Skip to main content
Download PDF

Alcohol use and associated factors among women attending antenatal care in Southern Ethiopia: a facility based cross sectional study

BMC Research Notes volume 12, Article number: 690 (2019) Cite this article

Abstract

Objectives

The aim of this study was to assess the prevalence and associated factors of alcohol use among women attending Antenatal Care in Gedeo zone rural health centers (Southern Ethiopia). This was a cross-sectional study conducted among randomly selected 718 pregnant women attending Antenatal Care. Alcohol Use Disorder Identification Test-C was used to assess alcohol consumption. Variables with p-values of < 0.05 in the multivariable logistic regression were considered as having a statistically significant association with alcohol use.

Results

The prevalence of alcohol use among pregnant women attending antenatal care service was 8.1% with 95% CI (6.3–10.0). Unplanned pregnancy [AOR = 2.12, 95% CI (1.20, 3.73)], abortion history [AOR = 2.40, 95% CI (1.16, 4.96)], pre pregnancy alcohol use [AOR 2.17, 95% CI (1.18, 4.00)] and mental distress [AOR = 3.50, 95% CI (1.99, 6.15)] were variables found to have a statistically significant association with alcohol use. This calls a holistic and multi modal approach for the prevention, early identification and intervention of alcohol use during pregnancy. More emphasis should also be given for pregnant women with unplanned pregnancy, history of abortion, pre pregnancy alcohol use and mental distress.

Introduction

A couple of decades have been counted since alcohol use is identified as a global burden of disease with mortality rate of more than chronic medical conditions like HIV and tuberculosis [1]. Alcohol consumption has been identified as a critical problem among pregnant women and child bearing mothers dating back to very ancient time. This can significantly affect the health status of both the mother and her babies in almost all socioeconomic groups [2, 3].

Studies showed that binge alcohol drinking (drinking five and above units of drink in one occasion) is harmful for the mother and the developing fetus due to the destructive or teratogenic effects as well as higher vulnerability of fetal alcohol spectrum disorders [4, 5]. Although multiple clinical recommendations and public health campaigns are invested regarding the problems of alcohol use during pregnancy, evidences showed that pregnant women continue to consume alcohol across the world, particularly in low-income countries like Ethiopia [6,7,8].

World health organization (WHO) estimates the prevalence of alcohol consumption during pregnancy as 7.9% and 3.4–20.5% in Ethiopia and east Africa, respectively [7]. The prevalence of alcohol use among pregnant women was reported to be 15.1% in Tanzania [9], 34% in Ethiopia [10], 59.3% in Nigeria [11] and 20.4% in Ghana [12]. Partner alcohol drinking, multi parity, unplanned pregnancy, partner violence, history of still birth, abortion history and poor social support were some of the factors contributing for alcohol use during pregnancy [9, 10, 12,13,14].

Literatures also revealed that women might use alcohol as a coping mechanism to escape from pregnancy related stressful situations and emotional instability [15, 16]. The drinking habits of alcohol can be also determined by the culture, attitude or other socio-demographic contexts of the society in which the pregnant mother belongs [17, 18].

In Ethiopia, there are different locally made and culturally accepted alcoholic beverages (Tella, Tej, Areki, wine….) with different alcoholic contents. These alcoholic beverages are commonly consumed in daily basis during meals. Thus, people use such easily accessible and culturally acceptable beverages in different parties, ceremonies and even, in daily family meals [19, 20].

However, little is known regarding the prevalence and associated factors of alcohol use among pregnant women attending ANC service. Therefore, it is vital to screen alcohol use and identify its associated factors among women attending ANC service at rural health centers.

Main text

Methods

Study design and period

This was an institutional based cross sectional study conducted among women attending antenatal care in Gedeo zone rural health centers from June 1st to August 1st 2017.

Study setup

The study was conducted at Gedeo zone rural health centers. Gedeo zone is found in Southern Nation Nationalities and Peoples Regional (SNNPR) states of Ethiopia at 359 km Sothern from Addis Ababa (the capital city of Ethiopia). The total population size of the zone is 847,434 (424,742 male and 422,692 female) according to the 2007 population and housing census [21]. There are about 41,733 pregnant women estimated to initiate ANC1 within rural health centers of the zone annually.

Sample size and sampling technique

The sample size was determined using a single population proportion formula. We used assumptions of prevalence of alcohol use (p = 34%) from a study done in North-west part of Ethiopia (Bahir Dar) [10], 5% margin of error and 95% confidence interval. Considering 10% non response rate and design effect of two, the total sample size was 759.

Two-stage sampling technique was used to select study subjects. First, four woredas were randomly selected from a total of six woredas and two city administrations. In the second stage, two health centers were selected from each of the selected four woredas through lottery method. Then, the calculated sample size was proportionally allocated to each of eight randomly selected health centers. Finally, pregnant women attending ANC service were interviewed consecutively until the allocated sample size was addressed.

Data collection procedures and instruments

A pre-tested interviewer administered questionnaire was used for the data collection. The questionnaire had different components including socio demographic characteristics, obstetric and gynecological factors, substance related variables, Oslo-3 Social Support Scale, Self Reporting Questionnaire (SRQ-20) and Alcohol Use Disorder Identification Test-C (AUDIT-C).

Alcohol use was measured using AUDIT-C [22, 23] derived from the 10-item alcohol use disorder identification test which is cross culturally validated and preferred tool to measure alcohol consumption [24, 25]. AUDIT-C has been used in different studies to measure alcohol use among pregnant women [9, 26, 27]. It has three Likert scale questions used to evaluate the frequency and quantity of alcohol intake. AUDIT-C has a total sum score of 12 which can be categorized as low risk (1–3), moderate risk (4–5) and high risk (≥ 6). The questions of AUDIT-C were adapted for pregnancy and contextualized for the study area. In this study, women with sum scores of greater and equal to three were considered alcohol user.

Level of social support was assessed using Oslo-3 item Social Support Scale having a maximum sum score of 14. The sum scores were categorized as poor (0–3), moderate (9–11) and strong (12–14) [28]. An Ethiopian validated Self Reporting Questionnaire (SRQ-20) was used to screen mental distress. It shows god accuracy to screen mental distress in primary health care settings and communities of low-income countries with a cut-off point of 7 and above [29].

The questionnaire was first prepared in English and translated to Amharic and Gedeou’fa (commonly spoken languages in the study area). Back translation to English was done to check its consistency. Pre test was done on 5% (n = 43) of the sample among women attending ANC service at Chucko heath center. The data were collected by nine degree level health professionals supervised by three masters level public health professionals after attending 3 days of training regarding the contents of the questionnaire and data collection procedures.

Data analysis

First, the collected data were checked for its completeness and consistency and entered to Epi-INFO (software). Then, the data were exported to a Statistical Package for Social Science (SPSS-version 20) for analysis. Descriptive analysis was used to determine the prevalence of alcohol use and its distribution among the characteristics of participants. Both bivariable and multivariable binary logistic regression were computed to identify factors associated with alcohol use. Variables with p-values of ≤ 0.25 in the bivariable analysis were considered as candidates for multivariable regression to control possible confounders. In the final model, variables with p-values of < 0.05 were considered as having a statistically significant association with alcohol use at a corresponding 95% CI.

Results

Socio-demographic characteristics

Among a total of 759 women invited to participate, 718 completed the interview with a response rate of 94.6%. More than half, (53.5%; n = 384) of participants were within the age range of 25–29 years old and the mean (standard deviation) age of respondents was 27.1 (± 4.23) year. Large proportion, (77.6%; n = 557) of participants were married and living together. More than half (57.4%; n = 412) of the participants were Gedeo in ethnicity (Table 1).

Table 1 Socio-demographic characteristics of pregnant women attending Ante Natal Care in Gedeo Zone Health Centers, Southern Ethiopia, 2017 (n = 718)
Full size table

Obstetrics and psychosocial factors

Regarding the gestational age, 52.2% (n = 375) were within the third trimester. Of the total participants, 19.2% (n = 142) had pre pregnancy alcohol use history. About 26.2% (n = 188) of participants were screened positive for mental distress (Table 2).

Table 2 Obstetric, substance and psychosocial related factors among pregnant women attending Ante Natal Care in Gedeo Zone Health Centers, Southern Ethiopia, 2017 (n = 718)
Full size table

Prevalence and associated factors of alcohol use

The overall prevalence of alcohol use was found to be 8.1% (n = 58) with 95% CI (6.3, 10.0). During bivariable regression, age, place of residency, number of children, pregnancy plan, pre pregnancy alcohol use, abortion history, khat chewing, mental distress and level of social support were variables associated with alcohol use. After adjusting for possible confounders, unplanned pregnancy, abortion history, pre pregnancy alcohol use and mental distress were found to have a statistically significant association with alcohol use (Table 3).

Table 3 Variables associated with alcohol use among pregnant women attending Ante Natal Care in Gedeo Zone Health Centers, Southern Ethiopia, 2017
Full size table

Discussion

The prevalence of alcohol use was found to be 8.1% (n = 58) with 95% CI (6.3%-10.0%). The magnitude of alcohol use in this study was in line with WHO estimate of alcohol use during pregnancy in Ethiopia(7.9%) [7]. However, the prevalence of alcohol use in this study was lower than the prevalence of alcohol use reported from a study of Northwest Ethiopia (34%) [10]. The possible explanation for this difference might be due to the difference in the screening tools used. The study conducted in Bahir-Dare used “T-ACE” which is more sensitive than AUDIT-C to screen alcohol use and might overestimate the prevalence [26]. In addition, the study conducted at Bahir-Dare was a community based study that can address all pregnant women, even not attending ANC follow-up. However, our study included only pregnant women attending ANC clinic. Inclusion of only pregnant women attending ANC clinic might yield a lower prevalence of alcohol use as women attending ANC can have the opportunity of counseling service, and may gain better knowledge and attitude towards the health of the fetus and themselves. Furthermore, women with substance use including alcohol might under report their consumption while they are at ANC service due to the fear of breaking professional advice of “not taking any alcohol during pregnancy”. The prevalence of alcohol use in this study was also lower than other studies of Tanzania (15.1%) [9], Ghana (20.4%) [12] and Nigeria (59.3%) [11]. The possible reason for this discrepancy might be due to the differences of screening tools used to measure alcohol use as well as the cultural and socio-demographic variation of study participants.

This study also identified correlates of alcohol use among women attending ANC service. Accordingly, unplanned pregnancy, pre pregnancy alcohol use, abortion history and mental distress were found to have a statistically significant association. The odds of alcohol use among women with unplanned pregnancy were 2.1 times higher as compared to their counterparts. This is consistent with other studies of Bahir-Dare and Korea [10, 27]. The possible explanation for this correlation might be due the social and psychological crisis of unplanned pregnancy that can have a potential to push pregnant women for the initiation of alcohol or other substance use to get relief from their stress [30].

Similarly, the odds of having alcohol use among pregnant women who had pre pregnancy alcohol use history were 2.2 times higher than women who had not history of alcohol use before their current pregnancy. This finding is in agreement with a recent review and another similar study which identified pre pregnancy alcohol use as a precipitant for alcohol consumption during pregnancy [14, 27]. Moreover, the brain rewarding systems of alcohol has a tendency to develop dependency which might be difficult to abstain or decrease drinking, and enforce to search alcoholic beverages even during pregnancy period [31]. Pregnant women who had history of abortion had 2.4 times increased odds of being alcohol user as compared to women who had not abortion history. This might be explained by the fact that previous abortion can elevate rates of substance use and other mental health problems like depression and anxiety [32]. However, a study conducted in Tanzania showed a reverse result indicating complications in previous pregnancy as a protective factor of alcohol use during pregnancy [9]. The possible reason for this discrepancy might be due to the fact that some women may associate previous pregnancy complications with the negative effect of alcohol that might help them to cease drinking for their future pregnancy. On the contrary, others pregnant women may develop psychological distress following pregnancy related complication which can push them to use alcohol to escape from stressful situation. Furthermore, it needs further investigation in this regard.

Pregnant women with mental distress were 3.5 times more likely to use alcohol as compared to their counterparts. This might be due to the fact that people with mental distress are more like to use alcohol to reverse the difficulties of sleep initiation, social engagement and lack of happiness which are hallmark symptoms of mental distress [33, 34].

Limitations of the study

Participants were recruited from ANC clinics which might not be representative for women who do not attend ANC. Therefore, further community based study is recommended to address the level of alcohol use among women who do not attend ANC service. The cross-sectional nature of the study design might not show the cause and effect relationships between alcohol use and other variables.

Availability of data and materials

All the data included in this manuscript can be accessed from the corresponding author Birhanie Mekuriaw upon request through the email address of “biradilla@gmail.com”.

Abbreviations

ANC:

antenatal care

AOR:

adjusted odd ratio

CI:

confidence interval

AUDIT-C:

Alcohol Use Disorder Identification Test-Consumption

COR:

crude odd ratio

DURH:

Dilla University Referral Hospital

ETB:

Ethiopian Birr

SD:

standard deviation

SRQ:

Self Reporting Questionnaire

SSNPR:

Southern Nation Nationalities and Peoples of Region

T-ACE:

(Tolerance, Annoyed, Cut off and Eye opening)

WHO:

World Health Organization

References

  1. Mathers C, Ayuso-Mateos JL. Global burden of alcohol use disorders in the Year 2000: summary of methods and data sources. In.: GBD 2000 Working Paper. Geneva: World Health Organization. http://www.who. 2003.

  2. de Sanctis L, Memo L, Pichini S, Tarani L, Vagnarelli F. Fetal alcohol syndrome: new perspectives for an ancient and underestimated problem. J Matern Fetal Neonatal Med. 2011;24(sup1):34–7.

    Article  PubMed  Google Scholar 

  3. Abel EL. Maternal alcohol consumption and spontaneous abortion. Alcohol Alcohol. 1997;32(3):211–9.

    Article  CAS  PubMed  Google Scholar 

  4. Henderson J, Kesmodel U, Gray R. Systematic review of the fetal effects of prenatal binge-drinking. J Epidemiol Community Health. 2007;61(12):1069–73.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ornoy A, Ergaz Z. Alcohol abuse in pregnant women: effects on the fetus and newborn, mode of action and maternal treatment. Int J Environ Res Public Health. 2010;7(2):364–79.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Casiro OG, Stanwick RS, Pelech A, Taylor V. Public awareness of the risks of drinking alcohol during pregnancy: the effects of a television campaign Child Health Committee, Manitoba Medical Association. Can J Public Health. 1994;85(1):23–7.

    CAS  PubMed  Google Scholar 

  7. Popova S, Lange S, Probst C, Shield K, Kraicer-Melamed H, Ferreira-Borges C, Rehm J. Actual and predicted prevalence of alcohol consumption during pregnancy in the WHO African Region. Trop Med Int Health. 2016;21(10):1209–39.

    Article  PubMed  Google Scholar 

  8. Lange S, Probst C, Heer N, Roerecke M, Rehm J, Monteiro MG, Shield K, de Oliveira C, Popova S. Actual and predicted prevalence of alcohol consumption during pregnancy in Latin America and the Caribbean: systematic literature review and meta-analysis. Revista Panamericana de Salud Pública. 2017;41:e89.

    PubMed  PubMed Central  Google Scholar 

  9. Mpelo M, Kibusi SM, Moshi F, Nyundo A, Ntwenya JE, Mpondo BC. Prevalence and factors influencing alcohol use in pregnancy among women attending antenatal care in Dodoma region, Tanzania: a cross-sectional study. J Pregnancy. 2018;2018:8580318.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Anteab K, Demtsu B, Megra M. Assessment of Prevalence and Associated Factors of Alcohol Use during Pregnancy among the dwellers of Bahir-Dar. City, Northwest Ethiopia. 2014;5:939.

    Google Scholar 

  11. Ordinioha B, Brisibe S. Alcohol consumption among pregnant women attending the ante. natal clinic of a tertiary hospital in South South Nigeria. Niger J Clin Pract. 2015;18(1):13–7.

    CAS  PubMed  Google Scholar 

  12. Adusi-Poku Y, Edusei AK, Bonney AA, Tagbor H, Nakua E, Otupiri E. Pregnant women and alcohol use in the Bosomtwe district of the Ashanti region-Ghana. Afr J Reprod Health. 2012;16(1):55–60.

    PubMed  Google Scholar 

  13. Culley CL, Ramsey TD, Mugyenyi G, Kiwanuka GN, Ngonzi J, MacLeod S, Koren G, Grunau BE, Wiens MO. Alcohol exposure among pregnant women in Sub-Saharan Africa: a systematic review. J Popul Therap Clin Pharmacol. 2013;20(3):321–33.

    Google Scholar 

  14. Skagerstrom J, Chang G, Nilsen P. Predictors of drinking during pregnancy: a systematic review. J Women’s Health. 2011;20(6):901–13.

    Article  Google Scholar 

  15. Biratu A, Haile D. Prevalence of antenatal depression and associated factors among pregnant women in Addis Ababa, Ethiopia: a cross-sectional study. Reprod Health. 2015;12(1):99.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Thompson O, Ajayi I. Prevalence of antenatal depression and associated risk factors among pregnant women attending antenatal clinics in Abeokuta North Local Government Area. Nigeria. Depression research and treatment. 2016;2016:4518979.

    PubMed  Google Scholar 

  17. Peadon E, Payne J, Henley N. D’antoine H, Bartu A, O’Leary C, Bower C, Elliott EJ: attitudes and behaviour predict women’s intention to drink alcohol during pregnancy: the challenge for health professionals. BMC Public Health. 2011;11(1):584.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Petersen Williams P, Jordaan E, Mathews C, Lombard C, Parry CD. Alcohol and other drug use during pregnancy among women attending midwife obstetric units in the Cape Metropole. South Africa. Adv Prev Med. 2014;2014:871427.

    PubMed  Google Scholar 

  19. Soboka M, Tesfaye M, Feyissa GT, Hanlon C. Alcohol use disorders and associated factors among people living with HIV who are attending services in south west Ethiopia. BMC Res Notes. 2014;7(1):828.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Lee M, Regu M, Seleshe S. Uniqueness of Ethiopian traditional alcoholic beverage of plant origin, tella. J Ethnic Foods. 2015;2(3):110–4.

    Article  Google Scholar 

  21. Ethiopia C: Summary and statistical report of the 2007 population and housing census. Addis Ababa: Federal democratic republic of Ethiopia population census commission; 2008. p. 1–10.

    Google Scholar 

  22. Lopez MB, Lichtenberger A, Conde K, Cremonte M. Psychometric properties of brief screening tests for alcohol use disorders during pregnancy in Argentina. Revista brasileira de ginecologia e obstetricia. 2017;39(7):322–9.

    Article  PubMed  Google Scholar 

  23. Bradley KA, Bush KR, Epler AJ, Dobie DJ, Davis TM, Sporleder JL, Maynard C, Burman ML, Kivlahan DR. Two brief alcohol-screening tests From the Alcohol Use Disorders Identification Test (AUDIT): validation in a female Veterans Affairs patient population. Arch Intern Med. 2003;163(7):821–9.

    Article  PubMed  Google Scholar 

  24. Saunders JB, Aasland OG, Babor TF, De la Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction. 1993;88(6):791–804.

    Article  CAS  PubMed  Google Scholar 

  25. Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG: AUDIT: The alcoholuse disorders identification test. Guidelines for use in primary care. Geneva, Switzerland: World Health Organization, Department of Mental Health and Substance Dependence; 2001.

  26. Smith L, Savory J, Couves J, Burns E. Alcohol consumption during pregnancy: cross-sectional survey. Midwifery. 2014;30(12):1173–8.

    Article  PubMed  Google Scholar 

  27. Lee SH, Shin SJ, Won SD, Kim EJ, Oh DY. Alcohol use during pregnancy and related risk factors in Korea. Psychiatry Investig. 2010;7(2):86–92.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Abiola T, Udofia O, Zakari M. Psychometric properties of the 3-item oslo social support scale among clinical students of Bayero University Kano, Nigeria. Malay J Psychiatry. 2013;22(2):32–41.

    Google Scholar 

  29. Hanlon C, Medhin G, Alem A, Araya M, Abdulahi A, Hughes M, Tesfaye M, Wondimagegn D, Patel V, Prince M. Detecting perinatal common mental disorders in Ethiopia: validation of the self-reporting questionnaire and Edinburgh Postnatal Depression Scale. J Affect Disord. 2008;108(3):251–62.

    Article  PubMed  Google Scholar 

  30. Connery HS, Albright BB, Rodolico JM. Adolescent substance use and unplanned pregnancy: strategies for risk reduction. Obstet Gynecol Clin. 2014;41(2):191–203.

    Article  Google Scholar 

  31. Cutler JL. Kaplan and Sadock’s synopsis of psychiatry. J Psychiatr Pract®. 2016;22(1):68–9.

    Article  Google Scholar 

  32. Coleman PK, Coyle CT, Shuping M, Rue VM. Induced abortion and anxiety, mood, and substance abuse disorders: isolating the effects of abortion in the national comorbidity survey. J Psychiatr Res. 2009;43(8):770–6.

    Article  PubMed  Google Scholar 

  33. Jebena MG, Taha M, Nakajima M, Lemieux A, Lemessa F, Hoffman R, Tesfaye M, Belachew T, Workineh N, Kebede E. Household food insecurity and mental distress among pregnant women in Southwestern Ethiopia: a cross sectional study design. BMC Pregnancy Childbirth. 2015;15(1):250.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Geisner IM, Larimer ME, Neighbors C. The relationship among alcohol use, related problems, and symptoms of psychological distress: gender as a moderator in a college sample. Addict Behav. 2004;29(5):843–8.

    Article  Google Scholar 

Download references

Acknowledgements

We are thankful towards study participants for investing their fruitful time to participate in this study. Our gratitude also goes to health care professionals serving for antenatal care in the rural health center of Gedeo zone for their unlimited support and cooperation.

Funding

Not applicable.

Author information

Authors and Affiliations

  1. Department of Psychiatry, College of Health and Medical Science, Dilla University, Dilla, Ethiopia

    Birhanie Mekuriaw & Zelalem Belayneh

  2. Department of Public Health, College of Health and Medical Science, Dilla University, Dilla, Ethiopia

    Tinsae Shemelise & Robel Hussen

Authors
  1. Birhanie Mekuriaw
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zelalem Belayneh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tinsae Shemelise
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Robel Hussen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

BM and ZB conceived the research question, participated in the proposal development, data collection, analysis, interpretation and critically reviewed the manuscript. TS participated during data collection, analysis and interpretation of the data. RH contributed to the analysis and manuscript preparation. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Birhanie Mekuriaw.

Ethics declarations

Ethics approval and consent to participate

This study was ethically approval by the Institutional Review Board (IRB) of Dilla University. Permission letter was also obtained from Gedeo Zone Health Bureau. The Interview was conducted privately after securing written consent from each participant. The information obtained from participants was kept confidential during all stages of the study, and used only for the purpose of the study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mekuriaw, B., Belayneh, Z., Shemelise, T. et al. Alcohol use and associated factors among women attending antenatal care in Southern Ethiopia: a facility based cross sectional study. BMC Res Notes 12, 690 (2019). https://doi.org/10.1186/s13104-019-4703-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s13104-019-4703-4

Keywords

BMC Research Notes

ISSN: 1756-0500

Contact us