The Challenge of Non-Communicable Diseases and Road Traffic ...

An Overview 25
TABLE 5: Prevalence of Weekly Heavy Drinking Episodes among Drinkers in the Past 12 Months by Sex –
WHO Region and the World, 2005
WHO region Women (%) Men (%) Average Total (%)
Africa 16.2 30.5 25.1
Americas 4.5 17.9 12.0
Eastern Mediterranean 17.9 24.9 24.7
Europe 4.6 16.8 11.0
South-East Asia 12.9 23.0 21.7
Western Pacific 1.3 11.6 8.0
WORLD 4.2 16.1 11.5
Source: [97]
region abstain from alcohol, those that do drink do
so in a harmful way that increases risk particularly
of acute consequences: almost two-thirds of the alcohol-attributable
disease burden relates to injuries
[6], and heavy-episodic drinking is linked with unsafe
sex leading to STIs and HIV transmission [98].
The presence of alcohol as a contributory factor to
road crashes is likely to be under-reported in Africa,
due to lack of detection technology, and unspecified
reporting, due to limited use of standard codification,
logistics, and enforcement. Nevertheless, a
study in Nigeria over the period 1996-2000 found
alcohol to be a factor in 50 percent of police report
accidents [99].
There is a strong relationship between economic
wealth and alcohol consumption for low-income
countries: as GDP rises, the overall volume that is
consumed increases, and the proportion of abstainers
decreases [73]. Consumption of commercially-produced
alcohol is expected to rise as economic
conditions improve in African countries [100]; while
other regions have experienced stable consumption
trends, an increase has been noted in the African
and Southeast Asian regions. With Western markets
more or less saturated, low-income countries
and emerging markets with large populations such
as South Africa and Nigeria, and even Malawi and
Uganda, are being targeted by global alcohol corporations
[101]. Adolescents and young adults are
a particular target, for example through sponsorship
of sports [96].
Physical Activity and Travel
Overall physical activity levels are relatively high
in Africa, with most either work-related or transport-related.
This is especially so in rural areas, but
levels of physical inactivity have been shown to rise
with urbanization [102-104].
In most African cities, most residents walk or
use public transportation for daily routine activities.
Cycling is usually negligible in large cities, but
may reach 20 percent of daily journeys in smaller
cities [105]. Poor law enforcement combined with
poor road infrastructure, and high traffic mix and
little separation of vulnerable road users from high
speed motorized traffic, contribute to the high rate
of crashes and fatalities [59]. A poorly-regulated
private sector may be the major supplier of public
transport, and the risk to passengers of collision
and injury involving public buses is increased by
lack of seat belts, overcrowding, and hazardous road
environments: in Ghana, the majority (58 percent)
of crashes in urban areas involved buses and minibuses,
with most of those injured being their passengers
or pedestrians [63, 106].
3.2. Drivers of NCD Trends
Growing Urbanization
SSA is urbanizing faster than any other continent,
and in the Northern and Southern sub-regions over
half the total population already live in urban agglomerations
[107]. Rapidly-growing cities can be