EMRO 10 06 04 - WHO · Homemade brandy (wine) is brewed in Afghanistan. A plastic tube connects to...

COUNTRY PROFILES EASTERN MEDITERRANEAN REGION

WHO Global Status Report on Alcohol 2004 © World Health Organization 2004

1

AFGHANISTAN

Alcohol consumption Data collected by the WHO Regional Office for the Eastern Mediterranean in 2003 estimates that the extent of alcohol use in Afghanistan is moderate and that data from the last five years suggest an increasing trend in the use of alcohol.1

Traditional alcoholic beverages Homemade brandy (wine) is brewed in Afghanistan. A plastic tube connects to a pressure cooker filled with fermented melons, bananas or grapes that sits in the sun for 30 days before cooking. The alcohol is made for home consumption and not for sale.

Morbidity, health and social problems from alcohol use The first ever assessment of drug use in the Afghan capital Kabul has shown that alcohol is consumed by nearly 7000 people across the city. The assessment, made by the United Nations, also shows that many returning refugees and women are among the users. In addition, the war, poverty, and unemployment have meant that many people suffer from anxiety and emotional and health problems and turn to drinking as an escape.2

Country background information

Total population 2003 23 897 000 Life expectancy at birth (2002) Male 41.9

Adult (15+) 13 621 290 Female 43.4 % under 15 43 Probability of dying under age 5 per 1000 (2002) Male 258

Population distribution 2001 (%) Female 256

Urban 22 Gross National Income per capita 2002 US$ *

Rural 78 *Estimated to be in the low income range ($735 or less) In Afghanistan, it is estimated that 99% of the population are Muslim.

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Factbook 2003, The World Health Report 2004

References 1. World Health Organization/World Health Organization Regional Office for the Eastern Mediterranean

Questionnaire for Regional Situation Analysis on Drug Abuse 2003. Cairo, WHO Regional Office for the Eastern Mediterranean.

2. MacWilliam I. Afghans seek relief in drugs. BBC News, 7 August 2003.



2

BAHRAIN

Recorded adult per capita consumption (age 15+)

Sources: FAO (Food and Agriculture Organization of the United Nations), World Drink Trends 2003

Data collected by the WHO Regional Office for the Eastern Mediterranean in 2003 estimates that there is no alcohol use in Bahrain and that data from the last five years suggest a stable trend in the use of alcohol.1

Traditional alcoholic beverages Arak (grape spirit flavoured with aniseed) is commonly drunk in Bahrain.

Morbidity, health and social problems from alcohol use Between 1971 and 1975, psychiatric inpatient admissions for alcoholism increased from 5.1 to 15.5 and readmission rates went from 3.2 to 11.5 per 100 000 persons. Alcohol-related crime rates per 1000 population increased from 1.9 to 4.4 from 1970 to 1975. Traffic accidents involving alcohol rose from 2.5 per 1000 licensed drivers in 1974 to 3.2 in 1975.2

Country background Information

Total population 2003 724 000 Life expectancy at birth (2002) Male 72.1 Adult (15+) 514 040 Female 74.5 % under 15 29 Probability of dying under age 5 per 1000 (2002) Male 13


Urban 93 Gross National Income per capita 2002 US$ 11 130

Rural 7 In Bahrain, it is estimated that 100% of the population are Muslim.




0

1

2

3

4

5

6

7

8

1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Litr

es o

f pu

re a

lcoh

ol

Total

Beer

Spirits

Wine



3

2. Magruder KM. Alcohol problems in Bahrain [thesis]. Chapel Hill, University of North Carolina. In: National Institute on Alcohol Abuse and Alcohol Problems Science Database [online database]. Bethesda, National Institute on Alcohol Abuse and Alcoholism.



4

DJIBOUTI


0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Litr

es o

f pu

re a

lcoh

ol

Total

Beer

Spirits

Wine


Unrecorded alcohol consumption The unrecorded alcohol consumption in Djibouti is estimated to be 0.5 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).1


Total population 2003 703 000 Life expectancy at birth (2002) Male 48.6 Adult (15+) 400 710 Female 50.7 % under 15 43 Probability of dying under age 5 per 1000 (2002) Male 156


Urban 84 Gross National Income per capita 2002 US$ 900

Rural 16 In Djibouti, approximately 94% of the population are Muslim.


References 1. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2.

European Addiction Research, 2001, 7(3):155–157.



5

EGYPT


0

0.1

0.2

0.3

0.4

0.5

0.6

1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Litr

es o

f pu

re a

lcoh

ol

Total

Beer

Spirits

Wine


Data collected by the WHO Regional Office for the Eastern Mediterranean in 2003 estimates that the extent of alcohol use in Egypt is moderate and that data from the last five years suggest a stable trend in the use of alcohol.1

Last year abstainers

Total 99.5%

Mal

e 99

.0%

Fem

ale

100.

0%

Estimates from key alcohol experts show that the proportion of adult males and females who had been abstaining (last year before the survey) was 70% (males) and 98% (females). Data is for after year 1995.3

In a 1985–1986 survey of 5108 men working in the manufacturing industries (age range 14 to 59 years), it was found that 20.1% of the total sample admitted ever drinking alcohol. Most of the alcohol drinkers consumed beer (78.7%), and very few consumed wine (1.3%) or whiskey (0.9%) or any other beverage. In this sample of workers, the ages of onset for experimenting with alcohol was 23.81 (± 7.27) years.4

Data from the 2000–2001 Multi-Country Survey Study. Total sample size n = 4471; males n = 1958 and females n = 2513. Population aged 18 years and above.2



6

High risk drinkers

Total 0.1%

Mal

e 0.

2%

Fem

ale

0.0%

Heavy episodic drinkers

Total 0.1%

Mal

e 0.

1%

Fem

ale

0.0%

Youth drinking (last year abstainers)

Total 99.7%

Mal

e 99

.3%

Fem

ale

100.

0%

In a 1987 study of 14 656 male secondary school students constituting a 4% representative sample of the whole population of Egyptian secondary school boys (subjects ranged in age between slightly less than 15 and about 21 years of age with approximately 92% of them being Muslim and 8% Christian), it was found that 22.49% of the students admitted ever using alcohol. The majority (16.15%) went for beer. The study also found that just before reaching the age of 15 years about 62% of urban wine experimenters have had their first experience in contrast with only 41% of rural experimenters. For other distilled liquors, the corresponding percentages are somewhere around 45% versus 27%.5

In a survey of 2366 female university students (age range 17 to 30 years) from the Greater Cairo region, it was found that 19.32% of the total sample admitted ‘ever drinking alcohol’. Of the whole sample, 9.5% had tried beer, 1.52% wine, and 0.21% whiskey. The rest mentioned other beverages or combinations of beverages. When asked whether they have been going on with drinking until the present survey 38.51% of the ‘ever tried’ group said ‘yes’.6

Data from the 2000–2001 Multi-Country Survey Study. Total sample size n = 4471; males n = 1958 and females n = 2513. Population aged 18 years and above. Definition used: consumption of five or more standard drinks for males and three or more standard drinks for females on a typical drinking day.2

Data from the 2000–2001 Multi-Country Survey Study. Total sample size n = 4471; males n = 1958 and females n = 2513. Population aged 18 years and above. Definition used: at least once a week consumption of six or more standard drinks in one sitting.2

Data from the 2000–2001 Multi-Country Survey Study. Total sample size n = 708; males n = 284 and females n = 424. Population aged 18 to 24 years. For the age group 15 to 19 years (subsample n = 208), the rate of last year abstainers was 100% (total), 100% (males) and 100% (females).2



7

Youth drinking (heavy episodic drinkers)

Total 0.0%

Mal

e 0.

0%

Fem

ale

0.0%

Alcohol dependence (last year)

Total 0.2%

Mal

e 0.

4%

Fem

ale

0.0%

Note: These are preliminary, early-release, unpublished data from WHO's Multi-Country Survey Study made available exclusively for this report. Some estimates may change in the final analyses of these data.

Traditional alcoholic beverages Bouza (traditional beer) is a fermented alcoholic beverage produced from wheat in Egypt, and has been known by the Egyptians since the days of the Pharaohs. It is a thick, pasty yellow beverage and produces a sensation of heat when consumed. Like other opaque beers, bouza has a very short shelf-life and is expected to be consumed within a day. It has an alcoholic content of between 3.8% to 4.2%.7

Unrecorded alcohol consumption The unrecorded alcohol consumption in Egypt is estimated to be 0.5 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).3


Total population 2003 71 931 000 Life expectancy at birth (2002) Male 65.3

Adult (15+) 46 755 150 Female 69.0 % under 15 35 Probability of dying under age 5 per 1000 (2002) Male 38


Urban 43 Gross National Income per capita 2002 US$ 1470 Rural 57 In Egypt, approximately 94% of the population are Muslim.

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Health Report 2004

Data from the 2000–2001 Multi-Country Survey Study. Total sample size n = 708; males n = 284 and females n = 424. Population aged 18 to 24 years old. For the age group 15 to 19 years (subsample n = 208), the rate of heavy episodic drinkers was 0.0% (total), 0.0% (males) and 0.0% (females). Definition used: at least once a week consumption of six standard drinks in one sitting.2

Data from the 2000–2001 Multi-Country Survey Study. Total sample size n = 4476. Population aged 15 years and above. Alcohol dependence was measured using ICD-10 criteria.2



8



2. Ustun TB et al. WHO Multi-Country Survey Study on Health and Health System Responsiveness 2000–2001. In: Murray CJL, Evans DB, eds. Health Systems Performance Assessment: Debates, Methods and Empiricism. Geneva, World Health Organization, 2003.

3. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2. European Addiction Research, 2001, 7(3):155–157.

4. Soueif MI et al. The use of psychoactive substances among Egyptian males working in the manufacturing industries. Drug and Alcohol Dependence, 1988, 21(3):217–229.

5. Soueif MI et al. Use of psychoactive substances among male secondary school pupils in Egypt: a study on a nationwide representative sample. Drug and Alcohol Dependence, 1990, 26(1):63–79.

6. Soueif MI et al. The use of psychoactive substances by female Egyptian university students, compared with their male colleagues on selected items. Drug and Alcohol Dependence, 1987, 19(3):233–247.

7. Haard NF et al. Fermented cereals: a global perspective. Rome, Food and Agriculture Organization of the United Nations, 1999 (http://www.fao.org/docrep/x2184e/x2184e07.htm, accessed 27 March 2004).



9

IRAN (ISLAMIC REPUBLIC OF)


0

0.1

0.2

0.3

0.4

0.5

0.6

1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Litr

es o

f pur

e al

coho

l

Total

Beer

Spirits

Wine


Data collected by the WHO Regional Office for the Eastern Mediterranean in 2003 estimates that the extent of alcohol use in the Islamic Republic of Iran is considerable and that data from the last five years suggest an increasing trend in the use of alcohol.1

Lifetime abstainers in Shiraz

Total 73.4%

Mal

e 60

.4%

Fem

ale

86.3

%

In a study evaluating substance use among a sample of 205 psychiatric inpatients (70 women and 135 men) chosen randomly in Shiraz in the centre of the Fars province, 23.7% of men and 4.3% of women reported having used alcohol once or more in their lives.3

In a study evaluating substance use among a sample of 64 Iranian patients (32 men and 32 women) with nephrologic disease (chronic renal failure), 3.1% of the total sample reported using alcohol once or more in their lives.4

In a study evaluating substance use among a sample of 96 patients with cardiovascular disease admitted into the cardiac ward of general hospitals in 2001, the rate of lifetime abstainers was found to be 91.7%.5

Household survey of a nationally representative sample of 1400 subjects aged 15 years or older in Shiraz, Iran.2



10

Youth drinking (current users among high school students)

Total 4.3%

In a study evaluating prevalence of substance use in a sample of 400 Iranian nursing students (85.25% were female and 14.25% were male; mean age of females was 20.3 and of males was 22.8), 5.8% of the total sample reported usage of alcohol one or more times during their lives. In addition, 3.5% reported using alcohol occasionally, at least once a month.7

Alcohol dependence in Shiraz

Total 7.3%

Mal

e 11

.9%

Fem

ale

2.7%

The same survey also found that 11.4% of the total sample were occasional alcohol abusers (17.3% of men and 5.4% of women). Alcohol abuse was defined by DSM-IV criteria.2


Total population 2003 68 920 000 Life expectancy at birth (2002) Male 66.5 Adult (15+) 46 865 600 Female 71.7 % under 15 32 Probability of dying under age 5 per 1000 (2002) Male 42

Population distribution 2001 (%) Female 36 Urban 65 Gross National Income per capita 2002 US$ 1710

Rural 35 In the Islamic Republic of Iran, approximately 99% of the population are Muslim.




2. Ahmadi J, Sharifi M. Prevalence of alcohol use disorders in Shiraz, Iran. Journal of Substance Use, 2002, 7(4):251–254.

3. Ahmadi J et al. Substance use among Iranian psychiatric inpatients. Psychological Reports, 2001, 89(2):363–365.

4. Ahmadi J, Benrazavi L. Substance use among Iranian nephrologic patients. American Journal of Nephrology, 2002, 22(1):11–13.

2000 study assessing the rate of substance use among Iranian high school students (397 students in total; 200 girls and 197 boys). The same study found the rate of lifetime prevalence of alcohol use among the sample population to be 9.6%.6

A household survey conducted of a nationally representative sample of 1400 subjects aged 15 years or older. DSM-IV criteria for alcohol dependence was used.2



11

5. Ahmadi J, Benrazavi L. Substance use among Iranian cardiovascular patients. European Journal of Medical Research, 2002, 7(2):89–92.

6. Ahmadi J, Hasani M. Prevalence of substance use among Iranian high school students. Addictive Behaviors, 2003, 28(2):375–379.

7. Ahmadi J, Maharlooy N, Alishahi M. Substance abuse: prevalence in a sample of nursing students. Journal of Clinical Nursing, 2004, 13(1):60–64.



12

IRAQ


0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Litr

es o

f pur

e al

coho

l

Total

Beer

Spirits

Wine


Data collected by the WHO Regional Office for the Eastern Mediterranean in 2003 estimates that the extent of alcohol use in Iraq is moderate and that data from the last five years suggest an decreasing trend in the use of alcohol.1


Total 89%

Mal

e 80

%

Fem

ale

98%

Unrecorded Alcohol Consumption The unrecorded alcohol consumption in Iraq is estimated to be 0.0 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).2

Estimates from key alcohol experts showing proportion of adult males and females who had been abstaining (last year before the survey). Data is for after year 1995.2



13


Total population 2003 25 175 000 Life expectancy at birth (2002) Male 59.1 Adult (15+) 14 853 250 Female 63.1

% under 15 41 Probability of dying under age 5 per 1000 (2002) Male 119

Population distribution 2001 (%) Female 110 Urban 67 Gross National Income per capita 2002 US$ *

Rural 33 *Estimated to be in the lower middle income range ($736 to $2935) In Iraq, approximately 97% of the population are Muslim.







14

JORDAN


0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Litr

es o

f pu

re a

lcoh

ol

Total

Beer

Spirits

Wine


Data collected by the WHO Regional Office for the Eastern Mediterranean in 2003 estimates that the extent of alcohol use in Jordan is considerable and that data from the last five years suggest an increasing trend in the use of alcohol.1


Total 86%

Mal

e 74

%

Fem

ale

98%

Traditional alcoholic beverages Arak, an aniseed-flavoured spirit, is drunk with water and ice.

Unrecorded alcohol consumption The unrecorded alcohol consumption in Jordan is estimated to be 0.3 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).2

Morbidity, health and social problems from alcohol use In a study looking at data collected from all adult patients presented with acute poisoning to the emergency room at Jordan University Hospital from August 2000 to July 2001 (74 cases in total), alcohol alone was involved in 6.8% of patients whereas alcohol involvement (coingestion of drugs and alcohol) was detected in 5.4% of




15

poisoned patients. Ethanol overdose was only found among men and no case was found in women. 16% of poisoning cases presented with toxic levels involved alcohol.3

A study of fatal poisoning due to alcohol and drugs was carried out in the Greater Amman County, Jordan. A total of 60 deaths with alcohol and drugs represented 0.98% (n = 6109) of all postmortem cases performed at the forensic medicine department during the 18 years (1978 to 1996). 30 deaths (50%) were due to alcohol. All the alcohol cases involved adult males, with the age group of 30 to 49 years comprising the highest number of cases. It was observed that 13 (43.3%) alcohol deaths were among alcoholics, and a higher number 17 (56.6%) had unknown social history of alcohol drinking. Such a finding was not surprising since the question related to the personal habits such as alcohol intake produce similar results especially in societies that disapprove of alcohol ingestion as in the Jordanian society. The mean blood alcohol concentration was 280 mg/100 ml. Most of the deaths (71.4%) were observed at blood alcohol concentrations above 200 mg/100 ml. This study revealed that alcohol-related deaths in Jordanian society is ten and thirty times lower than those observed in America and Denmark. Although alcohol is legally marketed in Jordan, this finding was not surprising since Jordan was considered as one of the more conservative societies in the region.4






Rural 21 In Jordan, approximately 92% of the population are Muslim.





3. Hadidi K, Hijazi R. Patterns of adults poisoning in emergency room at Jordan University Hospital. Jordan Medical Journal, 2002, 36(1):15–21.

4. Abu-Al Ragheb SY, Hadidi KA. Fatal poisoning with alcohol and drugs in Greater Amman County. Forensic Science International, 1999, 99(3):209–215.



16

KUWAIT


0

0.02

0.04

0.06

0.08

0.1

0.12

0.14

1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Litr

es o

f pu

re a

lcoh

ol

Total

Beer

Spirits

Wine


Mortality rates from selected death causes where alcohol is one of the underlying risk factors The data represent all the deaths occurring in a country irrespective of whether alcohol was a direct or indirect contributor.

Chronic mortality

0

0.02

0.04

0.06

0.08

0.1

0.12

0.14

1972 1978 1982 1986 1995 1999

Year

SDR

per

1000

0

0.5

1

1.5

2

2.5

Alcohol use disorders

Cirrhosis of the liver

Mouth and oropharynx cancers Ischaem ic heart disease

Note: Chronic mortality time-series measured on two axes, ischaemic heart disease on right axis and the other causes on the left.



17

Acute mortality

Source: WHO Mortality Database

Morbidity, health and social problems from alcohol use In a 5-year report of an ongoing prospective follow-up study of treatment outcome of 100 Arab-Muslim alcoholics initially examined in Kuwait in 1983, it was found that the fifth-year treatment outcome of this group of alcoholics revealed 19 deaths, exceeding 14-fold the age-adjusted national death rate. This result supports reports from other centres that alcohol misuse is associated with high mortality rates mainly due to liver cirrhosis, cardiovascular disease, neoplasms and violent causes e.g. accidents and suicide.1

In a study that analysed 3781 urine and blood samples of specimens sent by attending physicians to the only public health reference laboratory for toxicological screening in the country, it was found that ethanol was present in 10% of the tested samples. There was a significant increase in the proportion of positive results for ethanol.2

A study investigating the extent to which alcohol consumption is associated with casualties in Kuwait studied blood alcohol levels in high-risk clinical populations such as patients with trauma, delirium/coma and parasuicides. Qualitative evidence of alcohol use was found in 107 out of 1058 patients (10%). The rate of alcohol-related casualty was significantly higher in traumatology hospital patients (15%) than in general hospital patients (7%). However, the absence of significant differences in place of casualty suggests that motor vehicle casualty may not be the major alcohol-associated risk in Kuwait and that work-related and domestic injuries are also affected by alcohol consumption.3

A study compared a sample of 70 alcohol and drug-dependent inpatients at the Kuwait Psychiatric Hospital (Sulaibikhat) with a matched group of 40 abstinent surgical ward inpatients at a general hospital on the basis of drugs abused, patterns of use, the effects of prohibition and sanction, motives for use, personality type, social complications, religious attitudes and family history. 62% of the experimental group abused alcohol.4

0

0.1

0.2

0.3

0.4

0.5

0.6

1972 1978 1982 1986 1995 1999

Year

SDR

per

1000 Falls

Intentional injuries Accidental poisonings Road traffic accidents



18




Population distribution 2001 (%) Female 12 Urban 96 Gross National Income per capita 2002 US$ 18 270 Rural 4 In Kuwait, approximately 85% of the population are Muslim.

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Factbook 2003, The World Health Report 2004.

References 1. Bilal AM et al. Prospective study of alcoholism treatment in Kuwait: a 5-year follow-up report. Drug

and Alcohol Dependence, 1989, 23(1):83–86. 2. Radovanovic Z et al. On substance abuse in Kuwait (1992–1997): Evidence from toxicological

screening of patients. Journal of Substance Abuse, 2000, 12(4):363–371. 3. Bilal AM, Angelo-Khattar M. Correlates of alcohol-related casualty in Kuwait. Acta Psychiatrica

Scandinavica, 1988, 78(4):417–420. 4. Demerdash AM et al. Some behavioural and psychosocial aspects of alcohol and drug dependence in

Kuwait Psychiatric Hospital. Acta Psychiatrica Scandinavica, 1981, 63(2):173–185.



19

LEBANON


0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Litr

es o

f pu

re a

lcoh

ol

Total

Beer

Spirits

Wine

Note: For the time period 1990 to 1996 the data is highly inconsistent and is therefore not included in the graph.


Data collected by the WHO Regional Office for the Eastern Mediterranean in 2003 estimates that the extent of alcohol use in Lebanon is considerable and that data from the last five years suggest an increasing trend in the use of alcohol.1


Total 77.4%

Mal

e 67

.4%

Fem

ale

86.7

%




20

High risk drinkers

Total 0.5%

Mal

e 0.

6%

Fem

ale

0.4%


Total 0.2%

Mal

e 0.

4%

Fem

ale

0.0%


Total 80.1%

Mal

e 74

.1%

Fem

ale

85.8

%

In a study comprising a stratified cluster sample of 1851 students from two major universities, 49.4% of the total sample reported ever using alcohol. Females were less likely to ever drink alcohol than males (40.7% versus 50.2%). 14.9% of the drinkers had ever drunk in one day as much as one bottle of liquor. Additionally, 5% of the drinkers had ever passed through a period of two weeks at least when they had seven or more drinks every day. Moreover, 10.7% of the drinkers admitted having seven drinks or more per day, once a week, for a period of two months. Furthermore, the lifetime prevalence of intoxication (ever got intoxicated – i.e. got drunk – at least once in their life) among drinkers in this sample was found to be 35%.3



Data from the 2000–2001 Multi-Country Survey Study. Total sample size n = 490; males n = 237 and females n = 253. Population aged 18 to 24 years. For the age group 15 to 19 years (subsample n = 137), the rate of last year abstainers was 86.1% (total), 82.8% (males) and 89.0% (females).2



21


Total 0.2%

Mal

e 0.

4%

Fem

ale

0.0%


Total 0.3%

Mal

e 0.

6%

Fem

ale

0.0%


A sample comprised of a stratified cluster sample of 1851 students from two major universities found the rate of alcohol dependence to be 3%. Alcohol dependence was measured according to DSM-III criteria. In the same survey, it was found that 5.7% of the sample were alcohol abusers and/or dependent on alcohol. 2.8% were abusers only.3

Traditional alcoholic beverages Arak, an aniseed-flavoured spirit is served with water.





Rural 10 In Lebanon, approximately 70% of the population are Muslim.




Data from the 2000–2001 Multi-Country Survey Study. Total sample size n = 490; males n = 237 and females n = 53. Population aged 18 to 24 years old. For the age group 15 to 19 years (subsample n = 137), the rate of heavy episodic drinkers was 0.0% (total), 0.0% (males) and 0.0% (females). Definition used: at least once a week consumption of six or more standard drinks in one sitting.2




22

2. Ustun TB et al. WHO Multi-Country Survey Study on Health and Health System Responsiveness 2000–2001. In: Murray CJL, Evans DB, eds. Health Systems Performance Assessment: Debates, Methods and Empiricism. Geneva, World Health Organization, 2003.

3. Karam E et al. Use and abuse of licit and illicit substances: prevalence and risk factors among students in Lebanon. European Addiction Research, 2000, 6(4):189–197.



23

LIBYAN ARAB JAMAHIRIYA (THE)





% under 15 31 Probablity of dying under age 5 per 1000 (2002) Male 19


Rural 12 *Estimated to be in the upper middle income range ($2936 to $9075) In the Libyan Arab Jamahiriya, approximately 97% of the population are Muslim.


0

0.2

0.4

0.6

0.8

1

1.2

1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Litr

es o

f pu

re a

lcoh

ol

Total

Beer

Spirits

Wine



24

MOROCCO


0

0.5

1

1.5

2

2.5

1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Litr

es o

f pu

re a

lcoh

ol

Total

Beer

Spirits

Wine


Data collected by the WHO Regional Office for the Eastern Mediterranean in 2003 estimates that the extent of alcohol use in Morocco is considerable and that data from the last five years suggest a stable trend in the use of alcohol.1

Lifetime abstainers

Total 90.2%

Mal

e 77

.3%

Fem

ale

99.4

%

Data from the 2003 World Health Survey. Total sample size n = 4999; males n = 2073 and females n = 2926. Population aged 18 years and above.2



25

Heavy and hazardous drinkers

Total 0.3%

Mal

e 0.

6%

Fem

ale

0.0%

According to the 2003 World Health Survey (total sample size n = 503; males n = 485 and females n = 18), the mean value (in grams) of pure alcohol consumed per day among drinkers was 5.1 (total), 4.7 (males) and 34.6 (females).2


Total 0.7%

Mal

e 1.

6%

Fem

ale

0.1%

Youth drinking (lifetime abstainers)

Total 93.1%

Mal

e 83

.4%

Fem

ale

99.4

%

Data from the 2003 World Health Survey. Total sample size n = 4999; males n = 2073 and females n = 2926. Population aged 18 years and above. Definition used: average consumption of 40 g or more of pure alcohol a day for men and 20 g or more of pure alcohol a day for women.2

Data from the 2003 World Health Survey. Total sample size n = 4999; males n = 2073 and females n = 2926. Population aged 18 years and above. Definition used: at least once a week consumption of five or more standard drinks in one sitting.2

Data from the 2003 World Health Survey. Total sample size n = 816; males n = 327 and females n = 489. Population aged 18 to 24 years old.2



26


Total 0.6%

Mal

e 1.

2%

Fem

ale

0.2%

Note: These are preliminary, early-release, unpublished data from WHO's World Health Survey made available exclusively for this report. Some estimates may change in the final analyses of these data.

Unrecorded alcohol consumption The unrecorded alcohol consumption in Morocco is estimated to be 1.0 litre pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).3

Morbidity, health and social problems from alcohol use There has been a significant increase in the consumption of alcoholic beverages among patients hospitalized in a psychiatric centre in Casablanca. Alcohol use has increased nearly threefold between 1977 and 1986. It is noted that alcohol use and abuse concern mostly the younger members of the population (aged between 21 and 30 years).4




Population distribution 2001 (%) Female 41 Urban 56 Gross National Income per capita 2002 US$ 1190 Rural 44 In Morocco, approximately 99% of the population are Muslim.




2. Ustun TB et al. The World Health Surveys. In: Murray CJL, Evans DB, eds. Health Systems Performance Assessment: Debates, Methods and Empiricism. Geneva, World Health Organization, 2003.


4. Touhami M. Morocco. In: Kortteinen T, ed. State Monopolies and Alcohol Prevention: Report and Working Papers of a Collaborative International Study. Helsinki, Social Research Institute for Alcohol Studies, 1989.

Data from the 2003 World Health Survey. Total sample size n = 816; males n = 327 and females n = 489. Population aged 18 to 24 years old. Definition used: at least once a week consumption of five or more standard drinks in one sitting.2



27

OMAN


0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Litr

es o

f pu

re a

lcoh

ol

Total

Beer

Spirits

Wine

Note: Data on spirits and wine only available from 1987 onwards.


Data collected by the WHO Regional Office for the Eastern Mediterranean in 2003 estimates that the extent of alcohol use in Oman is moderate and that data from the last five years suggest an increasing trend in the use of alcohol.1




Rural 23 In Oman, approximately 75% of the population are Muslim.

Sources: Population and Statistics Division of the United Nations Secretariat, World Bank World Development Indicators database, The World Factbook 2003





28

PAKISTAN


0

0.005

0.01

0.015

0.02

0.025

0.03

0.035

0.04

0.045

1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Litr

es o

f pu

re a

lcoh

ol

Total

Beer

Spirits

Wine

Note: Data on wine separately only available from 1996, before it has been included into the total alcohol consumption figure.



Total 94.5%

Mal

e 90

%

Fem

ale

99%

Among 450 youths admitted to the Drug Treatment Centre at the Mayo Hospital, Lahore, from 1990 to 1992, 81.3% of the sample reported regular usage of alcohol (which was the second most regularly used substance).2

Unrecorded alcohol consumption The unrecorded alcohol consumption in Pakistan is estimated to be 0.3 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).1




29



% under 15 41 Infant mortality rate (2002) Male 105


Rural 67 In Pakistan, approximately 97% of the population are Muslim.


References 1. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2.

European Addiction Research, 2001, 7(3):155–157. 2. Haq I. Multiple-drug abuse in a youth clinic sample in Pakistan. Contemporary Drug Problems, 1993,

20(1):87–92.



30

QATAR


0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Litr

es o

f pur

e al

coho

l

Total

Beer

Spirits

Wine



Total population 2003 610 000 Life expectancy at birth (2002) Male 74.8 Adult (15+) 451 400 Female 73.8



Rural 7 *Estimated to be in the high income range ($9076 and above) In Qatar, approximately 95% of the population are Muslim.




31

SAUDI ARABIA


0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

0.4

0.45

1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Litr

es o

f pu

re a

lcoh

ol

Total

Beer

Spirits

Wine


Data collected by the WHO Regional Office for the Eastern Mediterranean in 2003 estimates that the extent of alcohol use in Saudi Arabia is considerable and that data from the last five years suggest a stable trend in the use of alcohol.1


Total 97%

Mal

e 95

%

Fem

ale

99%

A cross-sectional study conducted in Al-Amal Hospital in Riyadh in March 1998 of 160 male patients aged 20 years or older found that alcohol was used by 23.75% of the patients.3




32

Alcohol abuse among male hospital patients

Mal

e 11

.2%

In a study of 120 male inpatients in a hospital for treatment of male substance abusers in Dammam in Saudi Arabia’s eastern region, it was found that 12.5% of the sample abused alcohol singularly (without abuse of other drugs). DSM-IV criteria for the diagnosis of substance abuse was used in this study.5

Unrecorded alcohol consumption The unrecorded alcohol consumption in Saudi Arabia is estimated to be 0.6 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).2

Morbidity, health and social problems from alcohol use

Saudi Arabia has a large number of expatriates, some of whom live in special quarters. Alcoholic beverages are available to them, but the unwritten rule is that the drinking takes place behind closed doors. While there are limited legal means to get alcohol and consume it privately, there is also smuggling, which is thought to be more active through the eastern side of the country. Alcohol can be brought in from neighbouring Gulf states, especially Bahrain, which is easily assessible via a causeway. Another smuggling route is from Jordan where spirits are available, and where some of it is manufactured, like beer and a spirit known as alaq. Those with a smaller budget resort to buying homemade alcohol, or make it themselves using grapes and dates. Occasionally, there are reports about the discovery of factories for making alcoholic beverages.6




Rural 13 In Saudi Arabia, it is estimated that 100% of the population are Muslim.





3. Al-Nahedh N. Relapse among substance-abuse patients in Riyadh, Saudi Arabia. Eastern Mediterranean Health Journal, 1999, 5(2):241–246.

4. Hafeiz HB. Socio-demographic correlates and pattern of drug abuse in Eastern Saudi Arabia. Drug and Alcohol Dependence, 1995, 38(3):255–259.

5. Amir T. Comparison of patterns of substance abuse in Saudi Arabia and the United Arab Emirates. Social Behaviour and Personality, 2001, 29(6):519–530.

6. Hawwari A. Getting a drink in Saudi Arabia. BBC News Online, 8 February 2001.

Preliminary study in the eastern region of Saudi Arabia. Clinico-statistical analysis of 116 patients (all male) was based on the DSM-III-R. Patients were 20 years and above. Of the patients 31% used alcohol, a further 20% abused alcohol in combination with other drugs.4



33

SOMALIA


0

0.01

0.02

0.03

0.04

0.05

0.06

0.07

1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Litr

es o

f pu

re a

lcoh

ol

Total

Beer

Spirits

Wine


Data collected by the WHO Regional Office for the Eastern Mediterranean in 2003 estimates that the extent of alcohol use in Somalia is moderate and that data from the last five years suggest an increasing trend in the use of alcohol.1

Traditional alcoholic beverages A locally concocted brew, popularly known as alaq, is widely sold in the Somali capital of Mogadishu. Alaq, which can contain dangerous chemicals, and is mostly consumed by poor and uneducated youth, constitutes a major problem with cases of deaths and blindness resulting from its consumption.2

Morbidity, health and social problems from alcohol use Alcohol abuse is rapidly increasing and claiming lives in the Somali capital Mogadishu, according to humanitarian and official sources. The increase is related to the large number of unemployed youths and freelance gunmen in the city, “who have nothing better to do”. It is believed that nearly 50% of all the crimes committed in Mogadishu are related to either alcohol or drugs. Recently there has been an increase in the number of establishments selling alcohol in the city. More worrying is the growing trend of poor and uneducated youths consuming a locally concocted brew, popularly known as alaq, which usually contains dangerous chemicals and can be potentially lethal.2





Rural 72 *Estimated to be in the low income range ($735 or less) In Somalia, approximately 99% of the population are Muslim.




34



2. [Anonymous]. Alcohol and drug abuse on the rise in Mogadishu. Somali News, 25 June 2002 (http://www.hamarey.com/index.php/article/articleprint/527/-1/4/, accessed 24 February 2004).



35

SUDAN (THE)


0

0.5

1

1.5

2

2.5

1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Litr

es o

f pu

re a

lcoh

ol

Total

Beer

Spirits

Wine

Note: No data on beer consumption available after 1981.


Alcohol users among a prison population In a study looking at 1569 prisoners in three main prisons in Khartoum, it was found that 32.2% of the sample used alcohol (which was the most frequently used drug).1

Traditional alcoholic beverages Merisa (traditional beer) is an alcoholic drink which is widely consumed in the Sudan. It is prepared from sorghum and millet by a relatively complex process. It has an alcoholic content of 6%.

Unrecorded alcohol consumption The unrecorded alcohol consumption in the Sudan is estimated to be 1.0 litre pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).2

Morbidity, health and social problems from alcohol use

Data from the Ministry of Health Division of Health Statistics and Research show that between 1979 and 1983 there were a total of 1079 alcohol-related inpatients (87% were male).3

Between 1979 and 1983, there were 210 cases of homicide and/or suicide that involved use of alcohol either by the victim or offender prior to the incident.3

Between 1979 and 1983, there were 5249 traffic charges involving drunk driving (this was 1.1% of the total traffic charges during that period).3



36





Rural 63 In the Sudan, approximately 70% of the population are Muslim.


References 1. El-Fatih IA et al. Drug use among prisoners in three main prisons in Khartoum, Sudan. Eastern

Mediterranean Health Journal, 1998, 4(1):122–127. 2. Alcohol per capita consumption, patterns of drinking and abstention worldwide after 1995. Appendix 2.

European Addiction Research, 2001, 7(3):155–157. 3. El-Tigani H. Alcohol-related casualties in the Sudan. Faculty of Medicine, University of Gezira, Wad

Medani, Sudan.



37

SYRIAN ARAB REPUBLIC (THE)


Note: From 1996 the wine category includes must of grape, which before 1996 was included in the overall total consumption figure.



Total 95.7%

Mal

e 92

.4%

Fem

ale

98.8

%

High risk drinkers

Total 0.2%

Mal

e 0.

4%

Fem

ale

0.0%

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Litr

es o

f pu

re a

lcoh

ol

Total

Beer

Spirits

Wine





38


Total 0.1%

Mal

e 0.

3%

Fem

ale

0.0%


Total 97.3%

Mal

e 95

.2%

Fem

ale

99.0

%


Total 0.1%

Mal

e 0.

1%

Fem

ale

0.0%


Total 0.2%

Mal

e 0.

5%

Fem

ale

0.0%


Data from the 2000–2001 Multi-Country Survey Study. Total sample size n = 1747; males n = 781 and females n = 966. Population aged 18 to 24 years. For the age group 15 to 19 years (subsample n = 554), the rate of last year abstainers was 98.4% (total), 97.4% (males) and 99.3% (females).1

Data from the 2000–2001 Multi-Country Survey Study. Total sample size n = 1747; males n = 781 and females n = 966. Population aged 18 to 24 years old. For the age group 15 to 19 years (subsample n = 554), the rate of heavy episodic drinkers was 0.2% (total), 0.4% (males) and 0.0% (females). Definition used: at least once a week consumption of six or more standard drinks in one sitting.1




39


Traditional alcoholic beverages Arak, an aniseed-flavoured spirit is produced and consumed.

Unrecorded alcohol consumption The unrecorded alcohol consumption in the Syrian Arab Republic is estimated to be 0.4 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).2





Rural 48 In the Syrian Arab Republic, approximately 90% of the population are Muslim.


References 1. Ustun TB et al. WHO Multi-Country Survey Study on Health and Health System Responsiveness

2000–2001. In: Murray CJL, Evans DB, eds. Health Systems Performance Assessment: Debates, Methods and Empiricism. Geneva, World Health Organization, 2003.




40

TUNISIA



Lifetime abstainers

Total 89.2%

Mal

e 77

.0%

Fem

ale

99.7

%

Estimates from key alcohol experts show that the proportion of adult males and females who had been abstaining (last year before the survey) was 70% (males) and 95% (females). Data is for after year 1995.2

In a survey done among 130 male drinkers in seven bars in Tunis, it was found that on average, each person consumed eight beers or 1.8 bottles of wine a day. All of these drinks were consumed between 18:00 and 20:00 (after work and before going home to their families).3

0

0.5

1

1.5

2

2.5

1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Litr

es o

f pu

re a

lcoh

ol

Total

Beer

Spirits

Wine




41


Total 1.2%

Mal

e 2.

6%

Fem

ale

0.0%


In the Centre of Mental Health Prevention, among 33 patients admitted between 1 January 1989 and 31 December 1996, 81.8% of cases abused alcohol by “drinking excessively” and 12.1% of cases were alcohol dependent.4


Total 2.5%

Mal

e 5.

2%

Fem

ale

0.0%


Total 88.2%

Mal

e 77

.7%

Fem

ale

99.7

%






42


Total 3.3%

Mal

e 6.

3%

Fem

ale

0.0%


Traditional alcoholic beverages Lagmi is produced from the sap of palm trees. Unless it is served as soon as it is taken from the tree, the liquid becomes a mildly alcoholic palm wine when it is left to ferment.5

Unrecorded alcohol consumption The unrecorded alcohol consumption in Tunisia is estimated to be 0.5 litres pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).2





Rural 34 In Tunisia, approximately 98% of the population are Muslim.


References 1. Ustun TB et al. The World Health Surveys. In: Murray CJL, Evans DB, eds. Health Systems

Performance Assessment: Debates, Methods and Empiricism. Geneva, World Health Organization, 2003.


3. Dellagi F, Douki S. L’alcoolodépendance en Tunisie: Facteurs socio-culturels spécifiques. Alcoologie, 1997, 19(4):419–423.

4. Zaâfrane F et al. Alcool et pathologie psychiatrique: Une enquête en hôpital psychiatrique tunisien. Alcoologie et Addictologie, 2000, 22(3): 247–253.

5. [Anonymous]. Tunisia – a country of wine and cheese (http://travel.iafrica.com/destin/africadest/918901.htm, accessed 31 March 2004).




43

UNITED ARAB EMIRATES (THE)



Lifetime abstainers

Total 89.6%

Mal

e 85

.8%

Fem

ale

94.4

%


Total 0.6%

Mal

e 0.

2%

Fem

ale

1.0%


0

2

4

6

8

10

12

14

16

1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Litr

es o

f pu

re a

lcoh

ol

Total

Beer

Spirits

Wine





44


Total 0.1%

Mal

e 0.

2%

Fem

ale

0.0%


Total 98.5%

Mal

e 99

.0%

Fem

ale

98.0

%


Total 0.0%

Mal

e 0.

0%

Fem

ale

0.0%


Unrecorded alcohol consumption The unrecorded alcohol consumption in the United Arab Emirates is estimated to be 1.0 litre pure alcohol per capita for population older than 15 for the years after 1995 (estimated by a group of key alcohol experts).2

Morbidity, health and social problems from alcohol use In a study conducted on family violence as well as its causes and how it leads to divorce, alcohol abuse was believed to be a major cause of domestic violence in this country.3

Of 747 male patients admitted during a 2-year period (1990–1991) to the psychiatric ward in Al-Ain district hospital, 71 (9.5%) were admitted with alcohol and drug use disorders. Regarding the type of drug used, 16 (22.5%) used alcohol alone. Hospital statistics on alcohol and drug misuse do not necessarily represent the drug situation in a community but may give a true profile of the more severe cases of substance use disorders. The public attitude in Arab-Muslim societies is intolerant to alcohol drinking and drug use in general, but more so in the case of women, so the absence of females in this sample is a reflection of this fact. If alcohol and drug use






45

ever occurs among women it is very secretive and may not reach the extent of dependence or harmful use and hence will not come to medical attention.4





Urban 87 Gross National Income per capita 2002 US$ *

Rural 13 *Estimated to be in the high income range ($9076 or more) In the United Arab Emirates, approximately 96% of the population are Muslim.


References 1. Ustun TB et al. The World Health Surveys. In: Murray CJL, Evans DB, eds. Health Systems

Performance Assessment: Debates, Methods and Empiricism. Geneva, World Health Organization, 2003.


3. Za’za B. Divorce due to domestic violence up. Gulf News, 7 January 2004 (http://www.amanjordan.org/english/daily_news/wmview.php?ArtID=3629, accessed 31 March 2004).

4. Younis YO, Saad AG. A profile of alcohol and drug misusers in an Arab community. Letters to the Editor, Addiction, 1995, 90(12):1683–1684.



46

YEMEN


0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

1961 1965 1969 1973 1977 1981 1985 1989 1993 1997 2001

Year

Litre

s of p

ure

alcoh

ol Total

Beer

Spirits

Wine


Data collected by the WHO Regional Office for the Eastern Mediterranean in 2003 estimates that the extent of alcohol use in Yemen is moderate and that data from the last five years suggest an increasing trend in the use of alcohol.1





Rural 75 In Yemen, approximately 99% of the population are Muslim.




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