Mali: chicha, a factor in the spread of smoking among young people

Surveys have revealed a limited knowledge of young people about the dangers associated with the consumption of chicha. It has effects on the respiratory, cardiovascular and digestive systems.

In Mali, the consumption of chicha is growing among young people, even though it is more dangerous than cigarettes. The shisha or hookah is a water pipe for smoking a tobacco preparation heated with charcoal, the smoke of which is cooled by passing through a container of water before being inhaled. Tobacco can be used in the form of tabamel, a mixture comprising molasses added with flavourings, which is consumed with charcoal. The smoke inhaled is comparable to that of a cigarette and potentially exposes smokers the effects of tobacco on health.

Originating in the Middle East, the shisha consists of several parts: a chimney, a hearth (an upper bowl), a tray that serves as an ashtray, a vase (a water tank), a pipe and a pipe.

Shisha is often a social activity practiced by a group of people who share a single device and take turns taking puffs of smoke through a mouthpiece.

Enthusiasm of young people

The first references to the consumption of shisha date from the XNUMXth century in Persia (current Iran) by the physicist Abu'l-Fath Gilani who is said to be its creator. According to the World Health Organization (WHO), more than 100 million people around the world consume shisha today and its use is widespread in America and the Middle East, but also in Africa. It is young people under 25 who are the most fond of it.

The enthusiasm for this new form of tobacco intoxication has motivated some studies yet plots on the knowledge, attitudes and behavior of adolescents and young people in the Malian capital on this trivialized consumption in full view of the parents.

These studies conducted by the team of the head of the pneumology department of the University Hospital Center (CHU) of Point G, Professor Yacouba Toloba, have drawn the attention of the highest Malian authorities to the dangers of this practice.

A first study, carried out among schoolchildren in communes 2 and 3 of the district of Bamako, the Malian capital, highlighted the extent of the problem. This study, which involved 3012 schoolchildren (high schools and vocational schools), was conducted between February and September 2021.

female predominance

First lessons: the prevalence of shisha consumption is then 71,3%, with a female predominance of 55,8% (1199 cases). The average age is 17 years old with extremes of 31 and 15 years old. Fashion is the most cited reason with 21% of cases. The majority – 53,1% – smoke shisha from time to time, and the weekend is the period chosen in 74,8% of cases, especially in the evening (89,2% of cases).

In 80,8% of cases, shisha smokers have their own device. The shisha bar is the place where young people prefer to smoke at 66,22% and mint is the favorite flavor for 38,4% of respondents. More than half of school chicha smokers, 58,1%, know that tobacco is dangerous. Cough and throat irritation are the most reported symptoms among shisha smokers.

A second cross-sectional study using a self-administered questionnaire via the internet (through Google form) pre-tested and validated with 364 young people from commune 4 in the district of Bamako was conducted by tobacco specialists from the CHU du point G and the CHU mother-child LUXEMBOURG from Bamako. In this work, 13% do not know that chicha is responsible for respiratory diseases. In this population, we found 19,23% regular consumers.

The age group of 15 to 20 years and that of 25 to 30 consume the most with respectively rates of 62,86% and 30%. They consume more in shisha bars and clubs (46%). The effects felt are dizziness (21,43%), throat irritation (15,71%), cough (14,29%) and dyspnea (5,71%). More than half of young people think that the water in the reservoir filters out toxic substances and do not know that shisha is more dangerous than cigarettes.

Nearly 25% claim to have used alcoholic beverages instead of water in the tank. The tip is not changed and is shared with other consumers in 95% of cases. However, half of consumers do not know that this tip is the source of the transmission of certain diseases: herpes, hepatitis, tuberculosis, Covid-19, etc.

Ignorance of dangers

These surveys highlighted a limited knowledge of the young people of Bamako on the dangers associated with the consumption of chicha. It is a real scourge for the health of young people and adolescents. It is dangerous by its effects on health in general.

It is important to remember that during the combustion of the shisha, like that of the cigarette, nearly 4000 chemical substances are emitted including nicotine, tar, carbon monoxide, cobalt, chromium and lead. Many of these substances are carcinogenic. The consumption of shisha has several health risks including: respiratory diseases (chronic bronchitis, chronic obstructive pulmonary disease, lung cancer); cardiovascular diseases, etc.

Drawing lessons from these studies, since August 15, 2022, the Malian authorities have forbidden the import, distribution, sale and use of chicha throughout the territory.

The decree provides the following:

Any person who is guilty of the production or import of chicha or any other similar device is punished by imprisonment for 1 to 10 days and a fine of 300 to 18 CFA francs (000 to 0,5 US dollars).

In addition, anyone found “guilty of the marketing of chicha or any other device is punished by a fine of 300 to 10 CFA francs (000 to 0,5 dollars)”. In addition, any individual who is guilty of using chicha or any other device is punished by imprisonment of 16 to 1 days and a fine of 10 to 300 CFA francs.

Today, the Central Office of Narcotics (OCS) is hard at work for the strict respect of the interministerial decree on the prohibition of chicha. In this context, many traders, bar managers and consumers were arrested and sanctioned according to the regulations in force.
These arrests prove that the consumption of shisha continues in a clandestine manner.

With the interministerial decree and the involvement of the OCS, together, we think we can overcome this scourge on Malian territory. Other studies are planned to assess the impact of the decision to ban the consumption of chicha.

In addition, the studies carried out in Bamako made it possible to formulate the following recommendations:

• the regular organization of campaigns to combat the consumption of
  shisha;
• scrupulous monitoring of the application of the provisions of Law 033 of July 12, 2010 on the restriction of tobacco advertising and use in Mali.

The results of our work sufficiently prove that this mode of trivialized tobacco consumption constitutes a real public health problem and its prevalence is no less important in the juvenile population.

Un presidential decree set the conditions for restricting tobacco advertising and use in Mali. In addition to this decree, Mali ratified in 2005 the Framework Convention WHO, the first anti-tobacco treaty negotiated under the auspices of the World Health Organization.

Salif Kone, Doctor of Medicine, specialist in pulmonology and lecturer, Free Scientific University of Bamako

This article is republished from The Conversation under Creative Commons license. Read theoriginal article.