A Meta-Analytic Review of Gender Disparity in the Magnitude of Substance Use among Young People in Ethiopia

  • Getachew Mullu Kassa College of Sciences, Debre Markos University, Debre Markos, .
  • Amanuel Alemu Abajobir 1College of Sciences, Debre Markos University, Debre Markos, . 2School of Public , The University of Queensland, Herston, Australia.



Background: Substance use is associated with higher odds of disabilities, mental illness, and loss of productivity, especially in young people. Despite a widespread use of substances by Ethiopian youths, little is known about national estimates to target interventions. This meta-analysis was therefore conducted to estimate the prevalence of substance use and determine the gender differences in substance use among young people in Ethiopia.

Methods: Relevant search engines were used to search published articles in PUBMED, MEDLINE, Cochrane review, CINAHL, and AJOL databases. The meta-analysis was conducted using STATA 14 software. Prevalence and odds ratios (ORs) with 95% confidence intervals (CIs) were used to determine gender differences in substance use. I2 statistics were used to test heterogeneity of the included studies. Egger’s test was used to assess publication bias.

Results: A total of 37 articles, 38,528 participants, were included in this review. The overall pooled lifetime and current prevalence of any substance use in Ethiopian youth was 33.84% (95%CI = 27.77, 39.91) and 25.2% (95%CI = 20.32, 30.07), respectively. Higher rates of lifetime alcohol consumption (33.95%), khat chewing (24.82%), and cigarette smoking (18.53%) were reported. The odds of substance use was threefold (lifetime OR = 3.2 and current OR = 2.8) in youth males when compared to females.

Conclusions: Nearly one-third of young people in Ethiopia use different substances in their lifetime. Young males are substantially at higher risk of substance use problems than females. Designing school- and community-based interventions appear to improve young people’s awareness towards multifaceted impacts of substance use.



Vos T, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 2017;390(10100):1211-59.

Kassa A, Taddesse F, Yilma A. Prevalence and factors determining psychoactive substance (PAS) use among Hawassa University (HU) undergraduate students, Hawassa . BMC public . 2014;14(1):1044.

Gebrehanna E, Berhane Y, Worku A. Khat chewing among n University Students-a growing concern. BMC public . 2014;14(1):1198.

Birhanu AM, Bisetegn TA, Woldeyohannes SM. High prevalence of substance use and associated factors among high school adolescents in Woreta Town, Northwest : multi-domain factor analysis. BMC public . 2014;14(1):1186.

Reda AA, Moges A, Biadgilign S, Wondmagegn BY. Prevalence and determinants of khat (Catha edulis) chewing among high school students in eastern : a cross-sectional study. PLoS one. 2012;7(3):e33946.

Deressa W, Azazh A. Substance use and its predictors among undergraduate medical students of Addis Ababa University in . BMC public . 2011;11(1):660.

Eticha T, Kidane F. The prevalence of and factors associated with current smoking among College of Sciences students, Mekelle University in northern . PloS one. 2014;9(10):e111033.

Dida N, Kassa Y, Sirak T, Zerga E, Dessalegn T. Substance use and associated factors among preparatory school students in Bale Zone, Oromia Regional State, Southeast . Harm reduction journal. 2014;11(1):21.

Wondemagegn AT, Cheme MC, Kibret KT. Perceived psychological, economic, and social impact of khat chewing among adolescents and adults in Nekemte Town, East Welega Zone, West . BioMed research international. 2017;2017.

Reda AA, Kotz D, Biadgilign S. Adult tobacco use practice and its correlates in eastern : A cross-sectional study. Harm reduction journal. 2013;10(1):28.

Lakew Y, Haile D. Tobacco use and associated factors among adults in : further analysis of the 2011 n

Demographic and Survey. BMC public . 2015;15(1):487.

Rudatsikira E, Abdo A, Muula AS. Prevalence and determinants of adolescent tobacco smoking in Addis Ababa, . BMC public . 2007;7(1):176.

Kebede D, Alem A. The epidemiology of alcohol dependence and problem drinking in Addis Ababa, . Acta Psychiatrica Scandinavica. 1999;100(S397):30-4.

UN. Sustainable Development Goals, 17 Goals to transform the world, Goal 3: Ensure y lives and promote well-being for all at all ages 2016 [Available from: http://www.un.org/sustainabledevelopment//.

Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS . 2009;6(7):e1000097.

Eshetu E, Gedif T. Prevalence of khat, cigarette and alcohol use among students of technology and pharmacy, Addis Ababa University. Ethiop Pharm J. 2006;24(2):116-24.

Meressa K, Mossie A, Gelaw Y. Effect of substance use on academic achievement of officer and medical students of Jimma University, southwest . n Journal of sciences. 2009;19(3).

Gebreslassie M, Feleke A, Melese T. Psychoactive substances use and associated factors among Axum University students, Axum Town, North . BMC public . 2013;13(1):693.

Derese A, Seme A, Misganaw C. Assessment of substance use and risky sexual behavior among Haramaya University Students, . Science Journal of Public . 2014;2(2):102-10.

Mohammed AY. Assessment of substance use and associated factor s among high school and preparatory school students of Ginnir Town, Bale Zone, Southeast . American Journal of Research. 2014;2(6):414-9.

Tesfaye G, Derese A, Hambisa MT. Substance use and associated factors among university students in : A cross-sectional study. Journal of addiction. 2014;2014.

Tsegay G, Esmael A. Psychoactive substances use (khat, alcohol and tobacco) and associated factors among Debre Markos University Students, North-West , 2013. J Def Manag. 2014;4(118).

Kumesa S, Mohammed M, Gebremariam E, Gelaw B, Seifu M. The Prevalence and Pattern of Social Drug Abuse Among Students of Rift Valley University College, Bishoftu Campus, 2014, Bishoftu, . J Pharma Care Sys. 2015;2(131):2376-0419.1000131.

Mossie TB, GebreMichael GB, Ayele AD. Magnitude of psychoactive substance abuse among university students, Adigrat, North : cross-sectional study. J Psych. 2015;18:281.

Hagos EG, Asfeha GG, Berihu BA. Prevalence of substance abuse among regular degree science students in Sheba University College in Mekelle Town, Tigray-. Journal of neurosciences in rural practice. 2016;7(2):200.

Kassa A, Wakgari N, Taddesse F. Determinants of alcohol use and khat chewing among Hawassa University students, : a cross sectional study. African sciences. 2016;16(3):822-30.

Adere A, Yimer NB, Kumsa H, Liben ML. Determinants of psychoactive substances use among Woldia University students in Northeastern . BMC research notes. 2017;10(1):441.

Kassaye M, Sherief HT, Fissehaye G, Teklu T. " Drug" use among high school students in Addis Ababa and Butajira. The n Journal of Development (EJHD). 2017;13(2).

Munn Z, Moola S, Lisy K, Riitano D. The Joanna Briggs Institute Reviewers’ Manual 2014. The Systematic Review of Prevalence and Incidence Data. Adelaide, SA: The Joanna Briggs Institute. 2014.

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ: British Medical Journal. 2003;327(7414):557.

Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088-101.

Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. Bmj. 1997;315(7109):629-34.

Astatkie A, Demissie M, Berhane Y, Worku A. Prevalence of and factors associated with regular khat chewing among university students in . Substance abuse and rehabilitation. 2015;6:41.

Abdeta T, Tolessa D, Adorjan K, Abera M. Prevalence, withdrawal symptoms and associated factors of khat chewing among students at Jimma University in . BMC psychiatry. 2017;17(1):142.

Wazema DH, Madhavi K. Prevalence of Khat abuse and associated factors among undergraduate students of Jimma University, . International Journal of Research in Medical Sciences. 2017;3(7):1751-7.

Kebede Y. Cigarette smoking and Khat chewing among college students in North West . n Journal of Development. 2002;16(1):9-17.

Baynesagne M, Ayele D, Weldegerima B. Prevalence, attitude and associated problems of khat use among Bahir Dar University students, Northwestern . Pharmacology online. 2009;1:157-65.

Lakew A, Tariku B, Deyessa N, Reta Y. Prevalence of Catha edulis (Khat) Chewing and Its Associated Factors among Ataye Secondary School Students in Northern Shoa, . Advances in Applied Sociology. 2014;4(10):225.

Dachew BA, Bifftu BB, Tiruneh BT. Khat use and its determinants among university students in northwest : a multivariable analysis. Int J Med Sci Public . 2015;4(3):319-23.

Teni F, Surur A, Hailemariam A, Aye A, Mitiku G, Gurmu A, et al. Prevalence, Reasons, and Perceived Effects of Khat Chewing Among Students of a College in Gondar Town, Northwestern : A Cross‑sectional Study. Annals of medical and sciences research. 2015;5(6):454-60.

Alem A, Kebede D, Kullgren G. The prevalence and socio‐demographic correlates of khat chewing in Butajira, . Acta Psychiatrica Scandinavica. 1999;100(S397):84-91.

Alem Atalay, Kebede D, Kullgren G. The epidemiology of problem drinking in Butajira, . Acta Psychiatrica Scandinavica. 1999;100(S397):77-83.

Kassa A, Deyno S. Prevalence and Determinants of Active and Passive Cigarette Smoking among undergraduate students at Hawassa University, Hawassa, . J Trop Dis. 2014;2.

Kassa A, Loha E, Esaiyas A. Prevalence of khat chewing and its effect on academic performance in Sidama zone, Southern . African Sciences. 2017;17(1):175-85.

Reda AA, Moges A, Wondmagegn BY, Biadgilign S. Alcohol drinking patterns among high school students in : a cross-sectional study. BMC public . 2012;12(1):213.

Reda AA, Moges A, Yazew B, Biadgilign S. Determinants of cigarette smoking among school adolescents in eastern : a cross-sectional study. Harm reduction journal. 2012;9(1):39.

Teshome D, Gedif T. Determinants of alcohol drinking and its association with sexual practices among high school students in Addis Ababa, : Cross sectional study. Open Journal of Preventive . 2013;3(06):420.

Dereje N, Abazinab S, Girma A. Prevalence and predictors of cigarette smoking among adolescents of : school based cross sectional survey. 2014.

Deas D, Brown ES. Adolescent substance abuse and psychiatric comorbidities. Journal of Clinical Psychiatry. 2006;67:18.

Caetano R, Nelson S, Cunradi C. Intimate partner violence, dependence symptoms and social consequences from drinking among white, black and Hispanic couples in the United States. The American journal on addictions. 2001;10 Suppl:60-9.

Grant BF, Stinson FS, Dawson DA, Chou SP, Dufour MC, Compton W, et al. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2004;61(8):807-16.

Gebiresilus AG, Gebresilus BG, Yizengaw SS, Sewasew DT, Mengesha TZ. Khat use prevalence, causes and its effect on mental , Bahir-Dar, north west . European Scientific Journal, ESJ. 2014;10(23).

Hasin DS, Stinson FS, Ogburn E, Grant BF. Prevalence, correlates, disability, and comorbidity of dsm-iv alcohol abuse and dependence in the united states: Results from the national epidemiologic survey on alcohol and related conditions. Archives of General Psychiatry. 2007;64(7):830-42.

Harwood HJ, Fountain D, Livermore G. The economic costs of alcohol and drug abuse in the United States, 1992: US Department of and Human Services, National Institutes of , National Institute on Drug Abuse, Office of Science Policy and Communications; 1998.

Atwoli L, Mungla PA, Ndung'u MN, Kinoti KC, Ogot EM. Prevalence of substance use among college students in Eldoret, western Kenya. BMC Psychiatry. 2011;11(1):34.

Madu SN, Matla M-QP. Illicit drug use, cigarette smoking and alcohol drinking behaviour among a sample of high school adolescents in the Pietersburg area of the Northern Province, South Africa. Journal of Adolescence. 2003;26(1):121-36.

Grant BF, Dawson DA. Age at onset of alcohol use and its association with DSM-IV alcohol abuse and dependence: results from the national longitudinal alcohol epidemiologic survey. Journal of Substance Abuse. 1997;9(Supplement C):103-10.

Central Statistical Agency (CSA) [] and ICF. 2016. Demographic and Survey 2016. Addis Ababa, , and Rockville, Maryland, USA: CSA and ICF.

The Recovery Village. A study of drug addiction between the genders United States of America: The Recovery Village; 2017 [Available from: https://www.therecoveryvillage.com/drug-addiction/study-between-genders/.

Brady KT, Randall CL. GENDER DIFFERENCES IN SUBSTANCE USE DISORDERS. Psychiatric Clinics of North America. 1999;22(2):241-52.

Tobler NS, Roona MR, Ochshorn P, Marshall DG, Streke AV,

Stackpole KM. School-based adolescent drug prevention programs: 1998 meta-analysis. Journal of primary Prevention. 2000;20(4):275-336.

Bangert-Drowns RL. The effects of school-based substance abuse education—a meta-analysis. Journal of drug education. 1988;18(3):243-64.

Weinberg NZ, Rahdert E, Colliver JD, Glantz MD. Adolescent Substance Abuse: A Review of the Past 10 Years. Journal of the American Academy of Child & Adolescent Psychiatry. 1998;37(3):252-61.

WHO. Substance abuse World Organization 2017 [Available from: http://www.who.int/topics/substance_abuse/en/.