Skip to main content

Advertisement

SpringerLink
Log in

The epidemiology of tobacco use in Ethiopia: a systematic review and meta-analysis

  • Review Article
  • Published:
Journal of Public Health Aims and scope Submit manuscript

Abstract

Background

Worldwide, tobacco smoking causes approximately 7.1 million deaths per year, and most of these deaths occur in low- and middle-income countries (LMICs) such as Ethiopia. The results of previously published studies in Ethiopia are inconsistent. However, there is no previous systematic review and meta-analysis reporting on the prevalence of tobacco smoking in Ethiopia. This systematic review and meta-analysis aimed to systematically summarize the available evidence on the epidemiology of tobacco smoking in Ethiopia and put forward suggestions for future clinical practice and research.

Methods

EMBASE, SCOPUS, and PubMed were searched for relevant studies on tobacco smoking in Ethiopia. We screened articles according to predetermined inclusion criteria. A meta-analysis of the studies was conducted using a random-effects model. We used the Newcastle–Ottawa scale with modifications to evaluate the quality of studies included in the meta-analysis. We also conducted a subgroup and sensitivity analysis to explore the source of heterogeneity. The heterogeneity of the studies was assessed by Cochran’s Q test and the I-square test. Egger’s test and visual inspection of the symmetry in funnel plots were used to check for the presence of publication bias.

Results

Of the total of 35 full-text articles, 19 studies with 28,716 participants were included in our review and meta-analysis. The pooled prevalence of current tobacco smoking was 6.67%, and lifetime smoking was 11.98%. Males had higher rates of current smoking (10.69% vs.1.1%), lifetime smoking (17.28% vs.4.73%), and tobacco dependence (7.7% vs. 0.2%) than females. The pooled prevalence of current and lifetime tobacco smoking among students was 5.93% and 8.97%, respectively. The prevalence of tobacco use among students was considerably lower than the prevalence in other populations of the country. The prevalence of current tobacco smoking was significantly higher in the years between 2014 and 2017 (8.24%) than in the year before 2014 (5.56%).

Conclusion

The prevalence of current and lifetime tobacco smoking was higher in males when compared to females. Measures to create awareness and to integrate the management of tobacco smoking and dependence at the primary health care level are warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

ASSIST:

Alcohol, Smoking and Substance Involvement Screening Test

GYTS:

Global Youth Tobacco Survey

ICD-10:

International Classification of Diseases, Tenth Revision

LMICs:

Low- and middle-income countries

NOS:

Newcastle Ottawa Scale

WHO:

World Health Organization

References

  • Adere A, Yimer NB, Kumsa H, Liben ML (2017) Determinants of psychoactive substances use among Woldia University students in northeastern Ethiopia. BMC Res Notes 10(1):441

    Article  PubMed  PubMed Central  Google Scholar 

  • Alem A, Kebede D, Kullgren G (1999) The epidemiology of problem drinking in Butajira, Ethiopia. Acta Psychiatr Scand 100(S397):77–83

  • Alemseged F, Haileamlak A, Tegegn A, Tessema F, Woldemichael K, Asefa M et al (2012) Risk factors for chronic non-communicable diseases at Gilgel Gibe Field Research Center, Southwest Ethiopia: population based study. Ethiop J Health Sci 22(4):19–28

    PubMed  PubMed Central  Google Scholar 

  • Batra A (2011) Treatment of tobacco dependence. Dtsch Arztebl Int 108(33):555–564

    PubMed  PubMed Central  Google Scholar 

  • Birhanu AM, Bisetegn TA, Woldeyohannes SM (2014) High prevalence of substance use and associated factors among high school adolescents in Woreta town, Northwest Ethiopia: multi-domain factor analysis. BMC Public Health 14(1):1186

    Article  PubMed  PubMed Central  Google Scholar 

  • Borenstein M, Hedges LV, Higgins J, Rothstein HR (2010) A basic introduction to fixed effect and random-effects models for meta-analysis. Res Synth Methods 1(2):97–111

    Article  PubMed  Google Scholar 

  • Brathwaite R, Addo J, Smeeth L, Lock K (2015) A systematic review of tobacco smoking prevalence and description of tobacco Control strategies in sub-Saharan African countries; 2007 to 2014. PLoS One 10(7):e0132401. https://doi.org/10.1371/journal.pone.0132401

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Burger M, Catto JW, Dalbagni G, Grossman HB, Herr H, Karakiewicz P, Shariat S (2013) Epidemiology and risk factors of urothelial bladder cancer. Eur Urol 63(2):234–241

    Article  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention (CDC) (2008) Smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 2000–2004. MMWR Morb Mortal Wkly Report, 57(45), 1226

  • Cox RG, Zhang L, Johnson WD, Bender DR (2007) Academic performance and substance use: findings from a state survey of public high school students. J Sch Health 77(3):109–115

    Article  PubMed  Google Scholar 

  • Dent C, Biglan A (2004) Relation between access to tobacco and adolescent smoking. Tobacco Control 13(4):334–338. https://doi.org/10.1136/tc.2003.004861

  • Deressa W, Azazh A (2011) Substance use and its predictors among undergraduate medical students of Addis Ababa University in Ethiopia. BMC Public Health 11(1):660

    Article  PubMed  PubMed Central  Google Scholar 

  • Dessie Y, Ebrahim J, Awoke T (2013) Mental distress among university students in Ethiopia: a cross sectional survey. Pan Afr Med J 15(1)

  • Dida N, Kassa Y, Sirak T, Zerga E, Dessalegn T (2014) Substance use and associated factors among preparatory school students in bale zone, Oromia regional state, Southeast Ethiopia. Harm Reduct J 11(1)

  • Doll R, Peto R, Boreham J, Sutherland I (2004) Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ 328(7455):1519

    Article  PubMed  PubMed Central  Google Scholar 

  • Doubeni CA, Li W, Fouayzi H, Difranza JR (2008) Perceived accessibility as a predictor of youth smoking. Ann Fam Med 6(4):323–330. https://doi.org/10.1370/afm.841

    Article  PubMed  PubMed Central  Google Scholar 

  • Eriksen M, Mackay J, Ross, H (2012). The Tobacco Atlas. Atlanta, GA: American Cancer Society; New York, NY: World Lung Foundation. In: Retrieved 18/01/2014 from http://tobaccoatlas.org/uploads/Images/PDFs/Tobacco_Atlas_2ndPrint.pdf

  • Eshetu E, Gedif T (2006) Prevalence of khat, cigarette and alcohol use among students of technology and pharmacy, Addis Ababa university. Ethiop Pharm J 24(2):116–124

    Google Scholar 

  • Gebreslassie M, Feleke A, Melese T (2013) Psychoactive substances use and associated factors among Axum University students, Axum town, North Ethiopia. BMC Public Health 13(1):693

    Article  PubMed  PubMed Central  Google Scholar 

  • Gelaye B, Lemma S, Deyassa N, Bahretibeb Y, Tesfaye M, Berhane Y, et al (2012) Prevalence and correlates of mental distress among working adults in Ethiopia. Clinical practice and epidemiology in mental health: CP & EMH. 8:126

  • Giovannucci E (2001) An updated review of the epidemiological evidence that cigarette smoking increases risk of colorectal cancer. Cancer Epidemiol Preven Biomarker 10(7):725–731

    CAS  Google Scholar 

  • Hagos EG, Asfeha GG, Berihu BA (2016) Prevalence of substance abuse among regular degree health science students in Sheba University College in Mekelle Town, Tigray-Ethiopia. J Neurosci Rural Pract 7(2):200

    Article  PubMed  PubMed Central  Google Scholar 

  • Haile YG, Alemu SM, Habtewold TD (2017) Common mental disorder and its association with academic performance among Debre Berhan University students, Ethiopia. Int J Ment Heal Syst 11(1):34

    Article  Google Scholar 

  • Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ: British Medical Journal 327(7414):557

    Article  PubMed  PubMed Central  Google Scholar 

  • Huncharek M, Haddock KS, Reid R, Kupelnick B (2010) Smoking as a risk factor for prostate cancer: a meta-analysis of 24 prospective cohort studies. Am J Public Health 100(4):693–701

    Article  PubMed  PubMed Central  Google Scholar 

  • Jha P (2011) Avoidable deaths from smoking: a global perspective. Public Health Rev 33(2):569–600. https://doi.org/10.1007/BF03391651

    Article  Google Scholar 

  • John U, Hanke M, Meyer C, Schumann A (2005) Gender and age differences among current smokers in a general population survey. BMC Public Health 5:57–57. https://doi.org/10.1186/1471-2458-5-57

    Article  PubMed  PubMed Central  Google Scholar 

  • Kebede D, Alem A (1999) The epidemiology of alcohol dependence and problem drinking in Addis Ababa, Ethiopia. Acta Psychiatrica Scandinavica, Suppl 99(397):30–34

    Article  Google Scholar 

  • Lakew Y, Haile D (2015) Tobacco use and associated factors among adults in Ethiopia: further analysis of the 2011 Ethiopian demographic and health survey. BMC Public Health 15:487–487. https://doi.org/10.1186/s12889-015-1820-4

    Article  PubMed  PubMed Central  Google Scholar 

  • Lakier JB (1992) Smoking and cardiovascular disease. Am J Med 93(1):S8–S12

    Article  Google Scholar 

  • Landis J, Koch G (1977) The measurement of observer agreement for categorical data. biometrics, 33. In: S

  • Lin HH, Ezzati M, Murray M (2007) Tobacco smoke, indoor air pollution and tuberculosis: a systematic review and meta-analysis. PLoS Med 4(1):e20

    Article  PubMed  PubMed Central  Google Scholar 

  • Lin HH, Murray M, Cohen T, Colijn C, Ezzati M (2008) Effects of smoking and solid-fuel use on COPD, lung cancer, and tuberculosis in China: a time-based, multiple risk factor, modelling study. Lancet 372(9648):1473–1483

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Links, G (1997) World development indicators

  • Lopez AD, Collishaw NE, Piha T (1994) A descriptive model of the cigarette epidemic in developed countries. Tob Control 3(3):242

    Article  PubMed Central  Google Scholar 

  • Lowenfels AB, Maisonneuve P, Whitcomb DC, Lerch MM, DiMagno EP (2001) Cigarette smoking as a risk factor for pancreatic cancer in patients with hereditary pancreatitis. Jama 286(2):169–170

    Article  CAS  PubMed  Google Scholar 

  • Manouchehrinia A, Tench CR, Maxted J, Bibani RH, Britton J, Constantinescu CS (2013) Tobacco smoking and disability progression in multiple sclerosis: United Kingdom cohort study. Brain 136(7):2298–2304

    Article  PubMed  PubMed Central  Google Scholar 

  • Mekonen T, Fekadu W, Mekonnen TC, Workie SB (2017) Substance use as a strong predictor of poor academic achievement among university students. Psychiatry J

  • Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Stewart LA (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4(1):1

    Article  PubMed  PubMed Central  Google Scholar 

  • Mossie A, Kindu D, Negash A (2016) Prevalence and severity of depression and its association with substance use in Jimma town, Southwest Ethiopia. Depression research and treatment

  • Reda AA, Kotz D, Biadgilign S (2013) Adult tobacco use practice and its correlates in eastern Ethiopia: a cross-sectional study. Harm Reduct J 10(1)

  • Reda AA, Moges A, Yazew B, Biadgilign S (2012) Determinants of cigarette smoking among school adolescents in eastern Ethiopia: a cross-sectional study. Harm Reduct J 9:39

    Article  PubMed  PubMed Central  Google Scholar 

  • Rehm J, Mathers C, Popova S, Thavorncharoensap M, Teerawattananon Y, Patra J (2009) Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet 373(9682):2223–2233

    Article  PubMed  Google Scholar 

  • Rudatsikira E, Abdo A, Muula AS (2007) Prevalence and determinants of adolescent tobacco smoking in Addis Ababa, Ethiopia. BMC Public Health 7:176

    Article  PubMed  PubMed Central  Google Scholar 

  • Shinton R, Beevers G (1989) Meta-analysis of relation between cigarette smoking and stroke. BMJ 298(6676):789–794

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25(9):603–605. https://doi.org/10.1007/s10654-010-9491-z

    Article  PubMed  Google Scholar 

  • Tadesse M (2014) Substance abuse and sexual HIV-risk behaviour among Dilla University students. Ethiopia Educ Res 5:368–374

    Article  Google Scholar 

  • Talamini G, Bassi C, Falconi M, Sartori N, Salvia R, Rigo L, Bovo P (1999) Alcohol and smoking as risk factors in chronic pancreatitis and pancreatic cancer. Dig Dis Sci 44(7):1303–1311

    Article  CAS  PubMed  Google Scholar 

  • Tang S, Bishwajit G, Luba TR, Yaya S (2018) Prevalence of smoking among men in Ethiopia and Kenya: a cross-sectional study. Int J Environ Res Public Health 15(6):1232. https://doi.org/10.3390/ijerph15061232

    Article  PubMed Central  Google Scholar 

  • Tesfaye G, Derese A, Hambisa MT (2014) Substance use and associated factors among university students in Ethiopia: a cross-sectional study. J Addict

  • Tezera N, Endalamaw A (2019) Current cigarette smoking and its predictors among school-going adolescents in East Africa: a systematic review and meta-analysis. Int J Pediatr 2019:9. https://doi.org/10.1155/2019/4769820

    Article  Google Scholar 

  • Will JC, Galuska DA, Ford ES, Mokdad A, Calle EE (2001) Cigarette smoking and diabetes mellitus: evidence of a positive association from a large prospective cohort study. Int J Epidemiol 30(3):540–546

    Article  CAS  PubMed  Google Scholar 

  • Wilson SH, Walker GM (1993) Unemployment and health: a review. Public Health 107(3):153–162

    Article  CAS  PubMed  Google Scholar 

  • World Health Organization (WHO) (2019), Tobacco Key facts, https://www.who.int/news-room/fact-sheets/detail/tobacco

  • Zatonski W, Przewozniak K, Sulkowska U, West R, Wojtyla A (2012) Tobacco smoking in countries of the European Union. Ann Agricult Environ Med 19(2)

Download references

Funding

The authors declare that no funding was received.

Author information

Authors and Affiliations

  1. Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia

    Getinet Ayano, Melat Solomon & Getahun Hibdiye

  2. Faculty of Heath Sciences, College of Medicine and Health Sciences, Hawassa University, Awassa, Ethiopia

    Bereket Duko

Authors
  1. Getinet Ayano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Melat Solomon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Getahun Hibdiye
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bereket Duko
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

GA and BD conceptualized the study, developed the manuscript, conducted the analyses, and drafted and approved the final manuscript. MS and GH performed the search and data extraction, and approved the final manuscript. GA and GH reviewed the protocol, and participated in discussion and consensus. BD and MS reviewed the protocol, and contributed to the subsequent drafts of the manuscript. All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Bereket Duko.

Ethics declarations

Competing interests

The authors declare that there are no competing interests.

Consent for publication

N/A

Ethics approval and consent to participate

N/A

Availability of data and material

All data generated or analyzed during this study are included in this article.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Supplementary file 1

Funnel plot of publication bias for current tobacco smoking in Ethiopia (DOCX 13 kb)

Supplementary file 2

Funnel plot of publication bias for lifetime tobacco smoking in Ethiopia (DOCX 14 kb)

Supplementary file 3

Sensitivity analysis of prevalence for each study being removed one at a time: prevalence and 95% confidence interval of current tobacco smoking in Ethiopia (DOCX 13 kb)

Supplementary file 4

Sensitivity analysis of prevalence for each study being removed one at a time: prevalence and 95% confidence interval of lifetime tobacco smoking in Ethiopia (DOCX 13 kb)

ESM 5

(DOCX 14 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ayano, G., Solomon, M., Hibdiye, G. et al. The epidemiology of tobacco use in Ethiopia: a systematic review and meta-analysis. J Public Health (Berl.) 30, 1143–1153 (2022). https://doi.org/10.1007/s10389-020-01385-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10389-020-01385-x

Keywords

Search

Navigation