Prevalence and Factors Associated with Intra-Vaginal Tobacco Powder Use among Women in The Gambia

Abstract

Background: Intra-vaginal tobacco powder, locally known as "Tabaa," is a mixture of powdered tobacco and other substances that women use vaginally for sexual enhancement and other perceived benefits. This issue elicited mixed feelings among Gambians, particularly healthcare professionals. Through a media report, the Ministry of Health warned women to stop the practice due to the potential negative consequences. Objectives: This study aimed to determine the prevalence and factors associated with intra-vaginal tobacco powder use among women in The Gambia. The findings will provide baseline information regarding the extent of intra-vaginal tobacco usage and the factors promoting them to enable the Ministry of Health and relevant stakeholders to design strategic interventions to combat the practice. Methods: A sequential exploratory mixed (qualitative-quantitative) approach was used. The research was a combination of healthcare facility-based and community-based studies, which was carried out in both rural and urban areas of The Gambia. Thirty (30) purposively selected participants were interviewed for the qualitative study, while the quantitative study recruited 400 women using a multistage sampling method. A structured questionnaire developed from the qualitative results was used to collect the quantitative data. STATA version 18 was used for the data analysis. Chi-square test and multivariate logistic regression analysis were used with a significance level of p<0.05, Adjusted Odds Ratio (aOR) and a 95% confidence interval (CI). Results:The qualitative results reveal that sexual enhancement, treating genital infections, hastening labour, lack of knowledge, long-distance marriage and polygamy were commonly cited as factors associated with intra-vaginal tobacco powder use. The main analysis in the quantitative study focused on the subset of 287 women who demonstrated awareness of intra-vaginal tobacco practices. The findings of the study revealed a lifetime prevalence of 23.7% (n=68) of intra-vaginal tobacco powder use among Gambian women, with 63.2% currently using it. Most of the women were married and within the age range of 30 to 39 years. Women aged 40 years and above (aOR = 3.20; 95% CI = 1.26–8.13; p = 0.015), from Farafenni and satellite villages (aOR = 2.20; 95% CI = 1.17-4.12; p = 0.014), had non-formal education (aOR = 2.23; 95% CI 0.64-7.79; p=0.210) and expressed perceived benefits (aOR = 16.50; 95% CI 6.10-44.50; p<0.001) have the greatest odds of using intra-vaginal tobacco powder. Conclusion: Intra-vaginal tobacco powder use is practised in the Gambia and is highest in rural areas. There is an urgent need for interventions, such as raising awareness to mitigate this practice.