Tobacco smoking in Sub-Saharan Africa: A systematic review and meta-analysis.

Abstract

Introduction: Population-level smoking (cigarette or tobacco or nicotine use) has reduced in high-income nations, but not proportionally compared to less developed regions. This study aimed to estimate smoking prevalence in Sub-Saharan Africa (SSA).

Approach: Databases searched included PubMed, EMBASE, PsycINFO, African Journal Online, the Global Health Data Exchange and Google Scholar. The search terms included 'cigarette', 'smoking', 'tobacco', 'nicotine', 'prevalence' and 'Sub-Saharan Africa'. Prevalence data on smoking was extracted separately for adolescents (10-17) and adults (18+). Prevalence of lifetime, past 12- and 6-month smoking was included. Weighted pooled prevalence was calculated using MetaXL, while meta-regression analysis was conducted with Stata version 17. For the estimation of pooled prevalence, we employed a DerSimonian-Laird estimation method. The risk of bias tool was utilised to assess the quality of the studies.

Key findings: We included 195 papers. Overall, between 2018 and 2023, the weighted lifetime smoking prevalence was 8.8% (95% confidence interval [CI] 5.1, 13.4%), with a past-year prevalence of 10.8% (CI 4.0%, 19.9%), and daily smoking was 3.5% (CI 0.0%, 9.5%) in SSA. Among adolescents, the lifetime prevalence was 4.5% (CI 2.0%, 8.0%), with a past-year prevalence of 4.1% (CI 0.0%, 13.4%) and daily smoking was 4.7% (CI 1.0%, 10.6%). Among adults, the lifetime prevalence of smoking was 12.7% (CI 6.6%, 20.4%), 12.1% (CI 2.6%, 26.2%) in the past year and daily smoking was 3.3% (CI 0.0%, 9.8%).

Implications: These findings highlight the importance of maintaining consistent monitoring and ensuring timely follow-up in implementing smoking prevention measures and regulations in SSA countries.