BACKGROUND OF THE STUDY
Herbal medicine use among pregnant women is increasing in many low and high income countries due to their cost-effectiveness in treatment and ease of access. The World Health Organization (WHO) defined herbal medicines as “herbs, herbal materials, herbal preparations and finished herbal products that contain as active ingredients parts of plants, or other plant materials, or combinations” [WHO, 2016] . Although, herbal medicines may be produced from any part of the plant, they are commonly made from the leaves, roots, bark, seeds, and flowers [Bandaranayake et al, 2016] . The herbs are eaten, swallowed, drunk, inhaled, or applied to the skin [Akerele, 2013] . In spite of the great advances observed in modern medicine in recent decades, medicinal plants still play a key role in world health [Calixto, 2010] .
Herbal medicines can be purchased in bulk in the crude form or as refined pharmaceutical dosage forms such as capsules, tablets, concentrated extracts, teas, tinctures and decoctions. The use of herbal medicines play significant roles in the management of both minor and major illnesses [Barnes, 2013; Gardiner et al, 2017; Eisenberg et al, 2013] and has been influenced by patients’ dissatisfaction with conventional allopathic medicines in terms of effectiveness and/or safety, satisfaction with therapeutic outcome [Huxtable, 1990; Abbot & Ernst, 2017] , and the perception that herbal medicines are inherently safe. Some of the more complex reasons for preference of herbal medicines are associated with cultural and personal beliefs, philosophical views on life and health [Ernst & White, 2010] , as well as comparison of experiences between conventional healthcare professionals and complementary medicine practitioners [Astin, 2014] by patients. The use of herbal medicine has been on increase in many developing and industrialized countries [Furnharm, 2016; Ernst, 2013] . It is known that between 65 and 80% of the world’s population use herbal medicines as their primary form of health care [Eisenberg et al, 2014; WHO, 2017] . Patients who are likely to be at risk from adverse effects of herbal medicines include those who are already prone to difficulties from regularly prescribed medications namely foetus, infants and older children, the elderly, as well as pregnant and lactating women [Drew, 2017; Anonymous, 2013; Philipson & Anderson, 1984a; Philipson & Anderson, 1984b; Gold & Cates, 1980; Roulet et al, 2018; Saxe, 1987] . In developing nations most especially, regulation of sales, importation and manufacturing of herbal medicines are not subject to rigorous scrutiny in terms of safety and efficacy as is the case for conventional western/allopathic medicines [WHO, 2016] . Pregnant women use herbal medicines for a variety of reasons such as for pregnancy-associated disorders including nausea, vomiting, and labor enhancement [Henry & Crowther, 2010] , as well as for illnesses and diseases due to pregnancy such as fatigue, respiratory and skin issues, and nutritional benefits [Fakeye et al, 2011] . Additionally, pregnant women use herbal medicines because of their wide availability, possibly better effectiveness relative to modern medicine, traditional and cultural beliefs in herbal medicines to cure diseases and relatively low cost of these medicines [Fakeye et al, 2011; Gardiner et al, 2017] .
Few studies on the pattern of use of herbal medicines during pregnancy showed that more than 10% of pregnant women reported the use of herbal medicinal products in Finland, Australia, and United States [McLennan et al, 2012; Hemminki et al, 2011; Pastore, 2010; Forster et al, 2016; Nordeng & Havnen, 2014] . To our knowledge, only one study has been carried out in Nigeria to evaluate the use of herbal medicines among pregnant women [Gharoro & Igbafe, 2010] . Despite the fact that knowledge of potential side effects of many herbal medicines in pregnancy is limited [Mabina et al, 2017; Maats & Crowther, 2012; Ernst, 2012; Tsui et al, 2011; Lacroix et al, 2010] , and that some herbal products may be teratogenic in human and animal models [Pakrashi & Bhattacharya, 1977; Seely et al, 2018; Dugoua et al, 2018; Goel et al, 2016] , data on the extent of women’s use of herbal medicines during pregnancy is scanty especially in sub-Sahara Africa, where the legislation for distribution and purchase of herbal medicines is not as stringent as it is for conventional medicines [Adisa & Fakeye, 2016] . The most common herbal remedies consumed by pregnant women globally are ginger (Zingiber officinale), garlic (Allium sativum), green tea (Camellia sinensis), peppermint (Mentha piperita), and fenugreek (Trigonella foenum graecum) [Ernst, 2012] . Studies in Australia and Kenya have shown that those pregnant women who are most likely to use herbal medicines include older and married women with low economic and educational status, nausea, and vomiting severity [Mothupi, 2014; Forster et al, 2016] . While pregnant women have increased use of herbal medicines worldwide, most of them are unaware of the possible side effects and teratogenic effects of some herbal remedies [Mothupi, 2014; Dugoua et al, 2018] . Pregnant and breastfeeding women are especially vulnerable to harmful effects from herbal medicines as the safety profiles and appropriate dosages of most herbal medicines in these groups are not well established [Conover, 2013] . This study aimed at determining the use of herbal medicine among pregnant women in Nigeria vis a vis use of herbal medicines and potential effects of herbal remedies on the foetus.
1.2 STATEMENT OF THE PROBLEM
In a setting like Nigeria where there is strong perception and widespread utilization of herbal preparations, it becomes imperative to investigate its use in pregnancy due to the effects it could have on the unborn child and the mother. Moreover, the need for nurses to have a reliable empirical data on the perception and utilization of herbal remedy in pregnancy is becoming extremely important for effective educational interventions. This will promote safe motherhood and reduce maternal and infant mortality resulting from misuse of herbs. Even though studies conducted across the six geo-political zones revealed strong perception of herbal remedy and high consumption rate among the Nigerian populace [Bamidele et al, 2011; Elujoba et al, 2015] , few research evidences exist on its use during pregnancy.
Considering the numerous symptoms associated with pregnancy due to physiological changes, there is higher probability of increased herbal consumption during pregnancy especially in rural communities. Moreover, research findings have consistently showed that herbal remedy is perceived to be safe due to its natural source [Adams & Connell, 2011] . It was also reported to be cheap, readily available and easily accessible with little self-control over the frequency and quantity taken at will. Due to these reasons, pregnant women may tend to use it more to relieve minor disorders during pregnancy. However, herbal medicines may contain substances that may be harmful to the foetus or the baby. Remedies have also been described to have the possibility of interacting with prescribed drugs and anaesthetic agents [Scott & Elmer, 2012; Maliakal & Wanwimolruk, 2011; Izzo & Ernst, 2011; Ang-Lee et al, 2011] or cause fetal malformations [Simpson et al, 2011; Vaes & Chyka, 2010] . In fact some authorities have cautioned against the use of almost all herbal medicines during pregnancy [Ernst, 2012] . Despite this available information, pregnant women still use herbal medicines. Since nurses and midwives are saddled with the responsibility of health promotion, prevention of complications and conservation of life through effective counselling and health education, the increasing demand for statistical data on the perception and pattern of use of herbal remedies during pregnancy in our immediate local community will help to know the extent of their use and alternative measures to develop safety among the users.
1.3 AIMS OF THE STUDY
The major purpose of this study is to examine the use of herbal medicine among pregnant women attending antenatal care in Shani Local Government Area. Other general objectives of the study are:
To investigate the prevalence of utilization of herbal medicine among pregnant women attending antenatal To examine the common herbal remedies used among women in Pregnancy To examine factors that influences the utilization of herbal drugs among pregnant women attending antenatal To assess women’s perception of safety and efficacy of herbal drugs among pregnant women attending antenatal To examine intervention programs to address issues relating to the use of herbal medicine among pregnant women
1.4 RESEARCH QUESTIONS
How is the prevalence of utilization of herbal medicine among pregnant women attending antenatal? What are the common herbal remedies used among women in Pregnancy? What are the factors that influence the utilization of herbal drugs among pregnant women attending antenatal? How is the perception of women about safety and efficacy of herbal drugs among pregnant women attending antenatal? What are the intervention programs to address issues relating to the use of herbal medicine among pregnant women?
1.5 RESEARCH HYPOTHESIS
H0: There is no significant use of herbal medicine among pregnant women attending antenatal care in Shani Local Government Area.
H1: There is a significant use of herbal medicine among pregnant women attending antenatal care in Shani Local Government Area.
1.6 SIGNIFICANCE OF THE STUDY
This study aimed at finding the magnitude at which herbal medicines are used during pregnancy and their associated factors. Results obtained will be used in health education delivery in antenatal clinics, enlighten the health providers about the magnitude so that they don’t attribute all poor foetal outcomes to herbs and therefore improve obstetric care. Knowledge of the extent and nature of use of herbal medicine related to pregnancy, labour and post-partum period is necessary for proper guidance in the health interest of both the mother and foetus. The study will also be of benefits to the midwives/nurses by assisting in planning and educating pregnant women attending antenatal clinic in Shani Local government on the importance and uses of herbal medicine in Nigeria. Further, the results of the study will help inform public health discourse about the use of alternative systems of care in the presence of a modern health care system. It will also be used as the baseline for more researches regarding use of herbal medicines in pregnancy.
1.7 SCOPE OF THE STUDY
The study is based on use of herbal medicine among pregnant women attending antenatal care, a case study of Shani Local Government, Borno State.
1.8 LIMITATION OF STUDY
Financial constraint- Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
Time constraint- The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.
1.9 OPERATIONALIZATION DEFINITION OF TERMS
Traditional Medicine: Traditional medicine is defined as the health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and exercises, applied singularly or in combination to treat, diagnose and prevent illnesses or maintain well-being.
Herbal Medicine: Herbal medicines are defined as plant-derived materials or preparations perceived to have therapeutic benefits; they often contain raw or processed ingredients from one or more plants. Herbal medicines include herbs, herbal materials, herbal preparations, and finished herbal products that contain parts of plants or other plant materials as active ingredients (WHO, 2018).
Pregnant Women: Pregnant women refer to women who are pregnant and in the age group between 19 to 35 yrs and are alslo considered as herbal medicines users if they take the herbal medicines through oral, intra-vaginal or topical routes. Other preparations that are consumed as nutriments and within routine meal preparation such as food additives were excluded.
Antenatal Care: Antenatal care is the routine health control of presumed healthy pregnant women without symptoms (screening), in order to diagnose diseases or complicating obstetric conditions without symptoms, and to provide information about lifestyle, pregnancy and delivery.