The tobacco industry has globalized and tobacco use continues to increase in low-and middle-income countries. A new study conducted by researchers at the East Tennessee State University College of Public Health estimated the prevalence of adult tobacco use in 17 Sub-Saharan Africa (SSA) countries and found that the prevalence of smoking ranged from 7.3 percent in Ghana to 37.1 percent in Sierra Leone, smokeless tobacco use ranged from 0.3 percent in Zambia to 24.6 percent in Madagascar, and use of all tobacco products ranged from 8.1 percent in Ghana to 48.9 percent in Madagascar. Researchers used Demographic Health Survey data for the years 2005 – 2010 to generate these estimates. The study was led by Dr. Hadii Mamudu, an assistant professor in the department of health services management and policy, working in collaboration with former doctoral student, Mr. Sreenivas Veeranki, and with colleagues at the WHO and the Indian Institute of Technology, and was published in BMC Public Health in September 2013.
Madagascar had exceptionally higher prevalence rates of all tobacco use (48.9 percent of men; 10.3 percent of women) and of smokeless tobacco (SLT) use (24.6 percent) than other SSA countries. “Because of the high rates of tobacco use in Madagascar, we needed to focus on understanding the drivers of adult tobacco consumption choices in this country,” says Dr. Mamudu.
Using 2008-09 Demographic Health Survey data for Madagascar, the research pinpointed the multiple socioeconomic and contextual factors that were associated with tobacco use. Age, education, wealth and occupation emerged as key determinants of adult tobacco use in Madagascar. Education particularly impacted SLT use, as adults with no or primary education had 7.7 and 6.5 times higher relative risks, respectively, of being a SLTs user than those with university education. SLT use was also higher among rural than urban residents. And whereas, among men, poverty was associated with increased SLT and dual tobacco use, wealthy women had higher relative risks of smoking prevalence than low-income women.
“Although the government continues to enact policies to address the problem, tobacco use remains higher in Madagascar than the other 16 SSA countries,” says Dr. Mamudu. “Our findings reinforce the need for effective implementation and enforcement of government enacted policies in low-and middle-income countries such as those in SSA,” he added. The authors called on the government and public health community of Madagascar to engage in health education efforts to make all forms of tobacco use socially unacceptable, while discouraging tobacco use initiation and encouraging cessation.
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[Photo: Dr. Hadii Mamudu]