Exposure to tobacco during pregnancy among mothers with low birth weight new borns in Arua District, Uganda

Abstract

Introduction

Exposure to tobacco during pregnancy is a risk to the mothers’ health and their unborn babies. It has been observed to be an important independent risk factor for the low birth-weight of newborns which may lead to fetal death. In Africa, Uganda is one of the countries with high prevalence of low birth weight newborns and is also experiencing an increasing trend in tobacco consumption. However, there is little evidence about the relationship between the prevalence of low birth weight and exposure to tobacco during pregnancy in Uganda.

Study Objectives: To determine the association between exposure to tobacco during pregnancy and low birth weight in Arua district so as to generate information that will be used by the district health team and other stake holders in designing appropriate strategies for preventing mothers from exposure to tobacco during pregnancy.

Methods: This was a facility based un-matched case control study conducted in Arua district, West Nile region. The cases were mothers with low birth weight newborns (<2500g) and the controls were mothers with normal birth weight newborns (≥2500g). A semi-structured questionnaire consisting of questions, with core items selected from the Global Tobacco Survey was used to collect information. Data was entered into the computer using Epi info version 3.5.1 and it was then exported to STATA 12 software for analysis. Odds ratios were used as the measure of association.

Results

Exposure to tobacco was significantly associated with low birth weight after adjusting for the potential confounders (AOR= 2.21, 95%CI=1.31-3.74), with 82.6% of cases compared to 68.2% of controls being exposed to tobacco during pregnancy. All the three forms of exposure to tobacco during pregnancy were found to be significantly associated with low birth weight after controlling for the potential confounders. The OR for the association between tobacco use during pregnancy and low birth weight was 8.2 (95%CI=3.46-21.45). After adjusting for age of the mother, alcohol use during pregnancy and mother’s nutritional status, the AORs were 11.95(95%CI=4.89-29.16), 6.69(95%CI=2.92-15.37), and 5.16(95%CI=2.24-11.86) respectively. Tobacco farming and processing was also found to be significantly associated with birth weight (OR= 2.98, 95%CI=1.54-5.79). Age was the only variable that affected this association and after adjusting for it, the AOR was 3.39 (95%CI=1.77-6.49). Exposure to Second Hand Smoke (SHS) at home was significantly associated with low birth weight (AOR=1.85, 95%CI=1.15-3.00). Conclusion

Exposure to tobacco during pregnancy is associated with the high incidence of low birth weight new-borns in Arua district. Considering the different forms of exposure to tobacco during pregnancy the association with low-birth weight was strongest between active tobacco use, followed by exposure through tobacco farming and processing and weak in Second Hand Smoke(SHS) exposure. Most of the mothers who were using tobacco were using it in a smokeless form,(by mixing dried tobacco leaves with ash and putting it under the tongue). These results provide baseline information from which control intervention can be tailored.