Global Tobacco Control Updates

Indoor secondhand tobacco smoke increases the risk of child death in Sub-Saharan Africa
26 Jun 2017
Research Alert

Globally, 40 percent of children are exposed to secondhand smoke (SHS), which is responsible for over 600,000 deaths per year. Inhalation of secondhand smoke results in serious health harms such as sudden infant death syndrome, premature death among children under five years old, acute respiratory infection, intensified asthma and ear problems. A study published in the journal PLoS ONE investigated the association between frequency of exposure to indoor SHS and risk of death among children under five years old in Sub-Saharan Africa (SSA). The study was based on Demographic Health Survey data of 787,484 children from 23 SSA countries.

Key Findings:

  • Daily exposure to SHS significantly increased the risk of death among children under five years old in 15 countries
    • These results were true across levels of household wealth, parental education, type of residence, child’s gender and other variables, in eight countries (Burundi, Côte d'Ivoire, Ethiopia, Kenya, Mozambique, Namibia, Rwanda, Sierra Leone, and Uganda). 
  • The risk of death from indoor SHS among children under five years old was higher in rural areas than in urban areas.
  • The majority of the children under five years old who were exposed to daily SHS resided in rural areas, had uneducated mothers and had fathers who were farmers.
    • Sierra Leone had the highest rate of children under five years old who were exposed daily to indoor SHS (43.4%) and Nigeria had the lowest rate of children exposed (5.8%). 
  • Longer duration of exposure to indoor SHS was associated with an increased risk of death.

Key Messages:

  • Exposure to SHS causes death and disease in children.
  • Comprehensive indoor smoke-free laws without exceptions improve public health and save lives, particularly for vulnerable populations such as children.
  • Article 8 of the WHO Framework Convention on Tobacco Control obligates Parties to enact and implement policies that provide comprehensive protection from SHS exposure by banning smoking in all indoor public places, workplaces and public transportation.

Full Citation: Owili PO, Muga MA, Pan W-C, Kuo H-W (2017) Indoor secondhand tobacco smoke and risk of under-five mortality in 23 sub-Saharan Africa countries: A population based study and meta-analysis. PLoS ONE 12(5): e0177271.

Link to full study [English only] available from

Additional Resources:

PLoS ONE is a peer-reviewed multidisciplinary open access scientific journal published by the Public Library of Science (PLOS) since 2006. The journal covers primary research from any discipline within science and medicine.

If you have questions about the study or how you may use it in your advocacy efforts, please contact


africa, secondhand smoke