Early Alcohol Use and Problem Drinking among Students in Zambia and Uganda

Excessive alcohol use is a serious public health concern worldwide; but less attention has been given to the prevalence; risk and protective factors; and consequences of early alcohol use in low-income; developing countries.The purpose of this study was to determine the associations between early alcohol use; before age 13; and problem drinking among adolescents in Uganda and Zambia. Data from students in Zambia (n=2257; 2004) and Uganda (n=3215; 2003) were obtained from the cross-sectional Global School-Based Student Health Survey (GSHS). The self-administered questionnaires were completed by students primarily 13 to 16 years of age. Multiple statistical models were computed using logistic regression analyses to test the associations between early alcohol initiation and problem drinking; while controlling for possible confounding factors (e.g.; current alcohol use; bullying victimization; sadness; lack of friends; missing school; lack of parental monitoring; and drug use). Results show that early alcohol initiation was associated with problem drinking in both Zambia (AOR=1.28; 95CI:1.02-1.61) and Uganda (AOR=1.48; 95CI: 1.11- 1.98) among youth after controlling for demographic characteristics; risky behaviors; and other possible confounders.The study shows that there is a significant association between alcohol initiation before 13 years of age and problem drinking among youth in these two countries. These findings underscore the need for interventions and strict alcohol controls as an important policy strategy for reducing alcohol use and its dire consequences among vulnerable youth

Prevalence and correlates of condom use at last sexual intercourse among in-school adolescents in urban areas of Uganda.

OBJECTIVES: Correct and consistent condom use remains an important public health intervention against the spread of Human Immunodeficiency Virus and other sexually transmitted infections. There is paucity of information on sexual behaviour of in-school adolescents in Uganda. We, therefore, used secondary data of the Uganda Global School-based Health Survey (UGSHS) conducted in 2003 to determine the prevalence and correlates of condom use at last sexual intercourse in urban areas of Uganda. METHODS: A two-stage cluster sampling technique was used to obtain a representative sample. Altogether 1709 students participated in the survey in urban areas of whom 179 (14.9% of males, and 7.9% of females) had sexual intercourse within 12 months before the survey. RESULTS: Overall 77.3% (79.7% of male, and 72.3% of female) adolescents used a condom at last sexual intercourse. Adolescents who drank alcohol and used drugs were 64% (OR = 1.64, 95% CI 1.54, 1.75) and 68%, (OR = 1.68, 95% CI 1.56, 1.81) more likely to have used a condom, respectively. Meanwhile, adolescents who ever got drunk, and who reported to ever had 2 or more sex partners were 55% (OR = 0.45, 95% CI 0.42, 0.48) and 35% (OR = 0.65, 95% CI 0.62, 0.68) less likely to have used a condom compared to those who had never got drunk, and who ever had 1 sex partner, respectively. Finally, adolescents who reported receiving no parental supervision were 45% (OR = 0.55, 95% CI 0.53, 0.58) less likely to have used a condom compared to those who reported receiving parental supervision. CONCLUSIONS: Parental supervision may be effective in promoting condom use among adolescents. Furthermore, drinking alcohol was associated with condom use probably due to peer pressure and easy access of condoms in drinking places as condoms are not actively promoted in schools. There is need for further research on how in-school adolescents could access condoms.

Soil-transmitted helminthiasis in Uganda: epidemiology and cost of control.

A country-wide description of the distribution of soil-transmitted helminths in Uganda is reported, based on data for 20-185 school-children from 271 schools. The overall prevalence of Ascaris lumbricoides, Trichuris trichiura and hookworm was 6.3%, 5.0% and 43.5%, respectively. The prevalence of A. lumbricoides and T. trichiura was unevenly distributed in the country with prevalence greatest in south-western Uganda whereas hookworm was generally more homogeneously distributed. Based on preliminary cost analysis of an ongoing school-based control programme, the financial delivery cost per school-child treated with albendazole is estimated to be between US dollar 0.04 and 0.08 in different districts.

Baseline survey of oral health of primary and secondary school pupils in Uganda.

BACKGROUND: Among the issues that determine the performance of a child at school is health. In recognition of this, the Uganda government has embarked on a school health program for the success of universal primary education. Although dental health is an important component of school health there is little information on it. OBJECTIVE: This study aimed at collecting information on dental health of pupils in school for evaluation and planning. DESIGN: A cross-sectional study using a multistage cluster sampling technique was used to select 685 children attending schools in 5 districts. Children were clinically examined for common illnesses/conditions. The oral examinations were done using simplified versions of Decayed, Missing, and Filled teeth (DMFT) index and Community Periodontal Index (CPI). Oral examinations also assessed presence of fluorosis. RESULTS: The pupils attending school were aged from 5 to 22 years. Sixty six percent (456) were found to be caries free with a group DMFT of 0.7. The D-component (decay) accounted for approximately 70% of the cases. Fifty nine percent of the pupils were found to have a healthy periodontium. Sixteen percent of the pupils were found to have some degree of fluorosis of whom the majority were from the highland districts of Kabale and Mbale. Urban school pupils were more likely to have caries (OR 1,69; 95% CI 1.21-2.37) than the rural. CONCLUSION: There is an upward trend in the caries prevalence when compared to studies done earlier. This study revealed a need to develop preventive programs alongside improvement of dental health services.

The role of the environment in the sexual activity of school students in Tororo and Pallisa Districts of Uganda.

Several models of adolescent sexual activity have previously been published and most of them suggest two basic components, biological and sociological. This article highlights important environmental factors in shaping the sexual behaviour of the school-going youth in Uganda. Students in education levels Senior 1 to 6 participated in the study. Information was collected from self-response structured questionnaires, focus-group discussions, and discussions with teachers. Student respondents were randomly selected.

PIP: Findings are reported from a cross-sectional study of the sexual behavior of randomly selected secondary school students in Tororo and Pallisa districts of Eastern Uganda. 322 males and 348 females from 14 secondary schools answered structured questionnaires while 50 additional students participated in focus group discussions. The survey respondents were aged 10-24 years, although approximately 70% were aged 15-19 years. 65% of the male and 32% of the female unmarried students reported having sexual experience. The mean ages at first sexual intercourse were 16.1 years for boys and 16.6 years for girls. Of those sexually active, 49% of the males and 25% of females had multiple sex partners. Parental care, peer influence, economic factors, and AIDS education are the main environmental factors which appear to have major influences in determining the nature of students' sexual activity in Uganda.

Underlying factors in female sexual partner instability in Kampala.

Divorced or separated persons are more likely to be infected with HIV than those in marital unions: sexual partner instability appears to have significant implications in STD/HIV transmission. While this appears empirically true, most current STD/HIV preventive strategies do not seem to address partner instability as an important underlying factor in STD/HIV transmission and control. This paper describes reasons why young females may be motivated to change sexual partners or have more than one sexual partner. The problems appear to be dissatisfaction due to infidelity of the male partner, fear of getting STD from current partner, drunken or unattractive male partner, economic problems, lack of leisure time together, male partner's children with other women, and male partner's relatives' influence. STD/AIDS Control Programs should note that dissatisfaction with partner may be an underlying factor in HIV transmission.

PIP: Most available research findings indicate that HIV transmission, in both heterosexual and homosexual relationships, is mainly the result of having sex with multiple partners. 40 randomly selected female students aged 15-39 years in tertiary educational institutions in Kampala participated in a study exploring why women change their sex partners concurrently or consecutively, or return to previous sex partners. 22.5% of the women had two or more current sex partners and 20% had acquired new sex partners in the previous 3 months, of whom five had resumed active sexual relationships with former sex partners. Two women aged 18-20 years reported being virgin, 10 had had 1 sex partner over the course of their lives, 18 had had 5-9, and 8 had had 10 or more. Information collected from these women indicates that young females may be motivated to change sex partners or have more than one sex partner because of dissatisfaction due to the infidelity of the male partner, fear of contracting a sexually transmitted disease from the current partner, having a drunken or unattractive male partner, economic problems, lack of leisure time together, the male partner's children are with other women, and the male partner's relatives' influence.

Social context of HIV infection in Uganda.

Some of the important policy and research implications of accumulating HIV/AIDS data are being ignored because of the attraction of social science research focused on the "multiple sexual mechanism' of infection and transmission. Attention is drawn to the other policy and research issues relating to information on the timing of infection through a reanalysis of existing data on cumulative AIDS cases. The most urgent need is to supplement the mainstream research on risk groups with studies of the timing and circumstances of entry into sexual activity in the pre-teen years.

PIP: Some of the important policy and research implications of HIV/AIDS data are being ignored because of the focus of social science research upon the multiple sexual mechanism of infection and transmission. Attention is drawn to the other policy and research issues relating to information on the timing of infection through a re-analysis of existing data on cumulative AIDS cases. However, the most urgent need is to supplement the mainstream research on risk groups with studies of the timing and circumstances of entry into sexual activity during the pre-teen years. The authors comment upon the social science response to the epidemic. This paper was written to help broaden the scope of discussion of the socioeconomic context of the rapid reproduction of infections and to focus upon the role of pre-teen girl-child sexuality in the dynamics of the epidemic.