Traditional medicine for the rich and knowledgeable: challenging assumptions about treatment-seeking behaviour in rural and peri-urban Nepal

The influence of urbanization on local ecological knowledge: a systematic review

Urbanization is a complex and multifaceted process studied across various scientific disciplines. However, in ethnobiology, research on the impacts of urbanization on local ecological knowledge (LEK) often lacks standardization and tends to focus primarily on local scales. This study aims to systematically characterize how researchers address urbanization in ethnobiology and assess its effects on LEK globally. We conducted a systematic review using the PRISMA protocol and selected 66 studies from the Web of Science and Scopus databases for analysis. Our findings reveal that researchers often do not adopt a consistent definition of urbanization, frequently framing their study areas within a simplistic urban-rural dichotomy. Although some studies used urbanization indicators, our qualitative analyses, including a correlation matrix, showed that these indicators were largely independent of each other. Additionally, principal component analysis (PCA) with clustering identified four groupings among the indicators, yet with low correlations between them. A t test analysis of the 66 papers shows that urbanization generally has a negative impact on LEK. Based on these findings, we emphasize the critical need for standardized urbanization indicators in ethnobiological studies and propose a new approach for characterizing urbanization, which will enhance the precision and relevance of future research in this field.

Trade-off between herbal and allopathic treatments: An ethnopharmacological case study in Rema-kalenga wildlife sanctuary, Bangladesh

The Rema-Kalenga Wildlife Sanctuary (RKWS) is a protected forest in Bangladesh that houses a variety of rare flora and fauna and supports the sustenance of 13 ethnic communities. This forest's indigenous and other inhabitants traditionally have a strong cultural connection to the plants, particularly medicinal plants. Due to modern allopathic medicine's rapid growth and commercial tree species prioritization, many medicinal plants are now on the verge of endangerment. Under such circumstances, it is crucial to explore how the local community perceives the importance of herbal treatments in contrast to allopathy, the underlying reasons for their perceptions, and the specific ailments for which they use the plants. The main objectives are: 1) to evaluate the perceptions of the local community towards allopathy and herbal medicine using Nussbaum's central capabilities approach, 2) to identify medicinal plant diversity, therapeutic usages, and quantitative indices, 3) to determine the factors that influence the use of medicinal plants. Repeated interviews and field surveys were conducted at the RKWS, interviewing 145 people, including the indigenous community (72.42 %) and traditional healers (8.27 %) from the surrounding seven villages. The study identified 51 medicinal plant species belonging to 39 families for their potent medicinal properties in treating various ailments. The predominant parts of the plants used in the treatments were leaves and roots. The uses were classified into 12 categories according to Nussbaum's central capabilities. The findings identified Aloe vera, Phyllanthus emblica, and Azadirachta indica as highly culturally important species. In contrast, Terminalia arjuna, Swertia chirata, and Azadirachta indica were found to have the highest relative importance. The underlying determinants influencing the preferences of individual users towards herbal medicine were income from agroforestry, beliefs, knowledge, and ethnicity, as revealed by the analysis of the ordinal logit model. The respondents viewed their strong inclination toward herbal medicine with many positive attitudes. Herbal medicine users held a negative perception of allopathy except for affiliation and practical reasons being viewed as the positive outcomes. Conversely, allopathic medicine users expressed mixed perceptions towards the treatment, with both positive and negative aspects being identified. Promoting the sustainable use of medicinal plants and their conservation efforts is imperative for the benefit of present and future generations in this region.

US South Asian Youths' Perspectives on the Use of Complementary and Alternative Medicine (CAM)

Complementary and alternative medicine (CAM) includes varied medical and healthcare systems, healing practices, and products that are outside of allopathy/biomedicine. The aim of this study was to examine US South Asian youths' beliefs, practices, decision-making, and experiences of using CAM. Ten focus group discussions with 36 participants were conducted. Data were coded deductively and inductively by four coders, working in pairs. Thematic analysis was performed. Disagreements were resolved through consensus. The results showed that CAM was appealing because of its often low cost, ease of access, family traditions to use CAM, and the perception that it was safe to use. Participants exercised pluralistic health choices. Some responses suggested a hierarchy wherein allopathy was used for serious, acute issues, and CAM for much of the remaining issues. The high use of and trust in CAM among young US South Asians raises important issues (e.g., provider support and integration to prevent potential interactions and avoid delaying allopathic treatment). More exploration is needed about the decision-making processes of US South Asian youth, including the perceived benefits/limitations of allopathy and CAM. US healthcare practitioners should familiarize themselves with South Asian social and cultural beliefs about healing to provide culturally-appropriate services and enhance patient care.

Utilization of Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homoeopathy (AYUSH) Practitioners' Services Among Older Adults: Results From the Longitudinal Aging Study in India

BACKGROUND

Ayurveda, yoga, naturopathy, Unani, Siddha, and homeopathy (AYUSH) form an alternative system of medicine in India. Understanding the utilization of AYUSH practitioners' services is crucial to substantiating the current government initiatives to mainstream AYUSH in the Indian health system. The utilization of AYUSH practitioners' services among different sub-populations, including older adults, for various health conditions is underexplored. The present study explores the utilization of AYUSH practitioners' service among older Indian adults and its correlates.

METHODS

During 2017-2018, the Longitudinal Aging Study in India (LASI) conducted a nationally representative study among adults aged 45 years or more and their spouses. The study leveraged this data from publicly available LASI. Descriptive analysis and cross-tabulation were performed using a subset of older adults (age ≥ 60 years, n = 31,464). The utilization of AYUSH practitioners' services was taken as the outcome variable. A logistic regression model was employed to understand the independent effect of various explorative variables on the use of AYUSH practitioners' services.

RESULTS

One in 14 older adults utilized the services of AYUSH practitioners. The socio-demographic factors that were looked at, including religion, residence, and caste were significant independent factors for AYUSH consultation. Among chronic conditions, hypertension (use-5.6%, AOR: 1.24, CI: 1.09-1.40), diabetes (use-4.2%, AOR: 1.31, CI: 1.09-1.57), and arthritis (use-9.1%, AOR: 0.59, CI: 0.52-0.67) were independent determinants of AYUSH practitioners' service utilization. In the fully adjusted model, the effect of explanatory variables is almost similar to that in the minimally adjusted model. Only the effect of the female gender was accentuated in magnitude, whereas the effect of diabetes was partially attenuated.

CONCLUSION

The preference for AYUSH practitioners' service among older adults is determined by the complex interplay between socio-demographic factors and disease conditions. Though utilization of AYUSH practitioners' service was high among certain underprivileged sections, it is assuring that education and income do not affect older populations' preference for AYUSH practitioners' service.

Ayurvedic practice, education and research, beyond dilemmas and confessions

Emergent diseases and the pursuit of universal health coverage have incited a renewed interest in the role of traditional medicines (TM) in healthcare. Ayurveda, a widely accepted and practised system in India, is gaining attention globally owing to its holistic and individualised therapeutic approaches. Addressing the contemporary relevance of Ayurveda in healthcare, the article examines concerns surrounding its core principles, educational methodologies, and research validation. Pertinent queries are raised about Ayurveda's relevance today and challenges in aligning Ayurvedic theories with current scientific paradigms and pedagogical dilemmas in Ayurvedic education. Further, we propose solutions, charting a course for Ayurveda's evolution in contemporary healthcare. This includes bridging epistemological differences by integrating modern scientific methodologies with Ayurvedic concepts. Addressing the educational challenges, we recommend comprehensive curriculum revisions considering contemporary healthcare needs. The teaching methodologies are to be enhanced to impart Ayurvedic principles effectively, acknowledging the limitations of ancient anatomical and physiological constructs. Training programs must prioritise equipping teachers with the ability to impart a critical understanding of Ayurveda's philosophy without undermining modern scientific concepts. In conclusion, this article underscores the importance of policy reforms in Ayurvedic curriculum design and teaching methodologies to ensure Ayurveda's sustained relevance and integration within contemporary healthcare systems.

Chromatographic Techniques and Pharmacological Analysis as a Quality Control Strategy for Serjania triquetra a Traditional Medicinal Plant

Serjania triquetra is a medicinal plant widely used in traditional medicine for the treatment of urinary tract diseases, renal affections, and its complications. The population can buy this plant in folk markets as a raw material mixed with several herbal remedies or as a health supplement. On the market, two commercial presentations were found for the vegetal material; one had a bulk appearance and the other was marketed wrapped in cellophane bags (HESt-2, HESt-3). Nevertheless, the plant has not been exhaustively investigated and quality control techniques have not been developed. This research aimed to realize a phytochemical study using an authentic, freshly collected sample as a reference for S. triquetra (HESt-1), using the compounds identified. A method for the determination of preliminary chromatographic fingerprinting was developed. Additionally, the vasorelaxant effect from three samples was evaluated with ex vivo rat models. Thus, three hydroalcoholic extracts (HESt-1, HESt-2, and HESt-3) were prepared by maceration. A total of nine compounds were fully identified from HESt-1 after the extract was subjected to open-column chromatography. Seven metabolites were detected by gas chromatography, while ursolic acid (UA) and allantoin were isolated and identified using UPLC-MS and NMR, respectively. Three extracts were analyzed for their chromatographic fingerprint by UPLC-MS. Biological activity was explored by ex vivo rat aorta ring model to evaluate vasorelaxant activity. All extracts showed a vasorelaxant effect in a concentration-dependent and endothelium-dependent manner. S. triquetra vascular activity may be attributed to UA and allantoin compounds previously described in the literature for this activity.

Perceptions and use of traditional African medicine in Lubumbashi, Haut-Katanga province (DR Congo): A cross-sectional study

In the Democratic Republic of Congo, the desire of the Ministry of Health to integrate Traditional African Medicine into the Official Health System remains limited by the lack of reliable data on several aspects of this medicine. This study aims to determine the perceptions of the Lubumbashi population towards Traditional African Medicine and the contexts of recourse to these therapeutic modalities. We conducted semi-structured interviews of population samples in each of the 7 Lubumbashi municipalities, which were semi-randomly selected in proportions to each population size, from January to June 2017 and from February to July 2018. A total of 4278 people (average age, 32.1 ± 10.4 years; 36.5% of women) have been surveyed. Among them, 75.8% define "Traditional African Medicine" as "herbal-based treatments"; 79.4% have resorted to traditional medicine, for several pathologies and social problems. This medicine was preferred for efficiency, speed of healing and low cost, as well as the presence of the diseases against which it would be the only one used. Most, (52.1%) have started with Conventional Medicine, then resorted to Traditional African Medicine, 34.7% started directly with Traditional African Medicine, while 13.2% combined these two medicines. From those who have resorted to Traditional African Medicine (n = 3396), 55% declare no concern towards traditional medicine, while 42.5% fear looseness, overdose, intoxication, and lack of hygiene; from those who have not resorted to Traditional African Medicine (n = 882), 78% are fearful of fear looseness, witchcraft, and fetishism. Traditional African Medicine remains an important health care resource for the Lubumbashi people. It is essential that decision-makers consider the importance of this health sector for the population, but also the reported fears and hindrances, and work towards the regulation, sanitization, and control of this medicine to ensure its safe use.

Traditional and complementary medicine use among cancer patients in Nepal: a cross-sectional survey

BACKGROUND

Traditional and complementary medicine (T&CM) is commonly used in South Asian countries such as Nepal. There are various causes and contributing factors for patients with cancer to consider using T&CM. However, little is known about the use of T&CM among the cancer population in this region.

METHODS

The study followed a cross-sectional design using a structured survey questionnaire. Survey participants were recruited from two National hospitals in Kathmandu, Nepal. The survey instrument comprised 30 questions, including variables on demographics, use of T&CM, and perceived level of disease severity, and cancer treatment. Chi-square test and logistic regression were used for data analysis using SPSS ver. 23.0.

RESULTS

Of 908 participants, 31.6% used one or more modalities of T&CM after a cancer diagnosis. The most commonly used T&CM was Ayurveda (46.5%), followed by yoga (32.4%). About 46% of T&CM users discussed their use with their doctors. The main source of information on T&CM was their family members and relatives (55.7%). Cancer type (head and neck cancer OR: 2.30, CI: 1.23-4.29; abdominal cancer OR: 2.69, CI: 1.47-4.95; lung cancer OR: 5.88, CI: 2.69-12.89), cancer stage (Stage I OR: 1.92¸CI: 1.14-3.25; Stage II OR: 1.76, CI: 1.06-2.94), and the patients' self-rated disease severity (high perceived severity OR: 1.50, CI: 1.05-2.16) were strong predictors of T&CM use.

CONCLUSION

This study underlined that despite the widespread use of T&CM among cancer patients in Nepal, most patients obtained information on T&CM from informal sources and did not disclose their use to physicians. To ensure the safe use of T&CM modalities, physicians should integrate questions on T&CM use into routine patient assessments in order to facilitate active communication and improve the quality of care.

Selection of medicinal plants for traditional medicines in Nepal

BACKGROUND

There are handful hypothesis-driven ethnobotanical studies in Nepal. In this study, we tested the non-random medicinal plant selection hypothesis using national- and community-level datasets through three different types of regression: linear model with raw data, linear model with log-transformed data and negative binomial model.

METHODS

For each of these model, we identified over-utilized families as those with highest positive Studentized residuals and underutilized families with highest negative Studentized residuals. The national-level data were collected from online databases and available literature while the community-level data were collected from Baitadi and Darchula districts.

RESULTS

Both dataset showed larger variance (national dataset mean 6.51 < variance 156.31, community dataset mean 1.16 < variance 2.38). All three types of regression were important to determine the medicinal plant species selection and use differences among the total plant families, although negative binomial regression was most useful. The negative binomial showed a positive nonlinear relationship between total plant family size and number of medicinal species per family for the national dataset (β1 = 0.0160 ± 0.0009, Z1 = 16.59, p < 0.00001, AIC1 = 1181), and with similar slope and stronger performance for the community dataset (β2 = 0.1747 ± 0.0199, Z2 = 8.76, p < 0.00001, AIC2 = 270.78). Moraceae and Euphorbiaceae were found over-utilized while Rosaceae, Cyperaceae and Caryophyllaceae were recorded as underutilized.

CONCLUSIONS

As our datasets showed larger variance, negative binomial regression was found the most useful for testing non-random medicinal plant selection hypothesis. The predictions made by non-random selection of medicinal plants hypothesis holds true for community-level studies. The identification of over-utilized families is the first step toward sustainable conservation of plant resources and it provides a baseline for pharmacological research that might be leading to drug discovery.

Assessing the perceptions and practices of peri-urban dairy farmers regarding bovine mastitis management in North-Western Nigeria

Peri-urban dairy farming is an emerging industry in sub-Saharan Africa that risks being undermined by diseases like bovine mastitis (BM) if farmers do not implement appropriate management programmes. However, little is currently known about farmer perceptions and practices towards BM due to challenges with accessing these herds for research. In this study, 49 intensive and 53 extensive peri-urban dairy farmers having ≥10 milking cows in Kaduna and Zaria metropolises, North-Western Nigeria were recruited through snowball sampling and on-farm interviews were conducted to collect information on herd demographics, milking procedures, and mastitis management. Descriptive statistics were provided for all study variables and statistical comparisons were made between intensive and extensive herds. The mean herd size was 33 milking cows (range: 11-62). A greater proportion of extensive herds contained only indigenous breeds of cattle (36/53; 68 %) compared with intensive herds (6/49; 12 %). Hand milking was the most common milking method across both herd types (93/102; 92 %). Intensive herds had better hand washing and udder cleaning practices, but there was no statistical difference between management systems with regards to floor, udder, and tail cleanliness. Only a small number of farms performed on-farm diagnosis of BM via strip cup test (4/102; 4%) or rapid mastitis test (3/102; 3%). Treatment of clinical mastitis was typically by intramuscular antibiotic injection (71/102; 70 %) or topically applied herbal preparations (14/102; 14 %). Dry cow intramammary therapy was only used by 6/46 intensive farms (13 %) and 1/53 extensive farms (2%). Most extensive herds (40/53; 76 %) reported milking cows with clinical mastitis after apparently healthy cows, however this practice was less common among intensive herds (5/49; 10 %). Extensive herds were less likely to request veterinary assistance for mastitis than intensive herds (17/53; 32 % versus 28/49; 57 %) and had higher perceived costs for treating BM cases. Intensive farmers reportedly received higher prices for milk than extensive farmers and perceived that BM was causing significantly more production losses in their herds. Only a small number of farmers (20/102; 20 %) kept mastitis treatment records for their herds. Overall, the study findings indicate that peri-urban dairy farmers may be lacking in awareness of BM impacts and access to basic resources to implement good practices such as hand washing between milking cows and antibiotic intramammary infusions.

Use of and attitudes towards herbal medicine during the COVID-19 pandemic: A cross-sectional study in Vietnam

Introduction

Herbal medicine has a long and rich history of practice in Vietnam. The use and attitudes towards herbal medicine, during the COVID-19 pandemic was explored in this study. The aims were to examine (1) the prevalence and indications for herbal medicine use, (2) the factors associated with herbal medicine use, and (3) Vietnamese peoples' attitudes towards herbal medicine.

Methods

A cross-sectional online survey was conducted in Vietnamese adults aged 18 years and older, distributed equally across the Northern, Central, and Southern regions of Vietnam, between September and October 2020. Descriptive statistics, chi-square tests, and univariate and multivariate logistic regression analyses were performed to achieve the study objectives.

Results

Nearly half of the respondents reported using herbal medicine for common illnesses during the COVID-19 pandemic. The prevalence was strongly associated with marital status, urbanicity, monthly income, and health status perception. Ginger (Zingiber officinale Rosc.), honey (Mel), garlic (Allium sativum L.), and perilla (Perilla frutescens (L.) Britt.) were the most commonly used herbal medicines, mainly for the treatment of sore throat, cough, nasal congestion, and fever. Nearly 70% of the participants believed herbal medicines to be safe, to have less side effects than conventional medicines, and to be effective for minor health conditions.

Conclusion

The use of herbal medicine during the COVID-19 pandemic was a common practice among Vietnamese people. These findings may have implications for future medical research in Vietnam, and for policy-makers and those in the pharmaceutical industry with regard to future regulations and product development.

'I treat it but I don't know what this disease is': a qualitative study on noma (cancrum oris) and traditional healing in northwest Nigeria

Background

Noma, a neglected disease mostly affecting children, with a 90% mortality rate if untreated, is an orofacial gangrene that disintegrates the tissues of the face in <1 wk. Noma can become inactive with early stage antibiotic treatment. Traditional healers, known as mai maganin gargajiya in Hausa, play an important role in the health system and provide care to noma patients.

Methods

We conducted 12 in-depth interviews with caretakers who were looking after noma patients admitted at the Noma Children's Hospital and 15 traditional healers in their home villages in Sokoto state, northwest Nigeria. We explored perceptions of noma, relationship dynamics, healthcare practices and intervention opportunities. Interviews were audiorecorded, transcribed and translated. Manual coding and thematic analysis were utilised.

Results

Traditional healers offered specialised forms of care for specific conditions and referral guidance. They viewed the stages of noma as different conditions with individualised remedies and were willing to refer noma patients. Caretakers trusted traditional healers.

Conclusions

Traditional healers could play a crucial role in the early detection of noma and the health-seeking decision-making process of patients. Intervention programmes should include traditional healers through training and referral partnerships. This collaboration could save lives and reduce the severity of noma complications.

Facilitators and barriers to the self-management of COPD: a qualitative study from rural Nepal

OBJECTIVE

To understand the facilitators and barriers to the self-management of chronic obstructive pulmonary disease (COPD) in rural Nepal.

SETTINGS

Community and primary care centres in rural Nepal.

PARTICIPANTS

A total of 14 participants (10 people with COPD and 4 health care providers) were interviewed.

PRIMARY AND SECONDARY OUTCOME MEASURES

People with COPD and healthcare provider's experience of COPD self-management in rural Nepal.

RESULTS

Facilitators and barriers affecting COPD self-management in Nepal operated at the patient-family, community and service provider levels. People with COPD were found to have a limited understanding of COPD and medications. Some participants reported receiving inadequate family support and described poor emotional health. At the community level, widespread use of complementary and alternative treatment was found to be driven by social networks and was used instead of western medicine. There were limited quality controls in place to monitor the safe use of alternative treatment. While a number of service level factors were identified by all participants, the pertinent concerns were the levels of trust and respect between doctors and their patients. Service level factors included patients' demands for doctor time and attention, limited confidence of people with COPD in communicating confidently and openly with their doctor, limited skills and expertise of the doctors in promoting behavioural change, frustration with doctors prescribing too many medicines and the length of time to diagnose the disease. These service level factors were underpinned by resource constraints operating in rural areas. These included inadequate infrastructure and resources, limited skills of primary level providers and lack of educational materials for COPD.

CONCLUSIONS

The study findings suggest the need for a more integrated model of care with multiple strategies targeting all three levels in order to improve the self-management practices among people with COPD.

Ethnomedicinal Uses of Plant Resources in the Machhapuchchhre Rural Municipality of Kaski District, Nepal

Background: Medicinal plants are being used by the majority of the population throughout the world for their primary health care needs. The reliance is also prevalent in Nepal, aided by its ethnic and biological diversity. This study aimed to catalogue the ethnomedicinal knowledge of plants used by local people of Machhapuchchhre Rural Municipality of Kaski district. Methods: Data were collected between February 2017 and April 2018 from eight different villages of the Kaski district by using semi-structured interviews, guided field works, focus group discussions, and in-depth interviews. The reported traditional uses were supported by local assistants, cataloguing vernacular names and crosschecking with the earlier published and gray literature. Results: A total of 105 medicinal plants, belonging to 58 families and 99 genera were documented to treat 70 different diseases and ailments. The highest numbers of plants (37) were used for gastrointestinal disorders and the lowest (4) were used for female genital disorders. Commonly used parts were underground portions (28 species) followed by fruits and seeds (25 species each). The most preferred dosage form was juice, used for 50 ailments, and the oral route was the most favored route of administration (77 species). The medicinal properties of 22 plant species were found hitherto unreported in the district. Conclusions: The study area was found to be rich in plant resources and the people have ample knowledge on the use of medicinal plants. Due to a lack of proper documentation, conservation, and cultivation practices, valuable plant species are at risk of extinction. Thus, appropriate conservation measures and scientific assessment of plant-lore in the district is immediately required.

Modern or traditional health care? Understanding the role of insurance in health-seeking behaviours among older Ghanaians

Aim:

This paper examined the association between wealth and health insurance status and the use of traditional medicine (TM) among older persons in Ghana.

Background:

There have been considerable efforts by sub-Saharan African countries to improve access to primary health care services, partly through the implementation of risk-pooling community or national health insurance schemes. The use of TM, which is often not covered under these insurance schemes, remains common in many countries, including Ghana. Understanding how health insurance and wealth influence the use of TM, or otherwise, is essential to the development of equitable health care policies.

Methods:

The study used data from the first wave of the World Health Organisation’s Study of Global Ageing and Adult Health conducted in Ghana in 2008. Descriptive statistics and negative loglog regression models were fitted to the data to examine the influence of insurance and wealth status on the use of TM, controlling for theoretically relevant factors.

Findings:

Seniors who had health insurance coverage were also 17% less likely to frequently seek treatment from a TM healer relative to the uninsured. For older persons in the poorest income quintile, the odds of frequently seeking treatment from TM increased by 61% when compared to those in the richest quintile. This figure was 46%, 62% and 40% for older persons in poorer, middle and richer income quintiles, respectively, compared to their counterparts in the richest income quintile.

Conclusion:

The findings indicate that TM was primarily used by the poor and persons who were not enrolled in the National Health Insurance Scheme. TM continues to be a vital health care resource for the poor and uninsured older adults in Ghana.

A study on food-medicine continuum among the non-institutionally trained siddha practitioners of Tiruvallur district, Tamil Nadu, India

BACKGROUND

Medicinal properties of the food species are one of the poorly documented and important areas of ethnopharmacology. The present survey quantitatively documented the medicinal foods prescribed by the non-institutionally trained siddha practitioners of Tiruvallur district of Tamil Nadu.

METHODS

Field work was carried out between December 2014 and April 2017 using a questionnaire. The illnesses mentioned by the informants were grouped as illness categories on the basis of emic perceptions. Sufficiency of sampling of this survey was assessed by plotting the cumulative number of UR and Shannon-Wiener's index. The indices such as informant consensus factor (FIC), Index of Agreement on Remedies (IAR), and Cultural Food Significance Index (CFSI) were calculated.

RESULTS

This study documented 165 medicinal foods used by 82 non-institutionally trained siddha practitioners of Tiruvallur district, and 73.93% of these preparations were plant based. Among the animal taxa, 82.05% were represented by fish taxa. The illness category gastrointestinal ailments is the majorly cited illness category treated with plant-based formulations. The illness categories viz., gastrointestinal ailments, hemorrhoids, and neural ailments had high consensus under the group of plant-based medicinal foods. In animal-based medicinal foods, kapha ailments had gained 23.07% of UR. The illness categories such as bone fractures, male reproductive ailments, blood ailments, and anabolic had high FIC values.

CONCLUSIONS

Deeper studies on different dietary cultures of India may help to derive better interpretations on food-medicine continuum. This study identified some important claims such as the use of citron, pomegranate and Solanum americanum (gastrointestinal ailments), Abutilon indicum, onions and elephant foot yam (hemorrhoids), Boerhavia diffusa (urinary ailments), Moringa oleifera (anemia), Aloe vera (gynecological ailments), Eclipta prostrata (liver ailments), ivy gourd (diabetes), citron (hypertension), Centella asiatica (psychological ailments), spade nose shark (lactogogue), reticulate whipray (wheezing and bronchitis), Katelysia opima (impotence), Indian squid (anemia), and Indian oil sardine (anabolic). More studies on these claims will help identify novel functional foods to add to the field of medical nutrition therapy, with traditional brand identity. Robust studies on the documentation of the traditional knowledge on marine resources will yield a good database for various stakeholders and policy makers.

Underlying determinants of health provider choice in urban slums: results from a discrete choice experiment in Ahmedabad, India

Background

Severe underutilization of healthcare facilities and lack of timely, affordable and effective access to healthcare services in resource-constrained, bottom of pyramid (BoP) settings are well-known issues, which foster a negative cycle of poor health outcomes, catastrophic health expenditures and poverty. Understanding BoP patients’ healthcare choices is vital to inform policymakers’ effective resource allocation and improve population health and livelihood in these areas. This paper examines the factors affecting the choice of health care provider in low-income settings, specifically the urban slums in India.

Method

A discrete choice experiment was carried out to elicit stated preferences of BoP populations. A total of 100 respondents were sampled using a multi-stage systemic random sampling of urban slums. Attributes were selected based on previous studies in developing countries, findings of a previous exploratory study in the study setting and qualitative interviews. Provider type and cost, distance to the facility, attitude of doctor and staff, appropriateness of care and familiarity with doctor were the attributes included in the study. A random effects logit regression was used to perform the analysis. Interaction effects were included to control for individual characteristics.

Results

The relatively most valued attribute is appropriateness of care (β=3.4213, p = 0.00), followed by familiarity with the doctor (β=2.8497, p = 0.00) and attitude of the doctor and staff towards the patient (β=1.8132, p = 0.00). As expected, respondents prefer shorter distance (β= − 0.0722, p = 0.00) but the relatively low importance of the attribute distance to the facility indicate that respondents are willing to travel longer if any of the other statistically significant attributes are present. Also, significant socioeconomic differences in preferences were observed, especially with regard to the type of provider.

Conclusion

The analyses did not reveal universal preferences for a provider type, but overall the traditional provider type is not well accepted. It also became evident that respondents valued appropriateness of care above other attributes. Despite the study limitations, the results have broader policy implications in the context of Indian government’s attempts to reduce high healthcare out-of-pocket expenditures and provide universal health coverage for its population. The government’s attempt to emphasize the focus on traditional providers should be carefully reconsidered.

Cross-cultural comparison of plant use knowledge in Baitadi and Darchula districts, Nepal Himalaya

BACKGROUND

This study seeks to better understand the human-nature interface and to measure the variability of plant use knowledge among cultures, through inter- and intracultural analyses. We compared plant collection, use, and management of two culturally distinct groups (Baitadi and Darchula) of the Nepal Himalaya. They inhabit different physiographic regions, yet share the same ecological landscape, environmental resources, and livelihood challenges. We hypothesized that the elderly, native, and traditional healers living in remote and rural places possess more diverse and detailed knowledge of plant use and conservation than young, non-native, and non-healers.

METHODS

A total of 106 people were contacted for interviews, and 100 (68 men and 32 women) agreed to share ethnobotanical, demographic, and socioeconomic information. They were asked about the three most important plants for their socioeconomic benefit, culture, primary health care, and livelihood.

RESULTS

The knowledge of plant collection, use, and its transfer was strongly associated with the cultural heritage whereas the ecogeographical condition influences the ways in which plants are collected and used. The divergent knowledge of plant collection, use, and transfer between the participants of Baitadi and Darchula was significantly (p < 0.001) attributed to the cultural heritage of the area. The low consensus of plant use (FiC 0-0.87; IASc 0-0.67) between Baitadi and Darchula district could be due to cultural divergence, varied accessibility, physiographic heterogeneity, and biodiversity uniqueness.

CONCLUSIONS

Differences in plant use knowledge may help in diversifying the strategies of plant use in accordance with the livelihood, culture, and environment, and therefore, more studies measuring these aspects can further the ecosystem and cultural health of the region.

Factors Contributing to the Decline of Traditional Practices in Communities from the Gwallek-Kedar area, Kailash Sacred Landscape, Nepal

Traditional knowledge and practices are increasingly recognized in the resource conservation and management practices, however are declining in many parts of the world including Nepal. Studies on the inventory of traditional knowledge are available, albeit limited, and empirical analysis of factors contributing to the decline of traditional knowledge are negligible in Nepal. We thus initiated this study in the Nepal part of the Kailash Sacred Landscape to (i) document traditional knowledge and practices on agriculture, forest-based herbal remedy, and genetic resource conservation; and (ii) identify factors contributing to the decline of traditional practices in the communities. Data was collected during September-December 2015 through key informant interviews, focus group discussions, and households survey. The household survey data was used in binary logistic regression analysis to identify factors contributing to the decline of six key traditional practices. The study documented 56 types of traditional practices. The regressions showed that the age of the respondent, distance to the nearest forest, distance to the nearest motorable road, family members' ill health, and seasonal migration of the household members for jobs significantly influencing to the decline of the particular traditional practices, however, their effects vary within a practice and among the practices. The use of modern medicine, increasing road linkages, decreasing trend of plant resource availability, and agriculture intensification are responsible for the decline of the particular traditional practices. We recommend to recognize their significance in the governing socio-ecological systems and to link the traditional and scientific knowledge systems through policy formulations.

Utilization of alternative systems of medicine as health care services in India: Evidence on AYUSH care from NSS 2014

AYUSH, an acronym for Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-Rigpa and Homeopathy represents the alternative systems of medicine recognized by the Government of India. Understanding the patterns of utilization of AYUSH care has been important for various reasons including an increased focus on its mainstreaming and integration with biomedicine-based health care system. Based on a nationally representative health survey 2014, we present an analysis to understand utilization of AYUSH care across socioeconomic and demographic groups in India. Overall, 6.9% of all patients seeking outpatient care in the reference period of last two weeks have used AYUSH services without any significant differentials across rural and urban India. Importantly, public health facilities play a key role in provisioning of AYUSH care in rural areas with higher utilization in Chhattisgarh, Kerala and West Bengal. Use of AYUSH among middle-income households is lower when compared with poorer and richer households. We also find that low-income households display a greater tendency for AYUSH self-medication. AYUSH care utilization is higher among patients with chronic diseases and also for treating skin-related and musculo-skeletal ailments. Although the overall share of AYUSH prescription drugs in total medical expenditure is only about 6% but the average expenditure for drugs on AYUSH and allopathy did not differ hugely. The discussion compares our estimates and findings with other studies and also highlights major policy issues around mainstreaming of AYUSH care.