Adaptation and validation of the alcohol use disorders identification test

: prevalence of co-morbid alcohol use disorders and selected chronic non-communicable diseases in Malawi

Abstract

Introduction: Harmful use of alcohol is one of the world’s leading health risks and is attributable to many health conditions including non-communicable diseases (NCDs). The Alcohol Use Disorders Identification Test (AUDIT), has not been adopted for use in Malawi and its validity as a screening tool has not been determined. Therefore, this research aimed at exploring feasibility and validating the use, of the AUDIT, as well as investigating the prevalence of comorbidity between alcohol use disorders (AUDs) and hypertension or diabetes mellitus at health facility level, in Malawi.

Methods: We deployed mixed-model and mixed-method designs across three sequential study phases. Data for all studies were collected at intervals between January 2016 and March 2017. Thematic content analysis using NVivo v10 was conducted for the qualitative data while SPSS v24 was used for various quantitative data analyses. Sensitivity, specificity, predictive values and Area Under the Receiver Operating curve were calculated and an optimal cut-off score was reached for the adapted AUDIT.

Findings: Lack of standardised guidelines and job aids and gaps in knowledge are among key factors that contribute to erratic AUD identification and management in Malawi. Traditional alcoholic drinks vary in strengths. Mean percent alcohol by volume (%ABV) for traditional spirits is 34.44%; 2.39% for traditional beers and 3.58% for traditional wines. The adapted AUDIT had lower sensitivity than specificity at the generic cut-off score of ≥8 (Se 71% and Sp 92%). Its optimal cut-off score in the Malawian setting is ≥4 (AUROC of 0.85, Se 82% and Sp 73%) for detection of moderate to severe AUDs. Comorbidity of AUDs and hypertension is high within Malawian out-patient departments (prevalence rate 22%).

Conclusions: It is feasible to use a contextualised AUDIT within Malawian health care facilities. General health care facilities, especially OPDs, are well placed to capture people affected by AUDs or both AUDs and NCDs in Malawi. To improve AUD identification and management within the Malawian health system, we recommend: standardisation of AUD guidelines and job aids; incorporation of AUD management in various training curricular for health care providers; integration of AUD screening into various out-patient chronic care clinics; and harmonisation of implementation guidelines for NCD and Mental health policies to enable integrated screening of both AUDs and chronic NCDs such as hypertension.

Date of Award	31 Jul 2020
Original language	English
Awarding Institution	University of St Andrews University of Malawi
Supervisor	Alexander Baldacchino (Supervisor) & Moffat Nyirenda (Supervisor)