THE PREVALENCE AND ASSOCIATED FACTORS OF ALCOHOL USE DURING PREGNANCY AMONG PREGNANT WOMEN IN THE BUEA TOWN HEALTH CENTRE.

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Alcohol intake is a socially accepted behaviour that forms part of everyday social interaction, especially in the African Society. Alcohol consumption brings people together as many who consume it do so in group settings.

Worldwide, the majority of clinical and government guidelines advocate for pregnant women to abstain from alcohol consumption during pregnancy due to potential adverse effects on pregnancy outcomes (Butt et al., 2011).

Consumption of alcoholic beverages during pregnancy might increase the incidence of preterm delivery and spontaneous abortion, substantial risk of mental, physical and psychological harm to her offspring which is the so-called fetal alcohol spectrum disorders (FASD) and fetal alcohol syndrome (FAS) (Sawyer et al., 2006).

The infant with FAS is characterized by at least one feature from the following: physical anomalies, intrauterine growth retardation, and moderate to severe learning difficulties and/or identifiable drinking problem of the mother (Viljoen et al., 2001).

Prenatal alcohol exposure is also associated with fetal death, reduced brain mass and prenatal and postnatal growth retardation (WHO, 1999). World Health Organization (WHO) had recognized the risk of prenatal alcohol exposure on developmental and intellectual disabilities (Denny et al., 2009).

Maternal alcohol consumption often occurs in conjunction with other risk factors like smoking and family history of alcohol abuse and so it is difficult to attribute the effects to fetal alcohol exposure or to the characteristics of the mother and the child’s home environment (Katrine et al., 2011).

Across the globe, it is evident that the consequences of using alcohol during pregnancy are similar, but its prevalence varies. It has been reported that up to 1 in 100 children in the United States are born with FASD.Furthermore, around 2 children in 1,000 are diagnosed with FAS in the US (Henriksen et la., 2004). European study discovered only 53% of women in France reported complete abstinence during pregnancy and an Australian study reported 81% of pregnant women consume alcohol (Denny et al., 2009). Study conducted in Geneva showed that about 36.3% of the women drank at least one glass of alcohol during pregnancy (Dupraz et al., 2013). Screening of alcohol use in Swedish antenatal clinics for the year preceding pregnancy, explored as one-third of the subjects (30%) was continued to regular alcohol use during pregnancy, and 6% reported consumption two to four times per month (So-Hee, 2011). A study done on one thousand pregnant Korean women who visited the Department of Obstetrics and Gynaecology in 2010 showed 16.4% of them were using alcohol during their pregnancy (Walter et al., 2011). The epidemiological study that had been done in Canadian women found that 10.8% of women drank alcohol at some point during their pregnancies (Goransson et al., 2003). A survey conducted in California reported that among women who recently gave birth found that approximately 15.8% of women in 2006 reported drinking during the first or third trimester of their pregnancy (Soowon et al., 2007). The highest fetal alcohol syndrome rate was documented in a South African community in Western Cape Province where FAS was reported to affect 40.5 to 46.4 children (May et al., 2000).

Despite the fact that alcohol use by pregnant women is a leading cause of mental, physical, and psychological problems in infants and children, nowadays trends indicated that the use of those alcohols has become one of the rising major public health and socio-economic problems particularly in developing countries (Odejide, 2010).

1.2 Statement of The Problem

Alcohol consumption is one of the most common preventable potentially harmful behaviours in which women engage during pregnancy. About twice as many women consume alcohol during pregnancy as illicit drugs (Mollman, 2012).

Excessive alcohol intake during pregnancy has been shown to capable of disturbing the development of an embryo or fetus and cause malformations. The effects of alcohol exposure in utero are dependent on dose, timing of exposure, maternal nutrition (Riley et al., 2011), and genetic factors (Warren & Li, 2005). Disorders caused by alcohol exposure in utero are classified under the umbrella term Fetal Alcohol Spectrum Disorders (FASD)(Sokol et al., 2003).

Although alcohol exposure is harmful during all stages of pregnancy the consequences vary. Animal studies have shown that the central nervous system (CNS) is susceptible to insult from maternal alcohol intake as early as the third week of gestation (Sulik, 2011). Alcohol exposure on gestation days 1-6 in rodents has been found to not only increase the risk of prenatal mortality but also increase the risk of, for example gestational growth and malformations (Padmanabhan and Hameed, 1988). This indicates that alcohol exposure in very early pregnancy, before the egg is implanted, can be teratogenic as well as lethal, at least to mice embryos (Stratton et al., 1996). High levels of alcohol consumption in early pregnancy have been associated with an increased risk of spontaneous abortion (Bailey & Sokol, 2011). The evidence for smaller amounts is uncertain (Henderson et al., 2007), but a few studies have found that the risk of spontaneous abortions increases gradually with dose of alcohol exposure in early human pregnancy (Nybo-Andersen et al., 2012; Windham et al., 1997).

Exposure to alcohol during early pregnancy has been found to cause dysmorphic facial features evident in FAS (Coles, 1994; Graham et al., 1988). Further, alcohol consumption in the first trimester has been associated with increased risk of preterm delivery and growth impairment even at relatively small amounts of exposure (Nykjaer et al., 2014). However, these findings have been contradicted by other studies. For example, in a prospective multicentre cohort study, no altered risks for preterm delivery or growth impairment were found among women consuming alcohol in early pregnancy (McCarthy et al., 2013).  No such findings exist for Cameroon, It is for the purpose of this study that we seek to determine the prevalence and risks factors associated with alcohol intake during pregnancy at the Buea town health centre.

1.3 Research Questions

1. what is the prevalence of alcohol consumption among pregnant women in the Buea town health centre?
2. What is the quantity and rate of consumption of alcohol among pregnant women in Buea town health centre?
3. What are the associated risks factors of alcohol use during pregnancy?

1.4 The Objective of The Study

1.4.1 Main Objective

The main objective of this study is to determine The Prevalence And Associated Factors Of Alcohol Use During Pregnancy Among Pregnant Women In The Buea Town Health Centre.

1.4.2 Specific objectives

Specifically, the study sought to;

1. To determine the prevalence of alcohol consumption among pregnant women attending ANC at the Buea Town health centre
2. To determine the quantity and rate of consumption of alcohol among pregnant women in Buea town health centre
3. Determined the associated risks factors of alcohol use during pregnancy

1.5 Hypothesis

Hₒ: There is no significant association between alcohol intake and socio-economic characteristics of pregnant women visiting ANC in Buea town health centre.

Hᵢ: There is a significant association between alcohol intake and socio-economic characteristics of pregnant women visiting ANC in Buea town health centre.

THE PREVALENCE AND ASSOCIATED FACTORS OF ALCOHOL USE DURING PREGNANCY AMONG PREGNANT WOMEN IN THE BUEA TOWN HEALTH CENTRE.