Alcohol production as an adaptive livelihood strategy for women farmers in Tanzania and its potential for unintended consequences on women's reproductive health

Cross-sectional study on the characteristics of unrecorded alcohol consumption in nine newly independent states between 2013 and 2017

OBJECTIVES

As unrecorded alcohol use contributes to a substantial burden of disease, this study characterises this phenomenon in newly independent states (NIS) of the former Soviet Union with regard to the sources of unrecorded alcohol, and the proportion of unrecorded of total alcohol consumption. We also investigate associated sociodemographic characteristics and drinking patterns.

DESIGN

Cross-sectional data on overall and unrecorded alcohol use in the past 7 days from WHO STEPwise Approach to NCD Risk Factor Surveillance (STEPS) surveys. Descriptive statistics were calculated at the country level, hierarchical logistic and linear regression models were used to investigate sociodemographic characteristics and drinking patterns associated with using unrecorded alcohol.

SETTING

Nine NIS (Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkmenistan and Uzbekistan) in the years 2013-2017.

PARTICIPANTS

Nationally representative samples including a total of 36 259 participants.

RESULTS

A total of 6251 participants (19.7%; 95% CI 7.9% to 31.5%) reported alcohol consumption in the past 7 days, 2185 of which (35.1%; 95% CI 8.2% to 62.0%) reported unrecorded alcohol consumption with pronounced differences between countries. The population-weighted average proportion of unrecorded consumption in nine NIS was 8.7% (95% CI 5.9% to 12.4%). The most common type of unrecorded alcohol was home-made spirits, followed by home-made beer and wine. Older (45-69 vs 25-44 years) and unemployed (vs employed) participants had higher odds of using unrecorded alcohol. More nuanced sociodemographic differences were observed for specific types of unrecorded alcohol.

CONCLUSIONS

This contribution is the first to highlight both, prevalence and composition of unrecorded alcohol consumption in nine NIS. The observed proportions and sources of unrecorded alcohol are discussed in light of local challenges in policy implementation, especially in regard to the newly formed Eurasian Economic Union (EAEU), as some but not all NIS are in the EAEU.

Participatory Methodologies With Adolescents: A Research Approach Used to Explore Structural Factors Affecting Alcohol Use and Related Unsafe Sex in Tanzania

Multiple methodological approaches have been used to explore adolescent alcohol use and related sexual behaviors, ranging from surveys to assessments of alcohol outlet density. Although surveys can capture the extent of alcohol use, they do not allow for a contextualized understanding of young people's voiced experiences with alcohol, including sociocultural, gendered and environmental pressures to consume, and related engagement in sex. The mapping of alcohol outlets provides physical density information, but infrequently from youths' perspectives. Traditional qualitative methods like in-depth interviews and focus group discussions do allow for a more nuanced understanding of adolescents' experiences, but they can be limited by the use of semi-structured guides that may negatively impact the fluidity of discussion. We seek to contribute to the methodological approaches utilized with adolescents by demonstrating how contextualized data were captured from Tanzanian adolescents' experiences of alcohol and sex, which are sensitive topics in many African countries. We collected data in secondary schools and youth centers across four sites in Dar es Salaam, the largest and most diverse city in Tanzania. As a complement to in-depth interviews, archival reviews, and a systematic mapping of alcohol availability, participatory methodologies such as photovoice, story writing, and drawing allowed Tanzanian youth to offer more honest, descriptions of lived experiences with their physical and social environment in relation to alcohol use and related sexual behavior patterns. Through participatory methods, study participants were able to discuss behaviors that are viewed as social transgressions, sensitive topics like violence in relation to sex, and views around their own self-agency. The use of a methodological toolkit including participatory methodologies enabled youth to trust the researchers and share sensitive information in a relatively short period of time, overcoming some of the challenges of traditional qualitative methods.

<i>Chuma na Uchizi</i>: A Livelihood Intervention to Increase Food Security of People Living with HIV in Rural Zambia

The objective of this study was to evaluate the impact of Chuma na Uchizi, a livelihood intervention for people living with HIV (PLHIV) in rural Eastern Province, Zambia, on food security. The intervention included cash transfers to purchase income-generating assets, access to a savings account, and life-skills training. The study employed a non-equivalent groups design to compare intervention (n = 50) and control participants (n = 51) who were receiving outpatient care from two comparable health facilities in distinct constituencies in the same geographic area. We collected data before and after implementation of the intervention. Chuma na Uchizi improved access to food. At follow-up, the intervention group reported lower food insecurity scores compared with the control group (β = -5.65; 95% CI - 10.85 --0.45). Livelihood programs for PLHIV are practical and may be a promising approach to address food insecurity and its adverse effects.

Social space and alcohol use initiation among youth in northern Tanzania

Introduction

Alcohol use is a key risk factor for disease worldwide. Consumption of alcohol is increasing in sub Saharan Africa, where youth are already at high risk of HIV due to its high prevalence in the region. Studies show that youth begin drinking alcohol early; however, there is a need to further explore the initiation of alcohol use in order to design appropriate interventions in this population.

Methods

We conducted a qualitative study with youth in Mwanza and Kilimanjaro regions in Tanzania to explore alcohol consumption among youth. Participants were a purposive sample of youth aged 15–24 composed of secondary school and college students, and formal and informal sector employees. We conducted 35 in-depth interviews using a semi-structured guide to understand youth’s personal experiences with alcohol consumption. Two social scientists conducted a multi stage, inductive analysis of the data.

Findings

Alcohol consumption was reported to mainly start during adolescence, although in some cases it started as early as at 10 years of age. Young women reported drinking less, and initiated drinking later compared to males. Social space assumed a primary role in alcohol initiation. The social environment and influence of important social actors were key aspects of youth’s social space. Youth reported starting to consume alcohol at home, social events and in stressful environments with key influencers being parents, relatives, peers and intimate partners.

Conclusions

Our findings show that the social space (social environment and interactions) plays an important role in influencing youth initial consumption of alcohol. Interventions addressing alcohol initiation among the population need to address the social spaces where initiation takes place and engage the significant actors in these spaces. There is need to further explore underlying societal drinking norms to better understand how they shape social environments and young people’s initiation of alcohol use.

Food insecurity, sexual risk taking, and sexual victimization in Ghanaian adolescents and young South African adults

OBJECTIVES

The objectives of this study were to examine whether food insecurity is associated with sexual risk taking and victimization in young people (aged 16-24); and to investigate whether the relationship of food insecurity with sexual risk taking and victimization is moderated by gender.

METHODS

Cross-sectional data were obtained in 2014 from a sample of Ghanaian adolescents (n = 773) and in 2015 from young South African adults (n = 823). We used multilevel logistic regression given the study's binary outcome and clustered data. We tested a moderation effect of gender by including an interaction between gender and food insecurity.

RESULTS

Food insecurity was highly prevalent (72% in Ghana and 83% in South Africa). Food insecurity was significantly associated with unwanted sexual contact among Ghanaian adolescents (OR 1.05, 95% CI 1.02, 1.08) and age-disparate sex among young South African adults (OR 1.03, 95% CI 1.00, 1.06). Results indicated no moderating effect of gender.

CONCLUSIONS

Our findings underscore the importance of food access on young people's sexual health, regardless of gender. Prevention efforts may be more relevant when integrated with food security interventions that target vulnerable adolescents and young adults, irrespective of gender.

Unrecorded alcohol use: a global modelling study based on nominal group assessments and survey data

BACKGROUND AND AIMS

Alcohol use is among the most important risk factors for burden of disease globally. An estimated quarter of the total alcohol consumed globally is unrecorded. However, due partly to the challenges associated with its assessment, evidence concerning the magnitude of unrecorded alcohol use is sparse. This study estimated country-specific proportions of unrecorded alcohol used in 2015.

DESIGN

A statistical model was developed for data prediction using data on the country-specific proportion of unrecorded alcohol use from nominal group expert assessments and secondary, nationally representative survey data and country-level covariates.

SETTING

Estimates were calculated for the country level, for four income groups and globally.

PARTICIPANTS

A total of 129 participants from 49 countries were included in the nominal group expert assessments. The survey data comprised 66 538 participants from 16 countries.

MEASUREMENTS

Experts completed a standardized questionnaire assessing the country-specific proportion of unrecorded alcohol. In the national surveys, the number of standard drinks of total and unrecorded alcohol use was assessed for the past 7 days.

FINDINGS

Based on predictions for 167 countries, a population-weighted average of 27.9% [95% confidence interval (CI) = 10.4-44.9%] of the total alcohol consumed in 2015 was unrecorded. The proportion of unrecorded alcohol was lower in high (9.4%, 95% CI = 2.4-16.4%) and upper middle-income countries (18.3%, 95% CI = 9.0-27.6%) and higher in low (43.1%, 95% CI = 26.5-59.7%) and lower middle-income countries (54.4%, 95% CI = 38.1-70.8%). This corresponded to 0.9 (high-income), 1.2 (upper middle-income), 3.2 (lower middle-income) and 1.8 (low-income) litres of unrecorded alcohol per capita.

CONCLUSIONS

A new method for modelling the country-level proportion of unrecorded alcohol use globally showed strong variation among geographical regions and income groups. Lower-income countries were associated with a higher proportion of unrecorded alcohol than higher-income countries.