A multicenter study on practices and related factors of traditional medicinal plant use during pregnancy among women receiving antenatal care in East Gojjam Zone, Northwest Ethiopia.

Background: Little is known about the practice of traditional medicinal plant use, especially during pregnancy in Ethiopia. Moreover, there has been no previous studies conducted on practices and related factors of medicinal plant use among pregnant women in Gojjam, northwest Ethiopia. Methods: A multicentered facility-based cross-sectional study was conducted from July 1 to 30 2021. A total of 423 pregnant mothers receiving antenatal care were included in this study. To recruit study participants, multistage sampling techniques were used. Data were collected using a semi-structured interviewer-administered questionnaire. SPSS version 20.0 statistical package was used for statistical analysis. Univariable and multivariable logistic regression analysis was performed to identify factors related to the medicinal plants' utilization status in pregnant mothers. The study results were presented in both descriptive statistics (percents, tables, graphs, mean, and dispersion measurements like standard deviation) and inferential statistics (odds ratio). Results: The magnitude of traditional medicinal plants' utilization during pregnancy was 47.7% (95%CI: 42.8-52.8%). Pregnant mothers residing in rural areas [Adjusted Odds Ratio (AOR) = 3.13; 95% Confidence Interval (CI):1.53, 6.41], who are illiterate (AOR = 2.99; 95%CI:1.097, 8.17), have illiterate husbands (AOR = 3.08; 95%CI:1.29, 7.33), married farmers (AOR = 4.92; 95%CI:1.87, 12.94), married merchants (AOR = 0.27; 95%CI:0.09, 0.78), have a divorced and widowed marital status (AOR = 3.93; 95%CI:1.25, 12.395), have low antenatal care visits (AOR = 4.76; 95%CI:1.93, 11.74), substance use history (AOR = 7.21; 95%CI:3.49, 14.9), and used medicinal plants in previous pregnancy (AOR = 4.06; 95%CI:2.03, 8.13) had statistically significant association with medicinal plant use during current pregnancy. Conclusions: The present study revealed that a relatively large number of mothers used medicinal plants of various types during their current pregnancy. Area of residence, maternal educational status, husband's education level, husband's occupation status, marital status, number of antenatal care visits, use of medicinal plants in previous pregnancies, and substance use history were among the factors which were significantly associated with the use of traditional medicinal plants during the current pregnancy. Overall, the current finding provides scientific evidence useful for health sector leaders and healthcare professionals on the utilization of unprescribed medicinal plants during pregnancy and the factors associated with the utilization of the plants. Hence, they may consider creating awareness and providing advice on the careful use of unprescribed medicinal plants among pregnant mothers, especially those residing in rural areas, who are illiterate, who have divorced and widowed marital status, and who have a previous history of herbal and substance use. This is because using traditional medicines without prior discussion with a healthcare expert may harm pregnant mothers and their unborn child, as the safety of the utilized plants in the current study area is not scientifically proven. Prospective studies which need to confirm the safety of the plants used are recommended mainly in the present study area.

Toxic effects of 70% ethanol extract of Moringa stenopetala leaf (Baker f.) Cufod. (Moringaceae) on fetus and placenta of pregnant Wistar rats.

BACKGROUND: Moringa stenopetala leaves (Baker f.) Cufod. (Moringaceae) are used as a staple food and traditional medicine for treating various diseases like malaria, hypertension, stomach pain, diabetes, elevated cholesterol, and removing the retained placenta. Its prenatal toxicity study is minimal. Thus, this study aimed to assess the toxic effects of a 70% ethanol extract of Moringa stenopetala leaf on the fetuses and placentas of pregnant Wistar rats. METHOD: Fresh leaves of Moringa stenopetala were collected, dried at room temperature, ground to powder, and extracted using 70% ethanol. For this study, five groups of animals, each containing ten pregnant rats, were used. Groups I-III were experimental groups and treated with 250, 500, and 1000 mg/kg body weight of Moringa stenopetala leaf extract, respectively. Groups IV and V were pair-fed and ad libitum control groups. The extract was given during gestation days 6 to 12. The fetuses were recovered at day 20 of gestation and examined for the presence of developmental delays, gross external malformations, skeletal and visceral defects. Gross and histopathological changes in the placenta were also evaluated. RESULTS: Compared to the pair-fed control group, maternal daily food intake and weight gain were reduced in the 1000 mg/kg-treated group during the treatment and post-treatment periods. A significantly higher number of fetal resorptions was also seen in the 1000 mg/kg treatment group. The crown-rump length and fetal and placental weights were all significantly reduced in pregnant rats given 1000 mg/kg. However, there were no visible malformations in the visceral organs as well as external genitalia in all the treatment and control groups. About 40.7% of the fetuses in the 1000 mg/kg treated rats had no proximal hindlimb phalanges. In addition, light microscopic investigations of the placenta in the high-dose treated rats revealed structural changes in the decidual basalis, trophoblastic zone, and labyrinthine zones. CONCLUSION: In conclusion, consumption of M. stenopetala leaves at a higher dose may have toxic effects on the development of rat fetuses. At a higher dose, the plant extract increased the number of fetal resorptions, reduced the number of fetuses, decreased the fetal and placental weights, and alter the placental histopathology. Thus, it is recommended to limit the excess feeding of M. stenopetala leaves during gestation.

Congenital Hydrocephalus and Associated Risk Factors: An Institution-Based Case-Control Study, Dessie Town, North East Ethiopia.

Introduction: Congenital hydrocephalus is one of the commonest congenital anomalies of the central nervous system. It is characterized by extensive accumulation of cerebrospinal fluid within the ventricles of the brain due to an imbalance between synthesis and absorption of cerebrospinal fluid. This study was planned to investigate the incidence and associated risk factors of congenital hydrocephalus. Methods: Unmatched case-control study was conducted in 34 (cases) and 104 (controls) pregnant women. Maternal data were collected from a structured questionnaire, and fetal-related data were recorded from obstetric ultrasound. Epi-info 7 and SPSS version 24 were used for data entry and analysis, respectively. The association between congenital hydrocephalus and risk factors was evaluated using binary logistic regression. Results: The incidence of congenital hydrocephalus was 2.67 per 1000 pregnancies. The result of multivariate logistic regression indicated that alcohol use and iron with folic acid supplementation during pregnancy were significantly associated with the development of congenital hydrocephalus (OR: 7.64, 95% CI: 1.97-29.66 and p-value: 0.003 and OR: 0.186, 95% CI: 0.07-0.49 and p-value: 0.001, respectively). Maternal exposure to typhus and typhoid and use of antibiotics during early pregnancy were also significantly associated with congenital hydrocephalus. Moreover, significant association was also observed between the simultaneous development of spina bifida and congenital hydrocephalus (p-value 0.03). Conclusion: In conclusion, alcohol consumption, unprescribed use of antibiotics and infection during pregnancy as well as absence of folic acid supplementation may predispose to congenital hydrocephalus.

The Developmental Toxicity of Thymus schimperi Essential Oil in Rat Embryos and Fetuses.

Background: In Ethiopian traditional medicine, the aerial parts of Thymus schimperi are widely used to treat diseases such as gonorrhea, cough, liver disease, kidney disease, hypertension, stomach pain, and fungal skin infections. In addition, they have been used as vegetables to flavor a broad variety of food products. However, there is an insufficient investigation of the toxic effect of Thymus schimperi essential oil. The aim of this study was, therefore, to evaluate the developmental toxicity of the essential oil of Thymus schimperi leaves on developing rat embryos and fetuses. Methods: Essential oil of the aerial parts of Thymus schimperi was extracted by hydrodistillation. Pregnant Wistar albino rats were randomly divided into five groups. The doses 65 mg/kg, 130 mg/kg, and 260 mg/kg of the essential of Thymus schimperi were administered by force feeding to the III-V groups, respectively. Groups I and II were negative and ad libitum control groups. The embryos and fetuses were revealed on days 12 and 20 of gestations, respectively. The embryos were examined for developmental delays or growth retardation. Gross external, skeletal, and visceral anomalies in the fetuses were examined. Results: In this study, the developmental scores of the number of implantation sites, crown-rump length, the number of somites, and morphological scores were significantly lower while the score of fetal resorptions was increased in a 12-day-old rat embryos treated with 260 mg/kg of the Thymus schimperi essential oil. There was also a significant delay in the development of the otic system, olfactory system, and a reduction in the number of branchial bars in 12-day-old embryos treated with 130 mg/kg and 260 mg/kg of the essential oil. However, external morphological examinations of rat fetuses revealed no detectable structural abnormalities. The fetal skull, vertebrae, hyoid, forelimb, and hindlimb ossification centers did not differ significantly across all the groups. Furthermore, there were no skeletal or soft-tissue malformations as a result of the essential oil treatment. Although the difference was not statistically significant, fetuses of the high-dose treatment group had a reduced number of ossification centers in the caudal vertebrae and hind limp phalanges. Conclusion: The essential oil of Thymus schimperi at high doses has a detrimental effect on the development of rat embryos and fetuses. Its developmental toxicity is evidenced by significant delays in fetal and embryonic development, a decrease in the number of implantation sites, and an increase in fetal resorption. Furthermore, administration of the essential oil in higher doses resulted in a significant decrease in placenta weight and litter weight. In addition, the present study provided evidence that using the Thymus schimperi essential oil in a high dose could affect the developing embryo and fetus. Thus, it is recommended to discourage the use of Thymus schimperi essential oil in high doses.

Composition of the Essential Oil Thymus schimperi and Evaluation of Its Acute and Subacute Toxicity in Wistar Albino Rats: In Silico Toxicity Studies.

BACKGROUND: In Ethiopian traditional medicine, the aerial part of Thymus schimperi is widely used to treat diseases such as gonorrhea, cough, liver disease, kidney disease, hypertension, stomach pain, and fungal skin infections. However, there is insufficient investigation on the toxic effect of the essential oil of T. schimperi. The aim of this study was, therefore, to evaluate the acute, subacute, and in silico toxicity of Thymus schimperi essential oil in the Wistar albino rats. METHOD: Essential oil of the aerial part of T. schimperi extracted by hydrodistillation was analyzed by GC-MS. The oil was subjected to toxicity studies. In the acute toxicity study, rats were randomly divided into seven groups (n = 5). The control group received only distilled water with 2% of tween 80, whereas the experimental groups received single doses of 300, 600, 900, 1200, 1500, and 2 000 mg/kg of the oil. In the subacute toxicity study, rats were randomly divided into four groups (n = 10). The control group received distilled water with 2% of tween 80, whereas the experimental groups received 65 mg/kg, 130 mg/kg, and 260 mg/kg of the oil orally for 28 days. At the end of the experiment, blood samples were collected for hematology and clinical chemistry evaluation. Gross pathology and histopathology of the liver and the kidneys were also evaluated. For the in silico toxicity study, PubChem CID numbers of GC-MS identified bioactive compounds in the essential oil of T. schimperi obtained from PubChem. Chemdraw (8.0) was used to construct two-dimensional structures of the compounds. The Swiss ADMET web tool was used to convert the two-dimensional structures into a simplified molecular-input line input system (SMILES). In addition, the toxicity parameters were predicted via vNN and ADMET servers. RESULTS: In this study, the LD50 of the essential oil of T. schimperi was found to be 1284.2 mg/kg. According to the World Health Organization, the oil is classified as moderately hazardous in its oral administration. In the subacute toxicity study, rats showed no significant changes in behavioral indices, gross pathology, body weight, biochemical, and most hematological parameters. However, hematological profiles showed a significant decrement in WBC counts and a significant increment of MCV in high dose (260 mg/kg) groups as compared to the control group. Furthermore, no significant differences were observed between the control and essential oil-treated groups, observed in the gross histopathology of the liver and the kidneys. In the in silico toxicity study, all compounds derived from the essential oil showed no cardiac toxicity (h-ERG Blocker), AMES (Ames Mutagenicity), and cytotoxicity via ADMET and vNN-ADMET toxicity predictors. However, by using these servers, about 8.6% of the compounds showed hepatotoxicity, only 3.45% caused drug-induced liver injury, and only 1.75% were potentially toxic to the mitochondrial membrane. CONCLUSION: From the results of this study, oral administration of the essential oil T. schimperi up to a dose of 130 mg/kg is not harmful. However, in the high-dose (260 mg/kg) group, the WBC count was significantly decreased and the MCV was significantly increased. In the in silico toxicity study, most of the components of the oil were found to be nontoxic, although a few of the compounds showed hepatotoxicity and mitochondrial membrane potential toxicity. It is, therefore, essential to conduct chronic toxicity of the essential oil as well as its components, which showed toxicity in the in silico study before using preparations containing the essential oil of T. schimperi.

Sub-chronic toxicity of ethanol leaf extract of Syzygium guineense on the biochemical parameters and histopathology of liver and kidney in the rats.

BACKGROUND: Syzygium guineense Wall. leaf is being used as a traditional medicine against hypertension and diabetes mellitus. Unlike its efficacy, the safety profile of this plant upon long-term administration has not been investigated yet. Therefore, this study investigated the sub-chronic toxicity of S. guineense leaves in rats. METHODS: Wistar albino rats, 10/sex/group were randomly assigned into four groups. Group I-III respectively received 250, 500, and 1000 mg/kg of body weight of 70 % ethanol extract ofS. guineense leaves for 90 consecutive days. Group IV (control) received distilled water. Throughout the experiment, clinical observations were carried out, food intake and weight of the rats also were measured. Finally, different biochemical parameters, organ weight, and histopathology of liver and kidneys were evaluated. RESULTS: Administration of 70 % ethanol extract ofS. guineense leaves decreased food intake and body weight gain of the test animals. Rats treated with 1000 mg/kg of S. guineense extract showed significantly increased serum alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase levels. Serum urea levels also increased in female rats treated with 500 and 1000 mg/kg body weight of S. guineense. Moreover, the blood glucose level of rats treated with 1000 mg/kg body weight was significantly decreased compared to the control group. However, the histology of the liver and kidneys were not significantly altered by any of the doses administered. CONCLUSION: Administration ofS. guineense in rats at a dose of 1000 mg/kg body weight affected the food consumption, weight gain, and serum levels of liver and kidney enzymes suggesting that S. guineense intake at high doses may be toxic. Therefore, liberal consumption of S. guineense leaves should be taken curiously and cautiously.

Teratogenic Effect of High Dose of Syzygium guineense (Myrtaceae) Leaves on Wistar Albino Rat Embryos and Fetuses.

Syzygium guineense is an important medicinal plant effective against hypertension, diabetes mellitus, and cancer but with no evidence of its teratogenicity. This study was planned to investigate the teratogenic potential of S. guineense leaves on rat embryos and fetuses. Five groups of Wistar albino rats, each consisting of ten pregnant rats, were used as experimental animals. Groups I-III rats were treated with 250, 500, and 1000 mg/kg of hydroethanolic extract of S. guineense leaves, and groups IV and V were control and ad libitum control, respectively. Rats were treated during day 6-12 of gestation. Embryos and fetuses were retrieved at day 12 and day 20 of gestation, respectively. The embryos were assessed for developmental delays and growth retardation. The fetuses were examined for gross external, skeletal, and visceral anomalies. In 12-day old rat embryos, crown-rump length, number of somites, and morphological scores were significantly reduced by the treatment of 1000 mg/kg of the extract. The external morphological and visceral examinations of rat fetuses did not reveal any detectable structural malformations in the cranial, nasal, oral cavities, and visceral organs. The ossification centers of fetal skull, vertebrae, hyoid, forelimb, and hindlimb bones were not significantly varied across all groups. However, even if not statistically significant, high-dose treated rat fetuses had a reduced number of ossification centers in the sternum, caudal vertebrae, metatarsal, metacarpal, and phalanges. Treatment with the hydroethanolic extract of S. guineense leaves produced no significant skeletal and soft tissue malformations. The plant extract did not produce significant teratogenic effects on rat embryos/fetuses up to 500 mg/kg doses but retarded the growth of embryos at high dose (1000 mg/kg) as evidenced by decreased crown-rump length, number of somites, and morphological scores. Therefore, it is not advisable to take large doses of the plant during pregnancy.

Prevalence and associated factors of birth defects among newborns in sub-Saharan African countries: a systematic review and meta-analysis.

INTRODUCTION: Birth defects are the most serious causes of infant mortality and disability in sub-Saharan African countries with variable magnitude. Hence, this study was aimed to determine the pooled prevalence of birth defects and its associated risk factors among newborn infants in sub-Saharan African countries. METHODS: A total of 43 eligible studies were identified through literature search from Medline (PubMed), EMBASE, HINARI, Google scholar, Science Direct, Cochrane Library and other sources. Extracted data were analyzed using STATA 15.0 statistical software. A random effect meta-analysis model was used. RESULTS: Twenty-five studies in 9 countries showed that the pooled prevalence of birth defects was 20.40 per 1,000 births (95% CI: 17.04, 23.77). In the sub-group analysis, the highest prevalence was observed in southern Africa region with a prevalence of 43 per 1000 (95% CI: 14.89, 71.10). The most prevalent types of birth defects were musculo-skeletal system defects with a pooled prevalence of 3.90 per 1000 (95% CI: 3.11, 4.70) while the least was Down syndrome 0.62 per 1000 (95% CI: 0.40, 0.84). Lack of folic acid supplementation (95% CI: 1.95, 7.88), presence of chronic disease (95% CI: 2.00, 6.07) and intake of drugs (95% CI: 3.88, 14.66) during pregnancy were significantly associated with the birth defects. CONCLUSION: The prevalence of birth defects is relatively high with high degree of regional variabilities. The most common types of birth defects were musculoskeletal defects. Lack of folic acid supplementation, presence of chronic disease and intake of drugs during pregnancy were significantly associated with birth defects.

Herbal medicine use and predictors among pregnant women attending antenatal care in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: The use of herbal medicine among pregnant women is increasing in many low- and high-income countries due to their cost-effectiveness in treatment and ease of access. Research findings across Ethiopia on the prevalence and predictors of herbal medicine use among pregnant women attending antenatal care are highly variable and inconsistent. Therefore, this systematic review and meta-analysis aims to estimate the overall prevalence of the use of herbal medicine and its predictors among pregnant women attending antenatal care in Ethiopia. METHOD: We searched articles in Medline (PubMed), EMBASE, HINARI, Google Scholar, Science Direct, Cochrane Library, and other sources. The study included a total of eight studies that reported the prevalence and predictors of herbal medicine use among pregnant women from different regions of Ethiopia. Cochrane Q test statistics and I2 tests were used to assess heterogeneity. A random effect meta-analysis model was used to estimate the pooled prevalence. In addition, the association between risk factors and herbal medicine use in pregnant women attending antenatal care were examined. RESULTS: A total of eight studies were included in this review. The pooled prevalence of herbal medicine use among pregnant women attending antenatal care in Ethiopia was 47.77% (95% CI: 28.00-67.55). Subgroup analysis by geographic regions has showed that the highest prevalence (57.49%;95% CI: 53.14, 61.85) was observed in Oromia Region and the lowest prevalence was observed in Addis Ababa (31.39%; 95% CI: 2.83, 79.96). The herbal medicines commonly consumed by women during pregnancy were ginger: 41.11% (95% CI: 25.90, 56.32), damakasse: 34.63% (95% CI: 17.68, 51.58), garlic: 32.98% (95% CI: 22.21, 43.76), tenaadam: 19.59% (95% CI: 7.54, 31.63) and eucalyptus: 4.71% (95% CI: 1.1, 8.26). Mothers' previous history of self-medication (95% CI: 1.91, 51.35), illness during pregnancy (95% CI: 1.56, 23.91), employment status (95% CI: 3.89, 10.89), educational status (95% CI: 1.52, 2.68), and place of residence (95% CI: 1.86, 3.23) were predictors of herbal medicine use by women during pregnancy. CONCLUSION: In this study, about half of women attending antenatal care use herbal medicine and it is relatively high. The most commonly consumed herbal medicine during pregnancy was ginger followed by damakasse, garlic, tenaadam and eucalyptus. During pregnancy, it is not known that these most commonly consumed plant species have harmful fetal effects. However, many of the medicinal plant species are poorly studied, and it is not possible to rule out teratogenic effects. Teamwork between healthcare professionals and traditional practitioners to educate on the use of medicinal plants will encourage healthier pregnancies and better health for mothers and infants.

Prevalence and outcomes of birth defects in newborns of South Wollo and Oromia zones of Amhara regional state: a retrospective study

Background: Congenital malformations (CMs) are structural and functional anomalies that have a significant but under-recognized cause of mortality and morbidity among infants and children under 5 years of age. CMs are not only life threatening, but also result in long-term disabilities that negatively affect individuals, families, health care systems and societies. Objectives: The purpose of this study was to describe the prevalence and outcomes of birth defects in newborns of South Wollo and Oromia zones of Amhara regional state. Methods: A retrospective cross-sectional study was done in three hospitals of South Wollo and Oromia zones, where 22,624 infants were born between January 2015 and December 2017. The presence and type of birth defects in the infants, as well as their outcomes, were identified by reviewing the medical records of their mothers. Medical records with incomplete information were excluded from the study. The data were collected using a pre-tested checklist for data collection. Results: A total of 22,624 infants were born during the study period. Three hundred and twenty-four (1.43%) newborns were delivered with birth defects. Anomalies of the central nervous system (CNS) were the most frequent type of birth defect (43.2%), followed by defects of the musculoskeletal system (19.7%), orofacial malformations (11.0%) and gastrointestinal system anomalies (6.1%). Most of the malformed infants were born from mothers with a history of alcohol intake (55.8%), lack of iron and folic acid supplementation (58.4%), family history of birth defects (58.7%) and history of diseases during pregnancy (53.5%). The outcomes of newborns with birth defects were significantly affected by the type of birth defect, gestational age, weight of the newborn and presence of twin pregnancy (p-value ≤0.05). Conclusions: The prevalence of CNS anomalies was the highest, followed by musculoskeletal system anomalies. The type of birth defect, gestational age, weight of newborn and twin pregnancy significantly affected outcomes of the newborns with congenital anomalies. Therefore, in order to reduce the prevalence of CMs, the identification and management of risk factors should be the focus of stakeholders

The embryopathic effects of zinc deficiency and the influnce of zinc supplementation on growth and organogenesis in zinc deficient rat embroyos.

BACKGROUND: Zinc deficiency during gestation is teratogenic in both humans and other mammalian species. OBJECTIVES: The objectives of this research were to investigate the embryopathic effects of zinc deficiency during the period of organogenesis and the influence of zinc supplementation of zinc deficient rats in 12 days old embryos. METHODS: There were four groups: ad libitum (C), pair-fed (PC), zinc deficient (ZD) and zinc deficient+zinc (ZDZ) groups. The ZD group received the zinc deficient liquid diet, the ZDZ group received the zinc deficient diet + 15 mg/Kg of Zinc Sulphate; and the PC group was restricted-fed the control diet, the amount consumed by the respective pair-mate in the ZD group while the group C received the liquid control diet unrestricted. RESULTS: Maternal weight-gain from days 6 to 12 of gestation were significantly lower in the zinc deficient (ZD) animals, compared to the ad libitum control (C), pair-fed control (PC) group or the zinc deficient + zinc (ZDZ) group. In addition, zinc deficiency resulted in significant reduction in growth of embryos (embryonic protein content, crown-rump length and number of somites) and in a significant retardation in development of organ primordia. Zinc supplementation of zinc deficient pregnant rats significantly improved crown-rump length, increased embryonic protein content and improved the development of somites. Moreover, the development of embryonic circulatory, nervous and musculoskeletal systems was improved by zinc supplementation of zinc deficient animals. CONCLUSION: These results show that zinc deficiency is embryopathic in vivo and that zinc supplementation of zinc deficient rats ameliorated the embryopathic effects of zinc deficiency.