Tobacco Use during Pregnancy and Its Associated Factors in a Mountain District of Eastern Nepal: A Cross-Sectional Questionnaire Survey

Tobacco use in currently married pregnant & lactating women in India; key findings from the National Family Health Survey-5

Background

Tobacco use among pregnant and lactating women carries dangerous repercussions for women and their children. Limited information is available at the national level on the prevalence and determinants of tobacco use in this vulnerable sub-population of women. This study aims to estimate the prevalence of tobacco use among currently married pregnant and lactating women and its association with demographic, behavioural and regional determinants in India.

Methods

A cross-sectional study was conducted during which secondary data from the fifth National Family Health Survey, 2019-2020, was analysed. The prevalence and associated 95% confidence intervals (CI) for different forms of tobacco use were documented among currently married pregnant and lactating women. Adjusted Odds Ratio and 95% CI were calculated using multivariate logistic regression to identify the independent factors associated with different forms of tobacco use among respondents after applying sampling weights.

Findings

In India, the prevalence of tobacco use among currently married pregnant and lactating women was 2.5% and 3.2%, respectively, with over 85% of tobacco-using currently married pregnant (85.6%) and lactating (85.6%) women using smokeless tobacco (SLT) only. Age group 30-34 years, working women and the richest wealth quintile were found to be independent predictors of smoked tobacco use among currently married pregnant women. In contrast, among the currently married lactating women, the middle wealth quintile and South Indian region were found to be independent predictors of smoked tobacco use.

Interpretation

Smokeless tobacco was found to be the most prevalent type of tobacco consumed by pregnant and lactating women in India. There is an urgent need to curb tobacco use in this vulnerable sub-population of women in the country by sensitising them to the harmful consequences of tobacco use by integrating tobacco awareness and cessation services during routine ante-natal examinations.

Funding

No funding was received for this study.

Second hand smoking and tobacco use among pregnant women in Yatinuwara Medical Officer of Health (MOH) area in Sri Lanka

This study was aimed to assess the prevalence and factors associated with second hand smoking (SHS) and tobacco use among pregnant women in Yatinuwara Medical Officer of Health area in Kandy district, Sri Lanka. This was a descriptive cross-sectional study using 390 pregnant women. Data were collected through a pre-tested, self-administered questionnaire. Fifty-four-point four percent were exposed to the SHS. Prevalence of smoking during pregnancy was 0.5% and eight women used smokeless tobacco (SLT). SHS was significantly associated with the age of the mother and family income. Women's age, monthly income, husband's education, husband's occupation, women's age at marriage and trimester of pregnancy were significantly associated with tobacco use. In conclusions, prevalence of SHS was high but tobacco use was low in pregnant women. An effective training program should be designed to educate pregnant women as well as their husbands on adverse effects of tobacco use and SHS during pregnancy.

Prevalence of tobacco use and associated risk factors among pregnant women in Maracha District, Uganda

Globally, tobacco use has become the largest public health threat that kills around 7 million people annually, of which about 6 million deaths are due to direct tobacco use, and 890,000 are attributed to passive smoking. This study assessed prevalence and associated risk factors of tobacco use among pregnant women, 15 to 49 years. Health facility-based analytical cross-sectional study was conducted among 199 pregnant women using purposive sampling technique and convenient sampling technique for the respondents. Chi-square test and binary logistic regression were used to compare quantitative data at a 95% CI. Prevalence of tobacco use among respondents was 39.2%. The results gives those who starting to smoke at more than 30 years (p≤0.001), agreeing that smoking makes pregnant women feel they have total control over their health and life (p≤0.008); the likelihood of tobacco use reduced among pregnant women aged 20-29 years (p≤0.032), those disagreeing that tobacco use as a sign of maturity (p≤0.003) and disagreeing that smoking can help calm nerves, control moods, and alleviates stress (p≤0.002). However, cultural factors that reduced the chances of smoking in pregnancy include smoking more than five times a day (p≤0.01) and smoking cigarettes (p≤0.017), were statistically associated with smoking. High prevalence of tobacco use among pregnant women in Kijomoro and Eliofe health center III was recorded. Thus, there is need to sensitize pregnant women about tobacco-related health problems on them and their unborn children.

The effect of substance use during pregnancy on neonatal outcomes in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Substance use during pregnancy mainly khat chewing (20%) and alcohol drinking (18.1%) are commonly practiced in Ethiopia. However, the effect of using these substances has not been studied nationally yet. Thus, this study was aimed to examine national evidence about the effect of substance use during pregnancy on birth outcome in the country, 2020.

METHODS

Primary studies were accessed through Google scholar, HINARI, SCOPUS and PubMed databases. The methodological and evidence quality of the included studies were critically appraised by the modified Newcastle-Ottawa quality assessment tool scale adapted for observational studies. From eligible studies, two authors extracted author/year, study region, study design, sample size and reported effect of antenatal substance use on birth outcome on an excel spreadsheet. During critical appraisal and data extraction, disagreements between the two authors were resolved by the involvement of a third author. The extracted data were then exported to stata version 14. Effect sizes were pooled using the fixed-effects model due to homogenous primary studies (I2 = 0.0%). Presence of publication bias was detected from asymmetry of funnel plot and statistically significant Egger's test (p = 0.000).

RESULTS

In this systematic review and meta-analysis, a total of 5,343 mother-neonate pairs were included from 15 studies. Alcohol, khat, cigarette and narghile were used during pregnancy, and significant adverse birth outcomes attributable to these substances were reported. From the pooled effect of alcohol use, drinking mothers were twice (95%CI: AOR = 2.16; 1.16, 3.17) likely to have newborns with birth defect; 9 times (95% CI: AOR = 9.39; 2.84, 15.94) more prone to own low birth weight neonates; and 1.9 times more prone to deliver preterm neonates (95% CI: AOR = 1.93; 0.52, 3.33) than the nondrinkers. Khat users were 2.4 times (95%CI: AOR = 2.4; 1.11, 5.19) more likely to have congenitally defected neonates; and 3.1 times (95%CI: AOR = 3.19; 1.01, 5.37) more risked to possess low birth weight neonates. Furthermore, antenatal cigarette smokers (95% CI: AOR = 4.36 (1.75, 6.98)) and narghile users (95% CI: AOR = 20.1; 3.94, 103) were at 4 and 20 times more likelihood of having low birth weight neonates as compared to their counterparts.

CONCLUSION

Prematurity, low birth weight and congenital malformation were the investigated adverse effects of antenatal substance use in Ethiopia. Therefore, the existing public health efforts should be encouraged to help women stop using these substances completely before pregnancy. Moreover, increasing public awareness about the potential negative impacts of substance use during pregnancy on birth outcome would be of greatest importance for comprehensive prevention of the problem.

White paper on smokeless tobacco & women's health in India

Smokeless tobacco (SLT) use is widespread across many nations and populations, and India shares more than three-quarters of the global burden of SLT consumption. Tobacco use in India has been largely viewed as a male-dominant behaviour. However, evidence from medical, social and behavioural sciences show significant SLT use among women and young girls. This paper highlights key dimensions of SLT use among women in India including prevalence and determinants, the health effects arising from SLT use and cessation behaviours. The paper concludes by providing recommendations with the aim of setting research priorities and policy agenda to achieve a tobacco-free society. The focus on women and girls is essential to achieve the national targets for tobacco control under the National Health Policy, 2017, and Sustainable Development Goals 3 of ensuring healthy lives and promote well-being for all.

Tobacco Use Among Reproductive Age Women in Ethiopia: Evidence from the National Health Survey

Purpose

To assess the prevalence and determinants of current tobacco use among reproductive-age women in Ethiopia.

Methods

A cross-sectional study was conducted by utilizing secondary data taken from the Ethiopian Demographic Health Survey of 2016. Descriptive statistics and logistic regressions were used to analyze the data. The odds ratio with a 95% confidence interval was considered to interpret associations and a significant association was stated at a p-value < 0.05.

Results

The overall magnitude of current tobacco use was 1.4% (n= 217). Majority of them 59.91% (n= 130) smoke cigarettes and followed by smoking gaya 43.32% (n= 94). Higher prevalence was found among participants from Gambella 44.24% (n= 96), Benishangul.59% (n= 36) and afar regions 13.36% (n= 29). Age group of 25–34 years [AOR = 2.78; 95% CI: 1.69, 4.57)], age group of ≥ 35 years [AOR = 4.24; 95% CI: 2.54, 7.07)], followers of protestant religion [AOR = 2.36; 95% CI: 4.17, 9.42], Islamic religion [AOR = 3.92; 95% CI: 2.16, 7.11], and traditional religion [AOR = 16.23; 95% CI: 8.33, 31.61], being in poorest wealth index [AOR = 15.78; 95% CI: 7.38, 33.70], poorer wealth index [AOR = 5.85; 95% CI: 2.64, 12.97], middle wealth index [AOR = 3.61; 95% CI: 1.57, 8.29], and richer wealth index [AOR = 2.48; 95% CI: 1.10, 5.85], who were never in union [AOR = 0.31; 95% CI: 0.14, 0.67], ever drinking alcohol [AOR = 5.44; 95% CI: 3.71, 7.95] and ever chewing khat [AOR = 7.59; 95% CI: 4.99, 11.55] were factors associated with current tobacco use.

Conclusion

Women used tobacco in different forms, and its distribution varies across Ethiopian regional states. The concerned body needs to give attention to the identified associated factors and regions with higher tobacco use.

Burden, prevention and control of tobacco consumption in Nepal: a narrative review of existing evidence

Tobacco consumption is one of the major public health problems in the world. Annually, 27 100 premature deaths are attributed to tobacco-related diseases in Nepal. Despite enacting different policies and strategies, the prevalence of tobacco consumption is still high. This study aims to synthesize prevalence, factors associated with its consumption and the policy initiatives for prevention and control in Nepal. This review includes peer-reviewed studies retrieved from two databases (PubMed and EMBASE) and published from 2000 to 2018, and policy initiatives on tobacco prevention and regulations in Nepal. A total of 32 studies and 5 policy documents were reviewed. Findings suggest that tobacco consumption was higher among men, illiterates, older people, people living in rural and mountainous areas and those who initiated smoking as adolescents. Peer pressure and parental/family smoking were major contributing factors for tobacco initiation. Policy analysis showed that low excise tax, weak monitoring mechanisms, poor compliance to bans on the advertisement and promotion of tobacco, smoke-free zones and insufficient programs on tobacco cessation were the major factors behind weak implementation of tobacco-control policies. Hence, targeted and high-risk group tobacco-cessation interventions, increasing taxation and strict policy implementation are crucial for effective tobacco prevention and control in Nepal.

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.

Prenatal Exposure to Gutkha, a Globally Relevant Smokeless Tobacco Product, Induces Hepatic Changes in Adult Mice

Maternal exposures during pregnancy affect the onset and progression of adult diseases in the offspring. A prior mouse study indicated that maternal tobacco smoke exposure affects hepatic fibrosis in adult offspring. Gutkha, a broadly used smokeless tobacco (ST) product, is widely used by pregnant woman in many countries. The objective of this murine study was to evaluate whether oral maternal exposure to gutkha during pregnancy alters non-alcoholic fatty liver disease (NAFLD) in adult offspring: risk factors for the progression of NAFLD to cirrhosis in adults remain elusive. Buccal cavity 'painting' of pregnant mice with gutkha began on gestational days (GD) 2-4 and continued until parturition. Beginning at 12 weeks of age, a subset of offspring were transitioned to a high-fat diet (HFD). Results demonstrated that prenatal exposure to gutkha followed by an HFD in adulthood significantly increased the histologic evidence of fatty liver disease only in adult male offspring. Changes in hepatic fibrosis-related cytokines (interleukin (IL)-1b and IL-6) and in hepatic collagen mRNA expression were observed when comparing adult male offspring exposed to gutkha in utero to those not exposed. These findings indicate that maternal use of gutkha during pregnancy affects NAFLD in adult offspring in a sex-dependent manner.