|Year : 2021 | Volume
| Issue : 4 | Page : 287-292
Knowledge of herbal medicines among pregnant women attending some antenatal clinics in Eastern Nigeria
Maureen Ogochukwu Akunne, Chigozie Gloria Anene-Okeke, Adaobi Uchenna Mosanya
Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka, Enugu State, Nigeria
|Date of Submission||07-Jan-2021|
|Date of Decision||01-Apr-2021|
|Date of Acceptance||24-May-2021|
|Date of Web Publication||17-Nov-2021|
Dr. Adaobi Uchenna Mosanya
Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka, PMB 410001, Enugu State
Source of Support: None, Conflict of Interest: None
BACKGROUND: There are no studies assessing the knowledge of herbal medicines among pregnant women in Eastern Nigeria despite a universal increase in herbal medicines used by this population who usually are at risk from their adverse effects. The purpose of this study was to investigate the knowledge of herbal medicines among expectant mothers in Eastern Nigeria in order to estimate any need for education on the safety and effectiveness of herbal medicines use in pregnancy.
METHODS: A cross-sectional and descriptive method was adopted, and data were collected with a validated questionnaire between June and August 2018 in three health facilities in Nsukka among pregnant women who attended antenatal clinics. A total of 300 participants were conveniently sampled. Descriptive and inferential statistical analyses were performed using SPSS 23. For statistical significance, P < 0.05.
RESULTS: Out of the 300 respondents who gave their consent, 93.3% were married, 89.9% were within the age range of 18–34 years old, and 82.8% of them had postprimary education. The mean percentage knowledge score of herbal medicine was 63.196%. More than half of the women scored below the mean score and were considered to have poor knowledge (57.9%). The respondents' sociodemographics had a nonsignificant statistical relationship with the level of knowledge of herbal medicines (P > 0.05).
CONCLUSIONS: Most of the pregnant women assessed in this study had poor knowledge of herbal medicine and no association with their sociodemographic characteristics was observed.
Keywords: Child health, herbal medicine, maternal health, Nigeria, pregnant women, risk factors
|How to cite this article:|
Akunne MO, Anene-Okeke CG, Mosanya AU. Knowledge of herbal medicines among pregnant women attending some antenatal clinics in Eastern Nigeria. Int J Health Allied Sci 2021;10:287-92
|How to cite this URL:|
Akunne MO, Anene-Okeke CG, Mosanya AU. Knowledge of herbal medicines among pregnant women attending some antenatal clinics in Eastern Nigeria. Int J Health Allied Sci [serial online] 2021 [cited 2023 May 30];10:287-92. Available from: https://www.ijhas.in/text.asp?2021/10/4/287/330553
| Introduction|| |
Herbal medicines are plant-sourced products with some therapeutic effects. In some literatures, they are known as traditional medicines. For thousands of years even before the invention of conventional therapeutic agents, many cultures have relied on herbal medicines as remedies for different kinds of illnesses. Such uses have been as a result of perceived advantages. For instance, it is understood by many users that herbal medicines are benevolent, safer, and more affordable. In developing countries, between 70% and 95% of the population use herbal medicines while in Africa, they are utilized by more than 80% of the population., The global prevalence of herbal medicines use is between 65% and 80%. Within this range is found the population of pregnant women. Many studies have been carried out globally to assess the prevalence of use of medicinal herbs among expectant mothers. The prevalence varies among many regions of the world. The use of traditional medicines among pregnant women in Africa showed prevalence as high as 80%. They were mostly used because of symptoms related to pregnancy. In the Asian region out of the total of 2729 pregnant women surveyed, about 47% had used herbal medicine at least once in their previous pregnancy. The prevalence of herbal medicine consumption during pregnancy in Europe, North America, and Australia was 29.3%. In Quebec, Canada, the prevalence was 9%. These prevalence shows that there were real and perceived benefits of herbal medicines for expectant mothers. Some of these uses are for the treatment of pregnancy-related symptoms as well as other chronic illnesses suffered by the pregnant woman. If a woman feels that herbal medicines are beneficial in supporting her health, her pregnancy, and growing fetus as well as labor and birth, she will definitely use it. In fact, it has been observed that women who on learning that they are expecting become anxious about the safety of their unborn baby and may instinctively have relied on herbal medicines instead of prescription medication, for the perceived notion that the former are natural and safer. The unborn child, infants and children, the elderly, pregnant, and lactating mothers are usually at high-risk of adverse effects arising from the use of herbal medicines. Some examples are preterm delivery, smaller head circumference of newborn, hypoglycemia, and uterine rupture. A systematic review of controlled trials revealed a total of 14 randomized control trials evaluating five different herbal medicines. Among these, ten were on ginger with only one study each on garlic, raspberry, cranberry, and St John's wort. Despite a global increase in herbal medicine use during pregnancy, there are no studies assessing the knowledge of pregnant women in Eastern Nigeria regarding medicinal herbs. Health literacy is very important for women, especially with respect to health care in pregnancy. Therefore, the study aimed to assess the level of knowledge of pregnant women about herbal medicines and any possible relationship between their knowledge and their sociodemographic characteristics. This will help to estimate how much need they have for adequate and updated education on the safety and effectiveness of herbal medicines use in pregnancy.
| Methods|| |
Study design and setting
A cross-sectional and descriptive method was adopted, and data were collected between June and August 2018 in three health facilities in Nsukka among pregnant women who accessed the clinics for antenatal services.
Selection of participants
Three hundred respondents were conveniently selected from the study sites. The respondents included in the study were pregnant women enrolled for antenatal clinic services who gave oral consent for participation.
Method of measurement
The instrument used for data collection was a validated questionnaire. This was developed in English language by a team of drug experts. However, for the participants who had no formal education, the questions were translated to the vernacular. The questionnaire items were obtained after careful and extensive literature search. The questions were based on the source and type of medicinal herbs, the doses, and some herbal medicines' outcomes on both the mother and the unborn child in the womb. The face and content validity were assessed by experts and researchers.
A pilot study was conducted using twenty respondents who were not included in the actual study. Afterward, few adjustments were made where necessary to arrive at clear, unambiguous, and comprehensive questions. The final questionnaire was divided into section A and section B. Section A contains respondents' demographic characteristics such as age, educational level, occupation, monthly income, and marital status, while section B contains ten items assessing respondents' knowledge of herbal medicine.
Data collection and processing
The questionnaires for the study were given to the respondents at their visit to the hospital for antenatal services with the help of trained research assistants. The questionnaires were completed and returned almost immediately without delays.
Statistical method used
The respondents' demographic characteristics and level of knowledge were analyzed and results presented as frequencies and percentages. Descriptive and inferential statistical analysis was done using IBM Statistical Product and Services Solution (SPSS) for Windows, Version 23.0 (IBM Corp, Version 23.0, and Armonk, NY, USA). For statistical significance, the value was P < 0.05. Chi-square test was used to evaluate the association between demographic characteristics and level of knowledge. Respondents whose responses were above the mean percentage knowledge score showed good knowledge of herbal medicines, and responses below the mean score demonstrate poor knowledge.
The Health Research Ethics Committee of the three health facilities granted the ethical approval for this study. Informed consent was received orally from each respondent.
| Results|| |
A total of 300 expectant women attending antenatal clinic took part in this study. Majority of the respondents assessed were from the community health center (51.3%). Greater percentage was between the ages of 18 and 34 years (89.9%). Most were married (93.3%) and majority of the respondents had received postprimary education (82.8%) or work as civil servants (44.2%). Details are shown in [Table 1].
[Table 2] shows the percentage scores of the respondents' responses on the questions about herbal medicines. About 97.7% of the women got correctly the answer to the question “Herbal medicines are plant-based substances while most participants did not answer correctly the question “Garlic can lower the blood lipid level during pregnancy” (35.7%).
The mean percentage knowledge score of herbal medicine was 63.196. [Table 3] shows that more than half of the women scored below the mean score and were considered to have poor knowledge (57.9%).
There was no association between the respondents' sociodemographics and the level of their knowledge of medicinal herbs (P > 0.05) [Table 4].
|Table 4: Association of level of knowledge with respondent's sociodemographics|
Click here to view
| Discussion|| |
The study assessed the herbal medicines' knowledge among pregnant women in Nsukka town accessing antenatal clinics. In Eastern Nigeria, one study had been carried out to assess the knowledge of herbal medicines in Nigeria, however among a different population. This limits the scope of comparisons we could make with respect to our studies. Suffice it to say, we will make the use of relevant studies to discuss our results. The age of most of the respondents fell within the category of 18–34 years old. This observation is comparable to similar studies conducted among pregnant women with respect to their use of herbal medicines., About 83% of the respondents had received postprimary education. Something similar was observed from a study among pregnant women in Northern Nigeria. Most of the respondents had poor knowledge of herbal medicines. This is worrisome. An even higher rate of poor knowledge was observed in a study among pregnant women in Malaysia. About 90% of the respondents had poor knowledge of herbal medicines. To have such minimal knowledge of herbal medicines among this vulnerable group will pose a serious danger to their health and their fetuses' health. This may have been caused by a low exposure to competent and good sources of knowledge about herbal medicines. As there are few available evidence-based efficacy and safety research on medicinal herbs used in pregnancy, they may rely on informal sources of information such as the internet, health food stores, or recommendations from relatives and friends. It has been demonstrated that inadequate information was given to women about the use of medicinal herbs during pregnancy. When the health-care professionals were consulted by the women for information regarding herbal medicines, no information was given in 85.7% of the cases. This may have led to harmful use of the herbal medicines. It was found among pregnant women in Southern Ethiopia that women who had sufficient knowledge of herbal medicines were 63% less likely to use herbal medicines during pregnancy than those without. A relationship was found in another study between prior knowledge about herbal medicines and self-medication among pregnant mothers. Prior knowledge accounted for 32% of the reported herbal self-treatment. The level of knowledge about the safety of some of the commonly used medicinal herbs in this region was low. For instance, most of them believed that the use of kola nut is good, therefore should be recommended during pregnancy and that Ginseng can be used by pregnant mothers with high blood pressure. Kola nuts, which contain caffeine, are shown in previous studies to be consumed by pregnant women., It is commonly used in the eastern part of Nigeria and readily available in the markets. Among the regular reasons for its use are for the cure of catarrh, cough, and cold. Other uses include suppression of hunger and fatigue, digestive aid before meals, and for headache. A number of uses in pregnancy are for controlling nausea and vomiting, common cold, and pedal edema. Nevertheless, pregnant women diagnosed of restless leg syndrome were more likely to have consumed kola nuts than those who were RSL negative (0.023). Ginseng should be avoided in pregnancy by all means, and even so in pregnant women with high blood pressure. It causes high blood pressure, uterine bleeding and can lead to androgynous babies. In this study, very few of the respondents were aware of the efficacy of garlic in lowering blood lipid. A randomized trial among primigravidas demonstrated that garlic effectively reduced the incidence of hypertension (P = 0.043) and reduction of total cholesterol (P = 0.038). Only about half of them know the usefulness of Dongoyaro (Azadirachta indica) in the treatment of malaria in pregnancy. An extraction obtained from boiling the leaves is taken orally by pregnant women for malaria treatment. In fact, many previous studies have also shown mistaken notions by pregnant women about herbal medicines' safety in pregnancy.,,,,,, Unfortunately, to the best of our knowledge, no clinical trials have been done in Nigeria to ascertain the safety and effectiveness of the commonly used medicinal herbs in pregnancy.
None of the respondents' sociodemographics were significantly associated with their knowledge of herbal medicines. This observation might have been caused by a low statistical power of the sample to detect any divergence between the women with good or poor knowledge of herbal medicine with respect to their sociodemographics. Perhaps the knowledge of the pregnant women regarding herbal medicines was so poor that their sociodemographic characteristics had no impact on it.
| Conclusions|| |
Our findings suggest that most of the pregnant women assessed in this study had poor knowledge of herbal medicine. Many were married with children, had post primary education. The respondents' social demographics were not associated with their knowledge of herbal medicines.
Limitations and recommendation
Our study had some limitations that deserve consideration as it will help in better understanding and interpretation of the implication of its findings and serve as gaps for future research. The respondents were conveniently sampled; the sample size was small and disproportionate, hence may not be a true representation of the target population even though three health facilities were used. Therefore, the setting need to be broadened as the assessment was carried out only in Nsukka. In addition, our study adopted a cross-sectional design, hence may have problem of recall bias among respondents as the data were collected at one point in time.
Despite this, our assessment is the first study among pregnant women in Eastern Nigeria. It has also demonstrated that there is obvious gap in knowledge which can be worked upon to improve local as well as global readiness for the appropriate use of herbal medicines by pregnant women. The results from this study will serve as a spring board for further studies and initiatives for creating awareness among pregnant women regarding the rational use of herbal medicines in pregnancy. Moreover, in order to prevent potential harm that the use of herbal medicines may impose on pregnant mothers and their unborn babies, health-care providers should utilize the opportunities of antenatal briefings to educate the women using information from evidence-based research regarding herbal medicines. Furthermore, clinical trials should be carried out on the common medicinal herbs used in Nigeria to provide sufficient evidence on their effectiveness and safety in pregnancy.
We acknowledge the support of the chief medical directors of three centers used for the study. We also appreciate all the pregnant women who consented to participate in the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
World Health Organisation. General Guidelines for Methodologies on Research and Evaluation of Traditional Medicine. Geneva: World Health Organization; 2000.
Lu Y, Hernandez P, Abegunde D, Edejer T. The World Medicines Situation 2011. Geneva, Switzerland: WHO; 2011. 32p.
Kasilo OMJ, Trapsida J-M. Regulation of traditional medicine in the WHO African region. African Heal Monit 2010:25–31.
WHO. Trends in Maternal Mortality : 1990 to 2015: estimates by WHO, UNICEF,UNFPA,World Bank Group and the United Nations Population Division. Geneva, Switzerland: WHO; 2015. 92p.
Shewamene Z, Dune T, Smith CA. The use of traditional medicine in maternity care among African women in Africa and the diaspora: A systematic review. BMC Complement Altern Med 2017;17:382.
Ahmed M, Hwang JH, Choi S, Han D. Safety classification of herbal medicines used among pregnant women in Asian countries: A systematic review. BMC Complement Altern Med 2017;17:1-11.
Kennedy DA, Lupattelli A, Koren G, Nordeng H. Safety classification of herbal medicines used in pregnancy in a multinational study. BMC Complement Altern Med 2016;16:102.
Moussally K, Oraichi D, Berard A. Herbal products use during pregnancy: Prevalence and predictors. Pharmacoepidemiol Drug Saf 2009;18:454-61.
Barnes LAJ, Barclay L, Mccaffery K, Aslani P. Complementary medicine products:Information sources, perceived benefits and maternal health literacy. Women and Birth 2018;32:493–520. https://doi.org/10.1016/j.wombi.2018.11.015
Dugoua JJ. Herbal medicines and pregnancy. J Popul Ther Clin Pharmacol 2010;17:e370-8.
Al-Ramahi R, Jaradat N, Adawi D. Use of herbal medicines during pregnancy in a group of Palestinian women. J Ethnopharmacol 2013;150:79-84.
Conover EA. Herbal agents and over-the-counter medications in pregnancy. Best Pract Res Clin Endocrinol Metab 2003;17:237-51.
Hajj ME, Holst L. Herbal medicine use during pregnancy: A review of the literature with a special focus on sub-saharan Africa. Front Pharmacol 2020;11:1-3.
Dante G, Pedrielli G, Annessi E, Facchinetti F. Herb remedies during pregnancy: A systematic review of controlled clinical trials. J Matern Neonatal Med 2013;26:306-12.
Onyiapat JL, Okoronkwo IL, Ogbonnaya NP. Complementary and alternative medicine use among adults in Enugu, Nigeria. BMC Complement Altern Med 2011;11:19.
Nworu CS, Udeogaranya PO, Okafor CK, Adikwu AO, Akah PA. Perception, usage and knowledge of herbal medicines by students and academic staff of University of Nigeria: A survey. Eur J Integr Med 2015;7:218-27.
Duru CB, Uwakwe KA, Chinomnso NC, Mbachi II, Diwe KC, Agunwa CC, et al
. Socio-demographic determinants of herbal medicine use in pregnancy among nigerian women attending clinics in a tertiary hospital in Imo State, South-East, Nigeria. Am J Med Stud 2016;4:1-10.
Fakeye TO, Adisa R, Musa IE. Attitude and use of herbal medicines among pregnant women in Nigeria. BMC Complement Altern Med 2009;9:1-7.
Sooi L, Keng SL. Herbal Medicines: Malaysian Women' s knowledge and practice. Evid Based Complement Altern Med 2013;2013:4-9.
Bayisa B, Tatiparthi R, Mulisa E. Use of herbal medicine among pregnant women on antenatal care at nekemte hospital, Western Ethiopia. Jundishapur J Nat Pharm Prod 2014;9:e17368.
Laelago T, Yohannes T, Lemango F. Prevalence of herbal medicine use and associated factors among pregnant women attending antenatal care at public health facilities in Hossana Town, Southern Ethiopia: Facility based cross sectional study. Arch Public Heal 2016;74:1-8.
Westfall RE. Herbal healing in pregnancy: Women's experiences. J Herb Pharmacother 2003;3:17-39.
Fitt E, Pell D, Cole D. Assessing caffeine intake in the United Kingdom diet. Food Chem 2013;140:421-6.
Ologe MO, Aboyeji AP, Ijaiya MA, Adesina KT, Adewara AA, Olarinoye JK. Herbal use among pregnant mothers in Ilorin, Kwra State, Nigeria. J Obstet Gynaecol (Lahore) 2008;28:720-1.
James PB, Bah AJ, Tommy MS, Wardle J, Steel A. Herbal medicines use during pregnancy in Sierra Leone : An exploratory cross-sectional study. Women and Birth 2017;31(5):e302–9. https://doi.org/10.1016/j.wombi.2017.12.006
Chinwe E, Dimkpa U, Onoh L, Onoh G, Ezeugwu U, Dibia J. Chronic kola nut consumption and its effect on uric acid level and lipid profile. J Mol Pathophysiol 2016;5:23.
Obineche JO. Kola nut: Revisiting the Igbo socio-cultural values and identity. AFRREV IJAH Int J Arts Humanit 2017;6:94.
Fawale MB, Ismaila IA, Kullima AA, Komolafe MA, Ijarotimi OA, Olowookere SA, et al. Restless legs syndrome: a rarity in the Nigerian pregnant population? Sleep Med 2018;43:47–53. https://doi.org/10.1016/j.sleep.2018.01.002
The Academy of Nutrition and Dietetics. Position of the academy of nutrition and dietetics: Nutrition and lifestyle for a healthy pregnancy outcome. J Acad Nutr Diet 2014;114:1099-103.
Shinde P, Patil P, Bairagi V. Herbs in pregnancy and lactation: A review appraisal. Int J Pharm Sci Res 2012;3:3001-6.
Ziaei S, Hantoshzadeh S, Rezasoltani P, Lamyian M. The effect of garlic tablet on plasma lipids and platelet aggregation in nulliparous pregnants at high risk of preeclampsia. Eur J Obstet Gynecol Reprod Biol 2001;99:201-6.
Ogwu MC, Osawaru M, Obahiagbon GE. Ethnobotanical survey of medicinal plants used for traditional reproductive care by Usen people of Edo State, Nigeria. Malaya J Biosci 2017;4:17-29.
Nyeko R, Tumwesigye NM, Halage AA. Prevalence and factors associated with use of herbal medicines during pregnancy among women attending postnatal clinics in Gulu district, Northern Uganda. BMC Pregnancy Childbirth 2016;16:1-2.
Cuzzolin L, Francini-pesenti F, Verlato G, Joppi M, Baldelli P, Benoni G. Use of herbal products among 392 Italian pregnant women: Focus on pregnancy outcome. Pharmacoepidemiol Drug Saf 2010;19:1151-8.
Holst L, Wright D, Nordeng H, Haavik S. Complementary therapies in clinical practice use of herbal preparations during pregnancy: Focus group discussion among expectant mothers attending a hospital antenatal clinic in Norwich, UK. Complement Ther Clin Pract 2009;15:225-9.
Volqvartz T, Vestergaard AL, Aagaard SK, Andreasen MF, Lesnikova I, Uldbjerg N, et al.
Use of alternative medicine, ginger and licorice among Danish pregnant women – A prospective cohort study. BMC Complement Altern Med 2019;19:1-10.
Mekuria AB, Erku DA, Gebresillassie BM, Birru EM, Tizazu B, Ahmedin A. Prevalence and associated factors of herbal medicine use among pregnant women on antenatal care follow-up at University of Gondar referral and teaching hospital, Ethiopia: A cross-sectional study. BMC Complement Altern Med 2017;17:1-7.
Nergard CS, Phung T, Ho T, Diallo D, Ballo N, Paulsen BS, et al.
Attitudes and use of medicinal plants during pregnancy among women at health care centers in three regions of Mali, West-Africa. J Ethnobiol Ethnomed 2015;11:1-11.
[Table 1], [Table 2], [Table 3], [Table 4]