This article describes the South African Community Epidemiology Network on Drug Use project, describes selected trends in treatment demand related to alcohol and other drug (AOD) use for a 10 year period, and reflects on the utility and impact of this initiative on policy and practice. Data are collected using a standardized data collection form from over 70 specialist AOD treatment centers in six sentinel sites in South Africa every 6 months. Data are also collected from police forensic records and community surveys. Treatment demand linked to methamphetamine use has increased substantially in recent years in one site (Cape Town), but not in other sites. Treatment demand for heroin-related problems has increased over time in most sites, with changes in the population group profile of patients being noted. Over time the proportion of adolescents admitted to treatment centers has also increased significantly. The project has informed policy development at provincial and national levels, has guided local training and resource allocation decisions, and has allowed us to engage meaningfully in international forums. It has furthermore strengthened collaboration among researchers and stimulated new research initiatives. Dissemination activities have been intensive.
KEY WORDS: Alcohol, drugs, surveillance, treatment demand, South Africa.
Following the collapse of Apartheid1 in South Africa in the early 1990s there has been a reduction of (negative) internal controls and a dramatic increase in air and land travel to and from this country. Both these conditions, together with other changes in the global production and marketing of illicit drugs, have stimulated an increase in drug transshipment through South Africa and an increase in local use of a wide variety of drugs that were not previously available.
In 1996 with funding from the World Health Organization, the South African Medical Research Council established the South African Community Epidemiological Network on Drug Use (SACENDU), an aggregate data collection system, to monitor alcohol and other drug use trends on an ongoing basis. SACENDU is a network of about 200 researchers, practitioners and policy makers from six sentinel areas (in five provinces) in South Africa: Cape Town, Durban, Port Elizabeth (PE), East London, Gauteng Province and Mpumalanga Province (Figure I).2 Plans are underway to expand the SACENDU network to other parts of the country; however, this paper will focus on the above areas for which longitudinal data are available.
Local epidemiological networks address many of the difficulties associated with national surveys: they are cost effective as they rely largely on existing resources; they limit the masking of location-specific differences; they use local data, increasing the likelihood of relating findings to specific denominator information; they help inform specific actions against alcohol and other drug-related problems in local community settings; there are increased opportunities for checking data validity as data are gleaned from multiple sources; and the networks are sustainable, providing infrastructure for further research at a local level (Sloboda & Kozel, 1999). AOD or drug only surveillance systems have been set up in various regions of the world (e.g., Latin America, South East Asia, and Western Europe), in different countries (e.g., USA, Canada, Mexico and Spain), in different states/provinces (e.g., Texas) and subregions (e.g., border towns along the US/Mexican border).
AOD surveillance systems typically comprise a network of stakeholders from within a certain location (e.g., city), and across locations, who collect information on AOD use patterns and consequences on an ongoing basis and report back such information at regular intervals (NIDA, 1998). Members of SACENDU meet every six months to provide communitylevel public health surveillance of alcohol and other drug (AOD) use trends and associated consequences through the presentation and discussion of various sources of quantitative and qualitative research data (Parry et al. …