Pharmacist-led smoking cessation services in Ethiopia: Knowledge and skills gap analysis
More details
Hide details
Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Gondar, Ethiopia
Department of Clinical and Administrative Pharmacy Sciences, College of Pharmacy, Howard University, Washington, United States
Daniel Asfaw Erku   

Department of Clinical Pharmacy, School of Pharmacy, University of Gondar, Lideta kebele 16, 196 Gondar, Ethiopia
Publish date: 2019-01-09
Tob. Induc. Dis. 2019;17(January):1
The present study’s objectives were: 1) assess the knowledge and attitude of pharmacists and pharmacy students regarding smoking/smoking cessation, and 2) document the extent of community pharmacists’ involvement in the provision of smoking cessation services in Ethiopia.

This study used cross-sectional and direct observation methods. A series of questionnaires were administered to final-year pharmacy students and practising pharmacists. Two scenarios simulating tobacco use in pregnancy and cardiovascular patients were selected and played by two well-trained simulated patients (SPs). Findings were analysed and presented using mean total scores, analysis of variances and independent sample t-test.

A total of 410 participants (213 out of 238 pharmacy students, response rate 89.5%; 197 out of 361 pharmacists, response rate 54.6%) completed the survey. Both pharmacy students and practising pharmacists had positive attitudes towards smoking cessation, and both groups had similar mean knowledge scores. A total of 80 simulated visits were conducted. Recipients of training on smoking cessation had significantly higher mean knowledge and attitude scores compared with those who did not receive such training. The majority of the pharmacists demonstrated poor in history-taking practice, and seldom assessed the patients’ nicotine dependence level. Nicotine replacement therapies (NRTs) were supplied in only 10 of the visits and suggested, but not dispensed, in 35 of the visits. On the other hand, pharmacists in 59 visits counselled patients to visit addiction specialists and physicians.

The present study revealed the presence of significant clinical knowledge gaps and inadequate skills among pharmacists regarding smoking cessation services. Educating pharmacists about smoking cessation support as part of their continuous professional development and providing a hands-on customised educational intervention, such as practice guidelines in the form of an Ask-Advise-Refer approach, about smoking cessation will be useful.

Giovino GA, Mirza SA, Samet JM, et al. Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys. The Lancet. 2012;380(9842):668-679. doi: 10.1016/s0140-6736(12)61085-x
World Health Organization. Tobacco Fact sheet 2018. Accessed April 14, 2018.
Brathwaite R, Addo J, Smeeth L, Lock K. A systematic review of tobacco smoking prevalence and description of tobacco control strategies in sub-Saharan African countries; 2007 to 2014. PLoS One. 2015;10(7):e0132401. doi: 10.1371/journal.pone.0132401
World Health Organization. Ethiopia-GATS-2016-Executive Summary. Accessed April 2, 2018.
Central Statistical Agency. Ethiopia Demographic and Health Survey 2011. Accessed April 14, 2018.
Defar A, Getachew T, Teklie H, et al. Tobacco use and its predictors among Ethiopian adults: A further analysis of Ethiopian NCD STEPS survey-2015. Ethiopian Journal of Health Development. 2017;31(1):331-339.
Misganaw A, Haregu TN, Deribe K, et al. National mortality burden due to communicable, non-communicable, and other diseases in Ethiopia, 1990–2015: findings from the Global Burden of Disease Study 2015. Population health metrics. 2017;15(1):29. doi:10.1186/s12963-017-0145-1
Tesfaye F, Byass P, Wall S, Berhane Y, Bonita R. Peer Reviewed: Association of Smoking and Khat (Catha edulis Forsk) Use With High Blood Pressure Among Adults in Addis Ababa, Ethiopia, 2006. Prev Chronic Dis. 2008;5(3).
Ethiopian Food Medicine and Healthcare Administration and Control Authority. Tobacco Control Directive 2015. https://www.tobaccocontrollaws.... Accessed April 14, 2018.
Federation of International Pharmacy (FIP). Global Pharmacy Workforce Report 2012. Accessed Septmeber 2, 2018.
Gebretekle GB, Fenta TG. Assessment of pharmacists workforce in Ethiopia. Ethiopian Journal of Health Development. 2013;27(1):1-10.
WHO. WHO report on the global tobacco epidemic, 2017. Accessed October 2, 2018.
FMHAHCA. National Essential Medicine List Fifth Edition Addis. Accessed October 3 2018.
Saba M, Diep J, Saini B, Dhippayom T. Meta‐analysis of the effectiveness of smoking cessation interventions in community pharmacy. J Clin Pharm Ther. 2014;39(3):240-247. doi: 10.1111/jcpt.12131
Philbrick AM, Newkirk EN, Farris KB, McDANEL DL, Horner KE. Effect of a pharmacist managed smoking cessation clinic on quit rates. Pharm Pract . 2009;7(3):150. doi:10.4321/s1886-36552009000300004
Brown TJ, Todd A, O'Malley C, et al. Community pharmacy-delivered interventions for public health priorities: a systematic review of interventions for alcohol reduction, smoking cessation and weight management, including meta-analysis for smoking cessation. BMJ open. 2016;6(2):e009828. doi:10.1136/bmjopen-2015-009828
Erku DA, Mersha AG. Involvement of community pharmacists in public health priorities: A multi-center descriptive survey in Ethiopia. PLoS One. 2017;12(7):e0180943. doi:10.1371/journal.pone.0180943
Goniewicz ML, Lingas EO, Czogala J, Koszowski B, Zielinska-Danch W, Sobczak A. The role of pharmacists in smoking cessation in Poland. Eval Health Prof. 2010;33(1):81-95. doi: 10.1177/0163278709356190
Erku DA, Mekuria AB, Surur AS, Gebresillassie BM. Extent of dispensing prescription-only medications without a prescription in community drug retail outlets in Addis Ababa, Ethiopia: a simulated-patient study. Drug, healthcare and patient safety. 2016;8:65. doi:10.2147/dhps.s106948
Nigussie WD. Patient counselling at dispensing of medicines in health care facility outpatient pharmacies of Bahir Dar city, Northwest Ethiopia. Sci J Public Health. 2014;2(2):126-134.
Tobacco Journal International. Steady growth for Ethiopian tobacco sector. Published January 2, 2013.
Tobacco TCPGT. A clinical practice guideline for treating tobacco use and dependence: 2008 update: a US public health service report. Am J Prev Med. 2008;35(2):158. doi: 10.1016/j.amepre.2008.04.009
Chong WW, Aslani P, Chen TF. Adherence to antidepressant medications: an evaluation of community pharmacists’ counseling practices. Patient preference and adherence. 2013;7:813. doi:10.2147/ppa.s48486
Chong WW, Aslani P, Chen TF. Pharmacist–patient communication on use of antidepressants: a simulated patient study in community pharmacy. Research in Social and Administrative Pharmacy. 2014;10(2):419-437. doi:10.1016/j.sapharm.2013.05.006
Kippist C, Wong K, Bartlett D, Saini B. How do pharmacists respond to complaints of acute insomnia? A simulated patient study. Int J Clin Pharm. 2011;33(2):237-245. doi:10.1007/s11096-011-9482-5
Rosenthal M, Austin Z, Tsuyuki RT. Are pharmacists the ultimate barrier to pharmacy practice change? Canadian Pharmacists Journal/Revue des Pharmaciens du Canada. 2010;143(1):37-42. doi:10.3821/1913-701x-143.1.37