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

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).

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.

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%).

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