Substance use disorders among men in urban and rural communities in South Africa: Culture
Lead Research Organisation:
London School of Hygiene & Tropical Medicine
Abstract
Men of lower socio-economic status in South Africa are more affected by substance use disorders (SUDs), and generally their use of treatment services is very low. Reasons for this are poorly understood but may be due to cultural factors. This study will describe what SUD treatment exists, evaluating barriers which prevent men using treatment services in 2 urban (Khayelitsha, Soshanguve) and 2 rural sites (King Dalindyebo, Madibeng) in South Africa. Specific objectives are to determine the: (1) how SUD treatment services are provided; (2) how demographic, cultural, economic, psychosocial factors and rural-urban migration influence men to seek treatment services; and (3) the burden and severity of SUDs, related common mental health disorders and associated factors.
We will conduct a detailed review of all treatment services in 3 study sites (in Khayelitsha an audit is already completed) providing services to men. One respondent (manager) will be interviewed in each service to collect information required. The influence of culture on how men with SUD seek treatment services will be explored in 32 in-depth interviews (8 per site) and 8 discussion groups (2 per site), and among SUDs treatment service providers in 24 in-depth interviews (6 per site). To determine the burden and severity of SUDs and associated health problems and risk factors, a household survey will be done in Year 2 in the Western Cape, Eastern Cape and North West provinces using random sampling of groups of households, targeting adult men 8 years and above (each N=547). We will also conduct a community survey in Soshanguve using a special sampling method (Respondent Driven Sampling) in Year 3 to estimate prevalence of nyaope use. Recruitment will involve a number of steps until the recommended sample size of 350 users is reached. Study findings will be presented to community stakeholders and key decision makers to propose interventions to improve treatment access.
We will conduct a detailed review of all treatment services in 3 study sites (in Khayelitsha an audit is already completed) providing services to men. One respondent (manager) will be interviewed in each service to collect information required. The influence of culture on how men with SUD seek treatment services will be explored in 32 in-depth interviews (8 per site) and 8 discussion groups (2 per site), and among SUDs treatment service providers in 24 in-depth interviews (6 per site). To determine the burden and severity of SUDs and associated health problems and risk factors, a household survey will be done in Year 2 in the Western Cape, Eastern Cape and North West provinces using random sampling of groups of households, targeting adult men 8 years and above (each N=547). We will also conduct a community survey in Soshanguve using a special sampling method (Respondent Driven Sampling) in Year 3 to estimate prevalence of nyaope use. Recruitment will involve a number of steps until the recommended sample size of 350 users is reached. Study findings will be presented to community stakeholders and key decision makers to propose interventions to improve treatment access.
Technical Summary
Substance use disorders (SUDs) disproportionately affect men of lower socio-economic status in South Africa, and treatment uptake is low. Reasons for this are poorly understood. This study examines the nature of SUD treatment provision, and obstacles to treatment-seeking among men in 2 urban (Khayelitsha, Soshanguve) and 2 rural sites (King Dalindyebo, Madibeng) in South Africa. Specific objectives are to determine the: (1) availability and nature of SUD treatment provision; (2) role of demographic, cultural, economic, psychosocial factors and rural-urban migration in treatment-seeking; and (3) prevalence and severity of SUDs, common comorbid psychiatric disorders and associated factors.
We will conduct an audit of all treatment services catering for men with SUDs in three study sites (in Khayelitsha an audit is already completed). In each service one respondent (manager) will be interviewed about the services provided. The role of culture in men's treatment-seeking will be explored via 32 in-depth interviews (8 per site) and 8 focus groups (2 per site) among men with SUDs, and IDIs with 24 SUDs treatment providers. Thematic analysis will identify cultural and other factors affecting treatment seeking dynamics. The prevalence and severity of SUDs and associated comorbidity and risk factors will be assessed via a household survey in Year 2 (in the Western Cape, Eastern Cape and North West provinces) using cluster random sampling, targeting 547 adult men18 years and above. We will also conduct a community survey in Soshanguve using Respondent Driven Sampling in Year 3 to estimate prevalence of nyaope use. Recruitment will involve multiple waves until the recommended sample of 350 users is reached. Findings will be presented to community stakeholders and key decision makers to propose interventions to improve treatment access, informed by all key cultural, economic and psychosocial factors.
We will conduct an audit of all treatment services catering for men with SUDs in three study sites (in Khayelitsha an audit is already completed). In each service one respondent (manager) will be interviewed about the services provided. The role of culture in men's treatment-seeking will be explored via 32 in-depth interviews (8 per site) and 8 focus groups (2 per site) among men with SUDs, and IDIs with 24 SUDs treatment providers. Thematic analysis will identify cultural and other factors affecting treatment seeking dynamics. The prevalence and severity of SUDs and associated comorbidity and risk factors will be assessed via a household survey in Year 2 (in the Western Cape, Eastern Cape and North West provinces) using cluster random sampling, targeting 547 adult men18 years and above. We will also conduct a community survey in Soshanguve using Respondent Driven Sampling in Year 3 to estimate prevalence of nyaope use. Recruitment will involve multiple waves until the recommended sample of 350 users is reached. Findings will be presented to community stakeholders and key decision makers to propose interventions to improve treatment access, informed by all key cultural, economic and psychosocial factors.
Planned Impact
This project's focus on cultural factors as an obstacle to access to treatment services for men with substance use disorders (SUDs) will generate new understandings of relevance to the design of services. We will translate these findings through (a) involving key stakeholders as advisors from the outset of the project, which will enable ongoing dialogue; (b) hosting annual public engagements about the findings of the project targeting policy-makers, communities and the research community; (c) targeted engagements with policy-makers in the parliamentary portfolio committee on health; and (d) producing materials that translate the findings into understandable messages directed to communities, civil society and policy makers.
Through dissemination and engagement, we anticipate stronger civil society action and attention to the need for better treatment, and greater responsiveness from policy makers when presented with evidence. The forthcoming National Health Insurance (NHI) Bill in South Africa will provide additional opportunities to ensure that appropriate services are provided within the packages of care in the NHI through the process of public submissions on the Bill.
Lastly, research capacity will be built through research training opportunities on the project for a range of postgraduate students, supervised by experts from participating institutions. The project seminars will share research expertise amongst institutions which will, along with the findings of the project, be incorporated into training programmes in public health across the country, thereby building the capacity of human resources to address the problems of SUDs in South Africa.
Through dissemination and engagement, we anticipate stronger civil society action and attention to the need for better treatment, and greater responsiveness from policy makers when presented with evidence. The forthcoming National Health Insurance (NHI) Bill in South Africa will provide additional opportunities to ensure that appropriate services are provided within the packages of care in the NHI through the process of public submissions on the Bill.
Lastly, research capacity will be built through research training opportunities on the project for a range of postgraduate students, supervised by experts from participating institutions. The project seminars will share research expertise amongst institutions which will, along with the findings of the project, be incorporated into training programmes in public health across the country, thereby building the capacity of human resources to address the problems of SUDs in South Africa.
Organisations
- London School of Hygiene & Tropical Medicine (Lead Research Organisation)
- Muhimbili University of Health and Allied Sciences (Collaboration)
- St. Augustine University of Tanzania (Collaboration)
- National Institute for Medical Research, Tanzania (Collaboration)
- St Francis Hospital, Tanzania (Collaboration)
- UNIVERSITY OF JOHANNESBURG (Collaboration)
People |
ORCID iD |
Publications
Selestine V
(2023)
The Role of Structural Factors in Support-Seeking Among Women Experiencing Intimate Partner Violence (IPV) in Mwanza, Tanzania: Findings From a Qualitative Study.
in Violence against women
Pham K
(2023)
Effects of helminths and anthelmintic treatment on cardiometabolic diseases and risk factors: A systematic review.
in PLoS neglected tropical diseases
Okello E
(2023)
Acceptability and applicability of biometric iris scanning for the identification and follow up of highly mobile research participants living in fishing communities along the shores of Lake Victoria in Kenya, Tanzania, and Uganda.
in International journal of medical informatics
Mzombwe M
(2019)
The ethical imperative to treat NCDs during research in Africa.
in The Lancet. Global health
Mosha N
(2022)
Intergenerational education and violence effects on adolescent education, early employment and adolescent parenting.
in Psychology, health & medicine
Meyer SR
(2023)
Disability and intimate partner violence: A cross-sectional study from Mwanza, Tanzania.
in Disability and health journal
McCulloch F
(2023)
Factors associated with attendance to a participatory gender training programme - A secondary analysis of data from the MAISHA study.
in Evaluation and program planning
Description | This study showed that alcohol use disorders and use of other substances was common among men in 3 provinces in South Africa. We also found many men did not seek treatment services although they knew the services were available in their communities. This suggests that treatment seeking is an issue which needs to be addressed. |
Exploitation Route | We are planning engagement meetings with policy makers and also create policy briefs which will be available to those interested to take this forward |
Sectors | Communities and Social Services/Policy Healthcare |
Description | Meeting |
Geographic Reach | Local/Municipal/Regional |
Policy Influence Type | Participation in a guidance/advisory committee |
Title | Computer server |
Description | We have purchased new computer server for storage of data collected in studies. |
Type Of Material | Improvements to research infrastructure |
Year Produced | 2018 |
Provided To Others? | No |
Impact | We have now additional computer space to store data collected in our studies. |
Title | Data collection using digital application |
Description | We have developed a computer app for use in data collection with adolescents and young people |
Type Of Material | Improvements to research infrastructure |
Year Produced | 2024 |
Provided To Others? | Yes |
Impact | This tool allows study participants to enter data on their own without a research staff present. This enhances confidentiality and we hope will improve the quality of data collected. |
Title | Data served access |
Description | We have developed capacity to transfer data remotely from a site to our servers. |
Type Of Material | Improvements to research infrastructure |
Year Produced | 2022 |
Provided To Others? | No |
Impact | This has allowed our staff working in remote areas to transmit data directly to our facilities in Mwanza |
Title | Improvement of online data storage facilities |
Description | We have purchased a new computer server allowing for more space to store data from various studies. |
Type Of Material | Improvements to research infrastructure |
Year Produced | 2020 |
Provided To Others? | Yes |
Impact | This have allowed studies to store data on secure data. Also allows staff to work from home and access files on the server. |
Title | Introduced use of OpenClinica for data management |
Description | This is an open source and GCP-compliant data management system which was introduced in all our studies in 2010 |
Type Of Material | Improvements to research infrastructure |
Year Produced | 2014 |
Provided To Others? | Yes |
Impact | This system have helped to standardise data management systems across our studies |
Title | Laboratory facility improvements |
Description | We have expanded our laboratory facilities by developing a new laboratory sample archive unit, biosafety level 3 laboratory, and development of capacity for isolation and preservation of peripheral blood mononuclear cells, and HIV viral genotyping |
Type Of Material | Improvements to research infrastructure |
Provided To Others? | No |
Impact | Improved laboratory infrastructure have allowed to expansion of the range of research studies conducted at our centre |
Title | New lab techniques introduced for studying vaginal microbiome |
Description | New lab techniques have been developed to study vaginal flora and how this influences the risk of HIV |
Type Of Material | Improvements to research infrastructure |
Provided To Others? | No |
Impact | This have helped us to work in this new area of work to identify the role of vaginal microbiome in HIV transmission. |
Title | Use of GPS for sampling study communities |
Description | We have used GPS to sample areas within the communities in a population survey. |
Type Of Material | Improvements to research infrastructure |
Provided To Others? | No |
Impact | This allowed us to draw random sample of households in a large community-based survey where listing of households was not available. |
Title | Use of android tablets for data collection |
Description | We have purchased android tablets which will be used in collecting data in a large clinical trial we are conducting in Tanzania |
Type Of Material | Improvements to research infrastructure |
Provided To Others? | No |
Impact | We expect this system will allow us to collect more accurate data and contribute in more timely data analysis |
Title | Use of electronic devices in collecting data |
Description | We programmed PDAs to collect data in our large population survey |
Type Of Material | Improvements to research infrastructure |
Provided To Others? | No |
Impact | This helped our team to collect more accurate data and minimise time required to clean the data after the survey |
Description | Muhimbili University College of Health and Allied Sciences |
Organisation | Muhimbili University of Health and Allied Sciences |
Country | Tanzania, United Republic of |
Sector | Academic/University |
PI Contribution | We have collaborated with this institution in organising a conference for non-communicable diseases in Tanzania |
Collaborator Contribution | This institution hosted this conference and helped MITU to participate in developing the scientific agenda |
Impact | The conference was highly successful |
Start Year | 2021 |
Description | St Augustine University |
Organisation | St. Augustine University of Tanzania |
Country | Tanzania, United Republic of |
Sector | Academic/University |
PI Contribution | We have provided training and ongoing support of junior staff members of this institution. |
Collaborator Contribution | University of Dodoma has visited our institution and contributed in providing clinical support for our research team |
Impact | Exchange visits and working together on training programme |
Start Year | 2019 |
Description | Tanzania Alcohol Prevention Association |
Organisation | National Institute for Medical Research, Tanzania |
Department | Mwanza Research Centre (MRC) |
Country | Tanzania, United Republic of |
Sector | Academic/University |
PI Contribution | We have worked with this organization to reach policy makers in Tanzania |
Collaborator Contribution | This collaborator have helped to arrange meetings with key policy makers in Tanzania |
Impact | We have held 3 meetings with high level government officials |
Start Year | 2022 |
Description | Tanzania Diabetes Association |
Organisation | St Francis Hospital, Tanzania |
Country | Tanzania, United Republic of |
Sector | Hospitals |
PI Contribution | I contributed in a proposal to seek for funding to explore NCDs in cities |
Collaborator Contribution | They provided training of our staff in MITU |
Impact | Not yet |
Start Year | 2022 |
Description | University of Johannesburg |
Organisation | University of Johannesburg |
Country | South Africa |
Sector | Academic/University |
PI Contribution | We are working with University of Johannesburg in a new MRC funded project |
Collaborator Contribution | We have a subcontract for this grant coming through this institution |
Impact | None at this time |
Start Year | 2019 |
Description | Conference |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Professional Practitioners |
Results and Impact | This was a poster presentation at a conference in South Africa |
Year(s) Of Engagement Activity | 2019 |
Description | Dissemination of EDCTP Women's Health Project results to participants |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Type Of Presentation | Paper Presentation |
Geographic Reach | Regional |
Primary Audience | Participants in your research and patient groups |
Results and Impact | We conducted 3 workshops (each attended by about 38 people) to provide results of this study to study participants and also health workers at 3 field sites in northern Tanzania. These workshops helped participants to know the key findings from this research and raise awareness about factors associated with HIV in this part of Tanzania |
Year(s) Of Engagement Activity | 2010 |
Description | Dissemination workshop (MDP 301 Trial) |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Type Of Presentation | Workshop Facilitator |
Geographic Reach | Regional |
Primary Audience | Health professionals |
Results and Impact | We had 45 people attending and who were very engaged during the workshop No notable impact |
Year(s) Of Engagement Activity | 2010 |
Description | Interview for national news |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Public/other audiences |
Results and Impact | Interview after the workshop |
Year(s) Of Engagement Activity | 2019 |
Description | Meeting |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Policymakers/politicians |
Results and Impact | This meeting was to review preliminary results of our study |
Year(s) Of Engagement Activity | 2023 |
Description | Meeting in Dar es Salaam, Tanzania |
Form Of Engagement Activity | Scientific meeting (conference/symposium etc.) |
Part Of Official Scheme? | No |
Type Of Presentation | Paper Presentation |
Geographic Reach | National |
Primary Audience | Policymakers/politicians |
Results and Impact | This meeting was organised to present results of a formative research on heterosexual anal sex. Was attended by 55 policy makers and scientists This meeting generated interest in this topic and future studies are being planned |
Year(s) Of Engagement Activity | 2013 |
Description | Meeting with Tanzania Ministry of Health officials |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Type Of Presentation | Workshop Facilitator |
Geographic Reach | National |
Primary Audience | Policymakers/politicians |
Results and Impact | This meeting was attended by 40 policy makers. Preliminary results of MRC-funded chronic diseases project were presented and discussed. This meeting helped to highlight the importance of chronic diseases in Tanzania |
Year(s) Of Engagement Activity | 2013 |
Description | Meeting with key stakeholders |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Other audiences |
Results and Impact | This meeting was designed to provide information about research studiues implemented by my group in Tanzania |
Year(s) Of Engagement Activity | 2018 |
Description | Meeting with policy makers |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Policymakers/politicians |
Results and Impact | This meeting was held at the Ministry of Health in Dar es Salaam to discuss findings of our health systems project and plan intervention phase. The presentation involved lively discussions and helpful input was obtained. After this meeting we were invited to be part of the chronic diseases working group in Tanzania. |
Year(s) Of Engagement Activity | 2014 |
Description | Open day and exhibition |
Form Of Engagement Activity | Participation in an open day or visit at my research institution |
Part Of Official Scheme? | No |
Type Of Presentation | Paper Presentation |
Geographic Reach | Local |
Primary Audience | Public/other audiences |
Results and Impact | About 150 people attended the open day and were engaged None |
Year(s) Of Engagement Activity | 2012 |
Description | Scientific conference |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | This was a scientific conference on HIV-related research. We presented findings from our research to about 80 people in attendance |
Year(s) Of Engagement Activity | 2021 |
Description | Visited Harvard School of Public Health |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Type Of Presentation | Paper Presentation |
Geographic Reach | International |
Primary Audience | Other academic audiences (collaborators, peers etc.) |
Results and Impact | This presentation was attended by 35 academic colleagues at Harvard I presented research studies implemented by Mwanza Intervention Trials Unit and opportunities for possible collaboration in the future was discussed. |
Year(s) Of Engagement Activity | 2013 |
Description | Website posting |
Form Of Engagement Activity | Engagement focused website, blog or social media channel |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Public/other audiences |
Results and Impact | This was an article describing our work in Mwanza, Tanzania. |
Year(s) Of Engagement Activity | 2019 |
Description | Workshop |
Form Of Engagement Activity | A formal working group, expert panel or dialogue |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | Meeting to review Tanzania alcohol and drug policy and implications for public health |
Year(s) Of Engagement Activity | 2023 |
Description | Workshop |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Policymakers/politicians |
Results and Impact | This workshop was aimed to disseminate results of our study aimed to improve health system respond to non-communicable diseases in public institutions in Tanzania. |
Year(s) Of Engagement Activity | 2017 |
Description | Workshop |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | 45 people attended information meeting |
Year(s) Of Engagement Activity | 2022 |
Description | Workshop |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Professional Practitioners |
Results and Impact | This workshop reviewed policies related to alcohol use in Tanzania |
Year(s) Of Engagement Activity | 2018 |
Description | Workshop |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | 45 people attended information meeting |
Year(s) Of Engagement Activity | 2022 |
Description | Workshop with community members |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | Regional |
Primary Audience | Public/other audiences |
Results and Impact | This meeting aimed to update members of the community about the research we are conducting |
Year(s) Of Engagement Activity | 2020 |