Date of Award

12-2024

Degree Type

Thesis

Degree Name

MS in Epidemiology & Biostatistics

First Advisor

Dr Syed Asad Ali

Second Advisor

Dr Ayesha Almas

Third Advisor

Dr Romina Iqbal

Department

Community Health Sciences

Abstract

Introduction: Smokeless tobacco (SLT) is a growing public health concern in developing countries and a risk factor for the development of non-communicable diseases in young adulthood. It is responsible for the loss of at least 2.5 million Disability-Adjusted Life Years (DALYs) globally and claims the lives of 90,791 individuals annually. The smokeless tobacco and its components interfere with iron and other nutrient absorption, reducing hemoglobin levels. Its specific effect among school-going 6 to 12 years children remains underexplored. This study aims to assess the association between smokeless tobacco and hemoglobin levels (Hb) among 6 to 12-year-old school-going children in Matiari, Pakistan.
Method: An analytical cross-sectional study was conducted from April to September 2024 in four primary co-education schools among school-going children aged 6 – 12 years in Matiari, a rural area in Sindh. A structured pretested questionnaire was used to obtain information on smokeless tobacco, diet, and health-related factors. HemoCue Hb 301 system was used to measure Hb levels (g/dl). Height (cm) and weight (Kg) were measured using a digital scale. All the data was collected using REDCap by trained research assistants. A systematic sampling technique was employed to ensure the school's representativeness of school. Multiple linear regression was used to assess the association between smokeless tobacco and hemoglobin levels and control for sociodemographic, diet, and health-related factors.
Result: The median hemoglobin level among SLT users was 10.80g/dl (IQR: 9.80-11.70) as compared to non-SLT users, which was 11.20g/dl (10.10 – 12.20) (P value= 0.17). Among 283 participants, 151 (53.36%) were males and the median age of participants was 8.06 years (IQR: 7-9 years). The prevalence of smokeless tobacco use among school-going children was 12.01% (n=34), and of these 21 (61.76%) were male. Most of the children used SLT for 1 – 10 days in the past 30 days (79.41%). The mean hemoglobin level among female children using smokeless tobacco was 1.27 g/dl lower as compared to male children not using smokeless tobacco after adjusting for 5 dietary iron intake, father occupation, and union council in the model (1.27, 95% CI: -2.40 – - 0.13).
Conclusion: Our study did not find an association between smokeless tobacco use and hemoglobin levels. However, overall, there was an increase in the number of children who have decreased hemoglobin levels. A more comprehensive study will be required to understand the adverse effects of SLT and the determinants and risk factors of low hemoglobin levels in children. In addition, integrating awareness of the harmful effects of SLT use and promoting a healthy diet as awareness in the school curriculum can help us to reduce the use of SLT among children.

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