Four types: single holistic, single embedded, multiple holistic, multiple embedded
The post-positive paradigm postulates there is one reality that can be objectively described and understood by “bracketing” oneself from the research to remove prejudice or bias. 27 Yin focuses on general explanation and prediction, emphasizing the formulation of propositions, akin to hypothesis testing. This approach is best suited for structured and objective data collection 9 , 11 and is often used for mixed-method studies.
Constructivism assumes that the phenomenon of interest is constructed and influenced by local contexts, including the interaction between researchers, individuals, and their environment. 27 It acknowledges multiple interpretations of reality 24 constructed within the context by the researcher and participants which are unlikely to be replicated, should either change. 5 , 20 Stake and Merriam’s constructivist approaches emphasize a story-like rendering of a problem and an iterative process of constructing the case study. 7 This stance values researcher reflexivity and transparency, 28 acknowledging how researchers’ experiences and disciplinary lenses influence their assumptions and beliefs about the nature of the phenomenon and development of the findings.
A key tenet of case study methodology often underemphasized in literature is the importance of defining the case and phenomenon. Researches should clearly describe the case with sufficient detail to allow readers to fully understand the setting and context and determine applicability. Trying to answer a question that is too broad often leads to an unclear definition of the case and phenomenon. 20 Cases should therefore be bound by time and place to ensure rigor and feasibility. 6
Yin 22 defines a case as “a contemporary phenomenon within its real-life context,” (p13) which may contain a single unit of analysis, including individuals, programs, corporations, or clinics 29 (holistic), or be broken into sub-units of analysis, such as projects, meetings, roles, or locations within the case (embedded). 30 Merriam 24 and Stake 5 similarly define a case as a single unit studied within a bounded system. Stake 5 , 23 suggests bounding cases by contexts and experiences where the phenomenon of interest can be a program, process, or experience. However, the line between the case and phenomenon can become muddy. For guidance, Stake 5 , 23 describes the case as the noun or entity and the phenomenon of interest as the verb, functioning, or activity of the case.
Yin’s approach to a case study is rooted in a formal proposition or theory which guides the case and is used to test the outcome. 1 Stake 5 advocates for a flexible design and explicitly states that data collection and analysis may commence at any point. Merriam’s 24 approach blends both Yin and Stake’s, allowing the necessary flexibility in data collection and analysis to meet the needs.
Yin 30 proposed three types of case study approaches—descriptive, explanatory, and exploratory. Each can be designed around single or multiple cases, creating six basic case study methodologies. Descriptive studies provide a rich description of the phenomenon within its context, which can be helpful in developing theories. To test a theory or determine cause and effect relationships, researchers can use an explanatory design. An exploratory model is typically used in the pilot-test phase to develop propositions (eg, Sibbald et al. 31 used this approach to explore interprofessional network complexity). Despite having distinct characteristics, the boundaries between case study types are flexible with significant overlap. 30 Each has five key components: (1) research question; (2) proposition; (3) unit of analysis; (4) logical linking that connects the theory with proposition; and (5) criteria for analyzing findings.
Contrary to Yin, Stake 5 believes the research process cannot be planned in its entirety because research evolves as it is performed. Consequently, researchers can adjust the design of their methods even after data collection has begun. Stake 5 classifies case studies into three categories: intrinsic, instrumental, and collective/multiple. Intrinsic case studies focus on gaining a better understanding of the case. These are often undertaken when the researcher has an interest in a specific case. Instrumental case study is used when the case itself is not of the utmost importance, and the issue or phenomenon (ie, the research question) being explored becomes the focus instead (eg, Paciocco 32 used an instrumental case study to evaluate the implementation of a chronic disease management program). 5 Collective designs are rooted in an instrumental case study and include multiple cases to gain an in-depth understanding of the complexity and particularity of a phenomenon across diverse contexts. 5 , 23 In collective designs, studying similarities and differences between the cases allows the phenomenon to be understood more intimately (for examples of this in the field, see van Zelm et al. 33 and Burrows et al. 34 In addition, Sibbald et al. 35 present an example where a cross-case analysis method is used to compare instrumental cases).
Merriam’s approach is flexible (similar to Stake) as well as stepwise and linear (similar to Yin). She advocates for conducting a literature review before designing the study to better understand the theoretical underpinnings. 24 , 25 Unlike Stake or Yin, Merriam proposes a step-by-step guide for researchers to design a case study. These steps include performing a literature review, creating a theoretical framework, identifying the problem, creating and refining the research question(s), and selecting a study sample that fits the question(s). 24 , 25 , 36
Using multiple data collection methods is a key characteristic of all case study methodology; it enhances the credibility of the findings by allowing different facets and views of the phenomenon to be explored. 23 Common methods include interviews, focus groups, observation, and document analysis. 5 , 37 By seeking patterns within and across data sources, a thick description of the case can be generated to support a greater understanding and interpretation of the whole phenomenon. 5 , 17 , 20 , 23 This technique is called triangulation and is used to explore cases with greater accuracy. 5 Although Stake 5 maintains case study is most often used in qualitative research, Yin 17 supports a mix of both quantitative and qualitative methods to triangulate data. This deliberate convergence of data sources (or mixed methods) allows researchers to find greater depth in their analysis and develop converging lines of inquiry. For example, case studies evaluating interventions commonly use qualitative interviews to describe the implementation process, barriers, and facilitators paired with a quantitative survey of comparative outcomes and effectiveness. 33 , 38 , 39
Yin 30 describes analysis as dependent on the chosen approach, whether it be (1) deductive and rely on theoretical propositions; (2) inductive and analyze data from the “ground up”; (3) organized to create a case description; or (4) used to examine plausible rival explanations. According to Yin’s 40 approach to descriptive case studies, carefully considering theory development is an important part of study design. “Theory” refers to field-relevant propositions, commonly agreed upon assumptions, or fully developed theories. 40 Stake 5 advocates for using the researcher’s intuition and impression to guide analysis through a categorical aggregation and direct interpretation. Merriam 24 uses six different methods to guide the “process of making meaning” (p178) : (1) ethnographic analysis; (2) narrative analysis; (3) phenomenological analysis; (4) constant comparative method; (5) content analysis; and (6) analytic induction.
Drawing upon a theoretical or conceptual framework to inform analysis improves the quality of case study and avoids the risk of description without meaning. 18 Using Stake’s 5 approach, researchers rely on protocols and previous knowledge to help make sense of new ideas; theory can guide the research and assist researchers in understanding how new information fits into existing knowledge.
Columbia University has recently demonstrated how case studies can help train future health leaders. 41 Case studies encompass components of systems thinking—considering connections and interactions between components of a system, alongside the implications and consequences of those relationships—to equip health leaders with tools to tackle global health issues. 41 Greenwood 42 evaluated Indigenous peoples’ relationship with the healthcare system in British Columbia and used a case study to challenge and educate health leaders across the country to enhance culturally sensitive health service environments.
An important but often omitted step in case study research is an assessment of quality and rigour. We recommend using a framework or set of criteria to assess the rigour of the qualitative research. Suitable resources include Caelli et al., 43 Houghten et al., 44 Ravenek and Rudman, 45 and Tracy. 46
Although “pragmatic” case studies (ie, utilizing practical and applicable methods) have existed within psychotherapy for some time, 47 , 48 only recently has the applicability of pragmatism as an underlying paradigmatic perspective been considered in HSR. 49 This is marked by uptake of pragmatism in Randomized Control Trials, recognizing that “gold standard” testing conditions do not reflect the reality of clinical settings 50 , 51 nor do a handful of epistemologically guided methodologies suit every research inquiry.
Pragmatism positions the research question as the basis for methodological choices, rather than a theory or epistemology, allowing researchers to pursue the most practical approach to understanding a problem or discovering an actionable solution. 52 Mixed methods are commonly used to create a deeper understanding of the case through converging qualitative and quantitative data. 52 Pragmatic case study is suited to HSR because its flexibility throughout the research process accommodates complexity, ever-changing systems, and disruptions to research plans. 49 , 50 Much like case study, pragmatism has been criticized for its flexibility and use when other approaches are seemingly ill-fit. 53 , 54 Similarly, authors argue that this results from a lack of investigation and proper application rather than a reflection of validity, legitimizing the need for more exploration and conversation among researchers and practitioners. 55
Although occasionally misunderstood as a less rigourous research methodology, 8 case study research is highly flexible and allows for contextual nuances. 5 , 6 Its use is valuable when the researcher desires a thorough understanding of a phenomenon or case bound by context. 11 If needed, multiple similar cases can be studied simultaneously, or one case within another. 16 , 17 There are currently three main approaches to case study, 5 , 17 , 24 each with their own definitions of a case, ontological and epistemological paradigms, methodologies, and data collection and analysis procedures. 37
Individuals’ experiences within health systems are influenced heavily by contextual factors, participant experience, and intricate relationships between different organizations and actors. 55 Case study research is well suited for HSR because it can track and examine these complex relationships and systems as they evolve over time. 6 , 7 It is important that researchers and health leaders using this methodology understand its key tenets and how to conduct a proper case study. Although there are many examples of case study in action, they are often under-reported and, when reported, not rigorously conducted. 9 Thus, decision-makers and health leaders should use these examples with caution. The proper reporting of case studies is necessary to bolster their credibility in HSR literature and provide readers sufficient information to critically assess the methodology. We also call on health leaders who frequently use case studies 56 – 58 to report them in the primary research literature.
The purpose of this article is to advocate for the continued and advanced use of case study in HSR and to provide literature-based guidance for decision-makers, policy-makers, and health leaders on how to engage in, read, and interpret findings from case study research. As health systems progress and evolve, the application of case study research will continue to increase as researchers and health leaders aim to capture the inherent complexities, nuances, and contextual factors. 7
Introduction.
Qualitative research is a valuable approach that allows researchers to explore complex phenomena and gain in-depth insights into the experiences and perspectives of individuals. In order to conduct qualitative research effectively, researchers often utilize various research methodologies and instruments. These methodologies and instruments serve as tools to collect and analyze data, enabling researchers to uncover rich and nuanced information.
In this article, we will delve into the world of qualitative research instruments, specifically focusing on research instrument examples. We will explore the different types of qualitative research instruments, provide specific examples, and discuss the advantages and limitations of using these instruments in qualitative research. By the end of this article, you will have a comprehensive understanding of the role and significance of research instruments in qualitative research.
Qualitative research instruments are tools that researchers use to collect and analyze data in qualitative research studies. These instruments help researchers gather rich and detailed information about a particular phenomenon or topic.
One of the main goals of qualitative research is to understand the subjective experiences and perspectives of individuals. To achieve this, researchers need to use instruments that allow for in-depth exploration and interpretation of data. Qualitative research instruments can take various forms, including interviews, questionnaires, observations, and focus groups. Each instrument has its own strengths and limitations, and researchers need to carefully select the most appropriate instrument for their study objectives.
Exploring qualitative research instruments involves understanding the characteristics and features of each instrument, as well as considering the research context and the specific research questions being addressed. Researchers also need to consider the ethical implications of using qualitative research instruments, such as ensuring informed consent and maintaining confidentiality and anonymity of participants.
Qualitative research instruments are tools used to collect data and gather information in qualitative research studies. These instruments help researchers explore and understand complex social phenomena in depth. There are several types of qualitative research instruments that can be used depending on the research objectives and the nature of the study.
Interviews are one of the most commonly used qualitative research instruments. They involve direct communication between the researcher and the participant, allowing for in-depth exploration of the participant’s experiences, perspectives, and opinions. Interviews can be structured, semi-structured, or unstructured , depending on the level of flexibility in the questioning process. They involve researchers asking open-ended questions to participants to gather in-depth information and insights. Interviews can be conducted face-to-face, over the phone, or through video conferencing.
Focus groups are another example of qualitative research instrument that involves a group discussion led by a researcher or moderator. Participants in a focus group share their thoughts, ideas, and experiences on a specific topic. This instrument allows for the exploration of group dynamics and the interaction between participants. It also allow researchers to gather multiple perspectives and generate rich qualitative data.
Observations are a powerful qualitative research instrument that involves systematic and careful observation of participants in their natural settings. This type of qualitative research instrument allows researchers to gather data on behavior, interactions, and social processes. Observations can be participant observations, where the researcher actively participates in the setting, or non-participant observations, where the researcher remains an observer.
Document analysis is a qualitative research instrument that involves the examination, analyzation and interpretation of written or recorded materials such as documents, texts, audio/video recordings or other written materials. Researchers analyze documents to gain insights into social, cultural, or historical contexts, as well as to understand the perspectives and meanings embedded in the documents.
Visual methods, such as photography, video recording, or drawings, can be used as qualitative research instruments. These methods allow participants to express their experiences and perspectives visually, providing rich and nuanced data. Visual methods can be particularly useful in studying topics related to art, culture, or visual communication.
Diaries or journals can be used as qualitative research instruments to collect data on participants’ thoughts, feelings, and experiences over a period of time. Participants record their daily activities, reflections, and emotions, providing valuable insights into their lived experiences.
While surveys are commonly associated with quantitative research, they can also be used as qualitative research instruments. Qualitative surveys typically include open-ended questions that allow participants to provide detailed responses. Surveys can be administered online, through interviews, or in written form.
Case studies are in-depth investigations of a particular individual, group, or phenomenon. They involve collecting and analyzing qualitative data from various sources such as interviews, observations, and document analysis. Case studies provide rich and detailed insights into specific contexts or situations.
Ethnography is a qualitative research instrument that involves immersing researchers in a particular social or cultural group to observe and understand their behaviors, beliefs, and practices. Ethnographic research often includes participant observation, interviews, and document analysis.
These are just a few examples of qualitative research instruments. Researchers can choose the most appropriate data collection method or combination of methods based on their research objectives, the nature of the research question, and the available resources.
Gathering in-depth and detailed information.
Qualitative research instruments offer several advantages that make them valuable tools in the research process. Firstly, qualitative research instruments allow researchers to gather in-depth and detailed information. Unlike quantitative research instruments that focus on numerical data, qualitative instruments provide rich and descriptive data about participants’ feelings, opinions, and experiences. This depth of information allows researchers to gain a comprehensive understanding of the research topic .
Another advantage of qualitative research instruments is their flexibility. Researchers can adapt their methods and questions during data collection to respond to emerging insights. This flexibility allows for a more dynamic and responsive research process, enabling researchers to explore new avenues and uncover unexpected findings.
Qualitative research instruments also offer the advantage of capturing data in natural settings. Unlike controlled laboratory settings often used in quantitative research, qualitative research takes place in real-world contexts. This natural setting allows researchers to observe participants’ behaviors and interactions in their natural environment, providing a more authentic and realistic representation of their experiences.
Furthermore, qualitative research instruments promote participant engagement and collaboration. By using methods such as interviews and focus groups, researchers can actively involve participants in the research process. This engagement fosters a sense of ownership and empowerment among participants, leading to more meaningful and insightful data.
Lastly, qualitative research instruments allow for the exploration of complex issues. Qualitative research is particularly useful when studying complex phenomena that cannot be easily quantified or measured. It allows researchers to delve into the underlying meanings, motivations, and social dynamics that shape individuals’ behaviors and experiences.
Qualitative research instruments have several limitations that researchers need to consider when conducting their studies. In this section, we will delve into the limitations of qualitative research instruments as compared to quantitative research.
One of the main drawbacks of qualitative research is that the process is time-consuming. Unlike quantitative research, which can collect data from a large sample size in a relatively short period of time, qualitative research requires in-depth interviews, observations, and analysis, which can take a significant amount of time.
Another limitation of qualitative research instruments is that the interpretations are subjective. Since qualitative research focuses on understanding the meaning and context of phenomena, the interpretations of the data can vary depending on the researcher’s perspective and biases. This subjectivity can introduce potential bias and affect the reliability and validity of the findings.
Additionally, qualitative research instruments often involve complex data analysis. Unlike quantitative research, which can use statistical methods to analyze data, qualitative research requires researchers to analyze textual or visual data, which can be time-consuming and challenging. The analysis process involves coding, categorizing, and interpreting the data, which requires expertise and careful attention to detail.
Furthermore, qualitative research instruments may face challenges in maintaining anonymity. In some cases, researchers may need to collect sensitive or personal information from participants, which can raise ethical concerns . Ensuring the privacy and confidentiality of participants’ data can be challenging, and researchers need to take appropriate measures to protect the participants’ identities and maintain their trust.
Another limitation of qualitative research instruments is the limited generalizability of the findings. Qualitative research often focuses on a specific context or a small sample size, which may limit the generalizability of the findings to a larger population. While qualitative research provides rich and detailed insights into a particular phenomenon, it may not be representative of the broader population or applicable to other settings.
Lastly, replicating findings in qualitative research can be difficult. Since qualitative research often involves in-depth exploration of a specific phenomenon, replicating the exact conditions and context of the original study can be challenging. This can make it difficult for other researchers to validate or replicate the findings, which is an essential aspect of scientific research.
Despite these limitations, qualitative research instruments offer valuable insights and understanding of complex phenomena. By acknowledging and addressing these limitations, researchers can enhance the rigor and validity of their qualitative research studies.
In conclusion, qualitative research instruments are powerful tools that enable researchers to explore and uncover the complexities of human experiences. By utilizing a range of instruments and considering their advantages and limitations, researchers can enhance the rigor and depth of their qualitative research studies.
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The case study research design have evolved over the past few years as a useful tool for investigating trends and specific situations in many scientific disciplines.
The case study has been especially used in social science, psychology, anthropology and ecology.
This method of study is especially useful for trying to test theoretical models by using them in real world situations. For example, if an anthropologist were to live amongst a remote tribe, whilst their observations might produce no quantitative data, they are still useful to science.
Basically, a case study is an in depth study of a particular situation rather than a sweeping statistical survey . It is a method used to narrow down a very broad field of research into one easily researchable topic.
Whilst it will not answer a question completely, it will give some indications and allow further elaboration and hypothesis creation on a subject.
The case study research design is also useful for testing whether scientific theories and models actually work in the real world. You may come out with a great computer model for describing how the ecosystem of a rock pool works but it is only by trying it out on a real life pool that you can see if it is a realistic simulation.
For psychologists, anthropologists and social scientists they have been regarded as a valid method of research for many years. Scientists are sometimes guilty of becoming bogged down in the general picture and it is sometimes important to understand specific cases and ensure a more holistic approach to research .
H.M.: An example of a study using the case study research design.
Some argue that because a case study is such a narrow field that its results cannot be extrapolated to fit an entire question and that they show only one narrow example. On the other hand, it is argued that a case study provides more realistic responses than a purely statistical survey.
The truth probably lies between the two and it is probably best to try and synergize the two approaches. It is valid to conduct case studies but they should be tied in with more general statistical processes.
For example, a statistical survey might show how much time people spend talking on mobile phones, but it is case studies of a narrow group that will determine why this is so.
The other main thing to remember during case studies is their flexibility. Whilst a pure scientist is trying to prove or disprove a hypothesis , a case study might introduce new and unexpected results during its course, and lead to research taking new directions.
The argument between case study and statistical method also appears to be one of scale. Whilst many 'physical' scientists avoid case studies, for psychology, anthropology and ecology they are an essential tool. It is important to ensure that you realize that a case study cannot be generalized to fit a whole population or ecosystem.
Finally, one peripheral point is that, when informing others of your results, case studies make more interesting topics than purely statistical surveys, something that has been realized by teachers and magazine editors for many years. The general public has little interest in pages of statistical calculations but some well placed case studies can have a strong impact.
The advantage of the case study research design is that you can focus on specific and interesting cases. This may be an attempt to test a theory with a typical case or it can be a specific topic that is of interest. Research should be thorough and note taking should be meticulous and systematic.
The first foundation of the case study is the subject and relevance. In a case study, you are deliberately trying to isolate a small study group, one individual case or one particular population.
For example, statistical analysis may have shown that birthrates in African countries are increasing. A case study on one or two specific countries becomes a powerful and focused tool for determining the social and economic pressures driving this.
In the design of a case study, it is important to plan and design how you are going to address the study and make sure that all collected data is relevant. Unlike a scientific report, there is no strict set of rules so the most important part is making sure that the study is focused and concise; otherwise you will end up having to wade through a lot of irrelevant information.
It is best if you make yourself a short list of 4 or 5 bullet points that you are going to try and address during the study. If you make sure that all research refers back to these then you will not be far wrong.
With a case study, even more than a questionnaire or survey , it is important to be passive in your research. You are much more of an observer than an experimenter and you must remember that, even in a multi-subject case, each case must be treated individually and then cross case conclusions can be drawn .
Analyzing results for a case study tends to be more opinion based than statistical methods. The usual idea is to try and collate your data into a manageable form and construct a narrative around it.
Use examples in your narrative whilst keeping things concise and interesting. It is useful to show some numerical data but remember that you are only trying to judge trends and not analyze every last piece of data. Constantly refer back to your bullet points so that you do not lose focus.
It is always a good idea to assume that a person reading your research may not possess a lot of knowledge of the subject so try to write accordingly.
In addition, unlike a scientific study which deals with facts, a case study is based on opinion and is very much designed to provoke reasoned debate. There really is no right or wrong answer in a case study.
Martyn Shuttleworth (Apr 1, 2008). Case Study Research Design. Retrieved Sep 09, 2024 from Explorable.com: https://explorable.com/case-study-research-design
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A topic in research methodology
A case study is an enquiry into one specific instance among many . Sometimes the case is selected because it is the specific case we wish to know about. There is something special about that case that makes it worth investigating. Such cases are described as intrinsic cases. However, often a case is selected for study because it is considered to represent the wider class of possible cases. The case is an extrinsic case study , as we study it less for its own value, but for its value in telling us something about the wider class of such cases. This is potentially problematic, as case study recognises the idiosyncratic nature of cases and so a case study is not readily generalisable.
“The use of case study is to understand something else…instrumental to accomplishing something other than understanding this particular teacher [or…]” Stake, 1995: p.3
“Sometimes (instrumental) cases are chosen because they are considered reasonably typical of a class of instances, where the complexity of what is being studied suggests more can be learnt by detailed exploration of an instant than surveying a representative sample..” Taber, 2014
My introduction to educational research:
Taber, K. S. (2013). Classroom-based Research and Evidence-based Practice: An introduction (2nd ed.). London: Sage.
Oregon state university study shows that allowing cyclists to yield at stop signs does not increase danger.
Cycling advocates in British Columbia hope a new U.S. study will boost the case to allow bicyclists to yield at stop signs and safely roll through intersections.
While it's the law in jurisdictions like B.C. for cyclists to stop at stop signs, like every other road user, it's common to see people on two wheels opt for an illegal yield — rolling past the sign after checking it's safe to proceed.
"It makes it a lot more efficient," said Vancouver cyclist Ben Cooper about getting through intersections. "I'm not going to come to a full stop. Like, the amount of energy it takes to stop my entire bike and get it going again — it just doesn't make sense."
The debate over whether rolling stops for cyclists should be enshrined in law has been ongoing since the early 1980s when Idaho first made it legal, resulting in the manoeuvre being named the Idaho stop.
Several other U.S. states have since followed suit, including B.C.'s Pacific Northwest neighbours of Washington and Oregon. No jurisdiction in Canada has yet adopted laws for rolling stops for bikes.
Cycling advocates in B.C. say they've been pushing the issue for years and hope a new study from researchers at Oregon State University, published this month in an academic transportation journal, will aid their argument.
"It is going at a very slow pace and we need to take dramatic, bold steps that will enable us to reform these outdated laws and have more people … cycling," said Navdeep Chhina, director of campaigns and inclusion with Metro Vancouver's HUB Cycling .
The Oregon study says with proper education for both cyclists and drivers, Idaho stops do not lead either riders or motorists to act unsafely.
One of the study's authors said they wanted to look at how well rolling-stop laws work, in a change from other studies that have looked at crash-data analysis and why riders yield at stop signs rather than stop as per the law.
"It required fully connecting two independent simulators, running subjects in pairs simultaneously and having each subject interacting with an avatar of the other in a shared virtual world," said David Hurwitz, a transportation engineering professor, in a release about the study.
Researchers observed 60 people paired off who went through 16 virtual interaction scenarios as either a cyclist or motorist, coming together at a four-way-stop intersection.
They found that instead of drivers being aggressive toward cyclists who appeared to be breaking the law by rolling through, driving participants approached intersections either more slowly or at a similar pace after being educated about what bicycle rolling stops were.
Cyclists, after also being taught about Idaho stops, preferred to yield rather than stop and went through intersections faster, meaning they spent less time in the intersection exposed to potential danger.
Nearly four out of five crashes involving cyclists in B.C. happen at intersections , according to ICBC.
Hurwitz said the study's findings suggest more work should be done by jurisdictions over the utility of rolling-stop laws.
"This research gives decision-makers information to support prospective legislative policies, set up educational programs and design robust enforcement practices," he said.
B.C.'s Ministry of Transportation is not rejecting the idea that Idaho stops could be made legal, but it said in a statement that more research would be required "to consider how the change would affect the safety of all road users."
In the meantime, it's reminding cyclists to come to a complete stop at a stop sign to ensure safety for the rider and all other road users.
Chad Pawson is a CBC News reporter in Vancouver. Please contact him at [email protected].
BMC Public Health volume 24 , Article number: 2436 ( 2024 ) Cite this article
Metrics details
Methamphetamine (MA) (Mkpurummiri) is seen as the most common, accessible and new drug of use/abuse in south east Nigeria. Despite the overwhelming evidence of the dire consequences of this drug to the users, there is lack of empirical research to determine its prevalence in this area where use is assumed to be common. This study aimed to determine the prevalence of MA use, characteristics of the users and the control measures.
A descriptive cross-sectional survey research design was conducted from May through November 2023 among adolescents/adults at the age bracket of 15-64 years in the five states of south east, Nigeria. Three hundred and seventy-one (371) respondents were recruited using purposive/convenience sampling methods. A semi structured questionnaire was the instrument used. Data were analyzed using percentage, bivariate and multivariate logistics regression statistics. The Prevalence of MA was determined using percentages whereas the factors that are associated with MA use were expressed using multivariate logistics regression statistics AORs and 95%CIs. The level of significance was set at P < 0.05.
The prevalence of Methamphetamine (Mkpurummiri) was (21.8%). The most common reason for MA use was depression (86.5%), the most common route of administration was inhalation (64.9%). The most common characteristic of MA (Mkpurummiri) user was aggressive/violent behaviour (94.1%).The control measures were self-control (92.2%), parental monitoring (85.7%), drug education (83.1%) and legal control (80.8%). The multivariate logistics regression statistics AOR shows that off-campus were 3 times (AOR = 0.298; CI = 0.12–0.73 P = 0.008), family house 4 times (AOR = 0.241; CI = 0.09–0.65; P = 0.005 \(\le 0.05\) ) less likely than on-campus to predict MA use. Recently married were 3.25 times (aOR = 3.25; CI = 1.47–7.18), divorced 3.45 times (aOR = 3.45; CI = 1.23–9.58), polygamy 2.3 times (aOR = 2.3; CI = 1.08–4.90; P = 0.031 \(\le 0.05\) ), tradition 4.44 times (aOR = 4.44; CI = 1.77–11.15; P = 0.001 \(\le 0.05)\) , more likely than others to use MA.
MA use prevalence was relatively high, and marital status, living arrangements, family type and religion were the predictors. These findings underscore the need for concerted effort among the relevant government agencies, community stakeholders, families, religious bodies and school authorities to designing MA use policy/laws with special focus on adopting the punitive measure used in checking cocaine users. This may help to arrest and prosecute the manufacturers, distributors and users of MA.
Peer Review reports
Hard drugs proliferations, accessibility and use particularly Methamphetamine (commonly called Mkpurummiri in South Eastern Nigeria) by adolescents/youths is an emerging public health threat and concerns globally [ 1 , 2 , 3 , 4 ]. Research has reported that hard drugs use/abuse is high across the world with the percentage of adolescents and youth topping the previous years [ 5 ]. For instance, in 2021, research has documented that one (1) in every seventeen (17) persons from the age of 15–64 years worldwide had used any illegal drugs in the past year [ 6 ]. It was also reported that the number of users had increased from 240 million in 2011 to 296 million in 2021, with 5.8 per cent estimate of the global population aged 15–64 [ 5 ]. The trend was as well recorded in several studies both in the year 2022 and 2023 globally [ 5 , 7 , 8 ]. In Nigeria, the prevalence of 20% to 65.7% of lifetime and current use of any illicit drug among adolescent/youth population has been documented [ 1 , 9 , 10 , 11 , 12 ].
Studies have reported Methamphetamine (MA) as the most common illicit drug use by adolescents and adults [ 5 , 13 , 14 , 15 ]. Adolescents and adults being at high risk of hard drugs use/abuse has been attributed to risk factors like increased adventurous tendencies, peer influences, curiosity, depression, anxiety, behavioural disorders and risk-taking behavior [ 10 , 16 ]. Adolescence and adults has got various definitions [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. However, for the purpose of the current study, UNODC classification of adolescents/adults drug users at age bracket of 15 to 64 is adopted to elicit information from MA users among the population [ 20 , 28 ].
Prevalence of MA use by Adolescents and adults has been reported. For instance, research carried out among American adolescents reported that approximately 4.7 million (2.1% of the U.S. population) have used MA at some stages in their lives [ 21 ]. Another US National Survey conducted from 2015–2018, reported 6.6 per, 1,000 rate of past-year MA use/ abuse among youth [ 22 ]. Further, the School-based drug surveys carried out in Ontario and Manitoba to determine MA use among adolescents students revealed prevalence of 2.7% and 3.3% within the past year preceding the survey [ 23 , 24 ]. In the same vein, the study conducted in low and middle income countries on MA use among the students, revealed that both male and female abuse MA with an estimate of 1.6 million using the drug in the past year preceding the survey [ 25 , 26 , 27 ].
In Nigeria, there was little or no empirical studies conducted to determine the prevalence of MA use despite overwhelming evidence of MA production, availability and use in the country. However, a comprehensive nationwide general drug use survey carried out among people aged 15–64 years in Nigeria estimated the prevalence of psychoactive drug use [ 28 ]. According to the study, the last year prevalence of drug use/abuse from the southern region was at the range of 13.8 per cent to 22.4 per cent which was higher compared to the northern region with the prevalence ranging from 10 per cent to 13.6 per cent [ 1 , 28 ]. The study further revealed that South-Eastern Nigeria, (Abia, Anambra, Ebonyi, Enugu and Imo States) had the prevalence of any drug use estimated at 13.8 per cent of the population or 1.5 million people aged 15–64 years [ 20 , 28 ]. It was further observed that out of every 4 drug users/abusers, 1 is a woman in Nigeria. Moreover, the annual prevalence of men 21.8 per cent or 10.8 million men, and women 7.0 per cent or 3.4 million women were reported as drug users in the past-year [ 28 ]. The UNODC study focused on the general drug abuse in Nigeria not MA use/abuse in particular. Nevertheless, the general drug use survey included MA with an estimated prevalence of 0.06 per cent, this was perceived as very low [ 28 ].
The UNODC estimate of MA use prevalence of 0.06 per cent may be very low due to the high rate of MA (Mkpurummiri) use/abuse in the region. Evidence from various Nigeria newspapers, magazines, grey literature, periodicals and article reviews reports [ 2 , 29 , 30 , 31 ], suggest that use of MA is common. More so, the evidence of manufacturing MA in the region by drug merchants, accessibility with the number of seizures by NDLEA has affirmed its ubiquity and high rate of abuse in south east region [ 30 , 32 ].
Research has revealed that MA was manufactured in some parts of Nigeria particularly in Igbo of South east and sold in the form of meth of crystalline powder, capsule or pressed tablet, and pill [ 13 , 14 , 33 ]. Due to the endemic nature of the drug in the region, the people of the area nicknamed the drug in a local parlance as “Mkpurummiri”. The name comes from the appearance of MA in the form of ice, broken glass-like or crystalline rocks [ 2 , 32 ]. MA (Mkpurummiri) has other street names as meth, crystal meth, crank, speed, and kryptonite [ 2 , 34 , 35 , 36 ]. The routes of administration of MA (Mkpurummiri), as reported by other studies include smoking, injection, snorting, ingesting, inhaling, chewing, and rubbing on the skin [ 2 , 34 , 36 ].
Several reports have it on the pages of Nigerian newspapers, Magazines and periodicals that it was common to observe some adolescents/adults MA (Mkpurummiri) users on the streets of various communities of south eastern Nigeria. The MA users were observed due to the way they dressed, like some dressed naked or half naked walking around the streets without shame [ 2 , 29 , 30 , 31 , 32 ]. Some of them were reported to have killed their parents, siblings, girlfriend, boyfriend, or burnt their houses. Some students among them have assaulted their teachers/lecturers leading to dropout from school and other consequences associated with MA use [ 2 , 29 , 30 , 31 , 32 ].
Methamphetamine (MA) has been variously conceived as a potent and highly addictive psychoactive stimulant that excites and raises the level of nervous (brain and spinal cord) activities [ 14 , 22 , 37 ]. MA is regarded as a dangerous drug due to its effect on the brain, thus, the use of any minute quantity is regarded as an abuse. The primary mechanism of action to the MA users is on the brain dopamine (DA) system, leading to high rate of abuse [ 38 , 39 ]. Moreover, the major effects of MA users include depression, antisocial behavior like risky sexual behaviors, sexual assault, rape, violent behavior, mental illness, movement disorders, cognitive impairments, insomnia, suicide and death [ 40 , 41 , 42 ].
UNIDOC has grouped the burden of the adolescents/adults psychoactive drug use/abuse including MA into four areas of international concern. This includes organized crime, illicit financial flows, corruption, and terrorism/insurgency [ 43 ]. Nigeria, especially South East region has been grasping with all these factors as grouped by UNIDOC like insecurity, organized crime, terrorism/insurgency, youth unemployment, increased violence, lawlessness, kidnapping, hostage-taking and cultism [ 44 , 45 ]. There is also evidence of rising spate of people living in abject poverty and the rising rate of unemployment and underemployment among Nigerian youths [ 46 , 47 , 48 , 49 ]. Further, the current challenges of high cost of living and hardship associated with subsidy removal by the current administration in Nigeria, might be causing depression and fuelling the youths vulnerability to MA use/abuse [ 50 ]. This may be so as insecurity, gang formation leading to kidnapping for ransom and armed robbery as a means to earn a living is the order of the day in Nigeria [ 1 , 32 , 48 , 49 ].
MA (Mkpurummiri) control measures have been observed among some community leaders, and stakeholders of some affected states. For instance, some community leaders have created local vigilante group who work in synergy with security operatives to identify and banish anyone found with MA including the manufacturers and peddlers. Individuals taking the drugs are publicly punished by flogging them at the village squares [ 2 , 29 , 32 ]. Some villagers and stakeholders have equally protested through the major roads to register their displeasure towards the phenomenon of MA (Mkpurummiri) abuse in the region [ 29 , 31 ]. However, despite all these effort to curb the menace, MA use/abuse has continued to be rampant in the region. The production and sale by some drug merchants and peddlers have continue to grow assuming a more critical dimensions and causing public hysteria [ 2 , 29 , 51 ]. Moreover, public flogging as a physical punishment to MA users which has been adopted by vigilante groups and stakeholders of some communities has not yielded the desired result [ 31 , 32 ]. The approach has also been seen as uncivilized, barbaric and not scientific [ 31 , 32 ]. The worst still was the compromise reported among the police and vigilante group which is frustrating the war against MA use [ 52 ]. This has led to the palpable fear of unknown that the measure adopted might fall back on the community leaders, hence, the MA users might strategize, form a gang of cultists to fight back and attack the community and their leaders [ 32 ].
The mentioned scenarios have prompted the current researchers to find a scientific means towards curbing this menace, hence a step towards prevention of any drug abuse including MA is by establishing the prevalence, determining the characteristics of the users and its risk [ 1 , 37 ]. Moreover, the global interventions for prevention of drug use/abuse in a population including its impact has recommended a widespread understanding of the prevalence of the drug, frequently implicated drugs, the affected population, sources of the drugs and the risk factors [ 1 , 43 ]. However, due to lack of studies describing the prevalence and factors influencing the use of MA, the authors were inspired to lay this ground work to determine the prevalence of MA (Mkpurummiri) use, characteristics of the users and the control measures among the population. This is because, if prevalence and characteristics of MA users could be established, it is hoped that the government at all level in collaboration with NDLEA, law enforcement agencies and other relevant stake holders may be better equipped in designing MA use policy/laws with the punitive measures to curb the menace. The policymakers may use the findings of the study to determine the most affected group either adolescents or adults and devise a more stringent measures in combating MA use among the population.
This is a descriptive cross-sectional survey research design conducted between May 2023 through November 2023, to determine the prevalence of methamphetamine (Mkpurummiri) use, characteristics of the users and the control measures among adolescents/adults of south-eastern Nigeria. South eastern Nigeria comprises of five states namely: Abia, Anambra, Ebonyi, Enugu, and Imo. This states have common boundaries with similar cultures and traditions. Due to this similar characteristics with the high rate of unemployment, increase in poverty level, low level of educational opportunities and high cost of living associated with socioeconomic implications of fuel subsidy removal in Nigeria, common sense would expect risky behaviours and social vices like, drug use/abuse among the adolescents and adults. The scenarios have necessitated the current study in the South Eastern Nigeria.
The population of the study comprises all adolescents and adults in the five states of South Eastern Nigeria, namely: Abia, Anambra, Ebonyi, Enugu and Imo with an estimated population of 1.5 million persons at the age bracket of 15-64 years [ 27 ]. Inclusion/exclusion criteria: All the adolescents/adults at the ages of 15 to 64yrs, residing at the South Eastern Nigeria and consented to participate in the study were recruited. Adolescents/adults who are below 15yrs and above 64years, and those who are sick or not available at the time of the study were excluded.
We calculated the sample size using the past year prevalence of drug abuse among adolescents/ adults in the South East Nigeria which was 13.8% with a population of 1.5million people aged 15 to 64 [ 20 ]. Thus;
Where N = 1,500,000, e = 0.04, P = 0.138, Z = 1.96
Adding 20% attrition rate, the total sample is 371.
The procedure for sample selection involved multi-stages. In the first stage, the South East region was clustered into five states namely: Abia, Anambra, Ebonyi, Enugu and Imo States. In the second stage, three (3) states were selected from the five (5) states, using simple random sampling technique of balloting with replacement. The stage three involved the use of purposive/convenience sampling technique to draw 127 participants from each of the three (3) states selected in the second stage, namely: Ebonyi, Imo and Anambra. The researchers therefore administered three hundred and seventy-one copies of the questionnaire to the respondents in those states and at any point where they were accessible and convenient to fill the questionnaire. However, out of three hundred and Seventy-one (371) copies of questionnaire administered to the participants, three hundred and sixty-two (362) were properly filled and fit for data analysis. Nine (9) copies were excluded due to incomplete responses and insufficient demographic characteristics.
A semi structured questionnaire was used for data collection. This was developed by the researchers after thoroughly reviewing relevant literature and questionnaire of some related studies [ 1 , 27 , 37 , 53 , 54 ]. The questionnaire was entitled, “Prevalence of Methamphetamine Use among Adolescents/Adults Questionnaire (PMUAAQ). This consisted of four sections: A, B, C and D. Section A; contained Ten (10) items of demographic characteristics of the participants. Section B consisted items on prevalence of methamphetamine (Mkpurummiri) use and reasons for Use/Abuse among Adolescents/Adults. The respondents were requested to use a tick [√] on the Yes or No question. Section C consisted the items on routes of administration of MA. The respondents were requested to use tick (√) to indicate their best options on the checklist. Section D also contained a checklist for the characteristics of the users and the control measures. Respondents were required to use tick (√) to indicate their options from the list.
The instrument was face-validated through the verdict of five experts before the final data collection. Two experts from the department of Human Kinetics and health education, one from the department of psychology, one from the field of Epidemiology and one from the department of community medicine, all from the universities in the south east, Nigeria. The five experts were given drafted copies of PMUAAYQ accompanied with the study objectives and research questions. The experts’ constructive criticisms, assessment of language, clarity and coverage of items, and appropriateness for the target group, viz-a-viz the specific objectives of the study were used to modify the instrument for data collection. The questionnaire was pretested among Forty (40) respondents from two other states (Enugu and Abia) that are not part of the study sample but were part of the study population. The reliability of the instrument was established with Cronbach Alpha statistics. The Cronbach’s alpha internal consistency reliability index of r = 0.923 was obtained thus, considered highly reliable to be used for the general study.
Data were collected from the participants in schools, village squares, streets, parks, playground, home environments, market places, churches, and other places convenient for the researchers until the desired sample size was reached. The researchers were many and hail from different states of the studied population. Therefore, we divided ourselves into groups based on the understanding of each community’s dialect, tradition, and proximity and conversant to the various communities of each selected state. The administration and filling of the questionnaire survey lasted about seven months. The survey was strictly conducted without coercion but based on respondents’ volition and consent. The respondents whose age fall within 15–16 years were regarded as minors thus, the consent to participate was obtained from their parents or legal guardians. We offered help to clarify instructions as well as assistance based interview using the questionnaire. This was to help some respondents who were unable to fill the questionnaire due to where they were located like a rave, eatery centers, view centers, lounge and restaurants. This was strictly for those who sought for it. The data were collected and crosschecked for completeness of information and responses.
Measurement of main outcome variables.
The dependent variable was the prevalence of methamphetamine (Mkpurummiri) use, while the independent variables (predictors) were the socio-demographic factors such as age which was categorized into two (adolescents 15-19 years and adults 20-64 years), sex (gender), marital status, level of education, residence/Living arrangements, family size, birth order, family type, family income status (Naira), and religious affiliations. These socio-demographic factors of the respondents were correlated with the prevalence of MA use among adolescents and adults using the multivariate logistics regression adjusted odds ratios (AOR).The prevalence of methamphetamine (Mkpurummiri) use was determined using the questions (Have you ever used Methamphetamine (Mkpurummiri) in the past one year?), and their reasons for use was assessed using the dichotomous response questions of Yes or No adapted from related studies [ 1 , 27 , 53 , 54 ]. The routes of administration of MA (Mkpurummiri) by the respondents including the characteristics of the users and its control measures were determined using a checklist. The respondents were requested to use tick (√) to indicate their best options on the checklist.
Data generated and properly filled were analyzed using IBM SPSS version 25 (Statistical Package for Social Science). The serial number was assigned to each question for easy identification and for correct data entry and analysis. The analysis of the data was done using frequencies, percentages, bivariate and multivariate logistics regression statistics, as required by the research questions. The multivariate logistics regression analysis was employed to estimate the adjusted odds ratios (AORs) along with 95% confidence intervals (CIs) to identify the independent predictors of demographic characteristics of the adolescents/adults MA use and the degree of the relationship. The level of significance was set at P < 0.05. The percentages extracted were presented using tables and figures.
Data from a total of three hundred and sixty-two (362) properly filled copies of the questionnaire were included for data analysis. The findings in Table 1 shows the age bracket of 15-19yrs which were classified as adolescents had the highest percentage (62.2%), whereas those at the age bracket of 20–64 years classified as adults had the percentage of 37.8%. On their sex (gender), the female had the majority (50.8%) whereas the male counterpart had 49.2%. On the marital status, those who were never married had 68%, married had 19.9% whereas formerly married (Divorce) had 12.2%. Regarding the level of education, those who were not in any school/dropout had 29.8%, those in primary school had 8.6%, secondary 10.5% and tertiary 29.8%. On the participant’s residence/living arrangements, those living off-campus/streets had 44.8%, and family house 33.7% whereas those on campus had 21.5%. On the family size, the participants whose family size is 1–2 had 22.1%, 3–4 had 41.2%, 5–6 had 22.7% and over 7 had 14.1%. Regarding family order of birth, majority of the participants are first born 42.8%, followed by middle born 32.6% and last born 24.6% respectively. As for the family type/structure, majority are from monogamous family with the percentage 53.9%, followed by Polygamous 26.5%, and Single parent 19.6% respectively. Family income status (Naira), those earning less than #30000 had 27.6%, from #30,000-#99,000 had 40.9% and those earning #100,000 and above had 31.5%. On the religion, majority of the participants are Christians 75.7%, followed by Traditional religion 17.1% and Muslim 7.2% respectively (Table 1 ).
Data in Table 2 shows that out of 362 of the respondents, 74 (21.8%) have used Methamphetamine (Mkpurummiri), while 288 (79.6%) have not. Therefore, the overall prevalence of Methamphetamine (Mkpurummiri) use in the past year was 21.8%. The commonest reasons for consuming Methamphetamine (Mkpurummiri) include: To overcome stress/depression (86.5%), Calm down worries (82.4%), Eliminate shyness (82.4%), Peer pressure (81.1%), low self-confidence (81.1%), performance improvement (73.0%) and Curiosity (55.4%) (Table 2 ).
The most common routes of administration of Methamphetamine (Mkpurummiri) were through the Inhalation (64.9%), Sniffing (51.4%). Swallow/cook with food (50.0%), Injection (48.6%), Smoking Ice (43.2%), and other routes of administration not specified shows (48.6%) (Table 3 ).
The characteristics of MA (Mkpurummiri) use among adolescents/adults were determined using checklist, percentage and frequency and presented in the graph in Fig. 1 . The findings show that the greater percentage of youth who use methamphetamine (mkpurummiri) were highly aggressive/violent (94.1%), followed by suicide (88.3), Depression (87.3%), Relationship problems (86%), Psychological distress (85.3%), School dropout (84%), absenteeism (83.1), Peer group influence (82.1%), Poor academic performance (81.4%), Anxiety/panic(80.8%), Risky sexual behavior (80.1%), Financial problems(79.2), Parental deprivation (77.5%), Sensation seeking (72%), Unemployment (70%), respectively (Fig. 1 ).
Characteristics of MA (Mkpurumiri) users, n = 362
The Data in the Fig. 2 represented the perceived control measures of MA (Mkpurummiri) use. The findings indicated that the best way to protect and avoid the use of MA (Mkpurummiri) by adolescents and adults is by self-control with the highest percentage of 92.2% followed by parental monitoring (85.7%), drug education (83.1%), legal control (80.8%), punitive measures by the concerned stakeholders (80.1%), strong neighborhood attachment (76.5) and by school based intervention mechanisms (70%) (Fig. 2 ).
Respondents’ perspectives on control measures of MA (Mkpurumiri) Use, n = 362
In Table 4 , we used multivariable/multivariate logistic regression to evaluate the respondents’ socio-demographic characteristics that were associated with MA use. Due to the dichotomous nature of our dependent variable in the past year MA use. The following socio-demographic characteristics of the respondents such as age, gender, marital status, educational level, residence/living arrangements, family size, order of birth, family type, family income, and religious affiliation were plugged in the multivariate logistic regression. The findings from the adjusted odd ratios shows that being recently married were 3.25 times (AOR = 3.25; CI = 1.47–7.18; P = 0.003 ≤ 0.05), and being “formerly married (divorced) 3.45 times (AOR = 3.45; CI = 1.23–9.58; P = 0.017 \(\le 0.05\) ) respectively more likely than never married to use Ma in the past year. On the residence/living arrangements, students living off-campus were 3 times (AOR = 0.298; CI = 0.12–0.73 P = 0.008), and family house 4 times (AOR = 0.241; CI = 0.09–0.65; P = 0.005 \(\le 0.05\) ) less than on-campus hostel youths to use Ma in the past year. On the family type, being from a “polygamous family were 2.3 times (AOR = 2.301; CI = 1.08–4.90; P = 0.031 \(\le 0.05)\) more likely than being from monogamous family to use Ma in the past year. Being from single parent (AOR = 0.518; CI = 0.16–1.67; P = 0.269 \(>0.05\) ) has no statistically significant association with the prevalence of Ma use. On the religious affiliation: Being traditional religion were 4.44 times (AOR = 4.44; CI = 1.77–11.15; P = 0.001 \(\le 0.05)\) more likely than being Christian religion to use Ma in the past year. Being Muslim (AOR = 1.606; CI = 0.58–4.45; P = 0.363 \(>0.05\) ) has no statistically significant association with Ma use in the past year (Table 4 ).
This study was among the first to examine the prevalence of MA (Mkpurummiri) use, characteristics of the users and the control measures among adolescents/adults of south-eastern Nigeria. The finding of the study revealed the overall prevalence of 21.8% MA (Mkpurummiri) use in the past year. The finding was anticipated and consequently not a surprise, though the prevalence was below expectations due to the several reports of MA use from Nigeria newspapers, Magazines, grey literature, periodicals and article reviews. These reports indicated MA increased production, availability, accessibility, pervasiveness and endemic among adolescents/adults of South Eastern Nigeria [ 2 , 29 , 32 ]. It was also reported that it is common to observe Methamphetamine (Mkpurummiri) users on the streets of various communities walking naked or half naked without shame [ 2 , 29 , 31 , 32 ]. Some students among them have assaulted their teachers/lecturers leading to dropout from school [ 2 , 29 , 32 ]. However, the current findings were somewhat higher though agreed with the study which reported prevalence of 12.7% of methamphetamine abuse in south western Iran [ 55 ]. The present study also revealed a higher prevalence more than other studies conducted among secondary school students MA and other drugs of use/abuse in the past year [ 56 , 57 ]. Nevertheless, the prevalence of the current study was somewhat lower than the prevalence 45.38% of MA use in the study conducted in 2015 among youths in China [ 58 ], although the prevalence rate of various studies varies. Thus, the high prevalence of the current study could be attributed to the available evidence on the recent discoveries by NDLEA on illegal laboratories where methamphetamine is manufactured by drug barons and their foreign counterparts including drug traffickers who made it available to the users [ 48 ]. All these have largely contributed to the rampant use of MA in the region [ 2 , 31 , 32 ].
The reasons commonly attributed to MA use were to overcome stress/depression and to calm down worries. These findings may not be unconnected with the high rate of unemployment, increase in poverty level, lack of educational opportunities, and high cost of living among other socioeconomic implications of fuel subsidy removal in Nigeria currently. All these factors may be fuelling the adolescents/adults vulnerability to drug use/abuse including MA leading to the formation of drug users gang, insecurity, kidnapping, armed robbery, cultism and the high rate of mental illness of the youths in the south eastern Nigeria [ 44 , 45 ]. The current findings alluded to the study which revealed poverty rate of about 50% of people living in abject poverty in Nigeria [ 46 ], and the rising rate of unemployment (23.1%) [ 47 ], including the challenges of high cost of living associated with the recent fuel subsidy removal in the country [ 50 ]. All these may be fuelling youth vulnerability to drugs to enable them cope and work harder to earn a living or to ward off the stress and frustration of daily living in hardship [ 1 ]. The findings of this study are in line with other studies which consistently reported depression, anxiety, frustration, unemployment, and predominantly socio-economic problems of the country as reasons for drug use/abuse [ 1 , 7 , 59 ].
The most common routes of administration of MA by users as identified in the study were inhalation, sniffing, swallowing/cooking with food among others. The findings were consistent with other studies which reported the mode of MA intake to include smoking, injection, snorting, ingestion, inhalation, chewing and rubbing on the skin [ 34 , 36 ].
The common characteristics of MA (Mkpurummiri) use in this study were aggressive/violent behavior, suicide, relationship problems, school dropout, absenteeism, poor academic performance, financial problems. The outcome of the study is not a surprise thus, in recent years, Nigeria as a country has simultaneously faced numerous challenges ranging from COVID-19 outbreak, high rate of inflation, unemployment and increase in poverty rates. Currently these challenges seem to be worse due to another level of hardship associated with the decision to remove petroleum subsidy which has a high significant impact on the cost of living especially among the youths. The current findings were in line with other studies which associated the characteristics of MA users such as violent behaviour, hopelessness, suicide, high rate of unemployment, relationship problems, school dropout, absenteeism, poor academic performance, financial problems and parental deprivation to adolescents/youths [ 1 , 44 , 60 , 61 , 62 ]. The findings further support the reports by WHO which revealed that persistent sadness, loss of interest in activities that are normally enjoyed, including inability to carry out daily activities are as a result of high cost of living that enhances illegal drug use/abuse [ 19 ].
The perceived control measures of MA (Mkpurummiri) use as identified in this study include self-control, parental monitoring, drug education, legal control, punitive measures, strong neighborhood attachment, and school based intervention mechanisms. This finding is in line with the study which reported parental monitoring, quality education, provision of employment opportunities, and inclusion of drug education in school as the most effective control measures for MA use [ 63 ]. Regarding self-control and parental monitoring identified in the current study, it affirmed other studies which reported parental support as a preventive/control measures for multiple outcomes including an individual self-control over illicit drug use/abuse [ 63 , 64 ]. Further, there should be more stringent measures by government at all levels and other relevant authorities to uphold the preventive/ control measures of MA use as identified in this study and to checkmate and eliminate the process of MA production, trading networks, circulation and the sale in the region [ 58 ].
The findings from the adjusted odd ratios show that being recently married as well as being formerly married (divorced) were more likely than never married to use Ma in the past one year. These findings might not be out of place hence the users of MA have reported increased sexual activities, duration of sex, quality and quantity of sexual pleasure including sexual performance [ 65 ]. Therefore, recently married may be using MA during honey moon for sexual pleasures and to enable them satisfy their partners sexually. On the other hand, those who are divorced or formally married may be using MA due to loneliness, decreased level of happiness, change in economic status and emotional/psychological problems and depression associated with divorce among couples. The findings are in line with the study which reported divorce as a potent risk factor from onset of drug abuse, thus, the prevalence of drug abuse is higher among divorced individuals than married couple [ 66 , 67 ]. The finding also supports the study which revealed common drug use/ abuse particularly MA among recently married and divorced family [ 68 , 69 ].
Residence/living arrangements indicated that students living in “off-campus” and those living in “family house” were less likely than those living “on-campus hostel” to use MA in the past year. This finding was not expected because those living off-campus hostel may be living amidst different group of people like hooligans, school dropout and perhaps might be prone to MA use. However, the finding was not deceitful as it is consistent with studies which reported that students who reside on-campus were more associated with heavier drinking and other drug use/abuse than those living off-campus and peers at home with parents [ 70 , 71 ]. The finding disagrees with the study which reported that students living off-campus without parents are more frequent and heavier drinkers including other drugs with greater consequences than students living on-campus [ 72 ]. This agreement and disagreement with reference to the findings could be attributed to varied geographical locations, subject composition and other demographic factors associated with the studies.
Family type shows that being from polygamous family were more likely than others to use Ma in the past year. The finding was not deceitful thus, it is in consonance with the study which attributed psychoactive substance use including MA to family type [ 73 ]. More so, the finding further supports the study which reported family factors like polygamous family as the most important predictor of Methamphetamine use/abuse [ 74 ]. The finding was at variant with studies which reported single-parent families as important predictors for future MA use and other delinquent behaviours [ 75 , 76 ].
On the religious affiliation, belonging to traditional religion were more likely than being an adherent of Christian religion to predict Ma use in the past year. However, being Muslim has no statistically significant association with Ma use in the past year. The outcome of this finding may be attributed to some traditional religious activities associated with the people of the area like traditional wrestling, traditional dances, masquerade cult, new yam festival and other festivals which when ongoing, predispose the people of the area especially the youth to be more vulnerable to excessive drug use and abuse including MA [ 77 ]. The Christian religion and Muslim religion which are known as custodians of public morality might be preaching against this menace to strengthen the religious faith and dissuade the people from the use of MA and other illicit drugs. However, the findings of the current study are in consonance with the study which revealed religion ( P = 0.009), as a predictor of psychoactive drug use including Ma [ 51 ]. It was also consistent with the study which revealed that the rate of drug abuse was higher among traditional religion than those of Christianity, Islam and other religions [ 73 , 78 ]. The finding further alluded to the study which reported that frequent attendance to religious fellowships was a high significant factor that reduces adolescents, youths and adults likelihood of anti-social activities including drug use/abuse [ 79 ].
The major strength was that this study on prevalence of methamphetamine (Mkpurummiri) use/ abuse was among the first in the south eastern Nigeria. This is because despite the availability of MA and its rampant use in the region, there was little or no empirical study to establish its prevalence. This necessitated the current study.
The weakness may be that we used prevalence of MA (Mkpurummiri) use/abuse in the past year because MA was assumed to be a new drug of abuse by adolescents/youths at the time of the study. Hence, we did not include the prevalence of life time and current MA use during data collection. Additionally, the method of data collection was quantitative that used closed ended questions which may not have captured all the predictors of MA use. The study suggested the use of mixed study or qualitative data collection like in-depth interview and/or Focus Group Discussion. Hence, in-depth interview and FGDs have the potential to facilitate group interaction which would help to understand other factors predicting MA use.
Our study provided the first data on the prevalence of MA (Mkpurummiri) use, characteristics of the users and the control measures among adolescents/adults of south-eastern Nigeria. The study revealed that the prevalence of MA use was relatively high thus requiring an urgent response to halt the spread and use/abuse of this dangerous drug in the region. The relevant government agencies, in collaboration with stakeholders in various communities, families, religious bodies and school managements/authorities should as a matter of urgency design and implement effective MA use policy/law and its consequences same with cocaine and other illicit drug users. This will help to arrest and prosecute the manufacturers, distributors, promoters and users of this dangerous drug. Other measures are to rehabilitate the MA users by providing employment opportunities and upholding the control measures of MA use among adolescents/adults as indicated in this study.
The data sets generated and analyzed during this study are available from the corresponding author on reasonable request through the email address of [email protected] or [email protected].
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We thank the stakeholders of various communities, state and university communities for their prompt approval and direction provided towards the successful conduct of this study in South East Nigeria. Special thanks also go to all the adolescents/adults who consented and participated actively in this study.
The authors received no financial support for this work.
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Nkiru Edith Obande-Ogbuinya
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Christian Okechukwu Aleke, Lois Nnenna Omaka-Amari, Emeka Usman Mong, Eunice Nwafor Afoke & Patricia C. Ngwakwe
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NEO-O and COA, conceived and commissioned the study. COA and NEO-O performed the literature search and screened for the selected studies, extracted the data and wrote the first draft of the manuscript. COA, AFO, EUM and LNO-A proposed the methodology, performed the analysis and interpretation of the study. COA, ENA, SCA-O, UMBI, UCI, ON, IMO, OYI, TNN, AON, REO, PCN, KAN and ICN revised and supervised all aspects of the study. All the authors reviewed and approved the final manuscript.
Correspondence to Christian Okechukwu Aleke .
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Ethical approval was obtained from Ebonyi State University Research Ethics committee (EBSU/DRIC/UREC/vol.7/05223). The approval letter introduced the researchers to the relevant stakeholders of various communities and respondents stating the objectives of the study. This helped the researchers to gain access to and cooperation from the respondents and the stakeholders of the study population. Before the commencement of the study, a written informed consent was obtained from all the participants. Regarding the minors, which refers to individuals below the age of 16 years, informed consent to take part in the study was obtained from their parents or legal guardians. In the consent letter, they were fully assured of confidentiality and anonymity of the data. All procedures were strictly performed in accordance with the Declaration of Helsinki ethical standards in 1964 and its amendments.
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Obande-Ogbuinya, N.E., Aleke, C.O., Omaka-Amari, L.N. et al. Prevalence of Methamphetamine (Mkpurummiri) use in south east Nigeria: a community-based cross-sectional study. BMC Public Health 24 , 2436 (2024). https://doi.org/10.1186/s12889-024-19921-9
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The purpose of case study research is twofold: (1) to provide descriptive information and (2) to suggest theoretical relevance. Rich description enables an in-depth or sharpened understanding of the case. It is unique given one characteristic: case studies draw from more than one data source. Case studies are inherently multimodal or mixed ...
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