Socio-demographic characteristics
A total of 470 patients participated in the study with a response rate of 98.95%; 5 (1.05%) with incomplete data were discarded. More than half of the participants, 255 (54.3%) were male and 256 (54.5%) urban residents. Their mean age was 36.64 (SD 13.24) years; the majority, 260 (55.3%), were married; 402 (85.5%) were Amhara, 436 (92.8%) Orthodox Christian followers 387 (82.3%) were living with their families and 147 (31.3%) were unable to read and write (Table 2).
Table 2: Distribution of sociodemographic characteristics of medical and surgical outpatients of University of Gondar specialized hospital, 2016 (n=470).
Variables
|
Categories
|
Frequency
|
Percentage
|
Sex
|
Male
|
255
|
54.3
|
Female
|
215
|
45.7
|
Age
|
18-24
|
106
|
22.6
|
25-34
|
128
|
27.2
|
35-44
|
90
|
19.1
|
45-54
|
75
|
16.0
|
55+
|
71
|
15.1
|
Religion
|
Orthodox
|
436
|
92.8
|
Muslim
|
27
|
5.7
|
Protestant
|
4
|
0.9
|
OthersR
|
3
|
0.6
|
Ethnicity
|
Amhara
|
402
|
85.5
|
Kimant
|
44
|
9.4
|
Tigre
|
17
|
3.6
|
OthersE
|
7
|
1.5
|
Educational status
|
Unable to read and write
|
147
|
31.3
|
Read and write only*
|
60
|
12.8
|
Primary school (grade 1-8)
|
110
|
23.4
|
Secondary school (grade 9-12)
|
76
|
16.2
|
Tertiary(TVET/college/university)
|
77
|
16.4
|
Marital status
|
Single
|
135
|
28.7
|
Married/in union
|
260
|
55.3
|
Divorced
|
34
|
7.2
|
Separated
|
11
|
2.3
|
Widowed/ widower
|
30
|
6.4
|
Occupation
|
Government employee
|
59
|
12.6
|
Housewife
|
102
|
21.7
|
Merchant
|
57
|
12.1
|
Daily laborer
|
20
|
4.3
|
Student
|
57
|
12.1
|
Farmer
|
122
|
26.0
|
OthersO
|
53
|
11.28
|
Residency
|
Urban
|
256
|
54.5
|
Rural
|
214
|
45.5
|
Living conditions
|
With family
|
387
|
82.3
|
Alone
|
83
|
17.7
|
Monthly income
|
<735
|
229
|
48.7
|
735-1176
|
95
|
20.2
|
>1176
|
146
|
31.1
|
NB: * Indicate informally educated people. OthersR includes (Catholic, Johba witness, and Adventist)
OthersE includes (Agew, Benshangul, and Oromo). OthersO includes (jobless, retired and carpenter)
Clinical and substance use characteristics
Of the participants, 156 (33.2%) had a history of hospital admission; 210 (44.7%) had more than two years of illness; some 54 (11.5%), were diagnosed with extra pulmonary tuberculosis; 55 (11.7%) were diagnosed with diabetes mellitus and 73 (15.5%) with cardiovascular diseases. More than half of the participants, 244 (51.9%), had a family history of alcohol use; 29 (6.2%) were lifetime cigarette smokers and 11 (2.3%) current smokers. The most preferable types of alcohol used by the participants, 128 (39.8%) and 125 (38.8%) were Tella and beer/draft respectively (Table 3).
Table 3: Distribution of clinical, and substance use characteristics of medical and surgical outpatients at University of Gondar specialized hospital, 2016 (470).
Variables
|
Categories
|
Frequency (n=470)
|
Percentage
|
Duration of illness
|
<6 months
|
123
|
26.2
|
6-24 months
|
137
|
29.1
|
>24 months
|
210
|
44.7
|
Previous hospital admission
|
Yes
|
156
|
33.2
|
No
|
314
|
66.8
|
Type of OPD
|
Medical
|
350
|
74.5
|
Surgical
|
120
|
25.5
|
History of mental illness
|
Yes
|
48
|
10.2
|
No
|
422
|
89.8
|
Diagnosis
|
Tuberculosis
|
54
|
11.5
|
Diabetes mellitus
|
56
|
11.9
|
Cardiovascular
|
73
|
15.5
|
Injury
|
29
|
6.2
|
Tumor
|
38
|
8.1
|
Gastritis
|
25
|
5.3
|
Urinary tract infection
|
35
|
7.4
|
Goiter
|
20
|
4.3
|
Breast tumor
|
13
|
2.8
|
OthersD
|
127
|
27.0
|
Family history of alcohol use
|
Yes
|
244
|
51.9
|
No
|
226
|
48.1
|
Lifetime use of cigarette smoking
|
Yes
|
29
|
6.2
|
No
|
441
|
93.8
|
Lifetime use of khat
|
Yes
|
23
|
4.9
|
No
|
447
|
95.1
|
Current use of cigarette smoking
|
Yes
|
11
|
2.3
|
No
|
459
|
97.7
|
Current use of khat
|
Yes
|
15
|
3.2
|
No
|
455
|
96.8
|
Current use of other substances
|
Yes
|
1
|
0.2
|
No
|
469
|
99.8
|
Most preferable types of alcohol she/he drunk*
|
Tella
|
128
|
39.8
|
Tej
|
4
|
1.2
|
Araki
|
28
|
8.7
|
Beer/draft
|
125
|
38.8
|
Wine
|
12
|
3.7
|
Whisky/Gin
|
25
|
7.8
|
Reason given for alcohol use
|
Socialization
|
244
|
75.8
|
Peer pressure
|
56
|
17.4
|
To relax
|
85
|
26.4
|
To get relief from stress
|
13
|
4.0
|
No specific reason
|
13
|
4.0
|
Note: OthersD includes diagnosis (hypertension, leishmaniasis, dermatological cases, diarrhea cases,
Pylonephritis, urolithiasis, typhus and typhoid, disc prolapsed, acute upper respiratory infection, parasitic infection, and other unspecified. * Local made ethanol beverages.
Magnitude of alcohol use and use disorders
The majority, 322 (68.50%) of the participants had a history of alcohol use, of whom, 111 (34.5%) had alcohol use disorders as defined by AUDIT with a total cutoff point of eight and above with a 95% CI (29.20, 39.80); with 86 (26.7%), 16 (5%) and 9 (2.8%), hazardous drinking, harmful use, and dependent respectively. In this study, the prevalence of AUDs was 95 (85.6%) among men and 16 (14.4%) for women. Of those, 75 (34.4%) medical outpatients and 36(34.6%) surgical outpatients had alcohol use disorders.
Factors associated with alcohol use disorders
In the bivariate analysis, sex, educational status, diagnosis of injury, history of mental illness, occupation, lifetime tobacco use, peer pressure and drinking for relaxation were candidates for the multivariable logistic regression analysis at p-value < 0.2. In the multivariable logistic regression analysis, male sex, history of mental illness, drinking for relaxation and lifetime tobacco use were significantly associated with AUDs at p-value < 0.05.
The multivariate analysis suggested male sex was 3.33 times more likely to develop AUDs compared to female sex (adjust odd ratio (AOR) =3.33, 95%CI =1.40, 7.93). Participants who had a history of mental illness were 2.68 times more likely to develop AUDs than those who had no such history (AOR=2.68, 95%CI=1.12, 6.38). Participants who drank for relaxation were 1.88 times more likely to develop AUDs compared to participants who didn’t (AOR=1.88, 95%CI=1.02, 3.48), and lifetime tobacco smokers were 5.64 times more likely to develop the problem than nonsmokers (AOR=5.64, 95%CI=1.95, 16.29) (Table 4).
Table 4:- Bivariate and multivariate analysis of alcohol use disorders and associated factors among alcohol user medical and surgical outpatients at Gondar university hospital (n=322), 2016
Variables
|
Categories
|
AUDs
|
OR (95% CI)
|
AOR (95% CI)
|
Yes
|
No
|
Sex
|
Female
|
16
|
101
|
1.00
|
1.00
|
Male
|
95
|
110
|
5.45(3.01,9.88)
|
3.33(1.40,7.93)**
|
Educational status
|
Can’t read and write
|
31
|
75
|
1.18(0.55, 2.51)
|
1.61(0.46, 5.68)
|
Read and write only
|
25
|
21
|
3.39(1.44, 7.99)
|
2.94(0.79, 10.94)
|
Primary school(1-8)
|
31
|
43
|
2.05(0.94, 4.49)
|
1.62(0.52, 5.00)
|
Secondary (9-12)
|
11
|
35
|
0.9(0.35, 2.26)
|
0.93(0.28, 3.03)
|
Above grade, 12th
|
13
|
37
|
1.00
|
1.00
|
Mental illness history
|
No
|
94
|
198
|
1.00
|
1.00
|
Yes
|
17
|
13
|
2.76(1.29, 5.91)
|
2.68(1.12, 6.38)*
|
Diagnosis of injury
|
No
|
97
|
199
|
1.00
|
1.00
|
Yes
|
14
|
12
|
2.39(1.07, 5.37)
|
2.06(0.82, 5.15)
|
Drinking for relaxation
|
No
|
70
|
167
|
1.00
|
1.00
|
Yes
|
41
|
44
|
2.22(1.34, 3.70)
|
1.88(1.02, 3.48)*
|
Lifetime use of tobacco
|
No
|
96
|
204
|
1.00
|
1.00
|
Yes
|
15
|
7
|
4.56(1.80,11.53)
|
5.64 (1.95, 16.3)**
|
Drinking due to peer pressure
|
No
|
86
|
180
|
1.00
|
1.00
|
Yes
|
25
|
31
|
1.69(0.94, 3.03)
|
1.26(0.64, 2.50)
|
Occupation
|
Employed
|
11
|
28
|
1.00
|
1.00
|
Housewife
|
8
|
48
|
0.42(0.15, 1.18)
|
1.59(0.33, 7.56)
|
Merchant
|
13
|
20
|
1.66(0.62, 4.44)
|
1.60(0.47, 5.54)
|
Daily laborer
|
6
|
7
|
2.18(0.6, 7.96)
|
2.04(0.42, 10.01)
|
Student
|
9
|
32
|
0.72(0.26, 1.98)
|
1.10(0.34, 3.52)
|
Farmer
|
50
|
58
|
2.19(1.00, 4.85)
|
1.96(0.63, 6.07)
|
OthersO
|
14
|
18
|
1.98(0.74, 5.31)
|
2.37(0.71, 7.88)
|
Note: Significance * (p-value <0.05), and ** (p-value <0.01)