Health Risks and Public Safety Concerns of Illicit Alcohol in Uganda: Alcohol Content, Hygiene & Sanitation in Production and Retail

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Uganda records one of the highest alcohol consumption rates in Africa, with more than half of its production classified as illicit. Unsafe production environments, poor hygiene, and limited regulatory enforcement exacerbate public health and safety risks. Aim: This study assessed health risks and public safety concerns associated with illicit alcohol in Uganda, focusing on alcohol strength, methanol contamination, and hygiene and sanitation in production and retail settings. Methods: A cross-sectional mixed-methods design was employed in Kampala and Arua between October and November 2024. Data was collected from 400 producers and retailers through surveys, structured observations, and laboratory analyses of alcohol content, methanol levels, and microbial contamination, supplemented with 20 key informant and in-depth interviews. Results: Findings revealed inconsistent and often under-declared alcohol strength up to 44.2%, with methanol concentrations in some spirits exceeding safe limits up to 640.59 mg/L. Opaque beers showed contamination with Staphylococcus aureus , linked to poor hygiene during handling and storage. Observation scores highlighted widespread unsanitary practices, including unsafe water source 36.7% in Arua and 63.3% in Kampala, dirty production areas 44.2% in Arua and 55.8% in Kampala, pest infestation, and lack of protective equipment. Retail environments mirrored these risks, with alcohol commonly served with dirty hands (31% in Arua and 69% in Kampala) and often stored, sold in unsafe containers/ environment. Conclusion and Recommendations: Illicit alcohol production and retail in Uganda present significant chemical, microbiological, and environmental risks, compounded by regulatory gaps and lack of awareness of ABV among producers. The unpredictability of alcohol strength, unsafe packaging, and unsanitary production environments underscore the scale of the public health threat, particularly in urban centres like Kampala. There is urgent need for strengthening regulatory oversight, including mandatory ABV testing and clear labelling requirements for alcoholic beverages. Community-based sensitization campaigns should address consumer awareness of alcohol strength and risks of illicit products. Enforcement of hygiene and sanitation standards in production and retail outlets, coupled with provision of affordable protective equipment and safe water, could mitigate contamination risks. There is need for a multi-sectoral collaboration between public health authorities, law enforcement, and community leaders is essential to reduce the public health burden of illicit alcohol. Health Risks Illicit Alcohol Alcohol Content Hygiene Production Retail Uganda Figures Figure 1 Introduction Illicit alcohol is defined as any alcohol that is produced, distributed, and consumed outside of government regulation (1). Illicit alcohol production practices often bypass good manufacturing and hygiene standards such as uncontrolled fermentation/distillation, re-use of contaminated containers, poor water and sanitation at production sites increasing the likelihood of toxic by-products and microbial contamination (2). It is also often contaminated, adulterated, or mislabelled, with documented risks including methanol poisoning and exposure to hazardous contaminants (3). Despite the adverse health effects of illicit alcohol, 25.5% of illicit alcohol is consumed globally, involves unrecorded alcohol (4), was consumed by 80%of the global adult population in the 2020 report of the World Mental Health Survey (5). The life-time prevalence of alcohol use among adults was estimated up to 68% in low lower middle-income countries in 2015 (6), 88.2% in European countries and 91.6% in the United States in 2016. There is a lot of unknown information about the illicit alcohol harms on people especially how issues like dirty production environments, weak oversight, and unsafe manufacturing make the problem of illicit alcohol worse. Notably, recurrent international outbreaks of methanol poisoning linked to adulterated or poorly distilled alcohol underscore the intersection of unsafe production and severe health outcomes, including blindness and death(7). Globally, an estimated 400 million people, or 7% of the world’s population aged 15 years and older, live with alcohol use disorders, and an estimated 209 million (3.7% of the adult world population) live with alcohol dependence, with substantial differences in the numbers of people affected in different World Health Organisation (WHO) regions(8). Across Africa, unrecorded alcohol is prevalent and closely tied to affordability pressures, limited regulatory enforcement capacity, and widespread informal production(9). Reviews and country case studies report recurring methanol poisoning events and highlight the contribution of low-cost, high-strength informal spirits and sachet packaging to easy accessibility (3). Inadequate hygiene and sanitation in production and retail settings such as use of non-food-grade containers, unsafe water, and poor storage further elevate risk (10). Alcohol industry narratives sometimes attribute high levels of illicit trade to taxation alone while public health experts emphasise the lack of comprehensive measures including excise taxes, minimum packaging standards, licensing, and enforcement to reduce production(11,12) At the regional level, the East African Community (EAC) adopted the Regional Policy on Prevention, Management and Control of Alcohol, Drugs and Other Substance Use (2019), which provides a framework for partner states to regulate both licit and illicit alcohol(13). The policy emphasizes the control of production, distribution, and sale of alcohol, alongside harmonized excise taxation measures aimed at curbing cross-border smuggling and undercutting of regulated products (14). More recently, the EAC has moved towards excise duty harmonization on alcoholic beverages, seeking to minimize disparities that fuel illicit trade and smuggling across borders (15). Despite these frameworks, prevention of illicit alcohol remains a persistent challenge in East Africa, including Uganda. According to the Uganda Alcohol Report 2022, Uganda is a significant producer of alcohol, with an annual production of 110.6 million litres. Of this, 67.7 million litres, or 61%, are classified as illicit(16). Locally distilled spirits (commonly referred to as waragi, among others) are mostly produced in informal settings with field studies reporting challenges in production such as inconsistent alcohol content, use of non‑food‑grade containers, poor sanitation at production sites, and unsafe disposal of distillation wastes that contaminate the environment. Uganda has experienced confirmed methanol poisoning outbreaks linked to adulterated spirits, including a 2022 event in the north‑west attributed to a gin adulterated at the production stage by an unlicensed manufacturer (3). Additionally, alcohol consumption in Uganda is a leading risk factor for mortality and morbidity for several diseases including Cancer. For example, 87 people are lost due to alcohol related complications per 100,000 in the country (7). Prior studies in Uganda had reported methanol-contaminated alcoholic beverages linked to several deadly poisoning outbreaks across different regions. In Arua City and Madi-Okollo District (Northwestern Uganda), a methanol-tainted gin (“Gin X”) outbreak in August 2022 resulted in 18 deaths out of 48 cases, representing a 38% case-fatality rate, with 12 of the fatalities occurring in Arua City (17). In Wakiso District (near Kampala), a June 2017 incident saw 15 cases and 12 deaths (an 80% fatality rate) caused by locally distilled waragi adulterated with high methanol levels(18). In Western Uganda, notably Kabale District, approximately 80 people died in April 2010 after consuming waragi laced with methanol over a three-week period(19) . Again close to 300 people are reported to have lost their lives due to alcohol poisoning between 2007 and 2009 in Uganda(20) Government of Uganda came up with policies aimed at strengthening regulation of alcohol production through awareness and improved monitoring systems such as the National Alcohol Control Policy 2019, and the ban on alcohol sell in sachets (21) to strengthen regulation of production, packaging, marketing and sale of alcohol albeit with any significant success. Existing studies on illicit alcohol such as (22) have mainly focused on consumption with a dearth of literature on hygiene in the production and retail sites of illicit alcohol. This study therefore sought to bridge this gap by assessing the health risks and public safety concerns associated with illicit alcohol in Uganda, focusing on alcohol strength, methanol contamination, and hygiene and sanitation in production and retail settings. Methodology Study Design This study adopted a cross-sectional, convergent mixed-methods design to investigate the health risks and public safety concerns associated with illicit alcohol production and retail in Uganda. The design combined quantitative survey, structured observations, laboratory analyses, and qualitative interviews, allowing triangulation of findings across multiple data sources. Mixed-methods approaches are well-suited for public health research as they capture both measurable risk patterns and contextual realities of community practices (23) Study Sites Data was collected in Arua District (Adalafu, Adravu, Ajia, Arivu, Eruba, Ewuata, Ocoko, Ogia, Okaliba, Oluko, Onyivu, Pajulu and Vurra) sub counties and Kampala Capital city (Kawempe, Makindye, Nakawa, Rubaga and Kampala central) divisions between October and November 2024. Arua district, located in north-western Uganda, was selected to represent a rural context with longstanding artisanal alcohol production and widespread informal markets. Kampala, the capital and largest metropolitan hub, was included to capture dynamics in an urban setting where counterfeit and smuggled alcoholic beverages are prevalent and regulatory enforcement is concentrated. The rural–urban contrast enabled identification of both context-specific and cross-cutting health and safety risks in illicit alcohol production and retail. Study Population and Sampling Population The study population comprised individuals engaged in the production and retail of illicit alcohol in Kampala and Arua districts. Given the informal and unregulated nature of the business, there are no official records or registers from which to draw a sampling frame. Instead, the population was identified through community mapping, snowball referrals, and guidance from local leaders and law enforcement personnel familiar with areas where illicit alcohol activities are concentrated. This population includes small-scale backyard brewers, distillers, and street-level or market-based retailers whose operations are often concealed, irregular, and undocumented, making them difficult to enumerate through conventional means. Quantitative The quantitative survey targeted illicit alcohol producers and retailers. A total of 400 respondents were recruited: Arua (100 producers and 100 retailors), Kampala (100 producers and 100 retailors). Eligibility criteria required participants to own or operate an illicit alcohol production or retail outlet and to have been active in business for at least six months prior to our study. Sampling was purposive and convenience-based, focusing on known hotspots of illicit alcohol production and retail, such as local trading centres and informal markets, until target numbers were reached. Qualitative The qualitative strand comprised 20 interviews, including eight in-depth interviews with producers and retailers (02 producers and 02 retailors in Arua; 02 producers and 02 retailors in Kampala) and twelve key informant interviews with regulatory and policy actors, including District Health Officers, community leaders, District Production Officers, Uganda Revenue Authority officials, a Public Health Inspector, and representatives from the Ministry of Trade, Ministry of Health, and the Uganda National Bureau of Standards. Purposive The sample size was increased from 384, as determined by Cochran’s formula for an unknown population, to 400 respondents to account for possible non-response and incomplete data, as well as enhance the representativeness and reliability of the findings. The addition of 16 respondents provides a safety margin that strengthens the validity of the study results while ensuring adequate coverage of both producers and retailers. Determination of Illicitness of Alcohol Products Before products were included in the study, they were scored for illicitness to ensure alignment with the study objectives. A composite scoring system based on eight regulatory and market-compliance indicators was used. Each product was assessed for: (i) presence of label/branding, (ii) use of reused bottles, (iii) taxation or licensing status, (iv) point of sale (e.g., private homes), (v) traceability of source, (vi) certification by the Uganda National Bureau of Standards (UNBS), (vii) evidence of improper or forged labelling, and (viii) distribution through unregulated channels. Products failing any of these checks were scored 1, while compliant features or products? were scored 0. The composite score was calculated as the sum of all indicators, with higher scores reflecting a greater likelihood of being illicit. Products scoring ≥ 3 were classified as illicit, while those scoring below this threshold were considered licit. This approach enabled recognition of cases where branded or semi-branded spirits appeared compliant but revealed illicit characteristics upon closer scrutiny, such as forged labelling or unregulated distribution. All products were procured covertly to ensure market authenticity, and anonymized for further laboratory testing. Data collection Quantitative surveys collected data on demographic characteristics, alcohol types, production and retail practices, hygiene and sanitation, ABV awareness, consumer characteristics, peak sales periods, and public safety considerations. Surveys were administered in local languages; Lugbara in Arua, Luganda in Kampala. Structured observations were conducted at all production and retail sites using a checklist adapted from the Kampala Capital City Authority (KCCA) Public Health Department. Observations focused on site location and environmental hazards, cleanliness of production and retail areas, water quality, hygiene of tools and equipment, worker hygiene practices, sanitation, pest control, and storage conditions for raw materials and finished products. Sites failing to meet hygiene and sanitation standards were scored, and the proportion of non-compliant producers and retailers was calculated. Observations relied on visual inspection, smell, and other environmental cues, capturing both overt and subtle indicators of contamination risks. Laboratory testing was conducted at the Makerere University, College of Natural sciences, Department of Chemistry Reference Laboratory, MoH-approved laboratory, under Ids-Certificate of analysis number No.2024.050-1 for ABV analysis, No.2024.050-2 for methanol testing, and No.2024.050-3 for microbiological analysis. The ABV value of beverages was measured using the ISO/In-House Densimetry-alcohol-ethanol method, while methanol and microbiological tests were performed according to standard ISO/In-House protocols. Laboratory tests aimed to determine the consistency of ABV in products with declared values, detect methanol in spirits, and identify microbial contamination in opaque alcoholic beverages. All samples were handled in coded, anonymized containers to avoid bias, and were only relabelled after results were finalized. For the qualitative component, data was collected through semi-structured in-depth interviews (IDIs) and key informant interviews (KIIs) to capture contextual insights into production, retail practices, and regulatory perspectives. IDIs were conducted in local languages (Lugbara in Arua and Luganda in Kampala), while KIIs were conducted in English; all interviews were audio-recorded with participant consent, and those in local languages were subsequently transcribed using the local language and translated into English. The interviews explored motivations for illicit alcohol production and sale, community norms, health and safety perceptions, and challenges in policy enforcement. Data analysis Quantitative data was entered into SPSS version 25. Descriptive statistics summarized demographic characteristics, alcohol types, and hygiene practices. Bivariate analyses, including chi-square tests, assessed associations between hygiene, alcohol type, and site. Statistical significance was set at p < 0.05. Qualitative data was analysed thematically using ATLAS.ti version 24. An initial coding framework based on the social-ecological model was refined inductively from emerging data. Codes were grouped at individual, community, and structural levels. Triangulation of survey, observation, laboratory, and qualitative data facilitated comprehensive interpretation of results. Data quality assurance Research assistants received five days of intensive training on study objectives, ethics, and data collection procedures. Tools were pre-tested in non-study sites and revised for clarity. Field supervisors conducted daily debriefings and spot checks to ensure adherence to protocols. Survey data were collected on encrypted tablets with validation checks, and laboratory tests followed standard protocols approved by the Ministry of Health. sampling ensured that both community and institutional perspectives were adequately captured. Sample size determination The sample size was determined using Cochran’s formula for an unknown (or very large) population using the formula; The sample size was increased from 384, as determined by Cochran’s formula for an unknown population, to 400 respondents to account for possible non-response and incomplete data, as well as enhance the representativeness and reliability of the findings. The addition of 16 respondents provides a safety margin that strengthens the validity of the study results while ensuring adequate coverage of both producers and retailers. Determination of Illicitness of Alcohol Products Before products were included in the study, they were scored for illicitness to ensure alignment with the study objectives. A composite scoring system based on eight regulatory and market-compliance indicators was used. Each product was assessed for: (i) presence of label/branding, (ii) use of reused bottles, (iii) taxation or licensing status, (iv) point of sale (e.g., private homes), (v) traceability of source, (vi) certification by the Uganda National Bureau of Standards (UNBS), (vii) evidence of improper or forged labelling, and (viii) distribution through unregulated channels. Products failing any of these checks were scored 1, while compliant features or products? were scored 0. The composite score was calculated as the sum of all indicators, with higher scores reflecting a greater likelihood of being illicit. Products scoring ≥ 3 were classified as illicit, while those scoring below this threshold were considered licit. This approach enabled recognition of cases where branded or semi-branded spirits appeared compliant but revealed illicit characteristics upon closer scrutiny, such as forged labelling or unregulated distribution. All products were procured covertly to ensure market authenticity, and anonymized for further laboratory testing. Data collection Quantitative surveys collected data on demographic characteristics, alcohol types, production and retail practices, hygiene and sanitation, ABV awareness, consumer characteristics, peak sales periods, and public safety considerations. Surveys were administered in local languages; Lugbara in Arua, Luganda in Kampala. Structured observations were conducted at all production and retail sites using a checklist adapted from the Kampala Capital City Authority (KCCA) Public Health Department. Observations focused on site location and environmental hazards, cleanliness of production and retail areas, water quality, hygiene of tools and equipment, worker hygiene practices, sanitation, pest control, and storage conditions for raw materials and finished products. Sites failing to meet hygiene and sanitation standards were scored, and the proportion of non-compliant producers and retailers was calculated. Observations relied on visual inspection, smell, and other environmental cues, capturing both overt and subtle indicators of contamination risks. Laboratory testing was conducted at the Makerere University, College of Natural sciences, Department of Chemistry Reference Laboratory, MoH-approved laboratory, under Ids-Certificate of analysis number No.2024.050-1 for ABV analysis, No.2024.050-2 for methanol testing, and No.2024.050-3 for microbiological analysis. The ABV value of beverages was measured using the ISO/In-House Densimetry-alcohol-ethanol method, while methanol and microbiological tests were performed according to standard ISO/In-House protocols. Laboratory tests aimed to determine the consistency of ABV in products with declared values, detect methanol in spirits, and identify microbial contamination in opaque alcoholic beverages. All samples were handled in coded, anonymized containers to avoid bias, and were only relabelled after results were finalized. For the qualitative component, data was collected through semi-structured in-depth interviews (IDIs) and key informant interviews (KIIs) to capture contextual insights into production, retail practices, and regulatory perspectives. IDIs were conducted in local languages (Lugbara in Arua and Luganda in Kampala), while KIIs were conducted in English; all interviews were audio-recorded with participant consent, and those in local languages were subsequently transcribed using the local language and translated into English. The interviews explored motivations for illicit alcohol production and sale, community norms, health and safety perceptions, and challenges in policy enforcement. Data analysis Quantitative data was entered into SPSS version 25. Descriptive statistics summarized demographic characteristics, alcohol types, and hygiene practices. Bivariate analyses, including chi-square tests, assessed associations between hygiene, alcohol type, and site. Statistical significance was set at p < 0.05. Qualitative data was analysed thematically using ATLAS.ti version 24. An initial coding framework based on the social-ecological model was refined inductively from emerging data. Codes were grouped at individual, community, and structural levels. Triangulation of survey, observation, laboratory, and qualitative data facilitated comprehensive interpretation of results. Data quality assurance Research assistants received five days of intensive training on study objectives, ethics, and data collection procedures. Tools were pre-tested in non-study sites and revised for clarity. Field supervisors conducted daily debriefings and spot checks to ensure adherence to protocols. Survey data were collected on encrypted tablets with validation checks, and laboratory tests followed standard protocols approved by the Ministry of Health. Results Demographic Profile of Producers and Retailers From table 1. Production was mainly dominated by females across the two regions (95,5%), aged between 25-44 years (55%) with no or primary level of education (75%). Majority of there are self-employed (80%) living in households of 10 and above occupants (55%) and earning less than Ugx 500000 average per month (77%). Retail was also dominated by females (72%) aged 25-44 years (59%) with primary and secondary (88%) living in households of 2-4 occupants (48%) and majority earning less than Ugx 500000 average per months (60%). Table 1 : Demographic profile of producers and retailers Producers Retailers Demographic characteristics Arua (n=100) Kampala (n=100) Total (%) Arua (n=100) Kampala (n=100) Total (%) Gender Female 100% 91% 95.5 67% 77% 72 Male 0% 9% 4.5 33% 23% 28 Age category 18-24 12% 4% 8 19% 16% 18 25-34 36% 17% 27 30% 30% 30 35-44 23% 33% 28 30% 27% 29 45-54 17% 31% 23 15% 26% 2 55& above 12% 15% 14 6% 1% 3 Highest education level No Education 12% 17% 15 5% 1% 3 Primary 66% 56% 60 58% 33% 46 Secondary 20% 26% 23 29% 55% 42 University/Tertiary 2% 1% 2 8% 11% 9 Occupation Formal employment 1% 1% 1 3% 2% 3 Informal employment 21% 16% 19 22% 17% 20 Self-employed 78% 83% 80 75% 81% 77 Marital status Single 5% 13% 9 15% 30% 23 Currently Married 62% 20% 40 57% 24% 40 Divorced 4% 4% 4 2% 2% 2 Living together 23% 12 3% 26% 14 Separated 23% 29% 26 14% 15% 15 Widowed 6% 11% 9 9% 3% 6 Household Size 1 2% 10% 6 3% 10% 7 2-4 6% 2% 4 38% 59% 48 5-10 28% 43% 35 51% 29% 40 Above 10 64% 45% 55 8% 2% 5 Religion Catholic 79% 56 68 68% 55% 61 Muslim 1% 2% 2 30% 35% 32 Pentecostal 3% 3 1% 8% 5 Protestant/Anglican 20% 37% 27 1% 2% 2 Average monthly income (Ugx) Less than 500,000 93% 61% 77 84% 35% 60 500,000-1,000,000 7% 35% 21 14% 29% 21 Above 1,000,000 4% 2 2% 36% 19 Alcohol type and packaging used Results in Table 2 revealed striking gaps in knowledge and regulation of alcohol strength. Production and retail practices, indicated that producers most frequently engaged in the manufacture of opaque beer (57.5%) and illicit spirits (42.5%), while retailers predominantly sold illicit spirits (53%). 89.5% of producers reported no awareness of alcohol by volume (ABV) values. The qualitative results confirmed reliance on approximation rather than standardized measurement, with one producer acknowledging: “We just approximate the strength based on how much ethanol we add” (Producer–IDI–Arua). Producers also acknowledged variability in product safety, noting: “ We try to maintain the ratios but sometimes it changes depending on the availability of ingredients. Sometimes the batches are weaker or stronger depending on what is available” (Producer–IDI–Arua). On the retail side, packaging and storage practices further undermined safety. Plastic bottles (90%), often reused and poorly cleaned, dominated, while 44% of retailers used glass bottles. Table 2 : Alcohol type and packaging used Producers Retailers Variable Arua (n=100) Kampala (n=100) Total Arua (n=100) Kampala (n=100) Total Most Common Alcohol Type Produced/Sold Illicit spirit 84% 1% 42% 65% 14% 39% Opaque Beer 16% 99% 58% 0% 0% 0% Both illicit and licit 35% 86% 61% ABV Awareness No 79% 100% 89% Yes 21% 0% 11% Containers Used (Production/Retail) Plastic 40% 95% 67% 87% 92% 90% Clay 68% 32% 50% 10% 3% 7% Metallic 39% 14% 27% 4% 2% Glass 6% 7% 7% 19% 68% 44% Stainless Steel 13% 13% 13% 0% 0% 0% Others 10% 8% 9% 6% 11% 9% ABV% and Biochemical Composition Unpredictable Potency of illicit alcohol The laboratory and survey findings from Table 3 demonstrate substantial variability in alcohol by volume (ABV) values across illicit beverages of common types. Illicit spirits such as Kampala’s “Crude Waragi” ranged between 42.4–44.2% ABV and Arua’s “Nguli” ranged15.4–20.4% ABV. Some of other illicit brands also exhibited marked deviations from declared or expected strength, with differences ranging up to 8.9%. The survey corroborated these laboratory findings: only 10.5% of producers reported knowledge of the ABV values of their products, with the majority relying on experience rather than standardized measurement. One producer explained, “We have no laboratory testing; we rely on experience to judge alcohol potency” (Producer-IDI-Kampala). Methanol composition in illicit alcoholic drinks Laboratory analyses in Table 3 revealed substantial variation in methanol content across different illicit alcoholic beverages. Methanol concentrations in Kampala’s “Crude Waragi” were very high, with one sample reaching 640.59 mg/L, and others at 173.57 mg/L and 219.90 mg/L. In Arua, “Spirit-05” exhibited negligible levels (<0.5). These levels far exceed internationally recognized safe limits for methanol (50 mg/L) in alcoholic beverages. The data also suggest a regional pattern, with Kampala-based illicit alcohol presenting the highest chemical hazard. Microbiological contamination in illicit alcoholic beverages Microbial safety assessment of opaque beers in Table 3 revealed no presence of E. coli, total coliforms, or Salmonella sp., indicating minimal faecal contamination. However, Staphylococcus aureus a pathogen commonly linked to poor hygiene and post-production contamination was detected in several samples. In Arua, “Opaque -01” contained 1.1 × 10⁴ cfu/mL, while in Kampala, “Opaque -05” and “Opaque -03” had 3.0 × 10⁴ cfu/mL and 3.5 × 10³ cfu/mL, respectively. Other samples such as “Opaque -02” showed lower or undetectable levels. 46.5% of production sites stored water in dirty, uncovered containers, facilitating contamination. Producers acknowledged minimal hygiene: "Some producers use whatever containers are available, hygiene is minimal" (Producer-IDI-Kampala). Producers also reported: " Opaque beer is also produced occasionally, but waragi [crude] is the mainstay because it sells faster " (Producer-IDI-Kampala). Table 3 : ABV% and Biochemical Composition Sample ID Location %AVB Methanol (mg/l) Illicit Spirits Spirit-01 Kampala 44.2 173.57 Spirit-02 Kampala 42.40 219.90 Spirit-03 Kampala 36.10 2.64 Spirit-04 Kampala 36.00 <0.5 Spirit-05 Arua 36.90 <0.5 Spirit-06 Kampala 39.20 1.63 Spirit-07 Kampala 640.59 Illicit Opaque Beers Sample ID Location Staphylococcus aureus (cfu) Opaque -01 Arua 1.1 × 10 4 /mL Opaque -02 Arua NIL Opaque -03 Kampala 3.5 × 10 3 /mL Opaque -04 Kampala 7 × 10 2 /mL Opaque -05 Kampala 3.0 × 10 4 /mL Opaque -06 Kampala NIL Hygiene and Sanitation in Production and Retail of Illicit Alcohol The study results from (Figure 1) reveal that poor storage of finished products was higher in Kampala (73%) compared to Arua (27%). Poor material storage facilities were also widespread as observed in Kampala (58.6%) than in Arua. The study results also show absence of pest control measures affecting nearly half of the producers in both locations (49.2% in Kampala and 50.8% in Arua). Inadequate sanitation was slightly higher in Kampala (53.5%) compared to Arua Worker-related unhygienic concerns were also evident with more than one-half from Kampala (53%) and 47% in Arua, while poor worker hygiene was documented at 53.4% in Kampala and 46.6% in Arua, increasing the possibility of direct contamination of products. The study results show that the use of unsanitary tools was another major issue, particularly in Kampala (60.1%). Additionally, about 64.4% of producers in Kamapala displayed poor water quality in their production which poses a great public health risk, with 64.4% of producers in Kampala. Similarly, dirty production areas were more common in Kampala (62.4%) than in Arua (37.6%). Finally, unsanitary location and surroundings were highly prevalent in Kampala (69.8%) compared to Arua (30.2%). A comparative analysis of Kampala and Arua across various hygiene and sanitation indicators discloses different disparities (Table 4). Kampala consistently displayed higher proportions across several indicators. Almost half of production sites operated in hazardous surroundings, including proximity to waste disposal areas and polluted water sources. This was more common in Kampala (80.2%) than Arua (19.8%), p=0.000. Urban producers explained that affordability and access to space dictated these choices: “ We work near the drainage because that is the only space we can afford. Customers don’t care about the surroundings, they care about cheap alcohol ” (Producer–IDI, Kampala). By contrast, rural informants highlighted coping strategies such as water treatment before use: “ The water in villages may come from streams, but people here often boil or filter before use. In town, they just use what is available in jerrycans, clean or not ” (KII–DHO, Arua). Dirty or visibly contaminated premises were significantly higher in Kampala (62.3%) p=0.000). Water storage practices showed a bit high rural vulnerability (50.5%). About 56.4% of Kampala producers used uncovered or dirty containers compared to relatively fewer respondents in Arua (p=0.047). Producers across both sites admitted reliance on makeshift or reused equipment: “ We use metal drums and plastic containers; some are recycled, but we clean them before use. Some producers use whatever containers are available, hygiene is minimal ” (Producer–IDI, Kampala). Retailers confirmed the same, describing resale in reused bottles or cups: “ We sell in small cups and reused bottles; not everyone cleans them, but most customers do not complain ” (Retailer–IDI, Kampala). Nearly all workers in production sites lacked protective gear, with personal hygiene lapses more common in Kampala (55.6%). Unsanitary practices, such as eating or smoking during production were widespread in both production sites (p=0.000) Producers attributed these lapses to poverty and informality: “ We cannot buy gloves or masks; that is for big factories, not for us ” (Producer–IDI, Kampala). Urban producers more frequently used dirty or poorly maintained tools with no cleaning supplies higher in Kampala (54.7%). Pest infestation was also high in Kampala (58.1%) compared to Arua (p=0.079). Retailers offered corroborating accounts: “ Rats and cockroaches are everywhere. We just cover the jerrycan and sell quickly before customers notice ” (Retailer–IDI, Kampala). Retail-level hygiene, the rural–urban divide extended to retail outlets. Unsanitary retail environments were significantly more common in Kampala, where 61.9% of outlets displayed products in visibly dirty conditions compared to 38.1% in Arua (p=0.004). Unsafe storage (direct sunlight or open containers) was reported in 66.2% of urban outlets vs 33.8% rural. While Kamapala retailers more often linked alcohol to consumer illness (68.9%), urban retailers normalized spoilage as inevitable: “ Sometimes it smells bad, but customers still buy because it is cheap ” (Retailer–IDI, Kampala). Notably, about 50% of outlets across both sites offered no warnings or health information to consumers (p=0.041). Table 4 : Proportion of illicit alcohol production sites and retailers by district with poor hygiene and sanitation indicators Indicator Arua n (%) Kampala n (%) P-value Environmental hazards 17(19.8) 69(80.2) 0.000 Visible contamination 49(37.7) 81(62.3) 0.000 Poor waste disposal 23(34.8) 43(65.2) 0.003 Unsafe water 11(36.7) 19(63.3) 0.113 Dirty water storage 47(50.5) 46(49.5) 0.887 Dirty tools 48(43.6) 62(56.4) 0.047 Poor hygiene (general) 36(44.4) 45(55.6) 0.195 No cleaning supplies 62(45.3) 75(54.7) 0.048 Pest infestation 31(41.9) 43(58.1) 0.079 Unsafe storage 12(18.8) 52(81.2) 0.000 Retailers Poor Retail Area Hygiene 32(38.1) 52(61.9) 0.004 Dirty area 20(35.1) 37(64.9) 0.008 Dirty hands 18(31.0) 40(69.0) 0.001 Unsanitary transfer 32(44.4) 40(55.6) 0.239 Poor Storage & Display 26(33.8) 51(66.2) 0.000 Exposed to elements 22(34.9) 41(65.1) 0.004 Signs of Contamination 25(37.9) 41(62.1) 0.016 Visible contamination 12(48.0) 13(52.0) 0.831 Consumer illness reports 14(31.1) 31(68.9) 0.004 Consumer risks 27(38.6) 43(61.4) 0.018 No warnings 72(46.2) 84(53.8) 0.041 Discussion The demographic profile of illicit alcohol producers and retailers in Uganda reflects entrenched socio-economic vulnerabilities and gendered livelihood patterns. Production was largely the domain of women, echoing findings from other African contexts where brewing is woven into household survival strategies(24). While this has often been framed as empowerment through income generation, others argue that the hazardous conditions and criminalization of such work trap women in cycles of poverty and marginalization (25,26). Recent gendered livelihood studies similarly show that women’s dominance in brewing is both an economic opportunity and a health liability, especially where regulatory gaps persist (Local academic/field studies, 1990s–2020s). Retailing, by contrast, attracted a more balanced gender mix and generated relatively higher earnings, suggesting that while distribution is more profitable, it is equally fraught with neglect of regulatory oversight. These observations illustrate how risks and rewards are unevenly distributed across the illicit alcohol value chain, shaping who bears the brunt of exposure and responsibility. Beyond these socio-economic dynamics, the most urgent concern emerging from this study is the unpredictable, inconsistent and often undeclared alcohol strength in illicit beverages. Large deviations between the measured and stated alcohol by volume (ABV) values expose consumers to unpredictable potency, with significant implications for acute intoxication, poisoning, and dependence. The fact that most producers acknowledged no knowledge of alcohol strength underscores a critical regulatory gap: consumers are denied even the most basic information about the products they consume. This mirrors findings from Kenya and Tanzania, where artisanal producers estimate rather than test alcohol strength, leaving drinkers vulnerable to unsafe exposures (27). Broader market analyses confirm that more than 65% of Uganda’s alcohol is illicit, consumed largely without labelling or traceability, reinforcing the systemic nature of this risk(15,28) The danger is further compounded by methanol contamination, which was particularly acute in urban samples. Similar incidents across Africa and Asia have been linked to outbreaks of blindness and death (29,30). Outbreak investigations in Uganda have traced fatalities directly to adulteration during production, where methanol was substituted for ethanol to reduce costs (17,18). Reviews of global methanol poisoning patterns emphasize that these are rarely accidents alone: poverty, weak enforcement, and perverse market incentives drive recurrent adulteration(1,31). The pattern observed here, with urban products showing consistently higher methanol levels than rural ones, suggests that competitive pressures in cities may push producers toward unsafe practices. This complicates intervention, for while technical training could reduce accidental contamination, addressing deliberate adulteration demands stronger enforcement, community awareness, and clinical preparedness (32,33) Microbiological analysis painted a subtler picture. While opaque beers showed limited faecal contamination, the frequent detection of Staphylococcus aureus pointed to lapses after fermentation, particularly during handling and storage. Fermentation itself is sometimes credited with suppressing pathogens, yet its protective effect was undermined here by unhygienic practices(34). The risk, therefore, does not manifest as explosive outbreaks of diarrhoeal disease but rather as a steady burden of sporadic foodborne illness linked to unsafe handling and poor storage (35). Recent field studies in Zambia confirm similar sanitation risks in illicit alcohol production and retail, highlighting pests, waste accumulation, and unclean equipment as drivers of consumer exposure (36). This reinforces the argument that the dangers of illicit alcohol cannot be reduced to chemical composition alone; they are deeply entwined with hygiene behaviours and environmental exposures. Many brewers operated in hazardous surroundings, often adjacent to waste sites, drainage channels, or other polluted spaces. In urban areas, land pressures and affordability forced producers into these unsafe locations, amplifying exposure to environmental contaminants(37). Water, the most fundamental input in alcohol production, was frequently drawn from sources stored in uncovered or visibly dirty containers, making contamination almost inevitable. Waste disposal practices were equally poor, with refuse and by-products often discarded nearby, attracting flies and rodents that in turn contaminated production sites(38). Equipment hygiene reflected similar neglect: many brewers relied on unwashed or damaged tools, sometimes reusing containers without cleaning them, in part, because cleaning supplies were scarce or unaffordable. Pest infestation, a near-universal problem, further increased the likelihood of contamination(39). Such unsanitary conditions have been widely documented as symptomatic of the contradictions between poverty-driven livelihoods and consumer safety in informal alcohol economies(38–42). These conditions were mirrored and extended in the retail environment. Alcohol was often stored in visibly dirty spaces, with products exposed to sunlight or heat that accelerated spoilage. Retailers handled beverages with bare hands, served drinks in unwashed bottles or cups, and rarely provided information or warnings to consumers. Many outlets operated without regard for proximity to schools, markets, or government offices, making unsafe alcohol a normalized everyday commodity, particularly in urban neighbourhoods. Consumers routinely encountered products with sediment or spoilage but consumed them regardless, reflecting how deeply entrenched this normalization has become. WHO 2018 confirm that affordability, accessibility, and cultural familiarity sustain this demand even where risks are well recognized (43,44) A striking feature of these findings is the contrast between Kampala and Arua. In almost every indicator, the capital city exhibited more hazardous practices than the rural district. Whereas some rural producers reported boiling or filtering water before use, urban producers appeared constrained by cost, space, and time, which discouraged even modest protective measures. The consequence is that urban communities are doubly exposed facing both higher chemical risks from methanol and ABV inconsistency, and greater environmental and microbiological risks linked to unhygienic surroundings. This urban–rural divide resonates with broader debates on slum urbanization and health inequities, and has been echoed in recent outbreak reports from Arua and Wakiso, where limited infrastructure compounded poisoning risks (17,18,41). Interventions must therefore be carefully tailored: cities require targeted regulation and infrastructural support for slum communities, while rural areas may benefit more from preventive education and community-driven hygiene improvements). Limitations and strengths This study was limited by its cross-sectional design, which restricts the ability to infer causal relationships between production or retail practices and the observed health risks. Data collection relied partly on self-reports from producers and retailers, raising the possibility of recall bias or deliberate underreporting on sensitive issues such as adulteration and unsafe handling in fear of regulation consequences. Although laboratory analyses offered valuable insights into alcohol strength and contamination, the number of samples tested was relatively small compared to the diversity of illicit beverages circulating in Uganda, which constrains the generalizability of chemical findings. The geographic scope was also restricted to Kampala and Arua; while these sites provided useful contrasts between urban and rural settings, they may not fully represent variations across other regions. Additionally, observational assessments of hygiene and sanitation were based on single site visits, which may not capture fluctuations in practices over time. Despite these limitations, the study demonstrates several methodological strengths. The mixed-methods design, integrating quantitative surveys, structured observations, laboratory testing, and qualitative interviews, enabled robust triangulation of findings across different sources of data. The combination of laboratory testing with field-based assessments provided concrete evidence on both chemical hazards such as methanol contamination and alcohol strength variability and environmental risks arising from poor hygiene and unsafe storage. The inclusion of perspectives from producers, retailers, and consumers grounded the findings in lived realities, offering a richer and more nuanced understanding of the socio-economic drivers and public health implications of illicit alcohol in Uganda. Conclusion and recommendations We conclude that illicit alcohol in Uganda poses severe risks to public health and community safety due to unpredictable alcohol strength, methanol contamination, and unsanitary production and retail practices. Addressing these risks requires enforcement of existing alcohol regulations through routine inspections and random quality-control checks, alongside targeted public health campaigns to raise awareness about the dangers of unregulated alcohol. Safer production and handling could be promoted through community training, provision of basic protective equipment, and improved sanitation practices. Livelihood alternatives should be prioritized, particularly for women who dominate production, to reduce dependence on unsafe brewing as a source of income. Integrating alcohol safety surveillance into public health systems, coupled with consumer education and access to affordable regulated beverages, can deter hazardous production practices and reduce alcohol-related harm at scale. Additionally, targeted interventions for youth and economically active populations such as awareness programs, alternative livelihoods, and safer recreational spaces are critical to reducing the social harms associated with illicit alcohol. Abbreviations ABV Alcohol by Volume cfu/mL Colony-Forming Units per millilitre DHO District Health Officer EAC East African Community ISO International Organization for Standardization KCCA Kampala Capital City Authority MAKSSREC Makerere University School of Social Sciences Research Ethics Committee mg/L Milligram per Litre MoH Ministry of Health SPSS Statistical Package for the Social Sciences UNBS Uganda National Bureau of Standards UNCST Uganda National Council for Science and Technology WHO World Health Organisation Declarations Ethics approval and consent to participate Ethical approval was obtained from the Uganda National Council for Science and Technology (UNCST) and the Makerere University School of Social Sciences Research Ethics Committee (MAKSSREC) Ref no. MAKSSREC2024-782, with additional clearance from the Kampala Capital City Authority (KCCA) Ref no. DPHE/KCCA/130/01. Informed consent was obtained from the participants before data collection ensuring their right to withdrawal and volunteer participation in accordance to the Declaration of Helsinki (2024 revision). Consent for publication This study required and obtained informed consent from participants and for participants data to be used and published in related research outputs. All data has been anonymised for confidentiality purposes. Clinical Trial Number Not Applicable Availability of data and materials The datasets generated and/or analysed during the current study are not publicly available as the individuals participating in this survey did not consent for their data to be shared beyond the research team, but are available from the corresponding author on reasonable request. Competing interests Aside from the funding source, all other authors declare no conflict of interest in the conduct of this study. AR and TA declare that they are full time employees of AB InBev Foundation. According to authors, the study was carried out without any financial or commercial ties that might be seen as a potential conflict of interest. Funding The AB InBev Foundation provided financial support for the study and publication of this article, according to the authors. The writers alone are responsible for the material, which may not represent the views of AB InBev or the AB InBev Foundation. All content is subject to ultimate, independent decision-making power by the writers and Arrow Empirical Research & Skills Enhancement (AERSE), as agreed. Authors’ Contributions SPR: Conceptualization, Formal analysis, Investigation, Designing Methodology, Writing – original draft, Writing – review & editing and Investigation. MT: Designing the sampling strategy, Developing the data analysis plan, Project administration, Advanced statistical analyses, Writing original draft, Writing - review & editing. KN: Conceptualization, Project design, designing the methodology, Resources, visualization, overseeing ethical approvals, Coordination, Analysis, writing original draft, Writing-review & editing, and disseminating results to stakeholders. CZ: Editing and reviewing. CK: Writing original draft, reviewing & editing, Formal analysis., Methodology, review & editing. LM: project design, Manuscript editing and reviewing. MS: Data collection, Analysis, Writing, review & editing. MM: Manuscript Editing and reviewing. SM: Formal analysis, Investigation. AR: Conceptualization, review & editing, Funding acquisition and Resources. TA: Conceptualization, Funding acquisition, Investigation, Methodology, Project administration, Resources, and Writing, review & editing. Acknowledgments The authors wish to acknowledge Makerere University, College of Natural sciences, Department of Chemistry Reference Laboratory, AB InBev, the sponsors of the study, Makerere University School of Social Sciences Research Ethics Committee (MAKSSREC), Kampala Capital City Authority (KCCA), and Arua district local government, for granting us permission to conduct this study. We also would like to thank all the key informants for providing all essential information. Supplementary material An English language version for the tools used during this study have been uploaded as supplementary file of this manuscript. References Manning L, Kowalska A. Illicit alcohol: Public health risk of methanol poisoning and policy mitigation strategies. Foods [Internet]. 2021;10(7):1–16. Available from: https://doi.org/10.1093/alcalc/agaf018 Zyambo C, Phiri MM, Zulu R, Mukupa M, Mabanti K, Matenga TFL, et al. 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Retail\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIllicit alcohol is defined as any alcohol that is produced, distributed, and consumed outside of government regulation (1). Illicit alcohol production practices often bypass good manufacturing and hygiene standards such as uncontrolled fermentation/distillation, re-use of contaminated containers, poor water and sanitation at production sites increasing the likelihood of toxic by-products and microbial contamination (2). It is also often contaminated, adulterated, or mislabelled, with documented risks including methanol poisoning and exposure to hazardous contaminants (3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDespite the adverse health effects of illicit alcohol, 25.5% of illicit alcohol is consumed globally, involves unrecorded alcohol (4), was consumed by 80%of the global adult population in the 2020 report of the World Mental Health Survey (5). The life-time prevalence of alcohol use among adults was estimated up to 68% in low lower middle-income countries in 2015 (6), 88.2% in European countries and 91.6% in the United States in 2016. There is a lot of unknown information about the illicit alcohol harms on people especially how issues like dirty production environments, weak oversight, and unsafe manufacturing make the problem of illicit alcohol worse.\u003c/p\u003e\n\u003cp\u003eNotably, recurrent international outbreaks of methanol poisoning linked to adulterated or poorly distilled alcohol underscore the intersection of unsafe production and severe health outcomes, including blindness and death(7). Globally, an estimated 400 million people, or 7% of the world\u0026rsquo;s population aged 15 years and older, live with alcohol use disorders, and an estimated 209 million (3.7% of the adult world population) live with alcohol dependence, with substantial differences in the numbers of people affected in different World Health Organisation (WHO) regions(8).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAcross Africa, unrecorded alcohol is prevalent and closely tied to affordability pressures, limited regulatory enforcement capacity, and widespread informal production(9). Reviews and country case studies report recurring methanol poisoning events and highlight the contribution of low-cost, high-strength informal spirits and sachet packaging to easy accessibility (3). Inadequate hygiene and sanitation in production and retail settings such as use of non-food-grade containers, unsafe water, and poor storage further elevate risk (10). Alcohol industry narratives sometimes attribute high levels of illicit trade to taxation alone while public health experts emphasise the lack of comprehensive measures including excise taxes, minimum packaging standards, licensing, and enforcement to reduce production(11,12)\u003c/p\u003e\n\u003cp\u003eAt the regional level, the East African Community (EAC) adopted the Regional Policy on Prevention, Management and Control of Alcohol, Drugs and Other Substance Use (2019), which provides a framework for partner states to regulate both licit and illicit alcohol(13). The policy emphasizes the control of production, distribution, and sale of alcohol, alongside harmonized excise taxation measures aimed at curbing cross-border smuggling and undercutting of regulated products (14). More recently, the EAC has moved towards excise duty harmonization on alcoholic beverages, seeking to minimize disparities that fuel illicit trade and smuggling across borders \u0026nbsp;(15). Despite these frameworks, prevention of illicit alcohol remains a persistent challenge in East Africa, including Uganda.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccording to the Uganda Alcohol Report 2022, Uganda is a significant producer of alcohol, with an annual production of 110.6 million litres. Of this, 67.7 million litres, or 61%, are classified as illicit(16). Locally distilled spirits (commonly referred to as waragi, among others) are mostly produced in informal settings with field studies reporting challenges in production such as inconsistent alcohol content, use of non‑food‑grade containers, poor sanitation at production sites, and unsafe disposal of distillation wastes that contaminate the environment. Uganda has experienced confirmed methanol poisoning outbreaks linked to adulterated spirits, including a 2022 event in the north‑west attributed to a gin adulterated at the production stage by an unlicensed manufacturer\u0026nbsp;(3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAdditionally, alcohol consumption in Uganda is a leading risk factor for mortality and morbidity for several diseases including Cancer. For example, \u0026nbsp;87 people \u0026nbsp;are lost \u0026nbsp; due to alcohol related complications per 100,000 in the country (7). \u0026nbsp;Prior studies in Uganda had reported methanol-contaminated alcoholic beverages linked to several deadly poisoning outbreaks across different regions. In Arua City and Madi-Okollo District (Northwestern Uganda), a methanol-tainted gin (\u0026ldquo;Gin X\u0026rdquo;) outbreak in August 2022 resulted in 18 deaths out of 48 cases, representing a 38% case-fatality rate, with 12 of the fatalities occurring in Arua City (17). In Wakiso District (near Kampala), a June 2017 incident saw 15 cases and 12 deaths (an 80% fatality rate) caused by locally distilled waragi adulterated with high methanol levels(18). In Western Uganda, notably Kabale District, approximately 80 people died in April 2010 after consuming waragi laced with methanol over a three-week period(19) . Again close to 300 people are reported to have lost their lives due to alcohol poisoning between 2007 and 2009 in Uganda(20)\u003c/p\u003e\n\u003cp\u003eGovernment of Uganda came up with policies aimed at strengthening regulation of alcohol production through awareness and improved monitoring systems such as the National Alcohol Control Policy 2019, and the ban on alcohol sell in sachets \u0026nbsp;(21) to strengthen regulation of production, packaging, marketing and sale of alcohol \u0026nbsp; albeit with any significant success. Existing studies on illicit alcohol such as (22) have mainly focused on consumption with a dearth of literature on hygiene in the production and retail sites of illicit alcohol. This study therefore sought to bridge this gap by assessing the health risks and public safety concerns associated with illicit alcohol in Uganda, focusing on alcohol strength, methanol contamination, and hygiene and sanitation in production and retail settings.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study adopted a cross-sectional, convergent mixed-methods design to investigate the health risks and public safety concerns associated with illicit alcohol production and retail in Uganda. The design combined quantitative survey, structured observations, laboratory analyses, and qualitative interviews, allowing triangulation of findings across multiple data sources. Mixed-methods approaches are well-suited for public health research as they capture both measurable risk patterns and contextual realities of community practices (23)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Sites\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData was collected in Arua District (Adalafu, Adravu, Ajia, Arivu, Eruba, Ewuata, Ocoko, Ogia, Okaliba, Oluko, Onyivu, Pajulu and Vurra) sub counties and Kampala Capital city (Kawempe, Makindye, Nakawa, Rubaga and Kampala central) divisions between October and November 2024. Arua district, located in north-western Uganda, was selected to represent a rural context with longstanding artisanal alcohol production and widespread informal markets. Kampala, the capital and largest metropolitan hub, was included to capture dynamics in an urban setting where counterfeit and smuggled alcoholic beverages are prevalent and regulatory enforcement is concentrated. The rural\u0026ndash;urban contrast enabled identification of both context-specific and cross-cutting health and safety risks in illicit alcohol production and retail.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Population and Sampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePopulation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study population comprised individuals engaged in the production and retail of illicit alcohol in Kampala and Arua districts. Given the informal and unregulated nature of the business, there are no official records or registers from which to draw a sampling frame. Instead, the population was identified through community mapping, snowball referrals, and guidance from local leaders and law enforcement personnel familiar with areas where illicit alcohol activities are concentrated. This population includes small-scale backyard brewers, distillers, and street-level or market-based retailers whose operations are often concealed, irregular, and undocumented, making them difficult to enumerate through conventional means.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuantitative\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe quantitative survey targeted illicit alcohol producers and retailers. A total of 400 respondents were recruited: Arua (100 producers and 100 retailors), Kampala (100 producers and 100 retailors). Eligibility criteria required participants to own or operate an illicit alcohol production or retail outlet and to have been active in business for at least six months prior to our study. Sampling was purposive and convenience-based, focusing on known hotspots of illicit alcohol production and retail, such as local trading centres and informal markets, until target numbers were reached.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQualitative\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe qualitative strand comprised 20 interviews, including eight in-depth interviews with producers and retailers (02 producers and 02 retailors in Arua; 02 producers and 02 retailors in Kampala) and twelve key informant interviews with regulatory and policy actors, including District Health Officers, community leaders, District Production Officers, Uganda Revenue Authority officials, a Public Health Inspector, and representatives from the Ministry of Trade, Ministry of Health, and the Uganda National Bureau of Standards. Purposive The sample size was increased from 384, as determined by Cochran\u0026rsquo;s formula for an unknown population, to 400 respondents to account for possible non-response and incomplete data, as well as enhance the representativeness and reliability of the findings. The addition of 16 respondents provides a safety margin that strengthens the validity of the study results while ensuring adequate coverage of both producers and retailers. Determination of Illicitness of Alcohol Products Before products were included in the study, they were scored for illicitness to ensure alignment with the study objectives. A composite scoring system based on eight regulatory and market-compliance indicators was used. Each product was assessed for: (i) presence of label/branding, (ii) use of reused bottles, (iii) taxation or licensing status, (iv) point of sale (e.g., private homes), (v) traceability of source, (vi) certification by the Uganda National Bureau of Standards (UNBS), (vii) evidence of improper or forged labelling, and (viii) distribution through unregulated channels. Products failing any of these checks were scored 1, while compliant features or products? were scored 0. The composite score was calculated as the sum of all indicators, with higher scores reflecting a greater likelihood of being illicit. Products scoring \u0026ge; 3 were classified as illicit, while those scoring below this threshold were considered licit. This approach enabled recognition of cases where branded or semi-branded spirits appeared compliant but revealed illicit characteristics upon closer scrutiny, such as forged labelling or unregulated distribution. All products were procured covertly to ensure market authenticity, and anonymized for further laboratory testing. Data collection Quantitative surveys collected data on demographic characteristics, alcohol types, production and retail practices, hygiene and sanitation, ABV awareness, consumer characteristics, peak sales periods, and public safety considerations. Surveys were administered in local languages; Lugbara in Arua, Luganda in Kampala. Structured observations were conducted at all production and retail sites using a checklist adapted from the Kampala Capital City Authority (KCCA) Public Health Department. Observations focused on site location and environmental hazards, cleanliness of production and retail areas, water quality, hygiene of tools and equipment, worker hygiene practices, sanitation, pest control, and storage conditions for raw materials and finished products. Sites failing to meet hygiene and sanitation standards were scored, and the proportion of non-compliant producers and retailers was calculated. Observations relied on visual inspection, smell, and other environmental cues, capturing both overt and subtle indicators of contamination risks. Laboratory testing was conducted at the Makerere University, College of Natural sciences, Department of Chemistry Reference Laboratory, MoH-approved laboratory, under Ids-Certificate of analysis number No.2024.050-1 for ABV analysis, No.2024.050-2 for methanol testing, and No.2024.050-3 for microbiological analysis. The ABV value of beverages was measured using the ISO/In-House Densimetry-alcohol-ethanol method, while methanol and microbiological tests were performed according to standard ISO/In-House protocols. Laboratory tests aimed to determine the consistency of ABV in products with declared values, detect methanol in spirits, and identify microbial contamination in opaque alcoholic beverages. All samples were handled in coded, anonymized containers to avoid bias, and were only relabelled after results were finalized. For the qualitative component, data was collected through semi-structured in-depth interviews (IDIs) and key informant interviews (KIIs) to capture contextual insights into production, retail practices, and regulatory perspectives. IDIs were conducted in local languages (Lugbara in Arua and Luganda in Kampala), while KIIs were conducted in English; all interviews were audio-recorded with participant consent, and those in local languages were subsequently transcribed using the local language and translated into English. The interviews explored motivations for illicit alcohol production and sale, community norms, health and safety perceptions, and challenges in policy enforcement. Data analysis Quantitative data was entered into SPSS version 25. Descriptive statistics summarized demographic characteristics, alcohol types, and hygiene practices. Bivariate analyses, including chi-square tests, assessed associations between hygiene, alcohol type, and site. Statistical significance was set at p \u0026lt; 0.05. Qualitative data was analysed thematically using ATLAS.ti version 24. An initial coding framework based on the social-ecological model was refined inductively from emerging data. Codes were grouped at individual, community, and structural levels. Triangulation of survey, observation, laboratory, and qualitative data facilitated comprehensive interpretation of results. Data quality assurance Research assistants received five days of intensive training on study objectives, ethics, and data collection procedures. Tools were pre-tested in non-study sites and revised for clarity. Field supervisors conducted daily debriefings and spot checks to ensure adherence to protocols. Survey data were collected on encrypted tablets with validation checks, and laboratory tests followed standard protocols approved by the Ministry of Health. sampling ensured that both community and institutional perspectives were adequately captured.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size determination\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size was determined using Cochran\u0026rsquo;s formula for an unknown (or very large) population using the formula;\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/58895_8739fc6c57c1c19a/58895_custom_files/img1765979588.png\" width=\"694\" height=\"198\"\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size was increased from 384, as determined by Cochran\u0026rsquo;s formula for an unknown population, to 400 respondents to account for possible non-response and incomplete data, as well as enhance the representativeness and reliability of the findings. The addition of 16 respondents provides a safety margin that strengthens the validity of the study results while ensuring adequate coverage of both producers and retailers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDetermination of Illicitness of Alcohol Products\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBefore products were included in the study, they were scored for illicitness to ensure alignment with the study objectives. A composite scoring system based on eight regulatory and market-compliance indicators was used. Each product was assessed for: (i) presence of label/branding, (ii) use of reused bottles, (iii) taxation or licensing status, (iv) point of sale (e.g., private homes), (v) traceability of source, (vi) certification by the Uganda National Bureau of Standards (UNBS), (vii) evidence of improper or forged labelling, and (viii) distribution through unregulated channels. Products failing any of these checks were scored 1, while compliant features or products? were scored 0.\u003c/p\u003e\n\u003cp\u003eThe composite score was calculated as the sum of all indicators, with higher scores reflecting a greater likelihood of being illicit. Products scoring \u0026ge; 3 were classified as illicit, while those scoring below this threshold were considered licit. This approach enabled recognition of cases where branded or semi-branded spirits appeared compliant but revealed illicit characteristics upon closer scrutiny, such as forged labelling or unregulated distribution. All products were procured covertly to ensure market authenticity, and anonymized for further laboratory testing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQuantitative surveys collected data on demographic characteristics, alcohol types, production and retail practices, hygiene and sanitation, ABV awareness, consumer characteristics, peak sales periods, and public safety considerations. Surveys were administered in local languages; Lugbara in Arua, Luganda in Kampala.\u003c/p\u003e\n\u003cp\u003eStructured observations were conducted at all production and retail sites using a checklist adapted from the Kampala Capital City Authority (KCCA) Public Health Department. Observations focused on site location and environmental hazards, cleanliness of production and retail areas, water quality, hygiene of tools and equipment, worker hygiene practices, sanitation, pest control, and storage conditions for raw materials and finished products. Sites failing to meet hygiene and sanitation standards were scored, and the proportion of non-compliant producers and retailers was calculated. Observations relied on visual inspection, smell, and other environmental cues, capturing both overt and subtle indicators of contamination risks.\u003c/p\u003e\n\u003cp\u003eLaboratory testing was conducted at the Makerere University, College of Natural sciences, Department of Chemistry Reference Laboratory, MoH-approved laboratory, under Ids-Certificate of analysis number No.2024.050-1 for ABV analysis, No.2024.050-2 for methanol testing, and No.2024.050-3 for microbiological analysis. The ABV value of beverages was measured using the ISO/In-House Densimetry-alcohol-ethanol method, while methanol and microbiological tests were performed according to standard ISO/In-House protocols. Laboratory tests aimed to determine the consistency of ABV in products with declared values, detect methanol in spirits, and identify microbial contamination in opaque alcoholic beverages. All samples were handled in coded, anonymized containers to avoid bias, and were only relabelled after results were finalized.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor the qualitative component, data was collected through semi-structured in-depth interviews (IDIs) and key informant interviews (KIIs) to capture contextual insights into production, retail practices, and regulatory perspectives. IDIs were conducted in local languages (Lugbara in Arua and Luganda in Kampala), while KIIs were conducted in English; all interviews were audio-recorded with participant consent, and those in local languages were subsequently transcribed using the local language and translated into English. The interviews explored motivations for illicit alcohol production and sale, community norms, health and safety perceptions, and challenges in policy enforcement.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQuantitative data was entered into SPSS version 25. Descriptive statistics summarized demographic characteristics, alcohol types, and hygiene practices. Bivariate analyses, including chi-square tests, assessed associations between hygiene, alcohol type, and site. Statistical significance was set at p \u0026lt; 0.05.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eQualitative data was analysed thematically using ATLAS.ti version 24. An initial coding framework based on the social-ecological model was refined inductively from emerging data. Codes were grouped at individual, community, and structural levels. Triangulation of survey, observation, laboratory, and qualitative data facilitated comprehensive interpretation of results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData quality assurance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResearch assistants received five days of intensive training on study objectives, ethics, and data collection procedures. Tools were pre-tested in non-study sites and revised for clarity. Field supervisors conducted daily debriefings and spot checks to ensure adherence to protocols. Survey data were collected on encrypted tablets with validation checks, and laboratory tests followed standard protocols approved by the Ministry of Health.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDemographic Profile of Producers and Retailers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom table 1. Production was mainly dominated by females across the two regions (95,5%), aged between 25-44 years (55%) with no or primary level of education (75%). Majority of there are self-employed (80%) living in households of 10 and above occupants (55%) and earning less than Ugx 500000 average per month (77%). Retail was also dominated by females (72%) aged 25-44 years (59%) with primary and secondary (88%) living in households of 2-4 occupants (48%) and majority earning less than Ugx 500000 average per months (60%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e: Demographic profile of producers and retailers\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProducers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRetailers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDemographic characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eArua\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=100)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKampala\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=100)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eArua\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=100)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKampala\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=100)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"bottom\" style=\"width: 595px;\"\u003e\n \u003cp\u003e\u0026nbsp;Gender\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e91%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95.5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e67%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e77%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e72\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e23%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e28\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"bottom\" style=\"width: 595px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003e18-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e12%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e19%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e16%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e18\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003e25-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e36%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e17%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e27\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e30\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003e35-44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e23%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e28\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e27%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e29\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003e45-54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e17%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e31%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e23\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e26%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003e55\u0026amp; above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e12%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e14\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"bottom\" style=\"width: 539px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHighest education level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNo Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e12%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e17%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e66%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e56%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e60\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e58%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e33%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e46\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e26%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e23\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e29%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e55%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e42\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eUniversity/Tertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e11%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"bottom\" style=\"width: 595px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eFormal employment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eInformal employment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e21%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e16%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e19\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e22%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e17%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e20\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eSelf-employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e78%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e83%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e80\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e75%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e81%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e77\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"bottom\" style=\"width: 595px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e13%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e23\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eCurrently Married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e62%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e40\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e57%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e24%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e40\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eLiving together\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e23%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e12\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e26%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e14\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eSeparated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e23%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e29%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e26\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e14%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e15%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e11%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"bottom\" style=\"width: 595px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousehold Size\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003e2-4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e38%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e59%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e48\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003e5-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e28%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e43%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e35\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e51%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e29%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e40\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eAbove 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e64%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e45%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e55\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"bottom\" style=\"width: 595px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eCatholic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e79%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e68\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e68%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e55%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e61\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e35%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e32\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003ePentecostal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eProtestant/Anglican\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e37%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e27\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"bottom\" style=\"width: 595px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAverage monthly income (Ugx)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eLess than 500,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e93%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e61%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e77\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e84%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e35%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e60\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003e500,000-1,000,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e35%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e21\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e14%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e29%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e21\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 198px;\"\u003e\n \u003cp\u003eAbove 1,000,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e36%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e19\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAlcohol type and packaging used\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eResults in Table 2 revealed striking gaps in knowledge and regulation of alcohol strength. Production and retail practices, indicated that producers most frequently engaged in the manufacture of opaque beer (57.5%) and illicit spirits (42.5%), while retailers predominantly sold illicit spirits (53%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e89.5% of producers reported no awareness of alcohol by volume (ABV) values. The qualitative results confirmed reliance on approximation rather than standardized measurement, with one producer acknowledging: \u003cem\u003e\u0026ldquo;We just approximate the strength based on how much ethanol we add\u0026rdquo;\u003c/em\u003e (Producer\u0026ndash;IDI\u0026ndash;Arua). Producers also acknowledged variability in product safety, noting: \u0026ldquo;\u003cem\u003eWe try to maintain the ratios but sometimes it changes depending on the availability of ingredients. Sometimes the batches are weaker or stronger depending on what is available\u0026rdquo;\u0026nbsp;\u003c/em\u003e(Producer\u0026ndash;IDI\u0026ndash;Arua). On the retail side, packaging and storage practices further undermined safety. Plastic bottles (90%), often reused and poorly cleaned, dominated, while 44% of retailers used glass bottles.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAlcohol type and packaging used\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProducers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"bottom\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRetailers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eArua\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=100)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKampala\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=100)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eArua\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=100)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKampala\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=100)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"bottom\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMost Common Alcohol Type Produced/Sold\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003eIllicit spirit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8px;\"\u003e\n \u003cp\u003e84%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e42%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e65%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e14%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e39%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003eOpaque Beer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8px;\"\u003e\n \u003cp\u003e16%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e99%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e58%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003eBoth illicit and licit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e35%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e86%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e61%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"bottom\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eABV Awareness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8px;\"\u003e\n \u003cp\u003e79%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e89%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8px;\"\u003e\n \u003cp\u003e21%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e11%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"bottom\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eContainers Used (Production/Retail)\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003ePlastic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8px;\"\u003e\n \u003cp\u003e40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e95%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e67%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e87%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e92%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e90%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003eClay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8px;\"\u003e\n \u003cp\u003e68%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e32%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e50%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003eMetallic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8px;\"\u003e\n \u003cp\u003e39%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e14%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e27%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003eGlass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8px;\"\u003e\n \u003cp\u003e6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e7%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e19%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e68%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e44%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003eStainless Steel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8px;\"\u003e\n \u003cp\u003e13%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e13%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e13%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 24px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8px;\"\u003e\n \u003cp\u003e10%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 12px;\"\u003e\n \u003cp\u003e11%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eABV% and Biochemical Composition\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUnpredictable Potency of illicit alcohol\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe laboratory and survey findings from Table 3 demonstrate substantial variability in alcohol by volume (ABV) values across illicit beverages of common types. Illicit spirits such as Kampala\u0026rsquo;s \u0026ldquo;Crude Waragi\u0026rdquo; ranged between 42.4\u0026ndash;44.2% ABV and Arua\u0026rsquo;s \u0026ldquo;Nguli\u0026rdquo; ranged15.4\u0026ndash;20.4% ABV. Some of other illicit brands also exhibited marked deviations from declared or expected strength, with differences ranging up to 8.9%. The survey corroborated these laboratory findings: only 10.5% of producers reported knowledge of the ABV values of their products, with the majority relying on experience rather than standardized measurement. One producer explained, \u003cem\u003e\u0026ldquo;We have no laboratory testing; we rely on experience to judge alcohol potency\u0026rdquo;\u003c/em\u003e (Producer-IDI-Kampala).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethanol composition in illicit alcoholic drinks\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLaboratory analyses in Table 3 revealed substantial variation in methanol content across different illicit alcoholic beverages. Methanol concentrations in Kampala\u0026rsquo;s \u0026ldquo;Crude Waragi\u0026rdquo; were very high, with one sample reaching 640.59 mg/L, and others at 173.57 mg/L and 219.90 mg/L. In Arua, \u0026ldquo;Spirit-05\u0026rdquo; exhibited negligible levels (\u0026lt;0.5). These levels far exceed internationally recognized safe limits for methanol (50 mg/L) in alcoholic beverages. The data also suggest a regional pattern, with Kampala-based illicit alcohol presenting the highest chemical hazard.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMicrobiological contamination in illicit alcoholic beverages\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMicrobial safety assessment of opaque beers in Table 3 revealed no presence of E. coli, total coliforms, or Salmonella sp., indicating minimal faecal contamination. However, Staphylococcus aureus a pathogen commonly linked to poor hygiene and post-production contamination was detected in several samples. In Arua, \u0026ldquo;Opaque -01\u0026rdquo; contained 1.1 \u0026times; 10⁴\u0026nbsp;cfu/mL, while in Kampala,\u0026nbsp;\u0026ldquo;Opaque -05\u0026rdquo; and \u0026ldquo;Opaque -03\u0026rdquo; had 3.0 \u0026times; 10⁴\u0026nbsp;cfu/mL and 3.5\u0026nbsp;\u0026times;\u0026nbsp;10\u0026sup3;\u0026nbsp;cfu/mL, respectively. Other samples such as\u0026nbsp;\u0026ldquo;Opaque -02\u0026rdquo;\u0026nbsp;showed lower or undetectable levels. 46.5% of production sites stored water in dirty, uncovered containers, facilitating contamination. Producers acknowledged minimal hygiene: \u0026quot;Some producers use whatever containers are available, hygiene is minimal\u0026quot; (Producer-IDI-Kampala). Producers also reported: \u0026quot;\u003cem\u003eOpaque beer is also produced occasionally, but waragi [crude] is the mainstay because it sells faster\u003c/em\u003e\u0026quot; (Producer-IDI-Kampala).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eABV% and Biochemical Composition\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSample ID\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLocation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%AVB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMethanol (mg/l)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIllicit Spirits\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eSpirit-01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eKampala\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e44.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e173.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eSpirit-02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eKampala\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e42.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e219.90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eSpirit-03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eKampala\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e36.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e2.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eSpirit-04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eKampala\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e36.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026lt;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eSpirit-05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eArua\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e36.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u0026lt;0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eSpirit-06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eKampala\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e39.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e1.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eSpirit-07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eKampala\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 23px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e640.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIllicit Opaque Beers\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSample ID\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLocation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStaphylococcus aureus (cfu)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eOpaque -01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eArua\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e1.1 \u0026times; 10\u003csup\u003e4\u0026nbsp;\u003c/sup\u003e/mL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eOpaque -02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eArua \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003eNIL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eOpaque -03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eKampala\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e3.5 \u0026times; 10\u003csup\u003e3\u003c/sup\u003e /mL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eOpaque -04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eKampala\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e7 \u0026times; 10\u003csup\u003e2\u003c/sup\u003e /mL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eOpaque -05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eKampala\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e3.0 \u0026times; 10\u003csup\u003e4\u0026nbsp;\u003c/sup\u003e/mL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 26px;\"\u003e\n \u003cp\u003eOpaque -06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24px;\"\u003e\n \u003cp\u003eKampala\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003eNIL\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eHygiene and Sanitation in Production and Retail of Illicit Alcohol\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study results from (Figure 1) reveal that poor storage of finished products was higher in Kampala (73%) compared to Arua (27%). Poor material storage facilities were also widespread as observed in Kampala (58.6%) than in Arua. The study results also show absence of pest control measures affecting nearly half of the producers in both locations (49.2% in Kampala and 50.8% in Arua). Inadequate sanitation was slightly higher in Kampala (53.5%) compared to Arua\u003c/p\u003e\n\u003cp\u003eWorker-related unhygienic concerns were also evident with more than one-half from Kampala (53%) and 47% in Arua, while poor worker hygiene was documented at 53.4% in Kampala and 46.6% in Arua, increasing the possibility of direct contamination of products. The study results show that the use of unsanitary tools was another major issue, particularly in Kampala (60.1%). Additionally, about 64.4% of producers in Kamapala displayed poor water quality in their production which poses a great public health risk, with 64.4% of producers in Kampala. Similarly, dirty production areas were more common in Kampala (62.4%) than in Arua (37.6%). Finally, unsanitary location and surroundings were highly prevalent in Kampala (69.8%) compared to Arua (30.2%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA comparative analysis of Kampala and Arua across various hygiene and sanitation indicators discloses different disparities (Table 4). Kampala consistently displayed higher proportions across several indicators. Almost half of production sites operated in hazardous surroundings, including proximity to waste disposal areas and polluted water sources. This was more common in Kampala (80.2%) than Arua (19.8%), p=0.000. Urban producers explained that affordability and access to space dictated these choices: \u0026ldquo;\u003cem\u003eWe work near the drainage because that is the only space we can afford. Customers don\u0026rsquo;t care about the surroundings, they care about cheap alcohol\u003c/em\u003e\u0026rdquo; (Producer\u0026ndash;IDI, Kampala). By contrast, rural informants highlighted coping strategies such as water treatment before use: \u0026ldquo;\u003cem\u003eThe water in villages may come from streams, but people here often boil or filter before use. In town, they just use what is available in jerrycans, clean or not\u003c/em\u003e\u0026rdquo; (KII\u0026ndash;DHO, Arua).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDirty or visibly contaminated premises were significantly higher in Kampala (62.3%) p=0.000). Water storage practices showed a bit high rural vulnerability (50.5%). About 56.4% of Kampala producers used uncovered or dirty containers compared to relatively fewer respondents in Arua (p=0.047). Producers across both sites admitted reliance on makeshift or reused equipment: \u0026ldquo;\u003cem\u003eWe use metal drums and plastic containers; some are recycled, but we clean them before use. Some producers use whatever containers are available, hygiene is minimal\u003c/em\u003e\u0026rdquo; (Producer\u0026ndash;IDI, Kampala). Retailers confirmed the same, describing resale in reused bottles or cups: \u0026ldquo;\u003cem\u003eWe sell in small cups and reused bottles; not everyone cleans them, but most customers do not complain\u003c/em\u003e\u0026rdquo; (Retailer\u0026ndash;IDI, Kampala).\u003c/p\u003e\n\u003cp\u003eNearly all workers in production sites lacked protective gear, with personal hygiene lapses more common in Kampala (55.6%). Unsanitary practices, such as eating or smoking during production were widespread in both production sites (p=0.000) Producers attributed these lapses to poverty and informality: \u0026ldquo;\u003cem\u003eWe cannot buy gloves or masks; that is for big factories, not for us\u003c/em\u003e\u0026rdquo; (Producer\u0026ndash;IDI, Kampala). Urban producers more frequently used dirty or poorly maintained tools with no cleaning supplies higher in Kampala (54.7%). Pest infestation was also high in Kampala (58.1%) compared to Arua (p=0.079). Retailers offered corroborating accounts: \u0026ldquo;\u003cem\u003eRats and cockroaches are everywhere. We just cover the jerrycan and sell quickly before customers notice\u003c/em\u003e\u0026rdquo; (Retailer\u0026ndash;IDI, Kampala).\u003c/p\u003e\n\u003cp\u003eRetail-level hygiene, the rural\u0026ndash;urban divide extended to retail outlets. Unsanitary retail environments were significantly more common in Kampala, where 61.9% of outlets displayed products in visibly dirty conditions compared to 38.1% in Arua (p=0.004). Unsafe storage (direct sunlight or open containers) was reported in 66.2% of urban outlets vs 33.8% rural. While Kamapala retailers more often linked alcohol to consumer illness (68.9%), urban retailers normalized spoilage as inevitable: \u0026ldquo;\u003cem\u003eSometimes it smells bad, but customers still buy because it is cheap\u003c/em\u003e\u0026rdquo; (Retailer\u0026ndash;IDI, Kampala). Notably, about 50% of outlets across both sites offered no warnings or health information to consumers (p=0.041). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTable\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e4\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e:\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003eProportion of illicit alcohol production sites and retailers by district with poor hygiene and sanitation indicators\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndicator\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eArua n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKampala n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eEnvironmental hazards\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e17(19.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e69(80.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eVisible contamination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e49(37.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e81(62.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003ePoor waste disposal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e23(34.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e43(65.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eUnsafe water\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e11(36.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e19(63.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eDirty water storage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e47(50.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e46(49.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.887\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eDirty tools\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e48(43.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e62(56.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003ePoor hygiene (general)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e36(44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e45(55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.195\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eNo cleaning supplies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e62(45.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e75(54.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003ePest infestation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e31(41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e43(58.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.079\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eUnsafe storage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e12(18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e52(81.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRetailers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003ePoor Retail Area Hygiene\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e32(38.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e52(61.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eDirty area\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e20(35.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e37(64.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eDirty hands\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e18(31.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e40(69.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eUnsanitary transfer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e32(44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e40(55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.239\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003ePoor Storage \u0026amp; Display\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e26(33.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e51(66.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eExposed to elements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e22(34.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e41(65.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eSigns of Contamination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e25(37.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e41(62.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eVisible contamination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e12(48.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e13(52.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.831\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eConsumer illness reports\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e14(31.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e31(68.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eConsumer risks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e27(38.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e43(61.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eNo warnings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e72(46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e84(53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e0.041\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe demographic profile of illicit alcohol producers and retailers in Uganda reflects entrenched socio-economic vulnerabilities and gendered livelihood patterns. Production was largely the domain of women, echoing findings from other African contexts where brewing is woven into household survival strategies(24). While this has often been framed as empowerment through income generation, others argue that the hazardous conditions and criminalization of such work trap women in cycles of poverty and marginalization (25,26). Recent gendered livelihood studies similarly show that women\u0026rsquo;s dominance in brewing is both an economic opportunity and a health liability, especially where regulatory gaps persist (Local academic/field studies, 1990s\u0026ndash;2020s). Retailing, by contrast, attracted a more balanced gender mix and generated relatively higher earnings, suggesting that while distribution is more profitable, it is equally fraught with neglect of regulatory oversight. These observations illustrate how risks and rewards are unevenly distributed across the illicit alcohol value chain, shaping who bears the brunt of exposure and responsibility.\u003c/p\u003e\n\u003cp\u003eBeyond these socio-economic dynamics, the most urgent concern emerging from this study is the unpredictable, inconsistent and often undeclared alcohol strength in illicit beverages. Large deviations between the measured and stated alcohol by volume (ABV) values expose consumers to unpredictable potency, with significant implications for acute intoxication, poisoning, and dependence. The fact that most producers acknowledged no knowledge of alcohol strength underscores a critical regulatory gap: consumers are denied even the most basic information about the products they consume. This mirrors findings from Kenya and Tanzania, where artisanal producers estimate rather than test alcohol strength, leaving drinkers vulnerable to unsafe exposures (27). Broader market analyses confirm that more than 65% of Uganda\u0026rsquo;s alcohol is illicit, consumed largely without labelling or traceability, reinforcing the systemic nature of this risk(15,28)\u003c/p\u003e\n\u003cp\u003eThe danger is further compounded by methanol contamination, which was particularly acute in urban samples. Similar incidents across Africa and Asia have been linked to outbreaks of blindness and death (29,30). Outbreak investigations in Uganda have traced fatalities directly to adulteration during production, where methanol was substituted for ethanol to reduce costs (17,18). Reviews of global methanol poisoning patterns emphasize that these are rarely accidents alone: poverty, weak enforcement, and perverse market incentives drive recurrent adulteration(1,31). The pattern observed here, with urban products showing consistently higher methanol levels than rural ones, suggests that competitive pressures in cities may push producers toward unsafe practices. This complicates intervention, for while technical training could reduce accidental contamination, addressing deliberate adulteration demands stronger enforcement, community awareness, and clinical preparedness (32,33)\u003c/p\u003e\n\u003cp\u003eMicrobiological analysis painted a subtler picture. While opaque beers showed limited faecal contamination, the frequent detection of Staphylococcus aureus pointed to lapses after fermentation, particularly during handling and storage. Fermentation itself is sometimes credited with suppressing pathogens, yet its protective effect was undermined here by unhygienic practices(34). The risk, therefore, does not manifest as explosive outbreaks of diarrhoeal disease but rather as a steady burden of sporadic foodborne illness linked to unsafe handling and poor storage (35). Recent field studies in Zambia confirm similar sanitation risks in illicit alcohol production and retail, highlighting pests, waste accumulation, and unclean equipment as drivers of consumer exposure (36). This reinforces the argument that the dangers of illicit alcohol cannot be reduced to chemical composition alone; they are deeply entwined with hygiene behaviours and environmental exposures.\u003c/p\u003e\n\u003cp\u003eMany brewers operated in hazardous surroundings, often adjacent to waste sites, drainage channels, or other polluted spaces. In urban areas, land pressures and affordability forced producers into these unsafe locations, amplifying exposure to environmental contaminants(37). Water, the most fundamental input in alcohol production, was frequently drawn from sources stored in uncovered or visibly dirty containers, making contamination almost inevitable. Waste disposal practices were equally poor, with refuse and by-products often discarded nearby, attracting flies and rodents that in turn contaminated production sites(38). Equipment hygiene reflected similar neglect: many brewers relied on unwashed or damaged tools, sometimes reusing containers without cleaning them, in part, because cleaning supplies were scarce or unaffordable. Pest infestation, a near-universal problem, further increased the likelihood of contamination(39). Such unsanitary conditions have been widely documented as symptomatic of the contradictions between poverty-driven livelihoods and consumer safety in informal alcohol economies(38\u0026ndash;42).\u003c/p\u003e\n\u003cp\u003eThese conditions were mirrored and extended in the retail environment. Alcohol was often stored in visibly dirty spaces, with products exposed to sunlight or heat that accelerated spoilage. Retailers handled beverages with bare hands, served drinks in unwashed bottles or cups, and rarely provided information or warnings to consumers. Many outlets operated without regard for proximity to schools, markets, or government offices, making unsafe alcohol a normalized everyday commodity, particularly in urban neighbourhoods. Consumers routinely encountered products with sediment or spoilage but consumed them regardless, reflecting how deeply entrenched this normalization has become. WHO 2018 confirm that affordability, accessibility, and cultural familiarity sustain this demand even where risks are well recognized (43,44)\u003c/p\u003e\n\u003cp\u003eA striking feature of these findings is the contrast between Kampala and Arua. In almost every indicator, the capital city exhibited more hazardous practices than the rural district. Whereas some rural producers reported boiling or filtering water before use, urban producers appeared constrained by cost, space, and time, which discouraged even modest protective measures. The consequence is that urban communities are doubly exposed facing both higher chemical risks from methanol and ABV inconsistency, and greater environmental and microbiological risks linked to unhygienic surroundings. This urban\u0026ndash;rural divide resonates with broader debates on slum urbanization and health inequities, and has been echoed in recent outbreak reports from Arua and Wakiso, where limited infrastructure compounded poisoning risks (17,18,41). Interventions must therefore be carefully tailored: cities require targeted regulation and infrastructural support for slum communities, while rural areas may benefit more from preventive education and community-driven hygiene improvements).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations and strengths\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was limited by its cross-sectional design, which restricts the ability to infer causal relationships between production or retail practices and the observed health risks. Data collection relied partly on self-reports from producers and retailers, raising the possibility of recall bias or deliberate underreporting on sensitive issues such as adulteration and unsafe handling in fear of regulation consequences. Although laboratory analyses offered valuable insights into alcohol strength and contamination, the number of samples tested was relatively small compared to the diversity of illicit beverages circulating in Uganda, which constrains the generalizability of chemical findings. The geographic scope was also restricted to Kampala and Arua; while these sites provided useful contrasts between urban and rural settings, they may not fully represent variations across other regions. Additionally, observational assessments of hygiene and sanitation were based on single site visits, which may not capture fluctuations in practices over time.\u003c/p\u003e\n\u003cp\u003eDespite these limitations, the study demonstrates several methodological strengths. The mixed-methods design, integrating quantitative surveys, structured observations, laboratory testing, and qualitative interviews, enabled robust triangulation of findings across different sources of data. The combination of laboratory testing with field-based assessments provided concrete evidence on both chemical hazards such as methanol contamination and alcohol strength variability and environmental risks arising from poor hygiene and unsafe storage. The inclusion of perspectives from producers, retailers, and consumers grounded the findings in lived realities, offering a richer and more nuanced understanding of the socio-economic drivers and public health implications of illicit alcohol in Uganda.\u003c/p\u003e"},{"header":"Conclusion and recommendations ","content":"\u003cp\u003eWe conclude that illicit alcohol in Uganda poses severe risks to public health and community safety due to unpredictable alcohol strength, methanol contamination, and unsanitary production and retail practices. Addressing these risks requires enforcement of existing alcohol regulations through routine inspections and random quality-control checks, alongside targeted public health campaigns to raise awareness about the dangers of unregulated alcohol. Safer production and handling could be promoted through community training, provision of basic protective equipment, and improved sanitation practices. Livelihood alternatives should be prioritized, particularly for women who dominate production, to reduce dependence on unsafe brewing as a source of income. Integrating alcohol safety surveillance into public health systems, coupled with consumer education and access to affordable regulated beverages, can deter hazardous production practices and reduce alcohol-related harm at scale. Additionally, targeted interventions for youth and economically active populations such as awareness programs, alternative livelihoods, and safer recreational spaces are critical to reducing the social harms associated with illicit alcohol.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eABV Alcohol by Volume \u003c/p\u003e\n\u003cp\u003ecfu/mL Colony-Forming Units per millilitre\u003c/p\u003e\n\u003cp\u003eDHO District Health Officer \u003c/p\u003e\n\u003cp\u003eEAC East African Community \u003c/p\u003e\n\u003cp\u003eISO International Organization for Standardization\u003c/p\u003e\n\u003cp\u003eKCCA Kampala Capital City Authority \u003c/p\u003e\n\u003cp\u003eMAKSSREC Makerere University School of Social Sciences Research Ethics Committee \u003c/p\u003e\n\u003cp\u003emg/L Milligram per Litre \u003c/p\u003e\n\u003cp\u003eMoH Ministry of Health \u003c/p\u003e\n\u003cp\u003eSPSS Statistical Package for the Social Sciences\u003c/p\u003e\n\u003cp\u003eUNBS Uganda National Bureau of Standards\u003c/p\u003e\n\u003cp\u003eUNCST Uganda National Council for Science and Technology \u003c/p\u003e\n\u003cp\u003eWHO World Health Organisation \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Uganda National Council for Science and Technology (UNCST) and the Makerere University School of Social Sciences Research Ethics Committee (MAKSSREC) Ref no. MAKSSREC2024-782, with additional clearance from the Kampala Capital City Authority (KCCA) Ref no. DPHE/KCCA/130/01.\u0026nbsp;Informed consent was obtained from the participants before data collection ensuring their right to withdrawal and volunteer participation\u0026nbsp;in accordance to the Declaration of Helsinki (2024 revision).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study required and obtained informed consent from participants and for participants data to be used and published in related research outputs. All data has been anonymised for confidentiality purposes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available as the individuals participating in this survey did not consent for their data to be shared beyond the research team, but are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAside from the funding source, all other authors declare no conflict of interest in the conduct of this study. AR and TA declare that they are full time employees of AB InBev Foundation. According to authors, the study was carried out without any financial or commercial ties that might be seen as a potential conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe AB InBev Foundation provided financial support for the study and publication of this article, according to the authors. The writers alone are responsible for the material, which may not represent the views of AB InBev or the AB InBev Foundation. All content is subject to ultimate, independent decision-making power by the writers and Arrow Empirical Research \u0026amp; Skills Enhancement (AERSE), as agreed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSPR: Conceptualization, Formal analysis, Investigation, Designing Methodology, Writing \u0026ndash; original draft, Writing \u0026ndash; review \u0026amp; editing and Investigation. \u0026nbsp;MT: Designing the sampling strategy, Developing the data analysis plan, Project administration, Advanced statistical analyses, Writing original draft, Writing - review \u0026amp; editing. KN: \u0026nbsp;Conceptualization, Project design, designing the methodology, Resources, visualization, overseeing ethical approvals, Coordination, Analysis, writing original draft, Writing-review \u0026amp; editing, and disseminating results to stakeholders. CZ: \u0026nbsp; \u0026nbsp;Editing and reviewing. CK: Writing original draft, reviewing \u0026amp; editing, Formal analysis., Methodology, review \u0026amp; editing. LM: project design, Manuscript editing and reviewing. MS: Data collection, Analysis, Writing, review \u0026amp; editing. MM: Manuscript Editing and reviewing. SM: Formal analysis, Investigation. AR: Conceptualization, review \u0026amp; editing, Funding acquisition and Resources. TA: Conceptualization, Funding acquisition, Investigation, Methodology, Project administration, Resources, and Writing, review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors wish to acknowledge Makerere University, College of Natural sciences, Department of Chemistry Reference Laboratory, AB InBev, the sponsors of the study, Makerere University School of Social Sciences Research Ethics Committee (MAKSSREC), Kampala Capital City Authority (KCCA), and Arua district local government, for granting us permission to conduct this study. We also would like to thank all the key informants for providing all essential information.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSupplementary material\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn English language version for the tools used during this study have been uploaded as supplementary file of this manuscript.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eManning L, Kowalska A. Illicit alcohol: Public health risk of methanol poisoning and policy mitigation strategies. Foods [Internet]. 2021;10(7):1\u0026ndash;16. Available from: https://doi.org/10.1093/alcalc/agaf018\u003c/li\u003e\n\u003cli\u003eZyambo C, Phiri MM, Zulu R, Mukupa M, Mabanti K, Matenga TFL, et al. Illicit alcohol consumption and its associated factors among patrons in Zambia: a cross-sectional analytical study. 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Available from: https://www.who.int/docs/default-source/resources/bp-the-public-health-burden-of-unsafe-foods---a-need-for-global-commitment-en.pdf\u003c/li\u003e\n\u003cli\u003eMukupa M, Zyambo C, Phiri MM, Zulu R, Matenga TFL, Mabanti K, et al. Hygiene and sanitation public health risks in illicit alcohol production and retail in Zambia. Front Epidemiol. 2025;5(April):1\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eFazzo L, Manno V, Iavarone I, Minelli G, De Santis M, Beccaloni E, et al. The health impact of hazardous waste landfills and illegal dumps contaminated sites: An epidemiological study at ecological level in Italian Region. Front Public Heal. 2023;11. \u003c/li\u003e\n\u003cli\u003eAkhtar N, Syakir Ishak MI, Bhawani SA, Umar K. Various natural and anthropogenic factors responsible for water quality degradation: A review. Water (Switzerland). 2021;13(19). \u003c/li\u003e\n\u003cli\u003eBingham G V., Hagstrum DW. Importance of Sanitation for Stored-Product Pest Management. Insects. 2024;15(1):1\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eCallinan S, Laslett A-M, Rekve D, Room R, Waleewong O, Benegal V, et al. Alcohol\u0026rsquo;s harm to others: An international collaborative project. Int J Alcohol Drug Res. 2016;5(2):25\u0026ndash;32. \u003c/li\u003e\n\u003cli\u003eEze NM, Njoku HA, Eseadi C, Akubue BN, Ezeanwu AB, Ugwu UC, et al. Alcohol consumption and awareness of its effects on health among secondary school students in Nigeria. Med (United States). 2017;96(48). \u003c/li\u003e\n\u003cli\u003eObi DC, Obijiofor IB, Obi-Okaro AC, Nnebue CC, Obi AC, Ezenyeaku CA, et al. Investigating Substance Abuse in Vulnerable Nigerian Youth: A Cross-Sectional Study of Out-of-School Adolescents. Niger Heal J. 2024;24(3):1402\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eNichifor B, Zait L, Timiras L. Drivers, Barriers, and Innovations in Sustainable Food Consumption: A Systematic Literature Review. Sustain [Internet]. 2025;17(5). Available from: https://doi.org/10.3390/%0Asu17052233\u003c/li\u003e\n\u003cli\u003eHammer JH, Parent MC, Spiker DA, World Health Organization. Global status report on alcohol and health 2018 [Internet]. Vol. 65, Global status report on alcohol. 2018. 74\u0026ndash;85 p. Available from: http://www.who.int/substance_abuse/publications/global_alcohol_report/msbgsruprofiles.pdf%0Ahttp://www.ncbi.nlm.nih.gov/pubmed/29355346\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Health Risks, Illicit Alcohol, Alcohol Content, Hygiene, Production, Retail, Uganda","lastPublishedDoi":"10.21203/rs.3.rs-8041331/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8041331/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e Illicit alcohol, produced and sold outside regulation, is a global health concern due to risks of contamination, methanol poisoning, and unsafe alcohol strength. Uganda records one of the highest alcohol consumption rates in Africa, with more than half of its production classified as illicit. Unsafe production environments, poor hygiene, and limited regulatory enforcement exacerbate public health and safety risks.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003e This study assessed health risks and public safety concerns associated with illicit alcohol in Uganda, focusing on alcohol strength, methanol contamination, and hygiene and sanitation in production and retail settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A cross-sectional mixed-methods design was employed in Kampala and Arua between October and November 2024. Data was collected from 400 producers and retailers through surveys, structured observations, and laboratory analyses of alcohol content, methanol levels, and microbial contamination, supplemented with 20 key informant and in-depth interviews.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Findings revealed inconsistent and often under-declared alcohol strength up to 44.2%, with methanol concentrations in some spirits exceeding safe limits up to 640.59 mg/L. Opaque beers showed contamination with \u003cem\u003eStaphylococcus aureus\u003c/em\u003e, linked to poor hygiene during handling and storage. Observation scores highlighted widespread unsanitary practices, including unsafe water source 36.7% in Arua and 63.3% in Kampala, dirty production areas 44.2% in Arua and 55.8% in Kampala, pest infestation, and lack of protective equipment. Retail environments mirrored these risks, with alcohol commonly served with dirty hands (31% in Arua and 69% in Kampala) and often stored, sold in unsafe containers/ environment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion and Recommendations:\u003c/strong\u003e Illicit alcohol production and retail in Uganda present significant chemical, microbiological, and environmental risks, compounded by regulatory gaps and lack of awareness of ABV among producers. The unpredictability of alcohol strength, unsafe packaging, and unsanitary production environments underscore the scale of the public health threat, particularly in urban centres like Kampala. There is urgent need for strengthening regulatory oversight, including mandatory ABV testing and clear labelling requirements for alcoholic beverages. Community-based sensitization campaigns should address consumer awareness of alcohol strength and risks of illicit products. Enforcement of hygiene and sanitation standards in production and retail outlets, coupled with provision of affordable protective equipment and safe water, could mitigate contamination risks. There is need for a multi-sectoral collaboration between public health authorities, law enforcement, and community leaders is essential to reduce the public health burden of illicit alcohol.\u003c/p\u003e","manuscriptTitle":"Health Risks and Public Safety Concerns of Illicit Alcohol in Uganda: Alcohol Content, Hygiene \u0026amp; Sanitation in Production and Retail","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-17 13:59:24","doi":"10.21203/rs.3.rs-8041331/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-12-12T10:47:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-08T13:30:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-14T05:24:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-13T12:45:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-11-13T12:41:50+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4ff4d53d-02b7-4a70-9937-fef0c3da8b33","owner":[],"postedDate":"December 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-17T13:59:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-17 13:59:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8041331","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8041331","identity":"rs-8041331","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}