Background:
In 2008, the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) Article 11 Guidelines were adopted. The objective of this study was to: (1) describe the current status of packaging and labeling in all 47 countries of the WHO African Region, and (2) assess the improvement of health warning labels (HWLs) since adoption of the Guidelines.

Methods:
We analyzed over 225 pieces of legislation from the African Region in Tobacco Control Laws, a database of the International Legal Consortium at the Campaign for Tobacco-Free Kids. In addition, we reviewed the 2017 WHO MPOWER Report. We assessed HWLs type (text-only vs. pictorial), size as a percentage of the principal display areas (PDAs), and other packaging and labeling requirements.

Results:

As of July 2017, 11 countries have no laws requiring HWLs; 10 require text-only HWLs of less than 30%; 11 require text-only HWLs of at least 30%; 2 require pictorial HWLs of less than 50%; and 13 require pictorial HWLs of at least 50%. The number of countries fulfilling other requirements is shown in the table below.



[Number of Countries with Additional Requirements]



Since adoption of the Article 11 Guidelines, the total number of countries requiring HWLs of at least 30% has increased more than 5 times (from 5 to 26); HWLs of at least 50% has spiked (from 1 to 15); HWLs of at least 75% has gone from none to 1. The number of countries with pictorial HWLs has jumped from none to 15.

Conclusions:
Few countries in the African Region have fulfilled key HWLs provisions. Almost half ban misleading descriptors, but less than one fifth ban emission yields or require qualitative constituents and emission information. Adoption of the Guidelines contributed to an increase in effective HWLs. However, only 13 of 47 countries have achieved their recommendations of pictorial HWLs on at least 50% of the PDAs.