Assessment of Tobacco Control Policy Instruments, Status and Effectiveness in Africa: A Systematic Literature Review

Alleviating the public health burden of hypertension: debating precision prevention as a possible solution

Hypertension is a major global health concern, with deaths attributed to the condition expected to increase to 1.57 million by 2034, particularly affecting low-and-middle-income countries such as those within sub-Saharan Africa. Non-communicable diseases, with hypertension as a core contributor, account for 74.36% of global deaths. The burden of hypertension in sub-Saharan Africa is significant, with an estimated 10-20 million people currently affected. Systemic barriers, such as fragmented health services and socioeconomic inequalities, coupled with shifts in greater salt-intake, ultra-processed foods, more sedentary lifestyles, and overburdened healthcare services, have exacerbated elevated blood pressure and poorer management of people living with hypertension in sub-Saharan Africa. Most public health strategies focus on detecting, treating, and controlling hypertension through lifestyle modifications and medication. However, evidence suggests only 10% of population hypertension is well managed. This indicates a growing need to shift towards preventative efforts. Precision prevention, a tailored health intervention approach utilising individual and population-specific factors - genetic, environmental, and social determinants - offers a potential alternative. Precision prevention aims to deliver the right preventative measures to the right population at the right time, promising to enhance intervention efficiency and health outcomes. This paper highlights various intervention levers, including environmental, biological, and behavioural modifications, examines case studies from high-income countries, and discusses the potential for implementing precision prevention in South Africa. While precision prevention shows promise, we also discuss the significant barriers to its implementation in LMICs such as those within sub-Saharan Africa.

Tobacco use and readiness to treat tobacco users among primary healthcare professionals in Soweto

BACKGROUND

Despite its hampering influence on the willingness of healthcare professionals (HCPs) to implement tobacco cessation treatments, the tobacco use status of these professionals remains understudied in South Africa.

METHODS

This cross-sectional study, which sampled 444 HCPs, was conducted in five community health centres in Soweto. A self-administered questionnaire collected information on socio-demography, tobacco use, quit attempts and readiness to implement tobacco cessation treatments for their patients.

RESULTS

The mean age was 41 years. Most were female, 80% (n = 355); single, 54.1% (n = 240) and black professionals, 91.6% (n = 405). About 22% (n = 96) were ever-users of tobacco, 12.6% (n = 56) current users and 9% (n = 40) ex-users. About 56.6% (n = 30) of current users had contemplated quitting in the past year. Approximately 68% (n = 300) and 82.2% (n = 365) of respondents were ready and willing to implement tobacco cessation treatments, respectively. Only 32% (n = 143) of respondents had received any training on tobacco use and cessation treatments. There was no significant association between tobacco use and readiness to implement cessation treatments (p = 0.50).

CONCLUSION

Tobacco use is prevalent among HCPs and does not influence the implementation of cessation treatments in South African primary health care. Although most reported readiness and willingness to quit tobacco use, more training is required in both formal education and continued professional development.Contribution: This study demonstrates the alarming rate of tobacco product use among primary health care professionals in South Africa. While there is a strong willingness to implement tobacco cessation treatments for their patients, most healthcare professionals still require training to enhance their self-efficacy.

Tobacco control research on the African continent: a 22-year literature review and network analysis

OBJECTIVE

Describe the landscape of tobacco-related topics, funders and institutional networks in Africa.

DATA SOURCES

We searched PubMed, Embase and African Index Medicus for published articles from January 1996 to August 2018 in any language.

STUDY SELECTION

Two researchers independently reviewed titles and abstracts for a focus on nicotine or tobacco product(s) and describe data or recommendations specific to Africa. Ultimately, 818 articles were identified.

DATA EXTRACTION

Three independent coders conducted qualitative analyses of articles and extracted funders, study populations, countries of research focus, research topics, tobacco products, study design and data source. A bibliometric analysis estimated coauthorship networks between the countries of authors' primary institutional affiliation.

DATA SYNTHESIS

All 54 African countries were represented in two or more articles. The coauthorship network included 2714 unique authors representing 90 countries. Most articles employed a cross-sectional study design with primary data collection, focused on cigarettes and studied use behaviour. Few articles examined tobacco farming or interventions for cessation or prevention. The most frequently cited funder was the US National Institutes of Health (27.2%). A range of coauthorship patterns existed between African institutions with some coauthoring with one institution while others coauthored with 761 institutions in other African countries.

CONCLUSIONS

The literature review identified the need for implementation research for tobacco control interventions and policies, economic and development impacts of tobacco use research, and tobacco industry and tobacco production and farming research. Numbers of research collaborations between institutions in Africa vary, suggesting the need for regional institutional capacity building.

A Scoping Review of Tobacco Control Health Communication in Africa: Moving towards Involving Young People

Health communication has been highlighted as a cost-effective preventive intervention in Africa, where the prevalence of tobacco use is still relatively low compared to other World Health Organization (WHO) regions. This scoping review aimed to examine tobacco control health communication interventions in Africa. The review was guided by the PRISMA-ScR checklist. Data was extracted from 20 peer-reviewed papers, WHO Global Health Observatory on anti-tobacco mass-media campaigns for 54 African countries, and 6 WHO Framework Convention on Tobacco Control reports on Article 12. Data extraction informed by the Joanna Briggs Institute (JBI) data-extraction questions was used for peer-reviewed studies while a pre-determined template was used for the other sources. Narrative data synthesis informed by the JBI manual for evidence synthesis was employed. A lack of research that comprehensively addresses all areas of health communication and inconsistent use of health communication campaigns were identified. Only an average of 6 countries had ever implemented high-quality national mass-media campaigns in a decade, while an average of 33 countries consistently failed to conduct campaigns that lasted more than 3 weeks. Although the involvement of key populations was clearly vital to ensure content relevance and message clarity, a lack of health communication informed by young people was observed, as they rarely participated in key decision-making despite reportedly being the targets of interventions. Clear health communication for tobacco-use prevention informed by young people is lacking in African countries. Active participation of young people in developing targeted campaigns is needed to facilitate content relevance and comprehension to ultimately contribute to tobacco-use prevention.

How does Indian news media report smokeless tobacco control? A content analysis of the gutka ban enforcement

Smokeless tobacco (SLT) products like gutka and paan masala are a growing public health crisis in India. Despite enacting a ban-the highest form of regulation-little is known about implementation progress. The purpose of this study was to look at how enforcement of gutka ban is covered in Indian news media and if media is a reliable source of data. We conducted a content analysis of online news reports (n = 192) from 2011 to 2019. News characteristics such as name and type of publication, language, location, slant and beat coverage, visuals, and administrative focus were quantified. Similarly, news contents were inductively coded to examine dominant themes and the implementation landscape. We found that coverage was initially low but increased after 2016. Overall, news reports were in favor of the ban. Five leading English newspapers covered the majority of the ban enforcement reports. Prominent themes like consumption, health hazards, tobacco control responses, impact on livelihoods, and illicit trade were drawn from the textual analysis as the main arguments in relation to the ban. Gutka is largely seen as an issue of crime reflected by the contents, sources, and frequent use of pictures depicting law enforcement. The interconnected distribution channels of the gutka industry hindered enforcement, highlighting the need to study the complexities of regional and local SLT supply chains.

An investigation of the Sustainability of Village Savings and Loans Associations (VSLAs) amidst Covid-19 and its impact on household income levels: lessons from Malawi, Sub-Saharan Africa

BACKGROUND

Food security, malnutrition, and poverty are some of the challenges that most of the sub-Saharan African countries have been historically facing. With the coming of Covid-19 pandemic, the sustainability of the Village Savings and Loans Association which are formed to counter fight these challenges is questioned.

AIM

This study aimed to assess factors associated with the Sustainability of VSLAs amidst Covid-19 and its impacts on households' income levels.

METHODS

An online cross-sectional design was conducted from November to January 2021, targeting VSLAs members in Mzuzu. A snowball and respondent-driven sampling technique were used to recruit the needful participants using a referral approach. IBM SPSS version 23 was used to perform descriptive statistics, Chi-Square, and binary logistic regression with unstandardized Beta (β), Odds Ratios (OR), and 95% Confidence Interval (CI) being taken into account with P-value set at 0.1, 0.05 and 0.01 significance levels.

RESULTS

Our study finds that household income declined by 54% for those earnings belonged to ˂ MK5,000, as compared to 38% and 15% for medium (MK5,000 ≥ MK10,000) and higher (> MK10,000) income bands respectively. Our study shows that gender (β = 0.437, p = 0.094), age-group (β = 1.317, p = 0.000), education (β = 2.181, p = 0.047), share contributions (β = 1.035, p = 0.008), meetings (β = 0.572, p = 0.021), occupation (β = -0.453, p = 0.106), and frequency of meeting (β = -0.507, p = 0.049) were positively and negatively statistically significant predictors.

CONCLUSION

According to the findings of this study, households with lower income earners, which is one of the indicators of poverty, are more affected by the pandemic than their counterparts. We urge that the Malawi governments should maintain and, if they haven't already, implement programs that support low-income households, such as transfer payments, which have been shown to uplift people out of income poverty in many developing countries.