|Year : 2018 | Volume
| Issue : 2 | Page : 77-81
Herbal medicine use by Saudi patients with chronic diseases: A cross-sectional study (experience from Southern Region of Saudi Arabia)
Mushabab Ayed Alghamdi1, Abdel Gaffar A. Mohammed2, Fahad Alfahaid3, Ali Albshabshe4
1 Department of Internal Medicine, College of Medicine, University of Bisha, Bisha, Kingdom of Saudi Arabia
2 Department of Medicine, Division of Rheumatology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
3 Department of Family Medicine, College of Medicine, Majmaah University, Majmaah, Kingdom of Saudi Arabia
4 Department of Internal Medicine, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
|Date of Web Publication||2-Apr-2018|
Dr. Mushabab Ayed Alghamdi
Department of Internal Medicine, College of Medicine, University of Bisha, Bisha
Kingdom of Saudi Arabia
Background: Herbal medicine use has become a popular treatment among patients with chronic diseases worldwide. Many patients with chronic illnesses use herbal medicine without consulting their healthcare professionals. Therefore, the primary aim of this study was to determine the frequency and correlates of herbal medicine use in Saudi patients with chronic diseases. The secondary aim was to explore how frequent patients with chronic illnesses consult their healthcare professionals for concomitant use of conventional treatment and herbal medicine.
Materials and Method: A cross-sectional study conducted from December 2014 to January 2015 at King Abdullah General Hospital in Bisha. Adults aged > 18 years with chronic illnesses were enrolled in the study. The survey data form included demographic data and types of herbal medicines. Multivariate logistic regression was used to explore the effect of different factors promoting the use of herbal medicine.
Results: Of the 235 patients who completed the data form, the prevalence of herbal medicine users was (67.65%), with Trigonella foenum-graecum (32.7%), Pimpinella anisum (19.49%), Nigella sativa (17.61%), Green tea (13.83%) and Peganum (5.66%) as the most frequently used. Nearly 88.67% of herb users did not consult their healthcare professionals. Almost 90.56% of healthcare professionals did not respond to herbs users' questions about herbal medicine. Patients with increased age and living in the urban area are likely to use herbal medicine with odds ratio (OR): 4.12, 95% confidence interval (CI): 1.94–8.74 and OR: 109.20, 95% CI: 31.88–374.02, respectively.
Conclusion: This study revealed a high prevalence of herbal medicine use among patients with chronic diseases. More awareness and education about risks and complications of herbal medicine use are needed for both patients and healthcare professionals.
Keywords: chronic diseases, complementary and alternative medicine, herbal medicine
|How to cite this article:|
Alghamdi MA, A. Mohammed AG, Alfahaid F, Albshabshe A. Herbal medicine use by Saudi patients with chronic diseases: A cross-sectional study (experience from Southern Region of Saudi Arabia). J Health Spec 2018;6:77-81
|How to cite this URL:|
Alghamdi MA, A. Mohammed AG, Alfahaid F, Albshabshe A. Herbal medicine use by Saudi patients with chronic diseases: A cross-sectional study (experience from Southern Region of Saudi Arabia). J Health Spec [serial online] 2018 [cited 2019 Mar 18];6:77-81. Available from: http://www.thejhs.org/text.asp?2018/6/2/77/229025
| Introduction|| |
The World Health Organization (WHO) defined traditional medicines as a diverse health practice including the use of herbal medicines, mineral-based medicines and animal parts which are used as a single material or in combination to treat, diagnose or prevent illness and to maintain well-being. The term complementary/alternative/non-conventional medicine is used alternately with traditional medicine in some countries. Complementary and alternative medicines (CAM) are extremely becoming popular with a high prevalence of use worldwide. In the United States, National Health Interview Survey (NHIS) from the Centers of Disease Control and Prevention (CDC) found that approximately 40% of adults and around 10% of children had used CAM treatment. In Australia, Armstrong et al. described an incidence of approximately 24% of CAM use among Australian adult patients with chronic illnesses. The WHO estimates that in many developed countries, 70%–80% of the population has used some forms of alternative or complementary medicine. More than 80% of the African and Asian populations use traditional medicine for primary healthcare. With regard to Saudi Arabia, the prevalence of herbal medicine use was estimated to be between 8% and 76% as reported recently by Alrowais and Alyousefi. Patients with chronic illnesses use herbal medicine for several reasons including conflicting information of current medical knowledge, unsatisfactory conventional medical practices, increased cost of standard medical care  and spiritual reasons as well as the placebo effect of the traditional medicine.
Although CAM is increasingly used in hospitals and clinics, the conventional health professionals have a little knowledge on CAM; moreover, the vast majority of the patients do not report CAM use to their healthcare providers which is the likelihood going to compromise the quality of healthcare.
There are several studies that explored the use of herbal medicine by Saudi patients with chronic illnesses; however, few studies have addressed the physicians' concern and awareness of use of herbal medicine by their patients. Therefore, the aim of this study is to explore the factors that promote the use of herbal medicine among chronically ill patients and to determine the role of healthcare providers in herbal medicine use and their concern about the use of herbs by their chronically ill patients.
| Materials and Methods|| |
A cross-sectional study was conducted from December 2014 to January 2015 at King Abdullah General Hospital in Bisha, in which a total of 235 randomly selected chronically ill adults (>18 years) were recruited. Data were collected from all participants using a structured data form; the data included demographic data, types of chronic illnesses, level of education, employment status and place of residence. The data form also included questions about characteristics of the herbs product used, frequency of use, reason for use, the motivation for herbal use and whether the health providers have asked about the use of herbal medicine and whether they responded to any to the patient's queries about herbal medicine. Ethical approval was obtained from Ethics Committee of the University of Bisha, and informed verbal consent was also obtained from all participants.
Statistical package for social science SPSS 22 (SPSS Inc. Chicago-USA). The percentages and frequencies of the participants' responses to each question were analysed. Univariate logistic regression was used to identify factors that were associated with herbal use, where herbal users and nonusers were entered as independent variables; significant variables detected in the univariate analysis were further adjusted using multivariate logistic regression model. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported. Descriptive data were reported as mean ± standard deviation; statistical significance is considered as P < 0.05.
| Results|| |
A total of 235 patients were included in this study. There were 152 male (64.68%) and 83 female (53.31%) patients. The demographic data and level of education are presented in [Table 1]. The number of herbal medicine users was 159 (67.65%), with Trigonella foenum-graecum (32.7%), Pimpinella anisum (19.49%), Nigella sativa (17.61%), Green tea (13.83%) and Peganum (5.66%) as the most frequently used as shown in [Table 1].
Herbal medicine use was recommended by family and friends in 85.46%, herbal therapist in 10.91% and physician in 3.64% of patients. Among those patients who used herbs, hypertension, diabetes and ischemic heart disease were the most common chronic illnesses associated with herbal use. Most of the herb users did not communicate with their physicians regarding the use of herbal medicine (88.67%). When asking the respondent about whether their physician asks them about herbal medication use, 90.56% of healthcare providers did not respond to herbs users' questions about herbal medicine. Herbal medicines were used for pain relief (41.82%) and other reasons (58.18%). With regard to non-user, 95.75% of them believed that herbal medicine has no benefit and 4.26% considered it unsafe. On univariate analysis [Table 2], comparing herbs users to non-users, males had significantly higher odds of herbal use (OR: 4.23, 95% CI: 2.37–7.57) in comparison to females. In terms of age, herbs user is more in those <70 years of age as compared to those between 30–70 and <30 years (OR: 3.41, 95% CI: 1.45–8.01). Herbs use was more common among illiterates (OR: 15.01, 95% CI: 7.71–29.20). Unemployment and living in an urban area are associated with increased use of herbs with OR: 6.21, 95% CI: 3.31–11.65 and OR: 22.88, 95% CI: 11.22–46.64, respectively. After adjustment using multivariate model [Table 3], increased age as well as living in the urban area was associated with herbal use with OR: 4.12, 95% CI: 1.94–8.74 and OR: 109.20, 95% CI: 31.88–374.02, respectively.
|Table 2: Univariate logistic regression analysis of factors associated with herbs usage|
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|Table 3: Multivariate logistic regression of factors associated with herbs usage adjusted for gender, education and employment|
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| Discussion|| |
Herbal medicine use has become a popular type of therapy in both Western and Arab countries., There are several reports addressing the use of herbal medicine among Saudi patients; however, most of these studies have been conducted in patients with various medical conditions. Therefore, different rates of herbal medicine use were reported. Al-Faris reported the use of herbs in 8.7% of patients with headache, back pain and irritable bowel syndrome, while Al Moamary reported herbal use in 23% of patients with bronchial asthma. Moreover, Albedah et al. described a high prevalence (75%) of herbs use among individuals with chronic illnesses, acute illness and well-being. In this study, 76% of patients with chronic illness had used herbal medicine which is different from what has been mentioned before. These differences might be explained by several factors such as the variations in study samples and traditional background.
Our findings were also higher than what has been reported by Tulunay et al., who described herbal medicine use in 29% of Turkish patients with chronic illness. The reason for this variation is likely attributed to a small number of patients in our study. Another Australian national study reported herbal medicine use in quarter of patients with chronic illness, which is much lower than what we have found in our study. An explanation for this discrepancy is the large number of patients in their study as well as the difference in the background of patients' ethnicity, traditions and beliefs.
Another important finding reflected by our current study is the high rate of herb use among female which is consistent with the previous reports.,
It is worth mentioning that our study showed that the use of the herb was more common among illiterates; however, several previous reports revealed that individuals who had high education level were more likely to use herbs.,, In this study, herbal medicine use was influenced by family and friends in 85% of conditions. This finding is in partial agreement with what has been described by Naja et al. in their study.
Of note, we found that the > 90% of healthcare workers did not ask their patients about the use of herbal medicine which is similar to the previous studies. Moreover, the majority of the healthcare workers did answer the patients' questions which could be related to lack of knowledge on herbal medicine as documented before by two studies., The multivariate analysis in this study revealed a positive relationship between increasing age and herbal medicine use. These findings are in the same line with previous reports., Furthermore, living in urban area was significantly associated with herbal medicine. These findings can be explained in the context of what previously has been described by Oreagba et al.
It is worth mentioning that our study has some limitations. First, the duration of the study is relatively short. Second, it is confined to one city which cannot be a true representative of the whole population. Therefore, further studies with a larger sample size and a better representation of the entire population should be carried out.
| Conclusion|| |
The use of herbal medicine is very common among patients with chronic illnesses; however, the majority of herbs users did not consult their healthcare providers about herbal medicine use; moreover, healthcare professionals did not respond to their patients' inquiries about herbal medicine. These facts warrant the need for education and awareness about herbal medicine among patients and healthcare professionals.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
World Health Organization. General Guidelines for Methodologies on Research and Evaluation of Traditional Medicine. Geneva: World Health Organization; 2000.
Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Report 2008;12:1-23.
Armstrong AR, Thiébaut SP, Brown LJ, Nepal B. Australian adults use complementary and alternative medicine in the treatment of chronic illness: A national study. Aust N
Z J Public Health 2011;35:384-90.
World Health Organization. WHO Traditional Medicine Strategy 2002-2005. WHO/EDM/TRM/2002.1. Geneva: World Health Organisation; 2002.
Neergheen-Bhujun VS. “Underestimating the Toxicological Challenges Associated with the Use of Herbal Medicinal Products in Developing Countries,” BioMed Research International, 2013;2013:9. Article ID 804086. doi:10.1155/2013/804086.
Alrowais NA, Alyousefi NA. The prevalence extent of complementary and alternative medicine (CAM) use among Saudis. Saudi Pharm J 2017;25:306-18.
Hufford DJ. Evaluating complementary and alternative medicine: The limits of science and of scientists. J Law Med Ethics 2003;31:198-212.
Tait EM, Laditka JM, Laditka SB, Nies MA, Racine EF, Tsulukidze MM. Reasons why older Americans use complementary and alternative medicine: Costly or ineffective conventional medicine and recommendations from health care providers, family, and friends. Educ Gerontol 2013;39:684-700.
Purohit MP, Wells RE, Zafonte RD, Davis RB, Phillips RS. Neuropsychiatric symptoms and the use of complementary and alternative medicine. PM R 2013;5:24-31.
Thomson P, Jones J, Browne M, Leslie SJ. Why people seek complementary and alternative medicine before conventional medical treatment: A population based study. Complement Ther Clin Pract 2014;20:339-46.
Strouss L, Mackley A, Guillen U, Paul DA, Locke R. Complementary and alternative medicine use in women during pregnancy: Do their healthcare providers know? BMC Complement Altern Med 2014;14:85.
Fox P, Coughlan B, Butler M, Kelleher C. Complementary alternative medicine (CAM) use in Ireland: A secondary analysis of SLAN data. Complement Ther Med 2010;18:95-103.
Al-Faris EA. The pattern of alternative medicine use among patients attending health centres in a military community in Riyadh. J Family Community Med 2000;7:17-25.
Al Moamary MS. Unconventional therapy use among asthma patients in a tertiary care center in Riyadh, Saudi Arabia. Ann Thorac Med 2008;3:48-51.
] [Full text]
AlBedah AM, Khalil MK, Elolemy AT, Al Mudaiheem AA, Al Eidi S, Al-Yahia OA, et al.
The use of and out-of-pocket spending on complementary and alternative medicine in Qassim province, Saudi Arabia. Ann Saudi Med 2013;33:282-9.
Tulunay M, Aypak C, Yikilkan H, Gorpelioglu S. Herbal medicine use among patients with chronic diseases. J Intercult Ethnopharmacol 2015;4:217-20.
Liwa A, Roediger R, Jaka H, Bougaila A, Smart L, Langwick S, et al.
Herbal and alternative medicine use in Tanzanian adults admitted with hypertension-related diseases: A Mixed-methods study. Int J Hypertens 2017;2017:5692572.
Gücük İpek E, Güray Y, Demirkan B, Güray U, Kafes H, Başyiǧit F, et al.
The prevalence of alternative herbal medicine and nutritional complementary product intake in patients admitted to out-patient cardiology departments. Turk Kardiyol Dern Ars 2013;41:218-24.
Naja F, Alameddine M, Itani L, Shoaib H, Hariri D, Talhouk S, et al.
The use of complementary and alternative medicine among Lebanese adults: Results from a national survey. Evid Based Complement Alternat Med 2015;2015:682397.
Kretchy IA, Owusu-Daaku F, Danquah S. Patterns and determinants of the use of complementary and alternative medicine: A cross-sectional study of hypertensive patients in Ghana. BMC Complement Altern Med 2014;14:44.
Huang A, Seshadri K, Matthews TA, Ostfeld BM. Parental perspectives on use, benefits, and physician knowledge of complementary and alternative medicine in children with autistic disorder and attention-deficit/hyperactivity disorder. J Altern Complement Med 2013;19:746-50.
Djuv A, Nilsen OG, Steinsbekk A. The co-use of conventional drugs and herbs among patients in Norwegian general practice: A cross-sectional study. BMC Complement Altern Med 2013;13:295.
Oreagba IA, Oshikoya KA, Amachree M. Herbal medicine use among urban residents in Lagos, Nigeria. BMC Complement Altern Med 2011;11:117.
[Table 1], [Table 2], [Table 3]