Prevalence and predictors of traditional medicine use among persons with diabetes in Africa: a systematic review

The utilization of traditional medicine (TM) is prevalent among the general population in Africa; however, its use among individuals with diabetes in the region remains underdocumented. This review aimed to synthesize the available literature to identify the prevalence and predictors of TM use among persons with diabetes in Africa. A systematic search was conducted across multiple databases, including MEDLINE, Embase, CINAHL, and AMED, covering studies published from 2000 to April 2023. Of 1560 records identified, 24 articles met the inclusion criteria. The prevalence of TM use varied significantly, ranging from 12.4% to 77.1%, with a median prevalence of 50%. TM was commonly used concurrently with conventional medicine (CM) (35.4-88.4%), with a majority (63.8-91.3%) not disclosing TM use to healthcare providers. Female gender, long diabetes duration, use of oral antiglycaemic medication and family history of diabetes emerged as the most common factors that predicted the use of TM. This review highlights the widespread use of TM among individuals with diabetes in Africa, often in conjunction with CM. The high prevalence of undisclosed TM use emphasizes the urgent need for healthcare providers to actively inquire about TM use during clinical consultations to address potential herb-drug interactions and adverse effects.

Mapping prevalence and patterns of use of, and expenditure on, traditional, complementary and alternative medicine in New Zealand: a scoping review of qualitative and quantitative studies

AIM

Traditional, complementary and alternative medicine (TCAM) is a popular healthcare choice worldwide. The extent of data available on TCAM, including prevalence and patterns of use in New Zealand, is unknown. This scoping review aims to map the existing research describing the use of TCAM (including prevalence, access, expenditure and concurrent use with conventional medicines) in New Zealand.

METHOD

Research databases (MEDLINE, EMBASE, AMED, IPA (International Pharmaceutical Abstracts), CINAHL, PsycINFO and Scopus) and grey literature (Google Scholar and New Zealand government and relevant organisations' websites) were searched for studies published before 7 June 2019. Studies reporting on the prevalence and/or exploring aspects of TCAM use were included in this review.

RESULTS

In total, 72 studies were reviewed. Available data suggest that TCAM use is widespread among New Zealanders, and some consumers pay large sums of money out-of-pocket. A wide range of TCAM practices and products is used by people of all ages and ethnicities and with various health conditions. There is some evidence of consumers using TCAM concurrently with conventional medicines. Studies were generally small, localised and conducted in sub-populations (e.g., specific age groups, health conditions). Different TCAM definitions, data collection tools, methods and prevalence measurement were used across studies, thereby limiting the comparability of data locally and internationally.

CONCLUSION

A considerable number of studies/reports on TCAM use are available. Still, there is a lack of comprehensive, nationally representative data on prevalence and patterns of use of TCAM, including its use in relation to conventional medicine(s) in New Zealand.

The Experience of Colombian Medical Students in a Pilot Cultural Safety Training Program: A Qualitative Study Using the Most Significant Change Technique

Problem: The Colombian government provides health services grounded in the Western biomedical model, yet 40% of the population use cultural and traditional practices to maintain their health. Adversarial interactions between physicians and patients from other cultures hinder access to quality health services and reinforce health disparities. Cultural safety is an approach to medical training that encourages practitioners to examine how their own culture shapes their clinical practice and how to respect their patients' worldviews. This approach could help bridge the cultural divide in Colombian health services, improving multicultural access to health services and reducing health disparities. Intervention: In 2016, we conducted a pilot cultural safety training program in Cota, Colombia. A five-month training program for medical students included: (a) theoretical training on cultural safety and participatory research, and (b) a community-based intervention, co-designed by community leaders, training supervisors, and the medical students, with the aim of strengthening cultural practices related to health. Evaluation used the Most Significant Change narrative approach, which allows participants to communicate the changes most meaningful to them. Using an inductive thematic analysis, the authors analyzed the stories and discussed these findings in a debriefing session with the medical students. Context: Cota is located only 15 kilometers from Bogota, the national capital and biggest city of Colombia, so the small town has gone through rapid urbanization and cultural change. A few decades ago, inhabitants of Cota were mainly peasants with Indigenous and European traditions. Urbanization displaced agriculture with industrial and commercial occupations. One consequence of this change was loss of cultural health care practices and resources, for example, medicinal plants, that the community had used for centuries. Impact: A group of 13 final-year medical students (ten female and three male, age range 20-24) participated in the study. The medical students listed four areas of change after their experience: increased respect for traditional health practices to provide better healthcare; increased recognition of traditional practices as part of their cultural heritage and identity; a desire to deepen their knowledge about cultural practices; and openness to incorporate cultural practices in healthcare. Lessons Learned: Medical students reported positive perceptions of their patients' cultural practices after participating in this community-based training program. The training preceded a positive shift in perceptions and was accepted by Colombian medical students. To the best of our knowledge, this was the first documented cultural safety training initiative with medical students in Colombia and an early attempt to apply the cultural safety approach outside the Indigenous experience.

Knowledge of health workers on snakes and snakebite management and treatment seeking behavior of snakebite victims in Bhutan

Background

Published information on snakebite is rare in Bhutan although remarkably higher number of snakebites and associated deaths are reported from other South Asian countries.

Aims and methodology

Structured questionnaire was used to collect knowledge of health workers in snakebite management and health seeking behavior of snakebite victims as observed by health workers. Study was conducted in purposively sampled 10 Dzongkhags (district level administrative units) with higher incidence of snakebites.

Result

Heath workers scored 27–91% (with an average of 63%, SD = 14) for 52 questions related to snake identification and snakebite management. Among 118 health workers interviewed, 23% had adequate knowledge on snakes and snakebite management while 77% had inadequate knowledge. Among 32 Doctors, 63% of them scored above or equal to 75%. Health workers from Sarpang scored higher (76%, SD = 11) than those from other Dzongkhags. Snakebite victim's visit to local (traditional) healers prior to seeking medical help from hospital was observed by 75 (63%) health workers. Fifty one percent of health workers observed patients treated with local methods such as the use of black stone called Jhhar Mauro (believed to absorb snake venom), application of honey, rubbing of green herbal paste made up of Khenpa Shing (Artemisia myriantha Wallich ex Besser var. paleocephala [Pamp] Ling) and consumption of fluid made up of Neem leaf (Azadirachta indica Juss). Use of tight tourniquet as a first aid to snakebite was observed by 80% of the health workers.

Conclusion

Health workers lack confidence in snakebite management. Snakebite victims are likely to suffer from harmful local practices and traditional beliefs on local treatment practices. Empowering health workers with adequate knowledge on snakebite management and making locals aware in pre-hospital care of snakebites are needed to improve the pre- and in-hospital management of snakebite in Bhutan.

Snakebites affect people globally including Bhutan and snakes are source of fear and excitement. Major proportion (62.7%) of Bhutanese population who thrive on agro-farming, rearing livestock, and searching forest products are at risk of snake envenomations. Deaths due to snakebites are dependent upon use of first aid type, provisions available with the health facilities, and health seeking behaviors of snakebite victims. This multi-center study was conducted to assess the level of knowledge of health workers and its association with their demographic features and health seeking behavior of snakebite victims as observed by health workers using investigator administered structured questionnaire. We included 12 hospitals and a Basic Health Unit (BHU) from 10 snakebite prone Dzongkhags with 962 (84%) snakebites from January 2013 to December 2017 in the country. Among 118 health workers interviewed, 27 (23%) had adequate level of knowledge with remaining 91 (77%) having inadequate knowledge. Male health workers and Doctors had better level of knowledge than other study groups. Health workers from Sarpang scored higher compared to those from other Dzongkhags. A total of 42% (n = 50) health workers scored below 60% (31 or less correct responses for 52 questions), which demands requirement of training and inclusion of practice-oriented courses in training curriculum of health professionals for snakebite management. Often, use of traditional medication and less frequent adherence to WHO recommended first aid measures was observed by 5% (n = 6) respondents. The adoption of non-recommended treatment practices seems to delay proper treatment resulting in gangrene and associated complications.

Traditional medicine use in Timor-Leste

BACKGROUND

Traditional medicine use is common amongst peoples in developing nations. Timor-Leste is no exception. However little is known about the prevalence, pattern, satisfaction with, cost or type of traditional medicine used in Timor-Leste. This study aims to describe the prevalence, nature and basic demographic factors associated with contemporary traditional medicine use in Timor-Leste.

METHODS

A structured interview questionnaire was administered in Tetun to 50 surgical patients, 50 internal medicine patients, 50 hospital staff and 50 hospital visitors at Hospital Nacional Guido Valadares, Timor-Leste's major referral hospital.

RESULTS

60% of respondents reported having used traditional medicine; 32% within the last year. The greatest use was amongst surgical patients, the least amongst hospital staff. The frequency of traditional medicine use was comparable amongst all groups regardless of size of community, residence or level of education. Traditional medicine use in Timor-Leste is sufficiently common to represent part of the cultural norm. Factors described as promoting traditional medicine use included cost, limited access to other medical services and a belief that traditional medicine was free of side effects. Approximately half the patients reported using traditional medicine for their current illness and many for chronic illness in conjunction with conventional medicine.

CONCLUSION

Traditional medicine use is common in Timor-Leste. Medical practitioners need to be cognizant of the common and potentially concomitant use of traditional medicine alongside conventional medicine when treating patients in Timor-Leste.

Determinants of traditional medicine utilization for children: a parental level study in Tole District, Oromia, Ethiopia

BACKGROUND

In Ethiopia, about 80% of the population use traditional medicine (TM) due to the cultural acceptability of healers and local pharmacopeias, the relatively low cost of traditional medicine, and the difficulty of accessing modern health facilities. This study was aimed at assessing traditional medicine utilization and its determinants among parents of the children employing a case study of the Tole District of South West of Oromia, Ethiopia.

METHODS

A community-based cross-sectional data were collected from 267 parents who have children less than 18 years old. The respondents were selected through a systematic random sampling technique. Both descriptive and exploratory techniques were used to analyze the data. The exploratory logistic regression analysis was carried out to identify factors determining the use of traditional medicine (TM).

RESULTS

We found out that 85.9% of parents used TM for their children. Herbal medicine 73 (34.4%), massage 55 (25.9%), and religious/prayer therapy 25 (11.8%) were the major therapies used by parents for their children. In the study area, the rate of parental TM utuilization for their children was determined by monthly income [OR: 0.25(0.08, 0.78)], cultural belief [OR: 3.01(1.16, 7.83)], religious belief [OR = 3.17(1.26, 7.93)], and duration of illness [OR = 3.11(1.07, 9.02)].

CONCLUSION

Traditional medicine use is highly prevalent that its contribution to the public health is significant as some could not access to and afford modern health services in the area. Therefore, health professionals should advise parents side-by-side procuring modern health services. In light of this, further research will be needed on the safety and efficacy of TM for wider application.

Ebola survivors' healthcare-seeking experiences and preferences of conventional, complementary and traditional medicine use: A qualitative exploratory study in Sierra Leone

BACKGROUND

and Purpose: This study explores Ebola survivors' healthcare-seeking experiences within the context of Sierra Leone's free healthcare initiative (FHCI) and comprehensive package for Ebola survivors (CPES) program while also exploring the enablers and barriers to their use of informal healthcare.

MATERIALS AND METHODS

We employed an inductive, exploratory qualitative approach using focus group discussion with 41 adults Ebola survivors in the four administrative regions of Sierra Leone.

RESULTS

Biomedical care was the first choice of treatment option for most survivors immediately following post-ETC discharge. Survivors' healthcare-seeking experience varies before and after their inclusion into FHCI and the establishment of the CPES program. Personal and health system factors influenced survivors' decision to seek multiple healthcare approaches, especially T&CM.

CONCLUSION

Our findings suggest the determinants of Ebola survivors' healthcare-seeking experiences should be considered when developing and implementing programs aimed at improving the current health status of Ebola survivors in Sierra Leone.

Warming the postpartum body as a form of postnatal care: An ethnographic study of medical injections and traditional health practices in Cambodia

Postpartum care is a critical element for ensuring survival and health of mothers and newborns but is often inadequate in low- and middle-income countries due to barriers to access and resource constraints. Newly delivered mothers and their families often rely on traditional forms of postnatal care rooted in social and cultural customs or may blend modern and traditional forms of care. This ethnographic study sought to explore use of biomedical and traditional forms of postnatal care. Data were collected through unstructured observation and in-depth interviews with 15 mothers. Participants reported embracing traditional understandings of health and illness in the post-partum period centered on heating the body through diet, steaming, and other applications of heat, yet also seeking injections from private health care providers. Thematic analysis explored concepts related to transitioning forms of postnatal care, valuing of care through different lenses, and diverse sources of advice on postnatal care. Mothers also described concurrent use of both traditional medicine and biomedical postnatal care, and the importance of adhering to cultural traditions of postnatal care for future health. Maternal and newborn health are closely associated with postnatal care, so ensuring culturally appropriate and high-quality care must be an important priority for stakeholders including understand health practices that are evolving to include injections.

Formulation and consideration of World Health Organization international classification of traditional medicine

In the 11th revision of the International Classification of Diseases (ICD), the World Health Organization included traditional medicine disorders and patterns originated from ancient Chinese medicine that are commonly used in China, Japan, Korea and elsewhere around the world. For the first time, a chapter on traditional medicine was incorporated, which has completely changed the status quo on the lack of information on traditional medicine and health statistics in the ICD. In this study, we systematically analyzed the background, structure, content and characteristics of the Traditional Medicine chapter, with focus on its positive effects on promoting the development and utilization of Traditional Chinese Medicine worldwide.

Facilitators and barriers to traditional medicine use among cancer patients in Malawi

BACKGROUND

Increasing access to conventional cancer treatment (CT) in low-income countries (LICs) is an important public health initiative to address the global burden of cancer. However, LICs have a high prevalence of use of traditional and complementary medicine (T&CM). It is important to consider the factors that influence a patient's choice to use T&CM, CT, or both for their cancer treatment.

METHODS

We conducted focus groups among adult cancer patients in Lilongwe, Malawi to identify facilitators and barriers of T&CM use. Focus groups were recorded, transcribed, translated, and underwent thematic content analysis.

RESULTS

Cultural norms, T&CM access, T&CM success, and CT failure were all identified as facilitators to T&CM use. CT success and T&CM failure were identified as barriers. Access and norms appear to determine initial treatment selection, while treatment outcomes dictate continued use of T&CM or CT.

CONCLUSION

This study identified a pragmatic and experience-based treatment selection process that aligns with the social cognitive theory of behavior and assists in comprehending the factors that influence T&CM use among cancer patients in a low resource setting.

Pattern of health care utilization and traditional and complementary medicine use among Ebola survivors in Sierra Leone

Background

It is well established that Ebola Survivors experience a myriad of physical and psychological sequelae. However, little is known about how they seek care to address their health needs. Our study determines the current healthcare seeking behaviour among Ebola survivors and determines the prevalence, pattern of use and correlates of traditional and complementary medicine (T&CM) use among Ebola survivors in Sierra Leone.

Methods

We conducted a nationwide questionnaire survey among a cross-sectional sample of Ebola Survivors in Sierra Leone between January and August 2018. We employed descriptive statistics, chi-square test, Fisher exact two-tailed test and backward stepwise binary regression analysis for data analysis. A p-value less than 0.05 was considered statistically significant.

Results

Ebola Survivors who participated in our study (n = 358), visited a healthcare provider (n = 308, 86.0%), self-medicated with conventional medicines (n = 255, 71.2%) and visited a private pharmacy outlet (n = 141, 39.4%). Survivors also self-medicated with T&CM products (n = 107, 29.9%), concurrently self-medicated with conventional and T&CM products (n = 62, 17.3%), and visited a T&CM practitioner (n = 41, 11.5%). Almost half of (n = 163, 45.5%) Ebola survivors reported using T&CM treatments for post ebola related symptoms and non-Ebola related symptoms since their discharge from an Ebola treatment centre. Ebola survivors who considered their health to be fair or poor (AOR = 4.08; 95%CI: 2.22–7.50; p<0.01), presented with arthralgia (AOR = 2.52; 95%CI: 1.11–5.69, p = 0.026) and were discharged three years or less (AOR = 3.14; 95%CI: 1.13–8.73, p = 0.028) were more likely to use T&CM. Family (n = 101,62.0%) and friends (n = 38,23.3%) were the common sources of T&CM information. Abdominal pain (n = 49, 30.1%) followed by joint pain (n = 46, 28.2%) and back pain (n = 43, 26.4%) were the most cited post–Ebola indications for T&CM use. More than three-quarters of T&CM users (n = 135, 82.8%) failed to disclose their use of T&CM to their healthcare providers.

Conclusion

Ebola survivors in Sierra Leone employ a myriad of healthcare options including T&CM in addressing their healthcare needs. Researchers, health policy makers and healthcare providers should be aware of the substantial role of T&CM in the health seeking of survivors, and this topic that should be factored into future research, policy formulation and implementation as well as routine practice regarding Ebola survivors.

Maternal, prenatal and traditional practice factors associated with perinatal mortality in Yemen

BACKGROUND

Perinatal mortality remains a major international problem responsible for nearly six million stillbirths and neonatal deaths.

OBJECTIVES

To estimate the perinatal mortality rate in Sana'a, Yemen and to identify risk factors for perinatal deaths.

METHODS

A community-based prospective cohort study was carried out between 2015 and 2016. Nine-hundred and eighty pregnant women were identified and followed up to 7 days following birth. A multi-stage cluster sampling was used to select participants from community households', residing in the five districts of the Sana'a City, Yemen.

RESULTS

Total of 952 pregnant women were tracked up to 7 days after giving birth. The perinatal mortality rate, the stillbirth rate and the early neonatal mortality rate, were 89.3 per 1000, 46.2 per 1000 and 45.2 per 1000, respectively. In multivariable analysis older age (35+ years) of mothers at birth (Relative Risk=2.83), teenage mothers' age at first pregnancy (<18 years) (Relative Risk=1.57), primipara mothers (Relative Risk=1.90), multi-nuclear family (Relative Risk=1.74), mud house (Relative Risk=2.02), mothers who underwent female genital mutilation (Relative Risk=2.92) and mothers who chewed khat (Relative Risk=1.60) were factors associated with increased risk of perinatal death, whereas a positive mother's tetanus vaccination status (Relative Risk=0.49) were significant protective factors against perinatal deaths.

CONCLUSION

Rates of perinatal mortality were higher in Sana'a City compared to perinatal mortality at the national level estimated by World Health Organization. It is imperative there be sustainable interventions in order to improve the country's maternal and newborn health.

Plants used by the rural community of Bananal, Mato Grosso, Brazil: Aspects of popular knowledge

Studies in rural communities are important to maintain popular knowledge between generations, as well as to identify new species for pharmaceutical production. Thus, the objectives of this study were to determine which plant species the rural community of Bananal, Mato Grosso, Brazil, uses by calculating the levels of fidelity and concordance regarding species uses among residents and to determine if there is a relationship between the number of known useful plants and levels of education, age, and residence time. Ethnobotanical data was collected from residents of the community through semi-structured interviews in January/December/2016. Species diversity was calculated using Shannon-Wiener, Level of Fidelity (LF), Correction Factor, and the Percentage of Agreement regarding the Main Uses (AMU). Statistical tests were performed using generalized linear models (GLM) in the R environment. The plant use indications were grouped according to the International Classification of Diseases and Related Health Problems (ICD 10). We found 152 species belonging to 130 genera and 67 families. The most frequently used plant parts were leaves, and decoction was the most frequent preparation mode. Strychnos pseudoquina was the species with the highest amount of use indications. The diversity index was 4.5 nats/ind^-1. The body system with the most citations was the code XVIII of ICD 10, corresponding to the species: alfavaca, mentraste, terramicina, angelim, fedegoso. Medicinal species with AMU values higher than 25% were: Strychnos pseudoquina, Plectranthus barbatus, Citrus sinensis cv. pera, Cymbopogon citratus. There was a relationship between the number of useful plants and the residence time of the participants. The Bananal community revealed high species richness and the relationship of knowledge showed that the older the residents and the longer their residence time in the community, the more knowledge they acquired.

Utilization patterns of traditional medicine in Taiwan and South Korea by using national health insurance data in 2011

BACKGROUND

The growing popularity of traditional medicine (TM) is reflected in the increasing trend for its use worldwide. Many people are turning to use TM as a complementary or integrative treatment. The aim of this study is to present the first nationwide report describing the use of TM in two countries (South Korea and Taiwan).

MATERIALS AND METHODS

To present the TM utilization patterns between South Korea and Taiwan, we analyzed data from the National Health Insurance cohorts in each country, each of which has approximately one million inhabitants.

RESULTS

In total, 261,478 (25.5%) of 1,025,340 people in South Korea and 260,529 (26.8%) of 970,866 people in Taiwan used TM services at least once under the National Health Insurance in 2011. Using multivariable logistic regression, TM users in South Korea were significantly more likely to be female, 61-80 years of age and individuals with a high income, and those in Taiwan were significantly more likely to be female, 21-40 years of age and individuals with a middle income. The two countries showed similar utilization patterns in visit seasons. People visited TM clinics more frequently than TM hospitals in both countries. The most common TM treatment in South Korea was acupuncture, whereas in Taiwan, various powdered Chinese herbal preparations were the most commonly used treatment. The most common diseases for people seeking TM services were musculoskeletal system and connective tissue diseases in South Korea and Symptoms, signs, and ill-defined conditions in Taiwan.

CONCLUSION

According to the National Health Insurance database, about one fourth of the NHI beneficiaries of South Korea and Taiwan had TM use in 2011. Different TM utilization patterns existed between South Korea and Taiwan, which might be due to the differences in insurance coverage between the two countries.

The commercialization of traditional medicine in modern Cambodia

Globally, traditional medicine has long been used to address relatively common illness, mental ill health and during childbirth and post-natal care. However, traditional medicine is primarily provided by the private sector and it is unclear how far expenditures on traditional medicine contribute to household impoverishment. A life history method was used to understand the health seeking experience of 24 households over the last 60 years in Cambodia, a country with high out-of-pocket expenditures for health. The life histories suggest that traditional medicine in Cambodia has been undergoing a process of commercialization, with significant impacts on poor households. In the earlier lives of respondents, payments for traditional medicine were reported to have been flexible, voluntary or appropriate to patients’ financial means. In contrast, contemporary practitioners appear to seek immediate cash payments that have frequently led to considerable debt and asset sales by traditional medicine users. Given traditional medicine‘s popularity as a source of treatment in Cambodia and its potential to contribute to household impoverishment, we suggest that it needs to be included in a national conversation about achieving Universal Health Coverage in the country.

Prevalence and factors associated with the use of traditional medicines among human immunodeficiency virus and acquired immunodeficiency syndrome patients in Sokoto, Nigeria

Background

In resource-scarce settings like Nigeria, access to conventional drugs and antiretroviral therapy (ART) is highly limited, hence the resort to use of traditional herbal medicine by a significant number of people living with human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) (PLWHAs). Traditional medicine (TM) continues to provide health coverage for most of the people in developing countries, and it is equally becoming increasingly popular in western countries.

Aim

This study aims to present the status and use of TM and determine the factors associated with its use among patients with HIV/AIDS on highly active ART in a tertiary health institution in Sokoto, Northwest Nigeria.

Methodology

This was a descriptive, cross-sectional study involving HIV/AIDS patients attending antiretroviral treatment center of the Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria. The study population comprised PLWHAs attending the ART clinic of the hospital (UDUTH). A total of 271 respondents were recruited into the study and administered a set of pretested structured questionnaire. Ethical approval for this study was obtained from the ethical committee of the teaching hospital.

Results

Only 11 (4.2%) of the respondents had used TM before, of whom 9 (5%) were females and 2 (2.7%) were males with P = 0.399. Only one of the respondents had side effects following the use of TM, and the most common reason for the use of TM was as a result of too much weight loss.

Conclusion

Although the use of TM among the study participants in Sokoto was low, there is need to educate PLWHAs about the possible risks of interactions following the concurrent use of TM and ART.

Ethnopharmacological Study of Medicinal Plants Used for Treating Dysuria: A Collection from Traditional Markets in Shiraz

Background: Data from the ethnopharmacological field on the treatment of dysuria are provided and analyzed with regard to traditional healers from Shiraz and in comparison to previous studies. Material and Methods: From April 21 to June 25, 2014, we visited traditional markets called Attari in Shiraz, and plants used in dysuria were collected. Questionnaires asking for general information on the traditional healers named Attars, local names of plant species, plant parts, preparation methods, etc. were prepared in order to gather data from Attars. Results: We visited 40 Attari, and 29 questionnaires were filled in by male Attars. Evaluation of our investigation revealed that Tribulus terrestris, Zea mays, and Cerasus avium were the most common plants suggested by Attars (24, 23, and 23, respectively). Infusion (37%) and decoction (34%) were the most common preparation methods for these plants. 50% of the main effects intended by the Attars were antimicrobial effects, while diuretic effects were reported at 35.7%. The temperament of the plants, as one aspect of the questionnaires, showed that more plants have a hot and dry temperament (47.9%). According to available studies about the plants, we found that flavonoids (78.3%), higher terpenoids (43.5%), and essential oils (39.1%) exist in higher amounts than other components in the plants. Conclusions: We analyzed the information gathered from the questionnaires and from previous studies and found that flavonoids are the most important constituents among the plants, especially those that exist in T. terrestris, Z. mays, and C. avium. Due to the useful effects of flavonoids in urological diseases, we suggest to evaluate and concentrate on the effects of flavonoids in dysuria treatments.

Human urine-based therapeutics in Spain from the early 20th century to the present: a historical literature overview and a present-day case study

Human urine is currently the subject of biomedical investigations as a potential therapeutic resource and it continues to be used in remedies in different cultures and societies, including the Spanish culture. In this study we gather etnomedical knowledge about urotherapy and determine their associated symbolisms in Spain. A literature overview and a case study were carried out to compile urine-based remedies and as a direct analysis of symbolic systems. Urotherapy is widespread in Spanish folk medicine. Among the 204 collected remedies, those related to treatment of diseases or skin conditions predominate (63%). Remedies have been reported for the treatment of skin diseases such as eczema, chloasma, alopecia, etc. to treat or alleviate burns, chilblains, wounds or skin chapping, and as a treatment of venomous bites. Most of the collected remedies have an associated naturalist symbolism, based on local traditions and the transmission of empirical initial knowledge. The use of urine in Spain is a result of the interaction of two types of practice: a local and traditional urotherapy, rural and with a utilitarian purpose, and a technical urotherapy, limited to an urban environment and a naturopathic medicine.

A scoping review protocol on social participation of indigenous elders, intergenerational solidarity and their influence on individual and community wellness

INTRODUCTION

Indigenous elders have traditionally played an important role in maintaining social cohesion within their communities. Today, part of this role has been taken over by government social and healthcare services, but they are having limited success in addressing social challenges. Increasing elders' social participation and intergenerational solidarity might foster community development and benefit young people, families, communities and the elders themselves. However, knowledge of the contribution of elders' social participation and intergenerational solidarity to wellness is scattered and needs to be synthesised. This protocol presents a scoping review on the social participation of indigenous elders, intergenerational solidarity and their influence on individual and community wellness.

METHODS AND ANALYSIS

This scoping review protocol is based on an innovative methodological framework designed to gather information from the scientific and grey literature and from indigenous sources. It was developed by an interdisciplinary team including indigenous scholars/researchers, knowledge users and key informants. In addition to searching information databases in fields such as public health and indigenous studies, an advisory committee will ensure that information is gathered from grey literature and indigenous sources.

ETHICS

The protocol was approved by the Ethics Review Board of the Université du Québec en Abitibi-Témiscamingue and the First Nations of Quebec and Labrador Health and Social Services Commission.

DISCUSSION

The comprehensive synthesis of the scientific and grey literature and indigenous sources proposed in this protocol will not only raise awareness within indigenous communities and among healthcare professionals and community organisations, but will also enable decision-makers to better meet the needs of indigenous people.

CONCLUSION

The innovative methodological framework proposed in this scoping review protocol will yield richer information on the contribution of elders to community wellness. This work is an essential preliminary step towards developing research involving indigenous communities, drawing on the social participation of elders and intergenerational solidarity.

Hospital Works to Make Native American Patients Feel Comfortable

To accommodate its Native American patients, who make up about 40% of the patient population, Flagstaff Medical Center offers traditional food and has a traditional healer on staff. The hospital has full-time Navajo interpreters as well as 39 staff members who are back-up interpreters. Instead of giving Native American patients a large packet of information they may not understand or trust, care managers work with the primary care providers on the reservation and ensure they are aware of the hospitalization at the discharge plan. At risk Native American patients who need follow-up receive monitoring devices that use cellphone technology and transmit their data to a telehealth nurse who intervenes when the data are out of normal range.

Traditional medicine among people of Pakistani descent in the capital region of Copenhagen

ETHNOPHARMACOLOGICAL RELEVANCE

Studies show that ethnic minorities continue to use their cultural traditional medicines also after migration to the West. Research in this field is necessary, given that little is known about traditional medicines' impact on health-related problems. This study sheds light on the issue through a qualitative study among ethnic Pakistanis residing in Denmark.

AIM OF THE STUDY

The study addresses perception, knowledge and attitudes regarding the use of medicinal plants among Pakistanis living in Copenhagen. We furthermore document and identify the medicinal plants used in households.

MATERIALS AND METHODS

Data were collected through in-depth, semi-structured interviews with sixteen ethnic Pakistanis aged 30-80 years. Interviews were transcribed verbatim and analysed through Emerson's two-phased analysis method. Medicinal plant products in the interviewees' households were collected, photographed, identified and deposited at Museum of Natural Medicine at University of Copenhagen.

RESULTS

A total number of 121 Pakistani traditional medicines were identified, and found to represent both medicinal plants and foods. The average number of quoted Pakistani Traditional Medicines was 18 (N=16). Interviewees independently reported the same traditions for preparation and consumption of Pakistani traditional medicines. Factors that play a role in choosing to use Pakistani traditional medicines are frequent visits to Pakistan, belief in the healing power of totkas (homemade medicinal preparation), religious knowledge and the occurrence of recent illness within the family. Further, the upkeep of traditional use depends on the availability of Pakistani traditional medicines.

CONCLUSION

The study enhanced understanding of ethnic Pakistanis' perception and continued use of traditional medicines within the household after migration to the West. In the context of Western biomedicine, little is known of the potential toxicity and side-effects of many of the Pakistani traditional medicines found to be used in households in Copenhagen.

Social Perception of Infertility and Its Treatment in Late Medieval Italy: Margherita Datini, an Italian Merchant's Wife

Because the perception of infertility in medieval Europe ranged from the extremely religious view of it as a malediction of God or the devil's work, to the reasonable medical conception of it as a sort of disease to treat, it is very difficult to determine the general attitudes of ordinary people towards infertility. This article seeks to elucidate the common social perception of infertility and its treatment in late medieval Europe by analyzing the case of Margherita Datini, an Italian merchant's wife who lived in the 1400s. It relies heavily on the documents left by her and her husband, Francesco Datini; the couple left many records, including letters of correspondence between them. Margherita and those around her regarded infertility not as the devil's curse or a punishment by God but as a disease that can be cured. Margherita and her husband, Francesco, tried hard to cure their infertility. They received treatment and prescriptions from several doctors while also relying on folk remedies, religious therapies, and even magical remedies. The comparative analysis of Datini documents, medical books, and theoretical treatises or prescriptive essays by clerics suggests that the general perception of infertility in medieval Europe was located between the extremely religious and modern medical conceptions of it.

North Carolina Latino Farmworkers' Use of Traditional Healers: A Pilot Study

Farmworkers in the United States experience high rates of injury and illness but have limited access to conventional health care. Farmworkers are often from countries that have active traditional healers, so understanding the use of traditional healers among farmworkers is important. This pilot study (1) describes the use of traditional healers among farmworkers and (2) compares the use of traditional healers by farmworkers with other Latino immigrants. Interviews were conducted in 2015 with 100 Mexican farmworkers (80 men, 20 women) and 100 Mexican immigrant non-farmworkers (50 men, 50 women) in North Carolina. Most farmworkers (78%) had H-2A visas. More farmworkers (64%) than non-farmworkers (41%) had ever used traditional healers. Among farmworkers, 21% (vs. 11% of non-farmworkers) had used curanderos, 54% (vs. 32%) sobadores, 43% (vs. 21%) hueseros, 11% (vs. 13%) yerberos, and 4% (vs. 6%) espiritualistas. More farmworkers had used a traditional healer in the past year (16% vs. 8%), but fewer had used this healer in the United States (4% vs. 8%). Among all participants, males (58.5%) more than females (41.4%) (P = .0214), and returning to Mexico annually (64.1%) more than who do not (45.1%) (P = .0086) had ever used any traditional healer. This pilot study indicates the need for further research that documents the use of traditional healers by Latino farmworkers with diverse visa statuses, from countries in addition to Mexico, and in other regions in the United States. This research should also delineate the specific illnesses and injuries for which Latino farmworkers use traditional healers.

Integrating traditional medical practice with primary healthcare system in Eritrea

BACKGROUND

The purpose of this paper was to assess the perceptions and attitudes of modern medical practitioners (MMPs) and traditional medical practitioners (TMPs) about traditional medical practice and to analyze the utilization of traditional medicine in Eritrea.

METHODS

The data for this study were collected in a 10-month period from January to October 2004. A cross-sectional study was conducted in three sub-zones of Eritrea: Dekemhare, Ghinda, and Maekel. A total of 500 (250 each) MMPs and TMPs, and 1657 households were included in the study. Data were collected both by questionnaire and an interview (with key informants).

RESULTS

Our study reveals that there is a significant difference in perception and attitude between MMPs and TMPs about traditional medical practice in Eritrea. Their differences lie not only in their way of thinking but also in their perceptions of man and health. Our study further shows that in most rural communities in Eritrea, the use of traditional medicine and self-care is extensive. This is the case even in the presence of the supposedly free/subsidized health care available in government health centers.

CONCLUSIONS

Higher confidence in traditional medicine for the treatment of serious illnesses, irrespective of availability of western medical service in many parts of Eritrea, indicates the need for selective integration of traditional medical practice with the primary healthcare system of the country.

Mā mahi, ka ora: by work, we prosper--traditional healers and workforce development

AIM

Rongoā Māori practitioners make a valuable contribution towards Māori health outcomes, albeit with limited resourcing or formal training. This paper reports on a survey of healers/healing practices-specifically healers' aspirations for professional development and training-and considers the implications for healing practice and future training undertakings.

METHODS

Healers in seven districts around the country were surveyed about rongoā practice and service delivery during 2013. Consenting healers completed surveys either in person, via phone, or returned them via post, according to their preference and convenience. Resulting data were analysed and reported according to frequency of responses.

RESULTS

Thirty-eight healers/rongoā clinics completed the survey--a 79% response rate. Respondents were primarily Māori (88%), female (69%), aged 50 years or older (60%), and worked as volunteers. Informal training modes focused on te reo, mātauranga and tikanga were the most common means of skill/ knowledge acquisition, and preferred modes for further training.

CONCLUSIONS

The survey highlights the pressing need for expansion of the rongoā Māori workforce and training/service funding, to sustain rongoā practice. The findings add to what little is known about the training pathways and aspirations of practising healers, identified targets of the Māori Health Workforce Development Plan 2006.

Past, present and perspectives of Manipur traditional medicine: A major health care system available for rural population in the North-East India

BACKGROUND

Traditional health care practices are still being followed extensively in Manipur, North-East India. This is the major or the only medical facility available in some rural areas of Manipur. Cross cultural ethno-pharmacological survey was conducted to document traditional health care practices by Maiba-Maibi (male-female traditional health care practitioners of Manipur).

MATERIALS AND METHODS

All together 59 traditional practitioners belonging to 12 ethnic communities in nine districts of the Manipur state were interviewed. A predesigned questionnaire was used for interviews, which included queries for type of ailments treating, symptoms, bioresources used, method of preparation, dosage forms, formulation, unit doses. The entire interviews were done in the residence of respective Maiba-Maibi, their patient handing and preparation of medicinal formulations were documented in written and audio-visual format.

RESULTS

The survey recorded traditional knowledge on 949 formulations used for 66 human ailments. Five hundred forty six plant products, 42 animal products and 22 organic/inorganic materials were found to be used in these 949 formulations. Five plant species - Zingiber officinale (Zingiberaceae), Cocos nucifera (Arecaceae), Oroxylum indicum (Bignonaceae), Curcuma longa (Zingiberaceae) and Allium sativum (Liliaceae) used by maximum number of Maiba and Maibi in maximum number of formulations.

RECOMMENDATION

This particular method of documentation keeps traditional knowledge alive. The WHO estimated perspective of traditional medicine across the world. These observations support therapeutic worth of Manipur Traditional medicines (MTM). Having generated a large database in course of this survey, next focus targeted for the scientific justification of MTM with an aim to develop commercially viable products.

From Disease to Holiness: Religious-based health remedies of Italian folk medicine (XIX-XX century)

BACKGROUND

The relationship between spirituality, religion and medicine has been recognized since antiquity. Despite large differences in their history, society, economy and cultures human communities shared a common belief that spirituality and religion played an important role in the healing of diseases.

METHODS

The study of religious remedies used by Italian folk medicine in order to treat diseases was based on a review of literature sources compiled between the late nineteenth century and the early to mid twentieth century.

RESULTS

This approach lead to the unearthing of heterogeneous healing methods that have been divided into different categories: Saints, Pilgrimages, Holy Water/Blessed Oil, Blessings, Religious Objects, Contact, Signs, Formulas and The Religious Calendar. Some of these practices, partly still performed in Italy, are a part of the landscape of the official Catholic Church, others come out of a process of syncretism between the Catholic Religion, the magic world and pre-Christian rituals.

CONCLUSIONS

The vastus corpus of religious remedies, highlighted in the present work, shows the need for spirituality of the sick and represent a symbolic framework, that works as a filter, mediates, containing the pain that constantly fills everyone's lives in remote ages even in the third millennium. All of this confirms how important the health-workers know and interpret these existential needs from anthropological and psychological points of view.

Does Environmental Instability Favor the Production and Horizontal Transmission of Knowledge regarding Medicinal Plants? A Study in Southeast Brazil

Greater socio-environmental instability favors the individual production of knowledge because innovations are adapted to new circumstances. Furthermore, instability stimulates the horizontal transmission of knowledge because this mechanism disseminates adapted information. This study investigates the following hypothesis: Greater socio-environmental instability favors the production of knowledge (innovation) to adapt to new situations, and socio-environmental instability stimulates the horizontal transmission of knowledge, which is a mechanism that diffuses adapted information. In addition, the present study describes "how", "when", "from whom" and the "stimulus/context", in which knowledge regarding medicinal plants is gained or transferred. Data were collected through semi-structured interviews from three groups that represented different levels of socio-environmental instability. Socio-environmental instability did not favor individual knowledge production or any cultural transmission modes, including vertical to horizontal, despite increasing the frequency of horizontal pathways. Vertical transmission was the most important knowledge transmission strategy in all of the groups in which mothers were the most common models (knowledge sources). Significantly, childhood was the most important learning stage, although learning also occurred throughout life. Direct teaching using language was notable as a knowledge transmission strategy. Illness was the main stimulus that triggered local learning. Learning modes about medicinal plants were influenced by the knowledge itself, particularly the dynamic uses of therapeutic resources.

Ethno-medicinal study of plants used for treatment of human ailments, with residents of the surrounding region of forest fragments of Paraná, Brazil

ETHNOPHARMACOLOGICAL RELEVANCE

This study aims to document the traditional knowledge on the use of medicinal plants in the neighborhood of the protected area "Parque Estadual da Cabeça do Cachorro", a fragment of seasonal semideciduous forests. This vegetation is intensely fragmented and disturbed; despite its importance there are few records of the traditional knowledge of medicinal species.

MATERIAL AND METHODS

Twenty-four residents in the neighborhood of the protected area "Parque Estadual da Cabeça do Cachorro" were interviewed. The residents were questioned about preparation techniques, recommended doses, ways of administration and healing properties of various parts of the plants and were invited to walk through the park to collect in situ some species of plants. The recognized medicinal species were identified and traditional knowledge was systematized. Quantitative indices (Informant Consensus Factor - FIC and Use Value - UV) were calculated.

RESULTS

115 species of medicinal plants belonging to 54 botanical families were cited. Asteraceae (n=14), Fabaceae (n=11), Myrtaceae (n=6), Bignoniaceae, Solanaceae and Verbenaceae (n=5) were the most species-rich. The highest use values were calculated for Achyrocline satureioides, Aristolochia triangularis and Bauhinia forficata (0.63). Moreover, the informants consensus about usages of medicinal plants ranges from 0.024 to 0.663, which shows high level of agreements among the informants for gastro-intestinal and respiratory system diseases. Furthermore, for the first time, new traditional medicinal uses of Asteraceae (Chromolaena pedunculosa Hook. & Arn.), Commelinaceae (Tradescantia fluminensis Vell.) and Polypodiaceae (Microgramma vacciniifolia Langsd. & Fisch.) species were reported.

CONCLUSIONS

Present study revealed that the residents of the surrounding region of forest fragments of Paraná are rich in ethno-medicinal knowledge and rely on plant-based remedies for common health problems. As in many parts of Brazil knowledge of the past is combined with new knowledge that has recently been incorporated emphasizing the cultural changes that this area is experiencing. Despite the use of different species of plants are crucial to their way of life, there is concern that these rich popular knowledge may disappear in the future as a result of a possible modernization of this area.

Effect of acharya technique upon back pain among industrial workers

Back pain is a universal problem affecting people from all regions of the world. Since relief using modern systems of medicine is hardly forthcoming, the efficacy of indigenously developed Acharya Technique was assessed. Using purposive sampling, data was collected from 30 industrial workers from Erode (TN). It was found that while 36.7 percent participants had complete discomfort in back pain before resorting to Acharya Technique, after its administration, 40percent had only mild discomfort in back pain, thus showing the effectiveness of this technique. It is suggested to include Acharya Technique in continuing educational programmes on wider scale.

Recourse to multiple tratments or the problem of the therapeutic itinerary in Louga

Louga, where the nomadic pastoral economy and the sedentary agricultural economy coexist, provides a particular environment to study the therapeutic itinerary of the population. In this region, as in developing countries, the great majority of people have a low income. As a consequence, recourse to modern medicine has economical and geographical limitations and traditional medicine is preferred for its accessibility. However, practices show simultaneous recourse to both health care systems. Another widespread practice not to be neglected is self-medication, in which both modern drugs and products derived from the traditional pharmacopoeia are employed. This research deals with all health practices across a geographic area marked by a strong traditional influence. The study of the choice of treatment in such a context traces the laborious therapeutic itinerary of each patient in search of health improvement.

Use of home remedies: a cross-sectional survey of patients in Germany

BACKGROUND

Reliable information regarding patient knowledge of home remedies and the types of health problems patients use them for is scarce. Nevertheless, anecdotal evidence indicates that home remedies are used by patients for managing minor health problems and that this can be sufficient for symptom management while the body recovers from minor health problems. The aim of the presented study was to explore patient use of home remedies in Germany.

METHODS

A questionnaire was developed and pretested in a pilot study phase. The revised questionnaire was comprised of questions about general knowledge and experienced efficiency of home remedies, the use of home remedies for common health problems and socio-demographic data. Patients were recruited via randomly selected addresses of general practitioners (GPs) in three regions of Germany (Heidelberg, Erfurt and Hanover and surrounding areas). The questionnaire was handed out in the waiting area of GP practices. The data was analyzed descriptively.

RESULTS

480 of 592 patients from 37 GP practices were included, according to a response rate of 81%. Based on the survey results, home remedies were widely known and used by about 80% of our respondents (on average 22 different home remedies were used per person). The most frequently used home remedies were steam-inhalation, hot lemon drink, honey, chamomile tea and chicken soup. 80% of respondents tried home remedies before pharmaceutical options. Information about home remedies was most commonly gained from family members, rather than from written guides, media or GPs.

CONCLUSIONS

These results provide an initial overview on the use of home remedies from the patient's perspective in a German context. Bearing in mind the high use of home remedies that was reported by patients in the study, it is highly likely that GPs in Germany may need to advise patients on their use of home remedies during consultations. To this end, given the scarcity of reliable information on home remedies, further research is needed.

Public awareness, patterns of use and attitudes toward natural health products in Kuwait: a cross-sectional survey

BACKGROUND

There has been a global rise in the use of natural health products (NHPs). Proper regulation of NHPs is pivotal to ensure good quality control standards, enhance consumers' safety and facilitate their integration into modern healthcare systems. There is scarcity of published data on the prevalence of NHPs usage among the general Kuwaiti population. Hence, this study was designed to determine awareness, patterns of use, general attitude and information requirements about NHPs among the public in Kuwait.

METHODS

A descriptive cross-sectional survey was performed using a pretested self-administered questionnaire on a sample of 1300 Kuwaiti individuals, selected from six governorates in Kuwait using a multistage stratified clustered sampling. Descriptive and multivariate logistic regression analysis were used in data analysis.

RESULTS

The response rate was 90.2%. NHPs were thought to be herbal remedies by most of participants (63.5%), followed by vitamins/minerals (40.5%), traditional medicines (21.1%), probiotics (14.9%), amino acids and essential fatty acids (7.2%), and homeopathic medicines (5.6%). NHPs usage was reported by 71.4% (95% CI: 68.8-74.0%) of respondents, and mostly associated with females (OR: 1.90; 95% CI: 1.44-2.51). Herbal remedies were the most commonly used (41.3%; 95% CI: 38.5-44.2%). The most common reasons for using NHPs were to promote and maintain health and to prevent illness and build immune system. Family members and/or friends and mass media were the main sources for providing information about NHPs. About 18% of consumers have experienced a side effect due to using a NHP. Attitudes toward NHPs were generally positive; with more than 75% of participants believing that the Ministry of Health in Kuwait should regulate the claims made by the manufacturers of NHPs and it is important to talk to a medical doctor or a pharmacist prior to using NHPs. Most of the respondents showed increased interest to acquire knowledge about different types of information related to NHPs.

CONCLUSIONS

The prevalence of use of NHPs among Kuwaiti population is high. The present findings have major public health policy implications for Kuwait. Therefore, there is an apparent need to establish effective health education programs and implement better and more regulated NHPs use policies in Kuwait.

Use of traditional medicines to cope with climate-sensitive diseases in a resource poor setting in Bangladesh

BACKGROUND

This study aims to explore the use of traditional medicines to cope with climate sensitive diseases in areas vulnerable to climate change. We assessed the extent to which traditional or alternative medicines were used for the treatment of the climate sensitive diseases by villagers as part of their health-coping strategies.

METHODS

The study deployed a mixed-method research design to know the health-coping strategies of the people in a resource-poor setting.A cross sectional study was conducted from September 2010 to March 2011 among 450 households selected randomly in the districts of Rajshahi and Khulna, Bangladesh. The elder males or females of each household were interviewed. For qualitative methods, twelve focus group discussions (six with females and six with males) and fifteen key informant interviews were conducted by the research team, using interview guidelines on the use of traditional medicine.

RESULTS

Univariate analysis showed that the use of traditional medicines has increased among community members of all socio-economic and demographic backgrounds. Due to the increased incidence of disease and sickness respondents had to increase the use of their cultural means to cope with adverse health situations.

CONCLUSIONS

A systematic collection of knowledge on the use of traditional medicines to cope with climate-sensitive diseases can help the adaptation of communities vulnerable to climate change. In addition it can be instrumental in creating a directory of traditional medicine components used for specific diseases and highlight the effectiveness and relevance of traditional medicines as health-coping strategies. This may be useful for policymakers, researchers, and development partners to adapt existing health care policy in resource-limited contexts. It may also encourage WHO, national and international institutions, such as pharmaceutical companies, to carry out research investigating the effectiveness of these traditional medicines and integrate them with modern medicine. Overall, it could increase the health coping capacity of people in a resource-poor setting and contribute to their adaptation capabilities.

Childhood infections, antibiotics, and resistance: what are parents saying now?

Parental misconceptions and even "demand" for unnecessary antibiotics were previously viewed as contributors to overuse of these agents. We conducted focus groups to explore the knowledge and attitudes surrounding common infections and antibiotic use in the current era of more judicious prescribing. Among diverse groups of parents, we found widespread use of home remedies and considerable concern regarding antibiotic resistance. Parents generally expressed the desire to use antibiotics only when necessary. There was appreciation of inherent error in the diagnosis of common infections, with most trust placed in providers with whom parents had long-standing relationships. While some parents had experience with "watchful waiting" for otitis media, there was little enthusiasm for this approach. While there may still be room for further education, it appears that parents have become more informed and sophisticated regarding appropriate uses of antibiotics. This has likely contributed to the declines seen in their use nationally.

Use of natural health products in children: qualitative analysis of parents' experiences

OBJECTIVE

To gain a more thorough understanding of why parents choose to give their children natural health products (NHPs), parents' sources of information about NHPs, and the extent of disclosure and conversation with family doctors about the use of NHPs.

DESIGN

Qualitative study.

SETTING

Newfoundland and Labrador.

PARTICIPANTS

Parents of children who were using NHPs (N = 20).

METHODS

Individual, semistructured interviews were carried out with parents to obtain a better understanding of the reasoning behind the use of NHPs. Key themes emerging from the qualitative data were identified according to a number of criteria, including relevance to the research objectives, frequency with which a theme was mentioned, relative importance of the themes based on the amount of text taken up to address an issue, and emphasis (eg, emphatic or emotional speech).

MAIN FINDINGS

The types of NHPs used by parents participating in this study varied, except for the use of multivitamins. In addition, use of the products themselves was variable and inconsistent. Parents reported few concerns about the use of NHPs. The most commonly reported source of information about NHPs was family and friends. Most participants had not spoken to their family doctors about the use of NHPs.

CONCLUSION

Participants considered NHPs to be "natural" and seemed to equate this assessment with safety. This might explain why these parents sought advice and information from family and friends rather than from their family doctors and often failed to disclose the use of NHPs to their children's family doctors.

Traditional and commercial herb use in health self- management among rural multiethnic older adults

This study analyzes the role of traditional and commercial herbs in older adults’ health self-management based on Leventhal’s Self-Regulatory Model conceptual framework. Sixty-two African American and White adults age 65 and older completed qualitative interviews describing the forms of herbs currently being used, sources of information about them, interpretations of health (acute symptoms or chronic conditions) that led to their use, and the initiation and suspension of use. Traditional herbs are native to the region or have been traditionally cultivated, usually taken raw or boiled to produce tea, and used for treating mild symptoms. Commercial herbs are prepared as pills, extracts, or teas; they are purchased at local stores or ordered by catalog or Internet and used for health promotion, illness prevention, or treatment of chronic conditions. Herbs are widely used among older adults; this analysis differentiates the types of herbs they use and their reasons for herbs use.

Prevalence and factors associated with the use of alternative (folk) medicine practitioners in 8 countries of the former Soviet Union

BACKGROUND

Research suggests that since the collapse of the Soviet Union there has been a sharp growth in the use of complementary and alternative medicine (CAM) in some former Soviet countries. However, as yet, comparatively little is known about the use of CAM in the countries throughout this region. Against this background, the aim of the current study was to determine the prevalence of using alternative (folk) medicine practitioners in eight countries of the former Soviet Union (fSU) and to examine factors associated with their use.

METHODS

Data were obtained from the Living Conditions, Lifestyles and Health (LLH) survey undertaken in eight former Soviet countries (Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine) in 2001. In this nationally representative cross-sectional survey, 18428 respondents were asked about how they treated 10 symptoms, with options including the use of alternative (folk) medicine practitioners. Multivariate logistic regression analysis was used to determine the factors associated with the treatment of differing symptoms by such practitioners in these countries.

RESULTS

The prevalence of using an alternative (folk) medicine practitioner for symptom treatment varied widely between countries, ranging from 3.5% in Armenia to 25.0% in Kyrgyzstan. For nearly every symptom, respondents living in rural locations were more likely to use an alternative (folk) medicine practitioner than urban residents. Greater wealth was also associated with using these practitioners, while distrust of doctors played a role in the treatment of some symptoms.

CONCLUSIONS

The widespread use of alternative (folk) medicine practitioners in some fSU countries and the growth of this form of health care provision in the post-Soviet period in conditions of variable licensing and regulation, highlights the urgent need for more research on this phenomenon and its potential effects on population health in the countries in this region.

Complementary treatment of the common cold and flu with medicinal plants--results from two samples of pharmacy customers in Estonia

The aim of the current survey was to investigate the complementary self-treatment of the common cold and flu with medicinal plants among pharmacy customers in Estonia. A multiple-choice questionnaire listing 10 plants and posing questions on the perceived characteristics of cold and flu, the effectiveness of plants, help-seeking behaviour, self-treatment and sources of information, was distributed to a sample of participants in two medium size pharmacies. The participants were pharmacy customers: 150 in Tallinn (mostly Russian speaking) and 150 in Kuressaare (mostly Estonian speaking). The mean number of plants used by participants was 4.1. Of the respondents, 69% self-treated the common cold and flu and 28% consulted with a general practitioner. In general, medicinal plants were considered effective in the treatment of the above-mentioned illnesses and 56% of the respondents had used exclusively medicinal plants or their combination with OTC medicines and other means of folk medicine for treatment. The use of medicinal plants increased with age and was more frequent among female than male respondents. Among Estonian-speaking customers lime flowers, blackcurrant and camomile were more frequently used, and among Russian speaking customers raspberry and lemon fruits. Regardless of some statistically significant differences in preferred species among different age, education, sex and nationality groups, the general attitude towards medicinal plants for self-treatment of the common cold and flu in Estonia was very favourable.

Traditional plant use in the National Park of Cilento and Vallo di Diano, Campania, Southern, Italy

AIM OF STUDY

This paper reports an ethobotanical survey of the traditional uses of medicinal and useful plants in an area of the National Park of Cilento and Vallo di Diano, Campania, Southern Italy.

MATERIALS AND METHODS

This study conducted between 2009 and 2011, gathered information on the medicinal plants traditionally used in Southern Italy (Campania Region). In all, we interviewed 70 key informants, whose age ranged between 50 and 85 years. This people belonged to families which had strong links with traditional activities of the area.

RESULTS

The research resulted to the identification of 192 plants belonging to 64 families. Among the species reported, 86 are used in human medicine, 15 in veterinary medicine, 69 as human foods, 18 as animal feed, 61 for domestic and 8 for agricultural uses.

CONCLUSION

A survey of the available literature on Southern Italy ethnobotany reveals that some species have been never reported and about 10% of cited uses are new. Data obtained show that in the studied area the folk use of plants is alive and still derives from daily practice.

People, plants and health: a conceptual framework for assessing changes in medicinal plant consumption

BACKGROUND

A large number of people in both developing and developed countries rely on medicinal plant products to maintain their health or treat illnesses. Available evidence suggests that medicinal plant consumption will remain stable or increase in the short to medium term. Knowledge on what factors determine medicinal plant consumption is, however, scattered across many disciplines, impeding, for example, systematic consideration of plant-based traditional medicine in national health care systems. The aim of the paper is to develop a conceptual framework for understanding medicinal plant consumption dynamics. Consumption is employed in the economic sense: use of medicinal plants by consumers or in the production of other goods.

METHODS

PubMed and Web of Knowledge (formerly Web of Science) were searched using a set of medicinal plant key terms (folk/peasant/rural/traditional/ethno/indigenous/CAM/herbal/botanical/phytotherapy); each search terms was combined with terms related to medicinal plant consumption dynamics (medicinal plants/health care/preference/trade/treatment seeking behavior/domestication/sustainability/conservation/urban/migration/climate change/policy/production systems). To eliminate studies not directly focused on medicinal plant consumption, searches were limited by a number of terms (chemistry/clinical/in vitro/antibacterial/dose/molecular/trial/efficacy/antimicrobial/alkaloid/bioactive/inhibit/antibody/purification/antioxidant/DNA/rat/aqueous). A total of 1940 references were identified; manual screening for relevance reduced this to 645 relevant documents. As the conceptual framework emerged inductively, additional targeted literature searches were undertaken on specific factors and link, bringing the final number of references to 737.

RESULTS

The paper first defines the four main groups of medicinal plant users (1. Hunter-gatherers, 2. Farmers and pastoralists, 3. Urban and peri-urban people, 4. Entrepreneurs) and the three main types of benefits (consumer, producer, society-wide) derived from medicinal plants usage. Then a single unified conceptual framework for understanding the factors influencing medicinal plant consumption in the economic sense is proposed; the framework distinguishes four spatial levels of analysis (international, national, local, household) and identifies and describes 15 factors and their relationships.

CONCLUSIONS

The framework provides a basis for increasing our conceptual understanding of medicinal plant consumption dynamics, allows a positioning of existing studies, and can serve to guide future research in the area. This would inform the formation of future health and natural resource management policies.

TB questions, East Kwaio answers: community-based participatory research in a remote area of Solomon Islands

INTRODUCTION

East Kwaio is a remote region on the island of Malaita, Solomon Islands. Atoifi Adventist Hospital (the Hospital) is the only hospital and tuberculosis (TB) services provider in the region. If people come to the Hospital with TB, they are usually admitted for the two-month intensive phase of treatment as there are no community-based TB services. Most people walk or travel by canoe to the Hospital as there are no roads. East Kwaio is known to have high rates of TB; however, it has a low case detection rate and low treatment completion. The aims of this study were to explore why people with TB, especially from the mountain areas, present to the Hospital so late in their illness or do not present at all. The study was part of a larger project to strengthen the research capacity of local health workers and community leaders, supported by visiting researchers from Australia.

METHODS

Semi-structured interviews with TB patients, a focus group of key informants and direct interaction with a community with a history of TB were used to explore reasons why people present to the Hospital late in their TB illness.

RESULTS

Four interviews and a focus group of 12 key informants were conducted and a mountain hamlet with a history of TB was visited. The results represent the data from the interviews and the focus group. The time delay in presenting to the Hospital from when participants first became unwell ranged between two and three years. In the mountain hamlet, two additional people with probable TB were seen who had not presented to the Hospital during illnesses of five and nine months. Reasons for delays included: seeking care from traditional healers; the challenge of accessing health services due to distance, cost and cultural issues different from the Hospital's worldview; social isolation when in hospital; and being old so not having long to live. Delays in diagnosis of people with TB will increase the risk of transmission to family and through hamlets and villages. This study has led to plans being developed to build a more culturally appropriate TB ward and community treatment program.

CONCLUSIONS

The study has identified TB questions that need East Kwaio answers. It has shown that a small project can inform the development of important changes to TB services, such as the redevelopment and relocation of the TB ward. To enable TB control, the local health services need to develop an understanding of, and appropriately engage with, traditional beliefs that influence how people interact with Hospital TB treatment and management. This is the case even if the beliefs are based on a worldview different than that of the health service providers. Ongoing operational research is required into TB diagnosis and treatment services and the many factors that contribute to the high TB burden in this remote area.

Healthcare-seeking behaviour among the tribal people of Bangladesh: Can the current health system really meet their needs?

Despite the wealth of studies on health and healthcare-seeking behaviour among the Bengali population in Bangladesh, relatively few studies have focused specifically on the tribal groups in the country. This study aimed at exploring the context, reasons, and choices in patterns of healthcare-seeking behaviour of the hill tribal population of Bangladesh to present the obstacles and challenges faced in accessing healthcare provision in the tribal areas. Participatory tools and techniques, including focus-group discussions, in-depth interviews, and participant-observations, were used involving 218 men, women, adolescent boys, and girls belonging to nine different tribal communities in six districts. Data were transcribed and analyzed using the narrative analysis approach. The following four main findings emerged from the study, suggesting that the tribal communities may differ from the predominant Bengali population in their health needs and priorities: (a) Traditional healers are still very popular among the tribal population in Bangladesh; (b) Perceptions of the quality and manner of treatment and communication can override costs when it comes to provider-preference; (c) Gender and age play a role in making decisions in households in relation to health matters and treatment-seeking; and (d) Distinct differences exist among the tribal people concerning their knowledge on health, awareness, and treatment-seeking behaviour. The findings challenge the present service-delivery system that has largely been based on the needs and priorities of the plainland population. The present system needs to be reviewed carefully to include a broader approach that takes the sociocultural factors into account, if meaningful improvements are to be made in the health of the tribal people of Bangladesh.

Can Andean medicine coexist with biomedical healthcare? A comparison of two rural communities in Peru and Bolivia

BACKGROUND

It is commonly assumed that indigenous medical systems remain strong in developing countries because biomedicine is physically inaccessible or financially not affordable. This paper compares the health-seeking behavior of households from rural Andean communities at a Peruvian and a Bolivian study site. The main research question was whether the increased presence of biomedicine led to a displacement of Andean indigenous medical practices or to coexistence of the two healing traditions.

METHODOLOGY

Open-ended interviews and free listing exercises were conducted between June 2006 and December 2008 with 18 households at each study site. Qualitative identification of households' therapeutic strategies and use of remedies was carried out by means of content analysis of interview transcriptions and inductive interference. Furthermore, a quantitative assessment of the incidence of culture-bound illnesses in local ethnobiological inventories was performed.

RESULTS

Our findings indicate that the health-seeking behavior of the Andean households in this study is independent of the degree of availability of biomedical facilities in terms of quality of services provided, physical accessibility, and financial affordability, except for specific practices such as childbirth. Preference for natural remedies over pharmaceuticals coexists with biomedical healthcare that is both accessible and affordable. Furthermore, our results show that greater access to biomedicine does not lead to less prevalence of Andean indigenous medical knowledge, as represented by the levels of knowledge about culture-bound illnesses.

CONCLUSIONS

The take-home lesson for health policy-makers from this study is that the main obstacle to use of biomedicine in resource-poor rural areas might not be infrastructural or economic alone. Rather, it may lie in lack of sufficient recognition by biomedical practitioners of the value and importance of indigenous medical systems. We propose that the implementation of health care in indigenous communities be designed as a process of joint development of complementary knowledge and practices from indigenous and biomedical health traditions.

Health-seeking behaviour in Pakistan: a narrative review of the existing literature

INTRODUCTION

This narrative review was carried out to collate the work of researchers on health-seeking behaviour in Pakistan, to discuss the methods used, highlight the emerging themes and identify areas that have yet to be studied.

STUDY DESIGN

Review.

METHODS

An overview of studies on health-seeking behaviour in Pakistan, found via searches on scholarly databases intended to locate material of medical and anthropological relevance.

RESULTS

In total, 29 articles were reviewed with a range of different methodologies. A retrospective approach was the most common. A variety of medical conditions have been studied in terms of health-seeking behaviour of people experiencing such conditions. However, a wide range of chronic illnesses have yet to be studied. Nevertheless, some studies highlighting unusual issues such as snake bites and health-seeking behaviour of street children were also found. In terms of geographical area, the majority of studies reviewed were performed in the provinces of Sind and Punjab, with little research targeting the people from the two other provinces (Balochistan and Khyber Pakhtunkhwa) of Pakistan. Predominant utilization of private healthcare facilities, self-medication, involvement of traditional healers in the healthcare system, women's autonomy, and superstitions and fallacies associated with health-seeking behaviour were found to be the themes that repeatedly emerged in the literature reviewed.

CONCLUSIONS

The sociocultural and religious background of Pakistan means that health-seeking behaviour resembles a mosaic. There is a need to improve the quality of service provided by the public healthcare sector and the recruitment of female staff. Traditional healers should be trained and integrated into the mainstream to provide adequate healthcare. Serious efforts are required to increase the awareness and educational level of the public, especially women in rural areas, in order to fight against myths and superstitions associated with health-seeking behaviour.

Medicinal plants used with Thai Traditional Medicine in modern healthcare services: a case study in Kabchoeng Hospital, Surin Province, Thailand

ETHNOPHARMACOLOGICAL RELEVANCE

Thai Traditional Medicine (TTM) is available in many modern hospitals in Thailand. However, there have been difficulties in integrating TTM, particularly the practices of the use of herbal medicines, into modern healthcare services. Kabchoeng Hospital is one hospital that has been able to overcome these difficulties. Thus, this study aimed to document the successful utilization of herbal medicine at Kabchoeng Hospital. The documentation focused on both the knowledge of medicinal plants and the success factors that facilitated the utilization of herbal medicine in the context of a modern hospital in Thailand.

MATERIALS AND METHODS

Kabchoeng Hospital was intentionally selected for this case study. Participatory observation was used for the data collection. There were six groups of key informants: three applied Thai Traditional Medicine practitioners (ATTMPs), a pharmacist, two physicians, two folk healers, the head of an herbal cultivation and collection group, and 190 patients. The plant specimens were collected and identified based on the botanical literature and a comparison with authentic specimens; these identifications were assisted by microscopic and thin layer chromatography (TLC) techniques.

RESULTS

Eighty-nine medicinal plants were used for the herbal preparations. The ATTMPs used these plants to prepare 29 standard herbal preparations and occasional extemporaneous preparations. Moreover, in this hospital, seven herbal preparations were purchased from herbal medicine manufacturers. In total, 36 preparations were used for 10 groups of symptoms, such as the treatment of respiratory system disorders, musculo-skeletal system disorders, and digestive system disorders. Four success factors that facilitated the utilization of herbal medicine at Kabchoeng Hospital were determined. These factors included a proper understanding of the uses of herbal medicines, the successful integration of the modern and TTM healthcare teams, the support of an herbal cultivation and collection group, and the acceptance of the local people.

CONCLUSIONS

The practices that support the use of herbal medicine at Kabchoeng Hospital illustrated the successful application of TTM and also represented a model for the integration of TTM, and particularly the use of herbal medicine, into modern hospitals. This integration will be beneficial for sustainable healthcare systems in Thailand and in other countries where modern medicine is the mainstream medical system.

Betel quid use in relation to infectious disease outcomes in Cambodia

OBJECTIVES

The habitual chewing of betel quid (areca nut, betel leaf, tobacco) is estimated to occur among 600 million persons in Asia and the Asia-Pacific Region. Emerging data from rural Asia indicate that the betel quid is part of traditional medicine practices that promote its use for a wide range of ailments, including infectious disease. In the present study, we examined the association between betel quid, traditional medicine, and infectious disease outcomes.

METHODS

For the purpose of a nationwide, interviewer-administered, cross-sectional survey of tobacco use (including betel quid), we conducted a stratified three-stage cluster sampling of 13 988 adults aged 18 years and older from all provinces of Cambodia.

RESULTS

We found an association between the intensity of betel quid use and HIV/AIDS (odds ratio (OR) 2.06, 95% CI 1.09-3.89), dengue fever (OR 2.40, 95% CI 1.55-2.72), tuberculosis (OR 1.50, 95% CI 0.96-2.36), and typhoid (OR 1.48, 95% CI 0.95-2.30). These associations were even stronger in women - the primary users of betel quid in Cambodia. Multivariable analyses that controlled for age, gender, income, education, urban versus rural dwelling, receiving care from traditional medicine practitioners, and cigarette smoking did not alter the betel quid-infectious disease association.

CONCLUSIONS

Our findings raise the possibility of a role of betel quid use in the transmission of infectious disease through pathways such as immunosuppression, oral route of entry for a pathogen (i.e., through injury to the oral mucosa), and contamination (i.e., fecal-oral) of the betel quid ingredients.

Local knowledge and socio-economic determinants of traditional medicines' utilization in livestock health management in Southwest Nigeria

Smallholder livestock farmers in Nigeria utilize traditional medicines derived from medicinal plants (PMs) for the maintenance of their animals' health. This study was designed to determine the PMs used in the study area and their level of utilization by livestock farmers, compare the level of utilization of PMs across the three states surveyed and identify the socio-economic factors influencing farmer's utilization of PMs. Thirty-five PMs were identified. Farmers had considerable knowledge about the identified PMs but about 80.0% of them used the PMs to poor/moderate extent. There were statistical differences in the utilization level of PMs among the three states. Six socio-economic variables were found to be statistically significant in influencing PMs' utilization. Farmer's age, household size, distance to the nearest veterinary hospital/clinic and extent of travels, had positive effects while negative effects were exhibited by farm income and number of heads of livestock. It was concluded that there was considerable knowledge about PMs and that utilization of PMs varied between the three states. It was recommended that local knowledge of PMs be preserved in the study area through screening and documentation.