Sex disparities in current cigarette smoking prevalence among individuals aged 15 years and older in 39 African countries: a descriptive study using the World Health Organization Health Equity Assessment Toolkit

Abstract

BACKGROUND: Cigarette smoking remains a major preventable cause of disease and mortality. Comparable sex-disaggregated estimates are needed to describe smoking patterns across African countries and support tobacco control planning. OBJECTIVE: To provide a multi-country descriptive summary of the current prevalence of cigarette smoking disaggregated by sex among people aged ≥ 15 years in 39 African countries. METHODS: This cross-sectional descriptive analysis used non-age-standardized WHO Global Health Observatory modelled estimates for 2022, accessed through Health Equity Assessment Toolkit version 6.0. Current cigarette smoking prevalence (M_Est_cig_curr) was disaggregated by sex and exported for 39 countries. Absolute differences were calculated as female minus male prevalence. Male-to-female prevalence ratios were derived from the exported point estimates for supplementary analysis. The dataset comprised modelled estimates rather than directly observed survey data. RESULTS: The overall prevalence ranged from 1.7% in Ghana to 18.2% in Seychelles. The prevalence of males exceeded that of females in all 39 countries. The male-minus-female gap ranged from 3.3 pp in Ghana to 36.4 pp in Lesotho; gaps also exceeded 25 pp in Mauritius, Algeria, Madagascar, and Seychelles. The prevalence in females was highest in South Africa (5.1%) and Seychelles (4.5%). CONCLUSION: This study shows substantial sex differences in current cigarette smoking across the included African countries, driven mainly by a higher prevalence among men. These findings support strengthened sex-disaggregated surveillance and tobacco control responses tailored to observed country patterns. Explanations involving social norms, marketing, or policy context should be treated as hypotheses because these factors were not measured in this study.