Herbal Medicines use During Pregnancy: Perceptions of Pregnant Women and Associated Factors at Kawempe National Referral Hospital

Herbal Medicines use During Pregnancy: Perceptions of Pregnant Women and Associated Factors at Kawempe National Referral Hospital | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Herbal Medicines use During Pregnancy: Perceptions of Pregnant Women and Associated Factors at Kawempe National Referral Hospital Jonathan Gwoyitamuno, Saul Sebairawo, Dr. Rajab Kalid This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7837990/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Uganda still registers a higher rate of herbal medicine use during pregnancy ranging from 20.4% to 69.8%. Despite the high prevalence, there is limited data published on perceived safety and efficacy of herbal medicines during pregnancy. This study aimed at assessing the perceptions of pregnant women on herbal medicines use and the associated factors at Kawempe National Referral Hospital. In this cross-sectional study, 291 pregnant women who had come for antenatal care visits participated after informed consent. After a systematic sampling, a questionnaire was administered to collect data on demographics, perception on severity and efficacy. Majority of the participants were between 20–29 years of age and had attained a secondary level of education. Perception on safety was among 64.2% of pregnant women while perception on efficacy was at 73.2%. Level of education (p = 0.011, 0.012), Occupation (p < 0.001, = 0.009) and Use/non-use of herbal medicine during pregnancy (P < 0.001, 0,001) were significantly associated with the perceptions of pregnant women on the safety and efficacy of herbal medicine during pregnancy respectively. Majority of the pregnant women still perceive herbal medicines to be safe and effective during pregnancy. Therefore, sensitization and regulations by National Drug Authority should be enhanced. Clinical Pharmacology Pregnancy herbal medicines safety and efficacy herbal medicines Kawempe Uganda Figures Figure 1 Figure 2 Introduction In spite of the increased acceptance of modern medicine across societies, herbal medicines are still widely used in developed and developing countries [ 1 ]. Approximately 65–80% of the world’s population use traditional medicine as their primary form of health care. In sub-Saharan Africa, up to 80% of the population use herbal medicines to meet their health care needs [ 2 ]. Reliance on herbal medicines is relatively high among rural populations, and is associated with challenges in accessing public healthcare in Africa [ 3 ]. The usage of herbal medicines among pregnant women is increasing across the globe, though little data exists on efficacy and safety of herbal medicines use in pregnancy [ 4 , 5 ]. Worldwide, around 67% of women use herbal medicines during pregnancy. In Africa, there is a wide variation in herbal medicine usage during pregnancy, ranging from 10 to 100% [ 4 ]. Many physiological changes happen during pregnancy, which may cause nausea, vomiting, heartburn, constipation, hypertension, peripheral edema [ 6 ]. Therefore exposure to herbal medicines is frequent in pregnancy to meet some of the health care needs and often on a self-treatment basis. Most common herbs used are ginger (69.8%), garlic (39.8%), Eucalyptus globulus , moringa and others. Nausea (23.90%) and morning sickness (21.05%) are the most common reasons for herbal medicine use in pregnancy [ 2 ]. While use of herbal medicines in pregnancy varies considerably between countries, many of the same herbs are used [ 7 ]. Safety and efficacy data for herbal medicines used in pregnancy are mainly based on experience over time as few clinical trials have been performed. One of the greatest concerns is that there is some evidence of expectant mothers taking some of the potentially harmful herbal medicines where documentation is inadequate to evaluate safety in pregnancy [ 8 ]. Herbal medicines are not evaluated according to the same standards as conventional pharmaceuticals. The lack of safety documentation associated with unlicensed herbal medicines plus the inadequate quality control in their production constitutes a risk for their use during pregnancy [ 8 ]. Although some herbal products may induce premature uterine contractions or even be teratogenic, knowledge of potential side effects of many herbal medicines in pregnancy is limited. Pregnant women recognize the potential risks of drug usage during pregnancy but they do not realize that herbal products too could be toxic. They base on the implicit belief that herbal products, being natural are necessarily safe [ 7 ]. Other facilitators of herbal medicine use during pregnancy include cultural beliefs that herbal medicines can strengthen the pregnancy and previous experience with herbal medicines [ 2 ]. Majority of the pregnant women don’t disclose their use of herbal medicines to health care providers. The most frequently reported reasons for non-disclosure include; forgetting to inform the health care worker, followed by doctor did not ask, afraid of doctor’s response, and it was not important to disclose [ 5 ]. This poses a risk since the herbal medicines can have potentially harmful interactions with the conventional medicines. Therefore study aimed at assessing the perceptions of pregnant women on herbal medicines use and the associated factors at Kawempe National Referral Hospital-Central Uganda. Methods and materials Study setting. A cross sectional study was carried out at Kawempe National Referral Hospital (KNRH) located in Kawempe division, Kampala district, 6km from Kampala city Centre. It offers comprehensive gynecological and obstetric services to women residing in and near Kampala and those referred from other health facilities in Uganda. KNRH is a large hospital with over 21,000 deliveries per annum, 200 antenatal clinic visits and 100 child admissions per day[ 9 ]. The hospital provides preventative and curative care during pregnancy and intra-partum, newborn and postnatal care, a pediatric ward and vaccination services at a standard indicative of care in urban Uganda. The hospital runs an antenatal care (ANC) clinic 3 times a week. Data collection tool and tools. Data collection tool was first developed in English and were translated in to local language (Luganda) .Review and approval was made by the supervisor. A questionnaire was prepared by reviewing different literatures and other checklists which were related to the subject. This questionnaire contained a total of 27 questions about demographics and current herbal medication use, perception on efficacy of herbal medicines. Herbal medicine use as well as concerns about safety of herbal medicines. After obtaining an informed consent, information from pregnant mothers during their antenatal visit was collected through a face to face interview using pretested structured and interviewer administered questionnaires by trained experienced research assistants who were fluent in Luganda and English. Pregnant mothers were interviewed thoroughly by the trained research assistants under supervision of the supervisor, however those who were literate were asked to complete the questionnaires with help of research assistants. Continuous follow up and supervision was made by the supervisor throughout the data collection period. Data quality management Training about the objective of the study, data collection tool, data collection procedures, ethical consideration to ensure uniformity during data collection and to minimize errors was given to research assistants by the supervisor. The questionnaire was pilot-tested on 12 pregnant mothers within the same age group and level of education as the study population to test for understanding of the questions, estimate duration of the interviews, test reliability and validity of the tool. These women were personally interviewed by one of the investigators and asked to rephrase the items using their own words, after which the questionnaire was modified to make it easier to understand Ambiguous, complex and irrelevant questions were modified and the final version was used for data collection. Close supervision was carried out by the investigators during the data collection time. Data from each respondent were checked for its completeness, clarity, consistency and accuracy by the supervisor. Data Analysis Process The data collected were checked for completeness and consistencies and then it was cleaned, coded and compiled in Microsoft excel sheet 2016, later cleaned and then exported to IBM SPSS Statistics software version 27 to perform statistical analysis. In order to be able to handle missing data, all the questionnaires were numbered. Descriptive statistics were created and presented with text and tables. Bivariate analysis was performed to determine the association between each independent variable and the dependent variable. A p value of < 0.05 was considered statistically significant at multivariate analysis at a 95% confidence interval. Finally, both the crude odds ratio and the adjusted odds ratio were reported with 95% confidence intervals (CI). Ethical consideration The ethical approval was obtained from the Institutional Review Board (IRB) research and ethics committee of the School of Health Sciences Makerere University with a reference number MAKSHSREC-2023-452. Permission to conduct the study was sought from KNRH administration and it was granted by the hospital director. The study was integrated in service provision and did not interrupt or delay tailored care for the pregnant mothers. All pregnant mothers were requested to give n informed consent written consent before being interviewed and they were notified that they have the right to refuse or terminate at any point of the interview The consent form was also translated into the local language for those who never understood English and it was read out to each pregnant mother. To ensure thorough understanding, pregnant mothers were given an opportunity to ask questions before signing the consent form. Privacy of the participants was observed by using Unique IDs instead of names. The questionnaires were administered in a secluded private area for confidentiality and privacy of participant information. Uganda’s Ministry of Health infection prevention procedures and guidelines for COVID-19 were followed by both the research team and the study participants. Study target and source population The target population were mothers seeking care at KNRH. The study population were pregnant mothers at KNRH who had come for antenatal care (ANC) visits during the study period. Sample size determination and sampling technique A sample size of 384 pregnant mothers was sampled to participate in this study. The sample size was calculated using the Cochran’s (1977), where estimated proportion of pregnant women who perceive that herbal medicines are safe and effective in pregnancy, which in this case was 50% because there was no published statistics in Uganda for this proportion. The sampling error used was 5% at a 95% level of confidence with an assumption that antenatal visits were evenly distributed over the months. KNRH has over 200 antenatal clinic visits per day of antenatal visit (3 days of antenatal visits per week i.e Tuesday, Wednesday and Thursday) [ 9 ] and the study was conducted at KNRH in 6 days of antenatal visits, giving a population size of about 1200 women. Since the sample size was a significant fraction (typically, greater than 5%) of the total population size, finite population correction (FPC) for proportion of 291 mothers was determined to lower the bias and increasing statistical power. Sampling procedure and participant recruitment. The study employed a systematic sampling was used to select participants. Given that our total sample size was 291 pregnant women and we were to correct our data for 6 days, our daily sample size (n) was (291/6) ≈ 49. Daily population size (N) is 200 antenatal care visits. Therefore, sampling interval, k, given by: k = N/n which is 200/49 ≈ 4. A random starting point between 1 and 4 was selected, and every 4th eligible pregnant woman was selected to participate in the study until 49 pregnant women have participated in the study per day for 6 days. Though sometimes the numbers could exceed 200 and we would get more than 49 pregnant women participating in the study. Inclusion criteria : Eligible study participants were Women who were pregnant and were visiting KNRH for ANC visit. Exclusion criteria Non-consenting pregnant women and those who were very sick were excluded. Dependent variables The dependent variable was the perceptions of pregnant women on the safety and efficacy of herbal medicines use during pregnancy. Independent variables The independent variables comprised of socio-demographic characteristics of interest including age, level of education, parity, marital status, job and place of residence, users and non-users of herbal medicines. Operational definitions Herbal medicines are plants or plant parts that are locally used to treat disease and enhance general health and wellbeing. An herb is a plant or plant part used because of its therapeutic properties. An herbal supplement is a product made from plants and used solely for internal use. Herbal medicines use is the therapeutic utilization of plants, plant parts or plant extracts to treat disease and enhance general health and wellbeing. Pregnancy is the term used to describe the period in which a fetus develops inside a woman's womb or uterus. Perceptions refer to the way in which something is regarded, understood or interpreted. Efficacy refers to ability of a drug to produce a desired result or effect. Safety in relation to drug use refers to the frequency of adverse drug effects (i.e., physical or laboratory toxicity that could possibly be related to the drug) that are treatment emergent. Results Socio-demographic characteristics of the study participants. Majority of the 291 pregnant women, 56.4% (n = 164/291) were between 20–29 years of age. The education level attained by most of the pregnant women, 47.1% (n = 137/291) was secondary level and most of the pregnant women, 45.7% (n = 133/291) were self-employed. Many of the pregnant women were married, 64.9% (n = 189/291) and were residing in urban areas, 67.4% (n = 196/291) as detailed in Table 1 Table 1 Socio-demographic characteristics of the pregnant women that were participants. Variable Frequency, (n = 291) Percentage (%) Age (years) 20–29 164 56.4 30–39 101 34.7 40 and above 14 4.8 19 and below 12 4.1 Level of education Secondary 137 47.1 University/Institution 80 27.5 Primary 74 25.4 Occupation Self-employed 133 45.7 Unemployed 111 38.1 Formal employment 46 15.8 Marital Status Married 189 64.9 Single 75 25.8 Divorced 24 8.2 Area of Residence Urban 196 67.4 Rural 93 32.0 Herbal medicine use in pregnancy About 62.5% (n = 182/291) of the pregnant women were users of herbal medicines in pregnancy. Among the users of herbal medicines in pregnancy, 51.7% (n = 92/178) of them used the herbal medicine daily to several times a week. Majority of the pregnant women, 42.3% (n = 77/182) used herbal medicines during the second trimester of pregnancy. Family and friends, 67.6% (n = 123/182) were the main source of recommendation for herbal medicine use in pregnancy and 58% (n = 105/181) of the pregnant women did not disclose to their healthcare provider that they were using herbal medicines during pregnancy as shown in Table 2 Table 2 Use of herbal medicine in pregnancy. Have you used herbal medicines during pregnancy? Frequency, (n = 291) Percentage (%) Yes 182 62.5 No 109 37.5 Frequency of herbal medicine use Frequency, (n = 178) Percentage (%) Daily-several times a week 92 51.7 Once a week-once a month 86 48.3 Time of pregnancy when herbal medicine is used Frequency, (n = 182) Percentage (%) 3–6 months 77 42.3 0–3 months 65 35.7 > 6 months 40 22.0 Source of recommendation for herbal medicine use Frequency, (n = 182) Percentage (%) Family/friends 123 67.6 Self 29 15.9 Health worker 24 13.2 Internet 6 3.3 Disclosure to healthcare provider Frequency, (n = 181) Percentage (%) No 105 58.0 Yes 76 42.0 The total number of pregnant women may vary due to missing data on individual questions. Reasons for using herbal medicine. The most cited reasons for use of herbal medicine among the pregnant women is vomiting and nausea (22.9%), cough (15.1%), better health of the unborn baby 13.4%, and to increase chances of safe delivery 12.8% as shown in Fig. 1 . Perceptions on safety and efficacy of herbal medicines in pregnancy. Perceptions on safety Majority of the pregnant women, 64.2% (n = 186/291) perceived herbal medicines to be safe during pregnancy. Most of the pregnant women 47.8%, n = 139/291 strongly agree or agree that herbal medicines are safe to use during the first 3 months of pregnancy. The perceptions of pregnant women on the safety of herbal medicines during pregnancy are shown in Table 3 Table 3 Pregnant women’s perceptions on the safety of herbal medicines during pregnancy. Statements Frequency, n = 291 (%) Strongly disagree or Disagree Neutral Strongly agree or Agree I believe herbal medicine is safe to use during pregnancy 66 (22.8) 38 (13.1) 186 (64.2) Herbal medicines are safe to use during the first 3 months of pregnancy 90 (30.9) 62 (21.3) 139 (47.8) Herbal medicines are safe to use during the last 3 months of pregnancy 104 (35.7) 68 (23.4) 119 (40.9) I believe that herbal medicine is as safe as prescription medicine for pregnant women 86 (29.6) 89 (30.6) 116 (39.8) I am comfortable recommending herbal medicine to other pregnant women 95 (32.8) 59 (20.3) 136 (46.9) Herbal medicine is safer than prescription medication for pregnant women. 158 (54.4) 79 (27.2) 53 (18.3) If I had herbal medicine prescribed by a health worker during pregnancy, I would adhere to the treatment. 48 (16.6) 23 (7.9) 219 (75.3) Perceptions on efficacy. Out of the 291 pregnant women that participated in our study, 73.2% (n = 213/291) perceived herbal medicine to be effective in treating pregnancy related conditions. More than a half of the pregnant women, 52.1% (n = 151/291) strongly disagreed or disagreed that herbal medicine is more effective than prescription medication for treating pregnancy-related conditions as shown in Table 4 Table 4 Pregnant women’s perceptions on the efficacy of herbal medicines during pregnancy. Statements Frequency, n = 291 (%) Strongly disagree or Disagree Neutral Strongly agree or Agree Herbal medicine is effective for treating pregnancy-related conditions 52 (17.8) 26 (8.9) 213 (73.2%) Herbal medicine is as effective as prescription medication for treating pregnancy-related conditions 79 (27.2) 76 (26.1) 136 (46.7) I am comfortable recommending herbal medicine to other pregnant women for treatment 100 (34.4) 78 (26.8) 133 (38.8) Herbal medicine is more effective than prescription medication for treating pregnancy-related conditions 151 (52.1) 85 (29.2) 54 (18. 6) Majority of the pregnant women, 58.1% (n = 169/291) that participated in our study perceive herbal medicines to be are safe and effective in pregnancy as illustrated in Fig. 2 . Factors associated with the perceptions of pregnant women on safety and efficacy of herbal medicines. Herbal medicine use. Perceptions on safety and efficacy of herbal medicine during pregnancy was consistent with use/non-use as shown in Table 5 .The majority of users of herbal medicine, 90.6% (n = 165/182 strongly agreed or agreed that herbal medicines were safe during pregnancy while many of the non-users, 56.9% (n = 62/109) strongly disagreed or disagreed that herbal medicine was safe during pregnancy ( p < 0.001).For the efficacy of herbal medicines in pregnancy, majority of both the users, 88.4%, (n = 161/182) and non-users, 47.7% (n = 52/109) strongly agreed or agreed that herbal medicines were effective for treating pregnancy-related conditions ( p < 0.001). Table 5 Perceptions of pregnant women on the safety and efficacy of herbal medicines in pregnancy in relation to herbal medicines use during pregnancy. Have you used herbal medicines during pregnancy Pearson Chi-square Analysis Yes Frequency, n = 182 (%) No Frequency, n = 109 (%) X 2 df p-value Herbal medicine is safe to use during pregnancy. Strongly disagree or Disagree 5 (2.7) 62 (56.9) 155.97 4 < 0.001 Neutral 12 (6.6) 26 (23.8) Strongly agree or Agree 165 (90.6) 21 (19.3) Herbal medicine is effective for treating pregnancy-related conditions. Strongly disagree or Disagree 13 (7.1) 39 (35.8) 65.28 4 < 0.001 Neutral 8 (4.4) 18 (16.5) Strongly agree or Agree 161 (88.4) 52 (47.7) Socio-demographic characteristics Level of education was significantly associated with the perceptions of pregnant women on the safety ( p = 0.011 and efficacy ( p = 0.012) of herbal medicine during pregnancy. Majority of the women with secondary level education strongly agree or agree that herbal medicines are safe and effective during pregnancy followed by women with primary level education. Occupation was also significantly associated with the perceptions of pregnant women on safety ( p < 0.001) and efficacy ( p = 0.009) of herbal medicines in pregnancy. Majority of the self-employed women strongly agreed or agreed that herbal medicines are safe and effective during pregnancy as shown in Table 6 & 7 . Table 6 Association of socio-demographic characteristics with perceptions of pregnant women on the safety of herbal medicines during pregnancy. Herbal medicine is safe to use during pregnancy, Frequency (n = 291) Pearson Chi-Square Analysis Strongly disagree or Disagree Neutral Strongly agree or Agree X 2 df p-value Age (Years) 19 and below 2 3 7 9.73 12 0.640 20–29 36 24 103 30–39 25 9 67 40 and above 3 2 9 Marital Status Single 25 13 46 12.14 8 0.145 Married 43 23 123 Divorced 7 0 17 Area of Residence Urban 43 28 124 6.99 4 0.137 Rural 22 10 61 Level of Education Primary 9 12 53 19.83 8 0.011 Secondary 28 14 94 University/ Institution 29 12 39 Occupation Unemployed 19 15 76 40.78 8 < 0.001 Self-employed 22 16 95 Formal employment 25 7 14 The total number of pregnant women may vary due to missing data on individual questions. Table 7 Association of socio-demographic characteristics with perceptions of pregnant women on the efficacy of herbal medicines during pregnancy. Herbal medicine is effective for treating pregnancy-related conditions , Frequency (n = 291) Pearson Chi-Square Analysis Strongly disagree or Disagree Neutral Strongly agree or Agree X 2 df p-value Age (Years) 19 and below 1 4 7 16.16 12 0.184 20–29 29 16 119 30–39 20 5 76 40 and above 2 1 11 Marital Status Single 5 8 62 9.34 8 0.315 Married 39 17 133 Divorced 5 1 18 Area of Residence Urban 30 19 147 8.85 4 0.065 Rural 21 7 65 Level of Education Primary 6 6 62 19.59 8 0.012 Secondary 34 14 99 University/Institution 22 6 52 Occupation Unemployed 12 14 85 20.32 8 0.009 Self-employed 25 7 101 Formal employment 15 5 26 The total number of pregnant women may vary due to missing data on individual questions. Discussion of the results In this study we set to study the perceptions of pregnant women on the safety and efficacy of herbal medicines during pregnancy and the factors associated with their perceptions at a tertiary hospital in Uganda. Women’s perception of safety and efficacy towards medicine during pregnancy is an important factor affecting the treatment and use of medication, sometimes perhaps in an inappropriate way [ 10 ]. Assessing perceptions about the safety and efficacy of herbal medicine among pregnant women during pregnancy is essential, as it can be a tool in determining strategies to ensure safe and appropriate use of herbal medicines during pregnancy. Perceptions of pregnant women on safety and efficacy of herbal medicines. Majority of the pregnant women, 64.2% (n = 186/291) perceived herbal medicines to be safe during pregnancy. This result is similar to the findings of a study done in North Ethiopia by Abdollahi et al. (2019) who found out that 57.3% of pregnant women had a positive attitude towards the effects of herbal medicine usage during pregnancy [ 11 ]. This could be explained by the fact that herbal remedies have been used for generations to treat various ailments, including during pregnancy [ 2 ] therefore these traditional practices often shape people's perceptions and beliefs about the safety and efficacy of herbal medicines. More than a half of the pregnant women, 52.1% (n = 151/291) strongly disagreed or disagreed that herbal medicine is more effective than prescription medication for treating pregnancy-related conditions. This is comparable to the results reported by Mothupi (2014) in Nairobi, Kenya where majority of the pregnant women agreed with the statement that Western medicine is more efficacious than herbal medicine for most of the illnesses associated with pregnancy [ 3 ]. This similarity may be due to the area where the studies were carried out. Both this study and the one done by Mothupi were carried out in health care facilities and western medicine is generally the primary approach recommended and practiced by healthcare professionals in these settings. Pregnant women tend to trust and value the expertise and guidance of their healthcare providers, further reinforcing the belief that Western medicine is more efficacious. The percentage of pregnant women, 73.2% (n = 213/291) who perceive herbal medicines to be effective in treating pregnancy-related conditions is higher than those that perceive herbal medicines to be safe in pregnancy, 63.9% (n = 186/291). Associated Factors Perceptions on safety and efficacy of herbal medicine during pregnancy was consistent with use/ non-use of herbal medicine in pregnancy ( p < 0.001). Majority of the pregnant women who used herbal medicines during pregnancy perceived and believed that herbal medicines are effective and safe during pregnancy, a finding comparable to that reported by Nyeko et al. (2016) in Gulu, Uganda [ 7 ] and Rahman et al. (2008) in Malaysia [ 12 ]. Similar findings have been reported by other authors such Mothupi (2014) in Nairobi, Kenya, [ 3 ]. This could be explained by the fact that perception on the safety and effectiveness of herbal medicines in solving problems will tend to influence whether mothers might use them again in the next pregnancy. More still, the above findings could also be related to cultural beliefs on causation of ill-health and belief that herbal medicines are inherently safe and cure many illnesses [ 7 ]. Therefore, given that majority of the women do interface with the healthcare system at least once during their pregnancy, the healthcare providers should use this as an opportunity to sensitize them on the various limitations and potential adverse effects of herbal medicines, especially with regards to pregnancy. Level of education was significantly associated with the perceptions of pregnant women on the safety and efficacy of herbal medicine during pregnancy ( p = 0.011) and (p = 0.012) respectively. Pregnant women with secondary education or only primary education perceived herbal medicine to be safe and effective during pregnancy more than pregnant women with university/institutional (higher) education. These findings are in line with the findings of Mothupi (2014) in Nairobi, Kenya [ 3 ] and different from the findings of Wolgast et al (2019) in Sweden [ 13 ] who did not find any associations between level of education and perceptions about herbal medicines. A possible explanation to this is that pregnant women with lower levels of education may have limited access to accurate and up-to-date healthcare information, including information on the potential risks and benefits of herbal medicines during pregnancy. They may rely on word-of-mouth, traditional beliefs, or cultural practices that promote the use of herbal medicines without fully understanding their potential dangers. Lower-educated and moderately educated pregnant women may come from communities or cultures where the use of herbal medicines is deeply ingrained in traditional practices. These cultural beliefs and traditions may have been passed down through generations, reinforcing the perception that herbal medicines are safe and effective. The results are different from those from a study in Sweden probably due to the high level of public sensitization about medication use in such developed countries. This finding therefore calls for concerted efforts in community sensitization in changing some of these perceptions. Occupation was also significantly associated with the perceptions of pregnant women on safety and efficacy of herbal medicines in pregnancy ( p < 0.001) and (p = 0.009) respectively. This is similar to the findings of Laelago et al. (2016) in Hossana town, Southern Ethiopia [ 14 ]. Majority of the self-employed women strongly agreeing or agreeing that herbal medicines are safe and effective during pregnancy. Being self-employed often requires a certain level of independence, self-reliance, and a proactive attitude towards problem-solving. Pregnant women who are self-employed may exhibit a similar mindset when it comes to their health. They may perceive herbal medicines as a way to take control of their own health, relying on self-care practices rather than seeking external medical advice. Strength and limitations of the study. By selecting potential study participants systematically, the selection bias was minimized. The study was done in only one health care facility. Our study site being the biggest gynecological center in the country makes the findings can be generalizable to a Ugandan population. Another limitation is of questionnaire studies in general. To minimize information bias brought about by self-reporting, the respondents were assured of anonymity which probably increased the honesty of the answers. Conclusion and Recommendations Majority of the pregnant women perceived herbal medicines to be safe and effective during pregnancy. The perceptions of pregnant women on the safety and efficacy of herbal medicines were associated with use/non-use of herbal medicine of herbal medicine during pregnancy, level of education and occupation. Basing on this study findings, we recommend : A qualitative study on the perceptions of pregnant women on the safety and efficacy of herbal medicine should be conducted to broaden understanding of the subject, Healthcare providers should always ask pregnant mothers whether they are using herbal medicine or not and then sensitize and discuss with them the benefits and various limitations of herbal medicines, especially with regards to pregnancy, and the National Drug authority to strengthen its regulation in order to ensure safe use of herbal medicines and also encourage development of herbal medicines while following the standard guidelines. Abbreviations ANC : Antenatal Care, IRB : Institutional Review Board, KNRH : Kawempe National Referral Hospital, SDG 3 : Sustainable Development Goal 3, G.J : Gwoyitamuno Jonathan, S.S: Sebairawo Saul, K.R: Karidi Rajab. Declarations Supplementary Materials Supplementary materials will be provided by the corresponding author up on request.. Author Contributions G.J and S.S - conceived the idea, designed the study, provided resources, collected data, wrote the reports and drafted the first version of manuscript. G.J –Data entry, Analysis and data interpretation. K.R - Guided in proposal writing, supervision of research process, verification of analyzed data and approved the thesis. K.R – Provided technical guidance, approved thesis and supervision, All authors reviewed the manuscript and approved the final version of the manuscript. Funding This research received no external funding, it was self-sponsored. Institutional Review Board Statement This study was conducted in accordance with the Declaration of Helsinki, and approved by Institutional Review Board (IRB) research and ethics committee of the School of Health Sciences Makerere University with a reference number MAKSHSREC-2023-452. Permission to conduct the study was sought from KNRH administration and it was granted by the hospital director. The study was integrated in service provision and did not interrupt or delay tailored care for the pregnant mothers Informed Consent Statement All participants provided written informed consent at enrollment. The consent process was administered in both English and local language determined by the preference of the participant. Data Availability Statement Data used in this study is available from the corresponding author upon request. Acknowledgments We are grateful to the administration of Kawempe National Referral Hospital for granting us permission to carry out our study from their facility .We further extend our sincere gratitude to the ANC department at KNRH for technical support during data collection. We appreciate our supervisor Dr. Kalidi Rajab for the guidance throughout this research. We also extend appreciation to the study participants, research assistants for their cooperation during data collection. 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Yazdani Chareti, "The relationship between women's characteristics and herbal medicines use during pregnancy," Women Health, vol. 59, no. 6, pp. 579-590, Jul 2019, doi: 10.1080/03630242.2017.1421285. A. A. Rahman, S. A. Sulaiman, Z. Ahmad, W. N. W. Daud, and A. M. Hamid, "Prevalence and pattern of use of herbal medicines during pregnancy in Tumpat district, Kelantan," The Malaysian journal of medical sciences: MJMS, vol. 15, no. 3, p. 40, 2008. E. Wolgast, L. Lindh-Astrand, and C. Lilliecreutz, "Women's perceptions of medication use during pregnancy and breastfeeding-A Swedish cross-sectional questionnaire study," Acta Obstet Gynecol Scand, vol. 98, no. 7, pp. 856-864, Jul 2019, doi: 10.1111/aogs.13570. T. Laelago, T. Yohannes, and F. Lemango, "Prevalence of herbal medicine use and associated factors among pregnant women attending antenatal care at public health facilities in Hossana Town, Southern Ethiopia: facility based cross sectional study," Archives of Public Health, vol. 74, no. 1, p. 7, 2016/02/15 2016, doi: 10.1186/s13690-016-0118-z. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7837990","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":528216278,"identity":"8adee36f-affa-435b-babb-5d544bcf7cd1","order_by":0,"name":"Jonathan Gwoyitamuno","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4ElEQVRIiWNgGAWjYLCCBAjF+ABI8PARpwWih9kApIWNFGvYJMAkIcXyEcnHJB7+sIs2uN18rPJrjp0MGwPzw0c38GgxvJGWJpGQkJy74c6xtNuy25KBDmMzNs7Bp2V2jhlQC3Puhhs5ZrcltzEDtfCwSROhpR6spVhyWz1hLfLSYC2HwVoYP247TFiLgfyzZIuEtOO5M2+kJUszbjvOw8ZMwC/yPYcP3vxhU53bdyP54Mef26rt+dmbHz7Ga8sBBhYJGIeZB0ziUQ62pYGB+QOMw/iDgOpRMApGwSgYmQAADyBIk6CBfh0AAAAASUVORK5CYII=","orcid":"","institution":"Department of pharmacy, College of health sciences, Makerere University, P.O .Box 7062.Kampala, Uganda","correspondingAuthor":true,"prefix":"","firstName":"Jonathan","middleName":"","lastName":"Gwoyitamuno","suffix":""},{"id":528216279,"identity":"a9d27ee0-d041-40e9-9d0a-e15a3f39de7a","order_by":1,"name":"Saul Sebairawo","email":"","orcid":"","institution":"Department of pharmacy, College of health sciences, Makerere University, P.O .Box 7062.Kampala, Uganda","correspondingAuthor":false,"prefix":"","firstName":"Saul","middleName":"","lastName":"Sebairawo","suffix":""},{"id":528216280,"identity":"daa3a5f9-8916-4ec2-b2e0-58613382764b","order_by":2,"name":"Dr. Rajab Kalid","email":"","orcid":"","institution":"Department of pharmacy, College of health sciences, Makerere University, PO. 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09:02:18","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":111444,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7837990/v1/2894989d324faafc2457ce2b.html"},{"id":93571076,"identity":"0cd821f3-2df6-4cb1-9dda-72e68131e829","added_by":"auto","created_at":"2025-10-15 09:02:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":25436,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eReasons for use of herbal medicine in pregnancy\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7837990/v1/78322c93f57443612566e919.png"},{"id":93571081,"identity":"4f6581fb-c343-468b-94d0-bc890aff7269","added_by":"auto","created_at":"2025-10-15 09:02:18","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":172670,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003ePerceptions of pregnant women on both the safety and efficacy of herbal medicines during pregnancy.\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7837990/v1/51c236b132479c7717ed7dc3.jpeg"},{"id":93574832,"identity":"2059c295-6b3b-4c18-bb3d-d6e1889cb2ea","added_by":"auto","created_at":"2025-10-15 09:18:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1784720,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7837990/v1/9397cb9e-42f0-4ee1-a5bc-447cac378239.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eHerbal Medicines use During Pregnancy: Perceptions of Pregnant Women and Associated Factors at Kawempe National Referral Hospital\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn spite of the increased acceptance of modern medicine across societies, herbal medicines are still widely used in developed and developing countries [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Approximately 65\u0026ndash;80% of the world\u0026rsquo;s population use traditional medicine as their primary form of health care. In sub-Saharan Africa, up to 80% of the population use herbal medicines to meet their health care needs [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Reliance on herbal medicines is relatively high among rural populations, and is associated with challenges in accessing public healthcare in Africa [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The usage of herbal medicines among pregnant women is increasing across the globe, though little data exists on efficacy and safety of herbal medicines use in pregnancy [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Worldwide, around 67% of women use herbal medicines during pregnancy. In Africa, there is a wide variation in herbal medicine usage during pregnancy, ranging from 10 to 100% [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMany physiological changes happen during pregnancy, which may cause nausea, vomiting, heartburn, constipation, hypertension, peripheral edema [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Therefore exposure to herbal medicines is frequent in pregnancy to meet some of the health care needs and often on a self-treatment basis. Most common herbs used are ginger (69.8%), garlic (39.8%), \u003cem\u003eEucalyptus globulus\u003c/em\u003e, moringa and others. Nausea (23.90%) and morning sickness (21.05%) are the most common reasons for herbal medicine use in pregnancy [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. While use of herbal medicines in pregnancy varies considerably between countries, many of the same herbs are used [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSafety and efficacy data for herbal medicines used in pregnancy are mainly based on experience over time as few clinical trials have been performed. One of the greatest concerns is that there is some evidence of expectant mothers taking some of the potentially harmful herbal medicines where documentation is inadequate to evaluate safety in pregnancy [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHerbal medicines are not evaluated according to the same standards as conventional pharmaceuticals. The lack of safety documentation associated with unlicensed herbal medicines plus the inadequate quality control in their production constitutes a risk for their use during pregnancy [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough some herbal products may induce premature uterine contractions or even be teratogenic, knowledge of potential side effects of many herbal medicines in pregnancy is limited. Pregnant women recognize the potential risks of drug usage during pregnancy but they do not realize that herbal products too could be toxic. They base on the implicit belief that herbal products, being natural are necessarily safe [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Other facilitators of herbal medicine use during pregnancy include cultural beliefs that herbal medicines can strengthen the pregnancy and previous experience with herbal medicines [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMajority of the pregnant women don\u0026rsquo;t disclose their use of herbal medicines to health care providers. The most frequently reported reasons for non-disclosure include; forgetting to inform the health care worker, followed by doctor did not ask, afraid of doctor\u0026rsquo;s response, and it was not important to disclose [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This poses a risk since the herbal medicines can have potentially harmful interactions with the conventional medicines. Therefore study aimed at assessing the perceptions of pregnant women on herbal medicines use and the associated factors at Kawempe National Referral Hospital-Central Uganda.\u003c/p\u003e"},{"header":"Methods and materials","content":"\u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cb\u003eStudy setting.\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eA cross sectional study was carried out at Kawempe National Referral Hospital (KNRH) located in Kawempe division, Kampala district, 6km from Kampala city Centre. It offers comprehensive gynecological and obstetric services to women residing in and near Kampala and those referred from other health facilities in Uganda. KNRH is a large hospital with over 21,000 deliveries per annum, 200 antenatal clinic visits and 100 child admissions per day[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The hospital provides preventative and curative care during pregnancy and intra-partum, newborn and postnatal care, a pediatric ward and vaccination services at a standard indicative of care in urban Uganda. The hospital runs an antenatal care (ANC) clinic 3 times a week.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData collection tool and tools.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eData collection tool was first developed in English and were translated in to local language (Luganda) .Review and approval was made by the supervisor. A questionnaire was prepared by reviewing different literatures and other checklists which were related to the subject. This questionnaire contained a total of 27 questions about demographics and current herbal medication use, perception on efficacy of herbal medicines. Herbal medicine use as well as concerns about safety of herbal medicines. After obtaining an informed consent, information from pregnant mothers during their antenatal visit was collected through a face to face interview using pretested structured and interviewer administered questionnaires by trained experienced research assistants who were fluent in Luganda and English. Pregnant mothers were interviewed thoroughly by the trained research assistants under supervision of the supervisor, however those who were literate were asked to complete the questionnaires with help of research assistants. Continuous follow up and supervision was made by the supervisor throughout the data collection period.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData quality management\u003c/h2\u003e\u003cp\u003eTraining about the objective of the study, data collection tool, data collection procedures, ethical consideration to ensure uniformity during data collection and to minimize errors was given to research assistants by the supervisor.\u003c/p\u003e\u003cp\u003eThe questionnaire was pilot-tested on 12 pregnant mothers within the same age group and level of education as the study population to test for understanding of the questions, estimate duration of the interviews, test reliability and validity of the tool. These women were personally interviewed by one of the investigators and asked to rephrase the items using their own words, after which the questionnaire was modified to make it easier to understand Ambiguous, complex and irrelevant questions were modified and the final version was used for data collection. Close supervision was carried out by the investigators during the data collection time. Data from each respondent were checked for its completeness, clarity, consistency and accuracy by the supervisor.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData Analysis Process\u003c/h3\u003e\n\u003cp\u003eThe data collected were checked for completeness and consistencies and then it was cleaned, coded and compiled in Microsoft excel sheet 2016, later cleaned and then exported to IBM SPSS Statistics software version 27 to perform statistical analysis. In order to be able to handle missing data, all the questionnaires were numbered. Descriptive statistics were created and presented with text and tables. Bivariate analysis was performed to determine the association between each independent variable and the dependent variable. A p value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant at multivariate analysis at a 95% confidence interval. Finally, both the crude odds ratio and the adjusted odds ratio were reported with 95% confidence intervals (CI).\u003c/p\u003e\n\u003ch3\u003eEthical consideration\u003c/h3\u003e\n\u003cp\u003e The ethical approval was obtained from the Institutional Review Board (IRB) research and ethics committee of the School of Health Sciences Makerere University with a reference number MAKSHSREC-2023-452. Permission to conduct the study was sought from KNRH administration and it was granted by the hospital director. The study was integrated in service provision and did not interrupt or delay tailored care for the pregnant mothers. All pregnant mothers were requested to give n informed consent written consent before being interviewed and they were notified that they have the right to refuse or terminate at any point of the interview The consent form was also translated into the local language for those who never understood English and it was read out to each pregnant mother. To ensure thorough understanding, pregnant mothers were given an opportunity to ask questions before signing the consent form. Privacy of the participants was observed by using Unique IDs instead of names. The questionnaires were administered in a secluded private area for confidentiality and privacy of participant information. Uganda\u0026rsquo;s Ministry of Health infection prevention procedures and guidelines for COVID-19 were followed by both the research team and the study participants.\u003c/p\u003e\n\u003ch3\u003eStudy target and source population\u003c/h3\u003e\n\u003cp\u003eThe target population were mothers seeking care at KNRH. The study population were pregnant mothers at KNRH who had come for antenatal care (ANC) visits during the study period.\u003c/p\u003e\n\u003ch3\u003eSample size determination and sampling technique\u003c/h3\u003e\n\u003cp\u003eA sample size of 384 pregnant mothers was sampled to participate in this study. The sample size was calculated using the Cochran\u0026rsquo;s (1977), where estimated proportion of pregnant women who perceive that herbal medicines are safe and effective in pregnancy, which in this case was 50% because there was no published statistics in Uganda for this proportion. The sampling error used was 5% at a 95% level of confidence with an assumption that antenatal visits were evenly distributed over the months. KNRH has over 200 antenatal clinic visits per day of antenatal visit (3 days of antenatal visits per week i.e Tuesday, Wednesday and Thursday) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] and the study was conducted at KNRH in 6 days of antenatal visits, giving a population size of about 1200 women. Since the sample size was a significant fraction (typically, greater than 5%) of the total population size, finite population correction (FPC) for proportion of 291 mothers was determined to lower the bias and increasing statistical power.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSampling procedure and participant recruitment.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study employed a systematic sampling was used to select participants. Given that our total sample size was 291 pregnant women and we were to correct our data for 6 days, our daily sample size (n) was (291/6)\u0026thinsp;\u0026asymp;\u0026thinsp;49. Daily population size (N) is 200 antenatal care visits. Therefore, sampling interval, k, given by: k\u0026thinsp;=\u0026thinsp;N/n which is 200/49\u0026thinsp;\u0026asymp;\u0026thinsp;4. A random starting point between 1 and 4 was selected, and every 4th eligible pregnant woman was selected to participate in the study until 49 pregnant women have participated in the study per day for 6 days. Though sometimes the numbers could exceed 200 and we would get more than 49 pregnant women participating in the study.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e\u003cb\u003eInclusion criteria\u003c/b\u003e:\u003c/h2\u003e\u003cp\u003eEligible study participants were Women who were pregnant and were visiting KNRH for ANC visit.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eExclusion criteria\u003c/h3\u003e\n\u003cp\u003eNon-consenting pregnant women and those who were very sick were excluded.\u003c/p\u003e\n\u003ch3\u003eDependent variables\u003c/h3\u003e\n\u003cp\u003eThe dependent variable was the perceptions of pregnant women on the safety and efficacy of herbal medicines use during pregnancy.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eIndependent variables\u003c/h2\u003e\u003cp\u003eThe independent variables comprised of socio-demographic characteristics of interest including age, level of education, parity, marital status, job and place of residence, users and non-users of herbal medicines.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eOperational definitions\u003c/h2\u003e\u003cp\u003e\u003cb\u003eHerbal medicines\u003c/b\u003e are plants or plant parts that are locally used to treat disease and enhance general health and wellbeing.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAn herb\u003c/b\u003e is a plant or plant part used because of its therapeutic properties.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAn herbal supplement\u003c/b\u003e is a product made from plants and used solely for internal use.\u003c/p\u003e\u003cp\u003e\u003cb\u003eHerbal medicines use\u003c/b\u003e is the therapeutic utilization of plants, plant parts or plant extracts to treat disease and enhance general health and wellbeing.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePregnancy\u003c/b\u003e is the term used to describe the period in which a fetus develops inside a woman's womb or uterus.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePerceptions\u003c/b\u003e refer to the way in which something is regarded, understood or interpreted.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEfficacy\u003c/b\u003e refers to ability of a drug to produce a desired result or effect.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSafety\u003c/b\u003e in relation to drug use refers to the frequency of adverse drug effects (i.e., physical or laboratory toxicity that could possibly be related to the drug) that are treatment emergent.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eSocio-demographic characteristics of the study participants.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMajority of the 291 pregnant women, 56.4% (n = 164/291) were between 20–29 years of age. The education level attained by most of the pregnant women, 47.1% (n = 137/291) was secondary level and most of the pregnant women, 45.7% (n = 133/291) were self-employed. Many of the pregnant women were married, 64.9% (n = 189/291) and were residing in urban areas, 67.4% (n = 196/291) as detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003eSocio-demographic characteristics of the pregnant women that were participants.\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eFrequency, (n = 291)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20–29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e164\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30–39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e40 and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e19 and below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLevel of education\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUniversity/Institution\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e111\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFormal employment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e189\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e64.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eArea of Residence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e196\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e67.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eHerbal medicine use in pregnancy\u003c/h2\u003e\u003cp\u003eAbout 62.5% (n = 182/291) of the pregnant women were users of herbal medicines in pregnancy. Among the users of herbal medicines in pregnancy, 51.7% (n = 92/178) of them used the herbal medicine daily to several times a week. Majority of the pregnant women, 42.3% (n = 77/182) used herbal medicines during the second trimester of pregnancy. Family and friends, 67.6% (n = 123/182) were the main source of recommendation for herbal medicine use in pregnancy and 58% (n = 105/181) of the pregnant women did not disclose to their healthcare provider that they were using herbal medicines during pregnancy as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eUse of herbal medicine in pregnancy.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eHave you used herbal medicines during pregnancy?\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFrequency, (n = 291)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e182\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e62.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e109\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e37.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFrequency of herbal medicine use\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFrequency, (n = 178)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDaily-several times a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e51.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOnce a week-once a month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e48.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTime of pregnancy when herbal medicine is used\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFrequency, (n = 182)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3–6 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e42.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0–3 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e35.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026gt; 6 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e22.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSource of recommendation for herbal medicine use\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFrequency, (n = 182)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"3\" nameend=\"c2\" namest=\"c1\" rowspan=\"4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFamily/friends\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e123\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e67.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSelf\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e15.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHealth worker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e13.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eInternet\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e3.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDisclosure to healthcare provider\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFrequency, (n = 181)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e105\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e58.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e42.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eThe total number of pregnant women may vary due to missing data on individual questions.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eReasons for using herbal medicine.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe most cited reasons for use of herbal medicine among the pregnant women is vomiting and nausea (22.9%), cough (15.1%), better health of the unborn baby 13.4%, and to increase chances of safe delivery 12.8% as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003ePerceptions on safety and efficacy of herbal medicines in pregnancy.\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003ePerceptions on safety\u003c/h2\u003e\u003cp\u003eMajority of the pregnant women, 64.2% (n = 186/291) perceived herbal medicines to be safe during pregnancy. Most of the pregnant women 47.8%, n = 139/291 strongly agree or agree that herbal medicines are safe to use during the first 3 months of pregnancy. The perceptions of pregnant women on the safety of herbal medicines during pregnancy are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePregnant \u003cem\u003ewomen’s perceptions on the safety of herbal medicines during pregnancy.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eStatements\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eFrequency, n = 291 (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStrongly disagree or Disagree\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStrongly agree or Agree\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI believe herbal medicine is safe to use during pregnancy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e66 (22.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38 (13.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e186 (64.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHerbal medicines are safe to use during the first 3 months of pregnancy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90 (30.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62 (21.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e139 (47.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHerbal medicines are safe to use during the last 3 months of pregnancy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e104 (35.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68 (23.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e119 (40.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI believe that herbal medicine is as safe as prescription medicine for pregnant women\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e86 (29.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89 (30.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e116 (39.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI am comfortable recommending herbal medicine to other pregnant women\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e95 (32.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59 (20.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e136 (46.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHerbal medicine is safer than prescription medication for pregnant women.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e158 (54.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e79 (27.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e53 (18.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIf I had herbal medicine prescribed by a health worker during pregnancy, I would adhere to the treatment.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48 (16.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (7.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e219 (75.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003ePerceptions on efficacy.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOut of the 291 pregnant women that participated in our study, 73.2% (n = 213/291) perceived herbal medicine to be effective in treating pregnancy related conditions. More than a half of the pregnant women, 52.1% (n = 151/291) strongly disagreed or disagreed that herbal medicine is more effective than prescription medication for treating pregnancy-related conditions as shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cb\u003ePregnant women’s perceptions on the efficacy of herbal medicines during pregnancy.\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eStatements\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eFrequency, n = 291 (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStrongly disagree or Disagree\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStrongly agree or Agree\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHerbal medicine is effective for treating pregnancy-related conditions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52 (17.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26 (8.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e213 (73.2%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHerbal medicine is as effective as prescription medication for treating pregnancy-related conditions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e79 (27.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e76 (26.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e136 (46.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eI am comfortable recommending herbal medicine to other pregnant women for treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e100 (34.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e78 (26.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e133 (38.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHerbal medicine is more effective than prescription medication for treating pregnancy-related conditions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e151 (52.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85 (29.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e54 (18. 6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eMajority of the pregnant women, 58.1% (n = 169/291) that participated in our study perceive herbal medicines to be are safe and effective in pregnancy as illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eFactors associated with the perceptions of pregnant women on safety and efficacy of herbal medicines.\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eHerbal medicine use.\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePerceptions on safety and efficacy of herbal medicine during pregnancy was consistent with use/non-use as shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.The majority of users of herbal medicine, 90.6% (n = 165/182 strongly agreed or agreed that herbal medicines were safe during pregnancy while many of the non-users, 56.9% (n = 62/109) strongly disagreed or disagreed that herbal medicine was safe during pregnancy (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001).For the efficacy of herbal medicines in pregnancy, majority of both the users, 88.4%, (n = 161/182) and non-users, 47.7% (n = 52/109) strongly agreed or agreed that herbal medicines were effective for treating pregnancy-related conditions (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003ePerceptions of pregnant women on the safety and efficacy of herbal medicines in pregnancy in relation to herbal medicines use during pregnancy.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eHave you used herbal medicines during pregnancy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c7\" namest=\"c5\" rowspan=\"2\"\u003e\u003cp\u003ePearson Chi-square Analysis\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eFrequency, n = 182 (%)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eFrequency, n = 109 (%)\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003eX\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003edf\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eHerbal medicine is safe to use during pregnancy.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStrongly disagree or Disagree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (2.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62 (56.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e155.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (6.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26 (23.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStrongly agree or Agree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e165 (90.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21 (19.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eHerbal medicine is effective for treating pregnancy-related conditions.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStrongly disagree or Disagree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (7.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39 (35.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e65.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (4.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18 (16.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStrongly agree or Agree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e161 (88.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e52 (47.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eSocio-demographic characteristics\u003c/h2\u003e\u003cp\u003eLevel of education was significantly associated with the perceptions of pregnant women on the safety (\u003cem\u003ep\u003c/em\u003e = 0.011 and efficacy (\u003cem\u003ep\u003c/em\u003e = 0.012) of herbal medicine during pregnancy. Majority of the women with secondary level education strongly agree or agree that herbal medicines are safe and effective during pregnancy followed by women with primary level education. Occupation was also significantly associated with the perceptions of pregnant women on safety (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001) and efficacy (\u003cem\u003ep\u003c/em\u003e = 0.009) of herbal medicines in pregnancy. Majority of the self-employed women strongly agreed or agreed that herbal medicines are safe and effective during pregnancy as shown in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e \u0026amp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eAssociation of socio-demographic characteristics with perceptions of pregnant women on the safety of herbal medicines during pregnancy.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"11\"\u003e\u003c/colgroup\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" morerows=\"1\" nameend=\"c5\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003eHerbal medicine is safe to use during pregnancy, Frequency (n = 291)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u003cp\u003ePearson Chi-Square Analysis\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eStrongly disagree or Disagree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eStrongly agree or Agree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003eX\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003edf\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eAge (Years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003e19 and below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e9.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.640\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003e20–29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e103\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003e30–39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003e40 and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e12.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.145\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e123\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c3\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eArea of Residence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e124\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e6.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.137\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e61\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" morerows=\"2\" nameend=\"c4\" namest=\"c1\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eLevel of Education\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e19.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.011\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e94\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eUniversity/ Institution\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e40.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eSelf-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eFormal employment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eThe total number of pregnant women may vary due to missing data on individual questions.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eAssociation of socio-demographic characteristics with perceptions of pregnant women on the efficacy of herbal medicines during pregnancy.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"11\"\u003e\u003c/colgroup\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" morerows=\"1\" nameend=\"c5\" namest=\"c1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003eHerbal medicine is effective for treating pregnancy-related conditions ,\u003c/p\u003e\u003cp\u003eFrequency (n = 291)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e\u003cp\u003ePearson Chi-Square Analysis\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eStrongly disagree or Disagree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNeutral\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eStrongly agree or Agree\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u003cb\u003eX\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003edf\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eAge (Years)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003e19 and below\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e16.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e0.184\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003e20–29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e119\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003e30–39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003e40 and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e9.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.315\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e133\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c3\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cb\u003eArea of Residence\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e147\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e8.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.065\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" morerows=\"2\" nameend=\"c4\" namest=\"c1\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eLevel of Education\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e19.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSecondary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eUniversity/Institution\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e20.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eSelf-employed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e101\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003eFormal employment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eThe total number of pregnant women may vary due to missing data on individual questions.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion of the results","content":"\u003cp\u003eIn this study we set to study the perceptions of pregnant women on the safety and efficacy of herbal medicines during pregnancy and the factors associated with their perceptions at a tertiary hospital in Uganda. Women’s perception of safety and efficacy towards medicine during pregnancy is an important factor affecting the treatment and use of medication, sometimes perhaps in an inappropriate way [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Assessing perceptions about the safety and efficacy of herbal medicine among pregnant women during pregnancy is essential, as it can be a tool in determining strategies to ensure safe and appropriate use of herbal medicines during pregnancy.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePerceptions of pregnant women on safety and efficacy of herbal medicines.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMajority of the pregnant women, 64.2% (n = 186/291) perceived herbal medicines to be safe during pregnancy. This result is similar to the findings of a study done in North Ethiopia by Abdollahi et al. (2019) who found out that 57.3% of pregnant women had a positive attitude towards the effects of herbal medicine usage during pregnancy [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This could be explained by the fact that herbal remedies have been used for generations to treat various ailments, including during pregnancy [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] therefore these traditional practices often shape people's perceptions and beliefs about the safety and efficacy of herbal medicines.\u003c/p\u003e\u003cp\u003eMore than a half of the pregnant women, 52.1% (n = 151/291) strongly disagreed or disagreed that herbal medicine is more effective than prescription medication for treating pregnancy-related conditions. This is comparable to the results reported by Mothupi (2014) in Nairobi, Kenya where majority of the pregnant women agreed with the statement that Western medicine is more efficacious than herbal medicine for most of the illnesses associated with pregnancy [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This similarity may be due to the area where the studies were carried out. Both this study and the one done by Mothupi were carried out in health care facilities and western medicine is generally the primary approach recommended and practiced by healthcare professionals in these settings. Pregnant women tend to trust and value the expertise and guidance of their healthcare providers, further reinforcing the belief that Western medicine is more efficacious.\u003c/p\u003e\u003cp\u003eThe percentage of pregnant women, 73.2% (n = 213/291) who perceive herbal medicines to be effective in treating pregnancy-related conditions is higher than those that perceive herbal medicines to be safe in pregnancy, 63.9% (n = 186/291).\u003c/p\u003e\u003ch2\u003eAssociated Factors\u003c/h2\u003e\u003cp\u003ePerceptions on safety and efficacy of herbal medicine during pregnancy was consistent with use/ non-use of herbal medicine in pregnancy (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001). Majority of the pregnant women who used herbal medicines during pregnancy perceived and believed that herbal medicines are effective and safe during pregnancy, a finding comparable to that reported by Nyeko et al. (2016) in Gulu, Uganda [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] and Rahman et al. (2008) in Malaysia [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Similar findings have been reported by other authors such Mothupi (2014) in Nairobi, Kenya, [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This could be explained by the fact that perception on the safety and effectiveness of herbal medicines in solving problems will tend to influence whether mothers might use them again in the next pregnancy. More still, the above findings could also be related to cultural beliefs on causation of ill-health and belief that herbal medicines are inherently safe and cure many illnesses [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Therefore, given that majority of the women do interface with the healthcare system at least once during their pregnancy, the healthcare providers should use this as an opportunity to sensitize them on the various limitations and potential adverse effects of herbal medicines, especially with regards to pregnancy.\u003c/p\u003e\u003cp\u003eLevel of education was significantly associated with the perceptions of pregnant women on the safety and efficacy of herbal medicine during pregnancy (\u003cem\u003ep\u003c/em\u003e = 0.011) and (p = 0.012) respectively. Pregnant women with secondary education or only primary education perceived herbal medicine to be safe and effective during pregnancy more than pregnant women with university/institutional (higher) education. These findings are in line with the findings of Mothupi (2014) in Nairobi, Kenya [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] and different from the findings of Wolgast et al (2019) in Sweden [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] who did not find any associations between level of education and perceptions about herbal medicines. A possible explanation to this is that pregnant women with lower levels of education may have limited access to accurate and up-to-date healthcare information, including information on the potential risks and benefits of herbal medicines during pregnancy. They may rely on word-of-mouth, traditional beliefs, or cultural practices that promote the use of herbal medicines without fully understanding their potential dangers. Lower-educated and moderately educated pregnant women may come from communities or cultures where the use of herbal medicines is deeply ingrained in traditional practices. These cultural beliefs and traditions may have been passed down through generations, reinforcing the perception that herbal medicines are safe and effective. The results are different from those from a study in Sweden probably due to the high level of public sensitization about medication use in such developed countries. This finding therefore calls for concerted efforts in community sensitization in changing some of these perceptions.\u003c/p\u003e\u003cp\u003eOccupation was also significantly associated with the perceptions of pregnant women on safety and efficacy of herbal medicines in pregnancy (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001) and (p = 0.009) respectively. This is similar to the findings of Laelago et al. (2016) in Hossana town, Southern Ethiopia [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Majority of the self-employed women strongly agreeing or agreeing that herbal medicines are safe and effective during pregnancy. Being self-employed often requires a certain level of independence, self-reliance, and a proactive attitude towards problem-solving. Pregnant women who are self-employed may exhibit a similar mindset when it comes to their health. They may perceive herbal medicines as a way to take control of their own health, relying on self-care practices rather than seeking external medical advice.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStrength and limitations of the study.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBy selecting potential study participants systematically, the selection bias was minimized.\u003c/p\u003e\u003cp\u003eThe study was done in only one health care facility. Our study site being the biggest gynecological center in the country makes the findings can be generalizable to a Ugandan population.\u003c/p\u003e\u003cp\u003eAnother limitation is of questionnaire studies in general. To minimize information bias brought about by self-reporting, the respondents were assured of anonymity which probably increased the honesty of the answers.\u003c/p\u003e"},{"header":"Conclusion and Recommendations","content":"\u003cp\u003eMajority of the pregnant women perceived herbal medicines to be safe and effective during pregnancy. The perceptions of pregnant women on the safety and efficacy of herbal medicines were associated with use/non-use of herbal medicine of herbal medicine during pregnancy, level of education and occupation.\u003c/p\u003e\u003cp\u003e Basing on this study findings, we recommend : A qualitative study on the perceptions of pregnant women on the safety and efficacy of herbal medicine should be conducted to broaden understanding of the subject, Healthcare providers should always ask pregnant mothers whether they are using herbal medicine or not and then sensitize and discuss with them the benefits and various limitations of herbal medicines, especially with regards to pregnancy, and the National Drug authority to strengthen its regulation in order to ensure safe use of herbal medicines and also encourage development of herbal medicines while following the standard guidelines.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eANC\u003c/strong\u003e: Antenatal Care, \u003cstrong\u003eIRB\u003c/strong\u003e: Institutional Review Board, \u003cstrong\u003eKNRH\u003c/strong\u003e: Kawempe National Referral Hospital, \u003cstrong\u003eSDG 3\u003c/strong\u003e: Sustainable Development Goal 3, \u003cstrong\u003eG.J\u003c/strong\u003e: Gwoyitamuno Jonathan, \u003cstrong\u003eS.S:\u0026nbsp;\u003c/strong\u003eSebairawo Saul, \u003cstrong\u003eK.R:\u003c/strong\u003e Karidi Rajab.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eSupplementary Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSupplementary materials will be provided by the corresponding author up on request..\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor \u0026nbsp; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eG.J\u003c/strong\u003e and \u003cstrong\u003eS.S\u003c/strong\u003e - conceived the idea, designed the study, provided resources, collected data, wrote the reports and drafted the first version of manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eG.J\u003c/strong\u003e \u0026ndash;Data entry, Analysis and data interpretation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eK.R\u003c/strong\u003e - Guided in proposal writing, supervision of research process, verification of analyzed data and approved the thesis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eK.R\u003c/strong\u003e \u0026ndash; Provided technical guidance, approved thesis and supervision,\u003c/p\u003e\n\u003cp\u003eAll authors reviewed the manuscript and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis research received no external funding, it was self-sponsored.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstitutional Review Board Statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki, and approved by Institutional Review Board (IRB) research and ethics committee of the School of Health Sciences Makerere University with a reference number MAKSHSREC-2023-452. Permission to conduct the study was sought from KNRH administration and it was granted by the hospital director. The study was integrated in service provision and did not interrupt or delay tailored care for the pregnant mothers\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants provided written informed consent at enrollment. The consent process was administered in both English and local language determined by the preference of the participant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData used in this study is available from the corresponding author upon request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful to the administration of Kawempe National Referral Hospital for granting us permission to carry out our study from their facility .We further extend our sincere gratitude to the ANC department at KNRH for technical support during data collection. We appreciate our supervisor Dr. Kalidi Rajab for the guidance throughout this research. We also extend appreciation to the study participants, research assistants for their cooperation during data collection. This study was a dissertation for a degree of pharmacy of Makerere University, collage of health sciences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eM. M. Al Akeel, W. M. Al Ghamdi, S. Al Habib, M. Koshm, and F. Al Otaibi, \u0026quot;Herbal medicines: Saudi population knowledge, attitude, and practice at a glance,\u0026quot; \u003cem\u003eJ Family Med Prim Care, \u003c/em\u003evol. 7, no. 5, pp. 865-875, Sep-Oct 2018, doi: 10.4103/jfmpc.jfmpc_315_17.\u003c/li\u003e\n\u003cli\u003eG. T. Addis, B. D. Workneh, and M. H. 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Lemango, \u0026quot;Prevalence of herbal medicine use and associated factors among pregnant women attending antenatal care at public health facilities in Hossana Town, Southern Ethiopia: facility based cross sectional study,\u0026quot; \u003cem\u003eArchives of Public Health, \u003c/em\u003evol. 74, no. 1, p. 7, 2016/02/15 2016, doi: 10.1186/s13690-016-0118-z.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Makerere University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Pregnancy, herbal medicines, safety and efficacy, herbal medicines, Kawempe, Uganda","lastPublishedDoi":"10.21203/rs.3.rs-7837990/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7837990/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eUganda still registers a higher rate of herbal medicine use during pregnancy ranging from 20.4% to 69.8%. Despite the high prevalence, there is limited data published on perceived safety and efficacy of herbal medicines during pregnancy. This study aimed at assessing the perceptions of pregnant women on herbal medicines use and the associated factors at Kawempe National Referral Hospital. In this cross-sectional study, 291 pregnant women who had come for antenatal care visits participated after informed consent. After a systematic sampling, a questionnaire was administered to collect data on demographics, perception on severity and efficacy. Majority of the participants were between 20\u0026ndash;29 years of age and had attained a secondary level of education. Perception on safety was among 64.2% of pregnant women while perception on efficacy was at 73.2%. Level of education (p\u0026thinsp;=\u0026thinsp;0.011, 0.012), Occupation (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, =\u0026thinsp;0.009) and Use/non-use of herbal medicine during pregnancy (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 0,001) were significantly associated with the perceptions of pregnant women on the safety and efficacy of herbal medicine during pregnancy respectively. Majority of the pregnant women still perceive herbal medicines to be safe and effective during pregnancy. Therefore, sensitization and regulations by National Drug Authority should be enhanced.\u003c/p\u003e","manuscriptTitle":"Herbal Medicines use During Pregnancy: Perceptions of Pregnant Women and Associated Factors at Kawempe National Referral Hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-15 09:02:13","doi":"10.21203/rs.3.rs-7837990/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"926e2703-1f96-4a60-baba-fa88e35129ba","owner":[],"postedDate":"October 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":56146060,"name":"Clinical Pharmacology"}],"tags":[],"updatedAt":"2025-10-15T09:02:13+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-15 09:02:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7837990","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7837990","identity":"rs-7837990","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}