A Systematic Review of Tobacco Smoking Prevalence and Description of Tobacco Control Strategies in Sub-Saharan African Countries; 2007 to 2014

Abstract

ObjectiveTo systematically review current smoking prevalence among adults in sub-Saharan Africa from 2007 to May 2014 and to describe the context of tobacco control strategies in these countries.Data SourcesFive databases, Medline, Embase, Africa-wide Information, Cinahl Plus, and Global Health were searched using a systematic search strategy. There were no language restrictions.Study Selection26 included studies measured current smoking prevalence in nationally representative adult populations in sub-Saharan African countries.Data ExtractionStudy details were independently extracted using a standard datasheet. Data on tobacco control policies, taxation and trends in prices were obtained from the Implementation Database of the WHO FCTC website.ResultsStudies represented 13 countries. Current smoking prevalence varied widely ranging from 1.8% in Zambia to 25.8% in Sierra Leone. The prevalence of smoking was consistently lower in women compared to men with the widest gender difference observed in Malawi (men 25.9%, women 2.9%). Rwanda had the highest prevalence of women smokers (12.6%) and Ghana had the lowest (0.2%). Rural, urban patterns were inconsistent. Most countries have implemented demand-reduction measures including bans on advertising, and taxation rates but to different extents.ConclusionSmoking prevalence varied widely across sub-Saharan Africa, even between similar country regions, but was always higher in men. High smoking rates were observed among countries in the eastern and southern regions of Africa, mainly among men in Ethiopia, Malawi, Rwanda, and Zambia and women in Rwanda and rural Zambia. Effective action to reduce smoking across sub-Saharan Africa, particularly targeting population groups at increased risk remains a pressing public health priority.

Tobacco Control Progress in Low and Middle Income Countries in Comparison to High Income Countries

“…Due to decreasing tobacco consumption in HICs, industries may target markets in LDCs and LMICs in the Asian-Pacific, African and Middle Eastern regions where consumption is currently on the rise [10], with Africa as the continent predicted to have the highest increases in smoking prevalence [6,21]. Although gender gaps have narrowed regarding smoking prevalence in most HICs and parts of Latin America and Eastern Europe, female smoking prevalence remains lower than male smoking prevalence in many LDCs and LMICs, encouraging industrial expansion into formerly untapped markets—recruiting non-smokers, women and children in LDCs and LMICs [5,10,25]. A study investigating gender empowerment and female-to-male smoking prevalence ratios (female empowerment as measured by economic participation and decision-making, political participation and decision-making, and power over economic resources), determined that rates of female smoking were higher than males in countries with higher female empowerment [32].…”

“…Nevertheless, tobacco consumption in low and middle income countries is prevalent and such countries continue to confront growing burdens of such modern health risks. A systematic review of smoking prevalence in African adults revealed estimated male smoking prevalence in rural areas up to 22.8% in Rwanda and 40.4% in Zambia [5]. Without implementation and enforcement of proper tobacco control policies, global smoking prevalence could be as high as 22.0% in 2030, with the African region increasing from 15.8% in 2010 to 21.9% in 2030 [6].…”

Electronic Cigarettes for Curbing the Tobacco-Induced Burden of Noncommunicable Diseases: Evidence Revisited with Emphasis on Challenges in Sub-Saharan Africa

“…According to 2012 WHO estimates for the African region, this prevalence was almost at 22% in males and 2-3% in females, hence an overall prevalence around 12% [2]. A recent systematic review conducted by Brathwaite et al who compiled data between 2007 and 2014 from 13 SSA countries (mostly from Eastern, Western, and Southern Africa) showed that the prevalence of smoking varied immensely across SSA, from 1.8% to 25.8% [25]. …”

“…It is worth highlighting therefore that the prevalence of tobacco use is rapidly increasing in Africa [5, 25, 26]. Indeed, we learn from Brathwaite et al that cigarette consumption in Africa and some Middle Eastern countries increased by 57% between 1990 and 2009 while it decreased by approximately 26% in Western Europe during the same period [25].…”

“…Indeed, we learn from Brathwaite et al that cigarette consumption in Africa and some Middle Eastern countries increased by 57% between 1990 and 2009 while it decreased by approximately 26% in Western Europe during the same period [25]. It is anticipated that the African smoking prevalence will rise to 22% by 2030 if nothing is done [27].…”