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Iddrisu M, Doat AR, Abdulai AM, Wuni A. They patronize herbal medicine, coincidence or planned behaviour: A case of hypertensive patients in Tamale? Nurs Open 2023. [PMID: 37060167 DOI: 10.1002/nop2.1754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 02/08/2023] [Accepted: 03/24/2023] [Indexed: 04/16/2023] Open
Abstract
AIM This study assessed, if use of herbal medicine (HM) among hypertensive patients is coincidence or planned. DESIGN Cross-sectional survey. METHODS The study used a cross-sectional survey for collection of data from four (4) herbal medicine clinics in the Tamale metropolis in northern Ghana. RESULTS The final or overall regression model was significant at R2 = 0.350, F(7, 214) = 16.464, p < 0.001. No sociodemographic characteristic predicted herbal medicine use. Only religion and educational level were associated with herbal medicine use. Attitude (p = 0.002), subjective norms (p = 0.001) and behavioural intention (p = 0.000) significantly predicted HM use. PUBLIC CONTRIBUTION Data were collected from respondents only after they had verbally given free and informed consent to take part in the study. The results of this study therefore showed that herbal medicine use among these patients is not coincidence but planned. Health professionals by this study should appreciate the effect of religion and educational background in their health education on Herbal Medicines.
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Affiliation(s)
| | - Abdul Razak Doat
- Department of Nursing, School of Nursing and Midwifery, CK Tedam University of Technology and Applied Sciences, Navrongo, Ghana
| | | | - Abubakari Wuni
- Nursing and Midwifery Training College, Tamale, Ghana
- Department of medicine for the elderly, Cambridge University Hospital's NHS Foundation, Adddenrookes Hospital, Cambridge United Kingdom, Cambridge, United Kingdom
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Ssenku JE, Okurut SA, Namuli A, Kudamba A, Tugume P, Matovu P, Wasige G, Kafeero HM, Walusansa A. Medicinal plant use, conservation, and the associated traditional knowledge in rural communities in Eastern Uganda. Trop Med Health 2022; 50:39. [PMID: 35668541 PMCID: PMC9168352 DOI: 10.1186/s41182-022-00428-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background The global consumption of herbal medicine is increasing steadily, posing an extinction risk to medicinal plants. Uganda is among the top ten countries with a high threat of herbal medicine extinction, and Traditional Medicinal Knowledge (TMK) erosion. This might be attributed to the inadequate documentation, plus many more unclear hindrances. In this study, plant species used to treat human diseases in Butaleja district in Eastern Uganda and their associated TMK were documented. The conservation methods for medicinal plants were also evaluated. The rationale was to support the preservation of ethnopharmacological knowledge.
Methods Data were collected from 80 herbalists using semi-structured questionnaires, from July 2020 to March 2021. Additionally, guided field walks and observations were conducted. Quantitative indices such as, use categories and informant consensus factor (ICF) were evaluated to elucidate the importance of the medicinal plants. Data were analyzed using STATA version-15.0 software. Results In total, 133 species, belonging to 34 families and 125 genera were identified. Fabaceae (65%), and Solanaceae (29%) were the dominant families. Leaves (80%), and roots (15%), were the commonest parts used in medicinal preparations; mostly administered orally as decoctions (34.6%) and infusions (16%). The commonest illnesses treated were cough (7.74%), gastric ulcers (7.42%), and malaria (4.52%). The informant consensus factor was high for all disease categories (≥ 0.8), indicating homogeneity of knowledge about remedies used. Only 73% of the respondents made efforts to conserve medicinal plants. The commonest conservation strategy was preservation of forests with spiritually valued species (100%), while compliance with government regulations was the rarest (4.5%). Overall, efforts to stop the extinction of medicinal plants and TMK were inadequate.
Conclusion and recommendations There was enormous dependency on a rich diversity of medicinal plant species and TMK for healthcare and income generation. The potential for medicinal plant biodiversity loss was evident due to habitat destruction. Inclusion of traditional cultural norms in conservation strategies, and laboratory-based efficacy tests for the species identified are necessary, to promote the conservative and utilization of validated herbal medicines and TMK in rural settings. Supplementary Information The online version contains supplementary material available at 10.1186/s41182-022-00428-1.
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Affiliation(s)
- Jamilu E Ssenku
- Department of Biological Sciences, Faculty of Science, Islamic University in Uganda, Mbale, Uganda. .,Department of Plant Sciences, Microbiology and Biotechnology, Makerere University, Kampala, Uganda.
| | - Shaban A Okurut
- Department of Biological Sciences, Faculty of Science, Islamic University in Uganda, Mbale, Uganda
| | - Aidah Namuli
- Department of Biological Sciences, Faculty of Science, Islamic University in Uganda, Mbale, Uganda
| | - Ali Kudamba
- Department of Biological Sciences, Faculty of Science, Islamic University in Uganda, Mbale, Uganda
| | - Patience Tugume
- Department of Plant Sciences, Microbiology and Biotechnology, Makerere University, Kampala, Uganda
| | - Paul Matovu
- Department of Plant Sciences, Microbiology and Biotechnology, Makerere University, Kampala, Uganda.,Forestry Sector Support Department, Nyabyeya Forestry College, Ministry of Water and Environment, Masindi, Uganda
| | - Godfrey Wasige
- Department of Biological Sciences, Faculty of Science, Islamic University in Uganda, Mbale, Uganda
| | - Hussein M Kafeero
- Department of Microbiology and Immunology, Faculty of Health Sciences, Habib Medical School, Islamic University in Uganda, Kampala, Uganda
| | - Abdul Walusansa
- Department of Biological Sciences, Faculty of Science, Islamic University in Uganda, Mbale, Uganda.,Department of Microbiology and Immunology, Faculty of Health Sciences, Habib Medical School, Islamic University in Uganda, Kampala, Uganda.,Department of Plant Sciences, Microbiology and Biotechnology, Makerere University, Kampala, Uganda
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Kamvura TT, Dambi JM, Chiriseri E, Turner J, Verhey R, Chibanda D. Barriers to the provision of non-communicable disease care in Zimbabwe: a qualitative study of primary health care nurses. BMC Nurs 2022; 21:64. [PMID: 35303865 PMCID: PMC8932172 DOI: 10.1186/s12912-022-00841-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Non-communicable diseases (NCDs) contribute significantly to the global disease burden, with low-and middle-income (LMICs) countries disproportionately affected. A significant knowledge gap in NCDs exacerbates the high burden, worsened by perennial health system challenges, including human and financial resources constraints. Primary health care workers play a crucial role in offering health care to most people in LMICs, and their views on the barriers to the provision of quality care for NCDs are critical. This study explored perceived barriers to providing NCDs care in primary health care facilities in Zimbabwe. Methods In-depth, individual semi-structured interviews were conducted with general nurses in primary care facilities until data saturation was reached. We focused on diabetes, hypertension, and depression, the three most common conditions in primary care in Zimbabwe. We used thematic content analysis based on an interview guide developed following a situational analysis of NCDs care in Zimbabwe and views from patients with lived experiences. Results Saturation was reached after interviewing 10 participants from five busy urban clinics. For all three NCDs, we identified four cross-cutting barriers, a) poor access to medication and functional equipment such as blood pressure machines, urinalysis strips; b) high cost of private care; c)poor working conditions; and d) poor awareness from both patients and the community which often resulted in the use of alternative potentially harmful remedies. Participants indicated that empowering communities could be an effective and low-cost approach to positive lifestyle changes and health-seeking behaviours. Participants indicated that the Friendship bench, a task-shifting programme working with trained community grandmothers, could provide a platform to introduce NCDs care at the community level. Also, creating community awareness and initiating screening at a community level through community health workers (CHWs) could reduce the workload on the clinic nursing staff. Conclusion Our findings reflect those from other LMICs, with poor work conditions and resources shortages being salient barriers to optimal NCDs care at the facility level. Zimbabwe's primary health care system faces several challenges that call for exploring ways to alleviate worker fatigue through strengthened community-led care for NCDs. Empowering communities could improve awareness and positive lifestyle changes, thus optimising NCD care. Further, there is a need to optimise NCD care in urban Zimbabwe through a holistic and multisectoral approach to improve working conditions, basic clinical supplies and essential drugs, which are the significant challenges facing the country's health care sector. The Friendship Bench could be an ideal entry point for providing an integrated NCD care package for diabetes, hypertension and depression. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-022-00841-1.
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Affiliation(s)
- Tiny Tinashe Kamvura
- The Friendship Bench, Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
| | - Jermaine M Dambi
- The Friendship Bench, Rehabilitation Sciences Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Ephraim Chiriseri
- The Friendship Bench, Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Jean Turner
- The Friendship Bench, Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Ruth Verhey
- The Friendship Bench, Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Dixon Chibanda
- The Friendship Bench, Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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Cavagna P, Takombe JL, Damorou JM, Kouam Kouam C, Diop IB, Ikama SM, Kramoh KE, Ali Toure I, Balde D, Dzudie A, Ferreira B, Houenassi M, Kane A, Kimbally-Kaki SG, Kingue S, Limbole E, Mfeukeu Kuate L, Mipinda JB, N'Guetta R, Nhavoto C, Sidy Ali A, Gaye B, Tajeu GS, Macquart De Terline D, Perier MC, Azizi M, Jouven X, Antignac M. Blood pressure-lowering medicines implemented in 12 African countries: the cross-sectional multination EIGHT study. BMJ Open 2021; 11:e049632. [PMID: 34857562 PMCID: PMC8640662 DOI: 10.1136/bmjopen-2021-049632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE In Africa, the number of patients with hypertension is expected to reach 216.8 million by 2030. Large-scale data on antihypertensive medications used in Sub-Saharan Africa (SSA) are scarce.Here, we describe antihypertensive drug strategies and identify treatment factors associated with blood pressure (BP) control in 12 Sub-Saharan countries. SETTING Outpatient consultations for hypertension in urban tertiary cardiology centres of 29 hospitals from 17 cities across 12 SSA countries between January 2014 and November 2015. PARTICIPANTS Patients ≥18 years of age with hypertension were enrolled at any visit during outpatient consultations in the cardiology departments MAIN OUTCOME MEASURE: We collected BP levels, demographic characteristics and antihypertensive treatment use (including traditional medicine) of patients with hypertension attending outpatient visits. BP control was defined as seated office BP <140/90 mm Hg. We used logistic regression with a random effect on countries to assess factors of BP control. RESULTS Overall, 2198 hypertensive patients were included and a total of 96.6% (n=2123) were on antihypertensive medications. Among treated patients, 653 (30.8%) patients received a monotherapy by calcium channel blocker (n=324, 49.6%), renin-angiotensin system blocker (RAS) (n=126, 19.3%) or diuretic (n=122, 18.7%). Two-drug strategies were prescribed in 927 (43.6%) patients including mainly diuretics and RAS (n=327, 42% of two-drug strategies). Prescriptions of three-drugs or more were used in 543 (25.6%) patients. Overall, among treated patients, 1630 (76.7%) had uncontrolled BP, of whom 462 (28.3%) had BP levels ≥180/110 mm Hg, mainly in those on monotherapy. After adjustment for sociodemographic factors, the use of traditional medicine was the only factor significantly associated with uncontrolled BP (OR 1.72 (1.19 to 2.49) p<0.01). CONCLUSION Our study provided large-scale data on antihypertensive prescriptions in the African continent. Among patients declared adherent to drugs, poor BP control was significantly associated with the use of traditional medicine.
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Affiliation(s)
- Pauline Cavagna
- Department of Pharmacy, St Antoine Hospital, AP-HP Sorbonne Université, Paris, France
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Paris, France
| | - Jean Laurent Takombe
- Department of Internal Medicine, General Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | | | | | - Stephane Méo Ikama
- Cardiology, National University Hospital of Brazzaville, Marien NGOUABI University, Brazzaville, Congo
| | - Kouadio Euloge Kramoh
- Cardiology, Institute of Cardiology of Abidjan (Côte d'Ivoire), BPV 206, abidjan, Côte d'Ivoire
| | - Ibrahim Ali Toure
- Internal Medicine and Cardiology, University Hospital of Lamorde, Niamey University, Niamey, Niger
| | - Dadhi Balde
- Cardiology, University Hospital of Conakry, Conakry, Guinea
| | - Anastase Dzudie
- Cardiac Intensive Care & Cardiac Pacing Unit, Douala General Hospital, Douala, Cameroon
| | | | - Martin Houenassi
- National University Hospital of Hubert K. MAGA (CNHU-HKM), Cotonou, Benin
| | - Adama Kane
- Cardiology, St Louis Hospital, Dakar, Senegal
| | - Suzy Gisele Kimbally-Kaki
- Cardiology, National University Hospital of Brazzaville, Marien NGOUABI University, Brazzaville, Congo
| | - Samuel Kingue
- University of Yaoundé, Ministry of Public Health, Yaoundé, Cameroon
| | - Emmanuel Limbole
- Cardiology, University of Medicine of Kinshasa, Kinshasa, Democratic Republic of the Congo
- Department of Internal Medicine of la Gombe (CMCG), Department of Internal Medicine, Ngaliema Hospital, Kinshasa, Democratic Republic of the Congo
| | | | | | - Roland N'Guetta
- Cardiology, Institute of Cardiology of Abidjan (Côte d'Ivoire), BPV 206, abidjan, Côte d'Ivoire
| | | | | | - Bamba Gaye
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Paris, France
| | - Gabriel S Tajeu
- Department of Health Services Administration Cardiology Clinics and Policy, Temple University, Philadelphia, Pennsylvania, USA
| | - Diane Macquart De Terline
- Department of Pharmacy, St Antoine Hospital, AP-HP Sorbonne Université, Paris, France
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Paris, France
| | | | - Michel Azizi
- Hypertension Unit, European Georges Pompidou Hospital, AP-HP Centre, Paris, France
- INSERM, Centre d'Investigation Clinique 1418, Paris, France
- Cardiovascular epidemiology department, University of Paris, Paris, France
| | - Xavier Jouven
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Paris, France
- Cardiovascular epidemiology department, University of Paris, Paris, France
- Cardiology, European Georges Pompidou Hospital, AP-HP Centre, Paris, France
| | - Marie Antignac
- Department of Pharmacy, St Antoine Hospital, AP-HP Sorbonne Université, Paris, France
- Université de Paris, PARCC, INSERM, F-75015 Paris, France, Paris, France
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Mushagalusa Kasali F, Ahadi Irenge C, Murhula Hamuli P, Birindwa Mulashe P, Murhula Katabana D, Mangambu Mokoso JD, Mpiana PT, Ntokamunda Kadima J. Ethnopharmacological Survey on Treatment of Hypertension by Traditional Healers in Bukavu City, DR Congo. Evid Based Complement Alternat Med 2021; 2021:6684855. [PMID: 34335835 DOI: 10.1155/2021/6684855] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 06/07/2021] [Accepted: 07/03/2021] [Indexed: 11/18/2022]
Abstract
Background Ethnopharmacological studies are relevant for sustaining and improving knowledge of traditional medicine within the framework of complementary/alternative therapeutic practices based solely on experience and observation across generations. Hypertension is a common cardiovascular disorder affecting more than 50% of older people in Africa (PLoS One. 2019; 14 (4): e0214934; published online on April 5, 2019, doi: 10.1371/journal.pone.0214934). Methods We conducted a cross-sectional survey from October 2014 to August 2015 with 18 renowned traditional healers from the city of Bukavu to capture botanical plant species and remedies used by herbalists to manage hypertension in the Democratic Republic of Congo. Results Respondents cited 41 plant species belonging to 25 botanical families. The ten most common plants are Allium sativum, Galinsoga ciliata, Moringa oleifera, Bidens pilosa, Persea americana, Piper capense, Catharanthus roseus, Rauvolfia vomitoria, Sida rhombifolia, and Vernonia amygdalina. The parts used are primary leaves (48.8%) formulated as oral decoctions (65.9%). Conclusion The literature review validated the use of 73.2% of the plants listed. Plants of high local use-value not supported by other studies deserve in-depth chemical and pharmacological studies.
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Cavagna P, Kramoh KE, Sidy Ali A, Balde DM, Traore AK, Khoury S, Jouven X, Antignac M. The importance of considering cultural and environmental elements in an interventional model of care to fight hypertension in Africa. J Clin Hypertens (Greenwich) 2021; 23:1269-1270. [PMID: 33830601 PMCID: PMC8678716 DOI: 10.1111/jch.14252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Pauline Cavagna
- Department of Pharmacy, St Antoine Hospital, AP-HP Sorbonne Université, Paris, France.,INSERM U970, Paris Cardiovascular Research Center, Université de Paris, Paris, France
| | | | - Abdallahi Sidy Ali
- Centre National de Cardiologie, Cabinet de Cardiologie, Nouakchott, Mauritania
| | - Dahdi M Balde
- Cardiology Department, University Hospital of Conakry, Conakry, Guinea
| | | | - Stephanie Khoury
- INSERM U970, Paris Cardiovascular Research Center, Université de Paris, Paris, France
| | - Xavier Jouven
- INSERM U970, Paris Cardiovascular Research Center, Université de Paris, Paris, France.,Cardiovascular Epidemiology Department, Université de Paris, Paris, France.,Cardiology Department, AP-HP Centre, European Georges Pompidou Hospital, Paris, France
| | - Marie Antignac
- Department of Pharmacy, St Antoine Hospital, AP-HP Sorbonne Université, Paris, France.,INSERM U970, Paris Cardiovascular Research Center, Université de Paris, Paris, France
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Stein E, Pulle J, Zimmerman M, Otim I, Atala J, Rwebembera J, Oyella LM, Harik N, Okello E, Sable C, Beaton A. Previous Traditional Medicine Use for Sore Throat among Children Evaluated for Rheumatic Fever in Northern Uganda. Am J Trop Med Hyg 2020; 104:842-847. [PMID: 33319727 DOI: 10.4269/ajtmh.20-0288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 11/01/2020] [Indexed: 11/07/2022] Open
Abstract
Timely diagnosis of group A streptococcal (GAS) sore throat coupled with appropriate antibiotic treatment is necessary to prevent serious post-streptococcal complications, including rheumatic fever (RF) and rheumatic heart disease (RHD). Traditional medicine (TM) is a known common adjunct to formal medical care in sub-Saharan Africa. A better understanding of health-seeking behavior for sore throat both within and outside the formal medical system is critical to improving primary prevention efforts of RF and RHD. A prospective mixed-methods study on the use of TM for sore throat was embedded within a larger epidemiological study of RF in Northern Uganda. Children presenting with symptoms of RF were interviewed about recent TM use as well as health services use for sore throat. One hundred children with a median age of 10 years (interquartile range: 6.8-13 years) completed the TM interview with their parent/guardian as part of a research study of RF. Seventeen, or 17%, accessed a TM provider for sore throat as part of the current illness, and 70% accessed TM for sore throat in the past (73% current or past use). Of the 20 parents who witnessed the TM visit, 100% reported use of crude tonsillectomy. Penicillin was the most frequently prescribed medication by TM providers in 52% of participants who were seen by a TM provider. The use of TM among children presenting with symptoms of sore throat in northern Uganda is common and frequently used in tandem with diagnostic services offered through the formal healthcare system. Engagement with TM practitioners may provide an important avenue for designing effective primary prevention and management strategies of RF and reduce the global burden of RHD.
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Affiliation(s)
- Elizabeth Stein
- Children's National Heart Institute, Children's National Hospital, Washington, District of Columbia.,University of Washington School of Medicine, Seattle, Washington
| | - Jafesi Pulle
- Uganda Heart Institute, Mulago National Referral Hospital, Kampala, Uganda
| | | | - Isaac Otim
- Uganda Heart Institute, Mulago National Referral Hospital, Kampala, Uganda
| | - Jenifer Atala
- Uganda Heart Institute, Mulago National Referral Hospital, Kampala, Uganda
| | - Joselyn Rwebembera
- Uganda Heart Institute, Mulago National Referral Hospital, Kampala, Uganda
| | - Linda Mary Oyella
- Uganda Heart Institute, Mulago National Referral Hospital, Kampala, Uganda
| | - Nada Harik
- Division of Infectious Diseases, Children's National Hospital, Washington, District of Columbia
| | - Emmy Okello
- Uganda Heart Institute, Mulago National Referral Hospital, Kampala, Uganda
| | - Craig Sable
- Children's National Heart Institute, Children's National Hospital, Washington, District of Columbia
| | - Andrea Beaton
- Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, Ohio
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Owusu S, Gaye YE, Hall S, Junkins A, Sohail M, Franklin S, Aung M, Jolly PE. Factors associated with the use of complementary and alternative therapies among patients with hypertension and type 2 diabetes mellitus in Western Jamaica: a cross-sectional study. BMC Complement Med Ther 2020; 20:314. [PMID: 33069215 PMCID: PMC7568371 DOI: 10.1186/s12906-020-03109-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 10/08/2020] [Indexed: 12/26/2022] Open
Abstract
Background This study examined the prevalence and predictors of complementary and alternative medicine use among clinic patients with hypertension and/or type 2 diabetes mellitus in western Jamaica. Methods A cross-sectional study using an investigator-administered questionnaire was conducted from May to August 2017. Data on sociodemographic factors, complementary and alternative medicine use, and knowledge and perceptions of complementary and alternative medicine were collected from the patients. Multivariable logistic regression analysis was used to examine associations between patient characteristics and knowledge and perceptions of complementary and alternative medicine and complementary and alternative medicine use. Results A total of 362 patients were invited to participate and 345 (95.3%) completed the questionnaire; 311 (90.1%) had hypertension, 130 (37.7%) had type 2 diabetes mellitus and 96 (27.8%) had both diseases. Seventy-nine percent of the participants with hypertension and 65% with type 2 diabetes mellitus reported current use of complementary and alternative medicine. Self-reported knowledge of complementary and alternative medicine (none/poor vs average/good/excellent) was significantly associated with complementary and alternative medicine use for hypertension (AOR = 0.33, 95% CI = 0.13–0.87) and type 2 diabetes mellitus (AOR = 0.06, 95% CI = 0.01–0.37). Believing that complementary and alternative medicine is a natural method for treating hypertension was significantly associated with complementary and alternative medicine use among patients with hypertension (AOR = 3.9, 95% CI = 1.26–12.00), and belief that it is acceptable to use prescription medication and complementary and alternative medicine simultaneously was significantly associated with complementary and alternative medicine use among patients with type 2 diabetes mellitus (AOR =7.19, CI = 1.34–38.52). Conclusions Participants’ perceptions of their knowledge and beliefs regarding complementary and alternative medicine strongly influence their use of complementary and alternative medicine. These findings can be used in designing educational interventions to promote the proper use, and mitigate detrimental effects, of complementary and alternative medicine in this population.
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Affiliation(s)
- Samuel Owusu
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294-0022, USA
| | - Yai-Ellen Gaye
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294-0022, USA
| | - Skyla Hall
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294-0022, USA
| | - Anna Junkins
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294-0022, USA
| | - Maira Sohail
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294-0022, USA
| | - Sarah Franklin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294-0022, USA
| | - Maung Aung
- Epidemiology Unit, Western Regional Health Authority, Ministry of Health, Montego Bay, St. James, Jamaica
| | - Pauline E Jolly
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294-0022, USA.
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Tusubira AK, Akiteng AR, Nakirya BD, Nalwoga R, Ssinabulya I, Nalwadda CK, Schwartz JI. Accessing medicines for non-communicable diseases: Patients and health care workers' experiences at public and private health facilities in Uganda. PLoS One 2020; 15:e0235696. [PMID: 32634164 PMCID: PMC7340292 DOI: 10.1371/journal.pone.0235696] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/20/2020] [Indexed: 12/15/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are increasingly prevalent in low- and middle-income countries. Successful management requires consistent access to appropriate medicines. Availability of NCD medicines is generally low, especially in the public sector, however, little is known about other factors affecting access. We explored barriers and facilitators of access to medicines for diabetes and hypertension at public and private health facilities in Uganda. Methods We conducted a qualitative descriptive study at six public hospitals and five private health facilities in different regions of Uganda. Data collection included 36 in-depth interviews and 14 focus group discussions (n = 128) among purposively selected adult outpatients with diabetes and/or hypertension and 26 key informant interviews with healthcare workers and patient association leaders. Transcripts were coded and emerging themes identified using the Framework method. Results Four main themes emerged: Stocking of medicines and supplies, Financial factors, Individual behaviour and attitudes, and Service delivery at health facilities. Stocking of medicines and supplies mainly presented barriers to access at public facilities including frequent stockouts, failure to stock certain medicines and low quality brands often rejected by patients. Financial factors, especially high cost of medicines and limited insurance coverage, were barriers in private facilities. Free service provision was a facilitator at public facilities. Patients’ confusion resulting from mixed messages and their preference for herbal treatments were cross-sector barriers. While flexibility in NCD service provision was a facilitator at private facilities, provider burnout and limited operating hours were barriers in public facilities. Patient-driven associations exist at some public facilities and help mitigate inadequate medicine stock. Conclusion Access to NCD medicines in Uganda is influenced by both health system and patient factors. Some factors are sector-specific, while others cross-cutting between public and private sectors. Due to commonalities in barriers, potential strategies for overcoming them may include patient-driven associations, public-private partnerships, and multi-modal health education platforms.
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Affiliation(s)
- Andrew K. Tusubira
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- * E-mail:
| | - Ann R. Akiteng
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Brenda D. Nakirya
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Ritah Nalwoga
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
| | - Isaac Ssinabulya
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Uganda Heart Institute, Mulago National Referral Hospital, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Christine K. Nalwadda
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences Makerere University, Kampala, Uganda
| | - Jeremy I. Schwartz
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, United States of America
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Lee JW, Hyun MK, Lee JH. Determinants of concurrent use of Biomedicine and Korean Medicine on the hypertension patients: a cross-sectional study. Integr Med Res 2020; 10:100429. [PMID: 32904209 PMCID: PMC7452361 DOI: 10.1016/j.imr.2020.100429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/04/2020] [Accepted: 05/15/2020] [Indexed: 12/01/2022] Open
Abstract
Background This study assessed the utilization of biomedicine and Korean Medicine (KM) among hypertension patients. Methods The study was a cross-sectional analysis conducted using the Korean National Health and Nutrition Examination Survey (KNHANES), which is a nationwide survey conducted every year for a representative Korean population. The use of outpatient healthcare services for hypertension patients was analyzed, and the usage determinants adjusted by the demographic and health status variables were identified. A chi-square test and logistic regression analysis were used for statistical analysis using R (version 3.6.0). Results Among 3320 hypertension patients, 208 patients (6.27%, Weighted%: 5.99%) used the biomedicine and KM concurrently. Multivariable regression analyses revealed hypertension patients who were obese (OR: 1.417, CI: 1.007–1.995) and had an experience of sickness (OR: 2.323, CI: 1.561–3.457) to be more likely to use biomedicine and KM concurrently. Conclusion The utilization rate and determinants of the concurrent use of biomedicine and KM were identified in patients with hypertension. Although the overall usage rate was not high, the health care patterns of healthcare consumers need to be understood. Therefore, further studies on its effectiveness and safety are recommended.
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Affiliation(s)
- Jang Won Lee
- Department of Preventive Medicine, College of Korean Medicine, Dongguk University, Gyeongju, Republic of Korea
| | - Min Kyung Hyun
- Department of Preventive Medicine, College of Korean Medicine, Dongguk University, Gyeongju, Republic of Korea
| | - Ji Hyun Lee
- Hanjoong Hospital of Korean Medicine, Bucheon, Republic of Korea
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Mwaka AD, Tusabe G, Garimoi CO, Vohra S, Ibingira C. Integration of traditional and complementary medicine into medical school curricula: a survey among medical students in Makerere University, Uganda. BMJ Open 2019; 9:e030316. [PMID: 31488487 PMCID: PMC6731838 DOI: 10.1136/bmjopen-2019-030316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe the disposition and sociodemographic characteristics of medical students associated with inclusion of traditional and complementary medicine in medical school curricula in Uganda. DESIGN A cross-sectional study conducted during May 2017. A pretested questionnaire was used to collect data. Disposition to include principles of traditional and complementary medicine into medical school curricula was determined as proportion and associated factors determined through multivariate logistic regression. PARTICIPANTS AND SETTING Medical students in their second to fifth years at the College of Health Sciences, Makerere University, Uganda. Makerere University is the oldest public university in the East African region. RESULTS 393 of 395 participants responded. About 60% (192/325) of participants recommended inclusion of traditional and complementary medicine principles into medical school curricula in Uganda. The disposition to include traditional and complementary medicine into medical school curricula was not associated with sex, age group or region of origin of the students. However, compared with the second year students, the third (OR 0.34; 95% CI 0.17 to 0.66) and fifth (OR 0.39; 95% CI 0.16 to 0.93) year students were significantly less likely to recommend inclusion of traditional and complementary medicine into the medical school curricula. Participants who hold positive attributes and believe in effectiveness of traditional and complementary medicine were statistically significantly more likely to recommend inclusion into the medical school curricula in Uganda. CONCLUSIONS Inclusion of principles of traditional and complementary medicine into medical school curricula to increase knowledge, inform practice and research, and moderate attitudes of physicians towards traditional medicine practice is acceptable by medical students at Makerere University. These findings can inform review of medical schools' curricula in Uganda.
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Affiliation(s)
- Amos Deogratius Mwaka
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Gersave Tusabe
- Department of Philosophy, Makerere University College of Humanities and Social Sciences, Kampala, Uganda
| | - Christopher Orach Garimoi
- Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sunita Vohra
- Departments of Paediatrics, Medicine, and Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Charles Ibingira
- Department of Anatomy, Makerere University College of Health Sciences, Kampala, Uganda
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Diallo MST, Traore MS, Balde MA, Camara AK, Baldé ES, Traore S, Oulare K, Diallo TS, Laurent S, Muller RN, Tuenter E, Pieters L, Balde AM. Prevalence, management and ethnobotanical investigation of hypertension in two Guinean urban districts. J Ethnopharmacol 2019; 231:73-79. [PMID: 30056206 DOI: 10.1016/j.jep.2018.07.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/04/2018] [Accepted: 07/25/2018] [Indexed: 06/08/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Hypertension is an important public health challenge in low- and middle-income countries, and in many African countries including Guinea medicinal plants are still widely used for its treatment. MATERIALS AND METHODS The objective of this study was to determine the prevalence of hypertension in two Guinean urban districts (Pounthioun and Dowsare), to describe its management and to collect information on traditional herbal remedies. A total of 316 participants entered the study, 28.2% (89/316) men and 71.8% (227/316) women. Of these, 181 were from Dowsare (50 men and 131 women) and 135 from Pounthioun (39 men and 96 women). The mean age of subjects was 40.8 ± 14.0 years (range18 - 88years), while the majority of subjects (63.3% or 200/316) were 45-74 years old. RESULTS The overall prevalence of hypertension was 44.9% (142/316): 46.4% (84/181) from Dowsare and 43.0% (58/135) from Pounthioun. Ethnobotanical investigations among hypertensive patients led to the collection of 15 plant species, among which Hymenocardia acida leaves and Uapaca togoensis stem bark were the most cited. Phytochemical investigation of these two plant species led to the isolation and identification of isovitexin and isoorientin from H. acida, and betulinic acid and lupeol from U. togoensis. CONCLUSION The presence of these constituents in Hymenocardia acida leaves and Uapaca togoensis stem bark may at least in part support their traditional use against hypertension in Guinea.
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Affiliation(s)
- M S T Diallo
- Department of Pharmacy, University Gamal Abdel Nasser of Conakry, BP 1017, Guinea; Research and Valorization Center on Medicinal Plants Dubreka, BP 6411 Conakry, Guinea; Service de Chimie Générale, Organique et Biomédicale; Laboratoire de RMN et d'Imagerie Moléculaire, Université de Mons, Belgium
| | - M S Traore
- Department of Pharmacy, University Gamal Abdel Nasser of Conakry, BP 1017, Guinea; Research and Valorization Center on Medicinal Plants Dubreka, BP 6411 Conakry, Guinea
| | - M A Balde
- Department of Pharmacy, University Gamal Abdel Nasser of Conakry, BP 1017, Guinea; Research and Valorization Center on Medicinal Plants Dubreka, BP 6411 Conakry, Guinea
| | - A K Camara
- Department of Pharmacy, University Gamal Abdel Nasser of Conakry, BP 1017, Guinea
| | - E S Baldé
- Department of Pharmacy, University Gamal Abdel Nasser of Conakry, BP 1017, Guinea; Research and Valorization Center on Medicinal Plants Dubreka, BP 6411 Conakry, Guinea
| | - S Traore
- Research and Valorization Center on Medicinal Plants Dubreka, BP 6411 Conakry, Guinea
| | - K Oulare
- Research and Valorization Center on Medicinal Plants Dubreka, BP 6411 Conakry, Guinea
| | - T S Diallo
- Research and Valorization Center on Medicinal Plants Dubreka, BP 6411 Conakry, Guinea
| | - S Laurent
- Service de Chimie Générale, Organique et Biomédicale; Laboratoire de RMN et d'Imagerie Moléculaire, Université de Mons, Belgium
| | - R N Muller
- Service de Chimie Générale, Organique et Biomédicale; Laboratoire de RMN et d'Imagerie Moléculaire, Université de Mons, Belgium
| | - E Tuenter
- Natural Products & Food Research and Analysis (NatuRA), Department of Pharmaceutical Sciences, University of Antwerp, Belgium
| | - L Pieters
- Natural Products & Food Research and Analysis (NatuRA), Department of Pharmaceutical Sciences, University of Antwerp, Belgium
| | - A M Balde
- Department of Pharmacy, University Gamal Abdel Nasser of Conakry, BP 1017, Guinea; Research and Valorization Center on Medicinal Plants Dubreka, BP 6411 Conakry, Guinea.
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Mwaka AD, Tusabe G, Orach Garimoi C, Vohra S. Turning a blind eye and a deaf ear to traditional and complementary medicine practice does not make it go away: a qualitative study exploring perceptions and attitudes of stakeholders towards the integration of traditional and complementary medicine into medical school curriculum in Uganda. BMC Med Educ 2018; 18:310. [PMID: 30563506 PMCID: PMC6299601 DOI: 10.1186/s12909-018-1419-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 12/03/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND A substantial proportion of healthcare professionals have inadequate understanding of traditional and complementary medicine and often consider their use inappropriate. METHODS We conducted a qualitative study to understand the perceptions and attitudes of medical students, medical school faculty and traditional and complementary medicine practitioners. In-depth interviews and focus group discussions were used to collect data. Thematic approach was used in data analysis to identify emerging themes and sub themes. Data analysis was supported with use of Atlas.ti v6.1.1. RESULTS The majority of participants commended the inclusion of traditional and complementary medicine principles into medical school curricula. The main reasons advanced were that: patients are already using these medicines and doctors need to understand them; doctors would be more accommodating to use and not rebuke patients, thereby minimizing delays in care due to pursuit of alternative therapies; promote patient safety; foster therapeutic alliance and adherence to therapy; uphold patients' right to self-determination; lead to discovery of new drugs from traditional medicines; and set ground for regulation of practices and quality control. However, participants anticipated operational and ethical challenges that include inadequate number of faculty to teach the subject, congested curricula, increased costs in research and development to produce evidence-base data, obstruction by pharmaceutical companies, inaccessibility to and depletion of medicinal plants, and potential conflicts due to diversity in culture and values. A substantial minority of participants thought traditional medicine need not be taught in medical schools because there is lack of scientific evidence on efficacy, safety, and side effects profiles. These shortfalls could make the determination of benefits (beneficence) and harm (maleficence) difficult, as well as compromise the ability of physicians to adequately disclose benefits and harms to patients and family, thereby undermining the process of informed consent and patient autonomy. CONCLUSIONS Training medical students in principles of traditional and complementary medicine is considered reasonable, feasible, and acceptable; and could lead to improvement in health outcomes. There are anticipated challenges to implementing a hybrid medical school curricula, but these are surmountable and need not delay introducing traditional and complementary medicine principles into medical school curricula in Uganda.
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Affiliation(s)
- Amos Deogratius Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
- Cancer Awareness and Early Detection Coalition (CAEDCO), Kampala, Uganda
| | - Gervase Tusabe
- Department of Philosophy, School of Liberal and Performing Arts, College of Humanities and Social Sciences, Makerere University, Kampala, Uganda
| | - Christopher Orach Garimoi
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sunita Vohra
- Departments of Paediatrics, Medicine, and Psychiatry, University of Alberta, Edmonton, Canada
- Faculty of Medicine & Dentistry, Integrative Health Institute, University of Alberta, Edmonton, Canada
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James PB, Wardle J, Steel A, Adams J. Traditional, complementary and alternative medicine use in Sub-Saharan Africa: a systematic review. BMJ Glob Health 2018; 3:e000895. [PMID: 30483405 PMCID: PMC6231111 DOI: 10.1136/bmjgh-2018-000895] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 08/26/2018] [Accepted: 08/27/2018] [Indexed: 12/31/2022] Open
Abstract
Background The WHO estimates that a considerable number of people in Sub-Saharan Africa (SSA) rely on traditional, complementary and alternative medicine (TCAM) to meet their primary healthcare needs, yet there remains a dearth of research evidence on the overall picture of TCAM utilisation in the region. Methods We conducted a literature search of original articles examining TCAM use in SSA between 1 January 2006 and 28 February 2017, employing Medline, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Scopus, ProQuest, PubMed, Embase and African Journals Online databases. A critical appraisal of relevant articles reporting a quantitative or mixed-method design was undertaken. Results Despite the heterogeneity and general low quality of the identified literature, the review highlights a relatively high use of TCAM alone or in combination with orthodox medicine, in both general population and in specific health conditions in SSA. TCAM users compared with non-TCAM users are more likely to be of low socioeconomic and educational status, while there were inconsistencies in age, sex, spatial location and religious affiliation between TCAM users and non-TCAM users. Most TCAM users (55.8%–100%) in SSA fail to disclose TCAM use to their healthcare providers, with the main reasons for non-disclosure being fear of receiving improper care, healthcare providers’ negative attitude and a lack of enquiry about TCAM use from healthcare providers. Conclusion TCAM use in SSA is significant, although most studies emerge from a few countries. Factors associated with TCAM use in SSA are similar to those observed in other regions, but further research may be required to further elucidate challenges and opportunities related to TCAM use specific to SSA.
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Affiliation(s)
- Peter Bai James
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Jon Wardle
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- Office of Research, Endeavour College of Natural Health, Brisbane, Queensland, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Abstract
To assess the efficacy and safety of wet cupping in adults with hypertension, we conducted a systematic review and meta-analysis using 13 databases. Wet cupping alone or in combination with antihypertensive medication or acupuncture was used. Seven randomized trials were included, most not of high methodological quality. A few small studies suggested that wet cupping alone versus antihypertensive medication significantly reduced blood pressure and Traditional Chinese Medicine syndrome (hypertension-related symptoms). However based on current evidence, no firm conclusions can be drawn and no clinical recommendations made. Research projects included need validation. Studies indicate that wet cupping is a safe therapy.
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Affiliation(s)
- Shuting Lu
- a Jiangsu Food & Pharmaceutical Science College, College of Health , Huai , China
| | - Shizheng Du
- b Nursing College , Nanjing University of Chinese Medicine , Nanjing , China
| | - Anne Fish
- c College of Nursing (ISP Program) , University of Missouri-St. Louis , St. Louis , USA
| | - Cong Tang
- b Nursing College , Nanjing University of Chinese Medicine , Nanjing , China
| | - Qingqing Lou
- d Department of Health Education , Jiangsu Province Academy of Traditional Chinese Medicine , Nanjing , China
| | - Xuefang Zhang
- e Department of Nursing , Nanjing City Hospital of Traditional Chinese Medicine , Nanjing , China
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Musinguzi G, Anthierens S, Nuwaha F, Van Geertruyden JP, Wanyenze RK, Bastiaens H. Factors Influencing Compliance and Health Seeking Behaviour for Hypertension in Mukono and Buikwe in Uganda: A Qualitative Study. Int J Hypertens 2018; 2018:8307591. [PMID: 29854433 DOI: 10.1155/2018/8307591] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/07/2018] [Accepted: 03/20/2018] [Indexed: 11/17/2022] Open
Abstract
Background and Methods Hypertension is a global public health challenge and a leading risk factor for cardiovascular morbidity and mortality. Hypertension control rates are low worldwide, and delay in seeking care is associated with increased mortality. Methods In a qualitative study, known hypertensive patients were interviewed to explore factors influencing compliance and health seeking behaviour (HSB). Data was analyzed following a semantic thematic analysis approach. Results Patients sought various channels of care for their hypertension. Self-medication and access to antihypertensive drugs with or without prescription were common as well as use of herbal remedies. Regular monitoring of blood pressure was not a common practice. Factors influencing HSB were related to health systems and the patient socioeconomic and structural environment. The main system issues were related to availability and attitudes of staff and shortage of supplies and medicines. The patient factors were related to awareness, perceived severity, perceived effectiveness of therapy, adverse effects, and perceived fears of lifelong dependence on medicines. The patient socioeconomic status played a role as did the marketing of traditional medicine. Conclusion Patients seek varied channels of care for their hypertension. Strategies to address the multifactorial dimensions that affect HSB are needed to improve hypertension control in this population.
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James PB, Kamara H, Bah AJ, Steel A, Wardle J. Herbal medicine use among hypertensive patients attending public and private health facilities in Freetown Sierra Leone. Complement Ther Clin Pract 2018; 31:7-15. [PMID: 29705483 DOI: 10.1016/j.ctcp.2018.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/21/2017] [Accepted: 01/03/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study aimed to determine the prevalence, determinants and pattern of herbal medicine use among hypertensive patients in Freetown. METHODS AND MATERIALS We conducted a cross-sectional study among hypertensive patients attending public and private health facilities in Freetown, Sierra Leone between August and October 2016. We analyzed the data using SPSS version 24. We used Chi-square, Fisher exact two-tailed test and regression analysis for data analysis. A p-value less than 0.05 was considered statistically significant. RESULTS Out of 260 study participants, over half (n = 148, 56.9%) reported using herbal medicine for the treatment of hypertension alone or together with comorbid condition(s). The most commonly used herbal medicine among users were honey (n = 89, 33.3%), moringa (n = 80, 30.0%) and garlic (n = 73, 27.3%). No significant difference existed between users and non-users of herbal medicine with regards to socio-demographic and health-related factors. The majority (n = 241, 92.7%) of respondents considered herbal medicine beneficial if it was recommended by a healthcare provider yet 85.1% (n = 126) did not disclose their herbal medicine use to their health care provider. CONCLUSION There is a high use of herbal medicines among hypertensive patients in Freetown, Sierra Leone. It is essential for healthcare providers to take heed of the findings of this study and routinely ask their patients about their herbal medicine use status. Such practice will provide the opportunity to discuss the benefits and risks of herbal medicine use with the aim of maximizing patient desired therapeutic outcomes.
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Affiliation(s)
- Peter Bai James
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW 2007, Australia; Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - Halimatu Kamara
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - Abdulai Jawo Bah
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Faculty of Basic Medical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW 2007, Australia; Endeavour College of Natural Health, 269 Wickham St, Fortitude Valley, Brisbane, QLD 4006, Australia.
| | - Jon Wardle
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW 2007, Australia.
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Ibrahim IR, Hassali MA, Saleem F, Al Tukmagi HF, Dawood OT. Use of complementary and alternative medicines: a cross-sectional study among hypertensive patients in Iraq. J Pharm Health Serv Res 2017. [DOI: 10.1111/jphs.12209] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Inas Rifaat Ibrahim
- Social and Administrative Pharmacy; School of Pharmaceutical Sciences; Universiti Sains Malaysia; Penang Malaysia
| | - Mohamed Azmi Hassali
- Social and Administrative Pharmacy; School of Pharmaceutical Sciences; Universiti Sains Malaysia; Penang Malaysia
| | - Fahad Saleem
- Faculty of Pharmacy and Health Sciences; University of Baluchistan; Quetta Pakistan
| | - Haydar F. Al Tukmagi
- Department of Clinical Pharmacy; College of Pharmacy; University of Baghdad; Baghdad Iraq
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Liwa A, Roediger R, Jaka H, Bougaila A, Smart L, Langwick S, Peck R. Herbal and Alternative Medicine Use in Tanzanian Adults Admitted with Hypertension-Related Diseases: A Mixed-Methods Study. Int J Hypertens 2017; 2017:5692572. [PMID: 28634545 DOI: 10.1155/2017/5692572] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Hypertension is increasingly common in sub-Saharan Africa where traditional medicine use is also common. We conducted a hospital-based, mixed-methods study to determine prevalence, pattern, and correlates of herbal and alternative medicine use in Tanzanian adults hospitalized with hypertension. Methods A standardized questionnaire was administered. In-depth interviews were performed on a subset of participants. Factors associated with herbal medicine use were determined by logistic regression. The association between traditional medicine uses and allopathic medication adherence was determined using ordinal logistic regression. Qualitative data were analyzed according to grounded theory. Results Of 213 adults enrolled, 52 (24.4%) reported using herbs during the previous month and 47 (22.1%) reported concurrent use of herbs and allopathic medicines. Lower educational level, nonprofessional employment, and lack of health insurance were significantly associated with herbal medicine use. Alternative medicines use was not associated with lower medication adherence. Qualitative interviews identified several important themes including reasons for herbal medicine use. Conclusion The use of traditional medicines is very common among patients with hypertension. Adults from low socioeconomic status, those with misunderstandings about hypertension, and those without health insurance were more likely to take herbs. Open, nonjudgmental communication between healthcare workers and patients regarding use of traditional medicines must be encouraged in Africa.
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Lulebo AM, Mapatano MA, Mutombo PB, Mafuta EM, Samba G, Coppieters Y. Prevalence and determinants of use of complementary and alternative medicine by hypertensive patients attending primary health care facilities in Kinshasa, Democratic Republic of the Congo: a cross-sectional study. BMC Complement Altern Med 2017; 17:205. [PMID: 28390416 PMCID: PMC5385009 DOI: 10.1186/s12906-017-1722-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 04/04/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND In the Democratic Republic of the Congo the control of hypertension is poor, characterized by an increasing number of reported cases of hypertension related complications. Poor control of hypertension is associated with non-adherence to antihypertensive medication. It is well established that the use of complementary and alternative medicine is one of the main factors of non-adherence to antihypertensive medication. The aim of this study is to determine the prevalence and factors associated with the use of complementary and alternative medicine. METHODS A cross-sectional study was carried out at the Kinshasa Primary Health-care (KPHC) facilities network in November 2014. A structured interview questionnaire was administrated to a total of 280hypertensive patients. Complementary and alternative medicine were defined according to the National Institute of Health classification as a group of diverse medical and healthcare systems, practices, and products that are not presently considered to be part of conventional medicine. Data were summarized using proportion and mean (with standard deviation). The student's t test and χ2 test were used respectively for mean and proportion comparison. Logistic regression analysis identified determinants of the use of complementary and alternative medicine. RESULTS The prevalence of use of complementary and alternative medicine was 26.1% (95% CI: 20.7% - 31.8%).Determinants of use of complementary and alternative medicine included misperception about hypertension curability (OR = 2.1; 95%CI: 1.1-3.7) and experience of medication side effects (OR = 2.9; 95%CI: 1.7-5.1). CONCLUSION The use of CAM for hypertensive patients is a major problem; antihypertensives with fewer side effects must be emphasized. Religious leaders must become involved in the communication for behavioral change activities to improve the quality of life for hypertensive patients.
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Abstract
BACKGROUND Self-medication is commonly practised by patients, underpinned by health beliefs that affect their adherence to medication regimens, and impacting on treatment outcomes. OBJECTIVES This review explores the scope of self-medication practices among people with hypertension, in terms of the scale of use, types of medication and influencing factors. METHOD A comprehensive search of English language, peer-reviewed literature published between 2000 and 2014 was performed. Twenty-seven studies met the inclusion criteria; 22 of these focused on complementary and alternative medicines (CAMs). RESULTS Anti-hypertensive medications are listed among the 11% of products that patients reportedly obtain over-the-counter (OTC) for self-medication. On average, 25% of patients use CAMs, mostly herbs, to lower blood pressure. Recommendations by family, friends and neighbours are the most influential factors for self-medication with CAMs. Faith in treatment with CAMs, dissatisfaction with conventional medicine and the desire to reduce medication costs are also cited. Most (70%) patients with hypertension take OTC medicines to treat minor illnesses. The concurrent use of anti-hypertensive medications with analgesics and herbal medicines is commonly practised. The sociodemographic profile of patients engaging in self-medication differs markedly in the articles reviewed; self-medication practices cannot be attributed to a particular profile. Low disclosure of self-medication is consistently reported. CONCLUSION This review highlights a high proportion of people with hypertension practise self-medication. Further studies are needed to assess the impact of self-medication with OTC and anti-hypertensive medications on hypertension treatment. Health professionals involved in hypertension management should be mindful of any types of self-medication practices.
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Affiliation(s)
- Riana Rahmawati
- Graduate School of Health, Discipline of Pharmacy, The University of Technology Sydney, Sydney, New South Wales, Australia.,Pharmacology Department, Faculty of Medicine, Islamic University of Indonesia, Yogyakarta, Indonesia
| | - Beata V Bajorek
- Graduate School of Health, Discipline of Pharmacy, The University of Technology Sydney, Sydney, New South Wales, Australia.,Department of Pharmacy, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Abstract
The purpose of this review was to evaluate the efficacy and safety of qigong for hypertension.A systematic literature search was performed in 7 databases from their respective inceptions until April 2014, including the Cochrane Library, EMBASE, PubMed, Chinese Scientific Journal Database, Chinese Biomedical Literature Database, Wanfang database, and Chinese National Knowledge Infrastructure. Randomized controlled trials of qigong as either monotherapy or adjunctive therapy with antihypertensive drugs versus no intervention, exercise, or antihypertensive drugs for hypertension were identified. The risk of bias was assessed using the tool described in Cochrane Handbook for Systematic Review of Interventions, version 5.1.0.Twenty trials containing 2349 hypertensive patients were included in the meta-analysis. The risk of bias was generally high. Compared with no intervention, qigong significantly reduced systolic blood pressure (SBP) (weighted mean difference [WMD] = -17.40 mm Hg, 95% confidence interval [CI] -21.06 to -13.74, P < 0.00001) and diastolic blood pressure (DBP) (WMD = -10.15 mm Hg, 95% CI -13.99 to -6.30, P < 0.00001). Qigong was inferior to exercise in decreasing SBP (WMD = 6.51 mm Hg, 95% CI 2.81 to 10.21, P = 0.0006), but no significant difference between the effects of qigong and exercise on DBP (WMD = 0.67 mm Hg, 95% CI -1.39 to 2.73, P = 0.52) was identified. Compared with antihypertensive drugs, qigong produced a clinically meaningful but not statistically significant reduction in SBP (WMD = -7.91 mm Hg, 95% CI -16.81 to 1.00, P = 0.08), but appeared to be more effective in lowering DBP (WMD = -6.08 mm Hg, 95% CI -9.58 to -2.58, P = 0.0007). Qigong plus antihypertensive drugs significantly lowered both SBP (WMD = -11.99 mm Hg, 95% CI -15.59 to -8.39, P < 0.00001) and DBP (WMD = -5.28 mm Hg, 95% CI, -8.13 to -2.42, P = 0.0003) compared with antihypertensive drugs alone. No serious adverse events were reported.The meta-analysis suggests that qigong is an effective therapy for hypertension. However, more rigorously designed randomized controlled trials with long-term follow-up focusing on hard clinical outcomes are required to confirm the results.
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Affiliation(s)
- Xingjiang Xiong
- From the Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences (XX); Bio-organic and Natural Products Laboratory, McLean Hospital, Harvard Medical School, Belmont, MA, USA (XL); Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences (PW), Beijing, China; Bio-organic and Natural Products Laboratory, McLean Hospital, Harvard Medical School, Belmont, MA; and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada (YZ)
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Mani J, Juengel E, Arslan I, Bartsch G, Filmann N, Ackermann H, Nelson K, Haferkamp A, Engl T, Blaheta RA. Use of complementary and alternative medicine before and after organ removal due to urologic cancer. Patient Prefer Adherence 2015; 9:1407-12. [PMID: 26491269 PMCID: PMC4599187 DOI: 10.2147/ppa.s90061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Many patients use complementary and alternative medicine (CAM) as primary treatment or symptom relief for a variety of illnesses. This study was designed to investigate the influence of surgical removal of a tumor-bearing urogenital organ on CAM use. METHODS From 2007 to 2011, 350 patients underwent major urological surgery for kidney, prostate, or bladder cancer at the Goethe-University Hospital, Frankfurt, Germany. Data from 172 patients (49%), who returned a questionnaire, were retrospectively evaluated using the hospital information system along with the questionnaire to objectify CAM use 2 years before and after surgery. RESULTS From the 172 patients returning questionnaires, 56 (33%) used CAM before and/or after surgery and 116 (67%) never used CAM. Of the 56 CAM users, 30 (54%) used CAM presurgery and 53 (95%) used CAM postsurgery, indicating a significant change of mind about CAM use. Patients of German nationality used CAM significantly more than patients of other nationalities. Higher educational status (high-school diploma or higher) was a significant factor in favor of CAM use. The most common type of CAM used before/after surgery was an alternative medical system (63/49%), a manipulative and body-based method (50/19%), and a biological-based therapy (37/32%). Information about CAM, either provided by medical professionals or by other sources, was the main reason determining whether patients used CAM or not. CONCLUSION The number of patients using CAM almost doubled after surgical removal of a cancer-bearing organ. Better awareness and understanding of CAM use by medical professionals could improve patient counseling.
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Affiliation(s)
- Jens Mani
- Department of Urology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
- Correspondence: Jens Mani, Department of Urology, Goethe-University, Theodor-Stern-Kai 7, D-60590 Frankfurt am Main, Germany, Tel +49 69 6301 7109, Fax +49 69 6301 7108, Email
| | - Eva Juengel
- Department of Urology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
| | - Ilhan Arslan
- Department of Urology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
| | - Georg Bartsch
- Department of Urology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
| | - Natalie Filmann
- Institute of Biostatistics and Mathematical Modeling, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
| | - Hanns Ackermann
- Institute of Biostatistics and Mathematical Modeling, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
| | - Karen Nelson
- Department of Vascular and Endovascular Surgery, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
| | - Axel Haferkamp
- Department of Urology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
| | - Tobias Engl
- Department of Urology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
| | - Roman A Blaheta
- Department of Urology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany
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