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

This study was conducted in Hossana town, the capital of Hadiya Zone, SNNPR of Ethiopia. The town is situated 232 Km Southwest of Addis Ababa and 194kms northwest of the regional capital Hawassa. The town has one zonal hospital, three public health centres and 25 clinics of all types. This study was conducted on antenatal clinics of the hospital and the health centres.

In Ethiopia antenatal care is given based on focused antenatal care approach. Focused antenatal care with four visits per pregnancy is mainstreamed at all service delivery levels. It is given in health posts, health Centres, hospitals and clinics.

Facility based cross sectional study was conducted among 363 pregnant women from May to June 2015.

The estimated sample size was 363 pregnant women and it was selected by systematic sampling technique.

Pretested structured questionnaire was used to collect data from each study subject. Majority of the questions were adopted from related literature with slight modification made in line with the objective of this particular study and to fit to the local context. Data collected on socio-demographic factors includes age, marital status, educational level, monthly income of house hold, occupation and religion of respondents.

On behavioural factors, knowledge and attitude toward herbal medicine use response was sought. Environmental factors that included in study were access to health facility, sources of information and sources to obtain herbal medicine. Knowledge on common herbal medicine use, complication of herbal medicine use to pregnant mother and foetus were obtained.

Data collected on pregnancy related factors includes parity, gravidity, stages of pregnancy and current pregnancy status. Responses were also sought on use of herbs during pregnancy, indication to use, routes and untoward effects of post administration of herbal medicines.

The questionnaire was first prepared in English, translated into Amharic and then re-translated back to English to check for its consistency.

Four nurses and two public health masters were recruited as interviewers and supervisors respectively. Data collectors were trained for 2 days on interviewing techniques, purpose of the study and ethical aspects. Pre-test was carried out on one health facility which was not included in the actual study. Based on the result, data collectors were reoriented and the questionnaire was modified as necessary. The principal investigators and supervisors made a day to day on site supervision during the whole period of data collection.

The women were considered as herbal medicines users if they took the herbal medicines through oral, intra-vaginal or topical routes. Other preparations that are consumed as nutriments and within routine meal preparation such as food additives were excluded.

The income for study participant was calculated in Ethiopian Birr. The individual respondents income was compared with the mean (≥ mean or < mean).

Knowledge was measured using 10 items prepared to assess it. Respondents were asked knowledge related questions and right answer was given a value of 1 and for those incorrect answers a value of 0 was given. Then, total score was computed by summing up all the items together. The respondents score was dichotomized as sufficient knowledge or insufficient knowledge.

Attitude was measured using seven items on five points Likert scale ranged from strongly disagree to strongly agree. After computing the mean of all respondents’ responses, the mean score of each respondent was dichotomized as have positive attitude or negative attitude.

Data were entered into Epi-Data version 3.1 [16], then, it was exported into SPSS version 16.0 statistical software for analysis [17]. Different frequency tables and descriptive summaries were used to describe the study variables. Bivariate logistic regression analysis was used to see significance of association between the outcome and independent variables. Variables with p-value <0.05 in bivariate analysis were transferred to multivariate logistic regression. Odds ratios at 95 % CI were computed to measure the strength of the association between the outcome and the explanatory variables. P-values less than 0.05 were considered as statistical significant in the multivariate analysis.

Prior to data collection, appropriate ethical clearance was taken from ethical clearance committee of Hossana College of Health Sciences. The study included patients that had given informed consent before data collection. In order to establish anonymous linkage, only the codes, not the names of the respondents, were registered on the questionnaire. During the training of data collectors and supervisor ethical issues was addressed as important component of the research.

Of the 363 pregnant women attending the antenatal care clinic, 353 (97 %) gave an informed consent and were included in the study. The study included pregnant women irrespective of trimester. Majority of the respondents 344 (97.5 %) were married. Concerning educational level; 129 (36.5 %) of the respondents attended primary education (grade 1–8) and 129 (36.5 %) respondents’ educational level was secondary education (grade 9–12). Based on the finding minimum, mean and maximum ages of the respondents were 16, 25.4, and 40 years respectively with SD of 4.1. The mean family income of the respondents was 2116.22 Ethiopian birr per month. The minimum and the maximum family income per month was 200 and 9,900 ETB respectively. One hundred eight seven (53.0 %) of the pregnant women were housewives. Majority of respondents 238 (67.4 %) were protestant religion followers (Table 1).

Of the respondents, 258 (73.1 %) with 95 % CI :( 68.1–78.1) used herbal medicine during current pregnancy. From those who took herbal preparations during current pregnancy, 189 (53.5 %) used in the third trimester (Table 2).

The herbal preparations that had taken by the respondents during the current pregnancy were ginger 144 (55.8 %), garlic 180 (69.8 %), eucalyptus 30 (11.6 %), tenaadam 68 (26.4 %), damakesse 59 (22.8 %), feto 9 (3.5 %), omore 8 (3.1 %) and others (anamura, barewa, duba fire, limich, tosign (thymus serrulatus) 13 (5.0 %) (Fig. 1).

Indications for using the herbal medicine during pregnancy were nausea 82 (31.8 %), vomiting 42 (16.3 %), abdominal pain 64 (24.8 %), cold 185 (71.7 %), malaria 8 (3.1 %) and others (amoebiasis, fever, taeniasis, typhoid fever, tonsillitis, diarrhoea) 55 (21.3 %).

From the participants included in this study, 92.1 % of the respondents heard about herbal medicine from different sources. With respect to knowledge on herbal medicine, 80.7 % of the respondents had sufficient knowledge on herbal medicine. From the respondents, 169 (47.9 %), 114 (32.3 %), 105 (29.7 %) raised abortion, excessive uterine contraction, uterine rupture respectively as possible complications of herbal medicine use.

Out of 353 respondents, 184 (52.1 %) had positive attitude and 169 (47.9 %) had negative attitude towards herbal medicine use (Table 3).

Concerning current pregnancy status, around three fourth 273 (77.3 %) were planned pregnancy and the rest 80 (22.7 %) were unplanned. Out of the 353 respondents, 150 (76.1 %) of women had 1–2 children. From the pregnant women included in this study, 71.4 % of women became pregnant 1–2 times. Regarding trimester, around half 189 (53.5 %) of the respondents were in the third trimester (Table 1).

Out of the respondents, 214 (60.6 %) had access to health facility in less than five kilometres and only few 28 (7.8 %) walk more than 10 km to get nearby health facility. Concerning source of information, nearly half 159 (49.2 %) of the respondents obtained information about herbal medicine from parents/relatives. From those women who used herbal medicine during pregnancy, 105 (41.5 %) got from market places and 76 (29.5 %) prepared by themselves (Table 4).

Selected variables that were significantly associated at the bivariate analysis were further examined in the in multivariate logistic regression to see their relative effects on the use of herbal medicine.

Result of bivariate analysis showed that educational status (p < 0.001), occupation (p < 0.001), average monthly income (p < 0.05), knowledge (p < 0.05), attitude of the respondents towards herbal medicine (p ≤ 0.001) and trimester of pregnancy (p < 0.05) as candidates for multivariate analysis at p-value <0.05 (Table 5).

In multivariate logistic regression analysis educational status, occupation of respondents, knowledge on use of herbal medicine and trimester of pregnancy were significantly associated with herbal medicine use (Table 5).

Pregnant women who had no formal education were 4.4 times higher to use herbal medicine as compared to those women who attend more than secondary education(AOR: 4.41, 95 % CI: (1.107, 17.556)). Pregnant who had primary education were 4.1 times higher to use herbal medicine as compared to those who attended more than secondary education (AOR: 4.15, 95 % CI: (1.506, 11.447)) and pregnant women who attended secondary education were 2.6 folds higher to use herbal medicine during the current pregnancy as compared to those who do attended more than secondary (AOR: 2.55, 95 % CI: (1.083, 6.025)).

The odds of using herbal medicine during pregnancy was 5.7 folds higher in students as compared to housewives (AOR: (5.68, 95 % CI: (1.528, 21.129)).

Respondents who had sufficient knowledge on herbal medicine use were 63 % less likely to use herbal medicine during pregnancy as those who had insufficient knowledge on herbal medicine (AOR: 0.37, 95 % CI: (0.189, 0.789). Respondents who were in the second trimester were 78 % less likely to use herbal medicine as compared to those who were in the first trimester (AOR: 0.22, 95 % CI: (0.078, 0.762)).

The high response rate (97 %) and exploring some herbs that were not studied previously are strength of the study. There are limitations to this study. Like all self-reported exposure assessments, under reporting is very likely. As it is cross-sectional, it fails to show seasonal variability in the use of herbal medicine.