According to a new report from World Health Organization (WHO), entitled "Mortality Attributable to Tobacco,”   five per cent of all deaths from communicable diseases worldwide and 14 per cent of deaths resulting from non-communicable illnesses among adults aged 30 and above were attributable to tobacco use. Tobacco is one of the addictive substances abused since ancient times in all parts of the world.  Nicotine is the prime ingredient of tobacco which is addictive and    harmful.Those living with tobacco use have a poor quality of life and suffer from multiple health related problems. Tobacco when smoked in form of cigarettes produces smoke which contains carbon. Carbon produces blackish discoloration of the lips and fingers of the smoker a tell tale sign that he has been smoking. An individual who has been smoking tobacco suffers from chronic bronchitis due to chronic damage to the lungs. Such individuals have chronic cough and chest pain. They develop a lean pinched look with swelling of proximal parts of fingers. They are prone to diseases of the lungs like T.B., pneumonias and also lung cancer.Tobacco damages the nerve responsible for vision causing visual disturbances and blindness. The brain center responsible for maintaining equilibrium of the body is damaged leading to difficulty in walking. Even small chores like combing or dressing become difficult.    The blood vessels of the body become constricted by tobacco. This results in precipitation and aggravation of hypertension. It is a risk factor for causing coronary artery disease.  A tobacco user is at greater risk of suffering from heart attacks as compared to a non smoker.  Blood vessels of the brain are affected resulting in stroke. The blood supply to limbs is reduced causing cramps like pain on walking and working. If this condition progresses, gangrene sets in necessitating amputation of the affected limb.Kidneys are also damaged due to the reduced blood supply, resulting in chronic kidney failure.Due to diminished blood supply to the nerves,   the person suffers from troublesome abnormal sensations in the limbs like undue coldness or sense of insects crawling.  In people who chew tobacco, there is chronic inflammation of the oral cavity due to which gradually the mouth becomes tight and one finds it difficult to open it. It can be then corrected only surgically. These people are at greater risk for developing   cancers of the mouth. Tobacco   and its smoke contain 19 identified cancer producing substances   and is a known risk factor for cancers of the larynx, stomach and pancreas. Men using tobacco develop sexual impotence sooner or later. Women who smoke can develop sterility. If pregnant, there can be abortion. If the pregnancy continues, there is high risk of intrauterine death or delivery of a low birth weight baby born with birth defects. The appetite of a person is suppressed by tobacco, contrary to the claim of some people that smoking serves as appetizer for them. A chronic smoker becomes malnourished.Thus it can be seen that there is absolutely no advantage of tobacco and many harmful effects. Once somebody starts using tobacco, initially he feels good due to its stimulant effects on the brain. Later on the body becomes dependant on it, thus craving for more.  Over time as he starts suffering from health problems, he   finds it difficult to give it up. The   onset and severity of health hazards of tobacco depend on the age of the individual, quantity of tobacco consumed and presence of other co morbid conditions, but nobody is immune to the damage caused by tobacco. Some people think that smoking a pipe is safe or just occasional smoking is harmless. But these are myths. If one has started using tobacco, sooner he gives it up, better it is.People who do not   smoke but are exposed to smoke exhaled by one smoking are also at risk of developing health hazards. Considering the health risks for a passive smoker, smoking in public places is rightly banned in Rwanda and is very well implemented also. Pande is a specialist Internal medicine-Ruhengeri Hospital