Alcohol Consumption in Ethiopia

(Literature Review)

Table of Contents

  1. Background
  2. Alcohol Consumption in Ethiopia
  3. Types and Sources of Alcohol in Ethiopia
  4. Non-commercial, Illicit Alcohol
  5. Factory Drinks
  6. Profile of Alcohol Users
  7. Frequency, amount and Context of Alcohol Drinking
  8. Reasons for drinking Alcohol
  9. Alcohol, Khat, Sexual Behavior and Condom Use
  10. Alcohol Policy
  11. Barriers to adopting responsible drinking behavior
  12. Facilitators to adopting responsible drinking behavior

Acronymsand Abbreviations

ABV Alcohol by Volume

AIDS Acquired Immune Deficiency Syndrome

BSS Behavioral Surveillance Survey

CSA Central Statistics Agency

CSWs Commercial Sex Workers

EPHA Ethiopian Public Health Association

HIV Human Immunodeficiency Virus

ICAP International Center for alcohol Policies

ISY In-school Youths

OSY Out of School Youth

SNNPR Southern Nations, Nationalities and People’s Region

STI Sexually Transmitted Infections

WHO World’s Health Organization

Glossary

Arada a person considered as modern and cool

Areque home-distilledalcohol beverage.

Borde local beer made from maize, sorghum, barley.

Chebsie The consumption of alcohol after chewing Khat

Khat a green leafed stimulant drug.

Tej a honey wine

Tella a home brewed beer made of barley and wheat

  1. Background

Alcoholic beverages are drinks containing ethyl alcohol or ethanol which is an intoxicating ingredient. Itis produced by the fermentation of yeast, sugars and starches mainly derived from cereal grains. It often slow down the function of the central nervous system and can impair judgment and alter a person’s emotions, abilities and behaviors. Yet, the production and consumption of such kind of alcoholic beverages occurs in most cultures around the world. It plays an important role in social events and interactions mainly because when consumed in small amounts, it can help a person feel relaxed and less anxious. But if consumed in a larger amount, alcoholic beverages may have a negative impact on one’s health as well as social and financial well-being.

In Ethiopia, although alcohol is an integral part of peoples’ lives, especially during holidays, celebrations and recreations, there is a lack of reliable data in the country regarding the amount of alcohol produced, sold and consumed as well as the health problems inherent by it. This literature review explores the limited researches, aiming to provide an insight into the actual situation of alcohol consumption in the country, especially in relation to its contribution to the spread of HIV/AIDS.

  1. Alcohol Consumption in Ethiopia
  • The WHO Global Status Report on Alcohol released in 2004 showed that in Ethiopia, a total of recorded 0.91 liters of pure alcohol are consumed per capita each year by people aged 15 and above while the unrecorded (non-commercial) alcohol consumption is estimated to be 1.0 liters of pure alcohol per capita. This data may seem low when compared with other African counties like Nigeria which is nearly 19.7 liters per capita, making it one of the countries with high level of alcohol consumption.
  • Data from the 2003 world Health survey conducted among adult men and women aged 18 and above indicate that the mean value (in grams) of pure alcohol consumed per day among male and female drinkers was 23.6 with the highest being among males (27.8). From the participating 4920 males and 2377 females, 4.1% (7.7% male and 0.4% female) of them have also been identified as heavy episodic drinkers as they consume five or more standard drinks in one sitting at least once a week.
  • In addition to these, a 1994 prevalence study of alcohol dependence and problem drinking among representative sample of 10203 adults in Addis Ababa, has found that the total prevalence rate of alcohol dependence is 1.1% (2.5% for males and 0.3% for females). Since prevalence rate is constantly change, one should put in mind that the current prevalence rate may be much higher than this.
  • In 2007, a nationwide study was conducted on Alcohol and Khat consumption and the association with HIV/AIDS prevention, care and support. It involved over 10,000 participants from rural and urban areas (male and female aged 15-59) from selected 12 woredas (that have high HIV prevalence, based on antenatal clinic based HIV sentinel surveillance reported in the 6th AIDS report) in eight regions (Tigray, Afar, Oromia, Amhara, SNNPR, Addis Ababa, Dire Dawa, Benishangul Gumez). Results of this study show that the prevalence of alcohol consumption and Khat chewing is high in all the selected woredas of the regions and is progressively increasing from time to time. However, percent of respondents who ever drank alcohol varies from one region to the other, ranging from 9% in Duphti, Afar, to 70.2% in Adama, Oromia Region. But most generally, the prevalence is greater than or equal to 20% in the woredas of all the regions except for Dire Dawa and Duphti in Afar.

The table below shows the summary of alcohol andKhat consumption in all the woredas.

Prevalence of the Behaviors / Low / Moderate / High
Percentages of respondents who ever drank alcohol
< 20 (Low), 20-39 (Moderate), 40 < (High) / Dire Dawa
Duphti / Dilla
Assosa
Dessie
Jimma
Awassa / Adama
Bahir Dar
Maychew
Addis Ababa (Gulelle,Kirkos)
Percentages of respondents who ever chewed Khat
<10 (Low), 10-19 (Moderate), 20< (High) / Maychew / Adama
Awassa
Bahir Dar
Assosa
Addis Ababa (Gulelle,Kirkos) / Dilla
Dire Dawa
Duphti
Dessie
Jimma
  1. Types and Sources of Alcohol in Ethiopia

Alcoholic beverages are generally divided into three different types i.e. wine, beer and distilled spirits. Beer and wine are produced by the fermentation of sugar or starches from cereal grains. The alcohol concentrations of these beverages are usually lower when compared to distilled spirits which has higher alcohol content as it is produced by fermentation followed by distillation. Ethiopia is supplied with all these different types, ranging from imported wine and liquors (distilled spirits like whisky, vodka, gin), to beers produced by local factories and non-commercial (traditional) drinks.

3.1 Non-commercial or illicit alcohol Beverages

In this review, non-commercial (Illicit) alcohol is defined as traditional alcohol drinks produced for home consumption or limited local trade. According to ICAP (2008), it may also include a range of non-beverage alcohols (derived from medicinal compounds, automobile products like benzene, and cosmetics), a relatively widespread phenomenon in some areas, particularly among problem drinkers in the lowest socioeconomic status.

The very fact that such kinds ofillicit or non-commercial beverages are unrecorded makes it obviously difficult to assess their accurate alcohol contents or how much of this types of local drinks are being produced and consumed compared to legally sold alcohols. Yet, they remain to be the most widely consumed alcohol as they are inexpensive and easily accessible than factory produced beverages. For this reason, factory produced drinks tend to be mainly consumed by people who can afford the more expensive price and by urban dwellers while locally produced and home-brewed alcoholic beverages are predominantly used in the rural areas and by people living in the urban areas who cannot afford factory made drinks. For instance, young people, (as young as 14 yrs old and university students) tend to consume local beverages like Areque and Tella as their main source of alcohol since these drinks are easily accessible to them and cannot afford other kinds of factory drinks (EPHA,2007).

These traditional or locally produced alcohols are also quite significant in economic terms. Many households in the country, especially women engage in the production and sales of these beverages as their main source of income to support themselves and their families. Some of the popular locally produced and home-brewed beer, wine and distilled alcohol beverages are the following:

  • Tella is a home brewed beer made of barley and wheat. The alcohol content varies from place to place, but usually it is 6% to 7% ABV. Filtered tella has higher alcohol content. This drink is usually perceived as a harmless social drink and is usually prepared by women except in monasteries and church compounds. Tella is almost never sold in bars but in small houses “tella bets”. It is also the beverage of choice for family occasions and religious celebrations (mahebers). It is very popular and highly valued as its production requires considerable skill and patience. It is, by far, the most commonly consumed alcoholic beverage in the country and assumed that over two million hectoliters of it is brewed annually in households and drinking houses in Addis Ababa (Sahle and Gashe, 1991 cited in Gizaw, 2006).
  • Shamita is another traditional beverage (beer), which is low in alcohol content. It can be made in an overnight fermentation of mainly roasted barley flour and, consumed as meal-replacement (Bacha et al., 1999 cited in Gizaw, 2006).
  • Tej is a honey wine with alcohol content varying from 8% to 14% ABV. It is prepared from honey, water and leaves of Gesho. Previously, it was for people in the upper class, but now it is widespread among all social groups, consumed on holidays and at weddings as well as served in hotels and bars (Tej bets) across the country.
  • Borde is a local beer mostly consumed by people in southwestern parts of the country. It is considered as a drink for people in the lower socio-economic status. It is prepared by women from fermented maize, sorghum, barley, or a mixture of the three. Bordè can be very thick and serve as a substitute for meals during long trips.It is also used for medical and ritual purposes. Consumers believe that it enhances lactation and mothers are encouraged to drink substantial amounts of it after giving birth (Kebede et al., 2002 cited in Gizaw, 2006).
  • Araqé, or katikala isa home-distilled beverage with alcohol content ranging from 30% to almost 50% ABV. This beverage is more expensive than the other drinks and is popularly viewed as very strong and dangerous to consume. Araki is brewed in rural and semi-urban areas and is used more commonly by farmers and semi-urban dwellers than by people who live in the cities. And in cities, people who drink araqe are predominantly from lower class or those who have become dependent on alcohol and cannot afford to buy industrially produced alcohol beverages.

Of these traditionally fermented beverages however, the most popular ones are tej (honey wine), tella (a malt beverage like beer) and areki (distilled liquor). These drinks are widely served on festive occasions and at social gatherings.

3.2 Factory Drinks

Aside from locally fermented drinks, factory beer is the other type of beverage which is mostly consumed, especially in urban areas. There are currently five breweries in Ethiopia namely BGI Group, Dashen, Harar, Meta and Bedele Factories and Meta Beer, Kidus Giorgis Bira, Harar Bira, Bati Bira, castel and Dashen Bira are the most popular factory beers with strengths usually ranging from 4% to 6% ABV.In addition to these, the national alcohol and liquor factory is the biggest factory producing liquors like Areque and gin.

According to the Statistical Abstract of 2007 produced by CSA, breweries in Ethiopia are said to have produced 1.56 million hectoliter of beer during 2006 and this represented 37% of all beverages produced by commercial producers in the country. In addition to this, 15% of all beverages produced further included wine and other alcoholic spirits (liquors) while the remaining were soft drinks (

There are hard facts indicating that beer market in Ethiopia has been growing and the demand for it is rising. Consumption of these factory beers are also said to be largely urban. These beer factories have made substantial publicity to step up consumption, mainly through supporting sports and other events. According to EPHA (2007), next to tella, factory beer and draft are thus found to be the most consumed alcohol drinks during the last 12 months in all the selected areas especially in Awassa (52.2%), Dire Dawa (65.4%) and Addis Ababa (46.5%).

  1. Profile of Alcohol Users
  • EPHA’s Study conducted in 2007 showed that the habit of alcohol drinking is more common among males than females. When looking at the socio-demographic characteristics of people who ever drank alcohol, there are more males 49.7% than females 33.9%. In support of this, findings from the 2005 Behavioral Surveillance survey have also showed that the use of Khat and alcohol are much more common among males than females. However, the habit of consuming alcohol and Khat is also increasing from time to time among females.
  • Aside from the gender difference, marital status is also found to play an important part on the level of alcohol consumption as people, who are single, divorced or people in non-marital relationships are found to use alcohol more than those who are married. However, no marked difference was observed among people from different education and economic background (EPHA, 2007).
  • With regard to residency or location of subjects who ever drunk alcohol, majority are found to be urban dwellers accounting for 66% (Ibid).
  • Alcoholic drinks are consumed by all age groups. When looking at the percentage of people who ever drunk alcohol, 30.5% of the young adults aged 15-24 have indicated that they have had alcohol drinks at least once in their life. It seems as age increases, the likelihood of people to consume alcohol increases as well however, young people seem to be the most involved in alcohol and Khat consumption than any other population group (Ibid).
  • The Behavioral Surveillance Survey conducted in 2005, has further showed that use of khat and alcoholic drinks is much more common among the OSY than ISY.
  1. Frequency, amount and context of Drinking Alcohol

The amount, frequency and the contexts in which drinking occurs are very important to look into to understand the situation of alcohol consumption. While some people only drink on weekends and in bars, others may have alcohol integrated into their daily life. In relation to this, according to EPHA (2007), most of the study participants from the different regions are occasional drinkers. With regards to frequency of alcohol consumption during the last 12 months, majority of the respondents said once a week, in almost all the regions ranging from 7.9% in Addis Ababa to 25.2% in Maychew, Tigray Region. The next majority further reported that they drink alcoholic beverages two to four times in a week period of time.

Amount of alcohol drinks consumed on a typical drinking day range from 1 to 5/6 standard drinks. But, relatively fewer people consume 5 to 6 drinks, while majority have 2 to 4 drinks. As indicated earlier, tella (the home brewed harmless social drink with an alcohol content ranging from 6% to 7% ABV) and factory beer/draft are the most popular drinks across the country. Beer is highly consumed in Awassa, Dire Dawa and Addis Ababa while tella is highly consumed in Adama, Assosa, Bahir Dar, Dessie, Dupthti, Jimma and Addis Ababa (Ibid).

Holidays are the most common time of drinking in all the regions ranging from 67.6% in Assossa, 64.1% in Dessie to 21.6%, 28.3 and 28.2% in Bahir Dar, Awassa and Jimma respectively followed by evening (night) times, the highest being in Awassa (48%) and Addis Ababa (38%). According to the report, the most common place were drinking takes placeis in the respondent’s own home followed by in bars/ clubs and tella bets.

Participants of the study further indicated that they usually drink alcohol with their group of friends while only some of them said alone or with their marital partner. Since women are not culturally allowed to drink alcohol especially in public, they tend to drink with their spouses or a family member while men are more likely to go out of their house and drink on their own or with friends. Alcohol use is considered as part of their construction of maleness so they can go out and have a drink wherever and with whoever they want. However, these alcohol-serving places like bars are often contact places for sexual encounters, increasing their chances of being exposed to risky sexual behaviors.

  1. Reasons for Drinking Alcohol

People drink alcohol for a lot of different reasons but the most common one is to relax and have a good time. Peer pressure, accessibility, cultural acceptability, parental involvement and low self esteem (to boost confidence) are some of the other underlying factors associated with alcohol and Khat consumption. In this particular study conducted by EPHA (2007),main reason for drinking alcohol has also been identified to be, to relax while the next majority reported that they drink alcohol because people they hang out with drink as well.

Some people also drink alcoholic beverages to avoid or 'forget' their problems and anxieties, like fromproblems arising from economic stress. Poverty is a serious problem among most people in the country due to lack of access to higher education and high unemployment rate. There is also a great shortage of public recreational areas which leaves most with little options on how to spend their days. So, to escape from their unpleasant reality, most people particularly young men turn to chewing khat, drinking alcohol and exploring sex with multiple partners(Getenet, 2006).