The adverse health effects of exposure to environmental tobacco smoke (ETS) on children are well-documented, and yet, gender difference in low birthweight among newborns whose mothers were exposed to ETS during pregnancy still remains contentious. We therefore explored the association between ETS exposure and risk of low birthweight, and further determined the gender difference in the association between exposure to ETS during pregnancy and birth weight in Africa. The Demographic Health Surveys of 23 African countries with information on 208,027 newborns were used. The associations between exposure to ETS and birth weight was estimated using multiple logistic regression models. Exposure to ETS increased the risk of low birthweight in Africa (adjusted odds ratio (OR) = 1.06; 95% Confidence Interval (CI): 1.02⁻1.10). A stratified analysis, by gender, revealed that male newborns whose mothers were exposed to ETS were 1.08 (95% CI: 1.02⁻1.14) times more likely to be low in birthweight than those whose mothers were not exposed, with those exposed weekly (adjusted OR = 1.17; 95% CI: 1.01⁻1.35) and daily (adjusted OR = 1.06; 95% CI: 1.01⁻1.12) being more likely to have low birthweight. Exposure to ETS is significantly associated with low birthweight in Africa, mainly among male newborns. Gender could possibly be a modifier, and hence, research on biological plausibility is necessary. Moreover, a public health promotion on behavioral changes is likely to have a positive impact on newborns’ health.
Keywords: Sub-Saharan Africa; environmental tobacco smoke; gender; low birthweight.