Methods and prevalence of tobacco use in Botswana

Introduction

Background of study

Tobacco use is a major public health problem globally. According to the World Health Organization
(WHO), tobacco is the second most important cause of death in the world. It is currently estimated to be
responsible for about 5 million deaths each year worldwide. This figure is expected to rise to about 8.4
million by the year 2020, with 70% of those deaths occurring in developing countries. Deaths due to
tobacco consumption are on the rise, from 5.4 million in 2005 to 6.4 million in 2015 and 8.3 million in
2030 of which more than 80% will be in developing countries. Smokeless tobacco use is a significant
health risk and cause of disease. Over 300 million people use smokeless tobacco worldwide. More than
250 million adult smokeless tobacco users are in low- and middle-income countries, the total burden of
smokeless tobacco use is likely to be substantial. In Ethiopia, nationally representative data on the
smokeless tobacco use is not available. Most studies conducted in the country focused on cigarette
smoking. (4) There are many misperceptions with regard to tobacco use, for example that it aids
concentration, suppresses appetite, reduces anxiety and tension, causes skeletal muscle relaxation, and
induces feelings of pleasure. Specifically, GATS in Botswana was conducted to produce nationally
representative estimates of (a) adult tobacco use estimates for both smoked and smokeless tobacco,.
Botswana conducted GATS for the first time in 2017 to fulfill its obligations under WHO FCTC and further
implement the WHO MPOWER package.

Problem statement

Tobacco use is harmful and addictive. All forms of tobacco cause fatal and disabling health problems
throughout life. In addition to the increased risk for developing specific diseases, tobacco users have a
significantly higher risk for general health problems than nonsmokers. Tobacco use is a major
preventable cause of premature deaths and diseases worldwide as approximately more than 8 million
people die each year due to tobacco-related illnesses. This figure is expected to increase to more than
ten million a year by 2030. If current trends continue, tobacco use may kill a billion people by the end of
this century. It is estimated that more than three-quarters of these deaths will be in low- and middle-
income countries, Botswana inclusive.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2888365/

Objectives

 To determine the prevalence of smoking and smokeless tobacco use by gender

 To determine the prevalence of smoking and smokeless tobacco use by age

Research questions

 What is the most prevalent tobacco use in Botswana

 Which age group is the most prevalent in smokeless and smoking methods of use

 Which gender is most prevalent in smokeless and smoking tobacco

Significance of the study

Specifically, GATS in Botswana was conducted to produce nationally representative estimates of (a)
adult tobacco use estimates for both smoked and smokeless tobacco,

 For formulation of health policies for both smoking and smokeless methods of tobacco use.

 For educational and introduction of interventions by gender and age

 For research purposes

Literature review

A total of 759 participants randomly selected from the population of employees were administered
questionnaire in Hindi containing demographic profile, patterns of smoking, and use of smokeless
tobacco. Results: Forty-one percent of the surveyed males (n = 750) used tobacco either by smoking or
smokeless method or both (9.7% used both, 23.4% smoked, and 27.3% used smokeless tobacco) Twenty
percent of our sample were dependent on nicotine and the highest prevalence was seen in those using
both smoking and the smokeless tobacco. Divinakumar KJ, Patra P, Prakash J, Daniel A.
https://pubmed.ncbi.nlm.nih.gov/29456316/

According GLOBAL ADULT TOBACCO SURVEY 2017, Tobacco Use: In 2017, 17.6 percent (240,000) of
adults in Botswana reported current tobacco use in any form (27.0% among men and 8.8% among
women). Overall, 14.2 percent (190,000) of adults smoked tobacco (25.7% among men and 3.6% among
women) and 4.3 percent (60,000) adults used smokeless.

Methodology

Target Population and Sample Frame

GATS Botswana targeted all non-institutionalized adult men and women aged 16 years and above who
considered Botswana as their usual place of residence. All members of the target population were
sampled from the households they considered their usual place of residence. A usual member of a
sampled household was any otherwise-eligible resident who has no other residence, or has multiple
residences, but has been living in the selected household for at least half of the time during the past 12
months. The target population included individuals who resided in Botswana even if they were not
citizens of Botswana. Non–citizens were eligible to participate in this survey provided they had been
residing in Botswana for at least 6 months of the 12 months before the administration of the GATS
questionnaire

Sample design

A multi-stage, geographically clustered sample design was used. One individual was randomly chosen
from each selected household to participate in the survey. The survey provided information on
respondents’ background characteristics, tobacco use (smoking and smokeless). A total of 5,965
households were sampled and there were 4,643 completed individual interviews. The household
response rate was 81.8 percent, the person level response rate was 97.8 percent, and overall response
rate was 80.0 percent

Sample method

The sampling frame for GATS Botswana was delineated from the 2011 Population and Housing Census.
During the 2011 Population and Housing census, Botswana was divided into census districts. Therefore,
stratified random sampling was used and the sampling units were stratified by census districts.

Sample Size Determination:

sample size calculation

n=Za²x P x(1-P) = 4 x P x (1-P) x D

e² e²

n= required sample

Z= z-score

a=4

4= factors to archive 95% of confidence level

P= 0.15 predicated prevalence

e= margin of error

D= design effect should be between 1.5 and 2.5

Sample size= 6000

2.4. Data Collection Procedures

The standard Global Adult Tobacco Survey questionnaire was adapted. The questionnaire was
administered via a face-to-face approach and in either English or Setswana depending on the
respondent’s preference. The survey information was collected using handheld electronic devices

Inclusions

Rural areas

Adults aged 15 and above

exclusions

Data analysis
 Fig 2
Overall, 14.2 percent (190,000) of adults smoked tobacco (25.7% among men and 3.6% among women)

Fig 3
4.3 percent (60,000) adults used smokeless tobacco (2.1% among men, and 6.3% among women).

Fig. 5

Fig 6

Fig 7

Recommendation
Protecting people from secondhand smoke in all public places, including bars/nightclubs and
restaurants.
• Integration of tobacco cessation services, including counseling and provision of pharmacotherapy, in
the national health care system to help tobacco users to quit.
• Warning on the dangers of tobacco use through large, pictorial health warnings on tobacco products.
• Reduce exposure to pro-tobacco messages and tobacco industry marketing.
• Reduce affordability of cigarettes by increasing prices of tobacco products and prohibiting of the sale
of single cigarettes
Therefore, an efficient and systematic surveillance mechanism is essential to monitor and manage the
tobacco epidemic

 introduction of interventions
  awarness programs
 educational programs
 detailed packages/ advertisments

Conclusion
 Tobacco use in Botswana and other African countries which conducted GATS, proves Botswana
to be the most prevalent in tobacco use by a difference of 8.9 as compared to the last study
conducted at Tanzania. We discovered that the most common method of use is tobacco
smoking. Tobacco Use: In 2017, 17.6 percent (240,000) of adults in Botswana reported current
tobacco use in any form (27.0% among men and 8.8% among women).

References

 Global Adult Tobacco Survey: Report 2017

 The Toll of Tobacco in South Africa

 SANHANES-1, 2012. The Toll of Tobacco in South Africa. [online] Campaign for Tobacco-Free
Kids. Available at: <https://www.tobaccofreekids.org/problem/toll-global/africa/south-
africa> [Accessed 20 October 2021].

 https://www.bing.com/search?
q=adults+aged+61+and+abbove+smoking+tobacco+in+southren+africa&qs=n&form=QBRE&sp
=-1&pq=adults+aged+61+and+abbove+smoking+tobacco+in+southren+africa&sc=0-
60&sk=&cvid=44C7B454AF4A421BA5A88AF4DFA23364

 https://www.researchgate.net/publication/258058379_Tobacco_use_in_older_adults_in_Gha
na_Sociodemographic_characteristics_health_risks_and_subjective_wellbeing

 https://archpublichealth.biomedcentral.com/articles/10.1186/s13690-021-00699-w

 (Nickie, 2021. Women and Smokeless Tobacco Use - KillTheCan.org. [online] KillTheCan.org.
Available at: <https://www.killthecan.org/facts-figures/women-and-smokeless-tobacco-use/>
[Accessed 20 October 2021].

 https://pubmed.ncbi.nlm.nih.gov/11346276/

 https://www.drugs.com/cg/how-to-quit-using-smokeless-tobacco.html

 K.Jonas, K.Zuma, O. Shisana, P. Reddy, R. Sewpaul. 2015. Prevalence of tobacco use among
adults. Results from the first South African National Health and Nutrition Examination Survey