Knowledge, Attitude and Smoking Patterns Among Pregnant Women: A Jordanian Perspective

The Epidemiology and Health Burdens of Influenza Infections Amongst Hospitalized Children Under 5 Years of Age in Jordan: A National Multi-Center Cross-Sectional Study

BACKGROUND/OBJECTIVES

Seasonal influenza is a significant global health concern, causing substantial morbidity and mortality, particularly among high-risk groups such as children under five years old. There is scarce local evidence from developing countries such as Jordan on the burden of influenza, which has limited preventive measures. This multi-center national cross-sectional study aimed to assess the epidemiological and clinical burden of influenza among hospitalized children under five years old in Jordan.

METHODS

Data were collected from 1000 participants across four hospitals between November 2022 and April 2023. Nasopharyngeal specimens were analyzed using multiplex RT-PCR to determine positivity for influenza A and B.

RESULTS

We found a 9.9% positivity rate, predominantly influenza A (8.4%), while influenza B was positive among 1.5% of the participants. Positivity rates were higher in older age groups, particularly children older than 2 years. Influenza-positive cases exhibited longer fever durations and higher rates of sore throat. There were no positive influenza cases among participants if they or any of their family members received the influenza vaccine, highlighting the vaccine's protective role. Logistic regression analysis identified maternal smoking during pregnancy as a significant predictor of influenza positivity.

CONCLUSIONS

The findings of this study underscore the need for enhanced vaccination efforts and public health policies targeting young children and pregnant women in Jordan. Expanding vaccination uptake could significantly mitigate the burden of influenza and its complications in this vulnerable population.

Understanding Miscarriage Prevalence and Risk Factors: Insights from Women in Jordan

Background and Objectives: Miscarriage is a complication that is influenced by many risk factors that have been reported in different studies and that vary among countries. Despite the influence of various known risk factors for miscarriage, 30% to 50% of miscarriages are from unidentified causes. The aim of this study is to determine the prevalence of miscarriages in Jordan and the associated risk factors. Materials and Methods: A cross-sectional online survey was conducted in Jordan among married women to investigate the prevalence of miscarriages and identify potential risk factors. Results: Women (n = 704) were surveyed, and 17.9% reported a history of miscarriage. The identified risk factors were being an active smoker during pregnancy, having more than four children, having a family history of miscarriage, having fertility problems, receiving medical assistance for conception, and traveling by air during pregnancy. Conclusions: The results suggest that there are both modifiable and non-modifiable risk factors for miscarriages in Jordan and that a proportion of these may be preventable. The findings can be used to enhance patient awareness and inform policy development to decrease the incidence of miscarriage in the country.

Prevalence of cigarette use and addiction among Chinese females by age and province: Findings from nationwide China Health Literacy Survey during 2018-19

BACKGROUND

The prevalence of cigarette smoking among women is significantly different from that of men, however, cigarette use by women is little known. The study aims to describe cigarette use prevalence and patterns among Chinese females by age and province.

METHODS

This study was based on the 2018 China Health Literacy Survey (2018 CHLS), a nationally representative cross-sectional study, and our analysis included 43,319 female participants aged 20-69 with valid data. The prevalence of cigarette use was estimated overall by sociodemographic factors and weighted based on the census population data. The logistic regression model was conducted to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for the risk factors associated with cigarette use and dependency.

RESULTS

In China, the estimated female current cigarette use prevalence was 1.85%, with over half of the population suffering from tobacco dependence (7.34 million). Jilin Province has the highest cigarette prevalence among women (10.59%), while Fujian Province has the lowest (0.27%). Participants over 60 years old (aOR=1.61, 95%CI=1.20-2.14), single (aOR=1.54, 95%CI=1.07-2.21), with primary education (aOR=1.93, 95%CI=1.47-2.52) were more likely to smoke. The age of smoking initiation among women intergenerational advanced, and compared to the cigarette users without tobacco dependence, those who have tobacco dependence start smoking earlier in all age groups (25.69 years vs. 19.36 years, p<0.001).

CONCLUSIONS

The cigarette use prevalence among Chinese women was 1.85%, and there are significant differences among provinces. We noted a trend of women initiating smoking at increasingly younger ages, particularly among those with tobacco dependence.

Predictive factors and adverse perinatal outcomes associated with maternal smoking status

To identify risk factors for smoking among pregnant women, and adverse perinatal outcomes among pregnant women. A case-control study of singleton full-term pregnant women who gave birth at a university hospital in Jordan in June 2020. Pregnant women were divided into three groups according to their smoking status, active, passive, and non-smokers. They were interviewed using a semi-structured questionnaire that included demographic data, current pregnancy history, and neonatal outcomes. Low-level maternal education, unemployment, secondary antenatal care, and having a smoking husband were identified as risk factors for smoke exposure among pregnant women. The risk for cesarean section was ninefold higher in nulliparous smoking women. Women with low family income, those who did not receive information about the hazards of smoking, unemployed passive smoking women, and multiparty raised the risk of neonatal intensive care unit admission among active smoking women. This risk increased in active and passive women with lower levels of education, and inactive smoking women with low family income by 25 times compared to women with a higher level of education. Smoking is associated with adverse perinatal outcomes. Appropriate preventive strategies should address modifiable risk factors for smoking during pregnancy.

Practices of pregnant women regarding tobacco and alcohol use during pregnancy at one primary health care clinic in Southern Namibia

Tobacco and alcohol use during pregnancy has negative consequences, to the fetus. The study purpose was to investigate the practices of pregnant women regarding the use of tobacco and alcohol during pregnancy. A quantitative research approach with a descriptive, cross-sectional, analytical design was used. The population were all pregnant women aged 18 years and above attending antenatal care at Mariental clinic. Written informed consent was obtained from all respondents prior to data collection. Data was collected from 211 respondents selected through a systematic sampling. Data was analysed using Statistical Package of the Social Sciences version 27. Descriptive statistics were used for frequencies and percentages. Fisher's Exact test at 0.05 alpha level was used to determine the association between variables. The mean age was 28.8 with a standard deviation of 6.9 years. Most participants, 92 (43.6%) were aged between 18 and 24 years. Majority, 186 (88.15%) were in third trimester of pregnancy and 154 (73%) were single. Most 148 (70.14%) respondents have good practices towards alcohol use during pregnancy. Moreover, 190 (90%) of the respondents were classified as having good practices towards tobacco use in pregnancy. Educational levels showed a significant association with practices towards tobacco smoking (P=0.042). The study concluded good practices among pregnant women on alcohol and tobacco smoking during pregnancy. It is recommended that health facilities should introduce awareness campaign on the dangers of alcohol and tobacco use during pregnancy. Moreover, educational materials should be developed in local languages and distributed to community.

Knowledge of pregnant women regarding tobacco and alcohol use in pregnancy at Mariental clinic, Hardap region: a quantitative study

Globally, alcohol and tobacco use during pregnancy is a challenge and linked to negative effects on health and wellbeing on both mother and the fetus. To investigate the knowledge of pregnant women attending antenatal care at Mariental clinic regarding the use of tobacco and alcohol in pregnancy. A quantitative approach with descriptive, cross-sectional, analytical design was used. The population were all pregnant women attending antenatal care at Mariental clinic. Systematic sampling method was used to select the sample of 224 pregnant women. Data was collected using a self-administered questionnaire that collected information on sociodemographic data and knowledge on tobacco and alcohol use. Data was analysed using Statistical Package of the Social Sciences (SPSS) version 27. Descriptive statistics was utilized to generatee frequencies and percentages. Fisher's Exact test at 0.05 alpha level was used to determine the association between variables. The mean age was 28.8 with a standard deviation of 6.9 years. Most participants, 43.6% were aged between 18 and 24 years. Majority, 88.15% were in third trimester of pregnancy, 73% were single, and unemployed. Most participants 78.7% have a high level of knowledge regarding the use of alcohol during pregnancy and 70.1% have higher level of knowledge regarding tobacco use during pregnancy. No association was found on the level of knowledge on alcohol and tobacco use during pregnancy and socio demographic characteristics as all variables show a P-value of more than 0.05. Participants have higher knowledge on alcohol and tobacco use during pregnancy.

Public awareness, prevalence, and regulations for the sale of electronic cigarettes in Arab countries: A narrative review

The majority of the Arab countries have high records of daily tobacco smoking. Electronic cigarettes (e-cigarettes) use has exponentially increased in the past decade in Arab countries. Consumers' willingness to quit smoking traditional cigarettes and their perception of e-cigarettes as a safer alternative to conventional cigarettes have increased the demand for these devices. This narrative review aimed to gather and discuss the available literature on the awareness, prevalence, and sales regulations of e-cigarettes in Arab countries. A search was conducted on electronic databases such as PubMed, Medline, Scopus, and Google Scholar with no time limits until the end of 2021. Some of the recent studies (2019-2021) considered in this review have reported that more than 25% of participants were e-cigarettes users. The prevalence of e-cigarettes has increased drastically with raised awareness of e-cigarettes among the population in these Arab countries. Most of the users of e-cigarettes are young males. In addition, an increase in e-cigarettes use has been reported in females. The policies which regulate trade and sale of e-cigarettes and related products were issued in only three Arab countries. In contrast, regulations for the trade and sale of traditional cigarette products are also applied in some countries to e-cigarette products, banning the sale of e-cigarettes to minors and/or amend smoke-free laws to restrict public use of e-cigarettes. There is a need for a concerted effort to assess the prevalence and significant rise of e-cigarettes consumption in Arab societies to help implement and improve harm reduction policies.

The impact of an online educational program to reduce second-hand exposure to smoke among nonsmoking pregnant women; a hospital-based intervention study

Background

Second-hand smoke is recognized as a public health concern, especially for pregnant women.

Objectives

To compare pregnant women's exposure and perceptions of SHS pre-and post-intervention.

Materials and methods

The study was conducted with a sample of 32 pregnant women at a tertiary university hospital in Jordan. Using a semi-structured questionnaire, researchers asked women about their knowledge, attitude and behavior regarding prenatal exposure to smoke before and after an intervention that included motivation, communication, education and counselling by using a range of media. A cotinine test was conducted to measure levels in second-hand smokers.

Results

The average maternal age was 30.88 ± 1.69 years; 68% were highly educated, 43% were employed, 37% reported not having sufficient income, and 62% did not attend for antenatal care on a regular basis. There was a significant increase in knowledge and awareness regarding second-hand smoking and its effect on pregnancy outcomes after the intervention. More than 90% of pregnant women supported a comprehensive policy in relation to smoking, and 33% of used to leave the room where others smoked. This percentage increased to 70% after the intervention. Cotinine level decreased after the intervention in 81% of cases.

Conclusions

There is an increase in knowledge and awareness regarding second-hand smoking and its effects on pregnancy outcomes after implementation of an educational intervention.

Active and Passive Maternal Smoking During Pregnancy and Birth Outcomes: A Study From a Developing Country

Background:

Smoking is one of the modifiable risk factors for adverse maternal and neonatal outcomes and is associated with low birth weight, preterm birth, respiratory, antepartum and intrapartum stillbirth, and perinatal death as well as long-term morbidity in offspring and sudden unexpected infant death. The rate of smoking in low- and middle-income countries is still relevantly high, and Jordan is no exception.

Objective:

To investigate the effect of active and passive smoking during pregnancy on adverse pregnancy outcomes.

Methods:

The case-control study was conducted in Jordan in June 2020. Healthy women with full-term singleton pregnancy (n = 180) were interviewed and stratified into three groups: Group I, active smokers; Group II, passive smokers; and Group III, nonsmokers. The study variables included demographic data, current pregnancy history, cotinine level of mothers and newborns, and perinatal outcomes. Statistical analysis was performed using the application package IBM SPSS 25. Various algorithms of statistical analysis were used depending on the type of distribution of feature and data quality. The threshold for statistical significance was set at p < 0.05.

Results:

Active smokers had significantly lower gestational age at delivery compared to passive and nonsmoking women (p = 0.038 and p = 0.003, respectively). Neonates from active smoking mothers had significantly lower birth weight compared to neonates from passive and nonsmoking women (p = 0.016 and p = 0.019, respectively), significantly lower head and chest circumferences compared to babies from passive smokers (p < 0.001 and p = 0.036, respectively), and significantly lower first-minute Apgar score compared to those from nonsmoking women (p = 0.023). The urine cotinine level was significantly higher in both active and passive smoking women (both p < 0.01), and it was significantly higher in newborns who had been exposed to smoking in utero despite maternal active or passive smoking status (both p < 0.001). There was a weak negative correlation between urine cotinine level and birth weight: r = –0.14 for maternal cotinine level and r = –0.15 for neonate cotinine level.

Conclusions:

The current study illustrated that smoking during pregnancy leads to offspring with reduced birth weight, birth length, and head and chest circumference; reduces delivery gestational age; and lowers the first-minute Apgar score. Our study findings highlight the need for further research issued to smoking effects on perinatal outcomes, the implementation of actions to develop cessation interventions in the preconception period, and an evaluation of useful interventions to enhance a smoking-free environment during pregnancy.