That a community based multimodal intervention will lead to a sustained reduction in community alcohol use and psycho-social consequences.
Aims • To implement on a larger scale the successful intervention elements that were developed and tested in the pilot study of a community based alcohol education and community mobilisation program in rural Sri Lankan villages. • To measure the effect of the intervention on alcohol use and depression within each village. • To measure the effect of the intervention on alcohol use disorders, deliberate self-harm and key social outcomes. • To assess the effect on village social capital and support networks. • To evaluate context specific barriers to, and facilitators of, implementation • Undertake a cost effectiveness analysis from a societal perspective
Background Alcohol is in the top five causes of disability and death world-wide, contributing to 5.9% (over one in 20) of all deaths globally, 17% of deaths from unintentional injuries and 16% of gastrointestinal deaths are attributable to alcohol (3). South East Asia has the second highest rate of harm per litre of alcohol in the world (after Eastern Europe) (3). This relates to riskier consumption patterns, including use of illicit alcohol (3). Illicit alcohol largely falls outside the scope of established regulation approaches used in high income countries, such as taxation, pricing and limits on availability (4-6). In rural Sri Lanka, alcohol consumption is a significant social and medical problem (3)and is strongly linked with high annual incidence of suicide and deliberate self-harm (363/100,000) (7-9). Sri Lanka currently has the world’s third highest male suicide rate at 46/100,000/year (10). In terms of social and culturally deleterious impacts, alcohol is also a major cause of domestic violence and depression in families (11,12). There is also a strong relationship between poverty and alcohol use (13,14). Alcohol related cirrhosis cases, accidents and deaths are well documented in Sri Lankan hospital practice (15). The cirrhosis mortality rate of 33.4 per 100,000 males is among the highest in the world, over double the rate of 14.1 in the UK (16). In LMIC, including Sri Lanka, alcohol is linked with road traffic accidents and other forms of injury (17,18). Sri Lankan injury rates are high with a mortality rate of 177 (95% CI 72 to 283) and disability rate of 290 (95% CI 250 to 330) per 100,000 people (19) (about 3 fold higher than the global average).
Professor Andrew Dawson
CIB Professor Nicholas Glozier
CIC Professor Katherine Conigrave
CID Professor Indika Gawarammana
CIE Dr Kylie Lee
CIF Dr Melissa Pearson
CIG Professor Nicholas Buckley CIJ Professor Stephen Jan CII Dr Lalith Senarathna
CIJ Dr Ranil Abeyasinghe
- National Health and Medical Research Council, Australia