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Assinatura do Candidato: ________________________________________________________

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Questions 01 to 05 refer to the text below.

EXAMINING CHARACTERISTICS OF RECORDED AND UNRECORDED ALCOHOL CONSUMERS IN

KENYA

Rahma S. Mkuu, Adam E. Barry, Francisco A. Montiel Ishino, Ann O. Amuta

Alcohol consumption contributes to over 5% of the global burden of disease and is ranked
among the leading risk factors for morbidity and mortality worldwide (GBD 2013). Consumption is
associated with cardiovascular disease and increased rates of exposure to HIV infection,
tuberculosis, and pneumonia, which are among the global leading causes of death and disability
(Baliunas D. et al., 2010). Intentional and unintentional injuries are also associated with alcohol
consumption (Chen CM, Yoon YH., 2017).
Across the globe, there are two primary types of alcohol consumed, recorded and
unrecorded. Recorded alcohol refers to alcohol that is regulat ed, controlled, tracked, and legally
purchased (Rehm J, Klotsche J, Patra J., 2007). On the other hand, unrecorded alcohol is alcohol
that is not regulated and is: (1) illegally produced; (2) illegally imported through cross -border
smuggling; (3) homebrew/homemade; (4) not consumed where it is registered, e.g., duty free
shops; or (5) not intended for consumption, i.e., surrogate alcohol such as aftershave (Giesbrecht
N et al.,2000). It is estimated that 25% of alcohol consumed globally is unrecorded (W orld Health
Organization, 2014) and consumption is associated with many unique risks. Unrecorded alcohol
consumption represents a unique public health threat worthy of further investigation.
Compared to recorded alcohol, unrecorded alcohol in sub -Saharan Africa is consumed at
more frequency and in greater quantities (International Center for Alcohol Policies, 2012). For
instance, in Kenya unrecorded alcohol is consumed more frequently than recorded alcohol (Papas
RK et al., 2010). In Kenya, several public health concerns are associated with unrecorded alcohol
consumption, such as fatalities and hospitalizations (Gridneff I, Ombok E, 2014). On May 7th
2014, it was reported that over 75 people in Kenya died and 181 were hospitalized as a result of
consuming unrecorded alcohol (Muraya JW, 2014).
Many of the deleterious consequences associated with unrecorded alcohol consumption in
Kenya are attributed to the practice of adulterating the alcohol with harmful substances such as
methanol, car battery acid, and other harmful substances believed to increase potency (Carey K
et al., 2015). For example, chang’aa a distilled homebrew unrecorded alcohol in form of a spirit
(unsweetened distilled alcohol with higher alcohol content) in Kenya is nicknamed “kill me quick”
for its high perceived and actual measured potency (Carey K et al., 2015). A unique characteristic
of unrecorded alcohol in Kenya is those who brew also commercialize it. The unrecorded alcohols
such as homebrew which are typically sold from homes are also gener ally cheap and affordable
(Papas RK et al., 2010). A glass of chang’aa is 50 Kenyan shillings ($0.50 United States (U.S.))
compared to a bottle of recorded beer that costs twice as much (Dixon R, 2010). Additionally,
unrecorded alcohol in Kenya is closely tied to traditional and cultural practices (Papas RK et al.,
2010). Due to this constellation of factors - high potency, low cost, and cultural importance –
consumption of unrecorded alcohol in Kenya continues to be high and significantly contributes to
the burden of morbidity and mortality in the country.
The health and social challenges of recorded alcohol consumption are relatively well
established; however, there is a significant gap in the literature examining unrecorded alcohol
consumption, particularly in Africa. To the best of our knowledge, there is a scarcity of studies
specifically examining consumption patterns and demographic characteristics of recorded and
unrecorded alcohol consumption in Kenya (Kuballa T, 2018). Consequently, herein we aim to
examine: (1) differences in number of drinking events in the last month and binge drinking defined
as having 6 standard drinks during at least one occasion in the last 30 days (World Health
Organization, 2014) between individuals who exclusively consumed recorded alcohol and those
who reported consuming unrecorded alcohol; and (2) demographic differences between
individuals who exclusively consumed recorded alcohol and those who consumed unrecorded
alcohol.
Discussion
Alcohol consumption, both recorded and unrecorded were higher among men. These
findings are similar to prior research findings that report higher alcohol consumption prevalence

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among Kenyan men (Olack B et al., 2015). Olack and colleagues assert men are four times more
likely to report consuming alcohol in the past thirty days compared to women in Nairobi, Kenya
(Olack B et al., 2015). Excessive drinking in men poses a great public health concern as men are
more likely than women to take behavioral risks, such as driving over the speed limit, n ot wearing
a safety belt while operating a motor vehicle, and engage in physical altercations than women.
Drinking excessively further increases the likelihood of injury, hospitalization, or death among
men (Centers for Disease Control and Prevention, 2016 ). Collectively, these findings highlight the
need for development and evaluation of gender -based public health initiatives to minimize the
risks associated with alcohol consumption in Kenya.
Seventy seven percent of those reporting recent alcohol consumpt ion were mostly young
adults between 18 and 44 years. Consistent with our findings of high alcohol consumption among
this age range, Jenkins and colleagues (Jenkins R et al., 2015) and The National Campaign
Against Drug Abuse Authority (2011) found that young adults make up the largest proportion of
individuals who consume alcohol. Overall, participants in our investigation study were evenly
distributed by social class (i.e., poorest, poor, middle, richer, and riche st), level of education (i.e.,
primary incomplete, primary complete, secondary or more), residence (i.e., rural versus urban),
which may indicate how entrenched alcohol consumption is culturally in Kenya, given it was
common across social and economic lines and geographic locations (Jenkins R et al., 2015).
Several demographic characteristics were also related to consumption of unrecorded
alcohol. Education was found to be a protective factor for unrecorded alcohol consumption.
Individuals who had not completed primary education had higher odds of consuming unrecorded
alcohol. Our findings align with a previous study from Kinoti, Jason, and Harper (Kinoti KE, Jason
LA, Harper GW, 2011), who contend individuals with lower education levels (52.5%) were
significantly more likely to consume unrecorded alcohol compared to those with high education
(37.8%). Similarly, individuals living in poverty, those in the poor or poorest wealth categories,
were also more likely to report recent unrecorded alcohol consumption . Our findings reveal that
social determinants leading to disparate health outcomes are present and persistent in the high
prevalence of unrecorded alcohol consumption (Olack B et al., 2015).
Public health interventions aimed at monitoring and evaluating the effects and
consumption of unrecorded alcohol should target low SES individuals and those with lower levels
of educational attainment. Health promotion programs should also work to educate individuals on
the negative effects of unrecorded alcohol (Mutu ri N, 2014). In Kenya, homebrew was legalized
in 2013–2014 under the condition that brewers register and follow guidelines to ensure safe brew
processes. However, after cases of methanol poisoning were reported from unregistered brewers
in 2014, homebrew was outlawed again. There has yet to be evidence of whether the policy is
improving and reducing negative effects such as mortality from homebrew.
Conclusions
Given this is one of the first, or few, nationally representative investigations examining
differences between individuals who consume recorded alcohol and those who consume
unrecorded alcohol in Kenya, our study adds to the scarce literature on unrecorded alcohol
consumption behaviors and determinants in Kenya. Overall, our study found that individu als who
consume unrecorded alcohol are more likely to binge drink and smoke. These individuals are from
lower SES and are more likely to have low levels of education. These demographic factors
provide an initial evidence base for the beginning formation of educational and social marketing
efforts targeting unrecorded alcohol consumers. Our focus on unrecorded alcohol consumption
should not be interpreted as indication that recorded alcohol is less harmful than unrecorded
alcohols such as homebrew. We recogn ize alcohol consumption is one of the leading risk factors
for morbidity and mortality worldwide and both unrecorded alcohol such as homebrew and
recorded alcohols such as commercialized beer are both public health concerns. That said,
unrecorded alcohol consumption is unique, and will consequently require novel investigations and
interventions. Our study bridges an important literature gap; understanding unrecorded alcohol
consumption behaviors and the socio-demographic factors that are unique to individua ls who
consume unrecorded alcohol. Targeted and tailored interventions to reduce unrecorded alcohol
consumption should focus on individuals who are current smokers, poor, and those with low
educational attainment.

Available in: [https://link.springer.com/article/10.1186/s12889-018-5960-1]. Access in: 18 mar. 2019. [Adapted].

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Question 1
According to the text, explain what the terms recorded and unrecorded alcohol mean and why
unrecorded alcohol is a public health concern in Kenya.

Espaço para Resposta

Question 2
Write about the research lacuna in this area of study presented by the authors and the
objective(s) of their research.
Espaço para Resposta

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Question 3
Explain what chang’aa is and state what determinants, related to unrecorded alcohol, contribute
to mortality in Kenya.
Espaço para Resposta

Question 4
Write about the results of the research in relation to gender and its impact on public health and to
age.
Espaço para Resposta

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Question 5
Explain how education and poverty are related to unrecorded alcohol consumption, according to
the results of this study.

Espaço para Resposta

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