Knowledge and Attitudes of Patent Medicine Vendors towards Tobacco Harm Reduction in Ebonyi State, Nigeria: A Mixed Methods Study

The negative health consequences of cigarette smoking have been well documented. Cigarette smoking prevalence is high in Nigeria. A very high proportion of smokers in Nigeria are aware of the dangerous effects of cigarette smoking and most of them want to quit, but their quitting attempts often prove unsuccessful. Evidence shows that tobacco harm reduction (THR) products such as electronic cigarettes are effective in helping smokers to quit. Patent medicine vendors (PMVs) have been successfully integrated into several public health interventions in Nigeria and could prove useful in the provision of tobacco harm reduction products to smokers. This study sought to assess the knowledge and attitudes of patent medicine vendors towards tobacco harm reduction in Ebonyi State, Nigeria. A convergent mixed methods design was used. Cross-sectional survey and indepth interviews (IDIs) were conducted among from 320 PMVs and 25 PMVs, respectively. Descriptive univariate and Pearson's chi square analysis and thematic data analysis were done for survey and IDI data, respectively. There were low awareness and poor knowledge of tobacco harm reduction among the PMVS. Most of them (95.9%, n = 307) said they will seek out and attend training on THR while 89.1% (n = 285) opined that PMVs have a role in providing THR products to smokers. Most (86.9, n = 298) said they will encourage their colleagues to participate in the provision of THR products. Curiously, only 56.9% (n = 182) expressed the desire to include THR products in their stock at the moment; this is explained by two factors: Lack of knowledge of THR and the fear of harassment and extortion by Police and pharmaceutical regulatory agents. Patent medicine vendors represent a very important platform for the provisioning of THR products to smokers, but low awareness and poor knowledge are key constraints. Therefore, there is a need for awareness creation and improvement of PMV's knowledge of THR.