Smoking ban in public places poorly enforced in Ethiopia

An Ethiopian study assessed the effectiveness of the smoking ban in public places, and found that the provision is respected in only 12.3% of these places, including administrative, medical or educational establishments. This study has the interest of laying a first milestone, with a view to other subsequent evaluations. The authors call for a better application of this smoking ban in public places in Ethiopia.

With a smoking prevalence of 3.7 % in 2016, Ethiopia is among the least smoking countries in the world. To remain so, this country adopted in 2019 one of the strongest anti-smoking laws on the African continent[1]. This law notably banned the sale of heated tobacco, electronic cigarettes and flavoured tobacco products. It also banned smoking in all public places and workplaces, as well as within a 10-metre perimeter around these buildings, and does not provide for any areas dedicated to smokers.

This ban on smoking in public places seems to be poorly implemented. To assess precisely to what extent, a team of Ethiopian researchers conducted an observational and qualitative study in 12 cities, covering the country's 4 administrative regions.[2].

An elaborate protocol for observation and data collection

A total of 1,282 sites were visited and analyzed by trained observers armed with observation criteria and grids. 7 categories of public places were defined, including administrative buildings, healthcare facilities, education centers, transit areas (bus stations, taxi ranks), hotels, restaurants, and bars and cafes. In addition to the interviews conducted, the observation criteria involved noting the presence of no-smoking signs, the possible existence of a dedicated smoking area, the visibility of cigarette butts in or around the place, the smell of cigarette smoke, the presence of ashtrays or lighters, and the identification of at least one active smoker in the place visited.

Total smoking ban poorly enforced in Ethiopia

The results show that the smoking ban is not respected in most of the places visited. In particular, it is not applied in 97.1 % of administrative buildings, in 92.5 % of educational establishments, in 89.8 % of bars and cafés, in 88.4 % of catering establishments, in 84 % of hotels and in all transit places. Healthcare facilities are the least affected, with "only" 70.8 % of establishments not respecting the total smoking ban. A result that seems far from the objective which called for all these places to become 100 % non-smoking. In the end, only 12.3 % of the places visited respected the law on tobacco.

The detailed analysis indicates that 80 % of the observed sites did not have any smoking ban signage; when it was present, it was however affixed in the most appropriate places in 76 % of the cases, and was presented in a language understandable by the inhabitants in 96 % of the situations. The region of Harari, already highlighted in other studies for its highest prevalence of smoking, was the one where the smoking ban was the least well respected. The smell of tobacco smoke was noted in most places, except for places of care and education, but ultimately proved to be too subjective and imprecise data to be completely validated.

A study with many merits

Among the merits of this study, the precise quantification and identification of public places are its main strengths, providing reliable data where similar studies located exposure to tobacco smoke in only 10 % to 60 % of public places. The methodological rigor and the use of precise evaluation criteria make it possible to replicate these observations in the future. This study is therefore useful in more than one way, by assessing the real level of application of the law, by presenting itself as a reference base for future studies, and finally in that it makes it possible to identify some of the levers on which to act. So much valuable information that are often lacking in African countries, where the lack of reliable data prevents proper assessment of the measures implemented and the progress made.

The authors conclude that better enforcement of the smoking ban is needed in Ethiopia, and recommend two areas for improvement: first, by raising public awareness of the importance of this regulation, and second, by significantly strengthening controls to enforce it. Among the improvements to be made to the study protocol, the authors suggest, although this is more expensive, measuring particles present in indoor air in order to verify its quality.

Keywords: Ethiopia, smoking ban, public places, evaluation

M.F.

[1] FCTC, Ethiopia: parliament passing one of the strongest tobacco control legislations in Africa, published February 13, 2019, accessed March 2, 2023.

[2] Mengesha SD, Shimeles B, Zewdie B, et al. Smoke-free law compliance and predictive factors in Ethiopia: observational assessment of public places and workplaces, Tob Control Epub ahead of print: 2 March 2023. doi:10.1136/tc-2022-057750