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VOLUME 13 NUMBER 2 • DECEMBER 2016

91

SA JOURNAL OF DIABETES & VASCULAR DISEASE

REVIEW

Tobacco use in SSA

Most estimates of tobacco use in SSA vary in their operational

definitions. For instance, some surveys have used different age

ranges for men and women and between countries. Also, while

some surveys considered current tobacco use including smoked

and non-smoked tobacco, others have used only daily cigarette

smoking. Moreover, these studies were performed in different

years, making comparison of prevalence of tobacco use across

most African countries problematic.

According to WHO-Afro,

33

tobacco-smoking rates were

considerably lower (< 10%) in countries such as Democratic Republic

of Congo, Congo, Ethiopia, Nigeria, Ghana, Swaziland and Lesotho.

Countries in Central, West and East Africa had smoking prevalence

rates ranging between 10 and 19%. High rates of tobacco use

(> 20%) were found mainly in southern Africa, Guinea, Guinea

Bissau, Niger, Seychelles and Mauritius. There were no data from

certain countries such as Angola, Central African Republic, Gabon

and Equatorial Guinea.

It is widely known that some countries on the continent are

major tobacco growers. For instance, tobacco accounts for 61 and

23% of export earnings in Malawi and Zimbabwe, respectively.

South Africa, Tanzania, Kenya and Nigeria rank closely behind

Malawi and Zimbabwe. Continual commercial pressures, price

incentives and other subsidies provided by transnational cigarette

companies to African farmers, coupled with aggressive marketing

and advertisements will drive the prevalence of tobacco use in SSA.

It is therefore not surprising that very few African countries have

been signatories to the Framework Convention on Tobacco Control

Ratification, with countries such as Zimbabwe, Malawi and Eritrea

declining to sign the convention altogether.

Table 3 shows age-standardised prevalence estimates for

current smokers in males and females aged 25 years or older in

2006 in selected countries. In general, smoking prevalence remains

quite low among African women, although increased trends are

emerging in young urban women. The prevalence of smoking is

20 to 50 times higher in men than in women across Africa, with

estimates of below 2% in women in most SSA countries except

in South Africa and Namibia, where smoking prevalence among

women was 5.5 and 5.9%, respectively.

34

Various estimates of smoking prevalence in African men

between 1976 and 2005 revealed rates below 10% in many African

countries. But in Tanzania, Mozambique, South Africa, Mauritius

and Seychelles, smoking prevalence rates ranged between 15 and

30%. Smoking prevalence rates in adults increased substantially

across SSA by 2009, especially in Mauritius where a third of adults

smoked, closely followed by South Africa, Tanzania, Burkina Faso

TABLE 2.

Prevalence of physical inactivity in selected SSA countries,

WHO 2003.

Country

N/U/R (18–69 years)

Males (%)

[95% CI]

Females (%)

[95% CI]

Both genders (%)

[95% CI]

Congo (

n

= 1 335)

M:F = 623:712

23.5

[16.5–30.5]

30.2

[21.8–38.51]

27.2

[20.5–33.9]

Ethiopia (

n

= 4 430)

M:F = 2 171:2 259

9.4

[7.1–11.8]

16.0

[13.9–18.2]

12.7

[11.0–14.4]

Ghana (

n

= 3 362)

M:F = 1 532:1 830

7.9

[5.9–9.8]

15.1

[12.7–17.5]

11.5

[9.7–13.3]

South Africa (

n

= 2 028)

M:F = 957:1071

43.0

[37.4–48.6]

46.6

[41.4–51.9]

44.9

[40.4–49.4]

Zimbabwe (

n

= 3 570)

M:F = 1 296:2 274

14.1

[11.6–16.6]

22.0

[19.6–24.5]

18.1

[16.4–19.8]

N/U/R = National Urban and Rural Survey.

Source:

http://infobase.who.int.

A

Fig. 1.

Physical activity in men and women aged 18 to 69 years in selected

countries.

Table 3.

Age-standardised prevalence estimates for tobacco smoking

(current users) in males and females aged 15 years and older in selected

sub-Saharan African countries by region, 2006.

Region/country

Current smoking

prevalence in males

aged 15 + years (%)

Current smoking

prevalence in females

aged 15 + years (%)

Eastern Africa

Uganda

UR Tanzania

19.0

24.0

2.0

2.0

Central Africa

DR Congo

Malawi

13.0

21.0

0.6

2.0

Western Africa

Nigeria

Ghana

12.0

10.0

0.2

0.5

Southern Africa

Zimbabwe

South Africa

33.0

29.0

2.0

8.0

Islands

Mauritius

Seychelles

34.0

32.0

0.9

3.0

DR Congo = Democratic Republic of Congo, UR Tanzania = United Republic

of Tanzania.

Source:

https://apps.who.int/infobase/Comparisons.aspx

Accessed on 31

December 2011.

The figures represent age-standardised prevalence rates, using the standard

WHO world population for age, for current tobacco smokers. These figures

should be used only to draw comparisons of prevalence between countries

and between men and women within a country. These figures are different

from the crude data reported in country surveys in Infobase.