Assessment on Potential Factors to Affect the Availability and Accessibility of Snus in Low-and-middle Income Countries: The Case of Malawi
Authors: Sikwese Kate , Jekete Wilfred 
Published: April 2022

Abstract
Introduction and literature reviewThis study focused on assessing the factors that may affect the availability and accessibility of snus in Malawi and provide possible means to ensure and enhance the availability and accessibility of snus in the country. Tobacco smoking is not just one of the world’s largest, most pressing and most preventable health concerns, but an epidemic in the making. The available evidence indicates that both the burden of disease and smoking prevalence are on the rise in Malawi. The country’s efforts to address such epidemic have been ineffective with limited preventive and therapeutic interventions tailored at making people to cease from smoking tobacco. Little is known about the health importance of tobacco harm reduction products that have the potential to improve the health of a regular smoker by ending smoking. On the other hand, the use of sophisticated tobacco Harm Reduction products has proven to be expensive hence unsustainable for the Low-Middle income countries such as Malawi, hence interventions such as the use of Snus has been viewed as the most possible alternative to Nicotine consumption. Thus, this report assessed the possible factors that may affect the availability and accessibility of snus as a tobacco harm reduction product in the country.Methodology: It was conducted in three districts of Mchinji, Rumphi and Balaka, and employed quantitative and qualitative research methods. The data were collected from 100 randomly sampled respondents and 16 key informants play roles various roles in tobacco, health, political and economic sectors of the country. The data collected were cleaned, coded and analyzed in accordance with the research objectives. The analysis was guided by four research questions which included questions on willingness to quit consumption of combustible cigarettes, factors affecting the availability of snus, health perspective towards cigarette consumption and measure to enhance availability and accessibility. Descriptive statistics (percentages and frequency) were used to present the analyzed data and findings in tables and graphs.Results: The study has revealed that majority of key informants and combustible cigarettes consumers perceive smoking as bad to human health, and a number of them made attempts to quit smoking by failed due to stress, lack of alternative source of containing nicotine cravings etc. On the other hand, lack of political willingness and commitment, taxation and lack of policies and regulations are some of the factors that may negatively affect the availability and accessibility of snus in the country. On the other hand, the health benefits of snus and the affordability among the rural consumers has been highlighted as some of the benefits and factors that may stimulate snus demand and enhance its availability and accessibility positively.Conclusion and Recommendations:Inconclusion, the use snus as a harm reduction product can be of greater importance in helping to reduce cases of non-communicable infections as evidenced in Pakistan. With regards to the socio-economic status of most rural based combustible cigarette consumers, snus tends to provide a better option for switching to safer nicotine as it is cheaper hence quite affordable by the majority which may directly contribute to a significant decline in combustible cigarette use hence improving the health wellbeing of individuals who have opted to switch thereby attaining the Sustainable Development Goal 3. It can be recommended that, government should consider how harm reduction products are taxed, it very important to consider the relative harms of different tobacco products in taxation, where a harm reduction approach would apply differential taxation based on the relative harms associated with different products. The government also need to accommodate tobacco harm reduction strategies in its policies which will more likely enhance and ensure the availability and accessibility of snus and other related products will are more likely to reduce the risk associated with tobacco combustion.