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Water-Pipe Tobacco Epidemic in Tobacco Naive Communities: Experience from Ethiopia*

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Water-Pipe Tobacco Epidemic in Tobacco Naive Communities: Experience from Ethiopia* Open Journal of Epidemiology, 2013, 3, 184-192 OJEpi http://dx.doi.org/10.4236/ojepi.2013.34027 Published Online November 2013 (http://www.scirp.org/journal/ojepi/) Water-pipe tobacco epidemic in tobacco naive * communities: Experience from Ethiopia Molla Gedefaw1#, Amanuel Eshete1, Mekonnen Aychiluhem1, Mr. Telake Azale2 1GAMBY College of Medical Sciences, Bahir Dar, Ethiopia 2University of Gondar, Gondar, Ethiopia Email: #[email protected] Received 14 August 2013; revised 14 September 2013; accepted 21 September 2013 Copyright © 2013 Molla Gedefaw et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT study participants were tobacco naive and really un- aware of the contents WPT; but about 94% of them Water-pipe tobacco (WPT) is a public health threat had been khat chewers before they started with WPT of the 21st century. As a fashion, it swiftly spreads to smoking. In this region, khat had until recently been all corners of the world in no more than two decades. It is a new phenomenon for Ethiopia in general and used by the Muslims only. WPT smoking is an even for Amhara National Regional State in particular. The more recent phenomenon. “Khat stimulates, and WPT major objective of this study was to gain in-depth calms down,” said study participants. That means by baseline information about water-pipe tobacco smok- using the later as an antidote for the former, people ing practice in Bahir Dar City, 2012. An explorative start ruining their health with substances containing study was conducted at Bahir Dar City—capital of chemicals proven to be notorious to human health. Amhara National Regional State. It is home for one of This combination of deadly addictions seems to be pe- the largest universities in the country with more than culiar to Ethiopia and appears to be a serious public 40,000 students. Of the total 50 WPT lounges, six were health threat to tobacco naive communities in the re- identified based on their customer variety, and loaded gion. Therefore, their rapid progression needs to be by the help of police officers who had ample experi- met with appropriate interventions urgently. It also ence in fighting the expansion of WPT smoking in the warrants further investigations. city. A total of 115 people participated in this study. In-depth interviews and focus group discussions (FGD) Keywords: Water-Pipe; Tobacco; Khat; Tobacco Naïve; were conducted, and the tape recorded data were Community; Epidemic thematically analyzed. More than 80% of the study participants were below 40 Years, and more than 30% 1. INTRODUCTION of the total study participants were students. The pro- fession of the remaining participants ranges from World Health Organization declares tobacco as one of the daily laborers to university instructors. Females ac- greatest threats to global health. More than 30% of world’s counted for 37.39%. The following factors were found adult population is becoming consumers of tobacco. About to be pertinent for rapid increment of water-pipe to- 5 million people die prematurely from health consequen- bacco smoking: geographic and economic accessibil- ces of tobacco use every year [1]. WHO warns that a bil- ity, peer pressure, deceiving characteristics of WPT- lion people will die of adverse health effects of tobacco st non-irritant and aromatic, lack of knowledge, and ab- epidemic within the 21 century unless effective majors sence of effective policy. The most outstanding find- are undertaken [2]. The public health challenge of tobac- ings of this study were the following: almost all of the co is unique in that tobacco producers [1] undermine pu- blic health efforts because they gain unbelievably huge * Conflict of interests: Authors declared that they have no conflict of In- wealth, and power which enables them to endure all sorts terests. Author’s contribution: This manuscript is extracted from the Master’s of anti-tobacco policies, and campaigns. thesis (masters of public health) of Mr. Amanuel Eshtie. Dr. Malla Ge- The future seems even worse [1] because thanks to in- defaw was his principal advisor. Dr. Mekonnen Aychiluhm and Mr. novation of tobacco producing companies, tobacco seems Telake Azale were his co-advisors. All played their role perfectly. #Corresponding author. to succeed in reaching every corner of the world in dif- OPEN ACCESS M. Gedefaw et al. / Open Journal of Epidemiology 3 (2013) 184-192 185 ferent forms, and tastes more than ever before [3]. For producing companies are based, Ethiopia will be proba- instance, Nakhla pioneered the concept of aromatic mo- bly one of the most affected countries in the horn of Af- lasses, and established itself as a number one producer of rica. aromatic water-pipe tobacco. In 2011 alone, its total sales The vulnerability of Ethiopia to WPT seems to be ag- volume was approximately 24,000 tons which is equiva- gravated by the high consumption of khat (Catha edulis). lent to 24 billion cigarettes [4]. The company currently Khat is an evergreen plant consumed mostly for stimu- operates in up to 20 African countries including Algeria, lation, and recreation purposes. In Ethiopia, studies indi- Morocco, Nigeria, Tanzania and South Africa. cate that the plant is nowadays highly abused especially To make things worse, giant international tobacco pro- by the young people [13]. Therefore, it causes multitudes ducing companies showed interest in the production of of health and social problems [14-16]. Besides, this plant aromatic water-pipe tobacco production. For instance, is found to be an entry point to starting with other sub- according to Euro Monitor (20th of November, 2012) [4], stances such as cigarettes and alcohol [13]. Japan Tobacco Inc. signed an agreement with Nakhla— Hence, this explorative study was conducted to gain the number one water-pipe tobacco manufacturer-based in-depth baseline information about water-pipe tobacco in Egypt, and Saudiarabia to produce water-wipe tobac- smoking practice in Bahir Dar city. The finding of this co. study will serve as a springboard for further studies. More- Although water-pipe tobacco smoking has a long his- over, it gives highlight about current practices of WPT tory in the Middle-East, India, and North Africa, litera- smoking in the city which can help stimulate public health ture indicates that its resurgence coincides with the intro- action to start checking the rapid expansion of WPT duction of flavored water-pipe tobacco in the last decade smoking in the horn of Africa. of the 20th century [5,6]. Water-pipe tobacco has differ- ent names such as Nargila, Hookah, Hubble-Bubble, Wa- 2. MATERIALS AND METHODS ter Pipe and Shisha in deferent countries. In this paper An explorative study was conducted in Bahir Dar City, we used water-pipe to cover all these different names as the capital of Amhara National Regional State, Ethiopia recommended by WHO regional office for eastern Medi- from September to December, 2012. The city has a total terranean Region, 2006 [7]. population of 267,350. It is situated south of Lake Tana, From a public health point of view, we believe that the and Blue Nile River. The Lake has several Orthodox expansion of flavored water-pipe tobacco appears the most Christian dominated historical heritages. Hence, it is one malignant of all tobacco forms. Having less irritant na- of the tourist attraction sites in Ethiopia. The farmers are ture, different aroma, and taste [3,8], it delivers all sorts nearly hundred percent Orthodox Christians. The city has of known and unknown harmful components of tobacco one public university and several other private owned to children, tobacco naïve adults and elderly in many and public colleges. The university alone has also above countries of the world [9]. Therefore, nowadays water- 40,000 students. pipe tobacco smoking is declared as a global epidemic Currently, the city has 17 Kebeles which is equivalent surrounded with lots of misconceptions [3,5,10,11]. to a district. According to the records of the city police, Cognizant of the debilitating health risks of tobacco, there are about 50 water pipe smoking lounges in the city. nations across the world are very much concerned about Of these, nine of them were well known and hence vis- the rapid expansion of water-pipe tobacco smoking [3,11, ited by many people despite the fact that water-pipe smo- 12]. This concern is actually well shared even among na- king is not legal. Smokers, as well as lounge owners could tions where water wipe-pipe tobacco smoking is consid- be taken to police station and punished. ered as a tradition [6]. WHO warns that more than a bil- The study target of this research were water pipe smo- lion people will die from adverse health effects of tobac- kers, lounge owners, and polices who were actively play- co epidemic, and the major segment will be from the ing their respective roles in all kebeles of Bahir Dar City. middle and low income countries [2]. A total of 115 people participated in this study. These Water-wipe tobacco (WPT) is a new phenomenon in all water-pipe tobacco smokers were accessed at six Ethiopia in general, and in Amhara National Regional lounges. These six sites were selected by the help of po- State in particular. This part of the country has been lice officers, and community polices. Their selection was highly dominated with Coptic Orthodox Christian culture, based on their customer variety and load. and parents had the chance to nurture their children in a In depth interview, observation, and focus group dis- tobacco free environment. Unfortunately, however, what cussion were the data collection tools.
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