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

Social determinants of hazardous alcohol use in a Ugandan population cohort

BACKGROUND

There is a limited population-based data on hazardous alcohol use and associated social determinants in many African countries.

OBJECTIVES

To examine patterns of hazardous alcohol use across a range of social determinants of health in Uganda, with a particular focus on gender differences.

METHODS

This cross-sectional study used data collected in 2021-2022 from an open population cohort spanning urban, semi-urban, and rural communities. Alcohol use was assessed with the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C). Covariates were selected according to the WHO's Social Determinants of Health framework. Poisson regression with robust variance was used for data analysis.

RESULTS

Of the 3459 participants, 2085 (60%) were women. Overall, the prevalence of hazardous alcohol use was 5% among women and 18% among men. Strong positive associations with hazardous use were found for individuals residing in semi-urban areas (female aPR 2.1 [95% CI 1.3-3.3], male aPR 1.8 [95% CI 1.4-2.5]), past-year perpetration of intimate partner violence (female aPR 2.2 [95% CI 0.8-5.6], male aPR 1.4 [95% CI 0.9-2.2]), smoking, middle age for men (aPR 1.6 [95% CI 1.2-2.2]), and employment as a vendor in a restaurant or bar for women (aPR 1.5 [95% CI 1.0-2.2]). Strong negative associations were found for high educational attainment, Muslim or Pentecostal religion, and living in a marriage or union for women (aPR 0.7 [95% CI 0.5-1.0]).

CONCLUSIONS

Hazardous alcohol use was prevalent, especially among men, in a representative Ugandan population sample. Specific target groups for public health and clinical interventions were identified, such as women working in the hospitality sector. Residents of semi-urban communities may encounter unique risks for hazardous alcohol use, compared with rural and highly urban populations.

Transnational alcohol corporations in Nigeria as commercial determinants of health: Implications for policy

Research on commercial determinants of health (CDoH) has burgeoned in the Global North. However, despite the heavy presence of harmful commodity industries in Africa, little scholarly attention has been paid to CDoH. Transnational alcohol corporations (TNACs) in Nigeria deploy well-articulated marketing strategies and practices that negatively impact health in their quest for profit maximisation, wealth extraction and influence. Nevertheless, their tactics and practices are largely unregulated and understudied. This commentary demonstrates how TNACs in Nigeria are a key pervasive and harmful CDoH, highlighting the policy implications of their strategies and practices. Focusing on changing norms that constrain young people's drinking, TNACs promote hazardous drinking practices by using drinking games as a marketing strategy where the winners receive more alcohol and money as prizes. Alcohol corporations also encourage sexual risk-taking and associated harm by marketing alcoholic bitters as aphrodisiacs and sex enhancers. From 2014 to 2016, one TNAC organised the annual Nigerian Beer Symposium, spreading misleading information that beer consumption prevents cancer, reduces kidney stones, and improves women's skin beauty. Furthermore, through partnerships with the government, TNACs appear to use industry-led corporate social responsibility (CSR) initiatives to lobby officials, enhance corporate reputations, sustain pro-drinking framings, disinformation/misinformation and self-regulation, and silence discussions on alcohol policy implementation. While TNACs' products and practices negatively impact health/equities, decision-makers appear to enable their enormous power. The government should embrace evidence against TNACs as CDoH, implement policies to regulate them and collaborate with civil society organisations/advocates to hold them to account. Relatedly, the government should hold TNACs to account through international mechanisms because most of their practices violate laws in the Global North countries where they are headquartered.

Testing a systematically braided alcohol reduction and HIV status neutral intervention among people receiving STI care in Malawi: study protocol for a pilot hybrid type 1 effectiveness-implementation randomized controlled trial

Background

Heavy alcohol use is common in Malawi among people receiving sexually transmitted infections (STI) care and is a critical barrier to the success of HIV prevention and treatment efforts.

Methods

This protocol presents a pilot hybrid type 1 effectiveness-implementation trial evaluating the short-term effectiveness and implementation of a scalable evidence-based intervention (EBI) to reduce alcohol use and provide HIV prevention and treatment counseling for people with heavy drinking receiving STI care in Malawi. We developed a 3-session intervention, Treat4All, that uses motivational interviewing, problem-solving skills, psychoeducation, alcohol refusal, HIV prevention and treatment skills building, and goal setting to reduce alcohol and facilitate engagement in HIV prevention and treatment. We have also integrated HIV prevention content to focus on persistent PrEP use and HIV treatment adherence to improve antiretroviral therapy (ART) adherence and viral suppression. We will conduct a two-arm pilot randomized controlled trial (RCT) in an STI care setting in urban Malawi to compare the preliminary effectiveness and implementation of Treat4All to usual care for decreasing the proportion of heavy drinking days, corroborated with phosphatidylethanol, an alcohol biomarker, and improving HIV outcomes (viral suppression among PWH; PrEP use among those at risk). We will randomly assign 160 people receiving STI care in Lilongwe who report heavy drinking (n = 80 people with HIV; PWH; n = 80 people at high risk of HIV acquisition) to Treat4All or usual care.

Discussion

Our study will produce a systematically braided, scalable HIV status-neutral EBI for alcohol reduction and optimization of HIV prevention and treatment behaviors to evaluate in a larger effectiveness-implementation trial. Our study will directly expand alcohol reduction and HIV status-neutral programs for alcohol-impacted populations throughout sub-Saharan Africa and other regions where alcohol contributes to the ongoing HIV epidemic.

Clinical trial registration

ClinicalTrials.gov, NCT06668363.

Changing public perceptions of alcohol, alcohol harms and alcohol policies: A multi-methods study to develop novel framing approaches

BACKGROUND AND AIMS

Public perceptions of alcohol and its related harms and policies are shaped by multiple discourses and can influence behaviour and policy support. As part of a FrameWorks-informed project to test framing approaches to improve public understanding and support for evidence-based alcohol policies in the UK, this research aimed to (i) summarise relevant evidence; (ii) compare how public understanding of alcohol harms differs from those of academic and charity experts; and (iii) develop novel framing approaches.

METHODS

(1) a literature review including systematic, scoping and targeted components to understand previous evidence on effective framing from behaviour change, UK alcohol policy and FrameWorks literatures; (2) comparison of public views of alcohol harms and policies from four focus groups (n = 20) with those of public health experts; (3) an iterative process involving workshops and stakeholder consultation to develop 12 novel framing approaches.

RESULTS

We found no previous study that directly tested framing approaches for alcohol policy advocacy. Our narrative summary of 35 studies found that explaining diverse harms may be important, whereas framing that engenders empathy, emphasises dependence or invokes a sense of crisis may be less effective. In focus groups, the public linked alcohol to pleasure/socialising, whilst understandings of harm focused on severe alcohol problems and individual deficits of biology or personality, with policy proposals focused mainly on treatment/support services. Public health experts highlighted more diverse harms and solutions, emphasising environmental and commercial causes. Comparison of public and expert views yielded six tasks for novel framing approaches to deepen public understanding. The team co-developed initial framing ideas (n = 31), before finalising 12 narrative framing approaches based on values (n = 5), metaphors (n = 3) and explanation (n = 4).

CONCLUSIONS

In the United Kingdom, public and expert understandings of alcoholrelated harms, causes and solutions differ. Along with prior evidence, these differences can inform novel framing approaches designed to deepen public understanding.

Alcohol industry involvement in the delayed South Africa Draft Liquor Amendment Bill 2016: a case study based on freedom of information requests

BACKGROUND

South Africa is reported to have one of the highest per capita rates of alcohol consumption among drinkers globally, with alcohol harms exacerbating socio-economic inequalities in the country. The Draft Liquor Amendment Bill 2016 proposed new restrictions on alcohol advertising, availability, and liability of retailers and manufacturers for harm related to any contravention of the regulations. To date, the Bill has not progressed through the legislative process. The alcohol industry is known to use a diverse set of strategies to delay evidence-based policies globally.

METHODS

We aimed to explore Bill-related activity by industry within the National Economic and Development Labour Council, a multi-stakeholder forum that assesses socio-economic policies before they reach parliament. On 06 July 2023 we made a Request for Access to Record, using form two of the Promotion of Access to Information Act (PAIA), no. 2 of 2000 to the National Economic and Development Labour Council for access to minutes of all meetings, reports, and any other publications related to the Bill between January 2016 and December 2022. Informed by Ulucanlar et al's (2023) model and taxonomies of corporate political activity, we extracted data on industry Bill-related activity and thematically analysed key events, presented here as a narrative synthesis.

RESULTS

We identified activity by 14 alcohol industry organisations related to the Bill between 2016 and 2022. Industry representation on five National Economic and Development Labour Council-related committees identified between 2017 and 2021 facilitated their involvement in Bill-related discussions and supported access to other government departments. Community representation was low in all committees compared to industry, labour, and government. Industry funded two socio-economic assessments of the Bill in 2017 and 2022, despite an independent socio-economic impact assessment having already been completed. The 2017 report delayed progress of the Bill, and the 2022 're-evaluation' was more critical of the proposed measures, with the differing conclusions attributed to different methodologies. During the covid-19 pandemic, industry used a 'carrot and stick' approach of legal threats and donations to attempt to move towards self-regulation via a social compact. The National Economic and Development Labour Council confirmed in 2023 that the social compact was unsuccessful.

CONCLUSIONS

Early 'regulatory capture' gave the alcohol industry the opportunity to shape assessment of the Bill within the National Economic and Development Labour Council. Our findings are in line with previous studies on corporate influence on policy globally, and support calls for a reassessment of the role and proportion of industry representation within the National Economic and Development Labour Council locally.

Alcohol restrictions and suicide rates in South Africa during the COVID-19 pandemic: results of a natural experiment

BACKGROUND

Alcohol use is a well-established potentially modifiable risk factor for suicide, yet few studies have investigated the impact of alcohol restrictions on suicide rates, particularly in low- and middle-income countries.

METHODS

We used data from nationally representative annual surveys of postmortem investigations in 2017 (n=6117) and 2020/21 (n=6586) to estimate changes in suicide rates associated with the COVID-19 pandemic and related alcohol restrictions.

FINDINGS

Age standardised suicide mortality rates per 100 000 were 10.91 (10.64, 11.18) in 2017 and 10.82 (10.56, 11.08) in 2020/2021, with approximately 4.4 times more deaths among males than females in both periods. No significant differences were observed between overall suicide rates during the 2020/2021 pandemic period compared with 2017 (risk ratio=1.04 (1.00, 1.07)), but in the 15-24-year age group, suicide rates were 11% higher among males and 31% higher among females than in 2017. Partial alcohol restrictions during the pandemic were not associated with lower suicide risk. However, the shift from partial to full restriction on the sale of alcohol was associated with an 18% (95% CI 10% to 25%) reduction in suicides for both sexes combined and a 22% (95% CI 13% to 30%) reduction in suicides among men, but no significant reduction among women.

INTERPRETATION

Our findings offer some support for the hypothesis that restricting access to alcohol at a population level is associated with a reduction in suicide rates and suggests that restricted access to alcohol may have been one of the reasons global suicide rates did not increase during the pandemic in some countries.

Alcohol marketing as a commercial determinant of health: daily diary insights from young women in Kampala

Alcohol marketing, as a commercial determinant of health, presents an emerging threat to global health and is of particular importance in low-resource settings. This study is composed of data from 'The Onward Project On Wellbeing and Adversity' (TOPOWA) project, a multicomponent prospective cohort study examining the mechanistic pathways of adverse mental health conditions among women aged 18 to 24 years living in the Kampala slums in Uganda. The cohort consists of 300 women recruited in 2023 from three study sites (i.e., Banda, Bwaise, and Makindye). In this study, we deployed an underutilized tool, daily diaries, for assessing the exposure to alcohol marketing and an alcohol-promoting environment among young women living in the urban slums of Kampala, Uganda to spur new research and action. At baseline, participants completed a 5-day daily diary and an interviewer-administered survey. Findings show that alcohol-related neighborhood features were most frequently reported, including bars (Mean = 3.88 days), people drinking alcohol (Mean = 3.75), alcohol selling points (Mean = 3.45) and alcohol ads on TV (Mean = 2.51). Women who were exposed to bars (PR = 1.31) and alcohol ads on billboards (PR = 1.14) in a day were more likely to report alcohol use. Similarly, those exposed to alcohol ads on billboards (PR = 1.76) and bars (PR = 2.02) every day were more likely to report alcohol use. Higher cumulative exposure to different alcohol-related features was associated with a greater likelihood of alcohol use, particularly in the group with the highest exposure level. These findings underscore a need to develop alcohol counter-marketing strategies and harm reduction approaches. Daily diaries proved to be a feasible strategy in capturing real-time exposure data, which could in turn support prevention measures and the evaluation of intervention strategies.

Tax and noncommunicable diseases attributable to tobacco and alcohol consumption in 5 Sub-Saharan African countries

Background

Increased taxation on alcohol and tobacco is among the cost-effective measures used to deal with the burden of noncommunicable diseases (NCDs) globally. Despite adopting such efforts, the impacts of taxation on alcohol and tobacco are yet to be fully understood.

Objective

The study's objective is to find empirical evidence regarding changes in the NCD mortality rate associated with changes in the tax rates of tobacco and alcohol.

Methods

The study adopted the System Generalized Method of Moments (SGMM) to explore the relationship between levels of taxes and NCD mortality rates. The SGMM allowed the inclusion of the dependent variable as an explanatory variable, assuming reverse causality was assumed.

Results

There appears to be a negative relationship between increased taxes and the rates of NCDs. Specifically, we provide empirical evidence supporting the negative association between taxes on alcohol and tobacco cigarettes and the mortality rates from NCDs, which aligns with the propositions advocated by the World Health Organization (WHO). Additionally, the interaction between alcohol taxes on spirits and beer indicates a possibility of complementarity, consistent with taxation principles. Notably, we also observed that higher tobacco cigarette prices are negatively associated with NCD mortality rates.

Conclusion

The results indicate that increasing taxes on major health risk factors is necessary to reduce non-communicable diseases (NCDs). Implementing these tax increases will likely help achieve Sustainable Development Goal 3.4, which aims to reduce NCD mortality by one-third by the year 2030.

Exploring links-exposure to alcohol adverts on social media in relation to alcohol use among university students in Uganda

AIM

This study assessed the association between exposure to alcohol adverts on social media and alcohol use among university students in Uganda since alcohol consumption has severe effects, especially in countries with weak regulations for alcohol marketing.

METHODS

In total, 996 undergraduate students at Makerere University responded to a questionnaire assessing exposure to alcohol advertising on social media (independent variable) and alcohol use (dependent variable). Adjusted multinomial logistic regression was used to analyse data.

RESULTS

One in ten students reported hazardous drinking, while three in ten students were low-risk drinkers. Most students (70.1%) reported low exposure to alcohol adverts on social media, followed by high exposure (12.1%), and 17.8% reported no exposure. A key finding was that exposure to alcohol adverts on social media was significantly associated with alcohol use, especially the high exposure and hazardous drinking (odds ratio = 12.62, 95% confidence interval: 4.43-35.96). Students reporting high exposure to alcohol adverts on social media also had higher odds of low-risk drinking (odds ratio = 3.70, 95% confidence interval: 1.88-7.27) than those with low exposure (odds ratio = 1.77, 95% confidence interval: 1.09-2.87), in reference to no exposure.

CONCLUSION

Among Ugandan university students, exposure to alcohol adverts on social media is common and associated with alcohol use, in a dose-response manner. These findings suggest a need for a design and implementation of alcohol interventions for students using social media.

Enhancing Alcohol-Related Research in Africa: Possibility for a Continental-Wide Alliance

Alcohol-related harms constitute a major public health concern in Africa, with high rates of alcohol consumption and associated negative health and social consequences. Despite this, there is a lack of comprehensive and coordinated research on alcohol use and related harms across the continent. This paper discusses common factors such as diverse traditions and cultures, prevailing low socioeconomic status, gendered approach, limited policy and weak regulation and compliance to existing alcohol control policies that contribute to alcohol-related problems, and the challenges facing alcohol-related research including limited research, isolated and uncoordinated research, and resource scarcity; it further proposes strategies for advancing a continental-wide alliance to enhance alcohol-related research in Africa. The alliance would bring together researchers, policymakers, and other stakeholders to collaborate on research projects, share data and resources, and develop evidence-based interventions to reduce alcohol-related harms. Furthermore, the paper outlines the potential benefits of such an alliance, including improved data collection and analysis, greater capacity building for researchers, and more effective policy and program development. The paper concludes that a continental-wide alliance on alcohol-related research in Africa has the potential to significantly enhance our understanding of alcohol use and related harms on the continent and to inform effective prevention and intervention strategies.

Alcohol use and alcohol use disorders in sub-Saharan Africa: A systematic review and meta-analysis

BACKGROUND AND AIMS

Population-level alcohol use data are available from high-income countries, but limited research has been conducted in sub-Saharan Africa. This systematic review and meta-analysis aimed to summarize population-level alcohol use in sub-Saharan Africa.

METHOD

Databases searched included PubMed, EMBASE, PsycINFO and AJOL, without language restrictions. Searches were also conducted in the Global Health Data Exchange (GHDx) and Google Scholar. Search terms encompassed 'substance' or 'substance-related disorders' and 'prevalence' and 'sub-Saharan Africa'. We included general population studies on alcohol use (including any use, high-risk alcohol use and alcohol use disorders) from 2018 onwards. Prevalence data for alcohol use among sub-Saharan African adolescents (10-17) and adults (18+) were extracted. Analyses included life-time and past 12- and 6-month alcohol use.

RESULTS

We included 141 papers. Among adolescents, the life-time prevalence of alcohol use was 23.3% [95% confidence interval (CI) = 11.3-37.1%], 36.2% (CI = 18.4-56.1%) in the past year and 11.3% (CI = 4.5-20.4%) in the past 6 months. Among adolescents, 12-month prevalence of alcohol use disorder and alcohol dependence were 7.7% (CI = 0.0-27.8%) and 4.1% (CI = 1.4-7.9%), respectively. Among adults, the life-time prevalence of alcohol use was 34.9% (CI = 17.7-54.1%), 27.1% (CI = 5.0-56.4%) in the past year and 32.2% (CI = 19.8-46.0%) in the past 6 months. Among adults, the 12-month prevalence of alcohol use disorder and alcohol dependence were 9.5% (CI = 0.0-30.4%) and 4.3% (CI = 0.8-9.8%), respectively. The highest weighted life-time prevalence of alcohol use, 86.4%, was reported in Tanzania among adults. The highest weighted past 6-month prevalence of alcohol use, 80.6%, was found in Zambia among adolescents.

CONCLUSION

Alcohol use patterns vary across countries and subregions within sub-Saharan Africa, and comprehensive population-level data on alcohol use remain scarce in numerous sub-Saharan African countries. The prevalence of alcohol use disorder is common among adolescents in sub-Saharan Africa.

The influence of crisis on policy formulation: the case of alcohol regulation in South Africa during COVID-19 (2020-21)

This study contributes to a neglected aspect of health policy analysis: policy formulation processes. Context is central to the policy cycle, yet the influence of crises on policy formulation is underrepresented in the health policy literature in low- and middle-income countries (LMICs). This paper analyses a detailed case study of how the COVID-19 crisis influenced policy formulation processes for the regulation of alcohol in South Africa, as part of COVID-19 control measures, in 2020 and 2021. It provides a picture of the policy context, specifically considering the extent to which the crisis influenced the position and power of actors, and policy content. Qualitative data were collected from nine key informant interviews and 127 documents. Data were analysed using thematic content analysis. A policy formulation conceptual framework was applied as a lens to describe complex policy formulation processes. The study revealed that the perceived urgency of the pandemic prompted a heightened sense of awareness of alcohol-related trauma as a known, preventable threat to public health system capacity. This enabled a high degree of innovation among decision-makers in the generation of alternative alcohol policy content. Within the context of uncertainty, epistemic and experiential policy learning drove rapid, adaptive cycles of policy formulation, demonstrating the importance of historical and emerging public health evidence in crisis-driven decision-making. Within the context of centralization and limited opportunities for stakeholder participation, non-state actors mobilized to influence policy through the public arena. The paper concludes that crisis-driven policy formulation processes are shaped by abrupt redistributions of power among policy actors and the dynamic interplay of evolving economic, political and public health priorities. Understanding the complexity of the local policy context may allow actors to navigate opportunities for public health-oriented alcohol policy reforms in South Africa and other LMICs.

Emotional and cognitive influences on alcohol consumption in middle-aged and elderly Tanzanians: a population-based study

Alcohol consumption in Tanzania exceeds the global average. While sociodemographic difference in alcohol consumption in Tanzania have been studied, the relationship between psycho-cognitive phenomena and alcohol consumption has garnered little attention. Our study examines how depressive symptoms and cognitive performance affect alcohol consumption, considering sociodemographic variations. We interviewed 2299 Tanzanian adults, with an average age of 53 years, to assess their alcohol consumption, depressive symptoms, cognitive performance, and sociodemographic characteristics using a zero-inflated negative binomial regression model. The logistic portion of our model revealed that the likelihood alcohol consumption increased by 8.4% (95% confidence interval [CI] 3.6%, 13.1%, p < 0.001) as depressive symptom severity increased. Conversely, the count portion of the model indicated that with each one-unit increase in the severity of depressive symptoms, the estimated number of drinks decreased by 2.3% (95% CI [0.4%, 4.0%], p = .016). Additionally, the number of drinks consumed decreased by 4.7% (95% CI [1.2%, 8.1%], p = .010) for each increased cognitive score. Men exhibited higher alcohol consumption than women, and Christians tended to consume more than Muslims. These findings suggest that middle-aged and elderly adults in Tanzania tend to consume alcohol when they feel depressed but moderate their drinking habits by leveraging their cognitive abilities.

Corporate social responsibility, policy framing and strategic marketing: understanding the alcohol industry's use of social media in Uganda

BACKGROUND

Sub-Saharan Africa is important to the future of alcohol and global health because the alcohol market there is expanding rapidly in a relatively young population. This entails a corresponding contest about whether the policy measures adopted will be shaped by scientific evidence or by industry interference in alcohol policy. This study examines how alcohol industry actors use social media.

METHODS

Uganda was selected for study because of high levels of alcohol harm and recent alcohol policy debates. Data on the X (formerly Twitter) activity of the Ugandan companies of AB InBev and Diageo, who are the two main brewers, and the trade association including both, were collected, coded and thematically analysed.

RESULTS

X is used overwhelmingly by alcohol industry actors in Uganda to promote corporate social responsibility (CSR) and alcohol policy framing content. There is little direct product marketing. The framing of policy problems and solutions, and of the actors involved in policymaking and CSR resembles that used elsewhere in the political strategies of the transnational alcohol corporations. Content which appears more emphasised in Uganda includes material on farmers, illicit trade and contribution to the economy. As elsewhere, it avoids giving attention to the policy measures which would make a difference to the levels of alcohol harms endured by Uganda. Rhetorically, X is thus used to create a parallel universe, in which the actual harms and what is known about how to reduce them are conspicuous by their absence.

CONCLUSIONS

The alcohol industry presents itself as indispensable to Uganda's future and appears to have developed relationships with politicians, partnerships with government, and built a coalition with farmers. This means the alcohol industry may be well positioned to oppose public health policy measures, even though their arguments lack substance and are at odds with the evidence.

Negotiating situational abstinence and moderation: a study of regular and heavy-drinking young Nigerians

Studies that have examined young people's drinking behaviour, particularly how they abstain from alcohol or drink lightly and their motivations, have focused on Western contexts. Currently, studies on how and why young Africans abstain from alcohol or drink moderately are lacking. Therefore, there is a need to examine young people's drinking behaviours/practices on the continent to facilitate health promotion interventions. This study, which uses qualitative data elicited from 53 participants, explores how young Nigerian men and women who consume alcohol and drink heavily enact and negotiate abstinence and moderate drinking and the factors that motivate their choices. Some participants constructed situational abstinence, while others participated in temporary light drinking in their friendship networks, but these attracted some consequences. Peers pressured them, but some deployed the ability to offer 'valid' explanations and express self-determination and agency to ward off such pressures and negotiate situational abstinence or moderate drinking. Additionally, the fear of public embarrassment, negative publicity on social media due to intoxication and parental influences motivated some participants' occasional sobriety. Others relied on previous personal or friends' negative experiences of drunkenness or the consequences of heavy drinking represented in movies and books to construct occasional light drinking. The findings demonstrated how enacting and rejecting particular forms of masculinity and embodied gendered drinking practices, more generally, in some friendship groups, facilitated situational abstinence and moderation. Policymakers should partner with young people to design interventions that encourage abstinence or moderation and mitigate the current drinking practices in Nigeria, which will enhance health promotion.

From Shadows to Spotlight: Exploring the Escalating Burden of Alcohol-Associated Liver Disease and Alcohol Use Disorder in Young Women

INTRODUCTION

The burden of alcohol-related complications is considerable, particularly alcohol-associated liver disease and alcohol use disorder (AUD). However, there are deficiencies in comprehensive epidemiological research focusing on these issues, especially among young women who display higher susceptibility to such complications compared with their male counterparts. We thus aimed to determine the global burden of these conditions in this vulnerable group.

METHODS

Leveraging data from the Global Burden of Disease Study 2019, we analyzed the prevalence, mortality, and disability-adjusted life years of alcohol-associated cirrhosis (AC), liver cancer from alcohol, and AUD in young women. The findings were categorized by region, nation, and sociodemographic index.

RESULTS

The highest age-standardized prevalence rates were observed in AUD (895.96 [95% uncertainty interval (UI) 722.6-1,103.58]), followed by AC (65.33 [95% UI 48.37-86.49]) and liver cancer from alcohol (0.13 [95% UI 0.09-0.19]) per 100,000 people. The highest age-standardized mortality rates were observed in AC (0.75 [95% UI 0.55-0.97]), followed by AUD (0.48 [95% UI 0.43-0.53]) and liver cancer from alcohol (0.06 [95% UI 0.04-0.09]). The highest burdens of AC and AUD were observed in Central Europe, whereas the high-income Asia Pacific had the highest burden of liver cancer from alcohol.

DISCUSSION

Throughout the past decade, the trend of AUD varied among regions while the impact of alcohol-associated liver disease has increased, requiring urgent public health strategy to mitigate these complications, particularly in female patients in Europe and the Asia-Pacific region.

Alcohol industry-sponsored music festivals, alcohol marketing and drinking practices among young Nigerians: Implications for policy

INTRODUCTION

The global alcohol industry sponsors social/music events targeting young people; however, existing literature focuses on Westernised contexts. Given the decline in young people's drinking in many Western countries, it appears that multinational alcohol companies are importing the strategies they have used in high-income countries to the Global South countries like Nigeria to recoup profits. This study aims to examine the Guinness Show- a free one-month annual music festival, alcohol marketing at the festival and the extent to which the event encourages diverse drinking practices among its attendees.

METHODS

We observed the music festival before collecting data through 53 interviews and 3 focus groups (N = 26). Data were analysed to generate themes with the aid of NVivo 12 software.

FINDINGS

Over 6000 participants attend the Guinness Show daily, and participants gave detailed descriptions of the music festival, alcohol marketing activities that occur in it and the drinking practices of attendees, indicating that they were highly knowledgeable of the event. The Guinness Show attracts famous music artistes and other entertainers. Therefore, young people attend to see them perform free of charge. However, diverse alcohol promotions (e.g., quantity deals, low prices, giveaways) that happen daily, the strategic use of young women as 'beer promoters', and the pleasure the event induces by fusing music/entertainment into alcogenic environments, encourage drinking and drunkenness. All the attendees drank alcohol, and some engaged in impulse buying, while many consumed excessively due to promotions (e.g., buy-two-get-one free), which facilitated intoxication and the loss of control.

CONCLUSIONS

Guinness Nigeria organises the event for strategic brand communication, generating brand capital, and encouraging alcohol purchases and consumption among young people. Policymakers should reconsider self-regulation and implement national alcohol control policies and other public health interventions to restrain the alcohol industry from sponsoring such events.

Identifying and Validating Alcohol Diagnostics for Injury-Related Trauma in South Africa: Protocol for a Mixed Methods Study

BACKGROUND

The burden of alcohol use among patients with trauma and the relative injury risks is not routinely measured in South Africa. Given the prominent burden of alcohol on hospital trauma departments, South Africa needs practical, cost-effective, and accurate alcohol diagnostic tools for testing, surveillance, and clinical management of patients with trauma.

OBJECTIVE

This study aims to validate alcohol diagnostics for injury-related trauma and assess its use for improving national health practice and policy.

METHODS

The Alcohol Diagnostic Validation for Injury-Related Trauma study will use mixed methods across 3 work packages. Five web-based focus group discussions will be conducted with 6 to 8 key stakeholders, each across 4 areas of expertise (clinical, academic, policy, and operational) to determine the type of alcohol information that will be useful for different stakeholders in the injury prevention and health care sectors. We will then conduct a small pilot study followed by a validation study of alcohol diagnostic tools (clinical assessment, breath analysis, and fingerprick blood) against enzyme immunoassay blood concentration analysis in a tertiary hospital trauma setting with 1000 patients. Finally, selected alcohol diagnostic tools will be tested in a district hospital setting with a further 1000 patients alongside community-based participatory research on the use of the selected tools.

RESULTS

Pilot data are being collected, and the protocol will be modified based on the results.

CONCLUSIONS

Through this project, we hope to identify and validate the most appropriate methods of diagnosing alcohol-related injury and violence in a clinical setting. The findings from this study are likely to be highly relevant and could influence our primary beneficiaries-policy makers and senior health clinicians-to adopt new practices and policies around alcohol testing in injured patients. The findings will be disseminated to relevant national and provincial government departments, policy experts, and clinicians. Additionally, we will engage in media advocacy and with our stakeholders, including community representatives, work through several nonprofit partners to reach civil society organizations and share findings. In addition, we will publish findings in scientific journals.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52949.

The confluence of legacy, corporate social responsibility, and public health: The case of Migros and alcohol-free retailing in Switzerland

BACKGROUND

Alcohol policy studies have traditionally focused on formal policymaking processes. Retail cooperatives, however, have rarely been studied as sites of public health interventions. Migros, a cooperatively owned chain of supermarkets in Switzerland, has long forbidden alcohol sales in its supermarkets. Focusing on processes of framing, this study explores a recent unsuccessful attempt to reverse the long-standing ban via membership vote in 2022.

METHODS

The study draws on a range of data sources, including company documents, a televised debate, and the results of a large online survey among the general population conducted ahead of the referendum. Using thematic analysis, it investigates various campaign-related arguments, including those made by Migros management, NGOs, and other key campaign participants.

RESULTS

Proponents and opponents used a combination of public health, economic/market-oriented, and corporate social responsibility (CSR) frames. Migros's longstanding dedication to CSR, its participatory governance structure, and the regional political dynamics in the Swiss context are essential in understanding the nature and impact of framing.

CONCLUSIONS

Alcohol-related harm arises from a complex interaction between different social, political, and economic factors. Reducing harm requires approaches that consider the range of contexts and measures that can shape alcohol availability.

Factor structure of the alcohol expectancies questionnaire among adolescents in rural Ghana

INTRODUCTION

Children's early experiences with alcohol inform the development of alcohol-related beliefs which are known to predict alcohol consumption during the critical stage of adolescence. Yet, there has been considerably less research into these alcohol-related cognitions in low- and middle-income countries (LMIC) and existing measures of these beliefs are highly reflective of Western contexts, which may not be fully appropriate for use in LMICs. The aim is to ascertain the construct validity of the Alcohol Expectancies Questionnaire (AEQ) in a non-Western sample.

METHODS

A cross-sectional diagnostic accuracy study involving 500 adolescents aged 10 to 18 years randomly selected from the database of the Navrongo Health and Demographic Surveillance System. Participants were administered the locally back translated version of the 34-item AEQ. Confirmatory factor analysis using the lavaan package in R was conducted to generate indices for the factor structure of the AEQ.

RESULTS

Confirmatory factor analyses showed that while groupings of positive and negative expectancies were similar to those observed when expectancies have been assessed previously in Western studies, these formed a single 'alcohol expectancy' factor. Questions relating to positive tension reduction and negative physical expectancies showed inconsistent responses in this study.

DISCUSSION AND CONCLUSIONS

Commonly used tools for the assessment of alcohol expectancies may not be suitable for use in Ghana, possibly owing to their development and validation in Western contexts. These findings have implications for the assessment of alcohol-related beliefs in LMIC settings and begin to map out a research agenda to develop more contextually and culturally attune alcohol assessments.

Whole-of-community and intersectoral interventions that address alcohol-related harms: A scoping review

Alcohol harms threaten global population health, with youth particularly vulnerable. Low - and middle-income countries (LMIC) are increasingly targeted by the alcohol industry. Intersectoral and whole-of-community actions are recommended to combat alcohol harms, but there is insufficient global evidence synthesis and research examining interventions in LMIC. This paper maps existing literature on whole-of - community and intersectoral alcohol harms reduction interventions in high-income countries (HIC) and LMIC. Systematic searching and screening produced 61 articles from an initial set of 1325: HIC (n = 53), LMIC (n = 8). Data were extracted on geographic location, intersectoral action, reported outcomes, barriers, and enablers. HIC interventions most often targeted adolescents and combined community action with other components. LMIC interventions did not target adolescents or use policy, schools, alcohol outlets, or enforcement components. Programme enablers were a clear intervention focus with high political support and local level leadership, locally appropriate plans, high community motivation, community action and specific strategies for parents. Challenges were sustainability, complexity of interventions, managing participant expectations and difficulty engaging multiple sectors. A learning agenda to pilot, scale and sustain whole-of-community approaches to address alcohol harms in settings is crucial, with consideration of local contexts and capacities, more standardised methods, and a focus on community-driven action.

Alcohol misuse as a social determinant of food insecurity among smallholder farmers

The availability and affordability of alcohol in smallholder communities have surged the misuse of alcohol. Misusing alcohol has dire health and nutrition consequences in smallholder communities. Alcohol misuse can divert household resources from essential household needs such as food and also hinder local food production. In the context of multiple stressors on smallholder farmers' livelihoods, it is crucial to assess the relationship between alcohol consumption and smallholder farmers' experience of hunger. Therefore, we used data from a cross-sectional survey involving 1100 smallholder farmers in the Upper West region of Ghana to examine the association between alcohol consumption and household food insecurity. Results showed that daily (OR = 3.81; p ≤ 0.001) and weekly/frequent (OR = 2.32; p ≤ 0.001) consumption of alcohol was significantly associated with higher odds of household food insecurity compared to no consumption. The relationship between alcohol and food insecurity was bidirectional. The experience of food insecurity was also significantly associated with higher odds of occasional or frequent alcohol consumption. While alcohol misuse can transition smallholder households into food insecurity, the household heads of food insecure households may resort to alcohol to cope with underlying stressors such as climate change and food insecurity. This calls for policy interventions to mitigate alcohol misuse through regulations, surveillance, economic disincentives and improving the social mechanisms of resilience to climate change and food insecurity in smallholder communities. However, policy approaches must be cautious not to disrupt the livelihoods of vulnerable smallholder farmers.

Alcohol licensing legislation and licensing system in South-West Nigeria: Implications to regulate physical availability of alcohol

INTRODUCTION

The proliferation of alcohol outlets has led to increased physical availability of alcohol, harmful alcohol consumption and related harm in Nigeria. This study explored alcohol licensing legislations and licensing systems across local government councils (LGC) in South-West, Nigeria.

METHODS

Twenty-four LGCs across three states participated in the study. Data were generated from: (i) documents containing LGC liquor licensing legislations; and (ii) semi-structured interviews conducted with 50 LGC officials (16 legislative council clerks and 34 finance officers [director of finance, rate officers and revenue collectors]) were thematically analysed using NVivo.

RESULTS

Nine of the sampled LGC enacted liquor licence bylaws. These mostly specified categories of liquor licences issued and licensing fees. None of the liquor licence bylaw contained regulations for controlling physical availability of alcohol and outlet density. Finance officials were licensing officers and there were no licensing committees across the LGCs. The LGC officials were unanimous in stating that generating revenue from licensing fees was the main objective for licensing alcohol outlets. The LGCs licensed alcohol outlets indiscriminately and failed to regulate outlet density.

DISCUSSION AND CONCLUSION

The absence of regulations for controlling outlet density has implications for physical availability of alcohol in Nigeria. Our findings strongly suggest the need to develop national liquor licensing legislation with public health objectives and implementing regulations for controlling temporal and spatial availability of alcohol. Each LGC should inaugurate a licensing committee with clearly defined roles and responsibilities for licensing stakeholders such as LGC health officials, law enforcement agencies and community members.

Community voices on alcohol harm in Sierra Leone: Perceptions of prevention needs

Objective

The research purpose is to determine alcohol prevention needs in Sierra Leone.

Methods

We analyzed a cross-sectional survey from fall 2020, distributed by the West African Alcohol Policy Alliance to their partners across nine West African countries. The survey included questions on perceptions of alcohol harm, research priorities, and capacity and reach of the organizations represented. Only participants from Sierra Leone were included (n = 33).

Results

When asked if they thought measures taken to prevent alcohol-related harm in their country have been adequate, 66% answered inadequate (n = 32). Asked if heavy drinking of commercial alcohol is a concern in their community, 96% said yes (n = 25), and 92% said heavy drinking of traditional brew or distilled spirits is a concern in their community (n = 24). Finally, 91% said that their organization would be interested in implementing an alcohol counter-marketing campaign (n = 23).

Conclusions

Based on the perception of survey participants, efforts to prevent alcohol-related harm thus far are inadequate in Sierra Leone where heavy drinking is a critical concern. CBOs and NGOs already engaged in alcohol harm prevention are eager to support and adopt new strategies.

Innovation

This is the first research to seek direct input from CBOS and NGOs about alcohol harm prevention in Sierra Leone.

Perceived harms and protective behavioural strategies among khat chewers: a qualitative study in Jimma, Ethiopia

BACKGROUND

While there have been many previous studies focusing on the adverse effects of khat chewing, attempts to investigate the protective behavioural strategies (PBS) employed by the khat using population are rare. PBS are strategies that substance users employ to minimize or alleviate the possible negative consequences related to the behaviour. This study focuses on the harms that chewers associate with khat use, and the behavioural strategies they practise to prevent or minimize these harms.

METHODS

A community-based qualitative study was conducted using a snowball sampling technique to recruit a diverse sample of khat chewing participants (N = 102) in Jimma city, Ethiopia. Face-to-face in-depth interviews were carried out with the participants.

RESULTS

Participants identified a variety of harms likely to result from chewing khat. These include impacts on their finances, work, social life and health. The PBS that participants employed to avoid or minimize the risks were classified into four themes based on their temporal sequence with khat chewing sessions: prior to chewing, during chewing, after chewing and general PBS covering the whole of their khat chewing career. The PBS enable khat chewers to prevent or minimize the adverse health consequences of chewing, socialize and work without or with fewer difficulties and manage their economy successfully.

CONCLUSION

The study participants believe that khat-related harms are avoidable if khat users implement appropriate strategies prior to, during and after chewing, and if they apply PBS to khat-related factors (e.g. type, amount and frequency), set factors (e.g. reason for using and health behaviour) and setting factors (e.g. place of use, when used, with whom used and social norms) covering the whole of their khat chewing career.

Alcohol policy framing in South Africa during the early stages of COVID-19: using extraordinary times to make an argument for a new normal

INTRODUCTION

Public health and alcohol industry actors compete to frame alcohol policy problems and solutions. Little is known about how sudden shifts in the political context provide moments for policy actors to re-frame alcohol-related issues. South Africa's temporary bans on alcohol sales during the COVID-19 pandemic offered an opportunity to study this phenomenon.

METHODS

We identified Professor Charles Parry from the South African Medical Research Council as a key policy actor. Parry uses a Twitter account primarily to comment on alcohol-related issues in South Africa. We harvested his tweets posted from March 18 to August 31, 2020, coinciding with the first two alcohol sales bans. We conducted a thematic analysis of the tweets to understand how Parry framed alcohol policy evidence and issues during these 'extraordinary times.'

RESULTS

Parry underlined the extent of alcohol-related harm during 'normal times' with scientific evidence and contested industry actors' efforts to re-frame relevant evidence in a coherent and well-constructed argument. Parry used the temporary sales restrictions to highlight the magnitude of the health and social harms resulting from alcohol consumption, particularly trauma, rather than the COVID-19 transmission risks. Parry portrayed the sales ban as a policy learning opportunity (or 'experiment') for South Africa and beyond.

CONCLUSIONS

Crisis conditions can provide new openings for public health (and industry) actors to make salient particular features of alcohol and alcohol policy evidence.

Influencing the global governance of alcohol: Alcohol industry views in submissions to the WHO consultation for the Alcohol Action Plan 2022-2030

BACKGROUND

In 2020, the Secretariat of the World Health Organization (WHO) conducted an open consultation, with public submissions, for the purpose of developing an Alcohol Action Plan to "strengthen implementation" of the WHO's 2010 Global Strategy to Reduce the Harmful Use of Alcohol. The consultation process and public submissions provided an opportunity to critically examine alcohol industry perspectives and arguments in relation to the global governance of alcohol.

METHODS

48 alcohol industry submissions to the WHO's 2020 consultation were included for analysis. Directed content analysis was used to examine the policy positions and arguments made by industry actors. Thematic analysis was employed to further explore the framing of industry arguments.

RESULTS

In framing their arguments, alcohol industry actors positioned themselves as important stakeholders in policy debates; differentiated "normal" drinking from consumption that merits intervention; argued that alcohol policy should be made at the national, rather than global, level; and supported industry self-regulation or co-regulation rather than cost-effective public health measures to prevent harms from alcohol.

CONCLUSION

The alcohol industry's submissions to the WHO's 2020 consultation could be seen as efforts to stymie improvements in the global governance of alcohol, and repeats several framing strategies that the industry has used in other forums, both national and global. However, their arguments appear to have had little traction in the creation of the Alcohol Action Plan. Changes from the Working Document to the adopted Action Plan show little acceptance by WHO of industry arguments.

Can alcohol policy prevent harms to women and children from men's alcohol consumption? An overview of existing literature and suggested ways forward

The World Health Organization's list of cost-effective alcohol control policies is a widely-used resource that highlights strategies to address alcohol-related harms. However, there is more evidence on how recommended policies impact harms to people who drink alcohol-such as physical health problems caused by heavy alcohol use-than on secondhand harms inflicted on someone other than the person drinking alcohol, i.e., alcohol's harms to others. In this essay, we describe evidence of impacts of alcohol policy on harms to women and children resulting from men's alcohol consumption, as well as options for making policies more relevant for reducing intimate partner violence and child abuse. We begin with an overview of harms to women and children resulting from men's alcohol consumption and review cost-effective alcohol policies with potential to reduce these harms based on likely mechanisms of action. Next, we present a rapid review of reviews to describe existing evidence of impacts of these policies on the outcomes of physical violence, sexual violence, and child abuse and neglect. We found little evidence of systematic evaluation of impacts of these important alcohol policies on harms to women and children. Thus, we advocate for increased attention in evaluation research to the impacts of alcohol policies on harms experienced by women and children who are exposed to men who drink alcohol. We also argue for more consideration of a broader range of policies and interventions to reduce these specific types of harm. Finally, we present a conceptual model illustrating how alcohol policies may be supplemented with other interventions specifically tailored to reduce alcohol-related harms commonly experienced by women and children as a result of men's alcohol use.

Global, regional and national burden of endocrine, metabolic, blood and immune disorders 1990-2019: a systematic analysis of the Global Burden of Disease study 2019

Background

Endocrine, metabolic, blood and immune disorders (EMBID) is a vital public health problem globally, but the study on its burden and global trends was scarce. We aimed to evaluate the global burden of disease and trends in EMBID from 1990 to 2019.

Methods

We extracted the data of EMBID-related on death cases, Age-standardized death rates (ASDRs), disability-adjusted life-years (DALYs), Age-standardized DALY rates, years of life lost (YLLs), Age-standardized YLL rates, years lived with disability (YLDs) and Age-standardized YLD rates between 1990 and 2019 from the Global Burden of Disease 2019, by sex, age, and year at the global and geographical region levels. The Annual rate of change was directly extracted from Global Health Data Exchange (GHDx) and we also calculated the age-related age-standardized rate (ASR) to quantify trends in EMBID-related deaths, DALYs, YLLs and YLDs.

Result

Globally, the EMBID-related ASDRs showed an increasing trend, whereas the DALYs ASR, YLLs ASR and YLDs ASR were decreased between 1990 to 2019. Furthermore, High-income North America and Southern Sub-Saharan Africa had the highest both ASDRs and DALYs ASR, and Southern Sub-Saharan Africa and Caribbean had the highest both YLDs ASR and YLLs ASR in 2019. Males had a higher EMBID-related ASDRs than females, but the DALYs ASR in females were higher than males. The burden of EMBID was higher in older-aged compared to other age groups, especially in developed regions.

Conclusion

Although EMBID-related ASRs for DALYs-, YLLs- and YLDs declined at the global level from 1990 to 2019, but the ASDRs was increasing. This implied high healthcare costs and more burden of ASDRs due to EMBID in the future. Therefore, there was an urgent need to adopt geographic targets, age-specific targets, prevention strategies and treatments for EMBID to reduce negative health outcomes globally.

Global burden of Liver Disease: 2023 Update

Liver disease accounts for 2 million deaths and is responsible for 4% of all deaths (1 out of every 25 deaths worldwide); approximately 2/3 of all liver related deaths occur in men. Deaths are largely attributable to complications of cirrhosis and hepatocellular carcinoma, with acute hepatitis accounting for a smaller proportion of deaths. The most common causes of cirrhosis worldwide are related to viral hepatitis, alcohol, and nonalcoholic fatty liver disease (NAFLD). Hepatotropic viruses are the etiological factor in most cases of acute hepatitis, but drug-induced liver injury increasingly accounts for a significant proportion of cases. This iteration of the global burden of liver disease is an update of the 2019 version and focuses mainly on areas where significant new information is available like alcohol-associated liver disease, NAFLD, viral hepatitis, and HCC. We also devote a separate section to the burden of liver disease in Africa, an area of the world typically neglected in such documents.

"Harm per litre" as a concept and a measure in studying determinants of relations between alcohol consumption and harm

The term "harm per litre" has been increasingly used in alcohol research in recent years as a concept and a comparative measure of alcohol-attributable harm in comparisons between environments, circumstances, and patterns of drinking. This essay discusses the origins of the term in connection with analyses in terms of patterns as well as levels of drinking and with concerns about differential harms from drinking different beverage types. Also discussed is the term's current primary usage, in the context of epidemiological concerns about differentially severe harms for poorer persons who drink. It is noted that these same concerns have been discussed, particularly in Britain, using the phrase "alcohol harm paradox". "Harm per litre" was initially most often used in comparisons between rates of alcohol-attributable harm by beverage type. After 2010, the expression was applied more broadly, particularly after its use in various World Health Organization-related discussions and documents. In addition, and especially from 2018 onwards when most of the papers using this term were published, it has been used in comparisons by socioeconomic status at the individual level, and by level of socioeconomic development at the country level. Almost all the findings indicate that people with lower socioeconomic status, and countries with lower average income, e.g., low income and lower-middle income countries, incur considerably higher harm per litre (with harm being expressed in disease burden and mortality) than upper middle-income and high-income countries. "Harm per litre" is a practicable and easy-to-understand concept to compare groups of individuals or countries, and to quantify health inequalities. The next important step will need to be elucidating a better causal understanding of the processes underlying these inequalities, with an emphasis on factors which can be most easily changed by interventions.

Decline in youth drinking in high-income settings: Implications for public health in low-income countries

Declining drinking among youth in many high-income countries has attracted scholarly attention and debates. Still, researchers are yet to globalize such research or examine its public health implications for low-resource settings. This commentary has two interrelated purposes. First, using evidence from Nigeria, it highlights how declining youth drinking in high-income countries may impact public health in low-income countries. Second, it highlights the necessity for research to examine youth drinking behaviours simultaneously worldwide. The declining drinking trends among young people in high-income countries have occurred simultaneously with global alcohol corporations being more aggressive in low-income countries like Nigeria. Relatedly, alcohol corporations may employ evidence regarding declines in drinking to argue against implementing stringent policies or other effective interventions in Nigeria (and other low-income settings), claiming their apparent success in the falling drinking trends in high-income settings. The article argues that research on the drinking decline among young people should be globalized because without commensurate attempts to examine their drinking behaviours/trends worldwide simultaneously, public and/or global health may be harmed for the reasons explored in this article.

Changes in hazardous drinking pre, during and post 70-day alcohol sales ban during COVID-19 pandemic in Botswana

BACKGROUND

Absolute alcohol sales bans instituted in countries like Botswana provide a rare opportunity for a quasi-natural experiment on how such strict policies influence users' behaviours during the COVID pandemic and beyond. From March 2020 to September 2021, Botswana banned the sales of alcohol on four separate occasions spanning a cumulative 225 days. We studied changes in retrospectively recalled hazardous drinking following the longest and last alcohol sales ban in Botswana.

METHODS

This online cross-sectional study, carried out following a 70-day alcohol sales ban in 2021, comprised a convenience sample of 1326 adults who completed the AUDIT-C and had to recall their alcohol use during three points: pre alcohol sale ban (before 28th June 2021), during alcohol sales ban (28th June 2021 to 5th September 2021), and post alcohol sales ban (after 5th September 2021).

RESULTS

The prevalence of hazardous drinking (defined by an AUDIT-C score of 3 or 4 for females and males, respectively) prior, during and post the alcohol sales ban was 52.6% (95%CI=49.8-55.3), 33.9% (95%CI=31.3-36.5), and 43.1% (95%CI=40.4-45.8), respectively.

CONCLUSION

The findings from this study showed that reduced alcohol availability by way of the fourth alcohol sales ban was associated with reductions in self-reported hazardous drinking, albeit at a lesser degree compared to during an earlier sales ban.

Prevalence and factors associated with alcohol consumption in a high school in northern Guinea

INTRODUCTION

The objective of this study was to determine the prevalence and factors associated with alcohol use in a high school in the Middle Guinea region in West Africa.

METHODS

An analytical cross-sectional study involving 342 high school students was conducted in November 2019 at the Mali centre high school. A questionnaire adapted from the standardised questionnaire validated by the World Health Organization as part of the Global Student Health Surveys was used for data collection. Students were asked about their alcohol use in the 30 days preceding the survey. Using logistic regression, we performed a multivariate analysis that controlled for independent variables to identify factors associated with alcohol use.

RESULTS

The age range was 14-27 years. The prevalence of alcohol consumption was 12.28% (95% confidence interval [CI] 8.80, 16.10). Note that 89.80% of the sample studied did not know of any harmful effects of alcohol on health. In a multivariate analysis, we showed that alcohol use was associated with tobacco use (adjusted odds ratio 24.82, 95% CI 20.73, 26.30) and having close friends who also consume alcohol (adjusted odds ratio 4.16, 95% CI 3.63, 6.37).

DISCUSSION AND CONCLUSION

The substantial prevalence of alcohol use, the high proportion of ignorance of the harmful effects of alcohol, and the reasons for the initial motivation for alcohol use found in this study should attract the attention of stakeholders. An action plan based on the two factors associated found could fight alcohol use at Mali centre high school.

Preventing Alcohol-Related Harm in East Africa: Stakeholder Perceptions of Readiness across Five Countries

OBJECTIVE

While alcohol-related harm is a recognized public health priority, the capacity to address and mitigate its harm is lacking, primarily in low-income countries. Recent developments including new tools that can assess readiness for preventing alcohol-related harm, specifically in low-resource settings, can be used to determine strengths and opportunities for supporting, planning, and resource allocation. In this study, we determined the perceptions of readiness and capacity for the prevention of alcohol-related harm across East Africa among stakeholders engaged in such work.

METHODS

We conducted a cross-sectional survey in 2020, distributed by the East Africa Alcohol Policy Alliance to their member alliances and stakeholders across five countries in East Africa (i.e., Burundi, Kenya, Rwanda, Tanzania, and Uganda). The survey included modified measures from the Readiness Assessment for the Prevention of Child Maltreatment (RAP-CM) short form, organizational size and funding, research capacity and priorities, and perceptions related to alcohol prevention and harm both locally and in the region. Analyses were computed based on 142 persons/organizations completing the survey.

RESULTS

In terms of general readiness, the overall adjusted aggregate score for East Africa was 39.70% (ranging from 30.5% in Burundi to 47.0% in Kenya). Of the 10 domains assessed (on a 0-10 scale), across all countries, knowledge of alcohol prevention (8.43), institutional links and resources (6.15) and legislation, mandates and policies (5.46) received the highest scores. In contrast, measures pertaining to resources (i.e., material, human, technical, and informal) received the lowest score.

CONCLUSIONS

Our results demonstrate substantial variability in the readiness to address alcohol-related harm across East Africa. The highest capacity was noted for knowledge towards alcohol prevention, institutional links, and legislative mandates and policies. However, important gaps were noted in terms of attitudes towards alcohol prevention, the will to address the problem, as well as material, human, and informal resources, which need to be urgently addressed to strengthen capacity for addressing and mitigating the significant toll of alcohol-related harm in the region.

Age-sex differences in the global burden of lower respiratory infections and risk factors, 1990-2019: results from the Global Burden of Disease Study 2019

BACKGROUND

The global burden of lower respiratory infections (LRIs) and corresponding risk factors in children older than 5 years and adults has not been studied as comprehensively as it has been in children younger than 5 years. We assessed the burden and trends of LRIs and risk factors across all age groups by sex, for 204 countries and territories.

METHODS

In this analysis of data for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we used clinician-diagnosed pneumonia or bronchiolitis as our case definition for LRIs. We included International Classification of Diseases 9th edition codes 079.6, 466-469, 470.0, 480-482.8, 483.0-483.9, 484.1-484.2, 484.6-484.7, and 487-489 and International Classification of Diseases 10th edition codes A48.1, A70, B97.4-B97.6, J09-J15.8, J16-J16.9, J20-J21.9, J91.0, P23.0-P23.4, and U04-U04.9. We used the Cause of Death Ensemble modelling strategy to analyse 23 109 site-years of vital registration data, 825 site-years of sample vital registration data, 1766 site-years of verbal autopsy data, and 681 site-years of mortality surveillance data. We used DisMod-MR 2.1, a Bayesian meta-regression tool, to analyse age-sex-specific incidence and prevalence data identified via systematic reviews of the literature, population-based survey data, and claims and inpatient data. Additionally, we estimated age-sex-specific LRI mortality that is attributable to the independent effects of 14 risk factors.

FINDINGS

Globally, in 2019, we estimated that there were 257 million (95% uncertainty interval [UI] 240-275) LRI incident episodes in males and 232 million (217-248) in females. In the same year, LRIs accounted for 1·30 million (95% UI 1·18-1·42) male deaths and 1·20 million (1·07-1·33) female deaths. Age-standardised incidence and mortality rates were 1·17 times (95% UI 1·16-1·18) and 1·31 times (95% UI 1·23-1·41) greater in males than in females in 2019. Between 1990 and 2019, LRI incidence and mortality rates declined at different rates across age groups and an increase in LRI episodes and deaths was estimated among all adult age groups, with males aged 70 years and older having the highest increase in LRI episodes (126·0% [95% UI 121·4-131·1]) and deaths (100·0% [83·4-115·9]). During the same period, LRI episodes and deaths in children younger than 15 years were estimated to have decreased, and the greatest decline was observed for LRI deaths in males younger than 5 years (-70·7% [-77·2 to -61·8]). The leading risk factors for LRI mortality varied across age groups and sex. More than half of global LRI deaths in children younger than 5 years were attributable to child wasting (population attributable fraction [PAF] 53·0% [95% UI 37·7-61·8] in males and 56·4% [40·7-65·1] in females), and more than a quarter of LRI deaths among those aged 5-14 years were attributable to household air pollution (PAF 26·0% [95% UI 16·6-35·5] for males and PAF 25·8% [16·3-35·4] for females). PAFs of male LRI deaths attributed to smoking were 20·4% (95% UI 15·4-25·2) in those aged 15-49 years, 30·5% (24·1-36·9) in those aged 50-69 years, and 21·9% (16·8-27·3) in those aged 70 years and older. PAFs of female LRI deaths attributed to household air pollution were 21·1% (95% UI 14·5-27·9) in those aged 15-49 years and 18·2% (12·5-24·5) in those aged 50-69 years. For females aged 70 years and older, the leading risk factor, ambient particulate matter, was responsible for 11·7% (95% UI 8·2-15·8) of LRI deaths.

INTERPRETATION

The patterns and progress in reducing the burden of LRIs and key risk factors for mortality varied across age groups and sexes. The progress seen in children younger than 5 years was clearly a result of targeted interventions, such as vaccination and reduction of exposure to risk factors. Similar interventions for other age groups could contribute to the achievement of multiple Sustainable Development Goals targets, including promoting wellbeing at all ages and reducing health inequalities. Interventions, including addressing risk factors such as child wasting, smoking, ambient particulate matter pollution, and household air pollution, would prevent deaths and reduce health disparities.

FUNDING

Bill & Melinda Gates Foundation.

Navigating Alcogenic Brand Environment: Exploring How Young Nigerians Negotiate and Make Sense of Alcohol Brand Preferences

No previous research has examined how and why Nigerians choose their alcohol brands. Using qualitative data, this study explored brand preference and the reasons for brand choice among 18 to 24 year-old Nigerians who use alcohol. Participants were divided into three categories based on their beer, spirit, and wine preferences. While most men preferred beer and spirits, many women chose traditional and recently developed flavoured beers and spirit-based drinks, which the alcohol industry promotes as women-friendly alcoholic drinks. Some participants chose low-strength brands to avoid heavy drinking and intoxication, while others preferred high-strength brands for immediate bodily thrills/intoxication. Some participants preferred expensive brands to cheaper beverages to construct social identity and portray an affluent lifestyle, while others used the consumption of ‘foreign’ or uncommon brands to enact distinction. Alcohol advertising and peer influence significantly impacted brand awareness and preferences. Interventions should focus on reducing alcohol/brand availability and accessibility in Nigeria.

Doing gender, doing alcohol: The paradox of gendered drinking practices among young Nigerians

Previous research on alcohol and gender identity constructions has primarily focused on Western countries. Studies from non-Western contexts can make crucial contributions to understandings of the impact of social constructions of masculinities and femininities on drinking behaviours and health. In traditional Nigeria, consumption norms prohibited women's and young people's alcohol use. Nowadays, young men and women use alcohol, and many enact identities with heavy drinking. This study uses gender performance theory and interviews/focus group data from 72 young Nigerian men and women to explore their masculinity performance and resistance to traditional femininity codes through drinking practices. Profiling women as vulnerable agents and the only gender that provides care and affective labour, most men reinscribed the consumption norms proscribing women's drinking while some recommended sweetened or flavour brands for women. Citing gender equality and criticizing/resisting local norms, the women argued that alcohol consumption should not be the prerogative of men. The men used competitive heavy drinking rituals and drunkenness to enact masculinity. Most of the women constructed counter-traditional/normative femininity with heavy drinking bouts, while others, who maintained the traditional femininity to avoid stigmatization, enacted secret, or solitary drinking with potential health impacts. The findings demonstrate how distinct social norms promote socio-structural constraints and power relations that suppress women's agency and encourage gender inequality with potential health impacts.

Recreation and Alcohol Consumption in Sub-Saharan Africa: Addressing Gender and Age Differences in Urban Areas-Praia, Cabo Verde

BACKGROUND

Reducing alcohol consumption and improving urban planning in African cities are public health priorities. The aim of this study was to explore gender and age differences in recreational activity participation and its link with self-reported alcohol consumption in three urban areas of Praia.

METHODS

A questionnaire was applied to a probabilistic sample of 1912 adults, with a median age of 35.0 (IQR: 26.0-48.8) years, living in informal, transition, and formal areas of the capital of Cabo Verde.

RESULTS

More than 80% of the participants reported rarely or never participating in recreational activities. Going daily or weekly to the café was the most reported recreational activity, regardless of the urban area. Participation in recreational activities was higher in men than women, decreasing with age in both cases. Alcohol consumption was significantly higher in men than women (72.4% versus 47.4%, p < 0.001). Multiple logistic regression models showed that going at least once to the bar/nightclub (for men and women) and going to the café (for women) were associated with alcohol consumption. Furthermore, age (for women), in a protective way, and having children (for men) appeared to be associated with alcohol consumption.

CONCLUSIONS

This study provides new data on the recreational environment in Praia and can contribute to the development of local and national public health policies and interventions in line with several SDGs to reduce alcohol consumption, enhance healthy leisure/recreation practices, and promote better living conditions for its inhabitants.

High rates of undiagnosed and uncontrolled hypertension upon a screening campaign in rural Rwanda: a cross-sectional study

BACKGROUND

Hypertension remains the major risk factor for cardiovascular diseases (CVDs) worldwide with a prevalence and mortality in low- and middle-income countries (LMICs) among the highest. The early detection of hypertension risk factors is a crucial pillar for CVD prevention.

DESIGN AND METHOD

This cross-sectional study included 4284 subjects, mean age 46 ± 16SD, 56.4% females and mean BMI 26.6 ± 3.7 SD. Data were collected through a screening campaign in rural area of Kirehe District, Eastern of Rwanda, with the objective to characterize and examine the prevalence of elevated blood pressure (BP) and other CVD risk factors. An adapted tool from the World Health Organization STEPwise Approach was used for data collection. Elevated BP was defined as ≥ 140/90 mm/Hg and elevated blood glucose as blood glucose ≥ 100 mg/dL after a 6-h fast.

RESULTS

Of the sampled population, 21.2% (n = 910) had an elevated BP at screening; BP was elevated among individuals not previously known to have HTN in 18.7% (n = 752). Among individuals with a prior diagnosis of HTN, 62.2% (n = 158 of 254) BP was uncontrolled. Age, weight, smoking, alcohol history and waist circumference were associated with BP in both univariate analyses and multivariate analysis.

CONCLUSION

High rates of elevated BP identified through a health screening campaign in this Rwandan district were surprising given the rural characteristics of the district and relatively low population age. These data highlight the need to implement an adequate strategy for the prevention, diagnosis, and control of HTN that includes rural areas of Rwanda as part of a multicomponent strategy for CVD prevention.

Impact of the COVID-19 Pandemic on Alcohol Treatment Access and Harm Prevention in West Africa: Reports from NGOs and Community-Based Organizations

BACKGROUND

Recent research highlights how the COVID-19 pandemic has significantly impacted alcohol consumption patterns, yet research thus far has largely overlooked the experience in West Africa. Research also has not addressed how the COVID-19 pandemic has affected access to alcohol treatment, support, and alcohol harm prevention. This study addresses this research gap in West Africa, a low-resource setting with a very high burden of alcohol harm.

OBJECTIVES

To understand the impact of the COVID-19 pandemic on alcohol use, access to alcohol, treatment access, and alcohol harm prevention activities in West Africa.

METHODS

This study analyzed data from a cross-sectional online survey conducted in August and September of 2020 and distributed by the West Africa Alcohol Policy Alliance to their member alliances and stakeholders across nine countries (N = 140 participants) to understand their perceptions on COVID-19 and alcohol-related topics.

RESULTS

Our findings convey a significant adverse impact on alcohol-focused NGOs and community-based organizations in West Africa. Overall, 94% of participants indicated that the COVID-19 pandemic adversely impacted their organizations' work. In addition, 71% of participants reported reduced access to alcohol treatment or support in their communities. Lastly, 44% of the respondents indicated that people in their community drank less alcohol than usual, and only 33% answered that they perceived it to be harder to get alcohol.

CONCLUSIONS

These data underscore the significant impact of the COVID-19 pandemic across West Africa with respect to accessing alcohol treatment and organizational capacity to address alcohol harm. With the lack of infrastructure to address alcohol harm, this impact could exacerbate the high level of alcohol use and harm in the region.

A readiness assessment for the prevention of alcohol-related harm in West Africa: A new methodological approach to inform practice and policy

OBJECTIVE

Alcohol-related harm is a growing concern globally and particularly in West Africa. However, tools for assessing the readiness for prevention of alcohol-related harm in low-resource settings have been lacking. We modified the WHO tool, the Readiness Assessment for the Prevention of Child Maltreatment Short Form (RAP-CM), to assess readiness for the prevention of alcohol-related harm across West Africa.

METHODS

We conducted a cross-sectional survey in the fall of 2020, distributed by the West Africa Alcohol Policy Alliance to their member alliances and stakeholders, predominantly community-based organizations (CBOs) and non-governmental organizations (NGOs), across 7 countries in West Africa (N = 140). The survey included modified measures from the RAP-CM short form.

RESULTS

In terms of general readiness, the overall adjusted aggregate score for West Africa was 45.0% (ranging from 42.9% in Liberia to 52.7% in Senegal). Of the ten domains assessed (on a 0-10 scale), across all countries, knowledge of alcohol-related harm prevention (8.3) and legislation, mandates, and policies (6.7) received the highest readiness scores. The lowest readiness scores were observed for human and technical resources (2.5), attitudes toward preventing alcohol-related harm (2.7), and the will to address the problem (2.9).

CONCLUSIONS

Our results demonstrate substantial variability across domains in the readiness to address alcohol-related harm with clear strengths and limitations for future priority setting and capacity building. The barriers to progress include attitudes toward alcohol-related harm prevention, lack of willingness to address the problem, and limited human and technical resources available. These barriers need to be mitigated to address the high burden of alcohol-related harm in the region and to inform both practice and policy.

The impact of alcohol taxation changes on unrecorded alcohol consumption: A review and recommendations

BACKGROUND

The diverse forms of unrecorded alcohol, defined as beverage alcohol not registered in official statistics in the country where it is consumed, comprise about one fourth of all alcohol consumed worldwide. Since unrecorded alcohol is usually cheaper than registered commercial alcohol, a standard argument against raising alcohol excise taxes has been that doing so could potentially result in an increase in unrecorded consumption. This contribution examines whether increases in taxation have in fact led to increases in consumption of unrecorded alcohol, and whether these increases in unrecorded alcohol should be considered to be a barrier to raising taxes. A second aim is to outline mitigation strategies to reduce unrecorded alcohol use.

METHODS

Narrative review of primary and secondary research, namely case studies and narrative and systematic reviews on unrecorded alcohol use worldwide.

RESULTS

Unrecorded alcohol consumption did not automatically increase with increases in taxation and subsequent price increases of registered commercial alcohol. Instead, the level of unrecorded consumption depended on: a) the availability and type of unrecorded alcohol; b) whether such consumption was non-stigmatized; c) the primary population groups which consumed unrecorded alcohol before the policy change; and d) the policy measures taken. Mitigation strategies are outlined.

CONCLUSIONS

Potential increases in the level of unrecorded alcohol consumption should be considered in the planning and implementation of substantial increases in alcohol taxation. However, unrecorded consumption should not be considered to be a principal barrier to implementing tax interventions, as evidence does not indicate an increase in consumption if mitigation measures are put in place by governments.