Uganda’s drink of death

By Abushedde Angella

Consumption of alcohol is among the four most important risk factors in the burden of disease and premature death

People say they drink alcohol either to have fun, celebrate an achievement, or “down their sorrows” after a major life stress. A little drink once in a while is one thing but a little more might contribute to your risk of illness or premature death according to the latest Global Burden of Disease (GBD) study.

This collaborative study of researchers from 50 countries around the world measures the years of life lost due to less than full health and premature death.

It is led by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in the United States and the Human Development Network (HDN) and the World Bank, supported by the Bill & Melinda Gates Foundation.

Uganda is not the only country where alcohol is among leading risk contributor to either less than full health and premature death. As a risk factor, alcohol is ranked fifth among major contributors to the global burden of disease after poor diet, high blood pressure, smoking, and household pollution.

But it is in Uganda alone globally when alcohol is the number one risk factor. The DR Congo, swazilanda, and Zimbabwe have major alcohol problems but not to the same extent as Uganda.

The global status report on alcohol and health released in 2004 by the WHO revealed that Uganda was the top contender for per capita consumption of alcohol in the world with over 19.4liters of alcohol consumed annually. The CNN ranked Uganda 8th in its world’s best drinking nations.

The GBD is based on a single measurement, the Disability-Adjusted Life Years (DALYs), to quantify the number of years of life lost as a result of both premature death and disability by age, sex, and geography for specific points in time. The intention of the report is to create a global public good that will be useful for informing the design of health systems and the creation of public health policy.

Four main trends have driven changes in the leading causes of DALYs globally: aging populations, increases in non-communicable diseases, shifts toward disabling causes and away from fatalcauses, and changes in risk factors.

According to the study, NCDs are rising in sub-Saharan Africa at similar rates to those found globally, but unlike the rest of the world; these causes have yet to displace the persistent health loss driven by communicable conditions.

This emergent “dual burden of disease” is experienced in many countries, but nowhere is it as striking as the epidemiological patterns found in the countries of sub-Saharan Africa.

“If we look at sub-Saharan Africa, you’ve got the double burden of communicable diseases and the rising instances of non-communicable diseases. The dilemma will be how to deal with the non-communicable diseases without compromising what you’ve already been doing for communicable diseases,” said Christine Kaseba-Sata, First Lady of Zambia, when the study was released.

In Uganda’s case, all causes of DALYs have close association to alcohol consumption. Top on the list are falls, interpersonal violence, HIV/Aids, road injury, and self-harm. The other significant causes of DALYs include syphilis, cirrhosis, and tuberculosis.

Alcohol has been linked to accidents and injuries. Between 10-20 victims of bodaboda accidents are received at Mulago hospital on a daily basis and 20% of the victims are left disabled.

“Across Kampala, motorcycles are the most commonly used means of transportation and are also the leading cause of disability and death especially from head injury,” says Kampala Metropolitan Police spokesperson, Ibin Ssenkumbi.

“Alcohol’s intoxicating and dependence properties have played a big role in the rise of non- communicable diseases in Uganda,” says Kaggwa Muggaga, an advisor at WHO.

The GBD researchers established a link between alcohol consumption in Uganda to the rise of cancer especially breast cancer, diabetes, cardiovascular diseases (CVDs), liver disease, respiratory infections, injuries and disability and mental disorders such as depression. These are the so-called Non-Communicable Diseases (NCDs) or ailments that are not spread from person to person.

According to the Uganda Heart Institute there has been a 500% increase in outpatient attendance due to heart related conditions over the past decade. The Uganda Cancer Institute has also reported an upward trend in cancer incidence over the past years particularly in HIV infection related cancers.

Regional referral hospitals have reported an increasing number of mental disorders, diabetes and chronic obstructive pulmonary disease patients either admitted in their medical wards or seen at their out patients clinics. Two million people are also believed to be living with diabetes in the country.

Part of the problem is that when someone drinks alcohol, it is quickly absorbed into the blood and carried throughout the body. Alcohol stays in the body for about two hours after being consumed and since a large percentage is not absorbed by the liver it goes to the rest of the body including the heart and brain affecting their performance and becoming a risk of diseases.

The toxic effects of alcohol on nerve cells effect memory, learning, reaction time, perception, obstruct thinking and complex reasoning.

If someone drinks heavily over a long period he or she is susceptible to fits, seizures and blackouts which can cause permanent mental disorders on the brain. Prolonged use of alcohol is also thought to be the cause of dementia.

High alcohol consumption in Uganda is linked to the aggressive marketing by manufacturers through mass media advertisements, sponsorship of sports activities, performing arts and music, free alcohol promotions at discount prices and total disregard of the law on availability of alcohol, time and selling points.

Uganda still has neither national alcohol policy nor an effective regulatory body. Police recently stepped up its surveillance to catch intoxicated motorists and pedestrians under the influence of alcohol.

“The government should reactivate the alcohol licensing boards, sensitise the current legal regime Enguli Act 1964, and regulate the brewery industry and media,” says Ssenkumbi, the spokesperson of the police.

Attempts by the Ministry of Health to regulate the consumption of alcohol have been opposed by the Ministry of Trade which has blocked a propose ban on the manufacture and consumption of local gin products; waragi, sachets.

The alcohol manufacturers successful opposed a rise in the tax levy on alcohol introduced in the 2012/13 budget. They argued that government would lose revenue if alcohol prices and smuggling increased. The proposal was also dropped this financial year.