Research Article: Assessing the health risks of consuming ‘sachet’ alcohol in Acoli, Uganda

Date Published: February 27, 2019

Publisher: Public Library of Science

Author(s): Ochan Otim, Tom Juma, Olara Otunnu, Catherine Haighton.


The increased mortality rate among the Acoli people of northern Uganda is anecdotally blamed on excessive consumption of cheap and widely available sachet-packaged alcohol in the region. In this paper, we quantify this perceived association by determining statistically the health risks associated with ingesting 20 heavy metals in 17 popular spirits products consumed in Acoli. Thirteen of these products were industrially packaged in sachets (locally known as ‘sachet,’ waragi, arege or moo lyec) and four were locally produced Lira-Lira spirits from Bolo, Awere and Teso Bar in the region and Nsambya in southern Uganda. A Scottish whisky purchased in San Diego (USA) was our reference. Risk assessment was performed according to standardized protocols developed by the United States Environmental Protection Agency (US EPA). Our results show that a strong correlation indeed exists between health risks and ingestion of spirits in Acoli. At >2.5 sachets/day for 240 day/year over a lifetime for example, the risk of developing cancer due to exposure to As, Pb and Cr alone is 1 in 102,041. This estimate excludes ethanol, a known carcinogen, and 17 heavy metals also studied due to lack of their cancer slope factors. The primary non-cancer related health risk factor in all samples tested is ethanol with unacceptably high health index of four. The Lira-Lira spirits, with 100–6000% copper above the US EPA limit for intake by oral ingestion in water, would be the ‘cleanest’ without copper and at par with the Scottish whisky. Collectively, we find that no amount of alcohol consumed in Acoli is safe. Preventive measures are therefore recommended to reduce mortality in Acoli in particular, and in Uganda in general. These measures should include public education, better public policies, creating productive economic activities other than brewing alcohol, and social activities that engage people away from drinking.

Partial Text

The sub-Saharan countries of Africa are currently experiencing an increase in adult mortality partly believed to be due to the heavy consumption of cheaply and widely available spirits in the region [1,2]. This scenario is best illustrated by the plight of the Acoli population of Uganda [3], a community in which uncontrolled alcohol consumption and alcohol dependency was acquired involuntarily during a 20-year civil war. This population, centered approximately 350 km (220 mi) north of Kampala, the capital city (S1 Fig), is emerging from two decades of interment in which the entire population (close to 2 million people) were confined into heavily guarded satellite camps [3–8]. Within these camps, distilled or refined alcohol dependency was allowed to take root, albeit disproportionally affecting twice as many adult males as women [8]. Since leaving the internment camps, this population continues to experience high death rates which the local population blamed on the consumption of the poorly regulated and readily available spirits in industrially packaged plastic sachets or tot packs of 100 mL or less [3,8–10]. The suspected linkage between mortality and alcohol consumption is strengthened by an incident in 2008 where over 100 deaths were officially attributed to alcohol poisoning in one locality alone [11]. For this reason and others, the Acoli population of Uganda are not only right in suspecting spirits, but their predicament also offers uniquely an opportunity to study a host of health-related factors associated with physical confinement and heavy alcohol consumption.

In this study, we used a combination of analytical instrumentation and easily accessible statistical tools to show that estimating carcinogenic and non-carcinogenic health risks associated with alcohol consumption in a local sub-Saharan community with limited resources is possible. By the approach, we identified ethanol as the irrefutable risk factor in all samples collected from the Acoli region of Uganda. Ethanol is not only designated as a carcinogen by the World Health Organization in 1988 [27], but is a prime suspect by this study in causing non-carcinogenic mortality increase among consumers. That said, some examples of potential synergistic health risks associated with heavy metal poisoning are given below.




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