Prevalence of alcohol use and associated factors among Dilla University Students, Dilla Town, Southern Ethiopia. 2018

Introduction Compared to other deadly communicable diseases, Psychoactive Substance use is among the leading cause of death. Repeated use linked to addiction, dependence and predisposition for criminal and antisocial behaviors. Even though drug use in Africa relatively is short; however the abuse of drug in Africa is escalating rapidly. Substances use is also one of the most burning and growing public health problems in Ethiopia, as in many developing countries; alcohol is the most frequently used substance. Objective To Assess the Prevalence of alcohol Use and Associated factors among Dilla University undergraduate students in Southern Ethiopia. 2018. Methods An Institution based cross -sectional study was conducted at Dilla University among undergraduate regular students from January-February. Systematic random sampling technique was used to get a total of 803 samples of students from each year and department of the university. The collected data was coded, entered in to EPI-INFO version7.1 and analyzed by using SPSS version 20. Crude and adjusted OR were analyzed using logistic regression and the level of significance of association was determined at P- value <0.05. Result A total of 803 participants were interviewed with a response rate of 91.7%. Among the Participants, alcohol use was found to be 67.6%. (41.8%; n=336). Being 4 th year students (AOR =2.66, 95% CI: 1.64, 4.31), having friends who use substance (AOR=1.53, 95% CI: 1.09, 2.1), being Khat user (AOR= 1.48, 95% CI: 1.05, 2.09) and being Cigarette smoker (AOR=1.76, 95% CI: 1.09, 2.84) were found to be significantly associated with alcohol use. Conclusion Half of the participants found to have alcohol use. Therefore, early prevention, detection and alleviating of alcohol use should be implemented among students in the university.


Introduction
Substance use among adolescents can lead to a variety of detrimental consequences. Cigarette smoking, alcohol drinking and cannabis use can increase accidental or intentional injuries, commission of crimes, mood disorders, and mortality, and can complicate normal psychosocial development (1,2) Over 20% of out-of-school youth had unprotected sex during the 12-month period prior to interview compared to 1.4% of in-school youth. Daily alcohol intake and khat intake were also associated with unprotected sex (3).
Abuse of substances, both licit and illicit is a cause of the health of the individuals and due to the socio-economic consequences and the devastating impact on close family members (4). Use of substances become one of the rising major public health and socio-economic problems worldwide and the use of substances have dramatically increased particularly in developing countries (5)(6)(7)(8).
Compared to other deadly communicable diseases, PAS use is among the leading cause of death (9)(10)(11)(12)(13). The history of drug use in Africa relatively short, however the abuse of drug in Africa is escalating rapidly for tobacco, alcohol and khat abuse to users to wide range of drug users (14). as in many developing countries; alcohol, khat and tobacco are the most frequently used substances in Ethiopia.
However, hard drugs such as heroin and cocaine are rarely used (8,15) Harmful use of alcohol accounts for nearly 6.5% of all deaths in Europe and alcohol related harm is highest and even in the world, but the burden is much higher in certain countries and for certain groups within countries (17).
An estimated 24.6 million Americans aged 12 or older were current (past month) illicit drug users, meaning they had used an illicit drug during the month prior to the survey interview. This estimate represents 9.4% of the population aged 12 or older(18).
A study done in western Kenya among college students, lifetime prevalence rate of alcohol use was 51.9%(19). being male, ease of getting an adult to buy alcohol, cigarette use and having multiple sexual partners are risk factors (20).
A study done in Ethiopia among Haramaya university students the magnitude of substance use was high, about two-thirds (62.4%) of the participants used at least one substance. commonly used substance was alcohol (50.2%) (21).
A study done in Axum university revealed that the lifetime prevalence of alcohol drinking (34.5%).
A study done in Hawassa, the study depicted that 40.8% used alcohol, 20.3% chewed khat, 11.9% smoked cigarettes, and 0.9% used marijuana(24). A study done among RVUC student, the life time prevalence of alcohol drinking among the study participants was 40.2%. Similarly, the current prevalence of alcohol drinking was 35.6% (25). About 5.9% of all global deaths were attributable to alcohol consumption. global deaths were attributable by alcohol (7.6%) males and (4.0%) females (17).
A study done in western Kenya among college students 75.1% were introduced by a friend while 23.5% were introduced by a relative. Majority of users wanted to relax (62.2%) or relieve stress (60.8%)(19).
A study done in Hawassa depicted that having family members who used PAS, peer influence, being male, and living alone during school age were found to be positively associated with overall PAS use in the past 12 months(24).The most common reason for social drugs abuse among university students were to for relaxation with friends 84(53.8%), peer pressure 72(46.2%) and to get relief from stress 56(35.9%) respectively (25). therefore; The aim of this study was to assess the prevalence of alcohol use and associated factors among Dilla university students

Methods & Materials Study Design and Period
Institutional based cross sectional study was used to assess the alcohol use and associated factors among Dilla University students Southern Ethiopia from January-February 2018.

Study Area
The study was conducted in Dilla University which is found in the Gedeo Zone, SNNPR and it is operating in three campus (main campus, oda yaa'a campus and hospital campus).Dilla university, one of the public universities in Ethiopia is located in the fertile coffee belt of Gedeo Zone, SNNPR,Ethiopia. The town is far located 363 KM from the capital city Addis Ababa.

Sample size and Sampling technique
Sample size was determined using single popaulation proportion formula. we calculated by assumption of (p=45.7%) from a study done in Southern Ethiopia(Hawassa University) (24) 95% confidence internal and 5% of margin of error. considering 15 % of non-response rate and a design effect of two for multistage sampling, the total sample size was computed to be 876.
Multistage sampling technique was used to select the study participants. First, students were divided into their colleges and departments. Then, further stratification was used based on the year of study.
Finally, systematic sampling technique was used to select students in each year of study from the list of students' name in their respective batch. K was calculated for each year separately .To find "K" 12138÷876=13.86~14.study subjects were selected every 14. Students from each year of study were allocated proportionally to their class size.

Data Collection Procedures and instruments
A pre-tested self-administered questionnaire was used for the data collection. The questionnaire had different components including socio demographic characteristics, clinical and alcohol use characteristics.
Alcohol use was measured by a self-structured questionnaire which was developed by reviewing relevant literature and previously used standardized instruments and protocols (19, 22, 24, 25, 29).
The questionnaire was constructed and administered in English since the medium of instruction in Ethiopia particularly in high schools and Universities is in English.
The data were collected by three degree holder's health professionals and supervised by two master holder psychiatry health professionals after attending 3 days of training regarding to the inclusion criteria, purpose of the study, written consent of participants and content of the self-administered questionnaire and data collection procedures.

Data Processing and Analysis
First, the coded Data were checked, cleaned by entering into EPI-INFO version 7.1(software). Then exported into a Statistical Package for Social Science (SPSS-version 20 window) for analysis.
Descriptive statistics was used to determine alcohol use and associated factors of participants.
Both bivariable and multivariable binary logistic regression were computed to identify factors associated with alcohol use. Variables with p-value of ≤ 0.25 in the bivarriable analysis were consider as the candidate for multivariable regression to control possible confounders. Finally, variables with p-value of <0.05 were as having a statistically significant association with alcohol use at corresponding 95% CI.

Result
A total of 876 participants were studied, Out of 876 participants, 803 participants responded for questionnaires and the overall response rate was 91.7%.

Description of Socio-Demographic Characteristics
Most of the study subjects were in the age group of 20-24 years old (81.7%; n = 656), and Majority of the participants were males (66.9%; n = 537) and were singles and orthodox Christians Of the study participants (88.9%; n = 714) were attended public high school by type of high school before (Table 1).    *P value is significant at P < 0.05 ***P value is significant at P < 0.001

Discussion
The study has tried to determine the prevalence of psychoactive substance use (alcohol use, khat use, and cigarette smoking) among 803 students and associated factors using a cross sectional study design and a selfstructured questionnaire. The study participants were predominantly males (66.9%; n = 537) which were similar to previous studies (34,35).
According to the study, participants who have habit of alcohol use were 336 (41.8%). the finding was in line with study done in Ethiopia (40.8%) (39) and (40.2%) (40). then the finding was significantly lower than a similar study done In Kenya (51.9%) (34) and in Ethiopia (50.2%) (21). however, the study was significantly higher than a similar study done in Axum university (34.5%) (22) and Debre Markos university (33.8%) in Ethiopia (38). the possible explanation for the observed difference in alcohol use could be due to the difference in alcohol accessibility, knowledge, and the study area.
Participants who have habit of alcohol drinking with current use in the last 30 days were (24.4%; n = 196). The finding was in line in a study done in Addis Ababa University among Medical students, current alcohol was consumed 22% (25% males vs. 14% females) (20) and lower than in Rift Valley University College students (35.6%)in Ethiopia (40). The possible reason might be the university setup and knowledge of the students.
The best reasons of alcohol use for the study participants were for pleasure and to socialize (18.7%; n = 150), and The presence of substance use friends was associated with the alcohol use habits of students in the campus.
Students having friends who use substance 1.53 times more likely to use alcohol in the campus as compared with the counterparts. The study is in line in Axum University among students, having family members and peer friends who drink alcohol were strongly associated with alcohol use (37).also the finding was similar with a study done in Ethiopia among students whose friends consume alcohol were more likely to consume alcohol and whose friends' use (8).
The study participants, being Khat chewers had strong association with alcohol use was about 1.48 times more as compared to counterparts.

Declarations Acknowledgement
We are thankful towards the study participants for investing their fruitful time to participate in the study. Our gratitude also goes to Dilla university research dissemination office for positive cooperation and support in the study process.

Authors' Contribution
YA and SY conceived the research question, participated in the proposal development, data collection, analysis, interpretation and critically reviewed the manuscript.

Funding
Not applicable

Availability of the Data and Materials
The data used to support the finding of this study are included within the manuscript can be accessed from the corresponding Author Yigrem Ali upon request through the email address of alyigrem@gmail.com

Ethical consideration
Ethical clearance was obtained from Institutional Review Board (IRB) of Dilla University. Formal permission was obtained from students and finally written consent was obtained from each participant during data collection. All participants were well informed about the aims and purpose of the study, its contribution to the future development of health system in the universities and the country. Those participants were informed that as the right is given to the study participants to refuse and stop or withdraw from participation at any time during data collection without loss of any entitlement.

Consent for publication:
Not applicable