Open access Original research

Use of herbal medicine during

pregnancy and associated factors among
pregnant women with access to public
healthcare in west Shewa zone, Central
Ethiopia: sequential mixed-­
method study
Gemechu Gelan Bekele ‍ ‍,1 Benyam Seifu Woldeyes,1 Getu Melesie Taye,2
Ermiyas Mulu Kebede,3 Delelegn Yilma Gebremichael3

To cite: Bekele GG, ABSTRACT

Woldeyes BS, Taye GM, et al. STRENGTHS AND LIMITATIONS OF THIS STUDY
Objective This study was aimed at assessing the
Use of herbal medicine during ⇒ The mixed approach provides greater insight and
prevalence of herbal drug use among pregnant women
pregnancy and associated strength into the research topic.
factors among pregnant with access to modern medicine and associated factors
in public health facilities in the west Shewa zone, Oromia ⇒ The study’s limitations could be that it is prone to
women with access to public
regional state, Ethiopia. recall bias, which could alter the results because the
healthcare in west Shewa zone,
pregnant women might not remember what drugs
Central Ethiopia: sequential Design A sequential mixed-­method study approach
mixed-­method study. BMJ Open they took, and most of the herbal remedies are not
was carried out among pregnant women and other
2024;14:e076303. doi:10.1136/ considered medicine in rural communities.
stakeholders.
bmjopen-2023-076303 ⇒ Women in early pregnancy may not have the op-
Setting This study was conducted at public health portunity to use medications, which could alter the
► Prepublication history facilities, including 3 public hospitals and 20 health reported outcomes of routinely used herbal drugs.
and additional supplemental centres, in the west Shewa zone of Ethiopia. ⇒ The effect of COVID-­19 on the community regard-
material for this paper are
Participants A systematically selected sample of 411 ing the use of home remedies for the treatment and
available online. To view these
files, please visit the journal
pregnant women was participated in the quantitative control measures.
online (https://doi.org/10.1136/​ study. For the qualitative method, focus group
bmjopen-2023-076303). discussions and in-­depth interviews were conducted
among pregnant women attending antenatal care and
Received 08 June 2023 key informants using an interview guide until data BACKGROUND
Accepted 18 January 2024 Traditional medicine, also known as comple-
saturation was achieved.
Primary outcome For outcome variables, the mentary and complementary medicine, is
respondents were asked if they used any herbal medicine the oldest system of healthcare. It appears to
during their current pregnancy. It was then recorded as be reviving in recent decades and is increas-
0=no and 1=yes. ingly in demand and used everywhere.1
Results The prevalence of herbal medicines was Health practices, approaches, knowledge
found to be 19.7%. The most commonly used herbal and beliefs in traditional medicine include
medicines were Zingiber officinale, Ocimum gratissimum, a wide range of medicines and therapies
© Author(s) (or their
Eucalyptus globules, Allium sativum and Rutacha lepensis. used to treat, diagnose and prevent illness,
employer(s)) 2024. Re-­use
permitted under CC BY-­NC. No Herbal medicine use during pregnancy was significantly as well as to maintain health and well-­being.2
commercial re-­use. See rights associated with older maternal age (adjusted OR (AOR) Humans have used herbal medicine, a type
and permissions. Published by 2.4, 95% CI 1.2 to 5.1), urban residence (AOR 2.3, 95% CI of traditional medicine derived from plants,
BMJ. 1.3 to 3.7) and second trimester of pregnancy (AOR 2.3,
1
as an ancient and culture-­bound method of
Department of Midwifery, Ambo 95% CI 1.3 to 4.5).
University, Ambo, Ethiopia
healing to cope and deal with various diseases
2
Conclusions In this study, one in five pregnant that threatened their existence.3
Department of Pharmacy, Ambo
women uses herbal medicine, which is relatively low. Over the last three decades, the demand
University, Ambo, Ethiopia
3 Sociodemographic factors and the duration of pregnancy
Department of Public Health, for and use of herbal medicine has grown not
Ambo University, Ambo, Ethiopia affected the utilisation of herbal drugs during pregnancy.
only in societies where modern healthcare
The most common herbals used by pregnant women
Correspondence to has gaps but also in societies where there is
were intended to treat minor disorders of pregnancy and
Dr Gemechu Gelan Bekele; a strong healthcare system.4 It is estimated
medical disorders such as hypertension.
​gemechugelan@​gmail.​com that between 65% and 80% of the world’s

Bekele GG, et al. BMJ Open 2024;14:e076303. doi:10.1136/bmjopen-2023-076303 1

Open access

population relies on herbal medicines and drugs as their METHODS

primary source of healthcare.5 6 Study area and period
Despite colonialism and western culture introducing The study was conducted in health facilities in the west
modern medical care and creating distrust, traditional Shewa zone, Oromia Regional State, Ethiopia. The zone
medicine plays an unsubstituted role in the health is located in the Oromia Regional State to the west of
systems of developing countries.4 7 Traditional medicine Addis Ababa, the capital city of Ethiopia. Ambo, the
is used by the majority of Ethiopians, and the govern- capital of the west Shewa zone, is located 114 km away
ment health policies recognise its importance. However, from Addis Ababa. According to information from the
research, long-­ term application and integration into west Shewa zonal health office, the total population in
modern medical practice have been limited. While there the zone is estimated to be 2 381 079, of which 1 214 350
has been significant progress in coverage and utilisation were females. The study was conducted from 1 July 2021
of the modern healthcare system, it appears that it does to 30 July 2021.
not replace traditional medicine.1
Study design
To support and nurture the pregnancy, the pregnant
A sequential explanatory mixed-­method study approach
mother undergoes significant physiological and anatom-
was carried out among pregnant women and other stake-
ical changes. These changes are usually associated holders. A quantitative cross-­sectional study design was
with minor health issues and complications. Pregnant employed, followed by an explorative qualitative study.
women are more likely to use herbal medicines because
the majority of minor pregnancy health concerns do Population
not require pharmaceutical treatment. Furthermore, All pregnant women who were attending ANC in the
different communities have different health practices, public health facilities of west Shewa were the source
knowledge and beliefs about medicines to protect preg- population, and pregnant women who were attending
nancy and promote the health of the mother and fetus.8 ANC in the selected public health facilities of west Shewa
The evidence on the benefits and potential risks of who had lived in the study area for more than 6 months
using herbal medicines during pregnancy is incon- were considered the study population for quantitative
clusive. According to studies, using herbal drugs study. Moreover, pregnant women, health professionals
while pregnant can have serious consequences for working in ANC, health extension workers, traditional
both the fetus and the mother because the safety healers and community leaders were the study popula-
profiles and appropriate dosages of most herbal tion for the qualitative study.
medicines are not well established. 5 9–11 Herbal medi-
cines, on the other hand, have been associated with Sample size determination
effective relief of pregnancy-­related symptoms, 12 a Sample size for quantitative study was determined based
lower risk of spontaneous preterm delivery 13 and a on a single population proportion formula considering
the prevalence of herbal drug use among pregnant
significant reduction in blood pressure in hyperten-
women in Nekemte town, which was 50.4%,22 95% confi-
sive patients. 14 15
dence level, 5% marginal error and 10% non-­response
Approximately half of pregnant women in Ethiopia
rate.
use herbal medicine or drugs, and the level and type ( ) (
Z α/2 2p 1−p
)
of herbal use vary by setting. 9 16 17 Pregnant women N= ‍ d2 ‍ ; (1.96)2(0.504) (0.496)/
2
use herbal drugs in the belief that they will treat (0.05) =384+39 (10% non-­response rate) =423
pregnancy-­related symptoms, ensure the successful For qualitative part, four focused group discussion
progression of the pregnancy and promote the (FGD) with 6–8 participants were undertaken at each
health and well-­b eing of the mother and fetus. 4 18–21 level of the health facility. The candidates for FGD were
The increased use of herbal drugs among preg- the primary study population (pregnant women) who
had used herbal drugs during their current pregnancy.
nant women while the usage of maternal health-
The number of FGDs was adjusted based on data satura-
care services has improved in the last few decades
tion. In-­depth interviews (IDIs) were conducted with key
prompted us to ask: Why do pregnant women use
informants: health professionals working in ANC, health
herbal drugs when they are receiving antenatal care
extension workers, traditional healers and community
(ANC) services from modern medicine? What are the leaders. Eight IDIs were conducted, and the maximum
shortcomings in modern medicine that necessitate number was decided based on the data saturation.
the use of herbal drugs? This study assessed the prev-
alence of herbal drug use among pregnant women Sampling procedure
with access to modern medicine and explored its There are 8 hospitals and 96 health centres in the
associated factors. This will be an input to unveil the west Shewa zone of Ethiopia. From the eight hospi-
reasons for seeking herbal drugs while having access tals, Guder Hospital was excluded since MCH service
to modern medicine among pregnant women in was not provided due to COVID-­ 19 during the study
Ethiopia. period. From the seven hospitals, three hospitals, namely

2 Bekele GG, et al. BMJ Open 2024;14:e076303. doi:10.1136/bmjopen-2023-076303

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Gedo Hospital, Ambo University Referral Hospital and logistic regression was used to control the confounders
Adaberga Hospital were selected randomly. Of the 92 and identify factors associated with the outcome variable.
health centres, 20 were selected randomly. The sample All explanatory variables that were significantly associ-
size was distributed proportional to the case flow, and ated with the outcome variable with a p value less than
the study participants were selected using a systematic 0.05 in the bivariate analyses were entered into the multi-
random sampling technique. variable logistic regression model. Crude and adjusted
Different techniques, such as snowballs, were used ORs (aORs) with their 95% CI were determined, and a
to find the elderlies, traditional healers, previous tradi- statistically significant association was asserted based on a
tional birth attendants and health extension workers p<0.05. Multicollinearity was checked using the variance
for IDI in order to get more relevant information about inflation factor.
the outcome variable. Four FGDs and eight IDIs were Qualitative data collection and analysis were under-
conducted to reach data saturation. taken simultaneously because of the interactive nature
of qualitative methods. Each day of data collection, the
Data collection tool audio tapes of IDI and FGDs were transcribed verbatim
The data collection tool for quantitative study was adopted in Afan Oromo and then translated into English. The
after reviewing similar literature conducted to assess transcribed data were internalised by reading it repeat-
the utilisation of traditional herbal drugs during preg- edly and translated into English by the investigator. The
nancy22–26 and others. The questionnaire was prepared in data were coded, categorised and thematically analysed.
English and translated into Afan Oromo, and the trans- Then coding and categorisation were done using open
lated version was used to collect the data (online supple- code software. Following interpretative content analysis
mental file 1). The questionnaire was designed in CSPRO principles, the words of participants and the meanings
V.7.3 software and exported to CSEntry for Android for they gave to their words were considered in coding and
electronic data collection. The data were collected by 13 categorisation. The first words or phrases were used to
BSC midwives and supervised by 5 MSc and above educa- form codes. Then, similar codes were brought together to
tional level personnel. form categories. Similar categories were brought together
A semistructured guide was also developed for the FGD to form a theme that represents the whole idea of the
and IDI, and it was conducted in Afan Oromo (online categories. Major concepts were deciphered by repeated
supplemental file 2). The guide was used to explore their reading through the notes and memos, summarising,
knowledge of how often pregnant women use herbal displaying and verifying. Based on the emerging themes,
drugs, the type of herbal drugs, the timing of utilisa- thematic content analysis was followed to summarise the
tion, the reason for using those drugs and the possible findings from the participants’ points of view. The find-
outcomes of the drugs on fetuses and pregnant women. ings from the qualitative data were triangulated with the
findings from the quantitative data.
Operational definition
Utilisation of herbal medicine
The use of at least one herbal medicine during this preg-
RESULTS
nancy, coded as 1 if they used it and 0 if not.
Sociodemographic characters
Data quality assurance A total of 411 pregnant women participated in the
The questionnaire was pretested on 5% of the sample size study, making a response rate of 97.2%. The mean
at Ginchi Primary Hospital, and necessary corrections age of the study participants was 28 years, with an
were made 1 week before the actual data collection time. SD of 4 years. The majority of the study participants,
Training was given for data collectors and supervisors for 401 (97.6%) were married; Oromo by ethnicity, 388
2 days. (94.4%); the occupation of housewife, 227 (55.2%)
The interview guide was also pretested to check the and 129 (31.4%) of them attended above the college.
difficulty of understanding and completeness, and modi- Regarding their husbands, 190 (46.2%) of them have
fications were made accordingly. The IDI and the FGD attended above the college level, and 173 (42.1%)
were conducted by MSC-­holder data collectors. of them stated their occupation is private employee.
The place of residence was rural for 238 (57.9%) of
Patient and public involvement the study participants, and the mean monthly income
No patient or the public was directly involved in devel- of the study participants was ETB5228 with an SD of
oping the research questions, the design, protocol, data ETB4530 (table 1).
collection tools, results and dissemination plan of the
study. Obstetric history
Regarding the obstetric history of the study partici-
Data processing and analysis pants, the mean number of pregnancies was twice, and
The quantitative data were collected by the CS-­ Entry the mean number of children was one. The majority
Android app and exported to SPSS V.25 for data anal- of women, 288 (70.1%), had a history of pregnancy
ysis. A basic descriptive analysis was computed. Binary (multigravida). Among these women with a history

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Table 1 Sociodemographic characteristics of pregnant women attending ANC in public health facilities of west Shewa zone,
Central Ethiopia, 2021
Variables Response Frequency Percentage
Age category Younger than 25 169 41.1
25–30 years 182 44.3
31 and above 60 14.6
Marital status Married 401 97.6
Unmarried 10 2.4
Ethnicity Oromo 388 94.4
Amhara 16 3.9
Gurage 7 1.7
Religion Orthodox 160 38.9
Muslim 18 4.4
Protestant 226 55.0
Wakefata 7 1.7
Occupation Housewife 227 55.2
Students 39 9.5
Government employee 64 15.6
Private business 59 14.4
Others 22 5.3
Education Can’t read and write 31 7.5
Can read and write 10 2.4
Primary 110 26.8
Secondary 131 31.9
College and above 129 31.4
Husband education Can’t read and write 22 5.4
Can read and write 12 2.9
Primary 59 14.4
Secondary 128 31.1
College and above 190 46.2
Husband occupation Not working 19 4.6
Government employee 149 36.3
Private business 173 42.1
Farmer 54 13.1
Others 16 3.9
Income category Less than 1000 41 10.0
1000–4999 179 43.6
5000–9999 121 29.4
10 000 and above 70 17.0
Residence Rural 238 57.9
Urban 173 42.1

ANC, antenatal care.

of pregnancy, 203 (70.5%) had ANC follow-­u p, 139 Current obstetric history
(48.3%) delivered at the hospital and 158 (54.9%) From the total of 411 respondents, 375 (91.2%) and
had used postnatal care services. Maternal previous 395 (96.1%) reported that their current pregnancy was
illness during pregnancy was reported among 49 planned and supported, respectively. All of the study
(17%) of the study participants (table 2). participants were attending ANC, and 233 (56.7%)

4 Bekele GG, et al. BMJ Open 2024;14:e076303. doi:10.1136/bmjopen-2023-076303

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Table 2 Obstetric history of pregnant women attending ANC in public health facilities of west Shewa zone, Central Ethiopia,
2021
Variables Response Frequency Percentage
No of pregnancy One 123 29.9
Two or three 196 47.7
4 and more 92 22.4
No of children One 123 50.0
Two or three 96 39.0
4 and more 27 11.0
Abortion No 363 88.3
Yes 48 11.7
Past illness No 246 85.4
Yes 42 14.6
Past ANC No 85 29.5
Yes 203 70.5
Place of last delivery Home 28 9.7
Health centre 121 42.0
Hospital 139 48.3
Past PNC No 130 45.1
Yes 158 54.9
Previous child illness No 248 86.1
Yes 40 13.9
Family planning No 121 29.4
Yes 290 70.6
ANC, antenatal care; PNC, postnatal care.

received health education during ANC follow-­ up tradition of using herbs. The two themes are presented in
regarding herbal medicine. More than three-­fourths, or triangulation with the quantitative data in the following
323 (78.6%), of them reported that they have not devel- sections.
oped any health problems during their current preg-
nancy. The mean distance between the health facilities Knowledge and herbal drug use during pregnancy
where they attend their ANC and home is 8.5 km with Nearly half (53.3%) of the study participants knew about
an SD of 5 km, and Bajaj was the most common mode herbal drugs, and 129 (67.2%) heard about them from
of transportation (54.0%). The majority of respondents family members. From the total respondents, about one-­
indicated that their desired place for delivering a baby fourth of them get the drugs from home remedies, 49
is the same facility as the one where they receive ANC (25.5%). Participants in the qualitative FGD revealed that
service, 285 (69.3%). the majority of herbal medications are purchased from
herbal drug vendors on the market or as home remedies.
Qualitative findings As an example, one woman stated that:
The qualitative study was conducted to explore more
Mostly they (herbal medicines) are prepared as home
information about the use of herbal medicine during
remedies. We can also get them from the market.
pregnancy. Four FGDs were undertaken with 6–8 preg-
There are also traditional healers in our community,
nant women who had used herbal drugs during their
so we can get this drug from them with minimal cost.
current pregnancy, and eight IDI were done among key
[G2P3]*
informants. From the qualitative analysis, facilitators of
herbal medicine use and commonly used herbal medi- *Following each quote is the participants’ focus group
cines were the two main emerging themes. The facili- number and participant number.
tator theme describes the factors that influence the use This study revealed that, about one-­ fifth of women
of herbal medicines and includes the belief that herbal (19.7%) used herbal drugs during pregnancy (table 3).
medicines are effective in treating many ailments, the The qualitative study participants also revealed the
availability of herbal medicines at low cost, cultural beliefs use of various herbal medications to manage different
that herbal medicines are safe for pregnancy and the pregnancy-­related ailments, like nausea, fever, vomiting,

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Table 3 Knowledge and utilisation of herbal medicine during pregnancy among women attending ANC in public health
facilities of west Shewa zone, Central Ethiopia, 2021
Variables Response Frequency Percentage
Know herbal medicine No 219 53.3
Yes 192 46.7
Source of information Traditional healers 40 20.8
(more than one response) Religious leaders 41 21.4
Family member 129 67.2
Neighbour/friend 63 32.8
Others 9 4.7
Used herbal during pregnancy No 330 80.3
Yes 81 19.7
Reason for using herbal drug Effective than conventional drug 51 62.9
(more than one response) Have fewer side effect 33 40.7
Lower cost 20 24.7
Availability without physician 42 51.9
prescription
Complement conventional 13 16.1
medicines
It is in our culture 10 12.3
Used when conventional 15 18.5
medicine it fails
Who recommend you… It’s my own idea 77 95.1
(more than one response) My husband 33 40.7
Friends or neighbours 31 38.3
Traditional healers 17 20.9
Healthcare providers 12 14.8
Religious leaders 2 2.5
Other 12 14.8
Contaminant use of herbal and No 27 33.3
modern drug Yes 54 66.7
Tell to healthcare provider at ANC No 50 62.8
Yes 31 37.2
If yes to tell to healthcare providers, To continue using the herbal drug 16 51.6
what was their response
To discontinue the herbal drug 10 32.3
Said nothing 5 16.1
ANC, antenatal care.

headaches, common colds and abdominal cramps. The Some diseases are not treatable with modern medica-
most commonly used herbal medicines by the study tion. Hepatitis B, for example, is treatable with herbal
participants during pregnancy were Zingiber officinale, medication but not with modern medicine. [G4P5]
Ocimum gratissimum, Eucalyptus globules, Allium sativum and
The other reasons for using herbal medicine while
Rutacha lepensis (online supplemental file 3).
having access to modern medicine were the availability
Reasons for using herbal medicine during pregnancy of the drugs without the need for a prescription by physi-
The reasons for using herbal drugs while receiving ANC cians, 42 (51.9%), having fewer side effects, 33 (40.7%),
at a health facility were studied, and the majority of the lower cost of drugs, 20 (24.7%), and being the culture to
women perceived herbal drugs as more efficient than use in pregnancy, 10 (12.3%) were among the reasons for
conventional drugs, 51 (62.9%). This is also in line with using herbal drugs. This was also supported by the results
the qualitative study finding where one woman stated: of qualitative studies.

6 Bekele GG, et al. BMJ Open 2024;14:e076303. doi:10.1136/bmjopen-2023-076303

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Modern drugs come with a slew of negative side ef- 31 (38.2%) of them informed the health professionals,
fects. The medicines used to treat peptic ulcer illness, and 16 (51.6%) of them were told to continue using the
for example, can aggravate the problem on their herbal drugs by the health professionals.
own. People utilize home remedies or traditional
medicine instead of pharmaceuticals because they Factors associated with herbal drug use during pregnancy
are afraid of negative drug side effects. [G3P1] Age, residence, educational status, previous child illness,
IDI participants also raised similar information: gestational age and herbal drug use during the non-­
pregnancy period were candidate variables for the multivari-
Mainly, there are misunderstandings in the commu- able logistic regression analysis with a p<0.2. In multivariate
nity regarding the use of modern medicine during analysis, three variables were significantly associated with
pregnancy. They don’t want to consider using mod- herbal drug utilisation during pregnancy with a p<0.05.
ern medicine as they believe that it could endanger Women aged 31 years and older are 2.4 times more
the life of their foetus because modern medicine likely to use herbal drugs than pregnant women younger
passes through different preparation processes in than 25 years (AOR 2.4, 95% CI 1.2 to 5.1). Urban resi-
fabric. For these reasons, the community prefers us- dent women were 2.3 times more likely to use herbal
ing the plants they know as medicine because they
drugs than pregnant women living in rural areas (AOR
consider them safe. [IDI7]
2.4, 95% CI 1.3 to 3.7). Second-­trimester women were
About two-­
thirds, (66.7%) of the women who used found to be 2.3 times more likely to use herbal drugs
herbal drugs during pregnancy also took conventional during pregnancy than third-­trimester pregnant women
drugs ordered during ANC follow-­up. Of these women, (AOR 2.3, 95% CI 1.3 to 4.5) (table 4).

Table 4 Bivariate and multivariable logistic regression analysis of factors associated with utilisation of herbal medicine among
pregnant women in west Shewa zone, Central Ethiopia, 2021
Herbal drug use
Frequency (%)
Variables No Yes COR (95% CI) AOR (95% CI)
Age category
 Younger than 25 143 (43.3) 26 (32.1) 1 1
 25–30 years 144 (43.6) 38 (46.9) 1.45 (0.8 to 2.5) 1.6 (0.9 to 2.9)
 31 and above 43 (13.0) 17 (21.0) 2.1 (1.08 to 4.3)* 2.4 (1.2 to 5.1)*
Educational status
 No formal education 32 (9.7) 9 (11.1) 1 1
 Primary 88 (26.7) 22 (27.2) 0.88 (0.3 to 2.1) 0.8 (0.6 to 1.2)
 High school 115 (34.8) 16 (19.8) 0.49 (0.2 to 1.2)* 0.5 (0.3 to 1.3)
 College and above 95 (28.8) 34 (42.0) 1.27 (0.5 to 2.9) 1.4 (0.8 to 3.1)
Residence
 Rural 203 (61.5) 35 (43.2) 1 1
 Urban 127 (38.5) 46 (56.8) 2.1 (1.3 to 3.4)* 2.3 (1.3 to 3.7)**
Previous child illness
 Yes 27 (11.8) 13 (22.0) 2.1 (1.1 to 4.1) 2.0 (0.9 to 4.6)
 No 202 (88.2) 46 (78.0) 1 1
Gestational age
 First trimester 110 (33.3) 26 (32.1) 1.4 (0.7 to 2.7) 1.4 (0.7 to 2.7)
 Second trimester 91 (27.6) 34 (42.0) 2.3 (1.2 to 4.2) 2.3 (1.3 to 4.5)*
 Third trimester 129 (39.1) 21 (25.9) 1 1
Previous herbal drug use
 Yes 251 (76.1) 52 (64.2) 1 1
 No 79 (23.9) 29 (35.8) 1.7 (1.1 to 2.9) 1.5 (0.8 to 2.9)
1 reference category
*p≤0.05, **p<0.01.
AOR, adjusted OR; COR, crude OR.

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DISCUSSION to utilize the medicinal plants because they are safe,

This research determined the prevalence of herbal particularly for pregnant women.’
medicine use during pregnancy and explored associated
Another significant factor related to the use of herbal
factors among pregnant women receiving ANC service at
medicine during pregnancy is gestational age. Unlike
public health facilities in the west Shewa zone of Central
a study conducted among pregnant women in Addis
Ethiopia.
Ababa, Ethiopia33 found that pregnant women are less
This study found that 19.7% of pregnant women used
likely to use self-­medication in the second trimester, this
herbal drugs during their pregnancy, which is compa- study found that the likelihood of using herbal medi-
rable with a study conducted among women attending cine is significantly higher in the second trimester than
postnatal clinics in Northern Uganda.27 This finding is in the last trimester. The possible explanation is that in
relatively higher than the proportion of herbal drug use Ethiopia, a large proportion of pregnant women drop
reported among pregnant women in the Kigoma region out before receiving the required number of ANC visits.
of Tanzania, 10.9%18 and 12% in Kenya.28 However, this According to the results of the 2019 Ethiopian Maternal
result is lower than the prevalence of herbal medicine and Demographic Health Study, 74% of women who gave
use documented in similar studies conducted in Italy,29 birth in the five years before the survey got prenatal treat-
Taiwan,6 Bangladesh,5 Nigeria21 and Egypt.30 Similarly, ment from a skilled practitioner at least once for their
this finding is lower than previous studies conducted in most recent pregnancy. For their most recent live birth,
Ethiopia.16 25 Prevalence rates may differ due to socio- however, only 43% had four or more ANC visits.34 With
cultural and ethnic variances in the studied areas. This a drop-­out from ANC care, pregnant women could miss
disparity could also be due to differences in accessi- out on the critical healthcare activities such as health
bility, price and regulating policies regarding the use promotion and counselling, including the risks of using
of herbal and modern medicine between countries and herbal medicine for the fetus and the mother. It is also
districts. supported by the qualitative study’s finding.
In this study, women over the age of 31 were found to Traditional medicine is generally not advised to be
be more likely to use herbal medicine during pregnancy used during pregnancy. However, if a problem emerges,
compared with their younger counterparts. This finding especially after 4 months, herbal medication is preferable
is consistent with findings from studies done among than conventional treatment because the former is made
pregnant women in Tanzania, Taiwan and Italy.6 18 29 This entirely of plant leaves or roots, which are safe to be used
finding could be explained by the women’s previous by pregnant women.
experiences with herbal medicine and their belief that it
helped them solve other difficulties, as well as its long-­ Strengths and limitations of the study
standing incorporation into the culture and perception The mixed approach provides greater insight and
as their own indigenous medicine.27 31 strength into the research topic.
When compared with rural dwellers, the odds of using The study’s limitations could be that it is prone to recall
herbal medicine during pregnancy were significantly bias, which could alter the results because the pregnant
higher among urban residents. However, a study of preg- women might not remember what drugs they took, and
nant women on ANC follow-­up at the University of Gondar most of the herbal remedies are not considered medicine
referral and teaching hospital in Ethiopia16 contradicts in rural communities. Another potential drawback is that
this finding. This could be explained by the fact that rural women in early pregnancy may not have the opportu-
individuals are more likely to accept healthcare practi- nity to use medications, which could alter the reported
tioners’ advice regarding the possible negative effects outcomes of routinely used herbal drugs. Furthermore,
of herbal medication during ANC follow-­ up, lowering the effect of COVID-­ 19 on the community regarding
the likelihood of herbal medicine use among rural resi- home remedies for the treatment and control measures.
dents. Moreover, herbal drugs were also considered as a Therefore, we recommend readers consider these limita-
therapeutic option for COVID-­19. Information on tele- tions while citing and interpreting the findings of this
vision, radio and the internet encourages consumers to study.
use herbal medicine more frequently, especially among
urban dwellers.32 On the other hand, in rural areas, most
herbal remedies are used as a nutritional supplement, but
CONCLUSION
in urban areas, they are used to cure problems during
According to this study, about one in five pregnant
pregnancy.27 The findings from the qualitative study also
women receiving ANC uses herbal medicines, which is
support this finding.
considerably lower than most of the earlier research done
Herbs are commonly used in urban settings, partic- in Ethiopia. The most frequently used herbal drugs were
ularly following the COVID-­19 outbreak. Because it Z. officinale, O. gratissimum, E. globules, A. sativum and R.
passes through several preparation processes in fab- chalepensis to treat minor obstetrical issues, the common
ric, modern medicine may risk the life of the foetus. cold and medical conditions such as hypertension. The
As a result of these factors, the community prefers use of herbal medications during pregnancy was affected

8 Bekele GG, et al. BMJ Open 2024;14:e076303. doi:10.1136/bmjopen-2023-076303

 Open access

by sociodemographic characteristics such as age, place of neurodegeneration (Alzheimer’s disease-­AD). Complementary

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University for the financial support to carry out the research. We are also grateful to Afr J Tradit Complement Altern Med 2011;8(5 Suppl):115–23.
the staff of the west Shewa zone health office for their cooperation and provision 8 Soma-­Pillay P, Nelson-­Piercy C, Tolppanen H, et al. Physiological
of important information. It is also our pleasure to acknowledge data collectors, changes in pregnancy: review articles. Cardiovasc J Afr
supervisors and study participants for giving their time during the study period. 2016;27:89–94.
9 John LJ, Shantakumari N. Herbal Medicines Use During Pregnancy:
Contributors GGB and BSW developed study objectives, data management and A Review from the Middle East. Oman Med J 2015;30:229–36.
analysis; they wrote the first draft of the manuscript. Also, contributed to the study 10 Duru CB, Uwakwe KA, Chinomnso NC, et al. Socio-­demographic
design, interpreted the results, drafted and revised the manuscript. DYG, EMK determinants of herbal medicine use in pregnancy among Nigerian
and GMT reviewed the manuscript for critical input, supervised all data analysis, women attending clinics in a tertiary Hospital in Imo State, south-­
east, Nigeria. Am J Med Stud 2016;4:1–10.
manuscript writing and provided critical input to the manuscript. All other authors
11 Kennedy DA, Lupattelli A, Koren G, et al. Safety classification of
critically revised the manuscript and approved the final version. GGB accepts full herbal medicines used in pregnancy in a multinational study. BMC
responsiblities for the work or the conduct of study as guarantor, had acces to the Complement Altern Med 2016;16:102.
data, and controlled the decison to publish. 12 Heitmann K, Nordeng H, Holst L. Pregnancy outcome after use of
Funding Ambo University provided financial support for this study in the amount cranberry in pregnancy--the Norwegian Mother and Child Cohort
Study. BMC Complement Altern Med 2013;13:1–12.
of US$500. 13 Myhre R, Brantsæter AL, Myking S, et al. Intakes of garlic and dried
Disclaimer The funders had no role in study design, data collection and analysis, fruits are associated with lower risk of spontaneous preterm delivery.
the decision to publish, or the preparation of the manuscript. J Nutr 2013;143:1100–8.
14 Wang HP, Yang J, Qin LQ, et al. Effect of Garlic on Blood Pressure: A
Competing interests None declared. Meta‐Analysis. J of Clinical Hypertension 2015;17:223–31. 10.1111/
jch.12473 Available: https://onlinelibrary.wiley.com/toc/17517176/​
Patient and public involvement Patients and/or the public were not involved in
17/3
the design, or conduct, or reporting, or dissemination plans of this research. 15 Ziaei S, Hantoshzadeh S, Rezasoltani P, et al. The effect of garlic
Patient consent for publication Consent obtained directly from patient(s). tablet on plasma lipids and platelet aggregation in nulliparous
pregnants at high risk of preeclampsia. European Journal of
Ethics approval This study involves human participants and was approved by Obstetrics & Gynecology and Reproductive Biology 2001;99:201–6.
Ambo University College of Medicine and Health Sciences ethical institutional 16 Mekuria AB, Erku DA, Gebresillassie BM, et al. Prevalence and
review committee with reference number AURH/M174/2/5/2013. Participants gave associated factors of herbal medicine use among pregnant
informed consent to participate in the study before taking part. women on antenatal care follow-­up at University of Gondar referral
and teaching hospital, Ethiopia: a cross-­sectional study. BMC
Provenance and peer review Not commissioned; externally peer reviewed. Complement Altern Med 2017;17:86:86.:.
Data availability statement Data are available on reasonable request. The data 17 Mudonhi N, Nunu WN. Traditional Medicine Utilisation Among
Pregnant Women in Sub-­saharan African Countries: A Systematic
used in this study will be available from the corresponding author on reasonable
Review of Literature. INQUIRY 2022;59.
request. 18 Fukunaga R, Morof D, Blanton C, et al. Factors associated with
Supplemental material This content has been supplied by the author(s). It has local herb use during pregnancy and labor among women in
not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been Kigoma region, Tanzania, 2014-­2016. BMC Pregnancy Childbirth
peer-­reviewed. Any opinions or recommendations discussed are solely those 2020;20.
19 Gouws C, Hamman JH. What are the dangers of drug interactions
of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and with herbal medicines? Expert Opinion on Drug Metabolism &
responsibility arising from any reliance placed on the content. Where the content Toxicology 2020;16:165–7.
includes any translated material, BMJ does not warrant the accuracy and reliability 20 Limaye D, Limaye V, Krause G, et al. A systematic review of the
of the translations (including but not limited to local regulations, clinical guidelines, literature on survey questionnaires to assess self-­medication
terminology, drug names and drug dosages), and is not responsible for any error practices. Int J Community Med Public Health 2017;4:2620.
and/or omissions arising from translation and adaptation or otherwise. 21 Onyiapat J, Okafor C, Okoronkwo I, et al. Complementary and
alternative medicine use: Results from a descriptive study of
Open access This is an open access article distributed in accordance with the pregnant women in Udi local Government area of Enugu state,
Creative Commons Attribution Non Commercial (CC BY-­NC 4.0) license, which Nigeria. BMC Complement Altern Med 2017;17:1–7.
permits others to distribute, remix, adapt, build upon this work non-­commercially, 22 Bayisa B, Tatiparthi R, Mulisa E. Use of herbal medicine among
and license their derivative works on different terms, provided the original work is pregnant women on antenatal care at nekemte hospital, Western
properly cited, appropriate credit is given, any changes made indicated, and the use ethiopia. Jundishapur J Nat Pharm Prod 2014;9:e17368.
is non-­commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. 23 Adane F, Seyoum G, Alamneh YM, et al. Herbal medicine use and
predictors among pregnant women attending antenatal care in
ORCID iD Ethiopia: a systematic review and meta-­analysis. BMC Pregnancy
Childbirth 2020;20.
Gemechu Gelan Bekele http://orcid.org/0000-0002-8476-5320
24 Emiru YK, Adamu BA, Erara M, et al. Complementary and Alternative
Medicine Use in a Pregnant Population, Northwest Ethiopia. Int J
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25 Laelago T, Yohannes T, Lemango F. Prevalence of herbal medicine
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