MUSAWA MUKUPA ^1* Cosmas Zyambo ^1,2 Masauso M. Phiri ^1,3 Richard Zulu ¹ Tulani Francis L Matenga ⁴ Kumbulani M. Mabanti ² Anna Hainze ⁵ Ahmed Ogwell ⁶ William Dejong ⁷ Dhally Menda ⁸ Angela Rizzo ⁹ Fastone M. Goma ¹ Tom Achoki ⁹

• ¹ Centre For Primary Care Research (CPCR), Lusaka, Zambia
• ² Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia
• ³ Department of Pathology and Microbiology, School of Medicine, University of Zambia, Lusaka, Zambia
• ⁴ Department of Health Promotion, School of Public Health, University of Zambia, Lusaka, Zambia
• ⁵ Brands on a Mission, Nairobi, Kenya
• ⁶ United Nations Foundation, New York, United States
• ⁷ School of Medicine, Tufts University, Boston, Massachusetts, United States
• ⁸ Churches Health Association of Zambia (CHAZ), Lusaka, Zambia
• ⁹ AB InBev Foundation, Washingtone, United States

Introduction: Illicit alcohol, existing outside legal frameworks, lacks safety standards and may contain harmful substances. In Africa, the illicit alcohol market is pervasive, contributing to significant public health challenges. The state in Zambia may not be so different where abuse of alcohol was associated to unintended injuries, suicidal ideation and physical fights that in some cases lead to death. This mirrors these challenges; according to the Zambia Stepwise Survey for Non-Communicable Diseases (NCDs) Risk Factors (2017), 21.7% of adults consume alcohol, with urban areas experiencing higher rates of illicit production. Aim: The study aimed to assess the public health risk implications associated with the production and retail of illicit alcohol based on the hygiene and sanitation of these premises. A quantitative approach was employed in Livingstone, Lusaka, and Ndola. Methods: We employed a quantitative approach was conducted in Livingstone, Lusaka, and Ndola. A hygiene and sanitation observation tool obtained from the Lusaka City Council was adapted and utilized to evaluate the conditions of these premises.The study found that Livingstone exhibited the highest rate of unavailability of water supply at illicit alcohol production sites, with 18% lacking access to water, while Lusaka had 13% without water supply of the zones selected, all sites in Ndola had water supply. Conclusion: Given the growing trend of consuming illicit alcohol in such unsanitary environments, urgent interventions are warranted. The study recommends the implementation of enforcement of regulations, including regular inspections and enhanced enforcement mechanisms, to ensure hygienic and sanitary production practices.