ABSTRACT
Inappropriate alcohol use among university students is a major global public health concern, due to its multiple and wide ranging direct or indirect effects on physical, psychosocial, and mental health. The study assessed the alcohol consumption pattern of undergraduate students in Michael Okpara University of Agriculture Umudike and Abia State University Umuahia campus. The study employed the use of a descriptive and cross-sectional design. A non probability (snow ball) sampling technique was used to select 300 students from Michael Okpara University of Agriculture Umudike and 131 students from Abia State University Umuahia campus. Data for the study was collected with the aid of a structured questionnaire which was validated by lecturers in the department of Human Nutrition and Dietetics while the respondents weight and height, waist circumference and hip circumference of the respondents was used to derive the BMI and Waist-Hip Ratio. The Alcohol Use Disorders Identification Test (AUDIT) was used to determine the prevalence of alcohol use and to identify persons with hazardous and harmful patterns of alcohol consumption. Frequencies and percentages were used to analyze the socio-economic characteristics of the students, while correlation was used to find the relationship between the alcohol consumption and anthropometric variables. The study found that more than half (57.8%) of the students were males, Most (52.0%) of the participants, earned less than N5000 monthly, more than half of the students (57.8%) lived off campus. A greater proportion (55.2%) of the population of fathers were civil servants, with Tertiary education level (45.2%). On alcohol consumption, more than half (69.1%) of the respondents consumed 5 bottles of alcohol 3-6 times per week. The result on alcohol consumption score audit showed that almost half (46.4%) of the respondents consumed 7-9 bottles of alcohol on a typical day, many (33.9%) consumed alcohol-based drinks monthly or less while majority (82.4%) had 6 or more alcoholic drinks at a sitting. Most of the respondents (52.4%) felt guilty after a drink monthly and (45.5%) did not get injured from alcohol consumption in the past year while (47.3%) of the respondents had concerns from individuals in the past year concerning their alcohol consumption. Lifestyle characteristics showed that majority (63.3%) spend hours per day on vigorous activities, less than half (28.3%) of the population engage in moderate physical activities weekly while more than half ( 55.9%) spends hours daily on moderate physical activities. On dietary habit, less than half (48.3%) of the population ate twice a day while about (62.6%) didn’t have time to eat enough food. About (36.2%) of the respondents skip meals with (45.7%) gave reasons for skipping as not being able to afford it and on religious beliefs. On anthropometry, a little above half (52.7%) of the population were within normal weight while 4.6% were obese. A greater proportion (61.3%) had normal waist-hip circumference while about (38.7%) were at risk. In conclusion the study reported a significant (p<0.05) negative relationship between religion and frequency of drinking alcohol (r = -0.146, p = 0.002), feeling of guilt after drinking (r = -0.258, p = 0.000), concerns about drinking from family and friends (r = -0.139, p =0.004) and injured because of alcohol (r = -0.158, p = 0.001), in conclusion, the result showed that most of the students were alcohol dependent meaning they need alcohol to have a good time and relax. Most of the students had good physical activity level as most walked to school. The study recommended that effective campus-based counselling, peer education, and national surveillance systems that can monitor risky drinking behaviours among youth should be developed and implemented.
TABLE
OF CONTENTS
Title Page
i
Certification
ii
Dedication
iii
Acknowledgement iv
Table of contents v
List of Tables viii
Abstract ix
CHAPTER 1
INTRODUCTION
1.1 Background of the study 1
1.2 Statement of problem 4
1.3
Objective of the study 8
1.3.1 The general objective of
the study 8
1.3.2 Specific objective of the study 8
1.4 Significance of the study 8
CHAPTER 2
LITERATURE REVIEW
2.1 Overview of alcohol in
Nigeria 10
2.2
Epidemiology of alcohol 12
2.3.
Alcohol Nigerian situation 14
2.4. The
Nigeria alcohol market 17
2.5.
Alcohol related harms 19
2.5.1.
Cancers 20
2.5.2.
Liver diseases 21
2.5.3.
Kidney diseases 22
2.5.4.
Cardiovascular disorders 22
2.5.5.
Respiratory diseases 23
2.5.6.
Mental health 23
2.5.7.
Suicide 24
2.5.8.
Violence 24
2.5.9.
Sexual health 25
2.5.10.
Academic performance 26
2.5.11.
Fertility and pregnancy 27
2.6.
Treatment for alcohol problems 28
2.7. Regulation of alcohol
availability and marketing 30
CHAPTER
3
MATERIALS
AND METHODS
3.1 Study design 34
3.2` Area of study 34
3.3 Population of the study 36
3.4. Sampling and sampling size 36
3.4.1 Sampling 36
3.4.2 Sampling size calculation 36
3.5 Sampling techniques 37
3.6
Preliminary activities 37
3.6.1 Preliminary visits 37
3.6.2 Training of research assistants 38
3.7. Informed consent and Ethical Approval 38
3.8. Data Collection 38
3.8.1 Questionnaire administration 38
3.8.2
Anthropometric measurements 39
3.8. Data analysis 40
3.8.1. Body Mass Index (BMI) 40
3.8.2. Waist circumference 41
3.8.3. Waist hip ration (WHR) 42
3.8.4. The Alcohol Use Disorders 43
3.9
Statistical analysis 43
CHAPTER 4
RESULTS AND DISCUSION
4.1 Socio-demographic characteristics
of the students 44
4.2 Alcohol consumption of
the students 48
4.3 Alcohol consumption
score (audit) of respondents 50
4.4 Lifestyle characteristics of respondents 53
4.4
Dietary habits of respondents 56
4.5
Anthropometric characteristics of respondents 59
4.6:
Relationship between socio-demographic characteristics and
alcohol consumption pattern 61
CHAPTER 5
CONCLUSION AND
RECOMMENDATIONS
5.1 Conclusion 63
5.2
Recommendations 63
REFERENCES
LIST OF TABLES
4.1a.
Socio-demographic characteristics of the participants 46
4.1b.
Socio-demographic characteristics of the participants 47
4.2. Alcohol consumption
of the students 49
4.3a. Alcohol consumption
score (AUDIT) of respondents 51
4.3a. Alcohol consumption
score (AUDIT) of respondents 52
4.4a Lifestyle
characteristics of respondents
54
4.4b Lifestyle
characteristics of respondents
55
4.4a. Dietary habits of
respondents 57
4.4b. Dietary habits of
respondents 58
4.5.
Anthropometric characteristics of respondents 60
4.6.
Relationship between lifestyle characteristics and alcohol consumption of
respondents 62
CHAPTER 1
INTRODUCTION
1.1. BACKGROUND OF THE STUDY
Since
the beginning of history, humans have searched for substances that would
sustain and protect them and also act on the nervous system to produce
pleasurable sensations. Alcohols are believed to provide pleasure because they
give inner peace and satisfaction, relax the muscles and heighten sensation
(Adekeye et al., 2015). Alcohol is
the most commonly used psychoactive substance in most parts of the world and
Its consumption has been considered normal, especially when drunk without
outright intoxication in Africa and other parts of the globe. Wine, beer,
spirit and other fermented alcoholic beverages were consumed in traditional
societies and some of these beverages are still used in this modern era for
different purposes (Emeka, 2013).
In Africa, these and other alcoholic beverages such as palm wine, burukutu,
etc. were consumed for pleasure soon after brewing or tapping (Odejide,
2006; Emeka, 2013) and were
rarely traded in the market (WHO, 2002). Though alcoholic beverages have been
consumed for hundreds of years, the pattern and purpose of consumption vary
considerably among societies and even within communities. Excess consumption
was not widely tolerated in many societies while few communities permitted it
(Willis, 2006).
Drinking
of alcohol was culturally tolerated as part of ceremonial lives of many ethnic
groups in Nigeria, especially in communities where it was not forbidden by
religion prior to the advent of colonialism (Obot, 2012). A unique feature of
this area that is now known as Nigeria was that different locally produced
alcoholic beverages distinguished ethnic groups. In the north, pito and burukutu
were commonly consumed. In the south, palm wine tapped from the palm tree
(Obot, 2012) was popular while the native gin locally called ogogoro,
kai-kai (Korieh, 2003), akpuru-achia, or Sapele water,
distilled from the fermented palm wine was widely consumed, especially in the
Niger-delta area.
In
recent decades, the pattern, quantity and reason for consumption are changing
rapidly, especially among youths (Chikere and Mayowa, 2011). This has resulted
in an increased burden of alcohol-related problems, estimated to exceed those
relating to tobacco consumption. Heavy alcohol consumption is associated with
many health and social problems.
In
sub-sahara African, alcohol is culturally tolerated during festivities and
ceremonies, especially in the absence of any religious restrictions (Obot, 2012).
Some reports, however, have shown increased and alarming daily consumption of
alcohol among adolescents and young adults, with Nigeria now ranked among the
leading countries with the highest per capital consumption of alcohol globally
(WHO, 2018). Consequently, there have been increases in several related social
and health issues including alcohol dependence, domestic violence, traffic
injuries, and several chronic diseases, suggesting a need to develop more
comprehensive population-wide preventive measures (Toroyan, 2009; Davies et al., 2018).
In Nigeria, there is a dearth of
empirical research on sales promotions, but available studies revealed that
alcohol marketing activities targeting young men and women (Obot, 2013),
especially undergraduate students (Umoh et
al., 2012; Dumbili, 2015; Dumdili, 2016a) are increasing in number.
In addition to being a part of the
emerging markets, one other reason for the rise in marketing activities is that
there is an increase in number of alcohol companies in Nigeria. For example, in
addition to the multinational alcohol corporations such as the ‘Nigerian
Breweries/Heineken’ and ‘Guinness Nigeria’ that were established in 1946 and
1962 respectively, other companies such as SABMiller and ‘‘Tradall SA’’ have
fairly recently established their businesses in the country (Dumbili, 2015b;
Obot, 2013).
Universities
in Nigeria are not like secondary school where the students will be monitor by
both the staffs of the school and their parents. It is a free environment where
students do all sort of things (drinking, partying, smoking, and some other
unhealthy lifestyle) without anybody checking their ways. In Nigeria universities, the lifestyle
behaviours of students are not only important for them, but also
relevant to policies concerning health. In addition, students are young, and
there is evidence
that risky lifestyle at an early age can reflect the health of the society they
are going to
live in the coming years (Steptoe et al., 2002; Garrusi et al., 2008)
and university years
may present a unique opportunity to develop healthy
lifestyle behaviours in a particular manner. Nigerian
University shows that the most currently used substances were mild stimulants
(33.3%), alcbhol (13.6%), sedatives (7.3%) and tobacco (3.2%) (Makanjuola et al., 2007). High rates of alcohol use
are also associated with risky sexual behaviour among university students. A
study conducted long ago by Obot and Ibanga (2002) reported that over 97,000
University students are victims of alcohol-related sexual assault or alcohol
abuse while several others reported being too intoxicated to know whether or
not they consented to having sex (Obot, 2000). The use and abuse of alcohol has
implications on the health status of students in schools, for instance, it is
the cause of many social and health problems, such as increase in crime rate
and high proportion of accidental injury.
This
work is therefore designed to evaluate the alcohol consumption pattern of
undergraduate students in selected tertiary institutions in Abia State Nigeria.
1.2. STATEMENT OF
PROBLEM
Alcohol
is the third leading preventable risk factor for the global burden of disease
and responsible for 3.3 million deaths (5.9% of all global deaths) (WHO, 2012).
In 2012, World Health Organization reported that 7.6 and 4% of deaths were
attributable to alcohol among males and females, respectively. Alcohol
contributes to over 200 diseases and injury-related health conditions, mostly
alcohol dependence, liver cirrhosis, cancers, and injuries (lim et al., 2012). Alcohol misuse is the
fifth leading risk factor of premature death globally; among people between the
ages of 15 and 49 years, it is the first leading cause (Lim et al., 2010; WHO, 2014).
Hence, inappropriate alcohol use among
university students is a major global public health concern, due to its
multiple and wide ranging direct or indirect effects on physical,
psychosocial, and mental health. In Nigeria, the prevalence of alcohol use
among students is high (43.5%) as reported by Anthony et al., (2019).
Evidence
have shown strong negative relationship between alcohol consumption, and the
deterioration of cognitive functions and worsening academic performance. For example,
excessive alcohol consumption is associated with disorders of memory,
attention, and planning (Crego et al., 2010;
Salas-Gomez et al., 2016; Carbia et al., 2017); daily drinking was
significantly negatively associated with academic performance (Mekonen et al., 2017); and problematic alcohol
use among university students was associated with poor academic performance
(Mekonen et al., 2017). The
relationship between heavy episodic drinking (HED) and academic engagement,
performance, and future aspirations among students suggests that students who
initiate binge drinking have poor school performance and engagement, which may
hinder achieving their future academic goals (Patte et al., 2017). Heavy episodic drinking (HED) students are more
likely to miss class, fall behind in their schoolwork, and perform poorly on a
test(s) or academic project(s) (Pikos and Kovacs, 2010). Likewise, heavy
drinking among youth is linked to lower school grades, truancy and degree
noncompletion (Donath et al., 2012;
Latvala et al., 2014; Kelly et al., 2015) High alcohol consumption
levels are associated with poor academic performance among young university
students (Kelly et al., 2015).
The
problems resulting from alcohol consumption in young people are different from
those in older adults. In young people, the negative effects derived from
alcohol consumption often involve changes in the relationship with family,
peers and teachers, poor school performance, aggression, crime, public disorder
and high-risk behaviors, such as driving after drinking, as well as unprotected
sexual activities, involving unintended pregnancy and sexually transmitted
diseases (Stueve
and O´Donnell, 2006).
In general, students who drink large amounts of alcohol have more risk
behaviors for themselves and for the others compared to students who do not
drink (Hingson
et al., 2006).
According to
National Institute on Alcohol Abuse and Alcoholism, (2013), chronic alcohol
abuse has been known to affect a person’s nutritional status and has been
reported to be linked with nutrient deficiencies and malnutrition. Alcohol
affects the nutritional process by interfering with digestion, absorption,
storage, utilization, and excretion of nutrients (National Institute on Alcohol
Abuse and Alcoholism, 2013). Alcohol depresses appetite and inhibits nutrients
from being utilized fully by the body after absorption hence affecting their
transportation, metabolism and storage (Prasad, 2014). Alcoholics usually
suffer from Protein Energy Malnutrition but the most common deficiencies are
for vitamins, particularly thiamine, pyridoxine, folate, and vitamin A, due to
dietary deficiency, damaged intestinal absorption, impaired nutrient
utilization and storage, increased metabolism, and a high rate of nutrient loss
(Kumar et al., 2011; Byung and Choi,
2005).
Some scholars
suggested that drinking small amounts of alcohol helps prevent conditions such
as diabetes, ischemic heart disease (IHD), dementia, and cognitive decline, but
none of the seminal review studies reported a “safest level” of alcohol
consumption (WHO, 2018). Another major concern about alcohol intake is that its
health implications that occur through the mechanisms of other diseases,
especially cancers, are likely to be underreported (Burton and Sheron, 2018).
Health related
prevalence caused by alcohol such as 13% of epilepsy cases, 48% of liver cirrhosis
cases, 26% of oral cancer cases, 20% of tuberculosis (TB) cases, 11% of colon
cancer cases, 5% of breast cancer cases, and 7% of hypertension (HTN) and heart
disease cases worldwide are very high and alarming (WHO 2018). Apart from high
prevalence of health related issues of alcohol, WHO, (2018), also reported that
alcohol is associated with 18% of suicides, 18% of interpersonal conflicts and
violence, 27% of road accidents.
The WHO (2018),
report notably reflected the use of the term “harmful use”. Even though experts
believe that no level of alcohol consumption improves health (WHO, 2018). In
general, even moderate alcohol consumption considerably increases the overall
risk of mortality, especially among young individuals (Whiten et al., 2002).
Despite the
increase in alcohol marketing activities by the transnational alcohol
corporations in Nigeria, the health and behavioral risks associated with
alcohol consumption, there was very few research on alcohol consumption pattern
of undergraduate students in southeastern part of Nigeria. The majority of data
from epidemiological surveys on alcohol consumption had been drawn from
households surveys (Lasebikan and Ola, 2016), street children (Morakinyo and
Odejide, 2003) prison population (Adesanya et
al,. 1997), commercial drivers (Lasebikan and Baiyewu, 2011) and the
elderly (Lasebikan and Gureje, 2015). There is a serious dearth of information
on prevalence of drinking in open-places, which constitute a special population
at risk of harmful and hazardous drinking, and from whom data obtained may
translate into effective policies on problem drinking for them.
Due
to these problems identified, it is worth carrying out the project to assess
the alcohol consumption pattern of undergraduate students and young adult in
general.
1.3 Objective of
the study
1.3.1 The general objective of the
study
The general objective of the study is to
assess alcohol consumption pattern of undergraduate alcoholics in Michael
Okpara University of Agriculture Umudike and Abia State University Umuahia
campus.
1.3.2
Specific objective of the study
The specific
objective of the study are to:
i.
assess the personal and socio-demographic
data of the respondents.
ii.
elicit information on the
lifestyle habits of the students using questionnaire
iii.
assess alcohol
consumption pattern of respondents
iv.
determine the
anthropometric status of the respondents
v.
assess the determinants
of alcohol use among the undergraduate students.
vi.
determine
the relationship between socio-economics data and alcohol use of the undergraduate students.
1.4
SIGNIFICANCE OF THE STUDY
This work will give an insight to the Alcohol
Consumption pattern of Undergraduate Students in Michael Okpara University of
Agriculture Umudike and Abia State University Umudike campus and will also help the respondents
understand effect of alcohol on their health.
This work will also provide a
fundamental data for nutritionist, public health workers, policy maker and
advocacies of alcohol use, food and nutrition. It will go a long way in helping
the stakeholders in nutrition and health to draw up appropriate intervention
programs for university student and other young adult.
Furthermore, findings from this
study could motivate nutrition professionals and scholars to carry out further
researches on the subject in the Nigerian context, as well as plan an
intervention to promote good alcohol use among the public
The result of this work will serve
as base line data for non-governmental organizations (NGOs) carry out
intervention programs in alcohol use among university students
The work will inform the public the alcohol related
lifestyle of respondents and how it affects their nutrition and health status.
This work will also provide a
fundamental data for nutritionist, public health workers, policy maker and
advocacies of food and nutrition. It will go a long way in helping the
stakeholders in nutrition to draw up appropriate intervention programs for Undergraduate
Students in Michael Okpara University of Agriculture Umudike and Abia State
University Umudike campus.
The
result of this work will also act as reference guide for students and
researchers
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