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

Abstract

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. 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. 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%). 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.