Psychosocial interventions for reducing alcohol consumption in sub-Saharan African settings: a systematic review and meta-analysis

Abstract

Background: Harmful alcohol use is a leading cause of morbidity and mortality in sub-Saharan Africa (sSA); however, the effects of non-pharmacological alcohol interventions in this region are unknown.

Design: A systematic review and meta-analysis of the available literature through 14 March 2019 was undertaken. Two authors extracted and reconciled relevant data and assessed risk of bias. Meta-analyses were conducted. The review protocol is registered on International Prospective Register of Systematic Reviews (PROSPERO) (CRD42019094509).

Setting: Studies conducted in sSA were eligible for inclusion.

Participants: Individuals participating in interventions aimed at reducing alcohol use.

Interventions: Randomized and non-randomized controlled trials testing non-pharmacological interventions (psychosocial and structural) on alcohol consumption in sSA.

Measurements: Eligible outcomes included the Alcohol Use Disorders Identification Test (AUDIT) scores; alcohol abstinence; measures of drinking quantity and frequency; and biomarkers of alcohol consumption.

Findings: Nineteen intervention trials (18 reports) testing psychosocial interventions (no structural interventions included), judged of moderate quality, were included in meta-analyses. A beneficial effect was identified for psychosocial interventions on alcohol abstinence at 3-6 months [odds ratio (OR) = 2.05, 95% confidence interval (CI) = 1.20-3.48, k = 5, n = 2312, I² = 79%] and 12-60 months (OR = 1.91, 95% CI = 1.40-2.61, k = 6, n = 2737, I² = 63%) follow-up. There were no statistically significant effects found for AUDIT score [2-3 months: mean differences (MD) = -1.13, 95% CI = -2.60 to 0.34, k = 6, n = 992, I² = 85%; 6 months: MD = -0.83, 95% CI = -1.92 to 0.26, k = 6, n = 1081, I² = 69%; 12 months: MD = -0.15, 95% CI = -1.66 to 1.36, k = 4; n = 677; I² = 75%], drinks per drinking day (3 months: MD = -0.22, 95% CI = -2.51 to 2.07, k = 2, n = 359, I² = 82%; 6-36 months: MD = -0.09, 95% CI = -0.49 to 0.30, k = 3, n = 1450, I² = 60%) or percentage of drinking days (3 months: MD = -4.60, 95% = -21.14 to 11.94; k = 2; n = 361; I² = 90%; 6-9 months: MD = 1.96, 95% CI = -6.54 to 10.46; k = 2; n = 818; I² = 88%).

Conclusion: Psychosocial interventions show promise at increasing self-reported alcohol abstinence in sSA, but clinical, methodological and statistical heterogeneity across meta-analytical outcomes suggests that results should be interpreted with caution.

Keywords: Alcohol; interventions; meta-analysis; psychosocial; sub-Saharan Africa; systematic review.

Figure 1.. Studies included in systematic review and meta-analysis

Adapted from the 2009 PRISMA Flow Diagram. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred Reporting Items for Systematic Reviews and MetaAnalyses: The PRISMA Statement. PLoS Med 2009;6(7): e1000097. doi:10.1371/journal.pmed1000097

Figure 2.. Results of meta-analyses with Alcohol Use Disorders Identification Test (AUDIT) score by follow-up period

Note: *indicates cluster randomized controlled trials (CRCT) for which the sample size was adjusted by design effect

Figure 3.. Results of meta-analyses with drinks per drinking day (DDD) by follow-up period

Note: *indicates cluster randomized controlled trials (CRCT) for which the sample size was adjusted by design effect

Figure 4.

Results of meta-analyses with percentage of drinking days (PDD) by follow-up period

Figure 5.. Results of meta-analyses with alcohol abstinence by follow-up period

Note: *indicates cluster randomized controlled trials (CRCT) for which the sample size was adjusted by design effect; note the direction of the intervention effect differs from the previous continuous outcomes to reflect the desired outcome of greater abstinence.

Figure 6.

Funnel plot of comparison: Alcohol abstinence outcome by subgroups, eligibility did include baseline drinking vs. eligibility did not include baseline drinking

Figure 7.

Risk of bias graph: review authors’ judgements about each risk of bias items presented as percentages across all included studies