PERINATAL RECREATIONAL DRUG USE: A CASE STUDY OF LIKONI SUB COUNTY HOSPITAL, MOMBASA COUNTY KENYA

Abstract

Drug use is a critical public health problem with perinatal recreational drug use posing as a threat to both maternal health and child survival. When used in pregnancy drugs can easily cross placental barrier, negatively affecting neurodevelopmental events and contributes significantly to poor pregnancy outcomes. In lactating mothers, drugs are expressed with breastmilk which exposes infants to adverse health effects. Maternal drug use is a barrier to seeking antenatal care partly due to guilt and fear of being reprimanded. This cross-sectional study sought to determine the extent of recreational drug use among perinatal mothers in Mombasa County. Ethical approval was obtained from Pwani University ERC and permission granted by Department of Health, Mombasa County. Purposive and convenient sampling methods were used to recruit 373 participants upon obtaining voluntary consent. A six panel plus alcohol saliva test kit confirmed actual drug use. Kruskal Wallis, Chi Square, logistic regression analysis was used to test associated factors, as well as determinants of perinatal drug use. Data was analyzed by Statistical Package for Social Sciences Version 23. Regarding socio-demographic characteristics, perinatal drug use was significantly associated with religion (P<0.001), marital status (P<0.001), multiple partners (P<0.001) and condom use (P<0.001). Being above 35 years and unemployed increased likelihood of perinatal drug use. Being separated, divorced and cohabiting were significant determinants of drug use; tetrahydrocannabinol (THC) (CRR=1.43, 95% CI:1.07-1.92, P=0.020), alcohol (ALC), (CRR=1.83, 95%CI: 1.22-2.72, P=0.003), amphetamine (AMP) (CRR=1.81, 95%CI:1.26-2.61,P=0.001) and cotinine (COT) (ARR=2.54, 95%CI:1.3- 4.90, P<0.001). Having multiple partners predicted use of THC (ARR 1.58, 95%CI:1.15-2.17, P=0.005), ALC (CRR=2.02, 95%CI:1.57-2.58, P<0.001), AMP (ARR=1.76, 95%CI:1.15-2.69, P=0.009) and COT (ARR=2.48, 95%CI:1.36-4.53, P<0.001). Muslim faith heightened the risk of AMP (ARR=2.04, 95%CI:1.33-3.13, P=0.001) and cocaine use (ARR=0.34, 95%CI:0.16-0.72, P=0.006). Using condoms strengthened AMP use (ARR=0.52, 95% CI:0.34-0.81, P=0.004). In anthropometric measurements, being undernourished and short-statured had association with perinatal drug use at -6.49 (95%CI: -9.88, -3.10; P<0.001), at-4.76 (95%CI: -8.50, -1.03; P=0.010) for weight and at-2.81 (95%CI: -4.81, -0.81), at -2.52 (95%CI: -4.74, -0.31) for height. THC (42.3%), ALC (41%) and AMP (23.9%) were the commonly used drugs. This is the first study to document perinatal drug use using saliva analysis in Kenya. In conclusion, THC, ALC, AMP and COT were the most used drugs. The most preferred combinations ALC-THC-AMP, ALC-THC-COT, and THC-AMP-OPI. Recommendations are strengthening of the family fabrics; increase of awareness on condom use; screening and identification of underlying root causes of under nutrition; inclusion of a drug use screening indicator in the current antenatal including the maternity admission profile and upscale on health education on the dangers of using drugs during perinatal period