Title: Herbal medicine use during pregnancy and child birth: Perceptions of women living in
Lilongwe rural, Malawi – A Qualitative Study.
Version: 0 Date: 17 Feb 2023
Reviewer's report:
The manuscript contains important information for the improvement of maternal and neonatal
health outcomes, especially in low-resource settings.  The use of herbal medicines is a common
practice in low-resource settings where access to health facilities is a challenge.
There are some areas that need to be revised to  strengthen the paper:
1. The title does not portray the contents of the article. Consider revising it because not all herbal
medicines are harmful during pregnancy and childbirth.  The title could be 'Herbal medicine
use during pregnancy and childbirth: Perceptions of women living in Lilongwe rural, Malawi
– A Qualitative Study'.
2. Abstract - BACKGROUND - The article is about the perception of women about the use of
herbal medicine and not necessarily the advantages of using herbal medicine during pregnancy
and labor. Therefore, the background should reflect that perspective.  (page 2, lines 6 to 9)
3. Abstract - AIM - The aim should be revised because the contents of the article do not reflect
the “potential use of herbal medicine during pregnancy and labor”.
4. Abstract - METHODS - Describe the qualitative research design that was used in this study
as a cross-sectional survey is not a qualitative research design.
5. Abstract - CONCLUSION - 'Perceptions among rural women on the use of herbal medicine
during pregnancy and labor are deep routed on cultural and personal experiences'. (page 2, lines
23 - 24).  What is the basis for this conclusion as the finding did not reflect the cultural aspect
regarding the use of herbal medicine?
6. Under background (page 3, lines 2-4)  What are the ‘finished herbal products containing active
ingredients’?  What are active ingredients in this context?
7.  How would the understanding of the reasons for the use of herbal medicine during pregnancy
and labor among women have implications for improving practice and reproductive health
policy?  (page 3, lines 5-6).
8. What are pain conditions? (page 3, line 12.
9.  The indications for the cesarean section have to be presented in medical terms and not in
layman's language.  For example, fetal distress is an indication of a cesarean section, and not use
of raspberry leaf and ingestion of castor oil to induce labor as indications of a cesarean section.
(page  3, lines 16-20).
10. This statement is not clear, 'As such, knowledge on the perceptions of women on the use
of herbal medicine during pregnancy and labor would generate evidence that will be crucial for
the prevention of herbal medicine associated complications and improvement of practice and
policy on the use of herbal medicine in Malawi'.  (page 3, lines 21-23).
11.  The background should include the prevalence of herbal medicine use and the common
herbal medicines used by women during pregnancy and childbirth in Malawi.
12. The study design section has to be rewritten.  The authors have combined two different study
approaches that are not complimenting each other.  Need to explain how the cross-sectional
survey was used in the study.
13. What type of qualitative study design was used in this study?
14.  The recruitment and sampling section has only explained the sampling process.  How were
the participants recruited?
15. Explain how was the number of participants determined, the number of 28 participants.
16. Remove the numbering under the results section.
17. Mention the herbs that have been identified in this study. (page 14, line 1)
18. What do you mean by this statement - 'The data generated from the current study are not
publicly available because we are still writing up from it '? (page 14, lines  29-30).
19.  The manuscript has to be edited by an English language expert before resubmission.