This chapter deals with the demographic characteristics, the knowledge and attitudes of women towards alcohol consumption and the factors associated with the knowledge and attitude of reproductive women towards alcohol consumption in Amhara Region of North western Ethiopia. It has been analyzed using descriptive statistics such as frequency, percentage and inferential statistics such as binary logistic regression.
Socio-Demographic and Economic Characteristics of Respondents in the Study Area
A total of 380 questionnaires were distributed and 374 of them were appropriately filled with the response rate of 97.4%. The mean age (± SD) of the respondents was 35.22 (± 7.359), with age ranging from 18 to 49 years. As it can be seen from Table 1, the age of the respondents has classified with 3 age categories. The result shows, 6.4 % of the respondents were in age category of 15 up to 24, while 40.1 of them were from 25 up to 34. The significant number of the respondent’s (53.5 %) were in the age category of 35 up to 49. This implies that, majority of the respondents were concentrated in the age category of adult age; the last age of reproductive time. As far as the marital status of the respondent’s concerned, 1.1 %, 2.1 % and 4.3 % of them were single, widowed and divorced women respectively. The significant number of respondent’s (92.5 %) were married women. It can be understood that, majority from marital status category was married. Regarding place of the residence, half of the respondents (50%) were rural and half of them also urban residents.
As per the religious affiliation of the respondents, 94.4 %, 4.8 %, and 0.8 % of them were Orthodox, Muslim and Protestant religion followers respectively. Concerning the educational level, 45.5 % of the respondents were an illiterate educational status, while 54.5% of them were literate. The occupational status of the respondents also determines the alcohol utilization during pregnancy. The government employee has obtained 13.1 % and 66.3 % of them are house wife. The 19.3 % of the respondents were engaged in their own business, while 1.3 % of were working as a daily laborer. Last but not least, the result shows that ,69.2 %, 28.9 % and 1.9 % of the respondents have an average monthly income from 500upto 2500, 2501upto5000 and 5001upto 7530 ETB with in the households respectively.
Table-1: Socio-Demographic and Economic Characteristics of Study Participants in West Gojjam Zone, Northwest, Ethiopia, 2021
Variables
|
Options
|
Frequency (N)
|
Percentage (%)
|
Age
|
15–24
|
24
|
6.4
|
25–34
|
150
|
40.1
|
35–49
|
200
|
53.5
|
Marital statues
|
Single
|
4
|
1.1
|
Married
|
346
|
92.5
|
Divorced
|
16
|
4.3
|
Widowed
|
8
|
2.1
|
Place of residence
|
Rural
|
187
|
50
|
Urban
|
187
|
50
|
Religious affiliation
|
Orthodox
|
353
|
94.4
|
Muslim
|
18
|
4.8
|
Protestant
|
3
|
0.8
|
Educational status
|
Illiterate
|
170
|
45.5
|
Literate
|
204
|
54.5
|
Occupational status
|
Government employee
|
49
|
13.1
|
House wife
|
248
|
66.3
|
Own business
|
72
|
19.3
|
Daily laborer
|
5
|
1.3
|
Average monthly income of households
|
500–2500
|
259
|
69.2
|
2501–5000
|
108
|
28.9
|
5001–7530
|
7
|
1.9
|
Source: Obtained from survey data, 2021 |
Knowledge of Reproductive Women with regard to Alcohol consumption during Pregnancy
The knowledge of women with regard to problems of drinking alcohol during pregnancy in the study Area is measured by asking the consequences of alcohol utilization. The findings demonstrated, majority of the respondents (82.4 %) has known the problems of alcohol use during pregnancy, while 17.6 % of them did not aware about the problem of alcohol utilization during pregnancy. However, the effects of alcohol consumption during pregnancy have multi-dimensional. Among those, affect the unborn child, low birth weight, mental retardation and delayed development. Principally, the knowledge of women towards the effects of alcohol utilization on the unborn child, 71.7 % of the respondents have an awareness about the effect, while 28.3 % of them are unaware about it. The study revealed that, women’s knowledge on health effect of alcohol consumption during pregnancy high.
Regarding the problem of low birth weight, about 47.3 % of the respondents have an awareness, while a significant number of the respondents (52.7 %) have no knowledge about this problem that comes from alcoholic utilization. Basically, 45.2 % of women were aware of about mental retardation that comes from alcohol utilization during pregnancy, while majority of them (54.8 %) did not know about it. The effect of alcohol utilization has leads to delayed development, and majority of women (53.2%) have no an awareness about the delayed development problem, while (46.8 %) of them has knowledge about this particular problem.
The result illustrates that, there are many effects of heavy alcohol use during pregnancy. These are miscarriage, premature birth, still birth and high blood pressure apart from among others. Concerning the miscarriage problem, 39.6 % of the respondents were an aware of about the heavy alcoholic utilization have effects during pregnancy, while a significant number of respondents (60.4 %) did not have awareness about to this problem. Regarding the problem of premature birth, a small number of respondents (27 %) were awarded, while 73 % of them were unaware of it. The 7.8 % of the respondents were aware of about the effects of alcoholic consumption leads to still birth, while majority of women (92.2%) were unaware about the effects of alcoholic consumption on still birth. A small number of respondents (26.5 %) have an aware about the high blood pressure, while a significant number of the respondents (73.5 %) did not aware. Moreover, a little number of respondents (12.3 %) have an aware about the other effects of alcohol consumption during pregnancy, while majority of the respondents (87.7%) were doing not aware about effects of alcoholic consumption particularly in times of pregnancy for maternal health and fetus.
The source of information about alcohol consumption exposure to miscarriage, high blood pressure, premature birth and others condition could be media, observation, family and health workers. The 20.1 % of the respondents were obtained the information from media, while 79.9 % did not obtained. Likewise, a very limited number of respondents (4.3 %) has gotten information from their observation, while majority of them (95.7%) did not gather information from their own observation. Around 20.3 % of women has obtained information from families, while 79.7 % of them did not obtain. A significant number of the respondents (54%) were taken information’s from the health workers, while 46 % of them did not. The source of information from peers, 8.6% of women has taken from it and majority of them (91.4 %) did not obtain their sources of information from peers. Additionally, 10.4 % of the respondents obtained information from neighbors, while majority of the respondents (89.6%) did not obtain the information from neighbors.
Table-2: Distribution of the Study Participants by Knowledge with Regard to Consumption of Alcohol During Pregnancy among Reproductive Women in West Gojjam Zone ,North-West Ethiopia, 2021
Do you know the problems of alcohol use during pregnancy
|
Yes
|
308
|
82.4
|
No
|
66
|
17.6
|
The effects of alcohol consumption during pregnancy
|
Affect the unborn child
|
Yes
|
268
|
71.7
|
No
|
106
|
28.3
|
Low birth weight
|
Yes
|
177
|
47.3
|
No
|
197
|
52.7
|
Mental retardation
|
Yes
|
169
|
45.2
|
No
|
205
|
54.8
|
Delayed development
|
Yes
|
175
|
46.8
|
No
|
199
|
53.2
|
The effect of heavy alcohol use during pregnancy
|
Miscarriage
|
Yes
|
148
|
39.6
|
No
|
226
|
60.4
|
Premature birth
|
Yes
|
101
|
73
|
No
|
273
|
73
|
Still birth
|
Yes
|
29
|
7.8
|
No
|
345
|
92.2
|
High blood pressure
|
Yes
|
99
|
26.5
|
No
|
275
|
73.5
|
Others
|
Yes
|
46
|
12.3
|
|
No
|
328
|
87.7
|
The source of information about alcohol consumption exposure to miscarriage, high blood pressure, premature birth and others condition.
|
Media
|
Yes
|
75
|
20.1
|
No
|
299
|
79.9
|
Observation
|
Yes
|
16
|
4.3
|
No
|
358
|
95.7
|
Family
|
Yes
|
76
|
20.3
|
No
|
298
|
79.7
|
Health worker
|
Yes
|
202
|
54
|
No
|
172
|
46
|
Peers
|
Yes
|
32
|
8.6
|
No
|
342
|
91.4
|
Neighbors
|
Yes
|
39
|
10.4
|
No
|
335
|
89.6
|
Source: Obtained from survey data, 2021 |
Factors Associated with Knowledge towards Alcohol Consumption during Pregnancy
In a bivariate logistic regression, those variables whose p-value was less than 0.25 in bi-variable analysis were; residence, educational status, pregnant currently and risk of alcohol consumption during pregnancy were entered into multivariate logistic regression for further analysis. The multivariate analysis revealed that, educational statues such as literate and the risk of alcohol consumption during pregnancy is low has significantly associated with knowledge towards alcohol consumption at the time of pregnancy in the study area.
The study revealed that, educational status of women was significantly associated with the level of knowledge on alcohol consumption during pregnancy. It had a positive relationship with knowledge of alcohol consumption in time of pregnancy. Regarding to the educational status of women those who are literate 0.416 time more likely had knowledge about problems of alcohol consumption in time of pregnancy than illiterate (AOR = 0.416; 95%CI = 0.207–0.836). This study showed that, the risk of alcohol consumption during pregnancy is low associated with knowledge of alcohol consumption during pregnancy. It has negative relationships with knowledge of alcohol consumption. The analysis indicated that, the risks of alcohol consumption during pregnancy is low 9.468 time less likely had knowledge about the problems of alcohol consumption than the risk alcohol consumption is high (AOR = 9.468; 95% CI = 3.466–25.868). The women’s who said that low, it might not have personal experiences with children affected by alcohol use during pregnancy, it is dangerous to the baby and their health.
Table-3: Factors Associated with Knowledge towards Alcohol consumption during Pregnancy in North-Western Ethiopia (N = 374)
Variables
|
Do you know the problems of alcohol use during pregnancy
|
Odds Ratio (OR)
|
Yes
|
No
|
B
|
COR (95%CI)
|
AOR (95%CI)
|
Place of residence
|
|
|
|
Rural
|
143
|
44
|
|
1
|
1
|
Urban
|
165
|
22
|
1.061(-0.305)
|
0.433(0.248–0.758) 0.003
|
0.737(0.366–1.486) 0.394
|
Educational status
|
|
|
|
Illiterate
|
126
|
44
|
|
1
|
1
|
Literate
|
182
|
22
|
1.061(-0.877)
|
2.889(1.650–5.057)0.000
|
0.416(0.207–0.836) 0.014
|
Pregnant currently
|
|
|
|
Yes
|
81
|
9
|
-0.815(-0.655)
|
0.442(0.210–0.934) 0.033
|
0.519 (0.237–1.137) 0.101
|
No
|
227
|
57
|
|
1
|
1
|
The risk of alcohol consumption during pregnancy
|
Low
|
51
|
37
|
-1.748(2.248)
|
0.174(0.096–0.317) 0.000
|
9.468(3.466–25.868)0.000
|
Medium
|
190
|
24
|
-2.274(0.551)
|
0.103(0.038–0.280)0.000
|
1.736(0.635–4.743) 0.282
|
High
|
67
|
5
|
|
1
|
1
|
Source: Obtained from survey data, 2021 |
Attitude of Reproductive Women towards consumption of Alcohol during Pregnancy
With regard to the existence of health problems [miscarriage, high blood pressure, premature birth and others health problems] occur within the families, 30.2 % of the respondents were responded that there is exist, while 69.8 of them no existence of these problems. Similarly, 54.3 % of the respondents were said one of the health problems [miscarriage, high blood pressure, premature birth and others] occur within the community, while 45.7 % of them were responded that not occurred. With a limited number of the respondent’s (10.4%) has an attitude that alcohol have beneficial effect on overall health, while a significant number of the respondent’s (89.6 %) did not believe that alcohol have beneficial effect on reproductive health. Concerning the risks of alcohol consumption during pregnancy, 23.5 %, 57.2 % and 19.3 % of the respondent’s indicated that, the risk of alcohol consumption during pregnancy is low, medium and high respectively.
As far as utilize of alcohol during pregnancy is concerned, 7.5%, 1.9 %, and 57.2% of the respondent’s has said agree, strongly agree and disagree on the utilization of alcohol during pregnancy is valuable respectively. The result has also showed that 7.8% and 25.7 % of the respondents were strongly disagree and neutral about the utilization of alcohol during pregnancy is valuable respectively. Regarding the severe effect of alcohol utilization on maternal and child health especially in times of pregnancy, 40.9%, 10.2 %, 12.6%, 4.8%, and 31.6 % of the respondent’s has agree, strongly agree, disagree, strongly disagree and neutral on severe effect of alcohol consumption on maternal and child health respectively.
Table-4: Percentage distribution of the attitudes of Reproductive Women towards alcohol consumption during Pregnancy in Northwest Ethiopia, 2021
Attitudes of Reproductive Women towards alcohol consumption during Pregnancy
|
Options
|
Frequency
|
Percentage
|
One of these health problems [miscarriage,
high blood pressure, premature birth and others]
within your family
|
Yes
|
113
|
30.2
|
No
|
261
|
69.8
|
One of the health problems [miscarriage, high blood pressure, premature birth and others] occur within your community
|
Yes
|
203
|
54.3
|
No
|
171
|
45.7
|
Alcohol has beneficial effect on all health?
|
Yes
|
39
|
10.4
|
No
|
335
|
89.6
|
From experiences, how do you see the risk of alcohol consumption during pregnancy?
|
Low
|
88
|
23.5
|
Medium
|
214
|
57.2
|
High
|
72
|
19.3
|
Utilize of alcohol during pregnancy is valuable?
|
Agree
|
28
|
7.5
|
Strongly agree
|
7
|
1.9
|
Disagree
|
214
|
57.2
|
Strongly disagree
|
29
|
7.8
|
Neutral
|
96
|
25.7
|
Do you agree the severe effect of alcohol utilization on maternal and child health especially in times of pregnancy?
|
Agree
|
153
|
40.9
|
Strongly agree
|
38
|
10.2
|
Disagree
|
47
|
12.6
|
Strongly disagree
|
18
|
4.8
|
Neutral
|
118
|
31.6
|
Source: Obtained from survey data, 2021 |
Factors Associated with Attitude towards Alcohol Consumption during Pregnancy
In a bivariate logistic regression analysis, educational status, occupational status, length of drink alcohol currently, relative encourage alcohol drink, knowing problems of alcohol use, effect of alcohol consumption unborn child and effect of alcohol use delay development. The effect of heavy alcohol use exposes high blood pressure, health problems [miscarriage, high blood pressure, premature birth and others] within your family, risk of alcohol consumption, utilize of alcohol during pregnancy is valuable and severe effect of alcohol use on maternal and child health were identified as significant at (p-value < 0.25) and this considered to entered into multivariate logistic regression analysis.
After multivariate analysis those variables such as: housewife occupational status and had own business, length of drink alcohol currently 3–4 days a week, relatives encourage drink alcohol during pregnancy, health problems [miscarriage, high blood pressure, premature birth and others] occur in family, risk of alcohol consumption could medium and high and agree on the consumption of alcohol during pregnancy is valuable were significantly associated with attitude towards alcohol consumption in time of pregnancy at (p-value < 0.05). However, the multivariate analysis shows that, housewife occupation status has a significant relationship with an attitude towards alcohol consumption during pregnancy among reproductive women. It had a negative relationship with attitude of alcohol consumption. Hence, the occupation status of women a housewife were 4.6 times less likely had an attitude towards problems of alcohol use during pregnancy than being a government employee (AOR = 4.620; 95% CI= (1.255–17.012). With regard to occupational status, women who had own business is positively associated with attitude on consumption of alcohol.
The logistic regression analysis showed that, women who had own business were 17.344 times more likely have a good attitude about the negative effect of alcohol consumption than government employee (AOR = 17.344;95% CI = 1.821165.148). The frequency of alcohol consumption currently for 3–4 days a week is positively related to women attitude on alcohol consumption. The findings of this study stipulate that, alcohol consumption currently for 3–4 days a week were 11.278 time more likely had a good attitude on the beneficial effect of reproductive health than every day (AOR = 11.278;95% CI = 1.231-103.287), which is significant at p < 0.05.Finding of this study also shows that, the respondents relatives encourage to drink alcohol during pregnancy have a negative relationship with attitude of women on consumption of alcohol have beneficial effects on maternal health. Among study participants their relatives encourage drinking alcohol were 0.309 times less likely had attitude towards alcohol use have beneficial effect on maternal health than not encouraged by relatives (AOR = 0.309;95%=0.110–0.868), which is significant at p < 0.05.
Women who had previously health problems such as; miscarriage, high blood pressure, premature birth and others’ problems existed within their family have negative relations with women’s attitude on consumption of alcohol have beneficial effect on maternal health. The reproductive health problems such as; miscarriage, high blood pressure, premature birth and others’ problems occur within their family (yes) were 0.330 times less likely had an attitude on alcohol use have beneficial effect on maternal health than (no) (AOR = 0.330;95% CI = 0.152–0.717).
The logistic regression analysis indicated that, those women who perceive the risk of alcohol consumption have beneficial effect on health is medium can have a good attitude as compared to women’s who perceives the risk of alcohol consumption as low by the odds ratio of (AOR = 7.112; 95% CI = 3.108–16.270). It is also shows that, the attitudes of women towards alcohol consumption have beneficial effect on health is high can have good attitude probability of alcohol consumption as compared to low perception of alcohol consumption by the odds ratio of (AOR = 4.902;95% CI = 1.474–16.297). The findings also demonstrated that, women who agree on the consumption of alcohol during pregnancy is valuable has less likely consumed alcohol as compared to neutral by the odds ratio (AOR = 0.082;95% CI = 0.023–0.287). This implies that, the level of agreement or attitude of women is statistically significant and negative relationship at p- value < 0.05.
Table-5: Factors Associated with Attitude towards Alcohol Consumption during Pregnancy
Variables
|
Attitudes about alcohol use during pregnancy
|
Odds Ratio (OR)
|
Yes
|
No
|
B
|
COR (95%CI)
|
AOR (95%CI)
|
Educational status
|
|
|
|
Illiterate
|
24
|
146
|
|
1
|
1
|
Literate
|
15
|
189
|
0.728(1.002)
|
2.071(1.049–4.090) 0.036
|
2.722 (0.928–7.990)0.068
|
Occupational status
|
|
|
|
Government employee
|
8
|
41
|
|
1
|
|
House wife
|
28
|
220
|
-0.427(1.530)
|
1.533(0.653-3.600)0.327
|
4.620(1.255–17.012)0.021
|
Own business
|
2
|
70
|
1.921(2.853)
|
6.829(1.383–33.714)0.018
|
17.344(1.821165.148)0.032
|
Daily laborer
|
1
|
4
|
0.248(0.789)
|
0.780(0.077–7.931)0.834
|
2.201(0.138–35.102) 0.577
|
How often you drink alcohol currently
|
|
|
Everyday
|
3
|
3
|
|
1
|
|
1–2 days a week
|
11
|
97
|
1.484 (1.406)
|
4.409(0.965–20.154)0.056
|
4.079(0.701–23.728) 0.118
|
2–3 days a week
|
12
|
80
|
1.204 (1.389)
|
3.333(0.734–15.133)0.119
|
4.0100(.675-23.817)0.127
|
3–4 days a week
|
2
|
38
|
2.251(2.423)
|
9.500(1.304–69.191)0.026
|
11.278(1.231-103.287)0.032
|
Once a week
|
3
|
35
|
1.764(2.060)
|
5.833(0.946–35.988)0.057
|
7.849(0.938–65.682) 0.057
|
Relative encourage you to drink alcohol during pregnancy
|
|
Yes
|
9
|
28
|
-1.191(-1.173)
|
0.304(0.131–0.704) 0.005
|
0.309(0.110–0.868) 0.026
|
No
|
30
|
307
|
|
1
|
1
|
Know the problems of alcohol use during pregnancy
|
|
Yes
|
24
|
284
|
1.247 (0.383)
|
3.480(1.710–7.084)0.001
|
1.467(0.419–5.142)0.549
|
No
|
15
|
51
|
|
1
|
1
|
Effects of alcohol consumption during pregnancy affect the unborn child
|
Yes
|
16
|
252
|
1.473(1.108)
|
4.364(2.201–8.654)0.000
|
3.028(0.939–9.766) 0.064
|
No
|
23
|
83
|
|
1
|
1
|
Effects of alcohol consumption during pregnancy delay development
|
|
Yes
|
12
|
163
|
0.757(0.176)
|
2.132(1.045–4.350)0.037
|
1.193(0.531–2.676)0.669
|
No
|
27
|
172
|
|
1
|
1
|
Effect of heavy alcohol use during pregnancy expose to high blood pressure
|
|
Yes
|
5
|
94
|
0.975(0.708
|
2.652(1.007–6.986)0.048
|
2.029(0.718–5.734)0.182
|
No
|
34
|
241
|
|
1
|
|
Health problems [miscarriage, high blood pressure, premature birth and others] within your family
|
Yes
|
18
|
95
|
-0.773(-1.109)
|
0.462(0.236–0.905) 0.024
|
0.330(0.152–0.717)0.005
|
No
|
21
|
240
|
|
1
|
1
|
The risk of alcohol consumption during pregnancy
|
Low
|
22
|
66
|
|
1
|
1
|
Medium
|
13
|
201
|
1.640(1.962)
|
5.154(2.459–10.801)0.000
|
7.112(3.108–16.270)0. 000
|
High
|
4
|
68
|
1.735(1.590)
|
5.667(1.853–17.331)0.002
|
4.902(1.474–16.297)0.010
|
Utilize alcohol during pregnancy is valuable
|
|
|
Agree
|
15
|
13
|
-2.686(-2.502)
|
0.068(0.023–0.199)0.000
|
0.082(0.023–0.287)0.000
|
Strongly agree
|
1
|
6
|
-0.751(-0.466)
|
0.472(0.050–4.488) 0.513
|
0.628 (0.056–6.994) 0.705
|
Disagree
|
14
|
200
|
0.117(0.345)
|
1.124(0.438–2.879)0.808
|
1.412(0.435–4.578) 0.565
|
Strongly disagree
|
2
|
27
|
0.060(-0.129)
|
1.062(0.208–5.416) 0.942
|
0.879(0.141–5.492) 0.890
|
Neutral
|
7
|
89
|
|
1
|
1
|
Do you agree the severe effect of alcohol use on maternal and child health especially in times of pregnancy?
|
Agree
|
15
|
138
|
-0.275(0.598)
|
0.760(0.320–1.802) 0.533
|
0.550(0.184–1.639) 0.283
|
Strongly agree
|
1
|
37
|
1.117(1.211)
|
3.055(0.374–24.932) 0.297
|
3.358(0.350-32.229) 0.294
|
Disagree
|
12
|
35
|
-1.424(-0.729)
|
0.241(0.094–0.619)0.003
|
0.482(0.150–1.552) 0.222
|
Strongly disagree
|
2
|
16
|
-0.415(-0.744)
|
0.661(0.131–3.336)0 .616
|
0.475(0.089–5.492) 0.890
|
Neutral
|
9
|
109
|
|
1
|
1
|
Source: Obtained from survey data, 2021 |