Substance Use among Street-Connected Children and Adolescents in Ghana and South Africa: A Cross-Country Comparison Study.

Using two cross-sectional surveys with a purposive sample of 376 homeless children and adolescents in both Ghana and South Africa, this study was conducted to examine the prevalence, sociodemographic and psychosocial correlates of substance use among street children and adolescents. An interviewer-administered questionnaire was used to obtain information on substance use, sociodemographic and psychosocial variables. Both bivariate and multivariate analyses showed that street-connected adolescents in Ghana reported higher prevalence of lifetime alcohol use and past-month alcohol use than those in South Africa. The protective effect of male gender was not observed in South Africa but significantly more pronounced in Ghana for all substances except past-month marijuana use. Sexual assault, indirect sexual victimization, physical beating, robbery, assault with a weapon and survival sex increased the odds of lifetime alcohol use and past-month alcohol use in Ghana. However, in South Africa, only robbery and assault with a weapon increased the odds of lifetime alcohol use while robbery and sexual assault increased the odds of past-month alcohol use. These results have implications for the development of harm reduction interventions, taking into consideration both the psychosocial and cultural context of substance use.