Labor comes with pain, hence expectant mothers would desire for procedures and materials that would quicken the process and provide relief to the extreme pain. Women in developing countries are known to patronize traditional medicines hence it is most probable traditional medicines will be used for labor purposes. This study therefore assessed the level of usage of traditional medicines among pregnant women in the Tamale metropolis, identified the products used and their reasons for usage. Using convenience sampling method, data was collected from 301 respondents from 20 suburbs within the Tamale metropolis using a semi-structured questionnaire. Data was analyzed using SPSS version 23 and association between variables obtained using appropriate tools. Up to 25.9% of respondents used traditional medicine immediately before or during their most recent labor. Lower educational status, staying with extended family members, being a believer in Islam, home delivery and ever using traditional medicine before the most recent pregnancy were statistically associated with the use of traditional medicine to manage labor processes (p < 0.05). Various plants were found in formulating the traditional labor medicine known locally as ‘kalghutim’ with the bark of the Shea tree ((Vitellaria paradoxa) being present in most formulations.

1. Management of Labor in Pregnant Women using Traditional Medicines in Northern Ghana – A Survey in the Tamale Metropolis
Management of Labor in Pregnant Women using Traditional
Medicines in Northern Ghana – A Survey in the Tamale
Metropolis
Evans Paul Kwame Ameade1*, Catherine Kuseba Adikem2, Winnifred Asibiti3
1Department of Pharmacy, School of Medicine and Health Sciences, University for Development Studies, Tamale
2,3 Department of Midwifery, School of Allied Health Sciences, University for Development Studies, Tamale
Labor comes with pain, hence expectant mothers would desire for procedures and materials that
would quicken the process and provide relief to the extreme pain. Women in developing countries
are known to patronize traditional medicines hence it is most probable traditional medicines will
be used for labor purposes. This study therefore assessed the level of usage of traditional
medicines among pregnant women in the Tamale metropolis, identified the products used and
their reasons for usage. Using convenience sampling method, data was collected from 301
respondents from 20 suburbs within the Tamale metropolis using a semi-structured
questionnaire. Data was analyzed using SPSS version 23 and association between variables
obtained using appropriate tools. Up to 25.9% of respondents used traditional medicine
immediately before or during their most recent labor. Lower educational status, staying with
extended family members, being a believer in Islam, home delivery and ever using traditional
medicine before the most recent pregnancy were statistically associated with the use of
traditional medicine to manage labor processes (p < 0.05). Various plants were found in
formulating the traditional labor medicine known locally as ‘kalghutim’ with the bark of the Shea
tree ((Vitellaria paradoxa) being present in most formulations.
Keywords: Traditional medicine, pregnancy, women, labor, uterotonics, Tamale
INTRODUCTION
Maternal and neonatal deaths continue to be on the rise
despite interventions by various governmental and non-
governmental organizations especially in developing
countries. About 808 women died out of complications
arising from pregnancy and childbirth every day in 2017
and of this number, about 540 occurred in sub-Saharan
Africa (WHO, 2020). The process of birthing a newborn
comes with various complication and difficulties which in a
hospital set up will require the use of various medications
and devices to ensure the safety of the mother and child.
Due to lack of access to modern healthcare services or for
some other reasons, some women resort to traditional
medicines to ensure the process of childbirth especially
labor less painful and also speed up the delivery process.
Although, the use of traditional medicines (TM) occurs
even in developed countries, it is more common in
developing countries, especially those in Africa. It is
estimated that an average of 58.2% of persons in sub-
Saharan Africa use Traditional medicines for their health
care needs (James et al., 2018). As much as TM had
played and continues to be useful to the healthcare needs
of persons living in developing countries, some studies
have shown a relationship between the use of traditional
practice systems and maternal mortality which should be
a matter of concern if efforts by the world to reduce
*Corresponding Author: Evans Paul Kwame Ameade,
Department of Pharmacy, School of Medicine and Health
Sciences, University for Development Studies, Tamale.
Email: sokpesh@yahoo.com
Co-Author 2
Email: cathyadikem2018@gmail.com
3
Email: winnifredsbt556@gmail.com
Research Article
Vol. 3(1), pp. 021-030, July, 2020. © www.premierpublishers.org. ISSN: 2298-0067
International Journal of Ethnopharmacology

2. Management of Labor in Pregnant Women using Traditional Medicines in Northern Ghana – A Survey in the Tamale Metropolis
Ameade et al. 22
maternal maternity would not be a wasteful venture.
(Sumankuuro et al., 2017). Various studies have however
found the use of herbs sometimes provided by traditional
birth attendants who prescribe them or herbal preparations
to accelerate or augment the labor process (Tripathi, et al.,
2013; Dika, et al., 2017). With the use of Traditional
medicine being an integral part of healthcare in developing
countries including Ghana not in doubt, it is almost certain
some women in Ghana will be using traditional medicines
which will mostly be of herbal origin to manage labor
situations. There is paucity of studies on the use of
Traditional medicine during labor in Ghana and even the
few studies in Ghana were conducted in the southern and
middle portions of the country (Adusi-Poku et al., 2015;
Alor, 2015). Since the southern and middle belts of Ghana
have vegetation different from the Guinea savanna type in
northern Ghana, it is possible the Tamale metropolis,
would have some unique plant materials that are used to
manage labor. This study therefore generally investigated
the use of traditional medicine in labor among expectant
women in the Tamale metropolis and ascertained their
level of awareness of the effects of TM on the labor
processes.
Specifically, this study
1. Assessed the prevalence of the use of traditional
medicine during labor as well as the components of
these medicines.
2. Determined the socio-demographic characteristics that
may be associated with the women using traditional
medicines in labor
3. Assessed how knowledgeable the women are about
the effects of TM taken before and during labor on the
child and mother.
METHODOLOGY
The study adopted descriptive cross-sectional survey
method. The study population were women in the Tamale
metropolis in their reproductive age of 15 to 49 years. The
population of this category of women was estimated to be
95,835 in 2013. Using Cochran formula at 95% confidence
interval and a 5% margin of error, as well as a possible
prevalence of use of TM in labor to be 23% based on a
similar study by Dika et al., (2017) in Mwanza, Tanzania,
a sample size of 301 was obtained. A de novo semi-
structured questionnaire was piloted from 20th to 27th
March, 2019 to ensure it was appropriate to be
administered so as to achieve the objectives of the study.
All ethical considerations were considered by obtaining
consent from respondents, asking permission from heads
of families and ensuring that the identities of respondents
were not taken. Actual data was collected from 1st to 15th
of April, 2019 using the questionnaire made up of 11 open
ended questions and 28 closed ended questions. The
questionnaire was divided into four sections; socio-
demographic characteristics, medical and obstetric
history, traditional medicine usage for labor and
knowledge on the effects of traditional medicine on mother
and child. Data was entered into the Statistical Package
for the Social Sciences (SPSS) Version 23 for analysis.
Results were presented as frequencies, and percentages.
Associations between variables were obtained using Chi-
square as well as ANOVA at a confidence interval of 95%.
Significance was assumed when p ≤ 0.05.
RESULTS
Socio demographic characteristics of respondents
Majority, 270 (89.7%) of the respondents were married,
with 7 (2.3%) being single. For their educational status,
most of the respondents 134(44.5%) had no formal
education whiles the rest have at least primary level
education. With respect to age, the largest age bracket
was 20-25 years representing, 84 (28%), while the least
was respondents above 45 years, 7 (2.2%). Majority of
respondents were adherents of the Islamic faith, 271
(90%) with the remaining, 30 (10 %) being Christians. The
number of employed women formed the largest group
which was 185 (61.5%) followed by unemployed
representing 116 (38.5%). Respondents living in a nuclear
family system were in the majority, 166 (55.1%) whiles the
extended family system were 135 (44.9%). Table 4.1
shows the socio-demographics characteristics of the
respondents.
Table 1: Socio-demographics characteristics of the
respondents
Variables Subgroups Frequency Percentage
Age <20 17 11.7
20-25 84 28
26-30 83 27.6
31-35 41 13.6
36-40 44 14.7
41-45 25 8.3
>45 7 2.2
Marital Status Single 7 2.3
Married 270 89.7
Co-habiting 24 8
Religion Christianity 30 10
Islamic 271 90
Family
System
Nuclear 166 55.1
Extended 135 44.9
Type of
Employment
Employed 185 61.5
Unemployed 116 38.5
Educational
Status
No formal
Education
134 44.5
Primary 81 26.9
JHS 57 18.9
At least
SHS/Vocational
29 9.7

3. Management of Labor in Pregnant Women using Traditional Medicines in Northern Ghana – A Survey in the Tamale Metropolis
Int. J. Ethnopharmacol. 23
Table 2: Obstetric characteristics of the respondents
Variables Subgroups Frequency Percentage
Total number of
deliveries
1 70 23.3
2 84 27.9
3 73 24.3
4 38 12.6
5 18 6
6 13 4.3
7 5 1.7
Ever had home
deliveries?
Yes 71 23.6
No 230 76.4
Frequency of
attendance to
ANC
0 7 2.3
1 10 3.3
2 28 9.3
3 29 9.6
4 47 15.6
5 57 18.9
6 58 19.3
7 53 17.6
8 or more 12 3.9
Obstetric history of respondents
Table 2 shows the obstetric characteristics of the
respondents. Most respondents had 2 children, 84 (27.9%)
with those having 3 children following, 73 (24.3%) while
those with 7 children being the least, 5 (1.7%). Up to 230
(76.4%) of the respondents had their most recent
deliveries at health facilities while 71 (23.6%) had home
deliveries. Only, 7 (2.3%) of the respondents had never
attended antenatal clinic (ANC) during their last
conception but most, 58 (19.3 %) had been to ANC, 6
times.
Traditional medicine usage by respondents
The use of traditional medicine in general and also
specifically during labor by respondents is as shown in
Table 3. Before their last pregnancy, 112 (37.2%) of
respondents used some form of traditional medicine for
various reasons but during pregnancy a lesser number, 49
(16.3%) continued with the use of traditional medicine.
Just before the onset of labor and during labor, 78 (25.9%)
used TM for reasons as shown in Table 4. Majority, 42
(53.8%) of women who used TM for labor did so just before
labor set in, while the rest used the medicines during labor.
Traditional Birth Attendants (TBAs), 31 (39.7%) and close
relatives, 19 (24.4%) were to top two category of persons
who supplied or recommended the TM the respondents
use for the labor process. All the TM used were taken
orally and may be powdered and mixed with porridges,
beverages, drinks, among others but using the materials
to prepare their soups was the most common, 35 (44.9%)
preparation method.
Table 3: The TM usage by the respondents
Variables Sub groups Frequency Percentage
Have you ever used TM before pregnancy? No 189 62.8
Yes 112 37.2
Did you use any traditional medicine in your last
pregnancy?
No 252 83.7
Yes 49 16.3
Have you ever used traditional medicine in your
previous labor before the most recent one? (n =
231)
No 154 66.7
Yes 77 33.3
Did you use any traditional medicine in your last
labor?
No 223 74.1
Yes 78 25.9
Sources of TM in you most recent labor? (n = 78) A friend 1 1.3
A herbal shop 1 1.3
Close relative 19 24.4
Self 18 23.1
Traditional birth attendant 31 39.7
Traditional healer 8 10.3
At what point in your labor was the TM used? (n =
78)
Before labor onset 42 53.8
During labor 36 46.2
What was the mode of preparation of the TM (n =
78)
Ground into powder and mix with porridge 14 17.9
Mixed with drink 2 2.6
Mixed with food 15 19.2
Mixed with porridge 5 6.4
Mixed with tea 7 9.0
Prepared with soup 35 44.9

4. Management of Labor in Pregnant Women using Traditional Medicines in Northern Ghana – A Survey in the Tamale Metropolis
Ameade et al. 24
Constituents of TM in labor
Table 4 shows the constituents of TM used in labor
amongst expectant women. The collective local name
given to TM used for pregnancy and labor is ‘kalghutim’
and usually made with various combinations of plant parts.
The natural materials used for the preparation of the
kalghutim as indicated by the respondents were Shea tree
(Vitellaria paradoxa), African peach (Nauclea latifolia),
Grewia mollis, Dry zone cedar (Pseudocedrela kotsehyi),
Large pink gardenia (Gardenia imperialis) and the fungus,
Amanita vaginata. The most common plant material found
in the Kalghutim preparations was the bark of the Shea
tree, 30 (33.7%) mostly for induction of labor and the least
used were the leaves and bark of Gardenia imperialis, 5
(5.6%) for relieving labor pains. Figures 1 to 6 (arrowed)
are the images of natural materials used in the formulation
of the Traditional medicines used in labor.
Table 4: The constituents of TM used in labor amongst women
Common
English
names
Local
Dagbanli
name*
Scientific NameFamily Parts
Commonly
Used
Number
of users
Percentages Chemical
constituents
Reference
African
peach
Gùlúŋgûŋ Nauclea latifolia
Sm
Rubiaceae Leaves 6 6.7 Steroids,
saponins,
alkaloids,
phenolic
compounds
Haudecoeur
et al., 2018
Large pink
gardenia
Dàzùlí Gardenia
imperialis K.
Schum
Rubiaceae Leaves and
bark
5 5.6 Flavonoids,
iridoids,
terpenoids,
steroids,
glycosides, D -
mannitol
Parmar and
Sharma,
2000
Dry zone
cedar
Síɣírìlì Pseudocedrela
kotsehyi
(Schweinf)
Harms
Meliaceae Roots 19 21.3 Carbohydrates,
glycosides,
saponins,
steroids,
flavonoids,
alkaloids,
tannins
Ayo et al.,
2010
- Yòlgá Grewia mollis
Juss.
Malvaceae Roots 16 18.0 Triterpenoids,
flavonoids,
steroids,
saponins,
tannins
Goyal, 2012
Toadstool Màlèɣú Amanita
vaginata Bull.**
Amanitaceae Whole
fungus
13 14.6 Phenol, ß-
carotene,
flavonoid,
lycopene,
ascorbic acid.
Paloi and
Acharya,
2013
Shea tree Tááŋà Vitellaria
paradoxa C.F.
Gaertn
Sapotaceae Bark 30 33.7 Flavonoids,
alkaloids,
phenols,
tannins,
glycosides
Fodouop et
al., 2017
*Respondents gave the local names of the materials and showed researchers these plants and fungus whose images are
as shown in figures 1 to 6. Botanical names were found after searching the local names of the plants in a publication on
Dagomba plant names (Blench, & Dendo, 2006). **Using Mushroom identifier app on an android phone, that was the
closest fungus that matched the image.

5. Management of Labor in Pregnant Women using Traditional Medicines in Northern Ghana – A Survey in the Tamale Metropolis
Int. J. Ethnopharmacol. 25
Figure 1: Dry zone cedar Figure 2: Shea tree Figure 3: Toadstool
(Pseudocedrela kotsehyi) (Vitellaria paradoxa) (Amanita vaginata)
Figure 4: Large pink Gardenia Figure 5: African peach Figure 6: Grewia mollis
(Gardenia imperialis) (Nauclea latifolia)
Reasons for the use of TM in labor
Out of the 78 of women who used TM, 32(41.0%) used
them to induce labor, 21(26.9%) for relieving of labor
pains, 14(17.9%) for augmentation of labor and 4(5.1%)
were for positioning of the fetus, 5(6.4%) for induction and
augmentation of labor while 2 (2.6%) were to appropriately
position the baby and relieve labor pain. Up to 71(91%) of
the respondents were satisfied with the outcome after
using the TIM while the rest, 7(9%) did not have the
purposes for the use of the TM being met. For those who
were not satisfied with the effect of the TM, their
dissatisfactions were due to experiencing severe uterine
contractions and pain, 5 (71.4%), and having to undergo
caesarean section despite the use of the TM, 2 (28.6%).
Majority, 58 (74.4%) of respondents did not experience
any suspected TM induced complications while the rest,
20 (25.6%) had some unpleasant results they attributed to
their use of the TM. About 35(44.9%) prepared it with soup
with the least mixing with drink, 2(2.6%). Table 5 shows
the reasons for which the expectant mothers used the TM
for their labor.

6. Management of Labor in Pregnant Women using Traditional Medicines in Northern Ghana – A Survey in the Tamale Metropolis
Ameade et al. 26
Table 5: Reasons for the use of the TM for labor
Question Response Frequency Percentage
What was your reason for taking traditional medicine in
labor (n = 78)
To augment labor 14 17.9
To induce and augment labor 5 6.4
To induce labor 32 41.0
To position the baby 4 5.1
To position and relieve labor pains 2 2.6
To relief labor pains 21 26.9
Was your reason for the use of the TM met? (n = 78) No 7 9
Yes 71 91
Why were your expectations for the use of the TM not
met? (n = 7)
I delivered through caesarean section 5 71.4
The pains became more severe 2 28.6
Were there any complication(s) you thought was or
were caused by the TM? (n = 78)
No 58 74.4
Yes 20 25.6
Table 6: Knowledge of respondents on effects of traditional medicine on labor
Variables Sub group Frequency Percentage Mean Score Mean Percentage
Any traditional medicine you take
can affect the labor process
Disagreed 14 4.7 3.74±0.672 74.8
Neutral 39 13.0
Agreed 218 72.4
Strongly agreed 30 10.0
Women in labor are not supposed
to take traditional medicine
Disagreed 19 6.3 3.88±0.634 77.6
Neutral 59 19.6
Agreed 203 67.4
Strongly agreed 20 6.6
Some traditional medicine have
uterotonic effects on the uterus
Disagreed 25 8.3 3.69±0.770 73.8
Neutral 74 24.6
Agreed 170 56.5
Strongly agreed 32 10.6
Taking traditional medicine without
medical advice in labor can lead to
maternal and perinatal death
Strongly disagreed 5 1.7 3.66±0.774 73.2
Disagreed 14 4.7
Neutral 87 28.9
Agreed 168 55.8
Strongly agreed 27 9
Traditional medicine is safer than
orthodox medicine
Strongly disagreed 61 20.3 2.35±0.974 47.0
Disagreed 116 38.5
Neutral 85 28.2
Agreed 35 11.6
Strongly agreed 4 1.3
Overall knowledge score 3.47±0.426 69.4
Complications respondents associated with their use
of TM in labor
Figure 7 shows the complications that some 20 (25.6%) of
respondents (78) who believed they suffered because of
their use of TM in labor. The complications the women
thought could have been caused by the TM they took
before or during labor were prolonged labor, 9 (45%)
postpartum hemorrhage, 5(25%), severe uterine
contractions, 4 (20%) and fetal death, 2 (10%).
Figure 7: Complications respondents associated with their
use of TM in labor
2 (10.0%)
5 (25%)
9 (45%)
4 (20%)
0
2
4
6
8
10
foetal death post partum
haemorrhage
prolonged
labour
severe
uterine
contractions
Numberofcomplications
Complications of TM in labor

7. Management of Labor in Pregnant Women using Traditional Medicines in Northern Ghana – A Survey in the Tamale Metropolis
Int. J. Ethnopharmacol. 27
Knowledge on effects of TM
Table 6 shows the knowledge of respondents on effects of
traditional medicines taken during labor. The mean
knowledge score for the question that TM can affect the
labor process was 3.74±0.672 (74.8%), while the question
that ‘Women are not supposed to use TM in labor scored
3.88±0.634 (77.6%). The knowledge score on some TM
having uterotonic effect was 3.69±0.770 (73.8%). The
knowledge score that TM can lead to maternal and
perinatal mortality was 3.66±0.774 (73.2%), while as score
of 2.35±0.974 (47.0%) was recorded for the statement that
TM is safer than orthodox medicine. The overall mean
knowledge score was 3.47±0.426 (69.4%).
Association between socio-demographics, obstetric
history and use of TM used in the most recent labor
Table 7 shows the association between socio
demographics characteristics, obstetric history and use of
traditional medicine in the most recent labor. Significant
difference was found between respondents based on
some socio-demographic characteristics; those with no
formal education and those who had some education (
32.8% vrs ≤ 19.8%, p < 0.001); followers of Islamic religion
and Christians (27.7% vrs 10.0%, p = 0.036); women in
extended family and those in nuclear families (30.7% vrs
20.0%, p = 0.035); women who delivered at home and
those who went to hospitals (60.6% vrs 15.2%, p < 0.001);
users of TM during pregnancy and non-users of TM
(69.4% vrs 17.5%, p < 0.001). Although women who were
single, belonging to higher income family (using residence
being apartment as a proxy), unemployed and non-
holders of National Health Insurance Scheme (NHIS)
cards were more users of TM in labor than their married or
cohabiting, low income earners, employers and holders of
NHIS cards counterparts respectively, but the differences
were not significant (p > 0.05).
Table 7: Association between socio-demographics characteristics, obstetric history and traditional medicine use
in last labor
Variable Sub group Did you use any traditional medicine in your last labor
No Yes p- value
Educational status No formal education 82 (61.2%) 52 (32.8%) <0.001*
Primary 65 (80.2%) 16 (19.8%)
Junior high school 50 (87.7%) 7 (12.3%)
At least Senior High school 26 (89.7%) 3 (10.3%)
Family system Extended 115 (69.3%) 51 (30.7%) 0.035*
Nuclear 108 (80.0%) 27 (20.0%)
Religion Christianity 27 (90.0%) 3 (10.0%) 0.036*
Islamic 196 (72.3%) 75 (27.7%)
Marital status Co-habiting 20 (83.3%) 4 (16.7%) 0.556
Married 198 (73.3%) 72 (26.7%)
Single 5 (71.4%) 2 (28.6%)
Type of Accommodation Apartment 11 (61.1%) 7 (38.9%) 0.145
Chamber and hall 40 (74.1%) 14 (25.9%)
Compound house 60 (83.3%) 12 (16.7%)
Single room 112 (71.3%) 45 (28.7%)
Type of Employment Employed 140 (75.7%) 45 (24.3%) 0.427
Unemployed 83 (71.6%) 33 (28.4%)
NHIS No 22 (68.8%) 10 (31.3%) 0.466
Yes 201 (74.7%) 68 (25.3%)
Home Delivery No 195 (84.8%) 35 (15.2%) <0.001*
Yes 28 (39.4%) 43 (60.6%)
Did you use any traditional
medicine in your last pregnancy
No 208 (82.5%) 44 (17.5%) <0.001*
Yes 15 (30.6%) 34 (69.4%)
*Statistically significant
DISCUSSION
With up to 80% of persons in developing countries using
traditional medicines for primary healthcare needs, it is
therefore not surprising that women still use traditional
medicines to manage pregnancy related challenges and
events in Africa (WHO, 2002). In this study, up to a third
(37.2%) of the women respondents used Traditional
medicines before pregnancy, a number higher than those
reported in several other studies (Adusi-Poku et al., 2015;
Alor, 2015; Dika et al., 2017; Maluma et al., 2017, Mothibe
and Tshabalala, 2018). Other reports from several other

8. Management of Labor in Pregnant Women using Traditional Medicines in Northern Ghana – A Survey in the Tamale Metropolis
countries including Ghana, Zimbabwe, Nigeria, Sierra
Leone and Malaysia recorded higher level of patronage of
TM by pregnant women than found in this study (Ab
Rahman et al., 2007; Mureyi et al., 2012; Olowokere and
Olajide, 2013; Ameade et al., 2018; James et al. 2018;
Ayelyini et al., 2019). The consumption of Traditional
medicine in this study seem to have decreased from 37.2%
to 16.3% during pregnancy which could be attributed to the
high level of attendance to antenatal clinics in this study
(97.7%) where women are usually advised to desist from
alternative medicines. The variations of prevalence of TM
usage from these studies could be due to the different
economic, religious and social settings in which these
studies were done. Studies conducted in conventional
health facilities possibly records lower prevalence because
of the unwillingness of respondents to divulge information
on their traditional medicine use due to the hostile attitude
of some health workers towards their use of alternative
medicine. The time of consumption of the traditional
medicine during pregnancy provides some inkling on the
intention of the user. This study found more than half
(53.8%) used the TM before the onset of labor which
indicates their intention was to induce the labor which they
or their caregivers who may be relatives or traditional birth
attendants’ thought may be delaying. A study in Tanzania
also found 56.1% of respondents using herbs to induce
labor (Dika et al., 2017). The traditional medicines and
especially herbs that are used to induce labor vary widely
across the world since distribution of plants is influenced
by various factors including the climate. Some previous
studies reported the use of coconut oil, raspberry leaf,
onions, ginger, neem, crushed ostrich eggshell and maize
porridge for managing labor among women (Vander Kooi
and Theobald, 2006; Ramasubramaniam et al, (2015);
Dika et al, 2017). Kamatenesi-Mugisha and Oryem-Origa,
(2007) documented the use of seventy-five medicinal plant
species and one fungal species which was a toadstool
mostly orally administered for induction of childbirth in
Western Uganda. This study also found the use of a
toadstool as one of the labor inducers and also the oral
route was the route for administration of these natural
uterotonic materials. Adusi-Poku et al., 2015 also reported
Nauclea latifolia as plant material used to arrest pre-term
labor but this plant is used among women in Tamale to
induce labor rather. These two effects of the same plant
can be possible since concentration of active components
of drugs can affect their indications. Ameade et al, (2018)
reported the use of Gardenia imperialis and Grewia mollis
among pregnant women in Tamale but for other
indications rather than labor induction or augmentation,
however in Togo and among the Yoruba in Nigeria, Grewia
mollis is reportedly used to ease child birth just as found in
this study [Grubben, 2008; Dalziel, (1937) as cited in Al-
Youssef et al. 2012]. Again, Grubben (2008) reported the
use of the bark of Pseudocedrela kotsehyi for facilitation of
childbirth just as found in this study. In this study, the
Shea tree, Vitellaria paradoxa was the most commonly
used plant for supporting the labor process. There is
paucity of information on its traditional use for facilitating
childbirth which requires some more study into this
medicinal property of the Shea tree. It is no gainsaying that
like all other medicines, these traditional medicines have
their unpleasant effects sometimes on the fetus, mother or
both with some fatal consequences. The respondents in
this study seem to have above average knowledge about
the possible effects of the TM some of them may be
consuming during the process of labor. This could be
because except 2.3% of the women, all have attended
antenatal clinics during the most recent pregnancy, where
health professionals advised them against the use of other
medicines besides those prescribed for them. However,
for 91% of the users of the TM to be satisfied with the
outcome of their use of the TM despite a quarter (25.6%)
associating some complications they suffered to the use of
the TM shows that women who use Traditional uterotonics
will invariably encourage others to resort to TM during
labor. In this study the complications respondents
associated to their TM usage in labor were mainly
prolonged labor 9(45%) and postpartum hemorrhage
(25%) which some health professionals sometimes
attribute to the TM they took as reported in a study in
Malawi (Maliwichi-Nyirenda and Maliwichi, 2010). It is
rather paradoxical for prolonged labor to occur after using
a drug that users were expecting to enhance or augment
their delivery process. Prolonged labor and postpartum
hemorrhage are usual occurrences during childbirth so
may not be associated to the use of the TM just as reported
in Zimbabwe (Mureyi et al., 2012). This study found
several socio-demographic characteristics of respondents
associated with their use of traditional medicine in labor.
Women with no formal education were found to
significantly use traditional medicine than the educated
just as reported in cross sectional study involving twelve
different African countries (Shewamene et al., 2017).
Again, this study found believers of the Islamic faith to
have a significant tendency to use TM in labor than their
Christian colleagues just as recorded in studies in Sierra
Leone and South Africa (Van der Kooi and Theobald,
2006; James et al., 2018). This can be explained by the
dominance of the followers of the Islamic faith who make
up to 90.2% of the total population in the Tamale
metropolis (Ghana Statistical Service, 2014). There was a
significant association between traditional medicine usage
and family system where women who live in extended
families were more users of TM in labor. Most Ghanaians
just like most Africans live in extended family systems
which have other relatives living together with a husband
and wife and their children with some of these relatives
being the elderly who have stayed in rural communities
and used TM for their health conditions (Makiwane and
Kaunda, 2018). It is therefore not surprising that beside the
traditional birth attendants, relatives were individuals who
mostly recommended this traditional uterotonics to the
women in this study which is corroborated by several other
studies in Africa (Olowokere and Olajide, 2013; Mothupi,
2014; Dika et al, 2017; Maluma et al., 2017). This study
suffers some constraints that are worth noting including
the fact that it was conducted only in one city in Ghana and
involved convenience sampling of respondents hence
results cannot be generalized. Despite these limitations,

9. Management of Labor in Pregnant Women using Traditional Medicines in Northern Ghana – A Survey in the Tamale Metropolis
itwill be useful for health workers to appreciate the level of
use of TM so appropriate interventions could be taken.
Also, further research can be conducted on the natural
substances used for the preparation of the traditional
uterotonics which could possibly lead to discovery of
useful drugs which can be used subsequently in the
conventional health facilities.
CONCLUSION
About a quarter of expectant mothers (25.9%) used TM to
facilitate labor mostly for induction or augmentation of the
process as well as reduce the associated pain. The bark
of the Shea tree was the most common component of the
traditional uterotonics which is locally known as Kalghutim.
However, the usage or otherwise of these traditional
uterotonics was found to be associated with no formal
education, living in the extended family system and also
being a Moslem. Generally, these women exhibited an
above average knowledge on the effects of TM on
maternal and child health but with majority of users being
satisfied with the outcome after use, the use of TM for labor
will continue into the future.
ACKNOWLEDGEMENTS
Wish to acknowledge the support of all the women who
took part in this study and graciously completed the
questionnaire. We are also grateful to Yenami Kaletor
Korku Ameade who read through the manuscript to correct
typographical and grammatical errors.
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Accepted 12 June 2020
Citation: Ameade EPK, Adikem CK, Asibiti W (2020):
Management of Labor in Pregnant Women using
Traditional Medicines in Northern Ghana – A Survey in the
Tamale Metropolis. International Journal of
Ethnopharmacology, 3(1): 021-030.
Copyright: © 2020 Ameade et al. This is an open-access
article distributed under the terms of the Creative
Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium,
provided the original author and source are cited.