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 March 14, 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 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 scientific manuscripts) testing psychosocial interventions (no structural intervention 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 (OR=2.05, 95% CI=1.20‐3.48, k=5, n=2,312, I2 = 79%) and 12‐60 months (OR=1.91, 95% CI=1.40‐2.61, k=6, n=2,737, I2 = 63%) follow‐up. There were no statistically significant effects found for AUDIT score (2‐3 month: MD= ‐1.13, 95% CI: ‐2.60‐0.34, k=6, n=992, I2=85%; 6 month: MD= ‐0.83, 95% CI= ‐1.92‐0.26, k=6, n=1081, I2=69%; 12 month: MD= ‐0.15, 95% CI = ‐1.66‐1.36, k=4; n=677; I2 = 75%), drinks per drinking day (3 months: MD: ‐0.22, 95% CI = ‐2.51‐2.07, k=2, n=359, I2=82%; 6‐36 months: MD= ‐0.09, 95% CI= ‐0.49‐0.30, k=3, n=1450, I2=60%), or percent drinking days (3 months: MD= ‐4.60, 95%= ‐21.14‐11.94; k=2; n=361; I2 = 90%; 6‐9 months: MD=1.96, 95% CI= ‐6.54‐10.46; 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‐analytic outcomes suggests results should be interpreted with caution.