Use of herbal medicine during pregnancy among women with access to public healthcare in Nairobi, Kenya: A cross-sectional survey

  • BMC Complementary and Alternative Medicine, Volume 14, No. 1, Year 2014

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Study Justification:
This study aimed to investigate the use of herbal medicine during pregnancy among women with access to public healthcare in Nairobi, Kenya. Maternal health is a public health priority in many African countries, but little is known about the use of herbal medicine during pregnancy. Understanding the patterns of herbal medicine use is important for healthcare professionals to provide appropriate care and guidance to pregnant women.
Highlights:
– 12% of women in the study used herbal medicine during their most recent pregnancy.
– The use of herbal medicine was associated with a lower level of education and previous use before the index pregnancy.
– Only 12.5% of users disclosed their use of herbal medicine to healthcare professionals.
– Women used herbal medicine for various conditions such as back pain, toothache, indigestion, and infectious diseases.
– High rates of self-prescribing and sourcing from family and friends were observed.
– Both users and non-users were unsure about the safety and contraindications of Western medicine during pregnancy compared to herbal medicine.
Recommendations:
– Healthcare professionals should play a role in the rational use of both herbal and Western medicine during pregnancy. This includes discussing contraindications and potential drug-herb interactions with patients.
– More studies are needed to understand the use of herbal medicines during pregnancy, labor, and the postpartum period in different geographical areas, as well as the health outcomes associated with their use.
Key Role Players:
– Healthcare professionals: They play a crucial role in providing guidance and education to pregnant women regarding the use of herbal medicine.
– Researchers: More studies are needed to further explore the use of herbal medicine during pregnancy and its impact on maternal and fetal health.
– Policy makers: They can help develop guidelines and regulations regarding the use of herbal medicine during pregnancy to ensure the safety and well-being of pregnant women.
Cost Items for Planning Recommendations:
– Research funding: Funding is needed to conduct further studies on the use of herbal medicine during pregnancy.
– Training and education: Healthcare professionals may require additional training and education to effectively counsel pregnant women on the use of herbal medicine.
– Development of guidelines: Policy makers may need to allocate resources for the development and implementation of guidelines regarding the use of herbal medicine during pregnancy.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study is a cross-sectional survey that included a relatively large sample size of 333 women. The data was collected through an interviewer-administered questionnaire, which allows for both qualitative and quantitative data to be gathered. The study provides descriptive statistics and uses statistical tests to analyze relationships among variables. However, the study is limited to women attending a childcare clinic in a specific district public health hospital in Nairobi, Kenya, which may limit the generalizability of the findings. To improve the strength of the evidence, future studies could include a more diverse sample from different geographical areas and healthcare settings. Additionally, conducting longitudinal studies to examine the health outcomes associated with the use of herbal medicines during pregnancy would provide more robust evidence.

Background: Maternal health is a public health priority in many African countries, but little is known about herbal medicine use in pregnancy. This study aimed to determine the pattern of use of herbal medicine in an urban setting, where women have relatively high access to public healthcare. Methods: This cross-sectional study included 333 women attending a childcare clinic in a district public health hospital in Nairobi, Kenya, during January and February, 2012, and who had delivered a baby within the past 9 months. Qualitative and quantitative data on herbal medicine use during their latest pregnancy were collected through an interviewer-administered questionnaire. Data was analysed descriptively and the Chi square test and Fishers’ exact test used to analyse relationships among variables. Results: About 12% of women used herbal medicine during their most recent pregnancy. The use of herbal medicine was associated with a lower level of education (p = 0.007) and use before the index pregnancy (p < 0.001). Only 12.5% of users disclosed such use to healthcare professionals, and about 20% used herbal medicine concomitantly with Western medicine for the same illness/condition. Women used herbal medicine for back pain, toothache, indigestion and infectious diseases, such as respiratory tract infections and malaria. A proportion of users took herbal medicine only to boost or maintain health. There were high rates of self-prescribing, as well as sourcing from family and friends. Beliefs about safety and efficacy were consistent with patterns of use or non-use, although both users and non-users were unsure about the safety and contraindications of Western medicine during pregnancy compared with that of herbal medicine. Conclusion: Herbal medicine is used by 12% of pregnant women with access to healthcare in an urban context in Kenya, and often occurs without the knowledge of healthcare practitioners. Healthcare professionals should play a role in rational use of both herbal and Western medicine, by discussing contraindications and the potential for drug-herb interactions with patients. More studies are needed into the use of herbal medicines during pregnancy, labour and the postpartum period in different geographical areas, and into the health outcomes associated with their use.

Women attending a childcare clinic at Mbagathi District Hospital in Nairobi, with infants no more than 9 months old, were invited by healthcare professionals to take part in the study. Mbagathi District Hospital was the only fully operational public healthcare facility in the Nairobi area mandated to provide an Integrated Management of Childcare and Illness clinic at the time of study (according to the Ministry of Health online registry of health facilities in Kenya). All the respondents were briefed on the definition of herbal medicine by the research assistants and gave signed consent to participate in the study. Only participants above 18 years of age and the biological mothers of infants participated in the study. After informed consent was obtained, data were collected using a semi-structured, interviewer-administered questionnaire to gather qualitative and quantitative information about sociodemographic characteristics, patterns of medicine use, and beliefs about safety and efficacy of medicines. The definition of herbal medicine was included in the questionnaire and given to participants at the beginning of the interview. The WHO estimated that 80% of African patients used herbal medicine, and thus respondents were needed for statistical analysis of data [1]. A more conservative sample size was used because studies have suggested a lower prevalence of herbal medicine in urban areas in Africa, though there is little data on herbal medicine use among urban women. A previous study suggested 40% use among obstetric patients in an urban African context [7]. At a 50% prevalence rate for the use of herbal medicine, the conservative sample size was estimated at 384 respondents. The formula used for determining sample size for this study was n = z2pq/d2, where n = number of respondents, z = value of the test statistic, p = the estimated proportion of use of herbal medicine, q = 1- p and d = degree of accuracy (5%). Of the targeted women, 337 (87%) agreed to take part in the survey. An analysis of non- response could not be performed because data for the non-respondents was not available. However, there was a high rate of inclusion. After excluding incomplete questionnaires, data of 333 women (86% of those targeted) were included in the analysis. Data were collected over 2 months during January and February 2012. Quantitative data are presented as descriptive statistics and were analysed by the Chi-square test at ∝ = 0.05 significance level using SPSS v16 (SPSS Inc., Chicago, IL, USA). Qualitative data were analysed using Microsoft Excel 2010. All the respondents were briefed on the definition of herbal medicine by the research assistants and gave signed consent to participate in the study. Only participants above 18 years of age, biological mothers of infants and who gave full informed consent participated in the study. The definition of herbal medicine was included in the questionnaire and given to participants at the beginning of the interview. Authorization to conduct the study was obtained from Mbagathi District Hospital. The proposal was approved by the Ethics Committee of Moi University Institutional Review Board.

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Based on the provided description, here are some potential innovations that could be recommended to improve access to maternal health:

1. Education and Awareness Programs: Develop and implement educational programs to increase awareness among pregnant women about the potential risks and benefits of herbal medicine use during pregnancy. These programs should also emphasize the importance of disclosing herbal medicine use to healthcare professionals.

2. Training for Healthcare Professionals: Provide training and education for healthcare professionals on herbal medicine use during pregnancy. This will enable them to have informed discussions with pregnant women, address their concerns, and provide appropriate guidance on the safe and effective use of herbal medicine.

3. Integration of Traditional and Western Medicine: Promote the integration of traditional herbal medicine and Western medicine in maternal healthcare settings. This can be done by establishing guidelines and protocols for healthcare professionals to follow when managing pregnant women who use herbal medicine.

4. Research and Evidence Generation: Conduct further research to better understand the use of herbal medicine during pregnancy, labor, and the postpartum period. This research should focus on different geographical areas and explore the health outcomes associated with herbal medicine use.

5. Collaboration with Traditional Healers: Foster collaboration between healthcare professionals and traditional healers to ensure a holistic approach to maternal healthcare. This collaboration can involve sharing knowledge, exchanging information, and working together to provide comprehensive care to pregnant women.

6. Regulation and Quality Control: Implement regulations and quality control measures to ensure the safety and efficacy of herbal medicines used during pregnancy. This can include establishing standards for manufacturing, labeling, and advertising herbal products, as well as monitoring their quality and safety.

7. Access to Affordable Healthcare: Improve access to affordable healthcare services, including prenatal care, for pregnant women. This can be achieved by strengthening public healthcare facilities, increasing the availability of healthcare professionals, and reducing financial barriers to accessing healthcare services.

8. Community Engagement and Empowerment: Engage and empower communities to take an active role in promoting maternal health. This can involve community-based initiatives, such as support groups, peer education programs, and community health workers, to provide information and support to pregnant women regarding herbal medicine use and other aspects of maternal health.

It is important to note that these recommendations are based on the information provided and may need to be tailored to the specific context and needs of the target population.
AI Innovations Description
Based on the study titled “Use of herbal medicine during pregnancy among women with access to public healthcare in Nairobi, Kenya: A cross-sectional survey,” the following recommendation can be developed into an innovation to improve access to maternal health:

1. Increase awareness and education: Develop educational programs and campaigns to raise awareness among pregnant women about the potential risks and benefits of herbal medicine use during pregnancy. This can be done through community health centers, antenatal clinics, and public health campaigns.

2. Strengthen healthcare provider training: Provide training to healthcare professionals, including doctors, nurses, and midwives, on herbal medicine use during pregnancy. This will enable them to have informed discussions with pregnant women about the safety and efficacy of herbal medicine and potential interactions with Western medicine.

3. Improve communication between healthcare professionals and pregnant women: Encourage open and non-judgmental communication between healthcare professionals and pregnant women regarding their use of herbal medicine. Healthcare providers should create a safe and supportive environment where women feel comfortable disclosing their herbal medicine use.

4. Conduct further research: Conduct more studies to explore the use of herbal medicines during pregnancy, labor, and the postpartum period in different geographical areas. This will help gather more data on the prevalence, patterns, and health outcomes associated with herbal medicine use, which can inform evidence-based guidelines and policies.

5. Develop guidelines and policies: Based on the findings of research studies, develop clear guidelines and policies on the use of herbal medicine during pregnancy. These guidelines should be easily accessible to healthcare professionals and pregnant women, ensuring consistent and evidence-based practices.

6. Collaborate with traditional healers: Engage with traditional healers and herbal medicine practitioners to promote safe and responsible use of herbal medicine during pregnancy. This collaboration can help bridge the gap between traditional and modern healthcare systems, ensuring that pregnant women receive comprehensive and culturally appropriate care.

By implementing these recommendations, access to maternal health can be improved by addressing the use of herbal medicine during pregnancy in an urban setting. This will help ensure the safety and well-being of pregnant women and their babies.
AI Innovations Methodology
Based on the provided description, here are some potential recommendations for improving access to maternal health:

1. Increase awareness and education: Develop educational programs and campaigns to raise awareness about the importance of maternal health and the potential risks associated with herbal medicine use during pregnancy. This can be done through community outreach programs, workshops, and informational materials.

2. Strengthen healthcare provider training: Provide training to healthcare professionals on herbal medicine use during pregnancy, including the potential risks and contraindications. This will enable them to have informed discussions with pregnant women and provide appropriate guidance and support.

3. Enhance communication between healthcare professionals and pregnant women: Encourage open and honest communication between healthcare professionals and pregnant women regarding the use of herbal medicine. This can be achieved through regular check-ups, counseling sessions, and the creation of a supportive and non-judgmental environment.

4. Improve regulation and quality control: Implement stricter regulations and quality control measures for herbal medicine products to ensure their safety and efficacy. This can involve working closely with regulatory authorities and herbal medicine manufacturers to establish standards and guidelines.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Baseline data collection: Gather data on the current use of herbal medicine during pregnancy, including the prevalence, patterns, and beliefs surrounding its use. This can be done through surveys, interviews, and medical records.

2. Intervention implementation: Implement the recommended interventions, such as awareness campaigns, healthcare provider training, and improved regulation. Ensure that these interventions are targeted towards the specific population and context.

3. Post-intervention data collection: Collect data after the implementation of the interventions to assess their impact on access to maternal health. This can include measuring changes in herbal medicine use, healthcare provider knowledge and practices, and women’s perceptions and behaviors related to maternal health.

4. Data analysis: Analyze the collected data using appropriate statistical methods to determine the effectiveness of the interventions. This can involve comparing pre- and post-intervention data, conducting statistical tests, and identifying any significant changes or trends.

5. Evaluation and feedback: Evaluate the results of the analysis and provide feedback to stakeholders, including healthcare professionals, policymakers, and the community. This feedback can inform future decision-making and guide further improvements in access to maternal health.

It is important to note that the methodology may vary depending on the specific context and resources available.


Statistics:
Citations: 77
Identifiers:
DOI: 10.1186/1472-6882-14-432
Research Areas:
Disparities, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants
Study Countries:
Kenya
Study Design:
Cross Sectional Study
Study Approach:
Mixed-methods, Qualitative, Quantitative
Participants Gender:
Female
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