Digestive Diseases in Sub-Saharan Africa

Changes and Challenges

Isidor Segal

• Publisher: Academic Press
• Year: 2018
• Print ISBN: 9780128156773
• eBook ISBN: 9780128156780
• Topic: Biological Sciences
• Subtopic: Biology
• Index: Biological Sciences

Digestive Diseases in Sub-Saharan Africa: Changes and Challenges provides an in-depth examination into the rise of western digestive diseases in Sub-Saharan Africa (SSA). For those interested in the causes of the major diseases of the 'West', the patterns in Africa have always reflected on the emergence of western diseases and elucidated the pattern of these conditions and their clinical course. Coverage includes the present epidemiology of GI diseases in SSA, the trends that are occurring, and the context of other emerging diseases. Appropriate for researchers, gastroenterologists and internists, this book brings together the latest research in a single, complete volume.- Provides evidence of the changes occurring in digestive disease in Sub-Saharan Africa due to Westernization- Covers urbanization, upward mobility, demographics, environmental changes, and the availability of natural resources that have a decisive influence on digestive diseases- Offers models for the amelioration of digestive diseases due to Westernization

Chapter 1

Alcohol and Smoking: Impact of Behavioral Risk Factors

Isidor Segal G.I.T. Unit, Chris Hani Baragwanath Hospital and University of Witwatersrand, Soweto, South Africa

Abstract

Alcohol is one of the top three priorities in public health and is the third leading cause of ill health and premature death. It is a recognized risk factor for morbidity and mortality globally. In digestive diseases, alcohol is a major cause of liver, pancreatic, and esophageal disease. Smoking, which is particularly common in LMICs, is also a promoter of cancers, cardiovascular and respiratory disease.

Alcohol: In Africa, although the average per capita consumption is less than half the European average, the figures do not account for much of the alcohol consumed in the form of traditional beverages. Most drinking takes place at bars and at parties during weekends, indicating the social nature of drinking in African countries. Among drinkers, binge drinking is common and there are high levels of youth drinking.

It is significant that in many African countries there has been a change in the type of ingredients used for making beer. Traditional ingredients such as sorghum have been replaced by maize, which has repercussions with regard to esophageal cancer.

Smoking: Active and passive smoking is a global problem and is a factor in the etiology of cancers, cardiovascular and respiratory diseases. The prevalence of smoking is relatively low in SSA. However, it is not only manufactured cigarettes that are smoked but also cigarettes made using various types of paper. This has been found to be a major carcinogenic factor in esophageal cancer.

Keywords

Alcohol and smoking in Africa; Traditional beers; Hand-rolled cigarettes; Esophageal cancer; Pancreatitis; Liver cirrhosis

Introduction

Alcohol Consumption

Global situation

Alcohol is one of the top three priority areas in public health. Although only half the global population drinks alcohol, it is the world’s 3rd leading cause of ill health and premature death after low birth weight and unsafe sex [1].

Alcohol is a recognized risk factor for morbidity and mortality. It contributes to or is the sole cause of chronic health problems because of its direct toxic effect on organs as in alcoholic liver cirrhosis and pancreatitis. Its intoxicating properties result in accidents and injuries. It is a dependent producing substance and contributes to social problems including domestic violence, family disruption, and all types of intentional and unintentional injury, including homicides, suicides, violence in the street and workplace problems such as absenteeism, low productivity, and inappropriate behavior [1, 2]. The harm from alcohol disproportionately affects poorer people. In digestive diseases alcohol is a cause of liver, pancreatic, and gastrointestinal diseases. It also increases the risk of HIV/AIDS, tuberculosis and community-acquired pneumonia. The real absolute risk of dying from an adverse alcohol-related condition increases with the total amount of alcohol consumed over a lifetime.

Alcohol Use in SSA

Alcohol has been an integral part of African social life for centuries. Except where it is banned for religious reasons, large quantities of brewed or distilled drinks are produced in local communities or by modern commercial enterprises to satisfy the tastes of a growing number of consumers. This includes even remote villages. Commercially produced beer is the most preferred drink and western spirits have usurped the cultural roles previously reserved for traditional drinks [2].

Data from the W.H.O. Global Alcoholic Database (GAD) [3] show a wide variation in per capita consumption of recorded alcohol in African countries ranging from less than 1 L of pure alcohol in some (mainly Muslim) countries to more than 10 L in a few of other countries. Today the average per capita consumption is a little under 4 L, less than half the European average [2]. The figures, however, do not account for much of the alcohol consumed in the form of traditional beverages.

Consumption of commercial beverages is expected to rise in the coming years as the economic conditions continue to improve in some countries and as a result of increasing marketing and promotional activities by the industry.

Alcohol consumption and drinking patterns: Unrecorded alcohol consumption refers to consumption of beverages that are not part of official statistics on production and trade reported to the FAO. In this category are traditional beverages made from palm trees, a variety of grains and fruits, and drinks distilled from these local brews [2]. Traditional drinks contribute significantly to the overall consumption of alcohol in all African countries where drinking is a common practice. The overall estimate of unrecorded alcohol consumed in African countries is 50% [3].

In countries like Kenya, Rwanda, Seychelles, and Zimbabwe, unrecorded consumption accounts for much more of the total consumption of alcohol.

There is a high rate of abstention in every country—more than 50% of adults are abstainers, and among women it is often as high as 80%. In some countries, however, notably Uganda and some regions in Nigeria, male and female drinkers, respectively, engage in heavy episodic drinking. The difference between men and women disappears when the focus is on drinkers only. For example, in Nigeria, South Africa, and Ethiopia, more women drinkers than men reported regular consumption of volumes of alcohol that exceed what can be defined as moderate drinking [2].

Most drinking takes place in bars and at parties during weekends, indicating the social nature of drinking in African countries. An example of the characteristic progression of alcohol consumption as people migrate from a mainly rural to an urban society is characterized by what has happened in one of the economic powerhouses of Africa-South Africa.

Alcohol consumption patterns in South Africa: South African adult per capita alcohol consumption (APC) in 2005 equaled 9.5 L of pure alcohol. Of this consumption 26.3% was homemade and illegally produced alcohol. APC in South Africa is above the rest of the world average of 6.13 L, and the regional average for Africa of 6.2, but below the European regions APC of 12.2 [4]. South Africa’s recorded APC showed an increasing trend until the mid-1990s, but over at least the last decade per capita demand has been shrinking—this is mainly due to the fact that South Africa is a saturated market, However those who do drink appear to do so at binging levels. 45.4% have weekly binges In South Africa, 65% of the population has never consumed alcohol—this is among the highest abstention rates in the world Of the 35% of the population that do consume alcohol, only a small percentage consume branded products. The largest percentage consume home brews or illegal products.

On analysis of pure alcohol consumed by the drinking population, South Africa has the 75th highest APC ratio in the world [4]. Consistent with global findings, alcoholism shows an increasing trend in lifetime prevalence use among youth aged 13–19 years in South Africa [5].

The small population of drinkers in Africa drinks excessively—i.e., heavy episode drinking. In South Africa, there are high levels of youth drinking of alcohol. In many African countries, there has been a change in the type of ingredients used in making beer with sorghum being replaced by maize.

Alcohol consumption is associated with cancer of the esophagus and the emergence of acute and chronic pancreatitis.

Smoking

Active and passive smoking is a global problem and is a factor in the etiology of cancers, cardiovascular and respiratory diseases.

The majority of more than 1 billion smokers worldwide now live in low- and middle-income countries. An estimated 60% of men in some countries in Eastern Europe and East Asia smoke. The prevalence of smoking among women is still highest in HMIC societies. The prevalence of smoking remains relatively low in sub-Saharan Africa and smokers smoke fewer cigarettes than do their Western and Asian counterparts [6]. Significantly, the type of cigarettes smoked in many African countries is different to that of other regions of the world. In South Africa, a study of 200 esophageal cancer (EO) patients and 391 controls showed that 75% of patients smoked cigarettes compared to 46% controls [7]. The survey also included questions about the use of hand-rolled cigarettes in which pipe tobacco is used wrapped in newspaper, brown paper, or telephone directory paper. Such cigarettes were often preferred because of their flavor and their slow-burning quality. They were also cheaper than commercial cigarettes. Tobacco smoked either in pipes or hand-rolled cigarettes was found to be a major carcinogenic stimulus in black South African populations. The crude relative risk (RR) (RR: 1.07) indicated that there was no risk involved in smoking only commercial cigarettes. However, in conjunction with other predictors, it becomes an important risk factor for esophageal cancer. Risk increased with increasing consumption for the smokers of both hand-rolled and commercial cigarettes [7].

Epidemiology of Esophageal Cancer-Relationship to Smoking, Alcohol, and Diet [7,8]

Esophageal cancer (EO) was a rare disease in the South African Black population until the last few decades. Increased incidence has occurred and at present it is the commonest cancer in Black men in many parts of South Africa. Among the risk factors identified as agents in the etiology of the disease are tobacco and alcohol abuse. Moreover, consumption of traditional beer made from maize was found to be a major risk factor. This predisposition probably arises from a lifelong mild deficiency, usually subclinical, of several micronutrients. The association between smoking pipe tobacco and consumption of traditional beer was found to be a major risk factor in the etiology of esophageal cancer.

Predictions for the 21st Century

The consumption of Western-type alcohol will increase in Africa mainly due to increased urbanization and exposure to promotion of alcoholic drinks by the media. However, traditiona...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Contributors
• Dedication
• Foreword
• Preface
• Acknowledgments
• Introduction
• Chapter 1: Alcohol and Smoking: Impact of Behavioral Risk Factors
• Chapter 2: Urbanization, Upward Mobility, Demographics, Environmental Changes, and Availability of Natural Resources in Sub-Saharan Africa (SSA)
• Chapter 3: Review of Traditional Digestive Diseases Common in SSA
• Chapter 4: Epidemiology of Digestive Diseases in SSA: Trends That are Occurring
• Chapter 5: Emerging Nonintestinal Diseases Arising in SSA
• Chapter 6: Changes in Nutritional Status of Africans: Dietary Recommendations for Sub-Saharan Africa
• Chapter 7: Cancer of the Esophagus in Sub-Saharan Africa
• Chapter 8: Duodenal Ulcer and Diet in Sub-Saharan Africa
• Chapter 9: Helicobacter pylori in Sub-Saharan Africa
• Chapter 10: Pancreatitis in Sub-Saharan Africa
• Chapter 11: HIV and the Digestive System
• Chapter 12: Characteristics of Inflammatory Bowel Disease in Sub-Saharan Africa
• Chapter 13: Abdominal Tuberculosis in Sub-Saharan Africa (SSA)
• Chapter 14: Colorectal Cancer in Sub-Saharan Africa
• Chapter 15: Aspects of Viral Hepatitis in Sub-Saharan Africa in the 21st Century
• Chapter 16: Hepatocellular Carcinoma in Africa
• Chapter 17: Biliary Disease in Sub-Saharan Africa
• Chapter 18: Amoebiasis in Sub-Saharan Africa
• Chapter 19: Intestinal Schistosomiasis in Africa
• Chapter 20: Cholera in SSA
• Chapter 21: Conclusions: Problems and Possible Solutions
• Index