Medicinal plants used among pregnant women in a tertiary teaching hospital in Jimma, Ethiopia: A cross-sectional study

BMJ Open, Volume 11, No. 8, Year 2021

Interpretation

Objective The aim of this study was to investigate and describe the use of medicinal plants during pregnancy among women admitted in the Maternity and Gynaecology wards at Jimma University Medical Centre (JUMC) in the southwest Ethiopia. Design Cross-sectional study. Setting Maternity and Gynaecology wards at JUMC. Participants 1117 hospitalised pregnant women or postpartum women. Main outcome measures Our primary outcomes of interest were the prevalence of use, types of medicinal plants used and their utilisation among pregnant women. Methods Data were collected through structured face-to-face interviews of pregnant women or postpartum women and review of patient medical records between February and June 2017. Results Overall, 28.6% of the women reported use of at least one medicinal plant during the pregnancy. Twenty-seven different types of medicinal plants were used. The most commonly used medicinal plants were Linum usitatissimum L. (flaxseed – use with caution) 22.0%, Ocimum lamiifolium L. (damakessie – safety unknown) 3.6% and Carica papaya L. (papaya – use with caution) 3.1%. The most common reason for use was preparation, induction or shortening of labour. Lack of access to health facility (mainly health posts), admission to maternity ward, khat chewing and alcohol consumption were the strongest predictors of medicinal plants use during pregnancy (OR >2). Only five medicinal plants used by women had sufficient evidence to be classified as safe to use in pregnancy. Conclusions Almost one-third of women at the tertiary hospital in Ethiopia reported use of medicinal plants during pregnancy, most frequently to prepare, induce, reduce the intensity or shorten duration of labour. Increased awareness about potential benefits or risks of medicinal plants use during pregnancy among healthcare professionals and patients, and increased access to childbirth providing healthcare facilities are important in order to promote safer pregnancies and better health outcomes for women and their unborn children. A hospital based cross-sectional study was conducted in the Maternity and Gynaecology wards at JUMC. JUMC is one of the oldest and largest public teaching University hospitals in the country located in Jimma city, 350 kilometres south-west of Addis Ababa (the capital city of Ethiopia).23 24 The referral hospital provides tertiary level medical care for about 20 million people coming from the whole south-west Ethiopia.23 Obstetrics and Gynaecology department of the medical centre has a patient load of approximately 7600 inpatients and 11 600 outpatients each year with bed capacity of around 265.24 Obstetrics and Gynaecology department has two inpatient wards; Gynaecology ward and Maternity ward (which includes maternity, labour and delivery ward and maternity operation theatre).23 Obstetric patients with 28 weeks of pregnancy or higher as well as women in labour are admitted in the maternity ward. On the other hand, women with a gestational length of less than 28 weeks are cared for at the gynaecology ward. The gynaecology ward also manages and treats gynaecological disorders in non-pregnant women. Hospitalised pregnant or postpartum women in the Maternity and Gynaecology wards at JUMC were invited to participate in the study during normal working hours. Participants were consecutively informed about the aim and procedures of the study and written informed consent was obtained from each study participant. Pregnant or postpartum patients aged ≥18 years admitted in the Maternity/Labour and Gynaecology wards at the time of data collection and willing to participate were included in the study. On the other hand, women who were too ill to participate, hard of hearing, unable to speak or mentally disabled, under 18 years of age, admitted for less than 4 hours, and non-pregnant women admitted in the gynaecology ward were excluded from the study. Single population proportion Kish formula25 was used to determine the sample size based on the following assumptions; 50% expected prevalence medicinal plant use (since there is no previous study conducted on the prevalence of medicinal plant use among hospitalised pregnant patients prior to admission), 5% level significance, 80% power, and an error margin of 3%. After adding a 5% non-response rate, a final sample size of 1121 pregnant women was required. Hospitalised pregnant and postpartum women were consecutively interviewed from February to June 2017. A pretested interview guided structured questionnaire, based on interviews and data extraction form were used for data collection. Nine trained pharmacists and nurses from the study area, with close supervision of one of the investigators, conducted all interviews and data extractions. The questionnaire contains questions about the women’s background, pregnancy-related illnesses and use of medicinal plants. After a thorough review of the literature,9 12 22 26 27 with special focus on prior studies in African countries, the authors developed the survey questionnaire. It was developed in English and then translated into Amharic and Afan Oromo languages (the predominant local languages) to suit the target population. The questionnaires were translated back into English by other persons to confirm the validity. Lecturers fluent in English and their own local language from Jimma University with previous experience of translating questionnaires performed the translation and back translation of the study questionnaire. The data collection tool was then piloted on a sample of 30 hospitalised pregnant or lactating women at Shenen Ghibe district hospital found in Jimma city, and based on the results from the pilot, list of 25 commonly used medicinal plants and open-ended questions were included. Plant scientific names were verified with The Plant List (www.theplantlist.org). Final version of the questionnaire contained 77 items, with multiple choice, and open-ended questions (online supplemental table 1). bmjopen-2020-046495supp001.pdf Treatment related characteristics, pregnancy characteristics, pregnancy outcomes and other medical information were retrieved from patients’ medical record using data extraction forms. Following the pretest, the data extraction form required minor revisions to improve comprehension and order (online supplemental table 2). bmjopen-2020-046495supp002.pdf Study participants were specifically asked about the use in pregnancy of 25 commonly used medicinal plants: Linum usitatissimum L., Ocimum lamiifolium L., Zingiber officinale Roscoe., Allium sativum L., Trigonella foenum-graecum L., Nigella sativa L., Ruta chalepensis L., Eucalyptus globulus Labill., Cinnamomum verum J.Presl, Taverniera abyssinica A. Rich, Artemisia abyssinica Sch. Bip. ex A.Rich., Croton macrostachyus Hochst., Echinops kebericho Mesfin, Hagenia abyssinica (Bruce ex Steud.) J.F.Gmel., Vernonia amygdalina Del., Brassica nigra (L.) K.Koch, Zehneria scabra Sond., Artemisia afra Jacq. ex Willd., Lepidium sativum L., Carica papaya L., Foeniculum vulgare Mill., Coriandrum sativum L., Ocimum basilicum L., Datura stramonium L. and Securidaca longipedunculata Fresen. The above listed medicinal plants were selected based on previous ethnopharmacological studies in Ethiopia and elsewhere in Africa9 12 28 29 and were presented to the women by mentioning the local names of the plants. The women were also asked if they had used any other medicinal plant during pregnancy, labour or breastfeeding. Details of use of medicinal plants was assessed by a series of questions including use of medicinal plant during pregnancy, type of medicinal plant used, reason for use and utilisation (part of plant used, method of preparation, mode of use, type of solvent, type of flavouring, dosage form, dosage, measures of formulation, route of administration, frequency of administration, duration of treatment, and episodes of use). Women were also asked about who recommended them the use of medicinal plants in pregnancy. Information about women’s safety concerns and experiences with use of medicinal plants in pregnancy was collected, and we included questions about beliefs about harmfulness, precautions to be taken and whether she had experienced any side effects or adverse effects after use of medicinal plants in pregnancy. Reference text books30–32 and literature reviews4 19 21 were used to evaluate safety of the medicinal plants in pregnancy, and classify them into four safety categories, namely safe to use in pregnancy, use with caution, potentially harmful and information unavailable for use in pregnancy (online supplemental table 3). Information from animal studies were used if human studies were lacking. If a medicinal plant preparation was composed of two or more plants, each plant was individually evaluated and classified. bmjopen-2020-046495supp003.pdf Sociodemographic information including age, religion, residence place, occupation, family size, ethnic group, marital status, educational level, access to modern health facility and walking distance to the facility were collected. Detailed information about the woman’s obstetrics and gynaecology history, history of adverse pregnancy outcome, medical history and medication experience, and social drug use were included. Pregnant women were specifically asked about 24 common pregnancy ailments and related symptoms: common cold/influenza, pain in back, neck or shoulder, headache, heartburn/reflux problems, abdominal cramps/ache, preparation for labour, induction of labour, expel retained placenta, postpartum bathing, well-being and nourishing fetus, leg/foot swelling, gestational hypertension, gestational diabetes, gastritis/burning sensation, constipation, general well-being, nausea, vomiting, emergency illnesses, urinary tract infection, depression, joint pain, sleeping problems and mental well-being. Participants were also asked whether they had used any treatment against ailments or pregnancy related conditions, whether they had had any other diseases or illnesses and, if yes, the name of any treatment received. In addition to the face-to-face interview questionnaire, information about pregnancy characteristics, pregnancy outcomes and other obstetrics information including gestational age, parity, gravidity, mode of delivery and length of hospital stay were collected using a data extraction form. Moreover, maternal and perinatal outcomes of the current pregnancy were collected. Data were extracted through review of patients’ medical cards. The final data were checked for completeness, and responses were entered into and analysed using the Statistical Package for the Social Sciences (SPSS) software V.25.0 for Windows (IBM SPSS Statistics). Respondents were categorised as users if they used at least one type of medicinal plant in their index pregnancy, whereas others were categorised as non-users. Routine meals and vitamin supplements were excluded. Descriptive statistics were used to calculate the prevalence (%) of medicinal plants use in pregnancy, reasons for use and information sources. Univariate and multivariate logistic regression analysis was used to identify significant factors associated with medicinal plant use. Logistic regression was expressed as crude and adjusted ORs with 95% CIs. First, the univariate logistic regression model was fit for all explanatory variables. From this, the multivariate model was built using purposeful selection of candidate variables based on a bivariate p≤0.05. We then fit a reduced model by removing variables having no role (p>0.05). A p<0.05 was considered statistically significant. Robustness of the multivariable model was checked using the Hosmer-Lemeshow test. Although there is a community representative in the Jimma University Institute of health Institutional Review Board, no patients or public were involved in the conception, design, conduct and planning of this study.

AI Digest

Study Justification:

– The study aimed to investigate and describe the use of medicinal plants during pregnancy among women admitted in the Maternity and Gynaecology wards at Jimma University Medical Centre (JUMC) in Ethiopia.
– This study is important because it provides insights into the prevalence, types, and reasons for the use of medicinal plants among pregnant women in a tertiary teaching hospital.
– Understanding the use of medicinal plants during pregnancy is crucial for healthcare professionals and policymakers to promote safer pregnancies and better health outcomes for women and their unborn children.

Study Highlights:

– The study found that 28.6% of the women reported using at least one medicinal plant during pregnancy.
– Twenty-seven different types of medicinal plants were used, with the most commonly used plants being Linum usitatissimum L., Ocimum lamiifolium L., and Carica papaya L.
– The main reason for using medicinal plants was for the preparation, induction, or shortening of labor.
– Factors such as lack of access to health facilities, admission to the maternity ward, khat chewing, and alcohol consumption were strong predictors of medicinal plant use during pregnancy.
– Only five medicinal plants used by women had sufficient evidence to be classified as safe to use in pregnancy.

Recommendations for Lay Readers:

– Pregnant women should be aware of the potential benefits and risks of using medicinal plants during pregnancy.
– Healthcare professionals should increase their knowledge about medicinal plants and their effects on pregnancy to provide accurate information and guidance to pregnant women.
– Access to childbirth healthcare facilities should be improved to ensure safer pregnancies and better health outcomes for women and their unborn children.

Recommendations for Policy Makers:

– Policies and guidelines should be developed to regulate the use of medicinal plants during pregnancy and ensure the safety of pregnant women.
– Education and awareness programs should be implemented to inform healthcare professionals and pregnant women about the potential benefits and risks of using medicinal plants during pregnancy.
– Investments should be made to improve access to healthcare facilities, especially in rural areas, to reduce the reliance on medicinal plants during pregnancy.

Key Role Players:

– Healthcare professionals (doctors, nurses, midwives) to provide accurate information and guidance to pregnant women.
– Pharmacists to ensure the safety and quality of medicinal plants used during pregnancy.
– Policy makers and government officials to develop and implement policies and guidelines.
– Community health workers to educate pregnant women about the use of medicinal plants during pregnancy.

Cost Items for Planning Recommendations:

– Development and implementation of education and awareness programs.
– Training and capacity building for healthcare professionals.
– Improving access to healthcare facilities, including infrastructure and transportation.
– Research and monitoring to gather more evidence on the safety and efficacy of medicinal plants used during pregnancy.
– Regulatory and enforcement measures to ensure compliance with policies and guidelines.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a cross-sectional study conducted in a tertiary teaching hospital in Jimma, Ethiopia. The study collected data through structured face-to-face interviews and review of patient medical records. The sample size was determined using the Kish formula and a final sample size of 1121 pregnant women was included. The study provides information on the prevalence of medicinal plant use during pregnancy, types of medicinal plants used, and their utilization. It also identifies predictors of medicinal plant use during pregnancy. However, the evidence is limited to the specific setting and population studied, and the study design does not allow for establishing causality. To improve the strength of the evidence, future studies could consider using a longitudinal design to assess the impact of medicinal plant use on pregnancy outcomes and include a more diverse population to enhance generalizability.

Abstract

A hospital based cross-sectional study was conducted in the Maternity and Gynaecology wards at JUMC. JUMC is one of the oldest and largest public teaching University hospitals in the country located in Jimma city, 350 kilometres south-west of Addis Ababa (the capital city of Ethiopia).23 24 The referral hospital provides tertiary level medical care for about 20 million people coming from the whole south-west Ethiopia.23 Obstetrics and Gynaecology department of the medical centre has a patient load of approximately 7600 inpatients and 11 600 outpatients each year with bed capacity of around 265.24 Obstetrics and Gynaecology department has two inpatient wards; Gynaecology ward and Maternity ward (which includes maternity, labour and delivery ward and maternity operation theatre).23 Obstetric patients with 28 weeks of pregnancy or higher as well as women in labour are admitted in the maternity ward. On the other hand, women with a gestational length of less than 28 weeks are cared for at the gynaecology ward. The gynaecology ward also manages and treats gynaecological disorders in non-pregnant women. Hospitalised pregnant or postpartum women in the Maternity and Gynaecology wards at JUMC were invited to participate in the study during normal working hours. Participants were consecutively informed about the aim and procedures of the study and written informed consent was obtained from each study participant. Pregnant or postpartum patients aged ≥18 years admitted in the Maternity/Labour and Gynaecology wards at the time of data collection and willing to participate were included in the study. On the other hand, women who were too ill to participate, hard of hearing, unable to speak or mentally disabled, under 18 years of age, admitted for less than 4 hours, and non-pregnant women admitted in the gynaecology ward were excluded from the study. Single population proportion Kish formula25 was used to determine the sample size based on the following assumptions; 50% expected prevalence medicinal plant use (since there is no previous study conducted on the prevalence of medicinal plant use among hospitalised pregnant patients prior to admission), 5% level significance, 80% power, and an error margin of 3%. After adding a 5% non-response rate, a final sample size of 1121 pregnant women was required. Hospitalised pregnant and postpartum women were consecutively interviewed from February to June 2017. A pretested interview guided structured questionnaire, based on interviews and data extraction form were used for data collection. Nine trained pharmacists and nurses from the study area, with close supervision of one of the investigators, conducted all interviews and data extractions. The questionnaire contains questions about the women’s background, pregnancy-related illnesses and use of medicinal plants. After a thorough review of the literature,9 12 22 26 27 with special focus on prior studies in African countries, the authors developed the survey questionnaire. It was developed in English and then translated into Amharic and Afan Oromo languages (the predominant local languages) to suit the target population. The questionnaires were translated back into English by other persons to confirm the validity. Lecturers fluent in English and their own local language from Jimma University with previous experience of translating questionnaires performed the translation and back translation of the study questionnaire. The data collection tool was then piloted on a sample of 30 hospitalised pregnant or lactating women at Shenen Ghibe district hospital found in Jimma city, and based on the results from the pilot, list of 25 commonly used medicinal plants and open-ended questions were included. Plant scientific names were verified with The Plant List (www.theplantlist.org). Final version of the questionnaire contained 77 items, with multiple choice, and open-ended questions (online supplemental table 1). bmjopen-2020-046495supp001.pdf Treatment related characteristics, pregnancy characteristics, pregnancy outcomes and other medical information were retrieved from patients’ medical record using data extraction forms. Following the pretest, the data extraction form required minor revisions to improve comprehension and order (online supplemental table 2). bmjopen-2020-046495supp002.pdf Study participants were specifically asked about the use in pregnancy of 25 commonly used medicinal plants: Linum usitatissimum L., Ocimum lamiifolium L., Zingiber officinale Roscoe., Allium sativum L., Trigonella foenum-graecum L., Nigella sativa L., Ruta chalepensis L., Eucalyptus globulus Labill., Cinnamomum verum J.Presl, Taverniera abyssinica A. Rich, Artemisia abyssinica Sch. Bip. ex A.Rich., Croton macrostachyus Hochst., Echinops kebericho Mesfin, Hagenia abyssinica (Bruce ex Steud.) J.F.Gmel., Vernonia amygdalina Del., Brassica nigra (L.) K.Koch, Zehneria scabra Sond., Artemisia afra Jacq. ex Willd., Lepidium sativum L., Carica papaya L., Foeniculum vulgare Mill., Coriandrum sativum L., Ocimum basilicum L., Datura stramonium L. and Securidaca longipedunculata Fresen. The above listed medicinal plants were selected based on previous ethnopharmacological studies in Ethiopia and elsewhere in Africa9 12 28 29 and were presented to the women by mentioning the local names of the plants. The women were also asked if they had used any other medicinal plant during pregnancy, labour or breastfeeding. Details of use of medicinal plants was assessed by a series of questions including use of medicinal plant during pregnancy, type of medicinal plant used, reason for use and utilisation (part of plant used, method of preparation, mode of use, type of solvent, type of flavouring, dosage form, dosage, measures of formulation, route of administration, frequency of administration, duration of treatment, and episodes of use). Women were also asked about who recommended them the use of medicinal plants in pregnancy. Information about women’s safety concerns and experiences with use of medicinal plants in pregnancy was collected, and we included questions about beliefs about harmfulness, precautions to be taken and whether she had experienced any side effects or adverse effects after use of medicinal plants in pregnancy. Reference text books30–32 and literature reviews4 19 21 were used to evaluate safety of the medicinal plants in pregnancy, and classify them into four safety categories, namely safe to use in pregnancy, use with caution, potentially harmful and information unavailable for use in pregnancy (online supplemental table 3). Information from animal studies were used if human studies were lacking. If a medicinal plant preparation was composed of two or more plants, each plant was individually evaluated and classified. bmjopen-2020-046495supp003.pdf Sociodemographic information including age, religion, residence place, occupation, family size, ethnic group, marital status, educational level, access to modern health facility and walking distance to the facility were collected. Detailed information about the woman’s obstetrics and gynaecology history, history of adverse pregnancy outcome, medical history and medication experience, and social drug use were included. Pregnant women were specifically asked about 24 common pregnancy ailments and related symptoms: common cold/influenza, pain in back, neck or shoulder, headache, heartburn/reflux problems, abdominal cramps/ache, preparation for labour, induction of labour, expel retained placenta, postpartum bathing, well-being and nourishing fetus, leg/foot swelling, gestational hypertension, gestational diabetes, gastritis/burning sensation, constipation, general well-being, nausea, vomiting, emergency illnesses, urinary tract infection, depression, joint pain, sleeping problems and mental well-being. Participants were also asked whether they had used any treatment against ailments or pregnancy related conditions, whether they had had any other diseases or illnesses and, if yes, the name of any treatment received. In addition to the face-to-face interview questionnaire, information about pregnancy characteristics, pregnancy outcomes and other obstetrics information including gestational age, parity, gravidity, mode of delivery and length of hospital stay were collected using a data extraction form. Moreover, maternal and perinatal outcomes of the current pregnancy were collected. Data were extracted through review of patients’ medical cards. The final data were checked for completeness, and responses were entered into and analysed using the Statistical Package for the Social Sciences (SPSS) software V.25.0 for Windows (IBM SPSS Statistics). Respondents were categorised as users if they used at least one type of medicinal plant in their index pregnancy, whereas others were categorised as non-users. Routine meals and vitamin supplements were excluded. Descriptive statistics were used to calculate the prevalence (%) of medicinal plants use in pregnancy, reasons for use and information sources. Univariate and multivariate logistic regression analysis was used to identify significant factors associated with medicinal plant use. Logistic regression was expressed as crude and adjusted ORs with 95% CIs. First, the univariate logistic regression model was fit for all explanatory variables. From this, the multivariate model was built using purposeful selection of candidate variables based on a bivariate p≤0.05. We then fit a reduced model by removing variables having no role (p>0.05). A p<0.05 was considered statistically significant. Robustness of the multivariable model was checked using the Hosmer-Lemeshow test. Although there is a community representative in the Jimma University Institute of health Institutional Review Board, no patients or public were involved in the conception, design, conduct and planning of this study.

Materials

Innovations

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

1. Telemedicine: Implementing telemedicine services can provide remote access to healthcare professionals, allowing pregnant women in rural areas to receive medical advice and consultations without having to travel long distances.

2. Mobile health (mHealth) applications: Developing mobile applications that provide information and resources on maternal health, including prenatal care, nutrition, and common pregnancy ailments, can empower women to take control of their health and make informed decisions.

3. Community health workers: Training and deploying community health workers who can provide basic prenatal care, education, and support to pregnant women in remote areas can help bridge the gap in access to maternal health services.

4. Mobile clinics: Establishing mobile clinics that travel to remote areas and provide comprehensive prenatal care, including screenings, vaccinations, and prenatal check-ups, can ensure that pregnant women have access to essential healthcare services.

5. Health education programs: Implementing health education programs that focus on maternal health and target both healthcare professionals and pregnant women can increase awareness about the importance of prenatal care and promote safer pregnancies.

6. Improving transportation infrastructure: Investing in transportation infrastructure, such as roads and ambulances, can facilitate timely access to healthcare facilities for pregnant women, especially in rural areas with limited transportation options.

7. Strengthening healthcare facilities: Upgrading and equipping healthcare facilities with necessary resources, including trained healthcare professionals, medical equipment, and medications, can improve the quality of maternal healthcare services and encourage women to seek care.

8. Collaborations and partnerships: Establishing collaborations and partnerships between healthcare organizations, government agencies, and non-profit organizations can leverage resources and expertise to improve access to maternal health services in underserved areas.

These innovations can help address the challenges faced by pregnant women in accessing maternal health services, particularly in remote and resource-limited settings.

AI Innovations Description

Based on the description provided, the recommendation to improve access to maternal health is to increase awareness about the potential benefits and risks of using medicinal plants during pregnancy among healthcare professionals and patients. This can be achieved through educational programs and training sessions for healthcare professionals, as well as informational materials and counseling for pregnant women.

Additionally, there should be an emphasis on increasing access to childbirth providing healthcare facilities, such as health posts, to ensure that pregnant women have access to proper medical care and guidance throughout their pregnancy. This can involve improving infrastructure, increasing the number of healthcare facilities, and ensuring that they are adequately staffed with trained healthcare professionals.

By increasing awareness and access to healthcare facilities, pregnant women will have the necessary information and resources to make informed decisions about their maternal health, leading to safer pregnancies and better health outcomes for both women and their unborn children.

AI Innovations Methodology

Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Increase awareness: Develop educational programs and campaigns to increase awareness among healthcare professionals and pregnant women about the potential benefits and risks of using medicinal plants during pregnancy. This can help promote safer pregnancies and better health outcomes.

2. Strengthen healthcare facilities: Improve access to childbirth providing healthcare facilities, especially in remote areas. This can be done by increasing the number of health posts and ensuring they are well-equipped to provide quality maternal healthcare services.

3. Training for healthcare professionals: Provide training and education for healthcare professionals on the safe use of medicinal plants during pregnancy. This can help them provide accurate information and guidance to pregnant women regarding the use of medicinal plants.

4. Research and evidence-based guidelines: Conduct further research on the safety and efficacy of medicinal plants commonly used during pregnancy. This can help establish evidence-based guidelines for healthcare professionals and pregnant women regarding the use of medicinal plants.

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

1. Define the objectives: Clearly define the objectives of the simulation, such as assessing the potential impact of increased awareness and improved access to healthcare facilities on maternal health outcomes.

2. Collect baseline data: Gather data on the current state of maternal health, including access to healthcare facilities, prevalence of medicinal plant use, and maternal health outcomes.

3. Develop a simulation model: Create a simulation model that incorporates various factors, such as increased awareness, improved access to healthcare facilities, and changes in medicinal plant use. The model should consider the potential interactions and effects of these factors on maternal health outcomes.

4. Input data and parameters: Input the collected baseline data into the simulation model, along with relevant parameters and assumptions. This may include data on population demographics, healthcare infrastructure, prevalence of medicinal plant use, and potential changes in awareness and access.

5. Run simulations: Run multiple simulations using the model to assess the impact of different scenarios, such as increased awareness alone, improved access to healthcare facilities alone, or a combination of both. This can help evaluate the potential effects on maternal health outcomes, such as reduction in complications, improved prenatal care, and better overall health outcomes for women and their unborn children.

6. Analyze results: Analyze the results of the simulations to determine the potential impact of the recommended interventions on improving access to maternal health. This may involve comparing different scenarios and assessing the magnitude of the effects.

7. Interpret and communicate findings: Interpret the findings of the simulations and communicate the results to relevant stakeholders, such as healthcare professionals, policymakers, and community members. This can help inform decision-making and guide the implementation of interventions to improve access to maternal health.

It is important to note that the methodology for simulating the impact of recommendations may vary depending on the specific context and available data.

Authors & Co-Authors

Statistics:

Citations: 1

Authors: 4

Identifiers:

DOI: 10.1136/bmjopen-2020-046495

Research Areas:

Community Interventions, Disability, Health System and Policy, Maternal Access, Maternal and Child Health, Mental Health, Noncommunicable Diseases, Quality of Care, Sexual and Reproductive Health, Social Determinants, Substance Abuse

Study Countries:

Ethiopia

Study Design:

Cross Sectional Study, Grounded Theory

Study Approach:

Mixed-methods, Quantitative, Systematic Review

Participants Gender:

Female