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

Abstract

Background and aimsPopulation‐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.MethodDatabases 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.ResultsWe 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.ConclusionAlcohol 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.

Commentary on Belete et al.: Alcohol use prevalence findings for sub‐Saharan Africa can be better understood when coupled with a deep appreciation of the continent's diverse cultural contexts and drinking patterns

“…SSA covers a large area consisting of more than 50 countries, people of many different ethnic groups and varying economic and political systems [2]. In the first systematic review of its kind for the region, which includes 141 articles and just over half a million people, Belete and colleagues [3] present prevalence rates of alcohol use, alcohol use disorders and alcohol dependence among adults and adolescents across this diverse region. A previous systematic review of alcohol use across the continent was restricted to adolescents [4].…”

“…The findings point to a need for a deeper understanding of the socio-cultural underpinnings of alcohol consumption in the different areas of the continent. For example, Belete et al [3] found that when Muslimmajority countries (and others that have a prohibition against alcohol) were excluded from the analyses, rather than increasing, the weighted lifetime prevalence of alcohol consumption decreased from 23.3% (CI = 11.8-37.1) to 14.1% (CI = 0.0%-41.8%) for adolescents (although the confidence overlapped). Among adults, the weighted lifetime prevalence of alcohol use was 34.9% (CI = 17.7%-54.1%) for all countries and higher at 39.3% (CI = 26.7%-52.6%) when those countries were excluded.…”

“…Belete and colleagues' [3] article revealed a plethora of lowquality prevalence studies on alcohol use in SSA. Most studies included in their systematic review did not meet three of the 10 criteria of the Hoys et al [10] risk of bias tool that the authors [3]…”