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This chapter will be addressing the Background of study, the Problem statement, Justification of study, Significant of studies, Research objective, Research questions and Operational definition of terms.

1.1 Background

Alcohol is a psychoactive substance that can cause both acute and chronic changes in the brain (Sadock, et al., 2011). Because of this drug with dependence-producing capability and leisure time activities many people have widely used it all over the world (WHO, 2018).

The scientific community‘s perception of alcohol as a teratogenic agent arose with the publication of Lemoine‘s pioneering study (Lange et al., 2017), which sparked in tears stain the harmful effects of intrauterine exposure to alcohol. However, it was not until 1973 that the diagnostic term

―Fetal Alcohol Syndrome‖ (FAS) was coined to describe the pattern of malformations seen in children of mothers who chronically consumed alcohol during pregnancy (Petrenko,el al., 2011). The term refers to a specific set of malformations or defects that may occur in the fetus due to a mother‘s  alcohol  consumption  during  pregnancy.

Today,  the  term  ―Fetal  Alcohol  Spectrum Disorders‖ (FASD) is an umbrella term to describe the wide range of neurocognitive disorders, congenital malformations, and other physical and behavioral problems resulting from prenatal exposure to alcohol (Inglin 2014).

Alcohol consumption during pregnancy has become the leading non-hereditary preventable cause of intellectual impairment. There is ample evidence of the teratogenic effects of prenatal alcohol exposure, with long-term consequences throughout the entire life cycle (Lange et al., 2017).

Regarding the consumption of low doses of alcohol during pregnancy, although there are animal studies and descriptive studies on humans showing that it may be teratogenic, consensus on the matter has not yet been achieved. However, in application of the principle of precaution, abstaining from any type of alcohol consumption during pregnancy is the only safe option (Petrenko, 2011).

According to WHO (2015), alcohol is a psychoactive substance with dependence-producing properties which causes burden in societies. Culture can either affect the knowledge of alcohol effects in pregnancy negatively or positively. Negatively in that the pregnant alcoholic would believe there is no side effect for a certain amount of alcohol consumption when pregnant or positively in that she would know alcohol has adverse effects on the fetus (Hammer & Inglin 2014).

According to the WHO report in 2018, 3 million people lose their lives worldwide every year from harmful use of alcohol. The prevalence of Fetal Alcohol Spectrum Disorder (FASD) globally which is resulted from prenatal alcohol exposure among children and youth in the general population estimated to be 7.7 out of 1000 population (Lange et al., 2017).

Globally the magnitude of alcohol consumption during the index of pregnancy is estimated to be 10% (WHO, 2011). In the USA the prevalence of alcohol use in pregnancy is 10.2% and women with productive age group reported a significantly higher prevalence of any alcohol use (Tan CH et al., 2015).

Countries in sub-Saharan African region alcohol exposure during pregnancy ranged from 2.2–87%. In this African region alcohol consumption in pregnancy is an increasing  problem among pregnant women (Gareri J, et al., 2008). In Ethiopia both traditional and manufactured alcoholic drinks are used, the estimated alcohol content for different traditional alcoholic drinks is 2–4% for ―tella‖ (traditional beer), 7–11% for ―tej‖ (honey wine) and up to 45% for ―araqe‖ (strong colorless liquor distilled from grain) (Fekadu A, et al., 2007).

According to 2015 national non-communicable diseases survey the overall prevalence of lifetime alcohol consumption in Ethiopia was 49.3% (Gonfa J, et al., 2017). A study done in Bahir-Dar city showed 34% of respondent use alcohol during pregnancy at least once per week (Anteab K, et al., 2014). Alcohol use during pregnancy is a significant public health problem, ultimately affecting the neonatal offspring.

A mother doesn‘t have to be alcoholic for damaging effects of alcohol for the fetus. It means that no safe amount and safe time to drink alcohol during pregnancy period (Kinney J, et al., 2000). Alcohol use during pregnancy has been a well-known risk factor for adverse pregnancy outcomes. This including stillbirth (Kesmodel et al., 2002), spontaneous abortion, premature birth, intrauterine growth retardation and low birth weight (Yang Q, et al., 2001).

More than one hundred years ago, Dr William Sullivan reported scientific evidence suggesting that alcohol has a toxic effect on developing embryos (Sullivan, 2008). The work was conducted at a time when degenerative features were thought to be passed on from parents to children, ultimately eliminating the family line (Sanders, 2011).

Alcoholism among fathers and mothers was viewed as equally important to their children‘s health. Sullivan decided to study the features of babies  born to  alcoholic mothers ―to illustrate  the mode in  which the  maternal intoxication appears to have reacted on the development of the offspring‖ (Sullivan, 2008). He reported that the rates of stillborn babies and infant mortality were more than twice as high among alcoholic mothers compared to nonalcoholic mothers.

At that time, Sullivan‘s work was not well distributed or acknowledged, and it took about 70 more years before Jones and colleagues published a study describing the relationship between alcohol consumption during pregnancy and prenatal growth deficiency and developmental delay, a syndrome they called Fetal Alcohol Syndrome, FAS (Jones & Smith, 1973).

Since the publication of the 1973 article, the research on neurodevelopment effects of exposure to alcohol inutero has grown rapidly. The association between embryonic and fetal exposure to alcohol and numerous adverse health consequences has been well documented (McGee Petrenko, 2011). There is general agreement that fetal exposure to high doses of alcohol is harmful and can cause lifelong problems.

1.2 Problem statement

Despite many guidelines that advise that women should avoid drinking any alcoholic beverages during any stage of pregnancy so as to save future generations from alcohol-associated mental, physical, and behavioral abnormalities, numerous studies have shown that a significant number of pregnant women continue to drink alcohol (Anteab K et al., 2014).

Regardless of the danger of alcohol on the fetus like poor mental growth a high proportion of pregnant women consume alcoholic beverages; policies have paid little attention to risks associated with alcohol consumption during pregnancy. (Henderson et al., 2007). Globally the rate of alcohol consumption during the beginning of pregnancy is estimated to be 10% (WHO, 2011).

Again, Alcohol use during pregnancy has been a well-known risk factor for adverse pregnancy outcomes. This including stillbirth (Kesmodel et al., 2002), still in Bomaka where I live, I realized majority of the pregnant women still practice alcoholism, this motivated I researcher to carry out a research on the effect of alcohol on pregnancy.

1.3 Objectives

1.3.1 General objectives

To assess pregnant women knowledge on the effect of alcohol consumption during pregnancy in the Bomaka community.

1.3.2 Specific objective

To assess pregnant women’s knowledge of alcohol consumption during pregnancy in the Bomaka community.
To determine factors influencing alcohol consumption during pregnancy in the Bomaka community.
To ascertain the effect of alcohol consumption during pregnancy on women in the Bomaka community.

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