Polysubstance use behavior among the male population in Ethiopia: Findings from the 2016 Ethiopia Demographic and Health Survey

Background: Substance use is predominantly associated with male behavior and is becoming one of the major public health challenges across the globe, including in Ethiopia. The purpose of this study was to estimate the magnitude and predictors of polysubstance use behavior among males in Ethiopia. Methods: Data were extracted from the 2016 Ethiopia Demographic and Health Survey (EDHS). From a total of 12,688 male participants in the EDHS, a sample was extracted of 7,931 males who used at least one substance (alcohol, khat or tobacco) during the time of the survey. Those who used more than one substance were considered as polysubstance users, which was the outcome of interest. Descriptive statistics was computed and displayed with tables and graph. Logistic regression was carried out to identify predictors of polysubstance use, and statistical significance was declared at a 95% confidence level. Results: Of the total sample of 12,688 males in the 2016 EDHS, 7,931 (62.5%) were currently using at least one substance. Regional distribution of current substance users shows that Amhara (18.5%), Tigray (14.2%) and Oromia (12.8%) have the highest percentage of substance users, respectively. Among the current any substance users, 15.0% use cigarettes daily or on some days – 74.7% of these are daily users. Nineteen per cent of current male substance users in Ethiopia are polysubstance users. The main substances consumed are alcohol only (53.1%), followed by khat only (25.9%). Polysubstance use behavior can be predicted by residence (urban residence: OR: 1.78; CI: 1.35, 2.34), educational status (secondary education: OR: 1.50; CI: 1.19, 1.89) and marital status (no longer living together: OR: 2.85; CI: 1.58, 5.15). Region, religion, wealth status, age, family size and media exposure are other factors significantly associated with polysubstance use behavior. Conclusions: Polysubstance use behavior among males is widespread in all regions of the country. Socio-demographic factors and access to media are predictors of polysubstance use. Therefore, in addition to law enforcement such as prohibition of advertising, there is a need to investigate underlying genetic, structural, policy and behavioral determinants of polysubstance use so that holistic interventions can be designed to target multiple substance use simultaneously. [Ethiop. J. Health Dev. 2020; 34(3):171-180] Key words: Alcohol, cigarettes, EDHS, Ethiopia, khat, males, polysubstance use, substance use