Use of herbal medicines is common amongst pregnant women in south western Uganda.
While herbal medicine is usually perceived as a rural phenomenon (19), the prevalence of herbal medicine in this current study done in an urban setting is high. This prevalence is similar to that reported other urban settings in Sub-Saharan Africa (12, 20, 21). However, the prevalence we report is higher than the reported prevalence in Northern Uganda(14), and other studies done in East Africa (11, 22) and West Africa (10, 23). This may be due to the difference in the social-cultural beliefs of the populations in these different study areas. Nonetheless, the study done in Nigeria by Gharoro and colleague (10) considered a few herbal medicines, which was not a representative of herbal medicine use among all pregnant women and possibly explains the lower prevalence they report.
Whereas pregnant mothers have different reasons for herbal medicine use in different stages of pregnancy, this current study revealed that more than three quarters of herbal medicine users, used them during labor. This finding is similar to what has been reported in Ethiopia(24). In addition, 80% of pregnant women in rural areas of western Uganda deliver using herbal remedies (13). Labor is a critical stage of pregnancy and should be handled with utmost care because it has a great impact on the health of the mother and baby, as well as pregnancy outcome. Therefore, health workers should always be keen to screen for herbal medicine use during labor process.
The findings of the current study showed that participants who perceived that herbal medicines are safe and important, were more likely to use them during pregnancy. This is consistent with the study done in Sub-Saharan Africa(11, 14, 25). In Northern Uganda, study found out that most women regard herbal medicines as “effective and safe” in addition to treating a wide range of ailments(14). Additionally, pregnant women in Nigeria use herbal medicines because they perceive them as “natural” and “safe” with no side effects (20). This is however not backed up by evidence since there is generally paucity of studies evaluating the safety and efficacy of these herbal preparations in Africa. Further still, the dosage profiles of these herbs are largely unknown. Our findings also show that majority of women attended antenatal care from a health facility at least once an indication that they believe and use conventional therapies and herbal medicines concurrently, further causing worry for potential drug-herb interactions. Therefore, health workers should be keen to assess herbal medicine use during routine ANC visits and educate pregnant women about the potential consequences of these herbal medicines.
In this current study, we show that first time mothers were more likely to use herbal medicines compared to those who had more than one pregnancy, which is consistent with other studies (26–28). This may be attributed to naivety to the pregnancy experience, which makes them vulnerable to take any herbal medicines recommended to them by their parents and relatives(28). The various pregnancy related ailments that are new to first time mothers may also trigger them to use herbal medicine.
We show that respondents who lived further from the health facility were more likely to use herbal medicine and is consistent with findings from elsewhere in East Africa(28). In the context of health care generally, long distances have also been associated with poor uptake of services among pregnant mothers (14, 29). This is so critical in a sense that pregnant women will find it so easy to use the herbal medicines which are accessible compared to the conventional care. Furthermore, it is documented that over 80% of pregnant women in Western Uganda deliver at their homes mainly with the assistance of traditional birth attendants who use herbal medicines (13). Therefore in the effort to improve maternal health and check on the stagnantly high maternal mortality, government should decentralize maternal health services, to increase accessibility to the population.
In this current study, we demonstrate that respondents, who were not satisfied with the services rendered to them at the health facility, were more likely to use herbal medicines during their most recent pregnancy. This finding is comparable with a study done in northern Uganda(14). Additionally, a systematic review of literature in developing countries revealed that a wide range of structural, process and outcome factors influence women’s satisfaction, and ultimately their update of conventional therapies, which leaves them with an option of using herbal medicines which are less costly and readily available(30). It’s therefore important that maternal health programs in health facilities put into account women’s perspective of care they need in order to improve services delivered.
Majority of pregnant women who used herbal medicines did not disclose to the attending health care workers (HCW). This finding is consistent with the previous studies in sub Saharan Africa (11, 14, 25, 31, 32). The qualitative study done in rural Ghana also confirm that much as pregnant women use both conventional and herbal medicines, they were hesitant to disclose herbal medicine use to their attending HCW for several reasons such as; the belief that herbs are “natural and safe”, fear of losing control of their health, perception that HCW don’t have knowledge about herbs and fear of being victimized or discouraged by HCW(32). This therefore calls for health workers’ concerted effort to continually update themselves on the herbs commonly used in their local communities. It is also relevant that HCWs actively assess herbal medicine use when pregnant women come to the health facilities during antenatal care or labor.
Limitations and Strengths
The data about pregnancy experiences was collected retrospectively, which makes it prone to recall bias. This was however reduced by considering women who were only six weeks postpartum and below. Furthermore, women with severe complications like uncociousness were excluded from participation, and therefore we couldn’t determine associations between herbal medicine and complications, or if developing complications led to the use of herbal medicine.
The study was conducted in a hospital setting and therefore, it is likely that some participants may have concealed information due to fear of perceived repercussions regarding care or stigma. This was reduced by explaining to the participants that this was an independent survey which would not in any way affect the quality of care being received in the hospital. In addition, using the hospital setting as our sampling frame could have introduced selection bias therefore the herbal medicine use we report may not be representative of the region.
Despite these limitations, our findings highlight an important area that the health care system should study further in collaboration with herbalists.