Prevalence of Tobacco Use in Ethiopia
According to a 2016 study, 5.0% of the adult population in Ethiopia (3.4 million individuals aged 15 or older) consume tobacco products. In addition, 3.7% of the adult population (2.5 million) are current tobacco smokers.
With regard to the types of tobacco products, 2.7% of the adult population of Ethiopia (1.9 million) are current consumers of manufactured cigarettes, while 1.7% (1.1 million) are current users of smokeless tobacco.
In general, there are two types of tobacco products: smoked tobacco (i.e, manufactured or hand-rolled cigarettes, cigars, pipe tobacco, gaya, and shisha), and smokeless tobacco (snuff and chewing tobacco). Smokeless tobacco is not smoked; rather, it is sniffed through the nose, held in the mouth, or chewed.
This page explores differences in tobacco use among different population groups in Ethiopia, with information represented in infographics and charts. The data are predominantly drawn from the 2016 Ethiopian Global Adult Tobacco Survey (GATS) and the Ethiopian Demographic and Health Surveys (DHSs) from 2005, 2011, and 2016. These data are supported by various additional research papers that are referenced throughout the page. Where possible, this page will be updated with new data that become available in future.
To learn more about the data and methods used in this page click here.
Prevalence of Tobacco Use
by Gender
Prevalence of Tobacco Use in Ethiopia (2016)
Source: GATS, 2016
Over four times as many men as women consume smoked and smokeless tobacco products in Ethiopia (2.8 million men versus 600,000 women).
This disparity is a well-noted global trend, especially in developing countries. This may be because men usually have more disposable income for tobacco and women face greater stigma for smoking.Compared to other sub-Saharan African countries, Ethiopia has relatively low rates of tobacco use. For example, 19.1% men and 4.5% of women in Kenya used tobacco in 2014,
while 6.2% of men and 0.5% of women in Nigeria used tobacco in 2018. Nonetheless, tobacco use in Ethiopia is still considered to be a serious public health concern. Annually, about 16,800 people in Ethiopia die from tobacco-related causes (259 men and 65 women per week).Even though significantly fewer females than males smoke in Ethiopia,the fact that most women are responsible for childcare presents an additional public health concern.
The impact of second-hand smoking on children’s health is well documented, and public awareness about this issue should be considered a priority. Tobacco use also causes ectopic pregnancy, reduced fertility, and increased likelihood of stillbirth amongst women.
Trends in Tobacco Prevalence Among Adult Males
To understand how tobacco use has changed over time, we used Ethiopian DHSs conducted in 2005, 2011, and 2016. Tobacco prevalence was so low amongst females that the DHS decided not to include them in the Ethiopian sample frame (in 2011, only 35 women in the sample reported using tobacco).
Trends in Tobacco Prevalence Among Adult Males Age 15-49 (2005-2016)
Source: Demographic and Health Survey 2005, 2011, and 2016
Based on DHS data, the prevalence of tobacco use among males in Ethiopia decreased by 6.3 percentage points between 2005 and 2016. In 2005, 11.7% of men aged 15-59 reported using tobacco, whereas in 2016 this amount declined to 5.4%. This decreasing trend is seen both for cigarettes and smokeless tobacco. The difference in the male prevalence between the DHS (5.4%) and GATS (8.1%) is probably because the DHS included males aged 15-59 whilst the GATS included all males over 15 years.
This trend is also echoed globally. In 2019, The World Health Organisation released a report stating that tobacco usage by men worldwide was on the decline for the first time. The report noted that the number of men using tobacco in 60% of countries globally had contracted since 2010.
Prevalence of Tobacco Use
by Education
Overall, 1.7% of the population use smokeless tobacco products. Smokeless tobacco use is more prevalent among less educated adults in Ethiopia, relative to those with more education. In particular, 2.6% of adults with no education (606,000 people) use smokeless tobacco products, compared to 0.4% of adults with secondary education (28,000 people). While research suggests smoking prevalence increases with lower levels of education, further exploration and surveys are recommended to determine the exact percentages (read more here).
Smokeless tobacco use in rural areas of Ethiopia was 2% compared with urban (0.4%) areas in 2016. Studies in Ethiopia indicate that those moving to or living in urban areas tend to be better educated than rural residents.
This education disparity could be the key factor behind the discrepancy in the use of smokeless tobacco in rural and urban areas of Ethiopia.
Prevalence of Tobacco Use
by Occupation
The use of tobacco by employed adults is significantly higher than homemakers (2.7 million versus 253,000, respectively).This could be because people who are employed have more disposable income to buy tobacco.
At the same time, the majority of homemakers in Ethiopia are women, who use tobacco significantly less than men.
Prevalence of Tobacco Use among the Homeless Population in SNNPR
A recent study measured the prevalence of smoking among people facing homelessness in the SNNPR.
Prevalence of Smoking Among the Homeless Population Ages 15-49 in Southern Ethiopia (2019)
The researchers found that 38.4% of homeless people in the region had smoked cigarettes at some point in their life, and 17.1% were currently smoking every day. This was nearly four times the regional prevalence of smoking in SNNPR (4.5%). This mirrors trends in other parts of the world. Higher smoking rates among the homeless can be attributed to mental illness disorders and alcohol and other substance abuse that may have contributed to them being homeless, as well as use of tobacco to cope with the stress of being homeless.
Prevalence of Tobacco Use
by Age
As illustrated above, a significantly higher percentage of people aged 45-64 years (8.9%) use tobacco in comparison to people aged 15-24 (2.4%). This trend is largely consistent with other studies conducted across African countries.
This result might be explained by adults having higher spending power and greater exposure to tobacco advertising in their youth. Worryingly, compared to adolescents and younger adults, there are very few global evidence-based cessation services developed and implemented for adults over 50 years. Investing in and implementing such services should be a national public health priority.About 70% of cigarette smokers aged 20–34 in the GATS 2016 survey had started smoking daily before the age of 20. This is in keeping with similar global trends; 70% of adults in Europe reported starting to smoke daily before the age of 18.
The implementation of tobacco prevention and smoking cessation programmes among young people should remain a priority, even if the prevalence of smoking is lowest among this age group.
Prevalence of Tobacco Use Among Adolescents
The prevalence of active tobacco smoking amongst adolescents (aged 13-19) is 2.6%.
Smoking prevalence increases with age, being higher among 19 year olds (7.4%) relative to younger teenagers. Prevalence is also higher among young men in comparison to young women (3.7% versus 1.3%). In addition, research suggests that smoking prevalence is slightly higher among urban youth relative to rural youth; however, further exploration and surveys to determine the current tobacco-use prevalence at national and sub-national levels are recommended. The greater access to home internet services in urban areas – which is correlated with higher rates of smoking among adolescents – may be a key factor behind this divergence.
Prevalence of Tobacco Use
by Regional States
Prevalence of Tobacco Use by Regional States
- Prevalence|
- 0% - 4.9%
- 5% - 9.9%
- 10% - 14.9%
- 15% - 100%
Source: GATS, 2016
Across administrative regions in Ethiopia, there is great variation in tobacco use.
The lowest prevalence rates are found in Tigray, Amhara, and Addis Ababa (0.8%, 1.6%, and 2.4% prevalence, respectively). However, the confidence intervals are fairly wide and many overlap, so that we cannot be fully confident in the results. The Eastern regions of Afar, Somali, and Harari have higher prevalence rates of smoking compared to other regions (21.7%, 11.8% and 7.6% respectively), possibly because the illicit cigarette trade is more active in those regions. Access to illicit cigarettes has been shown to increase the uptake of smoking in different countries, including Ethiopia. Ethiopia’s government is therefore urged to ratify and implement the provisions in the Protocol to Prevent Illicit Trade in Tobacco Products.Gaya (the traditional practice of burning a tobacco leaf over a fire and inhaling it via a bamboo stick) is especially common in Gambella, the Southern Nations, Nationalities, and People’s Region (SNNPR), and Benshangul Gumz. This practice may be related to local beliefs that smoking tobacco can prevent malaria.
Tobacco-use prevalence is largely the same across rural and urban areas in Ethiopia, and is similar to the trends in Kenya, Malawi, Nigeria, and Rwanda.
There is some evidence that smokeless tobacco use is more common in rural areas in Ethiopia (2.0%) than in urban areas (0.4%), which is similar to what is seen in Nigeria. Global evidence also shows that people perceive chewing tobacco to be less harmful than smoked tobacco. In addition to cigarettes, policy efforts should focus on smokeless products, since they are also addictive and cause non-communicable diseases such as oral and other cancers, dental diseases, hypertension, and heart disease.
Prevalence of Tobacco Use
by Product
Prevalence of Tobacco Use by Product Ages 15+ (2016)
Source: GATS, 2016
In Ethiopia, the overall tobacco-use prevalence is 5.0%. Breaking this down, we see that smoked-tobacco use (cigarettes, cigars, pipes, gaya, and shisha tobacco) is far more common, with a prevalence rate of 3.7%, compared to smokeless tobacco (suret or snuff and chewing tobacco) at 1.7%.
Prevalence of Tobacco Use, by Khat Chewing
Per the NCD Steps survey, 15.8% of tobacco users in Ethiopia were also khat chewers. Survey results indicate that tobacco users in rural areas (16.8%) were more likely to chew khat than their urban counterparts (11.5%). In addition, more men than women were khat consumers (21.1% versus 9.4%, respectively). According to one study, khat consumption has a direct impact on tobacco smoking patterns – for example, khat chewers are more likely to initiate and sustain tobacco smoking in comparison to non-chewers. At the same time, simultaneous tobacco and khat users are more likely to fail quitting attempts.
Another systematic review and meta-analysis study indicated that khat chewers are more likely to smoke than those who do not. The 2015 NCD steps survey similarly found that there was a significant link between khat chewing and cigarette smoking – per survey results, the proportion of cigarette smoking among khat users was 19.9% compared to just 9.2% among non-khat users. Future tobacco control initiatives and interventions should thus consider this relationship between khat chewing and tobacco smoking.Cigarette Smoking Among Khat and Non-Khat Users (2015)
Source: NCD Steps, 2015
