CHAPTER ONE

 Introduction

1.1 BACKGROUND

Alcohol has been and remains the drug most commonly used by women of reproductive age (Oei, 2020). Over the past 30 years, young women worldwide have been consuming more alcohol and with increasingly frequent patterns of risky behavior, such as “binge drinking” (four or more drinks in 2 h; Roozen et al., 2018). Unfortunately, alcohol consumption is also found in a significant proportion of women during their pregnancies. Popova et al.’s (2017) comprehensive systematic literature search and meta-analysis revealed that 10 %–15 % of pregnant women in Canada and the United States, respectively, consume alcohol, and about 3 % in both countries engage in binge drinking. There is no precise estimate of alcohol consumption by pregnant women in the European Union (Mendoza et al., 2020), but in a study carried out in 11 European countries, 15.8 % of the samples of pregnant and puerperal women reported they consumed alcohol during pregnancy (Mårdby et al., 2017). Based on these shreds of evidence, it should not be surprising that prenatal alcohol exposure (PAE) is a global health problem (Popova et al., 2017). Prevalence estimates of PAE vary around the world, from 4.1 % in Norway (Mårdby et al., 2017) and 7.3 % in the United States (Green et al., 2016) to 60.4 % in Ireland (Popova et al., 2017).

Worldwide, the majority of clinical and government guidelines advocate that women abstain from alcohol consumption during pregnancy due to potential adverse effects on pregnancy outcomes (Butt et al., 2011). According to the WHO report in 2018, 3 million people lose their lives worldwide every year from harmful use of alcohol.

Globally the magnitude of alcohol consumption during the index of pregnancy is estimated to be 10%. In the USA the prevalence of alcohol use in pregnancy is 10.2% and women in the reproductive age group reported a significantly higher prevalence of alcohol use. 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 that 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 used to regular alcohol use during pregnancy, and 6% reported consumption two to four times per month (So-Hee, 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).

Countries in Sub-Saharan African region alcohol exposure during pregnancy ranged from 2.2–87%. In this African region alcohol consumption in pregnancy is an increasing problem among pregnant women. A mother doesn’t have to be alcoholic for damaging effects of alcohol for the fetus. It means that there is no safe amount and safe time to drink alcohol during pregnancy period.Alcohol use during pregnancy has been a well-known risk factor for adverse pregnancy outcomes. This might increase the incidence of stillbirth , spontaneous abortion , premature birth , intrauterine growth retardation and low birth weight, substantial risk of mental, physical and psychological harm to her offspring called fetal

alcohol spectrum disorders(FASD) and fetal alcohol syndrome.

The estimated prevalence of alcohol consumption during pregnancy in Cameroon is 12.6% (95% CI: 9.9-15.4%)

A Fetal Alcohol Spectrum Disorder (FASD) is an umbrella term for the wide range of adverse effects to the developing fetus when exposed to alcohol during pregnancy. FASD includes, abnormal facial features called the philtrum, small head circumference, shorter than average height, low body weight, poor coordination, Attention deficit hyperactive disorder, memory problems, learning disabilities and school performance become decline, speech and language delays, intellectual disability or low IQ,  poor reasoning and judgment skills .

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).

 1.2  Statement of The Problem

 Alcohol is a teratogen and consumption during pregnancy can result in a range of conditions collectively referred to as the Fetal Alcohol Spectrum Disorders (FASD).

Alcohol’s effect on physical and structural development can manifest in several birth defects, including:Abnormal facial characteristics that may include wide-spaced eyes, a smooth ridge between the nose and upper lip (known as the philtrum), a flat nasal bridge, a thin upper lip, and an upturned nose, among others.Small head circumference, below average height and weight, problem with eyesight or hearing.

Despite the numerous effects of alcohol consumption about 15% of pregnant women still consume alcohol during pregnancy globally (National Health Research council,  2009). Numerous cases of Fetal Alcohol Spetrum (FAS) from all over the world have now been reported ( Cook et al., 2001). Since the begining of the 18 century, physicians and researchers in France and England have observed and reported the harmful effect of maternal alcohol consumption on offsprings. It was not untill 1973 however that a group of scientist at the university of Washington,  seattled, labelles a characteristics pattern of severe birth defects as Fetal Alcohol Syndrom (FAS) (Cook et al., 1990). In 1973, Jones and Smith coined the term FAS to describe a pattern of abnormalities observed in children born to alcoholic mothers.No such findings exist for Cameroon, This phenomenon may be thesame Cameroon especially in Buea,Molyko community in the Molyko Intergrated Health Center (MIHS). Women in the MIHS and molyko community still consume alcohol during pregnancy despite the numerous negative effects alcohol is known to have. It is for this purpose this study seek to evaluate the knowledge on the effect of alcohol intake during pregnancy at the Molyko Health center

1.3 Research Questions

Why do pregnant women in Molyko health Center consume alcohol?

What are the effects of excessive alcohol consumption on pregnancy(on mother, fetus and later in life of the baby)?

What measures can be taken to prevent this bad habits  of alcohol consumption during pregnancy?

1.4 Objective of The Study

1.4.1 General Objective

The main objective of this study is to find out if pregnant women receiving prenatal care at the Molyko health center know the effects and factors that influence them to consume alcohol during pregnancy and the measures that can be put in place to prevent it.

1.2 Specific objectives

Specifically, the study sought to;

To determine why pregnant women attending ANC at theMolyko heath center consume alcohol.

To find out if the pregnant women know the effects of excessive alcohol  consumption on pregnancy (on mother, fetus and later in the life of the baby).

To determine the measures taken to prevent this bad habits of alcohol consumption during pregnancy.

 1.5 Hypothesis