Alcohol consumption in the African context: contributions to a public health approach to policy decisions

A contribuição dos problemas ligados ao álcool para a carga de doenças em África tem sido amplamente negligenciada. Devido a rápidas mudanças no contexto de vários países e a novas evidências científicas relativas a doenças atribuíveis ao álcool, tais como HIV e a incidência de TB, os problemas e carga da doença em África relacionados com o consumo de álcool podem ser maiores do que o que foi previamente estimado. Ao mesmo tempo existe pouca informação sob a forma como os países estão a gerir o consumo de álcool e as consequências ligadas a esse consumo, o que sugere que uma avaliação das políticas nacionais é necessária nesta região. O objetivo geral desta tese é o de rever as evidências relacionadas com o consumo de álcool em África e analisar as políticas do álcool existentes, contribuindo assim para a melhoria das decisões políticas relacionadas com esse consumo na região. Em particular, a tese concentra-se nos quatro objetivos específicos seguintes: I) estimar a mortalidade e morbilidade atribuídas ao álcool em África; II) identificar os fatores que podem afetar a magnitude e os padrões de consumo de álcool em África; III) avaliar as respostas políticas nacionais relacionadas com o consumo de álcool em 46 países e sua eficácia para reduzir os malefícios relacionados com esse consumo; IV) documentar as diferentes etapas e atores envolvidos no desenvolvimento de uma política relativa ao consumo de álcool num país Africano (Malawi). A investigação utilizou diferentes tipos de métodos. Os resultados mostram que o consumo de álcool tem um grande impacto sobre a carga de doença e mortalidade nos países africanos, com o álcool sendo responsável, em 2012, por 6.4% de todas as mortes e 4.7% de todos os DALYs na Região (estudo I). A nossa análise identificou sete fatores que estão intimamente ligados a possíveis mudanças no consumo de álcool em África. Impulsionada em grande parte pela globalização, a convergência potencial desses fatores é suscetível de se associar a um crescimento contínuo no consumo de álcool bem como ao aumento da morbilidade e mortalidade relacionada ao álcool em todo o continente (estudo II). Os países têm vindo a utilizar diferentes tipos de medidas de política para controlar o consumo de álcool. A avaliação dos níveis atuais de restrição das políticas existentes, mostra que os países atingiram uma pontuação média de 44,1 de 100 pontos possíveis, variando entre 9,1 (São Tomé e Príncipe) e 75,0 pontos (Argélia). De acordo com nossos resultados, os níveis de restrição das políticas existentes estão negativamente correlacionados com o consumo de álcool em consumidores atuais (rs = -.353, p = 0,005) (Estudo III). O estudo IV reflete as dificuldades e complexidade dos processos políticos e sociais na elaboração de políticas de álcool no Malawi. Apesar da influência da indústria do álcool no estabelecimento da agenda politica e no processo de consulta, o nosso estudo demonstra que as organizações da sociedade civil, quando devidamente financiadas e apoiadas, podem desempenhar um papel importante e decisivo na evolução da política do governo com vista a defesa do interesse público. As frações de mortalidade e morbilidade atribuídas ao álcool em muitos países africanos são consideráveis e, portanto, o álcool não pode ser deixado de fora das agendas de saúde e desenvolvimento desses países. Os governos africanos precisam de ter um papel mais ativo na proteção da saúde da população. Embora os países tenham adotado algum tipo de medidas de políticas para controlar o consumo de álcool, os nossos resultados mostram que há uma necessidade de uma resposta política mais forte para reduzir a carga relacionada com o consumo de álcool no continente. Finalmente, devido às dificuldades inerentes ao desenvolvimento de políticas do álcool, os governos devem considerar fortemente o aumento da participação das organizações da sociedade civil para apoiar uma direção no sentido da defesa do interesse público.Alcohol-related problems and burden of disease in Africa has been largely neglected. Due to the rapidly changing context in several countries and new scientific evidences of alcohol-attributablediseases, such as HIV and TB incidence, alcohol-related problems and burden of disease in Africa might be higher than what has previously been estimated.At the same time there is little information on the extent to which African countries are addressing alcohol consumption and alcohol-related harm, which suggests that evaluations of national alcohol policies are needed in this region.The overall aim of this thesis is to reviewevidence about alcohol consumption and analyse alcohol-related policies in Africa, thus contributingto the improvement of alcohol-related policy decisions in this region. In particular the thesis concentrates on followingfour objectives: I) estimate alcohol-attributablemortality and morbidityin Africa; II) identifyfactors that might affect magnitude and patterns of alcohol consumption in Africa; III)evaluatenational alcohol policy responses in 46 countries and their effectiveness to reduce alcohol-related harm; IV) document the different stages and actors involved in the development of alcohol policy in one African country (Malawi).The research used different type of methods. Our results show thatalcohol consumption has a large impact on burden of disease and mortality in African countries, withalcohol being responsible, in 2012, for 6.4% of all deaths and 4.7% of all DALYs in the Region(study I). Our analysis identified seven factors which are closely tied to potential changes in alcohol consumption in Africa. Driven largely by globalization, a potential convergence of these factors is likely to be associated with continued growth in alcohol consumption and alcohol-related morbidity and mortality across the continent(study II).Countries have been using different types of policy measuresto control alcohol consumption. When evaluating current policy restrictiveness, countries attained a mean score of 44.1 of 100 points possible, ranging from 9.1 (Sao Tomé and Principe) to 75.0 (Algeria). According to our results, actual policy restrictiveness scores were negatively correlated with and APC among drinkers (rs = -.353, p = 0.005) (Study III). Study IV reflects the difficulties and complexityof alcohol policy development in Malawi. Despite the influence of the alcohol industry in the agenda-settingand consultative process, when adequately resourced and supported, civil society organizations were found toplay an ximportant and decisiverole in steering policy developments in a sound public-interest direction. Alcohol-attributable fractions of mortality and morbidity in many African countries are considerable and therefore alcohol cannot be left out of countries health and development agendas. African governments need to take a more active role in protecting the public’s health. Although countries have adopted some type of policy measures to control alcohol consumption, our results show that there is a need for a strongerpolicy response to reduce alcohol-related burden in the continent. Finally, due to the inherent difficulties in alcohol policydevelopment, governments should strongly consider increasing the involvement of civil society organisations to support sound public-interest direction

Efeitos socioeconômicos municipais da construção de usinas hidrelétricas apoiadas pelo BNDES

O BNDES e a Empresa de Pesquisa Energética (EPE) mantêm acordo de cooperação técnica para intercâmbio de informações e realização de estudos e pesquisas conjuntos referentes a atividades de monitoramento e avaliação de efetividade

Cross-sectional study on the characteristics of unrecorded alcohol consumption in nine newly independent states between 2013 and 2017

Objectives: As unrecorded alcohol use contributes to a substantial burden of disease, this study characterises this phenomenon in newly independent states (NIS) of the former Soviet Union with regard to the sources of unrecorded alcohol, and the proportion of unrecorded of total alcohol consumption. We also investigate associated sociodemographic characteristics and drinking patterns. Design: Cross-sectional data on overall and unrecorded alcohol use in the past 7 days from WHO STEPwise Approach to NCD Risk Factor Surveillance (STEPS) surveys. Descriptive statistics were calculated at the country level, hierarchical logistic and linear regression models were used to investigate sociodemographic characteristics and drinking patterns associated with using unrecorded alcohol. Setting: Nine NIS (Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkmenistan and Uzbekistan) in the years 2013–2017. Participants: Nationally representative samples including a total of 36 259 participants. Results: A total of 6251 participants (19.7%; 95% CI 7.9% to 31.5%) reported alcohol consumption in the past 7 days, 2185 of which (35.1%; 95% CI 8.2% to 62.0%) reported unrecorded alcohol consumption with pronounced differences between countries. The population-weighted average proportion of unrecorded consumption in nine NIS was 8.7% (95% CI 5.9% to 12.4%). The most common type of unrecorded alcohol was home-made spirits, followed by home-made beer and wine. Older (45–69 vs 25–44 years) and unemployed (vs employed) participants had higher odds of using unrecorded alcohol. More nuanced sociodemographic differences were observed for specific types of unrecorded alcohol. Conclusions This contribution is the first to highlight both, prevalence and composition of unrecorded alcohol consumption in nine NIS. The observed proportions and sources of unrecorded alcohol are discussed in light of local challenges in policy implementation, especially in regard to the newly formed Eurasian Economic Union (EAEU), as some but not all NIS are in the EAEU

Trends in early alcohol and drunkenness initiation, by gender and subregion

In 2014, around one in four adolescents in the Region first consumed alcohol at age 13 or younger, and just under one in 10 were first drunk at this early age. • Gender differences are not present in all countries and regions, but when present, boys are more likely to report early alcohol initiation and early drunkenness. • Early alcohol initiation has declined in most countries and regions. On average, early alcohol initiation across all countries and regions declined from 46% in 2002 to 28% in 2014. Similarly, early drunkenness more than halved, from 17% to 8%, over this period. • A significant increase in alcohol use at age 13 or younger was reported in Slovenia among both boys and girls and in Greece among girls only. • The biggest changes in early initiation of alcohol and drunkenness were seen in the Nordic and Ireland/Great Britain subregions, which had the highest prevalence in 2002. Less change was seen in the southern Europe/ Mediterranean subregio

Perfuração gastrointestinal relacionada a Granulomatose Eosinofílica com Poliangiíte pós-Covid-19 – um relato de caso

Introdução: A Granulomatose eosinofílica com poliangiíte (GEPA), anteriormente conhecida como Síndrome de Churg Strauss, é considerada uma doença rara e se caracteriza por uma vasculite necrotizante disseminada, associada com o anticorpo anticitoplasma do neutrófilo (ANCA)4,5. Ocorre infiltração eosinofílica, o qual pode acometer pulmões, coração, rins, tecido nervoso e trato gastrointestinal (TGI) 1, 2, 3 , e que o prognóstico varia de acordo com o sistema acometido 6. Relato do caso: Trata-se de paciente do sexo masculino, 58 anos, que deu entrada em pronto socorro com quadro de abdome perfurativo. O paciente possuía história de asma iniciada na vida adulta, além de internação recente por COVID-19. Os exames laboratoriais demonstravam eosinofilia importante (75% da contagem leucocitária), e o estudo anatomopatológico demonstrou enterite eosinofílica com focos de vasculite eosinofílica. Conclusão: A possibilidade de um diagnóstico de GEPA sempre deve suspeitado em pacientes que apresentam eosinofilia exuberante, principalmente quando associado com história de asma, polipose nasal e parestesias. Um diagnóstico precoce possibilita o início de uma abordagem terapêutica, o que gera significante melhora na qualidade de vida desses pacientes, bem como em seu prognóstico

Impact of the WHO “best buys” for alcohol policy on consumption and health in the Baltic countries and Poland 2000–2020

Funding Information: Funding: Research reported in this publication was in part supported by the (U.S.) National Institute on Alcohol Abuse and Alcoholism (NIAAA) of the National Institutes of Health (NIH), grant number 1R01AA028224 . This research was conducted as part of the project ‘Evaluation of the impact of alcohol control policies on morbidity and mortality in Lithuania and other Baltic states’ and we would like to thank the whole team for their input to wider discussions in generating the research reported in this paper. Content is the responsibility of the authors and does not reflect official positions of the NIAAA or the NIH. Publisher Copyright: © 2023Alcohol use is a major risk factor for burden of disease. This narrative review aims to document the effects of major alcohol control policies, in particular taxation increases and availability restrictions in the three Baltic countries (Estonia, Latvia, and Lithuania) between 2000 and 2020. These measures have been successful in curbing alcohol sales, in general without increasing consumption of alcoholic beverages from unrecorded sources; although for more recent changes this may have been partly due to the COVID-19 pandemic. Moreover, findings from time-series analyses suggest improved health, measured as reductions in all-cause and alcohol-attributable mortality, as well as narrowing absolute mortality inequalities between lower and higher educated groups. For most outcomes, there were sex differences observed, with alcohol control policies more strongly affecting males. In contrast to this successful path, alcohol control policies were mostly dismantled in the neighbouring country of Poland, resulting in a rising death toll due to liver cirrhosis and other alcohol-attributable deaths. The natural experiment in this region of high-income European countries with high consumption levels highlights the importance of effective alcohol control policies for improving population health.Peer reviewe

Exploring educational inequalities in hypertension control, salt knowledge and awareness, and patient advice : insights from the WHO STEPS surveys of adults from nine Eastern European and Central Asian countries

Objective: To inform strategies aimed at improving blood pressure (BP) control and reducing salt intake, we assessed educational inequalities in high blood pressure (HBP) awareness, treatment and control; physician’s advice on salt reduction; and salt knowledge, perceptions and consumption behaviours in Eastern Europe and Central Asia. Design: Data were collected in cross-sectional, population-based nationally representative surveys, using a multi-stage clustered sampling design. Five HBP awareness, treatment and control categories were created from measured BP and hypertension medication use. Education and other variables were self-reported. Weighted multinomial mixed-effects regression models, adjusted for confounders, were used to assess differences across education categories. Settings: Nine Eastern European and Central Asian countries (Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkey and Uzbekistan). Participants: Nationally representative samples of 30 455 adults aged 25–65 years. Results: HBP awareness, treatment and control varied substantially by education. The coverage of physician’s advice on salt was less frequent among participants with lower education, and those with untreated HBP or unaware of their HBP. The education gradient was evident in salt knowledge and perceptions of salt intake but not in salt consumption behaviours. Improved salt knowledge and perceptions were more prevalent among participants who received physician’s advice on salt reduction. Conclusions: There is a strong education gradient in HBP awareness, treatment and control as well as salt knowledge and perceived intake. Enhancements in public and patient knowledge and awareness of HBP and its risk factors targeting socio-economically disadvantaged groups are urgently needed to alleviate the growing HBP burden in low- and middle-income countries

Integrating maternal, newborn, child health and non-communicable disease care in the sustainable development goal era

Noncommunicable diseases (NCDs) and maternal newborn and child health (MNCH) are two deeply intertwined health areas that have been artificially separated by global health policies, resource allocations and programming. Optimal MNCH care can provide a unique opportunity to screen for, prevent and manage early signs of NCDs developing in both the woman and the neonate. This paper considers how NCDs, NCD modifiable risk factors, and NCD metabolic risk factors impact MNCH. We argue that integrated management is essential, but this faces challenges that manifest across all levels of domestic health systems. Progress toward Sustainable Development targets requires joined-up action