One in Three People with TB in Lesotho Smoke Cigarettes

Tuberculosis (TB) and cigarette smoking are both important public health problems in many low- and middle-income countries. Because the two issues can affect the same people, researchers wanted to understand how common smoking is among people with TB (PWTB) in Lesotho and which factors are linked with who smokes and how often. Alphonsus Ogbonna Ogbuabor̽ and colleagues used nationally representative survey data to look for patterns and drivers of cigarette use in this group. The study responds to a gap in research from sub-Saharan Africa where few large surveys have focused specifically on smoking status and smoking frequency among people diagnosed with TB. By measuring how many PWTB smoke and examining personal, household and mental-health factors, the researchers aimed to point to where public health efforts could focus to reduce smoking in this vulnerable population.

The team analyzed data from the 2023 Lesotho Demographic and Health Survey, focusing on 224 people with TB. The analysis accounted for sampling weight, stratification, and cluster sampling design. Outcome measures were smoking status and smoking frequency (daily smoking and occasional smoking). Predictor variables included socio-demographic factors, household characteristics, alcohol use, TB-related stigma, and mental health status. Associations were evaluated with Pearson’s chi-squared test and complex sample logistics regression, using a significance threshold of p<0.05. Key findings: the overall prevalence of cigarette smoking among PWTB was 32.2%; daily smoking was 24.9% and occasional smoking 7.3%. Adjusted odds ratios showed strong associations: being male (AOR=120.15, 95%CI:30.53-472.81, p<0.001), no media exposure (AOR=21.96, 95%CI:5.79-83.31, p<0.001), low media exposure (AOR=4.76, 95%CI:1.33-17.09, p=0.017), alcohol use (AOR=12.64, 95%CI:3.24-49.35, p<0.001), and mild depression (AOR=3.28, 95%CI: 3.28, 95%CI: 1.04-10.38, p=0.043) increased the odds of smoking. Moderate/severe depression showed reduced likelihood (AOR=0.06, 95%CI: 0.00-0.73, p=0.027). For daily smoking the strongest associations included being male (AOR=234.07, 95%CI:108.69-504.08, p<0.001), no media exposure (AOR=18.93, 95%CI:4.58-78.28, p<0.001), and alcohol use (AOR=21.26, 95%CI:3.79-119.23, p=0.001), while moderate/severe depression reduced likelihood (AOR=0.00, 95%CI: 0.00-0.00, p<0.001). For occasional smoking, being male (AOR=46.55, 95%CI:4.69-461.61, p=0.001), no media exposure (AOR=94.66, 95%CI:7.60-1179.67, p=0.001), low media exposure (AOR=26.34, 95%CI:2.54-272.98, p=0.007), and mild depression (AOR=6.18, 95%CI:1.43-26.66, p=0.015) increased odds.

These results point to a high burden of cigarette use among people with TB in Lesotho and identify clear groups and circumstances linked to smoking. Men were far more likely to smoke, and limited exposure to media and alcohol use were consistently associated with higher odds of both daily and occasional smoking. The findings on depression were mixed: mild depression was linked with increased smoking in some analyses, while moderate to severe depression was associated with lower odds of smoking. Based strictly on these findings, the study concludes that efforts to reduce smoking in people with TB in Lesotho should be targeted—particularly toward men—and should include improving media exposure to anti-tobacco messages, tackling alcohol use, and addressing mental health needs among people with TB. Policymakers and health programs can use these specific associations to shape prevention and cessation interventions tailored to the patterns seen in the national survey data.