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How Uganda can reduce smoking

Tuesday (May 31, 2011) is World No Tobacco Day which has been celebrated throughout the world on this date since 1988.

The aim of this day is to discourage people from using tobacco, raise global awareness about tobacco use and its negative health effects, and to increase awareness about tobacco company marketing strategies.

The Framework Convention on Tobacco Control (FCTC) to which Uganda is a signatory came into force in 2003 and obliges its signatories to take incremental action against tobacco consumption, marketing and exposure, among many other measures.

Tobacco was first discovered and used by native Americans for cultural and medicinal purposes. European explorers soon realised the importance of tobacco and brought it over to Europe and the Middle East, where it was first used for medicinal purposes and then recreation. Tobacco is now grown and cigarettes manufactured throughout the world.

Uganda itself is an exporter of tobacco; it accounts for 4% of all exports and generates $57 million in revenue. But this is at great environmental cost. The tobacco has to be cured and this is done by burning wood, resulting in deforestation.

Tobacco’s negative health effects were first noticed in the 1930s and the link to lung cancer was established in the 1950s. It has now been proven to be a major risk factor for heart and lung disease, stroke, high blood pressure, and impotence. Tobacco is the second major cause of death in the world; it is currently responsible for the death of one in ten adults worldwide.

Most tobacco-related deaths and disability occur among working-age adults. The economic impact of early death, disability and lost productivity contributes to the burden of poverty, retarding national development and further widening health inequities.

In the developed world, smoking rates are decreasing as consumer awareness about the health effects improves as well as governmental interventions, with restrictions on advertising, age of sale, graphic and bold health warnings on packets and restrictions on where tobacco can be smoked – such as the banning of smoking in public places.

In response to shrinking markets in the developed world, tobacco companies have started targeting the developing world, marketing more aggressively with a view to increasing sales here. Uganda has regulation on smoke-free environments in healthcare facilities, educational facilities, universities, governmental facilities and indoor offices.

However, Uganda is not yet observing the articles laid out in the FCTC as she allows smoking rooms in restaurants and pubs, public transport and other indoor workplaces. Uganda still permits tobacco sponsorship and advertising.

Tuberculosis (TB) is a major problem in Uganda with over 100,000 new cases and 10,000 deaths each year. A major risk for developing TB is smoking. It has been shown that smoking and being exposed to other people’s smoke increases the chance of developing TB. Children, in particular, are at much higher risk of developing TB if they are being exposed to second-hand smoke.

Continuing to smoke after completing treatment increases the chance of relapse. To get control of TB in Uganda a wide ranging approach needs to be adopted, from community projects like Touch Namuwongo sponsored by International Medical Foundation and Target TB, reducing the HIV burden and enabling people to have access to HIV medications, addressing malnourishment, but equally important is reducing the levels of smoking amongst Ugandans.

So, how can we reduce the numbers of smokers in Uganda? Education plays a big part. A 2007 survey of Ugandan school children showed that 70% knew about the dangers of smoking. Still, the number of smokers is increasing in Uganda. Currently, one in four adult men smoke and the 2007 Global Youth Tobacco survey reported that in Uganda, nearly one in five school children use tobacco products.

What is needed is a coordinated national mechanism for tobacco control, implementation of the articles Uganda agreed to in the FCTC such as banning tobacco advertising and sponsorship, putting prominent health warning on packets and increasing the price of tobacco through taxation.

People who are addicted to smoking need help to stop. At present, nicotine replacement therapy and drugs such as bupropion are not legally available in Uganda; these drugs have been shown to improve the chances of smokers successfully quitting. If we are to improve the numbers quitting smoking, then we have to offer educational, emotional and medical support to enable them do this.

There is a desperate need to reduce the levels of smoking. Every 6.5 seconds, one tobacco user dies from a tobacco-related disease somewhere in the world.

The author is a VSO doctor with International Hospital Kampala

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