I just attended the World Psychiatric Association (WPA) Regional Congress in Kampala (WPA 14), Uganda, this past week (Feb.6-8). The theme of the meeting was “Global Mental Health: Innovation and Opportunities for sub- Saharan Africa”. It was an excellent meeting with participants from Australia, Asia, Europe, North America, and of course Africa. I came away with a very important question that I’ve pondered since the conference ended and that is:

Who drives the alcohol prevention research agenda in sub-Saharan Africa?  

This WPA regional meeting was very well planned, there were over 120 exciting and informative plenary talks, scientific presentations and posters on a range of psychiatric issues.  It was truly a meeting of the minds of those who will drive future mental health research and prevention priorities for the sub-Saharan region. And, it is clearly indisputable that there is an enormous and unmet need for mental health research, prevention and treatment in this region. So, this conference was critically important for so many reasons.  Central discussions focused on building mental health capacity, increasing the mental health work force, defining mental health competencies, reducing stigma for mental health disorders, providing accurate diagnoses and many other important aspects of the many needs, particularly in sub-Saharan Africa.

As a psychiatric epidemiologist, I have been trained to study mental disorders in populations and to examine patterns and distributions of illness and to identify those factors that may increase or reduce risk for illness. I have chosen to focus most of my own research on alcohol use among youth and young adults and the factors that increase risk for alcohol use as well as the outcomes of heavy alcohol use, specifically injuries and violence. It is such a fascinating and troubling topic. Unfortunately, alcohol remains an enormous burden to most societies because of the many harmful consequences associated with its use.

So, I was a bit surprised at this WPA regional meeting of psychiatrists, that I did not really hear any discussion of alcohol or other drug use.  In fact, I was so fascinated by the absence of a discussion of alcohol and other drug use that I had to look through the entire conference program to count how many of the 120 plenary talks, scientific presentations and posters used a word like “alcohol”, “drug” or “substance use” in their titles. I found only 2.

Of course, there could have been presentations that discussed issues of alcohol or other drug use as part of their research projects or programs, but did not add that to the title of their presentations. But, even so, this absence of alcohol and other substance use research in a meeting of psychiatrists speaks volumes about the scarcity of alcohol and other drug use research underway in sub-Saharan Africa. In fact, I find this alarming.

Uganda, as an example, is often described as a country with one of the highest levels of alcohol per capita consumption in the world, as estimated by the World Health Organization. There are also other countries in the region with very high levels of alcohol use and alcohol-related problems.  So, I ask myself, who is driving the agenda for alcohol prevention and research? If it isn’t the leading psychiatrists in the region who are trained to diagnose and treat alcoholism, then who is making this growing burden a priority for both research and prevention?

Perhaps the real question should be, where are the researchers and are they paying attention?  

I’m aware of several important alcohol policy initiatives underway in the region and am thankful and optimistic that the many NGOs and alliances that are forming or growing, to tackle this issue will have a substantial impact. Many of these initiatives are focusing on the World Health Organization’s “Global Strategy to Reduce the Harmful Use of Alcohol” which is a true call for action in a global context. But, to drive true change and to have the impact that is needed, we will also need a strategic research agenda for alcohol use prevention research specifically for sub-Saharan Africa that is innovative, bold and that will create the scientific discovery needed to better understand how to best tackle the alcohol problem with scarce resources. This is particularly urgent given the growing investments in alcohol marketing and sales by the alcohol industry in the region. We need to know the big “fives” of epidemiology:  why, where, whom, when and how?  In other terms, research needs to examine how many people are affected by alcohol, directly and indirectly, why people are using alcohol, where do they consume it, who is at greatest risk, and how can we best prevent the problems? We cannot assume that strategies and findings from different countries and contexts will work in sub-Saharan Africa.

At the WPA meeting, Poster 6 (PO6) was intriguingly titled “What would it take to prepare for, intervene, and/or prevent the looming epidemic of alcohol and substance use disorders for sub-Saharan Africa?” (By authors Ssempijja & Makumbi). That question remains to be answered. I find this a critically important and escalating public health concern and urge us to work together to make a difference and to make a plan to address this “looming epidemic”.

For further reading:

WHO Global Mental Health Action Plan 2013 – 2020

 

Speak Your Mind

  • Kristina

    This is great and very important blog Monica! Thank u! This phenomena seems to be present/absent everywhere we look which is quite paradoxal. Alcohol is everywhere – on all the levels of a society which means that it has a very broad spectre of consequences on people’s lives in all the possible matters. Yet it is one of the most disregarded topics. And that is why I like your second question: where are the researchers and are they paying attention? I would like to have at least a hint. We know well why women’s movement did not want to take up alcohol as a problem although it is an obvious obstacle on the way to women’s equality and empowerment. Alcohols role would distract the attention from the role men had in creating unequal relations and in gender based violence. The attitude is changing in this area. But what’s with the researches? What is hindering them from speaking out loud about something that is so obvious?

  • Vendula

    Dear Monica, thank you for your post. I am from the Czech Rep., but currently doing an internship in Kampala, in a local organization called Somero Uganda which is situated in Kawempe division and focuses on work with young women. I am currently a student at 1st faculty of medicine in Prague, where I am studying a masters program in Addiction treatment. If you would be willing, I would love to get in contact with you. I was thinking of proposing a research in the slum area here and working a plan of alcohol and drug abuse in school where Somero organization works. Of course I would love this program to be a continuous work which could carry on after I leave Kampala. If you would be willing, I would like to learn from you and hear some advice. Please contact me at Vendulabrtnikova@gmail.com Thank you

  • Vendula

    Dear Monica,
    I am really impressed by your work in Kampala. I am originally from the Czech Rep., but I am currently doing an internship in Kampala in a local organization called Somero Uganda which focuses on work with young women. I am a student of 1st Faculty of Medicine in Prague, where I am studying a master’s program in Addiction treatment. I was thinking of proposing a research in the slum area here on alcohol and drug consumption and developing a preventive program for schools which Somero organization is in cooperation with. I would like it to be a long-term program, which could continue with this staff after I leave Uganda. If you were willing, I would love to get in contact with you and if you do not mind get some advice and recommendation. Please if you do not mind, contact me at Vendulabrtnikova@gmail.com

    • Dear Vendula,
      thanks for your comments here and for following Monica’s blog.
      We have informed Monica about your comments and she’ll surely soon get back to you.

      Best wishes,
      the IOGT website administrator