Guide d’aide au sevrage tabagique

Objectives

Algeria’s 2017 national smoking-cessation strategy treats tobacco use as a major public-health problem and addiction, rather than a lifestyle choice. It seeks coherence between tobacco-prevention activities, tobacco-control policy and accessible cessation support, contributing to the National Cancer Plan 2015–2019 and the National Multisectoral Strategic Plan for the Control of Non-Communicable Disease Risk Factors 2015–2019.[1]The overall aim is to reduce tobacco-related morbidity and mortality, particularly from cardiovascular disease, chronic respiratory disease and cancer, by helping users of all tobacco products to stop, preferably before disease develops but also after diagnosis.[2]

• Integrate tobacco-dependence management and smoking-cessation consultations into primary healthcare, while providing stepped referral for people requiring more intensive or specialised care.[3][4]
• Support cessation among adults aged 18 years and over, including pregnant women, and address smoked tobacco, oral tobacco, shisha and electronic cigarettes.[3][2]
• Promote cessation as beneficial at every age and disease stage, including among people with cancer, chronic obstructive pulmonary disease, coronary disease and mental-health conditions.[2][5][6][7][8]
• Strengthen health professionals’ capacity to understand tobacco dependence, provide cessation support, prevent passive smoking and act as non-smoking role models.[9][10]
• Apply the World Health Organization MPOWER package, including monitoring tobacco use and prevention policies, protecting people from tobacco smoke, warning about harms, enforcing restrictions on tobacco advertising, promotion and sponsorship, supporting cessation, and increasing tobacco taxation.[9]
• Provide personalised care based on smoking status, readiness to quit, dependence, previous quit attempts, psychosocial circumstances, co-morbidities, exposure to tobacco smoke and possible co-dependencies.[11][12][13]

The guide frames tobacco dependence as a physical, behavioural and psychological chronic condition. It aims to improve motivation, manage withdrawal, anxiety and depressive symptoms, strengthen treatment adherence, increase confidence in quitting and prevent relapse.[10][14]It does not set quantified national cessation targets or a time-bound performance framework in the supplied material.[15]

Implementation

The delivery model combines brief routine intervention, dedicated smoking-cessation support units and hospital referral services. It was developed through consultation and consensus involving the Ministry of Health, the Directorate-General for Prevention and Health Promotion, the Non-Communicable Diseases Control Programme, a national tobacco-control expert committee, health professionals, epidemiologists, civil-society participants and the World Health Organization Algeria office.[16][1][3]Care is organised across three levels, with clinical services providing first-level advice, specialised cessation units providing structured support, and hospital referral structures managing complex cases.[4][17]

• Identify tobacco use at clinical contact, record status in medical records or consultation registers, advise cessation, assess needs, assist quitting, refer when appropriate and provide follow-up.[4][17][18]
• Deliver first-level brief interventions of no more than three minutes through general medical, specialist and emergency services, repeating advice at subsequent contacts.[17][18]
• Operate second-level units with an initial reception consultation, collective therapeutic sessions for approximately 5 to 10 candidates and individual consultations delivered by doctors, nurses, psychologists and dietitians.[19]
• Refer complex cases, treatment failures, management requiring medicines other than nicotine substitutes, and relevant co-morbidities to third-level reference centres and competent specialists.[20][21]
• Assess consumption, exhaled carbon monoxide, nicotine dependence, motivation, depression, previous attempts and relapse history using structured tools, including Fagerström tests, motivation scales, the Major Depression Inventory, Beck Depression Inventory and consultation records.[12][13][22][23][24]
• Provide motivational interviewing, psychological support, cognitive behavioural therapy, physical activity, dietary support, telephone contact and relapse-prevention support according to individual circumstances.[25][14][26][20]
• Offer nicotine-replacement therapy as first-line pharmacological treatment, using patches, gum or lozenges and, where appropriate, combined transdermal and rapid-delivery forms; treatment is generally adapted to dependence and may last 8 to 12 weeks or longer.[27][28][29][30]
• Maintain close follow-up, initially weekly and subsequently monthly for three to six months, extending to 12 months for high dependence; assess cessation success after two to four weeks and analyse relapse causes at every visit.[31][32]

Tailored pathways address pregnancy, cardiovascular disease, mental-health conditions, chronic obstructive pulmonary disease, cancer, hospital admission, planned surgery, couples and fertility-related concerns.[33][5][6][7][8]For planned non-emergency surgery, cessation support is intended to begin six to eight weeks before the procedure.[8]Electronic cigarettes and electronic shisha are not recommended as cessation treatments because the material considers evidence on effectiveness and safety insufficient.[29][30]

Implementation envisages cessation units in public-sector facilities, supported by a doctor, paramedical worker, psychologist, secretary, reception worker and maintenance worker, alongside consultation space, carbon-monoxide monitors, pulse oximetry, clinical equipment, registers, information systems, education materials and nicotine substitutes.[34][35]National implementation also includes workforce training, public communication, research, surveillance, procurement and distribution of pharmacological products and equipment, and supervision and evaluation of cessation units by central authorities and unit physicians.[15]A dedicated budget is referenced, but no quantified allocation, cost, financing source or funding gap is specified.[15]

Monitoring is principally clinical: consultation records capture tobacco status, abstinence or reduction, cigarette consumption, carbon-monoxide readings, treatment, clinical measurements, referrals and specialist feedback.[36][37][38][39][40][41]The strategy calls for tobacco-use surveillance and epidemiological and clinical research, but the supplied material does not specify national indicators, reporting schedules, evaluation targets or formal accountability procedures.[15]

Monitoring & Evaluation

Monitoring is principally embedded in clinical tobacco-cessation assessment, consultation records and follow-up, while the wider strategy also envisages tobacco-use surveillance, research, supervision and evaluation of smoking-cessation support units. Quantitative programme indicators, reporting schedules, targets and formal accountability procedures are not specified in the supplied material.[15]

• Record tobacco-use status and brief cessation advice in patient records or consultation registers, and retain consultation, identification and appointment forms to support clinical traceability.[17][18][35]
• Assess tobacco dependence using the Fagerström test, including a simplified version, and use results to classify dependence and guide the intensity of cessation support.[13][30][22]
• Measure smoking intensity and recent exposure through exhaled carbon monoxide testing, recording cigarettes per day, duration of smoking and results in parts per million; interpretation should account for passive exposure and respiratory conditions.[12][42][43]
• Screen for depressive symptoms and psychosocial barriers to cessation using brief questions or validated questionnaires, including the Major Depression Inventory and abbreviated Beck Depression Inventory, alongside clinical assessment rather than as a sole diagnostic basis.[13][23][44]
• Document previous quit attempts, relapses, withdrawal symptoms, motivation, co-morbidities, treatment received and relevant social circumstances to tailor care and identify barriers to sustained abstinence.[13][31][45]
• Monitor progress through structured follow-up, initially weekly and subsequently monthly for three to six months, with follow-up extending to 12 months for people with high dependence.[31]
• Review treatment success after two to four weeks, assess abstinence or reduction in consumption, and analyse relapse causes at each consultation to determine whether psychological, behavioural or pharmacological support should continue or be adjusted.[31][32]
• Record follow-up measures including days abstinent, reduction of tobacco consumption by at least 50%, daily cigarette consumption, exhaled carbon monoxide, time since last cigarette, clinical observations, prescribed treatment and specialist feedback.[37][38][41]
• Monitor clinical parameters, including weight, body mass index, blood pressure, heart rate, respiratory rate and oxygen saturation, during initial and follow-up consultations.[36][37][38]
• Use population surveys as an evidence base for tobacco-use prevalence and quit attempts, including the Global Youth Tobacco Survey, Global Adult Tobacco Survey and World Health Organization STEPwise survey.[46][10]
• Establish tobacco-use surveillance and undertake epidemiological and clinical research, while supervising and evaluating smoking-cessation support-unit activities through coordination between central authorities and unit physicians.[15]
• Recognise that monitoring tobacco use and prevention policies forms part of the World Health Organization MPOWER strategy, although the extracts do not set out associated indicators or reporting mechanisms.[9]

Costing & Financing

Financing information is limited. The framework identifies the need for a dedicated budget and for human resources, facilities, equipment, communication materials and pharmacological products, but it provides no quantified budget, prices, financing sources, allocation formulae, funding-gap estimate or economic assumptions.[15][35]

• Provide a dedicated budget for procurement, management and distribution of pharmacological products and equipment, including registration of nicotine-replacement therapies and other relevant medicines or products.[15]
• Resource smoking-cessation units with a doctor, paramedical worker, psychologist, secretary, reception worker and surface-maintenance worker, alongside consultation and waiting spaces, administrative systems and clinical equipment.[35]
• Equip units with carbon-monoxide monitors, pulse oximeters, blood-pressure monitors, anthropometric equipment, computers, printing and scanning equipment, registers, forms and psychological-consultation materials.[35]
• Fund communication and education resources, including information materials, leaflets, posters, projection and videoconferencing equipment, telephone access and internet connectivity.[35]
• Make nicotine substitutes available in quantities linked to the estimated number of people attending consultations; the source does not provide unit costs or total procurement volumes.[35]
• Include nicotine-replacement therapies in the essential medicines list and make resources available for cessation support across the health system, although the extracts do not specify the responsible financing mechanism.[9]
• Record individual monthly expenditure on tobacco in Algerian dinars as part of assessment, including potential essential expenditure that could have been made with this money; no aggregate affordability analysis or monetary estimate is supplied.[47][36]
• Recognise the stated non-monetary economic assumption that positive reinforcement of desirable behaviour is more cost-effective than penalising undesirable behaviour.[14]