Health Risks and Public Safety Concerns of Illicit Alcohol in Uganda: Alcohol Content, Hygiene & Sanitation in Production and Retail

Introduction: Illicit alcohol, produced and sold outside regulation, is a global health concern due to risks of contamination, methanol poisoning, and unsafe alcohol strength. Uganda records one of the highest alcohol consumption rates in Africa, with more than half of its production classified as illicit. Unsafe production environments, poor hygiene, and limited regulatory enforcement exacerbate public health and safety risks. Aim: This study assessed health risks and public safety concerns associated with illicit alcohol in Uganda, focusing on alcohol strength, methanol contamination, and hygiene and sanitation in production and retail settings. Methods: A cross-sectional mixed-methods design was employed in Kampala and Arua between October and November 2024. Data was collected from 400 producers and retailers through surveys, structured observations, and laboratory analyses of alcohol content, methanol levels, and microbial contamination, supplemented with 20 key informant and in-depth interviews. Results: Findings revealed inconsistent and often under-declared alcohol strength up to 44.2%, with methanol concentrations in some spirits exceeding safe limits up to 640.59 mg/L. Opaque beers showed contamination with Staphylococcus aureus , linked to poor hygiene during handling and storage. Observation scores highlighted widespread unsanitary practices, including unsafe water source 36.7% in Arua and 63.3% in Kampala, dirty production areas 44.2% in Arua and 55.8% in Kampala, pest infestation, and lack of protective equipment. Retail environments mirrored these risks, with alcohol commonly served with dirty hands (31% in Arua and 69% in Kampala) and often stored, sold in unsafe containers/ environment. Conclusion and Recommendations: Illicit alcohol production and retail in Uganda present significant chemical, microbiological, and environmental risks, compounded by regulatory gaps and lack of awareness of ABV among producers. The unpredictability of alcohol strength, unsafe packaging, and unsanitary production environments underscore the scale of the public health threat, particularly in urban centres like Kampala. There is urgent need for strengthening regulatory oversight, including mandatory ABV testing and clear labelling requirements for alcoholic beverages. Community-based sensitization campaigns should address consumer awareness of alcohol strength and risks of illicit products. Enforcement of hygiene and sanitation standards in production and retail outlets, coupled with provision of affordable protective equipment and safe water, could mitigate contamination risks. There is need for a multi-sectoral collaboration between public health authorities, law enforcement, and community leaders is essential to reduce the public health burden of illicit alcohol.