Knowledge and Attitude of Women Towards Herbal Medicine Usage During Pregnancy and Associated Factors Among Mothers Who Gave Birth in the Last Twelve Months in Dega Damot District, Northwest Ethiopia

Drug, Healthcare and Patient Safety, Volume 14, Year 2022

Interpretation

Background: The use of herbal medicine is increasing globally, particularly in developing countries including Ethiopia, yet little is known regarding its effect and safety during pregnancy. Pregnant women prefer herbal medicine due to easy accessibility, traditional and cultural beliefs, and comparatively low cost. This study aimed to assess women’s knowledge and attitude towards the effects of herbal medicine usage during pregnancy and associated factors among women who gave birth in the last twelve months in Dega Damot district. Methods: A community-based cross-sectional study was conducted from January 1st to February 30th, 2021. A total of 872 women were selected using a stratified cluster sampling technique. Data were collected by face-to-face interviews using a structured, pretested, and interviewer-administered questionnaire. Data were entered into EPI data version 4.6 and exported to SPSS version 25 for analysis. Multivariable logistic regression was done and a p-value of ≤ 0.05 was used to declare the level of significance. Results: Women’s knowledge and positive attitude towards the effects of herbal medicine usage during pregnancy was 49.1% (95% CI: 46–52) and 57.3% (95% CI: 54–61), respectively. Access to media, had antenatal care visit, being urban dweller, history of herbal medicine usage, and a short distance to reach the nearby health facility were significantly associated with women’s knowledge about effects of herbal medicine usage. Besides, being primiparous and short traveling time to reach the nearby health facility was significantly associated with women’s attitude towards the effects of herbal medicine usage during pregnancy. Conclusion: Women’s knowledge and positive attitude towards the effects of herbal medicine usage during pregnancy was low. It is important to design strategies to improve the accessibilities of maternal health services, and expand access to media will have a great role in improving women’s knowledge and attitude towards herbal medicine usage during pregnancy. A community-based cross-sectional study was carried out from January 1st to February 30th, 2021, in Dega Damot district, northwest Ethiopia. The district’s administrative town, Feres Bet, is located about 400 km northwest of Addis Ababa (the capital city of Ethiopia) and 117 km from Bahir Dar (the capital city of Amhara regional state). Based on the 2014 population projection by the Central Statistical Agency of Ethiopia, the district has a total population of 152,343; of whom, 77,338 were women.18 The district is administratively divided into 34 kebeles (the smallest administrative unit in Ethiopia), which are 2 urban and 32 rural kebeles. In addition, the district has one primary hospital, eight health centers, and thirty-two health posts. The overall antenatal care service utilization and institutional delivery in the district were 37.4% and 38.2%, respectively.19 All mothers who gave birth in the last twelve months and reside in the selected clusters of Dega Damot district during the data collection period were included. Mothers who were seriously ill and unable to communicate throughout the data collection period were excluded. The sample size for this study was determined by using a single population proportion formula by considering the following assumptions: 50% proportion of women’s knowledge and attitude towards the effects of HM usage during pregnancy (since there were no similar studies in Ethiopia), 95% level of confidence, and 5% margin of error. Where n = required sample size, z = standard normal distribution curve value for 95% confidence level = 1.96, = level of significance, p = proportion of women’s knowledge and attitude on effects of herbal medicine usage during pregnancy, and d = margin of error. By considering a design effect of 2 and a 10% non-response rate, the final sample size was 847. Dega Damot district has a total of 34 kebeles (2 urban and 32 rural). The kebeles were stratified into urban and rural. Nine kebeles (1 urban and 8 rural) were selected randomly. A house-to-house visit was conducted and all eligible women in the selected kebeles (clusters) were interviewed. A stratified cluster sampling technique was used to draw the final sample size. Finally, due to the effect of cluster sampling, a total of 872 women were interviewed. Herbal medicine usage: is the intake of any herb or herbal preparation (syrup, paste, and powder) during pregnancy either self-prescribed or recommended by family members, friends, herbalists, or others to manage any symptom, or perceived to support baby’s development.9 Adequate knowledge: Six questions were prepared to assess the knowledge of women about the effects of herbal medicine usage during pregnancy. Each yes or no question were coded into 1 and 0 respectively and for other questions with more than one possible answer, at least one correct answer was coded as 1. The minimum and maximum scores were 0 and 6, respectively. Thus, based on the variables set to assess knowledge of women on the effects of HM usage during pregnancy, women who scored above the mean (3.68) were considered as having adequate knowledge.20 Positive attitude towards the effects of HM usage during pregnancy: Eight questions were prepared to assess the attitude of women towards herbal medicine. Each question has a five-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree). The total score was ranged from 8 to 40. Thus, based on the variables prepared to assess the attitude of women towards the effects of HM usage during pregnancy, women who scored above the mean (26.5) score were considered as having a positive attitude.20 Media exposure: Those who respond at least once a week for at least one of the media types (television, radio, or magazine) are considered to be regularly exposed.21 The data collection tool was developed by reviewing the literature.14,15,20,22–24 A structured, interviewer-administered questionnaire was used to collect the data through face-to-face interviews. Initially, the questionnaire was prepared in English and translated to the local (Amharic) language, and back to English to ensure consistency. The questionnaire comprises socio-demographic characteristics, reproductive and maternity healthcare characteristics, and knowledge and attitude-related questions. The study tool was assessed by a group of researchers to evaluate and enhance the items in the question. Four diploma and two BSc midwives were recruited for data collection and supervision, respectively. A pretest was done on 5% (43) of the calculated sample size outside of the study area. One-day training was given for data collectors and supervisors to assure language clarity and to give information on interview techniques, and how to keep the information. During the actual data collection period, the questionnaire was checked for completeness daily by the supervisors. The coded data were entered into EPI data version 4.6 and then exported to SPSS version 25 for cleaning and analysis purposes. The family wealth status was analyzed by using principal component analysis (PCA). Descriptive statistics were used to present the characteristics of the study participants. The binary logistic regression analysis was done to identify the factors associated with women’s knowledge and attitude towards HM usage during pregnancy. Variables having a p-value of ≤ 0.25 in the bivariable analysis were entered into a multivariable logistic regression analysis to identify independent factors associated with HM usage during pregnancy. The multicollinearity assumption was assessed using the variance inflation factor (VIF), in which VIF <10 were acceptable In the multivariable logistic regression, variables were selected in Backward Likelihood Ratio approach and a p-value of ≤ 0.05 with a 95% CI for the adjusted odds ratio was employed to ascertain the significant association. The study was conducted in accordance with the Ethiopian Health Research Ethics Guideline and the declaration of Helsinki. The ethical approval letter was obtained from the School of Midwifery, on behalf of the Institutional Review Board (IRB) of the University of Gondar. A formal letter of organizational approval was obtained from Dega Damot district health office. Afterward, the information regarding the purpose of the study and the rights of the participants was provided for the study participants. Finally, written informed consent was obtained from each participant before the actual data collection.

AI Digest

Study Justification:

– The use of herbal medicine during pregnancy is increasing globally, including in Ethiopia.
– However, there is limited knowledge about the effects and safety of herbal medicine during pregnancy.
– Pregnant women often choose herbal medicine due to accessibility, cultural beliefs, and cost.
– This study aimed to assess women’s knowledge and attitude towards herbal medicine usage during pregnancy and associated factors in Dega Damot district, Ethiopia.

Highlights:

– The study found that only 49.1% of women had adequate knowledge about the effects of herbal medicine usage during pregnancy.
– Additionally, 57.3% of women had a positive attitude towards herbal medicine usage during pregnancy.
– Factors such as access to media, antenatal care visits, urban residence, history of herbal medicine usage, and proximity to health facilities were associated with women’s knowledge about herbal medicine effects.
– Being primiparous and having a short travel time to reach a health facility were associated with women’s positive attitude towards herbal medicine usage during pregnancy.

Recommendations:

– Design strategies to improve access to maternal health services, including antenatal care, to enhance women’s knowledge and attitude towards herbal medicine usage during pregnancy.
– Expand access to media to provide accurate information about the effects and safety of herbal medicine during pregnancy.
– Conduct further research to explore the specific effects and safety of different herbal medicines commonly used during pregnancy.

Key Role Players:

– Ministry of Health: Responsible for developing and implementing policies related to maternal health and herbal medicine usage during pregnancy.
– Health professionals: Including midwives, doctors, and nurses who provide antenatal care and counseling to pregnant women.
– Traditional healers and herbalists: Collaborate with health professionals to provide accurate information and guidance on herbal medicine usage during pregnancy.
– Community leaders and influencers: Promote awareness and education about the effects and safety of herbal medicine during pregnancy.

Cost Items for Planning Recommendations:

– Training and capacity building for health professionals on herbal medicine usage during pregnancy.
– Development and dissemination of educational materials and media campaigns.
– Collaboration and coordination meetings between the Ministry of Health, health professionals, traditional healers, and community leaders.
– Research funding for further studies on the effects and safety of herbal medicine during pregnancy.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a community-based cross-sectional study conducted in Dega Damot district, northwest Ethiopia. The study used a stratified cluster sampling technique and included a total of 872 women who gave birth in the last twelve months. Data were collected through face-to-face interviews using a structured questionnaire. The study found that women’s knowledge and positive attitude towards the effects of herbal medicine usage during pregnancy were low. The study identified factors associated with women’s knowledge and attitude, such as access to media, antenatal care visit, urban dwelling, history of herbal medicine usage, and distance to the nearby health facility. The study concluded that strategies should be designed to improve access to maternal health services and expand access to media to improve women’s knowledge and attitude towards herbal medicine usage during pregnancy. However, the abstract does not provide information on the study’s limitations or potential biases, which could affect the strength of the evidence. To improve the evidence, future studies could consider using a larger sample size, including a more diverse population, and conducting a longitudinal study to assess the long-term effects of herbal medicine usage during pregnancy.

Abstract

A community-based cross-sectional study was carried out from January 1st to February 30th, 2021, in Dega Damot district, northwest Ethiopia. The district’s administrative town, Feres Bet, is located about 400 km northwest of Addis Ababa (the capital city of Ethiopia) and 117 km from Bahir Dar (the capital city of Amhara regional state). Based on the 2014 population projection by the Central Statistical Agency of Ethiopia, the district has a total population of 152,343; of whom, 77,338 were women.18 The district is administratively divided into 34 kebeles (the smallest administrative unit in Ethiopia), which are 2 urban and 32 rural kebeles. In addition, the district has one primary hospital, eight health centers, and thirty-two health posts. The overall antenatal care service utilization and institutional delivery in the district were 37.4% and 38.2%, respectively.19 All mothers who gave birth in the last twelve months and reside in the selected clusters of Dega Damot district during the data collection period were included. Mothers who were seriously ill and unable to communicate throughout the data collection period were excluded. The sample size for this study was determined by using a single population proportion formula by considering the following assumptions: 50% proportion of women’s knowledge and attitude towards the effects of HM usage during pregnancy (since there were no similar studies in Ethiopia), 95% level of confidence, and 5% margin of error. Where n = required sample size, z = standard normal distribution curve value for 95% confidence level = 1.96, = level of significance, p = proportion of women’s knowledge and attitude on effects of herbal medicine usage during pregnancy, and d = margin of error. By considering a design effect of 2 and a 10% non-response rate, the final sample size was 847. Dega Damot district has a total of 34 kebeles (2 urban and 32 rural). The kebeles were stratified into urban and rural. Nine kebeles (1 urban and 8 rural) were selected randomly. A house-to-house visit was conducted and all eligible women in the selected kebeles (clusters) were interviewed. A stratified cluster sampling technique was used to draw the final sample size. Finally, due to the effect of cluster sampling, a total of 872 women were interviewed. Herbal medicine usage: is the intake of any herb or herbal preparation (syrup, paste, and powder) during pregnancy either self-prescribed or recommended by family members, friends, herbalists, or others to manage any symptom, or perceived to support baby’s development.9 Adequate knowledge: Six questions were prepared to assess the knowledge of women about the effects of herbal medicine usage during pregnancy. Each yes or no question were coded into 1 and 0 respectively and for other questions with more than one possible answer, at least one correct answer was coded as 1. The minimum and maximum scores were 0 and 6, respectively. Thus, based on the variables set to assess knowledge of women on the effects of HM usage during pregnancy, women who scored above the mean (3.68) were considered as having adequate knowledge.20 Positive attitude towards the effects of HM usage during pregnancy: Eight questions were prepared to assess the attitude of women towards herbal medicine. Each question has a five-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree). The total score was ranged from 8 to 40. Thus, based on the variables prepared to assess the attitude of women towards the effects of HM usage during pregnancy, women who scored above the mean (26.5) score were considered as having a positive attitude.20 Media exposure: Those who respond at least once a week for at least one of the media types (television, radio, or magazine) are considered to be regularly exposed.21 The data collection tool was developed by reviewing the literature.14,15,20,22–24 A structured, interviewer-administered questionnaire was used to collect the data through face-to-face interviews. Initially, the questionnaire was prepared in English and translated to the local (Amharic) language, and back to English to ensure consistency. The questionnaire comprises socio-demographic characteristics, reproductive and maternity healthcare characteristics, and knowledge and attitude-related questions. The study tool was assessed by a group of researchers to evaluate and enhance the items in the question. Four diploma and two BSc midwives were recruited for data collection and supervision, respectively. A pretest was done on 5% (43) of the calculated sample size outside of the study area. One-day training was given for data collectors and supervisors to assure language clarity and to give information on interview techniques, and how to keep the information. During the actual data collection period, the questionnaire was checked for completeness daily by the supervisors. The coded data were entered into EPI data version 4.6 and then exported to SPSS version 25 for cleaning and analysis purposes. The family wealth status was analyzed by using principal component analysis (PCA). Descriptive statistics were used to present the characteristics of the study participants. The binary logistic regression analysis was done to identify the factors associated with women’s knowledge and attitude towards HM usage during pregnancy. Variables having a p-value of ≤ 0.25 in the bivariable analysis were entered into a multivariable logistic regression analysis to identify independent factors associated with HM usage during pregnancy. The multicollinearity assumption was assessed using the variance inflation factor (VIF), in which VIF <10 were acceptable In the multivariable logistic regression, variables were selected in Backward Likelihood Ratio approach and a p-value of ≤ 0.05 with a 95% CI for the adjusted odds ratio was employed to ascertain the significant association. The study was conducted in accordance with the Ethiopian Health Research Ethics Guideline and the declaration of Helsinki. The ethical approval letter was obtained from the School of Midwifery, on behalf of the Institutional Review Board (IRB) of the University of Gondar. A formal letter of organizational approval was obtained from Dega Damot district health office. Afterward, the information regarding the purpose of the study and the rights of the participants was provided for the study participants. Finally, written informed consent was obtained from each participant before the actual data collection.

Materials

N/A

Innovations

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

1. Mobile health (mHealth) interventions: Develop mobile applications or text messaging services to provide pregnant women with information about the effects and safety of herbal medicine usage during pregnancy. This can help improve their knowledge and attitude towards herbal medicine and promote safer practices.

2. Community health workers: Train and deploy community health workers in rural areas to educate pregnant women about the potential risks and benefits of herbal medicine usage during pregnancy. These workers can provide accurate information, address misconceptions, and refer women to appropriate healthcare facilities.

3. Telemedicine services: Establish telemedicine services to connect pregnant women in remote areas with healthcare providers who can provide guidance and advice on herbal medicine usage during pregnancy. This can help overcome geographical barriers and improve access to expert advice.

4. Health education campaigns: Conduct targeted health education campaigns to raise awareness about the effects and safety of herbal medicine usage during pregnancy. These campaigns can utilize various media channels, including radio, television, and magazines, to reach a wide audience and improve knowledge and attitudes.

5. Integration of traditional medicine and modern healthcare: Promote collaboration and communication between traditional healers and modern healthcare providers to ensure a holistic approach to maternal health. This can involve training traditional healers on safe herbal medicine practices and establishing referral systems between traditional healers and healthcare facilities.

6. Strengthening healthcare infrastructure: Improve the availability and accessibility of healthcare facilities, particularly in rural areas. This can include increasing the number of health centers and health posts, as well as ensuring that these facilities are well-equipped to provide maternal health services.

7. Empowering women through antenatal care: Enhance antenatal care services by incorporating comprehensive information about herbal medicine usage during pregnancy. This can include counseling sessions, educational materials, and discussions with healthcare providers to address women’s concerns and provide evidence-based guidance.

8. Research and evidence generation: Conduct further research to gather more evidence on the effects and safety of herbal medicine usage during pregnancy. This can help inform policy decisions and guide healthcare providers in providing appropriate care to pregnant women.

It is important to note that these recommendations are general and should be tailored to the specific context and needs of the community in Dega Damot district, Northwest Ethiopia.

AI Innovations Description

Based on the information provided, the following recommendation can be developed into an innovation to improve access to maternal health:

1. Design and implement targeted educational programs: Develop educational programs that specifically target pregnant women and their families to increase their knowledge and awareness about the effects and safety of herbal medicine usage during pregnancy. These programs should provide accurate and evidence-based information to dispel misconceptions and promote informed decision-making.

2. Strengthen antenatal care services: Enhance the quality and accessibility of antenatal care services in the Dega Damot district. This can be achieved by training healthcare providers on the importance of discussing herbal medicine usage during pregnancy with their patients and providing appropriate guidance. Antenatal care visits should include discussions on the potential risks and benefits of herbal medicine usage, as well as alternative options for managing symptoms.

3. Improve media coverage: Expand access to media, such as television, radio, and magazines, in the Dega Damot district. This will allow for the dissemination of accurate and evidence-based information about maternal health, including the effects and safety of herbal medicine usage during pregnancy. Collaborate with media outlets to develop and broadcast educational programs and advertisements that target pregnant women and their families.

4. Increase availability of healthcare facilities: Ensure that healthcare facilities, including primary hospitals, health centers, and health posts, are easily accessible to pregnant women in the Dega Damot district. This can be achieved by improving infrastructure, transportation, and communication systems. Additionally, consider establishing mobile healthcare units or telemedicine services to reach remote areas and provide essential maternal health services.

5. Collaborate with traditional healers: Engage with traditional healers in the Dega Damot district to promote safe and evidence-based practices regarding herbal medicine usage during pregnancy. Provide training and education to traditional healers on the potential risks and benefits of herbal medicine, as well as alternative options for managing pregnancy-related symptoms. Foster collaboration between traditional healers and healthcare providers to ensure holistic and integrated care for pregnant women.

By implementing these recommendations, access to maternal health services can be improved, and pregnant women in the Dega Damot district can make informed decisions regarding herbal medicine usage during pregnancy. This innovation will contribute to the overall well-being and safety of both mothers and their babies.

AI Innovations Methodology

Based on the provided description, the study aims to assess women’s knowledge and attitude towards the effects of herbal medicine usage during pregnancy in Dega Damot district, Northwest Ethiopia. The study also identifies factors associated with women’s knowledge and attitude towards herbal medicine usage during pregnancy.

To improve access to maternal health in this context, the following innovations and recommendations can be considered:

1. Health Education Programs: Implementing health education programs that specifically target pregnant women and their families can help increase awareness and knowledge about the potential risks and benefits of herbal medicine usage during pregnancy. These programs can be conducted through various channels such as community health centers, antenatal care clinics, and media platforms.

2. Training Healthcare Providers: Providing training and education to healthcare providers, including midwives and traditional birth attendants, on the safe and appropriate use of herbal medicine during pregnancy can improve their ability to provide accurate information and guidance to pregnant women. This can be done through workshops, seminars, and continuing education programs.

3. Integration of Traditional Medicine and Modern Healthcare: Promoting the integration of traditional medicine practices with modern healthcare systems can help ensure safe and effective use of herbal medicine during pregnancy. This can involve collaboration between traditional healers and healthcare providers to develop guidelines and protocols for the use of herbal medicine in pregnancy.

4. Strengthening Healthcare Infrastructure: Improving the accessibility and availability of healthcare facilities, particularly in rural areas, can enhance access to maternal health services. This can include increasing the number of health centers, improving transportation systems, and ensuring the availability of essential medicines and supplies.

To simulate the impact of these recommendations on improving access to maternal health, a methodology can be developed as follows:

1. Baseline Data Collection: Collect data on the current knowledge, attitudes, and practices related to herbal medicine usage during pregnancy among women in the study area. This can be done through surveys, interviews, and focus group discussions.

2. Intervention Implementation: Implement the recommended innovations, such as health education programs, training healthcare providers, and strengthening healthcare infrastructure. Monitor and document the implementation process.

3. Post-Intervention Data Collection: After a certain period of time, collect data again on the knowledge, attitudes, and practices related to herbal medicine usage during pregnancy among women in the study area. This can be done using the same methods as the baseline data collection.

4. Data Analysis: Compare the baseline and post-intervention data to assess the impact of the implemented innovations on improving access to maternal health. Analyze the data using appropriate statistical methods, such as chi-square tests or logistic regression, to determine the significance of any changes observed.

5. Evaluation and Recommendations: Evaluate the findings of the data analysis and draw conclusions regarding the effectiveness of the implemented innovations. Based on the results, provide recommendations for further improvements and interventions to continue enhancing access to maternal health.

It is important to note that the specific details of the methodology, including sample size determination, data collection tools, and statistical analysis techniques, may vary depending on the specific objectives and resources available for the study.

Authors & Co-Authors

Statistics:

Citations: 1

Authors: 9

Identifiers:

DOI: 10.2147/DHPS.S355773

Research Areas:

Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Workforce

Study Countries:

Ethiopia

Study Design:

Case-Control Study, Cross Sectional Study, Grounded Theory

Study Approach:

Quantitative

Participants Gender:

Female