It would be
nice to celebrate World No Tobacco Day with a piece of evidence from SSA
countries about how we can help people quit. But I can't find it, anywhere. On the other hand, 17 of the 27 countries in the world in which smoking prevalence is rising are in Africa, where big tobacco is flexing its
lobbying muscles. There are important public health interventions in the WHO's Framework Convention on Tobacco Control (FCTC), including raising
taxes and these are being implemented in some
African countries. The triple, half, double tactic has an effective ring to
it (triple the cost, halves the number of smokers and doubles the tax
revenues).
In 2005,
Cape Town was one of the sites of the Burden of Obstructive Lung Disease (BOLD) study. In it, 22% of men and 17% of women aged > 40 years were found to have
at least moderate COPD, compared to an international average of 10%. A similar high
prevalence of COPD to Tanzania and Uganda.
The most common risk factors were smoking, biomass fuel (moreso in women) and TB. In this weeks
featured article, the original cohort of patients of 189 persons with COPD
were followed up 12 years after their enrollment in the BOLD study, at which
point the authors found 45 (23%) had died, an outcome associated with age and
severity of COPD. Reflecting this years World No Tobacco day, the majority of
deaths that were of a known cause were from cardiovascular disease (10/24, 42%).
In those that could be followed-up (107 persons), there was a strong link with
pulmonary TB, with 37% of patients previously being diagnosed with PTB, and 10
persons (9%) having received treatment in the interim period, reflecting double
of the national incidence of TB. As expected, the majority of persons were current
(56%) or ex-smokers (32%), unfortunately biomass fuel exposure and passive
smoke exposure were not measured. Interestingly, in country were HIV
prevalence is 12.6%, none of the patients had HIV and all were from the
mixed-race community, making the sample non-representative of the country as a
whole. Finally, the majority of patients were symptomatic whilst having low
coverage of treatment (<1/3 on any inhalers).
In 2005,
Cape Town was one of the sites of the Burden of Obstructive Lung Disease (BOLD) study. In it, 22% of men and 17% of women aged > 40 years were found to have
at least moderate COPD, compared to an international average of 10%. A similar high
prevalence of COPD to Tanzania and Uganda.
The most common risk factors were smoking, biomass fuel (moreso in women) and TB. In this weeks
featured article, the original cohort of patients of 189 persons with COPD
were followed up 12 years after their enrollment in the BOLD study, at which
point the authors found 45 (23%) had died, an outcome associated with age and
severity of COPD. Reflecting this years World No Tobacco day, the majority of
deaths that were of a known cause were from cardiovascular disease (10/24, 42%).
In those that could be followed-up (107 persons), there was a strong link with
pulmonary TB, with 37% of patients previously being diagnosed with PTB, and 10
persons (9%) having received treatment in the interim period, reflecting double
of the national incidence of TB. As expected, the majority of persons were current
(56%) or ex-smokers (32%), unfortunately biomass fuel exposure and passive
smoke exposure were not measured. Interestingly, in country were HIV
prevalence is 12.6%, none of the patients had HIV and all were from the
mixed-race community, making the sample non-representative of the country as a
whole. Finally, the majority of patients were symptomatic whilst having low
coverage of treatment (<1/3 on any inhalers).
This
prospective observational study adds outcome and treatment gap data to evidence
of a high prevalence of COPD in South Africa and other SSA countries. The
Cochrane Tobacco
control library features multiple excellent reviews but the majority of
studies are based in developed countries. Now would be an excellent time for a
stop smoking intervention study, based in SSA. In the meantime, the next time
you have a consultation with a patient who smokes, for any reason, why not ask
them – “have you ever thought about
stopping smoking?” – even
a brief intervention will help.
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