Trends in smoking tobacco in Africa, 1990–2019: analysis from the global burden of disease study 2019

Tobacco is one of the leading causes of non-communicable diseases (NCDs) and premature deaths. The World Health Organization’s global NCD monitoring framework emphasizes a goal of reducing premature mortality from NCDs. This study described the population of smokers in Africa, alongside the trends in smoking by subregion, country, age, and sex between 1990 and 2019. We utilized tobacco smoking data from the Global Burden of Disease, produced by the Institute of Health Metrics and Evaluation and population reports from the World Bank database which was used to normalize the number of smokers and present the percentage of the population (≥ 15 years) that are smokers. We used the comparative risk assessment framework for 55 countries across the five subregions in Africa. The results of the analysis included the actual values as well as the lower and upper boundaries within 95% uncertainty interval (UI). The ranking of the countries (i.e., top 10 or bottom 10) was done using the year 2019 data sets. In Africa, the number of smokers increased from about 50 million in 1990 to 90 million in 2019. From 1990 to 2019, the proportion of smokers declined across all African subregions, with Southern Africa showing the highest initial rates. Countries like Seychelles, Djibouti, and Tunisia consistently had the highest smoking prevalence, exceeding 20%. In contrast, nations such as Nigeria, Ethiopia, and Sao Tome and Principe maintained the lowest proportions, mostly under 5%. Despite reductions in the proportion of smokers in some countries, others experienced rising trends, particularly in North and East Africa. The persistent regional and national disparities in smoking proportions suggest uneven implementation and effectiveness of tobacco control policies across the continent. These trends have significant implications for the growing burden of NCDs in the region, as tobacco use remains a key risk factor for cardiovascular disease, cancer, and respiratory illness. High smoking proportions signal potential future increase in NCD-related morbidity and mortality, emphasizing the urgency for comprehensive tobacco control measures. Strengthening policy enforcement, public education, and cessation support will be critical to mitigating tobacco-related NCDs in Africa.