ASSESSMENT OF FACTORS INFLUENCING THE UTILIZATION OF

COMPLEMENTARY AND ALTERNATIVE MEDICINE AMONG

CANCER PATIENTS AT MACHAKOS LEVEL FIVE HOSPITAL,
MACHAKOS COUNTY, KENYA

NGAI JACKLINE MBITHE

A RESEARCH PROPOSAL SUBMITTED TO DEPARTMENT OF

CLIICAL MEDICINE, SCHOOL OF MEDICINE IN PARTIAL
FULFILLMENT OF THE REQUIREMENT FOR THE AWARD OF THE
BACHELORS OF SCIENCE IN CLINICAL MEDICINE AND
COMMUNITY HEALTH AT JOMO KENYATTA UNIVERSITY OF
AGRICULTURE AND TECHNOLOGY.

2022

1
 DECLARATION AND APPROVAL

Declaration

I hereby declare that this Research Project is my original work and that it has not been presented
for award of any Degree.

NGAI JACKLINE MBITHE

Signature: ………………………………. DATE………………………………...

Approval

This proposal has been submitted for examination with my approval as university supervisor

Signature: ………………………………..DATE: ………………………………..

JOSEPHINE WAMBUI NYAGA

Lecturer

Department of Clinical Medicine

Jomo Kenyatta University of Agriculture and Technology (JKUAT)

2
 DEDICATION
This research work is dedicated to my family members who have been very supportive during
my Bachelor’s Degree Program.

3
 ACKNOWLEDGEMENT
I thank God Almighty for the sustenance, wisdom and strength He has accorded me to undertake
this research proposal. I sincerely thank the entire Jomo Kenyatta University of Agriculture and
Technology fraternity and the Department of Clinical Medicine for their support towards this
proposal. I sincerely appreciate my supervisor Miss Josephine Wambui Nyaga for her guidance.
I also acknowledge my parents and siblings for their support. May God bless you abundantly.

4
 TABLE OF CONTENTS
DECLARATION AND APPROVAL..........................................................................................ii

DEDICATION..............................................................................................................................iii

ACKNOWLEDGEMENT...........................................................................................................iv

TABLE OF CONTENTS..............................................................................................................v

LIST OF ABBREVIATIONS………………………………………..………………….…..…vii

DEFINITION OF TERMS……………………………………………………………………………………………………………viii
ABSTRACT………………………………………………………………………………………………………………………………………ix
CHAPTER ONE: INTRODUCTION..........................................................................................1

1.1 Background information............................................................................................................1

1.2 Statement of the problem……………………………………………………...…………...….3

1.3 Justification of the study………………………………………………………………...…….4
1.4 Objectives of the study..............................................................................................................4

1.4.1 General Objectives..................................................................................................................4

1.4.2 Specific Objectives..................................................................................................................4
1.5 Research questions...................................................................................................................5

CHAPTER TWO : LITERATURE REVIEW............................................................................6

2.0 Introduction................................................................................................................................6

2.1 Use of CAM worldwide.............................................................................................................6

2.2 Reasons why patients use CAM................................................................................................7

2.3 Pattern of CAM use in Africa....................................................................................................8

2.4 Pattern of CAM use in Kenya……………………………………………………………………………………………................10

2.5 Pattern of CAM use in Machakos County…………………………………...………………11

2.6 Factors that influence utilization of complementary alternative medicine……….………….11

2.6.1 Social - demographic factors and utilization of CAM……………………………………………………..11

2.6.2 Awareness and utilization of complementary alternative medicine…………………………………13

5
 2.6.3 Hospital related factors and CAM utilization…………………………………………………………..……….14
2.6.4 Culture and utilization of complementary alternative medicine……………………………………14
CHAPTER THREE: STUDY METHODOLOGY...................................................................17

3.0 Introduction............................................................................................................................17

3.1 Study area..............................................................................................................................17

3.2 Study design...........................................................................................................................17

3.3 Study Population......................................................................................................................17

3.3.1 Inclusion criteria…………………………………………………………………………………………………………………………17

3.3.2 Exclusion criteria…………………………………………………………………………………………………………………….….17

3.4: Sample size determination......................................................................................................18

3.5 Sampling technique…………………………………………………………………………………………………………………………18

3.6: Data collection method and tools...........................................................................................18

3.7 Pretesting of data collection tools………………………………………………………………………………………………….19

3.8: Data entry and analysis...................................................................................................................19

3.9: Ethical considerations.........................................................................................................................19

APPENDIX 1: CONSENT FORM………………………………………………………………………………………………………….22

APPENDIX 11: QUESTIONNAIRE……………………………………………………………………………………………………….23
APPENDIX 111: WORKPLAN………………………………………………………………………………………………………………27

APPENDIX 1V: MAPS………………………………………………………………………………………………………………………….28

6
 LIST OF ABBREVIATIONS
BBT Biologically-based therapies 

BHC Bio medically-oriented health care 

CAM Complementary and alternative medicine 

NCCAM National Center for Complementary and Alternative Medicine 

NCI National Cancer Institute 

NIH National Institutes of Health 

TM Traditional Medicine 

WHO World Health Organization

SSPS Statistical Package for the Social Sciences

7
 DEFINITION OF TERMS

Alternative Medicine: In this study alternative medicine includes herbs, exercise, diet, prayer,
and massage, chiropractic that are used outside the main stream medicine (conventional,
allopathic, and orthodox).

Complementary and Alternative Medicine: The use of various traditional methods in

maintaining health other than conventional medicine and are used in accordance to the culture,
belief and custom of the individual.

Culture: In this context culture is identified as the way of life to a group of people who live in
the same geographical location. Characterized by the whole complex of distinctive spiritual,
material, intellectual, emotional features, value systems, traditions and beliefs in a society or
social group.

Traditional Medicine (TM): Refers to knowledge, skills and practices based on the theories,
beliefs and experiences indigenous to different culture, used in the maintenance of health.

8
 ABSTRACT

Background: Cancer is among the leading causes of death globally. Despite advancing
technology in conventional methods of cancer diagnosis and treatment, access to services
remains a big challenge especially in the developing countries. Out of desperation, patients may
be tempted to use Complementary and Alternative Medicine (CAM) to improve their health
outcomes. This has led to the rise in use of Complementary and Alternative Medicine (CAM)
among patients with chronic diseases like cancer in developing nations. The rising use of
Complementary and Alternative Medicine (CAM) in the management and cure of diseases is an
emerging health concern because of its potential side effects, medical drug interactions and
results of its use. Dietary supplements, prayers, divination, herbal medicine and relaxation
techniques are a few of the most commonly used Complementary and Alternative Medicine
(CAM) types and patterns in Kenya. Patients’ reasons for using Complementary and Alternative
Medicine (CAM) as adjuvant therapy include inaccessibility of conventional medicine,
dissatisfaction, expensive allopathic medicine and recommendations by family and friends.
However, there is minimal data in Kenya and specifically Machakos County on use of
Complementary and Alternative Medicine (CAM) among cancer patients.
Purpose: The main objective is to assess the factors influencing the use of Complementary and
Alternative Medicine (CAM) among patients in Machakos Level 5 Hospital. The specific
objectives are: to assess the socio-demographic characteristics of cancer patients in Machakos
level 5 Hospital, to determine if the cancer patients at Machakos Level 5 Hospital use
Complementary and Alternative Medicine (CAM), to determine factors and reasons that lead to
the use of Complementary and Alternative Medicine among cancer patients in Machakos Level 5
hospital and to determine the types and patterns of Complementary and Alternative Medicine
(CAM) being used by cancer patients in Machakos Level 5 Hospital.
Methodology: This study will implore a descriptive quantitative cross-sectional study design.
Systematic random sampling will be used to select patient participants. Data will be collected
through a questionnaire for patients for a period of 4 weeks. Inclusion criteria for patient will be
adults 18-65 years. Quantitative data will be edited, coded, cleaned and entered into computer
and analyzed using Statistical Package of Social Sciences version 22.
The study findings will show the level of awareness and understanding about Complementary
Alternative Medicine and its effect on utilization among consumers.

9
 CHAPTER ONE: INTRODUCTION

1.1 Background information

The National Centre for Complementary and Alternative Medicine (NCCAM) defines CAM as
“a group of various medical and health care systems, practices, and products that are not
presently considered to be an aspect of conventional medicine. CAM compromises of
knowledge, skills and practices based on the theories, beliefs and culture. The knowledge is
passed from one generation to another for maintenance of health (WHO, 2002, 2005, 2012,
2014, 2019) CAM includes: manipulative body based therapies, alternative medicine, body and
mind, biological and energy therapies. In Kenya, there were 47,887 new cancer cases and 32,987
cancer deaths in 2018, with the most prevalent cases being the cancers of breast, cervix, and
esophagus, prostate and colorectal (Bray et al., 2018). About 80% of Kenyans have used CAM
in their lifetime for treatment of diseases. (WHO 2012)

Complementary and alternative medicine (CAM) use is common in patients especially those with
chronic illnesses such as cancer in developing countries ((WHO), 2002). The use of CAM as
adjuvant therapy has increased in the past few years in Kenya. In Machakos county CAM use
has also been in the rise in the past few years. CAM used in Kenya include: dietary supplements,
prayers, herbal medicine and relaxation (Dric LC, 2009). According to the NCCAM, CAM
modalities are not included in Conventional Medicine because there is insufficient prove that
they are effective or safe in the management of diseases (CAM, 2005-2009). More often than
not, patients who use CAM practices use it to improve their health and general well-being (Marie
A Hustelle, 2008), relieve symptoms which are associated with terminal illness or side effects of
conventional medicine and also for holistic approach which puts in to consideration the
management of diseases in the connection with mind, body and spirit (Hampel N, 2006).

According to Barnes and Powell-Griner (2004) the magnitude of CAM is evidenced by its
continued uptake globally at 80% and 85% in Africa. Majority of the population continue to buy
CAM products over the internet therefore there is a global access to CAM. This idea has
promoted client-oriented health and disease prevention which reduces the burden of expensive
healthcare (Antwi-baffour, Bello, Adjei, Mahmood & Ayeh-kumi, 2014). There is an upward
trend of both cost of health care and chronic illnesses in the healthcare system across the word

10
which has necessitated the use of complementary and alternative medicine (Barnes, Bloom, &
Interview, 2008; WHO, 2014).

Researchers recommend the use of CAM in treatment of various illnesses including: substance
abuse and alcoholism, attention deficit hyperactivity (Brown & Patel, 2005), autism spectrum
(Wendy, 2014), insomnia (Bertisch,Wells, Smith & McCarthy, 2012), stress and anxiety (Sarries
et al., 2012), depression (Medicine, 2010; Maher et al., 2015; America, 2016), schizophrenia
(Thomas, 2016). Utilization of CAM is based on various reasons as reported by previous studies;
nutrition and lifestyle (Guidance, 2006), wellness (Dale et al., 2014). Some patients avoid use of
conventional medicines because of the belief that chemicals have adverse effects on their body
systems but not because they are dissatisfied with conventional medicine (Astin, 1998).

A study done in Enugu Urban, Southeast Nigeria on patterns of complementary and alternative
medicine use, perceived benefits, and adverse effects among adult users showed that forms of
CAM therapies mostly consumed include herbal medicine, spiritual healing, relaxation
techniques, aloe vera, medicinal tea, and nutritional supplements (E. R. Ezeome and A. N.
Anarado, 2007) Many reasons have been given for the use of CAM which include treating or
preventing diseases, improving the quality of life, and promoting and maintaining health (WHO,
Geneva, Switzerland, 2002) Herbal CAM therapies are frequently obtained from traditional
herbal medicine practitioners (T. A. Okeke, H. U. Okafor, and B. S. Uzochukwu, 2006). About
85% of Nigerians are known to use and consult traditional medicine for healthcare, social, and
psychological benefits because of poverty and dissatisfaction with conventional medical care (K.
A. Oshikoya, I. O. Senbanjo, O. F. Njokanma, and A.Soipe, 2008)

A good number of CAM users take it concurrently with conventional medicine (E. R. Ezeome
and A. N. Anarado, 2007). However, some patients who use herbal products are reluctant to
disclose use of CAM to their doctors either due to fear of physician’s criticism or because the
physician failed to ask (H. Y. Chang, M. Wallis, and E. Tiralongo, 2007). In addition, most users
of CAM practice self-medication without guide or supervision from licensed or certified CAM
practitioners (P. M. Barnes, E. Powell-Griner, K. McFann, and R. L. Nahin, 2004). A study on
the use of complementary and alternative medicine by cancer patients at the University of
Nigeria Teaching Hospital, Enugu, Nigeria, showed that only 21.2% of the patients studied

11
reported unwanted side effects from CAM treatment. The side effects included full thickness
chemical burns following application of herbal product on the skin, slimming down, anorexia,
nausea and vomiting, general malaise, and diarrhea.

The World Health Organization (WHO) encourages member states to implement the policy on
traditional medicine, promote and regulate the practice of traditional medicine practitioners. The
organization also encourages a link between CAM practitioners, customers, healthcare workers
and a system of referral of patients with chronic diseases such as cancer from traditional
practitioners to conventional health facilities. However, this has not had a tremendous move
because of diversified rules and regulation on CAM. Some countries have established rules and
regulation of CAM products and practitioners like European countries (Amster A. Michael,
Cogert Greg. Lie A. Desiree. 2001: Sita, 2011)

1.2 Statement of the problem

CAM is broadly appreciated and embraced by different communities for treatment and cure of
different diseases affecting majority of the population in developing countries (Stradford et
al.,2014) WHO estimates that up to 80% of some populations in developing countries use
traditional medicine ((WHO), 2002).

According to the WHO, strategies have been developed to promote utilization of CAM products,
services and CAM practitioners. This includes; building knowledge base for active management
of CAM, setting policies, strengthening quality assurance, regulation of CAM products,
therapies, and CAM practitioners and promoting universal health coverage by integrating CAM
service delivery and self-health care. However, these strategies have partially been implemented
in Kenya and other countries (Ndetei M. David, Khasakhala, Oginga, Allan, Raja, 2007).

The rising incidence in use of CAM is greatly attributed to information and advice from friends
and relatives, marketing strategies, active involvement of patient in decision making and a strong
cultural belief in the effectiveness of CAM. However, conventional health workers over the
years have raised concerns regarding the use of CAM. These include; recognition and
registration of CAM products, therapies, CAM practitioners and quality assurance (WHO, 2007;
WHO, 2014). It is for this reason that there is need to assess the factors that influence utilization
of CAM among cancer patients in Machakos Level 5 Hospital, Machakos county, Kenya.
12
It is important for the population to understand that CAM does not work alone in exclusion of
conventional medicine. Because of over relying on CAM on isolation patients seek conventional
medical help late. This leads to late diagnosis and poor prognosis of the disease. This in turn
increases mortality rate. CAM can only be embraced as complementary treatment like dietary
supplements but not as the main therapy.

1.3 Justification of the study

The use of CAM is greatly attributed to affordability, availability and accessibility. CAM
continues to diagnose and treat chronic diseases within the population locally and globally. Poor
infrastructure in many developing countries coupled with inadequate health workforce are a few
of the major challenges. Most health workers including the senior consultants, medical and
clinical officers, nurses, nutritionists and community health workers are not aware about CAM
and it is not in their scope of practice. Some of the patients who are discharged from the wards to
enroll for outpatient clinic visits, they utilize CAM and do not adhere to conventional medicine.
With a huge population utilizing CAM, and especially those with chronic diseases like cancer,
this study comes right in time.
There is minimal research that has been done on CAM especially in developing nations. The
rising use of Complementary and Alternative Medicine (CAM) in the management and cure of
diseases is an emerging health concern because of its potential side effects, medical drug
interactions, toxicity levels and results of its use. The study findings will add to the body of
knowledge on the use of CAM. The results can be used to create a new way of holistic approach
which might involve combining complementary and alternative medicine and conventional
medicine in the treatment of diseases. The results may be important for basis of doing research.

1.4 Objectives of the study

1.4.1 General Objectives
To determine the factors that influence utilization of complementary and alternative medicine
among cancer patients at Machakos Level 5 Hospital

13
 1.4.2 Specific Objectives
i. To determine the socio-demographic characteristics of cancer patients using complementary and
alternative medicine in Machakos Level 5 Hospital
ii. To determine the client related factors contributing to use of complementary alternative medicine
among cancer patients in Machakos Level 5 Hospital
iii. To determine the hospital related factors contributing to the patients’ utilization of
complementary alternative medicine in Machakos Level 5 Hospital

1.5 Research questions

i. What are the socio-demographic characteristics of cancer patients in Machakos Level 5 Hospital,
Machakos County, Kenya?
ii. What are the client oriented factors that contribute to the use of complementary alternative
medicine among cancer patients in Machakos Level 5 Hospital, Machakos County, Kenya?

iii. What are the hospital related factors contributing to the utilization of complementary and
alternative medicine among cancer patient in Machakos Level 5 Hospital, Machakos County,
Kenya?

14
 CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction
This chapter provides a summary of the literature review that has been conducted towards the
study. It provides information on the previous research about utilization of complementary
alternative medicine. This information is intended to provider the reader with insight on why it
was necessary to conduct the current study.

2.1 Use of CAM worldwide

The use of CAM differs greatly between and within countries. The World Health Organization
(WHO) has published and summarized numerous surveys of use. However, in more developed
countries individuals choose CAM modalities according to their specific cultural beliefs and
values. For example, approximately 60 per cent of people living in France, Germany, and the
United Kingdom consume homeopathic or herbal products.

Use of CAM modalities among patients with debilitating, painful and chronic diseases such as
diabetes mellitus and cancer, is too higher, approximately between 50 to 90 percent. There is
slightly little or no correlation between the use of CAM modalities and scientific evidence that
they are medically effective or safe. For many CAM practices, the only evidence of their safety
and efficacy is embodied in fairy tale

Table2. 1 Approximations on the use of CAM by patients worldwide

Region or country Extent of use
Africa Used by 80 percent of the people as a primary
health care source.
Australia Used by 49 percent of adults

China About 30 to 50 percent use in primary health care

Greatly integrated to the health care. About 95
percent of hospitals in China use CAM
approaches

15
 India Widely used 2,860 hospitals provide traditional
medicine
Indonesia Used by 40 percent of the entire population
Used by 70 percent of the rural population
Japan 72 percent of physicians practice CAM

Thailand TM integrated into 1,120 health CENTREs

Vietnam Wholly integrated to the Vietnam’s health system

30 percent of people in this nation use CAM
approaches
Western countries CAM IS strongly integrated into the health care
system
France: approximately 75 percent of the people
have used CAM approaches once
Germany: 77percent of pain clinics provide
acupuncture
United States: 29 to 42 percent of population
uses CAM

Source WHO 2002

2.2 Reasons why patients use CAM

Approximately half of the patients who use CAM visit a CAM provider themselves and the
majority (66%) of CAM users had not informed their primary health care provider about the use
of CAM (Pitetti R, 2001). There is no strong connection between CAM use and patient income
and gender but there have been mixed findings relating CAM use to family size, ethnicity or
tribe, education level, insurance coverage and the age of the patient (Ottolini MC, 2001).

There are several reasons for the increasing use of CAM. Many CAM users reported use is
because of a “they found these health care alternatives to be more correlated with their own
beliefs systems, philosophical orientations and values toward health and life and not necessarily
as a result of being dissatisfied with conventional medicine ” (J.Astin, 1998)

16
Other reasons stated by CAM users included: CAM modalities being considered effective, fear
of drug side effects, they bring more satisfaction, dissatisfaction with conventional medicine, and
the urge for more personal attention given by CAM providers. In addition, many cultural
communities probably use CAM because of their traditional belief systems and community
cultural values. (Ottolini MC, 2001)

According to Astin (1998), people do not seek CAM because they are dissatisfied with
conventional medicine, but instead it is due to their own values, culture, belief and philosophical
orientation forwards health and life (Hoeflich, 2010). CAM is termed as mixed bag because of
integration of respect and collaboration between different views of health and healing, resulting
in mutual transformation. Biomedical practitioners focused on the diagnosis and treatment of
diseases.

2.3 Pattern of CAM use in Africa

Some of the most commonly used CAM approaches by cancer patients in Africa include
nutritional supplements and products, herbal medicine, relaxation techniques and spiritual
healing and prayers (Hampel N, 2006). These CAM modalities are broadly used by patients as a
replacement therapy or approach to conventional medicine. CAM use in Africa is also intensified
by the availability of traditional community healers, with an estimation that one traditional healer
is available to every 200 people. The traditional community healers selectively use CAM,
biomedical knowledge and a convincing language to make their clients perceive the effectiveness
of their treatments.

Additionally CAM use in Africa is also greatly associated with traditional cultural beliefs, advice
from family and friends and the age of the patient with majority of patients using CAM as those
40 years and above. Most importantly the unavailability of conventional prescribed drugs and
healthcare provision in Africa contributing to the high use of CAM.

The worrying concern is that patients may replace clinically based treatments with CAM agents
(J.Astin, 1998). These patients rarely inform their primary health care providers about CAM use,
an issue which warrants particular attention. There is also increased risk of drug interaction
between CAM modalities and conventional prescribed drugs. It is a known truth that majority
CAM therapies have active components without appropriate dosages and known side effects

17
have not been proven. Due to this most are administered at inappropriate doses, with fatal
potential health side effects.

A study done in Enugu Urban, Southeast Nigeria on patterns of complementary and alternative
medicine use, perceived benefits, and adverse effects among adult users showed that forms of
CAM therapies mostly consumed include herbal medicine, spiritual healing, relaxation
techniques, aloe vera, medicinal tea, and nutritional supplements (E. R. Ezeome and A. N.
Anarado, 2007) Many reasons have been given for the use of CAM which include treating or
preventing diseases, improving the quality of life, and promoting and maintaining health (WHO,
Geneva, Switzerland, 2002) Herbal CAM therapies are frequently obtained from traditional
herbal medicine practitioners (T. A. Okeke, H. U. Okafor, and B. S. Uzochukwu, 2006). About
85% of Nigerians are known to use and consult traditional medicine for healthcare, social, and
psychological benefits because of poverty and dissatisfaction with conventional medical care (K.
A. Oshikoya, I. O. Senbanjo, O. F. Njokanma, and A.Soipe, 2008)

A good number of CAM users take it concurrently with conventional medicine (E. R. Ezeome
and A. N. Anarado, 2007). However, some patients who use herbal products are reluctant to
disclose use of CAM to their doctors either due to fear of physician’s criticism or because the
physician failed to ask (H. Y. Chang, M. Wallis, and E. Tiralongo, 2007). In addition, most users
of CAM practice self-medication without guide or supervision from licensed or certified CAM
practitioners (P. M. Barnes, E. Powell-Griner, K. McFann, and R. L. Nahin, 2004). A study on
the use of complementary and alternative medicine by cancer patients at the University of
Nigeria Teaching Hospital, Enugu, Nigeria, showed that only 21.2% of the patients studied
reported unwanted side effects from CAM treatment. The side effects included full thickness
chemical burns following application of herbal product on the skin, slimming down, anorexia,
nausea and vomiting, general malaise, and diarrhea.

18
2.4 Pattern of CAM use in Kenya

A research done on CAM use by cancer patients at Kenyatta National Hospital, Nairobi, Kenya
showed that, in spite of the numerous steps made by the conventional therapy, many cancer
patients have resorted to using CAM since human beings always try new and alternative ways to
alleviate their pain or suffering. The most commonly used CAM modality is herbal medicine.
However, most patients do not get the expected results and do not tell this information to the
health care providers as they feel it is not of necessity. (Ong'udi M, Mutai P, Weru, 2019)

According to a study done in Meru about use of complementary and alternative medicine among
cancer patients in Meru County, Kenya. The most frequent site of primary cancer was that of the
gastrointestinal system and almost half of the respondents were using CAM. There was no
association between use of CAM and the socio demographic characteristics of the participants
such as age, level of education, level of income, marital status, religion and location of residence
(Kiraki Monicah W, Gabriel Mbugua, Robert Kei Mburugu, 2019)

The main reasons outlined for using CAM included; hope of cure for the disease improving
immunity, relieving cancer symptoms, and managing cancer pain. Non-use of CAM was
associated with lack of awareness of methods, fear of complicating the disease, unwillingness to
use the method and satisfaction with the conventional treatment. The frequently used CAMs
were the spiritual therapy, vitamins and minerals, local/traditional herbs, Chinese herbs and
support groups. Majority of the CAM users had disclosed to the health care provider about the
use. Friends and family members were the major sources of information on CAM. However,
church elders/pastors, herbalists and local chemist were the most common sources of CAM.
Some patients reported improved health and ability to cope with disease. None of the users
reported any adverse effects experienced after using CAM ((Kiraki Monicah W, Gabriel
Mbugua, Robert Kei Mburugu, 2019
2.5 Pattern of CAM use in Machakos County

Machakos County has experienced a high rise in the use of complementary and alternative
medicine. Spiritual healing and prayers, visiting witch doctors, dietary supplements, and
relaxation techniques are some of the most frequently used CAM modalities in Machakos. Some

19
of reasons for CAM use as a replacement therapy include inaccessibility and unavailability of
allopathic medicine, dissatisfaction with conventional and recommendations by family and
friends.

According to a study in 2004 on conservation status and use of medicinal plants by traditional
medical practitioners in Machakos District, Kenya. It showed that than 90% of the population I
Machakos use medicinal plants at one time or another as their primary source of healthcare. In
the rural areas and among the urban poor, herbal medicine is in most cases the only form of
health care, and sick persons only consult regular physicians as a last resort. (Kisangau, D.P.,
Musila, W., & Muema, J. (2004). Conservation status and use of medicinal plants by traditional
medical practitioners in Machakos District, Kenya).

2.6 Factors that influence utilization of complementary alternative medicine.

2.6.1 Social – demographic factors and utilization of complementary alternative medicine.

Socio-demographics are the characteristics of a population. Generally, characteristics such as
age, gender, ethnicity, education level, income, type of client, years of experience and location.
These factors influence how different populations use and utilize social services, health services
and other services.

A study done on the impact of the socio-demographic characteristics of complementary and

alternative medicine users in Serbia on over the counter (OTC) drug consumption showed that:
Two thirds (65.3%) of the CAM users consumed OTC drugs at their own discretion, without
recommendation by a physician or a relevant prescription. Users of OTC drugs were most often
females whose ages ranged within the average interval of 49 ± 16, whose education level was to
secondary school diploma, who were married and employed, lived in urban areas, mostly
Belgrade, belonged to the middle-income group, and followed relevant headlines via public
information channels (TV, the internet, radio, and print). Comparison of the results revealed, on
the one hand, that 2/3 of respondents who had used and 1/3 of those who did not consume OTC
drugs had undergone fecal occult blood tests over the past year and, on the other hand, that those
respondents had been less frequently hospitalized in the previous year. In addition, the same
responders were found to access available health care services more frequently than did others.
(Marina Luketina Sunjka, Remanja Rancic, Natasa Mihailovic, Mihajilo Jakovjevic, 2019).

20
CAM users were reported in many studies to be more common in individuals with a lower
socioeconomic status and who are unemployed and unskilled when compared with non-users
(Nxumalo N , Alaba O , Harris B , et al Utilization of traditional healers in South Africa and
costs to patients: 2011) With regard to the link between age and CAM use, generally, studies
conducted in urban or semi urban settings reported CAM users to be younger (20–50
years), whereas those conducted in a rural setting reported CAM users to more likely be older
(>55 years). An inconsistent pattern was observed from the available literature with respect to
educational status of CAM users. While four included studies reported CAM users to have little
or no formal education, two other studies provided a contrasting view. Generally, CAM users
compared with non-CAM users in the general population were more commonly reported to be
married than not married. Two studies reported on the link between CAM use and spatial
location of respondents. (Peltzer K, Pengpid S Prevalence and determinants of traditional,
complementary and alternative medicine provider use among adults from 32 countries. Chin J
Integr Med 2018)

A national household survey in South Africa identified rural residents as more likely to visit a
CAM practitioner than their urban counterparts, while a study among 324 residents of the
Ashanti Region of Ghana did not find any significant difference between CAM users residing in
both locations. The available literature reports an equivocal relationship between CAM use and
gender. On one hand, two studies from Ethiopia and Nigeria identified women more than men as
likely CAM users, while another Nigerian study reported men as likely users of CAM. With
respect to religion, a community-based study in Enugu, Nigeria reported CAM users were likely
to be Christians than other religions, whereas another Nigerian study conducted in Imo State did
not observe any significant difference. Meanwhile, two Nigerian studies reported no significant
correlation between the socio demographic characteristics of the respondents and CAM use.
(Adinma E , Azuike E ,  Okafor-Udah C, 2010 Ogbera AO , Dada O , Adeyeye F , et al 2011)

In summary, CAM users compared with non-CAM users in the general population across Sub-
Saharan Africa are more likely to be of low socioeconomic status, while there were
inconsistencies in age, sex, educational status, spatial location and religious affiliation among
CAM users.

2.6.2 Awareness and utilization of complementary alternative medicine

21
Awareness is the state of knowing, understanding, perceiving and having a feeling about a
situation. In this case people know all that entails CAM such as how and when to use CAM,
storage, contraindications, benefits, side effects, regulations and policies governing CAM (WHO
2007,2014. The WHO (2004) constructed consumer information about CAM to enable them use
CAM appropriately.

According to Astin (1998), the predictors of CAM include higher education. Health professionals
are also encouraged to be knowledgeable on CAM through trainings, continuous medical
education and workshops to equip themselves with skills and knowledge to enable them advise
patients and embark on research. This was witnessed in California where a third of family
physicians who were aware and believed that CAM works, were able to administer one of the 16
types of CAM (Amster A. Michael, Cogert Greg, Lie A. Desiree,2001; Gaylord, Susan; Norton,
Sally Curtis, 2004; Alliance, 2010; Fujiwara, Imanishi, Watanabe, Ozesa, & Sakurada, 2011).

There is a lot of diversity and variation of CAM because it is different from one
country/community to another and that is why every individual should take the responsibility to
know the CAM available in their native land (WHO, 2014). This will enable one to make an
informed choice because every person has the right to information (Stuttaford et al., 2014).

CAM knowledge is broadcasted from one generation to another verbally. For example a person
is recruited to work with CAM practitioners for a period of 6 months - 1 year till he/she gains
knowledge, skill and experience before allowed practice on his/her own (Lambert et al.,2009).
Majority of CAM practitioners had no formal education (primary, secondary or tertiary) before
21st century. In the early 21st century, there was establishment of education system up to
university level for those who would want to practice CAM especially in established economies
like European countries, Asia, China (Schoonover et al., 2014). In Lenya a person who wants to
practice CAM are also trained to university level although it is not a common practice.

2.6.3 Hospital related factors and CAM utilization

Cancer is among the leading causes of death globally. Despite advancing technology in
conventional methods of cancer diagnosis and treatment, access to services remains a big
challenge especially in the developing countries. Out of desperation, patients may be tempted to
use Complementary and Alternative Medicine (CAM) to improve their health outcomes. This

22
has led to the rise in use of Complementary and Alternative Medicine (CAM) among patients
with chronic diseases like cancer in developing nations.

2.6.4 Culture and utilization of complementary alternative medicine.

Culture is the way of life for a group of people living in geographical area with same
infrastructure. In addition to that, overview of Leininger’s theory of culture are diversity and
universality (2008), described culture as a set of values, beliefs and traditions that are held by a
specific group of people and passed on from one generation to another. Use of traditional
medicine depends on the traditional practices of that area in the maintenance of their health.

Every community has a system of health in line with its cultural values and beliefs. They have
traditional healers, diviners and spirits and they are often consulted first before seeking health
care in the conventional medicine. This has been practiced since ancient times before the coming
of Christian missionaries. The view of causes of wellness and illness differ from one culture to
another. At the same time, in some communities, the culture of CAM has been fully accepted
and integrated into the mainstream health like Chinese, Korea and Japan who have
institutionalized CAM to complement biomedicine (Sita, 2011; Shim, 2016)

According to Astin (1998), people do not seek CAM because they are dissatisfied with
conventional medicine, but instead it is due to their own values, culture, belief and philosophical
orientation forwards health and life (Hoeflich, 2010). CAM is termed as mixed bag because of
integration of respect and collaboration between different views of health and healing, resulting
in mutual transformation. Biomedical practitioners focused on the diagnosis and treatment of
diseases.

23
Immigration of individual within the same for example rural urban migration and vice versa
promotes a mix of culture and inter-exchange of cultures. International migration has led to
exchange of cultures between different nations and that is how some CAM came to be outside a
certain country of origin. For example, Chines medicine is now widespread to different countries
including Kenya.

Patients’ reasons for using Complementary and Alternative Medicine (CAM) as adjuvant therapy
include inaccessibility of conventional medicine, dissatisfaction, expensive allopathic medicine
and recommendations by family and friends.

According to Astin (1998), people do not seek CAM because they are dissatisfied with
conventional medicine, but instead it is due to their own values, culture, belief and philosophical
orientation forwards health and life (Hoeflich, 2010). CAM is termed as mixed bag because of
integration of respect and collaboration between different views of health and healing, resulting
in mutual transformation. Biomedical practitioners focused on the diagnosis and treatment of
diseases.

Other reasons stated by CAM users included: CAM modalities being considered effective, fear
of drug side effects, they bring more satisfaction and the urge for more personal attention given
by CAM providers

24
INDEPENDENT VARIABLES INTERVENING VARIABLE DEPENDENT VARIABLE

Awareness, Types Government

Modes of
admission Policies

Culture, belief,
Religion, value
Utilization of
CAM

Affordable/ cost

Comorbid
condition
Duration of illness

25
 CHAPTER THREE: STUDY METHODOLOGY

3.0 Introduction
This chapter describes the various method used in the study. It includes the study area, study
design, study population and sample, sampling technique and sample size and data collection
methods and tools.

3.1 Study area

Machakos Level 5 Hospital is situated in Eastern Kenya. The hospital is in Machakos Town
approximately 63.9km from Nairobi County which serves a population of about 1.5 Million
people from Machakos, Kitui and Makueni. It offers outpatient services and inpatient services
with presence of inpatient wards (male, female and paediatric) with a bed capacity of around 50
patients where very sick patients can be admitted. The hospital also provides ambulance services,
laboratory services, pharmaceutical services, nursing services, radiology services and child and
maternal health.

3.2 Study design

Quantitative descriptive cross sectional study will be used to carry out the study.

3.3 Study Population

The study population will be the patients attending the cancer clinic at Machakos Level 5
Hospital

3.3.1 Inclusion Criteria

Persons who are in 18 years and above attending Cancer clinic at Machakos Level 5 Hospital,
Machakos County and have given consent
3.3.2: Exclusion criteria
Persons in the inclusion criteria who will not consent or are severely sick and cannot participate
in the study.

26
3.4: Sample size determination.
Yamane’s formula (1967:886) was used to determine the sample size.

n = N

1 + N (e) 2

Where; n is the sample size

N is the daily population receiving healthcare services

e is the level of precision, usually 0.05

n = 300

1+300(0.05)2

n= 270

3.5: Sampling technique

A simple frame of the cancer patients in the hospital will be obtained from the central registry
using outpatient numbers. Then it will be stratified. The proportion of the patient in each strata
will be worked out by diving the number of patients in each strata by the total number of cancer
patients in the population in the hospital at the time of study and multiplying results by 270
which is the estimated sample size. In each of the strata, systematic random sampling will be
used to select the required number of patients until a total of 270 is reached. Systematic random
sampling from each stratum will be calculated by dividing the total number of patient stratum
(N) by the desired sample size (n) to give K. Every kth patient on the list and eligible will be
included in the sample.

3.6: Data collection method and tools

Data will be collected with a well-structured self-administered questionnaire after a consent is
sought.
27
3.7: Pretesting of data collection tools
The tool for data collection will be tested at a similar place using 27 respondents with the similar
characteristics before commencing the actual data collection process in order to ensure validity
and reliability of the results. Pre-testing with the interview guide will carried out at Thika Level
5 Hospital, Kiambu County

3.8: Data entry and analysis

Data will be collected, coded and entered into Microsoft excel for transfer into Statistical
Package for Social Science (SPSS) version 22. Data will then be summarized using means,
percentages, frequency tables and measures of dispersion.

3.9: Ethical considerations

The proposal is to be approved by the Jomo Kenyatta University Research and Ethical
Committee. Access to patients within Machakos Level 5 Hospital is to be granted by the Medical
Officer In charge at the hospital. Participants will be thoroughly explained to the study objectives
and freedom to be interviewed or withdraw. They will be required to sign a consent form.
Collected data will not reflect on an individual identity.

28
 References

(WHO), W. H. (2002, April 30th). Traditional Medicine Strategy. Retrieved from

www.who.int/medicines/publication/traditionalpolicy/en

Abdallah R, X. Y.–1. (2015). Complementary and Alternative Medicine Use in Women With
Gynecologic Malignancy Presenting for Care at a Comprehensive Cancer Cente. 1724-
1730.

Alireza Salehi, M. M. (n.d.). The Evaluation of Curative Effect of Acupuncture.

C. M. Gitobu, P. B. (2018). Satisfaction with Delivery Services Offered under the Free Maternal
Healthcare Policy in Kenyan 1.0%. Journal of Environmental and Public Health,2018.

CAM, N. C. (2005-2009, November 2018). Expandinding horizons in Kenya. Retrieved from

Strategic Planning: http:nccam.gov/aboutplans2005

Dric LC, H. f. (2009). Prevalence of glucose intolerance and assosiated risk factors in rural
urban populations in different ethnic groups in Kenya . PubMed|GoogleScholar. Retrieved
from Pubmed|Google Scholar

Duncan Mwangangi Matheka, A. R. (n.d.). Complementary and alternative medicine use among
diabetic patients in Africa: a Kenyan perspective.

Federation, I. D. (2013, April 30th ). Diabetes atlas 5th edition. Retrieved from http;\
www.idf.org\diabetesatlas\new\fifthedition

Hampel N, J. S. (2006). Gaining insight in what, where and when of CAM by cancer patients and
survivors . Chicago.

J.Astin. (1998). Why patients use alternative medicine: results of a national study. 1548-1559.

K. J. Kemper, S. V. (n.d.). The Use of Complementary and Alternative Medicine in Pediatrics.

KJ, K. (2002). The Holistic Approach to treatment of diseases 2nd edition.

Marie A Hustelle, P. K. (2008). Complimentary and Alternative Medicine use among the elderly
patients.

29
Maryanne Ong’udi, P. M. (2018). Study of the use of complementary and alternative medicine by
cancer patients at Kenyatta National Hospital, Nairobi, Kenya.

Molassiotis A, O. G. (2006). Complementary and alternative medicine use in patients with head
and neck cancers in Europe. European Journal.

Ottolini MC, H. E. (2001). Complementary and alternative medicine use among patients. 122-
125.

P., A. (2006). Diabetes and traditional medicine in Africa. Retrieved from google scholar.

Pitetti R, S. S. (2001). Complementary and alternative medicine use. 165-169.

PO Erah, I. S. (n.d.). Medication Management, Use and Safety in Non- Communicable Diseases:
Any Hope for the Nigerian Patients?

Rutebemberwa E, L. M. (2013, May 24). Use of traditional medicine for the treatment of
diabetes in Eastern Uganda: a qualitative exploration of reasons for choice. Retrieved
from BMC International Health & Human Rights:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3544563/

Duncan M.M , (Maryanne Ong’udi, 2018)A,R,D (2013). Complementary and alternative

medicine use among diabetic patients in Africa: a Kenyan perspective. Pan African
Medical Journal

(Duncan Mwangangi Matheka) (K. J. Kemper) (Mohamed M Abdelwahab) (PO Erah) (Alireza
Salehi)

30
APPENDIX
APPENDIX 1 CONSENT FORM

ASSESSMENT OF FACTORS INFLUENCING THE UTILIZATION OF

COMPLEMENTARY AND ALTERNATIVE MEDICINE AMONG CANCER PATIENTS
AT MACHAKOS LEVEL FIVE HOSPITAL, MACHAKOS COUNTY, KENYA

I hereby give my permission to JACKLINE MBITHE NGAI to allow me to respond to a

questionnaire and quote my response in a scholarly research proposal paper. I understand that
this work is for academic purposes.

I understand that I waive any claim for copyright to this material should the researcher ever
publish it in a scholarly journal or in electronic format online.

I understand that the research title is assessment of factors influencing the utilization of
complementary and alternative medicine among cancer patients at Machakos Level Five
Hospital, Machakos County, Kenya.

I also understand that the researcher hereby named JACKLINE MBITHE NGAI will maintain
my anonymity with regard to my responses to the questionnaire.
I hereby give my permission in the form of the signature below:

Signature of research participant

………………………………….. ………………………………………..

Signature of participant Date

Signature of researcher

I believe the participant is giving informed consent to participate in this study

………………..……………………. …………………………………………

31
Signature of researcher Date

APPENDIX 11: QUESTIONNAIRE

Questionnaire number….. Facility……………………………. Designee intials………

INSTRUCTIONS

Please do not write your name anywhere in this questionnaire

Put a tick in box next to the best response

Where no responses/ choices are provided please write the response in the spaces provided

SECTION 11: SOCIO DEMOGRAPHIC DATA

32
1. Gender MALE FEMALE (circle)
2. How old are you
(a)18-27 ☐ (b) 28-37 ☐ (c)38-47☐ (d) 48-57 ☐ (e) 58-67☐
3. Ethnicity……………………….
4. Religion
(a)Christian ☐ (b) Muslim ☐ (c) atheist ☐ (d) other ☐
5. Education

(a)Primary ☐ (b) Secondary ☐ (c) Tertiary☐

Other specify………………………

6. Marital status
(a)Married ☐ (b) Single☐ (c) Divorced☐
7. Duration of illness
(a)0-5 yrs.☐ (b) 6-10yrs ☐ (c) 11-15yrs ☐ (d)16-20yrs☐

SECTION 2: AWARENESS-CULTURE-AFFORDABILITY FACTORS THAT

INFLUENCE PATIENTS IN THE UTILIZATION OF COMPLEMENTARY
ALTERNATIVE MEDICINE AT MACHAKOS LEVEL 5 HOSPITAL

8. Awareness of the use of CAM in maintenance and health

☐ yes ☐ no

9. If no what are the reasons of utilizing CAM

10. What type of complementary and traditional medicine have you received?

Chiropractic

☐Prayers

☐Laxative

☐ Herbal medicine

33
 ☐Homeopathy

☐ Meditation

☐ Massage

☐ Nutrient

11. How are you been using your CAM and conventional treatment as your treatment progress

☐Use to help each other?

☐Use the CAM instead of the conventional medicine

☐Use conventional medicine instead of CAM

☐Others specify

12. What are the reasons for deciding to utilize CAM?

☐You were disappointed that conventional medicine is not healing

☐You think CAM is important keeping with your belief, culture and your inner-self

☐You want to control your treatment and your faith

☐You are trying that works

☐Conventional treatment lacks human touch

13. What benefits do you hope to get?

☐Relieve of symptoms of conventional treatment

☐Improve well being

☐Cure of your disease

☐Sleep and relaxation

☐Boost your immunity

34
Others specify……………………………………

14. How do you acquire the products?

☐Shops ☐visiting the practitioners

Others specify…………………………………..

15. Do you discuss the use of complementary and alternative medicine with your health care
worker?

☐Yes ☐ no

16. If no what are some of the reasons that hinder you fro discussing with health care worker

17. What are some of your cultural belief that support use of complementary medicine in your
community

18. How do you raise funds for paying your complementary and alternative medicine?

☐Sales ☐personal business

☐Harambees ☐ family contributions

19. Do you have a medical cover? YES NO

20. How much per dose do you pay (kshs)

☐0-1000 ☐1000-5000 ☐5000-10000

Others specify…………………………………………………..

21. In your opinion what are the structures that support and regulate complementary and
alternative medicine

☐Church ☐ Government

☐Community specify others……………………

35
APPENDIX 111: WORKPLAN
Activity January February March April May June
2022
2022

Proposal
development

Proposal defense

Ethical review

Data collection

Presentation of
results

Bound project
submission after
correction

APPENDIX 1V : MAPS

36
KENYAN MAP SHOWING MACHAKOS COUNTY

MACHAKOS COUNTY MAP SHOWING MACHAKOS LEVEL 5 HOSPITAL

37
38