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A Pilot Study on the Proportion Binge Drinking Among Female Social Drinkers of Kalingalinga in Lusaka, Zambia
Journal of Neurology & Neurosurgery- Lupine Publishers
Abstract
Objectives: Alcohol is a
psychoactive substance with dependence-producing properties and whose harmful
use causes a large burden disease, social and economic burden in societies.
Binge drinking is one of the commonest forms of alcohol misuse and has been on
an increase among many young women who find alcohol a source of pleasure and
enjoyment when they have time out with friends and peers. Since binge drinking
involves consumption of alcohol on an irregular basis, it may not be viewed as
a hazardous form of alcohol use by many drinkers. The present study aimed at
estimating the proportion of female binge drinkers in a population of female
social drinkers in Kalingalinga township of Lusaka, the capital city of Zambia.
We hypothesized that the proportion of binge drinking in a population of female
social drinkers is significantly high.
Methods: Through snowball
sampling, 100 questionnaires (i.e. Alcohol Use Disorders Identification
Test-AUDIT) were successfully distributed to and collected from female social
drinkers aged 20-39 between August and September 2016. A two-fold process was
followed in identifying binge drinkers; screening for hazardous alcohol
drinkers by identifying those that scored 8 points or above in the first place,
and thereafter identifying binge drinking characteristics from the hazardous
drinkers by following scores from the first three questions on the AUDIT.
Results: The results
reviewed that 54 of the 100 participants had some form of hazardous alcohol use
and 30 of the 54 hazardous drinkers possessed some binge drinking
characteristics. The proportion of female binge drinkers in a population of
female alcohol drinkers was estimated to be 0.556 (56.6%) while in the general
population it was estimated to be 0.094 which implies that 9.4% of women aged
20-39 of Kalingalinga in Lusaka, engage in alcohol binge drinking consuming on
average 7-9 drinks on occasion almost on a weekly basis. Further, if 56% of all
female alcohol drinkers aged 20-39 seem to engage in some form of alcohol binge
drinking, it means that that binge drinking is the highest form of alcohol
misuse among these female drinkers.
Conclusion: The results of
the present study suggest that there is more alcohol binge drinking among
female social drinkers of Kalingalinga in Lusaka, with an estimated proportion
of 0.556 (55.6%) among female alcohol drinkers and 0.094(9.4%) in the general
population of females aged between 20-39. The implication is that alcohol binge
drinking seems to be the highest form of alcohol misuse among female drinkers
in Kalingalinga.
Keywords: Alcohol abuse; AUDIT
Questionnaires; Binge drinking (BD); Heavy Episodic drinking (HED); social
drinkers
Introduction
Relevance Alcohol Abuse
Harmful alcohol use lead to about 3
million deaths per year in 2016 and that more than half of these deaths are
indirectly and directly associated to binge drinking or heavy episodic drinking
[1]. Although harmful alcohol use is a leading risk factor for death in males
aged 15-59 [2], the evidence of women involvement in alcohol misuse and their
vulnerability is a major public concern worldwide. Despite that 57% of the
global population aged 15 years and older abstained from drinking alcohol, in
2016 harmful alcohol accounted for 5.3% of all deaths worldwide making
mortality resulting from alcohol consumption higher than that caused by
prominent diseases such as tuberculosis, HIV/AIDS and diabetes.
Classification of Alcohol Abuse
Generally, alcohol abuse can be
classified in many ways depending on the context in which the information is
being used. In this study, five types of alcohol consumption (i.e. moderate
alcohol consumption, binge drinking, harmful alcohol use, heavy alcohol use,
low-risk drinking) have been defined to help readers differentiate the terms as
they apply in alcohol studies.
Firstly, the Dietary Guidelines for
Americans 2015-2020 define moderate alcohol consumption as a form of drinking
that is up to one or less drinks per day for women and up to two or less drinks
per day for women. Secondly, low -risk drinking involves drinking of alcohol
not more than 3 drinks on any single day and no more than 7 drinks per week
[3]. Harmful alcohol use, on the other hand, is alcohol consumption that
results in consequences to physical and mental health and is characterized by
two features: continued use despite the awareness of harmful medical and/or
social effects, and a pattern of physically hazardous use of the substance [4].
Heavy alcohol use means binge drinking on five or more days in the past month
[5].
Lastly, binge alcohol drinking can be a
confusing concept and its use can mean different things in different contexts.
Binge drinking is a kind of drinking that occurs when a person follows a
pattern of drinking that bring blood alcohol concentration (BAC) to 0.08-grams
percent or above [4]. For typical adults, this pattern corresponds to consuming
five or more drinks in males and four or more drinks in females, in about two
hours. Binge drinking can also be defined as a pattern of heavy drinking that
occurs in an extended period set aside for the purpose [6]. The terms “heavy
episodic drinking (HED), bout drinking and “spree drinking” are also used as
synonyms to binge drinking. All in all, the definition, ‘consuming of large
amounts of alcohol on an irregular basis’ [7] seems to be practical for a
developing country like Zambia where the consumption of non-quantified
alcoholic beverages is commonplace.
The Proportion of Alcohol Binge Drinking Globally
The proportion of binge drinking, like
many other forms of alcohol consumption, varies tremendously by region, race
and sex. Generally, in Muslim regions such as North Africa and the Middle East,
alcohol consumption is very low such that for some countries consumption is
close to. On the other hand, countries in Eastern Europe are the highest in
alcohol consumption with figures between 14-17 liters of alcohol per person per
year. The proportion of binge drinking seem to be different from the general
alcohol consumption. Some countries where overall alcohol consumption is low,
have high percentages of binge drinking. In Madagascar, more than two thirds
(65%) of drinkers have heavy episodes of drinking in the previous month.
Intraregional differences are also
evident: in Italy only 6% of drinkers had heavy episodes of drinking in
contrast to nearly half in Ireland, 42 % in Belgium, one third in UK and
France, and 20% in Spain [8]. The general alcohol consumption by gender shows
significant differences with men consuming more alcohol than women. Although
binge drinking is common among males than females, studies report that young
women have begun to show drinking patterns similar to those of their male
peers, especially regarding heavy episodic drinking [9].
Binge Drinking in Zambia
World Health Organization’s country
profile reports for Zambia, both 2014 and 2018, show that heavy episodic
drinking (binge drinking) is higher in males than females [1]. The proportions
of binge drinking are high in late adolescence and early adulthood though the
sex ratio is different from the general population especially among student
populations where an estimated 45.1% females compared to 38.7% males get drunk
[6]. This is remarkable because in the general population, non-student female
adolescents and young adults have a much lower tendency to binge drink compared
to their male peers. About 30-50% of all women drinkers in South Africa, Zambia
and Chad are said to be binge drinkers [10]. Topics on alcohol use in Zambia
are highly unexplored and many issues related to alcohol have remained elusive
to academia. Nevertheless, Zambia is among the nations with the highest levels
of drinking in Africa [11]. Findings by the WHO published in the Washington
Post, indicated that there is no nation that has harderdrinking women in the
world than Zambia [12]. An issue that needs extra research to ascertain the
truth.
The Significance of Alcohol Binge Drinking aAmong Female
Drinkers in Zambia
Female alcohol drinkers are more likely
to be affected by alcohol use disorders than male drinkers. Because of having a
higher concentration of fat in body tissue, females tend to reach a higher
alcohol consumption than male drinkers [13]. This in turn makes it possible for
female drinkers to metabolize alcohol much faster than males [14]. It should as
well be noted that the pharmacological impact of a given dose of alcohol is
greater in women than females implying that female alcohol drinkers are at a
higher risk of alcohol use disorders than male drinkers [15]. In 2016 the
leading contributors of to the burden of alcohol-attributable deaths among men
included injuries, digestive diseases and alcohol use disorders, whereas among
women the main contributors were cardiovascular diseases, digestive diseases
and injuries.
In a Zambian society, like many other
African countries, a typical woman is a multitask taker managing households,
children, jobs and extended family relationships. Because most habitual binge
drinkers may have false beliefs in their behavioral tolerance to the impairing
effects of alcohol [16], binge drinking females could be at risk of road and
household accidents, involvement in violence, unsafe sex practices, among other
things. Therefore, a study on binge drinking in female social drinkers is a
viable endeavor because it addresses an issue that not only affects the female
drinker but engulfs issues affecting family life and the wider society, which
the female is part of.
Methods
Sampling
By using snowball sampling method, 100
questionnaires were successfully distributed to female social drinkers aged
between 20 and 39. The sampling method was best suited to this study because
there is some stigma that is attached to alcohol consumption in Zambia which
makes it very difficult for most women to openly acknowledge that they consume
alcohol. To identify binge drinkers, the study took a two-fold approach;
identification of hazardous drinking in all the 100 participants in the first place,
followed by screening for binge drinking characteristics. The sampling was
preceded by dividing the study area into four and then identifying female
drinkers from each of the areas who would roll out to other drinkers.
From the 100 questionnaires, 54 were
screened as indicating some form of hazardous drinking because of scoring 8
points and above. The 54 questionnaires were further screened to identify
characteristics of binge drinking by using questions 1, 2 and 3. 30 females
were qualified as being alcohol binge drinkers based on the three indices of
alcohol consumption; frequency, quantity and intensity of drinking which match
questions 1, 2 and 3 of the AUDIT questionnaires. To make the study beneficial
to the participants, those identified as possessing some hazardous drinking
patterns were advised to seek psychosocial help from University Teaching
Hospital (UTH) or from other Mental Health care providers within Lusaka. By
using the phone numbers provided at the end of the questionnaires, participants
were contacted and advised to seek medical advice from UTH where arrangements
were already made for them.
Measures
Data was collected through hand-delivered
questionnaires (the Alcohol Use Identification Tool (AUDIT) questionnaires).
The AUDIT questionnaire is a well validated tool developed by the World Health
Organization (WHO) to assess alcohol consumption, drinking behaviors, and
alcohol related problems. The questionnaire has two versions; the clinician
administered and the self-administering versions. In this study, the
self-administered version was translated into the local language, Nyanja, and
used side by side the ones in English. Going by the major definitions on binge
drinking reviewed earlier, three indices of alcohol usage were identified and
associated to three main questions on the AUDIT. These were; frequency of
drinking, quantity of alcohol an individual drink and the intensity of
drinking.
From the AUDIT questionnaire the
frequency of drinking is determined by question 1 “How often do you have a
drink containing alcohol? (Never/ Monthly or less/2 to 4 times a month/2 to 3
times a week/4 or more times a week).” Second, third and fourth responses
(Monthly or less, 2 to 4 times a month, 2 to 3 times a week) are characteristic
of binge drinking because of the episodes per month or week [17,18]. Those that
drink daily or almost daily for example, were disqualified because they fall
under the category of chronic drinkers.
The quantity of drinking was determined
by question 2 from the questionnaire; “How many drinks containing alcohol do
you have on a typical day when you are drinking? (1 or 2, 3 or 4, 5 or 6, 7, 8,
or 9, 10 or more).” Finally, the intensity of alcohol drinking was determined
by question 3. “How often do you have 6 or more drinks on a single occasion?
(Never ⁄Less than monthly ⁄Weekly ⁄Daily or almost daily).
Results
The main characteristics considered were
age, years of education, presence/absence of impairments and alcohol drinking.
The mean age for the study participants was 27 with a standard deviation of
5.456. On average 43% of the participants had completed secondary education
(Table 1).
Table 1: Demographic Data for Participants.
In order to identify who engaged in
alcohol binge drinking, the study identified three characteristics of binge
drinking which cut across many scientific definitions of this form of drinking
which were reviewed in other scholars’ works. The characteristics were
frequency of drinking, quantity of drinking and intensity of drinking (Table
2).
Table 2: Characteristics of Binge Drinking among participants.
Proportion of Binge Drinkers in a Population of Female Alcohol
Drinkers
The proportion of binge drinkers from the
sampled number of social drinkers was calculated by using the formula:
Where,
p= population proportion
x= the number of items you are interested
in (i.e. female binge drinkers)
n= the total number of in the population
(i.e. all female social drinkers)
p = 30/54 = 0.556
Proportion of Binge Drinking in the General Population
The pie-chart below helps to show the
proportion of alcohol binge drinking in a total of 54 female social drinkers
whose AUDIT questionnaires were well completed and collected (Figure 1). From a
total of 54 social drinkers, 30 were classified as binge drinkers accounting
for 56% of all female drinkers aged 20-39. About 24 did not meet the criteria
of being classified as binge drinkers based on the three indices of alcohol
consumption; frequency, quantity and intensity of drinking, determined using
the AUDIT questionnaire. The 24 mainly comprised of chronic drinkers who
consumed alcohol almost on a daily basis and were referred to the University
Teaching Hospital for psychosocial help. Psychotherapy, both group and
individual, is recommended for the treatment of alcohol dependence (addiction)
which was observed in the 24 participants [4]. It involves educating patients
on the risks of continued alcohol use and requesting the patient to resume
personal responsibility for change.
Figure 1: Proportion of Female Binge Drinking.
The proportion of binge drinkers in the
general population of female social drinkers was estimated by using the formula
below.
P=number of potential BDs number of
females aged between 20-39
P= 7107553
P=0.094
Discussion
The results match other studies which
gave the same definition of binge drinking. The definitional characteristic of
binge drinking of ‘consuming large amounts of alcohol on irregular basis’9 that
was described earlier is such an example. The clinical definition of binge
drinking as the ‘drinking of alcohol that brings blood alcohol concentration
(BAC) to 0.08-gram percent or above [3], is another key example that match the
results of this study because the definition indicates that blood alcohol level
of 0.08-gram percent or above is only reached by taking 5 or more drinks or
more drinks (in males) or 4 or more drinks (in females) on an occasion’ [16].
Estimated Proportion of Binge Drinking
The population of all female inhabitants
in Kalingalinga is around 20194 according to 2010 Census [19] and those aged
between 20-39 are only 7553 females. Further, about 16.8% of the female
population comprise alcohol drinkers1 translating into 1268 potential female
drinkers. Going by the results in figure1, 56% of 1268 female drinkers is about
710 females who are potential binge drinkers. Therefore, the proportion of
binge drinking in Kalingalinga can be estimated to be 0.094. Expressed as a
percentage, the proportion of alcohol binge drinking is about 9.4% of all
females aged between 20-39.
The results of the present study have a
few similarities and contradictions with some other studies that were reviewed.
In 2011, more than 13.6 million (12.5%) U.S. adult women binge drank an average
of three times a month (frequency) and consumed on average six drinks on
occasion (intensity). The prevalence and intensity of binge drinking was
highest among women aged 18–24 years. Africa has the world’s highest proportion
of binge drinkers with about 25% of its population engaging in alcohol binge
drinking despite its large numbers of Muslims and evangelical Christians who
abstain from alcohol [20]. Among women who drink in South Africa, Zambia and
Chad 30-50% report binge drinking yet the prevalence of women drinking alcohol
in these countries ranges from 15-30% [10]. Binge drinking is mirrored here as
being the highest form of excessive alcohol drinking in females in Africa and
also Zambia [21].
In the case of Kalingalinga the results
seem to suggest that about 9.4% of women aged 20-39 years engage in alcohol
binge drinking consuming on average 7-9 drinks on occasion almost on a weekly
basis. Further, of all female alcohol drinkers, binge drinkers comprise the
highest group with about 56% higher than the percentage projected by Culley and
others in 2013. Therefore, the proportion rate of alcohol binge drinking among
females of Kalingalinga is estimated to be at 9.4% in the general population
for females aged between 20-39 years and 56% among all potential female
drinkers [22,23].
Limitations
In terms of limitations, the first
challenge was refusal by most women above 35 years to participate in the study
due to the stigma that is attached to female alcohol consumption because
Zambian culture does not approve of women engagement in alcohol drinking.
Secondly, defining binge drinking was another challenge as there is no standard
definition for this form of alcohol consumption. However, the review of many
available definitions helped to come up with three many indices of alcohol
consumptions which were typical of binge drinking; frequency of drinking,
quantity of consumed alcohol and the intensity of drinking.
Conclusion
Binge drinking, which involves consuming
large amounts of alcohol on an irregular basis, is one of the commonest forms
of alcohol misuse among adolescent girls and young women. The study
investigated the proportion of binge drinking among female alcohol drinkers
aged between 20-39 of Kalingalinga in Lusaka, the capital city of Zambia. In
conclusion, the results of the present study suggest that there is more alcohol
binge drinking among female social drinkers of Kalingalinga in Lusaka, with a
proportional rate of 9.4% in the general population of females aged between
20-39 and 56% among female alcohol drinkers of this age-group. The implication
is that alcohol binge drinking seems to be the highest form of alcohol misuse
among female drinkers in Kalingalinga.
The study has been a viable endeavor as
it has provided some estimation on the proportion of alcohol consumption among
females which can be important to policy makers and the general public. The
pattern of drinking reported by participants can be a source of worry because
this is capable of increasing the country’s disease burden in the next few
years if no measures are put in place. Further, the drinking pattern puts the
female drinkers at risk of road and home accidents, exposure to sexually
transmitted diseases and HIV/AIDS, and that the general outcome of alcohol
abuse will impinge on their multi-task taking skills. All these effects
mentioned here can exacerbate poverty levels in the Zambian society simply
because the whole society highly depends on the woman for its operations. There
is need to carry out more research in other parts of Lusaka in order to obtain
data that is generalizable and can help policy makers to act on this form of
drinking that is likely to deter economic development, increase disease burden
and affect family life, among others. Another viable proposition can be a
‘comparative investigation in the proportion of HIV/AIDS among female alcohol
drinkers and their non- drinking counterparts.
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