Health impact of alcohol regulatory interventions: a systematic review of policies in low- and middle-income countries.

Alcohol consumption poses significant public health challenges globally, with low- and middle-income countries (LMICs) experiencing a substantial burden from alcohol-related harm. However, the effectiveness of interventions to control alcohol consumption in LMICs remains understudied. This paper aims to investigate the effectiveness of alcohol regulatory interventions adopted in LMICs. A systematic search of MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science was conducted on 10 August 2024. The search strategy included terms related to regulatory interventions and their impact on alcohol consumption, health, and other related outcomes. Risk of bias was assessed using the National Institutes of Health, Cochrane Effective Practice and Organization of Care checklist, ISPOR-SDMD checklist, and CASP quality assessment tools, and a narrative synthesis was performed to summarize the review findings. Of the 169 full texts screened, 62 studies were included in this review. Most of the studies were conducted in upper-middle-income countries (n = 48, 77%), seven were from lower-middle-income countries, one from a low-income country, and others were combinations of the above. Sixty per cent of the included studies were of good quality. In terms of World Health Organization alcohol policy domains, 18 studies focused on restriction of physical availability, 11 on pricing, 1 on marketing, 21 on drink driving, and 11 on a combination of all policy domains. Alcohol consumption-related outcomes were reported in 26 studies, while health and other outcomes were reported in 25 and 14 studies, respectively. Restrictions on physical availability of alcohol were largely effective across all outcomes, while the pricing policy domain consistently demonstrated effectiveness in reducing alcohol consumption. The scarce evidence on marketing policy interventions was inconclusive; interventions targeting drink driving showed beneficial effects. The available evidence suggests that alcohol control policies are largely effective in LMICs. Further regular and statutory enforcement of these interventions is likely to improve their effectiveness.