|Year : 2021 | Volume
| Issue : 1 | Page : 28-33
Psychoactive substance use and associated factors among pregnant women attending antenatal clinic
Dauda Sulyman1, Kazeem Ayinde Ayanda1, Muhammad Bappah Aminu2, Lamaran Makama Dattijo2
1 Department of Psychiatry, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
2 Department of Obstetrics and Gynaecology, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
|Date of Submission||11-Feb-2020|
|Date of Decision||27-Mar-2020|
|Date of Acceptance||03-Jun-2020|
|Date of Web Publication||31-Mar-2021|
Dr. Dauda Sulyman
Department of Psychiatry, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi
Background: There is obvious change in the pattern of psychoactive substance use in this part of the world. The habit which was previously prerogative of adult males has now been extended to women. Women of reproductive age group, including pregnant ones now engage in the use of psychoactive substances, thereby exposing them and their unborn babies to various risks and dangers. Objectives: This study was carried out to determine the prevalence rate of use of psychoactive substances among pregnant women attending clinic in a teaching hospital, in a North-eastern State of Nigeria. Materials and Methods: It was a cross-sectional questionnaire-based survey. The Alcohol, Smoking and Substance Involvement Screening Test questionnaires were administered to 320 pregnant women that came for antenatal care (ANC) by research assistants. Results: The prevalence of substance use among the respondents was 13.3%. Tobacco products in form of snuff and cigarette (34.7%), sedatives and over the counter sleeping pills (32.8%) were commonly abused substances. Opiates in form of tramadol and codeine-containing cough syrups were also common (14.0%). Proportions of respondents that consume alcoholic products were 12.4%, whereas the remaining percentages were for other substances such as cannabis and solvent. Fathers' uses as well as partners' uses of psychoactive substances were variables that were significantly associated with the substance use by pregnant women in this study. Conclusion: The proportion of pregnant women that uses psychoactive substances was high in this study, especially when the fathers or partners also abuse substances. Efforts should therefore be made to screen women coming for ANC to diagnose those with substance use habit and manage them appropriately.
Keywords: Antenatal, Nigeria, pregnant women, psychoactive substances
|How to cite this article:|
Sulyman D, Ayanda KA, Aminu MB, Dattijo LM. Psychoactive substance use and associated factors among pregnant women attending antenatal clinic. Sahel Med J 2021;24:28-33
|How to cite this URL:|
Sulyman D, Ayanda KA, Aminu MB, Dattijo LM. Psychoactive substance use and associated factors among pregnant women attending antenatal clinic. Sahel Med J [serial online] 2021 [cited 2021 Apr 15];24:28-33. Available from: https://www.smjonline.org/text.asp?2021/24/1/28/312734
| Introduction|| |
In recent past, consumption of psychoactive substances used to be prerogative habit of adult men in Nigeria as well as most other sub-Saharan African societies. This might be due to different forms of censors and regulations, though unwritten, that prevent children as well as women from use of these substances. , These guides seem to be fast eroding, as females now engage freely and significantly in the use and misuse of psychoactive substances.
Significant proportions of females that are involved in this act are of reproductive age group; hence, there are resultant effects on pregnancies and unborn children. Studies have found that pregnant women abuse wide range of psychoactive substances just like their nonpregnant counterpart. These substances include alcohol, cigarette, stimulants, sedatives, opiates, cocaine, marijuana, and several others.,, Some reasons given for using these substances by expectant mothers may include control of nausea and vomiting, increasing quality, and volume of their blood, improving the weight of their babies, assisting them in sleeping well, reducing pain and several other reasons. ,
Majority of women that use psychoactive substances continue the use even when they are pregnant. Some of these women lack proper education on the dangers of substance abuse during pregnancy and claimed ignorance of the debilitating effects on themselves and the fetuses. , It has been revealed that psychoactive substances increase morbidity in mothers and children. Alcohol, for instance, is associated with fetal alcohol-spectrum disorders. Tobacco has been reported to lead to placental insufficiencies, spontaneous abortion, preterm deliveries, and low birth weight. Other common complications of substance misuse in pregnancy are withdrawal syndrome in the babies and growth restrictions. ,
Risk factors associated with the use of psychoactive substances during pregnancy include younger age, unwanted pregnancy, primigravida and primiparous, lower level of education and not being religious. The use of psychoactive substances could lead to lack of prenatal care and general neglect.,, Substance abusers are also prone to physical as well as sexual abuses.
There is dearth of documented studies on the prevalence and risk factors associated with the use of psychoactive substances among pregnant women in this part of the country. The knowledge of which is important in holistic planning not only for the expectant mothers but also for their unborn children. Therefore, the aim of this study was to find the prevalence and pattern of psychoactive substance use among pregnant women attending antenatal clinic at a University Teaching Hospital, in North-eastern Nigeria. It also looked into factors that are associated with the use of these substances among the studied population.
| Materials and Methods|| |
This survey was carried out among the pregnant women attending ante natal care at the Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, which is a federal tertiary health institution in North-eastern Nigeria. The ante natal clinic is being run by two teams from Obstetrics and Gynaecology department for 2 days each in a week (Team A runs their ante natal clinics on Mondays and Wednesdays, whereas Team B runs theirs on Tuesdays and Thursdays).
This survey is a descriptive, cross-sectional, hospital-based study. Participants were selected using the simple random sampling technique. Average attendance per clinic was 50 pregnant women, out of whom five respondents were usually randomly selected using ballot method.
The study lasted for 4 months (from March to June, 2019).
All pregnant women aged 18 years and above attending antenatal clinic during the study period constituted the study population.
Sample size was calculated using the Fisher's formula.
Where n = the desired sample size
z = the standard normal deviate set at 1.96 (95% confidence level)
p = the proportion in the target population estimated to have the disorder (16.9%)
q = 1 − p (1.0–0.169 = 0.831)
d = desired level of accuracy, set at 0.05
n = 1.962 × 0.169 × 0.831/0.052
n = 215.8.
The estimated sample size was 216. The study lasted for period of 4 months during which 320 responded were interviewed. This we believed improved the power of the study.
- Pregnant women attending antenatal care (ANC) that gave their informed consent
- Must be of age of 18 years and above.
- Patients with a prior history of psychiatric illness before the commencement of use of psychoactive substances
- Patients who are too ill to participate
- Anyone that decline to participate.
- Pro forma questionnaire: this was designed by the researchers to obtain the respondents sociodemographic variables such as the respondents' age, marital status, educational status, parents, and use of psychoactive substances.
- The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). It is a brief screening questionnaire to find out about people's use of psychoactive substances. It was developed by the World Health Organization and an international team of substance use researchers as a simple method of screening for hazardous, harmful, and dependent use of alcohol, tobacco, and other psychoactive substances. The questionnaire covers: tobacco, alcohol, cannabis, cocaine, amphetamine and stimulants, sedatives, hallucinogens, inhalants, opioids, and other drugs. The ASSIST is especially designed for the use by health-care workers in a range of health-care settings.
It is found to have high diagnostic accuracy (specificity >95%) and internal correlation co-efficiency of >0.7. It has been used in Nigeria among pregnant women and found to be reliable. Respondents that scored <10 points for alcohol and <3 for other psychoactive substances on ASSIST are considered to be of no or low risk and may not need any intervention. Those that score between 10 and 26 points on alcohol and 4 and 26 points for other psychoactive substances are considered to have moderate risk and may benefit from brief counseling as part of feedback discussion after ASSIST interview. Any respondent that scores 27 points and above on ASSIST is considered to have high risk and may benefit from substance use prevention and treatment professional intervention.
The purpose of the study was explained to the women who came for antenatal clinic and those that gave their informed written consent were recruited into this study. The questionnaire was administered to the respondents by two research assistants who were resident doctors in the department of obstetrics and gynaecology who had earlier had trainings on the use of the instruments. Those who had serious substance use problems (those that scored 27 points and above on ASSIST) were properly counseled and subsequently referred to psychiatric clinic for further review after discussing with the Senior Registrars or Consultants in charge of the clinics.
Data were analyzed using Epi info version 6.04d, a softwere developed by Centers for Disease Control and Protection (CDC) in Atlanta Georgia (US). Frequency table was generated and means were calculated using t-test. The level of statistical significant was set at 5% confidence limit for two-tailed test.
Approval for the study was obtained from the Ethics and Research committee of Abubakar Tafawa Balewa University Teaching Hospital with assigned number 0024/2018 dated September 7, 2018. We adhered to 2013 Helsink's declaration and guidelines. Confidentiality and privacy of respondents were protected by avoiding the use of names or hospital numbers on the questionnaires but rather with used of unique research identification numbers.
| Results|| |
Three hundred and twenty pregnant women participated in this study. Their ages ranged between 18 and 44 years with the average age of 26 ± 3.5 years. Majority of them were married (93.8%) and about 4.4% of them had previous marriages. More than 70% of the respondents were educated to at least secondary school level. Slightly above 58% of our respondents professed Islamic faith, and only 45% of the respondents were gainfully employed as at the time of the study.
Sixty percent of the women were multigravidarum; most of them accepted that the pregnancies were wanted. Up to 26% of the respondents reported lack of adequate financial support from their husbands; while about 32% were experiencing relationship difficulties.
About 41% of the respondents' fathers used psychoactive substances as against 13% of mothers. Similar percentage (40%) also reported that their husbands used psychoactive substances.
Although more than 87% of the women were aware of danger of use of psychoactive substances during pregnancy, only 52.5% reported that this information was offered to them during ANC [Table 1].
|Table 1: Sociodemographic and clinical variables of women attending antenatal clinic|
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Out of 320 women that participated in this study, 43 of them were current users of one form of psychoactive substance or the other. This gave the prevalence rate of use of drugs among pregnant women seen at the booking clinic to be 13.3%. Tobacco products were the most commonly abused substance (34.7%). This is followed by sedatives and over-the-counter sleeping pills (32.8%), and opiates in the form of tramadol and codeine containing cough syrups (14%). Proportions of respondents that consume alcoholic products were 12.4%, whereas the remaining percentage was for other substances such as cannabis, inhalants, and solvent. None of the respondents reported using injectable drugs.
The only factors that were statistically significant with substance use among pregnant women in our study were fathers and partners use of psychoactive substances (fathers use of drug: χ2 = 2.620, P = 0.018; partners use of drugs: χ2 = 3.033, P = 0.016) [Table 2].
|Table 2: Comparing pregnant women using psychoactive substances with nonusers|
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| Discussion|| |
Use of illicit and nonprescription medication during pregnancy is of major public health interest because of its implications on the health of expectant mothers and their unborn children. We found that about 13% of women who attended antenatal clinic used drugs not prescribed for them by medical professionals. These substances include tobacco in form of snuff and cigarette, sedatives such as benzodiazepines, alcohol of different brands, kolanut, tramadol, and codeine. Most of these substances are readily available and can be purchased in the community with little or no restriction. Uses of drugs such as cocaine and heroin which are illegal and criminalized in this part of the world are not found among our respondents. Our findings were similar to the results from similar studies done in other parts of the country. Envuladu et al. reported the prevalence rate of 10.8% among their cohort that were attending ante-natal clinic in Plateau, a North-central state of Nigeria. Similarly, Ajagbon et al. reported a prevalence rate of current psychoactive substance use among pregnant women in Abeokuta, a town in South-western region of Nigeria, to be 16.9%. However, prevalence rate of substance use among pregnant women in our study was lower than what was found in a neighboring state where the rate of use was as high as 43.8%. The difference between our study and theirs might be due to the fact that substances of abuse in our study were limited to illicit drugs while theirs included all medications such as antibiotics, etc.
This study did not find any association between the use of psychoactive substances and demographic variables. Some studies have reported positive association between younger age and substance use during pregnancy. Marital status was also reported to be a variable that might influence drug use. Ordinioha and Brisibe noted increased use of drugs among unmarried pregnant women than their married counterparts. Other factors found to be significantly associated with the substance use in the above study were religion of the women and their parity. For instance, use of alcohol was more among Christian respondents.
Respondents in this study, whose fathers used psychoactive substances, have more propensities to be drug users. This is similar to the finding by Ajagbon et al. where respondents whose fathers used psychoactive substances tend to use illicit drugs than respondents whose fathers did not. It has been shown that offspring of parents who abuse drugs tend to be drug users themselves. This association could be familial or as a result of social learning. ,
Another variable that was positively associated with substance use behavior in our study was partners' use of psychoactive substances. Significant numbers of our respondents who reported that their partners used substances were using drugs during pregnancy. It has also been reported that partners might influence use of psychoactive substances by their partners with whom they were in romantic relationship. This is likely the reason why women whose partners are drug users are more likely to be drug users than their counterparts whose partners do not use psychoactive substances.
Some respondents may not truthfully disclose their substance use behavior with the use of questionnaire. Urine or blood drug toxicology might be able to pick these kinds of respondents. However, it is generally believed that ASSIST has its own advantage over urine or blood drug toxicology because the later may not be able to pick users that do not recently take the substance.
| Conclusion|| |
High percentage of women attending ante-natal clinic admitted to using substance of abuse. Fathers' as well as partners' use of psychoactive substances were found to be contributory factors. Knowing the risks and dangers of use of illicit drugs during pregnancies to mothers and their babies should prompt screening for substance use problems among pregnant women attending ante-natal clinics. This will go a long way in averting these dangers and complications.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]