In South Africa most black women use antenatal care services and deliver in clinics, and a considerable number complement this use of formal health services with traditional medicine. This study reported here examined the knowledge, beliefs and practical experiences of pregnant women, traditional healers and midwives with regard to kgaba (traditional medicine) and explored what constitutes kgaba. Interviews (N=30) and focus group discussions (N=21) were carried out among participants in Mogwase district in the North West Province of South Africa, where the use of kgaba remedies is commonly believed to cause foetal distress and an increase in caesarean sections. Findings indicated that kgaba remedies are ingested not only to prevent or solve physical problems but are also perceived as valuable in protecting against the harm that evil spirits can cause during pregnancy. Experiences with kgaba differed among participants and this may relate to the variety of plants used, their preparation and dosage. The use of crushed ostrich eggshell, which is perceived as inducing labour, emerged as an important finding. The use of kgaba as perceived by the Tswana is an important component in the experience of pregnancy and labour. However, communication about the use of kgaba between pregnant women and health staff was poor and hinders reporting or recording of dosage and evaluation of effects. There is a need to develop strategies that promote open dialogue between health providers and communities on the use of traditional medicine. Key words: traditional medicine, labour, ethnopharmacology, South Africa Terms usedIn this study the term traditional medicine (TM) is used for medicines of plant, animal or mineral origin, which are taken orally. The definition of tradition healer (TH) includes both diviners, who use bone throwing for diagnosis, and herbalists. Nowadays the distinction between these two healers is not always clear and they may be combined.

Systematic reviews of randomized controlled trials are used to inform obstetric practice worldwide. It is not known whether obstetric practice in Nigeria currently follows best evidence. This study explored whether the practices in selected hospitals in Nigeria are consistent with available evidence. In Cross River State, 13 health facilities were studied through audit of case notes augmented with exit interviews with postpartum women. Sequential case notes (n=487) were audited and 113 postpartum women were interviewed. For practices where there is good evidence of benefit, routine use varied: antibiotics for pre-term rupture of membrane (83.3% n=6); partograph in monitoring labour (42% n=487); and prophylactic antibiotics for caesarean section (21.5% n=111). Practices with little evidence of benefit were commonly performed: pubic shaving (70.8% n=72); restriction of mobility (33.3% n= 2); supine position for the second stage of labour (97.2% n=72); and episiotomy (37.5% n=72) overall and 74% in primigravidae. Only 33.3% of women were allowed fluids during labour; and diazepam rather than magnesium sulphate was the drug of choice for treating eclampsia. This study demonstrates that a gap exists between best practice guided by reliable research evidence and current obstetric practice in health facilities in the hospitals studied.

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