Challenges for dedicated smoking cessation services in developing countries

• Published in: South African medical journal 2019-06, Vol.109 (6), p.431-436
• Main Authors: Cooper, C., van Zyl-Smit, R.N., Esmail, A., Dheda, K., Day, C., Tadzimirwa, G.Y., Kamkuemah, M.
• Format: Article
• Language: English
• Subjects: Carbon monoxide; Depression (Mood disorder); Developing countries; Health aspects; Lung cancer; Medical research; Nervous system agents; Nicotine; Public health; Resource allocation; Risk factors; Smoking; Smoking cessation; Youth smoking
• ISSN: 0256-9574; 2078-5135
• DOI: 10.7196/SAMJ.2019.v109i6.13631

Background. South Africa, ranked as the world’s second most stressful country to live in, has an estimated 7 million smokers. A dedicated smoking cessation clinic established at Groote Schuur Hospital, Cape Town, provides the only clinical service and training centre in the country. Objectives. To evaluate the smokers attending the clinic, in order to better understand the requirements of smoking cessation services in resource-limited settings. Methods. Demographic and smoking-related data were collected prospectively from all clinic attendees since its inception. Nicotine dependence, depression scores and exhaled carbon monoxide levels were formally evaluated. Consent was provided to review the data collected. Results. Ninety-seven smokers were evaluated. Their mean (standard deviation) age was 50.9 (10.7) years, and 59% (57/97) were male. The median age of smoking initiation was 16 years (interquartile range (IQR) 8 - 28), with a current median daily consumption of 12 cigarettes (IQR 7 - 20). Overall, men smoked more than women, with a median of 20 cigarettes per day (IQR 10 - 20) v. 12 (IQR 5 - 20), respectively (p=0.001). The median Fagerström nicotine dependence score was 5 (IQR 3 - 7), with scores of 6 (IQR 4 - 8) for men and 5 (2 - 7) for women (p=0.06); 50% of smokers had a Fagerström score