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 Table of Contents  
ORIGINAL RESEARCH REPORT
Year : 2017  |  Volume : 14  |  Issue : 1  |  Page : 25-28

Strategies to reduce barriers in reporting herbal use to the health-care provider among women of childbearing age in two communities in Ogun state, Nigeria


Department of Nursing Science, Faculty of Clinical Sciences, University of Lagos, Idi Araba, Lagos, Nigeria

Date of Web Publication30-Jan-2017

Correspondence Address:
Florence F Folami
Department of Nursing Science, Faculty of Clinical Science, University of Lagos, Idi Araba, Lagos
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2468-6859.199169

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  Abstract 

Background: The use of complementary and alternative medicine (CAM) has increased tremendously in the past decades. Herbs in this study involved the use of plant products in their raw or cooked forms which have not been subjected to laboratory investigations for their safety and efficacy. Objective: To explore strategies to reduce barriers in reporting herbal use to the health-care provider among childbearing age women in two communities in Ogun state, Nigeria. Materials and Methods: A descriptive cross-sectional survey was used to explore strategies to reduce barriers in reporting herbal use to the health-care provider. The study population constitutes childbearing age women that attend two private hospitals and one comprehensive health center in two communities of Ogun state, Nigeria. Out of the 270 patients who were randomly sampled for the study, 250 agreed to participate (response rate: 92.6%). Results: The mean age of the participants was 29.3 years ± 5.5 and 77.6% were married. The majority (69%) had used herbal medicines in the last 6 months before seeking medical care, and 66% did not disclose the use of herbal medicines to health-care providers. Conclusion: Health-care professionals should routinely include herbal remedy category in the list of drug history when asking about the patient's drug. This will help identify herbal remedy use and assist to take precautions relating to safety. Patients and traditional birth attendants should be educated through community mobilization and educational programs about alternative medicines particularly herbal. The disclosure of CAM use and its adverse outcomes should be encouraged by health-care professionals.

Keywords: Barriers, complementary and alternative medicine, health-care provider, herbal use, strategies


How to cite this article:
Folami FF, Ademuyiwa IY. Strategies to reduce barriers in reporting herbal use to the health-care provider among women of childbearing age in two communities in Ogun state, Nigeria. J Clin Sci 2017;14:25-8

How to cite this URL:
Folami FF, Ademuyiwa IY. Strategies to reduce barriers in reporting herbal use to the health-care provider among women of childbearing age in two communities in Ogun state, Nigeria. J Clin Sci [serial online] 2017 [cited 2019 Oct 14];14:25-8. Available from: http://www.jcsjournal.org/text.asp?2017/14/1/25/199169


  Introduction Top


The use of complementary and alternative medicine (CAM) has increased tremendously in the past decades. Beliefs about CAM use have been associated with patient's adherence to CAM.[1],[2] CAM has been used as a form of alternative therapy over the years, and their uses have effective sources of medicines, and this has become an important part of most cultures across the world. While pharmaceutical products have evolved over time to be the most preferred and alternative means of health care, the concurrent use of CAM remedies has not been abandoned entirely around the world. The 2007 National Health Interview Survey (NHIS), which involved a comprehensive survey of CAM use by Americans, showed that approximately 38% of adults use CAM.[3],[4]

The use of CAM still persists in local communities, especially in low-income countries where access to pharmaceutical products may be inaccessible or unaffordable. Kochhar K, Saywell R, Zollinger T, Mandzuk C, Haas D, Howell L.[5] stated in their study that inadequate access to pharmaceutical products was a result of lack of transportation, and economic resources are factors that increases the use of herbal remedies in low-income countries. Access to herbal remedies is easier than access to pharmaceutical products because they are readily available to buy in the local markets. McCrea and Pritchard [6] reported that many people use herbal medicine because of the publicity through the media, information from friends, and families who have benefitted from the individual herb or even from their own personal information and knowledge about a particular product.

Childbearing age women are the largest consumers of healthcare and their utilization of CAM.[5],[7],[8],[9] There is higher increase intake of herbal remedy as a form of alternative medicine among childbearing age women in the local communities, especially among pregnant women. However, it is known that any kind of medicine used during first 3 months of pregnancy might have a harmful effect on both the mother and the fetus; therefore, the risk of damage done to the fetus is great in the first few weeks of pregnancy when major organs are developing.

Research also examines the reasons for choosing herbal remedies. Studies surveying the United States adults examined that the most common reasons for herbal remedy use were to preserve health and for chronic nonlife-threatening conditions.[10],[11],[12] In people diagnosed with depression, the reason cited for choosing herbal remedies desired a natural approach that was consistent with their values and beliefs without experiencing negative side effects of pharmaceutical treatments.[10],[12] Herbal remedies were used among pregnant women for a variety of conditions during and after pregnancy including nausea, vomiting, perineal discomfort, lactation disorder, postpartum depression, preterm labor, and lower back pain.[13],[14],[15]

In Nigeria, laws regulating sales and distribution of herbal medicines are poor while access to herbal medicines is largely unrestricted. Indiscriminate use of herbal remedies in different forms is very rampant.[6] Manufacturers of herbal medicines usually offer a broad range of therapeutic claims which are powerful temptations for consumers who perceive herbal drugs to be better and safer alternatives to conventional drugs prescribed by their physicians. In a setting like Nigeria where there are strong perception and widespread utilization of herbal preparations, it becomes imperative to explore strategies to reduce barriers in reporting herbal use to the health-care provider; hence, this study explored strategies to reduce barriers in reporting herbal use to the health-care provider among childbearing age women in two communities in Ogun state, Nigeria.


  Materials and Methods Top


A descriptive cross-sectional survey was used to explore strategies to reduce barriers in reporting herbal use to the health-care provider among childbearing age women in two communities in Ogun state, Nigeria. The study population constitutes childbearing age women that attend two private hospitals and one comprehensive health center in two communities in Ogun state, Nigeria. The communities are semi-urban with a population of about 150,000 people and have two health centers and few private. A total of 250 respondents were randomly sampled for the study. The data were collected at the individual level using 23-item semi-structured questionnaire. The questionnaire was used to collect data on the sociodemographic characteristics of the women, the prevalence of utilization of herbal remedies, factors that influence the utilization of herbal use, and reasons for nondisclosure of herbal use to health-care provider. Respondents voluntarily participated in the study, and informed consent was obtained from the respondents.

Analysis of the data was done using Statistical Package for Social Sciences (IBM SPSS) 17.0 version. United States; 2010. Descriptive statistics were used to describe the demographic characteristics of the sample and major study variables. Associations between variables were examined using Chi-square.

Chi-square analysis was used to examine differences in likelihood to use CAM based on respondent characteristics; this was done using respondent total scale scores, divided at the median. An alpha level of 0.05 was considered significant for all tests.


  Results Top


A total of 250 questionnaires were distributed to women of childbearing age in the selected health-care institutions, and a response rate of 100% was gotten. The mean age of the participants was 29.3 years ± 5.5, and 194 (77.6%) of the participants were married. Seventy-five percent (187) of the participants have equal or greater than secondary education while 25% (63) of the participants have primary or less than primary education [Table 1]. The majority (69%) had used herbal medicines in the last 6 months before seeking medical care, and 66% did not disclose the use of herbal medicines to health-care providers. The participants were probed further for reasons for the herbal medicine use, herbal recommendation source, and reasons for nondisclosure of herbal use to health-care providers [Table 2] and [Table 3]. Participants (n = 130) were asked to pick the statement that best completed this sentence: “I do not tell my Health Care Provider about my CAM use because….” Out of the five structured responses and “other,” which allowed for an open-ended response, the most common response was because “he/she is most concerned about my physical well-being” (32%) and “other” (25%) followed by “I just did not think to tell him/her” (20%). The most common reasons participants (n = 25) reported to have selected “other” were: I'm comfortable speaking with my physician(s), my family told me not to report to my physician, a greater sense of control of self, and a more personal focus on health [Table 4].
Table 1: Demographic characteristics of the respondents

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Table 2: Reasons for using herbal medicine reported by the participants

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Table 3: Source of information on herbs

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Table 4: Reasons for nondisclosure of herbs use

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  Discussions Top


The findings of this study indicate a very high prevalence of CAM use among childbearing age women in Ajuwon-Akute communities. Although the prevalence found for the use of different CAM modalities were wide-ranging (28% to 91%), 88% prevalence for any type of CAM use as a therapy was higher than other estimates, which typically range from 40% to 83%.[5],[8],[16],[17] The reported nondisclosure percentage in this study (66%) is higher than the general population's estimate for CAM nondisclosure but comparable to other reported nondisclosure proportions among patients with a serious illness (47%–85%).[7],[10] There were some limitations to the findings of this study because the study only used childbearing age women in two communities in Ogun state, which may prevent the findings to be generalizable to different populations. This study found that the potential reasons for the low disclosure of herbal remedy usage to health-care providers are the same with the study done by Fakeye TO, Adisa R, Musa IE.[12] The reasons included a lack of inquiry from physicians, viewing the report of herbal use as unimportant, and fear of negative reaction from health-care provider. The findings indicated that out of the 31,044 participants, 29% used herbal remedies, and out of the 29%, only 33% reported it to their health-care provider.

This study also demonstrated that CAM use, specifically among childbearing age women in two communities in Ogun state, Nigeria, did not significantly vary by age or education. Other studies that reported CAM usage from underrepresented populations have found that CAM use was high among poor, older, and ethnic minority adults.[9] This inclusivity of results may contribute to our null findings when analyzing the overall use of CAM among a homogeneous group of patients. Furthermore, it indicates the importance of differentiating CAM modalities when assessing CAM use among childbearing age women.


  Conclusion Top


Potential reasons for the low disclosure of herbal remedy usage included a lack of inquiry from physicians as evidenced by the findings from the study that health-care providers are most concerned about patients' physical well-being, and most patients do not voluntarily disclose information unless they were asked. Effective health-care providers and patients communication can assist to determine how much and how often patients are using herbal remedies. Health-care providers should routinely include herbal remedy category in the list of drug history when asking about the patient's drug use. This will help identify those who use herbal remedies and therefore assist them to take precautions relating to safety. Understanding the pattern of women utilization of herbal remedies will enable health-care providers to provide the best quality of care for patients. Integration of conventional and CAM may also enhance disclosure, but there have been a growing number of concerns regarding the mixing of herbal remedies and conventional medicine due to some of the negative effects on patient care. Due to issues such as safety, efficacy, and herb-drug interaction, it is very important for childbearing age women to discuss herbal use with the health-care providers. Mothers, family members, friends, and traditional birth attendants should be educated through community mobilization and education programs that herbal medicines may be harmful therefore should be taken with precaution or avoided if possible. Considering the utilization of herbal remedy by the women in this study, there is a need for rigorous laboratory exploration of common herbal remedies being used by women. Such evidences are needed for educating women on the safe use of herbal remedy. Health professionals have a unique and distinct opportunity to fulfill this responsibility of educating childbearing age women on potential benefits and risks of using herbal remedy. There is also a need for research to better understand the barriers that prevent open communication among health-care providers and patients. These strategies would help toward optimizing patient care and promote integrative approach to health care.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Mbwanji JG. Prevalence of Herbal Medicine Use and Associated Factors among Pregnant Women Attending Antenatal clinic at Mbeya Refferal Hospital. Tanzania. Muhimbili University Institutional Repository; 2012.  Back to cited text no. 1
    
2.
Olowokere AE, Onibokun AO, Irinoye O. Health beliefs of women and breast cancer screening practices in selected rural communities of Oyo state. Afr J Midwifery Womens Health 2012;6:12-20.  Back to cited text no. 2
    
3.
Sharma M. Health belief model: Need for more utilization in alcohol and drug education. J Alcohol Drug Educ 2011;55:3-6.  Back to cited text no. 3
    
4.
Tamuno I, Omole-Ohonsi A, Fadare J. Use of herbal medicine among pregnant women attending a tertiary hospital in Northern Nigeria. Internet J Gyn Obstet 2011;15:3-6.  Back to cited text no. 4
    
5.
Kochhar K, Saywell R, Zollinger T, Mandzuk C, Haas D, Howell L, et al. Herbal remedy use among Hispanic women during pregnancy and while breastfeeding: Are physicians informed? Hisp Health Care Int 2010; 8:93-106.  Back to cited text no. 5
    
6.
McCrea CE, Pritchard ME. Concurrent herb-prescription medication use and health care provider disclosure among university students. Complement Ther Med 2011;19:32-6.  Back to cited text no. 6
    
7.
Louik C, Gardiner P, Kelley K, Mitchell AA. Use of herbal treatments in pregnancy. Am J Obstet Gynecol 2010;202:439.e1-10.  Back to cited text no. 7
    
8.
Griffith R, Tengnah C. Regulation of herbal medicines. Br J Community Nurs 2010;15:445-8.  Back to cited text no. 8
    
9.
Bamidele JO, Adebimpe WO, Oladele EA. Knowledge, attitude and use of alternative medical therapy among urban residents of Osun state Southwestern Nigeria. Afr J Tradit Complement Altern Med 2009;6:281-8.  Back to cited text no. 9
    
10.
Gratus C, Wilson S, Greenfield SM, Damery SL, Warmington SA, Grieve R, et al. The use of herbal medicines by people with cancer: A qualitative study. BMC Complement Altern Med 2009;9:14.  Back to cited text no. 10
    
11.
Blalock SJ, Gregory PJ, Patel RA, Norton LL, Callahan LF, Jordan JM. Factors associated with potential medication-herb/natural product interactions in a rural community. Altern Ther Health Med 2009;15:26-34.  Back to cited text no. 11
    
12.
Fakeye TO, Adisa R, Musa IE. Attitude and use of herbal medicines among pregnant women in Nigeria. BMC Complement Altern Med 2009;9:53.  Back to cited text no. 12
    
13.
Archer EL, Boyle DK. Herb and supplement use among the retail population of an independent, urban herb store. J Holist Nurs 2008;26:27-35.  Back to cited text no. 13
    
14.
Mehta DH, Gardiner PM, Phillips RS, McCarthy EP. Herbal and dietary supplement disclosure to health care providers by individuals with chronic conditions. J Altern Complement Med 2008;14:1263-9.  Back to cited text no. 14
    
15.
Arcury TA, Grzywacz JG, Bell RA, Neiberg RH, Lang W, Quandt SA. Herbal remedy use as health self-management among older adults. J Gerontol B Psychol Sci Soc Sci 2007;62:S142-9.  Back to cited text no. 15
    
16.
Marinac JS, Buchinger CL, Godfrey LA, Wooten JM, Sun C, Willsie SK. Herbal products and dietary supplements: A survey of use, attitudes, and knowledge among older adults. J Am Osteopath Assoc 2007;107:13-20.  Back to cited text no. 16
    
17.
Forster DA, Denning A, Wills G, Bolger M, McCarthy E. Herbal medicine use during pregnancy in a group of Australian women. BMC Pregnancy Childbirth 2006;6:21.  Back to cited text no. 17
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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