Drs. Mamudu and Pack Publish on Tobacco Cessation and Tuberculosis

Dr. Hadii Mamudu, Professor for the Department of Health Services Management and Policy, and Dr. Rob Pack, Associate Dean in the East Tennessee State University College of Public Health, have co-authored an article in BMC Public Health.  The article, “Health workers’ perceptions on where and how to integrate tobacco use cessation services into tuberculosis treatment; a qualitative exploratory study in Uganda,” examined focus group and key informant interviews in nine healthcare facilities in Uganda.

Elizeus Rutebemberwa, faculty in Makerere University School of Public Health, is lead author of the article. Additional co-authors include members of the Makerere University School of Public Health, the Centre for Tobacco Control in Africa, the World Health Organization, and the University of Nairobi.

Tuberculosis (TB) prevalence has been increasing in Uganda since the 1980s, accounting for 4% of total deaths in health facilities in 2018/2019. Smoking has been cited as one of the risk factors contributing to this increase. The prevalence of smoking among patients with TB in Kampala was about 26% in 2015.  In Uganda, TB treatment is in the communicable disease control department while tobacco use cessation is in the non-communicable disease department. Therefore, tobacco use cessation and TB control programs are not linked.

In this study, health workers’ perspectives were sought because these health workers are key in the tobacco cessation exercise. Advice from health workers improves utilization of cessation assistance. Health workers operate in both health facilities and communities where they carry out public health prevention and control activities. The study was conducted in nine health facilities: two from Kampala, which is the capital city; two from the eastern, three from the northern, and two from the western parts of the country. This was a qualitative exploratory study conducted using focus group discussions and key informant interviews.

Health workers highlighted that just like TB prevention starts in the community and TB treatment goes beyond health facility stay, integration of tobacco cessation should be started when people are still healthy and extended to those who have been healed as they go back to communities. There was need to coordinate with different organizations like peers, the media and TB treatment supporters.

The researchers concluded tobacco use cessation in TB treatment and control integrates a community public health intervention implemented through public health laws and a chronic disease treated at health facilities. Integration should therefore not be restricted to health facilities but be linked to activities in communities.