A clinical study of the implications of alcohol consumption among Zimbabwe's rural imbibers admitted at health facilities due  to alcohol abuse.It is true, a medical history is incomplete without inquiring into the history of alcohol intake. The range of medical diseases associated with excessive alcohol consumption are well known. There are also several established screening instruments for identification of those with harmful or hazardous drinking habits who are at risk of developing physical, medical and social problems. The amount of alcohol consumed can be measured fairly accurately in grams of absolute alcohol when a known quantity of an alcoholic beverage of known concentration is drunk. For instance a half-pint (290 mls) of ordinary beer or a glass of wine or a single measure of whisky (known as a unit of alcohol or one standard drink) contains approximately 10 g of absolute alcohol.5 A daily alcohol consumption of 20-40 g is known to be a risk factor contributing  to accidents, injuries and chronic health problems

Lutalo, S.K.

Mabonga, N.

Central African Journal of Medicine

English

IDS OpenDocs

The
Central African 
Journal 
of
Medicine
Supplementary Issue to 1992 Volume 38,
1991 University of Zimbabwe Annual Research Day
CENTRAL AFRICAN
JOURNAL OF MEDICINE
Vol. 38, No. 9, September, 1992
A clinical assessment of 
the consequences of 
alcohol consumption in 
‘communal’ drinkers in 
the Zimbabwean Midlands
SK LUTALO,* N MABONGA** 
SUMMARY
The study was undertaken to clinically assess the 
consequences of alcohol consumption in ‘communal’ 
d rin k in g  p a tien ts  w hose lev e ls  of alcoho l
*Harare Central Hospital 
P O Box ST 14 
Harare 
Zimbabwe
**Gweru Provincial Hospital
P O Box 135 
Gweru 
Zimbabwe 
Correspondence to: 
SKLutalo
380
CENTRAL AFRICAN
JOURNAL OF MEDICINE
Vol. 38, No. 9, September, 1992
consumption could not be determined accurately in 
grams of alcohol. The level of alcohol consumed by 
100 adult ‘communal’ drinking medical patients per 
drinking session was scored on a scale 0-10. The 
score was based on a qualitative impression of how 
much alcohol was drunk, level of consciousness, 
behaviour and gait.
The frequency of drinking days in a week was 
scored on a 0-7 scale. The duration of drinking in 
years prior to registration at the clinic was also 
recorded. The pattern of diseases among the drinkers 
was compared to that of 70 adult non-drinkers. The 
individual diseases were ranked to association with 
alcohol consumption by the Kruskal-Wallis Test.
The drinkers attained a mean level score of 
5,75 ± 2,16, a frequency of 4,75 ± 2,4 days but the 
duration of prior drinking varied greatly. Gout, 
dilated cardiomyopathy, epilepsy and hypertension 
ranked highest in that order to alcohol usage. 
Rheumatic heart disease and Diabetes mellitus 
ranked low. The probability significance were, for 
level score p=0,005, frequency p=0,016 and duration
p=0,001.
This method was able to identify the morbid 
chronic medical diseases associated with alcohol 
usage in ‘communal’ drinkers. There is a need to 
evaluate it against a known screening instrument like 
the Alcohol Use Disorders Identification Test 
(AUDIT).
INTRODUCTION
It is true, a medical history is incomplete without 
inquiring into the history of alcohol intake. The range 
of medical diseases associated with excessive alcohol 
consumption arc well known.1’4 There are also 
several established screening instruments lor 
identification of those with harmful or hazardous 
drinking habits who are at risk of developing 
physical, medical and social problems.5,6 The 
amount of alcohol consumed can be measured fairly 
accurately in grams of absolute alcohol when a 
known quantity of an alcoholic beverage of known 
conccnuation is drunk. For instance a half-pint (290 
mis) of ordinary beer or a glass of wine or a single 
measure of whisky (known as a unit of alcohol or one 
standard drink) contains approximately 10 g of 
absolute alcohol.5 A daily alcohol consumption of 
20-40 g is known to be a risk factor contributim; to 
accidents, injuries and chronic health problems.6
It is, however, not always possible to assess 
accurately the amount of alcohol drunk by an 
individual in situations where people share drinks 
from the same container or where the alcohol content 
of the beverage is unknown. Such a ‘communal’ 
drinker will usually drink as much as to attain his or 
her preconceived level without knowing the amount 
of alcoholic beverage consumed. This poses a special 
problem in evaluating the level of alcohol consumed 
on the health of such people, and may prove a barrier 
in counselling problem drinkers in general medical 
wards or primary health care settings.
The purpose of this study was to evaluate clinically 
the consequences of alcohol consumption is such 
‘communal’ drinkers.
MATERIALS AND METHODS
The medical records of patients entered into the 
Gweru Provincial Hospital Endemic M edical 
Diseases Register 8 between March 1973 and 
December 1990 were retrieved and used for the study. 
The main diseases registered are hypertension 
36,6 pc, heart diseases 24,9 pc, Diabetes mellitus 
12,4 pc, epilepsy 8,4 pc and inflammatory rheuma- 
tological diseases two pc. The register serves only 
patients who reside in Gweru City and a defined 
adjacent rural area, in the Midlands province of 
Zimbabwe, who primarily depend on public funding 
for their medical care. Only chronic, recurrent or 
important medical diseases diagnosed by a consultant 
Physician who require long term follow-up or 
treatment are registered.8 Diseases like cirrhosis and 
hepatocellular carcinoma which are considered to 
have no effective treatment are routinely excluded 
from the register. A history of alcohol consumption is 
routinely taken and recorded at the time of 
registration. It has been the practice of the register 
clinic since its inception in 1973 to document alcohol 
consumption of all patients.
In this study, the registered patients were 
categorized into two groups of those with recorded 
history of alcohol consumption and those without. 
Using computer generated random numbers, 100 
cases from each of the two groups were selected for 
further study. All patients under 20 years of age at the 
time of registration were excluded.
For each patient the following information was 
extracted; the main medical disease diagnosed, sex,
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CENTRAL AFRICAN
JOURNAL OF MEDICINE
Vol. 38, No. 9, September, 1992
age at diagnosis and alcohol consumption. The effect 
of alcohol consumption on the individual at each 
drinking session had been scored on a scale 0-10 
based on a qualitative impression of how much was 
drunk, level of consciousness/behaviour and gait as 
shown in Table I. The interview was done by a 
specia lly  trained  c lin ica l nursing siste r (N 
M),indigenous to the area, on the day of registration, 
in confidence when the patient was sober, alone or 
with a relative or friend.
Table I: Qualitative assessment o f effect o f alcohol 
after a drinking session
Points on 
Scale Effect on the individual
0 N o alcohol drunk
1 Very little drunk, conscious, norm al gait
2 Little drunk, conscious, normal gait
3 M oderate drunk, conscious, norm al gait
4 A  little  excited, normal gait
5 M oderate ly excited, normal gait
6 Very excited, norm al gait
7 Very excited, m ild drunken gait
8 Excited, severe drunken gait
9 Sem iconscious, unable to  w alk
10 Unconscious.
The frequency of drinking was based on how many 
days of the week the patient normally drank and was 
scored on a scale on a scale 0-7. Also the duration in 
years of drinking prior to registration was noted. The 
data were analysed using an Amstrad personal 
computer and SPSS software system. The diseases as 
they occur in patients were combined and ranked 
according to the parameters of the effect of the 
sessional consumption of alcohol, the frequency of 
days of drinking in a week and the duration of 
drinking prior to diagnosis. The mean rank score for 
each individual disease was determined and the 
Kruskal-Wallis statistic computed. The larger the 
mean rank, the closer would be the association of the 
disease to the parameter evaluated. The Chi-squared 
(X2) test was used for association and the significance 
level was set at p<0,05. A significant Kruskal-Wallis 
statistic would suggest that the disease’s association 
to the parameters assessed individually, would not be 
the same.
RESULTS
The total number of registered patients was well 
above two thousands but only 1 005 patients had a 
definite recorded history of no alcohol use while 705 
patients had a record of drinking. All the 100 patients 
sampled from the alcohol drinking group were 20 
years old and above and were therefore included in 
the study while only 70 of the 100 sampled from the 
non-drinking group were of the age to be included. 
The total number studied was therefore 170.
Of the 170 patients, the mean age was 50 range 
20-83 years, 94 were men and 76 were women. 
Among the alcohol drinking group only 27 pc were 
women, 73 pc being men, but in the non-drinking 
group it was the reverse, 70 pc women and only 30 
pc men.
The percentage frequency distribution score of the 
usual level of drinking attained per session and the 
frequency of drinking per week in the alcohol group 
is shown in Table II.
Table 11: 
patients
The drinking scores o f the 100 drinking
p c  o f p a tie n ts  for
S c o re p c  o f p a tie n ts  for f re q u e n c y  d a y s
s e s s io n  e ffe c t  s c o re in a  w e e k
1 0 13
2 11 15
3 1 3 14
4 5 4
5 14 0
6 11 0
7 1 8 5 4
8 2 3 —
9 5 —
1 0 0 -
T ota l 1 0 0 1 0 0
The mean level of drunkenness score was 5,75 ± 
2,16 and the frequency per week was 4,74 ± 2,4 days. 
Forty two pc of patients drank on three days while 
54 pc drank on seven days a week. Those whose level 
of drunkenness score was six or higher and the 
frequency per week was five or greater were 
considered above average drinkers. The duration of 
drinking prior to registration is shown in Table III.
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CENTRAL AFRICAN
JOURNAL OF MEDICINE
Vol. 38, No. 9, September, 1992
Table III: Percentage frequency distribution of 
drinking patients according to duration o f prior 
drinking
Duration (years) pc of patients
1-5 25
6-10 22
11-15 15
16-20 15
Over 20 23
Total 100
The commoner treatable diseases registered were 
hypertension (n=53), rheumatic heart disease (n=31), 
diabetes (n=29), dilated cardiomyopathy (n=17), 
epilepsy (n=7), gout (n=2) and a sizeable collection 
of miscellaneous others (n=31). The diseases were 
ranked to a lco h o l co n su m p tio n  using the 
Kruskal-Wallis Test as shown in Table IV. The 
association of these diseases with alcohol usage 
ranked high in gout, dilated cardiomyopathy, 
epilepsy and hypertension but low in rheumatic heart 
disease, diabetes and the miscellaneous others.
Table IV: Kruskal-Wallis ranking o f diseases to 
alcohol drinking session effect, weekly frequency and 
duration o f prior drinking in the 170 patients.
D is e a s e
M e a n  R a n k  
L e v e l S c o r e
M e a n  R a n k  
F re q u e n c y
M e a n  R a n k  
D u ra tio n
1. G o u t  (n = 2 ) 1 3 6 ,5
S c o r e
1 4 3 ,5
(Y e a rs )
1 4 2 ,0
2. D ila te d  C a rd io -
m y o p a th y  (n = 1 7 ) 1 1 8 ,9 1 1 5 ,5 1 2 7 ,1
3. E p ile p s y  (n = 7 ) 1 0 1 ,1  ' 9 2 ,3 95,1
4 . H y p e rte n s io n
(n = 5 3 ) 8 7 ,8 89,1 8 8 ,2
5 . R h e u m a tic  H e a r t
D is e a s e  (n = 3 1 ) 7 8 ,7 77,1 7 8 ,2
6  D ia b e te s  (n = 2 9 ) 6 4 ,0 6 8 ,9 7 0 ,0
7. O th e rs  (n = 3 1 ) 8 3 ,1 8 1 ,6 74,1
S ta tis tic X 2 =  1 8 ,3 7 X 2 =  1 5 ,5 6 X2 =  2 2 ,4 2
P ro b a b ility P < 0 ,0 0 5 P < 0 ,0 1 6 P < 0 ,0 0 1
S ig n ific a n c e S S s
The frequency distribution of the four main diseases 
namely dilated cardiomyopathy, hypertension, 
diabetes and rheumatic heart disease in the drinking 
group did not differ significantly when those who 
drank above the average (n=41) were compared with 
those who drank below the average (n=37), 
(X2= 1,848 p>0,10).
DISCUSSION
It has been possible to assess the influence of alcohol 
consumption on some diseases seen in patients who 
drank beverages whose alcohol contents could not be 
quantified definitively. The method studied is not a 
screening test like the Alcohol Use Disorders 
Identification Test (AUDIT)5 which identifies those 
with hazardous drinking, but it has confirmed those 
diseases already known to rank highly on the long 
term effect of alcohol. It does not determine a causal 
relationship between alcohol and the disease.
Since the self-reporting of alcohol use was done 
when the individual was sober and in confidence by 
a person indigenous to the area and culture at the time 
of recording other clinical data, it is assumed that 
false information was minimised.9
The bimodal distribution of drinking days in a 
week suggests that there arc two clear groups of 
drinkers. Those who drink on one to three days 
probably drink on weekends only while the other 
54 pc drink throughout the week. Twenty eight pc of 
the drinkers usually attained levels of eight to nine 
scores when gait becomes seriously disturbed. The 
duration of drinking prior to registration varied 
considerably.
The number of patients who had drunk for a few 
years approximated that of those who had drunk for 
over twenty years. The association of excessive 
alcohol use and gait is well recognized.1 'l0,11 Two 
cases of gout were included in this study and both 
were in above average drinkers group. Gout is not 
necessarily a rich person’s disease since it has been 
reported in those who w ould otherw ise be 
categorized in a lower socio-economic group, 
particularly in those who drink home brewed or home 
distilled alcoholic beverages in excess.10
D ilated cardiom yopathy has been shown
2 12previously to be associated with alcohol excess. ’
In this study the disease ranks highly to use of 
alcohol. The high rank score of epilepsy with alcohol 
use found in this study is not surprising since alcohol 
per se can cause or aggravate seizure attacks. 
Epileptics should always be advised strongly against 
drinking. Similarly the association of alcohol excess 
to the development of hypertension is also well 
known. The high rank score is consistent with 
previous findings.3
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CENTRAL AFRICAN
JOURNAL OF MEDICINE
Vol. 38, No. 9, September, 1992
Rheumatic heart disease (RHD) ranking of alcohol 
use in this study was low partly because the disease 
afflicts relatively young people13 who w ould 
normally be non-drinkers and it is not known to be 
associated with excessive alcohol consumption. 
Diabetes mellitus rank to alcohol use was quite low 
in this study but the risk of developing non-insulin 
dependent Diabetes mellitus in heavy drinkers has 
been found in previous studies, but also low.4 The 
diabetics however, should be discouraged from 
drinking since alcohol would predispose them to 
pancreatitis, hypoglycaemia and other metabolic 
d isturbances which would render treatm ent 
particularly difficult.
An attempt to demonstrate the occurrence of 
particular diseases among above average and below 
average drinkers did not reach significant levels. 
Difficulties in discriminating between infrequent/ 
moderate drinkers and heavy drinkers have been 
encountered elsewhere.14
A future study should be undertaken to attempt to 
standardise the scales used in this study against 
established screening instruments such as the AUDIT 
to find out whether this method could be established 
as an alternative screening instrument particularly 
suitable to populations or cultures who drink 
beverages whose alcohol content are not accurately 
known or who share drinks from a common container. 
If this was to be, the method would be applicable in 
general medical practice15 and rural Primary Health 
Care settings when a brief but effective intervention 
with those at risk might be possible. Thus far it has 
been possible to identify common chronic diseases 
associated with alcohol consumption in ‘communal’ 
drinkers in an urban and peri-urban area of 
Zimbabwe.
ACKNOWLEDGEMENTS
We thank Mrs Violet Acuda for the computer 
analysis, Professor W Acuda for reading through the 
manuscript, Miss A Marisa for typing and the 
Secretary for Health for permission to publish.
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A clinical assessment of the consequences of alcohol consumption in ‘communal’ drinkers in the Zimbabwean Midlands

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A clinical assessment of the consequences of alcohol consumption in ‘communal’ drinkers in the Zimbabwean Midlands

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