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Authors:Charles D. H. Parry, Pamela J. Trangenstein, Jodilee Erasmus, Aadielah Diedericks, Nadine Harker Pages: 93 - 117 Abstract: This manuscript describes a process to develop a set of indicators to monitor and evaluate the implementation of the Western Cape Alcohol-Related Harms Reduction (AHR) White Paper in South Africa and provide a final set of indicators. Drawing on the framework in Andréasson et al. (2009), a logic model with categories and types of indicators (i.e. prevention, determinants, consumption, and alcohol-related harms) was used to develop an initial set of 255 indicators. The methodological process followed involved a) scoping of a large electronic database maintained by the South African Medical Research Council, b) a comprehensive literature review and, c) reaching out to18 international key informants. Iterative communications with stakeholders from diverse government entities via email, telephone calls and individual and multi-person face-to-face meetings, together with a consensus process involving the study team was used to refine the indicators. The final set included 176 indicators; 108, (61.4%) of these were “core” indicators, and 68 (38.6%) were “expanded” indicators, meaning they added to the core indicators in given areas which would be useful to have but are of a lower priority or are likely to be less easy to obtain. Of the core indicators, 45 (42.4%) were deemed by policy makers/researchers in the Premier’s office as “high-level indicators,” denoting that they were the most essential. This manuscript demonstrates that it is possible to develop evidence-based, location-specific indicators to evaluate policy implementation. PubDate: 2023-02-25 Issue No:Vol. 20, No. 2 (2023)
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Authors:Orfega Zwawua, Rohani Ismail, Mohd Yasin Mohd Azhar, Norhayati Mohd Noor, Targema Iorvaa Pages: 119 - 131 Abstract: There are indications that the practices or behaviour involving tramadol use have not been measured with valid and reliable tools in the past. A scale that can be used to identify tramadol abuse practices in both clinical and non-clinical settings would be useful for possible intervention efforts. The objective of this study was, therefore, to develop and validate a scale to measure tramadol abuse. The scale items were sourced from the literature and outcomes from focus group discussions (FGDs) with 16 longterm tramadol users who were screened with Q-cup urine drug test kit (Q-CUDTK). Six experts and 30 long-term tramadol users were engaged for content and face validations of the items respectively. For construct validation, 180 tramadol users participated. Exploratory factor analysis (EFA) was applied to identify the underlying factor structure of the scale and Cronbach’s alpha was computed for the scale internal consistency. Two items failed to meet the I-CVI (item-content validity index) cut-off point (I-CVIs < 0.83) and were deleted leaving 18 items with the S-CVI (scale-validity index) of 0.93. Three more items were deleted for having factor loadings below 0.50 leaving 15 items. The EFA resulted in the extraction of three factors: frequency of use (7 items), intensity of use (5 items) and pattern of use (3 items) with the reliability coefficients of 0.95, 0.96 and 0.89 respectively. We named this scale ‘Tram-BEHAV’ because it can be used to identify tramadol abuse behaviour for possible intervention. It can also be used for the evaluation of tramadol abuse intervention programmes. PubDate: 2023-02-25 Issue No:Vol. 20, No. 2 (2023)
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Authors:Cheneal Puljević, Steffi Cook, Jason Ferris, Catherine Ward Pages: 133 - 142 Abstract: Despite high levels of alcohol-related injury in South Africa, there are no screening and brief intervention (SBI) programs in any hospital trauma centres. We conducted semistructured interviews with 16 trauma centre staff (8 doctors, 7 nurses, 1 social worker) focused on barriers and enablers to the future implementation of a SBI program. Data were analysed using thematic analysis. Perceived barriers included time constraints and injury treatment as priority, with the central barrier being inadequate funding. Enablers included the support of senior staff, and training. These findings can be used to support the successful implementation of a SBI program in South African trauma centres, with the purpose of reducing high rates of risky alcohol use and related injury recidivism. PubDate: 2023-02-25 Issue No:Vol. 20, No. 2 (2023)
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Authors:Kennedy Amone-P’Olak, Bernard Omech Pages: 143 - 158 Abstract: Worldwide, cannabis is the most commonly used drug after tobacco and alcohol, especially among young adults. In Africa, cannabis use is often associated with mental health problems. However, few studies have been conducted to assess which mental health problems are linked to cannabis use, particularly among young adults. This study examined the prevalence, distribution and risks of cannabis use attributed to generalised anxiety disorders. Data from 615 young adults (Mean age = 22.15, ±2.55, 18 – 25; 60.2% female) were used to compute the prevalence and distribution of cannabis use and binary logistic regression models fitted to quantify the risk of using cannabis attributed to different levels of anxiety severity. Of the 615 respondents, 13.8%, 20.4% and 31.7% reported using cannabis in the past month, the past year and lifetime, respectively. Similarly, 11.2% were hazardous users and 5.2% had possible cannabis use disorders. The odds of using cannabis varied with the severity of anxiety symptoms. Compared to those with minimal anxiety problems, the risks of using cannabis ranged from 2.61 (95% Confidence Intervals (CI) 1.65-4.93) to 3.72 (95% CI: 2.10-6.61) for mild anxiety and from 3.68 (95% CI: 2.08 – 6.98) to 6.32 (95% CI: 2.40-16.64) for severe anxiety. Interventions to reduce cannabis use and its concomitant long-term negative consequences should target reducing anxiety problems among young adults. Practitioners should prioritise mental health literacy and programmes such as relaxation techniques and guided selfhelp interventions, which are known to be cheap, effective, and efficient in alleviating anxiety problems. PubDate: 2023-02-25 Issue No:Vol. 20, No. 2 (2023)
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Authors:Ikenna D. Ebuenyi, Eze Uzoechi Chikezie, Ifeoma N. Onyeka Pages: 159 - 164 Abstract: Substance use disorder is a major contributor to disability adjusted life year. Globally and especially in Africa there is high treatment gap for substance use disorders (SUDs) and lack of training in addiction psychiatry. This commentary discusses challenges to SUD treatment and training in Africa and offers suggestions to advance the field. Sociopolitical and health system factors limit the availability of treatment and training of healthcare providers for addiction in Africa. It is essential that governments in Africa prioritise investment in addiction treatment and training to reduce the morbidity and mortality associated with lack of treatment. PubDate: 2023-02-25 Issue No:Vol. 20, No. 2 (2023)