Prevalence and determinants of using complementary and alternative medicine for the treatment of chronic illnesses: A multicenter study in Bangladesh

Natural disasters, livelihood, and healthcare challenges of the people of a riverine island in Bangladesh: A mixed-method exploration

BACKGROUND

Bangladesh's islands, because of their geographical location, frequently encounter crises like floods and river erosion, which pose significant threats to the residents' well-being and livelihoods. To delve into the effects of these disasters on livelihood and healthcare challenges, a mixed-method study was undertaken in a riverine-island near a major river of Bangladesh.

METHODOLOGY

Between February 15th and February 28th, 2023, a cross-sectional study was conducted on an island in Bangladesh. The quantitative method involved conducting a survey of 442 households, with a total of 2921 participants. Additionally, 10 in-depth interviews and 10 key-informant interviews were conducted using semi-structured guidelines. Qualitative interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic analysis. Triangulation was employed in this study through the integration of qualitative and quantitative analysis, resulting in the presentation of findings that offer an in-depth comprehension of the phenomenon being investigated.

RESULTS

River erosions and floods are common and recurring natural disasters that significantly impact the lives of the riverine island inhabitants. These disasters often disrupted their livelihoods, forced many residents to endure substandard living conditions or relocated during flood events. The island faced a low diagnostic prevalence of chronic diseases (e.g., 5.1% of adults were hypertension and 2.5% are diabetes) because of the absence of diagnostic facilities and a shortage of certified doctors. A significant number of chronic illness people in the community turned to alternative medicine sources (39.3%) such as homeopathy, Kabiraj, and Ayurvedic medicine, especially it gets increased during periods of natural disasters. Moreover, reproductive aged women revealed that 79.4% of them gave birth at home, with 6.0% of these home deliveries resulting in miscarriage or infant death. The destruction of crops, unstable job opportunities, an inadequate educational system, and a deficient healthcare delivery system exacerbated the hardships faced by the population affected by these disasters.

CONCLUSION

The failure to seek treatment for chronic diseases and undiagnosed diseases is a significant health issue among the aging adults on the island. Island residents face the challenge of establishing effective prevention strategies for the well-being of older adults especially at the period of natural disasters. It is crucial for the government and non-governmental organizations (NGOs) to collaborate to prevent the negative effects of floods and river erosions. This should include efforts to enhance the quality of education, healthcare services, job opportunities, and financial assistance for rebuilding homes.

Prevalence and associated factors of herbal medicine use among patients living with chronic disease in Ethiopia: A systematic review and meta-analysis

Background

Complementary use of medicinal plants with prescribed drugs is becoming more widespread concern among people with chronic disease like cancer, HIV/AIDS, diabetes and hypertension. Consequently, the purpose of this review was to determine the prevalence and associated factors of herbal medicine use among patients suffering from chronic disease.

Methods

This systematic review and meta-analysis was conducted by searching articles from Cochrane library, Google scholar, PubMed and African journal online. Data was extracted using Microsoft excel format and imported in to Stata software version 11 (Stata Corp LLC, TX, USA) for analysis. Statistical heterogeneity across the studies was investigated using Cochran's Q chi-square test at the significance level of <0.05 and the I2 index. A random-effects model was used to estimate the pooled prevalence of herbal medicine use.

Results

Our systematic search yielded a total of 17,665 records from four databases (Google scholar (12,800), PubMed (3835), Cochrane library (30) and African journal online (12). The pooled estimate of herbal medicine use among patients with chronic disease in Ethiopia is found to be 56.94% (95% CI: 49.75, 64.12, P < 0.001). Being female (POR = 2.06, 95% CI = 1.55, 2.75, I2 = 10.0%), rural residence (POR = 2.80, 95% CI = 1.42, 5.52, I2 = 89.1%), duration of the disease greater than 5 years (POR = 6.42, 95% CI = 4.188, 9.84, I2 = 48.3%) and having complication (POR = 4.65, 95% CI = 3.75, 5.77, I2 = 0.0%) were factors associated with herbal medicine use among patients living with chronic disease.

Conclusion

The study found a high prevalence of herbal medicine use among patients living with chronic disease. Being female, rural residence, duration of disease greater than 5 years and having complication were factors that are significantly associated with herbal medicine use. The prevalence of herbal medicine use among persons with chronic disease in Ethiopia presents significant implications for healthcare practice. Healthcare professionals need to adopt a patient-centered strategy that promotes open, judgment-free discussions about herbal medicine usage.

Prospero registration

CRD42024498817.

Factors influencing the use of natural health products, in particular for concentration and cognition in Germany

BACKGROUND

Natural health products (NHP) are an important part of the healthcare system. They are mainly non-prescription and sold over the counter, which requires active decision making by the consumer. Within the framework of the Complementary and Alternative Healthcare Model, this study aims to identify factors that influence NHP usage, in particular related to concentration and cognition (CC), a topic that concerns all ages and social classes within the population.

METHODS

Data were collected by means of a representative online survey (n = 1,707) in Germany in April 2022. Three user groups were defined: NHPCC users, who used NHP for CC (12 month prevalence); nCC-NHP users, who used NHP but not for CC indications (12 month prevalence); and past NHP users, who have used NHP but not within the previous 12 months. Independent influencing variables were categorized into predisposing, enabling, need, and health service use factors. Data were analyzed with descriptive statistics, inferential statistics, and binary logistic regression models to compare NHPCC users to nCC-NHP users (model 1) and to past NHP users (model 2).

RESULTS

A higher share of NHPCC and nCC-NHP users compared to past NHP users were women, self-medicated with NHP, and used information about NHP provided by health professionals or on product. Their openness-to-change value orientation was more pronounced than of past users. Compared to nCC-NHP and past NHP users, the probability of being an NHPCC user increased if an individual had more difficulties in daily attention and memory performance, made use of health professionals and literature to seek information about NHP, and used NHP for health support and illness prevention. Additionally, a female gender, NHP self-medication, and having higher values of self-transcendence were significant indicators for NHPCC usage compared to past NHP usage.

CONCLUSION

NHP manufacturers, health professionals, and policymakers should be aware of the factors that lead to NHP consumption decisions and consider them in the development and optimization of healthcare strategies as well as in the marketing and communication strategies of companies producing NHP, in particular for CC. The current study can contribute to characterizing the target groups and to defining the aims and communication channels of such campaigns.

Knowledge, attitude, and perceptions of healthcare professionals towards complementary and alternative medicine: a cross-sectional survey from twin cities of Pakistan

BACKGROUND

The growing popularity and use of complementary and alternative medicine (CAM) products among the general public worldwide has been well documented. This study aimed to investigate the knowledge, attitude, and perceptions (KAP) of Pakistani healthcare professionals (HCP) toward CAM and to document their views on integrating CAM education with the curriculum of undergraduate health science programs.

METHOD

A cross-sectional study using simple random sampling was conducted for a duration of ten months among HCPs from Pakistan's twin cities: Islamabad and RawalpindiThe data were collected using a self-administered and validated (Cronbach's alpha: 0.71) questionnaire. This questionnaire consisted of five sections, namely; demographic, attitude, perception, integration and knowledge.

RESULT

The response rate was 91.20% (500/456). The participants included 160 physicians, 155 nurses,and 141 pharmacists. The majority of the respondents were females, 67.50%, and unmarried (60.50%).The majority of HCPs participating in this study agreed that CAM modalities may benefit conventional medicine system. Likewise, most HCPs perceived different CAM therapies aseffective treatment options. More than 50% HCPs suggested CAM elective courses in the curriculum of the health sciences program.Overall, 79.17% of the HCPs have poor knowledge of CAM. Physicians have the highest knowledge score 25.63%, followed by pharmacists 21.99%, and nurses 12.26%. Knowledge status was significantly associated with age, profession, and experience of practice (p = 0.001,0.001 & 0.019).

CONCLUSION

This study revealed that despite the overall positive attitude of HCPs toward CAM, the score of knowledge is low. Therefore, the survey recommends evidence-based guidelines for the rationale use of CAM and updated syllabi of undergraduate health programs which will assist the future HCPs in increasing professionals' knowledge toachieve better health outcomes for the general public.

Accidental poisoning with aconite overdose: A case report and resuscitative emergency management in a tertiary level hospital of Bangladesh

Intoxication with aconite, a common over-the-counter herbal medicine in Asia, can result in ventricular tachycardia and cardiac arrest and requires heart rate monitoring in a critical care setting and aggressive use of antiarrhythmica. Educational efforts in the appropriate use of alternative medicine may help prevent intoxication.

Prevalence, Pattern, and Predictors of Ever Use of Complementary and Alternative Medicine in Diabetes and Hypertension: A Cross-Sectional Study

Introduction

Noncommunicable diseases (NCDs) have emerged as a pandemic globally and the situation is worse for developing nations. The four major NCDs that are responsible for a major proportion of mortality across the globe are cardiovascular diseases, cancer, respiratory diseases, and diabetes. For a country with limited resources, an integrated approach toward the management of NCDs is of particular importance. Complementary and alternative medicines (CAMs) are those health-care and medical practices that are not currently an integral part of conventional medicine system. This study was undertaken to estimate the prevalence, pattern, and predictors of CAM use among patients with NCDs (diabetes, hypertension, or both).

Materials and Methods

A health-facility-based cross-sectional study was conducted at different levels of government health-care facilities in Rishikesh, Uttarakhand. CAM categories included alternative medical systems, mind-body intervention, biologically based therapies, manipulative and body-based methods, and energy therapies. Additionally, jhaad phook/local healers were also included in our study.

Results

The study showed that 41% of all the study participants were ever users of CAM. While most of the users were practicing more than one type of CAM, the most common type of CAM practiced was alternative medicine system (83.3%) followed by mind-body medicine (40.2%). Except religion and place of residence of the study participant, no other factor showed a significant association with ever usage of CAM.

Conclusion

CAM use was popular among study participants as almost half of them were using/consuming it and alternative medicine system was the most common type of CAM practiced.

Protective effects of the Terminalia bellirica tannin-induced Nrf2/HO-1 signaling pathway in rats with high-altitude pulmonary hypertension

BACKGROUND

Oxidative stress and endothelial cell dysfunction induced by high-altitude hypoxia have important roles in the pathological process of high-altitude pulmonary hypertension (HAPH). Tannins present in Terminalia bellirica (Gaertn.) Roxb. (TTR) have pharmacological activities that produce oxidation resistance and exert anti-inflammatory effects. Whether TTR exerts a protective effect on HAPH remains unknown.

METHODS

A rat model of HAPH was established. The mean pulmonary arterial pressure (mPAP) of the animals was measured, the serum levels of SOD, MDA, and GSH-Px were measured using ELISA, and the expression of Bax, Bcl-2, Nrf2, and HO-1 proteins in the lung tissue of each group of rats was measured using Western blotting. Pathological changes in the lung tissue were also observed. A model of damage to H₂O₂-induced pulmonary artery endothelial cells (PAECs) was generated, and cell proliferation was measured using CCK-8 assays. Flow cytometry was used to measure ROS levels in PAECs. Western blotting was used to detect the expression of Bax, Bcl-2, Nrf2, and HO-1 proteins in PAECs.

RESULTS

The hemodynamic and pathologic findings showed that the mPAP of HAPH rats increased markedly, and the vascular wall thickness increased (P < 0.05). TTR reduced mPAP, alleviated or slowed pulmonary arterial remodeling, increased GSH-Px and SOD activity, lowered the level of MDA (P < 0.05), and downregulated the expression of Bax in the lung tissues of HAPH rats, while the expression of Bcl-2, Nrf2, and HO-1 was upregulated (P < 0.05). The results of the cell experiments showed that TTR inhibited H₂O₂-induced PAEC apoptosis and ROS production (P < 0.05), downregulated the expression of Bax in PAECs, and upregulated the expression of Bcl-2, Nrf2, and HO-1 (P < 0.05).

CONCLUSION

The results suggest that TTR reduces pulmonary arterial pressure, decreases oxidative stress during HAPH, and exerts protective effects in rats with HAPH and that its mechanism of action is related to regulation of the Nrf2/HO-1 signaling pathway.

The relationship between use of complementary and alternative medicine and health literacy in chronically ill outpatient cases: a cross-sectional study in southeastern Iran

Background

Chronically ill outpatient cases use a variety of complementary and alternative medicines due to their diseases and therapeutic complications. Chronic condition, quality of life, and health literacy all affect the use of complementary medicine among chronically ill outpatient cases. Health literacy helps patients make fully informed decisions about the use of complementary and alternative medicine. This study aimed to investigate the relationship between complementary and alternative medicine and health literacy in chronically ill outpatient cases.

Method

This cross-sectional analytical-descriptive study was conducted on 400 chronically ill outpatient cases referred to medical centers affiliated to Kerman University of Medical Sciences. Convenience sampling was used. Research tools included the complementary and alternative medicine questionnaire and the health literacy questionnaire. SPSS25 was used to analyze data.

Results

The mean use of complementary and alternative medicine in a recent year was 16.75 ± 7.89, which was lower than the mid-point of the questionnaire (84). Prayer, medicinal plants, vitamin supplements, music therapy, and art therapy were the mostly used complementary and alternative medicine methods. The most common reasons for using complementary medicine were to reduce physical complications and improve anxiety and stress. The mean satisfaction with the use of complementary and alternative medicine was 34.96 ± 6.69. The mean health literacy score was 67.13 ± 19.90. Decision-making and the use of health information had the highest mean score among the dimensions of health literacy, whereas reading skills received the lowest mean score. We found a significant and direct relationship between the use of complementary and alternative medicine, health literacy, and all its dimensions.

Conclusion

The study results showed that health literacy predicted the use of complementary and alternative medicine. Health education and promotion programs may be useful for improvement of health literacy in the community.

Knowledge, attitude, perceived effectiveness and self-practice of complementary and alternative medicine: a cross-sectional comparison between medical and non-medical students of Bangladesh

BACKGROUND

Bangladesh's population commonly utilizes Complementary and alternative medicine (CAM) to treat their health issues. Despite the increasing interest in CAM, it has been excluded from conventional medical training in Bangladesh for many years. Therefore, this study assessed and compared the knowledge level, attitude, perceived effectiveness, and self-practice of CAM among undergraduate students of Bangladesh.

METHODS

This cross-sectional group comparison study was conducted among undergraduate (both medical and non-medical) students of Bangladesh between November and December 2021. Data was collected using a self-reported pretested semi-structured online questionnaire. The questionnaire contained questions regarding background information, knowledge regarding CAM, source of CAM knowledge, attitude towards CAM, interest in attaining CAM knowledge, perceived effectiveness of CAM, perceived adverse effects of CAM, self-practice of CAM, and whether would they refer CAM to others. A total of 576 students responded and the data gathered allowed for the following: (1) an overview of the study groups, (2) respondents' general perception and knowledge regarding CAM, and (3) a comparison of respondents' CAM knowledge, general perception, and usage by area of study. Data were analyzed using STATA (v.16) and descriptive statistics, Pearson's chi-square test, and Mann-Whitney U test were performed.

RESULTS

A total of 329 medical students and 247 non-medical students participated in the study. The mean age of the participants was 21.57 ± 1.8 years and 56.2% of them were male. The most known CAM among medical (M) students was homeopathy (44.6%) and among non-medical (NM) students were herbal medicine (45.7%). Non-medical students had significantly better knowledge about nine out of twelve CAM modalities included in the study, and no significant differences were present for the rest of the modalities. Medical (81.1%) and non-medical students (86.2%) perceived traditional Chinese medicine and homeopathy to be the most effective respectively. "Incorporating CAM with conventional medicine would result in increased patient satisfaction" showed the most statistically significant (p = 0.0002) difference among both groups. Yoga was the most often practiced modality among medical students and homeopathy among non-medical students.

CONCLUSION

Medical students have a lacking of knowledge and a positive attitude towards CAM, despite its very common practice among the people of Bangladesh. Therefore, emphasis should be put on the inclusion of CAM modules in medical training.

Complementary Therapies: A Risk of Rupture with General Medicine? A Qualitative Study About the Personal Health Care Journey of Shiatsu Users in France

Context: In 2014, the World Health Organization launched its second strategic plan on the development of complementary medicine. Shiatsu is one of eight alternative approaches worthy of interest. No study explored its users' health trajectories and the motives and experiences of their use of shiatsu. Aim: To explore motives and experiences of the use of shiatsu and its users' health care trajectories in France. Design and Setting: Qualitative study with shiatsu users. Methods: Semistructured telephone interviews with shiatsu users and audio recordings during shiatsu sessions. Shiatsu users were recruited across France by shiatsu practitioners who had no specific instructions on the profile of users to include. Descriptive then thematic analysis of data, with triangulation, according to a phenomenological approach, using MAXQDA© software. Results: Ten interviews and seven recordings were made to gather sufficient data. The major themes identified were the previous knowledge and representations of shiatsu, the symptoms leading to this use, the ineffectiveness of conventional medicine and the user's health trajectories. Users were looking for an alternative to conventional medicine and often resorted to other complementary medicines. They generally had no prior knowledge of shiatsu. They were advised to try shiatsu by those around them, never by a physician. Their main reasons for having recourse to shiatsu were pain, anxiety, and sleep disorders. Users initially tried conventional medicine. Some sought to modify or reduce their medicine intake. Shiatsu then became a regular practice. Users described derogatory reactions from their general practitioner (GP) to this complementary therapy. Conclusion: This study highlights a fluctuating and ambivalent relationship between complementary medicine and conventional medicine. Shiatsu users' health care trajectories include several phases: trust in conventional medicine then disappointment, rupture and risk taking for their health. To avoid this rupture, GP should be involved in the use of complementary therapies.

A Cross-Sectional Assessment of Complementary and Alternative Medicine (CAM) Use among Patients with Chronic Diseases (CDs) in Qassim, Saudi Arabia

This study aims to investigate CAM use among CD patients from Qassim, Saudi Arabia and to compare CAM practice with different demographic and disease characteristics of the participants. A cross-sectional study was conducted among CD patients. During the three-months of data collection period, a total of 377 patients were approached and 208 patients participated in the study, giving a response rate of 55.17%. A p value of <0.05 was considered as significant. Among the study population, 94 (45.2%) patients were CAM users. Diabetes mellitus patients were the majority (48 (51.06%)) followed by hypertensive patients (34 (36.17%)). Spiritual therapies were the most common CAM followed by herbal products. Among CAM users, 41 (19.7%) patients reported disclosing CAM use to their health care providers. Among all the sociodemographic variables, gender (p = 0.029), marital status (p = 0.034) and education level (p = 0.047) were significantly associated with CAM use. In conclusion, the use of CAM among CD patients was relatively high in Qassim. Patients reported using CAM without disclosing to their health care providers which is a major health risk. It is critical to counsel CD patients regarding rational and informed CAM use in order to prevent harmful and unwanted effects.

Proportion and associated factors of the utilisation of complementary and alternative medicine exclusively in a hospital in Bangladesh

Background

Complementary and alternative medicine (CAM) has played a critical role in ensuring universal access to basic health care services around the world. In Bangladesh, conventional medicine is a common approach for health care practices, yet, due to Bangladesh’s high out-of-pocket payment, millions of people utilise CAM-based healthcare services for illnesses. In Bangladesh, there is a scarcity of data on how CAM is perceived and utilised. The goal of this study was to determine the proportion and correlates of the utilisation of CAM among patients visiting a tertiary level hospital, in Bangladesh.

Methods

A cross-sectional survey involving 1,183 patients who received health care from a hospital in Bangladesh was interviewed for this study. The associated factors on utilising CAM were identified using multivariable logistic regression analysis.

Results

Thirty-three percent of patients utilised CAM exclusively to treat their illnesses, whereas the rest utilised conventional medicine before CAM. Young adult patients aged 26 to 45 years (AOR = 6.26, 95% CI:3.24–12.07), patients without education (AOR = 2.99, 1.81–4.93), and married patients (AOR = 1.79, 1.08–2.97) were the most likely to be only CAM users. The most common reasons for using CAM were belief in its effectiveness, less adverse effects, affordability and lower costs.

Conclusion

In Bangladesh, CAM plays a significant role in health care delivery, with high-levels of patient satisfaction and health benefits. Patients who are older and have a higher level of education are more hesitant to use CAM for their illness, yet CAM has the potential to play a significant role in reducing hospitalisation by providing high reliability and low costs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12906-022-03709-8.

A Randomized Controlled Trial of Thai Medicinal Plant-4 Cream versus Diclofenac Gel in the Management of Symptomatic Osteoarthritis of the Knee

Background

Osteoarthritis of the knee is a common degenerative musculoskeletal condition. Thai Medicinal Plant-4 (TMP-4) cream is made up of Garcinia mangostana peel, Sesamum indicum seeds, Glycine max (L.) Merr. seeds, and Centella asiatica leaves, all of which have anti-inflammatory and analgesic properties. The present study aimed at determining the efficacy and safety of TMP-4 cream versus diclofenac gel in the treatment of symptomatic osteoarthritis of the knee.

Methods

A randomized-controlled trial was conducted to assess knee pain on a scale of 100 mm Visual Analog Scale (VAS) and other key metrics, including VAS knee stiffness, a modified 10-step stair climb test, a timed up and go test, the Knee Injury and Osteoarthritis Outcome Score, and safety outcomes, following administration of either TMP-4 cream or diclofenac gel for 4 weeks.

Results

A total of 199 patients with moderate knee pain intensity were randomly assigned to either TMP-4 cream or diclofenac gel (allocation ratio 1 : 1). The mean changes of VAS knee pain in the TMP-4 cream and diclofenac gel groups were −31.68 ± 14.18 mm and −31.09 ± 12.41 mm, respectively, (mean difference = −0.58, 95% confidence interval = −4.37–3.20, P=0.761). The upper limit of 95% confidence interval for the comparison between TMP-4 cream and diclofenac gel was within the predefined margin of 7 mm for noninferiority. The safety was comparable between the two interventions.

Conclusions

TMP-4 cream was noninferior to diclofenac gel in relieving osteoarthritic knee pain and may be considered as an alternative therapeutic option in the treatment of symptomatic osteoarthritis of the knee.