{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T18:02:50Z","timestamp":1780682570915,"version":"3.54.1"},"reference-count":56,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Low- and middle-income countries face a significant dual burden of tuberculosis (TB) and cigarette smoking. Nevertheless, studies examining the prevalence and determinants of smoking status and frequency among people with TB (PWTB) are scarce in sub-Saharan Africa, including Lesotho. Therefore, this study evaluated the prevalence and determinants of smoking status and frequency among people with TB in Lesotho.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data on people with TB from the 2023 Lesotho Demographic and Health Survey were used in this study (n\u2009=\u2009326). The data were adjusted for sampling weight, stratification, and cluster sampling design. The outcome variables were smoking status and smoking frequency (daily smoking and occasional smoking). The independent variables included socio-demographic factors, household characteristics, alcohol use, TB-related stigma, and mental health status. We evaluated the association between outcome and predictor variables using Pearson\u2019s chi-squared test and complex sample logistics regression. Statistical significance was set at a p-value\u2009&lt;\u20090.05.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The prevalence of cigarette smoking among PWTB is 23.8%. The prevalence of daily and occasional smoking among PWTB is 17.3% and 6.5%, respectively. Being male (AOR\u2009=\u2009107.48, 95%CI:22.65-510.03, p\u2009&lt;\u20090.001), no media exposure (AOR\u2009=\u20093.65, 95%CI:1.43-9.30, p\u2009=\u20090.007), and alcohol use (AOR\u2009=\u20096.98, 95%CI:2.21-22.05, p\u2009=\u20090.001) increased the odds of smoking among PWTB. Being male (AOR\u2009=\u2009211.28, 95%CI:25.86-1725.91, p\u2009&lt;\u20090.001), no media exposure (AOR\u2009=\u20093.95, 95%CI:1.27-12.26, p\u2009=\u20090.018), and alcohol use (AOR\u2009=\u200915.10, 95%CI:3.36-67.89, p\u2009&lt;\u20090.001) increased the odds of daily smoking among PWTB. Being male (AOR\u2009=\u200939.98, 95%CI:4.76-335.88, p\u2009=\u20090.001) increased the odds of occasional smoking among PWTB. Depression did not significantly influence smoking status of people with TB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The prevalence of smoking among PWTB is high in Lesotho. Our findings underscore the importance of gender-sensitive tobacco use prevention and control interventions among PWTB, an inclusive and adequately funded long-term plan for best-practice anti-tobacco media campaign, and integrating management of substance use disorder into TB control policy and routine TB care in Lesotho.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0335002","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T17:26:44Z","timestamp":1780680404000},"page":"e0335002","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence and determinants of cigarette smoking and smoking frequency among people with tuberculosis in Lesotho: Evidence from a nationwide cross-sectional survey"],"prefix":"10.1371","volume":"21","author":[{"given":"Calista Ogechukwu","family":"Dozie-Nwakile","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6024-2608","authenticated-orcid":true,"given":"Alphonsus Ogbonna","family":"Ogbuabor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nwanneka Chidinma","family":"Ghasi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Chukwuemeka","family":"Ogbuabor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"issue":"1","key":"pone.0335002.ref001","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.chest.2023.08.021","article-title":"Is Tobacco Use Associated With Risk of Recurrence and Mortality Among People With TB?: A Systematic Review and Meta-Analysis","volume":"165","author":"AL Vidyasagaran","year":"2024","journal-title":"Chest"},{"key":"pone.0335002.ref002","doi-asserted-by":"crossref","DOI":"10.54394\/CJQU6666","volume-title":"Global tuberculosis report 2024","author":"World Health Organization","year":"2024"},{"key":"pone.0335002.ref003","article-title":"Global, regional, and national burdens of MDR-TB attributable to smoking from 1990 to 2021 with a prediction from 2022 to 2050","volume":"13","author":"D Dan","year":"2025","journal-title":"Front Public Health"},{"key":"pone.0335002.ref004","volume-title":"WHO global report on trends in prevalence of tobacco use 2000-2025","author":"World Health Organization","year":"2021"},{"key":"pone.0335002.ref005","doi-asserted-by":"crossref","first-page":"102191","DOI":"10.1016\/j.eclinm.2023.102191","article-title":"Association of diabetes, smoking, and alcohol use with subclinical-to-symptomatic spectrum of tuberculosis in 16 countries: an individual participant data meta-analysis of national tuberculosis prevalence surveys","volume":"63","author":"Y Hamada","year":"2023","journal-title":"EClinicalMedicine"},{"issue":"6","key":"pone.0335002.ref006","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1136\/jech-2014-204292","article-title":"Cigarette smoking and pulmonary tuberculosis in northern California","volume":"69","author":"GS Smith","year":"2015","journal-title":"J Epidemiol Community Health"},{"key":"pone.0335002.ref007","volume-title":"WHO consolidated guidelines on tuberculosis. Module 2: screening \u2013 systematic screening for tuberculosis disease","author":"World Health Organization","year":"2021"},{"issue":"6","key":"pone.0335002.ref008","doi-asserted-by":"crossref","first-page":"2501","DOI":"10.4269\/ajtmh.20-0424","article-title":"Epidemiological, mycobacteriological, and clinical characteristics of smoking pulmonary tuberculosis patients, in Lambar\u00e9n\u00e9, Gabon: a cross-sectional study","volume":"103","author":"BR Adegbite","year":"2020","journal-title":"Am J Trop Med Hyg"},{"issue":"7","key":"pone.0335002.ref009","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1080\/17476348.2018.1481394","article-title":"Should tobacco control intervention be implemented into tuberculosis control program?","volume":"12","author":"C-Y Chiang","year":"2018","journal-title":"Expert Rev Respir Med"},{"key":"pone.0335002.ref010","doi-asserted-by":"crossref","first-page":"1017967","DOI":"10.3389\/fpubh.2023.1017967","article-title":"Effects of smoking on the severity and transmission of pulmonary tuberculosis: A hospital-based case control study","volume":"11","author":"Y Feng","year":"2023","journal-title":"Front Public Health"},{"key":"pone.0335002.ref011","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1186\/s12879-016-1819-1","article-title":"Factors associated with smoking among tuberculosis patients in Spain","volume":"16","author":"M\u00c1 Jim\u00e9nez-Fuentes","year":"2016","journal-title":"BMC Infect Dis"},{"issue":"4","key":"pone.0335002.ref012","doi-asserted-by":"crossref","first-page":"2365","DOI":"10.3390\/ijerph19042365","article-title":"Epidemiology and Risk Factors of Delayed Sputum Smear Conversion in Malaysian Aborigines with Smear-Positive Pulmonary Tuberculosis","volume":"19","author":"MN Ibrahim","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pone.0335002.ref013","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1186\/s12890-021-01483-w","article-title":"Sputum smear conversion and associated factors among smear-positive pulmonary tuberculosis patients in East Gojjam Zone, Northwest Ethiopia: a longitudinal study","volume":"21","author":"MA Asemahagn","year":"2021","journal-title":"BMC Pulm Med"},{"issue":"7","key":"pone.0335002.ref014","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0220507","article-title":"Smoking, alcohol use disorder and tuberculosis treatment outcomes: A dual co-morbidity burden that cannot be ignored","volume":"14","author":"BE Thomas","year":"2019","journal-title":"PLoS One"},{"issue":"3","key":"pone.0335002.ref015","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1183\/09031936.00114214","article-title":"Smoking adversely affects treatment response, outcome and relapse in tuberculosis","volume":"45","author":"CC Leung","year":"2015","journal-title":"Eur Respir J"},{"issue":"4","key":"pone.0335002.ref016","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/j.ijtb.2023.04.010","article-title":"Relationship between smoking and tuberculosis recurrence: A systematic review and meta-analysis","volume":"70","author":"F Pourali","year":"2023","journal-title":"Indian J Tuberc"},{"issue":"1","key":"pone.0335002.ref017","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1186\/s12889-020-08856-6","article-title":"Effect of smoking on treatment outcome among tuberculosis patients in Malaysia; a multicenter study","volume":"20","author":"AH Khan","year":"2020","journal-title":"BMC Public Health"},{"issue":"3","key":"pone.0335002.ref018","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1590\/1806-9282.20200825","article-title":"Smoking prevalence and effects on treatment outcomes in patients with tuberculosis","volume":"67","author":"KR de Vargas","year":"2021","journal-title":"Rev Assoc Med Bras (1992)"},{"issue":"5","key":"pone.0335002.ref019","doi-asserted-by":"crossref","first-page":"2150","DOI":"10.4103\/jfmpc.jfmpc_1170_21","article-title":"Prevalence of tobacco consumption and smoking and its effect on outcome among microbiologically confirmed new pulmonary tuberculosis patients on daily regimen of DOTS in Amritsar city","volume":"11","author":"H Gupta","year":"2022","journal-title":"J Family Med Prim Care"},{"issue":"6","key":"pone.0335002.ref020","doi-asserted-by":"crossref","first-page":"390","DOI":"10.2471\/BLT.14.147439","article-title":"Tobacco smoking and tuberculosis treatment outcomes: a prospective cohort study in Georgia","volume":"93","author":"M Gegia","year":"2015","journal-title":"Bull World Health Organ"},{"issue":"9","key":"pone.0335002.ref021","doi-asserted-by":"crossref","first-page":"1846","DOI":"10.1093\/aje\/kwy081","article-title":"Contribution of Smoking to Tuberculosis Incidence and Mortality in High-Tuberculosis-Burden Countries","volume":"187","author":"GA Amere","year":"2018","journal-title":"Am J Epidemiol"},{"issue":"9","key":"pone.0335002.ref022","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0239333","article-title":"Effect of smoking on tuberculosis treatment outcomes: A systematic review and meta-analysis","volume":"15","author":"A Burusie","year":"2020","journal-title":"PLoS One"},{"key":"pone.0335002.ref023","article-title":"Tobacco smoking impact on tuberculosis treatment outcome: an observational study from West Africa","author":"JG Bay","year":"2022","journal-title":"Int J Infect Dis"},{"key":"pone.0335002.ref024","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s12889-015-1376-3","article-title":"Tuberculosis risk factors among tuberculosis patients in Kampala, Uganda: implications for tuberculosis control","volume":"15","author":"BJ Kirenga","year":"2015","journal-title":"BMC Public Health"},{"issue":"37","key":"pone.0335002.ref025","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000030737","article-title":"Cigarette smoking is associated with an increase in blood monocytes in people with tuberculosis: A cross-sectional study","volume":"101","author":"JB Baluku","year":"2022","journal-title":"Medicine (Baltimore)"},{"issue":"5","key":"pone.0335002.ref026","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1093\/cid\/ciz284","article-title":"Diabetes Mellitus Among Pulmonary Tuberculosis Patients From 4 Tuberculosis-endemic Countries: The TANDEM Study","volume":"70","author":"C Ugarte-Gil","year":"2020","journal-title":"Clin Infect Dis"},{"issue":"1","key":"pone.0335002.ref027","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1183\/09031936.00137710","article-title":"High prevalence of smoking among patients with suspected tuberculosis in South Africa","volume":"38","author":"L Brunet","year":"2011","journal-title":"Eur Respir J"},{"key":"pone.0335002.ref028","first-page":"1146","article-title":"Smoking habits and alcohol use of patients with tuberculosis at Standerton Tuberculosis Specialised Hospital, Mpumalanga, South Africa","volume":"24","author":"J Wessels","year":"2019","journal-title":"Health SA"},{"issue":"4","key":"pone.0335002.ref029","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0214235","article-title":"Risk factors for tuberculosis: A case-control study in Addis Ababa, Ethiopia","volume":"14","author":"E Shimeles","year":"2019","journal-title":"PLoS One"},{"issue":"1","key":"pone.0335002.ref030","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1177\/10547738221132096","article-title":"Depression, anxiety, and cigarette smoking among patients with tuberculosis","volume":"32","author":"A Jones-Patten","year":"2023","journal-title":"Clin Nurs Res"},{"issue":"6","key":"pone.0335002.ref031","first-page":"120","article-title":"Tobacco Use Behaviors and Associated Factors among Newly Diagnosed Tuberculosis Patients in Benin and Burkina Faso","volume":"9","author":"AR Ou\u00e9draogo","year":"2024","journal-title":"Trop Med Infect Dis"},{"key":"pone.0335002.ref032","doi-asserted-by":"crossref","first-page":"136","DOI":"10.18332\/tid\/171551","article-title":"High prevalence of current tobacco smoking among patients with tuberculosis and people living with HIV in Jordan: A cross-sectional survey","volume":"21","author":"A Teshima","year":"2023","journal-title":"Tob Induc Dis"},{"key":"pone.0335002.ref033","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.drugalcdep.2016.11.006","article-title":"Prevalence and patterns of cigarette smoking among patients co-infected with human immunodeficiency virus and tuberculosis in Tanzania","volume":"170","author":"RS Mwiru","year":"2017","journal-title":"Drug Alcohol Depend"},{"issue":"1","key":"pone.0335002.ref034","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1186\/s12890-023-02693-0","article-title":"Do patients attempt and succeed in quitting smoking during tuberculosis treatment? A prospective cohort study","volume":"23","author":"J Lee","year":"2023","journal-title":"BMC Pulm Med"},{"key":"pone.0335002.ref035","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/j.ijregi.2022.12.008","article-title":"Evaluating determinants of treatment outcomes among tuberculosis patients in the mining district of Butha Buthe, Lesotho","volume":"6","author":"VD Ngah","year":"2023","journal-title":"IJID Reg"},{"issue":"1","key":"pone.0335002.ref036","article-title":"Factors associated with unfavourable treatment outcomes among tuberculosis patients at health facilities of Maseru, Lesotho","volume":"66","author":"MM Leketa","year":"2024","journal-title":"S Afr Fam Pract (2004)"},{"issue":"5","key":"pone.0335002.ref037","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0285774","article-title":"Understanding barriers to tuberculosis diagnosis and treatment completion in a low-resource setting: A mixed-methods study in the Kingdom of Lesotho","volume":"18","author":"AT Andom","year":"2023","journal-title":"PLoS One"},{"issue":"1","key":"pone.0335002.ref038","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1186\/s12879-019-3688-x","article-title":"Knowledge, attitude and associated factors towards tuberculosis in Lesotho: a population based study","volume":"19","author":"TR Luba","year":"2019","journal-title":"BMC Infect Dis"},{"key":"pone.0335002.ref039","volume-title":"National Tuberculosis Strategic Plan of Lesotho, 2018-2022","author":"Government of Lesotho","year":"2018"},{"key":"pone.0335002.ref040","volume-title":"Lesotho Demographic and Health Survey 2023-24: Final Report","author":"Ministry of Health L, ICF","year":"2024"},{"key":"pone.0335002.ref041","volume-title":"Nigeria demographic and health survey 2018","author":"NPC N, ICF","year":"2019"},{"key":"pone.0335002.ref042","doi-asserted-by":"crossref","DOI":"10.2139\/ssrn.2826925","volume-title":"Measuring women\u2019s empowerment in Rwanda","author":"A Musonera","year":"2016"},{"issue":"3","key":"pone.0335002.ref043","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1177\/0049124116638107","article-title":"Log-likelihood-based pseudo-R2 in logistic regression: Deriving sample-sensitive benchmarks","volume":"47","author":"GAJ Hemmert","year":"2018","journal-title":"Sociological Methodology Research"},{"key":"pone.0335002.ref044","first-page":"70","article-title":"Smoking prevalence among tuberculosis patients: A crosssectional study in Bangladesh and Pakistan","volume":"18","author":"A-M Marshall","year":"2020","journal-title":"Tob Induc Dis"},{"issue":"8","key":"pone.0335002.ref045","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0271511","article-title":"Prevalence of modifiable risk factors of tuberculosis and their population attributable fraction in Iran: A cross-sectional study","volume":"17","author":"K Sadeghi","year":"2022","journal-title":"PLoS One"},{"issue":"7","key":"pone.0335002.ref046","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0132401","article-title":"A Systematic Review of Tobacco Smoking Prevalence and Description of Tobacco Control Strategies in Sub-Saharan African Countries; 2007 to 2014","volume":"10","author":"R Brathwaite","year":"2015","journal-title":"PLoS One"},{"issue":"1","key":"pone.0335002.ref047","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1186\/s12889-024-18188-4","article-title":"Frequency of cigarette smoking and its associated factors among men in East Africa: a pooled prevalence analysis of national survey using multinomial regression","volume":"24","author":"B Terefe","year":"2024","journal-title":"BMC Public Health"},{"issue":"2","key":"pone.0335002.ref048","article-title":"Tobacco use and mass media utilization in sub-Saharan Africa","volume":"10","author":"TNO Achia","year":"2015","journal-title":"PLoS One"},{"issue":"2","key":"pone.0335002.ref049","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1080\/10410236.2020.1831755","article-title":"Beyond Educating the Masses: The Role of Public Health Communication in Addressing Socioeconomic- and Residence-based Disparities in Tobacco Risk Perception","volume":"37","author":"MA Bekalu","year":"2022","journal-title":"Health Commun"},{"issue":"3","key":"pone.0335002.ref050","doi-asserted-by":"crossref","first-page":"259","DOI":"10.3390\/ijerph21030259","article-title":"A Scoping Review of Tobacco Control Health Communication in Africa: Moving towards Involving Young People","volume":"21","author":"C Aienobe-Asekharen","year":"2024","journal-title":"Int J Environ Res Public Health"},{"issue":"2","key":"pone.0335002.ref051","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1136\/tobaccocontrol-2021-056540","article-title":"Landscape of tobacco control in sub-Saharan Africa","volume":"31","author":"CO Egbe","year":"2022","journal-title":"Tob Control"},{"issue":"1","key":"pone.0335002.ref052","doi-asserted-by":"crossref","first-page":"59","DOI":"10.3390\/ijerph16010059","article-title":"Prevalence of Alcohol and Tobacco Use among Men and Women in Namibia","volume":"16","author":"Z He","year":"2018","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pone.0335002.ref053","doi-asserted-by":"crossref","first-page":"111","DOI":"10.31557\/APJCP.2023.24.1.111","article-title":"Prevalence and Factors Associated with Tobacco Smoking in a National Representative Sample of Zambian Adults: Data from the 2017 STEPS - NCDs Survey","volume":"24","author":"C Zyambo","year":"2023","journal-title":"Asian Pac J Cancer Prev"},{"issue":"13","key":"pone.0335002.ref054","doi-asserted-by":"crossref","first-page":"7752","DOI":"10.3390\/su14137752","article-title":"The Influence of Alcohol Consumption on Tobacco Use among Urban Older Adults: Evidence from Western China in 2017","volume":"14","author":"C Li","year":"2022","journal-title":"Sustainability"},{"key":"pone.0335002.ref055","article-title":"Depression among TB patients and associated factors in Kathmandu Valley, Nepal","volume":"7","author":"P Shrestha","year":"2020","journal-title":"Glob Ment Health (Camb)"},{"issue":"2","key":"pone.0335002.ref056","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1001\/archpsyc.55.2.161","article-title":"Major depression and stages of smoking. A longitudinal investigation","volume":"55","author":"N Breslau","year":"1998","journal-title":"Arch Gen Psychiatry"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0335002","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T17:26:53Z","timestamp":1780680413000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0335002"}},"subtitle":[],"editor":[{"given":"Mulu Tiruneh","family":"Asemu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,5]]},"references-count":56,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6,5]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0335002","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,5]]}}}