Tobacco free government health care facilities: Compliance scenario of a capital/ metropolitan city

Introduction: Exposure to secondhand tobacco smoke increases risk of non-communicable diseases. Globally 1.2 million deaths of non-smokers are attributed to secondhand smoking. According to global Adult Tobacco Survey Bangladesh, 2017, 12.7% of adult populations visiting health care facilities (HCF) are exposed to secondhand smoke. Objectives: This compliance survey was carried out to explain current situation of government HCFs to make them tobacco free. Methods: A cross-sectional study was conducted in April, 2019 among all of the government HCFs of Dhaka City. Among the facilities under study, 21 were outdoor clinics and 30 were hospitals having inpatient facility. Trained field research assistants observed HCF buildings and premises at pick working hours for evidence of smoking and smokeless tobacco use. They also assessed the display of anti-tobacco signage, provision of support for quitting and presence of tobacco product sell points in and around the HCF. Results: In one-third of HCFs smoking was observed and in two-third cigarette butt was found. Odor of smoke was found in 18% of HCF. Overall evidence of smoking was observed in 71% of HCFs. Consumption of smokeless tobacco was observed in 45% of HCF. Tobacco consumption was almost three times higher in hospitals having inpatient facilities than outdoor clinics. Anti-tobacco signage were found to be displayed in 55% of HCF. Half of the signage was compliant to existing law. Signage compliance was more in hospitals. Cessation clinic was present in one hospital only, but counseling service is provided from 29% of HCF. Tobacco products were found to be sold in 14% HCF and point of sale was present just outside the boundary of 80% HCFs. All HCFs were free from tobacco advertisement. Conclusion(s): In Dhaka city very few government HCFs are tobacco free. Attention to cessation clinic, increase awareness among staff, patients and attending persons can help to ensure tobacco free HCFs.