Tobacco use among tuberculosis patients across 30 districts in India in 2013 and 2017

Abstract

Background: In 2016, India estimated about 2.8 million tuberculosis (TB) cases (Global TB Report 2017) and about 267 million adults (>15years) in India using tobacco in any form (GATS 2017). Tobacco is one of the important drivers of TB epidemic. The Union South East Asia office just concluded the Endline Knowledge, Attitude and Practice (KAP) survey on TB across 30 districts in India among various stakeholders including TB patients. As part of the survey, TB patient's tobacco use was also captured. Methods: The Endline KAP survey methodology was similar to the previous surveys (midline in 2013 and baseline in 2011) except for data captured digitally in endline and paper based in previous surveys. Briefly, the survey was conducted as part of a large Global Fund supported TB project “Axshya” being implemented across 300 districts. 30 districts were selected using systematic random sampling and from each district 10 primary sampling units were selected randomly. The data was collected during October-November 2017. The survey identified about 307 self-reported TB patients. Pre-tested questionnaires were used after obtaining patient consent. Results: The overall tobacco users in Endline were 34% (N=103/307) and in Midline 30% (N=135/496). Among males, the proportion remained same about 43% in both the surveys, however among women this increased marginally to 14% from 12%. Proportion of those who smoke decreased from 37% in midline to 31% in endline. And the proportion of those who use smokeless tobacco increased from 55% to 59% respectively. Interestingly, proportion of men using smokeless tobacco increased and that of women decreased. However these differences are statistically not significant. Conclusions: The preliminary analysis shows proportion of tobacco users among TB patients is marginally increased. Though the overall tobacco users in India decreased, tobacco use among TB patients seems unchanged, indicating nothing significant has been done for tobacco cessation among TB patients. (Figure presented).