Prevalence of Alcohol Use and Associated Factors in Pregnant Antenatal Care Attendees in Mpumalanga, South Africa

A scoping review of the determinants of foetal alcohol spectrum disorder in South Africa: an intersectional perspective

Foetal alcohol spectrum disorder (FASD) affects babies born to mothers who consume alcohol while pregnant. South Africa has the highest prevalence of FASD in the world. We review the social determinants underpinning FASD in South Africa and add critical insight from an intersectional feminist perspective. We undertook a scoping review, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines. Drawing from EBSCOhost and PubMed, 95 articles were screened, with 21 selected for analysis. We used the intersectionality wheel to conceptualize how the social and structural determinants of FASD identified by the literature are interconnected and indicative of broader inequalities shaping the women and children affected. Key intersecting social determinants that facilitate drinking during pregnancy among marginalized populations in South Africa documented in the existing literature include social norms and knowledge around drinking and drinking during pregnancy, alcohol addiction and biological dependence, gender-based violence, inadequate access to contraception and abortion services, trauma and mental health, and moralization and stigma. Most of the studies found were quantitative. From an intersectional perspective, there was limited analysis of how the determinants identified intersect with one another in ways that exacerbate inequalities and how they relate to the broader structural and systemic factors undermining healthy pregnancies. There was also little representation of pregnant women’s own perspectives or discussion about the power dynamics involved. While social determinants are noted in the literature on FASD in South Africa, much more is needed from an intersectionality lens to understand the perspectives of affected women, their social contexts and the nature of the power relations involved. A critical stance towards the victim/active agent dichotomy that often frames women who drink during pregnancy opens up space to understand the nuances needed to support the women involved while also illustrating the contextual barriers to drinking cessation that need to be addressed through holistic approaches.

Prevalence of risky alcohol use behavior and associated factors in pregnant antenatal care attendees in Debre Berhan, Ethiopia, 2018

BACKGROUND

National Institute of alcohol and alcoholism define Problem/risky use of alcohol as drinking in a way that can negatively impact our health and life, but the body is not physically dependent on the substance. Risky alcohol use behavior is harmful to both the fetus and the mother such as maternal alcohol intoxication and alcohol use disorder, abortion, stillbirth, low birth weight, and prematurity. This study is aimed to assess the prevalence of risky alcohol use for both the mother and the fetus during pregnancy among mothers who have used alcohol at least once in the current pregnancy.

METHODS

Institution based cross-sectional study was conducted among a total of 380 mothers who have used alcohol at least once during the current pregnancy. The participants were selected using a systematic random sampling technique. Both Bivariable and Multivariable Binary Logistic Regression models were done to identify associated factors. Odds Ratios with their 95% Confidence Interval was computed and variables with a p-value < 0.05 during multivariable analysis were considered significantly associated factors.

RESULTS

A total of 380 mothers who used alcohol at least once (any amount) in the current pregnancy were included in the study and further interviewed for risky alcohol use behavior with a response rate of 100%. The overall prevalence of risky alcohol use behavior was 16.1% (95% CI = 12.1, 19.7). Having poor social support, having moderate to severe depression and anxiety, having diagnosed family history of mental illness, having a history of abortion were important factors which significantly associated with risky alcohol use behavior.

CONCLUSION

Significant proportions of pregnant mothers were risky alcohol drinkers. It will be better if screening of any amount of alcohol use during pregnancy and providing health education (about the risk of alcohol use) for all pregnant women who attend antenatal care follow up.

Actual and predicted prevalence of alcohol consumption during pregnancy in the WHO African Region

OBJECTIVE

To estimate the prevalence of alcohol consumption and binge drinking during pregnancy among the general population in the World Health Organization (WHO) African Region, by country.

METHODS

First, a comprehensive systematic literature search was performed to identify all published and unpublished studies. Then, several meta-analyses, assuming a random-effects model, were conducted to estimate the prevalence of alcohol consumption and binge drinking during pregnancy among the general population for countries in the WHO African Region with two or more studies available. Lastly, for countries with less than two studies or no known data predictions were obtained using regression modelling.

RESULTS

The estimated prevalence of alcohol consumption during pregnancy among the general population ranged from 2.2% (95% confidence interval [CI]: 1.6-2.8%; Equatorial Guinea) to 12.6% (95% CI: 9.9-15.4%; Cameroon) in Central Africa, 3.4% (95% CI: 2.6-4.3%; Seychelles) to 20.5% (95% CI: 16.4-24.7%; Uganda) in Eastern Africa, 5.7% (95% CI: 4.4-7.1%; Botswana) to 14.2% (95% CI: 11.1-17.3%; Namibia) in Southern Africa, 6.6% (95% CI: 5.0-8.3%; Mauritania) to 14.8% (95% CI: 11.6-17.9%; Sierra Leone) in Western Africa, and 4.3% (95% CI: 3.2-5.3%; Algeria) in Northern Africa.

CONCLUSIONS

The high prevalence of alcohol consumption and binge drinking during pregnancy in some African countries calls for educational campaigns, screening and targeted interventions for women of childbearing age.