Smoking Clouds Africa’s Future

Warning: This Area Contains Tobacco Smoke

Warning: This Area Contains Tobacco Smoke (Photo credit: tbone_sandwich)

By Masimba Biriwasha | Global Editor At Large | December 28, 2013

IT’S not often that you hear of smoking and its attendant health problems in Africa. After all, the continent has humongous and more immediate problems to deal with that smoking pales in significance. But the specter of public health challenges that are likely to be caused by an ever growing epidemic of smoking in Africa are worrisome to say the least. Africans can only ignore the smoking scourge at their own peril: tobacco users who die prematurely deprive their families of income, raise the cost of health care and hinder economic development.

Because there is a lag of several years between when people start using tobacco and when their health suffers, African governments may find it convenient to ignore the problem. Cash outs from tobacco companies may also prevent action but the price to be paid will be huge as more Africans take up smoking.

There are 1.1 billion smokers in the world today with that number expected to increase to 1.6 billion by the year 2025. Tobacco use is expected to claim one billion lives this century unless serious anti-smoking efforts are made on a global level.

According to a new study by the American Cancer Society report titled, Tobacco Use in Africa: Tobacco Control Through Prevention, Africa is likely to be a future epicenter of a tobacco epidemic if current trends continue.

While many African countries have low smoking prevalence, the American Cancer Society forecasts a significant increase in the near future. According the report, the number of adult smokers in Africa is expected to balloon from 77 million to 572 million smokers by 2100 if new policies are not implemented and enforced to stem the epidemic.

As economies and populations grow, Africa will provide a lucrative market for tobacco companies, raising fears of a spike in smoking related problems. The report projects that by 2060, Africa will have the second most smokers of any region, behind Asia, with 14 per cent of the world’s smokers (from the current 6 per cent), and by 2100 Africa will be home to 21 per cent of the world’s smokers.

“Not only is significant market scope brought about by population growth and a low base of smoking prevalence, but also through the potential for increased sales to current smokers. As economies and incomes grow, and as cigarette and tobacco markets in Africa develop and mature, so will smoking intensity, thereby increasing the value of the market dramatically,” states the report, adding that without action, Africa will grow from being the fly on the wall, to the elephant in the room of tobacco health problems.

In Africa, the benefits of the prevention strategy in terms of public health seem smaller at first due to the current lower smoking prevalence, but they will skyrocket in the near future due to population growth and the projected number of smokers in the long run, states the report.

“Africa is on a trajectory of needless tobacco-related death and disease,” said John R. Seffrin, Chief Executive Officer of the American Cancer Society. “But there is a clear opportunity to curb and prevent tobacco use and save millions of lives with a combination of targeted prevention and intervention policies. With appropriate intervention, we could avert an estimated 139 million premature deaths from smoking. The charge is clear.”

According to the World Health Organization (WHO), the tobacco epidemic is one of the biggest public health threats the world has ever faced, killing nearly six million people a year. More than five million of those deaths are the result of direct tobacco use while more than 600 000 are the result of non-smokers being exposed to second-hand smoke. Approximately one person dies every six seconds due to tobacco, accounting for one in 10 adult deaths.

TB/HIV poses challenges for Zimbabwe

By Chief K.Masimba Biriwasha

Harare, Zimbabwe – Charles Raradza, 44, fell seriously ill in 2001, coughing uncontrollably. He went to get tested for tuberculosis (TB) at a nearby hospital but the bacteria was not detected in his sputum.

Unconvinced, Raradza went to another hospital where a sputum and lung X-ray test revealed that he was indeed TB-infected.

“I was immediately enrolled into the hospital’s directly observed treatment therapy (DOTS), and had to take 13 tablets a day. The tablets were very painful. I guess because I love life so much I never defaulted during the six months that I was on the course,” said Raradza.

After two years, Raradza started coughing again. He went to get tested for TB again.

“At the hospital, it was discovered that I had TB, so I was given 60 injections and tablets – its was painful but I stuck through it. I was put on the 6-month long DOTS programme again,” he said.

In 2005 Raradza said he went to a Voluntary Counseling and Testing centre to get tested for HIV.

“It was unheard of then for anyone to go and get tested but I gathered my courage and went to the testing centre. I tested HIV positive, and was enrolled into the anteritroviral programme,” he said.

After noticing Raradza’s poor response to the AIDS drugs, Raradza said that a doctor-friend of his recommended another TB test. For a third time in his life, Raradza had TB, and he had to go through the treatment regimen of 60 injection and tablets.

According to Dr Tonderai Murimwa, an official in the Ministry of Health and Child Welfare’s AIDS and TB Unit, Raradza’s case of failed detection of TB is not unique and is attributed to changing epidemiological patterns in Zimbabwe.

“Diagnosis of TB is usually straightforward, the best test is sputum microscopy. But HIV changes the way the body reacts to infections. That’s why X-ray is now required but it is very expensive technology and the country cannot afford it at the moment,” said Dr Tonderai Murimwa, an official in the Ministry of Health and Child Welfare’s AIDS and TB unit.

Murimwa added that the drug distribution in the country had experienced severe challenges over the past decade due to lack of material resources such as transport, fuel and personnel.me

TB is a leading cause of illness and death for people living with HIV—about one in five of the world’s 1.8 million AIDS-related deaths in 2009 was associated with TB. The majority of people living with HIV and TB are in sub-Saharan Africa. The risk of developing tuberculosis (TB) is estimated to be between 20-37 times greater in people living with HIV than among those without HIV infection.

According to UNAIDS, TB places a heavy burden on people living with HIV including significant illness that requires at a minimum six months of treatment, with the associated economic costs to the individual, his or her family and the health-care system.

Among African nations, Zimbabwe is one of those most heavily affected by tuberculosis (TB). The deadly combination of TB and HIV epidemics is igniting a silent and uncontrollable epidemic of drug resistant TB that will negate previous national health gains.

The 2009 Global Tuberculosis Control Report from the World Health Organization (WHO) ranks Zimbabwe 17th among 22 countries worldwide with the highest TB burden. Zimbabwe had an estimated 71,961 new TB cases in 2007, with an estimated incidence rate of 539 cases per 100,000 population.

For the past 20 years, Zimbabwe has fought TB fairly successfully, providing free access to WHO-recommended treatments. In the past few years, however, the disease has re-emerged as a leading killer, especially among HIV positive people, who are often not identified though long-established TB tests.

An estimated two-thirds of Zimbabweans with TB are also infected with HIV. As a consequence, Zimbabwe has a staggering six times more TB cases than it did 20 years ago. According to statistics, the success rate of directly observed treatment is just 74 percent, far below the WHO recommended rate of 85 percent.

“In Africa, HIV is the potent factor in the progression of latent TB. People living with HIV are susceptible to TB infection. TB is the most common serious infection associated with HIV infection. The two diseases go hand in hand. This call for an integrated and collaborative approach in dealing with the two conditions,” said Dr. Patrick Hazangwe, a WHO official.

In Zimbabwe, the TB problem is compounded by the fact that patients often fail to complete treatment because they cannot afford the transport costs to and from health centers. The lack of access to health services in remote or rural parts of the country adds to the likelihood that large numbers of TB infections are going undetected and untreated.

To complicate matters, the brain drain of qualified front-line health care workers from Zimbabwe has resulted in poor healthcare delivery. Leck of medical practitioners coupled with obsolete machinery has also worsened the problem.

According to Betty Chikava, Member of Parliament for Mt Darwin East, poor financing of the health ministry is a key hindrance to an effective response to TB and other diseases.

“The Ministry of Health and Child Welfare has received paltry funding – only 7 percent of its projected budget; medical personnel in the hospitals and clinics are seriously overworked. The Ministry of Finance needs to be brought into the picture so that they can finance the health ministry adequately,” she said.