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Background: According to World Health Organization (WHO) estimates, 80 % of the population living in rural areas in developing countries depends on traditional medicine for their health needs, including use during pregnancy. Despite the fact that knowledge of potential side effects of many herbal medicines in pregnancy is limited and that some herbal products may be teratogenic, data on the extent of use of herbal medicines by women during pregnancy in the study setting is largely unknown. We determined the prevalence and factors associated with herbal medicine use during pregnancy among women attending postnatal clinics in Gulu district, Northern Uganda. Methods: This was a descriptive cross-sectional study which involved 383 women attending postnatal care across four sites in Gulu district using quantitative and qualitative methods of data collection. A structured questionnaire was used to collect quantitative data while qualitative data were obtained using focus group discussions and key informant interviews. The selection of the study participants was by systematic sampling and the main outcome variable was the proportion of mothers who used herbal medicine. Quantitative data was coded and entered into a computerized database using Epidata 3.1. Analysis was done using Statistical Package for Social Scientists version 13, while thematic analysis was used for qualitative data. Results: The prevalence of herbal medicines use during the current pregnancy was 20 % (78/383), and was commonly used in the second 23 % (18/78) and third 21 % (16/78) trimesters. The factors significantly associated with use of herbal medicines during pregnancy were perception (OR 2.18, CI 1.02-4.66), and having ever used herbal medicines during previous pregnancy (OR 2.51, CI 1.21-5.19) and for other reasons (OR 3.87, CI 1.46-10.25). Conclusions: The use of herbal medicines during pregnancy among women in Gulu district is common, which may be an indicator for poor access to conventional western healthcare. Perception that herbal medicines are effective and having ever used herbal medicines during previous pregnancy were associated with use of herbal medicines during current pregnancy. This therefore calls for community sensitization drives on the dangers of indiscriminate use of herbal medicine in pregnancy, as well as integration of trained traditional herbalists and all those community persons who influence the process in addressing the varied health needs of pregnant women.
The study was conducted in four (4) selected health facilities in Gulu district, northern Uganda, with a population of 479,496 inhabitants [33]. The main economic activity in the district is subsistence agriculture, in which over 90 % of the population is engaged. The district has one government regional referral hospital, two private hospitals, two health centre IVs and thirteen health centre IIIs which provide maternal health services including postnatal care services. However, access to health services still remains a challenge in the district as a whole. Over 37 % of the population moves a distance of more than 5 km to reach health services. High levels of poverty and illiteracy, especially among women, is exacerbated by high prevalence of preventable diseases. This was a descriptive cross-sectional study, using both quantitative and qualitative methods, and involving 383 postnatal mothers attending postnatal clinics (PNC) within the study period. The sample size was calculated using the Kish Leslie formula [34], using the formula, n = z2pq/d2, where n = required sample size, z = standard normal value corresponding to 95 % confidence interval (1.96), p = estimated proportion of herbal medicine use among pregnant women, which in this case is 21 % [9], q = p-1, and d = absolute errors between estimated and true value (5 %). This was multiplied by a design effect of 1.5, giving a total sample size of 383. The study population consisted of women attending postnatal clinic in the facilities in Gulu district during the study period. Women who were critically sick at the time of the visit (5 respondents) and those who were not able to understand the questions because of language barrier (2 respondents) were excluded. Multistage sampling technique was used to select first, the health facilities for the study, and later, the respondents from each facility selected. The health facilities were first grouped into three strata comprising hospitals, health center IVs and health center IIIs. The only public hospital together with the two private hospitals were all grouped as one stratum of ‘hospitals’. Simple random sampling was then used to select the desired number of facility from each stratum where two hospitals and one health center each from the health center IV and III strata were selected as sites for the study. The determination of the number of health facilities chosen from each stratum was purposive in order to keep the research within the scope. The selection of the study participants from each of the sampled health facility was done by systematic sampling until the required sample size was realized. According to a preliminary survey of records from the health facility postnatal registers, it was estimated that about 20 mothers attend the PNC daily in hospitals and health center IVs (HCIVs), while about 10 attend in health center IIIs (HCIIIs). We therefore recruited 6 participants each day from the hospitals and HCIVs, and 3 from health center III. Therefore, every third mother (20/6 and 10/3 for hospitals/HCIV and HCIII respectively) was selected for the study, with the first participant being picked at random from assigned numbers. The selected mothers were then introduced to the study in more details, including the working definition of herbal medicine, and informed consent obtained for participation in the study before enrollement. A pre-coded and pre-tested structured questionnaire to capture respondents’ demographic characteristics, obstetrics characteristics, herbal medicine use during pregnancy and associated factors, and characteristics of herbal medicine use was used to collect quantitative data, while qualitative data were collected from focus group discussions (FGD) and key informant interviews (KII) using FGD and KII guides respectively. The questionnaires and interview guides were written in English as well as translated and administered in the local language understood by the participants. For qualitative data, three focus group discussions (FGDs) were conducted in the community involving women who had not been part of the quantitative study in order to get a local perspective of the subject matter. Eight mothers were included in each of the FGDs. The groups involved mothers in the age group 20–38 years excluding grandmothers and mothers-in-law who usually have great influence in this community, in order to allow free expression of views. The discussions were moderated by the researcher and recorded on tape as well as notes taken by a rapporteur. Four key informants comprising one village health team (VHT), one local council one and two midwives were selectively interviewed to get a broader perspective of the aspects of herbal medicine use during pregnancy. Data were coded and entered into a computerized database using Epidata 3.1. Data were cleaned and analysis was done at three levels using Statistical Package for Social Scientists (SPSS) version 13 software package. In univariate analysis, categorical variables were summarized as proportions, while continuous variables as means, median and standard deviations (SD). Prevalence was calculated as the proportion of study participants who used herbal medicines, the denominator being all postnatal mothers enrolled in the study. In the bi-variate analysis, the chi-square test (for categorical variables) and student t-test (for continuous variables) were used to test if the factors among mothers who used herbal medicines during pregnancy were different from those among mothers who did not use herbal medicines. Odds ratios, with 95 % confidence interval (CI) was used to measure the strength of association between use of herbal medicines during pregnancy and individual, socio-cultural, obstetrics/maternal, and health systems factors. Multivariable analysis using logistic regression, backward stepwise procedure was used to select variables to be included in the final model to determine the factors that were independently associated with use of herbal medicine during pregnancy. Included in the model at multivariable analysis were factors that were significant at bivariate analysis and those with scientific plausibility though were not significant. P-value <0.05 was considered for statistical significance. Results were summarized in bar graphs, tables, and texts. Qualitative information generated from the FGDs and Key informant interviews were analyzed manually using thematic analysis according to emerging themes. Transcribed data were coded and main emerging themes were identified and presented as text quotes.
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