Tobacco Cessation in Ethiopia
In 2016, 42.0% of smokers in Ethiopia aged 15 years and above attempted to quit smoking in the previous 12 months, while 23.5% of smokers planned to quit within the following 12 months.
Most primary healthcare providers in Ethiopia do not offer smoking cessation services. Furthermore, the majority of healthcare providers have limited knowledge of smoking cessation interventions.
Quitting smoking has extensive health benefits, of which the greatest is reduced risk of tobacco-related diseases.
There are 1.3 billion tobacco users around the world, many of whom want to quit. However, many people do not have access to the facilities/resources needed to quit smoking.
Currently, about 32% of the world’s population has adequate access to cessation services.In Ethiopia, 3.2 million adults (5% of the adult population) used tobacco products in 2016. About four out of ten adult smokers made an attempt to quit smoking in the same year. About five out of ten smokers who visited a healthcare provider received advice to quit smoking from the provider.
Smoking cessation is important from a public health standpoint as it improves health, saves lives, and reduces financial burdens.
However, most smokers usually fail to quit smoking because they do not receive sufficient support. Evidence suggests that the powerful addictive nature of nicotine makes it extremely difficult for users to quit. Moreover, users who have quit are more likely to relapse due to this acquired dependence on smoking (i.e., nicotine). Successful smoking cessation thus depends on a constructive and supportive relationship between a smoker and a cessation service provider. Smokers may be more likely to quit if they get access to holistic cessation services, including treatments with medication services and counseling sessions. Ethiopia is among the six countries that were advanced to best-practice level with their tobacco use cessation services.This page provides information on the levels of public awareness on the harms of tobacco use, the benefits of quitting, and the percentage of smokers who want to quit.
Levels of Public Awareness
on the Harms of Smoking in Ethiopia
Most members of the public are aware of the dangers associated with smoking tobacco.
Percentage of Adults (15 years and Older) Who Believe That Smoking Causes Serious Illness and Various Diseases, 2016
Source: GATS, 2016
Majority (88%) of respondents to the Ethiopia Global Adult Tobacco Survey (GATS), undertaken in 2016, believed that smoking causes serious illnesses. For instance, 81.7% of the respondents believed that smoking causes lung cancer, while 75.9% believed that secondhand smoke causes serious illness to non-smokers. Some 57.4% of adults believed that smokeless tobacco use causes serious illness.
Several studies indicate that people in higher wealth quintiles have a greater level of awareness about the harms of tobacco than people in lower wealth quintiles.
Attempts to Quit Tobacco Smoking in Ethiopia
About 23.5% of tobacco smokers aged 15 and above planned to quit within 12 months.
Percentage of Adults (15 years and Older) Who Plan to Quit Smoking, 2016
Source: GATS, 2016
According to the 2016 GATS, only 10.7% of smokers in Ethiopia planned to quit within 12 months while 45.1% of smokers planned to quit in future (but not within 12 months). Almost one third of smokers (31.3%) had no plans to quit at all.
Most healthcare providers do not help patients quit smoking due to a lack of knowledge, time, and referral sources.
In addition, they may not regard provision of smoking cessation services as their responsibility. Little attention has been paid to tobacco cessation interventions in Sub-Saharan Africa. There are very few programs designed to support individuals who wish to quit smoking. In addition, there are scant efforts to train healthcare practitioners in smoking cessation. Moreover, healthcare workers are not generally committed to ensuring that patients quit smoking.
Factors Driving Quitting Attempts in Ethiopia
According to the 2016 GATS, 42% of respondents had attempted to quit smoking in the previous 12 months.
About 80% of smokers who tried to quit in the previous 12 months did so without any assistance. On the other hand, 53% of smokers who visited a healthcare provider in the previous 12 months were advised to quit smoking by a health worker. According to GATS 2016 data, several factors played a role in the smoking cessation attempts, including gender, level of income/wealth, educational level, employment status, religion, and awareness about the harms of tobacco use.
More adult males than females attempted to quit smoking
The findings from the 2016 GATS align with the results of other studies that reveal individuals in lower wealth categories are less likely to quit smoking than individuals in higher wealth categories.
More than half (51.6%) of the smokers who made attempts to quit were aware of the health harms of tobacco use, while only 16.3% were unaware of the health dangers.
More employed adults than homemakers attempted to quit smoking.
Studies have revealed that an individual’s education and health literacy may influence how seriously advice is taken, impacting the success of subsequent smoking cessation efforts.
Tobacco Cessation
Services in Ethiopia
Delivery of tobacco cessation services in Ethiopia is generally hampered by a lack of knowledge, trained personnel, and medication.
The 2016 GATS also assessed whether smokers who had quit smoking for less than 12 months had received smoking cessation advice from the healthcare providers they visited in the previous year.
Approximately 23% of smokers who had quit for less than 12 months had visited a healthcare provider in the previous year. More than half (56%) of these smokers who visited a healthcare provider were asked about their tobacco smoking status, and a further half (53%)were advised to stop smoking tobacco by the healthcare provider.Research shows that brief advice offered by healthcare providers can increase quitting attempts by 40% and boost successful quit rates by 2-3%.
Evidence further shows that the intensity of counseling significantly increases long-term smoking abstinence rates. Minimal counseling (<3 minutes), moderate intensity counseling (3-10 minutes), and high intensity counseling (>10 minutes) increase abstinence rates for tobacco use by 13.4%, 16%, and 22.1%, respectively.According to health facility-based studies in Ethiopia, 70.4% of healthcare providers do not generally know how to provide smoking cessation advice. Some studies have indicated that 97.5% of healthcare providers in Ethiopia did not carry out smoking cessation interventions.
A facility-based study of pharmacy professionals also showed that there were clinical knowledge gaps on tobacco cessation services among healthcare workers in Ethiopia. There were no tobacco use cessation guidelines or strategies for healthcare workers in Ethiopia, and tobacco use cessation was not included among the indicators reporting list. Similarly, studies in Kenya and Jordan revealed that knowledge of tobacco use cessation services among healthcare workers was low.
Types of Interventions
There are several interventions to aid smoking cessation, but these interventions do not exist or are scarce in Ethiopia.
Smoking cessation is the process of quitting tobacco use.
There are numerous effective cessation interventions globally that can help smokers quit. There are two broad types of interventions, namely behavioral and pharmacological interventions.Behavioral interventions can be classified into two types, namely population-level approaches and individual specialist approaches. Population-level approaches include brief advice and quitlines, whereas individual specialist approaches include intensive behavioral support and cessation clinics.
Pharmacological interventions cover nicotine replacement therapies (NRTs) and non-nicotine pharmacotherapies.
Below are descriptions of the types of tobacco cessation interventions that are generally available in Ethiopia as well as the medications included in the list of essential medicines in the country. According to the WHO Tobacco epidemic report 2023, Ethiopia is among the three low-income countries that make cost covered NRTs available to those who want to quit tobacco and among the three African countries that established national toll-free quit lines.
Brief Advice
Quitlines
Quitlines
A national toll-free quitline is a telephone counseling service that can provide both proactive and reactive counseling sessions. A reactive quitline provides an immediate response to a call initiated by a tobacco user, but only responds to incoming calls. A proactive quitline schedules follow-up calls to tobacco users to provide ongoing support.
Pharmacological interventions
Pharmacological interventions
Pharmacotherapies include nicotine-based and non-nicotine-based medications that are given to smokers.
- Nicotine Replacement Therapy (NRT): This is the remedial administration of nicotine to the body by means other than tobacco to facilitate quitting. NRTs are a safe alternative to cigarettes. With NRTs, a patient can absorb less nicotine at much slower rates than smokers. NRTs include nicotine patches, nicotine gums, nicotine inhalers, nicotine lozenges, and nicotine nasal sprays. NRTs lessen craving and nicotine addiction withdrawal symptoms by providing a low controlled dose of nicotine without the toxins found in cigarettes. NRT doses are gradually reduced over time to help the tobacco user get used to less and less nicotine stimulation. All forms of NRT are better than no treatment. For instance, nicotine gum increases the chance of quitting by 43% compared to no treatment, while, nicotine a patch increases the chance of quitting by 66% compared to no treatment.
- Non-nicotine pharmacotherapies:
Bupropion: Bupropion was originally used as an antidepressant. It lessens some nicotine withdrawal symptoms such as anxiety, irritability, and depression.
It affects the urge to smoke by acting on the chemicals (neurotransmitters) in the brain.Varenicline: Varenicline is a new drug developed specifically for smoking cessation. It acts as a nicotine antagonist and agonist. As an antagonist, it blocks nicotinic receptors in the brain, thereby reducing the pleasurable effects of cigarettes and other tobacco products and potentially the risk of full or temporary lapses. As a partial nicotine agonist, it attaches to and partially stimulates nicotine receptors in the brain, thereby reducing cravings and withdrawal symptoms.
Naltrexone: Naltrexone is a prescription medication used to treat alcohol and opioid use disorders. It has several beneficial effects in the treatment of nicotine dependence. It improves quit rates, increases time to smoke their first cigarette after waking up, reduces the number of cigarettes smoked and smoking urges, and lessens the amount of weight gained.
Intensive behavioral support
Intensive behavioral support
Behavior support refers to multiple individual or group counseling sessions aimed at helping people stop tobacco use. It includes all cessation assistance that imparts knowledge about tobacco use and quitting. It also provides resources to develop skills and strategies for changing behavior.
Cessation clinics
Cessation clinics
These are clinics specializing in tobacco cessation services. These clinics offer intensive behavioral support, and where appropriate, medications or advice delivered by specially trained practitioners.
These clinics, however, are not available in Ethiopia.
Effectiveness of Medications Used to Treat Tobacco Addiction
Varenicline and NRT (nicotine gums, transdermal patches, nicotine nasal sprays, nicotine inhalers, and nicotine sublingual tablets) are the leading treatments for sustained smoking cessation.
Use of pharmacotherapy remedies for seven to twelve weeks increases the likelihood of successful smoking cessation. Health provider training programs and rewards for providing cessation support are similarly beneficial.
Availability of Health Facilities Providing Cessation Services
There are only 26 substance use disorder treatment centers spread across the 7 regions and two city administrations in Ethiopia, half of which are located in Addis Ababa. However, plans are in place to provide tobacco cessation services at primary healthcare facilities across the country.
Nineteen of these treatment centers are government owned, three are managed by non-government organizations, and four are run by private sector entities. Four regions (Benishangul Gumuz, Gambella, Southwest Ethiopia and Somali Regions) have no known substance abuse treatment centers.
Facilities Providing Substance Treatment Services
Please select a region to reveal the cessation facilities available, which will be displayed as orange dots in the map. Then hover over the dot to display more information.
- Number of Facilities|
- 1 - 2
- 3 - 4
- ≥ 5
- No Facility