The Burden of Generational Harm due to Alcohol use in Tanzania: a mixed method study of pregnant women

BackgroundRates of prenatal alcohol use in Sub-Saharan Africa (SSA) are increasing, despite regulatory bodies urging pregnant women to abstain from alcohol. Tanzania has minimal policies, interventions, and young female education addressing alcohol consumption during pregnancy (ACDP), leading to a considerable number of pregnancies being exposed to alcohol and consequent health consequences like fetal alcohol spectrum disorder (FASD). Research investigating the prevalence of ACDP in SSA --specifically in Tanzania-- is abundant. In Tanzania, there is a limited understanding of alcohol use practices among pregnant women who consume alcohol (PWCA), as well as community knowledge, attitudes, and cultural beliefs related to ACDP. MethodsA total of 655 individuals were enrolled in this sequential, explanatory mixed-methods study using systematic random sampling between October 2021 and May 2022. Quantitative survey data from 533 female patients presenting for care at KCMC ED or RHC were analyzed to compare sociodemographic factors and alcohol use practices among pregnant, younger non-pregnant, and older non-pregnant women using descriptive frequencies in RStudio. Nineteen participants were purposively selected based on quantitative survey data for qualitative semi-structured IDIs exploring knowledge, attitudes, and cultural beliefs surrounding ACDP. A grounded theory approach was used to analyze in-depth interviews (IDIs) in NVivo. ResultsA large percent of pregnant women reported alcohol consumption of at least once per week (42.2%). Older non-pregnant women had the highest rates of alcohol use per week (66.0%) and were more likely to believe alcohol use was acceptable during pregnancy. Younger non-pregnant women reported the highest weekly alcohol expenses and held the highest prevalence of harmful or hazardous drinking (HHD) (16.4%). Average [SD] AUDIT scores were 1.70 [3.28] for pregnant women, 2.94 [4.79] for younger non-pregnant women, and 2.51 [4.36] for older non-pregnant women. Older non-pregnant women exhibited the highest prevalence of depression (31.4%). Average [SD] PHQ-9 scores were 4.71 [3.12] for pregnant women, 5.85 [4.80] for younger non-pregnant women, and 7.29 [5.55] for older non-pregnant women. Qualitative analyses demonstrated that (1) cultural beliefs are intricately tied to perceived benefits of ACDP, (2) a history of alcohol use preceding pregnancy largely influences ACDP, and (3) community views of PWCA are negative. SignificanceOur findings demonstrate a concerning trend of ACDP in Moshi, Tanzania. Cultural and community beliefs, along with limited knowledge of ACDP, among women of all ages appear to influence ACDP and community views of PWCA. Consequently, community-wide education initiatives and pre-pregnancy interventions highlighting the dangers of ACDP are necessary. Holistic support services may help curb alcohol use and improve birth experiences. Further research is needed to explore ACDP as a form of self-medication for depression, fear, anxiety, and pain in pregnant women in SSA.