Alcohol policy stringency and alcohol use disorder burden in Africa: a cross-national scoping review

Alcohol use disorder (AUD) is a leading contributor to disease burden across African Union member states, yet national policy environments remain fragmented, underfunded, and inconsistently enforced. The WHO SAFER initiative provides a standardized framework for assessing national alcohol policy stringency, but its empirical relationship with AUD burden across the African continent has not been systematically examined. A cross-national critical review was conducted using desk-based secondary data extraction from the WHO Global Status Report on Alcohol and Health (2018 and 2024 editions), WHO SAFER country-level domain assessments, WHO GISAH indicator SA_0000001462 (AUD 12-month prevalence, 2016), and WHO GISAH indicator SA_0000001743 (alcohol-attributable all-cause deaths, 2019). Unrecorded alcohol share was computed from WHO 2024 Annex 2 table A2.1.2. All 55 African Union member states were eligible for inclusion. Countries were stratified by SAFER profile category and compared on AUD prevalence and alcohol-attributable mortality. Findings were synthesized narratively with tabular comparison across WHO African subregions. Countries with weaker SAFER profiles showed consistently higher rates of AUD prevalence and alcohol-attributable mortality across all regional groupings. Policy deficits were most pronounced in the drink-driving countermeasures and pricing/taxation domains. West and Central African states carried the highest burden relative to policy investment. Unrecorded alcohol consumption, ranging from under 10% in Botswana to over 60% in Cameroon by WHO 2024 estimates, was identified as a structural confounder that formal policy instruments do not reach. The policy domains with the strongest international evidence base for harm reduction are precisely those most consistently underdeveloped across Africa. African governments should prioritise funded excise taxation reform as the immediate target, with minimum unit pricing introduced where recorded consumption carries a sufficient market share for a price floor to bind. Enacting legislation without dedicated enforcement infrastructure and monitoring systems will not produce the harm reductions the international evidence predicts.