Published in PLOS One on 2026-06-05, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Calista Ogechukwu Dozie-Nwakile, Alphonsus Ogbonna Ogbuabor, Nwanneka Chidinma Ghasi, Daniel Chukwuemeka Ogbuabor
Source: PLOS One • DOI 10.1371/journal.pone.0335002
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Low- 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.
Data on people with TB from the 2023 Lesotho Demographic and Health Survey were used in this study (n = 326). 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 independent 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 Pearson’s chi-squared test and complex sample logistics regression. Statistical significance was set at a p-value < 0.05.
The prevalence of cigarette smoking among PWTB is 23.8%. The prevalence of daily and occasional smoking among PWTB is 17.3% and 6.5%, respectively. Being male (AOR = 107.48, 95%CI:22.65-510.03, p < 0.001), no media exposure (AOR = 3.65, 95%CI:1.43-9.30, p = 0.007), and alcohol use (AOR = 6.98, 95%CI:2.21-22.05, p = 0.001) increased the odds of smoking among PWTB. Being male (AOR = 211.28, 95%CI:25.86-1725.91, p < 0.001), no media exposure (AOR = 3.95, 95%CI:1.27-12.26, p = 0.018), and alcohol use (AOR = 15.10, 95%CI:3.36-67.89, p < 0.001) increased the odds of daily smoking among PWTB. Being male (AOR = 39.98, 95%CI:4.76-335.88, p = 0.001) increased the odds of occasional smoking among PWTB. Depression did not significantly influence smoking status of people with TB.
The prevalence of smoking among PWTB is high in Lesotho. Our findings underscore the importance of gender-sensitive tobacco use prevention and control interventions among PWTB, an inclusive and adequately funded long-term plan for best-practice anti-tobacco media campaign, and integrating management of substance use disorder into TB control policy and routine TB care in Lesotho.
Background
Low- and middle-income countries (LMICs) face a significant dual burden of tuberculosis (TB) and cigarette smoking [1]. In 2023, approximately 10.8 million people globally were affected by TB, leading to an estimated 1.25 million deaths [2]. Despite a decline in incidence rates, sub-Saharan Africa (SSA) continues to host over 50% of the countries with a high burden of TB, including Lesotho [2]. Although there has been a 15% reduction in TB incidence, Lesotho’s rate remains high at 664 cases per 100,000 people [2]. Lesotho has the highest multidrug-resistant TB burden connected to smoking, with age-standardized disability-adjusted life-year (DALY) rate and age-standardized DALYs rates per 100,000 people 4.45 (95%UI, 0.99–13.52) and 156.12 (95%UI, 34.26–471.88) [3]. Equally, more than 80% of the 1.3 billion smokers worldwide live in low- and middle-income countries, contributing to over eight million deaths each year from tobacco-related causes [4]. In SSA, the prevalence of cigarette smoking stands at 7.1%, which is significantly lower than Lesotho’s 18.3% [4]. Smoking accounts for more than 20% of global TB incidence and about 1,400 TB cases in Lesotho [2]. Current smokers are more likely to have both symptomatic and subclinical TB [5]. Ever-smokers, current smokers, and past smokers have an elevated risk of TB in comparison to never-smokers [6]. Consequently, the End TB strategy emphasizes the importance of TB screening for smokers and incorporates smoking cessation into standard TB care practices [7].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider public health desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Calista Ogechukwu Dozie-Nwakile, Alphonsus Ogbonna Ogbuabor, Nwanneka Chidinma Ghasi, Daniel Chukwuemeka Ogbuabor. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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