Knowledge, attitude and practice on substance use among high school students in Nairobi, Kenya
The main objective of this study was to determine the knowledge, attitude and practice of substance use among high school students. This study focused on alcohol, tobacco, miraa and bhang. The study was carried out in Nairobi Province in both public and private schools, which were either boarding or day schools. This was a cross- sectional study with focus group discussions and in-depth interviews. Multistage sampling was done and 481 students filled a standardised self-administered questionnaire. Most of the students had fair knowledge about the drug effects. This knowledge ranged from 72.4% for alcohol to 62.4% for tobacco. Ninety-nine percent of the respondents felt that drug use was a serious problem among high school students. There was a strong disapproval among the students towards the use of the various drugs in the following percentages 47%,54%,45% and 64% for alcohol, tobacco, khat and bhang respectively. However the Form 2 and 4 students seemed liberal in attitude and behaviour towards the use of these drugs while the Form 1 pupils were more emphatic to reject use and the Form 3 students seemed to be inbetween the two extremes. Use of miraa was significantly more likely to be approved by the day scholars than the boarders (p = 0.008). Attitude was significantly related to past year use of alcohol (p = 0.0017) or miraa (p = 0.0026), so that poor attitude was a predictor to the use of alcohol or miraa. The level of knowledge on the effects of the drugs on use was not related to the use of any of the drugs (p > 0.05). There was no significant relationship between being a day scholar or boarder and the use of the various drugs. Lifetime prevalence drug use ranged from 57.5% for alcohol to 12.9% for bhang for the males, while the females had a range of 44.9% for alcohol to 6.6% for bhang. Past year use prevalence had a similar trend but with lower percentages. Being in the informal clubs or activities was significantly related to lifetime use of alcohol (p=0.002) and miraa (p=O.03). Similarly the past year use of alcohol had a significant relationship with the I informal clubs (p=0.04). Poly-drug use was common among the tobacco smokers and there was significant relationship between tobacco smoking and the use of alcohol (p=O.002),miraa (p=0.00 1) or bhang (p < 0.05). Initiation into the use of these drugs was found to be mainly by friends from their peer groups. Other initiators included family members like parents or older siblings, drug pushers/dealers. Many miscellaneous reasons for non-use or stopping to use drugs were mentioned, these included' smoking gives you a bad breath', ' chewing miraa is disgusting', ' bhang made me feel bad'. These could be used as a basis for developing Health Education for this population. Lack of confidentiality in the counselling departments of schools, poor example from teachers/parents, poor communication with parents and lack of access to psychologists or psychiatrists are some of the reasons given by the students for not fully accepting the intervention. strategies that should help them out of drug problems. The focus group discussions suggested ways of improving prevention of drug use, this included rehabilitation of drug victims, increased awareness of the problem in schools starting from upper primary and encouragement of peer counselling among students. It can be recommended from the study that Health Education information should contain all aspects about drugs so as to give comprehensive knowledge, attitude and skills for effective change. Health Education messages on drug use should be developed with the purpose of gathering the attention of target groups which include the upper primary and high school classes, the informal clubs/activities, tobacco users and community groups. Peer counselling should be instituted in all schools and all intervention areas should have a conducive environment that encourages students to seek help and support from their strategies.