Incidence and Self-Care of Nausea and Vomiting Among Pregnant Women Attending a Maternal Clinic 

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Incidence and Self-Care of Nausea and Vomiting Among Pregnant Women

Attending a Maternal Clinic

Ufuoma Shalom Ahwinahwi

1*

, Valentine Uche Odili

2

,

Ojevwe Esirorie

1

1

Department of Clinical Pharmacy and Pharmacy Administration, Delta State University ; P.M.B 1, Abraka- Nigeria

2Department of Clinical Pharmacy and Pharmacy Practice, University of Benin, P.M.B 1154, Benin City- Nigeria

Article Information Received 28 May 2016

Received in revised form 27 June 2016 Accepted 29 June 2016

Abstract

Nausea and vomiting (NVP) of pregnancy are common among women. The purpose of this

study was to determine the incidence of nausea and vomiting in pregnancy and the self- care

measures adopted by women attending a maternal clinic. A descriptive cross sectional study

was carried out utilizing an interviewer-administered questionnaire to consenting pregnant

women attending the maternal clinic of Central Hospital, Agbor; Delta state – Nigeria. Of the

521 gravid women included in the study, 221 (42.4%) were within the age group of 27 and 32

years and had secondary level of education 238(45.7%).The mean gravidity of the

participants was 2.68±1.54, mean gestational age at the time of the study was 24.68 weeks ±

7.40 and the mean gestational age at which nausea and vomiting were observed, and was

6.30 weeks ± 3.82. Three hundred and fifteen (60.5%) of the women experienced the symptoms of nausea and vomiting of pregnancy. Taking “bitterkola” (Garcinia kola) (22.9%) either alone or in combination with other substances was the most frequently occurring

measure to control nausea and vomiting. Other measures taken included taking “native chalk” (18.8%), Ginger (5.6%) bitter leaves (Amygdala vernonia) (7.6%), fruits (19.9%), chewing gum (4.7%), taking sweets (9.4%), taking drugs (3.7%) and rest (4.7%).Over 20%

of the study population with nausea and vomiting opined that nausea and vomiting had a

negative impact on their lives; however only 7.5% are discouraged from getting pregnant as

a result of nausea and vomiting. Use of self-care measures was associated with educational

level of the respondents (P=0.004). The rate of nausea and vomiting was high in the studied

participants and Bitterkola (Garcinia kola) was the most commonly used agent for its prevention. The respondents who experienced nausea and vomiting reported its huge

negative impact on their lives. Keywords:

Incidence, Self-care,

Nausea and vomiting, Pregnant women Corresponding Author: E-mail : ushaloma@yahoo.com Mob.: +2348084867230

1 Introduction

Nausea and Vomiting (NVP) in pregnancy is common among

women who are in the first trimester of pregnancy. About seven

to eight out of every 10 pregnant women experience Nausea

and vomitting1. Historically, nausea and vomiting of pregnancy

was first recorded about four millennia ago2. Although NVP is most commonly experienced in the first trimester, quite a

number of women suffer symptoms beyond twelve weeks of

gestation1. “Morning sickness” is commonly used to describe

NVP and is defined as nausea alone or the combination of

nausea, retching and occasional vomiting in early pregnancy3 or

a collection of symptoms such as food aversions, nausea and

vomiting, which occur in women during the first trimester of

pregnancy2, however, only about 17% of pregnant women have

symptoms only in the morning4. In some pregnant women

nausea and vomiting can begin in the first two weeks or one

month of pregnancy and usually stops by the 20th week of

pregnancy6. There is a more severe form of NVP called

Hyperemesis Gravidarium (HG) which occurs in 0.5% -3% of

pregnancies7,8. HG has been reported as the most common reason for hospitalization during the first trimester9 and carries

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an increased risk for low birth weight of the foetus 10. Studies have reported that NVP is associated with favorable pregnancy

outcomes3,7. A number of maternal characteristics, including

primiparity, younger maternal age and lower educational level

have been associated with nausea and vomiting of

pregnancy8,11. Higher maternal Body Mass Index (BMI) has

been identified as a risk factor for vomiting11. A meta-analysis12

which determined the global rates of nausea and vomiting in

pregnancy, included only two studies from the African continent

gave an average rate of 64% and 32.7% for women who had

only nausea without vomiting.

NVP has been found to affect a woman's life and professional

productivity. For instance, almost half of all pregnant women

who experience nausea and vomiting believe that NVP

adversely affects their relationship with their spouse, make them

depressed13, and reduces their work efficiency such that about

a quarter of them would need to be absent from work to contend

with the symptoms14. A study of 411 pregnant women3 revealed that women without NVP had poorer outcomes of pregnancy

such as, non-viable pregnancies and low infant birth weight.

Conversely, a meta-analysis of 11 studies concluded that

women with NVP had a lower risk of miscarriage15.

Some self-care practices by women who have NVP include

actions to either alleviate or stop such unhealthy disposition and

these include their lifestyles modification, diet, drugs and other

alternative therapies used. A Jordanian study16 revealed that

women used several strategies ranging from lifestyle

modifications, diet, complementary and alternative medicines

and drugs to alleviate the symptoms of nausea and vomiting in

pregnancy. Another study revealed that half of the women who

experienced nausea used anti-emetic herbal remedies, which

included ginger, peppermint and cannabis17. Most women with

nausea and vomiting in pregnancy can successfully be

managed in a primary care setting.

Nausea and vomiting in pregnancy which is common among

pregnant women has been studied in different parts of the

world1,16,18. The management of NVP in developed countries

has also been given much consideration as seen in our

literature search. A few of such studies19, 20 have been

conducted in Nigeria; there is, however, a dearth of studies on

self-care measures in the management of NVP in Nigeria and in

the immediate locality hence this study. This study will therefore

determine the incidence of nausea and vomiting in pregnancy in

this locality and to identify measures taken by the women to

alleviate nausea and vomiting determine its association with

their level of education.

2 Materials and Methods

2.1 Study design

The study was a cross sectional descriptive study conducted

using an interviewer administered questionnaire.

2.2 Setting and population

The study was conducted at the ante-natal clinic of Central

Hospital, Agbor in Delta State. Central Hospital Agbor is a

secondary health facility, and it is one of the four central

hospitals located in the State, Pregnant women attending the

clinic at the center benefit from free-maternal care, which was

on-going in the state at the time of this research.

The population comprised pregnant women attending ante-natal

clinic at the center for a period between the 15th May 2015 and

25th July 2015. About fifty pregnant women attend the clinic on

Mondays, Tuesdays and Wednesdays with another 50 freshly

registered at the clinic every Wednesday and given an

appointment for a future date. This results in a total of about 200

women visiting the clinic weekly. A total population of 1800 was

therefore achieved in the nine weeks of the study.

2.3 Sample size calculation

The sample size was calculated using Raosoft® sample size

calculator with a population of 1800, a margin of error at 5%,

confidence level at 95% and Response distribution of 50% and

a sample size of 317 was obtained. However, 521 pregnant

women were included in the study to make up for attrition.

2.4 Data collection

The interview was conducted with the aid of a questionnaire

which was drawn after careful consideration of the study

objectives, literature search and consultations with other

researchers. It consisted of 30-items which included a

demographic section and a section on Nausea and Vomiting in

Pregnancy. The Questionnaire was pre-tested among pregnant

women who do not attend the ante-natal clinic at the study

center and appropriate adjustments were made.

The questionnaire was administered to the pregnant women

waiting to receive ante-natal care after a brief introductory talk

on the purpose of the research.

2.5 Ethical considerations

Oral informed consent was obtained from the participants

before administering the questionnaire,

Permission to undertake this study was granted by the Hospital

Administration office.

2.6 Data analysis

Data gathered were entered into Microsoft Excel spreadsheet,

cleaned and sorted. Thereafter, it was loaded into the Statistical

Package for Social Sciences (SPSS) version 15. Descriptive

statistics of variables were reported as either frequencies

(percentages), or mean  (standard deviation) and inferential

statistics were also carried out and P˂0.05 were considered

(3)

3 Results

3.1 Demographics

A total of Five hundred and twenty-one pregnant women

participated in the study The majority of the respondents 221

(42.4%) were in the age group of 27 and 32 years followed by

144 (31.1%) who were within 21-26 years, other age ranges are

as shown in table 1. Four hundred and ninety-nine (95.8%)

were married and only 20 (4%) of them were single, divorced or

separated. The Ikas, 331 (63.5%) were the most frequent ethnic

group encountered. Majority of the respondents had a

secondary level education 238 (45.7%) while 229 (44.0%) had a

tertiary education. The education status of the other participants

is as depicted in table 1. The occupation of the respondents are

shown in the table 3.2, majority of them were traders 172

(33.3%) followed by artisans 90 (17.3 %).

The mean gravidity of the respondents was 2.68 ± 1.54 (range

1-10) and mean number of pregnancies to full term was 1.36 ±

1.34 (range 0-9). The mean gestational age at booking was

19.69 weeks ± 6.07 (range 4weeks - 40weeks) and mean

gestational age at the time of the study was (24.68 ± 7.40

(range 4 weeks - 42weeks). The mean gestational age at which

nausea and vomiting were observed was 6.30 weeks ± 3.82

(range 1week-28 weeks).

Majority of the women 438 (84.1%) did not have any disease

conditions while 31 (10%) reported malaria either alone or

associated with diarrhea and ulcer 31 (6%), and 13 (2.5%) had

pregnancy induced hypertension.

3.2 Incidence of nausea and vomiting

Three hundred and fifteen (61%) of the women experienced

either one or more of the following: nausea, vomiting and

excessive salivation which are symptoms of nausea and

vomiting during pregnancy (Table 2).

3.3 Measures taken to control nausea and vomiting

Measures taken by the participants to control nausea and

vomiting in pregnancy included a wide range of dietary, life style

modification and complementary and alternative medicine.

Among a total of 106 responses, Bitterkola (Garcinia kola) either used alone (8.4%) or in combination with other agents (14.5%)

was the most frequently mentioned substance taken to control

nausea and vomiting, other measures included the use of a

substance known as “native chalk” (18.8%), Ginger (5.6%),

chewing gum (4.7%) and sweets (9.4%), while some of the

participants increased their fluid intake (0.9%) and /or took

some rest (4.7%) as shown in table 3

3.4 Use of drugs in the control of NVP

Out of the 174 (33.4 %) participants who responded when

asked about drug use, 53 (30%) took drugs to alleviate nausea

and vomiting while 121 (70%) said they do not take drugs to

alleviate nausea and vomiting.

Table 1: Demographics of respondents

Characteristics Frequency (%)

Age group 15-20 18(3.5)

21-26 162(31.1)

27-32 221(42.4)

33-38 104(20.0)

39-44 14(20)

No Response 2 (0.4)

Marital status Single 17(3.3)

Married 499(95.8)

Separated/Divorced 3(0.6)

No Response 2(0.4)

Level of education No Basic Education 10(1.9)

Primary Education 36(6.9)

Secondary

Education 238(45.7)

Tertiary Education 229(44.0)

Postgraduate

Education 4(0.8)

No response 4(0.8)

Ethnicity Ika 331(63.3)

Urhobo 30(5.8)

Bini 16(3.1)

Esan 15(2.9)

Ukwani 18(3.3)

Ibo(Delta) 17(3.3)

Other 32(6.1)

Ghanaian 1(0.2)

No Response

Employment Student/Apprentice 24(4.6)

Artisan 90(17.3)

Trading/Business 197(35.9)

Housewife 71(13.9)

Public Servant 38(7.3)

Self-employed 10(1.9)

Private school

Teaching 23(4.3)

Other private

workers 12(2.1)

Nurse/Midwife 3(0.6)

(4)

Table 2: Incidence of Nausea and Vomiting

Symptoms Frequency (%)

Nausea 11 (2.1)

Nausea and Vomiting 49(9.4)

Nausea, Vomiting and excessive

salivation 103(19.8)

Nausea and excessive salivation 22(4.2)

Vomiting Only 38(7.3)

Vomiting and spitting 28(5.4)

Excessive salivation only 64(12.3)

None 204(39.2)

No Response 2(0.4)

Of the total respondents that used drugs, 25(47.2%), 11

(20.8%), and 3 (5.7%) said drugs were prescribed by doctor,

nurse and pharmacist respectively while the others (1426.4%)

got the drugs on their own or through recommendation from friends and family members. Forty-one (77 %) of the fifty –three

persons who used drugs said they got better after using the

prescribed medication.

3.5 Impact of Nausea and vomiting on the lives of the respondents

One hundred and twenty-eight of the sample population (24.6%)

felt nausea and vomiting had prevented them from carrying out

their normal activities and 122 (23.4%) thought they lost weight

as a result of nausea and vomiting. Eighty respondents (15.4%)

said that nausea and vomiting are serious enough problem to

warrant a sick day off from work and 105 (22.1%) of them said it

affects their quality of life. However, only 39 (7.5%) of all the

participants agreed that nausea and vomiting in pregnancy can

discourage them from getting pregnant again. This is as shown

in table 4

3.6 Association between taking self-care measures and educational level

There was an association between taking self-care measures

and educational level. This is shown in table 5

4 Discussions

This study is aimed at evaluating the incidence and self-care of

nausea and vomiting in pregnancy and its impact on the lives of

the women.

4.1 Incidence of nausea and vomiting The incidence of nausea and vomiting in pregnant women

studied was high compared to other previous studies.

Table 3: Measures taken by pregnant women to control nausea and vomiting

Measures Frequency (%)

n=106

Bitterkola alone 9((8)

Bitterkola and bitterleaf 1(0.9)

Bitterkola and fruits 4(3.7)

Bitterkloa and chewing gum 3(2.8)

Bitterkola and native chalk 4(3.7)

Bitterkola and ginger 2(1.9)

Bitterkola , native chalk and sweets 2(1.9)

Sweets (containing menthol) 7(6.6)

Native chalk 6(5.7)

Native chalk and sweets 2(1.9)

Native chalk and fruits 1(0,9)

Native chalk and ginger 1(0.9)

Native chalk and pepperfruit 1(1.9)

Native chalk , ginger and rest 1(1.9)

Bitterleaf/bitterleaf stalk 6(5.7)

Bitterleaf and chewing gum 1(1.9)

Sweets and chewing gum 5(4.7)

Fruits 13(12.3)

Fruits and sweets 2(1.9)

Fruits and chewing gum 1(1.9)

Fruits , chewing gum and biscuits 1(1.9)

Kolanut 3(2.8)

Kolanut and fruits 1(1.9)

Herbal remedies 4(3.7)

Ginger 3(2.8)

Ginger and rest 1(0.9)

Ginger and chewing gum 1 (1.9)

Chewing gum 2(1.9)

Chewing gum and biscuits 1(0.9)

Sweets and Bitter lemon drink 1(0.9)

Fluid intake , fruits and rest 1(0.9)

Avoid triggers and drugs 1(0.9)

Dietary changes 2(1.9)

Drugs 3(2.8)

Drugs and sweets 1(0..9)

Ate “Ukpa” 1(0.9)

Rest 5(4.7)

Went to the hospital 1(0.9)

The study revealed that nausea with or without vomiting was

experienced by over half of the respondents. This rates was

lower than reported in some studies1,5 and could be due to the fact that NVP is more common in whites than black women21.

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Nigeria where the incidence of NVP among gravid women was 49.2%.

Table 4: The Impact of Nausea and Vomiting on the lives of the respondents

Item (N= 521) Response N (%)

Yes No Undecided

Has the nausea and vomiting disturbed you from

carrying out you normal activities? 128(15.2) 79(2.9) 15(2.9)

Do you think you have lost weight as a result of

vomiting during this pregnancy? 122(23.4) 87(16.7) 16(3.1)

Do you think nausea and vomiting is serious enough

problem to warrant sick day off from work? 80(15.4) 97(18.6) 48(9.2)

Does nausea and vomiting affect your quality of life? 115(22.1) 89(17.1) 23(4.4)

Does nausea and vomiting discourage you from getting

pregnant again? 39(7.8) 150(28.8) 37(7.1)

Table 5: Relationship between taking self-care measures and educational level

Educational

level Frequency No Yes

P- value

Primary 28 5 3 -

Secondary 149 34 55 0.004

Tertiary 127 55 47 -

4.2 Measures taken to control nausea and vomiting of pregnancy

Strikingly, among the various measures taken by the

respondents to control nausea and vomiting of pregnancy,

bitterkola (Garcinia kola) either taken alone or in combination with other agents was most frequently used, Ginger has been

widely reported as an alternative medicine agent in the control

of nausea and vomiting22. Others such as chamomile,

peppermint and cannabis have also been studied17. Ginger was

only used by a few of the respondents in the current study. This

could be because the use of ginger for nausea and vomiting

was still unknown to majority if the respondents in this study.

There were no previous studies found on the use of bitterkola in

the control and treatment of nausea and vomiting in pregnancy,

this is highly suggestive of the speculation that bitterkola could

be a common practice of traditional and herbal remedies in this

locality. The use of native chalk or Nzu as it is called locally was reported also among the study participants. In 2009, United

States Food and Drug Administration department notified

healthcare professionals and pregnant and breastfeeding

mothers to avoid consuming Nzu, a traditional African remedy

for morning sickness because of potential health risks from

high level of lead and arsenic 23.

The proportion of respondents who used drugs to control

nausea and vomiting is low when compared with a previous

study where over 60% used pharmacologic agent in treating

nausea and vomiting in pregnancy24. Most of the drugs used

were prescribed by healthcare professionals and only a few

were taken based on the recommendation of family and friends.

This this may be due to the general belief in the locality that

using drugs indiscriminately by pregnant women could cause

harm to the baby, and the belief that herbal or alternative

medicines such as bitterkola are safer.

4.3 Impact of Nausea and vomiting on the lives of pregnant women

Over 20% of the participants believed nausea and vomiting had

some negative impact on their lives as shown by weight loss,

inability to carry out their normal activities and generally their

quality of life. This corroborates the findings of other studies25,26.

However, majority of the respondents would still get pregnant

despite NVP.. This is in consonance with another study27 were over 80% of the population did not consider termination of

pregnancy due to NVP.

4.4 Association between self-care measures and educational level

There was an association between self-care measures and

educational levels of the participants. This association has not

been found in any other reports, Kresheh16 however reported an association between paid employment and using various

strategies in controlling NVP.

(6)

There was a high incidence of nausea and vomiting in the

respondents studied. Various measures taken by the women to

control nausea and vomiting included Bitterkola (Garcinia kola), Native chalk, Ginger, Drugs, Chewing gum and sweets among

others while some of the participants increased fluid intake, took

some rest or went to the hospital. An appreciable proportion of

the women perceived nausea and vomiting had a negative

impact on their lives; however, only a small proportion would not

want to get pregnant because of nausea and vomiting.

Research studies, including clinical trials should be conducted

on Bitterkola (Garcinia kola) to determine its efficacy and safety in controlling nausea and vomiting in pregnancy.

6 Conflict of Interests

None declared.

7 Author’s contributions

VUO and USA conceived the study, USA and OE did the

literature review. OE and USA collected the data while VUO

carried out the statistical analyses. VUO and USA drafted the

manuscript. All authors read and approved the final manuscript.

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Figure

Table 1: Demographics of respondents

Table 1:

Demographics of respondents p.3
Table 2: Incidence of Nausea and Vomiting

Table 2:

Incidence of Nausea and Vomiting p.4
Table 3: Measures taken by pregnant women to control

Table 3:

Measures taken by pregnant women to control p.4
Table 4: The Impact of Nausea and Vomiting on the lives of the respondents

Table 4:

The Impact of Nausea and Vomiting on the lives of the respondents p.5
Table 5:  Relationship between taking self-care measures

Table 5:

Relationship between taking self-care measures p.5

References