The prevalence and characteristics of unrecorded alcohol consumption: a secondary analysis of cross-sectional surveys in 11 countries in sub-Saharan Africa

Abstract

Objective Empirical evidence on unrecorded alcohol (alcohol produced, distributed and sold outside government oversight) remains limited in sub-Saharan Africa, despite its contribution to total alcohol consumption in many low- and middle-income countries. We estimated the prevalence and main types of unrecorded alcohol consumption; investigated sociodemographic characteristics of its use; and examined differences in drinking patterns between consumers of recorded and unrecorded alcohol across 11 sub-Saharan African countries. Methods We conducted a cross-sectional analysis of nationally representative data from WHO’s STEPwise surveys collected between 2014 and 2022 in Benin, Botswana, Burkina Faso, Cabo Verde, Eswatini, Ethiopia, Liberia, Malawi, Sao Tome and Principe, Uganda, and Zambia. The sample included 48,230 adults aged 18–69 years. Weighted descriptive analyses were conducted at the country level, and hierarchical logistic and linear regression models examined sociodemographic correlates of unrecorded alcohol use and associations with drinking patterns. Findings More than a quarter (27.6%) of respondents consumed alcohol in the past week, and 51.3% of these consumed unrecorded alcohol, with marked differences across countries. Consumption was dominated by homebrewed products, although the relative contribution of spirits and beer or wine varied across settings. Among people who drink alcohol, unrecorded alcohol use was more common among men, older adults, those with lower educational attainment, and those not employed, and was associated with frequent drinking and higher average daily intake. Conclusion Unrecorded alcohol accounts for a large and heterogenous component of alcohol consumption in several sub-Saharan African countries. Surveillance systems and alcohol policies should explicitly account for unrecorded alcohol when assessing population exposure and designing health interventions.