Background:  Betel nut (BN) or Areca nut (AN) chewing habits on its own or with other ingredients including chewing tobacco are highly prevalent in many South East Asian countries as well as among the migrants from these countries residing around the world. The major alcaloid arecoline in betel nut has been found to carcinogenic and to be associated with a range of health risks, including negative effects on pregnancy outcomes.  It is also reportedly associated with nutritional deficiencies including lower folate status among men and women. Pregnancy imposes stress on folate stores because of increased requirements for growth of maternal tissues, the fetus and the placenta.  Folate deficiency during pregnancy is a major public health concern as it is associated with many adverse health outcomes including neural tube defects, low birth weight, preterm birth, delayed maturation of the nervous system, growth retardation and megaloblastic anemia. Aim: To evaluate the association between betel nut use and folate status among pregnant women in Matlab, Bangladesh. Design: A secondary analysis of data from the Maternal and Infant Nutrition Intervention in Matlab (MINIMat) trial.  A sub sample of pregnant women aged 14-50 years and living in the study area Matlab with available serum folate measurements (N= 730) was included in this study. Outcome variable was folate level and folate deficiency and the independent variable was betel nut consumption.  Logistic regression analysis and analyses of covariance (ANCOVA) were done. Results were adjusted for potential confounders. Results: Two-thirds (63%) of the women consumed betel nut and 17% had folate deficiency. Women who consumed betel nut combined with  chewing  tobacco were 2.57 times more likely to have folate deficiency (OR = 2.57; 95% CI = 1.23-5.36; p =0.012;) and  betel nut consumption 2-3 times/day was significantly associated with folate deficiency among users (OR = 2.51; 95% CI = 1.07–5.92; p =0.035). Mean serum folate levels were significantly lower among betel nut users as compared to non-users. Conclusion: Betel nut consumption combined with chewing tobacco is associated with lower serum folate level or folate deficiency among pregnant women in Matlab in Bangladesh. Strategies are needed for prevention and control of betel nut consumption in order to prevent adverse health outcomes. There is a need of more knowledge regarding betel nut use and other combined substances to distinguish their individual effects on folate deficiency.

Magister Scientiae Dentium - MSc(Dent) / Betel nut/quid chewing is a habit that is commonly practiced in the Indian subcontinent. This age-old social habit is still practiced by Indians in Durban, Kwazulu Natal (South Africa). The betel nut/quid is prepared in a variety of ways. The quid may be prepared with or without tobacco. This habit is said to be associated with the development of premalignant lesions,namely, Oral Submucous Fibrosis (OSF) which increases the susceptibility for malignancy of the oral mucosa and the foregut. The aim of this study was to investigate the prevalence of betel nut/quid chewing (with or without tobacco), the associated habits (smoking and alcohol consumption) and awareness of the harmful effects of the chewing habit among Indians in Durban, KwaZulu-Natal.A cross-sectional study design was chosen utilising a self-administered questionnaire and semi-structured interviews to collect data. Consenting participants were requested to complete a self-administered, structured questionnaire. The study population included any person in the Durban area who chewed betel nut/quid/tobacco. Only persons willingly and who consented to be part of the study, were included. The sample size was based on convenience. People were approached at the pan shops, leisure markets, traditional functions and at the dental practice the researcher operated at. A total of 101 respondents were interviewed.A significantly higher proportion of females chewed betel nut/quid from the total of the respondents. The results showed that the habit is increasingly practiced in the younger age group (20-39 years). There was evidence to show that the chewing habit is used more by the employed than the unemployed (p=0.055). Of the sample population, 78% were born in South Africa and the rest were immigrants from Pakistan, India and Dubai. All respondents from the migrant community were males. The most important reasons for chewing betel nut were for enjoyment and at special functions. More than two third indicated family members (aunts,uncles and cousins) influence as a reason for chewing, in comparison to influences by parents or grandparents. The study also indicated that parents were far more likely to influence betel nut chewing if grandparents did so (p-value= 0.000). In addition, the study revealed that family members (aunts, uncles and cousins) were far more likely to influence betel nut chewing if parents did so (p=0.000).The most popular ingredients chewed were betel nut, betel leaf, lime and pan masala and the most popular combinations were betel nut/lime/betel leaf quid preparation, betel nut alone,betel nut/betel leaf/lime/tobacco/pan masala and betel nut/betel leaf/lime/pan masala. Two thirds of the respondents do not know that betel nut chewing is harmful to their health, thus indicating a lack of awareness on the risks associated with the chewing habit, and the majority have not attempted to give up the habit. Most of the respondents retained their chewing habits after being informed about the risks. A little more than half the study population reported neither smoking nor drinking.The present study found that betel nut/quid chewing habits continue to be enjoyed by many people and most are unaware of the hazardous effects of the habit. More younger people are using the habit as compared to previous studies. This is probably because it is an affordable and easily accessible habit. It is recommended that aggressive awareness programmes on the harmful effects of betel nut/quid chewing be developed, similar to that for smoking cessation.Government health warnings need to be instituted, for example, by having written warnings on packagings. Taxes need to be imposed on the betel nut and condiments thereby reducing access to most people. Age restrictions need to be imposed on purchasing of the betel nut/quid thus making access difficult for the children.