MAGNITUDE OF TOBACCO USE AND ASSOCIATED FACTORS AMONG PREGNANT WOMEN ATTENDING ANTENATAL CARE AT PUBLIC HEALTH FACILITIES IN HARAR TOWN AND DIRE DAWA ADMINISTRATION, EASTERN ETHIOPIA: A MIXED METHODS STUDY

Abstract

Background: Tobacco use during pregnancy is one of the most important modifiable risk factors that can seriously and adversely affect the health of both women and their newborns. However, there is limited information on the magnitude of tobacco use and its associated factors among pregnant women in Ethiopia, particularly in the context of the specific study setting. Objective: To assess the magnitude of tobacco uses and associated factors among pregnant women attending antenatal care at selected public health facilities at Harar Town and Dire Dawa City Administration, eastern Ethiopia from June 15 – August 15, 2024. Method: An explanatory mixed-methods study was conducted among 796 pregnant women attending ANC at seven public health facilities in Harar Town and Dire Dawa. The quantitative cross-sectional survey used a pretested Kobo Toolbox questionnaire and was analyzed in Stata MP v17 (p < 0.05). The embedded qualitative component included 15 tobacco-using women purposively selected for in-depth interviews, which were transcribed, translated, coded, and analyzed thematically. Results: This study revealed that the magnitude of tobacco use during pregnancy among women attending antenatal care was 12.05% (95% CI: 9.9, 14.5). Urban residence (AOR = 8; 95% CI: 2.2–32.1), lack of tobacco-related advice during ANC (AOR = 6.1; 95% CI: 2.5–14.8), chronic comorbidities (AOR = 3.7; 95% CI: 1.6–8.5), khat chewing (AOR = 11; 95% CI: 3.5 40), and prior tobacco use (AOR = 13; 95% CI: 6.5–28) were significantly associated with tobacco use. Qualitative themes included habitual smoking, stress-related coping, limited awareness of the harms of tobacco, family and social normalization, peer influence, and environmental cues, all of which highlighted the contexts that sustain tobacco use during pregnancy. Conclusion: This study highlights a high magnitudeof tobacco use among pregnant women attending ANC and its key risk factors, including urban residence, chronic comorbidities, khat chewing, and prior tobacco use. Tobacco-related counseling during ANC helps reduce use, emphasizing the need for routine screening and culturally sensitive cessation support to protect maternal and newborn health.