Africa: Questions about the focus on shisha

In Africa, health professionals regret that the measures taken in several countries against the trade and use of shisha are not also applied to other tobacco products.

After Kenya, Gambia, Tanzania, Rwanda, Benin, Ghana, Senegal, Guinea and, since March 2022, Cameroon[1], it is Mali's turn to adopt legislation banning the importation, distribution, sale and use of shisha (water pipe)[2]. Several voices, from associations or public health actors, however, question this particular focus on shisha, while the legislation relating to other tobacco products, cigarettes first and foremost, is struggling to be applied.

The weight of conflicts of interest in Burkina Faso

In Burkina Faso, only the city of Ouagadougou has banned the use of shisha, in the name of protecting young people. "It is difficult to extend the rigor of the fight to cigarettes", says Georges Ouédraogo, head of the Ouagadougou Smoking Cessation Unit, "In recent years, when we wanted to toughen up the legislation against smoking, a march was organized in Bobo Dioulasso, the economic capital, with the families of employees to say that we were aiming for the loss of jobs for their husbands and children."[3]. "There are people who profit from this and who are supported by the tobacco industry", he continues, in order to explain the lack of support from the National Assembly for the fight against tobacco, despite a very comprehensive law adopted in 2010[4].

Taking care of the cigarette manufacturers' sensitivities

In Cameroon, the Ministry of Health remains silent when asked why cigarettes and other tobacco products were not banned at the same time as shisha. In fact, it is said that "to avoid any conflict with the tobacco industry", according to a source from this ministry who remained anonymous, particularly since the introduction of health warnings on cigarette packets in 2019. "Depending on interests, decisions taken, even at the highest level, are paradoxical if not contradictory", according to Abakar Mefire, sociology teacher at the Siantou Institute.

In this country, according to a source from the Ministry of Territorial Administration (MINAT), the ban on shisha was reportedly imposed following disturbances of public order in several cities in the country, perpetrated by young people who allegedly consumed shisha, potentially mixed with other substances. The prevalence of shisha use in Cameroon is subject to various interpretations, ranging from 40,000 young users (approximately 0.5% of the country's young urban population) to 46 % of young people in urban areas.

High toxicity of shisha, association with other products

If the consumption of shisha is of particular concern to the authorities of different countries, it is also because of the fashion effect it creates, the practice spreading in nightclubs of big cities. The association between the use of shisha and the consumption of illicit drugs is thus highlighted to regulate a practice often perceived as a simple distraction. In Africa, it is not uncommon, in fact, for the water of the shisha to be replaced by beer, other alcohols or fruity substances, sometimes by adding cannabis or cocaine to the preparation.^{3, [5]}Furthermore, the proportion of women hookah users (a quarter of users in Cameroon) is increasing rapidly and is at a level significantly higher than that, which is very low, of women tobacco smokers.

The high toxicity of shisha is itself a cause for concern. A single shisha is equivalent to the volume of smoke inhaled from 40 conventional cigarettes and the tar content of 26 cigarettes. The fact that the smoke passes through water or another liquid also increases the concentration of carbon monoxide, which is particularly harmful to the body. Shisha users are thus exposed to all the pathologies already identified for tobacco. The presence of nicotine in shisha tobacco is likely to promote addiction to this substance and lead its non-smoking users to become cigarette smokers. However, the bans taken against shisha would only really have an impact if they were accompanied by stronger measures concerning other tobacco products.

Keywords: Chicha, Africa, Mali, Burkina Faso, Cameroon

©Generation Without Tobacco

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[1] Cameroon bans sale and use of shisha and its products, Generation Without Tobacco, published March 18, 2022, consulted August 23, 2022. [2] Chicha: Import, sale, use prohibited in Mali, MaliWeb, published on August 17, 2022, consulted on August 23, 2022. [3] Nabaloum AA, Longmene Kaze B, Tobacco: Banning only shisha sparks controversy in Africa, SciDevNet, published 18 August 2022, accessed 23 August 2022. [4] Law No. 040-2010/AN, on the fight against tobacco in Burkina Faso, National Assembly of Burkina Faso, 2010. [5] In Kenya, the ban on shisha is only partially respected, Generation Without Tobacco, published on August 8, 2022, consulted on August 23, 2022. National Committee Against Smoking |