Unrecorded alcohol in East Africa: A case study of Kenya
Alcohol contributes substantially to the global morbidity and mortality burden. Unrecorded alcohol, alcohol that is purchased by means which precludes regulation, represents a substantial proportion of the alcohol consumed in East Africa. In Kenya, homebrew also known as traditional brew, has been linked to several fatalities and hospitalizations.
Previously banned, the Kenyan government recently legalized homebrew in an effort to regulate and reduce its harm. Despite legalization, however, homebrew continues to be endemic.
In this paper, the researchers examine the scope and harm associated with unrecorded alcohol in Kenya, and discuss current policies and interventions aimed at reducing production and consumption of unrecorded alcohol in the Kenyan context that reflect its culture, politics, environment and resources.
Opportunities for public health intervention?
Research has shown that there are several potential intervention targets in the actual process of making homebrews. First, brewers typically use contaminated water from sources such as rivers. Second, containers used throughout the process were recycled receptacles such as oil drums and bug repellent cans that are susceptible to erosion. Third, containers were left uncovered to ferment, leaving opportunities for contamination. Finally, brewers purposefully introduced toxins and additives to create more potent brews.
Opportunities to prevent contamination of homebrew could include regulating the brewing process by introducing brewing kits that would include water purification equipment and clean and easy to maintain brewing containers that include lids to avoid contamination. Moreover, these kits need to include clear guidelines on specific ingredients that cannot be added to adulterate the alcohol. Finally, there needs to be regular testing of the alcohol potency and toxicity to ensure its safety. As such, a brewing kit to approved brewers may reduce several of the health concerns and toxic agents present in current homebrew. However, for this intervention to be feasible and scalable, it is imperative that these kits are affordable to potential brewers to ensure use and uptake.
The most dangerous part of the brewing process is the addition of substances to make the brew more potent as customers tend to prefer brewers with reputations of having highly concentrated alcohol. Banning known substances used to adulterate home brew is one option. Another recommendation would be high taxation of items known to be used in the brewing process as well as items used to adulterate the alcohol such as methanol. This recommendation, however, may be limited as some products used in the brewing process are locally sourced which would make regulating access difficult. Second, the legalization of homebrew not only acknowledges that the government recognizes homebrew is deeply entrenched in the culture and traditions, but also provides a window of opportunity for strategies that may better fit the situation. Working with local and county governments to unionize home brewers to make themselves accountable for quality control may be a viable option. At the county government level, such intervention may be feasible and could be contextualized to fit the needs of the community. Taxation of the products, regulation and oversight by local governments may create an effective system for checks and balances.
The National Campaign Against Drug Abuse Authority (NACADA), although explicitly mentioned in the alcohol bill (National Council for Law Reporting, 2014) as the authority to address alcohol related challenges, is strapped for resources, as the bill does not allocate specific funding for the organization. Boosting’s NACADA’s resources both financial and technical support, will result in increased efforts and opportunities to address and coordinate efforts nationwide.
Educating producers on how to produce safe beverage as well as educating consumers on the risks of consuming homebrew are two key recommendations to address the homebrew crisis.
Current legislation is not sufficient and does not align with the specific challenges of the scope of unrecorded alcohol and harm in Kenya. The Kenyan government may consider working closely with stakeholders such as county governments and brewers to determine best approaches to combat the morbidity and mortality from contaminated homebrew. While research in this area is limited, in other countries such as Malawi, stakeholder perception and policy recommendations were obtained which is a critically important step in guiding the future direction of informal alcohol production and homebrew specifically.
Moreover, while not specifically addressed in this commentary, women tend to comprise the majority of those making homebrew. These hard-working women usually choose this line of work because of limited opportunities for schooling and because they have limited skills to seek other opportunities to support themselves and their families. As such, policies that seek to reduce and improve the manufacturing of homebrew need to consider the issue of gender and women empowerment in addition to providing other economic opportunities for women as a strategy to address this specific issue.
Clearly, research is needed to better highlight the prevalence and risk factors for homebrew consumption by the overall population but also vulnerable subgroups such as those that are HIV positive and children. Research needs to assess more specifically the feasibility of targeting the recommended intervention points in the manufacturing process of homebrew and the circumstances of the women who brew the alcohol, in order to provide new strategies to make the homebrew less toxic.
Finally, boosting funding and resources to the National Campaign Against Drug Abuse Authority (NACADA) should be an obvious priority in order to expand cultural centered approaches and health education strategies to reduce consumption of unrecorded alcohol nationwide.
Overall, homebrew consumption and production cannot be easily addressed via “best buys” means which public health entities employ to offset recorded alcohol consumption. Novel, multi-pronged approaches that consider cultural context and traditions are needed, along with recognition of the vast array of factors and stakeholders impacting the growing public health concern of the homebrew proliferation and consumption in Kenya and East Africa.