Predicting the prevalence and determinants of harmful alcohol consumption in Africa: Evidence from WHO STEPS surveys, 2014–2019

ABSTRACT Background: Harmful alcohol use is a major global health concern, contributing to over 5% of deaths and disease burden worldwide and linked to more than 200 health conditions. In Africa, heavy episodic drinking is associated with gender-based violence, traffic injuries, and noncommunicable diseases, highlighting the growing public health impact. Socioeconomic, cultural, and health system factors shape consumption patterns, yet regional data on prevalence and determinants remain limited. Materials and Methods: This study analyzed World Health Organization STEPwise approach to Surveillance survey data (2014–2019) from 12 African countries, including adults aged 18–69 years, to assess prevalence, determinants, and high-risk populations, providing evidence to guide targeted interventions and strengthen regional alcohol control policies. Results: Among 46,040 respondents, the overall prevalence of harmful alcohol use was 3.1% (95% confidence interval [CI]: 2.8–3.4), higher in males (4.7%, 95% CI: 4.2–5.3) than females (1.3%, 95% CI: 1.0–1.6), and in rural (3.7%, 95% CI: 3.2–4.2) compared with urban residents (2.2%, 95% CI: 1.8–2.7). Weighted logistic regression identified age, male gender, smoking, high salt intake, and self-employment as significant determinants (adjusted odds ratio: 1.85–4.39). Machine learning using XGBoost highlighted country, survey year, tobacco use, and dietary factors as the strongest predictors. Predicted probabilities increased with age in men, peaking at 6.8% (60–64 years), whereas remaining below 2% in women, indicating clear priority groups for intervention. Conclusion: Although overall prevalence is low, harmful alcohol use disproportionately affects men, older adults, rural residents, and those with specific behavioral risks. These findings underscore the need for context-specific, age-, and gender-targeted public health strategies that integrate behavioral modification, policy measures, and community engagement to reduce alcohol-related health and social burdens across African settings.