Dodoma clinics, Tanzania: 64.8% of 55 drinking pregnant women abstinent after hybrid counseling

Researchers in the Dodoma region of Tanzania tested a hybrid behavioral model in public reproductive and child health clinics. The model combined a single individual brief intervention with a six-week group behavioral program. According to the study published via doi.org, the design was prospective, uncontrolled, single-arm and quasi-experimental, with evaluations before and after the intervention biomedcentral.comdoi.orgbiomedcentral.comOpen source ↗. The authors report that 64.8% of the participants who initially consumed alcohol were fully abstinent at the three-month (ninety-day) follow-up.

Design and sample

Screening covered 365 pregnant women attending routine antenatal booking visits at six public clinics in two districts, Dodoma city council and Chamwino, chosen to represent urban and rural settings. Participants were selected by systematic random sampling and screened with the AUDIT-C tool; a score of 3 or higher counted as a positive result. Prevalence of alcohol use during the preceding three months was 15.1%, which corresponds to 55 women, and all of them were enrolled in the intervention arm.

The minimum screening sample was calculated at a 95% confidence level, a 5% margin of error and an assumed baseline prevalence of 37.4%, then rounded up to 365. For the 55 enrolled women, the authors state a statistical power above 90% to detect an effect size of Cohen's d of 0.5 or more with a paired-samples t-test. No untreated control group was used, for ethical reasons given the known risks of prenatal alcohol exposure, so each participant served as her own historical control. Standardized psychometric scales measured the frequency and volume of drinking, as well as self-efficacy and expectancies; baseline data were collected at the booking visit, immediately before the brief intervention.

Setting and context

Dodoma lies in the semi-arid zone of Central Tanzania, and about 80% of its population lives in rural or peri-urban communities that depend on subsistence, rain-fed agriculture biomedcentral.comdoi.orgbiomedcentral.comOpen source ↗. In agricultural off-seasons these communities often face economic inactivity and food insecurity, a period associated with greater production and consumption of locally brewed, unstandardized alcoholic drinks. Alcohol crosses the placenta and is linked to spontaneous abortion, preterm birth, low birth weight, stillbirth and fetal alcohol spectrum disorders. Routine practice in Tanzanian maternal health facilities has relied on informal questions about alcohol use rather than structured counseling.

The study has no control group. The authors note that future trials should stratify the effect by trimester.