ABSTRACT
Introduction Public health problems in the developing world are changing although it seems likely that the importance of alcohol-related problems has not yet been recognised. The number of persons injured in accidents is frequently ignored. It was reported recently (WHO 1981) that in 1973 the ratio of the number of cases of cholera, smallpox and road traffic casualties was 1.09:1.36:8.0, this figure not taking into account the under-reporting of road traffic casualties. In one very limited survey (WHO 1981) conducted in six of nine developing countries, accidents were recorded as the primary cause of death among children between the ages of 10 and 14, and two other countries reported accidents as the second most frequent cause. In a recent report (1980), the Zambian Ministry of Health stated that accidents account for nearly 8 per cent of all hospital admissions, 3.6 per cent of deaths and 9 per cent of total new out-patients. In children aged 14 and under, falls and burns constitute the main type of accident, ranking tenth in hospital admissions, eighth in health centre admissions and accounting for just under 4 per cent of all admissions. Accidents are not recorded as a significant cause of mortality in adults but injuries due to road traffic accidents are listed as ranking ninth in the causes of admissions to hospital. Injuries rank second as a cause for out-patient treatment (9.2 per cent)—the first being upper respiratory tract infections-and also rank high among child out-patients, being third and making up 9.2 per cent of the total. There is a marked tendency, when describing the medical consequences of drinking, to think only of ‘alcoholism’ thus:
We do not refer here to the weekend load of drunks and stab-wounds arriving in casualty, but to the decent solid middle class and middle income Blacks (mainly male) with jobs, home and families who now, nearly 20 years after liquor was made freely available to them, are presenting with the white man’s problem. (McCabe 1982)
This paper will focus on a wide range of alcohol-related problems, particularly as they are reflected in official statistics and in studies of the work of accident and casualty departments and admission wards. There is a lack of information from Africa on alcohol-related problems generally and in order to set the scene the paper first reviews some general reports on drinking and alcoholism, and then focuses upon statistics relating to alcohol-related injuries and accidents. An examination of road traffic statistics in particular will allow exploration of the problems to be met in relying upon official data. Other studies will then be reviewed which help to show how the quality of data might be improved, followed by a consideration of the methodology of data collection (both in specific projects and in improvements in official statistics), starting with a more detailed examination of the types of alcohol-related problems which might be significant in any such studies. Finally, there will be a summing up in which policy issues are examined and recommendations made. Literature from subSaharan Africa is reviewed and while South Africa is not examined, the paper mainly concentrates upon problems of the majority, namely the developing nations of that continent.
