Background:
Tobacco use in Bangladesh especially in rural area has been high, but report on its trend is lacking. The aim of this study was to examine tobacco use trend in a rural area of Bangladesh concomitant to a simple but persistent intervention.

Methods:
The study was done in Ekhlaspur village located in Chandpur district that has about 1000 households. Four cross-sectional surveys between 2006 and 2013 were done among adults (aged 25 to 64 years) to assess the trend of tobacco use in this village. One adult per household was selected targeting 400 to 1000 randomly selected households. Concomitantly an intervention package has been ongoing that included yard meetings, facility based counselling tagged with clinical services, observance of no tobacco days, special lectures in schools, and engagement of community organizations and opinion leaders. Prevalence of tobacco use and their 95% confidence intervals (CI) were obtained. Linier trend analysis was done using Excel to examine the trend of tobacco use.

Results:
Participants' mean age varied between 41 and 44 years in all four surveys. About half of them completed a five years of primary education. Six in 10 people at the beginning were found to use tobacco in any form in the village. A consistent decline in tobacco use has been observed from 62% (95% CI 57% to 68%) to in 2006 to 32% (24% to 41%) in 2013. The prevalence of smoking (from 35% to 14%) and smokeless tobacco (from 40% to 20%) showed a similar declining trend. Sex-specific results also showed similar trends (Figure 1).

Conclusions:
Community interventions in a sustainable manner can control tobacco use in rural communities of Bangladesh. Similar interventions can be replicated all over the country using lower tier of health system, public or private.