Tobacco Harm Reduction mechanisms could reduce Nicotine related deaths in Uganda

By Vivian Kamusiime

Currently, it is estimated that 3,000 Ugandans die of nicotine-related complications annually. This was revealed by Mr. Joel Sawa, the Chief Executive Officer of Tobacco Harm Reduction Uganda (an organization that advocates for tobacco harm reduction mechanisms), during a recent Nicotine Summit.

Dr. Patrick Menya, a consultant in orthopedic health, said that tobacco harm reduction has profound implications for public health, particularly in the field of orthopedics. He noted that, over the years, he has treated countless patients whose bone health had been compromised by cigarette smoking.

Research conducted by Tobacco Harm Reduction Uganda (THR-Uganda) in Lira District in January 2022 and in Bukedea District in December 2023 found that the average initiation age for smoking was 13.4 years. Additionally, 98.4% of smokers in Lira had never heard of tobacco harm reduction.

Alarmingly, 81.4% of all the smokers interviewed in these studies were young people. This situation is exacerbated by the fact that the Tobacco Control Act 2015 mainly focuses on prohibition and mandatory health warnings, without offering cessation measures for individuals who are already addicted, despite most users expressing a desire to quit smoking.

“In both Lira and Bukedea, users kept asking for a solution or a pill that could help them stop smoking,” says a report by THR-Uganda. However, there is no “magic pill” to end this habit.

Joshua Omonuk, a researcher and Secretary at THR-Uganda, stated, “The change in law has been beneficial to non-smokers but detrimental to those who smoke. For smokers, the need for pleasure is stronger than the fear of death, which is very worrying.” Against this background, Dr. Menya, who is also the Managing Director of Patpros Medical Services, emphasized that “Integrating low-risk nicotine alternatives into Uganda’s public health strategy is essential.”

Dr. Menya further explained that while cigarette smoking is undeniably harmful due to the toxins produced by combustion, nicotine itself, when used responsibly in safer forms, can contribute to harm reduction. Nicotine Replacement Therapies (NRTs), such as patches, gums, and lozenges, allow smokers to manage their cravings without exposure to the harmful byproducts of combustion. These products have been proven to help smokers transition away from cigarettes and reduce their overall health risks.

Emong Nathan, a smoker from Bukedea District who attended the summit, said he started smoking due to peer pressure. When he became ill, his doctor insisted he stop smoking. He confessed that it was very difficult to adhere to this advice because his peers continued the habit, and he was tempted to smoke whenever he was with them. Eventually, he managed to quit, but he testified that interventions using safer options could help smokers in their journey to quit.

Odongo Moses, a tobacco harm reduction activist, noted that many people think smokers are distant from their own circles, yet they are often loved ones close to us. It is also widely assumed that most smokers are men, while, in fact, many women smoke secretly.

The summit concluded with a call for research and innovation, with evidence presented underscoring the role of innovative nicotine alternatives—such as e-cigarettes, heated tobacco products, and nicotine pouches—in reducing the health risks associated with smoking.

By aligning with international best practices, Uganda can better address the complex challenges posed by tobacco use. Public awareness and collaborative efforts were emphasized, with a call for a national educational campaign to inform the public about the benefits of tobacco harm reduction and the availability of safer nicotine alternatives.

“Empowering smokers with clear, evidence-based information is key to helping them transition away from harmful tobacco use.”