Medicinal Plants Used in the Management of Sexual Dysfunction, Infertility and Improving Virility in the East African Community: A Systematic Review

Push and pull factors influencing preference for traditional healing by jaundiced patients in Bangladesh

BACKGROUND

Jaundice is a significant health issue in Bangladesh. Many patients choose traditional medicine (TM) over conventional medicine (CM) for treating jaundice. This study aimed to identify and analyze the push and pull factors influencing the preferences of jaundiced patients for traditional healing methods in Bangladesh.

METHODS

This cross-sectional study used a mixed-methods approach. Two focus group discussions (FGDs) were conducted with 16 participants (8 per group) who had experience of using traditional medicine for jaundice. In-depth interviews with five traditional healers were carried out to gather qualitative insights from the healers' perspectives. Quantitative data were collected from 400 jaundiced patients at a tertiary-level hospital using a semi-structured questionnaire. Chi-square tests and binary logistic regression were used to analyze associations between sociodemographic factors, push-pull factors, and treatment preferences.

RESULTS

The study found that 62% of participants favored TM for jaundice treatment. The scalp and hand cleansing rituals (46%), herbal remedies (37%), garlanding (23%), and use of talismans or amulets (21%) were the most common practices. Qualitative analysis revealed five push factors, eight pull factors, four intervening obstacles, and five personal factors that influenced jaundiced patients' preference for TM. Patients also emphasized the significance of spiritual and emotional aspects in their decision-making process when choosing TM. Significant associations were observed between treatment preference and age group (p = 0.002), residence (p = 0.018), education level (p<0.001), and religion (p = 0.015). Individuals aged 50 years and above (70.9%), rural residents (68%), and those with no or primary education (72%) were more likely to opt for TM. Key push factors towards TM included high costs of CM (OR: 6.80, 95% CI: 2.10-22.04) and perceived ineffectiveness of CM. Strong pull factors were accessibility of TM (OR: 11.18, 95% CI: 4.03-31.00), perceived effectiveness of TM (OR: 3.45, 95% CI: 1.05-11.37), personal testimonials (OR: 7.55, 95% CI: 2.75-20.69), lower costs of TM (OR: 10.48, 95% CI: 4.30-25.54) and lack of information about conventional treatments for jaundice (OR: 13.82, 95% CI: 4.62-41.33).

CONCLUSION

The study reveals that both push and pull factors influence jaundiced patients in Bangladesh to choose TM over CM, with decisions shaped by personal, socioeconomic, and geographical factors.

Serum gonadal hormones levels and hypogonadism in ART naïve newly diagnosed HIV infected adult males in Mwanza, Tanzania

BACKGROUND

Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is an endemic chronic disease which is characterized with progressive depletion of CD4 T cells and increased susceptibility to opportunistic infections. Previous studies have associated HIV infection with increased hypogonadism. However, the prevalence of hypogonadism remained poorly defined and widely ranging in various studies. This study aims to evaluate the serum gonadal hormonal levels and hypogonadism in antiretroviral therapy (ART) naïve newly diagnosed HIV infected-males in Mwanza, Tanzania.

METHODS

This was a comparison study involving 81 ART naïve newly diagnosed HIV-infected adult males as study group and 81 apparently healthy HIV-negative males as comparison group. The participants in the study group and comparison group were matched by body mass index and age. Serum hormones [Total testosterone (TT), follicle stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E) were estimated. Serum testosterone < 300 ng/dl, or testosterone > 300 ng/dl with high LH and FSH (compensatory hypogonadism) were taken as markers of hypogonadism. Data were analyzed using STATA version 15.

RESULTS

The median serum testosterone level among ART naïve newly diagnosed HIV-infected adult males was significantly lower as compared to their comparison group (447 [259-534] versus 517 [396-605]; p = 0.0074) and shown to decrease with decreasing CD4 level. The median [IQR] serum FSH level among ART naïve newly diagnosed HIV-infected adult males was significantly higher than among their comparison group (3.8 [2.1-6.5] versus 2.6 [1.8-4.2]; p = 0.0086). The differences in serum LH and Estradiol were not statistically significant. Furthermore, the proportion of hypogonadism was significantly higher among ART naïve newly diagnosed HIV-infected adult males than in their comparison group (37.0% [30/81] versus 14.8% [12/81]; p = 0.0006). Out of these 30, 24 HIV-infected males had secondary hypogonadism, one had primary, and the remaining five had compensatory hypogonadism.

CONCLUSION

Serum testosterone was lower and follicle stimulating hormone was higher among ART naïve HIV-infected males as compared to the HIV negative controls. Hypogonadism, mainly secondary, is common endocrine abnormality among ART naïve HIV-infected male patients in this study. HIV is associated with variations in gonadal hormones which may lead to sexual dysfunction in infected individuals.