The Proportion of Binge Drinking Among Female Social Drinkers of Kalingalinga in Lusaka, Zambia: A Pilot Study

Harmful alcohol use led to about 3 million deaths in 2016 and more than half of these deaths were indirectly and directly associated to binge drinking or heavy episodic drinking (WHO 2018). Although harmful alcohol use is a leading risk factor for death in males aged 15–59 years (Grucza et al. 2008), 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 (WHO 2018).

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 and 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 men. 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 (NIAAA 2004). Harmful alcohol use, on the other hand, is alcohol consumption that results in consequences to physical and mental health, and is characterised 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 (Ahuja 2006). Heavy alcohol use means binge drinking on five or more days in the past month (SAMHSA 2015).

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 (NIAAA 2004). 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 (NIAAA 2004). Binge drinking can also be defined as a pattern of heavy drinking that occurs in an extended period set aside for the purpose (WHO 2015). 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’ (Kokavec & Crowe 1999) seems to be practical for a developing country like Zambia, where the consumption of non-quantified alcoholic beverages is commonplace.

The proportion of binge drinking, like many other forms of alcohol consumption, varies tremendously by region, race, and gender. 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 zero (Grucza et al. 2008, Hannah & Max 2018). On the other hand, the countries in Eastern Europe are the highest in alcohol consumption with figures between 14–17 litres of alcohol per person per year (Hannah & Max 2018). The proportion of binge drinking seems to be different from the general alcohol consumption. Some countries, where the 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 the UK and France, and 20% in Spain (Hannah & Max 2018).

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 (WHO 2014, Anderson et al. 2013), studies report that young women have begun to show drinking patterns similar to those of their male peers, especially regarding heavy episodic drinking (Anderson et al. 2013).

World Health Organisation’s country profile reports for Zambia, both 2014 and 2018, show that heavy episodic drinking (binge drinking) is higher in males than females (WHO 2018). 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 (WHO 2014). 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 (Culley et al. 2013). 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 (Kabuba, Menon & Hestad 2011). Findings by WHO published in the Washington Post indicated that there is no nation that has harder-drinking women in the world other than Zambia (Mwale 2014). An issue that needs extra research to ascertain the truth.

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 (WHO 2014 and De Bellis 20005). This in turn makes it possible for female drinkers to metabolise alcohol much faster than males (Lisdahl et al. 2013). It should also 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 (IAS 2007). In 2016, the leading contributors 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 (WHO 2018).

In the Zambian society, like many other African countries, a typical woman is a multitasker managing households, children, jobs and extended family relationships. Because most habitual binge drinkers may have false beliefs in their behavioural tolerance to the impairing effects of alcohol (Brumback, Cao & King 2007), 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 endeavour 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 a part of.

By using snowball sampling method, 100 questionnaires were successfully distributed to female social drinkers aged between 20 and 39 years. 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 matched questions 1, 2 and 3 of the AUDIT questionnaire. To make the study beneficial to the participants, those identified as possessing some hazardous drinking patterns were advised to seek psychosocial help from the 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.

Data was collected through hand-delivered questionnaires (the Alcohol Use Identification Tool (AUDIT) questionnaires). The AUDIT questionnaire is a well validated tool developed by World Health Organization (WHO) to assess alcohol consumption, drinking behaviours, 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 with the questionnaire in English language. 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 on individual drinks and 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 (WHO 2014, Korhonen 2004 and Cranford, McCabe & Boyd 2006). The women who 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).

The main characteristics considered were age, years of education, presence or absence of impairments and alcohol drinking. The mean age for the study participants was 27 years with a standard deviation of 5.456. On average, 43% of the participants had completed secondary education.

In order to identify who engaged in alcohol binge drinking, the study identified three characteristics of binge drinking that 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.

The scores for these variables were: frequency (M = 2.17, SD = 0.834), quantity (M = 3.03, SD = 0.964) and intensity (M = 2.53, SD = 0.507). The mean of 2.17 represents response (2) on the questionnaire implying that an average female took an alcoholic drink ‘2 to 4 times per month’. This does not represent regular drinking but irregular type of drinking characteristic of binge drinking. Further, quantity is represented by a mean score of 3.03 translating into ‘7, 8 or 9 drinks’ per occasion, implying consumption of large amounts of alcohol on one sitting. Besides, the intensity of drinking was represented by an average of 2.53, which meant that taking of six or more alcoholic drinks was almost on a weekly basis.

The proportion of binge drinkers from the sampled number of social drinkers was calculated by using the following formula:

Therefore, the proportion of binge drinking from the 54 social drinkers was estimated to be at 0.556.

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.

From a total of 54 social drinkers, 30 were classified as binge drinkers accounting for 56% of all female drinkers aged 20–39 years. 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. 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 24 participants (Ahuja, 2006). It involves educating patients on the risks of continued alcohol use and requesting the patient to resume personal responsibility for change.

The proportion of binge drinkers in the general population of female social drinkers was estimated by using the formula given below:

P=number of potential BDs/number of females aged between 20-39years. Therefore, P=710/7533=0.094