Association between alcohol use and violence-related injury in emergency department patients in Moshi, Tanzania: analysis of a prospective trauma registry

Abstract

BackgroundHarmful and hazardous alcohol use and violence are major contributors to global mortality and morbidity, despite being both predictable and preventable. This study seeks to quantify the association between violence-related injury and alcohol use disorders in a referral hospital in Moshi, Tanzania using a prospective trauma registry. MethodsWe included all adult trauma patients (>17 years of age) presenting to the Kilimanjaro Christian Medical Center in Moshi, Tanzania in the registry. The trauma registry is an extensive instrument that was translated and back-translated from English to Kiswahili by local research assistants. The registry includes demographic information, patient history, clinical diagnosis and treatment, injury and surgery information, the Patient Health Questionnaire-2 (PHQ2), a behavioural health assessment, the Alcohol Use Disorders Identification Test (AUDIT), and substance use screening. An AUDIT score of ≥8 indicates harmful alcohol use in this setting. Alcohol use in the 6 h prior before injury was determined either from self-report or a blood alcohol concentration above 0. Category of injury (violence or non-violence) was self-reported. FindingsWe included data from 500 patients enrolled in the trauma registry between April 17, 2018, and Jan 12, 2019. Of these, 84 patients (16·8%) reported that their injury was due to violence. Patients with violence-related injuries were 2·21 times more likely to have a positive alcohol status than were patients who presented with injuries not related to violence (95% CI 1·36–3·60; p<0·01). Among patients with violence-related injuries, those with a positive alcohol status were 6·26 times more likely to have an AUDIT score ≥8 than were patients with a negative alcohol status (95% CI 2·13–18·39; p<0·001). InterpretationAlcohol use and violence-related injury pose a significant threat to health and wellbeing globally. In Moshi, Tanzania, both issues are prevalent and contribute to the burden of injury. To adequately reduce violence-related injuries in this setting, it is necessary to address harmful alcohol use. FundingFogarty International Center of the National Institutes of Health under Award Number K01TW010000 (PI, Staton) and the Duke Global Health Institute.