Yaya Sanni, Odusina Emmanuel Kolawole
The George Institute for Global Health, Imperial College London, London, United Kingdom.
Department of Demography and Social Statistics, Federal University, Oye Ekiti, Ekiti State, Nigeria.
PLoS One. 2025 Aug 21;20(8):e0330214. doi: 10.1371/journal.pone.0330214. eCollection 2025.
The reduction of maternal and child morbidity and mortality is essential for achieving the Sustainable Development Goals (especially goal 3 - wellbeing of mothers and children) in sub-Saharan Africa (SSA). Exposure to household second-hand smoke (SHS) has been linked to adverse birth outcomes, yet limited evidence exists on its impact on low birth weight (LBW) in SSA. This study examines the association between household SHS exposure and LBW across ten SSA countries using recent national survey data.
A cross-sectional study was conducted using data from the Demographic and Health Surveys (DHS) from ten SSA countries collected between 2020 and 2024. The sample included 45,684 women aged 15-49 who had given birth in the five years preceding the surveys. The primary outcome variable was LBW, defined as birth weight <2500 grams. SHS exposure was determined based on household smoking behavior. Bivariate analysis was conducted using Chi-square tests, and multivariate logistic regression models were employed to estimate adjusted odds ratios (AOR) with 95% confidence intervals (CI), controlling for maternal, household, and reproductive health factors.
Overall, 6.3% of women reported exposure to SHS, and 11.9% of births were classified as LBW. After adjusting for potential confounders, SHS exposure was significantly associated with increased odds of LBW (AOR = 1.28; 95% CI: 1.12-1.46, p < 0.01). The association was particularly pronounced in urban areas (AOR = 1.39; 95% CI: 1.17-1.65, p < 0.01). Other significant predictors of LBW included maternal age < 20 years, lower educational attainment, low antenatal care (ANC) attendance, and socioeconomic status.
Household SHS exposure is an independent risk factor for LBW in SSA. Given the significant burden of LBW on neonatal health, policies targeting SHS reduction-such as household smoking bans and integrating SHS awareness into prenatal care-should be prioritized. Future longitudinal studies should explore causal mechanisms in greater detail.
降低孕产妇和儿童发病率及死亡率对于撒哈拉以南非洲（SSA）实现可持续发展目标（尤其是目标3——孕产妇和儿童福祉）至关重要。接触家庭二手烟（SHS）与不良出生结局有关，但关于其对SSA地区低出生体重（LBW）影响的证据有限。本研究利用近期的国家调查数据，考察了SSA地区十个国家家庭SHS暴露与LBW之间的关联。
采用横断面研究，使用2020年至2024年期间收集的来自SSA地区十个国家的人口与健康调查（DHS）数据。样本包括45684名年龄在15至49岁之间、在调查前五年内分娩的妇女。主要结局变量是LBW，定义为出生体重<2500克。根据家庭吸烟行为确定SHS暴露情况。使用卡方检验进行双变量分析，并采用多变量逻辑回归模型估计调整后的优势比（AOR）及95%置信区间（CI），同时控制孕产妇、家庭和生殖健康因素。
总体而言，6.3%的妇女报告接触过SHS，11.9%的分娩被归类为LBW。在对潜在混杂因素进行调整后，SHS暴露与LBW几率增加显著相关（AOR = 1.28；95% CI：1.12 - 1.46，p < 0.01）。这种关联在城市地区尤为明显（AOR = 1.39；95% CI：1.17 - 1.65，p < 0.01）。LBW的其他显著预测因素包括孕产妇年龄<20岁、教育程度较低、产前保健（ANC）就诊率低以及社会经济地位。
家庭SHS暴露是SSA地区LBW的一个独立危险因素。鉴于LBW对新生儿健康的重大负担，应优先制定针对减少SHS的政策，如家庭吸烟禁令以及将SHS意识纳入产前保健。未来的纵向研究应更详细地探索因果机制。
