Antenatal tobacco use and iron deficiency anemia: formative research to integrate tobacco cessation into antenatal care for low-income women in Mumbai, India
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University of Michigan School of Public Health, United States of America
University of Michigan, United States of America
Healis - Sekhsaria Institute of Public Health, India
Municipal Corporation of Greater Mumbai, India
Publication date: 2018-03-01
Tob. Induc. Dis. 2018;16(Suppl 1):A382
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A formative study was conducted at governmental antenatal clinics serving low-income women in Mumbai, India to measure the association of tobacco use with iron deficiency anemia, consumption of iron-rich foods and household food insecurity; and to identify opportunities to integrate tobacco cessation services with existing antenatal care for iron deficiency and anemia control.

We administered a structured questionnaire to a sample of 100 pregnant patients at 5 governmental antenatal care clinics that serve low-income communities. Blood tests were done for serum cotinine, hemoglobin and ferritin. We also conducted 10 key informant interviews with physicians and auxiliary nurse midwives, and 5 focus group discussions with community health workers to better understand the services offered during antenatal clinic and home visits.

Blood test revealed that 16%, 72% and 41% of women used tobacco, were anemic and had iron deficiency anemia (IDA), respectively. Tobacco use was independently associated with IDA (OR=14.3; 95%CI=2.6, 77.9). Tobacco use and IDA were not associated with household food insecurity. Clinics had a system for screening and follow-up care for anemia and iron-deficiency, but not for tobacco use. Antenatal care providers were interested in including services to screen for tobacco use and provide cessation guidance. Patients wanted help to quit.

It may be worthwhile to assess the feasibility of integrating tobacco use screening and cessation services with antenatal services for anemia and iron deficiency at governmental clinics serving low-income populations in India.