The Role of Health Facilities in Supporting Adherence to Iron-folic Acid in Haiti and Malawi: A Study Linking Health Facility Survey and Population Survey Data

Abstract Background: Iron-folic acid (IFA) supplementation during pregnancy is key to prevent maternal anemia. In Malawi and Haiti, consumption of IFA supplements remains suboptimal. This study examined the IFA-related services provided in health facilities and their association with women’s adherence to IFA supplementation during pregnancy.Methods: This study used data from the Demographic and Health surveys (DHS) and the Service Provision Assessment (SPA) in Haiti and Malawi. Using GPS data collected in both surveys, each DHS cluster was linked to health facilities surveyed in the SPA within a specified buffer distance (5 km for urban areas and 10 km for rural areas). IFA-related services were examined for health facilities within the buffer, including the availability of IFA supplements, prescription of IFA, and client counseling on IFA. Adherence to IFA supplementation was examined for women who received antenatal care (ANC) for their most recent live birth in the 2 years preceding the DHS survey. Multilevel logistic regressions stratified by urban and rural locale were used to model associations between women’s consumption of IFA supplements and the health facility service environment, controlling for relevant covariates.Results: More than two-thirds of facilities with ANC services in Haiti and almost all ANC facilities in Malawi had IFA supplements available. Over 60% of ANC clients in Haiti and over 80% in Malawi received IFA supplements or an IFA prescription. Counseling on IFA was less common and focused on how to use IFA; few women were counseled on side effects. Only 42% of women in Haiti and 35% of women in Malawi took IFA supplements for at least 90 days. Multivariable models indicated that in both countries, adherence to IFA supplementation in rural areas was significantly associated with a high level of availability of ANC facilities offering IFA. IFA counseling was also positively associated with the IFA supplement adherence in rural Malawi but not in Haiti. IFA supplement adherence was consistently associated with the completion of four or more ANC visits in both countries.Conclusions: Continued efforts are required to address access to IFA supplements through improving both the use of ANC services and their quality, particularly in provider counseling.

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Examining the Role of Health Facilities in Supporting Iron Folic Acid Supplementation Adherence Among Women in Malawi (OR25-03-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz051.or25-03-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Rukundo Benedict ◽

Wenjuan Wang ◽

Lindsay Mallick

Keyword(s):

Folic Acid ◽

Side Effects ◽

Rural Areas ◽

Urban Areas ◽

Public Health Problem ◽

Health Facilities ◽

Health System Strengthening ◽

Gps Data ◽

Major Public Health Problem ◽

Iron Folic Acid

Abstract Objectives Maternal anemia is a major public health problem in many low and middle income countries. In Malawi, consumption of iron folic acid supplements (IFA) has remained low and unchanged since 2004, even with the support of national policy and programs. To understand program implementation challenges, our study examined the relationship between the IFA-related health service environment (HSE) during antenatal care (ANC) and women's adherence to IFA supplementation guidelines. Methods Data from the 2015–16 Malawi Demographic and Health Survey (DHS) and the 2013–14 Malawi Service Provision Assessment (SPA), both of which collect GPS data of clusters or health facilities, were used. Each DHS cluster was linked to SPA facilities within a specified buffer distance (5 km for urban and 10 km for rural) using GPS data. IFA-related HSE was defined as availability of IFA, observed prescription of IFA, and observed counseling on IFA in health facilities within the buffer. The HSE variables were aggregated to the cluster-level and classified as low, medium, or high. Multilevel logistic regressions, stratified by urban and rural locale, were used to model associations between consumption of IFA and HSE variables controlling for individual-level factors. Results In Malawi 44% of women in urban and 32% in rural areas reported IFA consumption for at least 90 days during their most recent pregnancy. IFA supplements were available in the majority of health facilities (94%) providing ANC. Among clients, 85% received IFA or were given a prescription, 59% were counseled on how to use IFA, and 3% were counseled on side effects. In rural areas, regression models showed that high levels of IFA availability in facilities (OR = 2.07; 95% CI: 1.13–3.80) and IFA counseling (OR = 1.42; 95% CI: 1.12–1.78) were associated with IFA consumption. No associations with any HSE variables were observed in urban areas. Conclusions Despite widespread availability and prescription of IFA supplements from health facilities, receipt of counseling was low, particularly for side effects. Findings in rural areas reinforce the importance of health system strengthening to ensure IFA availability and counseling to support IFA consumption during pregnancy. Further research is warranted to investigate factors that affect IFA consumption in urban areas. Funding Sources United States Agency for International Development (USAID) through the DHS Program (7200AA18C00083).

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Health system’s readiness to provide cardiovascular, diabetes and chronic respiratory disease related services in Nepal: analysis using 2015 health facility survey

10.21203/rs.3.rs-15600/v2 ◽

2020 ◽

Author(s):

Umesh Ghimire ◽

Nipun Shrestha ◽

Bipin Adhikari ◽

Suresh Meheta ◽

Yashashwi Pokharel ◽

...

Keyword(s):

Health Facility ◽

Health Facilities ◽

Public Hospitals ◽

World Health ◽

Related Services ◽

The Public ◽

Public Facilities ◽

Health Facility Survey ◽

Service Readiness ◽

Facility Survey

Abstract Background: The burgeoning rise of non-communicable diseases (NCDs) is posing serious challenges in resource constrained health facilities of Nepal. The main objective of this study was to assess the readiness of health facilities for cardiovascular diseases (CVDs), diabetes and chronic respiratory diseases (CRDs) services in Nepal. Methods: This study utilized data from the Nepal Health Facility Survey 2015. General readiness of 940 health facilities along with disease specific readiness for CVDs, diabetes and CRDs were assessed using service availability and readiness assessment manual of the World Health Organization (WHO). Health facilities were categorized into public and private facilities. Results: Out of a total of 940 health facilities assessed, private facilities showed higher availability of items of general service readiness, except for standard precautions for infection prevention, compared to public facilities. The multivariable adjusted regression coefficients for CVDs (β=2.87, 95%CI: 2.42-3.39), diabetes (β =3.02, 95%CI: 2.03-4.49) and CRDs (β=15.95, 95%CI: 4.61-55.13) at private facilities were higher than the public hospitals. Health facilities located in hills had higher readiness index for CVDs (β=1.99, 95%CI: 1.02 - 1.39). Service readiness for CVDs (β=1.13, 95%CI: 1.04-1.23) and diabetes (β=1.78, 95%CI: 1.23-2.59) were higher in the urban municipalities than in rural municipalities. Finally, disease related services readiness index was sub-optimal with some degree of variation at the province level in Nepal. Compared to province 1, Province 2 (β=0.83, 95%CI: 0.73-0.95), and province 4 (β =1.24, 95%CI: 1.07-1.43) and province 5 (β =1.17, 95%CI: 1.02-1.34) had higher readiness index for CVDs.Conclusions: This study found sub-optimal readiness of services related to three NCDs at the public facilities in Nepal. Compared to public facilities, private facilities showed higher readiness score for CVDs, diabetes and CRDs. To cope up with the growing burden of NCDs, urgent improvement in health services, particularly in public facilities are critical to manage common NCDs.

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Health system's readiness to provide cardiovascular, diabetes and chronic respiratory disease related services in Nepal: analysis using 2015 health facility survey

10.21203/rs.3.rs-15600/v1 ◽

2020 ◽

Author(s):

Umesh Ghimire ◽

Nipun Shrestha ◽

Bipin Adhikari ◽

Suresh Meheta ◽

Yashashwi Pokharel ◽

...

Keyword(s):

Health Facility ◽

Respiratory Disease ◽

Chronic Respiratory Disease ◽

Health Facilities ◽

World Health ◽

Related Services ◽

Public Facilities ◽

Health Facility Survey ◽

Service Readiness ◽

Facility Survey

Abstract Background: The burgeoning rise of non-communicable diseases is posing a serious challenge in resource constrained health facilities of Nepal. The main objective of this study was to assess the readiness of health facilities for cardiovascular, diabetes and chronic respiratory disease services in Nepal. Methods: This study utilized data from the Nepal Health Facility Survey 2015. General readiness of 940 health facilities along with disease specific readiness for cardiovascular diseases (CVDs), diabetes and cardiorespiratory diseases (CRDs) were assessed using service availability and readiness assessment manual of the World Health Organization (WHO). Health facilities were categorized into public and private facilities.Results: Out of a total of 940 health facilities assessed, private facilities showed higher availability of items of general service readiness, except for standard precautions for infection prevention, compared to public facilities. The multivariable adjusted regression coefficients for CVDs (β=2.87, 95%CI: 2.42-3.39), diabetes (β =3.02, 95%CI: 2.03-4.49) and CRDs (β=15.95, 95%CI: 4.61-55.13) at private facilities were higher than public hospitals. Health facilities located in hills had higher readiness index for CVDs (β=1.99, 95%CI: 1.02 - 1.39). Service readiness for CVDs (β=1.13, 95%CI: 1.04-1.23) and diabetes (β=1.78, 95%CI: 1.23-2.59) were higher in the urban municipalities than in rural municipalities. Finally, disease related services readiness index was sub-optimal with some degree of variation at the province level in Nepal. Province 2 for CVDs (β=0.83, 95%CI: 0.73-0.95), and province 4 (β =1.24, 95%CI: 1.07-1.43) and province 5 (β =1.17, 95%CI: 1.02-1.34) had higher readiness index compared to province 1.Conclusions: This study found a sub-optimal readiness of services related to three NCDs at the public facilities in Nepal. Compared to public facilities, private facilities showed higher readiness score for CVDs, diabetes and CRDs. To cope up with the growing burden of NCDs, urgent improvement in health services, particularly in public facilities are critical to manage common NCDs.

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A temporal analysis of maternal deaths in some selected health facilities in Zamfara State, Northwest Nigeria: How far were United Nations Millennium Development Goals (MDG) 5 achieved?

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v15i1.1284 ◽

2016 ◽

Vol 15 (1) ◽

Author(s):

Abdullahi Mohammed Maiwada ◽

Nor Azlina A Rahman ◽

Suzanah Abdul Rahman ◽

Nik Mazlan Mamat ◽

Tukur A Baba ◽

...

Keyword(s):

Maternal Mortality ◽

Health Facility ◽

Rural Areas ◽

Urban Areas ◽

Maternal Mortality Ratio ◽

Temporal Analysis ◽

Health Facilities ◽

Steady Increase ◽

Maternal Deaths ◽

Mortality Ratio

Introduction: The steady increase in maternal deaths in Nigeria is a serious source of concern to policy makers and key stakeholders as one of the major threats to the achievement of the MDGs. Nigeria is reported to have one of the highest maternal mortality ratios in the world. This study was aimed at examining the challenges confronting the achievement of the MDGs Goals 5 in Zamfara State northwest Nigeria in terms of maternal mortality ratio, causes and frequency of antenatal visits. Methods: Health facility based approach and statistics were used in assessing maternal mortality ratio. Data was collected from health facility records and folders of patients who lost their lives due to pregnancy and childbirth related illnesses in some selected health facilities in Zamfara State from 2011- 2015. Results: The results showed the highest maternal deaths are in the rural areas 5120/100,000 as compared to 750/100,000 urban health facilities. Haemorrhage was the leading medical cause of maternal death. Others include sepsis, eclampsia, sickle cell anaemia, obstructed labour and abortion. However, there was a significant increase in the number of antenatal care visits from 7.20% to 30.93% within the last five years. However, the maternal mortality rate has increased, though not stable from 735/100,000 in 2011 to 1248/100,000 in 2013 and 930/100,000 in mid-2015. Conclusions: There was an increase in maternal deaths in rural compared to urban areas health clinics despite increased in the attendance of ante natal care visits thus the 5th Millennium Development Goal in Zamfara State not achieved.

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1369Probabilistic data linkage of health facility and individual data using PMA2020 surveys

International Journal of Epidemiology ◽

10.1093/ije/dyab168.086 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Cauane Blumenberg ◽

Franciele Hellwig ◽

Aluisio Barros

Keyword(s):

Health Facility ◽

Rural Areas ◽

Urban Areas ◽

Performance Monitoring ◽

Health Facilities ◽

Sufficient Information ◽

Public And Private ◽

Individual Level ◽

Match Rate ◽

Probabilistic Linkage

Abstract Background Most studies rely on clustered analyses to study how the characteristics of health facilities influence individual outcomes. Our aim was to perform a probabilistic linkage between individual and health facility data to enable individual-level analyses. Methods We linked data from the most recent female questionnaire from 11 countries monitored by the Performance Monitoring for Action 2020 to a master health facility dataset (appending all rounds of surveys). Only women that reported which type of facility they visited were considered in the analysis. A probabilistic linkage was performed using 13 blocking variables (e.g., facility type and cluster of residence/location of the woman/facility) and 11 matching variables (e.g., types of contraceptive methods used/offered by the women/facility). Each concordant matching variable received a + 1 score, or a 0 score otherwise. We assessed linkage quality by pooled odds ratio of non-matches according to wealth tertiles (richest vs. poorest) and area of residence (urban vs. rural) using a meta-analytical approach. Results A total of 21,102 women and 7,056 facilities were considered in the linkage process. The average match rate was 57.9%, ranging from 42.5% in Indonesia to 69.1% in Burkina Faso. The pooled odds of non-match were 74% higher for the richest women compared to the poorest, and 67% higher for women living in urban areas compared to rural areas. Conclusions High match rates were achieved in countries with sufficient information on public and private facilities. The lack of information about private facilities contributed to the higher odds of non-match among the better off. Key messages We performed a probabilistic linkage approach to link individual and health facility data, making it possible to understand how the characteristics of health facilities can influence individual-level outcomes. Our findings also bring light to the importance of sampling both public and private facilities, aiming to maximise match rates and reduce differences on match rates according to socio demographic characteristics of the sample.

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Knowledge and intake of folic acid to prevent neural tube defects among pregnant women in urban China: a cross-sectional study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03893-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mingming Cui ◽

Xiao-Lin Lu ◽

Yan-Yu Lyu ◽

Fang Wang ◽

Xiao-Lu Xie ◽

...

Keyword(s):

Folic Acid ◽

Pregnant Women ◽

Neural Tube ◽

Neural Tube Defects ◽

Rural Women ◽

Rural Areas ◽

Urban Areas ◽

Unplanned Pregnancy ◽

Urban China ◽

Cross Sectional

Abstract Background The prevalence of neural tube defects (NTDs) in China declined during 2000–2017 with periconceptional folic acid (FA) supplementation, which is effective in reducing the risk of birth defects. We aimed to assess the knowledge and actual use of FA among Chinese pregnant women and to explore factors associated with FA use before pregnancy. Methods All data were collected in face-to-face interviews during health visits among pregnant women. We collected information about knowledge and use of FA supplements and demographic, socioeconomic, and health status. One maternity and childcare hospital was chosen in each of four cities: Beijing, Huaibei, Kunming, and Haikou. In total, 435 pregnant women were randomly recruited for interviews conducted from June to December 2016. Results A total of 428 pregnant women were included in this survey. Of these, 82.0% (351/428) knew that FA can prevent NTDs, and 75.9% (325/428) knew the correct time to take FA. Overall, 65.9% (282/428) of women knew both that FA can prevent NTDs and the recommended time to take FA before pregnancy. Approximately 95.1% (407/428) of women reported having ever taken FA, only 46.3% (198/428) had begun to take FA supplementation before conception, and 64.5% (109/169) of women from rural areas failed to take FA before pregnancy. Women living in northern China (odds ratio [OR] = 1.81, 95% confidence interval [CI], 1.18–2.77), those with unplanned pregnancy (OR = 1.99, 95% CI 1.30–3.04), and highly educated women (OR = 2.37, 95% CI 1.45–3.88) were more likely to know about FA. Women who were homemakers (OR = 1.94, 95% CI 1.21–3.11) and had unplanned pregnancy (OR = 6.18, 95% CI 4.01–9.53) were less likely to begin taking FA before pregnancy. Conclusions Our survey showed that most pregnant women knew about FA. Although preconception intake of FA can help to reduce NTDs, improving the rate of FA intake before pregnancy is needed in urban areas of China, especially among homemakers and women from rural areas or with unplanned pregnancy. Campaigns are needed to increase awareness about FA and FA use before pregnancy among rural women, homemakers, and those with unplanned pregnancy and lower education levels.

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Patterns of Alcohol Consumption in the PURE Poland Cohort Study and Their Relationship with Health Problems

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18084185 ◽

2021 ◽

Vol 18 (8) ◽

pp. 4185

Author(s):

Katarzyna Zatońska ◽

Piotr Psikus ◽

Alicja Basiak-Rasała ◽

Zuzanna Stępnicka ◽

Maria Wołyniec ◽

...

Keyword(s):

Cohort Study ◽

Alcohol Consumption ◽

Rural Areas ◽

Urban Areas ◽

Level Of Education ◽

Adult Participants ◽

Frequent Consumption ◽

Urban And Rural Areas ◽

Socio Demographic Factors ◽

High Level

(1) Background: Alcohol is a leading risk factor of premature morbidity and mortality. The objective of this study was to investigate the patterns of alcohol consumption in the PURE Poland cohort study baseline. (2) Methods: A Polish cohort was enrolled in the baseline study in 2007–2010. The study group consisted of 2021 adult participants of urban and rural areas from the Lower Silesia voivodeship in Poland (747 men and 1274 women). (3) Results: In the overall study population, 67.3% were current drinkers, 10.3% were former drinkers, and 22.4% were abstainers. Current use of alcohol products was more prevalent in men (77.2%), people living in urban areas (73.0%), and people with a higher level of education (78.0%). The percentage of current drinkers decreased with increasing age (from 73.4% in 30- to 44-year-olds to 48.8% in participants aged 64 and more). The majority of participants (89.2%) declared a low level of alcohol intake. The chance of high level of intake of alcohol was four times higher in men than in women (OR 4.17; CI 1.64–10.6). The majority of participants (54.6%) declared most frequent consumption of low-alcohol drinks (beer, wine) and 21% declared most frequent consumption of spirits. Current drinkers had almost 1.5-fold higher odds of diabetes and cardiovascular diseases (CVD) than never drinkers (OR 1.49, CI 1.03–2.17; OR 1.66, CI 1.27–2.18, respectively). Former drinkers had higher odds for hypertension and CVD than never drinkers (1.73, CI 1.05–2.85; OR 1.76, CI 1.22–2.53, respectively). (4) Conclusions: In our cohort study, we observed several socio-demographic factors differentiating the patterns of alcohol consumption. The preventive programs should focus predominantly on men, people aged <45 years, and those with a higher level of education.

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Factors Influencing Choice of Delivery Place among Mothers in Rukungiri and Kanungu Districts, South Western Uganda: A Cross Sectional Study

10.21203/rs.3.rs-128061/v1 ◽

2020 ◽

Author(s):

Richard Mugambe ◽

Habib Yakubu ◽

Solomon Wafula ◽

Tonny Ssekamatte ◽

Simon Kasasa ◽

...

Keyword(s):

Health Facility ◽

Rural Areas ◽

Health Workers ◽

Public Health Facility ◽

Facility Delivery ◽

Health Facilities ◽

Public Facility ◽

Cross Sectional ◽

Western Uganda ◽

Delivery Place

Abstract Background: Child birth in health facilities is generally associated with lower risk of maternal and neonatal mortality. However, in Uganda, little is known about factors that influence use of health facilities for delivery especially in rural areas. In this study, we examined the determinants of mothers’ decision of the choice of child delivery place in Western Uganda.Methods: Cross-sectional data was collected from 894 randomly-sampled mothers within the catchment of two private hospitals in Rukungiri and Kanungu districts. Data was collected on the place of delivery for the most recent child, mothers’ sociodemographic characteristics, health facility water, sanitation and hygiene (WASH) status. Modified Poisson regression was used to estimate prevalence ratios (PRs) for the determinants of mothers’ choice of delivery place as well as determinants for the choice of private versus public facility for delivery at 95% confidence intervals. Results: Majority of mothers (90.2%) delivered in health facilities. Non-facility deliveries were attributed to fast progression of labour (77.3%), lack of transport (31.8%) and high cost of hospital delivery (12.5%). Being engaged in business as an occupation [APR = 1.06, 95% CI (1.01 – 1.11)] and belonging to the highest wealth quintile [APR = 1.09, 95% CI (1.02 – 1.17)] favoured facility delivery while higher parity of 3 – 4 [APR = 0.93, 95% CI (0.88 – 0.99)] was inversely associated with facility delivery as compared to parity of 1-2. Choice of private facility over public facility was influenced by how mothers valued factors such as high skilled health workers [APR = 1.15, 95% CI (1.05 – 1.26)], higher quality of WASH services [APR = 1.11, 95% CI (1.04 – 1.17)], cost of the delivery [APR = 0.85, 95% CI (0.78 – 0.92)] and availability of caesarean services [APR = 1.13, 95% CI (1.08 – 1.19)].Conclusion: Utilization of health facility child delivery services was high. Health facility delivery service utilization was influenced by engaging in business, belonging to wealthiest quintile and being multiparous. Choice of private versus public health facility for child delivery was influenced by health facility WASH status, cost of services, and availability of skilled workforce and caesarean services.

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Geographic location of health facility and immunization program performance in Hoima district, western Uganda: a health facility level assessment

BMC Public Health ◽

10.1186/s12889-020-09859-z ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Nicholas Kwikiriza Magambo ◽

Francis Bajunirwe ◽

Fred Bagenda

Keyword(s):

Health Facility ◽

Urban Areas ◽

Health Workers ◽

Geographic Location ◽

Health Facilities ◽

Urban Setting ◽

World Health ◽

Program Performance ◽

Immunization Program ◽

Western Uganda

Abstract Background Globally, immunization coverage for childhood vaccines is below the immunization target of achieving at least 90% coverage with the pentavalent vaccine. In Uganda, a recent survey shows 80% of districts had poor immunization program performance. However, there is significant variation in performance within and between districts. We hypothesized that geographic location of a health facility may influence performance of its immunization programs. Therefore, the purpose of this study was to examine whether geographical location of a health facility within a district is associated with performance of the immunization program in Hoima district, western Uganda. Methods We conducted a cross sectional study using a mixed methods approach. The main study unit was a health center and we also interviewed health workers in-charge of the facilities and reviewed their health facility records. We reviewed the Uganda Health Management Information System (HMIS) 105 reports of six months to obtain data on immunization program performance. Performance was categorized using World Health Organization’s Reach Every District (RED) criteria and classified as poor if a facility fell in category 3 or 4 and good if 1 or 2. We also conducted key informant interviews with immunization focal persons in the district. We examined the association between dependent and independent variables using Fisher’s exact test. Results We collected data at 49 health facilities. Most of these facilities (55.1%) had poor immunization program performance. Proximal location to the central district headquarters was significantly associated with poor immunization program performance (p < 0.05). Attitudes of health workers in the more urban areas, differences in strategies for outreach site selection and community mobilization in the rural and urban areas were suggested as possible explanations. Conclusions Proximal location to the urban setting near district headquarters was strongly associated with poor immunization program performance. To be able to reach larger numbers of children for vaccination, interventions to improve performance should target health facilities in urban settings.

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Knowledge and attitude of South-Indian smokers towards smoking associated health risk

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1708706 ◽

2017 ◽

Vol 07 (02) ◽

pp. 024-030

Author(s):

Ananya Madiyal ◽

Vidya Ajila ◽

G. Subhas Babu ◽

Shruthi Hegde

Keyword(s):

Oral Cavity ◽

Rural Areas ◽

Urban Areas ◽

The Body ◽

Cross Sectional ◽

Level Of Education ◽

South Indian ◽

Intentions To Quit ◽

Knowledge And Attitude ◽

High Level

Abstract Aim: To assess the knowledge and attitude of South-Indian smokers towards health effects of smoking and their intentions to quit. Study design: A cross sectional questionnaire based survey was conducted among 550 smokers hailing from South India who reported to the out-patient department of the dental hospital. Results: Highest incidence of smoking in men was seen in those who received moderate level of education and those residing in rural areas. In female smokers, the highest incidence was seen in those residing in urban areas (53.8%) with a high level of education (38.4%). We found that males continued their habit mainly to destress while females used it to socialize. Majority of the participants were aware that smoking causes a host of problems in the oral cavity and 68.18% were aware that passive smoking was injurious to the body. Most of the responders admitted to having observed warnings on tobacco products and were willing to quit the habit with help from their dentists. Conclusion: Smokers are at risk for various diseases that include the cardiovascular, respiratory and reproductive systems as well as the oral cavity. This study sheds light on the level of awareness among current tobacco users and the areas of deficiency in patient education which should be addressed by clinicians.

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