Exploring a Road Map to Achieving Tobacco Endgame in sub-Saharan Africa: A Qualitative Study Among Stakeholders From...

Tobacco endgame seeks to bring an end to tobacco use or drastically reduce prevalence to less than 5%. Discussions about tobacco endgame and the possible strategies to achieve this goal in sub-Saharan African are sparse. This study aimed to explore sub-Saharan African tobacco control stakeholders' perspectives about tobacco endgame and ascertain what strategies they perceive to be suitable for the region to achieve this goal.

This qualitative study involved a purposive sample of 29 stakeholders interviewed via online platforms guided by a semi-structured interview schedule. Stakeholders were from academia, civil society, and government departments in 12 sub-Saharan African countries. Interviews were conducted in English or French, transcribed verbatim (those in French were then translated to English), and thematically analyzed with the aid of NVivo version 12 software.

There is support for the adoption of tobacco endgame in sub-Saharan Africa by tobacco control stakeholders in the region due to the negative impact of tobacco on health, the environment, and economy. Proposed endgame approaches for the region were recommended to be Afrocentric and sensitive to cultural and regional dynamics. Stakeholders believed that the success of endgame strategies depends on political will, multisectoral collaboration, availability of resources, buy-in from the public, and monitoring of the tobacco industry. Suggested endgame strategies were categorized into 5 themes: (1) product-focused (less addictive tobacco and regulation of novel products); (2) user-focused (smoke-free generation, cessation support, and promotion of sports); (3) market/supply-focused (licensing of sellers, increase in taxes, control of illicit trade, and alternative income for farmers); (4) institutional structure-focused (tobacco industry monitoring and regulation); and (5) legislation implementation-focused (effective implementation of international treaties aimed at lowering tobacco use prevalence).

There is support for a tobacco endgame in sub-Saharan Africa. Collaboration from various departments/ministries and support from government and the public would be needed to make tobacco endgame a reality in the region.