Table of Contents
DECLARATION…………………………………………………………………………………………… ii
DEDICATION STATEMENT……………………………………………………………………… iii
ACKNOWLEDGEMENT…………………………………………………………………………….. iv
LIST OF TABLES………………………………………………………………………………………… ix
LIST OF FIGURES……………………………………………………………………………………….. x
LIST OF PLATES………………………………………………………………………………………… xi
ABBREVIATION AND ACRONYMS………………………………………………………… xii
DEFINITION OF OPERATIONAL TERMS………………………………………………. xiii
ABSTRACT……………………………………………………………………………………………….. xiv
CHAPTER ONE: INTRODUCTION…………………………………………………………….. 1
- Background to the Study…………………………………………………………………………. 1
CHAPTER TWO: LITERATURE REVIEW………………………………………………… 9
CHAPTER THREE: MATERIALS AND METHODS…………………………………. 29
- Research Design……………………………………………………………………………………. 29
CHAPTER FOUR: RESULTS…………………………………………………………………….. 39
- Psycho-social Characteristics of the Persons with alcohol use disorder………….. 39
CHAPTER FIVE: DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS 58
- Discussion……………………………………………………………………………………………. 58
REFERENCES……………………………………………………………………………………………. 84
APPENDICES…………………………………………………………………………………………….. 89
Appendix 1: Informed Consent……………………………………………………………………. 89
Appendix 2: Idhini……………………………………………………………………………………… 92
Appendix 3: AUDIT…………………………………………………………………………………… 95
Appendix 4: Questionnaire………………………………………………………………………….. 97
Appendix 5: Map of Githunguri Sub County, Kiambu County……………………….. 102
Appendix 6: Budget………………………………………………………………………………….. 103
Appendix 7: Time Schedule……………………………………………………………………….. 104
Appendix 8: Application Letter………………………………………………………………….. 105
Appendix 9: Graduate School Approval to go to the Field……………………………. 104
Appendix 10: Clearance letter from Kenyatta University Ethical Committee…… 106
Appendix 11: Permit from National Commission for Science, Technology and Innovation (NACOSTI)…………………………………………………………………………………………….. 107
Appendix 12: Research Authorization from County Commissioner Kiambu County 108
Appendix 13: Research Authorization from the County Director of Education Kiambu County……………………………………………………………………………………………………. 109
LIST OF TABLES
Table 1.1: Alcohol-attributable deaths as well as population-attributable fractions by the type of injury……………………………………………………………………………………………………………. 10
Table 3.1: Sampled county wards together with number of villages and households in Githunguri Sub County…………………………………………………………………………………… 32
Table 4.1: Psycho-social characteristics of the persons with alcohol use disorder
……………………………………………………………………………………………………………….. 40
Table 4.2: Poverty and poverty indicators…………………………………………………………. 42
Table 4.3: Socio-demographic characteristics and alcohol-related physical injury
………………………………………………………………………………………..46
Table 4.4: Types of physical injuries…………………………………………………………………. 49
Table 4.5: Type of alcohol-related physical injury by gender……………………………….. 49
Table 4.6: Characterization of the occurrence of alcohol-related physical injuries 50
Table 4.7: Self-inflicted versus externally-inflicted physical injuries…………………….. 50
Table 4.8: Body part injured by each type of alcohol-related physical injury…………. 53
Table 4.9: Injury management…………………………………………………………………………. 54
Table 4.10: Location where the person with alcohol use disorder experienced the alcohol-related physical injury……………………………………………………………………………………. 57
LIST OF FIGURES
Figure 1.1: Conceptual Framework…………………………………………………………………….. 7
Figure 4.1: Proportion of respondents with alcohol-related physical injury due to drunkenness………………………………………………………………………………………………………………….. 43
Figure 4.2: Violence due to Alcohol Abuse……………………………………………………. 51
Figure 4.3: Parts of the Body Injured…………………………………………………………… 52
Figure 4.4: Home remedies used to manage alcohol-related physical injuries…… 55
Figure 4.5: Alcohol-related physical injury severity………………………………………. 56
LIST OF PLATES
Plate 1.1 (Contusion)…………………………………………………………………………………… 17
Plate 1.2 (Puncture)…………………………………………………………………………………….. 18
Plate 1.3 (Strain)…………………………………………………………………………………………. 18
Plate 1.4 (Abrasion)…………………………………………………………………………………….. 19
Plate 1.5 (Sprain)………………………………………………………………………………………… 19
Plate1.6 (Laceration)…………………………………………………………………………………… 20
Plate 1.7 (Incision)……………………………………………………………………………………… 20
Plate 1.8 (Avulsion)…………………………………………………………………………………….. 21
ABBREVIATION AND ACRONYMS
AAM: Alcohol-Attributable Mortality
AUD: Alcohol Use Disorder
AHRQ: Agency for Healthcare Research and Quality CDC: Centers for Disease Control and Prevention DALY: Disability-Adjusted Life Years
HHS: Department of Health and Human Services
ICECI: International Classification of External Causes of Injury
KNBS: Kenya National Bureau of Standards
MOH: Ministry of Health
NACADA: National Campaign Against Drug Abuse Authority NCADD: National Council on Alcoholism and Drug Dependence NICE: National Institute for Health and Care Excellence OIPRC: Ontario Injury Prevention Resource Center
ONS: Office for National Statistics
RTA: Road Traffic Accident
UN: United Nations
WHO: World Health Organization
DEFINITION OF OPERATIONAL TERMS
Alcohol drinker: Someone who drinks alcohol.
Injury: Damage to biological organisms, which is caused by physical harm (Agency for Healthcare Research and Quality (AHRQ), 2008).
Major injury: Injuries that require major surgery, casting (plaster) or advanced medical examination (AHRQ, 2008).
Minor injury:Injuries that require a simple intervention (AHRQ, 2008).
Moderate injury:Injuries that require minor surgery like suturing or even the fixing of splints (bone immobilizers) to the affected part (AHRQ, 2008).
Person with alcohol use disorder: This is an alcohol drinker, who has had alcohol harm his/her health, working ability or interpersonal relationships as manifested by having a score of ≥ 8 in the World Health Organization (W.H.O) AUDIT (W.H.O, 2013).
Physical injury: Damage to the skin, ligaments, muscle or tendon through impact, tearing, puncturing or cuts with a focus on soft tissue injuries and an exclusion of injuries to the bone.
Violence: Refers to any behavior involving physical force aimed at hurting, destroying or even killing another person. Violence in this study
mainly thus referred to any physical assault resulting from the
confrontation between the person with alcohol use disorder and another person (Office for National Statistics,2015).
ABSTRACT
Around 5.1% of the worldwide disease burden and injury, as well as 5.9% of all fatalities are linked to alcohol abuse. In Kenya, Kiambu County is one of the leading counties in alcohol abuse and alcohol-related physical injuries. The study established the types and management of alcohol-related physical injuries among 383 persons with alcohol use disorder in Githunguri Sub-county, Kiambu County. The cross- sectional survey specifically occurred from March-November 2015 in Githiga and Ngewa County wards. An Alcohol Use Disorders Identification Test (AUDIT)and a questionnaire helped in enrollment to study and data collection. Respondents were asked about the physical injuries they had sustained in the preceding 12 months and how they managed them. The Statistical package for social sciences (SPSS) helped incomputing the proportion for each injury. Chi-Square aided in measuring the relationship between study variables whereby p value of ≤0.05 was statistically significant. Incisions and abrasions were the leading injuries mainly occurring on the head and upper extremities. Leading contributors of alcohol abuse were socialization, loneliness and anxiety.The injuries were higher among males, those with secondary level of education, separated/divorced and 18-29 year-olds. Gender, level of education, marital status and agehad a statistically significant relationship withinjuries.Only 35.5% of theinjured respondents had sought medical care. Alcohol- related physical injuries were a significant but largely neglected contributor of disease burden. County and national governments should thus create a broad-based strategy to reduce the injuries by addressing issues such as male-child neglect, unemployment, poverty and drinking socialization.
CHAPTER ONE: INTRODUCTION
Background to the Study
Alcohol-related physical injuries among persons with alcohol use disorder have received disproportionately little attention as a key public health concern in Kenya(WHO, 2014). Alcohol abuse is an issue that affects many citizens in many countries across the globe. Worldwide, persons aged above 15 years consume an average of 6.2 litres of alcohol annually. This translates to around 13.5 grams of alcohol daily, with men said to drink more than women (WHO, 2014). The most consumed alcoholic drink is spirits (50.1%), followed by beer (34.8%) and then wine (8%), with the rest (7.1%) representing alcoholic beverages (rice wine, fermented beverages and fortified wines).
World Health Organization (WHO) (2014) indicates that alcohol abuse is a big risk factor for unintentional and intentional physical injuries, with 5.1% of the worldwide disease burden and injury, as well as 5.9% of all fatalities linked with alcohol. Alcohol abuse normally accounts for about 20.4% of the unintentional injuries and 3% of intentional injuries worldwide (Ibid.).
Regionally, alcohol-related physical injuries are high in countries where alcohol consumption rates are high. The rate of the injuries tends to be directly proportional to the Blood Alcohol Concentration (BAC). In Africa, there are about 29.8% current drinkers, 12.8% former drinkers and 57.4% lifetime drinkers (WHO, 2014). If this high rate of drinking is not addressed, there will continue to be more alcohol-related
physical injuries to the detriment of the persons with alcohol use disorder who always have to suffer the associated consequences of the injuries.
In Kenya, the emergency departments in many hospitals regularly receive many cases of alcohol-related physical injuries particularly at night National Agency for the Control of Alcohol and Drug Abuse (NACADA) (2011). Alcohol abuse has thus remained a significant social problem in Kenya and it comes with severe health ramifications. According to a recent report by (NACADA, 2011), alcohol consumers in Kenya are starting at a very young age, with 50% of the abusers being from 15-29 years of age. The situation is worsened by the consumption of illicit brew and overconsumption of legal alcohol.
In a study on factors leading to alcohol abuse among the students in the University of Nairobi, Hassan (2013) highlights the association between alcohol abuse and alcohol- related physical injuries reported in the University. Further, the report indicates that on a global scale, an upwards of 1400 students aged between 18-24 years die annually from alcohol-related injuries, with most of them being unintentional injuries. Accordingly, above 500,000 students within the same age category tend to sustain alcohol-related injuries annually (Ibid.). Excessive drinking patterns contribute to sexual and interpersonal violence, including physical fights.
In Kiambu County, especially in Githunguri Sub-county, the prevalence of alcohol- related physical injuries has been significantly high because of the increased alcohol abuse rate, which was estimated at 53% (NACADA, 2011). In studying alcohol- related physical injuries, as per the aim of this study, the research would create public
awareness on the consequences of alcohol abuse in Githunguri Sub-county and hence allow for advocacy for behavior change among alcohol drinkers. Kariuki (2010) highlights the historical trends in drug abuse in the Kenyan provinces. In terms of alcohol abuse, Kiambu County has been in the top two as revealed in a rapid assessment survey of the drug abuse patterns involving 383 interviewed drug abusers. In this survey, among the 383 drug abusers who participated in the study, the highest
(55) number of those who were abusing alcohol were from Eastern province, with 40 from central province (Currently Kiambu), 40 from Nairobi, 38 from Western/Nyanza, 30 from Rift valley and 22 from the Coast.
Over time, Kiambu has continued to record a higher number of persons with alcohol use disorder, with recent NACADA (2017) report shows Nairobi and Kiambu County (particularly Githunguri Sub-county) leading in the consumption of packaged alcohol. In a three day conference in Nairobi, NACADA chairman stated that persons with alcohol use disorder in Kiambu spend more than Kshs. 300 daily on alcohol.
Statement of the Problem
Abusing alcohol increases the risk of physical injuries due to its depressant effects that slows down the brain and alters the response mechanism of the body (NACADA, 2011). At the same time, someone who has abused alcohol is more likely to take certain risks. Combined, the reactions tend to increase the chance of sustaining physical injuries. The more a person drinks alcohol, the more likely s/he is to have alcohol-related physical injuries. The effects of the physical injuries in Githunguri Sub-county are quite severe, with some persons with alcohol use disorder becoming disabled and others dying (NACADA, 2011).In Githunguri Sub-county, alcohol- related physical injuries have been on the rise due to the high prevalence of alcohol
intake estimated at about 53% (NACADA, 2011). Considering the pervasive nature of the alcohol-related physical injuries among persons with alcohol use disorder in Githunguri Sub-county, it was important to conduct a study to find out the what and how of alcohol-related physical injuries in the area with a view of mitigating them. With such a study, it becomes easy to understand the commonest types of alcohol- related injuries sustained their disaggregated burden and the factors that contribute to the injuries.
Justification of the Study
The study is justified because there is limited data on the commonest types of alcohol- related physical injuries, disaggregated burden and factors leading to the injuries in Githunguri. In fact, Shield et al., (2012) also indicates that globally, the existing literature has associated alcohol abuse with many injuries and deaths, but data on the specific disaggregated burden is still limited. In Kenya, lacking sufficient data on the alcohol-related physical injuries is a major gap, especially considering the fact that there is a huge proportion of Kenyans who consume alcohol, with 28.6% of the consumption being illegally produced or unrecorded (WHO, 2014).
In a NACADA report (2011) on alcohol abuse in Central Province, the prevalence of alcohol use in many communities was averagely high at 53%. The report also indicates that 60% of the alcohol drinkers consumed beer before noon, a factor that interfered with their work and reduced their productivity. This reflects the situation in Githunguri Sub-county, which lies within the region. If not addressed, alcohol abuse will continue causing alcohol-related physical injuries, disabilities and a potential increase in the annual global deaths from alcohol, which have in the recent past been estimated at ˃2.5 million (HHS, 2014).
