Abstract
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.
Highlights
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]
Results show that the laboratory blank sample (the 50/50 (v/v) 100% ethanol/distilled water solutions) and the laboratory control sample spike duplicates, both included in each sample batch, had no unexpected results
We have presented an analytical approach for determining the health risks associated with consuming alcohol contaminated with heavy metal in this study
Summary
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] 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 [3,4,5,6,7,8]. For this reason and others, the Acoli population of Uganda are right in suspecting spirits, but their predicament offers uniquely an opportunity to study a host of health-related factors associated with physical confinement and heavy alcohol consumption
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