A household census of the total population, where field staff visit households and survey individuals to collect demographic information, occurs three times each year from January to April, May to August and September to December. The HDSS is a population-based system that is used to longitudinally record demographic data of more than 220 000 individuals. Health and demographic surveillance system and data processing As of September 2012, this epidemiological study is the largest study examining factors associated with alcohol and tobacco use in a sub-Saharan African country. Our study area has an ongoing Health and Demographic Surveillance System (HDSS), thereby providing an opportunity to sample across a population with known sociodemographic characteristics. The aim of our study was to estimate the prevalence of smoking and alcohol use amongst adults according to poverty level, marital status, sex and age in a rural population in western Kenya. The lack of comprehensive data representative of the Kenyan population limits our ability to assess the magnitude of the problem. Other research on tobacco and alcohol use in sub-Saharan Africa have identified these behaviours as risk factors or variables that impact treatment of communicable diseases ( Kalichman et al. 2004) and from small-scale surveys ( NACADA Authority 2007, 2010). In Kenya, epidemiological data on smoking and harmful use of alcohol are available for selected populations such as adults attending medical facilities ( Ndetei et al. 2010).ĭespite the expected contribution of tobacco use and the harmful use of alcohol to morbidity and mortality, epidemiological data are still lacking for many countries, especially countries with less established market economies ( Degenhardt et al. The need for action to deal with the growing burden of non-communicable diseases in African countries has been well documented ( Mayosi et al. When coupled with the current burden of infectious diseases, global health inequalities will be further exacerbated ( Ezzati et al. Without effective prevention and control programmes, as the economies of LMIC grow, so will risk factors for disorders such as cardiovascular diseases (including smoking). Smoking and alcohol consumption substantially contribute towards chronic diseases, which are estimated to cause more than 60% of deaths globally, with more than 80% of these occurring in LMIC ( Lopez & Mathers 2006 Abegunde et al. The prevalence of smoking is increasing amongst people in low- and middle-income countries (LMIC), and by 2030, tobacco use is predicted to result in more than eight million deaths worldwide, and 80% of these premature deaths occurring in LMIC (World Health Organization 2011c). Globally, tobacco-related illnesses kill up to half of its users or approximately six million people annually ( World Health Organization 2011b). People with alcohol-associated diseases smoke more than people with non-alcohol-related disease, suggesting a synergism between alcohol-related harm and cigarette smoking ( Lau et al. Alcohol use is a causal factor in 60 types of disease and injury, a contributory factor to 200 other diseases (such as cancers, liver cirrhosis, hypertension and pancreatitis) and is associated with violence, suicides, child abuse/neglect and workplace absenteeism ( Corrao et al. Worldwide, tobacco use continues to be the leading cause of preventable death (World Health Organization 2011c), and almost 4% of deaths are attributed to the harmful use of alcohol ( Rehm et al.
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