Reasons for Excessive Alcohol Use and It's Effects

REASONS FOR EXCESSIVE ALCOHOL USE AND IT’S EFFECTS

AMONG STUDENTS OF KAMPALA INTERNATIONAL UNIVERSITY

WESTERN CAMPUS

KALIZA ESTHER

DCM/0142 /143/DU

A RESEARCH PROPOSAL SUBMITTED TO SCHOOL OF ALLIED HEALTH

SCIENCES IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR

THE AWARD OF DIPLOMA IN CLINCAL MEDICINE

AND COMMUNITY HEALTH AT KAMPALA

INTERNATIONAL UNIVERSITY

JULY 2017

DECLARATION I Kaliza Esther, declare that this research report presented is my own work and that all the sources that I have used or quoted have been indicated and acknowledged by means of complete references.

SIGNATURE…………………………

DATE…………………………………

APPROVAL This research report has been done under my supervision and is ready to be submitted for examination with my approval. SUPERVISOR: MR. TASHOBYA DANIEL KAMUGISHA

Signature………………………………

Date……………………………………

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DEDICATION I dedicate this research report to my Mother Nambi Betty and Uncle Tibiita Swaliki for their support and love throughout my studies.

ACKNOWLEDGEMENT I acknowledge and appreciate the valuable contribution of my supervisor Mr.Tashobya Daniel Kamugisha who tirelessly guided me throughout my research report writing.

I am indebted to my mother, my uncle who financially and otherwise made my studies in medical school possible.

I would like to thank all the KIU-WC students and staff more so to the School of Allied Health Sciences (SAHS) who equipped me with relevant knowledge and skills throughout my study course.

Finally I wish to express my gratitude to my family whose support, input and encouragement made this research work possible. Not forgetting my dear friends and class colleagues.

LIST OF ABBREVIATIONS AND ACRONYMS -OH: Hydroxyl functional group in alcohol

AIDS: Acquired Immune Deficiency Syndrome

APC: Alcohol per capita

AUDs: Alcohol Use Disorders

CNN: Cable News Network

CVD: Cardiovascular disease

DALYS: Disability Adjusted Life Years

DUI: Driving Under the Influence

FAS: Fetal Alcohol Syndrome

GENACIS: Gender, Alcohol and Culture: an International Study

HIV: Human Immunodeficiency Virus

ICD: International Classification of Diseases

KIU-WC: Kampala International University- Western Campus

MUBS: Makerere University Business School

RCP: Royal College of Physicians

SAHS: School of Allied Health Sciences

STD/STIs: Sexually Transmitted Disease/ Infections

WHO: World Health Organization

TABLE OF CONTENT

DECLARATION ...... I APPROVAL ...... III DEDICATION ...... IV ACKNOWLEDGEMENT ...... V LIST OF ABBREVIATIONS AND ACRONYMS ...... VI CHAPTER ONE:...... 1

1.0 INTRODUCTION ...... 1 1.1 BACKGROUND...... 1 1.2 RESEARCH PROBLEM STATEMENT...... 4 1.3 JUSTIFICATION OF THE STUDY...... 5 1.4 OBJECTIVES OF THE STUDY ...... 5 1.4.1 General Objective ...... 5 1.4.2 Specific objectives ...... 6 1.5 RESEARCH QUESTIONS ...... 6

1.6 SCOPE OF THE STUDY ...... 6 LITERATURE REVIEW...... 8

2.0 INTRODUCTION...... 8 2.1 THE GLOBAL SITUATION...... 8 2.2 THE ALCOHOL SITUATION IN UGANDA ...... 9 2.3 COMMON REASONS WHY ALCOHOL IS CONSUMED ...... 11 2.4 EFFECTS OF ALCOHOL CONSUMPTION ...... 13 CHAPTER THREE...... 17 METHODOLOGY...... 17

3.1 STUDY DESIGN...... 17 3.2 STUDY AREA...... 17 3.3 POPULATION OF STUDY...... 18 3.3.1 Inclusion Criteria...... 18 3.3.2 Exclusion Criteria...... 18 3.4 STUDY VARIABLES...... 18 3.4.1 Dependent Variable...... 18 3.4.2 Independent Variables...... 18 3.5 SAMPLE SIZE DETERMINATION...... 18 3.6 DATA COLLECTION ...... 19

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3.7 SAMPLING METHODS...... 19 3.8 ANALYSIS OF DATA...... 19 3.9 QUALITY CONTROL...... 19 3.10 ETHICAL CONSIDERATIONS...... 19 CHAPTER FOUR...... 20 4.1 BIODATA OF RESPONDENTS ...... 20 4.1.1 Age groups of respondents ...... 20 4.1.2 Gender...... 21 4.1.3 Religion...... 22 4.1.4 Nationality...... 22 4.2.1 Reason(s) for not taking alcohol ...... 25 4.2.2 Type of alcohol consumed...... 25 4.2.3 Reason(s) for consuming alcohol ...... 26 4.2.4 Drinking patterns ...... 27 4.3.0 EFFECTS OF ALCOHOL ...... 27 4.3.1 Effect(s) of alcohol on respondents ...... 27 4.3.2 Awareness of the effects alcohol has on health...... 28 4.3.3 Effects of Alcohol ...... 29 CHAPTER FIVE ...... 30

5.1 DISCUSSION ...... 30 5.2 CHALLENGES...... 32 5.3 CONCLUSIONS...... 32 5.4 RECOMMENDATIONS ...... 33 REFERENCES ...... 35 APPENDICES ...... 37 APPENDIX I: QUESTIONNAIRE ...... 37 APPENDIX II:MORGAN’S TABLE ...... 39 APPENDIX III: MAP OF ISHAKA MUNICIPALITY IN BUSHENYI DISTRICT ...... 41 APPENDIX IV: MAP OF UGANDA SHOWING THE STUDY AREA ...... 42 APPENDIX V: INTRODUCTORY LETTER ...... 44

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ABSTRACT

BACKGROUND

People say they drink alcohol either to have fun, celebrate an achievement, or “down their sorrows” after a major life stress.

High alcohol consumption in Uganda is linked to the aggressive marketing by manufacturers through mass media advertisements, sponsorship of sports activities, performing arts and music, free alcohol promotions at discount prices and total disregard of the law on availability of alcohol, time and selling points. Uganda still has neither national alcohol policy nor an effective regulatory body. Attempts by the ministry of health to regulate the consumption of alcohol have been opposed by the ministry of trade which has blocked a propose ban on the manufacture and consumption of alcohol.

Adolescents and the youth are highly engaged in this practice, as they are the ones who frequent night clubs, bars and even throw house parties. Alcohol is affordable, and available.

This study focuses on the reasons for consumption of alcohol among students of KIU- WC. It also examines the effects these students have had with taking alcohol, as well as their awareness of the effects of alcohol.

METHODS

The campus, located in Western Uganda (Ishaka, Bushenyi) has a standing population of about three thousand two hundred and seventy one students. A sample size of three hundred and forty six students was estimated using a Morgan’s table, but because the study was carried out while most students were on a semester break, a sample size of two hundred sixty students was used in this study. A questionnaire was used for data collection.

RESULTS

Data has been presented in form of charts and tables. It showed that 52% of the respondents consume alcohol, and those who motioned they don’t basically attributed it to their religious affiliation. Most of the respondents (45%) were between ages; 23-27 years. The study also shows that for those who consume alcohol, many don’t solely consume one brand of alcohol.

The major reason given for consumption of alcohol was because “everyone does it.” This could be people taking alcohol so as the fit in the crowd. The next reason given was to relieve stress. Most of the respondents answered to having been absent from school because of alcohol. This could have been because they were nursing a hangover, catching up on sleep because they were out till late at night, or because they were busy drinking in their rooms or organizing a drink-party. The greatest percentage (78.46%) of respondents was found to be aware of the effects(s) alcohol has on health, while the remaining11.92% was unaware. 9.62% gave no response. Among the health effects known to the respondents, liver disease; a long term effect of alcohol consumption was listed by majority of the respondents (149). The least mentioned effect was acute intoxication; a short term effect of alcohol consumption.

In conclusion, this study demonstrates that majority of students in KIU-WC campus do consume alcohol for a number of reasons. Most of them are also well aware of the effects of alcohol, but still chose to drink. There is, therefore need to keep up with education of the public about excessive alcohol use. There is still need for the country to implement an alcohol law, governing the sale and consumption of alcoholic beverages.

CHAPTER ONE:

1.0 INTRODUCTION This chapter deals with study background, problem statement, study objectives, research questions, justification of the study, scope of the study and conceptual frame work.

1.1 BACKGROUND Globally drinking alcoholic beverages is a common feature of social gatherings. Nevertheless, the consumption of alcohol carries a risk of adverse health and social consequences related to its intoxicating, toxic and dependence-producing properties (WHO, 2014).

Alcohol is the most commonly used psychoactive substance in the world and is one of the leading causes of death and disability worldwide (J.Rehm, C.Mathers et al, 2009). Globally, alcohol use causes 1.8 million or 3.2% of all deaths and accounts for 4.0% of the disease burden. The disease burden related to alcohol use is especially great among low income and middle-income populations and countries, where alcohol consumption is increasing and injury rates are high due to limited implementation of public health policies and prevention strategies. (Palmier&NazariusM.Tumwesigye, 2011).A critical aspect of alcohol use is pre-teen alcohol initiation, which worsens adverse health outcomes among youth. Epidemiological studies in western countries have examined the association between early alcohol initiation and problems related to alcohol among youth, but data is lacking to study such associations in most developing countries.

Literature on pre-teen alcohol initiation have identified gender, age, monthly income, living arrangement, attitude toward alcohol use, perceived susceptibility of alcohol use, perceived self-efficacy, peer drinking, relatives drinking, accessibility of alcohol around

1 university, accessibility of alcohol around community, exposure to anti-alcohol campaign, (Vantamay S., 2009) exposure to alcohol advertising, and ownership of alcohol promotional items as significant correlates of alcohol use.

The risk of alcohol use among youth in low-income countries is a vital public health concern. In Africa, alcohol use is related to poverty, road traffic crashes, sexual intercourse among adolescents, unprotected sex,(Kalichman SC, Simbayi LC, Kaufman M, et al,2007)and psychological distress(Page RM, Hall CP,2009). To exacerbate the conditions, heavy episodic drinking is prevalent among young adults in several African countries (WHO, 2004). For example, more than one inevery three Zambian adolescents have ever drunk alcohol, (Muula AS, Kazembe LN,2007) and Uganda has been noted shaving the highest alcohol per capital consumption in the world (WHO,2004).

Ugandans consume more alcohol than counterparts in any African countries, demonstrating the citizens’ “abiding love for liquor”. According to a study done by US broadcaster, Cable News Network (CNN);titled “World’s 10 best drinking nations,” Uganda is ranked 8th globally (with home-made waragi (a.k.a war gin) and ajono (semi- fermented beer drunk from communal pots using long straws, topping the alcohol menu) ahead of Germany and Australia at positions 9 and 10, respectively. (www.cnn.com,March 2013).

Alcohol ranks high (6th position) in generating domestic revenue in Uganda. About 10% of revenue comes from alcohol and this has been reportedly to be steadily increasing since it is rooted in a very strong culture of alcohol acceptance. The lack of a clear national alcohol policy coupled with weak and poorly enforced laws provides fertile ground for increasing the availability and accessibility of alcohol in Uganda. In Uganda, most alcohol consumers have been found to be middle-aged, leading to the conclusion that age as a factor may be a determinant in alcohol consumption patterns.

Alcohol is a uniting factor among middle-aged persons who have lots of interest in common such as nightlife, and extra-marital affairs.(Mbulaiteye SM et al, 2002). The patterns of alcohol consumption among the youth show signs of cultural influence. Most tribes have a culture of brewing alcohol in homes thus exposing the youth to alcohol at an early age. As young people reach adolescence, alcohol consumption increases due to peer pressure (Idore ands. Obot and Robin eds. (2005). Recent information shows that alcohol is undermining the environment necessary for the care of children in homes (Ministry of Finance, Planning &Economic Development 2002). Alcohol has escalated child abuse, domestic violence and hygiene-related problems in homes. Reports indicate that many households face problems of compromised health and nutrition care because husbands spend the meager household income on alcohol, leading to the collapse of household’s economic security. Reports also indicate that men start drinking alcohol in bars as early as 8:00am and rarely contribute to the family economy. Alcohol has also been blamed for the increasing cases of extra-marital affairs which lead to domestic violence. This adversely affects nurturing and character formation among children and youth. (Ovuga E and Madrama C, 2006).

The use of alcohol with anxiety-enhancing drugs such as cannabis, tobacco, khat (mairungi) heroin and other medically prescribed drugs has also been said to be on the increase in both urban and rural areas, as well as among secondary and college students (GENACIS study 2005). Addictions levels begin to emerge at the age of 21and are highly associated with other stressors and poor coping skills among young people. Alcoholism increases with age in Uganda. In other words the older the individual the more likely he/she is to become an alcoholic. The lack of adequate negotiating and assertiveness skills, especially among girls leads them to indulge in alcohol abuse which paves the way forum protected sexual practices,

3 leading to sexually transmitted diseases or infections ( STDs/STIs) and unwanted pregnancies.

Alcohol abuse can result in severe medical problems such as alcohol poisoning, unconsciousness, respiratory depression and sometimes death. Young people are also at risk of vomiting, blackouts, risky sexual behavior and drunken driving. Knowledge about the health and social consequences of alcohol abuse among young people in urban areas is limited due to the limited access to information about the interventions by the Government and the civil society in this regard(Homel, R., Österberg, E,2003).Therefore there is a need to step up efforts to educate young people about dangers of drug abuse and educate health practitioners to be careful while prescribing drugs to young people so as to avoid drug abuse(WHO, 2005).

1.2 RESEARCH PROBLEM STATEMENT

The WHO estimates that around 2 billion people worldwide consume alcohol (WHO, 2004) and there is clearly no single reason why they do or why different people drink to different extents. It is apparent though that drinking is influenced by factors such as genetics, social environment, culture, age, gender, accessibility, exposure and personality. Alcohol consumption has been part of human history since antiquity. There are not only numerous Biblical examples and ancient myths which refer to alcohol but local oral history and archeological findings suggest that consumption has been part of African culture, rituals since “time memorial”. But the fact of enduring alcohol consumption and the passing down of this habit through generations does not adequately explain why alcohol is consumed (Prof. Melvyn Freeman, Prof Charles Parry, 2006).

Alcohol abuse is a significant problem among young people and a solution needs to be found. It is the drug of choice among the youth, often with devastating consequences.

Most people do consume alcohol, and barely know the effects it could have on them; be it short or long term effects. Alcohol plays a powerful role in risky sexual behavior, including unwanted, unintended and unprotected sexual activity, and sex with multiple partners. Alcohol is associated with academic failure and drug use. Young people drink too much and at too early an age, thereby creating problems for themselves, for people around them, and for society as a whole. A study conducted by Kabaireho (2009) on the prevalence of alcohol consumption among university students showed that 78% of the students were using alcohol. About 79% of the males used alcohol as compared to 75% among females. The study further showed that the majority (92%) of the students began drinking alcohol before joining university. By inference these findings are evidence that there is a general increase in the prevalence of alcohol and drug abuse among the youth, hence the need for this study to focus on educational institutions and the stakeholders to implement an alcohol law governing the sale and consumption of alcoholic beverages as a point of reference

1.3 JUSTIFICATION OF THE STUDY

Alcohol is a product that is highly advertised, and the media portrays alcohol consumption as something normal and acceptable. Each individual has reason(s) as to why he/she consumes alcohol and the amount consumed. Some know the effects of excessive alcohol consumption, and others don’t. This study seeks to document the possible reasons as to why students of KIU-WC consume alcohol in excess and the possible effects they have encountered.

1.4 OBJECTIVES OF THE STUDY

1.4.1 General Objective The study seeks to find the reasons for excessive alcohol consumption and its effects among students of KIU-WC.

1.4.2 Specific objectives i. To find the proportion of students of KIU-WC who consume alcohol. ii. To establish the possible reasons as to why students of KIU-WC consume alcohol in excessive amount. iii. To find whether the students of KIU-WC understand the effects of excessive alcohol consumption.

1.5 RESEARCH QUESTIONS 1. What is the proportion of students of KIU-WC that consume alcohol? 2. What are the possible reasons for excessive alcohol consumption among KIU-WC students? 3. What is the level of awareness about the effects of excessive alcohol consumption among students of KIU-WC?

1.6 SCOPE OF THE STUDY The study described the reasons for excessive alcohol use and its effects among students of KIU-WC, proportion of students who consumed alcohol and awareness about the effect of excessive alcohol consumption were also studied.

1.7 CONCEPTUAL FRAME WORK

Conceptual framework of reasons for excessive alcohol use and its effects among students of Kampala International University-Western Campus.

(INDEPENDENT VARIABLE)

(INTERV ENING (DEPENDENT

VARIABLE) Number of students who VARIABLE) consume alcohol. Reasons for excessive alcohol consumption and

its effects.

Awareness of the effects of alcohol

CHAPTER TWO.

LITERATURE REVIEW.

2.0 INTRODUCTION. This encompasses the available literature about alcohol consumption and its effects to the individuals guided by the specific objectives.

2.1 THE GLOBAL SITUATION. Alcohol is a complex health and social issue. There is little doubt that considerable harm is done through its abuse - even the alcohol industry accepts this - but in moderation drinking alcohol is an acceptable convention utilized by over 2 billion people world-wide (Prof. Melvyn Freeman Prof Charles Parry, 2006).

Worldwide consumption in 2010 was equal to 6.2 liters of pure alcohol consumed per person aged 15 years or older, which translates into 13.5 grams of pure alcohol per day. A quarter of this consumption (24.8%) was unrecorded, i.e., homemade alcohol, illegally produced or sold outside normal government controls. Of total recorded alcohol consumed worldwide, 50.1% was consumed in the form of spirits. Worldwide 61.7% of the population aged 15 years or older (15+) had not drunk alcohol in the past 12 months. In all WHO regions, females are more often lifetime abstainers than males. There is a considerable variation in prevalence of abstention across WHO regions. Worldwide about 16.0% of drinkers aged 15 years or older engage in heavy episodic drinking. In general, the greater the economic wealth of a country, the more alcohol is consumed and the smaller the number of abstainers. As a rule, high-income countries have the highest alcohol per capita consumption (APC) and the highest prevalence of heavy episodic drinking among drinkers (WHO, 2014).

In 2012, about 3.3 million deaths, or 5.9% of all global deaths, were attributable to alcohol consumption. There are significant sex differences in the proportion of global deaths attributable to alcohol, for example, in 2012, 7.6% of deaths among males and 4.0% of deaths among females were attributable to alcohol. There is also wide geographical variation in the proportion of alcohol-attributable deaths and disability adjusted life years(DALYs), with the highest alcohol-attributable fractions reported in the WHO European Region (WHO, 2014).

2.2 THE ALCOHOL SITUATION IN UGANDA

Recent developments indicate an increasing trend in alcohol consumption. WHO ranked Uganda the leading consumer of alcohol in the world Per Capita alcohol consumption in Uganda was 19.5 liters, closely followed by Luxembourg at 17.54 liters and the Czech Republic at 16.21 liters (WHO, 2005). Alcohol ranks high (6th position) in generating domestic revenue in Uganda. About 10% of revenue comes from alcohol and this has been reportedly to be steadily increasing since it is rooted in a very strong culture of alcohol acceptance. The lack of a clear national alcohol policy coupled with weak and poorly enforced laws provides fertile ground for increasing the availability and accessibility of alcohol in Uganda. Consumption of alcohol among college and university students is high on the campuses, in the hostels and the neighborhoods. Some of the major academic institutions such as Makerere University, Kyambogo University, Makerere Business School (MUBS) and Mukono University are surrounded by an array of bars that provide an environment conducive for students to take alcohol at their convenience. For instance, Makerere University is bordered by Wandegeya, a suburb that has over 500 bars. In the higher institutions of learning alcohol is consumed by both students and teaching staff. It is common practice for students and lecturers to take alcohol in the same bars. Alcohol on university campuses is easily accessible. Canteens located in the halls of residences provide both bottled alcohol and spirits in sachets. Hostel canteens also sell

9 alcohol all the time. Because of the easily availability and accessibility of alcohol in canteens, students start drinking alcohol as early as 10:00 am. Student guild canteens also occasionally provide discounted beer during cultural and entertainment festivals. It is reported that canteens in halls of residences make more money from selling alcohol than any other item. Incidences of alcohol use among students have been reported to occur mainly in the evenings and weekends. Students often organize binge-style parties on the weekends where massive drinking commonly takes place and often result in intoxication, alcohol hangovers and poisoning with males being more affected than females. These types of parties play a big role in initiating new students into the act of drinking alcohol. A number of studies show that some students regularly use drugs or alcohol to compensate for anxiety, depression, or poor social skills. The largest increase in consumption for both sexes has been among those aged below 25 years of age (Eastman2007). The number of male students who take alcohol at higher institutions of learning is more than that of females. In addition, university girls seem to prefer bottled beers while the male students go for both the bottled beers and spirits sold in sachets, the latter being favored because it’s cheap and very potent. A study conducted by Kabaireho (2009) on the prevalence of alcohol consumption among university students showed that 78% of the students were using alcohol. About 79% of the males used alcohol as compared to 75% among females. The study further showed that the majority (92%) of the students began drinking alcohol before joining university. By inference these findings are evidence that there is a general increase in the prevalence of alcohol and drug abuse among the youth, hence the need for this study to focus on educational institutions as a point of reference. Alcoholism greatly contributes to the deterioration in students’ academic performance. Many cases of deterioration in students’ performance and academic failure have been largely attributed to alcohol abuse, especially among male students. Many students have been expelled from universities due to decline in their academic performance as a result of excessive alcohol consumption. Alcohol use has also been partially responsible for

10 rape and violence on and outside campuses. Unintended suicides on college campuses are also highly associated with this trend. There is, thus an urgent need to work with college and university administrators to develop and enforce an alcohol policy to discourage the availability and sale of alcohol in halls of residence and hostels because of the harm it causes.

2.3 COMMON REASONS WHY ALCOHOL IS CONSUMED People say they drink either to have fun, celebrate an achievement, to “down their sorrows” after a major life stress. Listed below are a number of reasons,

Alcohol as a social lubricant; assists people to relax, converse more easily and mix socially. It dis inhibits defenses and facilitates “good company”, use of alcohol in ritual; Alcohol has a “mystique” not shared by non-alcoholic beverages and their use in traditional ritual (locally and internationally) appears to add to the aura of special occasions, social sharing; sharing an alcoholic drink with other people promotes a bonding and a connectedness amongst consumers often not gained through sharing non- alcoholic beverages and drinking alcohol is accepted - and even expected –behavior; there is very little public criticism of people who drink alcohol – even to states of drunkenness also to note is the taste and quality; though an acquired taste, consumers of alcohol enjoy the taste of alcohol. Some people develop sophisticated palates for alcohol and sincerely appreciate good quality.

Even traditionally made alcohol products vary in quality and demand is mediated by this. What one drinks and how one drinks it is very often an indication of culture and class, alcohol as a reducer of stress; Alcohol is often used to reduce the tension of an event – impending or actual. Research suggests that drinking can reduce stress in certain people and under certain circumstances. Differences include a family history of alcoholism, personality traits, self-consciousness, cognitive functioning and gender (Sayette, 2003).

Drinking as a means of dulling “the pain of poverty” or other hardships of life; for many people life is simply intolerable. They live in abysmal poverty or in life circumstances which produce unbearable emotional pain. Alcohol dulls that pain for as long as they are drinking, consumption as “macho” behavior ;(Mainly) men consume large amounts of alcohol as an indication of their strength and manliness. Behaviors such as drinking more than anyone else or more quickly than anyone else are often regarded as admirable masculine qualities. With changing gender roles some women also “prove” themselves with binge drinking patterns, also consumption in youth; as children are usually prohibited from drinking alcohol, youth (again mainly males) often sees drinking alcohol as a state of adult behavior to be aspired to, enjoyment of a state of intoxication; many people simply enjoy the feeling of intoxication, maintaining a state of inebriation; the state of inebriation is not maintained unless additional alcohol is consumed. This may lead to more consumption and to states of drunkenness not necessarily intended when starting to drink. Lack of information; many people are ignorant of the facts regarding the impacts and effects of alcohol and thus they drink without knowing the dangers. “Counter advertising” and education around alcohol in schools are limited, responding to peer pressure; many people, especially youth, may be, or feel, pressurized to drink alcohol as this is regarded as the social norm or the norm of a particular age or social/cultural grouping. The pressure to conform, especially amongst youth, is a well-documented psychological phenomenon. People may be (or fear they may be) excluded from or ostracized by the group if they do not partake in alcohol and lastly pressure from advertising/following role-models; while the alcohol industry claims that alcohol advertising is aimed solely at brand switching and that it is not aimed at promoting additional consumption – especially drinking amongst youth - evidence suggests that advertising does indeed increase consumption (Snyder, 2006).

2.4 EFFECTS OF ALCOHOL CONSUMPTION

The Royal College of Physicians (RCP) advises no more than 21 units per week for men and 14 units per week for women. But also, have 2-3 alcohol-free days a week to allow the liver time to recover after drinking anything but the smallest amount of alcohol. Alcohol impacts people and societies in many ways and it is determined by the volume of alcohol consumed, the pattern of drinking, and, on rare occasions, the quality of alcohol consumed. In 2012, about 3.3 million deaths, or 5.9 % of all global deaths, were attributable to alcohol consumption (WHO, 2014).

The harmful use of alcohol ranks among the top five risk factors for disease, disability and death throughout the world (WHO, 2011; Lim et al., 2012).

Alcohol consumption is a causal factor in more than 200 disease and injury conditions. Drinking alcohol is associated with a risk of developing health problems such as mental and behavioral disorders, including alcohol dependence, major non-communicable diseases such as liver cirrhosis, some cancers and cardiovascular diseases, as well as injuries resulting from violence and road clashes and collisions(Shield, Parry &Rehm, 2013).

The latest causal relationships are those between alcohol consumption and incidence of infectious diseases such as tuberculosis as well as the course of HIV/AIDS (Hendershot et al., 2009; Azar et al., 2010).Alcohol consumption by an expectant mother may cause fetal alcohol syndrome and pre-term birth complications. A significant proportion of the disease burden attributable to harmful drinking arises from unintentional and intentional injuries, including those due to road traffic crashes, violence, and suicides. Fatal injuries attributable to alcohol consumption tend to occur in relatively younger age groups (WHO, 2014).

The impact of alcohol consumption on chronic and acute health outcomes in populations is largely determined by two separate but related dimensions of drinking :The total volume of alcohol consumed and the pattern of drinking.

The context of drinking plays an important role in occurrence of alcohol-related harm, particularly associated with health effects of alcohol intoxication and on rare occasions, also the quality of alcohol consumed. There are three main direct mechanisms of harm caused by alcohol consumption in an individual (WHO, 2007). These three mechanisms are, toxic effects on organs and tissues, intoxication, leading to impairment of physical coordination, consciousness, cognition, perception, affect or behavior and lastly dependence, whereby the drinker’s self-control over his or her drinking behavior is impaired.

Major disease and injury categories causally impacted by alcohol consumption include; Neuropsychiatric conditions: alcohol use disorders (AUDs) are the most important neuropsychiatric conditions caused by alcohol consumption. Epilepsy is another disease causally impacted by alcohol, over and above withdrawal-induced seizures (Samokhvalovetal, 2010). Alcohol consumption is associated with many other neuropsychiatric conditions, such as depression or anxiety disorders (Kessler, 2004; Boden and Fergusson, 2011), but the complexity of the pathways of these associations currently prevents their inclusion in the estimates of alcohol-attributable disease burden (Rehm et al., 2010). Gastrointestinal diseases: liver cirrhosis (Rehm et al., 2010) and pancreatitis (both acute and chronic; Irving et al., 2009) are causally related to alcohol consumption. Higher levels of alcohol consumption create an exponential increase in risk. The impact of alcohol is so important that for both disease categories there are subcategories which are labeled as“alcoholic” or “alcohol-induced” in theinternational classification of diseases ( ICD).

Cancers: alcohol consumption has been identified as carcinogenic for the following cancercategories (International Agency for Research on Cancer, 2012) cancer of the mouth, Nasopharynx and oropharynx, laryngeal cancer, esophageal cancer, colon and rectum cancer, liver cancer and female breast cancer. In addition, alcohol consumption is likely to cause pancreatic cancer. The higher the consumption, the greater the risk for these cancers, with consumption as low as one drink per day causing significantly increased risk for some cancers, such as female breast cancer (Seitz et al., 2012; Rehm& Shield, 2013). Intentional injuries: alcohol consumption, especially heavy drinking, has been causally linked to suicide and violence (Cherpitel, 2013; Macdonald et al., 2013). Unintentional injuries: almost all categories of unintentional injuries are impacted by alcohol consumption. The effect is strongly linked to the alcohol concentration in the blood and the resulting effects on psychomotor abilities. Higher levels of alcohol consumption create an exponential increase in risk (Taylor et al., 2010). Cardiovascular diseases (CVD): the relationship between alcohol consumption and cardiovascular diseases is complex. The beneficial cardio-protective effect of relatively low levels of drinking for ischemic heart disease and ischemic stroke disappears with heavy drinking occasions. Moreover, alcohol consumption has detrimental effects on hypertension, atrial fibrillation and hemorrhagic stroke, regardless of the drinking pattern (Roerecke&Rehm, 2012). Fetal alcohol syndrome (FAS)and preterm birth complications: alcohol consumption by an expectant mother may cause these conditions that are detrimental to the health of a newborn infant (Foltran et al., 2011). Diabetes mellitus: a dual relationship exists, whereby a low-risk pattern of drinking may be beneficial while heavy drinking is detrimental (Baliunas et al., 2009). Infectious diseases: harmful use of alcohol weakens the immune system thus enabling development of pneumonia and tuberculosis. This effect is markedly more pronounced when associated with heavy drinking, and there may be a threshold effect, meaning that

15 disease symptoms manifest mainly if a person drinks above a certain level (Lönnrothet al., 2008). Alcohol consumption can have an impact not only on the incidence of diseases, injuries and other health conditions, but also on the course of disorders and their outcomes in individuals. There are gender differences in alcohol-related mortality, morbidity, as well as levels and patterns of alcohol consumption. The percentage of alcohol- attributable deaths among men amount to 7.6 % of all global deaths compared to 4.0 % of all deaths among women. Total alcohol per capita consumption in 2010 among male and female drinkers worldwide was on average 21.2 liters for males and 8.9 liters of pure alcohol for females (WHO, 2014).

2.5 WHO RESPONSE

The protection of the health of populations by preventing and reducing the harmful use of alcohol is a public health priority, and one of the objectives of the World Health Organization (WHO) is to reduce the health and social burden caused by the harmful use of alcohol. The Global strategy to reduce the harmful use of alcohol defines “harmful use” as drinking that causes detrimental health and social consequences for the drinker, the people around the drinker and society at large, as well as the patterns of drinking that are associated with increased risk of adverse health outcomes(Gmel et al., 2011). The vision of this strategy is to improve the health and social outcomes of individuals, families and communities, considerably reducing morbidity and mortality due to harmful use of alcohol and their ensuing social consequences (WHO, 2010).

CHAPTER THREE.

METHODOLOGY. 3.1 STUDY DESIGN. A cross-sectional study was used to determine the reasons for excessive alcohol use and the effects among students of KIU-WC.

3.2 STUDY AREA.

Kampala International University's Western Campus [KIU-WC] is situated on about 70 acres of land at Ishaka town in Bushenyi District, along Mbarara –Kasese Road in Western Uganda. This spacious campus was opened in November 2004. The School Allied of Health Sciences [SAHS] is located at the KIU-WC. It offers a number of courses in bachelors, diplomas and certificates.

Bushenyi District is one of the oldest districts in Uganda. It was created in 1974, curved out of Mbarara District Administration then in 2009, it was split into five districts (4 new districts of Buhweju, Mitooma, Sheema and Rubirizi districts) with one new municipal Council of Bushenyi- Ishaka. Bushenyi District lies between 0 0 N and 0 0 46’ S of the equator and 29 0 41’ East and 30 0 30’ East of Greenwich.

Bushenyi District headquarters is located 340 kilometres from Kampala in the South Western part of Uganda, neighbored with the districts of Rubirizi in theNorth, Buhweju and Sheema in the North East, Sheema in the East, Mitooma in the South West and Sheema in the South. The district has a land area of 3’949 square kilometers and lying between 910 – 2,500 meters above sea level. The main physical features within the district include natural tropical forests of Karinzu and Imaramagambo covering an area of 784 kilometres.

Bushenyi District has a population of 241,500 people made up of 117,000 males and 124,000 according to the projected population estimates of 2010.

3.3 POPULATION OF STUDY.

The study was conducted by the researcher at Kampala International University Western Campus which had a population of 10,271 students. The proportion of students of KIU- WC who consumed alcohol and the reason for excessive alcohol intake were also under study.

3.3.1 Inclusion Criteria. Current students of KIU-WC were the target for this study.

3.3.2 Exclusion Criteria. Students who were not willing to consent.

3.4 STUDY VARIABLES.

3.4.1 Dependent Variable. Reasons of excessive alcohol use and its effects amongst students of KIU-WC.

3.4.2 Independent Variables. Proportion of KIU-WC students who consume alcohol excessively.

Possible reasons for excessive alcohol consumption amongst KIU-WC students.

Level of awareness about the effects of excessive alcohol consumption amongst students of KIU-WC.

3.5 SAMPLE SIZE DETERMINATION. Morgan’s table was to determine the sample size for this study with a confidence interval of 95%, and a margin of error; 5.0%, the sample size for this study was three hundred forty six (346) students.

3.6 DATA COLLECTION Data was collected using a structured questionnaire which was administered by the researcher and the population under study answered questions by ticking in the corresponding space using a pencil or a pen and respondents given time frame of not more than two days to answer the questions.

3.7 SAMPLING METHODS. Simple random sampling was used for this study.

3.8 ANALYSIS OF DATA. Data collected was analyzed in form of tables and pie chart and bar graphs in respective of each objective, percentage were also used and descriptive words were used to explain the data that was represented.

3.9 QUALITY CONTROL.

To ensure quality control, I conducted a one day training for the one research assistant who there-after did field testing of the study tools. A total of four questionnaires were distributed for the pre-test with my close supervision.

3.10 ETHICAL CONSIDERATIONS An introductory letter was sought from the school of allied health sciences(SAHS) administration.

No student was coerced to participate in the study.

Names of participants were not used in the study, hence confidentiality of the participants.

CHAPTER FOUR.

DATA ANALYSIS AND PRESENTATION.

Kampala International University- Western Campus currently has a standing population of ten thousand two hundred seventy one students (10,271). The initial sample size for this study was three hundred forty six (346) students. At the time of the study, most students were on a semester break, and some of the students present were not willing to participate in the exercise. Only two hundred sixty (260) students participated in the exercise. The questionnaires were analyzed, and below are the results attained.

4.1 BIODATA OF RESPONDENTS

4.1.1 Age groups of respondents The majority (45%) of students who participated in the study were between 23-27 years, followed by those between 18-22 years; (34%). The rest of the respondents were below eighteen years, and others above twenty seven years.

Age of Respondents

7% 14%

<18 18-22 34% 23-27 >27 45%

Figure 1: Age of respondents.

4.1.2 Gender. More males (67%) than females (33%) participated in the study.

Gender of respondents

Female 33%

Male 67%

Figure 2: Gender of respondent.

4.1.3 Religion.

Majority (83%) of the respondents were Christians. This encompassed Anglicans, Catholics seventh day Adventists, Pentecostals etc. The remaining 17% were of Muslim faith.

17%

Christian Moslem 83%

Figure 3: Religion of respondents.

4.1.4 Nationality. One hundred sixty seven respondents; 64% were Ugandans, fifty six Nigerian, nineteen Kenyan and Tanzanians were eight. The others were Rwandese, Sudanese, Cameroonians, etc who were ten (10).

Nationality No. of respondents Ugandan 167 Nigerian 56 Kenyan 19 Tanzanian 8 Others 10

Table 1: Number of respondents by nationality

180 160 140 120 100 80 60 40 20 0 Ugandan Nigerian Kenyan Tanzanian Others

Figure 4: Nationality of respondents.

4.2 RESPONSE TO TAKING ALCOHOL

The majority of respondents 136; (52%) consumed alcohol, and the rest; 124 (48%) did not.

No 48% Yes 52%

Figure 5: Percentage of respondents who take alcohol

4.2.1 Reason(s) for not taking alcohol For those who responded to not consuming alcohol, most respondents; thirty seven (37) said it was because of their religious faith; being born again, this was followed by those who don’t consume it out of health reasons (34). The least of these respondents; ten (10) did not respond.

No response

Health reasons

I am Muslim

I am saved

I just don’t like alcohol

0 5 10 15 20 25 30 35 40

Figure 6: Reasons for not taking alcohol.

4.2.2 Type of alcohol consumed

Of the one hundred thirty six respondents who said they consumed alcohol, the majority; thirty one consumed beer only as their alcohol preference, followed by twenty two who chose wine.

The rest preferred more than just one alcoholic drink; for example twenty two preferred taking beer, spirits and gins as well as wines.

Sixteen respondents did not choose any alcohol type.

Type of alcohol preferred No. of respondents Beer only 31 Wines only 22 Beer+Spirits&Gins+Wines 22 Anything alcoholic 19 Beer+Spirits&Gins+Wines+ others (Malwa) 13 Spirits & Gins 6 Sherries 3 Spirits & Gins+ Wines 2 Others 2

Table 2: Type(s) of alcohol consumed.

4.2.3 Reason(s) for consuming alcohol

Fifty (50) respondents said they consumed alcohol because “everyone” does it. Forty eight said they did it to relieve stress, thirty said they found it cheap and readily available, whereas eight said they just felt like doing it.

I just feel like doing it

It is cheap and available

To relieve stress

Everyone does it

0 10 20 30 40 50

Figure 7: Reasons for consuming alcohol.

4.2.4 Drinking patterns Most of the respondents (37%) answered to consuming alcohol on a weekly basis. The least (29%) took alcohol on a monthly basis.

Frequency of Consuming Alcohol

Daily 29% 34% Weekly Monthly 37%

Figure 8: Drinking patterns.

4.3.0 EFFECTS OF ALCOHOL

4.3.1 Effect(s) of alcohol on respondents Eighty seven (87) respondents answered to having ever been absent from school because they consumed alcohol, thirty seven (37) responded to having ever been drunk while at school, thirty one (31) experience poor performance at school, and other had ever experienced an accident from drinking alcohol. The rest had ever been arrested, driven under the influence and had had family problems.

90 80 70 60 50 40 30 20 10 0

Figure 9: Effect(s) of alcohol on the respondents

4.3.2 Awareness of the effects alcohol has on health. The greatest percentage of respondents; 78.46% were aware of the effects alcohol has on health. 11.92% were unaware, and 9.62% didn’t respond.

80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Yes No No response

Figure 10: Percentage on awareness of the effects of alcohol on health.

4.3.3 Effects of Alcohol Majority of the respondents; one hundred forty nine (149) listed liver disease (a long term effect) as the commonest effect of alcohol consumption. This was followed by psychological/mental problems, the least mentioned effect was acute intoxication (a short term effect).

The majority of respondents 136; (52%) consumed alcohol, and the rest; 124 (48%) did not

Acute intoxication 18

Brain damage 19

Loss of jobs 25

Violence 25

Psychological/mental problems 80

liver disease 149

0 50 100 150 200

Figure 11: Effects of alcohol on health known by the respondents.

CHAPTER FIVE

DISCUSSION, CONCLUSIONS AND RECOMMEDATIONS

5.1 DISCUSSION The study was set to assess the reason(s) for alcohol consumption and its effects among students of KIU-WC. The majority of respondents (45.38%) were between the ages; twenty three to twenty seven years. Others were between eighteen to twenty two years (33.46%), above twenty seven years (13.85%). The least number of respondents was those below eighteen years (7.30%).

More than half (66.54%) of the respondents were male. There were more respondents of Christian faith (83.46%) than Islam (16.54%).

The respondents were of different nationality, with Ugandans being the majority (64.54%), followed by Nigerians (21.54%). The least number of respondents were Tanzanian (8). Other nationalities were Kenyans, Rwandese, Burundian, and Cameroonian.

More than half; one hundred thirty six (52.30%); the sample size of the population admitted to consuming alcohol.

The remaining one hundred twenty four (47.69%) said they did not consume alcohol. Of these, thirty seven attributed their not taking alcohol to their Christian faith; that is being born again. Other reasons given for not taking alcohol were; health (34), naturally don’t like it (24) and Islamic faith (19). Ten respondents didn’t give any reason. The world’s religions have differing relationships with alcohol. Many religions forbid alcoholic consumption or see it sinful or negative. Today, some Christians believe one ought to abstain from alcohol. Islam considers consumption of khamar(fermented drinks, wine) sinful under the Islamic dietary laws.

With a wide range of alcoholic beverages on the market today, it is quite rare to find individuals who solely consume one type of alcoholic beverage. This study, however, identified 31, 6, 22 and 3 individuals who consumed beer, spirits & gins, wines and Sherries solely respectively. The rest of the participants were found to consume a variety; for example twenty two consumed beer, spirits & gins as well as wine as reflected in table 2. Other alcoholic drinks of consumption were basically local brew like malwa and kwete.

Alcohol has been a part of communal life for millennia, and has an important place in social, spiritual, and emotional experience. There are a multitude of reasons as to why people drink. In this study, most of the respondents (50) said they drink because everyone does it. This could be linked to the fact that they drink in order to “fit in”. Forty eight (48) said they did it in order to relieve stress. In a study carried out in UK, in 2011, alcohol was named the top stress reliever; 61% of adults said drinking was their top choice after a stressful day. Donna Dawson, a psychologist said, “when it comes to drinking alcohol, the way the human brain works means we are naturally disposed to find a reason to indulge, particularly if we’ve had a tough day. An example of this is having a drink after work as a way to unwind from stress- in this scenario, the brain has decided that stress is ‘bad’ for us, and that alcohol, because is apparently relieves stress ‘is good’. So, at the end of the day, we may know that the second or third glass of alcohol is not really needed or desired, but the brain has already rationalized that if one glass felt good, then more will feel even better.” Thirty (30) respondents said they drink because alcohol is cheap and available, and eight (8) said they just felt like it.

Drinking patterns reflect how people drink instead of how much they drink. This study revealed 36.67% of the respondents who consume alcohol did it on a weekly basis, 33.83% on a daily basis, and 29.41% on a monthly basis.

Respondents turned out to have experienced more than one effect according to the questionnaire. The majority; eighty seven turned out to having been absent from school,

31 either because they were in bars, or even their rooms consuming alcohol, or they were recovering from the after effects (hangover) of alcohol consumption. Thirty seven (37) said they had ever been drunk while at school, thirty one (31) said they had ever had poor performance at school. This encompassed performance in academics, concentration in class, etc. Other effects included sustaining an injury, driving under the influence, having been arrested, as well as family problems.

For most people, drinking responsibly can be part of a balanced and healthy lifestyle. It is no secret that alcohol can cause major health problems. In adverts of alcoholic beverages, the closing remark is usually, “excessive alcohol consumption can be harmful to your health.” Worldwide, a vast number of individuals are aware of the health hazards of alcohol. The study showed that 78.46% of the respondents were aware of the effects alcohol has on health. 11.92% were unaware. 9.62% did not respond. According to the study, the commonest effect of alcohol on health mentioned was liver disease. This is in line with what is known worldwide; liver cirrhosis being the commonest known long term effect of alcohol consumption. This was followed by psychological/mental problem(s), which was listed by eighty (80) of the correspondents. Other effects mentioned were violence (25), loss of employment (25) brain damage (19), and acute intoxication (18).

5.2 CHALLENGES. During the time of the study, students of the university were on a semester break. Therefore the initial sample size (three hundred forty six) could not be reached. Hence the sample size used for the study was two hundred sixty from those who were still present and willing to participate.

5.3 CONCLUSIONS. Although classified as a depressant, the amount of alcohol consumed determines the type of effect. Most people drink for the stimulant effect, such a beer or glass of wine taken to “loosen up.“Reasons as to why people consume alcohol vary among individuals. A

32 number of factors; including environment, genetics, etc. come into play and influence an individual’s drinking habits. This study demonstrated the following reasons as to why students of KIU-WC consume alcohol; Everyone around me does it (36.76%), to relieve stress (35.29%), it is cheap and available (22.06%), lastly just feel like doing it (5.88%)

For those who said they didn’t take alcohol, the greatest reason was related to their religious affiliation; they were either “born again” Christians, or Muslims.

A greater percentage of the respondents (78.46%) were aware of the health effects alcohol has on health. More than half 73.04% of the respondents listed liver disease as an effect of alcohol consumption. This is a long term effect. The question is; “are people out there aware that the effects of alcohol consumption can be short or long term?”

5.4 RECOMMENDATIONS National level; Uganda, as a nation has no strict and enforceable law that governs the distribution and consumption of alcohol. Alcohol is affordable and can be accessed by anyone. The young are being initiated into consuming alcohol by either their parents, peers, or by the easy availability of alcoholic beverages. Adolescents are inquisitive and they would do just about anything to “taste the waters.” Just like as been done in the neighboring country; Kenya, there is, thus a need for the responsible bodies to formulate a law that governs the distribution and consumption of alcohol in the country.

There is still need for education of the population regarding the effects of alcohol. This study was done among students of the medical university, and despite their literacy, 11.92% of the respondents was not aware of the effects alcohol has on health. One, thus would wonder what figure would be attained if a nationwide research was to be conducted. There is, thus need for sensitization through health talks, media to see that people are well informed about the various effects of alcohol, be it on health or economy.

Among the respondents, a high proportion (33.83%) reported to consume alcohol on a daily basis. This number is too high, thus there is a need to start a campaign on moderate consumption of alcohol, both among students and among other members of the society at large.

REFERENCES A. Holderness& John Lambert (1977) .A New Certificate Chemistry, Fourth Edition Heinemann Educational Books Ltd.

Chronic Poverty Research Centre (2007) Drinking into Deeper Poverty A new Frontier for Chronic Poverty in Uganda

GENACIS study 2005 conducted by Tumwesigye and Kasirye, 26 Preliminary results from the Gender, Alcohol and Culture: An International Study (GENACIS Project).International Research Group on Gender and Alcohol

Gmel G, Jernigan J, Rehn N, Room R, Monteiro M, et al. (2007) The global distribution of average volume of alcohol consumption and patterns of drinking.

Homel, R., Österberg, E., Rehm, J., Room, R. &Rossow, I. (2013) Alcohol: No Ordinary Commodity—Research and Public

Idoreands.Obot and Robin eds. (2005) Alcohol and Gender and drinking problems: perspectives from low and middle Income Countries, GENACIS project, WHO. International Agency for Research on cancer (2012) Alcohol as a Factor.

J.Rehm, C.Mathers, S.Popova, M.Thavorncharoensap et al (2009) Global Burden of Disease and Injury and Economic Cost Attributable to Alcohol use and Alcohol-use Disorder The Lance Volume 373.

Mbulaiteye SM et al(2007). Alcohol and HIV: A Study among sexually active adults in rural Southwestern Uganda

Ovuga E and Madrama C (2006) Burden of alcohol use in the Uganda Police in Kampala District, African health Sciences Journal

Snyder L. (2006) Effects of Alcohol advertising exposure on drinking Among Youth.

WHO (2014) Global Status Report on Alcohol and Health

APPENDICES

Appendix I: Questionnaire REASONS FOR EXCESSIVE ALCOHOL USE AND ITS EFFECTS AMONG STUDENTS OF KIU-WC.

1. Demographic data; (Tick appropriately) a. Age (years)

Less than 18 18-22 23-27 >27 b. Gender

Female Male c. Religion

Christian Muslim Other (specify) d. Nationality

Kenyan Nigerian Tanzanian Ugandan Other (specify)

2. Reasons for alcohol consumption a. Do you take alcoholic drinks?

Yes No

If Yes, proceed to 2b, if NO, give reason(s) and proceed to 3b.

______

______b. Which drinks do you consume?

Beer Spirits and Gins Wines Sherries Others (specify)

c. Why do you consume alcohol?

Everyone around me does it

It is cheap and available

To relieve stress

Other reasons (specify) ______

______d. How often do you drink?

Daily Weekly Monthly

3. Effects of alcohol a. Have you ever....? (Check all that apply) Been absent from school because you used alcohol Been drunk at school Done poorly in school because you used alcohol Had family problems because you used alcohol Been arrested because you used alcohol Driven under the influence of alcohol

Had an injury because you used alcohol. b. Are you aware of the effects of alcohol on your health?

Yes No c. if Yes, what effects are you aware of?

……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………

….THANK YOU…

Appendix II:Morgan’s table

APPENDIX III: MAP OF ISHAKA MUNICIPALITY IN BUSHENYI DISTRICT

KEY:

: AREA OF STUDY (KIU-WC)

APPENDIX IV: MAP OF UGANDA SHOWING THE STUDY AREA

APPENDIX V: INTRODUCTORY LETTER