Background
Methods
Study setting
Study design and sample size
Sampling technique
Study procedure and data collection
Statistical analysis
Quantitative data
Qualitative data
Results
Socio-demographic characteristics
Variable | Frequency (N = 383) | Percent |
---|---|---|
Mean age | 25.32 (6.16)a | |
Age group (years): | ||
< 34 | 339 | 88.5 |
≥ 35 | 44 | 11.5 |
Occupation: | ||
Peasant | 292 | 76.2 |
Others | 91 | 23.8 |
Marital status: | ||
Married | 246 | 64.2 |
Not married | 137 | 35.8 |
Education level: | ||
Tertiary | 22 | 5.7 |
Below tertiary | 361 | 94.3 |
Religion: | ||
Catholic | 268 | 70.0 |
Others | 115 | 30.0 |
Average monthly income (UGX): | ||
< 75,000 | 251 | 71.7 |
≥ 75,000 | 99 | 28.3 |
Residence | ||
Rural (outside the municipality) | 282 | 73.6 |
Urban (within the municipality) | 101 | 26.4 |
Distance from health facility | ||
> 5 km | 169 | 44.1 |
≤ 5 km | 214 | 55.9 |
Study site | ||
Gulu hospital | 127 | 33.2 |
Lacor hospital | 115 | 30.0 |
Awach HCIV | 101 | 26.4 |
Bobi HCIII | 40 | 10.4 |
Characteristics | Number | Percent |
---|---|---|
Parity: | ||
Primiparous | 87 | 22.7 |
Para ≥2 | 296 | 77.3 |
ANC attendance: | ||
Yes | 381 | 99.5 |
No | 2 | 0.5 |
aNumber of ANC attendance: | ||
< 4 ANC | 195 | 50.9 |
≥ 4 ANC | 186 | 48.6 |
Place of delivery: | ||
Health facility | 326 | 85.1 |
Home | 57 | 14.9 |
Opinion about effectiveness & safety: | ||
Effective/safe | 122 | 31.9 |
Not effective | 261 | 68.1 |
bUsed HM during previous pregnancies: | ||
Yes | 121 | 35.7 |
No | 218 | 64.3 |
Ever used HM for other reasons | ||
Yes | 208 | 54.3 |
No | 175 | 45.7 |
Qualitative findings
Prevalence of herbal medicine use
Characteristics | Number (n = 78) | Percent |
---|---|---|
Trimester of pregnancy: | ||
1st trimester | 6 | 10.3 |
2nd trimester | 18 | 23.1 |
3rd trimester | 16 | 20.5 |
1st and 2nd trimester | 10 | 12.8 |
2nd and 3rd trimester | 11 | 14.1 |
During labour | 9 | 11.5 |
Throughout pregnancy | 6 | 7.7 |
Perception: | ||
Effective/safe | 51 | 82.3 |
Not effective | 11 | 17.7 |
Method of use: | ||
Ingestion | 54 | 69.2 |
Smearing on abdomen | 15 | 19.3 |
Insertion in vagina | 6 | 7.7 |
Inhalation | 3 | 3.8 |
Duration of HM use: | ||
< 3 week | 57 | 73.1 |
≥ 3 weeks | 21 | 26.9 |
Paid for herbal medicine: | ||
Yes | 57 | 73.1 |
No | 21 | 26.9 |
Source of herbal medicine: | ||
Gathered from bush | 37 | 47.4 |
Traditional healer | 39 | 50.0 |
Others | 2 | 2.6 |
Source of information to use HM | ||
Relative | 46 | 59.0 |
Herbalist | 20 | 25.6 |
Friend | 12 | 15.4 |
Would disclose use of HM to health worker | ||
Yes | 20 | 25.6 |
No | 58 | 74.4 |
Disclosed use of HM to health worker | ||
Yes | 8 | 10.3 |
No | 70 | 89.7 |
Concomitantly used HMs with ANC drugs | ||
Yes | 50 | 64.1 |
No | 28 | 35.9 |
“For me I think it is not possible to tell the health workers that you took local herbs because they can become rude to you since they say people should come to hospital when they are sick but not to use local medicines. They can also refuse to give you treatment from the hospital if you say you have taken local medicines when you are also receiving care from the hospital.” FGD, 20 year old mother.
“We sometimes get to know about these mothers using local herbal medicines during labour from the colour of their liquor or traces of the herbs in the genital parts, otherwise they will not tell you that they have used local herbs…” KII, midwife.
Characteristics | Numbera | Percentb |
---|---|---|
Obstetrics reasons (n = 106): | ||
Nausea and vomiting | 23 | 21.7 |
Abdominal/waist pain | 45 | 42.5 |
Keep the baby healthy | 8 | 7.5 |
Induce/enhance labour | 30 | 28.3 |
Socio-cultural beliefs (n = 120): | ||
Tradition of use | 43 | 35.8 |
HM cures many illnesses | 47 | 39.2 |
Herbs are more efficacious | 15 | 12.5 |
Herbs are safe in pregnancy | 15 | 12.5 |
Health systems (n = 109): | ||
Low cost of herbal medicine | 34 | 31.2 |
Difficulty accessing health facility | 45 | 41.3 |
Lack of drugs in health facility | 30 | 27.5 |
Concurrent illness (n = 105): | ||
Respiratory infections | 29 | 27.6 |
Febrile illness | 47 | 44.8 |
Skin problems | 25 | 23.8 |
Other reasons | 4 | 3.8 |
“…local herbs work as well as other medicines. It works in waist pain, perianal wounds in children and “twor rubanga” (TB spine). I had a painful period and when I tried the hospital the medicines did not work but when somebody gave me local herbs, it subsided.” FGD, 28 year old mother of four.
Factors associated with herbal medicine use
“I was told that the local herbs are the ones made into modern medicines, so they should work the same way. I have used local herbs for all my ailments, including during my previous pregnancies and I have not experienced any problems. It is true people take local herbs for many illnesses and they get cured, sometimes even if you are taken to the hospital, the doctor can even say go back for local herbs because they cannot manage that condition.” FGD, 35 year old mother.
Characteristics | Used HM N = 78 (%) | No HM use N = 305 (%) | OR (95 % CI) | p-value |
---|---|---|---|---|
Individual factors: | ||||
Age in years: | ||||
< 35 | 65 (19.2) | 274 (80.8) | 0.57 (0.28-1.14) | 0.108 |
≥ 35 | 13 (29.5) | 31 (70.5) | 1.0 | |
Residence: | ||||
Rural | 64 (22.7) | 218 (77.3) | 1.82 (0.97-3.42) | 0.059 |
Urban | 14 (13.9) | 87 (86.1) | 1.0 | |
Religion: | ||||
¶Catholic | 58 (21.6) | 210 (78.4) | 1.31 (0.75-2.30) | 0.344 |
Others | 20 (17.4) | 95 (82.6) | 1.0 | |
Education level: | ||||
Tertiary | 4 (18.2) | 18 (81.8) | 0.86 (0.28-2.62) | 0.793Ψ |
Below tertiary | 74 (20.5) | 287 (79.5) | 1.0 | |
Ever used HM: | ||||
Yes | 70 (33.7) | 138 (66.3) | 10.59 (4.93-22.77) | <0.001* |
No | 8 (4.6) | 167 (95.4) | 1.0 | |
Self-medication: | ||||
Yes | 67 (25.5) | 196 (74.5) | 3.39 (1.72-6.68) | <0.001* |
No | 11 (9.2) | 109 (90.8) | 1.0 | |
Income: | ||||
< 75,000 | 57 (22.7) | 194 (77.3) | 1.32 (0.73-2.39) | 0.353 |
≥ 75,000 | 18 (18.2) | 81 (81.8) | 1.0 | |
Socio-cultural factors: | ||||
Occupation: | ||||
Peasant | 64 (21.9) | 228 (78.1) | 1.54 (0.82-2.91) | 0.177 |
Others | 14 (15.4) | 77 (84.6) | 1.0 | |
Marital status: | ||||
Married | 51 (20.7) | 195 (79.3) | 1.07 (0.63-1.80) | 0.812 |
Not married | 27 (19.7) | 110 (80.3) | 1.0 | |
Perception: | ||||
Effective/safe | 57 (46.7) | 65 (53.3) | 10.02 (5.67-17.73) | <0.001* |
Not effective | 21 (8.0) | 240 (92.0) | 1.0 |
Characteristics | Used HM N = 78 (%) | No HM use N = 305 (%) | OR (95 % CI) | p-value |
---|---|---|---|---|
Obstetric/maternal factors: | ||||
Parity: | ||||
Primiparous | 11 (12.6) | 76 (87.4) | 0.50 (0.25-0.98) | 0.042* |
Para ≥2 | 69 (22.6) | 229 (77.4) | 1.0 | |
Used HM in previous preg | ||||
Yes | 54 (44.6) | 67 (55.4) | 7.98 (4.45-14.30) | <0.001* |
No | 20 (9.2) | 198 (90.8) | 1.0 | |
ANC attendance: | ||||
Yes | 78 (20.5) | 303 (79.5) | 0.80 (0.76-0.84) | 0.473Ψ |
No | 0 (0) | 2 (100) | 1.0 | |
Number of ANC: | ||||
< 4 | 42 (21.5) | 153 (78.5) | 1.18 (0.72-1.96) | 0.508 |
≥ 4 | 35 (18.8) | 151 (81.2) | 1.0 | |
Place of birth: | ||||
H/Facility | 61 (18.7) | 265 (81.3) | 0.54 (0.29-1.02) | 0.055 |
Home | 17 (29.8) | 40 (70.2) | 1.0 | |
Health system factors: | ||||
Distance from HF: | ||||
> 5 km | 48 (28.4) | 121 (71.6) | 2.43 (1.46-4.05) | 0.001* |
≤ 5 km | 30 (14.0) | 184 (86.0) | 1.0 | |
Costs of health services: | ||||
Expensive | 49 (23.2) | 162 (76.8) | 1.49 (0.89-2.49) | 0.124 |
Not expensive | 29 (16.9) | 143 (83.1) | 1.0 | |
Drug access in HFs: | ||||
Available | 42 (17.6) | 197 (82.4) | 0.64 (0.39-1.06) | 0.080 |
Not available | 36 (25.0) | 108 (75.0) | 1.0 |
“You can waste your little money and time going to the health facilities for problems like pain, cough, fever and the only thing they tell you is that there is no medicine, sometimes you only come back with aspirin or panadol, or you can even come back without any medicine and yet you travel from long distance which is expensive. So it is better to first get help from home and maybe only go to the health facility when you have failed to improve.” FGD, a mother of five.
“…some of our mothers come from far distances to receive healthcare services and sometimes they are not able to afford transport money, so they prefer to use local herbs and only come to hospitals at the end…” KII, midwife.
Characteristics | AOR (95 % CI) | p-value |
---|---|---|
Age (<35/≥35 years) | 1.05 (0.42-2.60) | 0.915 |
Self-medication (Yes/No) | 1.10 (0.46-2.61) | 0.835 |
Perception (effective/not effective) | 2.18 (1.02-4.66) | 0.044* |
Distance from health facility (>5 km/≤5 km) | 1.45 (0.71-2.97) | 0.310 |
Ever used herbal medicine (Yes/No) | 3.87 (1.46-10.25) | 0.006* |
Used HM in previous pregnancy (Yes/No) | 2.51 (1.21-5.19) | 0.013* |
Parity (para 1/para ≥2) | 0.82 (0.32-2.05) | 0.664 |