Rising substance use disorders in Malawi: analysis of hospital-based data (2010 to 2019)

Abstract

Background Africa has a long history of substance abuse, mostly limited to alcohol, tobacco and cannabis, with the East African region being home to one of the world’s highest rates. There are reports of increasing substance abuse in Malawi but limited research evidence to provide details on the extent and nature of the issue. Despite indications of high prevalence, help seeking behaviour among the population is minimal. Mental health services are underfunded by government, and not a key health priority. Access to affordable psychosocial treatment for substance abuse is limited. This paper reports analysis of service utilisation patterns among those assessed at the St John of God (SJOG) Hospital and referred for psychosocial services for substance abuse treatment since its establishment in 2010. This is the first study in Malawi reporting routinely collected patient data related to substance abuse treatment from outpatient psychosocial services. Methods We descriptively analysed retrospective routinely collected data related to substance use disorders from two SJOG hospital sites that provide psychosocial or psychopharmacological treatment to service users at the mental health clinic from 2010 to 2019. Results Analysis of routinely collected data indicated increasing substance abuse treatment within SJOG psychosocial services between 2010 to 2019, with alcohol, chamba (cannabis) and tobacco related substance use disorders being predominant conditions among service users. Age-related data from 2018–2019 showed 22% of service users were under 18 years, indicating evidence of youth substance abuse. Conclusions These findings indicate growing service utilisation for substance use treatment in outpatient psychosocial services over the last decade in Malawi. Importantly, there is need for better electronic health data recording infrastructure to facilitate monitoring of incidents to inform extent of substance use issues and evidence-based solutions for treatment services in Malawi.