The illicit cigarette market in the Democratic Republic of the Congo (DRC): Findings from a cross-sectional study of empty cigarette packs.

This study aimed to estimate the proportion of cigarettes consumed in the Democratic Republic of the Congo (DRC) that are illicit and the extent of cigarette tax evasion; and to identify the origins of and factors associated with illicit cigarettes. Data were collected from May 15 to June 9, 2023. Stratified, multistage sampling was used to select 32 health areas from which empty cigarette packs were collected. Each collected pack was examined and classified as licit if it complied, or illicit if it did not comply, with the DRC's tax stamp or written health warning requirements, or the requirements to have a notice indicating the prohibition of sale by/to minors or information on tar and nicotine content. We reported frequencies as numbers and percentages, and continuous variables as means or medians. We performed regression analysis and used adjusted odds ratios (aOR) and their 95% confidence intervals (CI) to measure associations. 8.6% (95% CI: 8.1, 9.2) of the 10622 empty cigarette packs collected were illicit, and had also evaded cigarette tax. 8.0% of the collected packs did not comply with written health warning requirements, 5.6% did not indicate the prohibition of sale by/to minors, and 4.5% did not have information on tar and nicotine content. Packs from low-income areas were more likely to be illicit than those collected from high-income areas (aOR 1.90; [95% CI: 1.48-2.43]). The likelihood of being an illicit cigarette increased with increasing susceptibility to armed conflict/insecurity. Packs from border provinces were less likely to be illicit than those from non-border provinces (aOR 0.48; [95% CI: 0.25-0.90]). All illicit cigarettes were imports from other countries. There is, therefore, a need to secure the cigarette supply chain, strengthening border controls and enforcement and compliance monitoring, and strengthening political commitment by ratifying the Protocol to Eliminate Illicit Trade in Tobacco Products.