PREGNANT WOMEN AND ALCOHOL USE IN THE BOSOMTWE DISTRICT, ASHANTI

Yaw Adusi-Poku

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OUTLINE OF PRESENTATION

• INTRODUCTION• PROBLEM STATEMENT• RESEARCH QUESTIONS• OBJECTIVES• METHODS• RESULTS• DISCUSSIONS• CONCLUSIONS• RECOMMENDATIONS

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INTRODUCTION(1)

• Although the existence of alcohol-induced fetal damage is well documented, 6-20% of women have been reported to drink alcohol ‘heavily’ pregnancy (Flynn et al,2003)

• In Africa, eg Namibia, home-brewed beverages are the main source of alcohol and the producers are women acting as a bait to drinking (WHO, 2004)

• In Ghana, a study conducted by GOFAS, an NGO in 3 regions of Ghana, revealed that 86% of pregnant women drank various forms of alcoholic beverages (Kunateh, 2007)

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INTRODUCTION (2)

• Alcohol has profound effects on the unborn baby by a mother who drinks.

• It is a spectrum of constellation of physical and cognitive abn. Severest form- FAS; minor forms-FAE ( Kunateh, 2000)

• Physical effects- small stature, small head, small eyes, small chin etc

• Cognitive defects: intellectual disability (Meck manual, 2005)

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PROBLEM STATEMENT

• Anecdotal claims of alcohol ingestion in the reproductive years in Bosomtwe District

• Claims that Lake Bosomtwe provides a conduit for alcohol ingestion

• Claims that women take unstandardised locally brewed alcohols- akpeteshie, pito etc

• Lack of data to support these claims

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Lake Bosomtwe

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A woman brewing Pito in Ghana

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CONCEPTUAL FRAMEWORK

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•Alcohol Spectrum Disorders (ASD)

•Low birth weight

•Spontaneous abortions

•Preterm delivery

•Petty thefts

•Absence from work

•Reduced job performance

Foetal Problems

Maternal Problems

Social Problems

Pregnant Women and alcohol use

Social Factors Economic factors Perceptions

·Advertisement targeted at women

•Social acceptability

·Higher disposable income

•Unemployment

·It reduces stress

•It helps to interract effectively with others.

Conceptual frameworkSource-Author’s own construct, 2010

RESEARCH QUESTIONS

• What are the demographic characteristics of pregnant women who drink alcohol attending ANC in the study district ?

• What is the level of knowledge about the general effects of alcohol among pregnant women attending ANC in the district?

• What types of alcoholic beverage are consumed?

• What are the socio-demographic factors that influence alcohol consumption?

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General Objective

• To assess alcohol consumption among pregnant women attending antenatal clinics in the Bosomtwe District

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Specific objective 1.

• To assess the level of knowledge of pregnant women attending ANC about the general effects of alcohol on pregnant women in the Bosom. District (15-44 yrs)

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Specific objective 2.

To determine the types of alcoholic beverage and average volume consumed among pregnant women

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Specific objective 3

• To identify Socio-demographic factors that influence alcohol consumption:

>Age

>Marital Status

>Educational level

>Occupation

>Religious affiliation

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METHODOLOGY(1)

Study Location

10 Health Facilities providing RCH

Study Period July –October, 2010

Study Design Descriptive Cross’t

Sample Size 401( detect 95% CI; 50% prevalence)FORMULA : n=Z2Pq d2

Inclusion criteria

i. confirmed preg, any gestation

ii. Any parity

iii. Consumers of alc >14%

Exclusion criteria i. Severely ill preg

ii. Alcoholic tinctures, syrups and that <14%

Sampling Method

i. Systematic RS where quota exceeded

ii. Other health facilities, all interviewed

Data Collection

Structured questionnaire, close & open 14

METHODOLOGY(2)

Pretesting Done prior to study at Foase, nearby district

Data handling Serially numbered, entered into EPiData; analysed in STATA 10

Measurements

i. Meansii. Chi-squareiii. Fischer Exact tests

iv. Logistic Regression

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RESULTS(1)Socio-demographic Characteristics of Drinkers

Socio-demographic Characteristics of Drinkers

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Drinkers freq %

Prevalence: 81.0 20.4

Age groupsi. highest-25-29

ii. least-40-44

26.03.0

34.0 21.0

Marital Statusi. Marriedii. Unmarried

50.030.0

61.738.3

Level of Educationi. None

ii primaryiii JHSiv Tertiary

21.020.037.03.0

25.924.745.73.7

Drinkers freq %

Religious groupsi. Christiansii. Muslimsiii. Others

69.00.012.0

85.00.015.0

Occupationi. Tradersii. Unemployediii. Farmers

28.019.018.0

34.623.522.0

Results(2)Assessment of level of knowledge (spontaneous answers to detrimental effects of alcohol)

Answers to detrimental effects of alcohol ( options)

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Mult resp variable Effects on mother (freq(%)

Effects on babyFreq(%)

Five correct ans 117(29.6) N/A

Four correct ans 49(12.4) N/A

Three correct ans 92(23.3) 160(40.3)

Two ≤ correct ans 71(18.0) 50(12.6)

don’t know 74(18.6) 74(18.6)

Alcohol can have the ff effects on (a) mother i. disrupt family relations ii. Interferes with her physiology iii. Premature delivery iv. Work related problems v. Legal problems vi. Don’t know (b) fetus i. structural defects ii. Spontaneous abortions iii. Mental impairment iv. Don’t know

Mention some detrimental effects of alcohol ingestion to pregnant woman

Freq %

Spontaneous correct ans

77 21.0

Spontaneous wrong ans

210 57.4

Non-response

79 21.6

RESULTS (3)

.Type of alcohol, freq. and % of consumers

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Ever received education on detrimental alcohol effects?

Freq %

yes 318 54.9

No 179 45.1

Where education received?

ANC clinics 73 33.5

From newspapers 2 0.9

Through television 24 11.0From radio 28 12.8

Church/mosques 9 4.1

Other sources: Grandma/husband/School

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Alcohol type Freq(%0 drinkers

Amount per drinking session

Akpeteshie 36.4 15 mls (1/2 tot)

Palm wine/Pito 11(14.4) 160 mls

Gingsing/kasapreko/pusher

21(27.3%) 30 mls

Beer 3(3.9%) 600 mls

Guinness 14(18.0%) 330 mls

*12.0% (not included in the Table) took more than one-type of alcoholic beverage

Uni-variate Analysis of Alcohol consumption and Socio-demographic variables

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Logistic Regression Analysis of Socio-demographic variables and Alcohol Consumption

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Discussions(1)-Prevalence

• Prevalence of alco drinkers: 20.4% high compared to BRFSS, 2005, USA- 12.0%; (Thanh & Johnsson, 2010), 5.8% in Canada

• However, highest drinking group(25-30yrs) consistent with (IAS, 2008), mostly in their 20’s and 30’s

• Highest drinkers : JHS and married. Differ from BRFSS, 2005, found college-educated and unmarried

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Discussions(2) Level of knowledge

• Two-thirds (57.0%) of 78.0% gave spontaneous wrong ans consistent with Env. Research Grp Ltd, 2000, a national survey in Canada, Two-thirds knew alcohol could be harmful but did not know what the effects really were.

• Close-ended multiple response variable about 80.0% gave at least one or more answers on the effects on the mother similar to the effects on the fetus (81.0%) consistent with the national survey in Canada about 89.0% believed alc could cause life-long disability in the child and some effects on the mother.

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Discussions(3) Level of knowledgewhere received education?

• About 33.0% received health education of the detrimental effects of alcohol at ANC. A proportion, about 11.0 % received both radio and TV

• Few 0.9% received educ via print media

• In contrast to a more literate society such as Canada, 72.0 % had received health edu in the print media compared to ANC/TV/Radio (Env Research Grp Ltd, 2000)

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Discussions(4) Type and average vol alcohol consumed

• A lot of the one-type-alcohol-drinkers preferred akpeteshie (half-tot-15mls) followed by Ginsing/Kasapreko/Pusher(one-tot)

• The above preference is similar with WHO report (2004). Traditional local drinks are very popular in Africa.

• Contrary to preferences Albertsen and others found that in Denmark, most preferred wine followed by mixed (Albertsen et al, 2004)

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Discussions(5)- Influence of Socio-demographic factors

• Marital status influenced alcohol consumption consistent with a study by Precott and Kendler (2001)

• Religious affiliation influenced alcohol consumption consistent with (Ayers et al, 2009)

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CONCLUSIONS & RECOMMENDATIONS

• Health Staff Majority received education at ANC.

Hence H.E. campaign embarked with strict M&E @ ANC .

• DHMT

(i) Training & Retraining programs should be organized regularly on how to deliver effectively, the harmful effects of alcohol pregnancy

(ii) I E & C via Local Information centres , mobile health vans

• DHMT & GES collaboration to educate school pupils & students. Programs should be inspected for content & quality

• District Administration

(i) Should take advantage of the FCUBE to increase girl-child formal education

(ii) Gain and regulate informal production of locally brewed alcohol to introduce standards

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REFERENCES• Albertsen K, Anne-Marie N. A, Olsen J,

Grønbæk M. (2004). Alcohol Consumption during Pregnancy and the Risk of Preterm Delivery. Am J Epidemiol January 15, 2004 vol. 159 no. 2 155-161

• Ayers W. J, Hofstetter R. C, Hughes C. S, Irvin L. V, Sim K. E, Hovell F. M. (2009). Exploring Religious Mechanisms for Healthy Alcohol Use: Religious Messages and Drinking Among Korean Women in California. J Stud Alcohol Drugs, 2009 November: 70(6): 890–898. Accessed at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2776119/. Retrieved 6th January, 2011

• Bursac Z, Gauss H. C, Williams K. D, Hosmer D.(2007). A Purposeful Selection of Variables Macro for Logistic Regression. SAS Global Forum Statistics and Data Analysis. Paper 173-2007. Accessed at http://www2.sas.com/proceedings/forum2007/173-2007.pdf. Retrieved, 12th January, 2011

• Flynn H. A, Marcus S. M, Barry K. L and Blow F. C. (2003). Rates and Correlates of Alcohol Use Among Pregnant Women in Obstetrics Clinics, Alcoholism: Clinical and Experimental Research, 27: 81–87. doi: 10.1111/j.1530-0277.2003.tb02725. Accessed at http://onlinelibrary.wiley.com/doi. Retrieved January 9th 2011

• Institute of Alcohol Studies - IAS, (2008).Women and Alcohol factsheet.Accessed at http://www.ias.org.uk/resources/factsheets/women.pdf-6. . Retrieved January 5th 2010

• Kunateh M. A. (2007). Ghanaians Consume 30 Million Litres of Alcohol Yearly. Accessed at: http://www.ghanadot.com/social_scene.feature.kunateh.alcohol.012309.html. Retrieved 10th January, 2010

• The Merck Manual, 2009. The Merck Manual of Diagnosis and Therapy. Retrieved, http://www.merck.com/mmpe/sec19/ch274/ch274i.html#sec19-ch274-ch274i-696. Retrieved, January 5th 2011

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REFERENCES cont’d• Prescott and Kendler. (2001). Associations

between Marital Status and Alcohol Consumption in a Longitudinal Study of Female Twins. J. Stud. Alcohol 62: 589-604, 2001. Accessed at http://www.jsad.com/jsad/article/Associations_between_Marital_Status_and_Alcohol_Consumption_in_a_Longitudin/1354.html. Retrieved 6th January, 2011

• Sullivan G. M. (2009). Too many pregnant women still drink alcohol. OB/GYN News. Accessed at http://findarticles.com/p/articles/mi_m0CYD/is_9_44/ai_n32429083/. Retrieved, January 25th 2011.

• World Health Organisation, (2004). Global Status Report on Alcohol 2004. Pp21-24. Accessed at: http://www.who.int/substance_abuse/publications/global_status_report_2004_overview.pdf. Retrieved, 5/01/11

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ACKNOWLEDGEMENTS

• My academic supervisor, Dr. A.K Edusei• Then DDHS- BOSOMTWE-Dr.(Mrs) Akua

Bonney• All lecturers of the department and associated

staff• All health workers, Bosomtwe District• All pregnant women, Bosomtwe district

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.

• THANK YOU

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