Abstract: Evidence indicates that the use of complementary and alternative medicine (CAM) is increasing globally in both the developed and developing countries. There is therefore a need for studies to determine the factors and safety concerns associated with CAM use. This study investigates the contributing factors and safety concerns of CAM use in a sample of a sub urban population of a community in north western Nigeria. A cross sectional study was conducted using the cluster sampling technique designed to select 500 respondents in Gidan-Igwai area in Sokoto North L.G.A. of Sokoto State Nigeria between May and June, 2011. Most of the study population had some form of formal education and gainfully employed but the lifetime CAM use was still high (84%). About 35% of respondents prefer CAM over orthodox medicine while 48% use CAM for their children. About 54% of the respondents thinks CAM is safe while diarrhoea and vomiting still remain the major reported adverse effect; this owes to the fact that the major indication for CAM use was GI conditions. Affordability and availability and incessant advertisement are part of the factors influencing the use of CAM. A significant proportion of respondent are satisfied with CAM use and are willing to continue, hence an urgent need for regulation and standardization of CAM practice for possible integration.
INTRODUCTION
Complementary and alternative medicine (CAM) is referred to as any form of medical or health care practices and products that does not form part of, or conform to present day orthodox medicine (NCCAM). It is referred to as complementary if used together with the orthodox medicine and alternative if used in place of orthodox medicine (Nwachukwu et al., 2011). These therapeutic practices and products may include among others; acupuncture, chiropractic, naturopathy, herbal medicine, traditional medicine, yoga and prayers that are not conventionally related with orthodox medicine (Adams, 2007). There has been a recent global rise in the use of CAM as an option for fulfillment of healthcare needs in both developed and developing nations, but with higher prevalence in the developing world (Yildrim et al., 2010; Hori et al., 2008). In many 3rd world countries 80% of the population depend on traditional medicine for their primary health care needs and in some African countries 60% of children with high fever will have their care givers use herbal medicine as the first line of treatment (Kasilo et al., 2010). In South-western Nigeria it has been reported that it is a common practice to use CAM to treat children with epilepsy, asthma and sickle cell anaemia (Oshikoya et al., 2008), as further studies have been advocated for CAM use in children with neurological disorders and define potential interactions (Soo et al., 2005). A wide spread use of herbal medicines by pregnant women in Nigeria has also been reported (Fakeye et al., 2009). CAM use is common among cancer patients (Ezeome and Anarado, 2007), osteoarthritis patients on orthodox medication (Obalum and Ogo, 2011), cardiovascular disease patients (Grant et al., 2012) and has been reported as a vital component of management among patients with diabetes, though it did not affect adherence to prescribed medications (Ogbera, et al., 2010). CAM use has also been reported to be high and a cause of non compliance in patients on antiretroviral therapy (Ekwunife et al., 2012).
Despite the health benefits of traditional medicine, adverse reactions have been reported with its use either as compliment or alternate, hence the need to ascertain the degree of adverse effects and safety concerns, so as to strengthen the advocacy for the need for adequate policy formulations and regulation to ensure safety and efficacy of CAM (Onyiapat et al., 2011). Also, as there are multitude of different types of CAM in use and multiple factors influencing their use, hence the need to quantify and describe factors influencing CAM use in our local communities as some CAM have been postulated to adversely affect pharmacokinetics of chemotherapeutic agents and ultimately influence treatment outcome (Jaime-Perez et al., 2012).
Thus, the objective of this study is to define the factors and safety concerns associated with CAM use among Gidan-Igwai residents in Sokoto, north western Nigeria. Based on the study findings the study seek to determine the prevalence of CAM use among the study population, to identify the medical indications and reasons for CAM use, to assess perception of safety of CAM use and to identify the degree and types of adverse effects arising from the use of CAM.
MATERIALS AND METHODS
A cross-sectional prospective study was conducted using cluster sampling method to select 500 respondents in Gidan-Igwai area in Sokoto North L.G.A. of Sokoto State Nigeria in 2011. A modified Semi-structured questionnaire adapted as modified from the methods in a previous similar study (Nwachukwu et al., 2011) was used to obtain information from respondents. Data was extracted, tabulated and analysed on SPSS (version 20.0) using Descriptive statistics. The questionnaire focuses on demography and life time CAM use, current CAM use, use of CAM in children, preference of CAM over orthodox medicine, safety perception and safety concerns, reasons for CAM use, indication for CAM use, types of CAM used, satisfaction and complications from CAM use and the possibility of future CAM use.
RESULTS
Socio-demographic data: The mean age of the study population was 40.4±11.3 years. About 370 (74%) of the study population were males, while 130 (26%) were females. About 48% were married while 52% of the population were unmarried. Hausa/Fulani constitute the major tribe in the study, 58% of the study population had some form of Western education and 55% were gainfully employed (Table 1).
Determinants of CAM use: From the results in Table 2, Lifetime CAM use was found to be 84%, Current CAM use 61%, Use of CAM in Children 48%, Preference of CAM over orthodox medicine was 35%, satisfaction with CAM use was 76 and 56% of respondents will still use CAM in the Future. While about 26% reported adverse effect from CAM use. Reasons for CAM use include trust, affordability and ready availability (Fig. 1), trust and believe in the effectiveness of the CAM preparations and practices accounted for about 29.8% of reasons for CAM use given by respondents, this was closely followed by the ready availability, accessibility and affordability of CAM when compared with orthodox medicine, accounting for 28.5% of respondents, while influence of family members friend and relations accounted for about 23.8%, with incessant advertisement and other reasons accounting for the rest.
| Table 1: | Demographic data of the study population N = 500 |
| Table 2: | Factors associated with CAM use N = 500 |
| Fig. 1: | Respondents reasons for CAM use in percentage |
Gastro Intestinal conditions accounted for about 50% of all indications for CAM use, followed by febrile illness accounting for about 20% (Fig. 2) and most used CAM were mainly local herbal preparations.
Safety concerns: For the safety Concerns, 54% of the study population thinks CAM is safe, while 17% thinks CAM is not safe and about 29% not sure whether or not CAM is safe (Fig. 3).
| Fig. 2: | Respondents medical indications for CAM use in percentage |
| Fig. 3: | Respondents perception of safety of CAM use in percentage |
| Fig. 4: | Respondents safety concerns of CAM use in percentage |
The main safety concern of respondents in this study was hygiene accounting for over 40%, followed by adverse effects accounting for about 29%, while lack of dosing regimen, content label and others accounted for the remainder (Fig. 4).
| Fig. 5: | Most common adverse effect reported from CAM use |
Adverse effect reported were mainly diarrhea and vomiting accounting for up to 53% (Fig. 5).
DISCUSSION
Majority of our respondents in this study were within the ages of 21 to 50 years with a mean age of the study population of 40±11.3 years. Majority were male and married from the Hausa extraction, with more than one half of the study population having some sort of employment and a form of western education, but despite the reported level of education and degree of employment in this study there was a high prevalence of CAM use among the people of Gidan Igwai, a sub-urban community in Sokoto state, the result is similar to reports of studies of CAM use in the general population, 88.5% in south-western Nigeria (Nwachukwu et al., 2011), 76% in Japan (Yamashita et al., 2002), 60% in Taiwan (Chen et al., 2007), 62% in the US (Tindle et al., 2005), in Australia (Xue et al., 2007), Canada (Millar, 1997), Denmark, Norway (Hanssen et al., 2005) and UK (Ernst and White, 2000) ranges from 9 to 69%.
Despite the fact that all of the study respondents were adults, almost one half of the study population uses CAM in their children this is in tandem with the studies of Oshikoya et al. (2008) who suggested that parents are willing to engage their doctors on the beneficial use of CA M for their children and hence paediatricians should be proactive in engaging their patients care givers to clear some of the misconceptions about CAM use in children, as treatment of the paediatric age group with CAM is common by their care givers with no input or guidance of their paediatrician (Ottolini et al., 2012).
Up to 35% of the study respondents prefers CAM to orthodox medications and more than double this figure are satisfied with the use of CAM, with more than one half of the study population ready to use CAM in the future, this may not be unrelated to its perceived ready availability, accesibility and affordability, this is similar to a report in Korea on the use of CAM in patients with androgenetic alopecia, atopic dermatitis and psoriasis, it was found that 51.6% of the respondents prefer CAM to orthodox medicine (Kim et al., 2012). Another similar study revealed that a significant percentage of the respondents not only prefer but also use alternative medical therapies despite the fact that they have an unhindered access to the orthodox medical care (Bamidele et al., 2009).
The main indication for CAM use was GI conditions popularly called “Dankanoma” in Hausa language (a vague description for a barrage of symptoms that may include several unrelated pathology from multiple organ systems but mostly beginning from the GIT). Most common adverse effect is diarrhoea and vomiting this may be due to the fact that most herbal products are taken orally and may not be unconnected to direct contamination of the local herbal preparations which is the most frequently used CAM, hence the health seeking behavior including CAM use amongst patients should be soughed for so as to counsel the patients on the potentials of adverse drug reactions, drug-CAM interactions and chronic complications (Obalum and Ogo, 2011).
More than one half of our study population think CAM use is safe and more than one quarter have no idea on whether or not CAM is safe, these findings are similar to the report of Grant et al. (2012) in which it was opined that a large portion of patients using CAM believes that they were safe if not safer than the orthodox prescriptions. This perception and belief may not be unconnected to the common ideology that CAM are mostly from natural products and hence has to be safe, the perception of safety of CAM may also be due to misconception of the potential hazards of some herbal products and practice and to the influence of incessant advertisement of its safety and efficacy on our airwaves. Bamidele et al. (2009) concluded that advising patients and the general public on alternative medical therapy presents a professional challenge because some of their effectiveness and safety are yet to be objectively validated. Soo et al. (2005) suggested that Doctors ought to open discussion on CAM at some point in clinic visits so that the patients and patient relatives can make informed decisions about using CAM and that clinicians must enquire from their patients about the use of CAM, so as to facilitate them as a guide to better advice the patients (Ezeome and Anarado, 2007).
CONCLUSION
The prevalence of CAM use is high in this environment, affordability and availability are the most frequent reason for its use. GI symptoms are the most common indication and the most common adverse effect. Hygiene and side effects is the most frequent safety concerns raised, though more than one half of the respondents thinks CAM is safe. A significant proportion of respondents prefer CAM over orthodox medications, satisfied with CAM use and are willing to continue, hence the need for regulation and standardization of CAM practice for possible integration. The need for the integration of CAM practice cannot be over emphasized, but it should be after capacity building and objective validation of the safety and efficacy of CAM products and practices. And an urgent need for standardization and legislation for regulation of CAM practices.