Men out-smoke women in every one of 39 African countries, WHO-data analysis finds

Across 39 African countries, the current prevalence of cigarette smoking is higher among men than among women in every single one — and the size of that gap varies more than tenfold from one country to the next, according to a descriptive study published in Global Health Action on 8 September 2026 [s1]. The analysis used non-age-standardized WHO Global Health Observatory modelled estimates for 2022, disaggregated by sex for people aged 15 years and older and accessed through the World Health Organization's Health Equity Assessment Toolkit version 6.0 [s1].

The overall prevalence of current cigarette smoking ranged from 1.7% in Ghana to 18.2% in Seychelles [s1]. Male prevalence exceeded female prevalence in all 39 countries, a uniformity the authors treat as the study's central finding [s1]. Where women smoked at all in measurable numbers, the prevalence was highest in South Africa, at 5.1%, and Seychelles, at 4.5% [s1].

A gap that ranges from 3 points to 36

The distance between men and women is where the numbers spread out. The male-minus-female gap ranged from 3.3 percentage points in Ghana to 36.4 percentage points in Lesotho, and gaps also exceeded 25 percentage points in Mauritius, Algeria, Madagascar, and Seychelles [s1]. In other words, the countries with the largest absolute sex differences are not a single geographic cluster: they span southern Africa, an Indian Ocean island state, and North Africa.

The study is deliberately descriptive. It reports what the modelled estimates show without claiming to explain why. The authors are explicit that proposed explanations — social norms, tobacco marketing, or differences in policy context — "should be treated as hypotheses because these factors were not measured in this study" [s1]. That caution matters, because the temptation with a clean cross-country ranking is to read a mechanism into it that the data cannot support.

What the numbers are, and are not

Two limitations sit at the centre of any careful reading. First, these are modelled estimates for 2022 rather than directly observed survey data — the dataset "comprised modelled estimates rather than directly observed survey data," the authors write, meaning each country figure is an inference built on available surveys, not a fresh headcount [s1]. Second, the estimates are non-age-standardized, so differences in the age structure of populations are not removed; a country with a younger or older population can look higher or lower for reasons unrelated to smoking behaviour itself.

Those caveats do not erase the pattern. A sex gap that holds in all 39 countries, with no exceptions, is the kind of consistency that survives a good deal of measurement noise. What the study cannot tell a reader is whether the low female figures reflect genuinely low uptake, under-ascertainment of women's smoking, or a mix of the two — a distinction that separate, survey-based work would need to settle.

Why the ranking is useful anyway

The value the authors claim is planning, not causation. Comparable sex-disaggregated estimates, they argue, are what tobacco-control programmes need to tailor responses to the country patterns actually observed rather than to a regional average that hides them [s1]. A programme in Lesotho, where the gap is widest, faces a different problem from one in Ghana, where both the overall prevalence and the gap are smallest — and an aggregate "African" smoking figure would tell neither what to do.

The broader stakes are set by the global toll of tobacco. WHO's tobacco fact sheet states that tobacco kills more than 7 million people each year, including over 1.6 million non-smokers exposed to second-hand smoke, and that around 80% of the world's 1.2 billion tobacco users live in low- and middle-income countries [s2]. Africa's measured smoking prevalence remains low relative to some other regions, which is precisely the argument tobacco-control advocates make for acting early: the countries in this analysis are, for the most part, at a stage where prevalence could still be held down rather than reversed after the fact — part of the region's wider non-communicable disease burden.

What to watch

The study's own recommendation is for "strengthened sex-disaggregated surveillance," which is a polite way of saying the modelled estimates are a starting point, not an endpoint [s1]. The figures that would confirm or revise this picture are country-level survey rounds that measure men's and women's smoking directly, particularly in the high-gap states of southern Africa. Until those arrive, the safest reading is the one the authors themselves offer: a robust, universal sex difference in who smokes, of a size that differs sharply by country, and whose causes remain, for now, an open question.

This article is informational and is not medical advice.

Sources

• Sex disparities in current cigarette smoking prevalence among individuals aged 15 years and older in 39 African countries — Global Health Action (Osborne, Sesay and Ali), 8 September 2026
• Tobacco (fact sheet) — World Health Organization