Cardiovascular Journal of Africa: Vol 24 No 2 (March 2013)

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CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 2, March 2013 AFRICA 37
Africa, Mauritius and Seychelles, while those in the Horn of
Africa and in West Africa are relatively more physically active
(Table 2, Fig. 1). This observation closely mirrors the reported
prevalence of overweight and obesity. There are no consistent
national (rural and urban) surveys for similar years or later from
other SSA countries.
The Seychelles Heart study of 2004, reported by Bovet and
colleagues in 2007, revealed a disparate prevalence of physical
inactivity, ranging from 28 to 58.6% in both genders aged 25
to 64 years, because of variable and subjective operational
definitions of physical inactivity using a modification of the
WHO STEPS survey questionnaire, which was not identical
to the IPAQ.32 More surveys are therefore required in many
SSA countries using standard questionnaires to provide better
insight of the emergence of this cardiovascular risk factor in
the continent. There are likely to be wide variations of the
levels of physical activities, determined by culture, gender, age,
occupation, socio-economic status and levels of education.
Tobacco use in SSA
Most estimates of tobacco use in SSA vary in their operational
definitions. For instance, some surveys have used different age
ranges for men and women and between countries. Also, while
some surveys considered current tobacco use including smoked
and non-smoked tobacco, others have used only daily cigarette
smoking. Moreover, these studies were performed in different
years, making comparison of prevalence of tobacco use across
most African countries problematic.
According to WHO-Afro,33 tobacco-smoking rates were
considerably lower (< 10%) in countries such as Democratic
Republic of Congo, Congo, Ethiopia, Nigeria, Ghana, Swaziland
and Lesotho. Countries in Central, West and East Africa had
smoking prevalence rates ranging between 10 and 19%. High
rates of tobacco use (> 20%) were found mainly in southern
Africa, Guinea, Guinea Bissau, Niger, Seychelles and Mauritius.
There were no data from certain countries such as Angola,
Central African Republic, Gabon and Equatorial Guinea.
It is widely known that some countries on the continent
are major tobacco growers. For instance, tobacco accounts
for 61 and 23% of export earnings in Malawi and Zimbabwe,
respectively. South Africa, Tanzania, Kenya and Nigeria rank
closely behind Malawi and Zimbabwe. Continual commercial
pressures, price incentives and other subsidies provided by
transnational cigarette companies to African farmers, coupled
with aggressive marketing and advertisements will drive the
prevalence of tobacco use in SSA. It is therefore not surprising
that very few African countries have been signatories to the
Framework Convention on Tobacco Control Ratification, with
countries such as Zimbabwe, Malawi and Eritrea declining to
sign the convention altogether.
Table 3 shows age-standardised prevalence estimates for
current smokers in males and females aged 25 years or older
in 2006 in selected countries. In general, smoking prevalence
remains quite low among African women, although increased
trends are emerging in young urban women. The prevalence of
smoking is 20 to 50 times higher in men than in women across
Africa, with estimates of below 2% in women in most SSA
TABLE 2. PREVALENCE OF PHYSICAL INACTIVITY IN
SELECTED SSA COUNTRIES,WHO 2003
Country
N/U/R (18–69 years)
Males (%)
[95% CI]
Females (%)
[95% CI]
Both genders (%)
[95% CI]
Congo (n = 1 335)
M:F = 623:712
23.5
[16.5–30.5]
30.2
[21.8–38.51]
27.2
[20.5–33.9]
Ethiopia (n = 4 430)
M:F = 2 171:2 259
9.4
[7.1–11.8]
16.0
[13.9–18.2]
12.7
[11.0–14.4]
Ghana (n = 3 362)
M:F = 1 532:1 830
7.9
[5.9–9.8]
15.1
[12.7–17.5]
11.5
[9.7–13.3]
South Africa (n = 2 028)
M:F = 957:1071
43.0
[37.4–48.6]
46.6
[41.4–51.9]
44.9
[40.4–49.4]
Zimbabwe (n = 3 570)
M:F = 1 296:2 274
14.1
[11.6–16.6]
22.0
[19.6–24.5]
18.1
[16.4–19.8]
N/U/R = National Urban and Rural Survey.
Source: . Accessed 28 December 2011.
TABLE 3.AGE-STANDARDISED PREVALENCE ESTIMATES
FOR TOBACCO SMOKING (CURRENT USERS) IN MALES
AND FEMALESAGED 15YEARSAND OLDER IN SELECTED
SUB-SAHARANAFRICAN COUNTRIES BY REGION, 2006
Region/country
Current smoking
prevalence in males
aged 15 + years (%)
Current smoking
prevalence in females
aged 15 + years (%)
Eastern Africa
Uganda
UR Tanzania
19.0
24.0
2.0
2.0
Central Africa
DR Congo
Malawi
13.0
21.0
0.6
2.0
Western Africa
Nigeria
Ghana
12.0
10.0
0.2
0.5
Southern Africa
Zimbabwe
South Africa
33.0
29.0
2.0
8.0
Islands
Mauritius
Seychelles
34.0
32.0
0.9
3.0
DR Congo = Democratic Republic of Congo, UR Tanzania = United Republic
of Tanzania.
Source: Accessed on 31
December 2011.
The figures represent age-standardised prevalence rates, using the standard
WHO world population for age, for current tobacco smokers. These figures
should be used only to draw comparisons of prevalence between countries and
between men and women within a country. These figures are different from the
crude data reported in country surveys in Infobase. Fig. 1. Physical activity in men and women aged 18 to 69
years in selected countries.
14000
12000
10000
8000
6000
4000
2000
0
South
Africa
Mauritius Congo Ghana Zimbabwe Ethiopia
No of males 957 1747 623 1532 1296 2171
No of females 1071 1850 712 1830 2274 2259
Both genders 2028 3597 1335 3362 3570 4430
MET-minutes per week
Males Females Both genders
National, Urban and Rural Survey, World Heath Survey, WHO, 2003.