Alcohol consumption, harms and policy developments in sub-Saharan Africa: The case for stronger national and regional responses.

ISSUES: Sub-Saharan Africa (SSA) has long been characterised as a region with weak alcohol policies, high proportions of abstainers and heavy episodic drinkers (among drinkers), and as a target for market expansion by global alcohol producers. However, inter-regional analyses of these issues are seldom conducted. APPROACH: Focusing mainly on the period 2000-2016, we compare alcohol consumption and harms, alcohol policy developments and alcohol industry activities over time and across the four sub-regions of SSA. KEY FINDINGS: Per-capita consumption of alcohol and alcohol-related disease burden have increased in Central Africa but stabilised or reduced in other regions, although they are still high. Most countries have implemented tax policies, but they have seldom adopted other World Health Organization 'best buys' for cost-effective alcohol control policies. Countries range from having minimal alcohol controls to having total bans (e.g. some Muslim-majority countries); and some, such as Botswana, have attempted stringent tax policies to address alcohol harm. Alcohol producers have continued their aggressive marketing and policy interference activities, some of which have been highlighted and, in a few instances, resisted by civil society and public health advocates, particularly in southern Africa. IMPLICATIONS: Increased government support and commitment are needed to be able to adopt and implement effective alcohol policies and respond to pressures from alcohol companies to which SSA remains a target market. CONCLUSION: SSA needs effective alcohol control measures in order to reverse the trajectory of worsening alcohol harms observed in some countries and reinforce improvements in alcohol harms observed in others.

The Prevalence and Context of Alcohol Use, Problem Drinking and Alcohol-Related Harm among Youth Living in the Slums of Kampala, Uganda.

BACKGROUND: The purpose of this paper is to investigate the prevalence and context of alcohol use, problem drinking and alcohol-related harm among boys and girls in the slums of Kampala, Uganda. METHODS: The Kampala Youth Survey is a cross-sectional study conducted in 2014 among youth (ages 12-18 years) living in the slums of Kampala (n = 1133) who were participating in Uganda Youth Development Link (UYDEL) centers. Chi-square tests were used to determine differences in alcohol use behaviors between 1) gender (boys vs. girls), and 2) alcohol use behaviors between problem drinkers and non-problem drinkers, stratified by gender. RESULTS: Among all participants (n = 1133), the prevalence of any alcohol use in the past 12 months was 31% (n = 346). A higher percentage of girl drinkers reported having sex in the past month, without a condom (57.9%) due to alcohol consumption, compared to boy drinkers (41.9%) (   χ 2 = 8.09, df = 1, p = 0.005). For girl and boy drinkers, nearly half (49.5% and 44.1%, respectively) met the criteria for problem drinkers, measured using the Cut-Annoyed-Guilty-Eye-Opener (CAGE) questionnaire. CONCLUSIONS: The high prevalence of alcohol use and problem drinking among youth, as well as alcohol-related harm, warrant urgent alcohol prevention and intervention strategies, particularly among these underserved girls.

The Risk Environment for Adopting and Continuing Injecting Drug Use: A Qualitative Study in Uyo, Nigeria.

Background: The bulk of research on adoption of injecting is from Europe and America, despite the existence of syndemics of drug injecting, HIV, and viral hepatitis globally. Objectives: This study explores adoption and continuation of injecting drug use. Methods: The study draws on in-depth interviews with 41 (n = 41) current male and female people who inject drugs recruited via snow-ball sampling in Uyo, Nigeria. A thematic and descriptive analysis was undertaken informed by the risk environment framework and focused on accounts of the factors influencing the process. Results: Accounts emphasized injecting adoption and continuation as a process influenced by individual, social, and structural factors within the risk environment, including concerns for pleasure/efficiency, prestige, exposure to/support for injecting within peer and sexual relationships, availability and purity of drugs, and dependence and increased cost of drug use. Conclusions/implications: Findings highlight the need to prevent adoption of injecting, reduce prevalence of injecting, and promote safe injecting through multi-level interventions, including peer-driven education, drug treatment services, needle and syringe distribution, oral drug substitution, and law enforcement targeting drug suppliers. The need for equivalent pleasure with minimal risk points to the strategic importance of peer interactions for inculcating new understandings of drug use and pleasure.

Botswana alcohol policy and the presidential levy controversy.

AIM: To assess the state of alcohol policy in Botswana in the context of a substantial levy imposed on alcohol sales by the President. DESIGN, MEASUREMENTS: Analysis of policy documents and media reports to describe the drivers of policy formation. SETTING, PARTICIPANTS: Botswana. FINDINGS: Legislation aimed at addressing the problem of excessive consumption of alcohol in the country has been proposed and enacted since independence in 1966 and a draft national alcohol policy is currently being debated. The policy recognizes the need to protect the rights of adult citizens of Botswana to purchase and consume alcohol in a safe and well-regulated manner and the role of government in ensuring that vulnerable members of the community are protected against the impact of harmful use of alcohol. In 2008, controversy erupted over the proposal by the President of the country to impose a 70% levy on alcohol products, later reduced to 30%. The industry responded by threatening to go to court and has since focused their response on what they claim to be serious economic losses due to reduced consumption of their products. CONCLUSIONS: The ongoing controversy in Botswana calls attention to the role of the industry in influencing the debate on alcohol and the need to keep in mind overall public health interest in efforts to develop and implement a national alcohol policy.

Packages of care for alcohol use disorders in low- and middle-income countries.

In the fourth in a series of six articles on packages of care for mental disorders in low- and middle-income countries, Vivek Benegal and colleagues discuss the treatment of alcohol use disorders.

Alcohol use and related problems in sub-saharan africa

Data from the World Health Organization Global Alcohol Database (GAD) show a wide variation in per capita consumption of recorded alcohol in African countries; ranging from less than 1 litre ofpure alcohol in some (mostly Muslim) countries to more than 10 litres in a couple of others. For all countries; a pattern of increasing per capita consumption emerged in the 1960s; continuedthroughout the 70s; and peaked around 1979 at about 4.5 litres. The steady rise in consumption paralleled post-independence economic boom in many countries; just as the slight decline in percapita consumption in the past two decades might be associated with worsening economic conditions. Today; the average per capita consumption is a little under 4 litres; less than half of theEuropean average. These figures do not account for much (in many cases the larger part) of the alcohol consumed in the form of traditional beverages since these are not reflected in officialrecords. Though a lot remains to be known about drinking and alcohol-related problems in Africa; there are a few consistent finding from survey research. Abstention rates are high; especially amongwomen; but high levels of (often episodic) consumption are common among male and female drinkers. Studies in several countries have shown an association between harmful consumption ofalcohol and health and social consequences; including death from road traffic accidents; domestic violence; HIV infection; and disorders requiring demand for treatment. Consumption of commercial beverages is expected to rise in the coming years as the economic conditions continue to improve in some countries and as a result of increasing marketing and promotion activities by the industry.National responses to these problems will require better research evidence on the health and social problems attributable to alcohol consumption; and the implementation of effective policies toaddress these problems in countries across the continent

Thirsting for the African Market

The overall per capita consumption of alcohol in the African continent remains low though rates in some countries are among the highest in the world. Africa; therefore; is one of several untapped markets in the world that have attracted attention from the alcohol industry in recent times. This paper reviews the prospects for global alcohol companies in the continent; examining the value of the African market to the industry as well as a range of political; social and economic factors which are associated with the growth of the market for commercial alcoholic beverages. To highlight and illustrate the activities of the industry; two case studies are presented focusing on marketing and promotional activities of key industry players in South Africa and Nigeria. The paper concludes with a call to African governments and the alcohol industry to become more aware of the public health and social dangers posed by alcohol consumption and to respond through prevention efforts aimed at limiting the exposure of young people to alcohol advertising and promotion