Intervention with communication techniques reduces tobacco use in the community: An experience from rural Bangladesh

Author(s) Shahidul Hoque1, SMA Hanifi2
Affiliation(s) 1Centre for Equity and Health Systems, icddr,b, Chakaria, Cox's Bazar, Bangladesh, 2Centre for Equity and Health Systems, icddr,b, icddr,b, Bangladesh.
Country - ies of focus Bangladesh
Relevant to the conference tracks Advocacy and Communication
Summary Tobacco use is one of the leading causes of early deaths and is gradually increasing in developing countries like Bangladesh. Bangladesh is on the verge of tobacco epidemic as 16% of total deaths among the people aged 30 years and above is connected to tobacco use. There are many difficulties in mitigating the tobacco menace in Bangladesh despite government laws and regulations. Community level effective communication strategy/techniques were largely absent in providing meaningful information about the harmful effect of tobacco use. icddr,b has develop and tested a package of communication techniques to reduce tobacco use at the community level.
Background Tobacco use has long been a leading contributor to premature death, and causes about 9% of deaths worldwide. Rates of smoking are increasing in many low-income and middle-income countries including Bangladesh. The proportion of tobacco-attributable deaths from tobacco use increases as the number of deaths increases. According to WHO, nearly 6 million people die from tobacco-related causes every year. If present patterns of use persist, tobacco use could cause as many as 1 billion premature deaths globally during the 21st century. Tobacco use, in particular smoking cigarettes and bidis, are common habits among the general male population in Bangladesh. Smoking related diseases such as pulmonary diseases, stroke, ischemic heart disease etc. are well documented. Smokers have a greater risk of dying from pulmonary tuberculosis as compared to non-smokers. Tobacco related illnesses accounted for 16% of the total deaths among the population of Bangladesh who are aged 30 years and above, which is about 25% of deaths in men and 7.6% in women. Smoking is also positively linked with the illicit drug use in Bangladesh. The cost of tobacco consumption at the national level is found to be associated with the increased health-care costs and loss of productivity due to illnesses and early deaths.
Objectives The objectives of the project are to document the effectiveness of various communication techniques in reducing the tobacco use in a targeted population and design a future intervention based on the effective techniques.
Methodology The project carried out in Chakaria, a rural sub district of Cox’s Bazar in Bangladesh where icddr,b is active in research and development activities since 1994. Fifteen villages from three unions were selected for the intervention and the same number were chosen for comparison. We have adopted various interventions in the form of Othan Baithaks or household courtyard meetings, peer group meetings, transmitting cell phone messages, counselling tobacco users through mobile phones and motivating village doctors to disseminate messages to the patients. The target audience is women and men aged 15 years and above. During the intervention, a female/male health worker showed/discussed the potential harmful effects of smoking and the dangers of passive smoking, emphasizing the idea that smokers not only put themselves at risk of serious health problems but also the people around them who are mainly family members. The health worker also transmitted the messages to all mothers that a developing baby can be affected by tobacco smoke if the mother smokes or if she is exposed to tobacco smoke during pregnancy. A video showing the harmful effects of tobacco use and large pictorial messages were displayed to communicating the message to smokers and non-smokers. Data were collected from follow-up, and mobile counselling, video sessions and process documentations were used for analyzing and interpreting the results.
Results During January 2011-June 2103 intervention period total 9760 women/men aged 15 years and above from 1600 households participated in the Othan Baithaks and organized video sessions. 1482 households had mobile phones and 78% of these households were contacted for counselling through mobile phone. Among the population, men were most likely to use tobacco than women. Among the targeted population 1173 (12%) quit tobacco, 728 (7.5%) committed to quit and 1482 (15%) persons reduced the use of tobacco compared to their daily uptake.
Conclusion Community level intervention can be an effective mechanism to reduce tobacco use along with government regulatory measures to combat tobacco menace. The regulatory framework can be designed such a way that the community can be engaged, informed and create a platform to use this as a prevention strategy.

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