“You cannot travel one hundred metres without finding such alcohol”: community perspectives on the availability of substitute alcohol products since the ban of alcohol sachets in Malawi and Uganda

Citation

Uny I, Odoi P, Namanda C, Burton R, Magalasi D, Orgill M, Parry C, Kaneka B & Tumwesigye NM “You cannot travel one hundred metres without finding such alcohol”: community perspectives on the availability of substitute alcohol products since the ban of alcohol sachets in Malawi and Uganda. BMC Global and Public Health. https://doi.org/10.21203/rs.3.rs-10344725/v1

Abstract
Background Malawi and Uganda banned alcohol sachets in 2017 and 2019 respectively, to reduce alcohol availability and affordability and protect population health, particularly young people and the most vulnerable in society. However, the unintended consequences of those bans, particularly the emergence of substitute products, is under-researched. Methods This qualitative study draws on 18 community focus group discussions conducted across both countries (n = 9 per country) between 2023 and 2024. Participants included adult men and women, in-school and out-of-school young males and females, traditional leaders, teachers, and health workers. Data were analysed thematically. Results While participants considered the sachet bans effective, this effectiveness seemed to last only a short while. All groups, from both countries, confirmed that substitute products have proliferated after the ban. These include small bottles of recorded high-strength spirits (of up to 220ml) and widely available unrecorded homebrews, sold by variable measures according to demand and community members’ purchasing power. The high affordability of those products was mentioned in a majority of groups. Participants indicated that some unrecorded alcohol may be adulterated with substances such as methanol and other untested additives. Community members expressed that substitute products are very widely available and often sold without age verification. In both countries this was viewed as leading to increased consumption and harm. Conclusion Sachet bans in Malawi and Uganda produced significant market displacement rather than meaningful reductions in alcohol availability. Without understanding the market more fully and without comprehensive legislation, banning a single product (such as sachets) is unlikely help to protect public health in the longer term.

Keywords
alcohol sachet ban; alcohol policy; Africa; unrecorded alcohol; alcohol harm; Malawi; Uganda; recorded alcohol

Journal
BMC Global and Public Health