Indoor secondhand tobacco smoke and risk of under-five mortality in 23 sub-Saharan Africa countries: A population based study and meta-analysis

Prevalence and correlates of tobacco use in Botswana: evidence from the 2014 Botswana STEPwise survey

BACKGROUND

Tobacco use is one of the notable risk factors for non-communicable diseases globally. The objective of this study was to assess the prevalence of tobacco use and identify its correlates in the general population of Botswana aged 15 to 69 years.

METHODS

This study used a nationally representative WHO STEPwise Approach to Non-Communicable Disease Risk Factor Surveillance (STEPS) risk factors conducted in 2014 to explore the prevalence of tobacco use and its correlates in Botswana. Using IBM SPSS version 27, data on 4062 people aged 15 to 69 years who had been selected using multistage cluster sampling and had successfully completed the individual questionnaire were analysed. The prevalence of current tobacco smoking and smokeless tobacco use was determined using descriptive statistics while multivariable logistic regression was employed to assess correlates of current tobacco smoking and smokeless tobacco use. All comparisons were statistically significant at 5% significance level.

RESULTS

From a total sample of 4062 participants the prevalence of current tobacco smoking was estimated to be 12.9% while smokeless tobacco use was 3.2%. Adjusted results indicate that the odds of current tobacco smoking were eight times (AOR = 8.57, C.I = 6.28-11.7) higher among males compared to their female counterparts; six(AOR = 6.52, C.I 3.64-11.6) and three (AOR = 3.27, C.I. =2.07-5.15) times higher among respondents with no education and primary level education respectively, compared to their counterparts with tertiary or higher education; while for alcohol users the odds of current tobacco smoking were four times (AOR = 4.28, C.I = 2.93-6.24) higher than among non-alcohol users. The odds of smokeless tobacco use were significantly higher among women compared to men (AOR = 7.34, C.I = 4.01-13.4); individuals aged 50-59 (AOR = 1.15, C.I = 1.06-3.37) and 60-69 years (AOR = 1.23, C.I. =1.08-3.63) compared to 15-29 years; individuals with no education (AOR = 2.07, C.I = 1.03-4.02) and primary education (AOR = 1.05, C.I = 1.01-2.23) compared to individuals with tertiary education. However, the odds of smokeless tobacco use were significantly lower among individuals who consume alcohol (AOR = 0.48, C.I. = 0.29-0.80) compared to non-alcohol consumers.

CONCLUSION

Findings of this study indicate the need to strengthen existing national policies to reduce harmful use of tobacco among men, women, older adults, no or primary education level individuals and alcohol users.

When women win, we all win-Call for a gendered global NCD agenda

Gender is a social determinant of health, interacting with other factors such as income, education, and housing and affects health care access and health care outcomes. This paper reviews key literature and policies on health disparities and gender disparities within health. It examines noncommunicable disease (NCD) health outcomes through a gender lens and challenges existing prevailing measures of success for NCD outcomes that focus primarily on mortality. Chronic respiratory disease, one of the four leading contributors to NCD mortality, is highlighted as a case study to demonstrate the gender gap. Women have different risk factors and higher morbidity for chronic respiratory disease compared to men but morbidity is shadowed by a penultimate research focus on mortality, which results in less attention to the gap in women's NCD outcomes. This, in turn, affects how resources, programs, and interventions are implemented. It will likely slow progress in reducing overall NCD burden if we do not address risk factors in an equitable fashion. The article closes with recommendations to address these gender gaps in NCD outcomes. At the policy level, increasing representation and inclusion in global public health leadership, prioritizing NCDs among marginalized populations by global health societies and political organizations, aligning the gendered global NCD agenda with other well-established movements will each catalyze change for gender-based disparities in global NCDs specifically. Lastly, incorporating gender-based indicators and targets in major NCD-related goals and advancing gender-based NCD research will strengthen the evidence base for women's unique NCD risks and health outcomes.

Attributable risk of household solid fuel use and second-hand smoke associated with under-5 mortality in 46 low- and lower-middle-income countries, 2010-2020

BACKGROUND

Household solid fuel use (including indoor and outdoor) and second-hand smoke (SHS) are considered to be major contributors of under-5 mortality (U5M) in low- and lower-middle-income countries (LMICs). This study provides a comprehensive assessment of their odds ratios and attributable mortality in LMICs.

METHODS

We used the Demographic Health Surveys data for under-5 children in 46 LMICs (n = 778,532) from 2010 to 2020. Mixed effect multilevel logistic regressions were conducted to estimate the pooled adjusted odds ratio (aOR) for U5M due to solid fuel use, SHS and their combination compared to no exposure to them in 46 LMICs. The attributable mortality of solid fuel use, SHS, and their combination were assessed for each LMIC.

FINDINGS

The pooled aOR of solid fuel use and SHS for U5M was estimated to be 1.27 (95% Confidence Interval (CI): 1.19-1.36) and 1.13 (95%CI: 1.06-1.25), respectively, whereas those of their combination was 1.40 (95%CI: 1.31-1.50). U5M attributable to indoor and outdoor solid fuel use was the highest in Myanmar (18.0%) and the Gambia (16.5%), respectively, while those attributable to SHS was the highest in Indonesia (9.8%). U5M attributable to the combination of solid fuel use and SHS was the highest in Timor-Leste (22.7%).

INTERPRETATION

The combined effect of exposure to solid fuel and SHS had a higher risk of U5M than the individual risk. The use of clean fuel and tobacco control measures should be integrated with other child health promotion policies.

FUNDING

This research was partially supported by a research grant from the Ministry of Education, Culture, Sports, Science and Technology of Japan (21H03203).

Parental tobacco and indoor secondhand smoking exposure and the risk of offspring under-five mortality in low- and middle-income countries

Children are vulnerable to exposure of secondhand smoking (SHS) which is a major preventable cause of disease and death. This study aimed to investigate the association between parental tobacco use or SHS exposure, respectively, and under-five mortality. Data were obtained from the nationally representative and population-based Demographic and Health Surveys in low- and middle-income countries (LMICs) between 2000 and 2018. Cox proportional hazard regression models with complex survey design were conducted to examine the adjusted associations between parental smoking and SHS exposure and child under-five mortality. In the pooled analysis of parental smoking, 437 322 children were included. Compared with children whose parents are not smoking, those whose father or both parents smoked any form of tobacco had higher risks of mortality (hazard ratio [HR] = 1.08, 95% confidence interval [CI] = 1.03-1.13; HR = 1.18, 95% CI = 1.06-1.32, respectively). In addition, parental using smokeless tobacco, smoking tobacco, and using smokeless tobacco and smoking tobacco simultaneously was significantly associated with child under-five mortality (HR = 1.07, 95% CI = 1.01-1.12; HR = 1.12, 95%CI = 1.04-1.21; and HR = 1.17, 95%CI = 1.06-1.30, respectively). In the pooled analysis of SHS exposure, 605 442 children were included, and weekly and daily SHS exposure were significantly associated with child under-five mortality (HR = 1.11, 95% CI = 1.03-1.20, and HR = 1.10, 95% CI = 1.06-1.15, respectively). The results were robust in most stratification analyses and sensitivity analyses. Parental tobacco use and indoor SHS exposure were associated with increased risk of under-five mortality in LMICs. Comprehensive tobacco control programs should be considered by policymakers in LMICs to promote smoke-free environments for children.

Household air pollution and under-five mortality in sub-Saharan Africa: an analysis of 14 demographic and health surveys

BACKGROUND

Globally, over four million deaths are attributed to exposure to household air pollution (HAP) annually. Evidence of the association between exposure to HAP and under-five mortality in sub-Saharan Africa (SSA) is insufficient. We assessed the association between exposure to HAP and under-five mortality risk in 14 SSA countries.

METHODS

We pooled Demographic and Health Survey (DHS) data from 14 SSA countries (N = 164376) collected between 2015 and 2018. We defined exposure to HAP as the use of biomass fuel for cooking in the household. Under-five mortality was defined as deaths before age five. Data were analyzed using mixed effects logistic regression models.

RESULTS

Of the study population, 73% were exposed to HAP and under-five mortality was observed in 5%. HAP exposure was associated with under-five mortality, adjusted odds ratio (OR) 1.33 (95% confidence interval (CI) [1.03-1.71]). Children from households who cooked inside the home had higher risk of under-five mortality compared to households that cooked in separate buildings [0.85 (0.73-0.98)] or outside [0.75 (0.64-0.87)]. Lower risk of under-five mortality was also observed in breastfed children [0.09 (0.05-0.18)] compared to non-breastfed children.

CONCLUSIONS

HAP exposure may be associated with an increased risk of under-five mortality in sub-Saharan Africa. More carefully designed longitudinal studies are required to contribute to these findings. In addition, awareness campaigns on the effects of HAP exposure and interventions to reduce the use of biomass fuels are required in SSA.

Perception of the risk of tobacco use in pregnancy and factors associated with tobacco use in rural areas of Myanmar

INTRODUCTION

Tobacco use is recognized as the most important preventable risk factor for pregnancy complications and undesirable fetal outcomes. This study examined the reported prevalence of tobacco use among married men and women residing in rural areas, and their knowledge on the risks of tobacco use during pregnancy and the factors associated with tobacco use.

METHODS

A cross-sectional study was conducted within 32 villages in the delta region of Myanmar, randomly selected through multistage sampling procedure by using a pre-tested structured questionnaire during 2016. In all, 617 people participated in the household survey.

RESULTS

About 80% of current smokers (109/128) smoked at home, of whom 16% reported the presence of a pregnant woman in their smoking area. Less than 25% of the respondents were aware of the negative impacts of tobacco use on pregnancy outcomes. Men had significantly lower perceived risk towards smoking on some pregnancy outcomes. Multivariate analysis confirmed the significant influence of male gender (adjusted OR, AOR=12.62; 95% CI: 6.30–25.29) and the age of women <35 years (AOR=3.51; 95% CI: 1.97–6.26) on current tobacco use, when controlling for other variables.

CONCLUSIONS

Men in the study villages and those with a low level of education had poor knowledge on the risks of tobacco on pregnancy outcomes. However, good knowledge and perceived risk of undesirable impacts on pregnancy did not have any influence on tobacco use.

Tobacco use and its determinants in the 2015 Kenya WHO STEPS survey

BACKGROUND

According to the World Health Organization (WHO), in 2015, over 1.1 billion people smoked tobacco, which represents around 15% of the global population. In Africa, around one in five adults smoke tobacco. The 2014 Kenya Global Adult Tobacco Survey reported that 2.5 million adults use tobacco products. The objective of our study was to describe patterns and determinants of tobacco use from the 2015 Kenya STEPS survey, including use of "smokeless" tobacco products and the more novel e-cigarettes.

METHODS

The WHO STEPwise approach to surveillance (STEPS) was completed in Kenya between April and June 2015. Logistic regression analyses was used to assess factors affecting prevalence and frequency of tobacco use. Sociodemographic variables associated with tobacco use were considered: age, sex, level of education, wealth quintile, and residence. The relationship with alcohol as an intervening risk factor was also assessed. Our main outcomes of interest were current tobacco use, daily tobacco use and use of smokeless tobacco products.

RESULTS

Of 4484 respondents, 605 (13.5%) reported being current tobacco users. Most active tobacco users were male (n = 507/605, 83.8%). Three out of four tobacco users (n = 468/605, 77.4%) reported being less than 50 years old, with the average start age being 21 (20.6, 95% CI 19.3-21.8) and the average quit age 27 (27.2, 95% CI 25.8-28.6). Most tobacco users had only ever attended up to primary school (n = 434/605, 71.7%). Men had nearly seven times higher odds of being tobacco users as compared to women (OR 7.63, 95% CI 5.63-10.33). Alcohol use had a positive effect on tobacco use. Finally, less than ten respondents reported having used e-cigarettes.

CONCLUSION

The 2015 Kenya WHO STEPS provided primary data on the status of tobacco use in the country and other leading NCD risk factors, such as alcohol, and associated diseases. Our findings highlight key target populations for tobacco cessation efforts: young people, men, those with lower levels of education, and alcohol consumers. Further data is needed on the use of smokeless tobacco, and its impact on smoked tobacco products, as well as on the novel use of e-cigarettes.