TREAT Child Alcohol Use Disorder (C-AUD) in Eastern Uganda: Screening, diagnostics, risk factors and handling of children drinking alcohol

Alcohol beverages play a social and cultural role, however, it also leads to mental health problems, physical damage, reduced social functioning and dependency or harmful alcohol use ('alcohol use disorder', AUD). Early and excessive substance use increases the risk for later problems. It is known that children growing up under social deprivation, under neglect, without adult care or among children living on the streets may use illicit drugs and alcohol. How common it is and how alcohol is used were not fully understood among children living under adult care in rural Uganda when this project commenced. Neither was the situation in the education and health sector fully understood. Our prior research experience in the area made us question the magnitude and the characteristics of alcohol- and substance use among children in Eastern Uganda. Uganda has like many other sub-Saharan countries high alcohol consumption per capita and traditions for home brewing. The TREAT C-AUD research project, with partners from Makerere University in Uganda, the University of Bergen and the Norwegian University of Science and Technology in Norway investigates the existence of alcohol drinking and substance use among children living under adult supervision and care, living within the communities. We focus on the age group 6-13 years overlapping with the recommended age for primary school attendance, although children in primary may also be older for various reasons or not go to school. The project is approaching the research topic from comprehensive perspectives including adaptation and validation of screening tools, a large cross-sectional study with caregivers and children, and qualitative interviews and quantitative surveys with children, and stakeholders in the communities, schools, and in the health system. We have been including community representatives, expert groups, user groups, and stakeholders in the development of screening tools and will do so in interpreting and disseminating the results. We have taken the COVID-19 situation into account both concerning its effect on the research questions at stake and the methods used. The TREAT C-AUD research project will therefore document to which degree alcohol drinking is a problem in the communities in Mbale District, Eastern Ugandan, and factors of relevance to the school, and health sectors. The project is also capturing children’s own perspectives. The development of tools can be used by the health- and school-system for the detection and handling of children having problems with alcohol.

Summary: Background: Alcohol use disorder including alcoholism or alcohol dependency among children is a neglected and under-researched area. The TREAT child alcohol use disorder (C-AUD) consortium have been present in the research area for years and observed and identified alcohol use including alcohol dependency among children. Objectives: This project will investigate the magnitude of C-AUD and related household, community, school, health system and clinical factors associated with the problem and suggest scalable changes in the health system for screening, diagnostic and treatment procedures in Uganda. Methods: It will adapt culturally appropriate and operational screening and diagnostic criteria for C-AUD; Investigate the prevalence of C-AUD in the community and health system in addition to risk- and protective factors for alcohol use in children. Further, it will identify the gap in the health system's handling of the issue and suggest changes to the practises. In order to achieve a holistic understanding of the problem we will investigate C-AUD from the children- and schools' point of view. As the field of alcohol use among children is under-researched, our research is explorative in nature aiming for getting a comprehensive understanding of the problems, including what makes alcohol use end up as alcohol use disorder. We will work in close collaboration with ministries, the communities, the school- and health system. We have capacities in child and adolescent psychiatry and substance use, child health and nutrition, public health and implementation research. We will use quantitative and qualitative methods of which the largest component is a community survey involving adapted screening tools and biomarkers in blood and urine. Conclusion: These research findings have the potential to contribute to SDG 3.4 and 3.5 on non-communicable diseases and substance use with relevance for children and respective implementation strategies in sub-Saharan Africa.