Factors influencing tobacco control policy in sub-Saharan Africa: a systematic review

We set out to systematically review and synthesise the existing evidence regarding key factors that influence the development of tobacco control policies in sub-Saharan Africa (SSA).

Scopus, Embase, Global Health and Medline databases were systematically searched using keywords including 'tobacco', 'policy' and 'development'. Inclusion criteria included: qualitative, primary studies focusing on at least one SSA country and exploring contextual factors and actors involved in the development of tobacco control policies. Our search was restricted to English-language publications with no publication date restrictions.

23 studies were included in this review, decided by two independent reviewers.

Data were extracted using a template and critical appraisal of the studies was carried out using the National Institute for Health and Care Excellence quality appraisal checklist for qualitative studies.

We conducted a narrative synthesis of 23 included studies.

Themes including economic reliance on tobacco, political will, the role of the tobacco industry and challenges of multisectoral approaches were commonly identified as key factors influencing policy development. Narratives about the importance of tobacco to local economies were commonly identified as inhibiting policy development, whereas strong advocacy networks were cited as key factors in successful policy development.

This review highlights the importance of exploring the key actors and broader contextual factors to understand tobacco control and policy development. The perceived importance of tobacco to low-income and middle-income country economies presents continued challenges to policy development, but advocacy networks and multisectoral action can be effective in countering this perception and heralding policy change.