A narrative systematic review of tobacco cessation interventions in Sub-Saharan Africa

Abstract

<jats:sec><jats:title>Aim:</jats:title><jats:p> In the face of increasing tobacco consumption in Sub-Saharan Africa, it is crucial to not only curb the uptake of tobacco, but to ensure that tobacco users quit. Considering the minimal attention that tobacco cessation interventions receive in Sub-Saharan Africa, this review aims to describe studies that evaluated tobacco cessation interventions in the region. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> A search of studies published till December 2019 that evaluated tobacco cessation interventions in Sub-Saharan Africa and examined tobacco quit rates was conducted in PubMed-Medline, Web of Science and Scopus. Study designs were not limited to randomised control trials but needed to include a control group. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Of the 454 titles and abstracts reviewed, eight studies, all conducted in South Africa, were included. The earliest publication was from 1988 and the most recent from 2019. Five studies were randomised control trials, two were quasi-experimental and one was a case–control study. Populations studied included community-based smokers (four studies) and university students, while the relevant clinic-based studies were conducted in pregnant women, tuberculosis patients and HIV-infected patients. Sample sizes were 23 in the case–control study, 87–561 in randomised control trials, and 979 (pregnant women) and 4090 (three rural communities) in the quasi-experimental studies. Four studies included nicotine replacement therapy in the interventions while four utilised only psychotherapy without adjunct pharmacotherapy. Quit rates were evaluated by exhaled carbon monoxide levels (five studies), blood carbon monoxide, urinary cotinine levels and self-reported quit rates. Four studies (two each with and without pharmacotherapy) reported significantly better outcomes in the intervention versus the control groups while one study findings (without pharmacotherapy) were significant in women but not men. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> This review highlights that scant attention has been paid to tobacco cessation intervention in Sub-Saharan Africa. The heterogeneity of these studies precluded comparisons across interventions or populations. There is a need for evidence-based low-cost tobacco cessation intervention that target high-risk population in Sub-Saharan Africa. </jats:p></jats:sec>

Burden and Disparities of Digestive Diseases in Sub-Saharan Africa

“…Peer et al and Mamudu et al have both pointed out that smoking cessation campaigns and tobacco control interventions are scant in SSA. 47,48 The region has been described as a "research desert" concerning tobacco control, with a clear need for increased investment in both research and training over the past 50 years. 48 The lack of comprehensive tobacco cessation interventions highlights an urgent need for SSA to prioritize and invest in effective tobacco control strategies.…”

Tobacco control research on the African continent: a 22-year literature review and network analysis

“…They identified eight central themes as critical to providing data to support tobacco control action: patterns of tobacco use, effects of use (including impacts on sustainable development goals), populations at risk, policy and implementation, sociocultural context of tobacco use, the tobacco industry, tobacco production and alternative livelihoods and the economics of tobacco and tobacco control 33. Other researchers have identified similar research needs to support tobacco control in Africa, such as research on targeted tobacco cessation interventions25 and the household economic impacts of tobacco use 31. The fact that our review found gaps in the literature in some of these focus areas has relevance for public health practice, because such data can play an important role in developing, gaining support for and implementing tobacco control policies and programmes.…”

“…Previous reviews have examined the prevalence of smoking21 22 and policy, media and economic landscape of sub-Saharan Africa,5 the implementation of school-based prevention programmes,23 24 cessation interventions,25 the application of research study designs and methods26 and tobacco policy assessment tools 27. These studies have shown that tobacco use behaviours vary greatly across sub-Saharan African countries along with the implementation of tobacco control policies 21 28.…”

Behavioural interventions for tobacco cessation in India: A systematic review and meta-analysis

“…As suggested in the review performed in sub-Saharan Africa, better approaches for developing countries would be to identify tobacco users in the already running national programs for TB, HIV, and maternal and child health programs and incorporate the component of tobacco cessation counseling in it. [ 52 ] There is a need to individualize counselling according to the requirement of each person. [ 53 ]…”