Burden of Tobacco in Pakistan: Findings From Global Adult Tobacco Survey 2014

Use of Smokeless Tobacco Before Conception and Its Relationship With Maternal and Fetal Outcomes of Pregnancy in Thatta, Pakistan: Findings From Women First Study

INTRODUCTION

Smokeless tobacco (SLT) consumption during pregnancy has adverse consequences for the mother and fetus. We aimed to investigate the effects of maternal pre-pregnancy SLT consumption on maternal and fetal outcomes in the district of Thatta, Pakistan.

AIMS AND METHODS

We conducted a secondary data analysis of an individual randomized controlled trial of preconception maternal nutrition. Study participants were women of reproductive age (WRA) residing in the district of Thatta, Pakistan. Participants were asked questions regarding the usage of commonly consumed SLT known as gutka (exposure variable). Study outcomes included maternal anemia, miscarriage, preterm births, stillbirths, and low birth weight. We performed a cox-regression analysis by controlling for confounders such as maternal age, education, parity, working status, body mass index, and geographic clusters.

RESULTS

The study revealed that 71.5% of the women reported using gutka, with a higher proportion residing in rural areas as compared with urban areas in the district of Thatta, Pakistan. In the multivariable analysis, we did not find a statistically significant association between gutka usage and anemia [(relative risk, RR: 1.04, 95% confidence interval, CI (0.92 to 1.16)], miscarriage [(RR: 1.08, 95% CI (0.75 to 1.54)], preterm birth [(RR: 1.37, 95% CI (0.64 to 2.93)], stillbirth [(RR: 1.02, 95% CI (0.39 to 2.61)], and low birth weight [(RR: 0.96, 95% CI (0.72 to 1.28)].

CONCLUSIONS

The study did not find an association between gutka usage before pregnancy and adverse maternal and fetal outcomes. In the future, robust epidemiological studies are required to detect true differences with a dose-response relationship between gutka usage both before and during pregnancy and adverse fetomaternal outcomes.

IMPLICATIONS

While most epidemiological studies conducted in Pakistan have focused on smoking and its adverse outcomes among males, none of the studies have measured the burden of SLT among WRA and its associated adverse outcomes. In addition, previously conducted studies have primarily assessed the effect of SLT usage during pregnancy rather than before pregnancy on adverse fetal and maternal outcomes. The current study is unique because it provides an insight into the usage of SLT among WRA before pregnancy and investigates the association between pre-pregnancy SLT usage and its adverse fetomaternal outcomes in rural Pakistan.

An overview of tobacco control interventions in the Global South

Purpose

The Framework Convention on Tobacco Control (FCTC) has been broadly successful but less so in the Global South. This paper aims to effectively design interventions that to mitigate tobacco-related harms in the Global South, further understanding of interventions in this environment will be helpful, in line with FCTC recommendations. The first objective was to locate and review all published literature relating to tobacco control interventions in the Global South. The second objective was to provide information on research trends within Global South tobacco control interventions.

Design/methodology/approach

A literature search was conducted across six databases.

Findings

Despite the FCTC detailing the significance of the research, studies are still lacking in the Global South. There are significant research gaps such as longitudinal studies, harm reduction and randomized controlled trials.

Research limitations/implications

Limitations arose from differences in study designs of reviewed studies, making it more complex to assess all studies under the same rubric.

Practical implications

Results indicate significant potential for tobacco control interventions in the Global South, potentially moving toward FCTC goals, but also highlight several areas of concern.

Originality/value

There is much evidence on the effectiveness of tobacco control in the Global North, especially in some parts of Europe and the USA. However, the evidence base in the Global South is far more limited. This paper provides an overview of Global South tobacco control interventions and suggests areas of concern, in line with the FCTC 15 years on.

The scope of tobacco cessation randomized controlled trials in low- to middle-income countries: protocol for a scoping review

BACKGROUND

Tobacco consumption is the leading cause of preventable death globally. The global mortality burden of tobacco use lies predominantly in low- to middle-income countries (LMICs). There is much evidence on the effectiveness of tobacco cessation RCTs in high-income nations. However, the evidence base in LMICs is far more limited. To effectively design randomized controlled trials (RCTs) that mitigate tobacco-related harms in LMICs, further understanding of RCTs in this environment will be helpful. We will provide quality evidence regarding the scope of tobacco cessation RCTs in LMICs.

METHODS

A scoping review of tobacco cessation RCTs will be conducted. MEDLINE, Embase, PsycINFO, Global Health, Web of Science and Sociological Abstracts will be searched to capture current literature. We will review RCTs that have already been done on tobacco cessation in the LMICs. The key outcome will be tobacco cessation in adults. Examples of the key outcome include smoking abstinence and reduction of tobacco use. Study selection will conform to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines and study quality assessed with a modified version of the Cochrane Collaboration's instrument.

DISCUSSION

As researchers attempt to minimize the harms from tobacco in LMICs, they need to be aware of scientific evidence to develop RCTs to achieve their aim. The review will complement the evidence base on tobacco cessation in LMICs.