The findings from this study suggest that the practice of self-medication is common among pregnant women in our environment. In this study, various substances ranging from traditional preparations/substances including kolanuts and local gin to orthodox medications were found to have been used by the pregnant women. Although the types of herbs vary according to place, different culture and custom, this is similar to reports in earlier studies within and outside Nigeria [2
]. These findings are frightening and very serious in view of the poor knowledge of the safety profiles of these substances among the women [11
]. Though the rates of use of some of the substances in this study are low, the difficulty in estimating the right and adequate dosages may pose serious problem [1
]. One major concern would be the potential harmful effects on the fetus. Therefore, the use of substances such as alcohol and alcohol-related mixtures for whatsoever reason during pregnancy should be discouraged. Evidence suggests that substances like alcohol is an important risk factor for burden of disease and social harm, accounting for 3.2% of all deaths and 4.0% of all disability adjusted life years (DALYs) globally [16
]. There is also increasing evidence that exposing fetus to alcohol in utero may result in intrauterine growth and postnatal development retardation [17
]. If the exposure is in the early month of pregnancy, these children could suffer from serious complications including, congenital malformation, mental retardation or even intrauterine fetal death [11
]. This therefore highlights the need for effective programmes that would target on prevention of self-medication among pregnant women and intervention to arrest complications.
Our study shows variation in the practice and use of self medication among the participants. In this study, about 25% and 35% of the pregnant women with high level of education used analgesics and antibiotics respectively. This, when compared with 6.9% and 12.0% of them with low level of education involved in the use of the same substances, is very significant. Also about 6.9% of women with low education self-medicate herbs compared to 5.6% of those with high education. These findings seem to suggest that the level of education influences the type and nature of substances used. Although earlier studies have association self-medication with factors such as self-employment, unemployment and third trimester of pregnancy, the use of herbal medicines has been strongly linked with low education [18
]. However, several reasons may be responsible for this differential practice in this study. First, the use of analgesics, antibiotics and alcohol by women with high level of education and traditional herbs by those with low level of education may be due to health beliefs, which to a large extent, determines the emotional and behavioural responses to illness [19
]. These beliefs involve expectancy and perceived benefits, as well as outcome for initiating and maintaining treatment. There is abundance of evidence that this perception plays a significant role in health-seeking behaviour and pathway to care [10
]. Secondly, it is possible that inspite of the poor knowledge of the efficacy of some of these substances among pregnant women with low education, alternative care is widely known to be readily accessible and affordable [18
]. Finally, high education may have increased awareness, more opportunities and options for different levels of care. In addition, the conscious effort for quick outcome may also have explained the high patronage of traditional herbs by the pregnant women with high level of education in this study.
The findings of this study seem to highlight a more disturbing trend of practice among pregnant women in our environment. An inference from the findings suggests that there is increasing trend of dual or simultaneous consultation during pregnancy. This is evident by the various agents seen to have been taken by the pregnant women, mostly traditional mixtures and herbs. This cuts across both educated and non-educated women. A possible explanation may be the belief on the efficacy of these substances on indigenous/traditional illnesses [5
]. Although various reasons have been proffered for this practice, the implications could be overwhelming, as issues related to possible drug interactions could be a major problem to both mother and the unborn child [13
]. Therefore, health care providers must be aware of this trend, in order to weigh the therapeutic benefits to mothers and the potential risk to the developing fetus [9
]. It is essential to routinely inquire about the woman′s self-medication practice so as to provide appropriate advice during antenatal care. Studies have shown that some of these preparations are often prepared under unhygienic conditions and has the possibility of causing microbial infection [5
]. In an environment such as ours, where every illness is attributable to supernatural deities and magical powers, judging from our cultural perception on causation of certain illnesses, this could portend serious danger to care of individuals with problems [20
]. Also in this study, various orthodox medical regimens were found to be used by pregnant women. A significant proportion, 42% of pregnant women self-medicate analgesics, 37% antibiotics and 4% various forms of sedatives. Even though, these are modern medicine, the act of self-medication could be dangerous, considering the possible poor knowledge of pharmacodynamics of these medicines [4
]. This is more worrisome as the sources and instructions concerning the use of these medicines are not from professionals. One major concern would be issue of inadequate dosing and resistance with respect to antibiotics. The widespread use of suboptimal dosages of antibiotics is a major threat, contributing to the development of resistant bacterial strains [23
]. Antibiotics, such as septrin, choramphenicol and tetracycline are dangerous and contraindicated during pregnancy [24
]. Apart from the resistance that may result from inadequate dosing, exposing fetus to them in early months of pregnancy may result in various complications, such as, kernicterus, gray baby syndrome and respiratory distress.
One other serious danger in our environment is the issue of counterfeit and expired drugs. This is a major threat to curative medical care, especially in rural communities [28
]. The condition is made worse by the fact that the control and sale of almost all drugs are lacking. Therefore, there is availability and increased use of these counterfeits and expired drugs among the people, and pregnant women are not spared. This is very rampant in many rural settings, and with the twin problems of poverty and poor level of education, this could be a source of many unresolved medical conditions during pregnancy. The implication would be the potential harmful effect on the fetus. Therefore, there is need to put in place measures to either control or ban the sale of drugs by unauthorized persons other than professionals. Efforts must also be made to make sure that drugs/medicines are only available to individuals on prescription from a physician following a consultation.
Interestingly, the findings of this study also revealed that pregnant women in our environment do not indulge in a more potent-habit forming substances. This is clearly demonstrated in this study as it has shown that no pregnant woman smoked cigarette/tobacco or used any other potent substances, such Indian hemp cocaine or heroin. Several reasons may have contributed to this. First, these substances except tobacco, cigarette and Indian Hemp to a large extent are foreign to the environment and the knowledge of their usefulness, if any is limited. Although it is important to emphasize that the non use of these substances does not mean that they are not available. Secondly, the cost of obtaining them may be very high and affordability may also influence their usage. Finally, the custom, which restricts women from using certain substances, even in times of ill-health, may have also contributed to their non use. The major constraints in this study are the difficulty in determining the outcome of these substances on both the mothers and fetus. Also being a self-report, the disclosure of information concerning the practice of self-medication may be biased. This study involves only the pregnant women who indulged in self-medication, not necessarily because of sickness, but due to physiological changes associated with pregnancy. Therefore, the perceived benefits leading to their continued use may be exaggerated. There is also the problem of itemizing and translating the various types of herbs into a common language that may easily be understood. This is an isolated hospital-based study; therefore, the results cannot be generalized. Finally, an instrument adapted from a modified form of 117-item self-report questionnaire based on the World Health organization guidelines for students’ substance-use surveys was used in the assessment; therefore introducing substances like ‘our traditional herbs’ not originally captured in the questionnaire can affect its validity and reliability.