Prevalence and determinants of cigarette smoking and smoking frequency among people with tuberculosis in Lesotho: evidence from a nationwide cross-sectional survey

BackgroundLow-and middle-income countries face a significant dual burden of tuberculosis (TB) and cigarette smoking. Nevertheless, studies examining the prevalence and determinants of smoking status and frequency among people with TB (PWTB) are scarce in sub-Saharan Africa, including Lesotho. Therefore, this study evaluated the prevalence and determinants of smoking status and frequency among people with TB in Lesotho. MethodsData on people with TB from the 2023 Lesotho Demographic and Health Survey were used in this study (n = 224). The data were adjusted for sampling weight, stratification, and cluster sampling design. The outcome variables were smoking status and smoking frequency (daily smoking and occasional smoking). The predictor variables included socio-demographic factors, household characteristics, alcohol use, TB-related stigma, and mental health status. We evaluated the association between outcome and predictor variables using Pearsons chi-squared test and complex sample logistics regression. Statistical significance was set at a p-value < 0.05. ResultsThe prevalence of cigarette smoking among PWTB is 32.2%. The prevalence of daily and occasional smoking among PWTB is 24.9% and 7.3%, respectively. 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 among PWTB. Nevertheless, moderate/severe depression (AOR=0.06, 95%CI: 0.00-0.73, p=0.027) reduced the likelihood of smoking among PWTB. 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) increased the odds of smoking among PWTB. In contrast, moderate/severe depression (AOR=0.00, 95%CI: 0.00-0.00, p<0.001) reduced the likelihood of smoking among PWTB. 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), and 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 the odds of smoking among PWTB. ConclusionThe high prevalence of smoking among PWTB needs to improve in Lesotho. Policies and programs to reduce smoking among PWTB must target the male gender, improve media exposure to anti-tobacco campaigns, reduce alcohol consumption and improve mental health among people with TB.