Complementary and Alternative Medicinal Use amongst Antenatal in a Rural Tertiary Care Hospital of Haryana
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
694 Research
Original Indian Journal
Articleof Public Health Research & Development, July 2020, Vol. 11, No. 7
Complementary and Alternative Medicinal Use amongst
Antenatal in a Rural Tertiary Care Hospital of Haryana
Ruby Bhatia, Prem Khosla2, Sunita Mor3, Neha Vashishat4, Gaurav Aggarwal5
1
Professor & Head Of Department, 2 Prof Pharmacology,3Asst. Prof Obs & Gynae), 4Ms Obs & Gynae Resident,
5
DM Cardiology Resident, Department of Obs & Gynae, MM Institute of Medical Science, (Deemed To Be
University), Mullana, Ambala (India)
Abstract
Background - WHO defines ‘Traditional medicine’ as the sum total of the knowledge, skills and practices
based on the theories, beliefs and experiences indigenous to different cultures, whether explicable or not,
used in the maintenance of health, as well as in the prevention, diagnosis, improvement or treatment of
physical and mental illnesses.
Aims and Objective - To study Complementary and alternative medicinal use in addition to allopathic
medicine amongst pregnant women visiting antenatal clinics in a rural tertiary care hospital of Haryana.
Material and Method – Antenatal women attending the Outpatient Department in a tertiary care hospital
situated in a rural area in Haryana.
Study Design – A prospective , cross sectional study
Result – A total of 128 pregnant women participated in the study. Majority of these i.e 83% reported use of
CAM during pregnancy. However pregnant women came forward with history of CAM use only after great
persuasion.
Conclusion –CAM is commonly used by majority of pregnant women in antenatal period. Rural women with
low sociodemographic status with lesser education , home maker and unbooked pregnancy are vulnerable
group for the CAM use. Moreover extremely low level of communication between CAM user and health
care provider is worrisome and demands that physician should inquire their patients about the use of CAM.
Key words: CAM: Complementary and alternative medicine, pregnant, antenatal.
Introduction non-conventional medicine are used interchangeably
with traditional medicine. [1] An estimate reveals that over
WHO defines ‘Traditional medicine’ as the sum
80% of the population in Asia and Africa depend upon
total of the knowledge, skills and practices based on
the traditional medicines for their primary health care. [2]
the theories, beliefs and experiences indigenous to
The WHO estimates that in many developed countries,
different cultures, whether explicable or not, used in
70% to 80% of the population has used some form of
the maintenance of health, as well as in the prevention,
CAM including Ayurvedic, homeopathic, naturopathic,
diagnosis, improvement or treatment of physical and
traditional, Native Indian medicine.[3] Studies have
mental illnesses. The terms complementary/alternative/
shown that women use these traditional medicines more
prolifically even when they are pregnant. [4] Of course,
Corresponding Author: these native medicines may have many a beneficial
Dr. Neha Vashishat, effects but have adverse ill effects on mother and fetus.
Department of Obs & Gynae, MMIMSR, Mullana, The indiscriminate or non- regulated use of several
Ambala Email id: drnehavashishat90@gmail.com
herbal medicines may put health of their users and fetusIndian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7 695
at risk of toxicity and fetal malformations. [5, 6] Their ill- · To evaluate beneficial and adverse effect on
effects may manifest because of their own or due to an fetus.
interaction with allopathic drugs. The latter may happen
when they fail to disclose about the use of CAM to the Material and Method
prescribing doctor. Uterine inertia and abortion have This study was conducted in antenatal clinic
been reported amongst the antenatal women taking these outpatient department of Obstetrics & Gynaecology in
CAM in few Studies. [7,8] Very few studies have been Maharishi Markandeshwar Institute of Medical Sciences
done in India and none in this part of our country that & Research Mullana, Ambala a rural tertiary care
has assessed the use of CAM in pregnant women. Thus hospital of Haryana after approval by the institutional
present study has been done to evaluate the use of CAM ethical committee. All antenatal women willing to
amongst antenatal women. participate in study. A structured questionnaire were
developed and vernacular translation in Hindi was
Aim & Objectives
utilised in participants not well versed with English. Data
To study CAM use amongst pregnant women was collected using proforma meeting the objectives
visiting antenatal clinics in department of obstetrics of the study after an informed written consent from
and gynaecology, MMIMSR deemed to be University participants. The questionnaire were validated by a team
Mullana- a rural tertiary care hospital in Haryana. of experts. Pregnant women were counselled regarding
aim of the study.
Objectives
Inclusion Criteria:
Primary
Antenatal women attending Outpatient Department
· To study the use of CAM amongst pregnant
in a tertiary care hospital- a rural area in Haryana, willing
women attending antenatal clinic in Department of
to participate in study.
Obstetrics and Gynaecology ,MMIMSR.
Exclusion Criteria:
Secondary
Unwilling to share information and refusal to give
· To assess correlation of CAM used with socio-
consent to participate in survey.
demographic characteristics in antenatal women.
· To study beneficial and adverse effects of CAM
on pregnant mother.
Methodlogy
TABLE 1:DISTRIBUTION OF ANTENATAL WOMEN ACCORDING TO GRAVIDITY
GRAVIDA TOTAL(N=128) CAM USERS(N=106)
PRIMI 43(34%) 38(36%)
SECOND 64(50%) 51(49%)
THIRD 15(12%) 13(12%)
>FOUR 06(4%) 04(3%)696 Indian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7
TABLE 2: DISTRIBUTION OF ANTENATAL CASES IN RELATION TO SEX OF PREVIOUS CHILD.
SEX OF PREVIOUS CHILD TOTAL CAM- USERS(N=106) NON-CAM USERS(N=22)
NO PREVIOUS CHILD 43(34%) 38(36%) 05(23%)
BOTH FEMALE AND MALE 21(16%) 17(16%) 04(18%)
FEMALE ONLY 56(44%) 50(47.1%) 06(27%)
MALE ONLY 8(6%) 01(0.9%) 7(32%)
TABLE 3: DISTRIBUTION OF ANTENATAL CASES ACCORDING TO THE TYPE OF CAM USED
(N=106).
TYPES OF CAM NUMBER OF USERS PERCENTAGE
GINGER 76 71%
HONEY 76 71%
ALMONDS 53 50%
GOAT MILK 21 20%
HERBS WITH DESI GHEE 35 33%
UNKNOWN 41 39%
MORE THAN ONE TYPE OF CAM WAS USED BY PREGNANT WOMEN
TABLE 4: DISTRIBUTION OF ANTENATAL CAM USERS ACCORDING TO SOURCE OF
PRESCRIPTION.
CAM User PERCENTAGE
FAMILY/FRIENDS 53 50%
RELIGIOUS GROUP(BABA, HAKIM) 41 38.6%
HEALTHCARE PROFESSIONALS 12 11.4%
TABLE 5: DISTRIBUTION OF ANTENATAL CASES IN RELATION TO MATERNAL AND FETAL
ADVERSE EFFECTS.
COMPLICATIONS CAM USERS NON CAM USERS
(N=15) N=12 (80%) N=3 (20%)
MISSED ABORTIONS 4(33%) -
AMBIGOUS GENITALA 3(25%) -
IUD 2(17%) -
ANENCEPHALY 2(17%) -
ACARDIAC TWIN 1(8%) 1(33%)
HYDROCEPHALUS - 2(67%)Indian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7 697
TABLE 6: DISTRIBUTION OF ANTENATAL CAM USERS IN RELATION TO REASONS FOR
USING CAM AND SATISFACTION WITH CAM
REASONS FOR CAM NUMBER OF
CAM USED SATISFIED NON- SATISFIED
USE USERS(106)
RELIEF OF NAUSEA,
GINGER AND
VOMITTING AND 75 (71%) 72(96%) 03(4%)
HONEY
DYSPEPSIA
FAMILY AND FRIENDS
HERBS AND DESI TRADITIONS FOR USING
24(23%) 24(100%) -
GHEE HERBS (MATERNAL
WELL BEING)
GOAT MILK AND
GROWTH OF FOETUS 56(53%) 41(73%) 15(27%)
ALMONDS
DESIRE FOR MALE
UNKNOWN 41(39%) 16(39%) 25(61%)
FOETUS
Results Ginger and honey was most commonly used CAM
A total of 128 pregnant women participated in in 71% pregnant women in our study for relief of nausea,
study. Majority of these i.e 83% (N=106) reported use vomiting and dyspepsia and amongst these 96% of users
of CAM during pregnancy . However pregnant women were satisfied with treatment. Use of herbs with desi
came forward with history of CAM use only after ghee was used by 23% for maternal health with 100%
great persuasion.78(74%) CAM users were unbooked satisfaction. Goat milk and almonds was used by 53%
pregnancies.82% of CAM users were in the age group and amongst these 73% had satisfaction for fetal growth.
of 21-30 years. Only 9.4% pregnant CAM users were CAM of unknown ingredients prescribed by sant/baba
below 20 years of age and 8.6% above 31 years of age. was used by 49 (39%) women for having male child but
76.5% of CAM users were educated less than or upto 61% were not satisfied due to adverse fetal effects(Table
class 12th only. 21 (16%) of pregnant CAM users did not 3). Among CAM users 76% reported use of ginger and
go to school. 50% CAM users were from lower middle honey, 50% used almonds, 33% used herbs with desi
class, 23% from upper lower and 16% from lower ghee and 20% used goat milk while 39% of the CAM
socio economic status. Only 11% CAM users belonged used were of unknown constituent prescribed by sant
to upper middle class. 93% CAM users were residing or hakim(Table 3). Majority of pregnant women were
in rural areas,89% were home makers. Unbooked using more than one type of CAM
pregnancy, low socioeconomic status, lower education,
In 50% CAM was advised by senior members of
home makers with rural background were positively
family and friends. 38.6% of CAM was supplied by
associated with utilisation of CAM.
religious group of prescribers i.e sant or hakim. CAM
Out of total 106 CAM users 38(36%) were used in this group contributed maximum number of fetal
primigravida, 51 (49%) were second gravida while only adverse outcomes due to unknown constituents of CAM
12% and 3% were third and fourth gravida or more (Table 4).
respectively(Table 1).
Out of 106 CAM users adverse maternal and fetal
Half of CAM users (50%) had previous female outcome were reported in twelve cases. Four patients
children only followed by 36% primigravida. Only one (33%) had missed abortion, ambiguous genitalia in
(0.9%) case with previous male child opted for CAM three cases(25%), anencephaly in two cases(17%) ,fetal
use(Table 2). acardia with TRAP in monozygotic twin in one case and
intra uterine death in two cases were some of the adverse698 Indian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7
fetal outcome reported among CAM users (Table 5). almonds, goat milk, herbs with desi ghee has been part
of Indian tradition since time immemorial, same were
Many of the pregnant women were taking more
used in 50%, 20% and 33% respectively by pregnant
than one type of CAM. About 71% of the CAM users
mothers for maternal and fetal wellbeing
considered its use for relief of nausea and vomiting,
53% for the safety of the fetus and 23% for the safety of It has been documented that congenital abnormalities
fetus. 96% of the patients using ginger and honey were caused by human teratogenic drugs accounts for less than
satisfied by its beneficial effects. Also 39% of the patient one percent of total congenital abnormalities.[17] In our
used CAM for the desire of male baby out of which 61% present study the adverse fetal complications were seen
were unsatisfied due to major adverse outcomes in baby in fifteen cases out which unknown CAM was observed
seen(Table 6). in twelve(80%) cases and the fetal complications were
ambiguous genitalia, anencephaly, IUD, acardiac twin
Discussion and missed abortions.
This study has been done to find out prevalence for
Public and private health care professionals and
CAM use among pregnant women and to know about
skilled health care provider are right source for antenatal
its beneficial and adverse effects. The study followed
check-up, treatment and drug advise and are important
prospective cross-sectional design and gathered
sources for information and guidance about health
information on the use of CAM by pregnant women
matters, but our patient also rely on wide range of other
who visited outpatient department of MMIMSR. We
sources including senior member of family and friends
found that 83% of pregnant women used at least one
(50%), alternative practitioners(11.4%) and religious
modality of CAM during pregnancy. Our study showed
group sant / baba or hakim (38.6%)for medication. It
significantly higher number of CAM users. However it
is essential for the physicians to understand what the
is much higher as compared to other studies conducted
patient are doing to seek health, as this understanding is
in Palestine, Malaysia, Egypt, Taiwan[9-12]. These
important to harness potential benefits to help patients to
variations in the prevalence of CAM are due to difference
avoid harm. The reasons why patients uses CAM could
in the proportion of CAM usage by number of factors
be due to conventional medicine too expensive, test cost,
such as design of study, difference in socio-demographic
thought about the conventional medicine would not help,
characteristics and different cultural traditions across
and thought about the additional benefits of combining
the globe. Unbooked pregnancy , reproductive age
conventional medicine with CAM. Other common
group 21-30 years, lower education below class 12,
reason was self-help approach to health and wellness as
lower socioeconomic status, rural background with
advice by their family members and friends.
home makers were using CAM to a great extent in
our study. Commonly used CAM was ginger and The major complications which occurred in
honey in 71% pregnant women for nausea, vomiting unknown CAM users could be due to its easy availability,
and dyspepsia with highest level of satisfaction(96%) poor knowledge, high cost of conventional medicines.
and no adverse effect. WHO also recommends ginger So it is important to examine the pattern of the drug
and honey for nausea in pregnant women[13]. Ginger used in pregnancy and to see to what extent there may
consists of antiemetic properties, which not only help be room for the improvement as pregnancy is a special
in digestion, but also suppress nausea. In relation to its physiological condition where drug treatment is a special
antiemetic properties, ginger acts peripherally, within concern. Careful counselling and consideration is need
the gastrointestinal tract, by increasing the gastric tone of hour as the health of the mother and unborn child life
and motility due to anticholinergic and antiserotonergic is at stake.
actions[14-15]. It is also reported to increase gastric
emptying.[16] This combination of functions explains the Conclusion
widely accepted ability of ginger to relieve symptoms CAM is commonly used by majority of pregnant
such as dyspepsia, abdominal pain, and nausea, which is women in antenatal period. Moreover extremely low
often associated with decreased gastric motility. Use of level of communication between CAM user and healthIndian Journal of Public Health Research & Development, July 2020, Vol. 11, No. 7 699
care provider is worrisome and demands that physician Gravidarum. European Journal Of Gynaecology
should inquire their patients about the use of CAM due And Reproductive Biology 1990;38:19-24.
to scarcity of evidence in support of CAM benefits 8. Tamuno I, Omole-Ohonsi A, Fadare J. Use
during pregnancy, it is very important to educate women Of Herbal Medicine Among Pregnant Women
on safe use of CAM especially during antenatal period Attending A Tertiary Hospital In Northern Nigeria.
with special reference to rural with low socio economic Int. J Gynaecology And Obstetrics 2010;15(2):1-8.
status, unbooked cases and low literate population 9. Jaradat N, Adawi D. Use of herbal medicines
. Based on result of our research, further studies with during pregnancy in a group of Palestinian women.
large population in CAM users with its beneficial and J Ethnopharmacol. 2013;150(1):79–84.
adverse effects is needed to be evaluated. 10. Rahman AA, Sulaiman SA, Ahmad Z, Salleh H,
Daud WNW, Hamid AM. Women’s attitude and
Conflict of Interest: None sociodemographic characteristics influencing usage
Funding: None of herbal medicines during pregnancy in Tumpat
District, Kelantan. Southeast Asian J Trop Med
Ethical Clearance: Approved Public Health. 2009;40(2):330–7.
11. Orief YI, Farghaly NF, Ibrahim MIA. Use of herbal
References medicines among pregnant women attending family
1. Hwang HJ, Kim RU, Ahmed M, Choi S, Al- health centers in Alexandria. Middle East Fertil Soc
Hammadi QN, Widad MN. Use Of Complementary J. 2014;19(1):42–50.
And Alternative Medicine In Pregnancy: A 12. Yeh H-Y, Chen Y-C, Chen F-P, Chou L-F,
Cross-Sectional Survey On Iraqi Women. BMC Chen T-J, Hwang S-J. Use of traditional Chinese
Complement Altern Med. 2016 July 7;191(16). medicine among pregnant women in Taiwan. Int J
2. Birdee SG, Kemper JK, Rothman R And Gardner P. Gynecol Obstet. 2009;107(2):147–50.
Use Of Complementary And Alternative Medicine 13. WHO recommendation on interventions for the
During Pregnancy And The Postpartum Period: relief of nausea during pregnancy. Available on
An Analysis Of The National Health Interview https://extranet.who.int/rhl/printpdf/151087.
Survey. J Womens Health(Larchmt). 2014 Oct 1; 14. Shibata C, Sasaki I, Naito H, Ueno T, Matsuno S.
23(10):824-829. The herbal medicine Dai-Kenchu-Tou stimulates
3. General Guidelines For Methodologies On upper gut motility through cholinergic and
Research And Evaluation Of Traditional Medicine. 5-hydroxytryptamine 3 receptors in conscious
Available From Whqlibdoc.Who.Int › WHO_EDM_ dogs. Surgery. 1999;126(5):918–24.
TRM_2000.1.Pdf. 15. Adbel-Aziz H, Windeck T, Ploch M, Verspohl
4. Hall HG, Griffiths DL, Mckenna LG. The Use Of EJ. Mode of action of gingerols and shogaols on
Complementary And Alternative Medicine By 5-HT3 receptors: binding studies, cation uptake
Pregnant Women: A Literature Reviw. Midwifery. by the receptor channel and contraction of isolated
2011;27(6):817-24. guinea-pig ileum. Eur J Pharmacol. 2006;530(1–
5. Bury RW, Fullinfaw RO. Problem With Herbal 2):136–43.
Medicines. Medical Journal Of Australia 1987; 16. Hu ML, Rayner CK, Wu KL, et al. Effect of ginger
146:324-25. on gastric motility and symptoms of functional
6. Abt AB, Oh JY, Huntigton RA, Burkhart KK. dyspepsia. World J Gastroenterol. 2011;17(1):105–
Chinese Herbal Medicine Induced Acute Renal 10.
Failure. Archives Of Internal Medicine 1995; 155: 17. Banhidy F., Lowry R.B., Czeizel A.E. — Risk and
211-12. Benefit of Drug Use During Pregnancy. Int J Med
7. Fischer- Rasumussen W, Kjaer SK, Dahl C, Sci. 2005;100(2):100-106.
Asping U. Ginger Treatment Of HyperemesisYou can also read
