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Im HB, Hwang JH, Choi D, Choi SJ, Han D. Patient-physician communication on herbal medicine use during pregnancy: a systematic review and meta-analysis. BMJ Glob Health 2024; 9:e013412. [PMID: 38448037 PMCID: PMC10916170 DOI: 10.1136/bmjgh-2023-013412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/01/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Lack of transparent communication between patients and physicians regarding the use of herbal medicine (HM) presents a major public health challenge, as inappropriate HM use poses health risks. Considering the widespread use of HM and the risk of adverse events, it is crucial for pregnant women to openly discuss their HM use with healthcare providers. Therefore, this systematic review and meta-analysis aims to estimate the pooled prevalence of pregnant women's HM use and disclosure to healthcare providers and to examine the relationship between HM disclosure and various maternal and child health (MCH) measures. METHODS A systematic search of five databases was conducted for cross-sectional studies on HM use during pregnancy published from 2000 to 2023. Data extraction followed a standardised approach, and Stata V.16.0 was used for data analysis. Also, Spearman's correlation coefficient was calculated to examine the association between use and disclosure of HM and various MCH indicators. RESULTS This review included 111 studies across 51 countries on the use of HM among pregnant women. Our findings showed that 34.4% of women used HM during pregnancy, driven by the perception that HM is presumably safer and more natural than conventional medical therapies. However, only 27.9% of the HM users disclosed their use to healthcare providers because they considered HM as harmless and were not prompted by the healthcare providers to discuss their self-care practices. Furthermore, a significant correlation was observed between HM disclosure and improved MCH outcomes. CONCLUSION Inadequate communication between pregnant women and physicians on HM use highlights a deficiency in the quality of care that may be associated with unfavourable maternal outcomes. Thus, physician engagement in effective and unbiased communication about HM during antenatal care, along with evidence-based guidance on HM use, can help mitigate the potential risks associated with inappropriate HM use.
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Affiliation(s)
- Hyea Bin Im
- Department of Global Health and Development, Hanyang University, Seoul, Korea
- Institute of Health Services Management, Hanyang University, Seoul, Korea
| | - Jung Hye Hwang
- Institute of Health Services Management, Hanyang University, Seoul, Korea
- Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Korea
| | - Dain Choi
- Department of Global Health and Development, Hanyang University, Seoul, Korea
- Institute of Health Services Management, Hanyang University, Seoul, Korea
| | - Soo Jeung Choi
- Department of Global Health and Development, Hanyang University, Seoul, Korea
- Institute of Health Services Management, Hanyang University, Seoul, Korea
| | - Dongwoon Han
- Department of Global Health and Development, Hanyang University, Seoul, Korea
- Department of Preventive Medicine, Hanyang University, Seoul, Korea
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Bouqoufi A, Laila L, Boujraf S, Hadj FAE, Razine R, Abouqal R, Khabbal Y. Prevalence and associated factors of self-medication in worldwide pregnant women: systematic review and meta-analysis. BMC Public Health 2024; 24:308. [PMID: 38279083 PMCID: PMC10821266 DOI: 10.1186/s12889-023-17195-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 11/09/2023] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Self-medication during pregnancy is of great interest. The use of drugs during pregnancy requires a careful reflection on the benefits to the mother and the risks to the fetus. Selecting a drug or drugs for treating pregnant women can be difficult for clinicians owing to the various pharmacokinetic and physiological changes encountered during pregnancy. This systematic review and meta-analysis aimed to estimate the pooled prevalence of self-medication and associated factors among women during pregnancy. METHODS Searches were carried out at PubMed, Science Direct, Web of Science, and Google Scholar. The quality of the studies and the risk of bias were analyzed using the Joanna Briggs Critical Appraisal Checklist for Analytical Cross-Sectional Studies instrument. The extracted data were tabulated and analyzed qualitatively and quantitatively through meta-analysis. RESULTS The overall prevalence of self-medication among pregnant women was 44.50% (95% CI: 38.92-50.23). Subgroup analyses showed differences in self-medication prevalence influenced by region, county income, and study design. The Heterogeneity, assessed by the statistical test I2 varied from 96 to 99% and was statistically significant. The result of this funnel plot showed that the funnel plot was symmetry with p-value = 0.36, and there is no publication bias. CONCLUSION The results obtained from this study showed that the prevalence of self-medication among pregnant women is relatively high. This requires effective measures and interventions to reduce self-medication. TRIAL REGISTRATION ID = CRD42022312333 .
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Affiliation(s)
- Afaf Bouqoufi
- Laboratory of Health and Science, Therapeutic Innovation, Translational Research, and Epidemiology. Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
| | - Lahlou Laila
- Laboratory of Health and Science, Therapeutic Innovation, Translational Research, and Epidemiology. Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
| | - Said Boujraf
- Clinical Neurosciences Laboratory, Faculty of Medicine, Sidi Mohamed Ben Abdellah University, Fez, Morocco.
| | - Fatima Ait El Hadj
- Laboratory of Health and Science, Therapeutic Innovation, Translational Research, and Epidemiology. Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
| | - Rachid Razine
- Laboraoty of Epidemiology and Clinical Research, Faculty of Medicine and Pharmacy, University Mohamed V, Rabat, Morocco
| | - Redouane Abouqal
- Laboraoty of Epidemiology and Clinical Research, Faculty of Medicine and Pharmacy, University Mohamed V, Rabat, Morocco
| | - Youssef Khabbal
- Laboratory of Health and Science, Therapeutic Innovation, Translational Research, and Epidemiology. Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
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Bouqoufi A, Lahlou L, Ait El Hadj F, Abdessadek M, Obtel M, Khabbal Y. Prevalence, motivation, and associated factors of medicinal herbs consumption in pregnant women from Eastern Mediterranean Regional Office: a systematic review. PHARMACEUTICAL BIOLOGY 2023; 61:1065-1081. [PMID: 37452524 DOI: 10.1080/13880209.2023.2229388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/17/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023]
Abstract
CONTEXT Worldwide access to medication remains a major public health problem that forces pregnant women to self-medicate with several sources, such as medicinal plants. This alternative medicine is increasing in many low- and high-income countries for several reasons. OBJECTIVE This a systematic literature review on the prevalence of herbal use during pregnancy from the World Health Organization (WHO) Eastern Mediterranean Regional Office. METHODS Cross-sectional studies were searched from January 2011 to June 2021 on PubMed, Scopus, and Web of Science. We used the Rayyan website to identify the relevant studies by screening the abstracts and titles. These were followed by reading the full texts to identify the final studies to be included. The data were extracted, and the quality of the studies was assessed using the quality appraisal tool. RESULTS Of the 33 studies included in this review, 19 were conducted in Iran, 5 in Saudi Arabia, 4 in Palestine, 2 in Egypt, and 1 each in Oman, Iraq, and Jordan; the prevalence of herbal medicine use among pregnant women varied from 19.2% to 90.2%. Several plants were mentioned for pain management during the pregnancy period. The findings suggest family and friends are major motivating sources for the use of herbal medicine. CONCLUSIONS The wide variety of herbal products used in this study reflects the traditions and geographic diversity of the region. Despite the importance of literature-based data about the use of herbal medicine, it is necessary to obtain knowledge, attitude, and motivation for herbal consumption among pregnant women.
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Affiliation(s)
- Afaf Bouqoufi
- Laboratory of Innovation Research in Health Sciences, Therapeutic Innovation, Translational Research, and Epidemiology, Ibn Zohr University, Agadir, Morocco
| | - Laila Lahlou
- Laboratory of Innovation Research in Health Sciences, Therapeutic Innovation, Translational Research, and Epidemiology, Ibn Zohr University, Agadir, Morocco
| | - Fatima Ait El Hadj
- Laboratory of Innovation Research in Health Sciences, Therapeutic Innovation, Translational Research, and Epidemiology, Ibn Zohr University, Agadir, Morocco
| | - Mohammed Abdessadek
- Laayoune Higher School of Technology, Ibn Zohr University, Laayoune, Morocco
| | - Majdouline Obtel
- Social Medicine, Public Health, Hygiene and Preventive Medicine Laboratory, Department of Public Health, Mohammed V University, Rabat, Morocco
| | - Youssef Khabbal
- Laboratory of Innovation Research in Health Sciences, Therapeutic Innovation, Translational Research, and Epidemiology, Ibn Zohr University, Agadir, Morocco
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Sumankuuro J, Baatiema L, Crockett J, Young J. Women's use of non-conventional herbal uterotonic in pregnancy and labour: evidence from birth attendants. BMC Pregnancy Childbirth 2022; 22:600. [PMID: 35896986 PMCID: PMC9327204 DOI: 10.1186/s12884-022-04934-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/19/2022] [Indexed: 11/14/2022] Open
Abstract
Background Over the years, governments and stakeholders have implemented various policies/programmes to improve maternal health outcomes in low-middle-income countries. In Ghana, Community Health Officers were trained as midwives to increase access to skilled maternal healthcare. The government subsequently banned traditional birth attendants from providing direct maternal healthcare in 2000. Despite these, there is an unprecedented utilisation of TBAs’ services, including herbal uterotonics. This has attempted to defeat stakeholders’ campaigns to improve maternal health outcomes. Thus, we explored and highlighted herbal uterotonic consumption in pregnancy and birth and the implications on maternal and newborn health outcomes in North-Western Ghana. Methods This was an exploratory qualitative study that investigated traditional birth attendants (n = 17) and healthcare providers' (n = 26) perspectives on the intake of herbal uterotonics in pregnancy and childbirth in rural Ghana, using in-depth interviews. A combination of convenience, purposive and snowball sampling procedures were employed in selecting participants. Results Findings were captured in two domains: (1) perceived rationale for herbal uterotonic intake, and (2) potential adverse impacts of herbal uterotonic intake in pregnancy and labour, and nine topics: (i) confidence in unskilled attendance at birth, (ii) cost and a shortage of essential medicines, (iii) herbal uterotonics as a remedy for obstetric problems, (iv) herbal uterotonics facilitate birth, (v) attraction of home birth for cultural reasons, (vi) affordability of herbal uterotonics, (vii) unintended consequences and adverse outcomes, (viii) risks using herbal uterotonics to manage fertility and (ix) risks using herbal uterotonics to facilitate home birth. Conclusion The findings have suggested that the intake of non-conventional herbal uterotonic is widespread in the study area, although the constituents of the herb are unknown. However, complex and multiple factors of healthcare cost, desire for homebirth, unawareness of the negative effects of such substances, perceived way of addressing obstetric problems and cultural undertones, among others, accounted for herbal uterotonics consumption. We also encourage research into the constituents of ‘mansugo’ and the potential benefits and adverse effects. We recommend qualitative studies involving previous users of this herbal uterotonic to inform policy and healthcare provision.
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Affiliation(s)
- Joshua Sumankuuro
- Faculty of Public Policy and Governance, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Ghana. .,Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. .,School of Community Health, Faculty of Science, Charles Sturt University, Orange, New South Wales, Australia. .,School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa.
| | - Leonard Baatiema
- Department of Health Policy and Management, University of Ghana, Accra, Ghana.,Department of Global Health and Population, Harvard T.H Chan School of Public Health, Harvard University, Boston, USA
| | - Judith Crockett
- School of Community Health, Faculty of Science, Charles Sturt University, Orange, New South Wales, Australia
| | - Jeanine Young
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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Millinga VP, Im HB, Hwang JH, Choi SJ, Han D. Use of Herbal Medicines Among Breastfeeding Mothers in Tanzania: A Cross-Sectional Study. Front Pharmacol 2022; 13:751129. [PMID: 35571105 PMCID: PMC9096166 DOI: 10.3389/fphar.2022.751129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 03/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background: There are limited data on the use of herbal medicines (HM) among breastfeeding mothers, despite the fact that knowledge of the possible benefits or harms of HM use has a direct relationship with the health of infants, especially in resource-limited countries. The study aims to determine the prevalence and factors associated with HM use among breastfeeding mothers in Tanzania. Methods: The study followed a cross-sectional design using a structured survey questionnaire. Survey participants were recruited from the reproductive and child health clinic at Uhuru health center in Morogoro, Tanzania. The survey instrument comprised of 34 questions, including demographic information, the pattern of HM use during breastfeeding, and women's perceptions of HM. Chi-square test and logistic regression were used for data analysis using SPSS ver. 24.0. Results: The majority of the respondents (53.8%) used HM during breastfeeding. The most commonly used HM was black pepper (Piper nigrum L.; 80.0%), followed by pumpkin seeds (Cucurbita pepo L.; 18.0%). About one-third (27.5%) of HM users discussed their use with their healthcare providers. In addition, higher education levels and low breastmilk supply were identified as potential predictors of HM use. Conclusion: The practice of HM use among breastfeeding mothers in Tanzania is popular to ease breastfeeding difficulties. However, the issue of the safety or effectiveness of HM is still an unknown agenda. This awakens the need to evaluate HM's safety, efficacy, and quality through pharmacological studies for scientific evidence. Lastly, a clinical guideline should be developed in healthcare settings to promote open dialogues between the healthcare providers and mothers to ensure the safe use of HM.
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Affiliation(s)
| | - Hyea Bin Im
- Department of Global Health and Development, Graduate School, Hanyang University, Seoul, South Korea.,Institute of Health Services Management, Hanyang University, Seoul, South Korea
| | - Jung Hye Hwang
- Department of Global Health and Development, Graduate School, Hanyang University, Seoul, South Korea.,Institute of Health Services Management, Hanyang University, Seoul, South Korea.,Department of Obstetrics and Gynecology, College of Medicine, Hanyang University, Seoul, South Korea
| | - Soo Jeung Choi
- Department of Global Health and Development, Graduate School, Hanyang University, Seoul, South Korea.,Institute of Health Services Management, Hanyang University, Seoul, South Korea
| | - Dongwoon Han
- Department of Global Health and Development, Graduate School, Hanyang University, Seoul, South Korea.,Institute of Health Services Management, Hanyang University, Seoul, South Korea.,Department of Preventive Medicine, College of Medicine, Hanyang University, Seoul, South Korea
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Sumankuuro J, Wulifan JK, Angko W, Crockett J, Derbile EK, Ganle JK. Predictors of maternal mortality in Ghana: evidence from the 2017 GMHS Verbal Autopsy data. Int J Health Plann Manage 2020; 35:1512-1531. [PMID: 32901986 DOI: 10.1002/hpm.3054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/25/2020] [Accepted: 08/07/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Maternal mortality remains a significant public health challenge in many low and middle-income countries, including Ghana. From Ghana's 2017 Maternal Health Survey verbal autopsy data, we examined the predictors of maternal mortality in Ghana. METHODS A total of 1240 deaths of women aged 15-49 were involved in the survey across all regions in Ghana. Binary and multivariate logistic regression analyses were employed; confidence level was set at 95%. RESULTS The results show that the prevalence of maternal death was 13.2% (164/1240). After adjusting for potential covariates, women aged 20-29 years (aOR = 4.270, 95%CI= 1.864 - 9.781, p=0.001), bled during labour/delivery (aOR= 0.241, 95%CI = 0.059 - 0.992, p=0.049), and those who used traditional/herbal medicines during pregnancy were more likely to die compared to non-users (aOR= 3.461, 95%CI = 1.651 - 7.258, p=0.001). CONCLUSION Our findings highlight the need to intensify maternal education regarding the value to be gained by increasing skilled healthcare during complications in pregnancy to allow effective management of complications during labour/delivery. Also, education for pregnant women and their families on possible adverse effects of using unapproved traditional/herbal medicines during pregnancy as well as a need to seek timely care before the onset of labour to allow healthcare providers ample opportunity to address labour and birth complications, is urgently required.
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Affiliation(s)
- Joshua Sumankuuro
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,School of Public Policy and Governance, Faculty of Planning and Land Management, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Ghana.,School of Community Health, Faculty of Science, Charles Sturt University, Australia
| | - Joseph K Wulifan
- School of Business and Law, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Ghana
| | - William Angko
- School of Business and Law, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Ghana
| | - Judith Crockett
- School of Community Health, Faculty of Science, Charles Sturt University, Australia
| | - Emmanuel K Derbile
- School of Public Policy and Governance, Faculty of Planning and Land Management, Simon Diedong Dombo University of Business and Integrated Development Studies, Wa, Ghana
| | - John K Ganle
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
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