{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,22]],"date-time":"2025-02-22T00:39:49Z","timestamp":1740184789277,"version":"3.37.3"},"reference-count":76,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2024,12,30]],"date-time":"2024-12-30T00:00:00Z","timestamp":1735516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006511","name":"Duke Global Health Institute, Duke University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006511","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100020353","name":"Josiah Charles Trent Memorial Foundation","doi-asserted-by":"publisher","award":["21-06"],"award-info":[{"award-number":["21-06"]}],"id":[{"id":"10.13039\/100020353","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000027","name":"National Institute on Alcohol Abuse and Alcoholism","doi-asserted-by":"publisher","award":["R01 AA027512"],"award-info":[{"award-number":["R01 AA027512"]}],"id":[{"id":"10.13039\/100000027","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:sec id=\"sec029\">\n<jats:title>Background<\/jats:title>\n<jats:p>Rates 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 educational programs addressing prenatal alcohol exposure. Consequently, a considerable number of mothers and their fetuses are exposed to alcohol, leading to serious health consequences like fetal alcohol spectrum disorder (FASD). Our study aims to understand the alcohol use practices of pregnant women, the knowledge and attitudes related to prenatal alcohol exposure among different genders and generations, and how these may be influenced by community perceptions and cultural beliefs among patients at Kilimanjaro Christian Medical Center (KCMC).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec030\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A total of 676 individuals seeking care at the KCMC Emergency Department (ED) or Reproductive Health Center (RHC) met our inclusion criteria, were approached for participation using a systematic random sampling method, and were enrolled. Of those, 541 women and 114 men completed the survey. The quantitative analysis focused exclusively on survey data from 533 women who reported their pregnancy status and age. Descriptive frequencies were used to compare sociodemographic factors and alcohol use practices across three female groups stratified by pregnancy status and age. Nineteen survey participants\u2014both men and women\u2014were purposively selected for qualitative semi-structured in-depth interviews (IDIs) exploring knowledge, attitudes, and cultural beliefs surrounding alcohol use during pregnancy. A grounded theory approach was used to analyze IDIs in NVivo.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec031\">\n<jats:title>Results<\/jats:title>\n<jats:p>A large percentage of pregnant women reported consuming alcohol at least once per week (42.2%). Older non-pregnant women exhibited the highest rate of alcohol use per week (66.0%). Many older non-pregnant women (28.7%) perceived alcohol use as acceptable during pregnancy. Younger non-pregnant women had the highest prevalence of harmful or hazardous drinking (HHD) at 16.4%. This group also reported the highest weekly alcohol expenses, with 18.1% spending over 10,000 Tanzanian shillings (TZS) per week. Median [IQR] DrInC scores were 0 [0\u20130] for pregnant women, 0 [0\u20137] for younger non-pregnant women, and 0 [0\u20131] for older non-pregnant women. Older non-pregnant women exhibited the highest prevalence of depression (31.4%). Median [IQR] PHQ-9 scores were 4 [3\u20136.25] for pregnant women, 5 [2\u20138] for younger non-pregnant women, and 6 [3\u201310] for older non-pregnant women. Qualitative analyses demonstrated that (1) cultural beliefs are intricately tied to perceived benefits of prenatal alcohol exposure, (2) a history of alcohol use preceding pregnancy largely influences prenatal alcohol use, and (3) community views of PWCA are negative.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec032\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Our findings demonstrate high rates of prenatal alcohol use in Moshi, Tanzania, with pre-pregnancy alcohol use as a significant predictor. Despite generally negative views of pregnant women who consume alcohol (PWCA), some sociocultural beliefs and limited knowledge about the dangers of prenatal alcohol exposure encouraged alcohol use during pregnancy. To improve health outcomes and reduce alcohol-related pregnancy complications for current and future generations, community-wide health messaging and pre-pregnancy interventions may prove beneficial for pregnant women and women of reproductive age who consume alcohol.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pgph.0003681","type":"journal-article","created":{"date-parts":[[2024,12,30]],"date-time":"2024-12-30T18:49:41Z","timestamp":1735584581000},"page":"e0003681","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["The burden of generational harm due to alcohol use in Tanzania: A mixed method study of pregnant 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T.","family":"Mmbaga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6468-2894","authenticated-orcid":true,"given":"Catherine A.","family":"Staton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,12,30]]},"reference":[{"issue":"10190","key":"pgph.0003681.ref001","doi-asserted-by":"crossref","first-page":"2493","DOI":"10.1016\/S0140-6736(18)32744-2","article-title":"Global alcohol exposure between 1990 and 2017 and forecasts until 2030: a modelling study","volume":"393","author":"J Manthey","year":"2019","journal-title":"Lancet"},{"issue":"1","key":"pgph.0003681.ref002","doi-asserted-by":"crossref","first-page":"e51","DOI":"10.1016\/S2468-2667(19)30231-2","article-title":"National, regional, and global burdens of disease from 2000 to 2016 attributable to alcohol use: a comparative risk assessment 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Ferreira-Borges","year":"2017","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pgph.0003681.ref015","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1186\/s13011-020-00325-y","article-title":"Correction to: alcohol consumption and its associated factors among pregnant women in sub-Saharan Africa: a systematic review and meta-analysis","volume":"15","author":"AE Addila","year":"2020","journal-title":"Subst Abuse Treat Prev Policy"},{"volume-title":"Alcohol consumption and harm in the African region: status report","year":"2013","author":"World Health Organization","key":"pgph.0003681.ref016"},{"key":"pgph.0003681.ref017","unstructured":"World Health Organization. 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Factors contributing to drinking alcohol during pregnancy in rural Kilimanjaro Tanzania: a descriptive qualitative study [MSc Thesis]. University of Cape Town; 2022. Available from: http:\/\/hdl.handle.net\/11427\/37568"},{"issue":"14","key":"pgph.0003681.ref022","doi-asserted-by":"crossref","first-page":"8661","DOI":"10.3390\/ijerph19148661","article-title":"Gender and context matter: behavioral and structural interventions for people who use alcohol and other drugs in Africa","volume":"19","author":"WM Wechsberg","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pgph.0003681.ref023","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1186\/s13063-022-06060-y","article-title":"PRACT: a pragmatic randomized adaptive clinical trial protocol to investigate a culturally adapted brief negotiational intervention for alcohol use in the emergency department in Tanzania","volume":"23","author":"CA Staton","year":"2022","journal-title":"Trials"},{"issue":"10","key":"pgph.0003681.ref024","doi-asserted-by":"crossref","first-page":"e0002009","DOI":"10.1371\/journal.pgph.0002009","article-title":"A mixed-methods comparison of gender differences in alcohol consumption and drinking characteristics among patients in Moshi, Tanzania","volume":"3","author":"A Pauley","year":"2023","journal-title":"PLOS Glob Public Health"},{"issue":"1","key":"pgph.0003681.ref025","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1080\/17457300.2015.1061562","article-title":"A prospective registry evaluating the epidemiology and clinical care of traumatic brain injury patients presenting to a regional referral hospital in Moshi, Tanzania: challenges and the way forward","volume":"24","author":"CA Staton","year":"2017","journal-title":"Int J Inj Contr Saf Promot"},{"key":"pgph.0003681.ref026","unstructured":"Kilimanjaro Christian Medical Centre. 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Available from: https:\/\/coilink.org\/20.500.12592\/mknnz6"},{"issue":"6","key":"pgph.0003681.ref029","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1111\/j.1360-0443.1993.tb02093.x","article-title":"Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption\u2013II","volume":"88","author":"JB Saunders","year":"1993","journal-title":"Addiction"},{"issue":"3","key":"pgph.0003681.ref030","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/S0376-8716(97)01353-7","article-title":"Utility of the AUDIT for identification of hazardous or harmful drinking in drug-dependent patients","volume":"45","author":"K Skipsey","year":"1997","journal-title":"Drug Alcohol Depend"},{"issue":"10","key":"pgph.0003681.ref031","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1111\/j.1360-0443.1995.tb03552.x","article-title":"The AUDIT questionnaire: choosing a cut-off score. Alcohol use disorder identification test","volume":"90","author":"KM Conigrave","year":"1995","journal-title":"Addiction"},{"issue":"1","key":"pgph.0003681.ref032","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1111\/acer.12593","article-title":"The use of alcohol use disorders identification test (AUDIT) in detecting alcohol use disorder and risk drinking in the general population: validation of AUDIT using schedules for clinical assessment in neuropsychiatry","volume":"39","author":"A Lundin","year":"2015","journal-title":"Alcohol Clin Exp Res"},{"issue":"7078","key":"pgph.0003681.ref033","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1136\/bmj.314.7078.420","article-title":"Efficacy of the alcohol use disorders identification test as a screening tool for hazardous alcohol intake and related disorders in primary care: a validity study","volume":"314","author":"M Piccinelli","year":"1997","journal-title":"BMJ"},{"issue":"1","key":"pgph.0003681.ref034","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1093\/alcalc\/agx058","article-title":"Cross-cultural adaptation and psychometric properties of the AUDIT and CAGE questionnaires in Tanzanian Swahili for a traumatic brain injury population","volume":"53","author":"JRN Vissoci","year":"2018","journal-title":"Alcohol Alcohol"},{"issue":"15","key":"pgph.0003681.ref035","doi-asserted-by":"crossref","first-page":"1681","DOI":"10.1001\/archinte.159.15.1681","article-title":"Hazardous and harmful alcohol consumption in primary care","volume":"159","author":"MC Reid","year":"1999","journal-title":"Arch Intern Med"},{"volume-title":"The drinker inventory of consequences (DrInC): an instrument for assessing adverse consequences of alcohol abuse: test manual","year":"1995","author":"WR Miller","key":"pgph.0003681.ref036"},{"issue":"1","key":"pgph.0003681.ref037","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1037\/adb0000344","article-title":"Revisiting the drinker inventory of consequences: an extensive evaluation of psychometric properties in two alcohol clinical trials","volume":"32","author":"M Kirouac","year":"2018","journal-title":"Psychol Addict Behav"},{"key":"pgph.0003681.ref038","doi-asserted-by":"crossref","first-page":"330","DOI":"10.3389\/fpubh.2018.00330","article-title":"Cross-culture adaptation and psychometric properties of the DrInC questionnaire in Tanzanian Swahili","volume":"6","author":"D Zhao","year":"2018","journal-title":"Front Public Health"},{"issue":"9","key":"pgph.0003681.ref039","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: validity of a brief depression severity measure","volume":"16","author":"K Kroenke","year":"2001","journal-title":"J Gen Intern Med"},{"issue":"9","key":"pgph.0003681.ref040","doi-asserted-by":"crossref","first-page":"509","DOI":"10.3928\/0048-5713-20020901-06","article-title":"The PHQ-9: a new depression diagnostic and severity measure","volume":"32","author":"K Kroenke","year":"2002","journal-title":"Psychiatr Ann"},{"issue":"18","key":"pgph.0003681.ref041","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1001\/jama.282.18.1737","article-title":"Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study","volume":"282","author":"Patient Health Questionnaire Primary Care Study Group","year":"1999","journal-title":"JAMA"},{"issue":"2","key":"pgph.0003681.ref042","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/j.psychres.2013.07.015","article-title":"Validity of the patient health questionnaire-9 for depression screening and diagnosis in East Africa","volume":"210","author":"B Gelaye","year":"2013","journal-title":"Psychiatry Res"},{"issue":"3","key":"pgph.0003681.ref043","doi-asserted-by":"crossref","first-page":"E191","DOI":"10.1503\/cmaj.110829","article-title":"Optimal cut-off score for diagnosing depression with the patient health questionnaire (PHQ-9): a meta-analysis","volume":"184","author":"L Manea","year":"2012","journal-title":"CMAJ"},{"key":"pgph.0003681.ref044","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.npbr.2018.11.002","article-title":"Validating the patient health questionnaire-9 (PHQ-9) for screening of depression in Tanzania","volume":"31","author":"MC Smith Fawzi","year":"2019","journal-title":"Neurol Psychiatry Brain Res"},{"issue":"11","key":"pgph.0003681.ref045","doi-asserted-by":"crossref","first-page":"1596","DOI":"10.1007\/s11606-007-0333-y","article-title":"Screening for depression in medical settings with the patient health questionnaire (PHQ): a diagnostic meta-analysis","volume":"22","author":"S Gilbody","year":"2007","journal-title":"J Gen Intern Med"},{"issue":"1","key":"pgph.0003681.ref046","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/S0015-0282(16)32587-0","article-title":"Reproductive span and rate of reproduction among Hutterite women","volume":"8","author":"C Tietze","year":"1957","journal-title":"Fertil Steril"},{"journal-title":"Births: provisional data for 2023","year":"2024","author":"BE Hamilton","key":"pgph.0003681.ref047"},{"key":"pgph.0003681.ref048","doi-asserted-by":"crossref","first-page":"114523","DOI":"10.1016\/j.socscimed.2021.114523","article-title":"Sample sizes for saturation in qualitative research: a systematic review of empirical tests","volume":"292","author":"M Hennink","year":"2022","journal-title":"Soc Sci Med"},{"issue":"1","key":"pgph.0003681.ref049","doi-asserted-by":"crossref","first-page":"6","DOI":"10.7748\/nr2011.10.19.1.6.c8765","article-title":"Navigating the grounded theory terrain. Part 2","volume":"19","author":"A Hunter","year":"2011","journal-title":"Nurse Res"},{"volume-title":"The SAGE handbook of grounded theory: paperback edition","year":"2010","author":"A Bryant","key":"pgph.0003681.ref050"},{"key":"pgph.0003681.ref051","doi-asserted-by":"crossref","DOI":"10.4324\/9780203793206","volume-title":"Discovery of grounded theory: strategies for qualitative research","author":"B Glaser","year":"2017"},{"key":"pgph.0003681.ref052","doi-asserted-by":"crossref","first-page":"2050312118822927","DOI":"10.1177\/2050312118822927","article-title":"Grounded theory research: a design framework for novice researchers","volume":"7","author":"Y Chun Tie","year":"2019","journal-title":"SAGE Open Med"},{"issue":"4","key":"pgph.0003681.ref053","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1111\/1475-6773.12275","article-title":"Using grounded theory method to capture and analyze health care experiences","volume":"50","author":"G Foley","year":"2015","journal-title":"Health Serv Res"},{"issue":"3","key":"pgph.0003681.ref054","doi-asserted-by":"crossref","first-page":"201","DOI":"10.4997\/jrcpe.2015.305","article-title":"Qualitative research in healthcare: an introduction to grounded theory using thematic analysis","volume":"45","author":"AL Chapman","year":"2015","journal-title":"J R Coll Physicians Edinb"},{"issue":"3","key":"pgph.0003681.ref055","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1093\/eurjcn\/zvaa034","article-title":"Grounded theory: what makes a grounded theory study?","volume":"20","author":"C Turner","year":"2021","journal-title":"Eur J Cardiovasc Nurs"},{"key":"pgph.0003681.ref056","unstructured":"Centers for Disease Control and Prevention. About fetal alcohol spectrum disorders (FASDs). CDC; 2024 Sep 6 [cited 2024 Dec 4]. Available from: https:\/\/www.cdc.gov\/fasd\/about\/index.html"},{"key":"pgph.0003681.ref057","unstructured":"National Institute on Alcohol Abuse and Alcoholism. Understanding fetal alcohol spectrum disorders. National Institute on Alcohol Abuse and Alcoholism [Internet]; 2023 Aug [cited 2024 Dec 4]. Available from: https:\/\/www.niaaa.nih.gov\/publications\/brochures-and-fact-sheets\/understanding-fetal-alcohol-spectrum-disorders#"},{"key":"pgph.0003681.ref058","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1007\/s10995-008-0328-2","article-title":"Alcohol consumption by women before and during pregnancy","volume":"13","author":"MK Ethen","year":"2009","journal-title":"Matern Child Health J"},{"key":"pgph.0003681.ref059","unstructured":"World Health Organization (WHO). Mental Health Atlas 2020\u2014United Republic of Tanzania; 2020. 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Pauley","year":"2023","journal-title":"medRxiv"},{"issue":"3","key":"pgph.0003681.ref063","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/0037-7856(72)90109-6","article-title":"Psychiatric disturbances during pregnancy in a rural group of African women","volume":"6","author":"MI Assael","year":"1972","journal-title":"Soc Sci Med"},{"key":"pgph.0003681.ref064","doi-asserted-by":"crossref","first-page":"89","DOI":"10.11604\/pamj.2020.37.89.23572","article-title":"The magnitude of postpartum depression among mothers in Africa: a literature review","volume":"37","author":"C Atuhaire","year":"2020","journal-title":"Pan Afr Med J"},{"issue":"11","key":"pgph.0003681.ref065","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1001\/archpsyc.1981.01780360109013","article-title":"Maternity blues in East African clinic attenders","volume":"38","author":"B Harris","year":"1981","journal-title":"Arch Gen Psychiatry"},{"issue":"4","key":"pgph.0003681.ref066","first-page":"386","article-title":"Overview: stress and alcohol use disorders revisited","volume":"34","author":"RM Anthenelli","year":"2012","journal-title":"Alcohol Res"},{"issue":"5","key":"pgph.0003681.ref067","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1093\/alcalc\/agh176","article-title":"The association between stress and drinking: modifying effects of gender and vulnerability","volume":"40","author":"DA Dawson","year":"2005","journal-title":"Alcohol Alcohol"},{"issue":"1","key":"pgph.0003681.ref068","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00213-011-2236-1","article-title":"Stressful life experiences, alcohol consumption, and alcohol use disorders: the epidemiologic evidence for four main types of stressors","volume":"218","author":"KM Keyes","year":"2011","journal-title":"Psychopharmacology 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