Characterisation of harmful use of alcohol in a rural setting: A Pilot study around Lake Bunyonyi in Kigezi Sub-region, Uganda

Introduction: Currently, Uganda has the highest per capita alcohol consumption in Africa, and the negative effects of alcohol abuse are quite prevalent. Some rural areas face a complex set of underlying factors that may be responsible for this trend, including unemployment and easy access to cheap alcohol. Kigezi Subregion is one of the areas most affected by the harmful use of alcohol. We aimed to estimate the prevalence of alcohol use disorder and identify factors associated with it. Methods A two-stage stratified sample survey was carried out and yielded 339 participants from 34 villages. It had standard questions on alcohol use and included the WHO’s AUDIT score. Harmful use of alcohol was measured in two ways, one as a proportion that fell into 8–40 AUDIT score (medium-very high risk range alcohol use- MHA) and another as proxy measure of alcohol use disorder (AUD) using the proportion of participants that, over the 12 months preceding the interview, at least once a month had been unable to stop drinking alcohol once they had started drinking, and/or failed to do what was normally expected of them because of drinking alcohol, and/or needed an alcoholic drink first in the morning to get going after a heavy drinking session. The inclusion criteria for participants were adults (aged 18+) and consenting to the study, while the exclusion criterion was withdrawal of consent during the interview process. The factors associated with harmful use disorder were determined using multilevel mixed effects generalised linear models that account for the clustering at the village level. Results The prevalence of AUD was 17.7% and of MHA was 28%. The prevalence of MHA was significantly lower among women (APR = 0.47, 0.28–0.76) and higher among those whose relatives or friends condoned alcohol consumption (APR = 1.77, 95% CI: 1.12–2.81), and it increased with improved income level (p < 0.001). Other factors included being more educated, a reduced frequency of engagement with religious activities, and earning a living through skilled trades. Key reasons for stopping alcohol include religious commitment, family background, and observed negative experiences. Most drinkers drink at the weekend, while a substantial number drink on any day of the week. Although a few people started drinking before 8 am, most started around 3 pm. Conclusion AUD and MHA prevalences are higher than those found in WHO’s recent nationwide study. The factors associated with harmful use of alcohol include family and friends’ influence, higher income level, and reduced religiosity. More research is needed to develop a suitable intervention to address this problem.