World No Tobacco Day: What's the situation in Rwanda?

Every May 31, the World Health Organisation (WHO) and partners mark World No Tobacco Day (WNTD), highlighting the risks associated with tobacco use and advocating for effective policies to reduce tobacco consumption. The Ministry of Health through Rwanda Biomedical Centre (RBC) is organising this year’s celebration under the theme, ‘Tobacco - a Threat to Development’ .The celebration will be marked by different activities such as increasing awareness using different channels of media (eg: Press conference planned on 31st May 2017 at RBC, radio talks on RBA, Radio 10, Radio Mariya, etc). According to WHO, about 6 million people die from tobacco use every year, a figure that is predicted to grow to more than 8 million a year by 2030 without intensified action. WHO also states that tobacco use is a threat to any person, regardless of gender, age, race, cultural or educational background. In Rwanda, the survey carried out NCD Risk Factors 2012-2013) showed that adult smoking prevalence was 12.8 per cent, while on the other hand, Rwanda Demographic Survey (RDHS) conducted 2014/15 shows that prevalence of tobacco use in Rwandan population is 10% (tobacco use in men aged 15-59 who smoke cigarettes and other tobacco products) and 2% (tobacco use in women aged 15-49 who smoke cigarettes, pipes and other tobacco products). The Global Youth Tobacco Survey(GYTS) 2008 findings shows that tobacco use prevalence in youth is 11.5%--13.3% for boys and 9.5% for girls; cigarette smoking prevalence is 1.8%- 3% for boys and 0.9% for girls. According to Francois Habiyaremye, the cardiovascular diseases officer at Rwanda Biomedical Centre, this calls for government to take some actions such as strengthening legislation promoting smoke free environments, health warnings on cigarette packages and increasing taxes on tobacco products. “This month, a lot of effort will be directed at the very high burden in young people. When preventing the use of tobacco in such generation, it means that we are putting more effort in controlling its use in future generations, which is our target,” he says. Measures taken There is a need to raise more awareness about the dangers of tobacco use, among the youth and general population and reminds everyone that it is prohibited to smoke tobacco and tobacco products (eg:shisha) in public places , according to Habiyeremye. He explains that the young generation should understand that when processing tobacco products, the tobacco companies add four thousand more chemicals which are carcinogenic. “It’s because of these chemicals that one gets addicted in a short period when they start smoking. Unfortunately, these products don’t allow one to easily quit the vice,” he says. Habiyeremye further points out that the aim of the celebration will be to raise awareness, especially among the youth, about the dangers of peer pressure, as well as the consequences of tobacco use. According to Dr Marie Aimee Muhimpundu, the head of non-communicable diseases at the Rwanda Biomedical Centre, they are trying to control second-hand smoking, a move already supported by the law which prohibits public smoking. “Increasing taxes on tobacco products will also make it expensive for smokers and discourage those intending to indulge in the vice,” she says. Muhimpundu says there are health facilities already in place such as Ndera Hospital where they offer support to the addicted persons to help them quit the vice. Another strategy, she says, is also to target young people in different fora such as in schools, youth organisations and media, as well as open discussions, in order to present all this information and at the same time answer participants’ concerns. Muhimpundu adds that to reduce tobacco use by youth, the ministry of health should work closely with the Ministry of Education to set some rules that will ensure control of tobacco use in education facilities. “For instance, in schools, there should be a good distance between the school and shops or canteens that sell tobacco products. Also, shops that sell snacks at school should not be allowed to sell cigarettes,” she says. Meanwhile, Habiyeremye says tobacco use is among modifiable risk factors and tobacco related morbidity and mortality are preventable. “For most young people smoking habits might be determined early in life. Therefore, there is need of developing and implementing specific strategies targeting age group between 25 and 34 years as they are the most leading users of tobacco products,” he explains. What the law says Official Gazette of 08/04/2013, under different articles has rules and regulations that are meant to guide, prevent as well as control the use of tobacco. It establishes modalities for controlling tobacco consumption and tobacco products that are manufactured in Rwanda as well as those imported so as to protect the Rwandan population. In particular, its purpose is: such regulations include preventing persons under 18 from any contact with tobacco and tobacco products, as well as to inform, educate and communicate to the public on the health, environmental, economic and social consequences. For instance, in article 9, there are prohibited premises for selling tobacco and tobacco products. Examples of such places include; all health facilities, all drugs production companies and pharmacies, children’s gardens and any other public place meant for children, schools, as well as higher institutions of learning, among others. All these and many other rules and regulations, Habiyaremye says, are there to ensure that there is prevention and control of tobacco use in the entire population. Consequences of tobacco use Rachna Pande, an internal medicine specialist, says tobacco has diverse negative health effects ranging from economic to environmental effects, on the global and national levels. Tobacco is the cross-cutting risk factor for four major non-communicable diseases, namely; cancers, heart diseases, chronic respiratory diseases and diabetes. She explains that for diabetes, smoking has been linked to type 2 diabetes. “Smokers are 30 to 40 per cent more likely to develop type 2 diabetes than non-smokers. Additionally, the more an individual smokes, the higher the risk for diabetes. Smokers are also likely to have respiratory infections. “This is because the immune system is the body’s way of protecting itself from infections and diseases, and smoking itself comprises the immune system thus prone to respiratory infections for those who smoke. Autoimmune diseases including rheumatoid arthritis are just some of the effects of smoking,” she says. Although smoking can affect any part of the body, Pande says lungs are the most affected because it damages one’s breathing and scars the lungs. “Smoking for a long period of time can lead to chronic obstructive pulmonary disease (COPD), a disease that gets worse over time and results to wheezing, shortness of breath, chest tightness among other effects. “Walls between the air sacs in the lungs lose their ability to stretch and shrink back. The lung tissue is destroyed, making it difficult or impossible to breathe (emphysema).asthma, pneumonia and tuberculosis are just some of the effects that come along with smoking,” she adds. Pande says tobacco results in economic loss (poverty), food insecurity, high health costs, reduced productivity as well as reduced life expectancy. “The environmental dimension includes loss of forest cover, pollution from smoke and tobacco residues,” she says.