Prevalence of Alcohol use Disorder among Prisoners in Ambo Town, West Shewa Zone, Oromia Regional State, Ethiopia, 2019

Background: Alcohol is a psycho active, toxic and potentially addictive substance. It is a causal factor in over 60 diseases and injuries and accounted for 6.4% of all deaths in the world and the prevalence of alcohol use disorder in the prisoner population to be higher than in the general population. Objective: To determine the prevalence of alcohol use disorder among prisoners at Ambo town, west shoa zone, Oromia regional state, Central Ethiopia, 2019 Method: An institutional based cross-sectional study was conducted in Ambo town by using systematic random sampling method, from sample of 345 prisoners by using self-reporting questionnaire (SRQ) interview by using AUDIT questionnaire. Simple random sampling was use to select number of prisoners. Data was checked for completeness and any incomplete information were excluded from the entry.The study was conducted after a letter of permission from Ambo university send to Ambo town general prison. Conclusion: The high prevalence of AUDs detected in our facility-based survey of Ambo town prisoners implies the need to design effective screening tools and feasible interventions for AUDs.This study found a high prevalence of alcohol use disorder among prisoners in a correctional institution in Ambo town, central Ethiopia, in the 12 months before imprisonment. The most commonly used was alcohol, followed by khat, nicotine, and shishas. Generally, despite the increased morbidity of alcohol users and unpleasant psychosocial consequences of this habit, most prisoners reported not receiving treatment prior to imprisonment.


Background
Alcohol is a psychoactive, toxic and potentially addictive substance (Babor T et al 2010).The WHO estimates that around 2 billion people worldwide consume alcohol (WHO 2004) a. It is apparent though that drinking is influenced by factors such as genetics, social environment, culture, age, gender, accessibility, exposure and personality.The relationship between alcohol and crime is, therefore, not a simple causal one. For instance, with regard to violence, alcohol is recognized as both a causal (Boden J, Fergusson DM, Horwood LJ 2012) as well as a contributory factor (WHO 2005). Specific pharmacological effects can affect an individual's behavior and judgment (Ramstad M 1950(Ramstad M -2003. Not all alcohol consumption, however, leads to violence and not all violence is due to alcohol. There is a complex interplay between the quantity of alcohol consumed, drinking patterns, and individual and contextual factors. Links between alcohol and violence appear to be stronger in countries where drinking is characterized by acute intoxication, such as in northern European countries (WHO 2005).Alcohol has been found to be a factor in half of all violent crimes A national study of prisoners and parolees in 1996 found that just under half had taken alcohol or other drugs just prior to the crime for which they were incarcerated (Rocha-Silva &Stahmer, 1996).Drinking was especially linked to rape and housebreaking offences. Regarding violent offences, arrestees indicated that they were under the influence of alcohol for 25% of weapons related offences, 22% of rapes, 17% of murders, 14% of assault cases and 10% of robberies. Levels of alcohol-related crime were particularly high for family violence offences at 49%, of arrestees also indicated that they were often under the influence of alcohol in cases involving property offences, for example, 22% of cases involving housebreaking and 12% of cases involving the theft of a motor vehicle. When asked why they consumed alcohol or other drugs in relation to crimes, many arrestees indicated they consumed these substances in order to give them courage to commit the crimes (Parry et al., 2004). Alcohol and illicit drug use account for 5.4% of the world's annual disease burden, with tobacco responsible for 3.7% (WHO 2010).It is a causal factor in over 60 diseases and injuries and accounted for 6.4% of all deaths in the European region in 2004 (Rhem J et al 2009). The prevalence of alcohol problems in prisoners is high, although the evidence base to date is limited, an international systematic review found that 18-30% of men and 10-24% of women prisoners had alcohol problems, but the studies were noted to be heterogeneous (Fazel S, Bains P, Doll H 2006). In the United Kingdom (Scotland) in 2011, 50% of prisoners reported that they were drunk at the time of their offences, an increase of 10% over the previous 5 years (Carnie J, Broderick R. Scottish Prisoner Survey 2011 Next to caffeine, alcohol is the second most commonly used psychoactive substance globally. However, as alcohol has an initial high concentration of acetaldehyde in the brain, symptoms of intoxication and deterioration of behavior was mostly ensue immediately in the drinker (Alcohol and mental health 2007; Sadock&Sadock 2007:394). When alcohol is continually used not only do physiological changes occur in the brain and nervous system, but psychologically the person can have an increased tendency towards addiction. Harmful drinking is a major determinant for neuropsychiatric disorders such as alcohol use disorders, epilepsy and other non-communicable diseases, for example, cardiovascular diseases, cirrhosis of the liver as well as some types of cancers (Alcohol 2013; WHO 2011:22).
Worldwide, A systematic international review found that 18-30% of men and 10-24% of women had alcohol problems defined as "alcohol abuse/dependence" (Fazel S, Bains P, Doll H 2006),In most European countries, the drinking of alcohol is common in the adult population, with 80-95% drinking at least occasionally (. Fazel S, Bains P, Doll H 2006). In the United Kingdom (Scotland) in 2011, 50% of prisoners reported that they were drunk at the time of their offences, an increase of 10% over the previous 5 years ( Rutherford M, Duggan S 2009). Nearly half (48%) said they would accept help for their alcohol problems if it was offered in the prison. Further Scottish research found that 73% of prisoners had an alcohol-use disorder, with 36% possibly being alcohol-dependent (Parkes T et al 2011).
The prevalence of alcohol problems is markedly higher in the Scottish prison population compared to the general population, at all ages and for both women and men, as shown in comparative analysis conducted as a separate part of this study [Parkes T, MacAskill S et al 2011].
In a survey of prisoners in Australia , hazardous and harmful drinking levels were reported to be 57% and 18%, respectively, among male prisoners compared to 49% and 13%, respectively, among females according to AUDIT scores (Jones GY. Hoffmann NG 2006)). In another study of a relatively small sample (n = 47), it was found that up to 60% of French male prisoners were positive for alcohol problems (scoring 8+ on AUDIT), with a higher prevalence when screening was conducted two weeks into their sentences rather than at the start (Parkes T et al 2011).
There is no study conducted in Ethiopia among prisoners, this study will be used as a baseline information for those who wants to do their research on this related topic, may aid to develop strategies for improvement of interventions on alcohol use in prisoners and this study was an input for investigation and identification of alcohol use health problems who living in the correctional areas or prison.

Method
An institutional based cross-sectional study design was used.

Study setting
Ambo general prison is located in Ambo town which is the capital town of West Shoa Zone of Oromia Region, Ethiopia; which is located approximately 114 km far from Finfinne to the Western direction. West Shoa is bordered on the south by South-West Shoa Zone and Jima Zone, on the North by the Amhara region and on the East by Finfinne special Zone and on West by HoroGuduruWollega Zone and East Wollega Zone. Ambo Prisons was established since 1940 Ec. The total prisoned during interview we did1856 (males=1802 and females=56)

Sample size determination
The formula that we have used to calculate sample size in the study was Where d=margin of error n= sample size Z=calculated number from Z- The AUDIT first three questions (1-3) explore quantity and frequency of alcohol consumption (Hazardous Alcohol Use), the second three questions (4-6) explore signs of alcohol dependency and the last four questions (7-10) explore Alcohol-related problems (harmful alcohol use). Each question has a response category that ranges from 0 to 4, with the first response for each question scoring 0 (never), the second scoring 1 (less than monthly), the third scoring 2 (monthly), the fourth scoring 3 (weekly), and the last response scoring 4 (daily or almost daily). For questions 9 and 10, which only have three responses, the scoring is 0, 2 and 4 (from left to right). To determine how many standard drinks of alcohol the patients took, question number two is modified to "Type of alcohol" and "Its amount". The response was converted to standard drinks. In accordance with the recommended scoring, a total AUDIT score of eight or more was used to define probable "alcohol use disorder". A total AUDIT score of 1-7 indicated social drinking, a score of 8-15 indicated "hazardous drinking" a score of 16-19 indicated "harmful drinking" and a score of 20 or above indicated probable alcohol dependence. The total AUDIT score, alcohol consumption level, signs of dependence, and markers of present harm should all play a role in Ethical clearance was obtained from the Ethical Review Committee of Ambo University, College of medicine and health sciences. The study participants were free to enroll in the study and withdraw from it at any time. All the interviews with participants were made with strict privacy after getting informed consent from the participants and assuring confidentiality. Every information accessed in due course was confidentially kept. Patients with AUD were referred to psychologists in the prisoners' clinic.  Table: -Alcohol Use Disorders among ambo town prison west shewa zone Oromia region, Ethiopia.

Discussion
In our current study the overall prevalence of AUDs (13.4%), defined by an AUDIT score ≥ 8,was substantially higher than that found in community-based studies carried out in Addis Ababa and Butajira, Ethiopia 2.7% and 3.7%, respectively [