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Feature Tobacco control

Rocketing smoking rates across Africa stoke TB and HIV fears

BMJ 2018; 361 doi: (Published 01 May 2018) Cite this as: BMJ 2018;361:k1884
  1. Hannah McNeish, freelance journalist
  1. Cape Town, South Africa
  1. hannahmcneish1{at}

As tobacco companies expand into developing world markets with lax regulation and low tax, fears are growing about the impact on already prevalent diseases, such as tuberculosis and AIDS. Hannah McNeish reports

In the late 19th century, the city of Cape Town on South Africa’s southern tip was advertised in European magazines as the perfect seaside spot to clear up “consumption,” as tuberculosis (TB) was once known.

Today, however, a generalised epidemic has swept through the city’s many deprived and densely populated neighbourhoods.

South Africa has one of the highest TB burdens in the world, with the World Health Organization estimating an incidence of 438 000 cases of active disease in 2015, about 0.8% of the population of around 54 million.1

But about 80% of the population is infected with TB bacteria—latent rather than active disease. The highest prevalence of latent TB is among people aged 30 to 39 who live in townships.

In Cape Town, one in five children aged 5 years is infected, rising to one in two 13 year olds, according to Linda-Gail Bekker, a TB specialist from the Desmond Tutu HIV Centre at the University of Cape Town.

“When you want to study TB, you come here: it’s got the highest number of TB specialists on the planet,” she told journalists at the university’s lung institute. “Add to this the imminent explosion in tobacco smoking, and you have a perfect storm throughout sub-Saharan Africa,” she said.

Regular …

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