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HomeHarm ReductionKZN state hospitals offer no nicotine alternatives to smoking TB patients

KZN state hospitals offer no nicotine alternatives to smoking TB patients

South Africa’s healthcare system’s regulation of patients’ access to cigarettes is so far behind the government’s ambitions to curb tobacco consumption that drug-resistant tuberculosis patients can access cigarettes at a provincial state hospital more easily than non-smoking alternatives, reports Fin24.

This is according to local research that was published in the Annals of Global Health, conducted between September and October 2015 at three hospitals in KwaZulu-Natal.

One of the researchers, Phindile Shangase, told Fin24 during the Global Forum on Nicotine in Warsaw, Poland last week (16 June) that the research uncovered various problems in hospitals’ ability to stop patients from smoking.

“First, when it comes to controlling smoking in public places, the government’s policies are not being enforced. In hospitals, there is easy access to cigarettes. It is not a secret,” she said.

And apart from the absence of barriers to accessing cigarettes, worse was the lack of awareness about safer alternatives, including vapes and heating systems, among state hospital patients and staff.

“They don’t know about vapes or other nicotine-replacement therapy. The most they know is nicotine gum. Nobody mentioned e-cigarettes: even staff did not know about this,” Shangase said.

The World Health Organization’s Framework Convention on Tobacco Control, to which South Africa is a signatory, recommends that smoking cessation support should be available at most hospitals.

However, the research findings indicate the shoddy state of the government’s tobacco and nicotine products regulation. Alternatives do exist in the system to help patients with DR-TB and other respiratory conditions to get nicotine through less harmful means.

But the study found that while private hospitals include nicotine alternatives for patients wanting to quit smoking, many public hospital staff were unaware that these alternatives even existed.

Phindile Shangase said the findings reiterated the need for smoking cessation intervention to be incorporated as an integral component of DR-TB management, noting that patients were interested in nicotine-replacement therapies and psychological support to help them quit smoking.

“Additionally, offering extramural activities and reducing the availability of cigarettes in and around hospitals may reduce cravings and thus smoking, and TB hospital-based research addressing specific cessation strategies for DR-TB inpatients is critical.”

Study details

Barriers to smoking cessation among drug-resistant tuberculosis patients in South Africa

Zifikile Phindile Shangase ,Joyce Mahlako Tsoka-Gwegweni, Catherine O. Egbe.

Published in Annals of Global Health on 20 June 2017


Drug-resistant tuberculosis (DR-TB) remains a significant cause of morbidity and mortality. The long-term health effects of smoking and the risk of adverse TB outcomes, including increased periods of infectiousness, have been reported among DR-TB patients in South Africa.

This study aimed to identify the barriers to smoking cessation among DR-TB inpatients at a hospital in Durban, South Africa.

A qualitative design using in-depth interviews with a purposive sample of 20 DR-TB inpatients was employed. The sample included 15 men and 5 women aged 18-70 years who self-identified as smokers. Open-ended questions were used to explore barriers militating against smoking cessation among this sample. Data were analysed with the aid of the software QSR NVivo10.

Personal and structural-level barriers (factors) to smoking cessation were identified. Personal factors included addiction and non–addiction-related barriers. Addiction-related barriers included smoking history, cravings for a cigarette, smoking as part of a daily routine, and failed quit attempts. Non–addiction-related barriers included lack of knowledge about quit strategies, psychosocial stress, lack of the willpower to quit smoking, and the influence of peers. Structural barriers included ineffective health education programmes, lack of extramural activities on admission to hospital leading to a lot of spare time, lack of smoking cessation interventions, and access to cigarettes within and around the hospital environment. Patients expressed interest in smoking cessation and conveyed their frustration at the lack of appropriate support to do so.

The findings reiterate the need for smoking cessation intervention to be incorporated as an integral component of DR-TB management in South Africa. Many patients expressed an interest in pharmacological aids and psychological support to help them to quit smoking. Additionally, offering extramural activities and enforcing smoke-free policies in hospital facilities will help to reduce patients' access to cigarettes while at the hospital.


Fin24 article – Hospitalised TB patients can get cigarettes more easily than safer alternatives – report (Open access)


Annals of Global Health article – Barriers to smoking cessation among drug-resistant tuberculosis patients in South Africa (Open access)


See more from MedicalBrief archives:


WHO versus Public Health England over e-cigarettes


E-cigarettes: What we know and what we don’t – Cancer Research UK


E-cigarettes: Misconceptions may prevent people from quitting smoking


Public Health England: Stopping smoking – What works?


Up in smoke – Are we wrong about the dangers of vaping?


What is harm reduction?





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