Source: www.observer.ug (Uganda, Africa)
Author: Racheal Ninsiima

Tobacco use is the single most preventable cause of death among adults and is a significant factor for several mouth, throat, lung and heart diseases.

It is also a major contributor to morbidity. Globally, the World Health Organisation (WHO) estimates that tobacco causes about 71% of lung cancer, 42% of chronic respiratory diseases, 20% of global tuberculosis incidence and nearly 10% of cardiovascular diseases. But the issue of smokeless products that contain tobacco has for long been ignored.

According to Dr Sheila Ndyanabangi, the tobacco control focal point person at the ministry of Health, schoolchildren are also consuming the products. This is because sometimes the ingredients are written in foreign languages which may not be understood by the consumers.

What is smokeless tobacco?
There are two basic forms of smokeless tobacco: snuff and chewing tobacco. An article ‘smokeless tobacco and how to quit’ on the website www.cancer.org, says snuff is finely ground tobacco packaged in cans and is sold either dry or moist. The nicotine in the snuff is absorbed through the tissues of the mouth as it is placed between the cheek and gum.

Snuff is designed to be both “Smoke-free” and “spit-free” and is marketed as a discreet way to use tobacco. Chewed tobacco comes along as long strands of tobacco leaves that are chewed by the user who thereafter spits out the brown liquid (saliva mixed with tobacco).

Types of smokeless tobacco
Mouth fresheners:
The commonest is Kuber. It is a highly addictive tobacco drug disguised as a mouth freshener and packed in sachets similar to tea leaves. Kuber may be added to tea or simply licked. According to Dr Ndyanabangi, Kuber, rich in nicotine, is widely consumed by secondary school students and taxi drivers.

Results of a research conducted by the Uganda Youth Development Link (UYDEL) in 2011 revealed that Kuber also contains drugs like cocaine and marijuana which may lead to hormonal change, impaired brain development, mental health disorders and heart problems.
Kuber is often chewed with mairungi leaves, sucked or taken with hot water as a beverage resulting in a drowsy feeling. Kuber is sold in shops and supermarkets.

Chocolate:
Many people value chocolate as a delicacy. However, tobacco is one of the sweeteners added to some brands of chocolate, especially dark chocolate. Among the ingredients are: cocoa, sugar, cocoa butter, tobacco, soya lecithin, milk and gluten.

Menthol products:
Dr Ndyanabangi says people ought to be careful with menthol products such as toothpaste, mouthwash and gum; they may also contain tobacco. In some, menthol is used as a sweetener to make them useable and disguise the smell of tobacco. Other products include nicotine lollipops, wafers and water. Currently in the US, tablets are being investigated for any form of tobacco.

Nevertheless, the fact still stands; smokeless tobacco is as lethal as cigars. Dr Prossy Mugyenyi, the manager at the Centre for Tobacco Control in Africa (CTCA), says the tobacco in these smokeless products acts as a receptor and the person keeps demanding more and more.

“Just like a person becomes addicted to smoking and becomes a chain smoker, so do these smokeless products make one addictive to the tar and nicotine in them,” Mugyenyi says.

No safe tobacco
According to Dr Jackson Orem, head of the Uganda Cancer Institute, there is no safe form of tobacco and at least 28 chemicals in smokeless tobacco have been found to cause cancer. Smokeless tobacco products raise the incidence of cancer, especially oral cancers like mouth, tongue and throat.

In addition, Mugyenyi says excessive exposure of one’s body to tobacco increases the risk of heart disease, stroke, teeth loss, gum disease and aneurysm (abnormal widening of a portion of an artery due to weakness in the wall of the blood vessel). However, despite the prevalent risk, Uganda does not have a comprehensive tobacco control law. The WHO Framework Convention on Tobacco Control (FTCT) to which Uganda has been signatory since 2003 is not enforced.

“There is a lot of illicit trade in the tobacco industry and the fines of Shs 20,000 to Shs 30,000 stipulated in the statutory instrument of 2004 to ban smoking in public places are not punitive enough and neither are they being enforced,” Ndyanabangi says.