Herbal medicine use and its associated factors among pregnant women attending antenatal care at Wollega University Referral Hospital, West Ethiopia.

Background: Herbal medications are plant-derived materials or products with therapeutic or other human health benefits, which contain either raw or processed ingredients from one or more plants. There are many different types of herbal medicine that spring from different cultures around the world. All these have the use of medicinal plants in common. Developing world general population relies on these traditional medicines for primary care. Besides, pregnant women use herbal medicines because of pregnancy related ailments and normal aliments. Therefore, the study aimed to assess prevalence and factors associated with herbal medicine use among pregnant women attending antenatal care at Wollega University Referral Hospital. Method: A facility based cross sectional study was conducted among pregnant women attending Wollega University Referral Hospital antenatal care from May to June 2018. Written informed consent was obtained from study participants prior to data collection. Univariate and Multivariate logistic regression analysis was used to determine factors associated with herbal medicine use. Association was significant when p-value is less than 0.05. Result: A total of 238 pregnant mothers were participated in the study. The respondents’ age ranges from 17 to 46 years. The prevalence of herbal medicine use among pregnant women attending antenatal care at Wollega University Referral Hospital was 66.40%. The use of herbal medicine during pregnancy was 3.885 times more likely among rural residents (AOR =3.885, 95% CI 1.121-13.47) than urban residents. Respondents who has monthly income between 1001 to 2000 Ethiopian Birr (AOR=2.585, 95% CI 1.125–5.940) were 2.585 times more likely to use Herbal medicine as compared to those who earn >3000 Ethiopian Birr. However, mothers of planned pregnancy (AOR=0.335, 95% CI 0.114-0.986) were less likely to use Herbal medicine as compared to those who had unplanned pregnancy. Conclusion: The prevalence of herbal medicine use among pregnant women attending antenatal care at Wollega University Referral hospital was 66.40%. Commonly used herbs were Garlic (24.37%) and ginger (18.07%). Rural residence and low income had significantly associated to herbal medicine use while planned pregnancy was inversely associated to herbal medicine use.


Background
Herbal medications are Botanical or Phytotherapy, which were plant-derived materials or products with therapeutic or other human health benefits, which contain either raw or processed ingredients from one or more plants. In some traditions, materials of inorganic or animal origin may also be present (1,2). There are many different types of herbal medicine that spring from different cultures around the world. All these have the use of medicinal plants in common, but they vary in the plants they use, the way they prepare and use medicines from these plants, and the philosophy of their treatment approaches. Different cultures may also use the same plants but differ in how it is used, or the part they use (3)(4)(5).
Herbal medicines were used in every country around the world and 70-95% of developing world general population rely on these traditional medicines for primary care (6,7). Besides, herbal medicines use among pregnant women was also common. In this population group use of herbal medicine varies from 22.3% to 82.3% in middle East, 48.6% in Gondar Ethiopia and 73.1% in Hosanna Ethiopia (3,4,8). The majority of studies reported maximum use of herbs were common during the first trimester of pregnancy probably due to the higher incidence of pregnancy related problems during this period (3,9). Pregnant women who use herbal medicine agree that herbal medicine was safe during pregnancy and efficacious over prescribed drugs for some illnesses and condition (10).
Herbal medicine has both beneficial and potential side effect. Herbs contain antioxidants, essential oils, and vitamins, which fight against germs, toxins, boost immunity level and have antiinflammatory function (2). In addition, herbal medicine use cause abdominal pain, rash and Chronic renal failure (2,11,12).
Pregnant women use herbal medicines to treat pregnancy related ailments and normal aliments (10,13). The pregnant women, in the preparation of the medicines for their diseases and conditions, used parts of raw medicinal plants. They used leaves, roots, barks, fruits, seeds and whole plant (13).
Besides, they also use aniseed, fenugreek, ginger, garlic, green tea, peppermint, eucalyptus, tenaadam, damakesse, feto and omore (8,14). These herbal medicine were mostly indicated for the management of toothache, various types of pain, flu, malaria, respiratory tract infections, digestive problems, inducing labour, skin problems, nausea, vomiting and pregnancy related conditions such as swollen feet and back pain (10,15). Therefore, the aim of this study is to assess prevalence of herbal medicine use and its associated factors in pregnancy women.

Study area and period
The study was conducted in Wollega University Referral Hospital (WURH) antenatal care (ANC), which is located in Nekemte Town, Oromia region, West Ethiopia. The study was conducted from May to June 2018 at ANC.

Study design
A facility based cross sectional study was conducted Study population All pregnant women attending ANC at WURH during the study period were included in the study.
However, those pregnant women who were critically ill and unable to hear and speak were excluded from study.

Sample Size Determination and Sampling Technique
The sample size was calculated using formula for a single population proportion considering the following assumptions: A 95% confidence level, margin of error (0.05) and proportion of herbal medicine use 50.4% (p=0.504) (16). Then substituting these values in the single population proportion formula yields 384 pregnant mothers. Since the total pregnant women attending ANC at WURH was less than 10,000, which was 553 pregnant women, reduction formula was applied as follow;

Pregnancy related information and Herbal Medicine use practice
One hundred twenty one (50.84%) of respondents were at their second trimester of pregnancy stage.
Most respondents, 220 (92.44%) of them were first visited ANC at their first trimester of pregnancy.
One hundred thirty (54.62%) of respondents visited ANC less than four times. Two hundred seventeen   However, herbal medicine use among pregnant women is higher than a study conducted in Ghana were only 52.7%, Nigeria 12%, Uganda 20% and Iran 34.4% use herbal medicine during pregnancy (9,10,13,15) . This difference can be due to inter cultural and accessibility variance of herbal medicine across countries which influence their use. Also our current finding of herbal medicine use lower than a study conducted in Mali were 79.9.% use herbal medicine (17). This variation might occurs due to disease prevalence between the study areas since malaria symptoms is common in Mali study which Place of residence affected herbal medicine use of pregnant women. Pregnant women who live in rural area use herbal medicine more likely than urban area which is supported by a similar study conducted in Gondar, Ethiopia (4). The possible reasons for the high usage among rural residents might be due to availability of traditional medicine in rural area. Also studies supported mothers residing in the rural areas are generally more knowledgeable on Herbal Medicines when compared to mothers in the urban area (18). Also, Respondents who has monthly income between 1001 to 2000 ETB were 2.585 times more likely to use Herbal medicine as compared to those who earn >3000 ETB which is similar with the study done in Gondar Ethiopia (4). This can be due to cheap price of the herbal medicine relative to modern medicine services and low income participants favors use of traditional medicines (19,20).
Mothers of planned pregnancy were less likely to use Herbal medicine as compared to those who had unplanned pregnancy. Unplanned pregnancy was associated with a significantly increased odds of Psychological Distress compared to planned pregnancy (21). Maternal emotions like embarrassment for getting pregnant and mother's own negative affection (22) can encourage the pregnant mothers to terminate pregnancy through illegal abortion by using herbal medicines.

Limitation Of The Study
Pregnant women might be confused or embarrassed to report the use of herbal medicines during data collection. Therefore, recall bias may influence the results.

Conclusion
The prevalence of herbal medicine use among pregnant women attending ANC at WURH was found to be 66.40%. Commonly used herbs among pregnant women were ginger (Zingiber officinale) 43 (18.07%) and Garlic 58 (24.37%). The most common indication for use was nausea/vomiting 65 (27.31%) and headache 53 (22.27%). Rural residence and low income had significantly associated to herbal medicine use while planned pregnancy was negative associated to herbal medicine use.

Declarations
The datasets used and/or analyzed during the current study are available from the Principal investigator on reasonable request

Consent for publication
Not applicable.

Ethical consideration
Ethical clearance was obtained from Ethical Review Committee of Wollega University, institute of Health sciences. A formal letters were written to WURH in order to get permission to conduct the study. Participation in this study was on a voluntary basis and written consent was obtained from study subjects prior to data collection.

Funding
There is no funding for this research