Substance use and substance use disorders in Africa: An epidemiological approach to the review of existing literature

Table 1 Epidemiology of substance use across the African continent

Region	Study type	Study group	Result	Ref.
Ghana	Population-based study	School-going adolescents	3.6% prevalence of substance use in the preceding 1 mo	[50]
Ghana	Cross-sectional study	894 high school students with a mean age of 17.4 yr	Lifetime alcohol use was 25.1%; with cigarette use and lifetime marijuana use being 7.5% and 2.6% respectively. Current alcohol use was 46.2%; current cigarette and marijuana use was 44.6%; and 58.3%, respectively	[51]
Ghana	Cross-sectional survey	227 street children and youths	Current prevalence of alcohol and marijuana use was 12% and 16.2%, respectively	[52]
Nigeria	Cross-sectional study Northwestern Nigeria	280 secondary school students	56% of them had a history of substance use (kolanut, cigarettes, and marijuana)	[53]
Nigeria	Cross-sectional study Southwestern Nigeria	249 secondary school students	Prevalence of alcohol and substance use was 21.7% and 26.3%, respectively, tramadol being the substance of choice	[54]
Nigeria	National drug survey	Population-based	Approximately 14.3 million people (accounting for 14.4% of the population aged between 15-64 yr) had a history of current and continuing substance drug use, with close to 3 million having at least a form of drug use disorder	[55]
Ethiopia	Demographic and health survey	Population-based	4% of youths and 6.3% of individuals in age groups of 25-29 yr smoked cigarettes, while 53% of men and 45% of women consumed alcohol	[59]
Ethiopia	Analysis of data extracted from the 2016 Ethiopia Demographic and Health Survey	12688 male cohorts	62.5% (7931 males) had a current history of substance use (alcohol, Kath, or tobacco). Inhabitants of the Amhara, Tigray and Oromia regions had a current substance use prevalence of 18.5%, 14.2% and 12.8%, respectively	[60]
Ethiopia	Cross-sectional study Northeastern Ethiopia	730 university students in	Lifetime prevalence of alcohol consumption, Kath chewing, and cigarette smoking was 33.1%, 13% and 7.9%, respectively, and current prevalence was 27.9%, 10.4% and 6.4%	[61]
Ethiopia	Cross-sectional study	794 university students	73.7% had a history of substance use with the lifetime prevalence of illicit drugs being 23.3%	[63]
Egypt	Hospital-based study (single-center experience)	First episode drug-induced psychosis patients	Substance abuse rates are as high as 10%-20% the global average with cannabis and tramadol being the most abused substance	[65]
Tunisia	Cross-sectional study	298 persons with a history of drug use	Cannabis was the most widely consumed illicit drug, followed by benzodiazepines, buprenorphine, cocaine, and ecstasy	[68]
Tunisia	Mediterranean school survey project	Secondary school students	Tobacco, alcohol, and cannabis were the substances most frequently used	[66,67]
Tunisia	Epidemiologic/toxicological investigation Northern Tunisia	11170 suspected drug users	A preponderance of males (97.4%), with a median age of 29 ± 7.91 yr. 91.3 % were single	[69]
South Africa	School-based survey	Secondary school students	13% of the students (aged 19 yr and below) had an history of cannabis use, although current use was 9%. 12% had a current use of heroin, 11% used inhalants and 6% consumed mandrax	[73]
South Africa	National household survey	Population-based	Past 3 mo prevalence for cannabis among 15-19-years-old was 3%	[74]

Table 2 African plants and herbs with psychostimulant potential

Region	Herbal preparation	Plant	Bioactive compound	Central nervous system activity	Toxicity	Ref.
East Africa	Khat chewing, drink made from dried leaves or smoking dried leaves	Catha Edulis	Phenylalkylamines and the cathedulins (Cathinone)	Improves performance, stay alert and to increase work capacity, excitement, appetite loss and euphoria	Memory impairment, sleeping disorders, liver toxicity, cardiovascular disease, psychosis and poor academic performance	[115,117,124-126]
West Africa	Different parts of the plant are smoked or used to make concoctions	Datura specie including stramonium and Datura metal	Atropine, scopolamine, and hyoscamine	Anticholinergic and hallucinogenic activity	Hyperthermia, tachycardia, delirium, pronounced amnesia, severe mydriasis, bizarre behaviors and painful photophobia	[135,136,141,145-148]
West Africa	Root bark concoctions	Tabernanthe iboga	Ibogaine	Stimulatory, hallucinogenic, and sedative effects	Development of ataxia, tremor, cardiac toxicity, and death	[149-151]
South Africa	Ubulawu drink	Silene undulata and Synaptolepis	Triterpenoid saponins	Mood altering effects including stimulating vivid or lucid dreams	Confusion	[113]
South Africa	Chewed, smoked, snorted or swallowed	Sceletium tortuosum	Mesembrenone, mesembrenol, mesembrine and tortuosamine	Increased libido, decreased stress, euphoria and appetite suppression	Anxiety, headache, hypertension, irritability, insomnia and nausea	[154,155]