Prevalence and factors associated with relapse among heroin users attending methadone clinic at Kidongo Chekundu Mental Hospital, Zanzibar, Tanzania
Mohamed Foum, Jamila
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Introduction: Heroin is one of the most addictive drugs. People who have been addicted to heroin frequently relapse even after a Methadone Assistance Therapy (MAT). Globally, relapse rate is high among heroin users. China and South Africa found the relapse rate within one year after treatment is about 80% - 95%. Different psychological (mental disorders, stress and cravings) and social problems such as social support, unemployment has been mentioned to be associated with relapse among heroin users. In Zanzibar, about 7000 to 12000 people addicted to heroin reported that relapse is common. However, knowledge gaps still exist particularly in the burden and factors associated with relapse among heroin users attending the methadone clinic in Zanzibar. Objective: To determine the prevalence and factors associated with relapse among heroin users attending the methadone clinic at Kidongo Chekundu mental hospital in Zanzibar. Methodology: This was a cross-sectional study that was carried out in Zanzibar, Tanzania. Participants were heroin users, (18 years and above) and were both males and females attending the MAT. Following informed consent, consecutive sampling was used to recruit the participants. A socio-demographic questionnaire, structured clinical questionnaire, GSE Scale, MSPSS questionnaire were used to collect data. Data was entered in Epi data and analyzed in SPSS version 25. Univariate, bivariate, and multivariable associations were analyzed. Results: The prevalence of relapse among the heroin users was 294 (89.4%). Peer pressure appeared to be the leading cause for using heroin – 199 (60.5%) among the participants. The likelihood of having a relapse is 2.10 times more among individuals with secondary level of education relative to those with primary level of education or informal education (cOR = 2.10, 95%CI: 1.43, 6.28). The risk of relapse was 2.04 and 4.22 times higher among individuals with stress (cOR = 2.04, 95%CI: 1.00, 4.22) and cravings (cOR=4.78, 95%CI: 1.11, 20.43) respectively. There was no significant association in perceived social support and self-efficacy. Conclusion: The prevalence of relapse among heroin users is high. Factors such as being male, education level, cravings, stress, and unemployment, were found to be significantly associated with relapse. Continued psychoeducation and counseling on relapse prevention to heroin users should be provided in order to support users to abstain from using heroin. Further studies to be done to explore other psychosocial aspects associated with relapse among heroin users such as family history of substance, adverse childhood experiences, family dynamics, relationship between psychiatric disorders and using of heroin.