Year. Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends Male 80%

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1 ALGERIA Recorded adult per capita consumption (age 15+) Litres of pure alcohol Beer Spirits Wine Year Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003 Last year abstainers 89% Male 80% Female 98% Estimates from key alcohol experts showing proportion of adult males and females who had been abstaining (last year before the survey). Data is for after year Unrecorded alcohol consumption The unrecorded alcohol consumption in Algeria is estimated to be 0.3 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts). 1 1

2 Country background information population Life expectancy at birth (2002) Male 67.5 Adult (15+) Female 71.2 % under Probability of dying under age 5 per 1000 (2002) Male 54 Population distribution 2001 (%) Female 43 Urban 53 Gross National Income per capita 2002 US$ 1720 Rural 47 In Algeria, approximately 99% of the population are Muslim. Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Factbook 2003, The World Health Report References 1. Alcohol per capita consumption, patterns of drinking and abstention worldwide after Appendix 2. European Addiction Research, 2001, 7(3):

3 ANGOLA Recorded adult per capita consumption (age 15+) 7 6 Litres of pure alcohol Beer Spirits Wine Year Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003 Traditional alcoholic beverages Traditional Angolan beer is brewed from the African palm nut. 1 Country background information population Life expectancy at birth (2002) Male 37.9 Adult (15+) Female 42.0 % under Probability of dying under age 5 per 1000 (2002) Male 279 Population distribution 2001 (%) Female 247 Urban 35 Gross National Income per capita 2002 US$ 660 Rural 65 Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004 References 1. Kabia H. Global Beer Network ( accessed 28 March 2004). 3

4 BENIN Recorded adult per capita consumption (age 15+) Litres of pure alcohol Beer Spirits Wine Year Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003 Abstainers in the city of Cotonou Male 16.8% Female 14.3% Survey conducted in the city of Cotonou in 1998 among people 10 years and older defined abstainers as non-users of alcohol (total sample size n = 540). 1 Regular drinkers in the city of Cotonou 25% Survey conducted in the city of Cotonou in 1998 among people 10 years and older (total sample size n = 540). Drinking was defined as regular drinking and having been intoxicated at least three times. The most consumed beverage was beer, followed by sodabi (distilled palm wine). 1 4

5 Traditional alcoholic beverages Shakparo beer is a traditional sorghum beer which has an important social, economic, ritual, nutritional and sanitary role in the Idashaland, Dassa-Zoume, in the savannah region of the Republic of Benin. It is traditionally brewed by Idasha women. It is brewed mainly from malted guinea corn. Sorghum, also called gros mil in French, seems to be the best cereal for brewing shakparo. The beverage has a fruity and sour taste, with a complex organic acid flavour and yoghurt and sorghum aroma. It is cloudy and yeasty in appearance with a brownish pink colour. The alcohol content ranges from 1% to 8% by volume. The traditional form of the product has a short shelf life and must be consumed within a few days. 2 Burukutu is a popular alcoholic beverage of a vinegar-like flavour prepared from sorghum grains. Fully matured burukutu beer has an acetic acid content which varies between 0.4% and 0.6%. 3 Palm wine, tchoukoutou (local beer) and sodabi (local spirit obtained by distilling palm wine) are also consumed in the Republic of Benin. Country background information population Life expectancy at birth (2002) Male 50.1 Adult (15+) Female 52.4 % under Probability of dying under age 5 per 1000 (2002) Male 166 Population distribution 2001 (%) Female 158 Urban 43 Gross National Income per capita 2002 US$ 380 Rural 57 Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004 References 1. Agossou T et al. L alcool et les drogues à Cotonou. De la consommation à l abus et aux mesures de protection. Alcoologie, 1999, 21(HS): Okambawa R. Shakparo: a traditional West African sorghum beer ( accessed 28 March 2004). 3. Haard NF et al. Fermented cereals: a global perspective. Rome, Food and Agriculture Organization of the United Nations, 1999 ( accessed 27 March 2004). 5

6 BOTSWANA Recorded adult per capita consumption (age 15+) Litres of pure alcohol Beer Spirits Wine Year Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003 Last year abstainers 53.5% Male 37% Female 70% Estimates from key alcohol experts showing proportion of adult males and females who had been abstaining (last year before the survey). Data is for after year A survey conducted in 1986 among workers at different workplaces mainly in Setswana found that the rate of current abstainers was 50%. A greater proportion of male compared to female respondents stated that they were current drinkers. 2 Alcohol abuse According to data collected for the Botswana Epidemiology Network on Drug Use (BENDU) in 2003 from four treatment centres, alcohol remains the most common primary substance of abuse reported by patients, accounting for 84% of the 72 patients. Home brews are the most common type of alcohol used as they are easily available and affordable. 3 Traditional alcoholic beverages Nyola is a home-brewed concoction prepared from commercially produced sorghum powder. About 750 grams of beer powder is mixed with five litres of warm water and allowed to ferment overnight before consumption. 4 Bojalwa (sorghum beer) and khadi are both home-brewed beer-like drinks that vary greatly in terms of taste, consistency and alcohol content depending on availability of ingredients and methods of fermentation. Indeed khadi could almost be described as a designer alcohol often brewed to the consumer s needs and tastes. It is 6

7 made from a base or mash that can consist of a combination of any of the following ingredients: wild berries, wild pumpkins, wild roots, oranges, sorghum and maize. Yeast, black tobacco or other unspecified substances are sometimes added to this base to give it strength, and there have been rumours around Ghanzi of car battery acid also being added. 4 Khadi has a higher alcohol content than bojalwa and has often been the particular subject of proclamations and laws throughout Botswana s colonial and modern legislative history. 5 Proprietary brand-name alcohol is popular if money is available. Industrially produced sorghum beers like Chibuku or Shake-shake and commercial beers like Castle and Lion are consumed, and around Ghanzi, Clubman mint, a cheap 23% alcohol mint punch sold in bottle stores is a favoured drink. 4 There are also a number of other local brews with a high alcohol content. The strongest, known as tho-tho-tho, is distilled from a sorghum concoction and can have an alcohol content of over 80% by volume. Others, which are brewed overnight from mostly yeast and sugar combinations, have such a high alcohol content that they go by ominous names such as o lala fa (you sleep right here), chechisa (hurry-up), laela mmago (say good bye to your mother), monna-tota (real man), motse o teng godimo (there is home in heaven), and so forth. Other less strong brews are made from wild fruits such as morula. They are, however, very seasonal. 6 It should be noted that one of the problems with home brews is that there is no quality control in their preparation and, concomitantly, no way of ascertaining their true alcohol content or assessing the true alcohol consumption of an individual drinking these brews over a period of time. 4 Unrecorded alcohol consumption The unrecorded alcohol consumption in Botswana is estimated to be 3.00 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts). 1 Morbidity, health and social problems from alcohol use In terms of health-related consequences, it was claimed by medical staff in local government clinics that habitual drinkers among the Basarwa suffer from general self-neglect, particularly poor personal hygiene and a tendency to forget to eat when drinking, which can lead to malnutrition. Physical side effects reported include pale skin, red eyes and weight loss with more serious cases developing symptoms of alcohol psychosis, particularly hallucinations and incoherence of thought. 4 Socially, alcohol is seen as a contributing factor to an increasing number of traumatic events and injuries reported at health facilities. Many of the injuries are sustained in violent physical fights or attacks in which sticks, knives and spears are commonly used. Wife beating is also claimed to be a more regular occurrence as is the beating of children by adults, hitherto unknown among the Basarwa. 4 The economic consequences of habitual alcohol use are devastating and act as distinct barriers to any sense of development. Informants stated that since a significant proportion of household income was spent on liquor, less cash was available for food, clothing and other essential items. As one informant succinctly stated: alcohol makes poor people poorer. A person who is regularly under the influence of alcohol will have little motivation or interest in working, unless it is to obtain money to buy more alcohol. One particular problem is that a regular drinker can easily become economically tied and indebted to alcohol vendors who are only too pleased to provide alcohol on credit. 4 A variety of delinquent acts and criminal offences were also perceived by workers to be associated with excessive alcohol consumption. One respondent reported that poaching by the Basarwa was the result of alcoholinduced adventurism. Another indicated that it was not uncommon for male and female children to either withdraw or drop out from school after Standard 7 due to alcohol abuse and that some young girls in the Ghanzi squatter camp had prostituted themselves to buy alcohol. 4 Child neglect is an increasing problem when parents are intoxicated so early in the day that they are not able to prepare food for their children, even if there is food available. A concern is that some parents will sell food to buy alcohol while others will give alcohol to their children as a food substitute and to stave off hunger. Generally, the neglect of young children due to alcohol abuse means that these children are under-socialized as well as malnourished, leading to a refusal to attend school, begging and stealing for food, and other delinquent activities. 4 It has been noted that the fairly high prevalence of folate, thiamine and iron deficiency in the population of the Ghanzi and Ngamiland communities of western Botswana may be related in part to alcohol consumption. Alcohol-related violence was responsible for a substantial number of injuries to men, women and children. Alcohol is believed to contribute to spousal and child abuse, and is a major cause of social conflict. 7 7

8 In a mixed economy such as Botswana, it is argued that one reward for seasonal labour was drinking alcohol. When the work is done for the day, the labour force drinks. And, they acquire a taste for the drink of their employers European style clear beers and wines. Farmers have long ago realized the increased profits to be gained by paying their workforce partially in tots of inexpensive wine. For the employers, it was cheap cheaper than paying African labourers only in cash. 8 Country background information population Life expectancy at birth (2002) Male 40.2 Adult (15+) Female 40.6 % under Probability of dying under age 5 per 1000 (2002) Male 104 Population distribution 2001 (%) Female 102 Urban 49 Gross National Income per capita 2002 US$ 2980 Rural 51 Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004 References 1. Alcohol per capita consumption, patterns of drinking and abstention worldwide after Appendix 2. European Addiction Research, 2001, 7(3): Molamu L. Alcohol research and public policy in Botswana. Paper presented at the symposium on Experiences with Community Action Projects for the Prevention of Alcohol and other Drug Problems. Toronto, Canada, March Parry CDH, Plüddemann A. Southern Africa Development Community Epidemiology Network on Drug Use (SENDU): January June Cape Town, Medical Research Council, Molamu L, Macdonald D. Alcohol abuse among the Basarwa of the Kgalagadi and Ghanzi districts in Botswana. Drugs: education, prevention and policy, 1996, 3(2): Recupero C. Alcohol legislation and development in Botswana from 1875 to the present: a review of the relevant literature. Social History of Alcohol Review, 1998, 36 37: [Anonymous]. Food and selected dishes. Embassy of Botswana Website, Japan ( accessed 27 March 2004). 7. Hitchcock RK, Draper P. Health issues among the San of Western Botswana ( accessed 29 March 2004). 8. Suggs DN. These young chaps think they are just men, too : redistributing masculinity in Kgatleng bars. Social Science and Medicine, 2001, 53(2):

9 BURKINA FASO Recorded adult per capita consumption (age 15+) 6 5 Litres of pure alcohol Beer Spirits Wine Year Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003 Lifetime abstainers 63.7% Male 63.4% Female 64.0% Survey. sample size n = 4782; males n = 2255 and females n = Survey population aged 18 years and above. 1 Heavy and hazardous drinkers 11.6% Male 10.0% Female 13.2% Survey. sample size n = 4782; males n = 2255 and females n = Survey population aged 18 years and above. Definition used: average consumption of 40 g or more of pure alcohol a day for men and 20 g or more of pure alcohol a day for women. 1 According to the 2003 World Health Survey (total sample size n = 1580; males n = 764 and females n = 816), the mean value (in grams) of pure alcohol consumed per day among drinkers was 25.2 (total), 30.5 (males) and 20.0 (females). 1 9

10 Heavy episodic drinkers 10.9% Male 13.9% Female 7.7% Survey. sample size n = 4782; males n = 2255 and females n = Survey population aged 18 years and above. Definition used: at least once a week consumption of five or more standard drinks in one sitting. 1 Youth drinking (lifetime abstainers) 74.6% Male 74.1% Female 75.2% Survey. sample size n = 1209; males n = 495 and females n = 714. Survey population aged 18 to 24 years old. 1 Youth drinking (heavy episodic drinkers) 6.4% Male 8.4% Female 5.1% Survey. sample size n = 1209; males n = 495 and females n = 714. Survey population aged 18 to 24 years old. Definition used: at least once a week consumption of five or more standard drinks in one sitting. 1 Note: These are preliminary, early-release, unpublished data from the World Health Survey made available exclusively for this report. Some estimates may change in the final analyses of the World Health Survey. Traditional alcoholic beverages The traditional beer, dolo, is made from sorgo or millet. Every region and every ethnic group have their own specific dolo. The Gourmantché in the East and the Samogo in the north-west brew it for four days. 2 Unrecorded alcohol consumption The unrecorded alcohol consumption in Burkina Faso is estimated to be 3.3 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts). 3 10

11 Country background information population Life expectancy at birth (2002) Male 40.6 Adult (15+) Female 42.6 % under Probability of dying under age 5 per 1000 (2002) Male 232 Population distribution 2001 (%) Female 217 Urban 17 Gross National Income per capita 2002 US$ 220 Rural 83 In Burkina Faso, approximately 50% of the population are Muslim. Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Factbook 2003, The World Health Report 2004 References 1. Ustun TB et al. The World Health Surveys. In: Murray CJL, Evans DB, eds. Health Systems Performance Assessment: Debates, Methods and Empiricism. Geneva, World Health Organization, [Anonymous]. Around Africa in eighty mouthfuls ( accessed 28 March 2004). 3. Alcohol per capita consumption, patterns of drinking and abstention worldwide after Appendix 2. European Addiction Research, 2001, 7(3):

12 BURUNDI Recorded adult per capita consumption (age 15+) Litres of pure alcohol Beer Spirits Wine Year Note: From 1996 the wine category includes fermented beverages, which before 1996 were included in the overall total consumption figure. Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003 Unrecorded alcohol consumption The unrecorded alcohol consumption in Burundi is estimated to be 4.7 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts). 1 Morbidity, health and social problems from alcohol use In Burundi, the majority of war crimes are committed by armed men and children acting under the influence of alcohol. 2 Country background information population Life expectancy at birth (2002) Male 38.7 Adult (15+) Female 43.0 % under Probability of dying under age 5 per 1000 (2002) Male 189 Population distribution 2001 (%) Female 177 Urban 9 Gross National Income per capita 2002 US$ 100 Rural 91 Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004 References 1. Alcohol per capita consumption, patterns of drinking and abstention worldwide after Appendix 2. European Addiction Research, 2001, 7(3): Thompson BR. Global binge: a report on alcohol abuse worldwide. World Vision s Today Magazine. December

13 CAMEROON Recorded adult per capita consumption (age 15+) 8 7 Litres of pure alcohol Beer Spirits Wine Year Note: From 1996 the wine category includes fermented beverages, which before 1996 were included in the overall total consumption figure. Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003 Abstainers in Biyem-Assi (do not drink alcohol) 67.2% Male 58.6% Female 74.2% Urban survey measuring those 15 years and above who drink alcohol in the Biyem-Assi health area: sample size for males n = 1641 and females n = In a study evaluating the habitual diet of a rural and urban population in Cameroon, it was found that the intake of alcohol was higher in rural men and women than in urban subjects. It was concluded that the habitual diet in rural Cameroon contained more alcohol than the diet in urban Cameroon. 2 Traditional alcoholic beverages Palm wine, or locally known as fitchuk, is made from raffia palms and has a high alcohol content. 3 Guinea corn beer is also drunk and it has a lower alcohol content, usually between 3% to 5% by volume. Unrecorded alcohol consumption The unrecorded alcohol consumption in Cameroon is estimated to be 2.6 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts). 4 13

14 Morbidity, health and social problems from alcohol use What is problematic in Cameroon is the high cost of purchasing even one beer a week given the income of an average rural family. When comparing the price of two major beers sold in a rural village in 1983 as a percentage of male and female wages, it was found that the cost of one beer represented 60 84% of women s and 36 50% of men s daily wages. Drinking even in these small amounts means that one day s wages is quickly consumed. The danger is when individuals start forsaking paying children s school fees because their money is spent on beer. Such individuals are considered disruptive of community life because their negligence impedes others from doing their work or meeting obligations toward friends, association members and kin. 5 Country background information population Life expectancy at birth (2002) Male 47.2 Adult (15+) Female 49.0 % under Probability of dying under age 5 per 1000 (2002) Male 162 Population distribution 2001 (%) Female 158 Urban 50 Gross National Income per capita 2002 US$ 560 Rural 50 Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004 References 1. Mbanya JC. Defining the relationship between poverty and non-communicable disease burden in Cameroon: Preliminary report Unpublished data from personal communication. In: WHO Global NCD InfoBase. Geneva, World Health Organization. 2. Mennen LI et al. The habitual diet in rural and urban Cameroon. European Journal of Clinical Nutrition, 2000, 54(2): Niba FN. Visiting Cameroon s palm wine capital. BBC News, 29 March 2002 ( accessed 28 March 2004). 4. Alcohol per capita consumption, patterns of drinking and abstention worldwide after Appendix 2. European Addiction Research, 2001, 7(3): Diduk S. European alcohol, history and the state in Cameroon. African Studies Review, 1993, 36(1):

15 CAPE VERDE Recorded adult per capita consumption (age 15+) 6 5 Litres of pure alcohol Beer Spirits Wine Year Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003 Traditional alcoholic beverages The grog, the national drink of Cape Verde, is produced everywhere in Santo Antao. In the Ribeira da Cruz village (western area), the production is still handmade. This sugar-cane alcohol is popular because it is very cheap. It has a high alcohol content (up to 65% by volume). 1 Country background information population Life expectancy at birth (2002) Male 66.6 Adult (15+) Female 72.9 % under Probability of dying under age 5 per 1000 (2002) Male 42 Population distribution 2001 (%) Female 30 Urban 58 Gross National Income per capita 2002 US$ 1720 Rural 42 Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004 References 1. Pietri N. Cape Verde: Santo Antao the savage island ( accessed 29 March 2004). 15

16 CENTRAL AFRICAN REPUBLIC (THE) Recorded adult per capita consumption (age 15+) Litres of pure alcohol Beer Spirits Wine Year Note: From 1996 the wine category includes fermented beverages, which before 1996, were included in the overall total consumption figure. Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003 Unrecorded alcohol consumption The unrecorded alcohol consumption in the Central African Republic is estimated to be 1.7 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts). 1 Country background information population Life expectancy at birth (2002) Male 42.1 Adult (15+) Female 43.7 % under Probability of dying under age 5 per 1000 (2002) Male 187 Population distribution 2001 (%) Female 173 Urban 42 Gross National Income per capita 2002 US$ 260 Rural 58 Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004 References 1. Alcohol per capita consumption, patterns of drinking and abstention worldwide after Appendix 2. European Addiction Research, 2001, 7(3):

17 CHAD Recorded adult per capita consumption (age 15+) Litres of pure alcohol Beer Spirits Wine Year Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003 Lifetime abstainers 77.2% Male 71.9% Female 82.0% Survey. sample size n = 4563; males n = 2159 and females n = Sample population aged 18 years and above. 1 Heavy and hazardous drinkers 11% Male 12.8% Female 9.5% Survey. sample size n = 4563; males n = 2159 and females n = Sample population aged 18 years and above. Definition used: average consumption of 40 g or more of pure alcohol a day for men and 20 g or more of pure alcohol a day for women. 1 According to the 2003 World Health Survey (total sample size n = 922; males n = 558 and females n = 364), the mean value (in grams) of pure alcohol consumed per day among drinkers was 49.9 (total), 61.6 (males) and 33.8 (females). 1 17

18 Heavy episodic drinkers 12.3% Male 17.2% Female 7.9% Survey. sample size n = 4563; males n = 2159 and females n = Sample population aged 18 years and above. Definition used: at least once a week consumption of five or more standard drinks in one sitting. 1 Youth drinking (lifetime abstainers) 81.1% Male 76.6% Female 84.9% Survey. sample size n = 992; males n = 441 and females n = 551. Sample population aged 18 to 24 years old. 1 Youth drinking (heavy episodic drinkers) 9.3% Male 13.7% Female 5.6% Survey. sample size n = 992; males n = 441 and females n = 551. Sample population aged 18 to 24 years old. Definition used: at least once a week consumption of five or more standard drinks in one sitting. 1 Note: These are preliminary, early-release, unpublished data from the World Health Survey made available exclusively for this report. Some estimates may change in the final analyses of the World Health Survey. Country background information population Life expectancy at birth (2002) Male 46.1 Adult (15+) Female 49.3 % under Probabilty of dying under age 5 per 1000 (2002) Male 202 Population distribution 2001 (%) Female 180 Urban 24 Gross National Income per capita 2002 US$ 220 Rural 76 In Chad, approximately 51% of the population are Muslim. Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Factbook 2003, The World Health Report

19 References 1. Ustun TB et al. The World Health Surveys. In: Murray CJL, Evans DB, eds. Health Systems Performance Assessment: Debates, Methods and Empiricism. Geneva, World Health Organization,

20 COMOROS (THE) Recorded adult per capita consumption (age 15+) Litres of pure alcohol Beer Spirits Wine Year Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003 Lifetime abstainers 98.4% Male 96.5% Female 99.9% Survey. sample size n = 1759; males n = 780 and females n = 979. Survey population aged 18 years and above. 1 Heavy and hazardous drinkers 0.0% Male 0.0% Female 0.0% Survey. sample size n = 1759; males n = 780 and females n = 979. Survey population aged 18 years and above. Definition used: average consumption of 40 g or more of pure alcohol a day for men and 20 g or more of pure alcohol a day for women. 1 According to the 2003 World Health Survey (total sample size n = 24; males n = 23 and females n = 1), the mean value (in grams) of pure alcohol consumed per day among drinkers was 6.0 (total), 6.4 (males) and 5.7 (females). 1 20

21 Heavy episodic drinkers 0.2% Male 0.4% Female 0.0% Survey. sample size n = 1759; males n = 780 and females n = 979. Survey population aged 18 years and above. Definition used: at least once a week consumption of five or more standard drinks in one sitting. 1 Youth drinking (lifetime abstainers) 98.6% Male 97.3% Female 100.0% Survey. sample size n = 351; males n = 180 and females n = 171. Survey population aged 18 to 24 years old. 1 Youth drinking (heavy episodic drinkers) 0.3% Male 0.6% Female 0.0% Survey. sample size n = 351; males n = 180 and females n = 171. Survey population aged 18 to 24 years old. Definition used: at least once a week consumption of five or more standard drinks in one sitting. 1 Note: These are preliminary, early-release, unpublished data from the World Health Survey made available exclusively for this report. Some estimates may change in the final analyses of the World Health Survey. Country background information population Life expectancy at birth (2002) Male 61.6 Adult (15+) Female 64.9 % under Probability of dying under age 5 per 1000 (2002) Male 80 Population distribution 2001 (%) Female 72 Urban 34 Gross National Income per capita 2002 US$ 390 Rural 66 In the Comoros, approximately 98% of the population are Muslim. Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Factbook 2003, The World Health Report

22 References 1. Ustun TB et al. The World Health Surveys. In: Murray CJL, Evans DB, eds. Health Systems Performance Assessment: Debates, Methods and Empiricism. Geneva, World Health Organization,

23 CONGO (THE) Recorded adult per capita consumption (age 15+) 6 5 Litres of pure alcohol Beer Spirits Wine Year Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003 Lifetime abstainers 55% Survey. sample size n = 1929; males n = 875 and females n = Survey population aged 18 years and above. 1 Male 48.3% Female 60.9% Heavy and hazardous drinkers 7.5% Male 6.2% Female 8.9% Survey. sample size n = 1929; males n = 875 and females n = Survey population aged 18 years and above. Definition used: average consumption of 40 g or more of pure alcohol a day for men and 20 g or more of pure alcohol a day for women. 1 According to the 2003 World Health Survey (total sample size n = 653; males n = 359 and females n = 294), the mean value (in grams) of pure alcohol consumed per day among drinkers was 17.1 (total), 20.2 (males) and 14.2 (females). 1 23

24 Heavy episodic drinkers 5.2% Male 8.3% Female 2.5% Survey. sample size n = 1929; males n = 875 and females n = Survey population aged 18 years and above. Definition used: at least once a week consumption of five or more standard drinks in one sitting. 1 Youth drinking (lifetime abstainers) 58.7% Survey. sample size n = 443; males n = 185 and females n = 258. Survey population aged 18 to 24 years old. 1 Male 59.0% Female 58.6% Youth drinking (heavy episodic drinkers) 3.9% Male 6.4% Female 2.2% Survey. sample size n = 443; males n = 185 and females n = 258. Survey population aged 18 to 24 years old. Definition used: at least once a week consumption of five or more standard drinks in one sitting. 1 Note: These are preliminary, early-release, unpublished data from the World Health Survey made available exclusively for this report. Some estimates may change in the final analyses of the World Health Survey. Country background information population Life expectancy at birth (2002) Male 51.6 Adult (15+) Female 54.5 % under Probabilty of dying under age 5 per 1000 (2002) Male 109 Population distribution 2001 (%) Female 101 Urban 66 Gross National Income per capita 2002 US$ 700 Rural 34 Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report

25 References 1. Ustun TB et al. The World Health Surveys. In: Murray CJL, Evans DB, eds. Health Systems Performance Assessment: Debates, Methods and Empiricism. Geneva, World Health Organization,

26 CÔTE D IVOIRE Recorded adult per capita consumption (age 15+) 6 5 Litres of pure alcohol Beer Spirits Wine Year Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003 Lifetime abstainers 64.9% Survey. sample size n = 3104; males n = 1774 and females n = Survey population aged 18 years and above. 1 Male 56.5% Female 76.4% Heavy and hazardous drinkers 2.8% Male 3.7% Female 1.6% Survey. sample size n = 3104; males n = 1774 and females n = Survey population aged 18 years and above. Definition used: average consumption of 40 g or more of pure alcohol a day for men and 20 g or more of pure alcohol a day for women. 1 26

27 According to the 2003 World Health Survey (total sample size n = 1048; males n = 756 and females n = 292), the mean value (in grams) of pure alcohol consumed per day among drinkers was 11.7 (total), 14.0 (males) and 5.5 (females). 1 Heavy episodic drinkers 4.1% Male 6.5% Female 0.9% Survey. sample size n = 3104; males n = 1774 and females n = Survey population aged 18 years and above. Definition used: at least once a week consumption of five or more standard drinks in one sitting. 1 Youth drinking (lifetime abstainers) 65.7% Survey. sample size n = 768; males n = 420 and females n = 348. Survey population aged 18 to 24 years old. 1 Male 57.8% Female 75.4% Youth drinking (heavy episodic drinkers) 3.9% Male 6.9% Female 0.3% Survey. sample size n = 768; males n = 420 and females n = 348. Survey population aged 18 to 24 years old. Definition used: at least once a week consumption of five or more standard drinks in one sitting. 1 Note: These are preliminary, early-release, unpublished data from the World Health Survey made available exclusively for this report. Some estimates may change in the final analyses of the World Health Survey. Traditional alcoholic beverages The most popular Ivorian drink is bandji, a juice extracted from palm, raphia or royal palm trees. The juice is alcoholic and more or less sweet depending on the extraction technique used. It plays several roles in traditional Ivorian society. It is offered to strangers to welcome them and used in ritual ceremonies to talk to deceased ancestors. It is also used to seal a reconciliation pact. Apart from bandji there are other locally manufactured alcoholic drinks e.g. dolo obtained by boiling millet or fermented sorghum. 2 Palm wine (kue za) is the traditional beverage of the Baoulé of Côte d Ivoire. Palm wine can be distilled to form koutoukou, but this spirit often contains undesirable esters and free acids. 3 27

28 The production and sale of koutoukou, a homemade brandy from Ghana, have been banned in Côte d Ivoire since Despite this ban, this alcoholic beverage is distilled illegally in all regions of the country, from fermentation of plant extracts, including wine made from the palm tree. 4 Country background information population Life expectancy at birth (2002) Male 43.1 Adult (15+) Female 48.0 % under Probability of dying under age 5 per 1000 (2002) Male 192 Population distribution 2001 (%) Female 143 Urban 44 Gross National Income per capita 2002 US$ 610 Rural 56 Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004 References 1. Ustun TB et al. The World Health Surveys. In: Murray CJL, Evans DB, eds. Health Systems Performance Assessment: Debates, Methods and Empiricism. Geneva, World Health Organization, [Anonymous]. Discover Côte d Ivoire ( accessed 8 July 2003). 3. Agroforestree Database. World Agroforestry Centre ( accessed 29 March 2004). 4. Camara PA. Alcoolisation au koutoukou en Côte d Ivoire: Constat et propositions [Koukoutou abuse in the Côte d Ivoire: Findings and proposals]. Alcoologie et Addictologie, 2003, 24(4):

29 DEMOCRATIC REPUBLIC OF THE CONGO (THE) Recorded adult per capita consumption (age 15+) Litres of pure alcohol Beer Spirits Wine Year Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003 Traditional alcoholic beverages There is an abundance of homemade liquor which has almost replaced beer in the countryside due to the fact that the latter is so expensive and difficult to get hold of. The various brands of homemade hooch (liquor) have names like kasiksi (I regret) and mokoyo (the dog that bites), and are concocted from cassava, maize, banana, sugar-cane or palm wine, depending on the region and availability. 1 The standard beverage drunk by the Kuba people is palm wine. When it comes to food and drink, palm wine has a pivotal position; it is honoured and celebrated and is much more than just a thirst-quencher. A dignitary passing through a village will be offered a calabash of palm wine, and will be expected to express himself exhaustively about its character, strength and so on. Men offer palm wine to each other, and those who have no palm trees of their own buy the wine. Four different species of palm are used for palm wine production: Elaeis guineensis, Raphia vinifera, Raphia laurentii, and Borassus aethiopicum. The wine is tapped into beautifully decorated calabashes and is left to ferment, its sweetness disappearing while its content of alcohol (and vinegar) increases. It has an alcoholic content of between 5% to 7%. Nowadays, there is also locally made manioc brandy, and maize beer (alcohol content 5%). 2 Lotoko is also consumed. Country background information population Life expectancy at birth (2002) Male 41.0 Adult (15+) Female 46.1 % under Probability of dying under age 5 per 1000 (2002) Male 221 Population distribution 2001 (%) Female 198 Urban 31 Gross National Income per capita 2002 US$ 90 Rural 69 Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report

30 References 1. [Anonymous]. Africa s lethal home-made brews. News24.com, 23 April 2003 ( accessed 16 September 2003). 2. Josefsson C. Politics of chaos. Essays on Kuba myth, development and death. University of Gothenburg, Department of Social Anthropology, SANS 2, In: Wine, women and men: one of three essays on the Kuba of Zaire ( accessed 28 March 2004). 30

31 EQUATORIAL GUINEA Recorded adult per capita consumption (age 15+) 7 6 Litres of pure alcohol Beer Spirits Wine Year Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003 Traditional alcoholic beverages Authorities in Equatorial Guinea have banned production and consumption of a concoction called kai-kai, made from yeast, sugar, water and tree bark. Kai-kai was banned years ago after it killed several people, but the drink is still popular as contraband because it is much cheaper than the liquor officially on sale, which is subject to state taxes. 1 Country background information population Life expectancy at birth (2002) Male 51.9 Adult (15+) Female 54.8 % under Probability of dying under age 5 per 1000 (2002) Male 157 Population distribution 2001 (%) Female 144 Urban 49 Gross National Income per capita 2001 US$ 700 Rural 51 Sources: Population Division and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004 References 1. [Anonymous]. Africa s lethal home-made brews. News24.com, 23 April 2003 ( accessed 16 September 2003). 31

32 ERITREA Recorded adult per capita consumption (age 15+) Litres of pure alcohol Beer Spirits Wine Year Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003 Traditional alcoholic beverages The national beverages are called suwa, a beer-like alcoholic drink, mies, a fermented honey drink, and zebib, a locally made anise-flavoured liquor. 1 Unrecorded alcohol consumption The unrecorded alcohol consumption in Eritrea is estimated to be 1.0 litre pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts). 2 Country background information population Life expectancy at birth (2002) Male 55.8 Adult (15+) Female 59.3 % under Probability of dying under age 5 per 1000 (2002) Male 117 Population distribution 2001 (%) Female 102 Urban 19 Gross National Income per capita 2002 US$ 160 Rural 81 In Eritrea, approximately 60% of the population are Muslim. Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Factbook 2003, The World Health Report 2004 References 1. [Anonymous]. Eritrean cuisine ( accessed 29 March 2004). 2. Alcohol per capita consumption, patterns of drinking and abstention worldwide after Appendix 2. European Addiction Research, 2001, 7(3):

33 ETHIOPIA Recorded adult per capita consumption (age 15+) Litres of pure alcohol Beer Spirits Wine Year Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003 Lifetime abstainers 60.2% Survey. sample size n = 4920; males n = 2377 and females n = Survey population aged 18 years and above. 1 Male 56.9% Female 63.7% Current abstainers in Butajira (non-drinkers) 77% Male 64% Female 85% A total of persons aged 15 and above, most residing in a rural district, were interviewed using the CAGE questionnaire as an important element of a general mental health survey. 2 33

34 Heavy and hazardous drinkers 9.3% Male 8.1% Female 10.6% Survey. sample size n = 4920; males n = 2377 and females n = Survey population aged 18 years and above. Definition used: average consumption of 40 g or more of pure alcohol a day for men and 20 g or more of pure alcohol a day for women. 1 According to the 2003 World Health Survey (total sample size n = 1222; males n = 723 and females n = 499), the mean value (in grams) of pure alcohol consumed per day among drinkers was 23.6 (total), 27.8 (males) and 17.2 (females). 1 Problem drinkers in Butajira (overall prevalence) 3.7% Male 7.5% Female 0.9% A total of persons aged 15 and above, most residing in a rural district, were interviewed using the CAGE questionnaire as an important element of a general mental health survey. Problem drinking was defined by two or more positive responses to the CAGE questionnaire. Note: Among those who drank, 16% met the criterion for problem drinking. 2 Heavy episodic drinkers 4.1% Male 7.7% Female 0.4% Survey. sample size n = 4920; males n = 2377 and females n = Survey population aged 18 years and above. Definition used: at least once a week consumption of five or more standard drinks in one sitting. 1 34

35 Youth drinking (lifetime abstainers) 69.4% Survey. sample size n = 1158; males n = 542 and females n = 616. Survey population aged 18 to 24 years old. 1 Male 70.3% Female 68.6% Youth drinking (heavy episodic drinkers) 2% Male 4.2% Female 0.2% Survey. sample size n = 1158; males n = 542 and females n = 616. Survey population aged 18 to 24 years old. Definition used: at least once a week consumption of five or more standard drinks in one sitting. 1 Note: These are preliminary, early-release, unpublished data from the World Health Survey made available exclusively for this report. Some estimates may change in the final analyses of the World Health Survey. Youth drinking in Addis Ababa (regular drinkers) 34% regional survey of young people in Addis Ababa (total sample size n = 1436, males n = 585 and females n = 851; aged 15 to 24 years of age). Of the 34% who consume alcoholic beverages regularly, 7% of these consumed more than 100 grams of pure alcohol per week 3 A 1998 study comprising 241 students randomly selected from two government schools and one private secondary school in Addis Ababa and 187 students from a government secondary school in Butajira found that the percentages of ever use of alcohol were 17.9%, 57.8% and 18.2% in the urban governmental high schools, private high school and Butajira rural governmental high school, respectively. 4 35

36 Alcohol dependence in Addis Ababa (lifetime prevalence) 1% Male 1.9% Female 0.1% A 1994 prevalence study of alcohol dependence and problem drinking in a representative sample of adults in Addis Ababa. CAGE (at least two positive CAGE items) and the Composite International Diagnostic Interview (CIDI) were used to identify cases of alcohol dependence. 5 A cross-sectional study among a sample of 501 adults in a rural community conducted between October 1995 and January 1996 using the CIDI found the lifetime prevalence rate of alcohol dependence to be 1.1% (total), 2.5% (males) and 0.3% (females). 6 Traditional alcoholic beverages Talla is an Ethiopian home-brewed beer which differs from the others in some respects. First it is brewed with barley or wheat, hops, or spices. Secondly, it has a smoky flavour due to the addition of bread darkened by baking and use of a fermentation vessel which has been smoked by inversion over smoldering wood. Talla is not processed under government regulations hence the alcohol content varies but is usually around 2% to 4%. Filtered tella has a higher alcohol content ranging from 5% to 6%. 7 Korefe is the name of the local beer made in Begemder Province among the Koumant ethnic group. Dehusked barley is left in water overnight, and after that toasted and milled. It is mixed with water and dried gesho leaves, and fermented in a clay container for two to three months. When the beverage is needed, a small quantity of the mixture is taken, more water is added and after a day's fermentation the beverage is ready for consumption. 7 Shamit is the local beer made among the Gurage ethnic group. Tef, kita and germinated barley (bekel) are milled and mixed with water, and the mixture is sieved after three to four days of fermentation. Dehusked barley is toasted on the mitad, milled and added to the mixture, and the beverage is ready to serve the next day, when Ethiopian cardamom, mitmitta, black cummin and bishop's weed are added. 7 Tej (indigenous honey wine) is a home-processed, but also commercially available honey wine. It is prepared from honey, water and leaves of Gesho. Sometimes, widely for commercial purposes, mixture of honey and sugar could be used for its preparation. In cases where sugar is used as part of the substrate, natural food colouring is added so that the beverage attains a yellow colour similar to that made from honey. Good quality tej is yellow, sweet, effervescent and cloudy due to the content of yeasts. A study found that the mean alcohol content of tej was between 6.98% and 10.9%. 8 Another study found that the average alcohol content of tej was 6.07%. 9 Araki is a distilled beverage. Ground gesho leaves and water are kept for three to four days and after that a kita made of tef or other cereals and germinated barley or wheat are added. The mixture is allowed to ferment for five to six days and then distilled. In the villages distillation is carried out with primitive equipment made of gourds and wood. The local beer tella can also be distilled to produce araqe. The araki can be redistilled and will then have a higher alcohol content. The average alcohol content of dagim araki is around 45%. The term dagim in Amharic refers to second time and indicates that it is distilled a second time. Araki is brewed in rural and semiurban areas and is used more commonly by farmers and semi-urban dwellers than by people who live in the cities. In cities, those who drink araki are predominantly lower class people or those who have become dependent upon alcohol and cannot afford to buy industrially produced alcohol. Since the government has no control over production of locally brewed alcoholic drinks, it is difficult to estimate the amount of alcohol production and consumption in Ethiopia. 7 Other alcoholic beverages to be found are borde (local beer) and katikala (a homemade distilled drink from maize or millet). 10 Unrecorded alcohol consumption The unrecorded alcohol consumption in Ethiopia is estimated to be 1.0 litre pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts)