Exposure to tobacco use in pregnancy and its determinants among sub-Saharan Africa women: analysis of pooled cross-sectional surveys

Background: Tobacco use in any form and exposure to second-hand smoking are major threat to human health globally. Worse still, it is an important threat to the health of pregnant women and their children. However, the prevalence of tobacco use among pregnant women in sub-Saharan Africa countries remains uncertain. This study assessed the prevalence and factors of tobacco use among pregnant women in sub-Saharan Africa countries. Methods: This study utilized data from Demographic and Health Surveys (DHS) conducted in 31 sub-Saharan Africa countries between 2008 and 2017, comprising 44,715 pregnant women (aged 15-49 years). We calculated sampling weights to account for differentials in probabilities of selection and estimated proportions and 95% CIs for tobacco use in pregnant women across various countries. The factors associated with tobacco use were examined using multivariable binary logistic regression models at a significant level of 5%. Results: Prevalence of tobacco use among pregnant women was similar to 2%. In Madagascar, the prevalence of tobacco use was 11.0%, while Lesotho (5.4%), Sierra Leone (4.8%), Namibia (4.4%) and Burundi (4.2%) were among the leading countries with high tobacco use pregnancy. The results of multivariable binary logistic regression model showed that pregnant women aged 25-34 years and >= 35 years were 2.26 times (OR = 2.26; 95%CI: 1.23, 4.15) and 2.45 times (OR = 2.45; 95%CI: 1.10, 5.45) as likely to use tobacco products, compared to women aged <= 24 years. The religious beliefs of pregnant women, who belong to other religion besides Islam, were 2.26 times as likely to use tobacco products compared to Christian women (OR = 2.26; 95%CI: 1.19, 4.31). In addition, pregnant women from households with middle-class wealth index had 64% reduction in tobacco products use among pregnant women, compared to those from poor households (OR = 0.36; 95%CI: 0.15-0.87). Conclusion: Overall, tobacco use in pregnant women in sub-Saharan Africa was low; however high prevalence estimates were noted in some countries. Prevention and management of tobacco use and exposure to second-hand smoke during pregnancy is crucial to protect maternal and child health in Africa continent. Pregnant women should be examined about their tobacco use preferably with a biochemical test and those who use tobacco products be encouraged to use cessation supports such as nicotine replacement therapy (NRT) where available. Health professionals should identify tobacco products users and advise to quit, most importantly by offer cessation support. When tobacco products users become pregnant, the health benefits of cessation of tobacco use should be well discussed with them especially during antenatal care. The tobacco use of other members of the household is also crucial, as having a user partner could widely predict the exposure of a pregnant woman.