Alcohol consumption and associated risk factors among high school students in Toamasina I, Madagascar: A case–control study

Introduction: Adolescent alcohol consumption is a major public health issue, yet recent data from Toamasina, Madagascar are scarce. This study aim to estimate the prevalence and the associated factors among high school students in Toamasina I.

Methods: We conducted a cross-sectional, retrospective, single-center analytical case–control study on 23–24 May 2024 in the Toamasina I School District. One high school was selected by cluster sampling. An anonymous self-administered questionnaire incorporating WHO AUDIT items was distributed (n=350). We included 200 eligible students: 100 alcohol consumers (cases) and 100 non-consumers (controls). Analyses were performed in R 4.4.3 using bivariate odds ratios (OR) and multivariate logistic regression.

Results: Alcohol consumption prevalence was 34%. Cases and controls had median age 17 years. In bivariate analysis, male sex (OR=2.33; p=0.006), bereavement (OR=1.93; p=0.031), separation (OR=2.39; p=0.010), paternal alcohol use (OR=1.93; p=0.038) and maternal alcohol use (OR=2.19; p=0.024) were associated with consumption. In multivariate analysis, independent factors were male gender (aOR=3.47; 95%CI 1.72–7.21; p=0.0006), bereavement (aOR=1.96; 95%CI 1.01–3.87; p=0.0474) and paternal alcohol use (aOR=2.79; 95%CI 1.36–5.91; p=0.0059).

Conclusion: Alcohol use is frequent among Toamasina I students and is linked to gender, family alcohol modeling and bereavement, supporting gender-sensitive school and family interventions and psychosocial support for adolescents experiencing recent or unresolved loss.