Abstract
BackgroundAlcohol, substance use, and mental health disorders constitute major public health issues worldwide, including in low income and lower middle-income countries, and early initiation of use is an important predictor for developing substance use disorders in later life. This study reports on the existence of childhood alcohol abuse and dependence in a sub-study of a trial cohort in Eastern Uganda.MethodsThe project SeeTheChild—Mental Child Health in Uganda (STC) included a sub-study of the Ugandan site of the study PROMISE SB: Saving Brains in Uganda and Burkina Faso. PROMISE SB was a follow-up study of a trial birth cohort (PROMISE EBF) that estimated the effect that peer counselling for exclusive breast-feeding had on the children’s cognitive functioning and mental health once they reached 5–8 years of age. The STC sub-study (N = 148) used the diagnostic tool MINI-KID to assess mental health conditions in children who scored medium and high (≥ 14) on the Strengths and Difficulties Questionnaire (SDQ) in the PROMISE SB cohort N = (119/148; 80.4%). Another 29/148 (19.6%) were recruited from the PROMISE SB cohort as a comparator with low SDQ scores (< 14). Additionally, the open-ended questions in the diagnostic history were analysed. The MINI-KID comprised diagnostic questions on alcohol abuse and dependence, and descriptive data from the sub-study are presented in this paper.ResultsA total of 11/148 (7.4%) children scored positive for alcohol abuse and dependence in this study, 10 of whom had high SDQ scores (≥ 14). The 10 children with SDQ-scores ≥ 14 had a variety of mental health comorbidities of which suicidality 3/10 (30.0%) and separation anxiety disorder 5/10 (50.0%) were the most common. The one child with an SDQ score below 14 did not have any comorbidities. Access to homemade brew, carer’s knowledge of the drinking, and difficult household circumstances were issues expressed in the children’s diagnostic histories.ConclusionsThe discovery of alcohol abuse and dependence among 5–8 year olds in clinical interviews from a community based trial cohort was unexpected, and we recommend continued research and increased awareness of these conditions in this age group.Trial registration Trial registration for PROMISE SB: Saving Brains in Uganda and Burkina Faso: Clinicaltrials.gov (NCT01882335), 20 June 2013. Regrettably, there was a 1 month delay in the registration compared to the commenced re-inclusion in the follow-up study: https://clinicaltrials.gov/ct2/show/NCT01882335?term=saving+brains&draw=2&rank=1
Highlights
Alcohol, substance use, and mental health disorders constitute major public health issues worldwide, including in low income and lower middle-income countries, and early initiation of use is an important predictor for developing substance use disorders in later life
Of the 765 mother-infant pairs recruited in Uganda into the PROMISE EBF trial [28], 530 (69.3%) parent–child pairs were included in the PROMISE Saving Brains in Uganda and Burkina Faso (SB) study in Uganda for an interview on socio-demographic characteristics and for responding to the Strengths and Difficulties Questionnaire (SDQ)
Of the 530 parent–child pairs analysed in PROMISE SB [27], 124 children met the criterion for a mental health interview of an SDQ score ≥ 14, of whom 120 (96.0%) were participating in the SeeTheChild—Mental Child Health in Uganda (STC) sub-study
Summary
Substance use, and mental health disorders constitute major public health issues worldwide, including in low income and lower middle-income countries, and early initiation of use is an important predictor for developing substance use disorders in later life. Data from the Global Burden of Disease Study 2010 showed that substance use and mental disorders were the leading causes of years lived with disability (YLD) worldwide [2]. The World Health Organization (WHO) has estimated that up to 76–85% of all people living with severe mental disorders and 99% of those with past-year substance use disorders in LMIC did not receive treatment [6, 7]. As a response to the inadequate handling of child and adolescent mental health, the Ministry of Health recently released “Child and Adolescent Mental Health Policy Guidelines” [11] in which substance use in children is recognised, stating that “alcohol and drug abuse in children and adolescents in Uganda is on the increase not well researched” [11]
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