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Social and economic factors influencing the patronage and use of

complementary and alternative medicine in Enugu

Article  in  Journal of Pharmacy & Bioresources · November 2013

DOI: 10.4314/jpb.v10i1.3

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 http://dx.doi.org/10.4314/jpb.v10i1.3 Journal of
Vol. 10 no. 1, pp. 17-24 (March 2013) PHARMACY AND
http://ajol.info/index.php/jpb BIORESOURCES

Social and economic factors influencing the patronage and

use of complementary and alternative medicine in Enugu
Stella F. Usifoh* and Anthony W. Udezi
Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Benin, Benin City.
Nigeria.

Received 14th February 2013; Accepted 15th March 2013

______________________________________________________________________________
Abstract
Traditional Medicine (TM) or Complementary and Alternative Medicine (CAM) covers approaches to medical
treatment that are outside of mainstream medical training. Different herbal products abound and they are flagrantly
advertised with claims of their ability to cure all diseases. The objective was to survey how safety, reliability,
effectiveness, availability, cost, and other socioeconomic factors influence use and patronage of TM as well as check
which common diseases are being treated and how the patient felt after the use of TM. A cross sectional community-
based survey using 21-item questionnaire consisting of socio-demographic and stem questions that have been
standardized and validated for reliability of response. Four hundred questionnaires were randomly distributed and
300 (75%) were returned and analyzed. 203(68%) of respondents claimed they use TM while 93(31%) claimed they
do not. Majority of respondents [108(57.9%)] were 21-40 years old, 26(12.7%) were within 41-50 and 40(19.7%)
above 50years. There were 117 females and 86 males. 26(12.7%) of the respondents had at least primary education,
while 16% used traditional medicine because it is cheaper and 31.3% because it is believed to cure many diseases.
Malaria treatment 128(33%) was highest followed by typhoid 79(20.5%), sexually transmitted disease 31(8.1%),
diabetes 25 (6.0%) and infertility 25(6.2%). Malaria and typhoid were the highest co-morbid infection treated with
TM. Socio-economic factors such as cost, effectiveness, availability, safety of the product, educational level,
average monthly income, age and sex affect the patronage and use of traditional medicine.

Keywords: Complementary and alternative medicine, traditional medicine, herbs, socio-economics,

______________________________________________________________________________

INTRODUCTION technique and exercise applied singly or in

Traditional Medicine (TM) or combination to diagnose, treat and prevent
Complementary and Alternative Medicine illness or maintain well being” (World Health
(CAM) covers approaches to medical Organization, 1976). The term CAM however
treatment that are outside of mainstream is an umbrella term covering complementary
medical training and are popularly used to therapies, which are defined as treatments
help meet some primary health care needs. (Lewington, 1993) while alternative medicine
The world Health Organization (WHO) is described as a practice used instead of
defined Traditional Medicine as “health standard medical treatment. It should be noted
practices, approaches, knowledge and belief that what is considered complementary in one
incorporating animal and mineral-based country may be conventional in another, for
medicine, spiritual therapies, manual instance herbal medicine and acupuncture are
*
Corresponding author. E-mail: [email protected] Tel: +234 (0) 8056226668
ISSN 0189-8442 © 2013 Faculty of Pharmaceutical Sciences, University of Jos, Jos. Nigeria.
18
S. F. Usifoh & A. W. Udezi / J. Pharmacy & Bioresources 10(1), 17-24 (2013)

practiced as complementary in the UK and A herbal remedy is thus one in which the
USA whereas they are considered a part of main therapeutic activity depends on plant or
conventional medicine in China. fungi. The pharmacopeia contains at least
TM covers therapeutic practices that 25% of drugs derived from herbs and many
have been in existence for hundreds of years others which are synthetic analogies built on
before the development and spread of modern prototype compounds isolated form plants
allopathic medicine and are still in use today. (Arvigo and Balik, 1994). Plant product use
These practices vary widely in keeping with covers some important therapeutic categories
the social and cultural heritage of different namely antimalarial, anticancer,
countries (World Health Organization, 1976). antimicrobials, contraceptives, muscle
TM majorly includes the use of herbs, relaxants, purgatives, hematinics, steroids and
homeopathy, religious and magical powers anesthesia. Advertisement in the mass media
that involve the use of incantations, charms, in Nigeria is a channel that TM providers
amulets religious verses, invocation of the often use to propagate spurious claims of “one
spirits etc. (Harun-Or-Rashid et al., 2011). product cures all”.
Medicinal plants are those that are It is believed that many modern
commonly used in treating and preventing medical practices like physiotherapy have
specific ailments and diseases, and are their origin in traditional medical practices.
generally considered to play a beneficial role The psychosomatic method of healing mental
in health care, Medicinal plants are already disorders used primarily by psychiatrics today
important to the global economy. Demand is is based loosely on ancient traditional medical
steadily increasing not only in developing practice (Sunshine, 1996). To date, TM
countries but also in the industrialized continues to give birth to modern medicines
nations. and medical practices. For instance a tincture
Today’s healthcare consumers now have of beach morning glory, Ipomoea pescaprace
more option available in both natural and (convolvulcene) is now certified as an anti
orthodox healthcare than before. It is not inflammatory treatment in Thailand
unusual for cancer patients who have elected (Lewington, 1993).
to undergo chemotherapy to also fortify their Consequently, increasing number of
immune system with herbs and other nations like China, Mexico, and Thailand
supplement before and/or after treatment. have decided to integrate traditional medicine
Traditional medicine incorporates the use of into their primary health care-systems. In
herbs which are finished, labelled medicinal these countries, ethnobotanical research into
products that contain active aerial or traditional medicine practices plays a critical
underground part of plants. Medicines role in documenting traditional healthcare
containing plant material combined with practices. Through research into tradition
chemically defined isolated constituents of medicine, China and Japan have successfully
plant are not considered to be herbal standardized ancient techniques like
medicines. However, WHO classifies herbal acupuncture and transformed the negative
medicines into three categories: Phyto- perception of the technique by the western
medicine or phyto-pharmaceuticals; Dietary world. Today, acupuncture is positively
supplements or nutriceuticals; Herbal perceived and used by countries outside Asia.
medicine containing crude, semi processed or Finished herbal medicines include dry
processed medicinal plant (World Health extracts, powders, liquid preparations,
Organization, 1991). granules, tablets, capsules and external or
topical preparations. Some studies in some
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S. F. Usifoh & A. W. Udezi / J. Pharmacy & Bioresources 10(1), 17-24 (2013)

parts of Nigeria have documented the use of locally made and 27 (13.2%) imported. From
CAM/TM by pregnant women and cancer those who used imported traditional medicine,
patients in the hospital. (Tamuno et al., 2011, 8 (30%) use GNLD, 11(40.7%) Tianshi,
Achema et al., 2012, Fakeye et al., 2009, 3(11%) Forever Living, 5 (18.5%) Tarsley
Aydin et al., 2008) and 1(3.7%) for other products.
The aim of this study was to survey
how safety, reliability, effectiveness, DISCUSSION
availability, cost, and other socioeconomic In this study, females and the
factors influence use and patronage of TM, to reproductive age (21-40 years) used
check the common ailments or diseases being traditional medicines more and this is in
treated and how the patient felt after the use concordance with other studies where the
of TM. This hopefully will enable us to know percentage of people who use herbal medicine
the health seeking behavior of people. is higher in female than male (Aydin et al.,
2008). Therefore males can be considered as
METHOD being less sensitive to illness than the females
The study was conducted in Enugu or choose not to take action (use traditional
town in South Eastern geo-political zone of medicines) against their diseases. In our
Nigeria. The indigenous people of Enugu are study, married people had more chronic
Igbo in ethnicity and language. illnesses such as hypertension and diabetes
while singles had more of malaria. There is a
Study design: A cross sectional survey of 400
relationship between traditional medicine use
participants using cluster and random
and educational status (World Health
sampling technique of the people residing in
Organization, 1991). This we found in our
Enugu was investigated after getting their
study where 19.1% of the respondents are
informed consent. Data were collected with a
without formal education and 79.9% with at
two-part, 21-item questionnaire consisting of
least primary level of education use TM. We
demographic data and stem questions that
also found that there is a significant
have been standardized and validated for
relationship between TM use with age,
reliability of response. The questionnaires
occupation, educational level, family setting
were self administered by literate respondents
and religion. However economic level has no
while those with little or no formal education
statistical significance. This is in contrast with
were interviewed in vernacular by a trained
previous study by Ezeome and Anarado
interviewer. Data were collected, coded and
(2007) where they found that age, marital
entered in Microsoft Excel for sorting and
status, educational level, religion and
thereafter reloaded and analyzed for
socioeconomic status had no effect on the use
inferential analysis with Statistical Package
of CAM by cancer patients. (Ezeome and
for Social Sciences (SPSS) version 17.0.
Anarado, 2007).
Worldwide results show high
RESULTS
percentage (70-80%) use of traditional
Four hundred questionnaires were
(WHO, 2002), our study also yields a high
distributed to the respondents, out of which
prevalence (67.7%). We also observed 41.9%
300 (75%) were returned and used for the
of the respondents can prepare traditional
analysis.
medicine.
Majority of the respondents
203(67.7%) claimed to use traditional
medicine out of which 165(80.9%) used the
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S. F. Usifoh & A. W. Udezi / J. Pharmacy & Bioresources 10(1), 17-24 (2013)

Table1: Demographic of the Respondents Based On Utilization of Traditional Medicine

DEMOGRAPHY VARIABLES YES (%) NO (%)
Do you use traditional medicine? 203 (67.7) 93 (31)
10-20 19 (9.3) 17 (18.3)
21-30 76 (37.3) 33 (35.5)
Age
31-40 42 (20.6) 18 (19.4)
P = 0.0334, χ2 =10.457
41-50 26 (12.7) 17 (18.3)
>51 40 (19.7) 8 (8,6)
Sex Male 86 (42.4) 41(44.1)
P = 0.801, χ2 = 0.0229 Female 117 (57.6) 52 (55.9)
Civil servant 45 (22.1) 38 (40.9)
Business men 42 (20.6) 13 (14.0)
Occupation
2 Farmer 43 (21.1) 3 (3.2)
P = <0.0001, χ = 25.63
Student 55 (27.0) 34(36.6)
Others 18 (9.3) 5 (5.4)
No formal education 39 (19.1) 1(1.1)
Educational level Primary 26 (12.7) 6 (6.5)
P = <0.0001, χ2 =29.372 Secondary 56 (27.5) 23 (24.7)
Tertiary 78 (39.7) 62 (66.7)
Family size Large above 7 64 (35.9) 21(22.6)
P = 0.0884, χ2 = 2.903 Below 6 121(59.3) 68(73.2)
Family setting Monogamy 138 (67.6) 75 (80.6)
P = 0.0392, χ2 = 4.252 Polygamy 45(22.1) 11 (11.8)
Single 86 (42.2) 46( 49.5)
Marital status
2 Married 114(55.9) 45 (48.4)
χ = 1.513, P = 0.469
Divorced 3 (1.5) 1(1.1)
Christian 162 (79.4) 90(96.8)
Religion Muslim 6 (2.9) 0 (0)
χ2 = 262.09, P = <0.0001 African traditional religion 30(14.7) 0 (0)
Others 4 (2.0) 3 (3.2)
500- 5000 Naira 73 (38.8) 27(29.0)
5500-15000 Naira 41(20.1) 18(19.4)
Monthly Income
2 15500-25000 Naira 28 (13.7) 9 (9.7)
χ =4.037, P = 0.4010
25500-50000 Naira 31 (15.2) 16 (17.2)
Above 50000 Naira 20 (9.8) 15 (16.2)
P-value <0.05 is significantly associated

Table 2: Usage and asses of Traditional medicine N=203

QUESTION YES (%) NO (%)
1. Do you use traditional medicine? 203 67.7 93 31
2. Can you prepare traditional medicine? 115 56.7 86 41.9
3. Is it readily available? 132 65.2 65 31.9
4. Would you go extra miles to buy traditional medicine even 119 58.6 71 34.8
when not available in your location?
5. Does the quality of traditional medicine affect your choice? 103 50.7 95 46.8
 21
S. F. Usifoh & A. W. Udezi / J. Pharmacy & Bioresources 10(1), 17-24 (2013)

Table 3: Diseases or Conditions treated with Traditional Medicine

Disease/ Condition Frequency %
1. Diabetes 25 6
2. Goiter 2 0.5
3. Pregnancy 13 3.4
4. Fibroids 13 3.4
5. Arthritis 17 4.4
6. Infertility 24 6.2
7. Hypertension 20 5.2
8. Malaria 128 33
9. Typhoid 79 20.5
10. Bone fracture 22 5.7
11. Cataract 3 0.8
12. Sexually transmitted diseases 31 8.1
13. Wound 17 4.4
Co- morbidity
Malaria and typhoid 39 10.1
Infertility, malaria & typhoid 10 2.6
Infertility, malaria, typhoid & sexual transmitted diseases 8 2.1
Bone fracture & wound 5 1.3
Pregnancy and infertility 5 1.3
Diabetics and hypertension 14 3.6
Pregnancy & hypertension 13 3.4
Malaria and sexually transmitted diseases 6 1.6
N = 385 and is more than 204 because of double entry

Fig. 1: Reasons for using traditional medicine (N = 203)

22
S. F. Usifoh & A. W. Udezi / J. Pharmacy & Bioresources 10(1), 17-24 (2013)

Fig. 2: Reasons for not using TMP

Table 4: Demographics of those that use local and foreign herbal products
VARIABES LOCAL N=165 (%) FOREIGN N=27 (%)
Sex Female 93 (56.4) 15 (55.6)
P = 0.911, χ2 =0.0125 Male 71 (43.0) `12 (7.3)
10-20 13 (7.9) 3 (11.1)
21-30 60 (36.4) 10 (37.0)
Age
31-31 36 (21.8) 6 (22.2)
P = 0.8124, χ2 = 1.580
41-50 21 (12.7) 4 (14.8)
>50 35 (21.2) 3 (11.1)
Civil servant 37 (22.4) 7 (25.9)
Business men 32 (19.4) 7 (25.9)
Occupation
Farmer 35(21.2) 4(14.8)
P = 0.516,
Student 44 (26.7) 7 (25.9)
Others 14 (8.5) 2 ( 7.4)
500- 5000 61(37) 4 (14.8)
5500-15000 31 18.8) 5 (18.5)
Monthly Income in Naira 15500-25000 21(12.7) 5 (18.5)
P = 0.105, χ2 = 9.099 25500-50000 25 (15.2) 5 (18.5)
Above 50000 13(7.9) 6 (22.2)
No response 7 (4.3) 2 (7.4)
N=203, P-value <0.05 is significant

Table 5: Perception on use and efficacy of treatment with traditional medicine

Classification Diseases Excellent V. good Good Poor V. poor
Malaria 46 (22.7%) 52(25.6%) 32(15.8%) 1(0.5%) 4(2.0%)
Infectious diseases Typhoid 26 (12.8%) 44(21.7%) 22(10.8%) 2(1.0%) 4 (2.0%)
STIs 14(6.9%) 25(12.3%) 12(5.9%) 3(1.5%) 5(2.5%)
Wounds 5 (5.2%) 8(3.9%) 10(4.9%) 8(3.9%) 13(7.4%)
Acute/traumatic Cases
Bone fracture 15(7.4%) 16(7.9%) 14(6.9%) 5(2.5%) 2(1.0%)
Diabetes 10(3.3%) 20(6.7%) 10(3.3%) 9(3.0%) 11(3.7%)
Hypertension 8(3.9%) 16 (7.9%) 8(3.9%) 8(3.9%) 14(6.9%)
Chronic diseases Arthritis 6(3.0%) 11(5.4%) 7(3.5%) 10(4.9%) 12(5.9%)
Goiter 1(0.3%) 8(2.7%) 13(4.3%) 4(1.3%) 8(2.7%)
Cataract 8(3.9%) 6(3.0%) 5(2.5%) 5(2.5%) 10(4.9%)
Pregnancy 11(3.7%) 7(2.3%) 15(5.0%) 8(2.7%) 2(0.7%)
Gynaecological cases Fibroids 13(4.3%) 21(7.0%) 9(3.0%) 0(0%) 2(0.7%)
Infertility 12(5.9%) 9(4.4%) 23(11.3%) 1(0.5%) 4(2.0%)
Regulation of TM practice 34(16, 8%) 48(23.6%) 76(37.4%) 18(8.9%) 9(4.4%)
 23
S. F. Usifoh & A. W. Udezi / J. Pharmacy & Bioresources 10(1), 17-24 (2013)

In many developing communities, TM antidepressants in treating depression but can

remains the only available and affordable be obtained at one-third the cost. This was in
health service for the majority of the line with our study as 24.5% of our
population living in these communities respondents used traditional medicine because
(Elujoba, 1999) and this is in line with our it is cheap. 49% of the respondents used
study where the availability of traditional traditional medicines because it cures many
medicine is high (65%) and is cheap. diseases. This could be because the practice
The respondents that use the TM for involves polypharmacy. Although the side
diabetes and hypertension were mainly the effects of traditional medicines are known
elderly. Thus it can be inferred that as the scientifically (Algier et al., 2005), our study
population ages, the prevalence of showed that only few respondents (9.8%) use
hypertension and related co-morbid diseases traditional medicines because they claim there
also increase (Oparah, 2010). It was not are no side effects. This could be due to lack
surprising from our study that malaria of awareness or because they cannot relate the
treatment (33%) accounts for highest side effects to the herbal medicine. High
proportion in the patronage and use of percentage of respondents who do not use
traditional medicine because malaria is traditional medicine because there is no
endemic in the area; indeed malaria is a standard dose could be due to high
known major public health problem in sub- educational status of the area. However, the
Saharan Africa (Enato, 2010). This was perception of the respondents on the use and
closely followed by typhoid 79(20.5%), efficacy of treatment of TM for various
sexually transmitted disease 31(8.1%), then ailments were very good except for some
diabetes 25 (6.0%) and infertility 24(6.2%). conditions like treatment of wound infection,
That malaria and typhoid were the highest arthritis and cataract. The regulation of TM is
infection treated with TM could be due to the necessary to ensure high standard, safety,
endemic nature of malaria and sometimes the quality and rational use as they are primarily
misdiagnosis or over diagnosis of typhoid in the first port of call for most patients in the
our setting (Onyekwere, 2007). Malaria and rural setting.
typhoid also were the highest co-morbid
infections that are treated concurrently. This Conclusion
is in line with previous study and it has Traditional medicines are commonly
always been a public health issue. (Uneke, used in Enugu State. Traditional medicine
2008). could become a critical tool in the fight
In concordance with our study, against diseases especially malaria and
respondents that have used traditional increase general access to health in the area.
medicine for bone fracture were more Most people perceive traditional medicines as
common to the extreme ages (10-20 years) efficacious, cost effective and a viable
and 51 years and above. alternative to orthodox medicine. For
Accumulating evidence suggests that traditional medicines, there is a trade-off
traditional medicine practice is valuable for between the benefits and potential for harm.
treatment of diseases (Algier et al., 2005; To minimize harm, it is necessary to fully
Wetzel et al., 1998). Importantly traditional integrate and regulate traditional medicine to
medicines are often less expensive than ensure high standard, safety quality and
conventional medication. For example, study rational use. Socio-economic factors such as
reports that Hyperium (St. John’s Wort) is not cost, effectiveness, availability, safety of the
only as effective as conventional product, educational level, average monthly
 24
S. F. Usifoh & A. W. Udezi / J. Pharmacy & Bioresources 10(1), 17-24 (2013)

income, age and sex affect the patronage and Lewington A., (1993) Medicinal Plant and Plant
use of traditional medicine. extracts. A review of their importation into Europe.
Cambridge, U. K. Traffic international: 12 – 15
Onyekwere C.A. (2007). Typhoid Fever: Misdiagnosis
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