Smoking Cessation Clinical Guidelines for Ghana

Objectives

Strengthen Ghana’s tobacco-control response by embedding evidence-based tobacco-dependence treatment and cessation support within routine healthcare, in line with Article 14 of the World Health Organization Framework Convention on Tobacco Control.[1]The guideline seeks to help healthcare professionals identify tobacco users, assess dependence, support quit attempts, prevent relapse and reduce exposure to second-hand smoke.[2][3]

• Promote routine, standardised tobacco-cessation care at all levels of health service delivery, ranging from brief interventions to behavioural support and pharmacological treatment.[1][2][4]
• Apply the 5As model by asking about tobacco use, advising users to quit, assessing readiness and dependence, assisting quit attempts, and arranging follow-up.[1][4]
• Use the 5Rs approach, namely relevance, risks, rewards, roadblocks and repetition, to build motivation among people who are not ready to quit.[4]
• Assess tobacco and nicotine dependence through tobacco-use frequency and quantity, self-reported behaviour, biochemical markers such as salivary cotinine, and the Fagerström Test for Nicotine Dependence.[2][5]
• Support clients to set quit dates, manage withdrawal and cravings, identify triggers and barriers, build coping skills, mobilise support from family and friends, and develop individual action plans.[4][6][7]
• Protect non-smokers through smoke-free environments, public awareness, support for smokers to quit, and implementation of protective tobacco-control measures.[2][3]
• Prioritise tailored cessation support for hospitalised tobacco users, pregnant and lactating women, children and adolescents, people with mental illness, and people with other substance addictions.[8][9][3]

Implementation

Deliver cessation support through routine healthcare, with all healthcare professionals expected to identify and document tobacco use, screen users for dependence, provide at least brief intervention to health-facility visitors, and refer or arrange further support as needed.[2][4]Service delivery combines individual and group counselling, telephone support, self-help resources, pharmacotherapy, follow-up and relapse prevention.[6][7]

• Integrate tobacco-dependence management into ordinary clinical encounters by recording tobacco-use status at every visit and using this information to guide intervention and follow-up.[1][4]
• Provide personalised counselling in supportive face-to-face settings, including individual counselling and group behavioural therapy, with at least four sessions and contacts around the quit date and during the first month.[6]
• Use practical counselling and motivational interviewing to address danger situations, negative mood, stress, peer pressure, previous unsuccessful quit attempts, fear of weight gain, withdrawal symptoms and urges to smoke.[4][6]
• Offer telephone counselling or quit-line support for quit assistance, follow-up and relapse support; record calls, classify the support provided, and refer clients for face-to-face services where appropriate.[6]
• Make cessation information available through booklets, brochures, websites, support groups and other information platforms covering tobacco harms, available interventions and further sources of support.[7]
• Offer nicotine replacement therapy, including gum, inhalers, lozenges, nasal sprays and patches, alongside behavioural advice and follow-up; use non-nicotine medicines such as bupropion and varenicline where appropriate.[7][10]
• Consider nicotine replacement therapy particularly for people with high or very high Fagerström dependence scores, while interpreting scores of 0–2 as very low, 3–4 as low, 5 as medium, 6–7 as high and 8–10 as very high dependence.[5][4]
• Provide intensive, continuing and individually tailored counselling to pregnant and lactating women, and consider nicotine replacement therapy when they cannot quit without assistance.[8]
• Screen children, adolescents and their parents for tobacco use, communicate a strong abstinence message, provide counselling or behavioural support, and help parents reduce children’s exposure to second-hand smoke.[8]
• Screen people with mental illness and substance addictions for tobacco use, offer proven cessation interventions, manage behavioural changes during nicotine withdrawal, review mental-health medicines where necessary, and treat tobacco use alongside other substance use.[9]
• Use hospital staff, including ward nurses, to identify tobacco users, recognise nicotine withdrawal, provide or arrange treatment, deliver motivational interviewing and make referrals.[3]
• Prevent relapse by identifying high-risk situations, planning responses to slips, avoiding triggers, strengthening coping and problem-solving skills, encouraging relevant lifestyle changes, and building family and peer support.[3][11]
• Provide tobacco health information to health-facility clients through health talks, information, education and communication materials, and audio-visual methods.[11]
• Support national coordination through the National Tobacco Control Steering Committee, which contributes to policy development, advocacy and intervention strategies; the Ghana Health Service acts as its secretariat, with a tobacco-control focal point in its Research and Development division under the Ministry of Health.[12]
• Implement relevant population measures under Part 6 of Ghana’s Public Health Act, 2012, including restrictions on the purchase and sale of tobacco products by age and assistance for people wishing to quit.[12]
• Embed supervision in existing supervisory structures and engage healthcare providers, respected individuals, businesses, groups and community bodies as tobacco-free champions.[11]
• Monitor cessation services continuously through routine performance tracking, periodic assessment of intervention-related changes, incorporation of tobacco-use information into existing data tools, routine data analysis, service improvement and feedback to authorities at each level.[11]
• Validate cessation at one month and again at three, six and twelve months, using follow-up contacts to recognise progress, identify difficulties and sustain quit attempts.[6]

Monitoring & Evaluation

Monitoring and evaluation combine patient-level assessment and follow-up with routine service-performance monitoring. Tobacco-use status should be documented for healthcare-facility visitors, tobacco users should be screened for dependence, and tobacco cessation should be incorporated into existing data-collection tools.[4][11]The available material does not set out a consolidated national indicator framework, reporting schedule, surveillance protocol or named accountability authority for the guideline as a whole.[1][12][13]

• Assess tobacco dependence through tobacco-use frequency and quantity, self-reported behaviour and, where used, biochemical measures such as salivary cotinine.[2][5]
• Apply the Fagerström Test for Nicotine Dependence to assess physical dependence and guide treatment decisions, particularly consideration of nicotine replacement therapy for high or very high dependence.[5][4]
• Interpret Fagerström scores as very low dependence at 0 to 2, low at 3 to 4, medium at 5, high at 6 to 7, and very high at 8 to 10.[5]
• Arrange follow-up as part of the Ask, Advise, Assess, Assist and Arrange model, and reassess readiness to quit repeatedly for people not initially motivated to stop.[4]
• Validate cessation outcomes ideally at one month and subsequently at three, six and twelve months.[6]
• Use each follow-up contact to recognise progress, identify difficulties and sustain the client’s quit attempt.[6]
• Record telephone cessation contacts and classify support as quit support, follow-up or relapse support; refer callers to face-to-face services when appropriate.[6]
• Screen priority populations, including pregnant and lactating women, children and adolescents, people with mental illness, and people with substance addictions, for tobacco use as part of operational service delivery.[8][9]
• Monitor patients with mental illness for behavioural changes during nicotine withdrawal and adjust mental-health medicines where necessary during a quit attempt.[9]
• Require healthcare providers to monitor and evaluate cessation services continuously through routine programme-performance tracking and periodic assessment of changes in targeted results.[11]
• Analyse routinely collected data, use findings to improve services and provide feedback to relevant authorities at each level.[11]
• Integrate supervision within existing supervisory structures rather than establish a separately specified oversight system.[11]

Historical tobacco-control surveillance cited in the material includes Global Youth Tobacco Surveys conducted in 2000, 2006 and 2009, as well as the Global School Personnel Survey.[1]These surveys are reported as prior monitoring activity, rather than as a defined surveillance arrangement for implementation of cessation services.[1]

The source identifies data collection to monitor service effectiveness and track patients’ tobacco-use status, but does not provide numerical targets, indicator definitions, reporting frequencies, data-quality procedures, evaluation designs or a formal sanctions-and-rewards accountability mechanism.[1][12][5]

Costing & Financing

No budget, expenditure estimate, allocation, funding source, resource-mobilisation plan, funding-gap assessment or quantified economic assumption is provided for implementation of the tobacco-cessation guideline.[14][12][4][3]The source therefore does not specify how cessation services, medicines, training, monitoring or follow-up should be financed.[1][6][7]

• Characterise tobacco-dependence treatment as cost effective, while providing no supporting monetary estimate or cost-effectiveness ratio.[14]
• Indicate qualitatively that cessation interventions associated with non-communicable diseases, including hypertension and cancers, are less costly than other routine medical interventions.[4]
• Identify resource inputs including healthcare-worker training, counselling, behavioural support, self-help materials, telephone support or quit lines, follow-up, and pharmacological treatment.[14][6][7]
• Include pharmacological options such as nicotine replacement therapy, bupropion and varenicline, without specifying procurement costs, patient charges, reimbursement arrangements or medicine funding sources.[7][10]
• Require tailored counselling and, where needed, nicotine replacement therapy for pregnant and lactating women, but provide no associated costing.[8]
• Provide no financial details for tobacco-use screening, biochemical assessment, service record-keeping, routine data analysis, supervision or feedback mechanisms.[5][11]

Financial feasibility, affordability assumptions, domestic versus external financing, and the scale of any unmet resource requirement are not specified in the supplied material.[14][9][15]