Alcohol use in special populations in Africa. Data from the World Health Survey and Study on global AGEing and adult health
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Alcohol use is an important factor in a population’s risk for disease and mortality. Alcohol has a long history of use in Africa, and changes in drinking behavior are underway in many African states. Women and older adults are two special populations that comprise sizable proportions of the general population and whose use of alcohol will have important consequences for public health in Africa. There is limited information about the drinking behavior of women and older adults, what factors are associated with different drinking patterns and how these populations compare to one another across African nations. Such information is necessary for the development of effective public health policies and for advancing our understanding alcohol epidemiology in Africa.
We aimed to determine the prevalence of various types of drinking patterns, correlates of these patterns and cross-national similarities and differences of both drinking patterns and associated correlates among African women and older adults.
This work is a secondary analysis of publicly available data from the World Health Organization. We used material from two nationally representative population-based surveys, the World Health Survey (WHS) and the Study on global AGEing and adult health (SAGE). The WHS was conducted in 20 African countries and SAGE in Ghana and South Africa. Both surveys collected data through face-to-face interviews using standardized instruments on alcohol use and a variety of measures of socio-demographics, health behaviors and well-being. We constructed alcohol measures based on self-reported use over the previous week.
A total of 40,739 African women were included in the WHS, and 4289 adults aged 50 and above in Ghana and 3666 in South Africa in the SAGE Survey. Overall, lifetime abstention rates ranged from 56% in Mauritius to 99% in Comoros among women. Among older adults, lifetime abstention was 42% in Ghana and 75% in South Africa. Among currently drinking women, rates of risky single-occasion drinking varied from 0.5% to 58% in Mauritius and Chad, respectively. Among current drinking older adults, at risk drinkers comprised 26% in Ghana and 37% in South Africa.
Socio-demographic correlates of current drinking among women included increasing age, having any education, working for pay, being married/cohabitating and living in an urban setting. Increasing age was the most common and consistent correlate, and few other correlates were consistent across states. Among older adults in Ghana and South Africa, the most common correlates of drinking pattern included ethnic group, religion and smoking.
Among women, 4 clusters of countries were identified based on the prevalence rates of the different drinking patterns and few correlates were common by cluster or geography, save the high rates of lifetime abstention among Muslim states in northern Africa. The older adult populations in Ghana and South Africa differed on all alcohol measures, while smoking was a common correlate of drinking behavior between the two countries.
Discussion and Conclusion
The high rates of lifetime abstention among African women are consistent with historical and current reports, and rates of risky single-occasion drinking are cause for concern and action. Drinking patterns among older adults in Ghana and South Africa mirror that of the general populations. The correlates identified suggest socio-cultural factors such as religion and tribal association are important factors in drinking behavior, as well as lifestyle factors such as smoking. The variety of drinking patterns and associated correlates across the states among both women and older adults suggests nations would benefit from tailored national alcohol policies that take into account alcohol use among women and older adults, and that continued monitoring of drinking patterns and associated correlates among these groups would be an important piece for understanding alcohol epidemiology in a dynamic African context.
List of papers. Papers II and III are removed from the thesis due to publisher restrictions.
Paper I: Martinez P, Røislien J, Naidoo N, Clausen T. Alcohol abstinence and drinking among African women: data from the World Health Surveys. BMC Public Health 2011 Mar 10;11:160. doi:10.1186/1471-2458-11-160. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Paper II: Martinez P, Landheim A, Clausen T, Lien L. A comparison of alcohol use and correlates of drinking patterns among men and women aged 50 and above in Ghana and South Africa. African Journal of Drug and Alcohol Studies 2011 10;2:75-88.
Paper III: Martinez P, Lien L, Landheim A, Kowal P, Clausen T. Quality of life and social engagement of alcohol abstainers and users among older adults in South Africa. Submitted to Quality of Life Research.