The prevalence and patterns of illicit alcohol consumption in twelve African countries: Evidence from WHO STEPS Surveys (2014–2019)

ABSTRACT Introduction Unrecorded alcohol, untaxed and often illicitly produced, poses major public health risks in Africa due to its unregulated nature, affordability, and widespread availability among vulnerable populations. Cultural practices, poverty, and weak policy enforcement contribute to its high use, especially among young people and rural communities. Methods This study used secondary data from the WHO STEPS conducted between 2014 and 2019 across twelve African countries: Algeria, Benin, Botswana, Eswatini, Ethiopia, Kenya, Malawi, Morocco, São Tomé and Príncipe, Sudan, Uganda, and Zambia. Multivariable logistic regression examined demographic and socioeconomic factors associated with illicit alcohol consumption, while quantile regression assessed variations in ethanol intake. Analyses were adjusted for complex survey design to ensure nationally representative and comparable estimates across countries. Results The overall prevalence was 8.3%, ranging from 0.1% in Morocco to 12.9% in Zambia. Men were more likely to consume illicit alcohol than women, with higher use observed among older adults, rural residents, and individuals with lower education levels. The median ethanol intake among illicit alcohol users was 62.5 g (IQR: 31.2–156.2 g), indicating heavy consumption among certain groups. Multivariable analysis confirmed significant associations between illicit alcohol use and socioeconomic disadvantage, highlighting deep inequalities that shape alcohol access and consumption patterns across the region. Conclusion The study highlights the urgent need for stronger surveillance, enforcement, and community-based prevention strategies. Policymakers should integrate alcohol control into broader health and social protection programs, ensuring safer and more affordable alternatives. Future work should include longitudinal monitoring, biochemical validation, and cross-border collaboration to address unrecorded alcohol trade and reduce its impact across the region.