The Burden of Alcohol consumption in the African Region World Health Organization 6 April, 2017 The Burden of Alcohol consumption in the African Region By Dr F. Zawaira WHO Representative

Harmful use of alcohol A pattern of drinking that causes or contributes to “physical or psychological harm, including impaired judgment or dysfunctional behaviour which may lead to disability or have adverse consequences for interpersonal relationships” WHO ICD-10 classification of mental and behavioural disorders.

The African context Highest alcohol consumption per drinker 30% female: 55% male are drinkers 2.2% of deaths attributable to alcohol Uganda highest per capita consumption in the world Alcohol production and consumption an integral part of the culture and the economy Local brews cheap and readily available

Alcohol and young people Binge drinking> 5drinks per occasion Decreasing age of onset 42.3% of Zambians aged 13-15 consume alcohol and 42.8% have been drunk (GSHS 2004) Namibia 32.8 and 31.8% Poverty, urbanization & socio-economic changes Drink for fun, social reasons, peer pressure

Alcohol and women Rates of consumption increasing In Zambia ratio of female : male adolescents heavy consumption 50.2 : 44.1% (GSHS 2004) South Africa weekday “risky drinkers” 8.7 : 6.9% Weekend “risky drinkers” 32.0 : 32.3%

Harmful patterns of drinking In 2006 STEPS survey among those who had drunk in the past 12 months: 23.7% had engaged in harmful patterns of drinking in Mozambique and Ivory Coast 60% in Algeria

Risk Factors for harmful use Urbanization Aggressive marketing Weak cultural controls Stress Financial and family problems Conditions of work Availability of alcohol

Costs of alcohol consumption High risk sexual behaviour and infection with STIs including HIV Traumatic injury and death due to RTAs caused by drink driving Absenteeism and Unemployment 25-30% of general hospital admissions alcohol related

Costs of alcohol consumption More than 50% of mental hospital admissions in Lesotho, Mauritius and Swaziland—alcohol dependence and delirium tremens Crime Violence, especially against women Chronic liver disease including cancers Blindness and death caused by home brews recorded in East Africa

Costs of alcohol consumption Fetal alcohol syndrome: 19-103 per 1000 births in South Africa compared to 0.05-2.0 in the USA Neglect and abuse of children leading to emotional, physical and educational problems Worsening of poverty

Issues & Challenges in the region Difficulty in quantifying consumption between industrial beverages and home brews Communal drinking and consumption of illicit brews with unknown alcohol levels No regular systematic surveillance and recording systems for production, consumption and quantifying health and social consequences – Southern African Epidemiology Network on Drug Use (SENDU)

Issues & Challenges in the region Lack of counseling, primary care intervention and specialized treatment centers in the Region. Where treatment centers exist as in SA, women are not accessing them due to stigma or domestic responsibilities Africa is targeted for marketing alcohol and tobacco especially to young people due to weak regulatory systems

Issues & Challenges in the region Lack of data from health facilities Public health problems caused by harmful use of alcohol are considerable and multi dimensional Low budgetary allocations in the absence of comprehensive policies

Policy processes WHO STEPS surveys undertaken by a number of countries…Malawi scheduled for next year Global school health surveys undertaken and still ongoing including in Malawi Technical consultation meeting—Brazzaville 2006 Regional committee in 2007 doc AFR/RC57/14 presented: Situation analysis and perspectives

Policy processes Member States requested for support to develop policies and plans to combat harmful use of alcohol RC in 2008 doc AFR/RC58/3: Actions to reduce harmful use of Alcohol tabled Regional office was requested to submit a Regional Strategy for consideration by the Regional committee in 2009 African Region Member states during the WHA this year requested for development of a Global strategy to be submitted in 2010

Strategies and policy options to reduce alcohol related harm Raising awareness and political commitment Strengthen Health-sector response Community action to reduce the harmful use of alcohol Enact/Enforce drink-driving policies and countermeasures Regulating the availability and sale of alcohol Addressing marketing of alcoholic beverages Pricing and taxing policies Harm reduction Reducing the public health impact of illegally and informally produced alcohol Improve surveillance

In Conclusion We all have a role to reduce harmful effects of alcohol in our societies. On behalf of WHO we stand ready to give the required assistance to our Member States

Thank you! Zikomo kwambiri!!