Socioeconomic Disparities in Drugs and Substance Abuse: Results from a Household Cross-sectional Survey in Murang’ a County, Kenya

Background: Drug and substance abuse has adverse health effects and a substantial economic burden to the global economies and at the household level. There is, however, limited data on socio-economic disparities in drugs and substance abuse in low-to-middle income countries such as Kenya. This study aimed to assess the socio-economic disparities in Murang’a county of central Kenya.Method: The study design was cross-sectional, and data collection was conducted between November and December 2017. A total of 449 households with at least one person who uses any drug or substance of abuse were randomly sampled from 4 purposively selected sub-locations of Murang’ a County. Structured questionnaires were used to collect data on types of drugs used, economic burden, and gender roles at the household level. Household socio-economic status (SES) was established (low, middle, and high SES ) using principal component analysis f(PCA) from a set of household assets and characteristics. Multivariate logistic regression analysis was used to assess the association between SES, gender, and other factors on the uptake of drugs and substance abuse. Results: Individuals in higher SES were more likely to use cigarettes ( OR=2.13; 95%CI=1.25-3.61, p=0.005) or piped tobacco (OR=11.37; 95% CI, 2.55-50.8; p-value=0.001) than those in low SES. The wealthier individuals were less likely to use legal alcohol (OR=0.39; 95%CI=0.21-0.71, p=0.002) than the poorest individuals. The use of prescription drugs did not vary with SES. A comparison of the median amount of money spent on acquiring drugs showed that richer individuals spent a significantly higher amount than the poorest individuals (Ksh 1500 vs. Ksh 1000, p=0.0310). Deaths related to drugs and substance abuse were more likely to occur in middle SES than amongst the poorest households (OR=2.96; 95%CI=1.03-8.45). Conclusion: Socioeconomic disparities exist in the use of drugs and substance abuse. The low-income individuals are at a higher risk of abuse and thus of economic burden due to catastrophic expenditure in acquiring the drugs. Cases of deaths were likely to occur in middle-income groups. Strategies to reduce drugs and substance abuse must address socio-economic disparities through targeted approaches to individuals in low-income groups.