Compliance of Sections 4–7 of Cigarette and Other Tobacco Products Act (COTPA) 2003 in India—A Systematic Review and Meta-analysis

In view of the vast variability of the compliance of Sections 4-7 of COTPA in India, a need for a collective evaluation appeared appropriate and timely. The aim of this review was to specifically analyze the country wide compliance of Section 4,5,6a and 6b,7 of COTPA along with the displays of signage on No Smoking (NoSmok) and Tobacco Free Institution (TFI). Studies published between 2003-December 2020 reporting compliance/non compliance (C/NC) were reviewed. Eligible study designs were observational studies and brief reports. To obtain the effect measure, Med Calc version 20 was used. 60 full text articles were assessed for eligibility and included in the qualitative and quantitative synthesis. The compliance for the Sections 4,5, 6b and 7 was 71.97% (95%CI:61.87-81.05, I2 =99.70%), 58.95% (95%CI:44.90-72.28, I2=99.53%), 51.08% (95% CI:39.30-62.81, I2=99.46%), 57.60% (95%CI:37.58-76.40, I2=99.48%) respectively whereas for the NoSmok and TFI board display it was 42.30% (95%CI:32.53-52.39, I2=99.75%) and 26.81% (95%CI:9.94-48.25, I2=99.51) respectively. Compliance of the Section 6a, sale of tobacco products to and by the minors was 66.39% (CI:49.50-81.36, I2=99.69%) and 94.11% (95%CI:78.54-99.99, I2=99.76%) respectively. This study observed a significant variability in compliance of Sections 4-7 of COTPA. It points to a critical need for a robust, self – sustained and effective enforcement mechanism countrywide to eliminate potential for any NC. Amendments to the COTPA appear critical for a policy reform and an optimal implementation.