering using the survey platform analysis in Stata version 15. We considered the p values of <0.05 statistically significant. Results Alcohol use prevalence in young people and adults was 17.9% and 23.3% in Eswatini, 10.9% and 22.1% in Malawi, and 14.6% and 32.4% in Zambia. The prevalence of AUD in young people and adults was 9.1% and 14.2% in Eswatini, 3.5% and 11.2% in Malawi, and 7.6% and 20.6% in Zambia. The correlates which had more risk of alcohol use and AUD encompass being male (aOR: 4.62 (95% CI: 3.35 -5.79), 20 – 24 year age group, higher education level (aOR: 1.70, 95% CI: 1.16 -2.48), divorced or separated or widowed in all 3 countries (aOR: 1.96, 95% CI: 1.55 -2.48), HIV positive status in Zambia (aOR: 1.49, 95% CI: 1.12 -1.99), multiple sexual partners in Malawi (aOR: 11.90, 95% CI: 6.76 -20.93), employed class in Zambia (aOR: 2.06, 95% CI: 1.64 -2.59) and engaging in commercial sexual relations in Malawi. Conclusion The reported ‘alcohol use and AUD’ are common in youth and adults in Eswatini, Malawi and Zambia. ‘Both alcohol use and AUD’ are related with being male, age group 20 – 24 years old, educational level (higher), HIV status, transactional sex and multiple sexual partners, widowed or separated and HIV status and risky sexual behaviours in the three countries. There is an urgent need for targeted alcohol interventions and such interventions could be integrated with sexual and reproductive health programs.
A research report submitted in fulfilment of the requirements for the degree of Master of Science in Epidemiology (Epidemiology and Biostatistics) to the Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, 2022