Article Review: Assessing the Health Risks of Consuming ‘Sachet’ Alcohol in Acoli, Uganda

By Aliker David Martin

Last week, Daily Monitor reported on a Study that found deadly metals in sachet Waragi sold in Acholi. 

This is a scientific scholarly article of more ten thousand words in over than twenty pages

In this blog post, my intention is to review this scholarly article to a more user friendly and shorter article. 

Since it’s a scientific report and I am from the arts orientation, there is a higher chance I would not digest this reading in totality but hope to make meaning from it like any literate.

The Research article, “Assessing the health risks of consuming ‘sachet’ alcohol in Acoli, Uganda” is the work of 3 distinguished scholars. 

Other than Tom Juma whose original nationality is not known to the blogger, Ochan Otim (PhD) and Dr.Olara Otunu are Ugandans hailing from Acholi sub region. 

The blogger believes this could have inspired their interest in this research in view of the fact that the authors received no particular funding from any publicly known research funding agency for this research.

The scholars Ochan Otim (PhD) is from the Department of Humanities and Sciences, University of California—Los Angeles, California. 

Tom Juma identifies with the Environmental Monitoring Division, City of Los Angeles, Playa Del Rey, California.

Olara Otunu is Former Under-Secretary-General of the United Nations, New York, New York, United States of America respectively and former President of Uganda People’s Party (UPC).

Catherine Haighton, Northumbria University, UK of Plos One Journal edited this work. Plos One is a nonprofit open-access science, technology and medicine publisher, innovator and advocacy organization with a library of open-access journals and other scientific literature under an open-content license.


As an introduction, the scholars opin that the sub-Saharan countries of Africa are currently experiencing an increase in adult mortality partly believed to be due to the heavy consumption of cheaply and widely available spirits in the region. Acholi sub region is referred to as a case in point.

To define the context of their research, the authors use Acholi sub region as their sample study area and share details on the Acholi demography.

The conflict background of the Acholi community is also placed into perspectives. This later helps to illustrate the factors driving alcohol production and consumption in Acoli.

In comparison, the scholars argue that historically, the cultural or recreational consumption of alcoholic beverages (wholly unrefined or ‘opaque beers’ in current lexicon) in Acoli was a highly controlled social affair, going as far back as the ‘discovery’ of fermentation (immortalized in a classic Acoli play Yom Cwiny Oneko Latina–Generosity Kills the Generous One.)

They further argue that  most of the opaque beers (lacoi/ malwa  and kwete in Uganda, and several in Tanzania are not only rich in nutrients , but also have no known side effects.

However in today’s industrial world of technology, the scholars argue that these opaque beers have been largely replaced by industrially distilled and blended spirits sold in easily affordable sachets or tots. Ethyl alcohol (ethanol), the main intoxicant in the sachets, has no known nutritional values, but has strong physiological effects. 

They further reiterate that the sachets/tot packaged spirits do not only have higher concentrations of ethanol than the opaque beers (up to 40% by volume), but contain toxic metals and organic pollutants as well (unpublished material), or blended with toxic substances by unscrupulous producers and sellers of alcohol.

Ethanol, a prime health risk suspect

In justifying their research on Ethanol (alcohol) as a prime health risk suspect responsible for the increased mortality rate in Acoli, the scholars argue that the well established research evidence on causal relationships between alcohol consumption and cancer of the larynx, and liver is reason good enough for this study.

Study design 

In their study design, the main goal of the study was to initiate an investigation into the link between alcohol consumption and health risk in Uganda in general and Acholi region in particular. 

Their approach was to assess the health risk associated with consuming heavy metal contaminated alcoholic products sold to the former internment camp residences.

The hopes and aspiration of these scholars is that their findings will help authorities in Uganda in developing the necessary and appropriate alcohol quality assurance standards and enforcement policies to minimize health risks associated with unsafe alcohol consumption.

Materials and methods

In this study, the methodology was intensely scientific and statistical in nature. Thirteen brands of 100-mlsachet-packaged spirits were used for this study. 

These purchases were done without attempts to pick true random samples because of the logistical challenges and the restrictions encountered in attempts to collect representative samples of the sachet types sold and consumed in the study area. 

That said, they mention that much diversity as possible was included on a first encounter basis.

Factors driving alcohol production and consumption in Acoli

The Scholars also noted that while it is important to establish that alcohol consumption in the Acoli population increases health risks significantly; there were majorly 3 factors driving alcohol production and consumption in Acoli namely:• The positive effects of increased economic activities that occurred after the war.• The rise in income that came with the end of the war.• The relative peace now prevailing in the region. 

Besides these 3 factors, the scholars observed that there are also lingering negative effects of the 20-year war. For instance, deprivation of livelihood in the internment camps during the war led to other downstream effects such as trauma, idleness, depression, violence, theft and others.

Cynically, the scholars also argue that the alcohol economy may also be driven by the dynamics of national politics in which regional marginalization is often a handy tool in the hands of those in power. 

For example, the increased supply of alcohol in the region may be a conscious or sub-conscious act of regional marginalization. Alcohol production and consumption may also be deliberately encouraged to serve certain political interests.

Study limitations. 

Several factors which are known to increase health risks of alcoholic consumption were not considered in this study. For instance, lack of materials used in the production of the Ugandan spirits studied to its health risks. 

The information of the ‘pots’ used for fermentation, distillation, or for storing the distillate before packaging, for example, was not available. 

Similarly, the soil in which the grains, cassava, or the potatoes used in the brewing process are grown, and the water used during the entire production process could account for the high level of metals and the variability observed in distillates.


The study found that consuming sachet packaged spirits in Uganda over a lifetime correlates with pronounced health risks in the Acoli population of Uganda.

This finding emphasizes the need to include ethanol as a factor in any estimates of health risks due to the consumption of alcoholic drinks in this population.

Other than public education about the health risks of excessive alcohol consumption, fun and productive socio economic activities must be developed to engage people away from excessive drinking. 

Finally, new policies based on the principle that no amount of alcohol is safe should be adopted to address the causes of alcohol related mortality in Uganda.

The review is by a Gulu Based Blogger and can be reached on

Published by La’Gulu

Aliker is the author of My Mayor (The Political Story of a Poor Elite and Rich Illitrate). Aliker is well spoken, a Blogger, Social Media Geek and an Alumni of Makerere University, Uganda Management Institute, Gulu University and University of San Diego-USA respectively.

Join the Conversation


  1. Ladit Aliker, you captured the essence of the study accurately. Mr. Tom Juma, one of the authors of the study, is from Bondo in Siaya County, Kenya. He has vested interest in the subject matter because it extends to his community as well.
    NB: I shall be available on 102 MEGA FM’s “Te Yat” program hosted by Ladit Stephen Balmoi Odong on Saturday Mar. 16, 2019 at 10 AM local time to share views with listeners on the way forward.


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