Understanding the Impacts and Perceptions of Alcohol Use in Northern Tanzania: A Mixed-Methods Analysis

Abstract Background Worldwide, alcohol is a leading risk factor for death and disability. Tanzania has particularly high rates of consumption and few resources dedicated to minimizing alcohol-related harm. Ongoing policy efforts are hampered by dynamic sociocultural, economic, and regulatory factors contributing to alcohol consumption. Through the voices of Kilimanjaro Christian Medical Center (KCMC) patients and a gender-focused lens, the goal of this project was to investigate community perceptions surrounding alcohol and the impact of its use in this region. Methods This was a mixed-methods study conducted at KCMC between October 2021 and May 2022. 678 adult (≥18 years old) Kiswahili-speaking patients who presented to KCMC’s Emergency Department (ED) or Reproductive Health Clinic (RHC) were enrolled through systematic random sampling to participate in quantitative surveys. Nineteen participants were selected for in-depth interviews (IDIs) through purposeful sampling. The impact and perceptions of alcohol use were measured through Drinkers’ Inventory of Consequences (DrInC) scores analyzed in R Studio through descriptive proportions, and IDI responses explored through a grounded theory approach utilizing both inductive and deductive coding methodologies. Results ED men were found to have the highest average [SD] DrInC scores (16.4 [19.6]), followed by ED women (9.11 [13.1]), and RHC women (5.47 [9.33]), with higher scores indicating greater perceived consequences. Participants noted alcohol has both perceived advantages and clear harms within their community. Increased conflict, long-term health outcomes, financial instability, stigma, and sexual assault were seen as negative consequences. Benefits were primarily identified for men and included upholding cultural practices, economic growth, and social unity. Physical and financial harm from alcohol impacted both genders, however, alcohol-related stigma and sexual assault were found to disproportionately affect women. Conclusion Our findings suggest that perceptions around drinking and alcohol’s social and physical consequences differ significantly by gender. To effectively minimize local alcohol-related harm, future alcohol-focused research and policy efforts should consider the distinct impacts alcohol has between genders.