Fatuma Rashid, 30, cuddles her 10-month-old baby in a salon that she runs at Mbezi Juu in the outskirts of Dar es Salaam. She has to stop braiding her client midway to breast feed her wailing baby.
The baby seems restless if the running nose and frequent coughs are anything to go by. Opposite the salon loud music is blaring and revelers are drinking and smoking at the bar!
Outside the salon there is a hive of activity, there is a shop and next to it is another makeshift tavern, where plastic seats are arranged around a small circular rickety table under a tree where another group of men are drink and smoke.
She lives behind the shops, a stone throw away from the bar and her salon.
“I had taken her to Amana Hospital yesterday because she has been coughing and sneezing all the time, the doctor told me to stay away from an environment where people smoke because it affects the baby lungs and overall development. But as you can see, this is my source of livelihood,” she confesses when asked why the baby is coughing.
Fatuma, just like her neighbours are oblivious of the dangers of second hand smoke to her and her young baby whose vital organs are still developing.
The International Journal of Health Sciences describes second-hand or environmental tobacco smoke as a combination of the smoke exhaled by a smoker and the smoke that comes from the end of a burning cigarette.
When someone breathes in this smoke, it is often referred to as passive smoking.
Non-Smokers like Fatuma and her baby are frequently exposed to this smoke. Dr Mariam Noorani, a pediatrician at The Aga Khan Hospital, Dar es Salaam explains that second-hand smoke causes numerous health problems in infants and children.
“Children exposed to second hand smoke suffer respiratory infections, frequent and severe asthma attacks, pneumonia and can lead even to sudden infant death syndrome,” she says. According to her, young children need to be protected from this kind of exposure which puts their health at risk and affect their overall development.
“Apart from pulmonary problems, children whose parents smoke around them get more ear infections and have fluid in their ears,” she elaborates.
She says that Aga Khan Hospital, Dar es Salaam educate parents from the time their children are born on how to protect them from environmental pollution including second hand smoke.
Dr Chris Peterson, a medical doctor at Muhimbili National Hospital department of oncology concurs with Dr Miriam that children are more at risk because their bodies are still growing and they breathe at faster rate than adults.
Dr Peterson points out that wheezing and coughing are more common in children who breathe secondhand smoke and they get such cases in the hospital pediatric unit.
“We often receive such cases including children being born with birth defects because their mothers were smoking during pregnancy,” he says.
As medical professional, they always try to educate parents on the risks of second hand smoke and health complications to children.
He says that though secondhand smoke can trigger an asthma attack in children, their counterparts with asthma who are around second hand smoke have more severe and frequent attacks and can put a child’s life in danger.
The Centre for Disease Control (CDC) factsheet corroborates these statements that children whose parents smoke or live in environment where people smoke fall sick more often and their lungs grow less than children who do not breathe secondhand smoke, and they get more bronchitis and pneumonia.
The Healthy Child organisation from the American Academy of Pediatrics states that a child’s cognitive development is also compromised due to neurotoxin effect of tobacco smoke. This means a child affected by second hand smoke show sub-optimal ability to read, comprehend, implement and fair poorly for IQ score.
Another study by the Faculty of Public Health UK has highlighted that children living in a disadvantage household are much likely exposed to second hand smoke.
In Tanzania, there are no studies on second hand smoke health impact on children.
However, a study involving 54 countries, published in the Lancet Journal in September 2014 titled “Tobacco use in pregnant women: analysis of data from Demographic and Health Surveys from 54 low-income and middle-income countries” revealed that prevention and management of tobacco use and exposure to second-hand smoke in pregnancy is crucial to protect maternal and child health in Low and Middle Income Countries.”
It established the risks associated with tobacco smoking during pregnancy for both mother and child to include pregnancy complications like placenta praevia, placental abruption, and pre-eclampsia and poor fetal outcomes like low birthweight, premature birth and overall perinatal mortality.
A related 2015 case study in Dhaka, Bangladesh by Oxford Academic journal on Secondhand Smoke Exposure in Primary School Children published on December 2017, revealed that despite a ban on smoking in public places, second hand smoke exposure among children in Bangladesh remains very high, a pointer to an urgent measure to reduce exposure to SHS in Bangladeshi children.
The study detailed that children bear the biggest burden of disease due to SHS exposure than any other age group. However, children living in many high-income countries have had a sharp decline in their exposure to SHS in recent years.
What remains unknown is if children living in low-income countries are still exposed to SHS despite having a ban on smoking in public places. Most primary school children in Dhaka, Bangladesh are still likely to be exposed to SHS.
The World Health Organization (WHO) shows that tobacco consumption is contributing to diseases such as cardiovascular, pulmonary, cancer and asthma, which kills 7 million people yearly, mostly in low and middle-income countries. Globally many as 40 per cent of children are exposed to second-hand smoking (SHS) and the global annual death toll as a result of tobacco use, including exposure to secondhand smoke pose greater risks to world population more than tuberculosis, HIV/AIDS and malaria combined according to WHO.
According to the Tobacco Atlas, which was released in March this year by Vital Strategies, a Non Governmental Organization based in the US and the American Cancer Society, Tobacco harms the health, the treasury, and the spirit of Tanzania.
Every year, more than 17200 of its people are killed by tobacco-related diseases. Sadly enough, more than 17000 children (10-14 years old) and 2473000 adults (15+ years old) continue to use tobacco each day.
In an interview with Your Health, Vital Strategies’ Senior Advisor for Tobacco Control, Dr Judith Mackay decried tobacco industry gratification in the face of the health threat and rising tobacco’s death toll.
“Something has to be done urgently to protect children who are affected by second hand smoke and tobacco control advocates need to act swiftly and intensify their efforts and create change in Tanzania,” she says.
Studies have established that tobacco will kill one billion people (1,000,000,000), if nothing is done. Though there are evidences of positive impact of smoke free legislation in some high income countries, such is scarce in developing countries like Tanzania,” the tobacco control expert pointed out.
The World Health Organization (WHO) has been coordinating an international convention on tobacco control, namely, the WHO Framework Convention on Tobacco Control (FCTC).
The treaty includes measures to reduce both supply and demand for tobacco. To reduce supply there are measures like prohibiting sales to and by people under the age of 18 (minors), and provision of support for economically viable alternatives to tobacco production.
‘To reduce demand, measures like ban of advertisement and labeling of tobacco products are mentioned.
In Tanzania, tobacco use is high, the status of FCTC implementation is superficial, and the effects of poor tobacco control by the government and the civil society are high.
Unfortunately, Tanzania just like other developing countries is a target of intensive tobacco industry marketing. For instance just a few weeks ago, another cigarette factory was opened in Morogoro.
Most smokers in Tanzania appear to lack the understanding of the harmful health effects of tobacco use and how it affects development of young children right from the womb, the corresponding high health care expenditure as well as reduced earnings that emanate from smoke related diseases.
Dr Peterson and Miriam all call on parents like Fatuma to try as much as they can to protect their children from second hand smoke by not allowing those who smoke anywhere in their homes, ensure their children’s schools are tobacco free and not allow anybody to smoke around the children even in the vehicles.
They also advise parents to look for recreational places, which are smoke free, thus completely ban smoking and should not at anytime expose their children who unfortunately have no control of their environment and are dependent on the authorities to introduce measures to protect them from the deadly second hand smoke.