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Article Excerpt
The consumption of psychoactive substances takes place in a defined political, organizational or societal context. Changes in substance use coincide with rapid societal change and deteriorating economic conditions (Myeni 1985; Soueif et al. 1990; Acuda et al. 1991; Adelekan et al. 1992; United Nations Office for Drug Control and Crime Prevention 1999; International Narcotics Control Board 2003). Many studies show an increase in the use of licit as well as illicit psychoactive substances in countries that are undergoing rapid socio-economic change (World Health Organization 1996; Parry 1998; Nkowane and Jansen 1999; United Nations Office for Drug Control and Crime Prevention 1999; International Narcotics Control Board 2003). On the African continent, where many countries are experiencing these drastic changes, psychoactive substances previously reserved for specific groups, occasions and ways of usage are increasingly used outside these settings. The range of substances used is also widening; and the use of mixtures or multiple substances is becoming more apparent (Desjarlais et al. 1995; Yach 1996; Khan and Arnott 1996; United Nations International Drug Control Program 1997; Nkowane and Jansen 1999; United Nations Office for Drug Control and Crime Prevention 1999; Riley and Marshall 1999; Belew et al. 2000; Adelekan, 2000). Apart from the substances that have traditionally been used (i.e., alcohol, tobacco, cannabis, and indigenous plant-based substances such as khat) on the African continent, other substances such as cocaine, heroin, lysergic acid diethylamide, Ecstasy, pain relievers (such as pethidine), anabolic steroids and solvents have emerged within the non-medical consumer market. The use of licit substances (e.g., alcohol, tobacco) and to a lesser extent of illicit substances (e.g., cannabis), which was earlier largely an adult-male phenomenon, has spread to women and to young people, who constitute a substantial proportion of the populations of the countries on the African continent (United Nations Office for Drug Control and Crime Prevention 1999). Adverse consequences of substance use have also been documented in a number of African countries. These include an increase in substance-use-related hospital admissions as well as a rising demand for specialized substance-related treatment services (Acuda and Sebit 1997; Parry and Pluddemann 2002).
Concern about the rise in substance use on the African continent relates to indications that the overall level of substance use in a community tends to correlate with the overall level of various adverse conditions in that community such as homelessness, dysfunctional families, crime, and poor mental and physical health (World Health Organization 1993a; Affinnih 2000). A rise in the general level of substance use--e.g., among young people--can thus be expected to increase the strain on scarce health-care, safety, criminal-justice and social-welfare services on the African continent and to impede development efforts (Wilson and Ramphele 1989; Harrison and Luck 1996; United Nations International Drug Control Program 1997).
Against the backdrop of the rise in psychoactive substance use and in the adverse consequences of such use on the African continent, calls for strengthening preventive action have increased over the past decade (International Narcotics Control Board 2003). The 32nd Assembly of African Heads of State and Government in Yaunde in Cameroon, for example, adopted in 1996 the Declaration and Plan of Action on Drug Abuse and Illicit Trafficking Control in Africa. The heads of state and governments committed themselves to enhancing their countries' capacity for effectively countering the adverse consequences of psychoactive substance use. In May 2002 the 1996 declaration was revised to include a special call for integrating efforts at preventing the adverse consequences of substance use with efforts at poverty alleviation, for mainstreaming substance-related prevention and, integrating it within broader development initiatives such as the New Partnership for Africa's Development (NEPAD) declaration of October 2001 (International Narcotics Control Board 2003; African Union 2001).
In 1997 the United Nations International Drug Control Program (UNDCP) and the World Health Organization (WHO) jointly initiated a project--the Global Initiative--for primary prevention of substance use among young people in selected communities in eight countries in Southern Africa, Eastern and Central Europe, and Southeast Asia. The project aimed to mobilize communities through local partners to implement prevention activities. This paper reports the results of the pre-intervention or baseline assessments that were conducted in three participating countries in Southern Africa (United Republic of Tanzania, Republic of South Africa, and Republic of Zambia).
Background to project and primary prevention
Considering that the rise in substance use among young people in African countries is now a priority concern and tends to be entwined with broad socio-economic conditions, the Global Initiative concentrated on primary prevention of substance use. The prevention strategies of the WHO are deeply embedded in the public health approach. This encompasses primary, secondary and tertiary prevention, with the aim of helping individuals adopt healthy practices and life styles, make use of relevant information and skills in order to avoid the use of psychoactive substances, and prevent or minimize the associated health consequences of substance use (World Health Organization 1993a, 1993b). Effective primary prevention activities ought to be comprehensive and include public health regulations and policies, educational programs especially for children and adolescents, media campaigns, community approaches that mobilize people for preventive actions, and other contextually relevant approaches (World Health Organization 1993a). It has also repeatedly been shown that primary prevention of substance use is better executed with full involvement and participation of the local communities (World Health Organization 1992, 1993a, 2002). However, in many developing countries prevention services are limited (World Health Organization 2002). The major constraints are lack of trained personnel, lack of information on proven strategies for prevention, and lack of successful programs that can be replicated. Most evidence on primary prevention and the cost effectiveness of such approaches comes from developed countries (World Health Organization 2002). These proven interventions thus tend to remain underused and undervalued, as often they are considered culturally inappropriate. The Global Initiative is an important step toward documenting and identifying effective primary preventive activities in selected countries. The project seeks to derive empirically substantiated model approaches and strategies in developing countries on prevention practices in which local communities fully participate.
The overall design of the Global Initiative comprises five sets of interrelated activities: (1) baseline assessment; (2) training of non-governmental organizations (NGOs); (3) public health interventions; (4) monitoring of activities, including documentation of experiences of the NGOs; and (5) post intervention assessment. Local NGOs are involved in these activities with a view to motivating them to mobilize their communities to respond to substance use among young people to empower them and to enhance the probability of sustainability beyond the project life. The evaluation of the activities will lead to the identification and documentation of best practices that can be adopted by other communities who wish to address the problem of substance use among youth.
Study sites
The study was carried out in three countries: South Africa, Tanzania and Zambia. Site selection was based on the presence of demarcated geographical boundaries, substance use problems, and viable community structures for carrying out primary prevention activities. Where feasible, the site selection included both rural and urban communities. Local research institutions in the three countries conducted the...
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