1. Fighting poverty through alcohol misuse prevention in Malawi A STUDY OF ALCOHOL USE AMONG THE ADULT POPULATION IN MALAWI

2. Research Group SINTEF Global Health and Welfare Professor Arne Eide, Stine Hellum Braathen, Gloria Azalde University of Malawi – Centre for Social Research Dr. Alister Munthali and Mr Massy Chiocha Hedmark University College Assistant Professor Erik Hoel University of Oslo Associate Professor Henrik Natvig National Statistical Office Mr. Jameson Ndawala

3. Reference group FORUT, Norway National Statistical Office (NSO), Malawi NGO Gender Coordination Network, Malawi Inter-Ministerial Committee on Drug Control (IMCDC), Malawi Ministry of Health, Malawi Drug Fight Malawi Malawi Alcohol Policy Alliance Malawi Girl Guides Association Ministry of Home Affairs and Internal Security, Malawi Task Force for a National Alcohol Policy, Malawi The Norwegian Church Aid, Malawi The Church and Society CCAP, Nkhoma Synod, Malawi WHO Country Office (Malawi) WHO Regional Office for Africa

4. The ALMA project The aim of the project is to meet Malawian policymakers' and stakeholders' expressed needs for empirical evidence that can be used in the development of national alcohol policies. Our main objective is to document, describe and explore patterns of alcohol use in the Malawian population. Specific objectives: To study the prevalence of alcohol consumption and misuse in Malawi through a broad based survey, and to use this data to explore (WP2) – the association between alcohol use/misuse and different dimensions of poverty (i.e. living standard, health and empowerment) – the association between alcohol use/misuse and gender – The general drinking pattern among adult population in Malawi To explore people's opinions and experiences of current and future policy and interventions related to alcohol use (WP3)

5. Methodology: Quantitative A nationally representative survey was conducted among persons aged 18+. Sample size was determined using a standard formula, 107 enumeration areas (EAs) were randomly selected. Screening questionnaire was administered to 31.676 households in these 107 EAs - equals a total of 63.352 individuals. After the screening, 20 households were randomly selected among those households where either the husband or spouse had been drinking past 12 months. A total of 1795 households were included in the study. Drinkers; 1776 males and 156 females. Both husband and wife were interviewed separately using an almost identical questionnaire

6. Methodology-Qualitative Informant category/ RegionNRCRSRNational level Traditional Authorities (TA/ Village Headmen/ Group Village Headmen) 323 Community members (CM)442 Workers/ owners of formal alcohol outlets (Bar/ Nightclub) 242 Brewers/ distillers/ sellers of informal alcohol332 Police (official and community based)222 School (teachers/headmasters)312 Official offices1111 Non-government organisations (NGOs)1 11 Traditional healers (TH)111 Health providers (hospital/ clinic)221 Religious leaders1221 Psychiatric wards 2 Total2322195 The qualitative study aimed at exploring people’s opinions on current and future policy and interventions related to alcohol. This included a review of literature and conducting interviews with:

7. Findings – national survey Among persons aged 18+ year, 14.5% reported to have drunk alcohol in the 12 months preceding the survey. Among heads and spouses in the households sampled, 27.3% of the men and 1.6% of the women reported drinking the last 12 months.

8. Findings The proportion of persons who reported any alcohol use in the last 12 months: Litres 100% alcohol per year (n = 1776 men, 156 women)

9. 8.5% of the females who reported drinking drank on average 1.6 liters of pure 100% alcohol in a year. This is equivalent to approximately 35 liters of Carlsberg beer with 4.5% alcohol content. 98.3% of the males who reported drinking drank on average 8.1 liters of pure 100% alcohol in a year. This is the same as approximately 175 liters of Carlsberg beer with 4.5% alcohol content.

10. Comparing alcohol types; 1776 men, 156 women

11. Alcohol use by religious affiliation and gender

13. Alcohol use by gender and age groups

14. Drinking by main occupation OccupationN Men Mean No. Litres Men (NS) N women Mean No. Of Litres Women (NS) Employed (White collar)1359.1190.97 Employed (Blue collar)3157.91221.62 Self employed/business4378.04300.99 Farmer8437.25861.66 Homemaker117.060- Retired178.3110.09 Receiving grants205.3352.67 Unemployed1217.5814.62 Total17807.761541.52

15. Alcohol use by socio-economic status (SES) Alcohol use (litres/year)

16. Alcohol use (yearly) by dietary diversity in households Alcohol use (litres/year)

17. Alcohol use (yearly) by level of education Alcohol use (litres/year)

18. Alcohol use (yearly) by physical health Alcohol use (litres/year)

19. Alcohol use (yearly) by mental health Alcohol use (litres/year)

20. Conclusion Less than one in three adult males drank alcohol 12 months prior to the survey. A very small percentage of women drink alcohol. Alcohol use was more common in central and northern Malawi as compared to the southern region. Drinkers from Southern Malawi drank more than alcohol users in the Central and Northern Malawi.

21. Conclusion There are no support for saying that alcohol use/abuse leads to poverty. However, the consequences are much more seriously for poor people drinking alcohol.

22. Findings – Qualitative study Most informants talked about the cheap and commonly available sachets as a major challenge. Most informants suggested banning of sachets mostly due to its accessible pricing and availability (size of bag and amount of alcohol) in relation to children. Major producers of alcohol also tried to make satchets to compete with other producers of satchets but proces could not compare. Sachets may or may not be banned, but they are produced and very available. In the few years sachets have been available, informants tell us that children’s drinking patterns have changed dramatically

23. Findings Opening hours formal alcohol sales – Current opening hours varies despite type of license – Many suggest stricter regulation with regards to opening hours, like for example opening later (after working hours) and closing earlier at night Age is difficult to enforce in Malawi – even children go and buy beer?

24. Findings Informal alcohol in relation to content and selling places – Informal alcohol can vary in alcohol percentage and content from brewer to brewer – Difficult to control production because it is produced in and sold from homes – Even our law enforcers go and drink there including community police. – Difficult to control opening hours – Kachasu is not included in any legal documents may be some bylaws?

25. Findings Understanding of harmful use People’s understanding of what is harmful can be questioned Drinking in itself regardless of amount is not seen as harmful Alcohol is considered harmful in the following situations: – Drinking without eating, drinking children, gender based violence, use of bad language, fights, traffic accidents and more People do not see the connection between alcohol use and poverty – There seems to be poor understanding of consequences of alcohol on living conditions among children, youth (and adults)

26. Findings Implementing of laws and regulations – Shortage of resources to implement, regulate and enforce laws (police, city and district assemblies) – Current fines to not deter illegal behavior – Knowledge of laws seems to be poor «They cannot punish people for breaking laws they don’t know about»

27. Findings Some suggestions from the communities – Many state that people drink because they have nothing to do and have no work, several suggest to put people into activity in the community, – Loans to to informal brewers to start alternative businesses – Loans to community members to ease poverty

28. Conclusions Strengthening communities will ensure positive role models – Empowering Chiefs, Village headmen and Traditional Authorities seems to be the key – Empowering parents Increase fines to change behaviour ALMA report: www.sintef.no/almawww.sintef.no/alma