Background: In 2005, the World Health Assembly asked member states to develop effective strategies and programs to reduce the negative consequences of harmful use of alcohol. To develop effective policies, we must already understand the phenomenon of alcohol consumption. But in Francophone west Africa, there are very few studies on the prevalence of alcohol, consumption patterns and factors associated with this consumption. The objectives of this study were to estimate the prevalence of alcohol use in schools in Burkina Faso and to identify socio-demographic factors associated with episodes of “heavy drinking”. Method: A cross-sectional study was conducted in October 2013 in six secondary schools of Bobo-Dioulasso. Three hundred and sixty-two students randomly drawn by stratified cluster sampling were interviewed by using a self-administered questionnaire adapted from the model ESPAD and WHO AUDIT questionnaire. HED (Heavy Episodic Drinking) was defined as consuming at least six local measures of alcoholic beverages around the 30 days prior investigation. The search for factors was performed using logistic regression and estimating standard errors were adjusted for clustering data. Results: The prevalence of experimentation of alcohol was estimated to 45.6% [CI 95% = 40.4 - 50.7]. This prevalence was reduced to 34.8% [CI 95% = 29.9 - 39.7], 24.3% [CI 95% = 19.9 - 28.7] and 18% [CI 95% = 14 - 21.9] if one considered the use of alcohol at least once respectively in the 12 months, 30 days and 7 days before the survey. The prevalence of HED was 16% [CI95% = 12.2 - 19.8]. Independent factors associated with the HED were alcohol use by parents or friends and father’s occupation. Episodes of “heavy drinking” were 8.3 (CI 95% = 4.9 - 14) and 2.8 (CI 95% = 1.3 - 5.8) respectively more frequent among students whose parents and friends were drinking. Neither religion nor sex nor age was not statistically associated with HED. Conclusion: This study confirms the high prevalence of alcohol consumption in schools in Burkina Faso and challenges policy makers to adopt effective policies to fight against the harmful use of alcohol especially in schools.
In 2012, 3.3 million deaths and 5.1% of the global burden of disease were attributable to alcohol consumption according to the World Health Organization (WHO) [
The use of alcohol may not only affect health but the way we drink also counts. This defines Heavy Episodic Drinking (HED) as the consumption of 60 grams or more of pure alcohol (6 or more standard measures in most countries) on one occasion during the last 30 days [
If there is generally in developed countries, laws governing the sale of alcohol by prohibiting its sale including generally the age of 18, it is not the same in developing countries, including Africa. Alcohol is generally sold without any age restriction. In 2012, the proportion of countries which had a policy on alcohol ranged from 20% in the WHO African region to 64% in the WHO Europe zone [
The Fifty-eighth World Health Assembly asked in 2005 to Member States to develop effective strategies and programs to reduce the negative consequences of harmful use of alcohol [
Our study contributes to the reinforcement of a very fragmented literature on alcohol use in West Africa Francophone. Its objectives were to estimate the prevalence of alcohol consumption in schools in Bobo-Dioulasso and to identify sociodemographic factors associated with consumption.
Bobo-Dioulasso is the second city of Burkina Faso. It covers an area of 136.78 km² and is located to 365 km from the capital Ouagadougou. Its population was estimated to 813,610 inhabitants in the year 2012 [
This was a cross-study in October 2013. The study population consisted of students of class 4th, 3rd, 2nd and 1ere (respectively 9th, 10th, 11th and 12th years of schooling) from high schools, public and private secondary schools in Bobo- Dioulasso. The choice of these classes was guided by the concern to obtain an especially adolescent population and who can easily understand the questionnaire.
Sampling was stratified cluster. The clusters were formed by educational institutions. They were first stratified by geographic location (East, West, South, Central and North). A school was then randomly drawn from each stratum except the central one where both institutions have been fired because of the greater number of schools and colleges for this geographical location.
The sample size was calculated for a simple random sampling using a 95% confidence level, a 5% margin of error and an expected prevalence of 34% for those who have already experienced alcohol (prevalence coming from the study of Nikiema et al.). This gave a sample of 345 students. This size was increased by 10% to take account the refusal to answer or incomplete responses which finally gave a size of 380 students. Each selected high school or college, we randomly drew 16 students in each of four classes.
The data were collected using a self-administered questionnaire. The question- naire was adapted to the model of the ESPAD (European School Survey Project on Alcohol and other Drugs) and the AUDIT Questionnaire (Alcohol Use Disorders Identification Test) WHO to reflect the vocabulary of students and denominations of some local alcohols. We defined the experimentation as the consumption of alcohol at least once in the life of the individual whether he continued this consumption later or not [
Other variables indicated concerned the socio-demographic characteristics of the students and their parents (age, sex, marital status of parents, family environment, parents’ religion, and parental occupation), consumption of alcohol in the family circle or the friends consumed alcohol type, quantity consumed, age at first use, the use of cigarettes.
Data collection was performed by a physician trained for this purpose. In each school selected students were gathered in a room to complete the questionnaire.
The study received approval from the DRESS (Regional Directorate of Secondary and Higher Education) of the Hauts-Bassins. The selected students have given written consent and questionnaires were anonymous. The analysis does not recognize the institutions concerned.
Data were entered using the EPI Data software and analyzed with Stata April 1.0. The prevalence was calculated for the different periods by dividing the number of consumers over the period by the size of the sample. For research, factors associated with HED related to students, we used multiple logistic regression. The dependent variable was HED and was 1 for all those who had had at least one HED within 30 days preceding the survey, and 0 if not. A bivariate analysis using the Chi-2 test was first performed. All variables that were associated with p < 0.25 [
A total of 362 students completed questionnaires corresponding to a rate of response which is 94.3%. The sample consisted of 57.2% male. The average age was 17.8 ± 2.4 years old with extremes of 13 and 25 years. Islam was practiced by the parents of students at 68%. The majority (68%) of the students said that both their parents lived together in the same house; 13.8% said that their two parents were separated or divorced and 18.0% of the students were orphans of at least one parent.
The prevalence of alcohol use at least once in life was 45.6% [CI 95% = 40.4 - 50.7]. This prevalence was reduced to 34.8% [CI 95% = 29.9 - 39.7], 24.3% [CI 95% = 19.9 - 28.7] and 18% [CI 95% = 14 - 21.9] if one considered the use of alcohol at least once in the 12 months respectively, 30 days and 7 days before the survey. The average age for initiation to alcohol was 12.6 ± 4.2 years, ranging from 4 to 21 years.
In the 7 days preceding the survey, 36, 34, 32 and 11 students (out of the 65 who consumed alcohol) consumed respectively beer, dolo, wine and liquor. The quantities consumed by student on average 2.6 ± 2.3 bottles of beer (66 cl = 1 bottle), 2.3 ± 1.2 glasses of wine, 1.7 liters of dolo ± 1.6 and 1.8 ± 1.8 liqueur balls.
Within 30 days preceding the survey, 16% of students [CI 95% = 12.2 - 19.8] consumed once at least more than six drinks on one occasion and were therefore classified as HED category.
In bivariate analysis, episodes of Heavy drinking were 3.6 times more frequent [CI 95% (2.0 - 6.3)] among students whose parents were not Muslim, compared to those whose parents were Muslims. The episodes of Heavy drinking also were 10.7 (CI 95% = 5.5 - 20.9) and 4.2 times (CI 95% = 2.2 - 8.1) respectively more frequent among students with at least one parent and friends drinking compared to those whose parents or friends do not drink.
In multiple logistic regression, only alcohol consumption by parents and friends as well as the father’s occupation were factors associated with Heavy drinking episodes among students. Thus, compared to farmers, HED is 2.7 times more common among students whose parents are employees. The frequencies of HED with students with at least one parent and friends consuming alcohol were reduced but remained statistically significant at respectively 8.3 (CI 95% = 4.9 - 14) and 2.8 (CI 95% = 1.3 - 5.8).
| Variables (n = 362) | Numbers | Percentages | P | ||
|---|---|---|---|---|---|
| HED | No HED | HED | No HED | ||
| Ethnicity ・ mossi ・ Bobo/Dioula ・ Senoufo/Toussian ・ Gourounsi ・ Fulani/Fulse ・ Samo ・ Other | 15 15 7 5 3 3 10 | 121 60 31 15 15 22 40 | 11.0 20.0 18.4 25.0 16.7 12.0 20.0 | 89.0 80.0 81.6 75.0 83.3 88.0 80.0 | 0463 |
| Sex ・ Male ・ Female | 34 24 | 173 131 | 16.4 15.5 | 83.6 84.5 | 0809 |
| Parent’s religion ・ Muslim ・ Other | 25 33 | 222 82 | 10.1 28.7 | 89.9 71.3 | <0.001 |
| Father’s education ・ No education ・ Primary ・ Secondary or more ・ Other* | 16 7 24 11 | 117 45 81 61 | 12.0 13.5 22.9 15.3 | 88.0 86.5 77.1 84.7 | 0138 |
| Mother’s education ・ No education ・ Primary ・ Secondary or more ・ Other* | 25 9 19 5 | 154 62 52 36 | 14.0 12.7 26.8 12.2 | 86.0 87.3 73.2 87.8 | 0053 |
| Parent’s marital status ・ Married ・ Separated/divorced ・ Widowers | 41 9 8 | 205 41 57 | 16.7 18.0 12.3 | 83.3 82.0 87.7 | 0642 |
| Social environment ・ With father and mother ・ With father or mother ・ Other Parent | 39 9 10 | 167 58 79 | 18.9 13.4 11.2 | 81.1 86.6 88.8 | 0207 |
| Parent’s consumer ・ No ・ At least one parent ・ Other* | 15 36 7 | 223 50 31 | 6.3 41.9 18.4 | 93.7 58.1 81.6 | <0.001 |
| Friend’s consumer ・ Yes ・ No. | 31 27 | 65 239 | 32.3 10.2 | 67.7 89.8 | <0.001 |
| Cigarettes ・ Yes ・ No. | 9 49 | 24 280 | 27.3 14.9 | 72.7 85.1 | 0065 |
| Age ・ 13 - 14 years ・ 15 - 17 years ・ 18 - 25 | 4 17 37 | 25 123 156 | 13.8 12.1 19.2 | 86.2 87.9 80.8 | 0213 |
| Father’s occupation ・ Farmer ・ trader ・ salaried ・ Other** | 13 12 25 8 | 94 93 66 51 | 12.2 11.4 27.5 13.6 | 87.8 88.6 72.5 86.4 | 0007 |
|---|---|---|---|---|---|
| Mother’s occupation ・ Household ・ shopping ・ Salaried ・ Other** | 43 8 4 3 | 235 33 20 16 | 15.5 19.5 16.7 15.8 | 84.5 80.5 83.3 84.2 | 0931 |
Other*: No information deceased. Other**: Other profession and died.
| Variables (N = 362) | NOT | Crude | adjusted | ||
|---|---|---|---|---|---|
| GOLD | CI 95% | GOLD | CI 95% | ||
| Religion ・ Muslim ・ Other | 247 115 | 1 3.6 | 2.0 - 6.3 | NS | |
| Father’s education ・ No education ・ primary ・ Secondary or more ・ Other | 133 52 105 72 | 1 1.1 2.2 1.3 | 0.2 - 5.4 0.9 - 4.9 0.7 - 2.4 | NS | |
| Mother’s education ・ No education ・ Primary ・ Secondary or more ・ Other | 179 71 71 41 | 1 0.9 2.3 0.9 | 0.4 - 1.8 1.5 - 3.4 0.3 - 2.7 | NS | |
| social environment ・ With mother and father ・ With mother or father ・ Other Parent | 206 67 89 | 1 0.7 0.5 | 0.4 - 1.1 0.3 - 0.9 | NS | |
| Parent’s consumer ・ No ・ At least one parent ・ Other | 238 86 38 | 1 10.7 3.4 | 5.5 - 20.9 1.4 - 8.3 | 1 8.3 3.4 | 4.9 - 14.0 1.4 - 8.3 |
| Friend’s consumer ・ No. ・ Yes | 266 96 | 1 4.2 | 2.2 - 8.1 | 1 2.8 | 1.3 - 5.8 |
| Tobacco ・ No. ・ Yes | 329 33 | 1 2.1 | 0.7 - 6.1 | NS | |
| Student’s age ・ 13 - 14 years ・ 15 - 17 years ・ 18 - 25 years | 29 140 193 | 0.7 0.6 1 | 0.2 - 2.8 0.2 - 1.6 | NS | |
| Father’s occupation ・ Farmer ・ trader ・ salaried ・ other | 107 105 91 59 | 1 0.9 2.7 1.1 | 0.5 - 1.8 1.8 - 4.1 0.4 - 2.9 | 1 1.5 1.9 0.9 | 0.7 - 2.9 1.4 - 2.5 0.4 - 2.1 |
In this study, the prevalence of School drinking were 45.6% [CI 95% = 40.4 - 50.7], 34.8% [CI 95% = 29.9 - 39.7] and 24.3% [CI 95% = 19.9 - 28.7] respectively for experimentation, in the last 12 months and 30 days preceding the survey. The factors associated with alcohol consumption were link to parents or friends consumption and parents’ occupation.
The prevalence of experimentation of alcohol in schools in Bobo Dioulasso is higher than that (34.14%) reported 10 years earlier by Nikiema et al. in Ouagadougou [
This high prevalence of alcohol consumption in schools in Burkina is in itself not a surprise. Indeed, promotional sales activities of drinks are organized in public places sometimes not far from schools and colleges or on the screens of the national television and students are exposed. To this must be added a certain cultural tolerance for alcohol in our societies. Thus, one can observe in certain regions or among certain ethnic groups in our country that parents give to drink to children under five years. This cultural influence and certain accessibility to local drinks could also explain the average age initiation to alcohol which is only 12 years old with a minimum of four years.
The prevalence of difference observed in our study with that of Nikiema et al. [
Although the prevalence of alcohol consumption is high in schools, it can be considered as occasional since going from 45.6% for the experiment to 18% during the seven days preceding the survey.
The prevalence of HED is 16% in our study. In Benin, Kpozehouen et al. found in 2014, 30.08% of misuse of alcohol (abusers, harmful use to consumers and alcohol-dependent). Globally, the WHO estimates the prevalence of HED to 16% [
Independent factors associated with heavy drinking episodes were the consumption of parents and friends and the father’s occupation. The religion that was statistically associated in the bivariate analysis was no longer in multivariate. The influence of alcohol consumption by family and/or friends about alcohol use was reported by several studies in Africa and is not limited only to school [
In Ivory Coast, N’Cho Dagnan Simplice et al. had found that alcohol consumption was more common among students who received more than 5000 FCFA (7.62 euros) as pocket money weekly [
Religion and gender were not independent factors associated with heavy drinking episodes in our study. Nikiema et al. (2011) did not find an association between religion, sex and the alcohol consumption among students in Ouagadougou. In contrast, in Ivory Coast, Dagnan et al. (2014) found that alcohol was more common in the Christian confession of students compared to Muslims. The adjustment was made only for socio-demographic variables in our study and it is possible that the persistence of residual confounding explains the fact that religion is not statistically associated in our study. However, Islam in Burkina seems less rigorous and it is not unusual to find alcoholic beverages in people of Muslim faith during feasts. This lack of association may reflect the reality in our context especially as Nikiema et al. (2011) did not find an association between alcohol and religion.
The calculation of the sample size did not take into account the effect and it is possible that the size used is not appropriate for efficient estimation of prevalence. Moreover, the number of students classified HED was relatively small (n = 58), which did not in multivariate analysis to have accurate estimations. However, this is one of the first studies in West Africa francophone that estimates the prevalence related to HED in schools and research associated factors.
The prevalence of alcohol consumption in schools in Bobo-Dioulasso, is high with a prevalence of experimentation estimated to 45.6% while 16% of students were classified as HED category considered by the WHO as a group at risk. This study also confirmed the influence of alcohol consumption in the family circle and friends in student behavior with respect to alcohol.
Burkina Faso has adopted a few years ago a law banning tobacco consumption in public places such as schools, hospitals, etc. But there is no similar legislation for alcohol and implementation of drinking establishments in the cities which don’t take into account the proximity of schools. It is probably the time that the authorities are concerned about it and that awareness is reinforced to parents and students. Further studies should also clarify the influence of the proximity of drinking establishments with schools on student behavior towards alcohol to provide evidence to encourage public authorities to act.
Koura, M., Méda, I.B., Ouattara, Z.D., Somé, C.C.B., Somda, K.S., Coulibaly, A., Ouédraogo, S. and Sawadogo, A. (2017) Prevalence and Factors Associated with Alcohol Consumption in Urban Schools in Burkina Faso. Open Journal of Gastroenterology, 7, 187-196. https://doi.org/10.4236/ojgas.2017.76020