Excessive consumption of ethanol, the intoxicating agent in alcoholic drinks, and the ingestion of heavy metals in contaminated foods and drinks are known to lead to all kinds of illnesses. In the Acoli community of northern Uganda, heavy alcohol consumption, which became an adaptive mechanism for coping with trauma, depression, idleness, violence, hopelessness, and deprivation of livelihood suffered when the more than two million people in the region were forcibly removed from their homes to live in horrendous conditions in internment camps for 20 years, is on the rise.
Occurring simultaneously with the rise in alcohol consumption is an increased mortality rate among young males, the heaviest consumers of alcohol. This increased mortality rate, which has so far impacted mainly this subpopulation considered the cradle of the Acoli society, is prompting the community to point a finger figuratively at brands of alcohol supplied conveniently in affordable and readily accessible 100-mL plastic sachets by the alcohol industry to make quick money. Compounding this problem is apparent, but regionally-driven unfriendly political environment which appears to be promoting the continuation of excessive alcohol consumption in Acoli after leaving the camps.
The public outcry against the sachet-packaged alcohols is one reason a few of us decided to investigate whether these sachet-packaged alcohols contain more than just alcohol. In a PLOS ONE paper entitled ‘‘Assessing the health risks of consuming ‘sachet’ alcohol in Acoli, Uganda,” we conducted an investigation of 12 sachet-packaged alcohol brands collected between 2014 and 2015 from Acoli in northern Uganda. These brands were Big 5 Vodka, Beckham Spirit, Bond 7 Whisky, Brigade Spirit, Chief Waragi Spirit, Goal Vodka, Kick Spirit Pineapple Waragi, Relax, Royal Vodka, Salongo Spirit, Uganda Waragi, and V6 Tangawizi Vodka. Other samples included four locally-brewed alcohols (known as Lira-Lira) from Bolo and Awere in the Pader district, Teso Bar in Lira Town, and Nsambya police barracks in Kampala. A 13th spirit, used as a “certified reference alcohol,” was a Scottish Whisky purchased in San Diego, California (USA).
The samples were tested for the presence of, and the extent of contamination by, silver, arsenic, aluminum, barium, beryllium, cadmium, cobalt, chromium, copper, manganese, molybdenum, nickel, and lead. The others were antimony, selenium, tin, vanadium, thallium, strontium, and zinc. The results were then analyzed statistically to determine the level of health risks posed by the consumption of the respective metal-contaminated alcohol.
Our investigation found that all the 20 selected heavy metals above were present in the Ugandan alcohol brands. This finding confirmed our suspicion that not only are heavy metals being consumed in the Acoli region but also that toxic amounts of these metals are perhaps accumulating in tissues of consumers to the detriment of young males who are the heavy consumers of sachet-packaged alcohols.
Not surprising, the result also shows that the primary health risk factor in all samples was, in fact, ethanol itself. Beyond ethanol, the risk of developing cancer over a lifetime due to exposure to arsenic, lead, and chromium in the drinks is about 1 consumer in every 100,000. The overall risks of developing cancer from consuming the alcohol studied in Acoli is very much larger than this because (i) there is no safe level of a cancer-causing agent of which ethanol is one, (ii) 17 heavy metals, also studied, were not included in estimating risks due to our lack of knowledge about their potentials to cause cancer, and (iii) the estimate assumes that an Acoli adult consumes only 2.5 sachet spirits per day over 240 days/year.
The statistical risk of developing health problems other than those related to cancer because of exposure to metals in Big 5 Vodka, Bond 7 Whisky, Beckam Gin, Goal Vodka and Kick Gin Pineapple brands is estimated to be 1 in every 654 consumers; the risk from consuming Brigade Gin, Chief Waragi, Royal Vodka, Salongo Gin, Uganda Waragi or V6 Tangawizi Vodka brands is 1 in 1404. For those who prefer Lira-Lira, the risk is 1 consumer out of 62 will develop non-cancer related health problem due to excessive consumption of copper in the drinks.
Public concern about the increasing number of deaths and crimes and loss of productivity attributed to alcohol consumption was serious enough for some government authorities to concede to the demand to ban sachet-packaged alcohol. In January 2016, the Gulu District in Acoli passed the Gulu Alcoholic Drinks Control Ordinance to regulate the production, sale, and consumption of sachet Waragi below 250 mL. Similarly, on March 2nd, 2019, three days after this study results were published in PLOS ONE, the Uganda government abolished sachet-packaging of alcoholic drinks. According to the ban, alcohol producers were allegedly warned a few years before to switch to plastic and glass bottles for packaging alcohol.
Although these are positive steps taken to combat the negative effect of consuming sachet-packaged alcohol, they do not address the question of what exactly may be causing death among consumers. Bearing this in mind, we took the first approach of its kind to address the root cause of alcohol-related deaths at the local level in a sub-Sahara African country. Now we know at least one of the factors, heavy metals, accounts for the pronounced health risks in the Acoli population of Uganda.
However, more studies need to be done to address other yet-unanswered questions. For example, unless the source of metal contamination is known, banning sachet-packaging or switching to plastic and glass bottles as the government recommended will not prevent the contamination of alcohol with heavy metals. In this sense, government decisions to ban sachet-packaging were not evidence-based and will be ineffective in addressing the underlying cause of health hazards.
In the meantime, the finding that Uganda Waragi and Bond 7 had low levels of heavy metal contamination or Lira-Lira had only a high level of copper but low level of the other metals is a good sign that the source of contamination is not universal. It could come from one or more sources such as the soil where grains, potatoes, and cassava are grown, or perhaps from water and equipment used in the production or the containers used for packaging and storage. It also suggests that it is feasible to produce alcohol with an insignificant level of metal contamination.
As to how many people are affected by alcohol-related illnesses in Uganda, it is not possible to give precise figures, but it is safe to say that the problem is pervasive throughout the entire northern region of Uganda. Perhaps, now that we have done this study and found that these brands of spirits are contaminated and pose serious health risks, it will be possible for other researchers to specifically examine health records and be able to correctly determine the number of deaths and illnesses that can be directly linked to the contaminants and consumption of sachet alcohol.
Lastly, it should be borne in mind that no amount of alcohol is safe. But if one must satisfy a craving for alcohol, the traditional African beers are recommended; they are low in alcohol contents, they are bulky meaning accidental overconsumption of ethanol in one sitting is minimized and, more importantly, they have high nutritional values.
These findings are described in the article entitled Assessing the health risks of consuming ‘sachet’ alcohol in Acoli, Uganda, recently published in the journal PLOS One.