Consumption and impacts of local brewed alcohol (akpeteshie) in the Upper West Region of Ghana: a public health tragedy

Abstract

This paper is part of a larger project on the consumption of a locally made alcohol, akpeteshie, and its impact on the health and well-being of the people in the Upper West Region of Ghana. The paper reports the findings of a qualitative study using focus group discussions about community perceptions and impacts of akpeteshie. Focus groups were undertaken differently for men (n=25) and women (n=20), and the contents were analysed using grounded theory and from a social learning perspective. Participants indicated that both the elderly and the young were engaged in the use and abuse of akpeteshie. Men drink mainly for coping responses, such as, increased self–confidence, adult status, and to cope with the various social demands. Women seem to drink for socialising with peers. Akpeteshie drinking by both men and women is on the rise, and is increasingly used for sexual abuse and rape. The findings reveal strong perceptions of the health and economic damage that alcohol is having on the people of the area; and the need for policy intervention that not only target health promotion, but an improvement of the socioeconomic conditions of the people and the akpeteshie vendors in the region.

Introduction

Alcohol issues today are on the rise and a cause for intense public health concern in both developed and developing countries of the world (see Ziervogel; Morojele; Van Der Riet; Parry, & Robertson; 1998; Holders; 1998; London; 1999). While there is extensive literature on alcohol use and abuse in developed countries, the same cannot be said about developing countries. However, in poorer nations the adverse consequences of the abuse of alcohol may be beginning to threaten the health of these nations and their national development (Houghston & Roche, 2001; Lamptey; 2001). in sub-saharan africa; Except for South Africa (e.g., Ziervogel et al., 1998; London (1999), London; 1999 (2000)), studies on the use and abuse of alcohol are extremely rare; with existing work mostly focusing on the urban contexts and/or adolescents (e.g., Ziervogel, Ahmed, Flisher, & Robertson, 1997; Ziervogel et al., 1998). In Ghana, Akyeampong (1996a) provides an elaborate historical perspective of alcohol in the country. however; Akyeampong's work focused on urban Ghana without much on what is happening in the rural areas (see also Willis, 1997) and also in the northern part (upper west; East and northern regions) of Ghana (Fig. 1).

In Ghana, the production and consumption of various forms of alcoholic beverages are an important part of daily life. While beer and other imported alcoholic drinks are expensive and scarce, a locally produced gin called akpeteshie is common and relatively cheaper. Akpeteshie is distilled from fermented palm wine or sugar cane juice in the southern parts of Ghana. The methods mostly used to distill akpeteshie are still relatively crude requiring a simple apparatus of two tins (usually four gallon kerosene tins) and copper tubing. The fermented palm wine or sugar cane juice is boiled with a coiled copper tube running from the boiling container through a receptacle filled with cooled water into an empty container. Steam rises from the boiling palm wine or sugar cane juice, condenses as it passes through the cool water and drips as gin into an empty container. While palm wine contains 3 to 5 per cent of alcohol by volume, the standardised alcohol strength of akpeteshie is between 40 and 50 per cent of volume (see Akyeampong, 1996b). It is possible akpeteshie contains large amounts of ethyl alcohol, and unknown amounts of organic acids, esters, aldehydes, methyl alcohol, and substances absorbed from the containers used for distillation or for storage.

Political, economic and cultural factors in Ghana influence the use and abuse of alcohol generally. Apketeshie was first legalised in Ghana in 1962, an act that was attributed to political pressure on the ruling government by party members who distilled the drink (Akyeampong (1995), Akyeampong (1996a)). This legalisation also enabled local producers to distribute it across the country. Prior to the introduction of akpeteshie to northern Ghanaian communities, the most common traditional brewed beverge drink was pito.¹ Pito drinking has always been considered a social event for meeting other community members, finding out about events in the community, and lending social support.

In the traditional Ghanaian context where there is little or no law enforcement, values are articulated and enforced in a lineage context, through older men and women exerting their authority as fathers and mothers, as guardians of sons and daughters (Akyeampong, 1995). In the past, it was the elders’ main responsibility, and in their interests to keep their younger kinsmen from drinking (see Akyeampong, 1996b). In the Upper West Region (UWR), and in fact other parts of Ghana, socioeconomic change (even under recently acclaimed economic successes through structural adjustment programmes), has brought deep, severe and massive economic hardships to both men and women (see Anyinam, 1989; Konadu-Agyemang, 2000).

Consequently, both men and youth are involved in the abuse of akpeteshie and other alcoholic drinks. However, similar to most public health and policy issues, government intervention on alcohol consumption normally boils down to “sweet political talk”. Repeated attempts to control akpeteshie through measures such as the prohibition of certain imports and through police campaigns against local distillation have proved ineffective (Akyeampong, 1995), except in a few isolated cases. For example, between 1972 and 1978, in response to the severe health and economic impact akpeteshie was having on people in the then Upper Region (now split into the Upper West and Upper East regions — see Fig. 1), the Regional Commissioner of the then ruling military government, Col. George Minyela, banned the importation and sale of akpeteshie in the region. However, by 1978 the Acheampong's government was overthrown in another military coup, and that ended the policy banning alcohol into this deprived region. Since then, there has been a free flow of akpeteshie from southern Ghana into the northern regions. More recently, there have been sporadic actions by individual communities or groups to solve the problem of akpeteshie consumption in their local communities. For example, recognizing that akpeteshie consumption and related consequences such as clan violence and fighting increased during funerals, the Chief and people of Guo in the Lawra District of the UWR banned the sale and use of apketeshie in their traditional area during funerals (see Ghana News Agency, 1999).

Despite the potential threats to the health of the region, there have been no coherent studies nor government strategy to address the problem. As part of a larger research to investigate the impact of akpeteshie in the region, this study reports the findings of a qualitative investigation which was conducted during June–July 2001, with three primary objectives: to explore the factors leading to rising akpeteshie consumption in the UWR of Ghana; to explore public perceptions of the impacts of akepteshie in the region; and to explore what the people consider to be the strategies that should be used to solve the problem of akpeteshie consumption.

The study was conducted in Charia, Wa District, UWR, Ghana. The paper provides a promising start to gaining insight into a topic that arouses great emotions and is surrounded by embarrassment both among men and women, and among the elderly and younger generations.

Drinking together is a social norm and serves to bind members of a group in ways that other joint activities do not. While drinking is one of the more potent ways in which people learn about their position in society (e.g., Houghton & Roche, 2001), all of the major theories of drinking and alcohol problems indicate the role of emotional regulation (Lang, Patrick & Stritzke, 1999; Maisto, Carey, & Bradizza, 1999; Houghston & Roche, 2001; Holahan, Moos, Holahan, Cronkite, & Randall, 2001). The social learning perspective draws attention to alcohol abuse as a habitual maladaptive coping response adopted by individuals who hold beliefs about the effects of alcohol (see Bandura, 1977; Abrams & Niaura, 1987; Cooper, Russell, Skinner, Frone, & Muder, 1992; Maisto et al., 1999). Both theory and research suggest that individuals with insufficient coping responses and strategies are more likely to drink and drink more in response to stressful situations or circumstances in their everyday lives (Cooper, Russell, & George, 1988; Williams & Clark, 1998). In general, reliance on avoidance coping consistently predicts more alcohol consumption and a lower likelihood of abstinence. Further, drinking to cope with distress has been associated with solitary drinking practices (Smith, Abbey, & Scott, 1993) and is also more likely to lead to abusive drinking than is social drinking (Abbey, Smith, & Scott, 1993).

Preconceived beliefs about the positive and negative outcomes of drinking alcohol are viewed as one of the major proximal determinants of drinking behaviour and as a mediator of many of the other psychological influences (see Cooper et al., 1988; Goldman, Del Boca, & Darkes, 1999). For example, the expectancy of tension reduction by alcohol can predict problem drinking (Brown, 1985). While moderate and heavy drinkers can hold greater expectancies of tension reduction from alcohol than do light drinkers (Rohsenow, 1983).

There are widely divergent drinking practices and alcohol effects observed throughout the world, as well as within different groups (MacAndrew & Edgerton, 1969; Johnson & Johnson, 1999; Houghton & Roche, 2001). According to Bandura (1969), sociocultural norms define and shape whether alcohol use will be encouraged at all and, if so, in what quantities and under what conditions. Hence, socially acceptable behaviour related to alcohol use and abuse varies from culture to culture, and also from person to person within a culture, the latter largely being determined by role or occupation, gender, age, status and position in society (see Bandura, 1977; Houghton & Roche, 2001). Consequently, the act of drinking alcohol cannot be understood solely within the context of the individual; it is an act infused with meaning that derives from socially determined conventions and consequences (McDonald, 1994).