Independent research, an ally in tobacco control in Africa

A comprehensive review of the scientific literature devoted to tobacco control on the African continent over a 22-year period identifies the themes addressed and points to new avenues to explore. These scientific publications are essential for supporting tobacco control policies.

Although smoking prevalence remains historically low in Africa (11.4 % overall in 2015, compared to 24.4 % in the rest of the world), this continent has seen an increase in cigarette sales volumes of 52 % between 1980 and 2016. Estimated at 8.4 % in 2020, this smoking prevalence, however, masks an expected increase in the number of smokers, due to the demographic growth of African countries.

The study of the evolution of this tobacco prevalence has long dominated scientific research on tobacco and its products in Africa, to the detriment of other themes. In order to detail the themes actually addressed, a team of researchers conducted a review of the scientific literature covering all research on tobacco on this continent, over a period of 22 years.[1].

Increase in publications on tobacco in Africa

The researchers identified 818 scientific and medical articles on the topic of tobacco in African countries, published between January 1, 1996, and August 15, 2018. From 16 articles in 1996 to 71 in 2017, these publications have seen a sharp increase since 2007, with 67 of the articles having been published after this date. The increase in smoking prevalence and actions taken by the tobacco industry since the 2000s would explain the development of this scientific interest.

All 54 African countries were cited in at least two of the collected articles, but most studies (82 %) focused on a single country. Quantitative studies (91 %) and cross-sectional analyses (81 %) clearly dominated other types of studies – to the detriment of qualitative and economic studies, which better explain behaviors and uses. 91 % of the collected articles were written in English and 9 % were in French.

In this literature review, the researchers identified all the authors of the articles, classified the countries where their research center was assigned and made correlations between the authors and the countries. They thus established a map of the networks of collaborations between African researchers, making it possible to evaluate the relative importance of each country in this network. This analysis shows that four countries (South Africa, Nigeria, Egypt and Tunisia) concentrate two-thirds (65 %) of the research. It also highlights that three other countries (Cameroon, Uganda, Senegal) also play an important connecting role between researchers from African countries. Furthermore, in publications involving non-African authors, African authors appear more often as the first signature of articles on tobacco, compared to articles on infectious diseases.

A concentration of research on tobacco use

The vast majority of topics covered in these publications concerned tobacco use: 53 % focused on tobacco consumption, 33 % on the potential determinants of tobacco use, and 24 % on knowledge and beliefs about smoking. While 27 % of the articles studied the consequences of smoking, only 5 % focused on smoking cessation and 3 % on prevention interventions. The topic of tobacco cultivation was only addressed in 1.7 % of the articles, even though tobacco leaf production represents a significant part of many African economies.[2], Zimbabwe and Malawi in the lead. This literature review, however, did not include the topic of "disease of the green tobacco ", one of the consequences of tobacco cultivation.

This polarization of African research on tobacco use is, according to the authors of the study, to the detriment of other themes that could advance the fight against tobacco, such as illicit trade, smoking cessation assistance, or the role played by tobacco in hindering economic development. It also raises the question of the choice of research themes, their funding, and the sustainability of this funding, the sources of which are too limited. The authors therefore suggest better investment in the eight research themes identified by the Centre for Tobacco Control in Africa (CTCA): tobacco use profiles; consequences (including economic) of use; at-risk populations; sociocultural context of use; implementation of anti-tobacco policies; tobacco industry; tobacco production and alternative crops; and the economics of tobacco and tobacco control.

Research, the foundation of the fight against smoking

Of the 54 African countries, 47 have ratified the Framework Convention on Tobacco Control (FCTC), but implementation of its measures remains very incomplete on the continent. Independent scientific research is essential here, as it helps support tobacco control policies and counter the arguments of studies funded by the tobacco industry. The issue of illicit trade has thus been the subject of a intense lobbying of the tobacco industry with African leaders. Strengthening independent research, including more investment and career prospects for African researchers, therefore appears to be one of the conditions for the success of tobacco control in Africa.

Keywords: Africa, research, CTCA, tobacco cultivation.

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[1] Twesten JE, Stecher C, Arinaitwe J, Parascandola M. Tobacco control research on the African continent: a 22-year literature review and network analysis. Tob Control Epub ahead of print: 19 April 2023. doi:10.1136/ tc-2022-057760

[2] Status of tobacco production and trade in Africa. Geneva: World Health Organization; 2021.