Research Article

Use of Herbal Medicine Among Pregnant Women on Antenatal Care at

Nekemte Hospital, Western Ethiopia

Abstract: Investigations across the India confirm dramatic increment in the use of complementary and alternative medicine in pregnant
women.The most important aspect is lack of awareness of pregnant women about potential effects of using traditional medicine on fetus; some
herbal products may be teratogenic in human and animal models. In this area, so far, no research has been conducted in Ethiopia to assess
traditional medicine use in pregnant women.
Objectives: Therefore, the main objective of this study was to investigate the prevalence and use of herbal drugs among pregnant women
attending Nekemte Hospital to provide baseline information for future studies.
Patients and Methods: A cross-sectional descriptive study was conducted by quantitative and qualitative approaches to identify the
prevalence of using herbal medicines among pregnant women. About 50.4% of study participants used herbal drugs during their pregnancy. The
proportion of herbal drug usage was gradually decreased along with the first, second and third trimesters of pregnancy. The most and least
commonly used herbs were ginger (44.36%) and tenaadam (9.15 %), respectively. The common indications of herbal remedies use during
pregnancy were nausea (23.90%) and morning sickness (21.05%).
Results: The result of the present study confirmed wide use of herbal drugs use during pregnancy that need to report the safety concerns of these
drugs during pregnancy.
Conclusions: To achieve the requirements of pregnant women, it is vital for health care workers to be familiar with the effect of herbal medicine
in pregnancy.

Keywords: Herbal Medicine; Pregnancy; alternative Medicine

1. Background
Investigations across the world confirm dramatic increment are managed by traditional birth attendants or relatives.
in the use of complementary and alternative medicine in Nevertheless, data available for the use of herbal medicine
pregnant women. Most pregnant women believe that these among pregnant women in Ethiopia is scarce. The most
medicines are ‘natural’ and ‘safe’ com- pared to modern drugs. important aspect is lack of awareness of pregnant women about
Besides, traditional medicine is believed to treat medical potential effect of traditional medicine use on fetus; some
problems and improve health status during pregnancy, birth and herbal products may be teratogenic in human and animal models
postpartum care in many rural areas of the world. There are few (3). Studying traditional medicine use during pregnancy is
researches performed on their safety, purity and adverse limited in Sub-Sahara Africa because of limited control of
consequences during pregnancy (1). Furthermore, herbs are traditional medicine distribution and purchase (4).
significantly used in developed countries (Europe, USA and
Australia). During 1990 to 1997, around 50% of preg- nant 2. Objectives
women in the USA used herbs during pregnancy, and more Therefore, the main objective of this study was to investigate
women were users of alternative medicines than men. However, the prevalence and use of herbal medicine among pregnant
herbal medicine is not currently subject to the same women attending Nekemte Hospital to provide baseline
regulations as conventional drugs. Therefore, many researchers information for future studies.
are exploring their adverse effect on human health, especially
the safety of herbal drugs in pregnancy (2). In Africa, more 3. Patients and Methods
pregnant women use herbal remedies to treat pregnancy
related prob- lems due to cost-effectiveness of therapy and easy
3.1. Study Site and Population
access of these products. In total, 80% of Ethiopian population
use traditional medicine and around 90% of all deliveries The present study was conducted at Nekemte Hospital in
Nekemte town, located 331 km far from the Ethiopian
Copyright © 2014, School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences; Published by DOCS. This is an open-access article distributed under the
terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and
redistribute the material just in noncommercial usages, provided the original work is properly cited.
 Bayisa B et al.

capital, Addis Ababa in the west direction, at 9°5'N lati- tude, Table 1. Sociodemographic Variables of Respondents a
36°33'E longitudes and altitude of 2088 ft to the sea level. The
Variables Results
hospital was established by a Swedish mission in 1932 E.C.
Age
18-23 74 (29.6)
3.2. Study Design and Sampling Technique
24-29 113 (45.20)
Semistructured questionnaires were used to study pos- sible
30-35 57 (22.8)
sources of information on the prevalence and use of herbal
medicine during pregnancy in a cross sectional manner. A total > 35 6 (2.4)
of 250 women were selected based on the expected prevalence Marital status
rate using minimum sample size for this survey as 50%. Married 222 (88.8)
Single 0 (0)
3.3. Study Variables Divorced 11 (4.4)
Age, socioeconomic status, sex, monthly income, eth- Widowed 6 (2.4)
nicity, educational level, marital status, and access to Separated 11 (4.4)
medical care were independent variables of the study; while, Educational level
types of used herbal medicine, preference of herb- al medicine,
Illiterate 51 (20.4)
preparation of traditional medicine, parts of plant used, type of
disease treated by traditional medi- cine, and method of use were Primary school (1-8) 38 (15.2)
dependent variables of the study. Filled questionnaires were Secondary school (9-12) 64 (25.6)
regularly checked to promote consistency and to ensure College/university 51 (20.4)
completion of data. Diploma/degree 46 (18.4)
1) Inclusion criteria were:
Ethnicity
- Pregnant women in 2-9 months of pregnancy
Oromo 188 (75.2)
- Those with a normal and uncomplicated pregnancy till the
date of appointment. Amhara 51 (20.4)
- Able to provide informed consent Tigrinia 11 (4.4)
- Legally adults (18 years and older) Others 0 (0)
2) Exclusion criteria were: Religion
- All patients who were unable to hear or communicate and
Orthodox 87 (35.0)
mentally disabled were excluded from the study.
- Those who did not fulfill the inclusion criteria. Muslim 13 (5.0)
Protestant 150 (60.0)
3.4. Ethical Considerations Monthly Income
< 500 46 (18.4)
All information from the participants was kept confi- dential
and participants’ name was not recorded on the research 500-1.300 85 (34.0)
documents. The purpose of this study was ex- plained to > 1.300 92 (36.8)
subjects. Confidentiality of the information was assured and Employment
the privacy of respondents was main- tained at a safe level. Employed 115 (46.0)
Housewife 135 (54.0)
4. Results Smoking status
Of 250 pregnant women participated in the study, most Smoker/ex-smoker 17 (6.8)
were in the age range of 24-29 years (45.2%), Oromo (75.2%), Non-smoker 233 (93.2)
married (88.8%), protestants (60%) and literate (25.2%) a Data are presented as No. (%).
(Table 1).

Table 2. Use of Herbal Medicines in Different Trimesters in Preg- nant

4.1. Usage of Herbal Drugs in Pregnancy Women at Nekemte Hospital From January 28, 2013 to Feb- ruary 8,
As shown in Table 2, more herbs (69.84%) were used dur- ing 2013 a
the first trimester and 4.76% of women used herbs in all Variables Response (Yes)
trimesters. The most and least commonly used herbs were First trimester 88 (69.84)
ginger (44.36%) and tenaadam (9.15 %), respectively (Table 3).
Second trimester 19 (15.08)
Third trimester 13 (10.32)
Throughout pregnancy 6 (4.76)
a Data are presented as No. (%).

2 Jundishapur J Nat Pharm Prod. 2014;9(4):e17368

 Bayisa B et al.

Table 3. Types of Herbal Medicines Used During Pregnancy a

Plants used Number of Women
Garlic (Allium sativum) 53 (37.32)
Ginger (zingiberofficinale) 63 (44.36)
Eucalyptus 13 (9.15)
Tenaadam (Rutachalenssis) 13 (9.15)
a Data are presented as No. (%).

Table 4. Sources to Obtain Herbal Medicines by Pregnant Women at

Nekemte Hospital From January 28, 2013 to February 8, 2013 a
Places Results
Traditional healers 6 (4.32) Self-
preparation 57 (41.01)
Herbalist 32 (23.02) Figure 1. Most Commonly Reported Indications for the Use of Herbal
Medicine in Pregnancy in This Study Population
Worship place 6 (4.32)

Market places 32 (23.02)

Neighbor 6 (4.32)
a Data are presented as No. (%)

Table 5. Sources of Information on Herbal Medicine for Preg- nant

Women at Nekemte Hospital From January 28, 2013 to Feb- ruary 8,
2013 a
Source of information Results
Health professionals 30 (14.29)
Traditional healers 20 (9.52)
Religious leaders 6 (2.86)
Family 50 (23.81)
Neighbor 72 (34.29)
Herbalist 32 (15.24) Figure 2. Reasons for Preference of Herbal Medicines Over Conventional
Medicine Among Pregnant Women in This Study
a Data are presented as No. (%).

Figure 1 represents frequently reported indications of 5. Discussion

traditional medicine use in pregnancy. A total 126 in- dications The result of the present study showed that most preg- nant
were reported (the mean of 1.6, range: 1-4 in- dications). women (50.4%) used herbs compared to other stud- ies
Generally, herbs were used to treat nausea (23.90%), performed in developed countries. The possible ex- planation is
morning sickness (21.05%), vomiting (15.31%), cough (15. probably easy accessibility (43.18%) and less affordability of
31 %), deficiency in nutrition (6.22%), and ma- laria (2.83%). conventional medicines. Most women rely on advices from
Around 41% of pregnant women prepared herbal remedies; their family and friends, and many did not disclose of care
while, the rest obtained it from herb- alists, traditional healers, providers (5). Herbal medicine use during pregnancy in a group
neighbors or reverence places (Table 4). As depicted in table of Australian women was reported as 36% (6). Age and
5, most participants re- ceived information from neighbor education significantly affected the use of herbal medicine. As
(34.29%) and family (23.81%). Most women took herbal they became older and more educated, the rate of herbal drug
medicines in the form of crude (43.16%), extract (23.16 %), usage was increased. Among herbal supplements, raspberry
maceration (23.16 %), and decoction (10.53%). Various parts of leaf (14%), ginger (12%) and chamomile (11%) were the
plants used by the participants were leaves and roots at the same most widely used; while the most commonly used herbs in our
ratio of 42.33%, followed by rhizome at 7.98 %, seed and stem study area were garlic, tenaadam, and ginger (6). A study by
at Nordeng and Havnen indicated wide use of echina-
3.68 %, respectively.

Jundishapur J Nat Pharm Prod. 2014;9(4):e17368 3

 Bayisa B et al.

cea, iron-rich herbs, ginger, chamomile and cranberry as herbal in 85.71% of the cases, much lower than family/friends, herbal
supplement during pregnancy (2). However, herbs used in our store, neighbors, religious person, traditional healers and
study were studied to be safe in most cases. Studies suggest alternative practitioner. This indicates that healthcare workers
ginger effectiveness against nausea and inflammation. there is play a small role regarding informa- tion provision about
insufficient studies regarding adverse effects of traditional herbal drugs to patients/custom- ers. The result of the present
plants during pregnancy (7). Leaves and roots (42.33%) were study clearly depicted that around 50.4% of the women used
the most widely used plant parts in the present study. herbal drugs during pregnancy in Nekemte Hospital, Nekemte
Nevertheless, different plant parts may be used due to region, Ethio- pia. Frequently used herbal drugs were ginger,
differences in the types of plants available in different regions. garlic, and tenaadam. Family and friends recommended the use
Most participants used herbal remedies to treat preg- nancy of herbal drugs in pregnancy.
related problems such as nausea (23.90%), morn- ing sickness
(21.05%), deficient nutrition (6.22%), vom- iting and cough 5.1. Recommendations
(15.31% and 15.31%, respectively) and malaria (2.83%).
This indicates that pregnant women preferred herbal It is suggested to perform further studies on adverse effects of
medicines because of accessibil- ity (43.18%). This may herbal medicines used by pregnant women. Wide use of herbal
also be due to less affordability of conventional medicines. drugs during pregnancy should be assessed carefully. Besides,
We found that use of herbs decreased as the trimester health education should be provided on the impact of herbal
increases, which is differ- ent from a research performed on medicines. The Min- istry of Health of Ethiopia should assess
Norwegian women where herbal drugs increased throughout integrated use of herbal medicine with conventional
pregnancy. This could be beneficial, as it may not increase medicines. In addition, hospitals should encourage traditional
pregnan- cy related problems (2). In contrast to other studies, the prac- titioners to work together with modern practitioners, and
association between age, educational level, marital sta- tus, safety and effectiveness of herbal medicines used during
income, ethnicity and source of information with herbal drug pregnancy should be approved and announced to the
use was not significant. Neighbors and fam- ilies were major community.
information sources in this study. Most of them preferred herbs
to modern medicine, because they believed that these herbs Acknowledgements
are safe, cost-effective and easily accessible. This result is
The authors would like to acknowledge Jimma Univer- sity.
somewhat similar to the research performed on Norwegian
women in 2004, as use of herbal drugs in pregnancy was mostly
recom- mended by family or friends (2). The use of traditional Authors’ Contributions
medicine in Ethiopia is not integrated in the health system. Study concept and design: Eshetu Mulisa and Bodena Bayisa;
Therefore, information provided by family and neighbors may acquisition of data: Bodena Bayisa; analysis and
not be enough to advise pregnant wom- en about the use of interpretation of data: Eshetu Mulisa and Bodena Bayisa;
herbal drugs. Increased self-medi- cation practice, poor patients’ drafting of the manuscript: Ramanjireddy Tati- parthi; critical
knowledge about drugs and accessibility of herbal medicines revision of the manuscript for impor- tant intellectual content:
may contribute to the use of herbal medicines (41.01%) at the Ramanjireddy Tatiparthi and Eshetu Mulisa; statistical
present study area. Self-administration of herbal drugs could analysis: Eshetu Mulisa and Bodena Bayisa; administrative,
result in harmful adverse effects not easily treated by conven- technical, and material supports: Jimma University; study
tional drugs. In this study, only 14.29% of the women re- ported supervision: Eshetu Mulisa.
to have received health advices from healthcare workers. This
study was relatively similar to the study performed on the use of
herbal drugs in pregnancy: a survey among 400 Norwegian References
women in which only 1. Khadivzadeh T, Ghabel M. Complementary and alternative medi- cine
use in pregnancy in Mashhad, Iran, 2007-8. Iran J Nurs Mid- wifery Res.
11.8% of women reported to have received advice from 2012;17(4):263–9.
healthcare workers. This may indicate ineffectiveness of 2. Nordeng H, Havnen GC. Use of herbal drugs in pregnancy: a sur- vey
healthcare workers consultation about alternative therapies in among 400 Norwegian women. Pharmacoepidemiol Drug Saf.
2004;13(6):371–80.
Nekemte town, or Nekemte Hospital Health Care personnel may
3. Kassaye KD, Amberbir A, Getachew B, Mussema Y. A historical
be reluctant to give advice in such matters, or both (2). overview of traditional medicine practices and policy in Ethio- pia.
Low information was given to women about herbal drugs Ethiop J Health Dev. 2006;20(2):127–34.
during pregnancy and this greatly causes mis- use and/or 4. Fakeye TO, Adisa R, Musa IE. Attitude and use of herbal medicines
among pregnant women in Nigeria. BMC Complement Altern Med.
potentially harmful use. When healthcare workers were 2009;9:53.
consulted, information was not delivered 5. Pallivalappila AR, Stewart D, Shetty A, Pande B, McLay JS. Comple-
mentary and Alternative Medicines Use during Pregnancy: A

4 Jundishapur J Nat Pharm Prod. 2014;9(4):e17368

 Bayisa B et al.

Systematic Review of Pregnant Women and Healthcare Profes- sional medicine use during pregnancy in a group of Australian women.
Views and Experiences. Evid Based Complement Alternat Med. BMC Pregnancy Childbirth. 2006;6:21.
2013;2013:205639. 7. Dog TL. The use of botanicals during pregnancy and lactation.
6. Forster DA, Denning A, Wills G, Bolger M, McCarthy E. Herbal Altern Ther Health Med. 2009;15(1):54–8.