Traditional medicines used by Pakistani migrants from Mirpur living in Bradford, Northern England

Use and perception of risk: traditional medicines of Pakistani immigrants in Norway

BACKGROUND

Pakistani immigrants are the largest non-Western ethnic minority group in Norway. Traditional medicines (TM) are extensively used in Pakistan, and studies show that ethnic minorities also use them to recover from illness after migration to the Western world. This study aims to explore Pakistani immigrants' experiences and perceptions of risk regarding the use of TM to treat illnesses.

METHODS

A qualitative study was conducted through in-depth interviews (n = 24) with Pakistani immigrants in Norway from February to March 2023. Participants were recruited through purposive and snowball sampling methods. The data was analyzed using Braun & Clarke's reflexive thematic analysis (RTA) using Nvivo.

RESULTS

RTA revealed three main themes and six sub-themes. The main themes were: (a) House of knowledge, (b) Choosing the best possible approach for health restoration, and (c) Adverse effects of TM used. A total of 96 different TM were identified, including herbs, food items, animal products, minerals, herbal products, and ritual remedies. All participants used TM to restore health in acute and chronic diseases, and many used TM along with conventional medicines. The participants' mothers were the primary source of knowledge about TM, and they passed it on to the next generation. They also frequently used religious knowledge to recover from illness. Although TM is considered safe because of its natural origin, some participants experienced adverse effects of TM, but none of them reported it to the health authorities.

CONCLUSION

The study helps to understand the experiences and perceptions of risk of Pakistani immigrants in Norway regarding traditional practices for treating health complaints. Public health policies to improve the health of these immigrants should consider the importance of TM in their lives. Further research is necessary to explore the safety and toxicity of those TM that are common in Pakistani households in Norway.

Narratives of Herbal Medicine Utilisation in the United Kingdom: Scoping Literature Review

Using thematic analysis of existing literature, this scoping review aims to explore the narratives of people using herbal medicine (HM) in the United Kingdom. Understanding who is using HM and why will enable better ways of facilitating the use of HM, as well as assist in designing future research. Ethnic groups were found to be primary users of HM in the United Kingdom. A sense of heritage continues to be important for these participants as it allows tradition and culture to stay alive within communities, as well as the ritualistic purposes of these plants. For women, another key demographic, concepts surrounding the naturalness of HMs are associated with the idea of femineity and self-healing. A reoccurring theme in the literature focusing on both ethnic groups and women’s perceptions is the judgement from healthcare practitioners/professionals (HCPs) when addressing the use of HM. However, studies that investigated the perceptions of HCPs on HM confirmed that they often were supportive of using HM where standard treatments had been unsuccessful, and if a patient had anecdotal evidence of a herb having been effective. Delving deeper into public narratives of HM usage will allow conventional healthcare systems to effectively integrate alternative approaches, as well as ensuring that future research into the benefits of HMs is relevant to how people use them.

'A disease like any other' traditional, complementary and alternative medicine use and perspectives in the context of COVID-19 among the Congolese community in Belgium

BACKGROUND

As a hard-hit area during the COVID-19 pandemic, Belgium knew the highest mortality among people from sub-Saharan African descent, compared to any other group living in the country. After migration, people often maintain traditional perceptions and habits regarding health and healthcare, resulting in a high prevalence of traditional, complementary and alternative medicine use among different migrant communities in northern urban settings. Despite being the largest community of sub-Saharan African descent in Belgium, little is known on ethnobotanical practices of the Belgian Congolese community. We therefore conducted an exploratory study on the use of medicinal plants in the context of COVID-19 and perceptions on this new disease among members of the Congolese community in Belgium.

METHODS

We conducted 16 in-depth semi-structured interviews with people of Congolese descent currently living in Belgium. Participants were selected using purposive sampling. Medicinal plant use in the context of COVID-19 was recorded through free-listing. Data on narratives, ideas and perceptions on the origin, cause/aetiology and overall measures against COVID-19 (including vaccination) were collected. Interview transcripts were analysed using thematic analysis.

RESULTS

Four overarching themes emerged from our data. Firstly, participants perceived the representation of the severity of COVID-19 by the Belgian media and government-and by extend by all governmental agencies in the global north-as exaggerated. As a result, traditional and complementary treatments were seen as feasible options to treat symptoms of the disease. Fifteen forms of traditional, complementary and alternative medicine were documented, of which thirteen were plants. Participants seem to fold back on their Congolese identity and traditional knowledge in seeking coping strategies to deal with the COVID-19 pandemic. Finally, institutional postcolonial distrust did not only seem to lead to distrust in official messages on the COVID-19 pandemic but also to feelings of vaccination hesitancy.

CONCLUSION

In the context of the COVID-19 pandemic, participants in our study retreated to, reshaped and adapted traditional and culture-bound knowledge. This study suggests that the fragile and sensitive relationship between sub-Saharan African migrant groups and other social/ethnic groups in Belgium might play a role in their sensitivity to health-threatening situations, such as the COVID-19 pandemic.

Effectiveness of Medicinal Plants for Glycaemic Control in Type 2 Diabetes: An Overview of Meta-Analyses of Clinical Trials

Aims: To rank the effectiveness of medicinal plants for glycaemic control in Type 2 Diabetes (T2DM). Methods: MEDLINE, EMBASE, CINAHL and Cochrane Central were searched in October 2020. We included meta-analyses of randomised controlled clinical trials measuring the effectiveness of medicinal plants on HbA1c and/or Fasting Plasma Glucose (FPG) in patients with T2DM. Results: Twenty five meta-analyses reported the effects of 18 plant-based remedies. Aloe vera leaf gel, Psyllium fibre and Fenugreek seeds had the largest effects on HbA1c: mean difference -0.99% [95% CI-1.75, -0.23], -0.97% [95% CI -1.94, -0.01] and -0.85% [95% CI -1.49, -0.22] respectively. Four other remedies reduced HbA1c by at least 0.5%: Nigella sativa, Astragalus membranaceus, and the traditional Chinese formulae Jinqi Jiangtang and Gegen Qinlian. No serious adverse effects were reported. Several other herbal medicines significantly reduced FPG. Tea and tea extracts (Camellia sinensis) were ineffective. However, in some trials duration of follow-up was insufficient to measure the full effect on HbA1c (<8 weeks). Many herbal remedies had not been evaluated in a meta-analysis. Conclusion: Several medicinal plants appear to be as effective as conventional antidiabetic treatments for reducing HbA1c. Rigorous trials with at least 3 months' follow-up are needed to ascertain the effects of promising plant-based preparations on diabetes.

Advancing urban ethnopharmacology: a modern concept of sustainability, conservation and cross-cultural adaptations of medicinal plant lore in the urban environment

The discipline 'urban ethnopharmacology' emerged as a collection of traditional knowledge, ancient civilizations, history and folklore being circulated since generations, usage of botanical products, palaeobotany and agronomy. Non-traditional botanical knowledge increases the availability of healthcare and other essential products to the underprivileged masses. Intercultural medicine essentially involves 'practices in healthcare that bridge indigenous medicine and western medicine, where both are considered as complementary'. A unique aspect of urban ethnopharmacology is its pluricultural character. Plant medicine blossomed due to intercultural interactions and has its roots in major anthropological events of the past. Unani medicine was developed by Khalif Harun Al Rashid and Khalif Al Mansur by translating Greek and Sanskrit works. Similarly, Indo-Aryan migration led to the development of Vedic culture, which product is Ayurveda. Greek medicine reached its summit when it travelled to Egypt. In the past few decades, ethnobotanical field studies proliferated, especially in the developed countries to cope with the increasing demands of population expansion. At the same time, sacred groves continued to be an important method of conservation across several cultures even in the urban aspect. Lack of scientific research, validating the efficiency, messy applications, biopiracy and slower results are the main constrains to limit its acceptability. Access to resources and benefit sharing may be considered as a potential solution. Indigenous communities can copyright their traditional formulations and then can collaborate with companies, who have to provide the original inventors with a fair share of the profits since a significant portion of the health economy is generated by herbal medicine. Search string included the terms 'Urban' + 'Ethnopharmacology', which was searched in Google Scholar to retrieve the relevant literature. The present review aims to critically analyse the global concept of urban ethnopharmacology with the inherent plurality of the cross-cultural adaptations of medicinal plant use by urban people across the world.

Traditional medicinal knowledge and practices among the tribal communities of Thakht-e-Sulaiman Hills, Pakistan

BACKGROUND

Little is known about the medical material and practices of tribes in the western border areas of Pakistan. The local population has inhabited this remote and isolated area for centuries, and gained medicinal knowledge with personal experiences and knowledge learned from forefathers. Due to the geographical isolation of the communities in the Sulaiman hills of Pakistan and their unique culture, the area is of importance for exploration and assessment.

METHODS

A total of 116 informants were interviewed in five foothill villages and the associated migratory mountain villages during 2010-2012 and 2015. Information was gathered mainly through semi-structured interviews and freelisting. Local diseases were categorized based on symptoms and affected organs. Descriptive statistics were used for data analysis.

RESULTS

Depending on the type of illness, typically a pulse diagnoser or a religious specialist is consulted. Medicinal plant knowledge and use is mostly known and advised by elders within the family. A total of 44 plant species from 32 families (588 use reports), 7 animal species and 6 minerals and other sources (384 use reports) were documented as materia medica. Among the plants, the Lamiaceae is the most dominantly used plant family, followed by Pinaceae. The most frequently reported single species was Teucrium stocksianum. The most often mentioned diseases and treatments fall into the categories of gastrointestinal, ritual, and musculoskeletal diseases. The use of goat and sheep skin as medicine was pivotal in the local medicinal system. Remedies from animal parts and other biological and non-biological sources were mainly used for musculoskeletal ailments and ritual treatments. Overall, people rely on both traditional and biomedical medication and treatments and combination of these systems.

CONCLUSION

This paper provides insight into the pluralistic medication system of rural communities of northwest Pakistan. It highlights the materia medica most commonly in use. A considerable part of the documented materia medica and local practices is part of an oral tradition and cannot be found in written sources or scientific articles. The gaining of new medicinal knowledge in the area was the good sign of continuation of traditional medicinal practices.

Wild plants and the food-medicine continuum-an ethnobotanical survey in Chapada Diamantina (Northeastern Brazil)

BACKGROUND

Ethnobotanical research has demonstrated that several wild food plants (WFP) are used for medicinal purposes. Therefore, in addition to constituting an important source of nutrients, WFP can be used to help treat and avoid health problems. This study sought to characterize the traditional use of plants considered simultaneously as food and medicine by local specialists in the community of Caeté-Açu, which borders Chapada Diamantina National Park (NE Brazil). We also sought to identify the variables that influence the species' cultural importance.

METHODS

We selected local specialists based on a snowball sample and used a free-listing technique to register the wild plants they knew that are both edible and medicinal. Then, we asked the specialists to rank each plant component cited according to the following attributes: (1) ease of acquisition, (2) taste, (3) smell, (4) nutritional value, and (5) medicinal value. We used multiple regression to determine the variables that influence the cultural salience.

RESULTS

The most culturally salient species was Anredera cordifolia (Ten.) Steenis. The main medicinal effects associated with this species were related to body strengthening, intestinal regulation, and stomach issues. The most salient used species were those that were easiest to acquire and had the highest perceived nutritional values.

CONCLUSION

It is likely that the sociocultural backgrounds of the respondents (elders, former miners, or descendants of miners) and the historical importance of wild food plants to local diets increased the predictive power of the perceived nutritional importance and ease of acquisition of these plants.

Phytotherapies in motion: French Guiana as a case study for cross-cultural ethnobotanical hybridization

BACKGROUND

French Guiana is characterized by a very multicultural population, made up of formerly settled groups (Amerindians, Maroons, Creoles) and more recent migrants (mostly from Latin America and the Caribbean). It is the ideal place to try to understand the influence of intercultural exchanges on the composition of medicinal floras and the evolution of phytotherapies under the effect of cross-culturalism.

METHODS

A combination of qualitative and quantitative methods was used. Semi-directive interviews were conducted in 12 localities of French Guiana's coast between January 2016 and June 2017, and the responses to all closed questions collected during the survey were computerized in an Excel spreadsheet to facilitate quantitative processing. Herbarium vouchers were collected and deposited at the Cayenne Herbarium to determine Linnaean names of medicinal species mentioned by the interviewees. A list of indicator species for each cultural group considered was adapted from community ecology to this ethnobiological context, according to the Dufrêne-Legendre model, via the "labdsv" package and the "indval" function, after performing a redundancy analysis (RDA).

RESULTS

A total of 205 people, belonging to 15 distinct cultural groups, were interviewed using semi-structured questionnaires. A total of 356 species (for 106 botanical families) were cited. We observed that pantropical and edible species hold a special place in these pharmacopeias. If compared to previous inventories, 31 recently introduced species can be counted. Furthermore, this study shows that the majority of the plants used are not specific to a particular group but shared by many communities. However, despite this obvious cross-culturalism of medicinal plants between the different cultural communities of French Guiana, divergent trends nevertheless appear through the importance of 29 indicator/cultural keystone species in 10 cultural groups. Finally, we have emphasized that the transmission of herbal medicine's knowledge in French Guiana is mainly feminine and intra-cultural.

CONCLUSION

French Guianese medicinal flora is undoubtedly related to the multiple cultures that settled this territory through the last centuries. Cultural pharmacopeias are more hybrid than sometimes expected, but cultural keystone species nevertheless arise from a common background, allowing to understand, and define, the relationships between cultural groups.

Nutritional and Functional Properties of Wild Food-Medicine Plants From the Coastal Region of South China

Food-medicine plants play an important role in providing nutrition and treating chronic diseases, especially in many minority communities and developing regions. The coastal region of South China has abundant resources of medicinal plants. A long history of cross-cultural medicinal practices among different minority groups has facilitated the development of a remarkable dietary culture by using food-medicine plants. However, integrative ethnobotanical research on both nutritional and functional properties of the food-medicine plants in this region is still limited. In this study, 27 commonly used wild food-medicine plants were recorded and analyzed from the coastal region of South China. Most of them are good sources for calcium (47.83-1099.89 mg/100 g fresh weight), dietary fiber (3.00-31.87 mg/100 g fresh weight), iron (1.17-24.73 mg/100 g fresh weight), and vitamin C (0.44-68.32 mg/100 g fresh weight). Solanum americanum has the highest average nutritive value and is also considered to be good sources for proteins (7.90 g/100 g fresh weight). Medicinal properties of the studied species can be classified into 8 categories: treatment of the damp-heat syndrome, digestive diseases, urologic diseases, arthropathy, respiratory diseases, gynecological diseases, snake or insect bites, and uses as a tonic. Treating the damp-heat syndrome or expelling warm pathogenic factors is the most commonly used ethnomedicinal practice in the study area. The present study highlights that the local ethnomedicinal practices are deeply influenced by local natural conditions and customs. Food-medicine plants with superior key nutrients have been used regularly in the diet as medicinal food to alleviate common endemic diseases.

Cardiovascular Disease & Cancer Risk Among South Asians: Impact of Sociocultural Influences on Lifestyle and Behavior

A comprehensive literature review revealed cultural beliefs, societal obligations, and gender roles within the South Asian community to be indirect contributors to the health of South Asian immigrants (SAIs). Health professionals need to increase their work with SAI communities to change less beneficial cultural elements such as misconceptions about health and exercise, and lack of communication when using alternative medicines. Community engaged efforts and continuing medical education are both needed to improve the health of the South Asian immigrant population in a culturally appropriate manner.

Exploring thoughts about pain and pain management: Interviews with South Asian community members in the UK

OBJECTIVE

This research sought to explore the pain management beliefs of members of the South Asian community living in the UK. In particular, their understanding of the key components of cognitive behavioural therapy (CBT) informed pain management programmes (PMPs) was explored.

METHODS

Snowball sampling was used to recruit 10 participants from a South Asian background for interview. Interviews were guided by a semi-structured interview schedule and explored pain history, specific pain experiences, community member expressions of, and reactions to, pain, treatment expectations and perceptions of self-management. Interviews were transcribed verbatim and subjected to descriptive thematic analysis.

RESULTS

Four themes were developed: impacts of chronic pain, within-group variations in responses to chronic pain, personal responsibility vs. paternalistic care, and the acceptability of pain management concepts (relaxation and meditation, exercise and physical activity, and thoughts and beliefs: the dangers of pain healers).

CONCLUSIONS

This work highlights how discourses around the impacts of chronic pain; beliefs about, and preferences for, approaches to care; and the acceptability of pain management concepts fit with existing PMP content. Recommendations are made regarding opportunities for social prescribing; consideration of the incorporation of acceptable forms of physical activity, including yoga and walking, within PMPs; and the potential benefit of highlighting role models and creating social opportunities for these activities. Some beliefs and practices in this area are under-researched, and further work that explores gender and generational differences in pain perceptions, and the potential dangers of the use of pain healers is needed.

Utilisation of Healthcare Services and Medicines by Pakistani Migrants Residing in High Income Countries: A Systematic Review and Thematic Synthesis

Migration, as a global phenomenon, gives rise to many challenges for healthcare professionals providing care to migrant populations. Migrants originating from diverse cultural backgrounds have unique beliefs and healthcare needs, and their utilisation of healthcare services and medicines is influenced by a number of factors. This review aims to assess the factors influencing the utilisation of healthcare services and medicines among Pakistani migrants residing in high income countries. The databases searched included PubMed/Medline, Scopus, EMBASE, Web of Science, CINAHL, and IPA. Of the 2566 publications initially obtained, 37 met the inclusion criteria. They included eight countries-the United Kingdom, United States of America, Canada, Denmark, Norway, Australia, United Arab Emirates and Cyprus. Eight descriptive themes emerged and two analytical constructs were established, as a result of thematic synthesis of included publications. The profile of utilisation of healthcare services and medicines among Pakistani migrants was multifaceted and influenced by their individual circumstances (socioeconomic characteristics; personal beliefs, preferences, and experiences; individual culture and religion; family and friends; and language and communication), and host country characteristics (work environment; healthcare organisation, access and affordability; and health professionals' education, practices, and preferences). Awareness of population-specific characteristics of migrant communities is important to promote and implement culturally appropriate healthcare practices and service provision.

Traditional medicine among people of Pakistani descent in the capital region of Copenhagen

ETHNOPHARMACOLOGICAL RELEVANCE

Studies show that ethnic minorities continue to use their cultural traditional medicines also after migration to the West. Research in this field is necessary, given that little is known about traditional medicines' impact on health-related problems. This study sheds light on the issue through a qualitative study among ethnic Pakistanis residing in Denmark.

AIM OF THE STUDY

The study addresses perception, knowledge and attitudes regarding the use of medicinal plants among Pakistanis living in Copenhagen. We furthermore document and identify the medicinal plants used in households.

MATERIALS AND METHODS

Data were collected through in-depth, semi-structured interviews with sixteen ethnic Pakistanis aged 30-80 years. Interviews were transcribed verbatim and analysed through Emerson's two-phased analysis method. Medicinal plant products in the interviewees' households were collected, photographed, identified and deposited at Museum of Natural Medicine at University of Copenhagen.

RESULTS

A total number of 121 Pakistani traditional medicines were identified, and found to represent both medicinal plants and foods. The average number of quoted Pakistani Traditional Medicines was 18 (N=16). Interviewees independently reported the same traditions for preparation and consumption of Pakistani traditional medicines. Factors that play a role in choosing to use Pakistani traditional medicines are frequent visits to Pakistan, belief in the healing power of totkas (homemade medicinal preparation), religious knowledge and the occurrence of recent illness within the family. Further, the upkeep of traditional use depends on the availability of Pakistani traditional medicines.

CONCLUSION

The study enhanced understanding of ethnic Pakistanis' perception and continued use of traditional medicines within the household after migration to the West. In the context of Western biomedicine, little is known of the potential toxicity and side-effects of many of the Pakistani traditional medicines found to be used in households in Copenhagen.

The Trade in African Medicinal Plants in Matonge-Ixelles, Brussels (Belgium)

Maintaining cultural identity and preference to treat cultural bound ailments with herbal medicine are motivations for migrants to continue using medicinal plants from their home country after moving to Europe and the USA. As it is generally easier to import exotic food than herbal medicine, migrants often shift to using species that double as food and medicine. This paper focuses on the trade in African medicinal plants in a Congolese neighborhood in Brussels (Belgium). What African medicinal plants are sold in Matonge, where do they come from, and to which extent are they food medicines? Does vendor ethnicity influence the diversity of the herbal medicine sold? We hypothesized that most medicinal plants, traders, and clients in Matonge were of Congolese origin, most plants used medicinally were mainly food crops and that culture-bound illnesses played a prominent role in medicinal plant use. We carried out a market survey in 2014 that involved an inventory of medicinal plants in 19 shops and interviews with 10 clients of African descent, voucher collection and data gathering on vernacular names and uses. We encountered 83 medicinal plant species, of which 71% was primarily used for food. The shredded leaves of Gnetum africanum Welw., Manihot esculenta Crantz, and Ipomoea batatas (L.) Lam were among the most frequently sold vegetables with medicinal uses. Cola nuts, shea butter, Aloe vera (L.) Burm.f., and Mondia whitei (Hook.f.). Skeels were the main non-food medicines sold. Women's health, aphrodisiacs, and rituals were the most important medicinal applications, but culture-bound ailments did not entirely dominate the plant uses. While most clients in Matonge were Congolese, most vendors and plant species were not. The Pakistanis dominated the food trade, and typical Congolese plants were sometimes replaced by West African species, creating confusion in vernacular names. African-managed shops had significantly more species of medicinal plants in stock than shops managed by Pakistanis. Almost all non-food herbal medicine was sold by Africans. Apart from informal shops, non-food herbal medicine was also sold from private homes and by ambulant vendors, probably to reduce costs and escape taxes and control by the authorities. We expect that in the future, increasing rent, strict regulations, and decreasing investments by the Congolese community will force the medicinal plant trade in Matonge to go even more underground.

Ethnobotany of the Balti community, Tormik valley, Karakorum range, Baltistan, Pakistan

BACKGROUND

Limited health facilities and malnutrition are major problems in the Karakorum Range of Northern Pakistan, often resulting in various human disorders. Since centuries, however, local communities in these areas have developed traditional methods for treating various ailments and local foods capes that can be significant for devising public health and nutritional policies. This study was intended to document the ethnobotanical knowledge of the local peoples in the Tormik Valley, especially in the medical and food domains.

METHODS

Field trips were undertaken in 14 different villages of the study area from 2010 to 2012. Ethnobotanical data were gathered using semi-structured interviews and group conversation with 69 informants. Details about local uses of plant species were recorded along with demographic characteristics of the visited communities. Relative frequency citation index (RFCi) and preference ranking index (PRi) tools were applied to determine the cultural significance of the reported species.

RESULTS

Sixty-three plant species, with a predominance of Asteraceae and Fabaceae family members, as well as their detailed folk uses were documented. Forty-three percent of the species were used to treat various diseases, 21 % were consumed as wild fruits and vegetables and 53 % of the species had multipurpose applications. Thymus linearis Benth, Hippophae rhamnoides ssp. turkestanica L. and Convolvulus arvensis L. were found to be the most utilized medicinal plant species, i.e. those with significant RFCi values (0.54, 0.51 and 0.48, respectively). Betula utilis D. Don was the most versatile taxon (seven different ways of utilization); being this species a common and easily accessible subalpine tree and then under anthropogenic pressure, the implementation of concrete strategies aimed at its in-situ and ex-situ conservation is strongly recommended.

CONCLUSION

The valleys in the Karakorum Mountains in the Northern Pakistan host significant Traditional Knowledge on local food and medicinal plant species, which need to be reconsidered and cautiously re-evaluated by ethnopharmacologists, and public health/nutrition actors. Furthermore, germane trans-disciplinary investigations are suggested to ensure the dynamic conservation of precious local knowledge systems, as well as plant diversity in Pakistani mountain regions.

Ethnomedicinal Uses of Honeybee Products in Lithuania: The First Analysis of Archival Sources

Lithuania has old ethnomedicine traditions, consisting of many recipes with herbal, animal, and mineral original ingredients. All these findings were mostly collected in Lithuanian language, often in local community's dialects, and stored only in archives. We analyzed archival sources about honeybee and its products used for medicinal purposes dated from 1886 till 1992 in different parts of Lithuania. We systematized and presented the most important information about bees and their products: indication for usage, ingredients used in the recipe, their preparation techniques, and application for therapeutic purposes. Researchers in Lithuania are now looking for new evidence based indications and preparation and standardization methods of bee products. Archival sources are a foundation for studies in Lithuania. The results can be integrated into scientifically approved folk medicine practices into today's healthcare.

Documenting the indigenous knowledge on medicinal flora from communities residing near Swat River (Suvastu) and in high mountainous areas in Swat-Pakistan

AIM OF THE STUDY

The present study aimed at documenting the indigenous knowledge on medicinal flora from the local communities residing near Swat River and high mountainous areas in Swat, Pakistan.

MATERIALS AND METHODS

Field study was carried out in 2013-14. The area was visited 17 times, and semi-structured and open-ended interviews were conducted in both the plain area nearby the Swat River (4 villages) and mountains (7 villages). A total of 83 erudite informants participated in the interviews with their prior consent. The collected data were analysed through quantitative indices viz., medicinal use value (MUV), relative frequency citation (RFC), family use value (FUV), informant consensus factor (ICF) and fidelity level (FL).

RESULTS

A total of 78 species belonging to 45 vascular plant families were documented as medicinally important. Lamiaceae was observed the dominant medicinal plant family with 11 species, leaf was the most used part, and powder the most preferred preparation type. Maximum MUV (1) was shared by 15 species while maximum RFC (0.385) was demonstrated by both Brassica juncea and Lepidium sativum. Smaller families with mostly 1 species showed higher FUV while among the larger families Amaryllidaceae and Papaveraceae showed maximum FUV of 0.89 and 0.87, respectively. Highest FL was shown by Mentha arvensis (70%) against gastrointestinal diseases. Highest ICF was demonstrated by hepatic disorders (0.93). Furthermore, we revealed 108 indigenous herbal medicinal recipes, 6 plants added to the medicinal plant trade list, 1 species (Vincetoxicum arnottianum) reported for the first time as medicinal plant, and several new uses for 49 well known medicinal plants.

CONCLUSION

The present survey documents diverse plant species that are utilised by local communities for treating a broad spectrum of disorders. Quantitative indices helped in marking important and most preferred plants. To conclude, we recommend the plants for pharmacological studies, documenting new uses, especially Vincetoxicum arnottianum, never screened before.

Parental beliefs and practice of spiritual methods for their sick children at a tertiary care hospital of Pakistan- a cross sectional questionnaire study

Background

Complementary and alternative medicine (CAM) comprises a variety of health care systems, practices, and products that are not usually thought to be part of allopathic medicine. This study investigated the parental beliefs and practices for use of spiritual methods in the treatment and early recovery of their children.

Methods

We performed a cross-sectional, descriptive study with convenience sampling of parents/caregivers of sick children who were admitted to the Children’s Hospital in Multan. A trained interviewer collected the data.

Results

A total of 1280 forms were analyzed. The majority of respondents were mothers (1053, 82.4 %), they resided in Multan (817, 63.8 %), and were not educated (754, 58.9 %). A total of 420 (32.8 %) respondents had a low socioeconomic background, 601 (47 %) were middle class, and 259 (20.2 %) were upper class. Grandmothers/mothers advised spiritual methods in the majority of respondents (605, 85.9 %). The parents used a variety of spiritual methods in 704 (55 %) children. Economic status and education showed an inverse relation with the use of CAM. A total of 809 (63.2 %) respondents believed that only a drug would heal the disease, while 575 (44.9 %) believed that spiritual methods have a 25 %–50 % role in healing. A total of 1269 (99.1 %) respondents believed that allopathic drugs are needed for healing, while only 0.9 % considered otherwise.

Conclusion

The majority of people believe that CAM is a contributory factor towards healing and does not interfere with allopathic treatment.

Electronic supplementary material

The online version of this article (doi:10.1186/s12906-016-0986-3) contains supplementary material, which is available to authorized users.

British-Pakistani women's perspectives of diabetes self-management: the role of identity

AIMS AND OBJECTIVES

To explore the effects of type 2 diabetes on British-Pakistani women's identity and its relationship with self-management.

BACKGROUND

Type 2 diabetes is more prevalent and has worse outcomes among some ethnic minority groups. This may be due to poorer self-management and an inadequate match of health services to patient needs. The influence that type 2 diabetes has on British-Pakistani women's identity and subsequent self-management has received limited attention.

DESIGN

An explorative qualitative study.

METHODS

Face-to-face semi-structured English and Urdu language interviews were conducted with a purposively selected heterogeneous sample of 15 British-Pakistani women with type 2 diabetes. Transcripts were analysed thematically.

RESULTS

Four themes emerged: Perceived change in self emphasised how British-Pakistani women underwent a conscious adaptation of identity following diagnosis; Familiarity with ill health reflected women's adjustment to their changed identity over time; Diagnosis improves social support enabled women to accept changes within themselves and Supporting family is a barrier to self-management demonstrated how family roles were an aspect of women's identities that was resilient to change. The over-arching theme Role re-alignment enables successful self-management encapsulated how self-management was a continuous process where achievements needed to be sustained. Inter-generational differences were also noted: first generation women talked about challenges associated with ageing and co-morbidities; second generation women talked about familial and work roles competing with self-management.

CONCLUSIONS

The complex nature of British-Pakistani women's self-identification requires consideration when planning and delivering healthcare.

RELEVANCE TO CLINICAL PRACTICE

Culturally competent practice should recognise how generational status influences self-identity and diabetes self-management in ethnically diverse women. Health professionals should remain mindful of effective self-management occurring alongside, and being influenced by, other aspects of life.

Food or medicine? The food-medicine interface in households in Sylhet

ETHNOPHARMACOLOGICAL RELEVANCE

Bangladesh has a rich traditional plant-medicine use, drawing on Ayurveda and Unami medicine. How these practices translate into people׳s homes and lives vary. Furthermore, the overlap between food and medicine is blurred and context-specific. This paper explores the food-medicine interface as experienced by Bengali women in their homes, in the context of transnational and generational changes.

AIM AND OBJECTIVES

The aim is to explore the overlap of food and medicines in homes of Bengali women in Sylhet. The objectives are to explore the influences on medicinal plant practice and to scrutinise how catagories of food and medicine are decided.

MATERIAL AND METHODS

The paper draws on in-depth ethnographic research conducted in Sylhet, North-east Bangladesh as part of a wider project looking at food and medicine use among Bengali women in both the UK and Bangladesh. Methods included participant observation, unstructured interviews and semi-structured interviews with a total of thirty women.

RESULTS

The study indicates that the use of plants as food and medicine is common among Bengali women in Sylhet. What is consumed as a food and/or a medicine varies between individuals, generations and families. The use and perceptions of food-medicines is also dependent on multiple factors such as age, education and availability of both plants and biomedicine. Where a plant may fall on the food-medicine spectrum depends on a range of factors including its purpose, consistency and taste.

CONCLUSIONS

Previous academic research has concentrated on the nutritional and pharmacological properties of culturally constructed food-medicines (Etkin and Ross, 1982; Owen and Johns, 2002, Pieroni and Quave, 2006). However, our findings indicate a contextualisation of the food-plant spectrum based on both local beliefs and wider structural factors, and thus not necessarily characteristics intrinsic to the products׳ pharmacological or nutritional properties. The implications of this research are of both academic relevance and practical importance to informing health services.

Isolated, but transnational: the glocal nature of Waldensian ethnobotany, Western Alps, NW Italy

BACKGROUND

An ethnobotanical field study on the traditional uses of wild plants for food as well as medicinal and veterinary plants was conducted in four Waldensian valleys (Chisone, Germanasca, Angrogna, and Pellice) in the Western Alps, Piedmont, NW Italy. Waldensians represent a religious Protestant Christian minority that originated in France and spread around 1,170 AD to the Italian side of Western Alps, where, although persecuted for centuries, approximately 20,000 believers still survive today, increasingly mixing with their Catholic neighbours.

METHODS

Interviews with a total of 47 elderly informants, belonging to both Waldensian and Catholic religious groups, were undertaken in ten Western Alpine villages, using standard ethnobotanical methods.

RESULTS

The uses of 85 wild and semi-domesticated food folk taxa, 96 medicinal folk taxa, and 45 veterinary folk taxa were recorded. Comparison of the collected data within the two religious communities shows that Waldensians had, or have retained, a more extensive ethnobotanical knowledge, and that approximately only half of the wild food and medicinal plants are known and used by both communities. Moreover, this convergence is greater for the wild food plant domain. Comparison of the collected data with ethnobotanical surveys conducted at the end of the 19th Century and the 1980s in one of studied valleys (Germanasca) shows that the majority of the plants recorded in the present study are used in the same or similar ways as they were decades ago. Idiosyncratic plant uses among Waldensians included both archaic uses, such as the fern Botrychium lunaria for skin problems, as well as uses that may be the result of local adaptions of Central and Northern European customs, including Veronica allionii and V. officinalis as recreational teas and Cetraria islandica in infusions to treat coughs.

CONCLUSIONS

The great resilience of plant knowledge among Waldensians may be the result of the long isolation and history of marginalisation that this group has faced during the last few centuries, although their ethnobotany present trans-national elements. Cross-cultural and ethno-historical approaches in ethnobotany may offer crucial data for understanding the trajectory of change of plant knowledge across time and space.

Prescribing patterns and adherence to medication among South-Asian, Chinese and white people with type 2 diabetes mellitus: a population-based cohort study

AIM

To determine the prescribing of and adherence to oral hypoglycaemic agents, insulin, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and statin therapy among South-Asian, Chinese and white people with newly diagnosed diabetes.

METHODS

The present study was a population-based cohort study using administrative and pharmacy databases to include all South-Asian, Chinese and white people aged ≥ 35 years with diabetes living in British Columbia, Canada (1997-2006). Adherence to each class of medication was measured using proportion of days covered over 1 year with optimum adherence defined as ≥ 80%.

RESULTS

The study population included 9529 South-Asian, 14 084 Chinese and 143 630 white people with diabetes. The proportion of people who were prescribed angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, statin or oral hypoglycaemic agents was ≤ 50% for all groups. South-Asian and Chinese people had significantly lower adherence for all medications than white people, with the lowest adherence to angiotensin-converting enzyme inhibitor treatment (South-Asian people: adjusted odds ratio 0.37, 95% CI 0.34-0.39; P<0.0001; Chinese people: adjusted odds ratio 0.50, 95% CI 0.47-0.54; P<0.0001) and statin therapy (South-Asian people: adjusted odds ratio 0.47, 95% CI 0.41 - 0.53, P < 0.0001; Chinese people: adjusted odds ratio 0.72, 95% CI 0.67 - 0.77; P<0.0001) compared with white people.

CONCLUSION

Adherence to evidence-based pharmacotherapy was substantially worse among the South-Asian and Chinese populations. Care providers need to be alerted to the high levels of non-adherence in these groups and the underlying causes need to be investigated.

The right to traditional, complementary, and alternative health care

BACKGROUND

State parties to human rights conventions and declarations are often faced with the seemingly contradictory problem of having an obligation to protect people from harmful practices while also having an obligation to enable access to culturally appropriate effective healing. As people increasingly migrate across the globe, previous distinctions between 'traditional' and 'complementary and alternative medicine' practices are being transcended. There are connections across transnational healing pathways that link local, national, and global movements of people and knowledge.

OBJECTIVE

This paper contributes to the development of the concept and practice of the right to health in all its forms, exploring the right to traditional, complementary, and alternative health (R2TCAH) across different contexts.

DESIGN

The paper draws on four settings - England, South Africa, Kenya, and Jordan - and is based on key informant interviews and a literature review undertaken in 2010, and updated in 2013. The paper begins by reviewing the international legal context for the right to health. It then considers legal and professional regulations from the global north and south.

RESULTS

Additional research is needed to establish the legal basis, compare regulatory frameworks, and explore patient and provider perspectives of regulation. This leads to being able to make recommendations on how to balance protection from harm and the obligation to ensure culturally appropriate services. Such an exploration must also challenge Western theories of human rights. Key concepts, such as individual harm, consent, and respect of the autonomy of the individual already established and recognised in international health law, could be adopted in the development of a template for future comparative research.

CONCLUSIONS

Exploration of the normative content of the right to health in all its forms will contribute to supporting traditional, complementary, and alternative health service users and providers in terms of access to information, non-discrimination, clarification of state obligations, and accountability.

Traditional and complementary approaches to health for children: Modelling the parental decision-making process using Andersen's Sociobehavioural Model

OBJECTIVES

Traditional and complementary approaches to health (TCA) are common for children. Andersen's Sociobehavioural Model (SBM) is often used to explain healthcare decision-making. This study aimed to identify the prevalence and determinants of traditional and complementary approaches to health (TCA) in a multi-ethnic child population, and to explore whether the SBM explained TCA health care decision-making in this population.

DESIGN

Cross-sectional questionnaire survey. NHS ethical approval was given.

SETTING

GP waiting rooms, Northwest London.

MAIN OUTCOME MEASURE AND ANALYSIS

All carers/parents (with children under 16), attending GP appointments on specific days, were asked to complete a questionnaire about TCA use; primary outcome 12-month child TCA use. Forward stepwise logistic regression tested appropriateness of the SBM.

RESULTS

A total of 394 questionnaires were returned, representing 737 children; a quarter White British. Prevalence of 12-month TCA use was 45.4%, mainly food-based herbs/spices for minor illnesses which were used prior to GP consultation. Over half identified that TCA was part of their ethnic/cultural background. Only 29% had discussed TCA with their GP. The strongest predictor of child TCA use in the SBM was carer TCA use, itself influenced by carer gender and ethnicity, and GP advice. Need factors were not influential.

CONCLUSIONS

Child TCA use was common in this multi-ethnic community, particularly the use of food-based remedies for minor illnesses, and carers' experience and background are central in deciding to use TCA for a child. TCA appears practiced as part of cultural background, with implications for GPs to be aware of their role in guiding patients to ensure safe practice.

Diversity and use of ethno-medicinal plants in the region of Swat, North Pakistan

BACKGROUND

Due to its diverse geographical and habitat conditions, northern Pakistan harbors a wealth of medicinal plants. The plants and their traditional use are part of the natural and cultural heritage of the region. This study was carried out to document which medicinal plant species and which plant parts are used in the region of Swat, which syndrome categories are particularly concerned, and which habitat spectrum is frequented by collectors. Finally, we assessed to which extent medicinal plants are vulnerable due to collection and habitat destruction.

METHODS

An ethnobotanical survey was undertaken in the Miandam area of Swat, North Pakistan. Data were collected through field assessment as well as from traditional healers and locals by means of personal interviews and semi-structured questionnaires.

RESULTS

A total of 106 ethno-medicinal plant species belonging to 54 plant families were recorded. The most common growth forms were perennial (43%) and short-lived herbs (23%), shrubs (16%), and trees (15%). Most frequently used plant parts were leaves (24%), fruits (18%) and subterranean parts (15%). A considerable proportion of the ethno-medicinal plant species and remedies concerns gastro-intestinal disorders. The remedies were mostly prepared in the form of decoction or powder and were mainly taken orally. Eighty out of 106 ethno-medicinal plants were indigenous. Almost 50% of the plants occurred in synanthropic vegetation while slightly more than 50% were found in semi-natural, though extensively grazed, woodland and grassland vegetation. Three species (Aconitum violaceum, Colchicum luteum, Jasminum humile) must be considered vulnerable due to excessive collection. Woodlands are the main source for non-synanthropic indigenous medicinal plants. The latter include many range-restricted taxa and plants of which rhizomes and other subterranean parts are dug out for further processing as medicine.

CONCLUSION

Medicinal plants are still widely used for treatment in the area of Swat. Some species of woodlands seem to be adapted to wood-pasture, but vulnerable to overcollecting, and in particular to deforestation. It is suggested to implement local small-scaled agroforestry systems to cultivate vulnerable and commercially valuable ethno-medicinal woodland plants under local self-government responsibility.

Migrant health in New Zealand: exploring issues concerning medicines access and use

Objectives

Every year a cohort of new migrants enters New Zealand (NZ), bringing challenges that impact on medicines use and health outcomes. The prescribing of medicines is a common therapeutic intervention and access to medicines and optimal use cannot be assumed for these populations. Internationally the literature exploring issues relating to medicines access and use by migrants in high-income countries is scarce. This study aims to explore attitudes, beliefs and perceptions of a cohort of migrants about medicines access and use in NZ.

Methods

A qualitative research methodology was employed with participants being recruited through snowballing techniques and interviewed (seven Indian and four Chinese). Following consent, a semi-structured guide was used for discussions. Themes were developed from codes based on the guide. These themes were developed by two members of the research team and reviewed by a third member.

Results

Emergent themes reflected the following dialogue: (a) financial barriers: paying doctor and pharmacist, lack of affordability of over-the-counter medicines, sharing medicines with family and friends; (b) information transfer and knowledge of rules, systems and initiatives, particularly regarding subsidies and brand switching; (c) misconceptions due to culture and language barriers, including not understanding information and lack of compliance in symptom-free disease; (d) perceptions of high quality in prescription medicines; (e) non-disclosure of traditional medicine use and (f) variability of community pharmacy service provision, especially counselling.

Conclusions

Significant barriers to access and optimal use of medicines by new migrants in NZ were identified. Policy change and educational interventions are likely to be required to improve medicines-related health care to migrant New Zealanders. Future research will need to quantify the extent of the issues and interventions should be developed and evaluated as ongoing research.

Comparative medical ethnobotany of the senegalese community living in turin (northwestern Italy) and in adeane (southern senegal)

A medico-ethnobotanical survey was conducted among the Senegalese migrant communities of Turin (Piedmont, NW Italy) and their peers living in Adeane (Casamance, Southern Senegal), both among healers and laypeople. Through 27 in-depth interviews, 71 medicinal plant taxa were recorded and identified in Adeane and 41 in Turin, for a total of 315 different folk remedies recorded in Senegal and 62 in Turin. The large majority of the medicinal plants recorded among Senegalese migrants in Turin were also used in their country of origin. These findings demonstrate the resilience of home remedies among migrants and consequently the role they should have in shaping public health policies devoted to migrant groups in Western Countries, which seek to seriously take into account culturally sensitive approaches, that is, emic health-seeking strategies.

Traditional food and herbal uses of wild plants in the ancient South-Slavic diaspora of Mundimitar/Montemitro (Southern Italy)

BACKGROUND

In Europe, only a limited number of cross-cultural comparative field studies or meta-analyses have been focused on the dynamics through which folk plant knowledge changes over space and time, while a few studies have contributed to the understanding of how plant uses change among newcomers. Nevertheless, ethnic minority groups and/or linguistic "isles" in Southern and Eastern Europe may provide wonderful arenas for understanding the various factors that influence changes in plant uses.

METHODS

A field ethnobotanical study was carried out in Mundimitar (Montemitro in Italian), a village of approx. 450 inhabitants, located in the Molise region of South-Eastern Italy. Mundimitar is a South-Slavic community, composed of the descendants of people who migrated to the area during the first half of the 14th century, probably from the lower Neretva valley (Dalmatia and Herzegovina regions). Eighteen key informants (average age: 63.7) were selected using the snowball sampling technique and participated in in-depth interviews regarding their Traditional Knowledge (TK) of the local flora.

RESULTS

Although TK on wild plants is eroded in Montemitro among the youngest generations, fifty-seven taxa (including two cultivated species, which were included due to their unusual uses) were quoted by the study participants. Half of the taxa have correspondence in the Croatian and Herzegovinian folk botanical nomenclature, and the other half with South-Italian folk plant names. A remarkable link to the wild vegetable uses recorded in Dalmatia is evident. A comparison of the collected data with the previous ethnobotanical data of the Molise region and of the entire Italian Peninsula pointed out a few uses that have not been recorded in Italy thus far: the culinary use of boiled black bryony (Tamus communis) shoots in sauces and also on pasta; the use of squirting cucumber ( Ecballium elaterium) juice for treating malaria in humans; the aerial parts of the elderberry tree ( Sambucus nigra) for treating erysipelas in pigs; the aerial parts of pellitory ( Parietaria judaica) in decoctions for treating haemorrhoids.

CONCLUSIONS

The fact that half of the most salient species documented in our case study - widely available both in Molise and in Dalmatia and Herzegovina - retain a Slavic name could indicate that they may have also been used in Dalmatia and Herzegovina before the migration took place. However, given the occurrence of several South-Italian plant names and uses, also a remarkable acculturation process affected the Slavic community of Montemitro during these last centuries. Future directions of research should try to simultaneously compare current ethnobotanical knowledge of both migrated communities and their counterparts in the areas of origin.

Pakistani pharmacy students' perception about complementary and alternative medicine

OBJECTIVES

To assess Pakistani pharmacy students' perceptions of complementary and alternative medicine (CAM), the frequency with which they use CAM, and barriers to use of CAM.

METHOD

A CAM health belief questionnaire was administered to 595 students enrolled in a 5-year doctor of pharmacy program (PharmD) in Pakistan.

RESULTS

Attitudes of students towards CAM were positive. Lack of evidence supporting CAM practices was considered to be the major barrier toward more students using CAM. A majority of students (79%) agreed that clinical care should integrate conventional medicine and CAM practices. Many CAM-based therapies, such as dietary supplements, massage, herbal medicines, and homoeopathic medicines were used by the students. Significant gender differences in attitude were observed, with male students having more conservative attitudes toward CAM use. A high percentage of students desired more training in CAM.

CONCLUSIONS

Pakistani students exhibited positive attitudes about the value of CAM and most felt that CAM should be included in the PharmD curriculum.

Functional foods and nutraceuticals in a market of bolivian immigrants in Buenos Aires (Argentina)

This paper presents the results of a research in urban ethnobotany, conducted in a market of Bolivian immigrants in the neighborhood of Liniers, Ciudad Autónoma de Buenos Aires (Argentina). Functional foods and nutraceuticals belonging to 50 species of 18 families, its products, and uses were recorded. Some products are exclusive from the Bolivian community; others are frequent within the community, but they are also available in the general commercial circuit; they are introduced into it, generally, through shops called dietéticas (“health-food stores”), where products associated with the maintenance of health are sold. On this basis, the traditional and nontraditional components of the urban botanical knowledge were evaluated as well as its dynamics in relation to the diffusion of the products. Both the framework and methodological design are innovative for the studies of the urban botanical knowledge and the traditional markets in metropolitan areas.

Cardiac medication prescribing and adherence after acute myocardial infarction in Chinese and South Asian Canadian patients

BACKGROUND

Failure to adhere to cardiac medications after acute myocardial infarction (AMI) is associated with increased mortality. Language barriers and preference for traditional medications may predispose certain ethnic groups at high risk for non-adherence. We compared prescribing and adherence to ACE-inhibitors (ACEI), beta-blockers (BB), and statins following AMI among elderly Chinese, South Asian, and Non-Asian patients.

METHODS

Retrospective-cohort study of elderly AMI survivors (1995-2002) using administrative data from British Columbia. AMI cases and ethnicity were identified using validated ICD-9/10 coding and surname algorithms, respectively. Medication adherence was assessed using the 'proportion of days covered' (PDC) metric with a PDC ≥ 0.80 indicating optimal adherence. The independent effect of ethnicity on adherence was assessed using multivariable modeling, adjusting for socio-demographic and clinical characteristics.

RESULTS

There were 9926 elderly AMI survivors (258 Chinese, 511 South Asian patients). More Chinese patients were prescribed BBs (79.7% vs. 73.1%, p = 0.04) and more South Asian patients were prescribed statins (73.5% vs. 65.2%, p = 0.001). Both Chinese (Odds Ratio [OR] 0.53; 95%CI, 0.39-0.73; p < 0.0001) and South Asian (OR 0.78; 95%CI, 0.61-0.99; p = 0.04) patients were less adherent to ACEI compared to Non-Asian patients. South Asian patients were more adherent to BBs (OR 1.3; 95%CI, 1.04-1.62; p = 0.02). There was no difference in prescribing of ACEI, nor adherence to statins among the ethnicities.

CONCLUSION

Despite a higher likelihood of being prescribed evidence-based therapies following AMI, Chinese and South Asian patients were less likely to adhere to ACEI compared to their Non-Asian counterparts.

Drug utilization patterns and reported health status in ethnic German migrants (Aussiedler) in Germany: a cross-sectional study

Background

Inadequate utilization of healthcare services by migrant populations is an important public health concern. Inadequate drug consumption and poor compliance to the therapeutic regimen are common manifestations of low health-care seeking behavior present in migrants even in the countries with well-established healthcare systems. There are few studies on the use of medicines among the different groups of migrants in Germany. The objective of this study is to investigate drug consumption patterns of ethnic German migrants (Aussiedler) and their current health status.

Methods

A cross-sectional study nested into a cohort of 18,621 individuals aged 20-70 years who migrated to Germany from the former Soviet Union between 1990 and 2005 was conducted. Data on consumption of drugs, drug handling, major health risk factors, and one-year disease prevalence were obtained for 114 individuals through a self-administered questionnaire and phone interviews. Results were compared to the data on the German population derived from the Disease Analyzer database and Robert Koch Institute (RKI) annual reports. Direct age standardization, test of differences, Chi-square test, and descriptive statistics were applied as appropriate. For drug classification the Anatomical Therapeutic Chemical (ATC) system was used.

Results

Of the respondents, 97% reported to have at least one disease within a 12-month period. The one-year prevalence of asthma (6.9%), hypertension (26.7%), chronic bronchitis (8.6%), and diabetes (4.9%) in migrants was similar to the general German population. 51% regularly took either over-the-counter (OTC) medication or prescription medicines. Six ATC groups were analyzed. The highest drug consumption was reported for the ATC cardiovascular (22%), nervous (9%), and muskulo-skeletal system (8%). 30% used OTC medicines obtained in the country of origin. Difficulties with drug handling were rare. Alcohol consumption did not differ from the German population (p = 0.19 males and 0.27 females), however smoking prevalence was lower (p < 0.01) in both sexes.

Conclusion

Ethnic German migrants seem to differ only slightly from Germans in health status, drug utilization, and disease risk factors, and if so, not in an extreme way. Country of origin remains a source of medicines for a substantial part of migrants. The study is limited by a small sample size and low response rate.

'It's like taking poison to kill poison but I have to get better': a qualitative study of beliefs about medicines in Rheumatoid arthritis and Systemic lupus erythematosus patients of South Asian origin

OBJECTIVE

To investigate factors that influence beliefs about medicines in patients of South Asian origin with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).

METHODS

Qualitative methodology was used to explore the health beliefs of South Asian patients and in particular the factors that influenced their beliefs about medicines and disease modifying anti-rheumatic drugs (DMARDs). Thirty two patients with RA and SLE took part in focus group discussions. Patients who chose to participate in focus groups conducted in English were compared with those who chose to participate groups conducted in Punjabi or Urdu.

RESULTS

Three main themes emerged to explain patients beliefs about medicines: (1) Beliefs about the necessity of DMARDs; (2) Concerns about DMARDs and other prescribed medicines including: (a) long-term side-effects; (b) the apparent lack of efficacy of some therapies; (c) concerns about changing from one drug to another and the large numbers of different medicines being taken; (3) Contextual factors which informed the patient's view on the necessity for particular medicines and concerns about them including: (a) beliefs about the causes of disease and the influence of religious beliefs on this; (b) barriers to communication with health care professionals about the medications being prescribed in clinic. In addition, our data revealed that these beliefs about DMARDs had important consequences for patient behaviour, including the use of traditional dietary and other non-pharmacological approaches. There were differences in views expressed between those who chose to speak in English and those who did not.

CONCLUSION

This study has identified themes that explain previous findings of negative beliefs about medicines in patients of South Asian origin. Beliefs about the causes of disease had an important impact on the way some patients viewed medicines for RA and SLE. This will have implications for educational programmes designed to promote patient involvement in disease management.

Why Surinamese migrants in the Netherlands continue to use medicinal herbs from their home country

AIM OF THE STUDY

When people migrate, they tend to bring along their medicinal plants. In order to improve migrant health, we need information on their traditional health beliefs and practices. This paper investigates medicinal plant use among Surinamese migrants in the Netherlands.

MATERIALS AND METHODS

Data from 210 semi-structured interviews among 1st and 2nd generation Surinamese migrants were analysed to determine which medicinal plants were used, for what purposes, which demographic, socio-economic or psycho-social factors play a role in the choice for traditional medicine and to clarify people's personal motives to use herbs. Variables associated with medicinal plant use were identified by using the Pearson gamma2 test and the two-sample t-test. After selecting significant variables by means of bivariate analyses, multinomial logistic regression with stepwise forward selection was used to assess whether medicinal plant use could be explained by a combination of these variables.

RESULTS

More than 75% of the respondents used herbal medicine, and 66% did so in the past year. Herbs were more frequently employed for health promotion (39%) than for disease prevention or cure (both 27%). Almost half of the respondents who had been ill the last year had used herbal medicine. More than 140 herb species were mentioned during the interviews. Plant use was often related to certain culture-bound health beliefs. Spiritual baths were the most popular traditional practice, followed by genital steam baths, bitter tonics, and the consumption of bitter vegetables. Afro-Surinamers more frequently used herbal medicine than Hindustani. The WINTI belief strongly influenced plant use, as well as the occurrence of an illness in the past year, and frequent visits to Suriname. Age, gender, income and education had no significant effect on the use of traditional medicine. Surinamers stated that they used medicinal herbs because they grew up with them; herbs were more effective and had fewer side effects than conventional therapies.

CONCLUSIONS

As long as certain culture-bound beliefs and health concepts remain prevalent among Surinamese migrants, and ties with their home country remain strong, they will continue using medicinal herbs from their country of origin. More research is needed on the health effects of frequently used medicinal plants by migrants in the Netherlands.

The use of herbal medicines by people with cancer in the UK: a systematic review of the literature

BACKGROUND AND AIM

Little is known about the use of herbal medicines by people living with cancer in the UK. This systematic review aimed to estimate the prevalence of herbal medicine use by this group, the characteristics of users, factors motivating use, and attitudes towards herbal remedies.

DESIGN AND METHODS

Fifteen electronic databases were searched. People who were research-active in the field were contacted and asked about further published or unpublished work. All studies identified as relevant to the purpose of the review were assessed. Searches were not restricted by publication type or date.

RESULTS

Of 1288 unique references identified, 11 met the eligibility criteria. Studies were excluded where research had been conducted outside the UK; where information on herbal medicine use was not differentiated from that relating to complementary and alternative therapies more broadly, and where neither prevalence of use nor information on user characteristics was included. Prevalence estimates ranged from 3.1 to 24.9%. Most studies did not obtain information specifically on herbal medicines and only one examined the characteristics and motivations of users of herbal medicines as distinct from complementary and alternative therapies in general.

CONCLUSION

The high degree of heterogeneity of methodology, sample selection and characteristics, and research design resulted in a wide range of estimates of prevalence. Well-designed research is needed to define the evidence base about the herbal medicines taken by people with cancer in the UK, the reasons for use, knowledge about possible effects and potential risks, and where people seek information.

Alpine ethnobotany in Italy: traditional knowledge of gastronomic and medicinal plants among the Occitans of the upper Varaita valley, Piedmont

A gastronomic and medical ethnobotanical study was conducted among the Occitan communities living in Blins/Bellino and Chianale, in the upper Val Varaita, in the Piedmontese Alps, North-Western Italy, and the traditional uses of 88 botanical taxa were recorded. Comparisons with and analysis of other ethnobotanical studies previously carried out in other Piemontese and surrounding areas, show that approximately one fourth of the botanical taxa quoted in this survey are also known in other surrounding Occitan valleys. It is also evident that traditional knowledge in the Varaita valley has been heavily eroded. This study also examined the local legal framework for the gathering of botanical taxa, and the potential utilization of the most quoted medicinal and food wild herbs in the local market, and suggests that the continuing widespread local collection from the wild of the aerial parts of Alpine wormwood for preparing liquors (Artemisia genipi, A. glacialis, and A. umbelliformis) should be seriously reconsidered in terms of sustainability, given the limited availability of these species, even though their collection is culturally salient in the entire study area.

Cross-cultural adaptation in urban ethnobotany: the Colombian folk pharmacopoeia in London

AIM OF THE STUDY

To investigate traditional health care practices and changes in medicinal plant use among the growing Colombian community in London.

MATERIALS AND METHODS

Ethnobotanical fieldwork consisted of qualitative, in-depth, semi-structured interviews with 23 Colombians living in London and botanical identification of 46 plant species actively used as herbal remedies. Subsequently, research data were compared with literature on ethnobotany and traditional herbal medicine in the home country, using a framework on cross-cultural adaptation, adjusted for the purpose of this study.

RESULTS

Similarities and discrepancies between data and literature are interpreted as potential indicators of continuity and loss (or deculturation) of traditional remedies, respectively. Remedies used in London that are not corroborated by the literature suggest possible newly acquired uses.

CONCLUSIONS

Cross-cultural adaptation related to health care practices is a multifaceted process. Persistence, loss and incorporation of remedies into the Colombian folk pharmacopoeia after migration are influenced by practical adaptation strategies as well as by symbolic-cultural motives of ethnic identity.

Complementary medicine use in multi-ethnic paediatric outpatients

OBJECTIVE

To determine the prevalence and determinants of complementary medicine (CM) use in a multi-ethnic paediatric outpatient population.

METHODOLOGY

A parent-completed questionnaire survey of paediatric outpatients attending general and sub-specialist outpatient clinics at a North West London hospital during September to December 2005.

RESULTS

Parents' use of CM for their children in this multi-ethnic population was higher than expected at 37%. Use was correlated with parental CM use and education but independent of ethnic group. Parental CM use and child's health status were significant predictors of child CM use. The main reason for using CM was word of mouth (45%) and the main source of information was friends and family (51%). The most popular treatments used for children were homeopathy and herbal medicine (used by 30% and 28% of CM users, respectively). 88% of CM was bought over the counter and 53% of CM use was not reported to their doctor. Parents also used traditional complementary remedies for their children.

CONCLUSIONS

These results suggest that CM use in children is higher than previously estimated in the UK. This indicates the need for greater professional awareness of CM as part of clinical care. There is a need to acknowledge the beliefs that inform parents' decision-making process.