Summary Background Ending the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally. Methods We estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available. Findings Globally in 2019, 1·14 billion (95% uncertainty interval 1·13–1·16) individuals were current smokers, who consumed 7·41 trillion (7·11–7·74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27·5% [26·5–28·5] reduction) and females (37·7% [35·4–39·9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0·99 billion (0·98–1·00) in 1990. Globally in 2019, smoking tobacco use accounted for 7·69 million (7·16–8·20) deaths and 200 million (185–214) disability-adjusted life-years, and was the leading risk factor for death among males (20·2% [19·3–21·1] of male deaths). 6·68 million [86·9%] of 7·69 million deaths attributable to smoking tobacco use were among current smokers. Interpretation In the absence of intervention, the annual toll of 7·69 million deaths and 200 million disability-adjusted life-years attributable to smoking will increase over the coming decades. Substantial progress in reducing the prevalence of smoking tobacco use has been observed in countries from all regions and at all stages of development, but a large implementation gap remains for tobacco control. Countries have a clear and urgent opportunity to pass strong, evidence-based policies to accelerate reductions in the prevalence of smoking and reap massive health benefits for their citizens. Funding Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.

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SARS-CoV-2 (COVID-19) is spreading rapidly within countries around the world, thus necessitating the World Health Organisation (WHO) to project that the peak of the pandemic has not been reached yet. Globally, COVID-19 public health control measures are being implemented; however, promising COVID-19 vaccine candidates are still in the early-stage clinical trials. Judging from previous vaccine programs around the world and the challenges encountered in the distribution and uptake, there seems to be no guarantee that there will be widespread acceptance and equitable distribution of the new COVID-19 vaccines when they are approved for use. Therefore, there is an urgent need to start engaging the public to allay their fears and misconceptions with the view to building trust and promoting acceptance and ultimately achieving a potential impact in controlling the pandemic. Borrowing from previously used successful public health strategies, including the application of the health belief model to engage communities, can go a long way in promoting the demand, uptake, and equitable distribution of the COVID-19 vaccine, thereby minimizing the likelihood of vaccine hesitancy.

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Objective:The objective of this study was to assess the perceived risk of breast cancer (BC) and adoption of risk reduction behaviours among female first-degree relatives (FDRs) of BC patients attending care at the Uganda Cancer Institute (UCI). Methods:A cross-sectional study was performed using a questionnaire to collect data between March to October 2019. Adult female FDRs of patients attending care at UCI were recruited consecutively. Breast cancer perceived risk was assessed using a verbal measure; 'My chances of getting BC are great' on a Likert scale with 5 response alternatives. Chi square tests and modified Poisson regression using generalised estimating equations model were used to determine associations and examine factors associated with perceived risk of BC. Results:We enrolled 296 FDRs from 186 female BC patients. Few participants 118/ 296 (40%) had high perceived risk of BC. Majority 165/296 (56%), had ever practiced breast self-examination. At the multivariable modified Poisson GEE model, women aged 36-45 years were more likely to perceive themselves to be at high risk of developing BC compared to women aged 18-25 years (adjusted prevalence ratio: 1.174; 95% confidence interval [95%CI] = 1.05-2.88; p value = 0.030) after adjusting for age, religion, educational level and residence. Conclusion:Few FDRs of BC patients perceived themselves to be at high risk of developing BC and do not seek risk reduction measures including screening and early diagnosis approaches. Breast cancer health education especially targeting younger women should emphasize the increased risk of BC in FDRs.

PURPOSE In East Africa, cervical cancer is a leading cause of morbidity and mortality among women diagnosed with cancer. In this study, we describe the burden of risk factors for cervical cancer among women of reproductive age in five East African countries. METHODS For each country, using STATA13 software and sampling weights, we analyzed the latest Demographic and Health Survey data sets conducted between 2014 and 2017 in Burundi, Kenya, Rwanda, Tanzania, and Uganda. We included women age 15-49 years and considered six risk factors (tobacco use, body mass index, age at first sexual intercourse, age at first birth, number of children, and hormonal contraceptive use). RESULTS Of the 93,616 women from the five countries, each country had more than half of the women younger than 30 years and lived in rural areas. Pooled proportion of women with at least one risk factor was 89% (95% CI, 87 to 91). Living in a rural area in Burundi (adjusted incidence rate ration 0.94; 95% CI, 0.9 to 0.99; P = .019) and Rwanda (adjusted incidence rate Ration 0.92; 95% CI, 0.88 to 0.96; P < .001) was associated with a lower number of risk factors compared with living in an urban area. In all the countries, women with complete secondary education were associated with a lower number of risk factors compared with those with no education. CONCLUSION This study reveals a high burden of risk factors for cervical cancer in East Africa, with a high proportion of women exposed to at least one risk factor. There is a need for interventions to reduce the exposure of women to these risk factors.

Introduction To practice adequate Infection Prevention and Control (IPC) measures, health professional students need to have adequate knowledge of IPC. In this study, we assessed the knowledge of health professional students at Makerere University College of Health Sciences on Infection Prevention and Control. Methods We conducted a cross-sectional online survey among health professional students studying at Makerere University College of Health Sciences located in Kampala, Uganda. An adapted questionnaire was used to measure knowledge on Infection Prevention and Control among students. Results A total of 202 health professional students were included in the study. The mean age was 24.43 years. Majority were male 63.37% (n = 128), from the school of medicine 70.79% (n = 143) and used one source of information for IPC 49.50% (n = 100). Being in year three (Adjusted coefficient, 6.08; 95% CI, 2.04–10.13; p-value = 0.003), year four (Adjusted coefficient, 10.87; 95% CI, 6.91–14.84; p < 0.001) and year five (Adjusted coefficient, 8.61; 95% CI, 4.45–12.78; p < 0.001) were associated with a higher mean in total percentage score of knowledge on IPC compared to being in year one. Conclusion IPC knowledge was good among health professional students in Makerere University although more emphasis is needed to improve on their IPC knowledge in various sections like hand hygiene. Infection Prevention and Control courses can be taught to these students starting from their first year of university education.