The SA Journal Diabetes & Vascular Disease Vol 13 No 2 (December 2016)

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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: 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: 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.