Prevalence and Predictors of Alcohol Consumption during Pregnancy in South-Eastern Nigeria

Preconception health risks among women of reproductive age in Sub-Saharan Africa: a systematic review of implications for preconception care

INTRODUCTION

Although preconception health risks are strongly linked to adverse pregnancy outcomes and offer opportunities to improve women's health, consolidated evidence remains limited in Sub-Saharan Africa (SSA). This review aims to synthesize evidence on preconception health risks in SSA, a region with the highest global rates of maternal and neonatal mortality and morbidity.

METHODS

We searched PubMed/MEDLINE, African Index Medicus, ScienceDirect, and Google Scholar for studies published up to June 30, 2023. Two reviewers independently assessed study quality using Joanna Briggs Institute tools. Studies with at least one modifiable preconception risk were included. Due to inconsistencies in outcome measurements, participant variability, and high heterogeneity, a meta-analysis was not reported. Findings were summarized in text, figures, and tables.

RESULTS

In the review, researchers selected 83 articles from a total of 3,425 retrieved articles. Overall, this review revealed a high proportion of preconception health risks among the participants which includes underweight (0.64% to 36.2%), overweight (8.3% to 76.7%), anemia (36.7% to 58.1%), unintended pregnancy (4.2% to 94.3%), alcohol intake (5.3% to 68.7%), smoking (1.1% to 20.3%), chewing khat (9.9% to 27.6%), history of chronic medical conditions (2% to 16.6%), a history of adverse pregnancy outcomes (11% to 51.9%), sexually transmitted infections (1.3% to 29.2%), psychosocial distress (13.9% to 60%), and intimate partner violence (6.7% to 43.7%).

CONCLUSION

The systematic review found that numerous women in  SSA encounter various preconception health risks factors. Therefore, the governments of respective countries need to give emphasis and adopt policies to integrate preconception care services in to the existing healthcare system so that both financial and human resources need to be mobilized. There is gaps in research, as the true burden of preconception health risks may be underestimated due to fragmented risk assessment methods.

REVIEW REGISTRATION

(PROSPERO: CRD42023446801).

Maternal substance use during pregnancy and associated factors in Adama, central Ethiopia

Background

Substance use, including tobacco, alcohol, khat, and illicit drugs, is a significant preventable contributor to the global burden of disease. Women are particularly vulnerable during their reproductive years, with substance use during pregnancy posing serious risks to maternal and fetal health. Therefore, this study aimed to assess of prevalence of substance use and determine associated risk factors among pregnant women in Adama, Central Ethiopia.

Methods

A health facility-based cross-sectional study was conducted among 472 pregnant women. Participants were selected using a systematic sampling technique. Data were collected through an interviewer-administered structured questionnaire. Binary logistic regression was employed to model the association between substance use and explanatory variables. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were used to estimate the strength of association. Statistical significance was determined at a p-value < 0.05.

Result

The overall prevalence of substance use during pregnancy was 22.0% (95% CI: 18.2-26.0). Unplanned pregnancy (AOR = 3.49, 95% CI: 1.23-9.89), pre-pregnancy substance use (AOR = 24.16, 95% CI: 11.49-40.82), husband/partner substance use (AOR = 4.51, 95% CI: 1.44-14.20), and ever heard about the side effects of substance use (AOR = 14.60, 95% CI: 5.31-17.65) were factors significantly associated with maternal substance use during pregnancy.

Conclusion

Nearly one in four pregnant women reported using substances during pregnancy. Educational and counseling interventions during antenatal care should emphasize the risks of substance use on maternal health and fetal development, particularly targeting women with a history of substance use or unplanned pregnancies. Efforts should also involve partners and employ community-based strategies to raise awareness of these risks.

Magnitude and risk factors of khat, alcohol and cigarettes use among pregnant women in Africa: a systematic review and meta-analysis

BACKGROUND

The use of khat, alcohol, and cigarettes during pregnancy is a serious public health problem associated with harmful outcomes for the fetus and the mother's health. Studies that investigated khat, alcohol, and cigarettes usage during pregnancy yielded varied and contradictory results. This study used a systematic review and meta-analysis to estimate the pooled prevalence and associated factors of khat, alcohol, and cigarettes use among pregnant women in Africa.

METHODS

A review of eligible studies was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. This review has been registered in PROSPERO with protocol ID CRD42021289074. Literature published in English from January 1, 2002 to November 30, 2021 was retrieved from PubMed, Google Scholar, Cochrane, HINARI, African Journal Online, and Science Direct databases. The quality of included articles was assessed using the Joanna Briggs Institute's (JBI) critical appraisal checklist. The I2 statistic and Cochran's Q test were used to assess the presence of heterogeneity between studies. To assess publication bias, a funnel plot and Egger's regression test were utilized. The random effect model was used to estimate the summary prevalence and the corresponding 95% confidence interval (CI) of risk factors for khat, alcohol, and cigarettes use.

RESULTS

Out of the 1509 studies identified, 71 met the inclusion criteria. The pooled prevalence of khat chewing, alcohol drinking, active smoking, and secondhand smoke exposure during pregnancy was 18.93%, 22.20%, 11.85%, and 43.45%, respectively. The subgroup analysis by UN sub-region showed the highest pooled prevalence of alcohol use during pregnancy in Middle Africa (25.69%) and the lowest in Northern Africa (1.10%). Several factors were identified as risk factors for alcohol use, including low educational level, younger age women, pre-pregnancy alcohol use, unplanned pregnancy, history of abortion, poor social support, mental distress, poor knowledge on alcohol risks, and partner alcohol use.

CONCLUSION

This review indicated that the pooled magnitude of khat, alcohol and cigarette use during pregnancy was higher in Africa. Substance use screening and brief interventions (SBI) should be routinely delivered in antenatal care settings to reduce pregnant women's substance use.

Alcohol consumption and tobacco exposure among pregnant women in Ibadan, Nigeria

BACKGROUND

Alcohol consumption and tobacco exposure during pregnancy are hazardous behaviours which are increasing significantly in low and middle-income countries, including sub-Saharan Africa. However, they have received little attention in Nigeria's maternal health research and services. The prevalence, pattern and predictors of alcohol consumption and tobacco exposure among pregnant women in Ibadan, Nigeria, were investigated.

METHODS

This is a part of a prospective cohort study among pregnant women in Ibadan, Nigeria (Ibadan Pregnancy Cohort Study (IbPCS), which investigated the associations between maternal obesity, lifestyle characteristics and perinatal outcomes in Ibadan. Alcohol consumption and tobacco exposure of 1745 pregnant women were assessed during enrollment by self-reports using an interviewer-administered questionnaire. Bivariate and multiple logistic regression analyses examined the associations at a 5% level of statistical significance.

RESULTS

The prevalence of pre-pregnancy alcohol consumption and alcohol consumption during pregnancy were 551 (31.7%) and 222 (12.7%), respectively, i.e. (one in every eight pregnancies is exposed to alcohol). Palm wine (52%) and beer (12%) were the most common alcohol consumed among pregnant women. The predictors of alcohol consumption during were pre-pregnancy alcohol use [AOR = 10.72, 95% CI: 6.88-16.70) and religion i.e. Muslims were less likely to consume alcohol during pregnancy compared to Christians: [AOR = 0.60, 95% CI: 0.40-0.92). The prevalence of tobacco exposure in the index pregnancy was 64 (3.7%), i.e. one in every 27 pregnancies is exposed to tobacco. In contrast, cigarette smoking, second-hand smoke and smokeless tobacco were 0.4, 1.7 and 1.8%, respectively. Pre-pregnancy cigarette smoking was reported by 33(1.9%) and was the most significant predictor [AOR = 12.95; 95% CI: 4.93, 34.03) of tobacco exposure during pregnancy in our study population.

CONCLUSIONS

Alcohol consumption and tobacco exposure are not uncommon and have been an ongoing but neglected threat to maternal and child health in Nigeria. Alcohol and tobacco control policy and programmes to prevent the use among pregnant and reproductive-age women in Nigeria should be implemented primarily during antenatal care.

Assessment of alcohol utilization during pregnancy and its associated factors among reproductive women in Mecha Woreda of North Western Ethiopia

Background

Pregnancy is a time when women are making many changes, including the patterns of alcohol consumption. Alcohol consumption during pregnancy encourages the risks of mothers and unborn child. Alcohol use during pregnancy can result in prematurity, brain damage, growth restriction, developmental delay and social, emotional and behavioral deficits, particularly in developing countries.

Methods

A community based cross-sectional study was employed. Structured questionnaires were used to assess the prevalence of alcohol utilization, and socio-demographic as well as economic characteristics of women who have pregnancy experience. Both bivariate and multivariate logistic regression models were employed. Descriptive and inferential statistical analyses were used.

Results

The study results showed that the prevalence of alcohol use and response rate was high. Factors like age group of women from 35–49 years (AOR = 0.221; 95%CI = 0.057–0.856), illiterate women(AOR = 2.697;95% CI = 1.207–6.026), currently pregnant (AOR = 0.139;95%CI = 0.057 0.343), women currently use alcohol (AOR = 0.021; 95% CI = 0.009 0.049), alcohol use pre-pregnancy (AOR = 0.016; 95% CI = 0.006–0.042), women drinking alcohol with husband during pregnancy (AOR = 0.228; 95% CI = 0.085–0.614), the risk of alcohol consumption during pregnancy is low(AOR = 0.262;95%CI = 0.074–0.925), risk alcohol consumption during pregnancy is medium (AOR = 0.296;95% CI = 0.103–0.849),utilization of alcohol during pregnancy is valuable (AOR = 0.104; 95%CI = .0.013–0.833) were statistically associated with alcohol use during pregnancy.

Conclusion

The result inferred that there is a high level of alcohol use throughout pregnancy. Due to the differences in the culture and communal means of drinking alcohol, the frequency of alcohol consumption during pregnancy varies among different regional studies and countries.

Alcohol use during pregnancy in post-conflict northern Uganda: pregnant women's experiences and provider perceptions

BACKGROUND

Alcohol use during pregnancy has been associated with several birth defects and developmental disabilities generally known as Fetal Alcohol Spectrum Disorders (FASD). Contextual in-depth understanding on why women drink while pregnant is scarce. For this reason, we explored pregnant women's experiences, knowledge, attitudes as well as provider perceptions regarding prenatal alcohol consumption to inform interventions meant to address alcohol-exposed pregnancies in post-conflict settings.

METHODS

In the months of May and June 2019, 30 in-depth interviews were conducted with pregnant mothers who reported maternal alcohol use during pregnancy. In addition 30 Key informant interviews were carried out with health workers providing Antenatal Care services (ANC) in health facilities in Gulu, Kitgum and Pader districts in Northern Uganda. Data was recorded, transcribed and subjected to thematic content analysis.

RESULTS

Women reported diverse views regarding maternal alcohol use during pregnancy. Whereas some felt it was favourable, others had misgivings about it. There was marked variability in knowledge on dangers of drinking during pregnancy. In this study, women reported that they found themselves in alluring situations that predisposed them to drinking alcohol. These included brewing alcohol as a source of livelihood, pregnancy-induced craving for alcohol, and participation in cultural festivities that are characterised by eating and drinking alcohol. Nonetheless, women who consume alcohol during pregnancy were not held in high esteem in the Acholi communities. Various prevention interventions reportedly existed in communities to address alcohol use during pregnancy including ANC health education, public debates, radio talk shows, community health worker group and individual counselling, and local council by laws.

CONCLUSIONS AND RECOMMENDATIONS

Pregnant mothers in post-conflict northern Uganda regard alcohol as a remedy to some of the social, economic and health challenges they face. Hence they continue drinking even during pregnancy because of the existing socio-cultural norms that promote it. The findings of this study demonstrate a need for sensitising communities in which pregnant women live so they can provide a supportive environment for mothers to abstain from alcohol consumption during pregnancy. Health care providers should ensure pregnant women consistently receive accurate and honest messages on the dangers of drinking during pregnancy so they can make informed decisions.

Pregnant women utilization of dental services: still a challenge in low resource setting

Background

Poor oral health in pregnancy can be associated with poor pregnancy outcome, however, dental consultation among pregnant women appears to be low.

Methods

This was a questionnaire-based study of 413 women who attended the antenatal clinic of University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu. The information obtained was analyzed using SPSS version 22. A p-value of less than 0.05 was considered statistically significant.

Results

Only 36 (8.7%) of the respondents had dental consultations in index pregnancy for complaints such as tooth ache and decay (66.7%) and pain as well as swelling of the gum (33.3%). The most common reason given for not visiting a dentist during the index pregnancy was the visit not being relevant to their pregnancy outcome (69.2%). After counseling them, only 249 (60.3%) agreed to have dental consultation during subsequent pregnancies. The relationship between visiting the dentist and place of residence (< 0.001), occupation (0.019) and frequency of brushing/ changing of brush (0.005, < 0.001 respectively) were statistically significant.

Conclusion

The prevalence of dental consultation during pregnancy is very low. Pregnant women should be encouraged to have routine dental consultation with oral health counseling and check-up incorporated as part of routine antenatal care.

Individual and community-level predictors of maternal alcohol consumption during pregnancy in Gondar town, Northwest Ethiopia: a multilevel logistic regression analysis

BACKGROUND

Prenatal alcohol consumption is a serious public health concern that is considered as one of the preventable risk factors for neonatal and childhood morbidity and several adverse pregnancy outcomes. This study aimed to determine the individual- and community-level predictors of maternal alcohol consumption during pregnancy in Gondar town, Northwest Ethiopia.

METHODS

A community-based cross-sectional study was conducted among pregnant women in Gondar town from 13 June to 24 August 2019. A cluster random sampling technique was used to select 1237 pregnant women. Data collection was carried out using the AUDIT-C pretested standard questionnaire. Bivariable and multivariable multilevel logistic regression analyses were computed to identify predictors of alcohol consumption using the odds ratio, 95% CI, and p-value < 0.05.

RESULTS

The prevalence of alcohol consumption during pregnancy was found to be 30.26% (95% CI: 27.74%, 32.91%). The study revealed that pregnant women who have a low knowledge level on harmful effect of alcohol consumption (AOR = 3.2; 95% CI: 1.9, 5.4), positive attitude towards alcohol consumption (AOR = 7.5; 95% 5, 11), history of pre-pregnancy alcohol consumption (AOR = 4.8; 95% CI: 3.4, 6.9), whose partner consume alcohol (AOR = 3.9; 95% CI: 2.5, 6), a perception that alcohol consumption is culturally or socially acceptable (AOR = 3.6; 95% CI: 2.4, 5.3), who were encouraged by their partners to consume alcohol (AOR = 4; 95% CI: 1.9, 8) were significantly associated with pregnancy alcohol consumption. Concerning the community-level characteristics, who had not ever heard/media exposure about the risk of alcohol drinking during pregnancy (AOR = 3; 95% CI: 1.7, 5.5), and who were from low community women's education attainment (AOR = 4; 95% CI: 2.2, 7.7) were statistically significant predictors of alcohol consumption during pregnancy.

CONCLUSIONS

The study revealed that alcohol consumption during pregnancy is prevalent in Gondar town. Both individual- and community-level predictors were found to be associated with alcohol consumption during pregnancy. Policymakers may take into account these predictors for individual and community-based interventions to which our results appear to point.

Magnitude and associated factors of substance use among pregnant women attending antenatal care in public hospitals of eastern Ethiopia

BACKGROUND

Use of substances like alcohol, tobacco and khat during pregnancy can bring miscarriage, prematurity, neurodevelopmental problems, sudden infant death syndrome and others. There are limited studies on the magnitude and associated factors of substance use among pregnant women in Eastern Ethiopia. Therefore, the aim of this study was to assess the magnitude and associated factors of substance use among pregnant women attending antenatal care in public hospitals of Easttern Ethiopia, 2019.

METHOD

Hospital based cross-sectional study was employed on 510 pregnant women attending ANC at public hospitals of Eastern Ethiopia (Jigjiga, Dire Dawa and Harar towns). Data were collected from the study participants that were selected using systematic sampling method from each public hospital. The data were collected through interviewer administered structured questionnaire. Binary logistic regressions with 95% confidence interval were used to determine the degree of association between covariates and outcome variable. Multicollinearity between independent variables by using the standard error was checked. The goodness of fit was tested by Hosmer-Lemeshow statistic and Omnibus tests.

RESULTS

Out of 526 participants, a total of 510 study participants were involved in this study thereby making a response rate of 96.9%. In this study, the magnitude of substance use among pregnant women attending ANC was 26.5% (95% CI: 22.7, 30.6%). Among the overall pregnant mothers, 100 (19.6%) chewed khat, 48 (9.4%) drank alcohol, 12 (2.4%) used tobacco products and 28(20.7%) were dual substance users. Pre pregnancy substance use (AOR = 27.25, CI: 14.107-52.66), partner substance use (AOR = 3.704 CI: 1.839-7.464), family substance use (AOR = 3.447 CI: 1.69-7.031) and the amount of monthly household income (AOR = 3.397, 95% CI: 1.316-8.766) were found to be statistically significant and positively associated with substance use during pregnancy.

CONCLUSION

The magnitude of antenatal substance use in the study area was 26.5%. Pre- pregnancy substance use, partner substance use, monthly house hold income and family substance use were found to be positively associated with substance use during pregnancy. Therefore, health education which is inclusive of child bearing age women with their partner and family may be helpful to decrease antenatal substance use during pregnancy.

Consumption of alcohol and binge drinking among pregnant women in Addis Ababa, Ethiopia: Prevalence and determinant factors

INTRODUCTION

People in Ethiopia, including pregnant women, highly consume both home-made and manufactured alcohol beverages due to lack of awareness about the harmful effect of risky alcohol use, and cultural acceptance of alcohol consumption. Alcohol consumption and other hazardous patterns of use like binge drinking have tremendous adverse effects on fetus and mothers. Therefore, this study aimed to assess the magnitude of alcohol consumption, binge drinking and its determinants among pregnant women residing in Kolfe sub-city, Addis Ababa, Ethiopia.

METHODS

Institutional based cross-sectional study was conducted among a total of 367 pregnant women. The participants were selected using a systematic random sampling method. Data were collected through a structured questionnaire. A binary logistic regression was conducted using SPSS version 20 software to identify determinants of alcohol consumption and binge drinking. A p-value < 0.05 was used to declare a statistical significance in multiple logistic regression. The results were described using adjusted odds ratio with a 95% confidence interval.

RESULTS

This study revealed that the prevalence of alcohol consumption, binge drinking, and weekly alcohol consumption of four or more units among pregnant women was 39.78%, 3.54% and 4.9%, respectively. Not having formal education [AOR 95% CI = 8.47 (2.42, 29.62), having primary education [AOR 95% CI = 4.26 (1.23, 14.74), being a housewife [AOR 95% CI = 4.18 (2.13, 8.22), having an unplanned pregnancy [AOR 95% CI = 2.47(1.33, 4.60), having a history of abortion [AOR 95% CI = 3.33 (1.33, 6.05)], not having awareness about the harmful effect of alcohol consumption [AOR 95% CI = 4.66 (2.53, 8.61)], and not having family social support [AOR 95% CI = 2(1.14,3.53) were determinants of alcohol consumption among pregnant women.

CONCLUSIONS

This study found a high level of alcohol consumption among pregnant women. Interventions to create awareness on the harmful effects of alcohol are needed. Moreover, strengthening social support during pregnancy and family planning services to reduce unplanned pregnancy and abortion should be considered.

Caffeine, alcohol, khat, and tobacco use during pregnancy in Butajira, South Central Ethiopia

Background

The use of excessive caffeine and consumption of alcohol, cigarette, and khat during pregnancy can result in adverse health effects on the fetus. The World Health Organization (WHO) recommends a daily caffeine intake not exceeding 300 mg. Likewise, pregnant women are recommended to avoid alcohol, khat and tobacco use. However, the prevalence’s of the use of substances among pregnant women were not well studied in developing countries such as Ethiopia. Therefore, the study aimed to estimate the prevalence of caffeine and alcohol consumption, khat chewing, and tobacco use during pregnancy and identify key factors associated with excess caffeine consumption.

Methods

We conducted a community based cross-sectional study and used a random sampling technique to recruit 352 pregnant women. We adapted a questionnaire from Caffeine Consumption Questionnaire-Revised (CCQ-R), Alcohol Use Disorder Identification Test (AUDIT), Global Adult Tobacco Survey (GATS), and Ethiopian Demographic Health Survey 2016 for caffeine, alcohol consumption, tobacco use, and khat chewing assessment, respectively. We conducted non-consecutive two days 24-hour recall to determine the habitual intake of caffeine from caffeinated beverages and foods. Prevalence with 95% confidence interval was estimated for excess caffeine intake per day, alcohol consumption, khat chewing, and passive tobacco smoking. We ran a multivariable binary logistic regression model to identify factors associated with excess caffeine intake.

Results

Almost all pregnant women (98.2%) consumed caffeine as estimated using the 2 days 24-hour average. The median daily caffeine intake was 170.5 mg and ranged from 0.00 mg to 549.8 mg per day. In addition, 17.6% (95% CI: 13.9%, 22.0%) of them had a daily caffeine consumption of 300 mg and above exceeding the WHO recommended daily caffeine intake during pregnancy. The prevalence of alcohol consumption and Khat chewing were 10.0% (95% CI: 7.2%, 13.7%) and 35.8% (95% CI: 30.8, 41.0%) respectively. None of the pregnant women were active tobacco smokers. However, 23.2% (95% CI: 19.0, 28.0%) were passive tobacco smokers. We found that pregnant women in the richest wealth quintile (AOR = 3.66; 95% CI: 1.13, 11.88), and the first trimester of pregnancy (AOR = 4.04; 95% CI: 1.26, 13.05) had higher odds of consuming excessive caffeine.

Conclusions

The study showed a considerable magnitude of substance use among pregnant women in the study area. Given this findings, we recommend, programs and services focusing on pregnant women to consider addressing substance use.

Alcohol consumption and its associated factors among pregnant women in Sub-Saharan Africa: a systematic review and meta-analysis' as given in the submission system

Background

Alcohol consumption during pregnancy represents a significant public health concern. It has several adverse health effects for both the mother and the developing fetus. This study aimed to estimate the pooled prevalence and the effect size of associated factors of alcohol consumption during pregnancy in Sub-Saharan Africa countries.

Methods

The results of the review were reported based on the Preferred Reporting Items for Systematic Review and Meta-Analysis statement (PRISMA) guideline and, it was registered in the Prospero database, number CRD42019127103. The available primary studies were collated from different databases: PubMed, CINAHL, Cochrane Library, PsycINFO, Google Scholar, African Journals Online and Centre for Addiction and Mental Health Library. The main search terms were [((alcohol consumption) OR (alcohol drinking) OR (alcohol use) OR (ethanol use) OR (alcohol exposure)) AND ((pregnant women) OR (pregnant mother) OR (during pregnancy)) AND (Sub-Saharan Africa)]. We used the Joanna Briggs Institute (JBI) for critical appraisal of studies. The random-effects model was computed to estimate the pooled prevalence. Heterogeneity between studies was checked using the I² statistic and the Cochrane Q test.

Results

The review resulted in 963 original studies after searching various databases, and finally 37 studies in qualitative synthesis and 30 articles in the systematic review and meta-analysis were included. The overall summary estimate of the prevalence of alcohol consumption during pregnancy was found to be 20.83% (95% CI: 18.21, 23.46). The pooled estimate of meta-analysis showed that depression (OR: 1.572; 95% CI: 1.34, 1.845), partners’ alcohol use (OR: 1.32, 95% CI: 1.11, 1.57), knowledge on harmful effect of alcohol consumption (OR: 0.36, 95% CI: 0.29, 0.45) and, unplanned pregnancy (OR: 2.33, 95% CI: 1.17, 4.63) were statistically significant factors with alcohol consumption during pregnancy.

Conclusions

The result showed that there was high alcohol consumption during pregnancy in Sub- Saharan Africa. Alcohol consumption during pregnancy was associated with depression, partners’ alcohol use, unplanned pregnancy and knowledge of the harmful effects of alcohol consumption. Therefore, this will be a basis for public policy and resource allocation for prevention initiatives.