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Meta-Analysis
. 2019 Apr;114(4):620-635.
doi: 10.1111/add.14518. Epub 2019 Jan 2.

The efficacy of smoking cessation interventions in low- and middle-income countries: a systematic review and meta-analysis

Maxwell Oluwole Akanbi  1   2 , Allison Jane Carroll  3 , Chad Achenbach  2   4 , Linda Catherine O'Dwyer  5 , Neil Jordan  1   6 , Brian Hitsman  3 , Lucy Ann Bilaver  1 , Megan Colleen McHugh  1 , Robert Murphy  2   4
Affiliations
Meta-Analysis

The efficacy of smoking cessation interventions in low- and middle-income countries: a systematic review and meta-analysis

Maxwell Oluwole Akanbi et al. Addiction. 2019 Apr.

Abstract

Aims: To summarize evidence for the efficacy of smoking cessation interventions in low- and middle-income countries (LMICs).

Design: Systematic review and meta-analysis of randomized controlled trials.

Setting: LMICs as defined by the World Bank.

Participants: Adult current cigarette smokers residing in LMICs.

Interventions: Behavioral and/or pharmacotherapy smoking cessation interventions.

Measurements: PubMed MEDLINE, EMBASE (embase.com), Cochrane Central Register of Controlled Trials (Wiley), PsycINFO (Ebsco), SciELO, WHO Global Index Medicus and Scopus were searched from inception to 4 April 2018. Only studies with at least 6 months of follow-up were included. We used the most rigorous assessment of abstinence reported by each study. Effect sizes were computed from abstracted data. Where possible, a meta-analysis was performed using Mantel-Haenzel random-effect models reporting odds ratios (OR) and 95% confidence intervals (CI).

Findings: Twenty-four randomized controlled trials were included. Six investigated the efficacy of pharmacological agents. Four trials that compared nicotine replacement therapy (NRT) to placebo found NRT improved cessation rates (n : NRT 546, control 684, OR = 1.76, 95% CI = 1.30-2.77, P < 0.001, I2 = 13%). Eight trials found that behavioral counseling was more effective than minimal interventions (e.g. brief advice); n : Counseling 2941, control 2794, OR = 6.87, 95% CI = 4.18-11.29, P < 0.001, I2 = 67%). There was also evidence of the benefit of brief advice over usual care (n : Brief advice 373, control 355, OR = 2.46, 95% CI = 1.56-3.88, P < 0.001, I2 = 0%).

Conclusion: Nicotine replacement therapy, behavioral counseling and brief advice appear to be effective in aiding smoking cessation in low- and middle-income countries. There is limited rigorous research on other smoking cessation interventions in these regions.

Keywords: Developing countries; low- and middle-income countries; meta-analysis; smoking cessation; systematic review; tobacco use.

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Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) flow diagram of study selection
Figure 2
Figure 2
Forest plot of the comparison of randomized controlled trials of recommended smoking cessation intervention in low‐ and middle‐income countries. Outcome: smoking abstinence at 6‐month follow‐up. Koegelenberg 2014 administered varenicline to both nicotine replacement therapy (NRT) and control groups. With the study excluded the NRT subtotal odds ratio (OR) = 1.59, 95% confidence interval (CI) = 1.04–2.44, I 2 = 29%, P = 0.03. [Colour figure can be viewed at wileyonlinelibrary.com]
Figure 3
Figure 3
Risk of bias graph: summary of risk of bias across all studies. [Colour figure can be viewed at wileyonlinelibrary.com]
Figure 4
Figure 4
Risk of bias assessment of individual studies. [Colour figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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