Alcohol consumption remains a long standing public health issue in Uganda. It can be harmful to vulnerable person with Diabetes, by interfering with self-care behaviors and affecting important organs in the body. Therefore, this study fill a knowledge gap on detecting factors associated with alcohol consumptions among persons with Diabetes in Kampala, to improve comprehensive diabetes care by providing possible strategies and interventions and inform management policies.
Alcohol consumption is a public health issue in Uganda. This study revealed that the prevalence of alcohol consumption among persons with Diabetes in the two selected health facilities (MNRH and St Francis Hospital) in Kampala was 23.45%. This high prevalence of alcohol consumption can be explained by the important significance of alcohol in people’s lives. Alcohol use in Uganda is widely accepted in local culture and tradition. Also, Uganda is abundantly supplied with alcoholic beverages (beer, wine, liquor produced in factories in the country or imported and informally produced beer and distilled liquor in local makeshift bars and homes), such as Heineken, Tusker, Guinness, Bell, Nile Special and Club. The findings were similar to a countrywide estimate of the prevalence of alcohol use in Uganda that showed an overall prevalence of current alcohol use of 26.8% (12). But the prevalence of alcohol consumption in this study was much lower than a study conducted among individuals with type 2 diabetes from 20 different countries in the world, where up to 30% patients were found to drink alcohol (19), and another study conducted in Northern California among adults with diabetes with the prevalence of 50% (6). That prevalence was much higher than the one conducted among Croatian, with 5.8% (21). This must be due to difference in sociodemographic and cultural characteristics among the different study populations.
In this study, majority of person with Diabetes, consumed alcohol hazardously (11.7%), followed by those who misused it (9.6%) and those who drink it occasionally (3.9%); the binge drinking was reported among 2.7% of participants. It is important to note that among participants who consume alcohol hazardously and who reported the binge drinking, the main reason of their drinking was the stress. A part from life events that are inherently stressful, diabetic patients have also to overcome the stress of their disease. In the present era of modernization, balancing work, family, leisure time and a chronic disease which is diabetes with all it requirement is a big challenge for patients, it may increase their stress level. Studies revealed that alcohol drinking is strongly associated with stress. It is mostly used as means of coping with life’s stresses (22, 23). Chronic stress can therefore interfere with a diabetic patient’s capacity to adhere to self-care behaviors which are essential to maintain good health (24). Our findings emphasize the importance of regular screening for stress as a routine diabetes care that will help to identify earlier the patients with stress and the earlier management of stress among persons with diabetes improve Glycemia control as well as quality of life and prognosis.
Majority of persons with Diabetes who take alcohol, consume beer, followed by those who consume spirit and wine. That is different from studies done in USA and Croatian where the majority of patients takes wine followed by those who takes beer and spirits (6, 21), and studies in Uganda among HIV patients (14). Uganda is abundantly supplied with alcoholic beverages that are mostly beers such as Tusker, Guinness, Bell, Nile, eagle and Club. Those beverages are cheaper, they are always available in retail and local shops, and they can also be taken in public places and even at home. Guidelines regulating alcohol production and commercial sale, time and places restriction for selling alcohol density of outlets and advertisements practices must be followed up.
Religion was significantly associated to alcohol consumption. Catholics were more likely to consume alcohol, compared to patients in others religions (Pentecostal, Protestant/Anglican and Muslims). Catholic religion, does not prohibit alcohol consumption contrary to other religions. Alcoholic beverage is considered as incompatible with a holy life that is why abstaining from alcohol is an obligation of all their adherents. This result is similar to other study done in Uganda (14, 16) and other countries (6, 25, 26) where Catholics followers were more likely to consume alcohol compare to others. According to WHO, religion might play a role in prevention of alcohol consumption (27). Thereby, religion can be used strategically to reduce alcohol related problems among persons with Diabetes. By providing health education to the followers, the information can be disseminate through populations.
The duration of the diseases was significantly associated with alcohol consumption. Diabetic patients who spent with diabetes more than five years were more likely to consume alcohol compare to those who had spent less than five years. This was consistent with other studies done in Asia and Africa where patients with DM duration of ≤ 5 years were more adherent to diet especially regarding alcohol intake, than those who had a duration of > 5 years (28–31).
According to Glasgow et al the duration of disease appears to have a negative relationship with diet adherence (32, 33). In 2010 Egede and Ellis showed that despondency can also be a factor influencing poor dietary practice regarding alcohol consumption among diabetic patients (34).
In most of health facilities in Uganda, patients presenting with diabetes are initially encourage to maintain diet which include to avoid alcohol consumption, in order to prevent complications. Over time, health education can be neglected due to lack of motivation, lack of time, absence of family and health care support, also patients might be fed up with following a dietary regimen. In that sense, health professionals need to double their attention to newly as well as to former diabetic patients, in other to provide them solid support in term of health education. They need to deeply discuss with diabetic patients about the importance of self-care behaviors that include to avoid alcohol consumption, because the reason for throwing away or dropping such behavior after five years of the disease duration could be the inadequate diabetic education or consultation and decrease of motivation over time.
This study shows that never married diabetic patients consume more alcohol compare to widow patients. This is similar with a study done in USA in 2016 in general population where never married people were more likely to consume alcohol compare to married and widow people (35).The finding is also similar with a study done among women in Accra (Ghana) (36). Widows have more responsibilities compare to never married people, especially when it comes to take care of children. So instead of purchasing alcohol, they tends to involve the major part of their resources in their children ‘needs. At the same time they have to spend less time with friends and coworkers and more time with kids that may encourage their less drinking.
Study limitations and strengths
Recall bias could have occurred as some data, especially from the questionnaire, were self-reported by the person with diabetes. The other limitation in this study is a social desirability bias that could have occurred since in the study, most of information was reported by participants. Persons with Diabetes who also drink alcohol may not disclose fully to the interviewers the extent of their drinking.
The strengths of this study include the use of the AUDIT questionnaire, a standardized internationally-validated tool for alcohol assessment in primary care settings, allowing for cross-study comparability. Furthermore, previous studies were focused on the general population or on some specific groups as HIV and psychiatric patients. This study examined alcohol consumption among persons with diabetes in Kampala, where there is continuous increase in diabetes incidence.