Social Determinants of Alcohol Use Disorder in Patients Attending Private Primary Care Clinics in Nairobi Kenya

Social Determinants of Alcohol Use Disorder in Patients Attending Private Primary Care Clinics in Nairobi Kenya | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Social Determinants of Alcohol Use Disorder in Patients Attending Private Primary Care Clinics in Nairobi Kenya Verah Kabwayi Elazia, Gulnaz Mohamoud, James Orwa, Mohamoud Merali, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4767131/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract Introduction: Socio-demographic factors are predictors of Alcohol Use Disorder (AUD). The Kenyan WHO STEPWISE survey indicated that 13% of adult Kenyans are heavy episodic drinkers. However, the relationship between social determinants of AUD among patients attending primary health care clinics has not been well investigated in Kenya. We aimed to determine the association between sociodemographic determinants and AUD in patients attending private primary care clinics in Nairobi, Kenya. Methods A cross-sectional survey design was used to purposively sample 389 patients. Data were collected using self-administered questionnaires adapted from the Alcohol Use Disorder Identification Test (AUDIT) Tool. The prevalence of AUD was calculated as a percentage of all the enrolled patients. Independent associations between explanatory variables and AUD were determined using the chi-square test. Variables with a p-value < 0.2 were considered for Multivariable Logistic Regression to identify factors associated with AUD. Results The prevalence of AUD in this cohort of participants was 18.5%. Significant social determinants for AUD were: tobacco and marijuana smoking (AOR 2.89 95%CI: 1.09–7.46), insomnia (AOR 3.40 95%CI: 1.52–7.70), and first-degree relatives who consumed alcohol (AOR 4.00 95% CI:1.86–8.63). The study showed that social determinants influenced the occurrence of AUD. Conclusion Alcohol users with insomnia, marijuana users and those with a family history of alcohol use should be prioritized for AUD screening. Further studies could explore the influence of these findings on AUD qualitatively. Alcohol use disorder Kenya AUDIT tool marijuana insomnia Figures Figure 1 Figure 2 Figure 3 Contribution This study enhances knowledge of social-determinants of AUD in patients attending these primary care clinics. INTRODUCTION The World Health Organization (WHO) estimates that one in every 20 deaths is attributed to alcohol use [ 1 ]. In 2016, alcohol use led to a global mortality of 3 million [ 2 ]. Harmful use of alcohol contributes to 5–6% of the annual global disease burden [ 1 – 3 ]. In Africa, there is a growing shift in the burden of diseases to the double-burden of infectious disease and non-communicable diseases (NCDs) [ 4 ]. It is projected that by 2050, the disease burden caused by Substance Use Disorder (SUD) and Alcohol Use Disorder (AUD) will increase by about 130% [ 5 ].Alcohol has been noted to be a causative agent or a catalyst for the occurrence of NCDs [ 4 , 6 ]. Alcohol leads to 50% of the aggregate hospital admissions and 55% of hospital mortalities in Kenya, thereby increasing the burden of care [ 7 ]. In Kenya, alcohol use has been linked to 7% of cancer cases, 42% of assault and 11% of unspecified soft tissue injury cases [ 8 ]. There is a shift in alcohol consumption patterns globally, and it is increasingly becoming a common phenomenon in social events [ 1 ]. Young people in the Western hemisphere tend to use alcohol to socialize and share their experiences [ 9 ].The norms and shared values of alcohol consumption differ regionally and culturally between different communities and nations [ 10 ]. In a broader context, alcohol use is linked with violent behaviours in schools, sports, political rallies or amongst spouses [ 11 – 15 ]. However in the Mediterranean and South American countries, drinking behaviour is largely peaceful and devoid of violent-related injuries [ 16 ].Whilst studies show that alcohol use and abuse decreases in the early stages of marriage, it has been noted globally that some couples engage in alcohol abuse due to marital distress. This includes violence and relationship conflicts [ 17 , 18 ]. In Kenya, alcohol use has been shown to exercerbate social conflicts related to marital distress [ 19 ].Addditionally, workplace distress may be worsened by relationship and marital problems [ 20 ]. Gender variation in alcohol intake has been documented with increasing prevalence among women [ 21 – 24 ]. In different cultural settings, alcohol use had variable effects on the instance of alcohol-related intimate partner violence [ 13 , 17 , 25 ]. In Kenya, the majority of alcohol consumers are between ages of 15–65, with the prevalence of 12.2% [ 26 ]. The highest prevalence of alcohol consumption was in Nairobi, the capital city of Kenya at 17.5% [ 26 ]. The high alcohol intake affects work productivity and poses a threat to the socio-economic development of the nation [ 27 , 28 ]. The challenge is that, alcohol use may become more severe in the future as increasingly high numbers of students are involved with its consumption [ 29 – 31 ]. Social determinants of health are the conditions in which people are born, grow, live and socialize, that affects their health either positively or negatively [ 32 ]. In Kenya, socio-demographic factors that have been documented as predictors of alcohol use were income, gender, age, religion and social status [ 33 , 34 ]. As focus shifts from the cause-effect nature of alcoholism, there is a dire need to understand the factors that propel people to use alcohol. The social environment propagates the use of alcohol and in-turn, predisposes individuals to AUD when they engage in problematic alcohol consumption [ 35 – 39 ]. In Kenya, school examinations, financial problems, relationship challenges, and peer pressure are some the factors that predispose students to alcohol use [ 12 , 29 , 40 , 41 ]. From a worldwide perspective, peer pressure plays an integral role in spurring alcohol consumption [ 36 , 42 – 44 ].The scenario in Kenya is not different, as peer pressure among adolescents and college students play a role in influencing the uptake of alcohol use [ 30 , 31 , 45 , 46 ]. The increased alcohol consumption may eventually lead to AUD. In other African countries, peer pressure contributes to many of the youth resorting to alcohol abuse which in turn leads to deprivation of their normal growth and development [ 29 , 47 – 49 ]. Despite several studies on the prevalence of AUD, the relationship with socio-demographic determinants has not been well documented especially in the private primary health sector [ 29 , 30 , 37 , 50 ]. Therefore, this study sought to provide insight into the prevalence and social determinants of AUD through the screening of patients at private primary health care clinics in the county of Nairobi. METHODS AND MATERIALS Study Design This cross-sectional study was conducted among patients who reported ever consuming alcohol and were attending outpatient primary care clinics in Nairobi. The study took place from May 1, 2020, to September 30, 2020. Study Settings and Population The study was conducted in 15 primary care clinics operated by the Aga Khan University Hospital in Nairobi County. The clinics offered health promotion, preventive and curative services to patients of all age groups residing in urban, semi-urban and peri-urban areas of the Nairobi County. Most of the patients attending these clinics were well-educated, English literate, covered by a medical insurance and were from different socio-economic backgrounds [ 51 , 52 ]. The patients information at these clinics are captured using the password protected electronic health record system. The clinics catered for scheduled and walk-in patients and also offered pharmacy, laboratory and x-ray services [ 51 , 52 ]. The study population comprised of adults (18 years and above) seeking care at the primary care clinics. Those who consumed alcohol within the last twelve months before the survey, were eligible for the study. Patients who were too sick to consent according to Canadian Emergency Triage and Acuity Scale (CETAS) criteria 1, 2, 3 were excluded from the study. Sample Size Sample size calculation used formula for analytical studies with categorical both for outcome and exposure. The sample size assumed, 95% level of significance, 80% power, prevalence of alcohol use among smokers and non-smokers of 43.3% and 32 9% respectively and non-response rate of 10%.. The percentage on smoking status and and outcome was based on a similar study by Victor et al [ 36 ]. The minimum calculated sample size was 377. However, the final sample size was 389, which was proportionately distributed amongst the 15 primary care clinics according to the average workload of that particular clinic per month. Sampling Strategy Purposive sampling was carried out at each primary care clinic until the required sample size for each facility was reached. The patients were approached in the triage room to ensure confidentiality before being attended by the respective physicians. As part of the triage process, the patients were asked if they had consumed alcohol in the last twelve months by the triage nurse. Those who answered “Yes” were directed to the research assistant who provided more information about the study. Consenting patients were provided with self-administered AUDIT tool and socio-demographic questionnaire which they filled in the waiting room as they waited to see the doctors. Measurements Data Collection Tools The data were collected through the use of a self-administered questionnaire. The questionnaire had two sections. The first section contained the AUDIT tool, which was used to screen and identify patients with AUD. AUDIT is a 10-items alcohol screening instrument which emphasizes the identification of alcohol use disorder for the last 12 months. It was developed by the World Health Organization in 1982 and has been found most effective in identifying subjects with less severe drinking problems, such as hazardous drinking, harmful drinking, and alcohol dependence (sensitivity, 94.1%, specificity, 91.7%) [ 53 ]. Each AUDIT tool question has a four-point Likert scale answers with a scoring of 0–4. The second part of the questionnaire contained the socio-demographic data and possible reasons for alcohol use. Content validity of this section of the questionnaies was checked by expert family physicians and the questionnaire was piloted to assess the reliability and feasibility. Data Analysis Summary measures of frequency and percentages were used to summarize categorical data. The association between the explanatory variables and AUD was determined using the chi-square test. Any variable with a p-value < 0.2 in the univariable analysis was considered for multivariable Logistic regression analysis in order to identify the sociodemographic determinants of AUD. A p-value < 0.05 was set as the level of significance and all analysis performed using SPSS version 23. RESULTS The socio-demographic characteristics are outlined in Table 1 . The study had 389 respondents and the majority of the study participants were male (n = 247;63.5%). Almost half of the respondents (n = 186; 47.8%) were aged between 26–35 years. More than half (n = 215; 55.3%) of the study participants were married. Most of the study participants were Christians (n = 302;77.6%), had a college level of education (n = 337;86.6%), were employed (n = 294;75.6%) and their income was in an income band of sh. 51,000-100,000 per month (n = 161;41.4%) (Table 2 ). The prevalence of AUD in this study was 18.5%. Table 1 Socio-demographic Characteristics of Respondents, N = 389 Variable N % Gender Male 247 63.5 Female 142 36.5 Age-group 18–25 54 13.9 26–35 186 47.8 36 and above 149 38.3 Marital status Single 124 31.9 Married 215 55.3 Separated/divorced/widowed 50 12.8 Income 0–50 56 14.4 51–100 161 41.4 101–150 116 29.8 Above 150 56 14.4 Employment Employed 294 75.6 Not employed 25 6.4 Self-employed 70 18.0 Education level Secondary 52 13.4 Tertiary 226 58.1 Higher (Postgraduate/PhD) 111 28.5 Religion Muslim 31 8.0 Hindu 29 7.5 Christian 302 77.6 African Religions 9 2.3 Others 18 4.6 Prevalence Rates of AUDs in Out-Patients The prevalence rate of AUDs as screened by the AUDIT tool was 18.5% (95% confidence interval: 15.7–23.8%). This represented 72 out of the 389 study participants (Fig. 1 ). Magnitude of Alcohol Use disorder Table 2 shows the classification of alcohol users into four categories (low-risk users, hazardous, harmful, and dependents). 80.4% of all the respondents were classified as low-risk users of alcohol (AUDIT score of 7 and below), 14.1% as hazardous, 2.8% as Harmful and 2.6% classified as alcohol dependent (score ≥ 20). Table 2 Classification of alcohol users. N Percentage (95% Confidence Interval) Low risk users score 0–7 313 80.4(76.2–84.3) Hazardous 8–15 55 14.1(10.8–18.0) Harmful 16–19 11 2.8(1.4-5.0) Dependent 20 or more 10 2.6(1.2–4.7) Prevalence of Alcohol Use Disorders per clinic The study was able to evaluate the prevalence rates of AUD per clinic. Mutithi clinic had the highest prevalence of AUD at 50% followed by Komarock clinic. T-mall clinic had the least cases of AUDs (Fig. 2 ). KEY : K: Komarock, E: Embakasi, R: Ridgeways, D: Dohnholm, SHQ: Safaricom Headquarters, Tw: Town, B: Buruburu, Es: Eastleigh, P: Prestige at Kilimani, Mu: Muthithi, Roy: Roysambu, C: Capital Center, SJ: Safaricom JCC, TM: T-Mall Social Factors Promoting Alcohol Use among Respondents Figure 3 shows the respondents' reasons for alcohol use, the majority of the respondents (84.6%) reported recreation and enjoyment as the reason why they indulged in alcohol consumption. The least mentioned reason for indulgence in alcohol was fear of withdrawal symptoms. Social Determinants associated with Alcohol use Disorder Among those who were screened to have AUD, high proportion reported use of alcohol as a results of fear of withdrawal, family/relatives consume alcohol, insomnia, cultural functions ,cigarate and marijuana smoking and financial challenges or lack of employment as compared to their counterparts (Table 3 ). In the multivariable analysis, the social determinants that were significantly associated with Alcohol Use Disorders were; smoking marijuana, insomnia, and having relatives who consume alcohol (father/mother/uncles/siblings). Those who reported smoking marijuana were three times more likely to have alcohol use disorder compared to their counterparts who were non-smokers of marijuana AOR 2.89; 95%:CI.(1.086–7.463). Those respondents who used alcohol for sleep inducement were 3.4 times higher compared to their counterparts who did not use alcohol for the same purpose (AOR 3.40; 95%CI:1.515–7.695). Respondents whose relatives consumed alcohol (father/mother/siblings) had four-fold higher odds of developing alcohol use disorder compared to those whose relatives do not drink (AOR 4.00; 95%CI: 1.862–8.626)(Table 3 ). Table 3 Univariate and multivariate analysis of social determinants associated with Alcohol Use Disorder Alcohol Use Disorder Yes (n = 72) No .(n = 317) P-value Variables n .(%) n .(%) COR .(95% CI) AOR .(95% CI) Gender Female 18.(12.7) 124.(87.3) Ref Ref Male 54.(21.9) 193.(78.1) 0.035 1.93.(1.099–3.520) 1.25.(0.634–2.539) Age 18–25 10.(18.5) 44.(81.5) Ref 26–35 31.(16.7) 155.(83.3) 0.623 0.88.(0.411–2.016) 36 and above 31.(20.8) 118.(79.2) 1.16.(0.538–2.661) Marital status Single 20.(16.1) 104.(83.9) Ref Ref Married 36.(16.7) 179.(83.3) 0.031 1.05.(0.580–1.929) 1.23.(0.569–2.770) Ex-married 16.(32.0) 34.(68.0) 2.45.(1.133–5.255) 1.29.(0.450–3.658) Income 0–50 12.(21.4) 44.(78.6) Ref 51–100 23.(14.3) 138.(85.7) 0.189 0.61.(0.285–1.362) 101–150 22.(19.0) 94.(81.0) 0.86.(0.395–1.935) above 150 15.(26.8) 41.(73.2) 1.34.(0.563–3.251) Employment Employed 47.(16.0) 247.(84.0) Ref Ref Unemployed 6.(24.0) 19.(76.0) 0.069 1.66.(0.580–4.163) 1.70.(0.464–5.727) Self-employed 19.(27.1) 51.(72.9) 1.96.(1.045–3.575) 1.44.(0.654–3.042) Education Secondary 14.(26.9) 38.(73.1) Ref Tertiary 38.(16.8) 188.(83.2) 0.236 0.55.(0.275–1.137) Higher 20.(18.0) 91.(82.0) 0.60.(0.274–1.320) Smoking Cigarettes No 45.(13.8) 282.(86.2) Ref Ref Yes 27.(43.5) 35.(56.5) < 0.001 4.83.(2.666–8.754) 1.90.(0.844–4.176) Chewing Khat/Mirra No 66.(17.8) 304.(82.2) Ref Yes 6.(31.6) 13.(68.4) 0.136 2.13.(0.725–5.593) Smoking marijuana No 56.(15.7) 300.(84.3) Ref Ref Yes 16.(48.5) 17.(51.5) < 0.001 5.04.(2.391–10.616) 2.89.(1.086–7.463)* Recreation and enjoyment No 11.(18.3) 49.(81.7) Ref Yes 61.(18.5) 268.(81.5) 0.999 1.01.(0.514–2.156) Work related stress No 35.(14.3) 209.(85.7) Ref Ref Yes 37.(25.5) 108.(74.5) 0.009 2.05.(1.219–3.441) 1.11.(0.557–2.175) Social functions No 20.(12.8) 136.(87.2) Ref Ref Yes 52.(22.3) 181.(77.7) 0.026 1.95.(1.130–3.492) 0.92.(0.454–1.890) Insomnia/lack of sleep No 38.(11.8) 284.(88.2) Ref Ref Yes 34.(50.7) 33.(49.3) < 0.001 7.70.(4.299–13.937) 3.40.(1.515–7.695)* Marital/relationship issues No 32.(14.3) 191.(85.7) Ref Ref Yes 40.(24.1) 126.(75.9) 0.021 1.90.(1.133–3.192) 1.12.(0.569–2.162) All/majority peers drink No 30.(12.0) 219.(88.0) Ref Ref Yes 42.(30.0) 98.(70.0) < 0.001 3.13.(1.857–5.330) 1.23.(0.588–2.524) Gives Confidence No 50.(15.9) 265.(84.1) Ref Ref Yes 22.(29.7) 52.(70.3) 0.009 2.24.(1.237–3.987) 0.80.(0.354–1.728) Financial challenges/lack of employment No 52.(14.9) 297.(85.1) Ref Ref Yes 20.(50.0) 20.(50.0) < 0.001 5.71.(2.870-11.409) 1.85.(0.726–4.665) Fear of withdrawal symptoms No 64.(17.2) 308.(82.8) Ref Ref Yes 8.(47.1) 9.(52.9) 0.005 4.28.(1.552–11.606) 0.31.(0.072–1.228) Family & Relatives No 42.(12.7) 288.(87.3) Ref Ref Yes 30.(50.8) 29.(49.2) < 0.001 7.09.(3.885–13.063) 4.00.(1.862–8.626)* Cultural events No 31.(11.7) 235.(88.3) Ref Ref Yes 41.(33.3) 82.(66.7) < 0.001 3.79.(2.239–6.481) 1.48.(0.731–2.937) Religion Muslim 5 .(16.1) 26.(83.9) Hindu 10 .(34.5) 19.(65.5) 2.74(0.830-10.031) Christian 53.(17.5) 249.(82.5) 0.3025 1.11(0.438–3.388) African religion 2.(22.2) 7.(77.8) 1.49.(0.185–8.718) *significant factors DISCUSSION Many AUD prevalence studies are undertaken in the community or institutional settings (21,30,84) but rarely within a primary health care setting. The prevalence of AUD in this study was 18.5%. The finding was similar to community studies conducted in Nairobi in 2020 and in Gondar in Ethiopia showed an AUD prevalence of 18.4% [ 26 ] and 23.7% respectively. In contrast, a study in Ethiopia that screened people living with HIV (PLHIV) for AUD found a slightly lower prevalence of 14.5% [ 53 ]. This lower prevalence, may be because PLHIV may be have been advised to abstain from alcohol. The present study showed that AUD prevalence increased in those users who had relatives who consumed alcohol. The findings of our study are congruent with the findings of other studies [ 54 – 57 ], where there are higher odds of developing AUD when family members and close associates of subjects consume alcohol. These findings may be explained by constant exposure and ease of access to alcohol by an individual who hails from a family that its members or when his contemparies consume alcohol. The study found an increase odds of AUD among marijuana users. Studies carried out amongst university students in Kenya, showed that about a quarter of marijuana users had heavy alcohol intake [ 30 , 58 ]. Globally, the use of marijuana alongside alcohol led to a higher chance of heavy drinking [ 59 – 62 ]. In addition, the use of marijuana due to interpersonal problems led to a seven-fold increase in alcohol-related risky behaviours and 5 five-fold increase of getting AUD [ 63 ]. Our results, consistent with other studies, assert that marijuana plays a significant role in encouraging the consumption of alcohol and the resultant occurrence of AUD. According to the present study, the odds of developing AUD in people with insomnia was threefold. Heavy Alcohol Consumption leads to poor quality night-time sleep, sleep pattern distortions, decreased sleep onset and sleep latency [ 64 ]. These findings by Colrain et al. may explain why some of the patients in the present study cited insomnia as a determinant for AUD [ 64 ]. The findings in the present study indicate a possibility that a high number of patients visiting hospitals with complaints of sleep disorders may have an underlying alcohol problem as the cause of insomnia. The study did not however find statistically significant association with other socidemographic determinants of AUD such as male gender, unemployment, older age, marital status, higher income percentile, higher levels of learning, recreational alcohol use, work related stress, relationship distress, social and cultural intake of alcohol and religion. These findings were incongruent to other studies where a higher odds of developing AUD was shown in males [ 1 ], those with marital distress [ 65 ], older people [ 66 ], non-muslims [ 67 – 70 ], those who are bereaved [ 71 ], those with lower educational attainment [ 72 ] and those in lower socioeconomic status [ 73 ]. LIMITATIONS The study was conducted at the primary care clinics of the Aga Khan University Hospital, located in an urban setting in Nairobi County. The findings may be applicable to other similar private primary healthcare facilities in urban areas. However, the generalizations drawn from this study may not apply to public primary healthcare clinics or rural populations in Kenya. The purposive sampling used in selecting the participants might have introduced selection bias into the study; however, the recruitment process ensured that participants from diverse socio-demographic characteristics were enrolled. The study could not establish a causal relationship between the exposures studied and alcohol use disorder (AUD), as the data were collected at a single point in time. Additionally, the design of the study did not allow for the examination of patient behavior before the study to understand the triggers of alcohol consumption. CONCLUSION This study showed that the social determinants that influenced the occurrence of AUD were insomnia, smoking marijuana and having relatives who consumed alcohol. The present study highlighted the importance and urgency of regular screening for AUD at primary healthcare facilities in patients to identify patients with these risk factors. The screening for AUD at primary care facilities, which is the first point of care for patients in health facilities cannot be overemphasized. Declarations Acknowledgement The study acknowledges the contribution of Paul Major Mattos in the editorial of the original research thesis and manuscript. Competing Interests The authors declare that they had no financial or personal relationships that may have inappropriately influenced them in writing this article Author’s Contribution V.K.E conceived the research idea that was planned and supervised with G.M, J.O. and J.S. V.K.E. carried out the research study. V.K.E, G.M, M.M, J.O. and J.S. contributed equally to the manuscript write-up. G.M,. J.O, and J.S. supervised the whole research. Funding Information The study was fully funded by the Aga Khan University research seed grant. Data Availability Statement Data sharing is subject to the rules and regulations of Aga Khan University Hospital that govern the process. Disclaimer The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors Ethical Considerations Ethical approval was obtained from Aga Khan University Hospital, Nairobi (AKUHN)’ Research Ethics and Review Board [Ref: 2019/IERC-109(v2)]. All health protocols concerning Covid-19 disease were put in place in compliance with the World Health Organization and the Ministry of Health of the Republic of Kenya guidelines, and safety policies of AKUHN. Consent for publication Not applicable References World Health Organization: Global status report on alcohol and health 2018 : World Health Organization; 2018. 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Takahashi R, Wilunda C, Magutah K, Mwaura-Tenambergen W, Wilunda B, Perngparn U: Correlates of alcohol consumption in rural western Kenya: a cross-sectional study . BMC psychiatry 2017, 17 :1-10. Kimani M: Drug and substance abuse in secondary schools in Kenya: A case study of Kiambu County . Master‘s Thesis. University of Nairobi; 2013. Mutisya D, Theuri J: ALCOHOL AND DRUG ABUSE AS ECOLOGICAL PREDICTORS OF RISK TAKING BEHAVIOUR AMONG SECONDARY SCHOOL STUDENTS IN KAJIADO NORTH SUB-COUNTY, KAJIADO COUNTY, KENYA . African Journal of Empirical Research 2021, 2 (1):50-55. Ajayi AI, Owolabi EO, Olajire OO: Alcohol use among Nigerian university students: prevalence, correlates and frequency of use . BMC public health 2019, 19 :1-11. Chauke T, Van der Heever H, Hoque M: Alcohol use amongst learners in rural high school in South Africa. Afr J Prim Health Care Fam Med. 2015; 7 (1): 1-6 . In . Gebeyehu ET, Srahbzu Biresaw M: Alcohol Use and Its Associated Factors among Adolescents Aged 15–19 Years at Governmental High Schools of Aksum Town, Tigray, Ethiopia, 2019: A Cross‐Sectional Study . Journal of addiction 2021, 2021 (1):5518946. Osaki H, Mshana G, Mbata D, Kapiga S, Changalucha J: Social space and alcohol use initiation among youth in northern Tanzania . PLoS One 2018, 13 (9):e0202200. Mohamoud G, Mash B, Merali M, Orwa J, Mahoney M: Perceptions regarding the scope of practice of family doctors amongst patients in primary care settings in Nairobi . African Journal of Primary Health Care and Family Medicine 2018, 10 (1):1-7. Mohamoud G, Mash R: Evaluation of the quality of service delivery in private sector, primary care clinics in Kenya: a descriptive patient survey . South African Family Practice 2020, 62 (4). Bultum JA, Yigzaw N, Demeke W, Alemayehu M: Alcohol use disorder and associated factors among human immunodeficiency virus infected patients attending antiretroviral therapy clinic at Bishoftu General Hospital, Oromiya region, Ethiopia . PloS one 2018, 13 (3):e0189312. Giusto A, Green EP, Simmons RA, Ayuku D, Patel P, Puffer ES: A multiple baseline study of a brief alcohol reduction and family engagement intervention for fathers in Kenya . Journal of Consulting and Clinical Psychology 2020, 88 (8):708. Kask K, Markina A, Podana Z: The effect of family factors on intense alcohol use among European adolescents: A multilevel analysis . Psychiatry Journal 2013, 2013 (1):250215. Leonard KE, Eiden RD: Marital and family processes in the context of alcohol use and alcohol disorders . Annu Rev Clin Psychol 2007, 3 (1):285-310. Rodriguez LM, Neighbors C, Knee CR: Problematic alcohol use and marital distress: An interdependence theory perspective . Addiction Research & Theory 2014, 22 (4):294-312. Tumuti S, Wang'eri T, Waweru EW, Ronoh AK: Prevalence, drugs used, sources, and awareness of curative and preventive measures among Kenyatta University students, Nairobi County, Kenya . Journal of Emerging Trends in Educational Research and Policy Studies 2014, 5 (3):352. Bucholz KK, McCutcheon VV, Agrawal A, Dick DM, Hesselbrock VM, Kramer JR, Kuperman S, Nurnberger Jr JI, Salvatore JE, Schuckit MA: Comparison of parent, peer, psychiatric, and cannabis use influences across stages of offspring alcohol involvement: evidence from the COGA prospective study . Alcoholism: clinical and experimental research 2017, 41 (2):359-368. Hua JT, Afshar M, Clark BJ, Kovacs EJ, Burnham EL: The relationship of cannabis decriminalization in Colorado and cannabis use in individuals with alcohol use disorders . Journal of cannabis research 2020, 2 :1-11. Metrik J, Gunn RL, Jackson KM, Sokolovsky AW, Borsari B: Daily patterns of marijuana and alcohol co‐use among individuals with alcohol and cannabis use disorders . Alcoholism: Clinical and Experimental Research 2018, 42 (6):1096-1104. Patterson A, Vu M, Haardörfer R, Windle M, Berg CJ: Motives for alcohol and marijuana use as predictors of use and problem use among young adult college students . Journal of Drug Issues 2020, 50 (4):359-377. Ramadan MM, Banta JE, Bahjri K, Montgomery SB: Frequency of cannabis use and alcohol-associated adverse effects in a representative sample of US adolescents and youth (2002–2014) a cross-sectional study . Journal of Cannabis Research 2020, 2 :1-8. Colrain IM, Nicholas CL, Baker FC: Alcohol and the sleeping brain . Handbook of clinical neurology 2014, 125 :415-431. Kendler KS, Lönn SL, Salvatore J, Sundquist J, Sundquist K: Effect of marriage on risk for onset of alcohol use disorder: a longitudinal and co-relative analysis in a Swedish national sample . American Journal of Psychiatry 2016, 173 (9):911-918. Lu W, Xu J, Taylor AW, Bewick BM, Fu Z, Wu N, Qian L, Yin P: Analysis of the alcohol drinking behavior and influencing factors among emerging adults and young adults: a cross-sectional study in Wuhan, China . BMC Public Health 2019, 19 :1-10. Arfken CL, Arnetz BB, Fakhouri M, Ventimiglia MJ, Jamil H: Alcohol use among Arab Americans: what is the prevalence? Journal of immigrant and minority health 2011, 13 :713-718. Assanangkornchai S, Conigrave KM, Saunders JB: Religious beliefs and practice, and alcohol use in Thai men . Alcohol and Alcoholism 2002, 37 (2):193-197. Grim BJ, Grim ME: Belief, behavior, and belonging: How faith is indispensable in preventing and recovering from substance abuse . Journal of religion and health 2019, 58 (5):1713-1750. Luczak SE, Prescott CA, Dalais C, Raine A, Venables PH, Mednick SA: Religious factors associated with alcohol involvement: Results from the Mauritian Joint Child Health Project . Drug and alcohol dependence 2014, 135 :37-44. Pilling J, Konkolÿ Thege B, Demetrovics Z, Kopp MS: Alcohol use in the first three years of bereavement: a national representative survey . Substance Abuse Treatment, Prevention, and Policy 2012, 7 :1-5. Rosoff DB, Clarke T-K, Adams MJ, McIntosh AM, Davey Smith G, Jung J, Lohoff FW: Educational attainment impacts drinking behaviors and risk for alcohol dependence: results from a two-sample Mendelian randomization study with~ 780,000 participants . Molecular psychiatry 2021, 26 (4):1119-1132. Karriker-Jaffe KJ, CM Roberts S, Bond J: Income inequality, alcohol use, and alcohol-related problems . American Journal of Public Health 2013, 103 (4):649-656. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 29 Jul, 2024 Editor assigned by journal 29 Jul, 2024 Submission checks completed at journal 29 Jul, 2024 First submitted to journal 19 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4767131","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":333147134,"identity":"717353b2-ff55-483d-a7f9-9508aeaa1416","order_by":0,"name":"Verah Kabwayi Elazia","email":"","orcid":"","institution":"Aga Khan Medical Centre Kitale","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Verah","middleName":"Kabwayi","lastName":"Elazia","suffix":""},{"id":333147135,"identity":"549d309c-f106-4364-ba9a-515e354b6a2f","order_by":1,"name":"Gulnaz Mohamoud","email":"","orcid":"","institution":"The Aga Khan University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Gulnaz","middleName":"","lastName":"Mohamoud","suffix":""},{"id":333147137,"identity":"45c45fed-8bb4-4323-974b-221f40587689","order_by":2,"name":"James Orwa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzklEQVRIiWNgGAWjYBACxgY4k/kAhHOAeC1sCcRpQQI8BsRpYW4/nfjwB4NNvsHxMx8/zmxjkOO7kUDAYT25m415GNIsN5zJ3Sy5sY3BWJKglobcbdIMDIcNzA7kbpB82MaQuIGglv6323/+AGk5/+bxT6CWesJaZuRuY+ABabmRwwZyWIIBYS1vN0vzGKQZ2N94ZmY545yE4cwzD/BrMezP3fjxR4WNgWR/8uObPWU28nzHCdhi2AAiDeB8CfzKQUCesJJRMApGwSgY8QAAPnNJvplqoL8AAAAASUVORK5CYII=","orcid":"","institution":"The Aga Khan University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"James","middleName":"","lastName":"Orwa","suffix":""},{"id":333147139,"identity":"60c9f343-edc4-45ce-bc0f-a35217d38b3c","order_by":3,"name":"Mohamoud Merali","email":"","orcid":"","institution":"Aga Khan University Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mohamoud","middleName":"","lastName":"Merali","suffix":""},{"id":333147140,"identity":"33241dd2-aa0a-4c8f-9cfb-651e2974488c","order_by":4,"name":"Jacob Shabani","email":"","orcid":"","institution":"The Aga Khan University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jacob","middleName":"","lastName":"Shabani","suffix":""}],"badges":[],"createdAt":"2024-07-19 08:56:54","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4767131/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4767131/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":63803176,"identity":"f78c515b-92e4-4f34-8f56-6f07eb9dec23","added_by":"auto","created_at":"2024-09-02 13:22:45","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":12132,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of AUDs\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4767131/v1/57dcf44bb13d93fb4ecfa883.png"},{"id":63803178,"identity":"43410462-b964-4276-bbda-d09b73d9ed2e","added_by":"auto","created_at":"2024-09-02 13:22:45","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":14692,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of AUDs per clinic.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKEY: \u003c/strong\u003eK: Komarock, E: Embakasi, R: Ridgeways, D: Dohnholm, SHQ: Safaricom Headquarters, Tw: Town, B: Buruburu, Es: Eastleigh, P: Prestige at Kilimani, Mu: Muthithi, Roy: Roysambu, C: Capital Center, SJ: Safaricom JCC, TM: T-Mall\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4767131/v1/d647edc779b72c88996808a7.png"},{"id":63804645,"identity":"557d18a6-14a7-47a6-a600-49c0c6e01cd8","added_by":"auto","created_at":"2024-09-02 13:30:45","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":35388,"visible":true,"origin":"","legend":"\u003cp\u003eReasons for alcohol use\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4767131/v1/ecf4c35e3c8b216a7494ef7c.png"},{"id":63806276,"identity":"cdb11d8e-6faf-4114-922d-51a044b7f970","added_by":"auto","created_at":"2024-09-02 13:38:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2628237,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4767131/v1/cfbb9aae-8af5-4ebf-9ca6-1875603896d0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eSocial Determinants of Alcohol Use Disorder in Patients Attending Private Primary Care Clinics in Nairobi Kenya\u003c/p\u003e","fulltext":[{"header":"Contribution","content":"\u003cp\u003eThis study enhances knowledge of social-determinants of AUD in patients attending these primary care clinics.\u0026nbsp;\u003c/p\u003e\n"},{"header":"INTRODUCTION","content":"\u003cp\u003eThe World Health Organization (WHO) estimates that one in every 20 deaths is attributed to alcohol use [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In 2016, alcohol use led to a global mortality of 3\u0026nbsp;million [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Harmful use of alcohol contributes to 5\u0026ndash;6% of the annual global disease burden [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In Africa, there is a growing shift in the burden of diseases to the double-burden of infectious disease and non-communicable diseases (NCDs) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. It is projected that by 2050, the disease burden caused by Substance Use Disorder (SUD) and Alcohol Use Disorder (AUD) will increase by about 130% [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].Alcohol has been noted to be a causative agent or a catalyst for the occurrence of NCDs [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Alcohol leads to 50% of the aggregate hospital admissions and 55% of hospital mortalities in Kenya, thereby increasing the burden of care [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In Kenya, alcohol use has been linked to 7% of cancer cases, 42% of assault and 11% of unspecified soft tissue injury cases [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere is a shift in alcohol consumption patterns globally, and it is increasingly becoming a common phenomenon in social events [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Young people in the Western hemisphere tend to use alcohol to socialize and share their experiences [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].The norms and shared values of alcohol consumption differ regionally and culturally between different communities and nations [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In a broader context, alcohol use is linked with violent behaviours in schools, sports, political rallies or amongst spouses [\u003cspan additionalcitationids=\"CR12 CR13 CR14\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However in the Mediterranean and South American countries, drinking behaviour is largely peaceful and devoid of violent-related injuries [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].Whilst studies show that alcohol use and abuse decreases in the early stages of marriage, it has been noted globally that some couples engage in alcohol abuse due to marital distress. This includes violence and relationship conflicts [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In Kenya, alcohol use has been shown to exercerbate social conflicts related to marital distress [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].Addditionally, workplace distress may be worsened by relationship and marital problems [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Gender variation in alcohol intake has been documented with increasing prevalence among women [\u003cspan additionalcitationids=\"CR22 CR23\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. In different cultural settings, alcohol use had variable effects on the instance of alcohol-related intimate partner violence [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Kenya, the majority of alcohol consumers are between ages of 15\u0026ndash;65, with the prevalence of 12.2% [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The highest prevalence of alcohol consumption was in Nairobi, the capital city of Kenya at 17.5% [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The high alcohol intake affects work productivity and poses a threat to the socio-economic development of the nation [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The challenge is that, alcohol use may become more severe in the future as increasingly high numbers of students are involved with its consumption [\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSocial determinants of health are the conditions in which people are born, grow, live and socialize, that affects their health either positively or negatively [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In Kenya, socio-demographic factors that have been documented as predictors of alcohol use were income, gender, age, religion and social status [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. As focus shifts from the cause-effect nature of alcoholism, there is a dire need to understand the factors that propel people to use alcohol.\u003c/p\u003e \u003cp\u003eThe social environment propagates the use of alcohol and in-turn, predisposes individuals to AUD when they engage in problematic alcohol consumption [\u003cspan additionalcitationids=\"CR36 CR37 CR38\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In Kenya, school examinations, financial problems, relationship challenges, and peer pressure are some the factors that predispose students to alcohol use [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. From a worldwide perspective, peer pressure plays an integral role in spurring alcohol consumption [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan additionalcitationids=\"CR43\" citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].The scenario in Kenya is not different, as peer pressure among adolescents and college students play a role in influencing the uptake of alcohol use [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. The increased alcohol consumption may eventually lead to AUD. In other African countries, peer pressure contributes to many of the youth resorting to alcohol abuse which in turn leads to deprivation of their normal growth and development [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan additionalcitationids=\"CR48\" citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite several studies on the prevalence of AUD, the relationship with socio-demographic determinants has not been well documented especially in the private primary health sector [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Therefore, this study sought to provide insight into the prevalence and social determinants of AUD through the screening of patients at private primary health care clinics in the county of Nairobi.\u003c/p\u003e"},{"header":"METHODS AND MATERIALS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis cross-sectional study was conducted among patients who reported ever consuming alcohol and were attending outpatient primary care clinics in Nairobi. The study took place from May 1, 2020, to September 30, 2020.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy Settings and Population\u003c/h2\u003e \u003cp\u003eThe study was conducted in 15 primary care clinics operated by the Aga Khan University Hospital in Nairobi County. The clinics offered health promotion, preventive and curative services to patients of all age groups residing in urban, semi-urban and peri-urban areas of the Nairobi County. Most of the patients attending these clinics were well-educated, English literate, covered by a medical insurance and were from different socio-economic backgrounds [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. The patients information at these clinics are captured using the password protected electronic health record system. The clinics catered for scheduled and walk-in patients and also offered pharmacy, laboratory and x-ray services [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study population comprised of adults (18 years and above) seeking care at the primary care clinics. Those who consumed alcohol within the last twelve months before the survey, were eligible for the study. Patients who were too sick to consent according to Canadian Emergency Triage and Acuity Scale (CETAS) criteria 1, 2, 3 were excluded from the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSample Size\u003c/h2\u003e \u003cp\u003eSample size calculation used formula for analytical studies with categorical both for outcome and exposure. The sample size assumed, 95% level of significance, 80% power, prevalence of alcohol use among smokers and non-smokers of 43.3% and 32 9% respectively and non-response rate of 10%.. The percentage on smoking status and and outcome was based on a similar study by Victor et al [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. The minimum calculated sample size was 377. However, the final sample size was 389, which was proportionately distributed amongst the 15 primary care clinics according to the average workload of that particular clinic per month.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSampling Strategy\u003c/h2\u003e \u003cp\u003e Purposive sampling was carried out at each primary care clinic until the required sample size for each facility was reached. The patients were approached in the triage room to ensure confidentiality before being attended by the respective physicians. As part of the triage process, the patients were asked if they had consumed alcohol in the last twelve months by the triage nurse. Those who answered \u0026ldquo;Yes\u0026rdquo; were directed to the research assistant who provided more information about the study. Consenting patients were provided with self-administered AUDIT tool and socio-demographic questionnaire which they filled in the waiting room as they waited to see the doctors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eMeasurements\u003c/h2\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eData Collection Tools\u003c/h2\u003e \u003cp\u003eThe data were collected through the use of a self-administered questionnaire. The questionnaire had two sections. The first section contained the AUDIT tool, which was used to screen and identify patients with AUD. AUDIT is a 10-items alcohol screening instrument which emphasizes the identification of alcohol use disorder for the last 12 months. It was developed by the World Health Organization in 1982 and has been found most effective in identifying subjects with less severe drinking problems, such as hazardous drinking, harmful drinking, and alcohol dependence (sensitivity, 94.1%, specificity, 91.7%) [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Each AUDIT tool question has a four-point Likert scale answers with a scoring of 0\u0026ndash;4.\u003c/p\u003e \u003cp\u003eThe second part of the questionnaire contained the socio-demographic data and possible reasons for alcohol use. Content validity of this section of the questionnaies was checked by expert family physicians and the questionnaire was piloted to assess the reliability and feasibility.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eSummary measures of frequency and percentages were used to summarize categorical data. The association between the explanatory variables and AUD was determined using the chi-square test. Any variable with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.2 in the univariable analysis was considered for multivariable Logistic regression analysis in order to identify the sociodemographic determinants of AUD. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was set as the level of significance and all analysis performed using SPSS version 23.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe socio-demographic characteristics are outlined in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The study had 389 respondents and the majority of the study participants were male (n\u0026thinsp;=\u0026thinsp;247;63.5%). Almost half of the respondents (n\u0026thinsp;=\u0026thinsp;186; 47.8%) were aged between 26\u0026ndash;35 years. More than half (n\u0026thinsp;=\u0026thinsp;215; 55.3%) of the study participants were married. Most of the study participants were Christians (n\u0026thinsp;=\u0026thinsp;302;77.6%), had a college level of education (n\u0026thinsp;=\u0026thinsp;337;86.6%), were employed (n\u0026thinsp;=\u0026thinsp;294;75.6%) and their income was in an income band of sh. 51,000-100,000 per month (n\u0026thinsp;=\u0026thinsp;161;41.4%) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The prevalence of AUD in this study was 18.5%.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic Characteristics of Respondents, N\u0026thinsp;=\u0026thinsp;389\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge-group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e36 and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeparated/divorced/widowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e51\u0026ndash;100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e101\u0026ndash;150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbove 150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e294\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigher (Postgraduate/PhD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHindu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChristian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e302\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfrican Religions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence Rates of AUDs in Out-Patients\u003c/h2\u003e \u003cp\u003eThe prevalence rate of AUDs as screened by the AUDIT tool was 18.5% (95% confidence interval: 15.7\u0026ndash;23.8%). This represented 72 out of the 389 study participants (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eMagnitude of Alcohol Use disorder\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the classification of alcohol users into four categories (low-risk users, hazardous, harmful, and dependents). 80.4% of all the respondents were classified as low-risk users of alcohol (AUDIT score of 7 and below), 14.1% as hazardous, 2.8% as Harmful and 2.6% classified as alcohol dependent (score\u0026thinsp;\u0026ge;\u0026thinsp;20).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClassification of alcohol users.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (95% Confidence Interval)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow risk users score 0\u0026ndash;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e313\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80.4(76.2\u0026ndash;84.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHazardous 8\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.1(10.8\u0026ndash;18.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHarmful 16\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.8(1.4-5.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDependent 20 or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.6(1.2\u0026ndash;4.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence of Alcohol Use Disorders per clinic\u003c/h2\u003e \u003cp\u003eThe study was able to evaluate the prevalence rates of AUD per clinic. Mutithi clinic had the highest prevalence of AUD at 50% followed by Komarock clinic. T-mall clinic had the least cases of AUDs (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eKEY\u003c/b\u003e: K: Komarock, E: Embakasi, R: Ridgeways, D: Dohnholm, SHQ: Safaricom Headquarters, Tw: Town, B: Buruburu, Es: Eastleigh, P: Prestige at Kilimani, Mu: Muthithi, Roy: Roysambu, C: Capital Center, SJ: Safaricom JCC, TM: T-Mall\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eSocial Factors Promoting Alcohol Use among Respondents\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the respondents' reasons for alcohol use, the majority of the respondents (84.6%) reported recreation and enjoyment as the reason why they indulged in alcohol consumption. The least mentioned reason for indulgence in alcohol was fear of withdrawal symptoms.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eSocial Determinants associated with Alcohol use Disorder\u003c/h2\u003e \u003cp\u003eAmong those who were screened to have AUD, high proportion reported use of alcohol as a results of fear of withdrawal, family/relatives consume alcohol, insomnia, cultural functions ,cigarate and marijuana smoking and financial challenges or lack of employment as compared to their counterparts (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the multivariable analysis, the social determinants that were significantly associated with Alcohol Use Disorders were; smoking marijuana, insomnia, and having relatives who consume alcohol (father/mother/uncles/siblings). Those who reported smoking marijuana were three times more likely to have alcohol use disorder compared to their counterparts who were non-smokers of marijuana AOR 2.89; 95%:CI.(1.086\u0026ndash;7.463). Those respondents who used alcohol for sleep inducement were 3.4 times higher compared to their counterparts who did not use alcohol for the same purpose (AOR 3.40; 95%CI:1.515\u0026ndash;7.695). Respondents whose relatives consumed alcohol (father/mother/siblings) had four-fold higher odds of developing alcohol use disorder compared to those whose relatives do not drink (AOR 4.00; 95%CI: 1.862\u0026ndash;8.626)(Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate and multivariate analysis of social determinants associated with Alcohol Use Disorder\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAlcohol Use Disorder\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes (n\u0026thinsp;=\u0026thinsp;72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo .(n\u0026thinsp;=\u0026thinsp;317)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en .(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en .(%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCOR .(95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAOR .(95% CI)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.(12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e124.(87.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54.(21.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e193.(78.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.93.(1.099\u0026ndash;3.520)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.25.(0.634\u0026ndash;2.539)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.(18.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.(81.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.(16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e155.(83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.623\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.88.(0.411\u0026ndash;2.016)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e36 and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.(20.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e118.(79.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.16.(0.538\u0026ndash;2.661)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.(16.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e104.(83.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.(16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e179.(83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.05.(0.580\u0026ndash;1.929)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.23.(0.569\u0026ndash;2.770)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEx-married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.(32.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.(68.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.45.(1.133\u0026ndash;5.255)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.29.(0.450\u0026ndash;3.658)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.(21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.(78.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e51\u0026ndash;100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e138.(85.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.61.(0.285\u0026ndash;1.362)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e101\u0026ndash;150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.(19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94.(81.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.86.(0.395\u0026ndash;1.935)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eabove 150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.(26.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.(73.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.34.(0.563\u0026ndash;3.251)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.(16.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e247.(84.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.(24.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.(76.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.66.(0.580\u0026ndash;4.163)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.70.(0.464\u0026ndash;5.727)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.(27.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.(72.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.96.(1.045\u0026ndash;3.575)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.44.(0.654\u0026ndash;3.042)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.(26.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.(73.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.(16.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e188.(83.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.55.(0.275\u0026ndash;1.137)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.(18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91.(82.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.60.(0.274\u0026ndash;1.320)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking Cigarettes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.(13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e282.(86.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.(43.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.(56.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.83.(2.666\u0026ndash;8.754)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.90.(0.844\u0026ndash;4.176)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChewing Khat/Mirra\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66.(17.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e304.(82.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.(31.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.(68.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.13.(0.725\u0026ndash;5.593)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking marijuana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56.(15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e300.(84.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16.(48.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.(51.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.04.(2.391\u0026ndash;10.616)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.89.(1.086\u0026ndash;7.463)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecreation and enjoyment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.(18.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.(81.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.(18.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e268.(81.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.01.(0.514\u0026ndash;2.156)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork related stress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35.(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e209.(85.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.(25.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108.(74.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.05.(1.219\u0026ndash;3.441)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.11.(0.557\u0026ndash;2.175)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial functions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.(12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e136.(87.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52.(22.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e181.(77.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.95.(1.130\u0026ndash;3.492)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.92.(0.454\u0026ndash;1.890)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsomnia/lack of sleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.(11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e284.(88.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.(50.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.(49.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.70.(4.299\u0026ndash;13.937)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.40.(1.515\u0026ndash;7.695)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital/relationship issues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e191.(85.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40.(24.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e126.(75.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.90.(1.133\u0026ndash;3.192)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.12.(0.569\u0026ndash;2.162)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAll/majority peers drink\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.(12.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e219.(88.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.(30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98.(70.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.13.(1.857\u0026ndash;5.330)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.23.(0.588\u0026ndash;2.524)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGives Confidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50.(15.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e265.(84.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.(29.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.(70.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.24.(1.237\u0026ndash;3.987)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.80.(0.354\u0026ndash;1.728)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinancial challenges/lack of employment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52.(14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e297.(85.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.71.(2.870-11.409)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.85.(0.726\u0026ndash;4.665)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFear of withdrawal symptoms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64.(17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e308.(82.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.(47.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.(52.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.28.(1.552\u0026ndash;11.606)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.31.(0.072\u0026ndash;1.228)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily \u0026amp; Relatives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.(12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e288.(87.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.(50.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.(49.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.09.(3.885\u0026ndash;13.063)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.00.(1.862\u0026ndash;8.626)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCultural events\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.(11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e235.(88.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82.(66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.79.(2.239\u0026ndash;6.481)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.48.(0.731\u0026ndash;2.937)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 .(16.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.(83.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHindu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 .(34.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.(65.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.74(0.830-10.031)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChristian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53.(17.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e249.(82.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.3025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.11(0.438\u0026ndash;3.388)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfrican religion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.(22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.(77.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.49.(0.185\u0026ndash;8.718)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e*significant factors\u003c/h2\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eMany AUD prevalence studies are undertaken in the community or institutional settings (21,30,84) but rarely within a primary health care setting. The prevalence of AUD in this study was 18.5%. The finding was similar to community studies conducted in Nairobi in 2020 and in Gondar in Ethiopia showed an AUD prevalence of 18.4% [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] and 23.7% respectively. In contrast, a study in Ethiopia that screened people living with HIV (PLHIV) for AUD found a slightly lower prevalence of 14.5% [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. This lower prevalence, may be because PLHIV may be have been advised to abstain from alcohol.\u003c/p\u003e \u003cp\u003eThe present study showed that AUD prevalence increased in those users who had relatives who consumed alcohol. The findings of our study are congruent with the findings of other studies [\u003cspan additionalcitationids=\"CR55 CR56\" citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e], where there are higher odds of developing AUD when family members and close associates of subjects consume alcohol. These findings may be explained by constant exposure and ease of access to alcohol by an individual who hails from a family that its members or when his contemparies consume alcohol.\u003c/p\u003e \u003cp\u003eThe study found an increase odds of AUD among marijuana users. Studies carried out amongst university students in Kenya, showed that about a quarter of marijuana users had heavy alcohol intake [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]. Globally, the use of marijuana alongside alcohol led to a higher chance of heavy drinking [\u003cspan additionalcitationids=\"CR60 CR61\" citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]. In addition, the use of marijuana due to interpersonal problems led to a seven-fold increase in alcohol-related risky behaviours and 5 five-fold increase of getting AUD [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. Our results, consistent with other studies, assert that marijuana plays a significant role in encouraging the consumption of alcohol and the resultant occurrence of AUD.\u003c/p\u003e \u003cp\u003eAccording to the present study, the odds of developing AUD in people with insomnia was threefold. Heavy Alcohol Consumption leads to poor quality night-time sleep, sleep pattern distortions, decreased sleep onset and sleep latency [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]. These findings by Colrain et al. may explain why some of the patients in the present study cited insomnia as a determinant for AUD [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]. The findings in the present study indicate a possibility that a high number of patients visiting hospitals with complaints of sleep disorders may have an underlying alcohol problem as the cause of insomnia.\u003c/p\u003e \u003cp\u003eThe study did not however find statistically significant association with other socidemographic determinants of AUD such as male gender, unemployment, older age, marital status, higher income percentile, higher levels of learning, recreational alcohol use, work related stress, relationship distress, social and cultural intake of alcohol and religion. These findings were incongruent to other studies where a higher odds of developing AUD was shown in males [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], those with marital distress [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e], older people [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e], non-muslims [\u003cspan additionalcitationids=\"CR68 CR69\" citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e], those who are bereaved [\u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e], those with lower educational attainment [\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e] and those in lower socioeconomic status [\u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLIMITATIONS\u003c/h2\u003e \u003cp\u003e The study was conducted at the primary care clinics of the Aga Khan University Hospital, located in an urban setting in Nairobi County. The findings may be applicable to other similar private primary healthcare facilities in urban areas. However, the generalizations drawn from this study may not apply to public primary healthcare clinics or rural populations in Kenya. The purposive sampling used in selecting the participants might have introduced selection bias into the study; however, the recruitment process ensured that participants from diverse socio-demographic characteristics were enrolled.\u003c/p\u003e \u003cp\u003eThe study could not establish a causal relationship between the exposures studied and alcohol use disorder (AUD), as the data were collected at a single point in time. Additionally, the design of the study did not allow for the examination of patient behavior before the study to understand the triggers of alcohol consumption.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study showed that the social determinants that influenced the occurrence of AUD were insomnia, smoking marijuana and having relatives who consumed alcohol. The present study highlighted the importance and urgency of regular screening for AUD at primary healthcare facilities in patients to identify patients with these risk factors. The screening for AUD at primary care facilities, which is the first point of care for patients in health facilities cannot be overemphasized.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study acknowledges the contribution of Paul Major Mattos in the editorial of the original research thesis and manuscript.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they had no financial or personal relationships that may have inappropriately influenced them in writing this article\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eV.K.E\u0026nbsp;conceived the research idea that was planned and supervised with G.M, \u0026nbsp;J.O. and J.S. V.K.E. carried out the research study. V.K.E, G.M, M.M, J.O. and J.S. contributed equally to the manuscript write-up. G.M,. J.O, and J.S. supervised the whole research.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was fully funded by the Aga Khan University research seed grant.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData sharing is subject to the rules and regulations of Aga Khan University Hospital that govern the process.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eDisclaimer\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from Aga Khan University Hospital, Nairobi \u0026nbsp; (AKUHN)\u0026rsquo; Research Ethics and Review Board [Ref: 2019/IERC-109(v2)]. All health protocols concerning Covid-19 disease were put in place in compliance with the World Health Organization and the Ministry of Health of the Republic of Kenya guidelines, and safety policies of AKUHN.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\n\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization: \u003cstrong\u003eGlobal status report on alcohol and health 2018\u003c/strong\u003e: World Health Organization; 2018.\u003c/li\u003e\n\u003cli\u003eDegenhardt L, Charlson F, Ferrari A, Santomauro D, Erskine H, Mantilla-Herrara A, Whiteford H, Leung J, Naghavi M, Griswold M: \u003cstrong\u003eThe global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990\u0026ndash;2016: a systematic analysis for the Global Burden of Disease Study 2016\u003c/strong\u003e. \u003cem\u003eThe Lancet Psychiatry \u003c/em\u003e2018, \u003cstrong\u003e5\u003c/strong\u003e(12):987-1012.\u003c/li\u003e\n\u003cli\u003eAnderson P, O\u0026rsquo;Donnell A, Kaner E: \u003cstrong\u003eManaging alcohol use disorder in primary health care\u003c/strong\u003e. \u003cem\u003eCurrent Psychiatry Reports \u003c/em\u003e2017, \u003cstrong\u003e19\u003c/strong\u003e:1-10.\u003c/li\u003e\n\u003cli\u003eJuma PA, Wisdom J: \u003cstrong\u003eIntroduction: Non-communicable disease prevention policies in six African countries\u003c/strong\u003e. \u003cem\u003eBMC Public Health \u003c/em\u003e2018, \u003cstrong\u003e18\u003c/strong\u003e(Suppl 1):955.\u003c/li\u003e\n\u003cli\u003eJaguga F, Kwobah E: \u003cstrong\u003eA review of the public sector substance use disorder treatment and prevention systems in Kenya\u003c/strong\u003e. \u003cem\u003eSubst Abuse Treat Prev Policy \u003c/em\u003e2020, \u003cstrong\u003e15\u003c/strong\u003e(1):47.\u003c/li\u003e\n\u003cli\u003eRehm J, Hasan OS, Imtiaz S, Probst C, Roerecke M, Shield K: \u003cstrong\u003eAlcohol and noncommunicable disease risk\u003c/strong\u003e. \u003cem\u003eCurrent Addiction Reports \u003c/em\u003e2018, \u003cstrong\u003e5\u003c/strong\u003e:72-85.\u003c/li\u003e\n\u003cli\u003eMinistry of Health (MoH) Kenya: \u003cstrong\u003eKenya national strategy for the prevention and control of non-communicable diseases 2015\u0026ndash;2020\u003c/strong\u003e. \u003cem\u003eNairobi: Ministry of Health Division of Non-communicable Diseases \u003c/em\u003e2015.\u003c/li\u003e\n\u003cli\u003eKenya National Bureau of Statistics: \u003cstrong\u003eKENYA STEPwise SURVEY FOR NON COMMUNICABLE DISEASES RISK FACTORS 2015 REPORT\u003c/strong\u003e. 2015.\u003c/li\u003e\n\u003cli\u003eRoss-Houle K, Quigg Z: \u003cstrong\u003eContent, perceptions and impact of alcoholic drink promotions in nightlife venues that are targeted towards students\u003c/strong\u003e. \u003cem\u003eAddictive Behaviors Reports \u003c/em\u003e2019, \u003cstrong\u003e9\u003c/strong\u003e:100163.\u003c/li\u003e\n\u003cli\u003eHarwood H: \u003cstrong\u003eNational Institute of Alcohol Abuse and Alcoholism\u003c/strong\u003e. \u003cem\u003eUpdating Estimates of the Economic Costs of Alcohol Abuse in the United States\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003eCherpitel CJ: \u003cstrong\u003eFocus on: the burden of alcohol use\u0026mdash;trauma and emergency outcomes\u003c/strong\u003e. \u003cem\u003eAlcohol research: current reviews \u003c/em\u003e2014, \u003cstrong\u003e35\u003c/strong\u003e(2):150.\u003c/li\u003e\n\u003cli\u003eCherpitel CJ, Ye Y, Bond J, Room R, Borges G: \u003cstrong\u003eAttribution of alcohol to violence-related injury: self and other\u0026rsquo;s drinking in the event\u003c/strong\u003e. \u003cem\u003eJournal of studies on alcohol and drugs \u003c/em\u003e2012, \u003cstrong\u003e73\u003c/strong\u003e(2):277-284.\u003c/li\u003e\n\u003cli\u003eOstrowsky MK: \u003cstrong\u003eSports Fans, Alcohol Use, and Violent Behavior: A Sociological Review\u003c/strong\u003e. \u003cem\u003eTrauma Violence Abuse \u003c/em\u003e2018, \u003cstrong\u003e19\u003c/strong\u003e(4):406-419.\u003c/li\u003e\n\u003cli\u003eRambaree K, Mousavi F, Ahmadi F: \u003cstrong\u003eSports participation and drug use among young people in Mauritius\u003c/strong\u003e. \u003cem\u003eInternatIonal Journal of adolescence and Youth \u003c/em\u003e2018, \u003cstrong\u003e23\u003c/strong\u003e(2):188-197.\u003c/li\u003e\n\u003cli\u003eZhou J, Heim D, Levy A: \u003cstrong\u003eSports Participation and Alcohol Use: Associations With Sports-Related Identities and Well-Being\u003c/strong\u003e. \u003cem\u003eJ Stud Alcohol Drugs \u003c/em\u003e2016, \u003cstrong\u003e77\u003c/strong\u003e(1):170-179.\u003c/li\u003e\n\u003cli\u003eFox K, Marsh P: \u003cstrong\u003eSocial and cultural aspects of drinking: A report to the European Commission\u003c/strong\u003e. 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The Kenyan WHO STEPWISE survey indicated that 13% of adult Kenyans are heavy episodic drinkers. However, the relationship between social determinants of AUD among patients attending primary health care clinics has not been well investigated in Kenya. We aimed to determine the association between sociodemographic determinants and AUD in patients attending private primary care clinics in Nairobi, Kenya.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional survey design was used to purposively sample 389 patients. Data were collected using self-administered questionnaires adapted from the Alcohol Use Disorder Identification Test (AUDIT) Tool. The prevalence of AUD was calculated as a percentage of all the enrolled patients. Independent associations between explanatory variables and AUD were determined using the chi-square test. Variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.2 were considered for Multivariable Logistic Regression to identify factors associated with AUD.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe prevalence of AUD in this cohort of participants was 18.5%. Significant social determinants for AUD were: tobacco and marijuana smoking (AOR 2.89 95%CI: 1.09\u0026ndash;7.46), insomnia (AOR 3.40 95%CI: 1.52\u0026ndash;7.70), and first-degree relatives who consumed alcohol (AOR 4.00 95% CI:1.86\u0026ndash;8.63). The study showed that social determinants influenced the occurrence of AUD.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eAlcohol users with insomnia, marijuana users and those with a family history of alcohol use should be prioritized for AUD screening. Further studies could explore the influence of these findings on AUD qualitatively.\u003c/p\u003e","manuscriptTitle":"Social Determinants of Alcohol Use Disorder in Patients Attending Private Primary Care Clinics in Nairobi Kenya","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-02 13:22:40","doi":"10.21203/rs.3.rs-4767131/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-29T11:14:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-29T06:57:14+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-29T06:56:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2024-07-19T08:55:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9c79e329-4a16-4dc5-95b9-1607ccb5e1ad","owner":[],"postedDate":"September 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-06-05T09:23:33+00:00","versionOfRecord":[],"versionCreatedAt":"2024-09-02 13:22:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4767131","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4767131","identity":"rs-4767131","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}