Inventaire d'enquêtes Demostaf

Background: Alcohol use is increasing among women in Africa, and comparable information about women’s current alcohol use is needed to inform national and international health policies relevant to the entire population. This study aimed to provide a comparative description of alcohol use among women across 20 African countries. Methods: Data were collected as part of the WHO World Health Survey using standardized questionnaires. In total, 40,739 adult women were included in the present study. Alcohol measures included lifetime abstinence, current use (≥1 drink in previous week), heavy drinking (15+ drinks in the previous week) and risky single-occasion drinking (5+ drinks on at least one day in the previous week). Country-specific descriptives of alcohol use were calculated, and K-means clustering was performed to identify countries with similar characteristics. Multiple logistic regression models were fitted for each country to identify factors associated with drinking status. Results: A total of 33,841 (81\%) African women reported lifetime abstinence. Current use ranged from 1\% in Malawi to 30\% in Burkina Faso. Among current drinkers, heavy drinking varied between 4\% in Ghana to 41\% in Chad, and risky single-occasion drinking ranged from associated with increased odds of being a current drinker in about half of the countries. Conclusions: A variety of drinking patterns are present among African women with lifetime abstention the most common. Countries with hazardous consumption patterns require serious attention to mitigate alcohol-related harm. Some similarities in factors related to alcohol use can be identified between different African countries, although these are limited and highlight the contextual diversity of female drinking in Africa. Background Alcohol use is an important factor in any woman’s health risk profile. Harmful patterns of alcohol con- sumption are strongly associated with increased morbid- ity and mortality [1]. Alcohol related morbidities include mental health disorders such as substance dependence and depression, and physical morbidities such as breast cancer, and HIV infection [2-5]. Women also experience unique negative social consequences of alcohol use that impact health, from increased risk of domestic violence and stigma [6,7]. The negative health and social conse- quences of alcohol use are further moderated by the volume of alcohol consumed and the pattern of use over time [8]. Alcohol use among women in Africa has traditionally been quite low, and high rates of lifetime abstention persist in many African countries [9]. However, popula- tion-based surveys have documented rates of alcohol use and harmful drinking among African women that raise concern, including episodic binge drinking and regular high consumption. Prevalence of alcohol use in the past-year among women was estimated at 30\% in Bostwana and 47\% in Namibia [9,10]. Heavy drinking was found in 38\% of women currently drinking in Nigeria and 20\% among current female drinkers in Uganda [11,12]. The negative consequences of harmful alcohol use are illustrated by studies that identify women’s alcohol use as a risk factor for HIV infection in Uganda and South Africa [13,14]. From the limited evidence available, factors associated with alcohol use among women in low to middle income countries included being single, higher socio-economic status and higher levels of education [15-17]. * Correspondence: priscilla.martinez@medisin.uio.no Norwegian Center for Addiction Research, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway Full list of author information is available at the end of the article Martinez et al. BMC Public Health 2011, 11:160 http://www.biomedcentral.com/1471-2458/11/160 © 2011 Martinez et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. African countries are categorized as low to middle income, and as such are often limited alcohol-policy environments [18]. As observed in Thailand, such an environment coupled with increasing incomes resulted in pronounced increases in rates of drinking among young women [19]. The heavy influence of the alcohol industry on the development of national alcohol policies favorable to alcohol advertising and distribution has recently been documented in several African countries [20]. The combination of minimally regulated alcohol companies and increased commoditization of their pro- ducts, along with higher levels of social tolerance towards female drinking predicates increases in the number of African women imbibing alcohol. A recent study using data from the WHO’s World Health Survey observed diverse patterns of drinking among 20 African countries, supporting the contention there is a variety of national drinking habits across the African continent [21]. This study, however, did not explicitly examine patterns of use among currently drinking women. Indeed, there is a paucity of research investigating African women’s use of alcohol and asso- ciated factors at a country level, limiting our current knowledge of the different ways women consume alco- hol in different African countries. This knowledge is important for gauging the expected increase in alcohol use by African women, and the inclusion of women’s interests in the development of national health and alco- hol policies. The WHO’s World Health Survey provided data on alcohol use and sociodemographics among women in 20 African countries [22]. Using this data, the present study provides a comparative description of alcohol use among women in Africa. We also aimed to identify broad similarities and differences in women’s drinking behaviors across the 20 countries, and determine socio- demographic factors associated with current drinking levels and different drinking patterns by country. Methods Data collection The data used for this study is publicly available from the WHO. Data were collected as part of the WHO World Health Survey (WHS) between 2002 and 2004 in 20 African countries [22]. Household samples were drawn from nationally representative sampling frames. A stratified, multi-stage cluster design was used where each household had a known non-zero probability of selection. One single respondent aged 18 years or above was randomly selected from each eligible household using Kish tables. In total 77,165 adults aged 18 years and older were included, and of these, 40,739 (53\%) were women. Response rates were reported at both the household and individual level and varied between 54 and 98\% at the household level (median = 90\%), and 85 and 99\% at the individual level (median = 98\%) [23]. The WHS used identical questionnaires for the face- to-face interviews in all 20 countries. Individual level data included sociodemographic variables such as mari- tal status, education and employment. WHS protocols and procedures were approved by the ethics committees in each participating country and informed consent was obtained from all participants. The instruments and sampling designs are described in further detail else- where [23,24]. Alcohol data The question “have you ever consumed a drink that contains alcohol?” was used to identify lifetime abstai- ners. If the respondent indicated positively, they were asked “how many standard drinks were consumed each day in the past 7 days”. From this, we constructed three variables related to drinking: ‘current drinkers’ were defined as any respondent who consumed at least 1 standard drink in the previous 7 days; ‘heavy drinkers’ were defined as those who had consumed a total of 15 or more standard drinks during the last 7 days; and ‘risky single-occasion drinkers’ were defined as those who consumed at least 5 or more standard drinks of alcohol on at least one day of the previous week. Note these three variables are not mutually exclusive. A showcard with pictures was used to illustrate what was meant by a “standard drink”, and defined by WHS as containing between 8-13 g of ethanol depending on the country. Statistical analyses All data were weighted, with post-stratification adjust- ments for age and gender using the UN population esti- mates as the reference population. Data were stratified by gender, and descriptive statistics presented as fre- quencies (\%) or means (SD). Prevalences for the ‘heavy drinker’ and ‘risky single-occasion drinker’ variables are presented out of the total ‘current drinker’ group, unless otherwise specified. All the rates presented are weighted proportions. In order to explore whether the 20 countries could be grouped into clusters based on similarities in percen- tages of the three drinking variables, i.e. ‘lifetime abstai- ners’, ‘heavy drinkers’ and ‘risky single-occasion drinkers’, we performed K-means clustering, averaging over 25 runs [25]. K-means clustering aims to divide a number of observations into a number of clusters where each observation belongs to the cluster with the nearest mean value(s) and the within-cluster variability is at a minimum. Only the 14 countries with values above 1\% for ‘heavy drinkers’ and ‘risky single-occasion drinkers’ Martinez et al. BMC Public Health 2011, 11:160 http://www.biomedcentral.com/1471-2458/11/160 Page 2 of 9