Assessing the health risks of consuming 'sachet' alcohol in Acoli, Uganda

War, forced displacement, and alcohol abuse: experiences and perceptions of war-affected south Sudanese refugee youth living in Bidibidi refugee settlement in northern Uganda

Refugees are at high risk of alcohol abuse due to their experiences of structural, physical, sexual, and psychological violence in their countries of origin, during flight, and within host communities. Given the prolonged civil war in their country, South Sudanese have continued to flee profound forms of violence and now constitute the largest population of refugees in Uganda. However, little is known about their displacement experiences, as well as the reality of alcohol use and abuse within refugee settlements. Drawing upon the direct voices of a sample of war-affected South Sudanese young people, this article explores their experiences of forced displacement and their links to alcohol abuse, as well as their perceptions regarding appropriate alcohol treatment interventions for refugees in the camp. A total of 22 semi-structured qualitative interviews were conducted with 14 refugee youth (aged 18-25) alongside eight adult key informants who work with the youth (religious leaders, sports coaches, educators, social workers, and settlement administrators). Using thematic analysis, the study revealed a series of key themes influencing and shaping the high incidence of alcohol abuse among the youth. These included traumatic wartime and migration experiences, family separation, poor prospects, and the ubiquitous availability of alcohol in the settlement. In addition, we show how alcohol operates as a strategic tool for survival for the youth, as well as highlight how these perceptions can help to inform alcohol treatment interventions in the Bidibidi refugee settlement. To our knowledge, this is the first in-depth study of alcohol abuse among war-affected South Sudanese refugee youth in Uganda, addressing a significant gap in the current literature on war-affected youth, forced displacement, and alcohol abuse. We contend that involving youth in the design of interventions can be helpful for culturally sensitive and relevant prevention, treatment, and care in refugee settings. In addition, providing employment opportunities and meaningful engagement for growth through social participation can help to address harmful alcohol use among youth in the camps.

Social domains of poor mental health: A qualitative pilot study of community stakeholders' understanding and demarcation of mental illness and its interpretations in rural Nigeria

Background and Aims

Although previous studies on mental health/illness in Nigeria have explored knowledge and attitude of community members using quantitative approaches, few studies have engaged stakeholders within rural communities on the issue of mental illness using qualitative approaches. Community stakeholders play a critical role in influencing health behaviors. The objective of this pilot study was to explore community stakeholders' understanding and demarcation of mental illness, and its interpretations in a rural Nigerian town. This is with the aim of shaping stakeholders understanding of people when they experience mental distress within the community.

Methods

The study was conducted in Ijebu-Igbo town of Ogun State in south-west Nigeria. In-depth interviews were conducted among two religious' leaders: a Pastor and an Imam, a traditional healer, a medical doctor, and a registered nurse, and a focus group discussion was held in a church with members of its advisory committee.

Results

The findings showed that community stakeholders gave multiple interpretations of mental illness and many attribute mental illness to spiritual attack, ancestral curse, anger of the gods, and personal affliction (Ogun-Afowofa). This has been categorized as familial and individual attributes in this study which is part of the main themes derived. The study findings also show that the understanding of community members regarding the root causes of mental illness is somewhat vague based on their poor knowledge of mental illness. This is because of the various interpretations they gave to explain mental health is based on their cultural orientation, socialization, and belief system, and not based on any medical knowledge.

Conclusion

This pilot study was conducted to justify the main study. There is therefore a need for health education interventions to enlighten and educate community stakeholders with requisite knowledge for better understanding and interpretation of mental illness. Also, through mental health education interventions, community members will gain clarity on what mental health is and what it is not.

Multivariate analysis of heavy metals content of beef from Soroti, Uganda

Information about food hygiene and quality in the sub-Saharan African countries remains scarce at a time when many of their citizenry are beginning to acquire the much coveted middle income status. Confounding this are challenges linked to monitoring on a continuous basis the safety of food produced by such lucrative industries as the beef industry. The objective of the current study was to initiate a process of encouraging changes in the status quo, by showing how a first step in that direction might look like. Using heavy metal contents of representative beef samples from butcheries in Soroti, Uganda, typical of a sub-Saharan country, we demonstrate how relationships and common sources of metals in food could be identified in a multivariate space. Beef samples from 40 sites were analyzed by atomic absorption spectrometry for iron (Fe), zinc (Zn), nickel (Ni), chromium (Cr), lead (Pb), copper (Cu), cobalt (Co) and cadmium (Cd). The study showed that all beef samples contained these metals, the extent of which were in the order: Fe > Zn >> Ni, Cr > Pb > Cu, Co > Cd. By correlation analysis, the pairs Ni and Cr, Cd and Co, Ni and Fe or Cr and Fe were found to be most likely coming from similar sources. At least three distinct characteristics of beef consumed in Soroti were also found, a distinction perhaps arising from three major categories of feedlots used to raise donor cattle. The incremental risk of children or adults developing cancer over a lifetime was estimated and found to fall into three categories, two of which are separately explained by the presence of Cr or Ni. The sources of these metals remain a matter of speculation on our part. More studies are needed to determine these sources and to understand the nature of cancer risk in the three categories of beef identified here.

First Report on the Presence of Toxic Metals and Metalloids in East Asian Bullfrog (Hoplobatrachus rugulosus) Legs

We examined the presence of As, Cr, Cd, and Pb in 42 samples of farmed East Asian bullfrog (Hoplobatrachus rugulosus) from Vietnam and Thailand by inductively coupled plasma-mass spectrometry (ICP-MS). An estimation of the dietary intake and exposure to the toxic elements analysed was also carried out. The results showed very high As levels, with mean values of 0.094 ± 0.085 mg/Kg w.w. and a maximum of 0.22 mg/Kg. No significant differences were found for As contents between areas of production (p > 0.05). No detectable Cd contents were found in all the samples examined. The Pb concentrations of the East Asian bullfrog legs samples were below the European Commission’s permitted levels. The Cr and Pb contents of the East Asian bullfrog produced in Vietnam were significantly higher than that produced in Thailand (p < 0.05). The target hazard quotient (THQ) ratio for Cr was not exceeded for all the samples analysed. In contrast, the benchmark dose lower confidence limit (BMDL) and THQ ratios for As were exceeded, indicating carcinogenic and non-carcinogenic risks for those who consume this type of food. The results of this work confirm the role of As-contaminated water absorption as an important source of arsenic for these adult organisms.

Comparison of metal bioaccumulation in crop types and consumable parts between two growth periods

A high proportion of populations in most developing countries live below the poverty line and those near refuse grounds resort to dumpsite farming to grow food. Consequently, high levels of waste-derived contaminants are found in crops consumed by these people. This study investigates the extent to which crops cultivated on the Mbale dumpsite (Uganda) were contaminated by 11 metals and 2 non-metals: iron (Fe), aluminum (Al), zinc (Zn), manganese (Mn), copper (Cu), mercury (Hg), lead (Pb), nickel (Ni), cobalt (Co), cadmium (Cd), selenium (Se), chromium (Cr), and arsenic (As). We investigated how element bioaccumulation in crops was influenced by the growth period (short- and long-term crop maturity). The short-term crops were Zea mays and Amaranthus cruentus, whereas the long-term crops were Manihot esculenta, Colocasia esculenta, Musa acuminata, Carica papaya, Coffea arabica, and Saccharum officinarum. Results showed that nine metals were present at concentrations above World Health Organization/Food and Agriculture Organization (WHO/FAO) food safety recommendations and hence may pose health risks to consumers. In this study, leaves contained higher metal concentrations than other analyzed consumable parts. Pb and Co were found at higher concentrations in leaves of short-term crops than in long-term crops. Among short-term crops, only Z. mays seeds contained permissible metal concentrations by WHO/FAO standards. The growth period was also found to influence metal bioaccumulation in crop types. Pb, Co, Fe, Al, and Cu concentrations were significantly higher in the short-term crops than in long-term crops, while Mn, Ni, and Cr concentrations were higher in long-term crops than in short-term crops. Overall, public awareness about the health risks associated with consuming short-term leafy crops grown on dumpsites should be improved to reduce toxic metal exposure. While implementing such a campaign, the food supply of individuals whose survival depends on such crops should not be jeopardized. Therefore, farmers need alternative farming areas outside dumpsites. Integr Environ Assess Manag 2022;18:1056-1071. © 2021 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Impact of the Sachet Alcohol Ban on Alcohol Availability in Uganda

OBJECTIVE

Alcohol use continues to be a major public health problem in Uganda. This study sought to estimate the availability of sachet alcohol among retail food and beverage establishments in two Ugandan districts (Kampala and Jinja) before and after enactment of the national sachet alcohol ban.

METHOD

Independent observations in 100 establishments were conducted by a pair of trained observers during the peak hours of 7 P.M. to 1 A.M. Using a standardized checklist, observers recorded indications of alcohol availability before and after enactment of the sachet alcohol ban.

RESULTS

Availability of (a) alcohol and (b) sachet alcohol were significantly affected by the ban. Before the ban, 69% of all establishments sold alcohol; there was a significant reduction in alcohol availability after enactment of the ban to 43% of the establishments (p < .001). This reduction was observed in off-premise establishments (p < .001), but not in on-premise establishments (p = .710). Additionally, before the sachet alcohol ban, 52% of all establishments sold sachet alcohol; however, there was a significant reduction in sachet availability after enactment of the ban (1.4%, p < .001).

CONCLUSIONS

Legislation banning the manufacture and sale of sachet alcohol has the potential to reduce sachet availability. Future studies should examine changes in alcohol consumption following the sachet alcohol ban.

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

ISSUES

Sub-Saharan Africa (SSA) has long been characterised as a region with weak alcohol policies, high proportions of abstainers and heavy episodic drinkers (among drinkers), and as a target for market expansion by global alcohol producers. However, inter-regional analyses of these issues are seldom conducted.

APPROACH

Focusing mainly on the period 2000-2016, we compare alcohol consumption and harms, alcohol policy developments and alcohol industry activities over time and across the four sub-regions of SSA.

KEY FINDINGS

Per-capita consumption of alcohol and alcohol-related disease burden have increased in Central Africa but stabilised or reduced in other regions, although they are still high. Most countries have implemented tax policies, but they have seldom adopted other World Health Organization 'best buys' for cost-effective alcohol control policies. Countries range from having minimal alcohol controls to having total bans (e.g. some Muslim-majority countries); and some, such as Botswana, have attempted stringent tax policies to address alcohol harm. Alcohol producers have continued their aggressive marketing and policy interference activities, some of which have been highlighted and, in a few instances, resisted by civil society and public health advocates, particularly in southern Africa.

IMPLICATIONS

Increased government support and commitment are needed to be able to adopt and implement effective alcohol policies and respond to pressures from alcohol companies to which SSA remains a target market.

CONCLUSION

SSA needs effective alcohol control measures in order to reverse the trajectory of worsening alcohol harms observed in some countries and reinforce improvements in alcohol harms observed in others.

Descriptive Analysis of Heavy Metals Content of Beef From Eastern Uganda and Their Safety for Public Consumption

In this study, we initiated an effort to generate information about beef safety in Uganda. Our entry point was to assess by atomic absorption spectrophotometry the levels of essential elements copper (Cu), cobalt (Co), iron (Fe) and zinc (Zn), and non-essential elements lead (Pb), chromium (Cr), nickel (Ni), and cadmium (Cd) in 40 beef samples collected from within and around Soroti (Uganda). The information was used to evaluate the safety of consuming such beef against the World Health Organization (WHO) limits. The latter was accomplished by (i) estimating the daily intake (EDI) of each metal in the study area, (ii) modeling the non-cancer health risk using the target hazard quotient (THQ) and (iii) modeling the cancer risk using the incremental lifetime cancer risk (ILCR). The study finds that the mean concentrations (±95% CI) and EDI were in the order of Fe > Zn > Cr > Ni > Pb > Co > Cu > Cd. Cancer risk was found to be due to Ni > Cr > Cd > Pb and significantly higher in children than adults. The latter particularly demonstrates the importance of Ni poisoning in the study area. Overall, while essential elements in our beef samples were below WHO limits (hence no health risks), non-essential elements had high health and cancer risks due to higher levels of Cr and Ni.

An analysis of heavy metals contamination and estimating the daily intakes of vegetables from Uganda

Background:

Environmental contamination with elevated levels of copper (Cu), cobalt (Co), iron (Fe), zinc (Zn), lead (Pb), chromium (Cr6+), cadmium (Cd), and nickel (Ni)—all states of which are found in Uganda—raises health risk to the public. Pb, Cr6+, Cd, and Ni for instance are generally considered nonessential to cellular functions, notwithstanding the importance of the oxidative state of the metals in bioavailability. As such, we aimed in this study (i) to evaluate heavy metal concentrations in four vegetables from a typical open-air market in Uganda, (ii) to assess the safety of consuming these vegetables against the World Health Organization (WHO) recommended limits of heavy metals consumption, and (iii) to formulate a model of estimated daily intake (EDI) among consumers in the country.

Methods:

This was a cross-sectional study conducted in five georeferenced markets of Bushenyi district in January 2020. Amaranthus, cabbages, scarlet eggplants, and tomatoes were collected from open markets, processed, and analyzed by atomic absorption spectrometry. Modeled EDI, principal component (PCA) and cluster analysis (CA) were conducted to identify relationships in the samples.

Results:

The levels of essential elements in the four vegetables were found to fall from Co > Cu > Fe > Zn. Those of non-essential metals were significantly higher and followed the pattern Cd > Cr > Pb > Ni. The highest EDI values were those of Cu in scarlet eggplants, Zn in amaranthus, Fe in amaranthus, Co in amaranthus, Pb in cabbages, total Cr in scarlet eggplant, Cd in cabbages and tomatoes, and Ni in cabbages. In comparison to international limits, EDIs for Zn, Cu, Co and Fe were low while Ni in cabbages were high. PCA showed high variations in scarlet eggplant and amaranthus. The study vegetables were found to be related with each other, not according to the location of the markets from where they were obtained, but according to their species by CA.

Conclusion:

The presence of non-essential elements above WHO limits raises policy challenges for the consumption and marketing of vegetables in the study area. Furthermore, low EDIs of essential elements in the vegetables create demand for nutritious foods to promote healthy communities.

Health Risk Assessment of Metals in Selected Drinks from Abeokuta, Southwestern Nigeria

The present study assessed the human health risk of metals in selected drinks from Abeokuta, southwestern Nigeria. Fifteen different brands of drinks (alcoholic, non-alcoholic, herbal and non-herbal) were purchased from notable markets in Abeokuta between June and August, 2018. A total of sixty drink samples were analysed for metals using atomic absorption spectrophotometry. Data were subjected to descriptive and inferential statistics. Human health risks were assessed for cancer risk (CR) and non-carcinogenic indices of hazard quotient (HQ) and hazard index (HI). Results showed acidic medium for most of the samples ranging from 3.12 ± 0.29 to 6.14 ± 0.17. The highest concentrations of Fe (5.53 ± 2.81 mg/L) and Mn (6.63 ± 8.33 mg/L) were found in Kunnu and Zobo, respectively. The HQ and HI values of Cu in bottled water indicated non-carcinogenic adverse effects, while the CR of Co in bottled water and bitters demonstrated carcinogenic effects. Regular monitoring of metals in drinks from the study area is recommended.

Heavy metal contamination in recorded and unrecorded spirits. Should we worry?

Heavy metals can be released into all alcoholic beverages during production and storage. However, there is at least a theoretical risk that they could be present in higher, and potentially toxic, concentrations in those produced in the household and small-scale stills common in Central and Eastern Europe, which lack quality control and whose products are unrecorded by authorities. Yet, so far, few studies comparing concentrations of heavy metals in recorded and unrecorded spirits have been published. In this study we ask whether there is any difference between heavy metal concentrations in recorded and unrecorded spirits and, thus, the related health risk. The levels of heavy metals were determined in recorded (n = 97) and unrecorded (n = 100) spirits using inductively coupled plasma optical emission spectrometric analysis and applied to population-based risk assessments, considering average, regular and chronic heavy drinkers. Concentrations of Cu, Zn, and Sn were significantly higher in unrecorded spirits than those in their recorded counterparts and recorded spirits contained significantly higher levels of Fe, Mn, and Ni than unrecorded spirits. Combined exposure to heavy metals posed a potential health risk in chronic heavy drinkers consuming recorded spirits. However, when compared to the health risk arising from drinking large volumes of ethanol, the risk is negligible. Consequently, there are no grounds to worry about the adverse effects of heavy metals from spirits.