110 likes | 359 Views
BUILDING SERVICE DELIVERY SYSTEMS FOR SUBSTANCE ABUSE TREATMENT UCLA INTEGRATED SUBSTANCE ABUSE PROGRAM CONFERENCE, SEPTEMBER 5 – 7, 2005; ISTANBUL, TURKEY. By Fred Kigozi M.D WPA Zone 14 Representative/ President Uganda Psychiatric Association, Director Butabika Hospital
E N D
BUILDING SERVICE DELIVERY SYSTEMS FOR SUBSTANCE ABUSE TREATMENTUCLA INTEGRATED SUBSTANCE ABUSE PROGRAM CONFERENCE, SEPTEMBER 5 – 7, 2005; ISTANBUL, TURKEY By Fred Kigozi M.D WPA Zone 14 Representative/ President Uganda Psychiatric Association, Director Butabika Hospital E-mail: buthosp@infocom.co.ug or <fredkigozi@yahoo.com>
Introduction: Uganda is located in East Africa. Size – 236,04 Sq. kms - Land – 199,710 sq km - Water - 36,330 sq km Population - 24.7 million - Male - 12.1 M - Female - 12.6 M - Urban population % = 12% Kampala – Capital city Equatorial climate Politically stable save for Northern insurgency GDP - 340 USD Economy – Mainly Agricultural
Health Indices: IMR - 28/1000 Life expectancy - 43 years MMR - 504/100,000 Fertility – 6.9 Safe water coverage – 43% Age structure - 0.4 years ~ 4.9 M
Major Religion: Anglican - 10.2 M Catholic - 8.8 M Muslim - 2.96 M Others - 1.1M
Drug Abuse Situation: Alcohol: ‣ Most commonly abused drug in the country with a per capita consumption of 17.4% (WHO – 1995). Tobacco: ‣ Commonly used all over the country. ‣ Serves as a gateway to use of other drugs by the youth. ‣ Many times used in combination with other drugs. Cannabis: ‣ Mostly commonly abused narcotic in the country. ‣ Contributes significantly to the admissions at the National Referral Mental Hospital (Approximately 10%) ‣ Grows all over the country ‣ Several seizures are made every year by police e.g. between June 2003 - June 2005:- • 27,315 kg of herbal cannabis was seized • 48,853,511 cannabis plants were destroyed. • 160 kg cannabis seeds were seized
Drug Abuse Situation: (Contd) Heroine: • Recently introduced in Uganda. • Initially known to be in transit from Asia Europe. • Of late used by both indigenous Ugandans and common especially among the business community, students and people returning from abroad. • Methods of use; sniffing, injecting – beginning to surface. Cocaine: • Not commonly used. Is available in very small quantities. Khat: • A legal drug at the moment. Originally used by foreigners from the Horn of Africa (Ethiopia, Somalia) culture now spread to indigenous Ugandans. Others: • Organic solvents mainly by street children, victims of war and HIV/AIDS.
Magnitude of the Problem: • Studies rather scanty. • Per capita consumption of alcohol 17.4l (WHO – 1995). • Hospital admission due to alcohol/drug abuse on the increase in Butabika Hospital ~ 15%. • Police reports of seizures on the increase between 2003 & 2005: - Heroin - 10.3 kg - Cannabis - 27,315 kg - Coccaine - None • Drug related crimes on the increase. • School surveys indicate increasing problems e.g. schools within the City – 20% admit to regular use of alcohol.
Substance Abuse related problems • Neuro-psychiatric Disorder • HIV through: - Impaired judgement after use - Commercial sexual workers - IDU • Physical injuries through RTA – resulting from use of Alcohol and drugs. • Physical illness due to withdrawal intoxication or chronic use.
Treatment: • Available at all levels of care due to our integrated treatment approach. • Specialized care is available only at the National Referral Mental Hospital. • A specialized facility 30 beds is available. This is supported by Government and clients get free treatment. • The Hospital also runs an Outpatient Treatment facility. • There are two NGOs based treatment centres with bed capacity of 12 and 15 beds respectively. These are paying facilities. Clients pay on average 20 USD per day. • Detoxification is done at any of the Government hospitals both at Outpatient and Inpatient levels. One NGO based Treatment Centre offers detoxification following support of UNODC – ROEA. • Methadone is not used. • After-care services exist alongside the emerging AA and NA support services. • On average, the National Referral sees 80 clients per year. • The two NGO Centres see about 100 clients per year.
Challenges: • Lack of an IMDCC. • Lack of policies related to demand reduction. • Weak and ineffective laws. • Low public awareness and education. • Limited skilled human resources. • Limited inpatient facilities. • No National Drug Control master plan.