Asma Complete Thesis Book

EFFECTS OF OVER USE DRUGS DURING PREGNANCY AND LACTATION IN WADAJIR DISTRACT
DECLARATION
I declare that this research dissertation on the –Effects Of Over Use Drugs During Pregnancy
And Lactation In WadjirDistract”is my original work and to the best of my knowledge,has not
been submitted for any award at any academic institution.
Name of the candidate: Asma Ali Hussein
Signature:------------------------------------
Date: -------/-------/2021
I
UNISO FACULTY OF HEALTH SCIENCE & MEDICINE DEP OF NURSING & MIDWIFERY
SUPERVISOR APPROVAL
I certify that this senior project supervised is satisfied in terms of scope and quality and in my
opinion is sufficient as the award of the Bachelor degree of medical nursing and midwifery and I
accepted for the submission to the examining panel.
I would like to acknowledge my dear Supervisor Mr. for his valuable suggestions supports and
guidance and to complete this thesis successfully.
Name: Mr. Mahad Mohamed Rage
Signature: ___________________________________
Date: _________/_________/_______
II
APPROVAL SHEET
We certify that this research has been done by Asma Ali Hussein under our supervision and is
now ready for the submission Faculty of medicine and health science to the department of school
of Nursing Midwifery.
It was great appreciation that I acknowledge the contribution and support of my supervisor,
associated Mr. Mahad Mohamed Rage whose time, effort and guidance were highly beneficial
throughout my bachelor thesis.
Thank you, Mr. Mr. Mahad Mohamed Rage, for your positive attitude and outlook; you are a
humble supervisor.
Supervisor: Mr. Mahad Mohamed Rage
Signature: __________________
Date: ____/_____/ ____
Head of School of Medical Nursing
Dr. Osmaan Abdi Ibrahim
Signature: __________________
Date: ____/_____/ ____
III
DEDICATION
I would like to dedicate my dissertation to my lovely parents who taught us discipline, patience
and self-righteousness. May ALLAH reward and keep them prosperous and wellbeing my
Mother FadumaNuurShuriye, my dear Father Ali Hussein Adam. My Dear sisters and brothers
Mohamed Bashir, SaciidBashir, Abdullahi Ali, Abdirahman Ali , Khadijo Ali,Mariya Ali and my
dear aunts Ardo Nuur and AyanNuur who moral support greatly contributed this piece of work.
I specially thank to my best friend and elder sister SawdaDaahir Abdi, dear sister blesses you for
always there for me and supporting, encouraging. Thank you anyhow. May ALLAH Reward you
JannatulFirdows.
I also specially thank to my elder brother Mahamed Bashir, you have worked to ensure that your
siblings are happy and successful, so I write this message to say Thank you more then millions
for being the most amazing older brother alive. May ALLAH Reward you JannatulFirdows.
Finally, I would like to thank My Dear Father: Ali Hussein who encouraged me to study and
make me believe that I do everything without supporting any other person, daddy you are most
important person in my life I just admire your sacrifice for me, your support means a lot to me.
Thank you for being there every time. May ALLAH Reward you JannatulFirdows.
IV
AKNOWLEDGMETS
Many thanks to Allah, who created me, made me Muslim and gave me the ability to complete
my thesis successful. Secondly, I would like to express my deep gratitude to my dear parents my
dear brothers and sisters for their unforgettable help and support during my educational period
and my whole life.
I would like to express my deep appreciation to my dear supervisor Mr. Mahad Mohamed Rage
for his valuable suggestions, support and guidance in completing this thesis successfully.
I gratefully acknowledge to the faculty of l Nursing Midwifery at University of Somalia, also go

to my most significant academic lecturers in the Nursing Midwifery Department for their tireless
and ambitious efforts to educate us at their best level.
I would like thanks all Uniso students specially my classmates NM:17B
I thank to my friends: Aish Salaad, Miski Isse, Dr Ahmed, Dr Amiin, Dr Alim and my beloved
lecturers and Friend Dr Alia Abdalla, Falis Mohamed,Amino, Shukri, DrOsmaan Abdi. I would
like thanks Mr. Mahad Mohamed Rage, who participate me with moral supports for writing my
thesis.
Finally, I should also like to express my deep sense of gratitude to everyone, who contributed to
my thesis development process through encouragement, technical support, also thankful students
Of Uniso especially college of Health science for their filling questionnaires for Being helpful
V
ABSTRACT
In the world some medicines are safe to take during pregnancy while other medicines may have
adverse effects on the unborn baby. Most medicines are assigned one of five Categories to help
identify the potential level of risk. It is very important to check each and Every medicine,
including over-the-counter medicines and natural supplements, to determine if they are safe to
take while pregnant. This is especially important during the first trimester of Pregnancy (0-13
weeks).The study examined the effect of over use drugs during pregnancy & lactation at Wadajir
distract. The main objectives was to provide an overview the effect of over use drugs during
pregnancy and lactation,to identify the risk and complication of over use drugs during pregnancy
&lactation The sample sizewas 50 respondents was taken to determine the ideal sample size for a
population; the study wasused Slovene’s formula due to the lack of enough resources and time.
The data obtained from the respondents was quantitative and it was collected through
questionnaire. The study will use a descriptive cross sectional study design because; cross
sectional study is in depth investigation of an individual, group, institution. Cross sectional study
helps the study to describe and explain study single or same entities in depth in order to gain
insight into the larger case. This design is appropriate for rich understanding of study population
on effects of over use of drugs during pregnancy and lactation in Wadajir district. Data analysis
was done by using computer especially excel spreadsheet which presents and analyses the data
appropriate way, and was used graphs and tables, as result of presentationthe majority of the
respondents has family and are stable emotionally 48% of them are university level, and 48%
were house wife while 22% were employed. The majority of the respondent 15(34.1%) were
aged 21-25years and were married in marital status, great number of respondent were second
trimester17 (38.6%), large number of respondent were suffered from kidney diseasebefore
pregnant. The unique nature of physiology of pregnancy presents challenges for pharmaceutical
treatment of chronic and acute disorders and for symptom management of many complaints
associated with pregnancy. It is the responsibility of all clinicians including pharmacists to
counsel patients with complete, accurate and current information on the risks and benefits of
using medications during pregnancy. In conclusion this research was descriptive review of There
is a moral obligation to protect from dissemination any and all personal information, of any type,
that has been obtained on the patient by any and all health care professionals at any medical
facility. The justification for the protection of this right is integral to the very provision of health
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care itself. It is essential that there exist a relationship of trust between the patient and health care
professional.
Contents
DECLARATION..........................................................................................................................................I
SUPERVISOR APPROVAL.......................................................................................................................II
APPROVAL SHEET..................................................................................................................................III
DEDICATION...........................................................................................................................................IV
AKNOWLEDGMETS................................................................................................................................V
ABSTRACT...............................................................................................................................................VI
CHAPTER ONE..........................................................................................................................................1
1.0 Introduction...............................................................................................................................1
1.1. Background of the study...........................................................................................................1
1.2 Problem Statement.............................................................................................................................3
1.3 Justification of the Study...................................................................................................................3
1.4 Research Objectives..........................................................................................................................4
1.4.1. General objective of the study...................................................................................................4
1.4.2.Specific Objectives.....................................................................................................................4
VII
1.5 Research Questions............................................................................................................................4

1.6 Significant of the study......................................................................................................................4
1.7 Scope of the Study.............................................................................................................................5
1.7.1 Time scope:................................................................................................................................5
1.7.2 Geographical scope:....................................................................................................................5
1.7.3 Theoretical scope:.......................................................................................................................5
1.8 Operational Definitions.....................................................................................................................5
CHAPTER TWO.........................................................................................................................................6
LITERATURE REVIEW............................................................................................................................6
2.0 Introduction...............................................................................................................................6
2.1 Theoretical framework.......................................................................................................................6
2.1.1 Public Health Theory and Practice..............................................................................................7
2.1.2 Health Behavior Theory..............................................................................................................7
2.2 Level of Knowledge of Effects of Over Uses of Drugs during Pregnancy and Lactation..................8
2.3 Risk factors associated with effects of over use drugs during pregnancy and lactation..................10
2.4Complication associated with effects of over use of drugs among pregnancy and lactation.............13
2.5 Literature Gap..................................................................................................................................16
2.6 Conceptual Framework....................................................................................................................16
CHAPTER THREE...................................................................................................................................18
RESEARCH METHODOLOGY..............................................................................................................18
3.0 Introduction.....................................................................................................................................18
3.1 Study Design...................................................................................................................................18
3.2 Study population..............................................................................................................................18
3.2.1 Inclusion Criteria......................................................................................................................18
3.2.2Exclusion Criteria......................................................................................................................19
3.3 Sample size determination...............................................................................................................19
3.4 Sample procedure/technique............................................................................................................19
3.5 Research instrument........................................................................................................................19
3.6 Data collection methods..................................................................................................................19
3.7 Data analysis procedure...................................................................................................................20
3.8 Validity and reliability of the study.................................................................................................20
VIII
3.8.1 Validity.....................................................................................................................................20
3.8.2 Reliability.................................................................................................................................21
3.9 Ethical consideration of the study....................................................................................................21
CHAPTER FOUR...................................................................................................................................22
DATA ANALAYSIS................................................................................................................................22
4.0 Introduction...................................................................................................................................22
Table 4.1 by age distribution..............................................................................................................22
Figure 4.1 Age of respondents...............................................................................................................23
4.2 Marital status:..................................................................................................................................23
Figure 4.2 Marital status:.......................................................................................................................24
Table: 4.3 Educational level..................................................................................................................24
Figure 4.3 educational level...................................................................................................................25
Table 4.4 occupational of respondents...................................................................................................25
Table 4.5 . Do you have any idea about effect of over use drugs during pregnancy and lactation?.......26
Figure 4.55. Do you have any idea about effect of over use drugs during pregnancy and lactation?.....27
Table 4.6 . Has any member of your family encounter the effect of over use drugs during pregnancy
and Lactation?.......................................................................................................................................27
Figure 4.6 . Has any member of your family encounter the effect of over use drugs during pregnancy
and Lactation?.......................................................................................................................................28
Tabable 4.7. Do you think that over use drugs during pregnancy &lactation is life threatening
condition?..............................................................................................................................................28
Figure 4.7. Do you think that over use drugs during pregnancy &lactation is life threatening condition?
...............................................................................................................................................................29
Table 4.8 Generally drug substance or medication can cause harm by the fetus:-.................................29
Figure 4.8 Generally drug substance or medication can cause harm by the fetus:-................................30
Table 4.9 Does the drug cross the placenta?..........................................................................................31
Figure 4.9 Does the drug cross the placenta?.........................................................................................32
Table 4.10 . Do you believe that tetracycline contraindicated during pregnancy?.................................32
Figure 4.10 . Do you believe that tetracycline contraindicated during pregnancy?................................33
Table 4.11 Do all medication pass through breast milk?.......................................................................33
Figure 4.11 Do all medication pass through breast milk?......................................................................34
Table4.12 Do you know safe drugs during pregnancy and lactation?....................................................34
Figure 4.12Do you know safe drugs during pregnancy and lactation?...................................................35
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Table 1.13 Do you ever attend any training on effect of over use drugs during pregnancy and lactation?
...............................................................................................................................................................35
Figure 4.13 Do you ever attend any training on effect of over use drugs during pregnancy and
lactation?...............................................................................................................................................36
Table 4.14 how ever drugs that do not cross the plecenta may still harm the fetas by effecting the uters
or the plecenta ......................................................................................................................................37
Figure 4.14 how ever drugs that do not cross the plecenta may still harm the fetas by effecting the uters
or the plecenta ......................................................................................................................................38
Table 4.15over use drugs particularly with otc medication is concerned potential for harm of pregnancy
women...................................................................................................................................................38
Figure 4.15over use drugs particularly with otc medication is concerned potential for harm of
pregnancy women..................................................................................................................................39
CHAPTER FIVE:......................................................................................................................................39
MAIN FINDINGS, LIMITATIONS OF THE STUDY, RECOMMENDATIONS...................................39
5.0 Introduction.....................................................................................................................................39
5.1 Main Finding...................................................................................................................................40
5.2 Limitations of the study...................................................................................................................41
5.3 Recommendations...........................................................................................................................41
APPENDIX (A)........................................................................................................................................43
REFERENCES........................................................................................................................................43
APPENDIX (B)........................................................................................................................................45
QUESTIONNAIRE...............................................................................................................................45
APPENDIX C: MAP OF SOMALIA........................................................................................................49
APPENDIX D: MAP OF MOGADISHU..................................................................................................50
APPENDIX E:MAP OF WARDAJIR DISTRICT....................................................................................52
X
XI
CHAPTER ONE
1.0 Introduction
This chapter contains a variety of units intended to introduce the study to the readers. These units
include background of the study, problem of statement, Justification of the study, general
objective of the study, specific objectives of the study, research questions, significance of study,
scope of the study, and operationaldefinitions.
1.1. Background of the study
Globally: In the world some medicines are safe to take during pregnancy while other medicines
may have adverse effects on the unborn baby. Most medicines are assigned one of five
Categories to help identify the potential level of risk. It is very important to check each and
Every medicine, including over-the-counter medicines and natural supplements, to determine if
they are safe to take while pregnant. This is especially important during the first trimester of
Pregnancy (0-13 weeks), a critical time for development of the embryo and fetus medicines can
also pass into breast milk in small quantities. Cilia most are safe for a mother to take and will not
cause any harm to a breastfeeding infant, some medicines such as cytotoxic Agents, lithium,
radiopharmaceuticals, and retinoid must be avoided. Statistics about human pregnancy-related
risks with prescription and nonprescription medications are most commonly derived from
epidemiological study data obtained through Cohort or case-controlled studies.( Med J Aust
1976:)
Cohort studies to a potential toxin and women not exposed. case-controlled studies evaluate
maternal factors in children with and without a specific developmental abnormality Cohort
studies generally provide a more representative population sample although large sample sizes
are usually needed to identify an increased frequency of negative pregnancy outcomes compare
adverse pregnancy outcomes between large groups of women exposed although women usually
tell their doctors that they want to avoid medication during pregnancy, the vast majority of
pregnant women consume both prescriptions and nonprescription medications. Women are often
very concerned about medication effects on the developing baby negative impact on pregnancy
by maternal stress has been supported by studies showing that women exposed to high stress
1
during pregnancy have a higher risk of delivering offspring with low birth weight when babies
are born prematurely and a higher incidence of cranial-Neural crest malformations (especially
cleft lip/palate and heart defects and ventricular septal Defects). (Forrest JM 19765)
Discussions about the treatment of headaches during pregnancy should ideally occur before
conception. Effective planning for treatment during pregnancy helps maximize use of safer
Therapies and minimize maternal anxiety, excessive headache-related disability, dehydration,
And analgesic overuse when standard therapies are excessively restricted. Most drugs enter the
breast milk through passive diffusion, with transfer highest for fat-Soluble drugs. Drugs that
might affect the baby may still be used by the nursing mother if she and her Doctor can identify
how long a harmful concentration will be present in her milk following drug ingestion. In the
United States, 5.9 percent of pregnant women between the ages of 15 and 44 were current illegal
drug users. This number shows that a small but significant number of women engage in drug use
during pregnancy. The National Institute on Drug Abuse (NIDA) explains that while several
factors affect the development of a fetus and a young child, prenatal drug use does seem to cause
harmful and sometimes long-term effects on the exposed child. It goes on to list the following
potential side effects of illegal drug use during pregnancy.(Indian J Pharm Sci 2009)
In Africa: There are many people who are dying over use of drugs during pregnant the majority
of women develop some degree of iron deficiency during pregnancy. Additionally, Folic acid
deficiency could contribute to anemia. Well-balanced diet is important for Nourishment of
mother and fetus. Meat, fish, dairy products, is good sources of protein. eggs, liver, enriched
bread or cereal and green vegetables are good sources for iron. The intake of vitamins, iron and
folic acid is helpful in preventing anemia.(Blackwell Publishing Ltd; 2007.)
In Somalia: There is no any Government that provides health service to society and control of
problem. This means that a large number within the population especially women may be dying
from the effect of over use drugs during pregnancy and lactation without any knowledge that
they have the problem. Somalia hasn’t any health facilitates and accurate pharmacist to Control
over use drugs during pregnancy and lactation .However the first most compelling step is to
design strategies to certain the level of knowledge within our population.
2
1.2 Problem Statement
Effect of over use drugs during pregnancy and lactation is very common in our country due to
the lack of knowledge and lack of health facilities that can influence community health. Drug
over use during pregnancy& lactation are increase in the worldwide. Simultaneously, there is
great variability in prevalence rates in different countries, regions and in different ethnic groups.
Drug overuse is very common in our country for that reason motivated to us to focus on my
research this topic about study on effect over use drugs during pregnancy and lactation .Very
large numbers of women in the world are died effect of over use drugs during Pregnancy
&lactation especially, in Somalia, there is no any Government that provides health Service to
society and control of problem. this means that a Large number within the population especially
women may be dying from the effect of over use Drugs during pregnancy and lactation without
any knowledge that they have the problem Somalia hasn’t any health facilitates and accurate
pharmacist to Control over use drugs during pregnancy and lactation .However the first most
compelling step is to design strategies to certain the level of Knowledge within our
population.Therefore, this study will identify effects of over use of drugs during pregnancy and
lactation in Wadajir district.
1.3 Justification of the Study
The study on theeffects of over use of drugs during pregnancy and lactation in Wadajir district
has different significances for different stakeholdersinvolving the health issues in the country.
While for the other researchers it will be a secondary datato find a detailed on the specific factors
influencing the government policies on health development by puttingconcrete information about
the relevant study.The study isimportant for organizations involving health development
programs serving community. This study will support the government representatives
particularly ministry of health.So the study is significant for the researchers on this issue and the
learning institutions and Somalis in general as well.
3
1.4 Research Objectives
1.4.1. General objective of the study

The main objective of the study to find out effects of over use of drugs during pregnancy and
lactation in Wadajir distract.
1.4.2.Specific Objectives
1. To asses level of knowledge of effects of over uses of drugs during pregnancy and
2. To determine risk factors associated with effects of over use drugs during pregnancy and
3. To describe complication associated with effects of over use of drugs among pregnancy
and lactation in Wadajir district.
1.5 Research Questions
1. What are the effects of over uses of drugs during pregnancy and lactation in Wadajir
district?
2. What are the risk factors associated with effects of over use drugs during pregnancy and
lactation in Wadajirdistrict?
3. What are the complications associated with effects of over use of drugs among pregnancy
and lactation in Wadajir district?
1.6 Significant of the study
This study was of significance to policy makers the government of the Somalia, WHO and the
ministry of health whom develop policies regarding the health society. In addition, this study was
of importance to all health institutions including Hospitals, MCH and other privates of health
since it provide an insight on the effect of over use drugs during pregnancy. Further, the study
will benefit to both the Muslims and non-Muslims. Lastly, this study was benefit to prospective
researchers, institutions since it will add on to the existing knowledge, and it may open up
additional gaps in literature, which may require further investigation.
4
1.7 Scope of the Study
The scope of this research constitutes these categories:
1.7.1 Time scope:

This research was conduct from April 2021 to July 2021
1.7.2 Geographical scope:

The research area is confined to Wadajir Distract in Benadir region, Somalia.
1.7.3 Theoretical scope:

The effect of over use drugs during pregnancy lactation.
1.8 Operational Definitions
Effects: a change which is result or consequence of an action or other cause.
Over use: excessive use.
Pregnancy: is the term used to describe the period in which a fetus develops inside a women’s
womb or uterus.
Lactation:the process of milk production.
Knowledge: facts, information, and skills acquired by a person through experience or education;
the theoretical or practical understanding of a subject.
Risk factors: Something that increases a person's chances of developing a disease.
Complication: a medical problem that occurs during a disease, or after a procedure or

treatment.
5
CHAPTER TWO
LITERATURE REVIEW
2.0 Introduction
This chapter discusses the related literature regarding the effects of over use of drugs during
pregnancy and lactation. The chapter is divided in three parts. The first section talks about the
theoretical framework that give clear and deep understanding of effects of over use of drugs
during pregnancy and lactation really mean, the second part discusses four variables; the first one
of knowledge of effects of over uses of drugs, second factors associated with effects of over use
drugs, third complication associated with effects of over use of drugs and how they have been
viewed by other researchers, academicians, theorists, through their various works. Part three
brings out the conceptual framework and interrelationship of the dependent and independent
variables.
2.1 Theoretical framework
Effect of over use drugs during pregnancy and lactation is very common in our country due to
the lack of knowledge and lack of health facilities that can influence community health.Use of
drugs during pregnancy & lactation is common, and must be taken cautiously. The goal of this
lesson is to discuss common drugs & side effects that may arise during these timesPregnancy is
the carrying of one or more offspring, known as a fetus or embryo, inside the womb of a female.
Lactation describes the secretion of milk from the mammary glands, the Process of providing
milk to the young, and the period of time that a mother lactates to feed her young one.This
process occurs in all female mammals, in humans it is commonly referred to as breastfeeding or
nursing. Drugs that a pregnant woman takes can affect the fetus in several ways. They can act
directly on the fetus causing damage or abnormal development leading to birth defects or death.
Drugs can also alter the function of the placenta usually by constricting blood vessels and
6
reducing the blood supply of oxygen and nutrients to the fetus from mother and thus resulting in
a baby that Is underweight and underdeveloped.(Ganapathy et al.2000)
2.1.1 Public Health Theory and Practice

Public health has done more than any other discipline to address global health issues and the
standard of living and life expectancy, especially during the past 100 years. Today, we are fine
tuning public health in many developed countries and most health professional courses now
include a substantial component of public health training. Health theory and practices involves
the Demography, Epidemiology, Evidence-based health care, Improving population health,
Screening, Health needs assessment, The health status of the population, Health care evaluation,
Decision-making in health care, Health protection and communicable disease control, Tackling
health inequalities, Health policy and Quality measurement and improvement in health care
(Stephen Gillan, 2007).
2.1.2 Health Behavior Theory

In behavioral medicine, professionals base their interventions on a few models that attempt to
explain people’s health-related behavior: the health belief model; As the one of the earliest
frameworks for understanding human behavior, the health belief model declares that individuals
will take health related actions based on six types of factors and associated beliefs as Perceived
Susceptibility, Perceived Severity, Perceived Benefits, Perceived Barriers/Costs and Cues to
Action. reasoned and planned behavior theory; This theory recognizes that individuals act
rationally and emphasizes the power of individual’s intention to induce behavior governed by
three principles as Attitudes, Subjective Norms, and Perceived Behavioral Control. Social
cognitive theory; Direct Modeling (Observing others in their social network engaging in a
particular behavior), Symbolic Modeling (Individuals more likely model behaviors by others
they identify with as portrayed in the media), These models’ aim is to recognize variables that
influence people’s behavior, and using the sum of variables, how likely the person will engage in
a particular behavior and its non-inclusion of race, gender, and socioeconomic status, all features
known to have a somewhat strong influence on health behavior (Lakhan, 2006).
2.2 Level of Knowledge of Effects of Over Uses of Drugs during Pregnancy and Lactation
7
Pregnancy is a special physiological state where medication intake presents a challenge and a
concern due to altered drug pharmacokinetics and drug crossing the placenta possibly causing
harm to the fetus. Medication treatment in pregnancy cannot be totally avoided since some
pregnant women may have chronic pathological conditions that require continuous or interrupted
treatment (e.g. asthma, epilepsy, and hypertension). To the best of our knowledge, no attempts
were made to spot the characteristics of pregnant women in the Community that influence the
medication intake. Such study is highly warranted since patients are believed to make deliberate
decisions regarding their drug taking, based on their beliefs about the illness and its
treatment. Also during pregnancy new medical conditions can develop and old ones can worsen
(e.g. migraine, headache, hyperacidity, nausea and vomiting) requiring drug therapy). So it
becomes a major concern for pregnant women to take medication whether prescription, over-the
counter. It has been documented that congenital abnormalities caused by human teratogenic
drugs account for less than 1% of total congenital abnormalities. Hence in 1979, Food and Drug
Administration developed a system that determines the teratogenic risk of drugs by considering
the quality of data from animal and human studies. FDA classifies various drugs used in
pregnancy into five categories, categories A, B, C, D and X. Category A is considered the safest
category and category X is absolutely contraindicated in pregnancy. This provides therapeutic
guidance for the clinician. (FDA, 2005)
Over use of drugs with over-the-counter (OTC) drugs is an important public health concern,
especially in the vulnerable population of pregnant women due to potential risks to both the
mother and fetus. Few studies have studied how factors, such as knowledge, affect self-
medication. The use of medication during pregnancy is a public health concern. Globally, almost
50% of pregnant women use medication in the early weeks of gestation. Using a web-based
multinational study, Lupattelli et al. discovered that 81.2% of pregnant women used at least one
type of medication, either prescribed or over-the-counter (OTC); over 65% self-medicated with
OTC medication.Over use of drugs, particularly with OTC medication is considered a potential
for harm for pregnant women. The United States Food and Drug Administration’s (FDA’s) 1979
regulations categorized drugs by pregnancy risk. There are five categories, each marked by a
letter: A, B, C, D, or X. Only a few OTC medications or prescription drugs are of category A or
B (indicating no evidence of risk to the fetus), whereas many drugs are of category C (indicating
8
evidence of potential benefits outweighing potential fetal risks), or of categories D or X

(indicating evidence of fetal risk).(Pharmacoepidemiol Drug Saf. 2008)
Indeed, medication use during pregnancy is a dilemma because the vulnerable population (i.e.,
pregnant women and children) is not included in clinical drug trials. Therefore, there is not
enough data of the effects from such medicine on the vulnerable groups. One such study
discovered an association between a pregnant woman’s use of aspirin and intracranial
hemorrhage in her newborn baby. Another study discovered an association between a pregnant
woman’s use of valproic acid and the risk of neural tube defects in her fetus. In general, studies
on the fetal effects of self-medication are limited because of the complexity of the
examination.Despite the dilemma, prenatal self-medication is reportedly frequent. Studies on
self-medication have reported its varying prevalence due to different study populations, design,
and socio-cultural contexts. For instance, over use of drugs was reported among 12.5% of
pregnant women in a study conducted in Netherlands, whereas a higher rate of 40% during
pregnancy was reported by another study conducted in the United Arab Emirates. In addition,
there were inconsistent findings of the effect of different factors on self-medication during
pregnancy from other studies. Studies concluded that factors such as one’s knowledge, beliefs,
and socio-demographic background are associated with self-medication during pregnancy. For
instance, in studies conducted in Ethiopia and Italy, pregnant women with more knowledge of
the risks of self-medication were less likely to self-medicate, compared with those with less
knowledge. However, studies investigating about the knowledge of potential risk effects of those
medications on the fetus are scarce.(PLoS One. 2018)
Due to self-medication’s potential for harm to both the mother and fetus, it is therefore
imperative to study the prevalence of self-medication and factors associated with self-medication
during pregnancy. In addition, such a study ought to focus on the factors of a pregnant woman’s
knowledge of OTC medication and beliefs on the use of medication. Findings from such studies
will help public health practitioners appraise the importance of a woman’s knowledge of the use
of OTC medication. An appraisal will help in the formulation of health education programs to
assist women in realizing how to safely manage their OTC use during pregnancy.Findings from
those studies would be vital for tailor-made interventions to promote the safe use of medication
9
during pregnancy for maternal and fetal health. Furthermore, it is important to examine effect
modifiers between the relationships of knowledge of OTC medication with the practice of self-
medication.( J Trop Med Public Health. 2016)
2.3 Risk factors associated with effects of over use drugs during pregnancy and lactation
Sometimes drugs are essential for the health of the pregnant woman and the fetus. In such
cases, a woman should talk with her doctor or other health care practitioner about the risks and
benefits of taking the drug. Before taking any drug (including over-the-counter drugs) or
dietary supplement (including medicinal herbs), a pregnant woman should consult her health
care practitioner. A health care practitioner may recommend that a woman take certain
vitamins and minerals during pregnancy.Drugs taken by a pregnant woman reach the fetus
primarily by crossing the placenta, the same route taken by oxygen and nutrients, which are
needed for the fetus's growth and development. However, drugs that do not cross the placenta
may still harm the fetus by affecting the uterus or the placenta.Until recently, the Food and
Drug Administration (FDA) classified drugs into five categories according to the degree of risk
they pose for the fetus if they are used during pregnancy. Drugs were classified from those
with the least risk to those that are highly toxic and should never be used by pregnant women
because they cause severe birth defects. One example of a highly toxic drug is thalidomide.
This drug causes extreme underdevelopment of arms and legs and defects of the intestine,
heart, and blood vessels in the babies of women who take the drug during pregnancy. (Am J
Obstet Gynecol. 1989)
The FDA's classification system was based largely on information from studies in animals,
which often do not apply to people. For example, some drugs (such as meclizine) cause birth
defects in animals, but the same effects have not been seen in people. Taking meclizine for
nausea and vomiting during pregnancy does not appear to increase the risk of having a baby
with ma birth defect. The classification system was based much less often on well-designed
studies in pregnant women because few such studies have been done. Thus, applying the
classification system in specific situations was difficult.Because of this problem, the FDA
eliminated the five risk categories. Instead, the FDA now requires that the drug label include
more information about the risk of taking every drug during pregnancy. This information
10
includes the following:The risks of taking the drug during pregnancy and breastfeeding. The
evidence that has identified these risks. (Reprod Toxicol. 1999)
In pregnancy, managing risks become complex because the pregnant woman is responsible for
the well-being of both herself and her unborn child. Most mothers put the needs of their baby
first. Western societies’ great focus on risks may contribute to pregnant women’s overestimation
of the potential danger attributed to the use of medicines. It may be speculated that because
pregnant women usually are recommended to refrain from a range of potentially dangerous
activities, such as eating unpasteurized cheese or painting walls, they may believe they should at
least refrain from the use of any kind of foreign substances, such as drugs. The 1960s’ discovery
of birth defects caused by the use of thalidomide in early pregnancy may also still contribute to
increased teratogenic risk perceptions. Furthermore, because the media usually stress the risks
related to the use of medicines rather than the benefits, this may influence attitudes to medicine
use in pregnancy.Another aspect is that pregnant women’s risk perceptions and health decisions
may be influenced by the experiences, opinions, and beliefs of family and friends.Perception of
teratogenic risk has also been shown to vary with age, level of education, parity, and
geographical region.(BMJ Open. 2015; )
People often overstate risks that have low probability but are dramatic, such as being in a plane
crash or having a malformed child. In contrast, they tend to underestimate more common risks,
for example, developing diabetes or hypertension. This phenomenon of probability neglect may
therefore contribute to the overestimation of drug-related teratogenic effects. Drug labeling may
also influence pregnant women’s risk perception. Patient information leaflets, and other
information provided by the pharmaceutical industry, often provide restrictive or unclear advice
regarding drug use in pregnancy. For example, the international patient information text
regarding use of the antidepressant escitalopram (Cipralex) in pregnancy is extensive and
presents several details regarding possible effects on newborns after exposure in the last
trimester. Such detailed information may act to increase women’s concerns for drug use, and
when the information in addition lacks a focus on the benefits of drug use in depression,
unrealistic teratogenic risk perception may easily be the result. ( Accessed August 16, 2016.)
Risk perceptions are determinants for confidence in the use of medicines, and risk perceptions
may therefore influence health behavior. Overestimating teratogenic risks can have an impact on
11
a woman’s decision on whether to continue a pregnancy after taking a drug and whether to take
prescribed medicines.It may also induce unnecessary anxiety for using a treatment that may
improve health during pregnancy. Drugs are not tested systematically in pregnant women
because of the ethical issues of including expectant mothers in clinical trials. Nevertheless,
physicians need to weigh risks and benefits of drug prescribing to pregnant patients, based on the
available knowledge. The fact that there is scientific uncertainty regarding teratogenic risks of
drug use in pregnancy may, however, increase the physician’s own perception of risk. For
example, inconsistent findings about the safety of antidepressants during pregnancy may be a
challenge to the physician in choices of drug prescribing.More research on the risk of drug use in
pregnancy is warranted to decrease the uncertainties related to the possible teratogenic effects of
the drugs.(Depress Anxiety. 2015;)
Probability neglect, as previously described, may also influence risk perception among
physicians. Although lay people and experts often define risks differently, the difference
decreases as experts are forced to go beyond the limits of available data and rely on intuition and
extrapolation. Therapeutic decisions in this context may also be influenced by the patient-
physician relationship. For example, a woman with 2 previous spontaneous abortions would be
expected to be skeptical of any drug therapy in her new pregnancy, and by communicating this to
her physician; she may influence the physician’s risk perception. A consequence of physicians’
erroneous risk perceptions may be that pregnant women with chronic diseases or acute
pregnancy-related symptoms do not get access to necessary drug treatment. Risk communication
provided by the physician may also have a significant impact on the risk perception of the
pregnant woman, and after receiving information about a possible teratogenic potential of a drug,
it may be difficult for the woman to accept reassuring evidence-based drug information.(Risk
Anal. 1982)
Drug information regarding pregnancy inherently conveys teratogenic risks. Consequently, if this
information is presented in such a way that realistic risks are perceived, it may result in
appropriate choices regarding drug use in pregnancy.Several aspects are important to address in
approaching realistic teratogenic risk perceptions. For pregnant women, health literacy, beliefs
about medicines, empowerment, and confidence in health care systems are some examples. (J
Health Commun. 2014)
12
2.4Complication associated with effects of over use of drugs among pregnancy and lactation
Thalidomide was used in the late 1950s as a sedative and as an agent to combat “morning
sickness.” Although it did not cause teratogenic effects in rats or mice, it has developed a
reputation as one of the most potent human teratogens known. The thalidomide tragedy
highlighted the fact that interspecies variability cannot accurately predict possible risks of
medication exposure at different stages of fetal development. Today, we recognize that many
medications cross the placenta to enter fetal circulation, and that the timing of that exposure
plays a critical role in causing harm. The damage caused by medications can be classified into 2
broad categories: those that are teratogens and those that cause adverse fetal affects. Teratogens
cause alteration of tissue development or organ formation and occur early in pregnancy. 1The
teratogenic period is generally defined as day 31 (from the start of the last menstrual cycle) to 71
assuming a 28-day cycle or approximately 2 to 8 weeks post conception. 1 Therefore, one of the
first things a health professional should ascertain when considering medication use in an
individual is the stage of their pregnancy. The most common teratogenic effects are neural tube
defects, congenital heart abnormalities, cleft lip or palate, and fetal stillbirth.(bstet Gynecol.
2009)
Conversely, adverse fetal effects result in dysfunction of an organ or tissue after that organ or
tissue has been formed. Some examples include difficult postnatal adaptation, withdrawal,
electrolyte abnormalities, and altered glucose metabolism. Medications that may cause adverse
fetal effects include some antipsychotic, antidepressant, and opioid medications. It is important
to note that some maternal diseases predispose an infant to have these same problems, making it
difficult to accurately identify the origin of any teratogenicity or adverse fetal effects.Relatively
few medications are known teratogens. It is estimated that only 2% to 3% of birth defects are
related to medications, leaving 97% to 98% to other causes. Although the number of mediations
associated with teratogenicity is small, it is important because many of the underlying causes of
congenital anomalies cannot be affected or changed, whereas drug exposure can be controlled.
(Pediatrics. 2012;)
The abuse of certain drugs or medications during pregnancy can have detrimental effects on the
fetus and neonate. Previous research has shown that 5% of pregnant women use 1 or more
addictive substances. Approximately 1 in 20 infants is exposed to illicit drugs.Marijuana,
13
cocaine, heroin, hallucinogens, and inhalants are examples of illicit drugs. According to a 2010
survey conducted by the National Institute on Drug Abuse (NIDA), 16% of pregnant women
aged 15 to 17 years, 7.4% of pregnant women aged 18 to 25 years, and 1.9% of pregnant women
aged 26 to 44 years abuse illicit substances. From 2002 through 2010, the rate of reported illicit
drug use among pregnant women aged 15 to 44 years rose from 3% to 4.4%. The maternal abuse
of narcotics has also risen because of “more liberal use of prescription opiates in pregnant
women to palliate acute and/or chronic pain.” As a result, the incidence of infants born addicted
to drugs has increased. The rise in substance use disorders among pregnant women is an
alarming public health concern because the abuse of these medications poses a health risk to the
fetus, the neonate, and the developing child.(Hudak ML, Tan RC 2012)
Likewise, maternal abuse of legal substances such as alcohol, caffeine, nicotine, and even
nonmedical use of prescription drugs during pregnancy is also concerning. Approximately 10%
of infants are exposed to alcohol in utero, and 20% are exposed to nicotine. In addition, pregnant
women may expose their fetuses to other legal medications (i.e., nonsteroidal anti-inflammatory
drugs, salicylates, angiotensin-converting enzyme inhibitors, warfarin, and others) that are not
known to have abusive potential but that are known to adversely affect the fetus. Thus, “legality
of a substance does not necessarily correlate with its safety profile.” These substances, whether
illicit or licit, can have long-lasting effects beyond the neonatal period. However, the true
incidence of maternal abuse of addictive, commonly used, and/or prescribed substances may
never be truly known as substance abuse is frequently underreported. The purpose of this article
is to report trends in prenatal substance abuse, to describe how the fetus is affected in utero, to
review methods to test for drug abuse in utero, and to describe licit and illicit drugs of abuse
during pregnancy. Treatment of exposed neonates will also be reviewed. This article ultimately
serves to update current knowledge of short- and long-term outcomes of drug-exposed neonates
with the goal of equipping pediatricians to fulfill their role as lifelong health care advocates to
babies, children, and young adults.(PA: Elsevier Saunders; 2015)
The human placenta serves to regulate the flow of substances and nutrients from the mother to
the fetus. Medications, drugs, and their metabolites can easily enter fetal circulation from the
placenta. Some factors that affect this placental transfer depend on the specific drug, the
concentrations of the drug in the maternal and fetal circulations, the method and timing of
14
administration, the genetic makeup of both the mother and the fetus, and the co-administration of
other drugs. “Other factors important to drug transfer across the placenta include differences
between the maternal and fetal osmotic pressures and pH, as well as changes in the uterine or
placental blood flow.” Cocaine, heroin, nicotine, and marijuana can affect placental blood flow
through vasoconstriction. The other factors that regulate placental drug transfer include high
lipid solubility, an unionized drug form, low molecular weight (<5000 Da), and low protein
binding. The adverse effects of in utero exposure to drugs can lead to abnormalities in breathing,
intrauterine growth restriction, and possibly fetal death. A fetal withdrawal syndrome has been
reported in which the abrupt cessation of opiates in utero can lead to premature delivery, low
birth weight (LBW), and even stillbirth. (ddict Sci Clin Pract. 2011;)
Structural abnormalities or teratogenicity may also result from in utero drug exposure. The
timing of drug exposure in utero determines the effect. One possible adverse effect of any abused
drug during the first week of pregnancy is miscarriage. The incidence of this complication is
unknown because it may be difficult to determine the exact date of conception and exclude other
factors that would cause termination of the pregnancy. It is well known that nearly all drugs of
abuse have been associated with preterm birth. The second to eight weeks of pregnancy compose
the period of organogenesis, when drugs can produce structural abnormalities at the cellular level
or interfere with growth of the developing fetus. Barbiturates during pregnancy have been noted
to cause dysmorphic features. There is evidence for remodeling of vessels in the heart associated
with selective serotonin reuptake inhibitor (SSRI) use during pregnancy. Alcohol, for instance,
can produce structural abnormalities that lead to fetal alcohol syndrome (FAS). Prenatal alcohol
intake can also cause fetal growth restriction. Likewise, heroin, methadone, nicotine, and cocaine
have also been implicated in interfering with fetal growth. However, these effects on fetal growth
may also be multifactorial because these abused substances are also known to reduce maternal
appetite, can affect placental blood flow, and are sometimes used by women in lower
socioeconomic groups with limited and disrupted resources. (Int J Pediatr. 2011)
2.5 Literature Gap
The purpose of the review of the above literature was to avoid unnecessary and unintentional
duplication of framework from which the research findings were interpreted and also
15
demonstrate the researcher’s familiarity with existing knowledge. The expected improvement in
maternal health in developing countries has not yet materialized. In addition to the factors related
to socioeconomic conditions, we have identified areas where large gaps between evidence and
practice are apparent. These gaps are in clinical care, implementation of effective practices and
in selecting research priorities. there is an urgent need to strengthen provider`s capacity to
deliver high-quality, evidence based care for mother’s health and child growth.
2.6 Conceptual Framework
IV
Level of knowledge
 Mother’s knowledge
about drugs during
pregnancy and
knowledge
DV
Risk factors
 Developmental
Over use
 Environmental of drugs
 Social
 Genetic
 Co-occurring
mentaldisorders

Complications
 Intrauterine growth
restriction
 low birth weigh
 Suppressed fetal
16
breathing
 Diarrhea for fetus
 Irritability
CHAPTER THREE
RESEARCH METHODOLOGY
3.0 Introduction
This chapter presents study design, population of study, inclusion and exclusion criteria, sample
size determination, sampling procedure/techniques, research instrument, data collection methods,
data analysis procedure, validity and reliability of the study and ethical consideration of the stud.
3.1 Study Design
The study will use a descriptive cross sectional study design because; cross sectional study is in
depth investigation of an individual, group, institution. Cross sectional study helps the study to
describe and explain study single or same entities in depth in order to gain insight into the larger
case. This design is appropriate for rich understanding of study population on effects of over use
of drugs during pregnancy and lactation in Wadajir district.
17
3.2 Study population
The target population of the study is will be eighty (80) and the sample population will besixty
seven (67) and this number of sample will be the target population that were responding the
survey questions. Those have different specializations and different backgrounds of education,
age, sex so that, the study population will be employees in health activities while some others
were business people co-owners of private hospitals and other will be university students.
3.2.1 Inclusion Criteria

The residents living in Wadajir district those employees in health clinics, house wives university
students, international and national NGO staffs works only included the study to participate.
3.2.2Exclusion Criteria
Anyone who were not living in Wadajir district those employees in health clinics, university
students, international and national NGO staffs works will be excluded and will not participate
the study and those unable to response the questionnaire and living in Wadajir district.
3.3 Sample size determination
The study will be used Slovene’s formula to select the respondents of the study from the
population, using the following formula:
n 80
n= 𝑛= =67 N= Population, e= error (always 5%).
1+ n(e)2 1+ 80 ( 0.05 ) 2
3.4 Sample procedure/technique
18
The sampling procedure will be non-probability sampling, specially the purposive sampling
technique. This type of sampling can be very useful in situations when the researchers need to
reach a targeted sample quickly, and where sampling for proportionality is not the main concern.
3.5 Research instrument
A self admitted questionnaire and face to face interview will be applied for the participants to
inquire the study questions. Therefore, the questionnaire comprised of three parts; socio
demographic factors, regulations and health investment and social determinants influencing
government policies on health development. The study preferred this mixed method because it is
the most appropriate in collecting information from respondents whose reside in geographically
Mogadishu-Somalia.
3.6 Data collection methods
The gathering procedure came after when the researchers obtain permission from the different
places of study population. Data collections will be start with observations along the area of the
study, setting questionnaire that will be valid and reliable for the requiring population.
Questionnaires cheeked from any errors, and then finally distributed. The researchers used
quantitative data analysis in the study. The study will be used closed-ended and a few open-
ended questions questionnaires. The study will directly distribute the questionnaire to the
respondents or the target groups as above detailed. In this case questionnaires have been self-
administered and interview to allow further probing and clarification of unclear issues.
3.7 Data analysis procedure
Data entered on spreadsheet using SPSS (Version 16.0) to describe the data by using descriptive
method. Frequency summary statistics and graphical summaries in charts pie, bar, Correlation
variables and Excel were presented.
3.8 Validity and reliability of the study
19
3.8.1 Validity
Validity refers to the extent to which data collection method accurately measures what it was
intended to measure or to the extent to which research findings are about what they are claimed
to be about (Saunders, et al., 2009). Generally, validity of each question or group of questions is
assessed rather than of the questionnaire as a whole. In order to increase validity of the questions
in this research, the research team utilized content validity index for the reason that the research
team constructed the questions as clear as possible, measuring only one thing at the time. English
being the language of the research might have had some influence in decreasing the validity of
20 questions; however, a great care exercised to decrease the faults. The issue of validity and
reliability is one important aspect that is worth to be considered when selecting research design.
Thus the study should have to be aware of to threats of reliability and validity of the result in this
study. To increase reliability, the study adapted relevant questionnaire and slightly modified.
While Validity refers to the extent to which data collection method accurately measures.
3.8.2 Reliability
Reliability refers to the extent to which your data collection techniques or analysis procedures
will yield consistent findings (Saunders, et al., 2009). Before distributing the questionnaire, the
research did pilot-testing with 3 experts including the supervisor. Some changes as well as
reformulations of questions and possible answers made as the result of this pilot test. In order to
avoid subject or participant bias, this is one of the threats to reliability, the inscrutability of the
respondents assured in the questionnaire and confidentiality in the questionnaire by the research.
3.9 Ethical consideration of the study
A researcher will be considered ethical issues during research project, and this can be
accomplished by exercising privacy, confidentiality and anonymity. Any anonymity and
confidentiality of the secret information was give high priority and this study will strictly, only
academic purpose and that utmost confidentiality would be observed. Moreover, the respondents
will be respected to maintain individual self-confidence. The issue of ethics is very important
part of the study. Thus, the data collected was keeping confidential and exclusively use for the
purpose of graduation requirement degree. The respondents will be informed of the contents and
20
the aims of the research prior to administration of the instrument. This research was fully
conducted ethically and all copyrights observed will be kept in place. Respondents will be
considered ethical issues during the research project, and this can be accomplished by exercising
privacy.
CHAPTER FOUR
DATA ANALAYSIS
4.0 Introduction
My study was cross sectional study and result of the study are presented in this unit as the
follows, data analysis done after was obtaining data from respondents through the questionnaire,
the data was show in the figure after collection data was analyzed by using scientific calculator
and the result are presented in the text, by chart and graphic in Microsoft excel.
Table 4.1 by age distribution
21
Respondent frequency percentage
15-25 30 45%
35-45 27 40%
Above 45 10 15%
Total 67 100%
The above table indicates the majority of the respondent 30(45%) were aged between 15-25
years, and 27(40%) were aged between 35-45 years, and 10(15%) were aged between above 45.
67
70
60
50
40
30
27
30
20
10
10 100%
45% 40% 15%
0
15-25 35-45 above 45 Total
frequency percentage
Figure 4.1 Age of respondents
4.2 Marital status:
Respondent frequency Percentage
divorce 20 30%
22
marriage 47 70%
Total 67 100%
The above table indicates the majority of respondent 47(70%) were marrige and 20(30%) were
divorce.
67 100%
Total
47 70%
marriage
20 30%
divorce
0 10 20 30 40 50 60 70
frequency persentage
Figure 4.2 Marital status:
Table: 4.3 Educational level
respondent frequency percentage
primary 9 13%
secondary 20 30%
23
university 38 57%
Total 67 100
The above table indicates the majority of the respondent 38(57%) were universirty, while
20(30%) were secondary and, 9(13%) were primary.
70 100%
60
50
57%
40
67 persentage
frequency
30
30% 38
20
13% 20
10 9
0
primary secondary university Total
Figure 4.3 educational level
Table 4.4 occupational of respondents
employee 18 27%
24
business 20 30%
unemployed 11 16%
House wife 18 27%
total 67 100%
The above table indicates the majority of respondent the 20(30%) business, while 18(27%) were
employee, and 18(27%) were hous hold and 11(16%) were unemployee.
100%
Total 67
27%
House wife 18
16%
Unemployee 11
30%
Business 20
27%
Employee 18
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Figure 4.4 occupational level
Table 4.5 . Do you have any idea about effect of over use drugs during pregnancy and lactation?
25
yes 67 67%
no 33 33%
total 67 100%
The above table indicates the majority of respondent 67(67%) were indicated that they have an
idea and with the rest 33(33%) have not an idea
67 100%
total
30 45%
no
37 55%
yes
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Figure 4.55. Do you have any idea about effect of over use drugs during pregnancy and
lactation?
Table 4.6 . Has any member of your family encounter the effect of over use drugs during
pregnancy and Lactation?
26
yes 37 55%
no 30 45%
total 67 100%
idea and with the rest 30(45%) have not an idea.
55% 45% 100%

100%
90%
80%
70%
60% 37 30 67
50%
40%
30%
20%
10%
0%
yes no total
Figure 4.6 . Has any member of your family encounter the effect of over use drugs during
pregnancy and Lactation?
Tabable 4.7. Do you think that over use drugs during pregnancy &lactation is life threatening
condition?
27
yes 40 60%
no 27 40%
total 67 100%
70 67
60
50
40
40
30 27
20
60%
40%
10 100%
0 persentage
yes frequency
no
total
Figure 4.7. Do you think that over use drugs during pregnancy &lactation is life threatening
condition?
Table 4.8 Generally drug substance or medication can cause harm by the fetus:-
28
yes 35 52%
no 32 48%
total 67 100%
total 67 100%
no 28 42%
yes 39 58%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Figure 4.8 Generally drug substance or medication can cause harm by the fetus:-
29
Table 4.9 Does the drug cross the placenta?
yes 39 58%%
no 28 42%
total 67 100%
100%
total 67
42%
no 28
58%
yes 39
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Figure 4.9 Does the drug cross the placenta?
30
Table 4.10 . Do you believe that tetracycline contraindicated during pregnancy?
yes 30 45%
no 37 55
total 67 100%
The above table indicates the majority of respondent 37(55%) were indicated that they have not
an idea and with the rest 30(45%) have an idea.
100%
total 67
42%
no 28
58%
yes 39
0 10 20 30 40 50 60 70
persentage frequency
Figure 4.10 . Do you believe that tetracycline contraindicated during pregnancy?
31
Table 4.11 Do all medication pass through breast milk?
yes 22 32%
no 45 67%
total 67 100%
total 67 100%
no 28 42%
yes 39 58%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Figure 4.11 Do all medication pass through breast milk?
32
Table4.12 Do you know safe drugs during pregnancy and lactation?
yes 27 40%
no 40 60%
total 67 100%
80
70
67
60
50
40 39
30
28
20
10
0 58% 42% 100%

yes no total
Figure 4.12Do you know safe drugs during pregnancy and lactation?
33
Table 1.13 Do you ever attend any training on effect of over use drugs during pregnancy and
lactation?
yes 39 58%
no 28 42%
total 67 100%
80
70
1
60
50
40 1
30 1
20
10
0 100% 100% 100%

0.5 1 1.5 2 2.5 3 3.5
Figure 4.13 Do you ever attend any training on effect of over use drugs during pregnancy and
lactation?
34
Table 4.14 how ever drugs that do not cross the plecenta may still harm the fetas by effecting the
uters or the plecenta .
yes 43 64%
no 24 36%
total 67 100%
67 67%
Total
22 33%
no
45 67%
yes
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
frequency pertcentage
Figure 4.14 how ever drugs that do not cross the plecenta may still harm the fetas by effecting
the uters or the plecenta .
35
Table 4.15over use drugs particularly with otc medication is concerned potential for harm of
pregnancy women
yes 45 67%
no 22 33%
total 67 100%
idea and with the rest 22(33%) have not an idea
67%
Total 67
33%
no 22
67%
yes 45
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
frequency pertcentage
Figure 4.15over use drugs particularly with otc medication is concerned potential for harm of
pregnancy women
36
CHAPTER FIVE:
MAIN FINDINGS, LIMITATIONS OF THE STUDY, RECOMMENDATIONS
5.0 Introduction
This chapter focuses on the summary of the results of the research study on previous chapters;
Chapter four was presented, analysed and discussed using the data obtained from the field. Based
on findings on the previous chapters.
5.1 Main Finding
The above table indicates the majority of the respondent 30(45%) were aged between 15-25
years, and 27(40%) were aged between 35-45 years, and 10(15%) were aged between above
45.The above table indicates the majority of respondent 47(70%) were marrige and 20(30%)
were divorce. The above table indicates the majority of the respondent 38(57%) were universirty,
while 20(30%) were secondary and, 9(13%) were primary. The above table indicates the
majority of respondent the 20(30%) business, while 18(27%) were employee, and 18(27%) were
hous hold and 11(16%) were unemployee. The above table indicates the majority of respondent
67(67%) were indicated that they have an idea and with the rest 33(33%) have not an idea. The
above table indicates the majority of respondent 37(55%) were indicated that they have an idea
and with the rest 30(45%) have not an idea. The above table indicates the majority of respondent
above table indicates the majority of respondent 35(52%) were indicated that they have an idea
and with the rest 32(48%) have not an idea. The above table indicates the majority of respondent
above table indicates the majority of respondent 37(55%) were indicated that they have not an
idea and with the rest 30(45%) have an idea. The above table indicates the majority of
respondent 45(67%) were indicated that they have not an idea and with the rest 22(32%) have an
37
idea. The above table indicates the majority of respondent 40(60%) were indicated that they have
not an idea and with the rest 27(40%) have an idea. The above table indicates the majority of
respondent 39(58%) were indicated that they have an idea and with the rest 28(42%) have not an
idea.
idea and with the rest 24(36%) have not an idea. The above table indicates the majority of
respondent 45(67%) were indicated that they have an idea and with the rest 22(33%) have not an
idea.
5.2 Limitations of the study
The unique nature of physiology of pregnancy presents challenges for pharmaceutical treatment
of chronic and acute disorders and for symptom management of many complaints associated
with pregnancy. It is the responsibility of all clinicians including pharmacists to counsel patients
with complete, accurate and current information on the risks and benefits of using medications
during pregnancy. Counseling women who have had exposure to drugs about risk of teratogens
involves accurately identifying exposure and quantifying the magnitude of exposure. This may
be straightforward for prescribed drugs. Also when selecting drugs to be used in pregnancy
effectively, drugs that have been in use for a long time are often preferable because fetal safety
has been established even though newer alternatives may be available.
5.3 CONCLUSIONS
In conclusion this research was descriptive review of There is a moral obligation to protect from
dissemination any and all personal information, of any type, that has been obtained on the patient
by any and all health care professionals at any medical facility. The justification for the
protection of this right is integral to the very provision of health care itself. It is essential that
there exist a relationship of trust between the patient and health care professional.
38
5.4 Recommendations
Community pharmacists should promote their roles, their knowledge, and their services to the
public
o enabling community pharmacists to practice their skills and use their knowledge
in advising
o pregnant and breastfeeding women, The public should be clearly educated about
the roles and health knowledge of community
o pharmacists. For example, antenatal clinics should provide information and
display posters about community pharmacists and promote them as a health
professional with a particular expertise in medicines that women can consult
outside of the hospital. On the other hand, drugs which might harm mothers and
their babies should also be
o highlighted and their dangers advertised. This can be done in several ways such as
the use of posters in health care premises, advertising on television or radio, using
information videos in antenatal and the proposed breastfeeding clinics.
Pharmacists in this study were concerned about the safety of over-use medicines
for women
o during pregnancy and breastfeeding. In addition, by working as part of a
healthcare team pharmacists might use referral systems to doctor or midwife.
39
APPENDIX (A)
REFERENCES
1. http://www.healthlit.org/documents/PregnancyBooklet.pdf 24.05.2011. 11:05pm.
2. Forrest JM. Drugs in pregnancy and lactation. Med J Aust 1976: 24; 2(4):138–41
. 3. P. Sachdeva, B. G. Patel and B. K. Patel. Drug Use in Pregnancy; a Point to Ponder. Indian J
Pharm Sci 2009; 71(1): 1–7.
4. (Scialli 1992; Moore and Persaud 2003).
5(van der Aaet al. 1998; Audus 1999; Ganapathy et al. 2000
6. Pacifici and Nottoli 1995; Hakkola et al. 1998; Audus 1999
7. (Audus 1999; Ganapathy et al. 2000; Young et al. 2003; Ganapathy and Prasad 2005; Mölsä
et al. 2005.
40
8.Bennett PN, Matheson I, Dukes NMG et al, eds. Drugs and human lactation Elsevier Science
Publisher B.V., Amsterdam, 1988.
9. Briggs CG, Freeman RK, Yaffe SJ. Drugs in pregnancy and lactation. Fourth edition.
Williams and Wilkins, Baltimore, MD, 1994.
10. American Academy of Pediatrics, Committee on Drugs. The Transfer of Drugs and Other
Chemicals into Human Milk. Pediatrics, 108:776-789, 2001
. 11. Royal College of Paediatrics and Child Health. Medicines for children 1999. RCPCH
Publication Limited, Hobbs the Printers Limited, Southampton, England 1999.
12. Breastfeeding counseling: A training course. World Health Organization (WHO/CDR/93.3-

6), 1993. 13. http://www.cdc.gov/ncbddd/pregnancy_gateway/meds/index.html. 25.05.2011.
05:45pm.
14. http://www.merckmanuals.com/home/sec22/ch259/ch259a.html. 25.05.2011. 06:25pm.
16. http://www.askdrsears.com/html/2/t028500.asp 26.05.2011. 11:10AM.
17. Gerald GB, Roger KF, Sumner JY. Drugs in pregnancy and lactation. Eighth edition.
Lipincott Williams and Wilkins. Philadelphia 2008.
18. Buhimschi CS, Weiner CP. Medications in pregnancy and lactation. In: Queenan JT, Spong
CY, Lockwood CJ, editors. Management of high-risk pregnancy: an evidence-based
approach.5th ed. Malden (MA): Blackwell Publishing Ltd; 2007. p. 38–58.
1 9. Mitchell AA. Systematic identification of drugs that cause birth defects–a new opportunity.
N Engle J Med 2003; 349:2556–9.
20. Carney EW, Scialli AR, Watson RE, DeSesso JM. Mechanisms regulating toxicant 44
disposition to the embryo during early pregnancy: an interspecies comparison. Birth Defects Res
C Embryo Today 2004; 72:345–60. 21. Armstrong J and Reilly JJ, “Breastfeeding and lowering
risk of childhood obesity,” Lancet 359(9322): 2003 (2002).
22. Picciano M, “Nutrient composition of human milk,” Pediatr. Clin. North Am., 48(1):53
(2001).
41
23. Atkinson HC, Begg EJ, and Darlow BA, “Drugs in human milk, Clinical Pharmacokinetic
Considerations,” Clinical Pharmacokinetics, 24:217(1988).
24. van Gelder MM, van Rooij IA, Miller RK, Zielhuis GA, de Jong-van den Berg LT and
Roeleveld N, “Teratogenic mechanism of medical drugs,”Hum. Reprod. Update,
16(4):378(2010). 25. Vaglenova J, Birru S, Pandiella NM, and Breeze CR, “An assessment of
the long-term development and behavioral teratogenicity of prenatal nicotine exposure,” Behav.
Brain Res., 150(1-2:159 (2004).
APPENDIX (B)
QUESTIONNAIRE
QUESTIONNAIRE
Dear respondent I am student of Somalia University, college of healthy science, department of

Nursing and midwifery. Respondent Sir/madam, I kindly requestyou to fill up this questionnaire
for theEffect of over use drugs during pregnancy and lactation in wadajir district. Please help us
for performing this research by answering the following questions.
Introduction to respondents
1. Please feel free tofill this questionnaire.

2. Please don’t write your name on this questionnaire.
3. All information was be private .
4. This research is only for academic purpose and not for money.
42
5. Please give correct short answer and you are free to choose fill it.
6. Please fill in the blank space provided to the best of your knowledge best of you are.
SECTION (A):DEMOGRAPHIC DATA
1. Age:
 15-25 ( ) 25-35 ( )
 35-45 ( )
 above 45 years
2. Marital status:
a) Married
b) Divorced
3. Level of education:-
a) Primary
b) Secondary
c) University
4. Occupation:
a) Employed
b) Business
c) Unemployed
d) Housewife
SECTION [B] SUBJECT KNOWLEDGE
5. Do you have any idea about effect of over use drugs during pregnancy and lactation?
a. Yes ( )
43
b. No ( )
6. Has any member of your family encounter the effect of over use drugs during pregnancy and
Lactation?
a. Yes ( )
b. No ( )
7. Do you think that over use drugs during pregnancy &lactation is life threatening condition?
a. Yes ( )
b. No ( )
8. Generally drug substance or medication can cause harm by the fetus:-
a) Yes( )
b) No( )
9. Does the drug cross the placenta?
d) Yes( )
e) No( )
10. Do you believe that tetracycline contraindicated during pregnancy?
a. Yes. ( )
b. No.( )
11. Do all medication pass through breast milk?
a. Yes. ( )
b. No.( )
12. Do you know safe drugs during pregnancy and lactation?
44
a) Yes( )
b) No( )
13. Do you ever attend any training on effect of over use drugs during pregnancy and lactation?
a) Yes( )
b) No( )
14. how ever drugs that do not cross the plecenta may still harm the fetas by effecting the uters or
the plecenta.
a) Yes( )
b) No( )
15. over use drugs particularly with otc medication is concerned potential for harm of pregnancy
women.
a) Yes( )
b) No( )
45
APPENDIX C: MAP OF SOMALIA
46
APPENDIX D: MAP OF MOGADISHU
47
APPENDIX E:MAP OF WARDAJIR DISTRICT
48
49

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EFFECTS OF OVER USE DRUGS DURING PREGNANCY AND LACTATION IN WADAJIR DISTRACT

Name of the candidate: Asma Ali Hussein

Name: Mr. Mahad Mohamed Rage

Supervisor: Mr. Mahad Mohamed Rage

Date: ____/_____/ ____

Head of School of Medical Nursing

Dr. Osmaan Abdi Ibrahim

Date: ____/_____/ ____

I gratefully acknowledge to the faculty of l Nursing Midwifery at University of Somalia, also go

I would like thanks all Uniso students specially my classmates NM:17B

1.5 Research Questions............................................................................................................................4

1.1. Background of the study

1.2 Problem Statement

1.3 Justification of the Study

1.4 Research Objectives

1.4.1. General objective of the study

1.5 Research Questions

1.6 Significant of the study

1.7 Scope of the Study

The scope of this research constitutes these categories:

1.7.1 Time scope:

1.7.2 Geographical scope:

1.7.3 Theoretical scope:

1.8 Operational Definitions

Effects: a change which is result or consequence of an action or other cause.

Over use: excessive use.

Lactation:the process of milk production.

Risk factors: Something that increases a person's chances of developing a disease.

Complication: a medical problem that occurs during a disease, or after a procedure or

2.1 Theoretical framework

2.1.1 Public Health Theory and Practice

2.1.2 Health Behavior Theory

evidence of potential benefits outweighing potential fetal risks), or of categories D or X

2.5 Literature Gap

2.6 Conceptual Framework

3.1 Study Design

3.2 Study population

3.2.1 Inclusion Criteria

3.3 Sample size determination

3.4 Sample procedure/technique

3.5 Research instrument

3.6 Data collection methods

3.7 Data analysis procedure

3.8 Validity and reliability of the study

3.9 Ethical consideration of the study

Respondent frequency percentage

Figure 4.1 Age of respondents

4.2 Marital status:

Respondent frequency Percentage

Figure 4.2 Marital status:

Table: 4.3 Educational level

respondent frequency percentage

Figure 4.3 educational level

Table 4.4 occupational of respondents

respondent frequency percentage

House wife 18 27%

Figure 4.4 occupational level

respondent frequency percentage

respondent frequency percentage

55% 45% 100%

Date: __/_/ __

Date: __/_/ __