Evidence for Harm Reduction Programming: Prevalence and Risk Factors of Tramadol Use among Adolescents in Juba, South Sudan
Ezbon WApary *
South Sudan Institute of Pharmacy Technicians, Juba, South Sudan and School of Public Health, University of Juba, Juba, South Sudan.
Amanya Iboyi
Graduate College, University of Juba, Juba, South Sudan.
Kon Alier
South Sudan Institute of Pharmacy Technicians, Juba, South Sudan and School of Medicine, University of Juba, Juba, South Sudan.
Malual Gabriel Deng
South Sudan Institute of Pharmacy Technicians, Juba, South Sudan.
Emmanuel Joseph Molla
South Sudan Institute of Pharmacy Technicians, Juba, South Sudan.
John Yekisuk Santo Kose
South Sudan Institute of Pharmacy Technicians, Juba, South Sudan.
Nyagora Henry Diu Pathout
South Sudan Institute of Pharmacy Technicians, Juba, South Sudan.
Changkel Banak
School of Public Health, University of Juba, Juba, South Sudan and Graduate College, University of Juba, Juba, South Sudan.
*Author to whom correspondence should be addressed.
Abstract
Background: Tramadol misuse among adolescents is an emerging public health concern in several African settings, facilitated by its accessibility and non-medical use. In Juba, South Sudan, empirical evidence on the prevalence and factors associated with tramadol use among adolescents remains limited.
Aim: This study assessed the prevalence and risk factors of tramadol use among adolescents in Juba, South Sudan.
Methods: A cross-sectional survey was conducted among 297 adolescents aged 12–17 years in Juba. A structured questionnaire gathered data on socio-demographic characteristics and tramadol use, which the researchers then entered using EpiData and analysed with SPSS version 27. Descriptive and inferential statistics, including chi-squared tests and Cramer's V, were computed with 95% confidence intervals (CIs). The study adhered to ethical standards.
Results: The sample was predominantly male (82.8%; 95% CI: 78.5–86.9) and aged 15–17 years (80.8%; 95% CI: 76.1–85.2). Most lived in low-income households (56.9%; 95% CI: 51.2–62.3), and 57.9% (95% CI: 51.9–63.6) engaged in paid work. The lifetime prevalence of tramadol use was 81.1% (95% CI: 76.8–85.9), past-12-month use was 72.1% (95% CI: 66.7–77.4), and past-30-day use was 62.6% (95% CI: 56.9–68.4). Initiation commonly occurred at ages 12–14 years (37.7%) and 15–17 years (43.1%). Regular use was notable, with 19.2% using tramadol several times per week and 13.5% using it daily or almost daily. Tramadol use was significantly associated with age (χ² = 39.73, p < .001, Cramer's V = 0.366), residential location (χ² = 60.91, p < .001, V = 0.453), household size (χ² = 22.78, p < .001), employment status (χ² = 29.31, p < .001), perceived family economic status (χ² = 12.22, p = 0.002), peer introduction (χ² = 120.67, p < .001, V = 0.637), peer pressure (68.5% vs. 57.1%; p = 0.043), and situational motives such as coping with stress (χ² = 125.91, p < .001, V = 0.651), among others.
Conclusion: Tramadol use is highly prevalent among adolescents in Juba, begins in early adolescence, and frequently occurs at regular or daily intervals. Use is shaped by an interplay of demographic, socioeconomic, peer, and psychosocial factors, with peer-related influences and situational motives showing the strongest associations. The findings indicate an urgent need for school-based prevention, regulation of tramadol access, and family-level interventions targeting young people in Juba as part of harm-reduction programming.
Keywords: Tramadol, adolescents, opioid misuse, substance use, prevalence, risk factors, peer influence, harm reduction