Alcohol use among pregnant women in post conflict northern Uganda: Prevalence, women’s experiences and effect of a communication intervention

Abstract

Introduction: Prenatal alcohol exposure is a risk factor for poor pregnancy and child outcomes. These include pre-term births (PTB), stillbirths, low birth weight (LBW) and several birth defects and developmental disabilities known as Fetal Alcohol Spectrum Disorders (FASD).The World Health Organisation recommends that pregnant women should completely abstain from alcohol (WHO, 2014). Ugandans are the highest per-capita consumers of alcohol in the African region and there has been reported increase in number of women consuming alcohol in the country including women in the reproductive age group(WHO,2023). To better understand the situation of alcohol consumption during pregnancy in post conflict northern Uganda, three sub studies were conducted (I-III) with the following objectives: To determine the prevalence and predictors of various forms of alcohol consumption among pregnant women in post conflict northern Uganda (I), to explore knowledge, attitudes and experiences of women who drink while pregnant (II) and to assess the effect of a communication intervention (III). Methodology: The study was conducted in Gulu, Kitgum, and Pader districts in Acholi sub-region and employed quantitative and qualitative methods using a socio ecological perspective. A baseline study was carried out and included sub study (I) and (II). In sub study (I) across sectional study in which 420 women seeking ANC services in health facilities in post conflict northern Uganda were interviewed using a structured questionnaire. In sub study (II), thirty women who reported alcohol use during pregnancy were followed up and interviewed about their knowledge, perceptions and experiences with regard to alcohol use using an in-depth interview guide. Thirty health workers providing ANC services were interviewed in the three districts to get their perspectives on alcohol use during pregnancy. All qualitative data was audio recorded and subjected to thematic content analysis using Atlas Ti 7. After the baseline survey, factors found to influence alcohol use were used to develop anti - alcohol messages. Kitgum and Pader districts were selected as control districts and Gulu district as the intervention district. Messages were developed, tested and translated into the local language. Community dialogues with already constituted groups and VHT home visits were used to raise awareness amongst the women, their spouses, family, leaders and other community members on dangers of drinking during pregnancy. It was done in three phases. After the first phase, monitoring was conducted using a simple monitoring tool to inform the next phase of the intervention. Twelve months from the onset of the intervention, impact evaluation was carried out in which 420 women seeking ANC services in health facilities in post conflict northern Uganda were interviewed(SubStudy III). Data was analysed using Paul Gertler’s Difference in difference to assess the effect of the intervention. ResultsIn Substudy I overall 23.6% of women reported alcohol use during current pregnancy. Individual factors such as knowledge, attitude, residence, parity and pre-pregnancy alcohol consumption predicted alcohol use during pregnancy In Substudy II women reported diverse views regarding maternal alcohol use during pregnancy. Whereas some felt it was favourable others had misgivings about it. Individual beliefs and challenges influenced women’s drinking.At community level, societal norms and values, unsupportive environment lured women into drinking during pregnancy. There was marked variability in knowledge on dangers of drinking during pregnancy influenced by individual and community factors. In substudy III Communication messages were significantly associated with reduced odds of binge drinking ( OR = 0.09; CI: 0.01 to 0.66). Also those who received the intervention were less likely to drink frequently ( OR= 0.75; CI: 0.07 to 7.5),had reduced odds of being harmful alcohol users (P=0.95) and were less likely to be hazardous drinkers (OR = 2.61; CI:0.24 to 27.68) although not to a significant level. The intervention also positively influenced having fair or adequate knowledge and having fair or positive attitude although not to a significant level. Conclusions In sub study I This study reveals that alcohol use (any mount) during pregnancy is moderate while other forms of alcohol use such as binge drinking, frequent drinking alcohol dependence, problematic and hazardous drinking were less commonly reported.Knowledge and attitude were important predictors of alcohol use. In substudy II Alcohol use is an economically and socially constructed reality in the Acholi subregion.Pregnant mothers believe alcohol has beneficial properties that would address some of their social and health issues. Hence they continue drinking even during pregnancy partly because of the existing socio-cultural norms that promote it. In substudy III:The communication intervention affected some patterns of alcohol use among pregnant women more so binge drinking which has been linked to FASD. But it did not significantly affect alcohol use (any amount), frequent drinking, alcohol dependence, harmful and hazardous drinking. Results of this study contribute to existing evidence that communication interventions are a promising approach in reduction of Alcohol Exposed Pregnancies(AEP). Recommendations While alleviating alcohol use, development partners and relevant government departments should consider communication and other interventions that increase knowledge and risk perception on alcohol use during pregnancy. The findings of this study demonstrate a need for sensitising communities in which pregnant women live so they can provide a supportive environment for mothers to abstain from alcohol consumption during pregnancy. Health care providers should ensure pregnant women consistently receive accurate and honest messages on the dangers of drinking during pregnancy so they can make informed choices. Policy makers should ensure that interventions aimed at promoting alcohol abstinence during pregnancy should be implemented alongside other strategies that address factors that influence pregnant women to drink to achieve maximum results.