Dr. Oliver C Ezechi is the Deputy Director Research & Consultant Obstetric gyneacologist and Head, Clinical Sciences Division, Nigerian Institute of Medical Research (NIMR) Lagos. He was one of the lead researchers out of about 20 in a new study titled: ‘ Effects of alcohol in pregnancy ’ which was carried out under the sponsorship of Nigerian Breweries Plc, Lagos, Nigeria. Last year, 40 babies had their first drink before they were born. So quipped Ezechi, recently, when he presented the result of the research to a mammoth crowd of professionals, experts and journalists at the fifth anniversary of the Prof. Innocent Ujah, as the Director General (DG) of NIMR. CHIOMA UMEHA (HEALTH EDITOR) was there and has the excerpts.
Evolution of the project
The project is was carried out based on convergence of ideas from two great Institutions
It is a research for national health which provide evidence and baseline information required for intervention against unsafe drinking in pregnancy
The project tagged; ‘Drink it right’ is aimed at improving awareness among women on the health related harm of alcohol use in pregnancy.
Effects of alcohol in pregnancy
Alcohol passes from the mother’s bloodstream to the fetus through the placenta.
The alcohol run’s through the fetus’s bloodstream, out into the amniotic fluid that surrounds it, and is taken in a second time.
The level of alcohol in the fetus’s blood is often two times higher than in the mother’s blood.
During the first trimester (zero-13 weeks), it causes teratogenesis (Morphologic abnormalities) and spontaneous abortion (miscarriages) during second trimester (>13-28 Weeks).
During third trimester (>28-40 Weeks), it causes preterm labour, low birth weight and small-for-date babies.
Alcohol is dangerous throughout every stage in pregnancy; it leads to central nervous system and brain damage. No amount of alcohol consumption can be considered safe during pregnancy.
Alcohol can damage the embryo or fetus at any stage of pregnancy; damage can occur in the earliest weeks of pregnancy, even before a woman knows she is pregnant and the cognitive effects and behavioural problems resulting from prenatal alcohol exposure are life-long.”
Justification of study
Health authorities are expected to develop guidelines and recommendation for the prevention and management of alcohol use in pregnancy based on country specific data.
Awareness creation against danger of alcohol in pregnancy requires accurate knowledge of the magnitude of the problem in the country.
Unfortunately, extensive literature search showed minimal and non representative information on the burden and pattern of alcohol use during pregnancy in Nigeria.
Objective of study
To determine the burden and pattern of alcohol use during pregnancy, with the purpose of contributing to evidence-based recommendation for policy formulation, development and implementation of an effective alcohol use in pregnancy prevention and control in Nigeria.
Long term goal of project
To improve awareness among pregnant women on the health related harm of alcohol use during pregnancy.
Methodology for study
It was a pilot study in Lagos State preparatory to a nationwide study. The lessons learnt and challenges encountered from the pilot study will be fed into the planned nationwide survey.
Study design and setting
It was cross sectional study.
Selection of health facilities
Facilities selected were three tertiary institutions and 25 General Hospitals. Also, 28 private hospitals were randomly selected.
Others selected were 61 primary health centres (PHC) in Lagos state; traditional birth attendant (TBA) centres and four pregnant women interviewed from each health facility. A total of 468 pregnant women were interviewed.
Ten local government areas (LGA) make up the site. These are: Lagos Mainland, Badagry/Apapa Ajeromi, Mushin/Surulere, Shomolu/Isolo/Oshodi, Eti-Osa/Epe, Ibeju Lekki/Lagos Island, Amuwo Odofin/Ojo, Kosofe/Ikorodu, Alimosho/Agege and Ikeja/Ifako Ijaiye.
The tertiary hospitals involved in the study were: FMC, Ebute Meta, under Lagos Mainland and LUTH in Mushin and LASUTH in Ikeja/Ifako Ijaiye.
There were 25 general hospital (GH) involved in the study including: Harvey Road Health Centre (HC); Ebutte Meta HC; Mainland Hospital; Badagry GH; Apapa GH, Surulere GH, Mushin GH, Gbagada GH, Shomolu GH, Oshodi Med Stores, Isolo GH, Ibeju Lekki GH, Epe GH, Lagos GH, Massy Street Children Hospital, LIMH, Onikan HC and Ajeromi GH.
Others are; Ketu Ejirin HC, Agbowa GH, Ikorodu GH, Ijede HC, Alimosho GH, Orile Agege GH and Ifako Ijaye GH.
Primary Health Centre
32 primary health centers (PHC) were involved in the study including; Otto PHC, Iwaya PHC, Sari PHC, Marine Beach, Ijora PHC, Ajara PHC, Apoa PHC, Ilogbo PHC, Itire Ijesha PHC, Ayantuga PHC, Orile PHC, Anjorin PHC, Akerele PHC, Mafoluku PHC, Akoka PHC, Jakande Estate PHC, Ishaga PHC, Oshodi PHC, Epe PHC, Ibowon PHC and Agbowa PHC.
Others are Ajah PHC, Ikota PHC, Oniru PHC, Ibeju PHC, Lafiaji PHC, Olowogbowo PHC, Ikoyi PHC, Obalende PHC, Apakin PHC and Okunraye PHC.
The private hospitals involved in the study are; Ore-ofe, Primus Medical Centre, Lagoon Hospital, A.Y Oyekan Hospital, Regina Mundi Catholic Hospital, Able God Hospital, Havana Specialist Hospital, R-Jolad, Life’s Fountain Medicare, Magbon Alade Medical Centre, Alasco Clinic, Epe Model Clinic, Adebisi Clinic and Ajike Sanda Memorial Medical Centre.
Others are; St Nicholas Hospital, St Kizito Clinic, Graceland Medical Centre, Ilogbo Central Hospital, Holy Family Catholic Hospital, Chevron Hospital, Catholic Hospital, Ijede, Subol Hospital, Ancilla Catholic Hospital, Duro Soleye Hospital and Adunmo Memorial Hospital.
Supervisor and researchers involved in study
Supervisor and Researchers involved in study are Prof. Innocent Ujah, Dr. Nwaokorie, Dr. Oliver Ezechi, Dr. Pascal Ezeobi, Ifeoma Idigbe, Dr. Stella Smith, Dr. Nwokoye, Idowu Edu, Dr. David and Dr. Gbajabiamilla.
Others are; Dr. Wapmuk, Dr. Greg, Dr. Ganiyu, Mrs. Afocha, Dr. Onubogu, Tajudeen Bamidele, Miss Awoderu, Dr Brai, Dr Oke, Jane Okowzu, Mr. Odewale, Mrs. Musa, Mrs. Sabdat Ekama, Mrs Adangbada, Bimbo Adedeji, Ihotu Agbo, Mr. Adeneye, Mrs. Kunle-Ope, Mr. Yisau , Dr. Onwujekwe, Dr. Gab-Okafor and Aisha Issa.
The survey on alchohol use in pregnancy also included a data capture form and certificate of consent. The certificate of consent contained the following information: “I have been invited to participate in this study.
I agree that the above information has been read to / by me that I have been able to ask questions about this study. I voluntarily consent to participate in this study and I understand that I can withdraw myself from this study anytime.”
The certificate of consent also required the name of participant, signature, date; name of witness, signature and date.
Completed questionnaires were submitted to supervisors for confirmation. The supervisors sent the questionnaires to Data Manager; Data double entered, cleaned and analysed.
Type and level of facility
The type and level of facility involved in the study are: Private, public; primary, secondary and tertiary facilities.
Alcohol use in pregnancy
Under alcohol use in pregnancy, 11.7 per cent respondents said that prevalence of alcohol use in pregnancy is 11.7 per cent. 48 per cent said No, while 52 per cent said, ‘Yes’ on the question- ‘Ever taken alcohol.’
However, 23.2 per cent said ‘Yes,’ while 78.8 per cent said ‘No’ to the question – ‘Alcohol used among ever used.’
Alcohol use by trimester of pregnancy
On the question – Alcohol use by trimester of pregnancy; 3.9 per cent said it is used in first trimester; 25.5 per cent – second trimester, while 70.6 per cent responded that it is in the third trimester.
Prevalence of alcohol use by LGA in Lagos State
The prevalence of alcohol use by Local Government Area (LGA) in Lagos State showed in this order – Ojo – 11 per cent(Highest) and Epe – 1.9 per cent (lowest)
Conclusively, alcohol use in pregnancy is common in the studied population. Majority do not know that alcohol use in pregnancy has adverse effects on the baby. Majority of those who take herbal preparation do not know it contains alcohol. Health workers do not often ask about alcohol use in pregnancy.
Obviously, there is urgent need for support by for a nationwide study to determine the burden of alcohol use in pregnancy for appropriate education for the community, women and their husbands.
Also, important are public health education on the effects of alcohol use in pregnancy through print, electronic media as well as community and sensitization at religious places of worship.
Other necessary steps are retraining of health workers on alcohol prevention counselling during pregnancy; Development of country specific guideline for the prevention and control of alcohol use in pregnancy.
A nationwide study supported by Nigerian Breweries should be conducted to determine the national prevalence of Alcohol use/abuse in pregnancy.
A follow-up case-control study, supported by Nigerian Breweries is expected to be conducted to determine the outcomes of babies born to women who consume alcohol in pregnancy.
Similarly, retraining of Health workers and integration of alcohol prevention into existing Ante Natal Services (ANC) services should be conducted.
The study was sponsored by Nigerian Breweries.The research was authorized by the following; Lagos State government, Lagos state Primary Health care Agency, Lagos State Health Management Board, Association of Traditional Birth Attendants and Management of Nigerian Institute of Medical Research (NIMR).
This story was published in Newswatch Times on November 5, 2015.