Herbal Medicine Use by People in Jordan: Exploring Believes and Knowledge of Herbalists and Their Customers

Jordanian Use of and Beliefs Concerning the Efficacy of Medicinal Plants: A Cross-Sectional Study

Background: Medicinal herbs are incorrectly believed to be free of risks and are commonly used for self-medication without medical supervision. Jordan does not currently have a national policy on traditional medicine (TM) and/or complementary/alternative medicine (CAM). The present study aims to explore the use of and beliefs about the efficacy of medicinal plants among the Jordanian population. Method: A cross-sectional study was conducted using a self-administrated questionnaire for the duration between April and June 2019. Multiple linear regression analysis was used to identify predictors of positive attitudes towards the use of medicinal plants. Results: A total of 1,057 individuals participated in the study. The participants in our study showed a positive attitude towards the use of medicinal plants and herbs (median score of 33.0 (interquartile range (IQR): 26.0-37.0; equals 68.8% of the maximum total score), and believed in alternative therapies other than chemical drugs for disease treatment, mainly using medicinal herbs and plants. The majority of the participants (77.8% (n = 822)) believe in the efficacy of the use of medicinal herbs and plants and are aware (64.6 % (n = 683)) of the correct and proper way of using these plants and herbs. Pharmacists and herbalist are the main sources of information for the proper use of medicinal herbs and plants. Age was the main predictor of positive attitudes towards the use of medicinal plants and herbs (P<0.001). Conclusion: Efforts must be made to regulate the dispensing of these products, to educate health service providers and to raise consumer awareness.

Use of traditional and complementary medicine for COVID 19 prophylaxis among healthcare professionals and students in Jordan: A cross-sectional study

INTRODUCTION

There is inadequate evidence to recommend the use of any traditional and complementary medicine (T&CM) methods such as vitamin, mineral, herbal or other dietary supplements to prevent or treat COVID 19. Members of the medical team are particularly at risk of exposure to high viral load of coronavirus. They have also the best access to professional information regarding disease treatment and prophylaxis and disseminate such knowledge. The aim of the study was to assess the prevalence of use of T&CM for the prophylaxis of COVID 19 among the healthcare professionals and students in Jordan, along with the most common types and the factors associated with T&CM use.

METHODOLOGY

A cross-sectional study of T&CM use was conducted in Jordan using a snowball sampling method to distribute Google Forms and to enrol participants during coronavirus outbreak between June 10, 2021, and August 28, 2021. The study included healthcare professionals or students who consented to participate in the survey. The survey excluded those participants who had filled the questionnaire at least once or were pregnant/breast-feeding at the time of the study. The questionnaire consisted of 29 items, including screening, checkbox, dichotomous, matrix and open-ended questions.

RESULTS

The response rate was 97.1%. Out of 560 study respondents, 359 (64.1%) reported using T&CM for COVID 19 prevention. Vitamins and nutrients were consumed by almost half (48.4%) of study participants, while nonpharmacological methods and herbal remedies were consumed by 35.2% and 25.2%, respectively. The most common source of information regarding T&CM use for COVID 19 prophylaxis included scientific publications (59.5%), followed by disease treatment guidelines (38.0%) and social media (32.3%). Adverse effects were reported by 8.5% and possible adverse effects were reported by another 8.5% of participants. The T&CM use was associated with working in contact with COVID 19 patients (OR: 1.625 (95% CI 1.047-2.523) (P = 0.03) and having a colleague as a source of information (OR: 1.720 (95% CI 1.026-2.883) (P = 0.04).

CONCLUSIONS

The prevalence of T&CM use for COVID 19 prevention among healthcare professionals and students in Jordan is high, with a significant proportion of participants reporting adverse effects. There is an urgent need for further research toward efficacy and safety of T&CM in COVID 19 prophylaxis as well as development of appropriate public health policy on this issue specific to each country.

Pharmacy practitioners' practice, awareness and knowledge about herbal products and their potential interactions with cardiovascular drugs

Background: Herbal medicine use is widespread among patients, as community pharmacies may provide such products. Therefore, pharmacy practitioners should be aware of potential herbal products' adverse effects and herb-drug interactions, particularly with medications for comorbid diseases, such as cardiovascular drugs, in which pharmacy practitioners need to have good knowledge to provide patients with relevant advice to get optimal and safe therapeutic outcomes. Accordingly, the study is designed to assess the knowledge and awareness of pharmacy practitioners regarding herbal product dispensing and cardiovascular drug interaction in Jordan and view their role in patients' counselling to set up safe and effective drug use. Methods: A cross-sectional study was conducted in Jordan using an online formatted questionnaire distributed to pharmacy practitioners working in community pharmacies. Descriptive and analytical statistics were performed for the responses using the Statistical Package for the Social Sciences (SPSS) software, version 26. Results: Out of 508 participants, 41.7% had medium knowledge of herbal products pertaining mainly to university education (68.1%); 55.1% of participants dispensed herbal products without prescriptions for obesity and weight reduction (72.8%) and gastrointestinal problems (70.9%); this is because respondents agreed that herbal remedies are safe (28.5%) and effective (38.4%). Whilst the knowledge level of respondents about herbal medicine interaction with cardiovascular medication was medium, with a mean of 1.94, as this interaction may result in potentially serious consequences, 40.7% of respondents strongly agreed to gain more knowledge about the side effects of herbal products and medicine interactions through educational courses. Conclusions: The pharmacy practitioners had medium knowledge of herbal products; however, more attention should be paid to herb-drug interactions in the pharmacy educational curriculum. Additionally, pharmacy practitioners need to refresh their knowledge by attending periodic educational courses and by using reliable resources for information about herbal products in order to provide effective and competent pharmaceutical care.

Herbal supplements in Jordan: a cross-sectional survey of pharmacists' perspectives and knowledge

OBJECTIVES

Pharmacists are ideal partners for engaging with the needs and expectations of patients. They can play a vital role by providing information and supplying herbal medicines. In some community settings, pharmacists are also the main first point of care. This study explored Jordanian community pharmacists' perspectives and knowledge of herbal medicines available in pharmacies.

DESIGN

A cross-sectional study using an online survey was developed, and it was distributed via social media platforms. The one-way analysis of variance (ANOVA) test was used to compare the mean knowledge scores between different demographic groups. Multiple linear regression analysis was used to identify predictors of herbal medicines knowledge.

SETTING

Jordanian community pharmacies.

PARTICIPANTS

401 Jordanian community pharmacists.

RESULTS

Herbal supplements are sold in practically all pharmacies (98.5%). Slimming aids (14.7%), followed by sexual and sports enhancements (14%) and maintaining general health (12.1%) were most requested by Jordanian customers. While supplements for maintaining general health (12%), followed by slimming aids (11.4%) and skin conditions (9.3%) were most recommended by Jordanian pharmacists. 63.1% were not aware of potential herb-drug interactions, 95.6% did not receive complaints from customers about herbal medicines and 41.2% would not report adverse reactions to the national pharmacovigilance services. The mean knowledge score for knowledge of use, regulation, adverse reactions, and drug interactions was 3.7 (SD: 0.7), 3.5 (SD: 0.8), 3.6 (SD: 0.8), and 3.6 (SD: 0.8) (out of 5), respectively. ANOVA test showed that total pharmacists' knowledge scores significantly differed based on the length of time practising pharmacy (p<0.05).

CONCLUSION

This study highlights some key concerns relating to recommendations, awareness and reporting of herbal medicines among Jordanian community pharmacists. Pharmacists need enhanced education to provide objective and evidence-based information on the benefits-risks of herbal medicines. Future studies need to be carried out to confirm whether our findings are transferable to other Middle Eastern countries.

Medications and natural products used in Jordan for prevention or treatment of COVID-19 infection during the second wave of the pandemic: A cross-sectional online survey

Worldwide, during the COVID-19 pandemic in 2019, there was an increase in the tendency of misusing prescription drugs as well as self-medicating with over-the-counters. Additionally, an increase in the use of herbs and natural products was reported. A descriptive cross-sectional survey was conducted in Jordan from May 19th to July 29th, 2021, to assess the medications and natural products used in Jordan during the second wave of the pandemic. The survey was developed and validated, then distributed using Google Forms via social media platforms. Data was analyzed using Statistical Package for Social Sciences-24. The study participants (n = 386) had a mean age of 29.35 (SD = 11.90) years. Most of participants were females (72.8%), not married (64.5%), non-smoker (69.2%), have a Jordanian nationality (80.6%), hold a bachelor's degree (73.1%), and living in the middle of Jordan (74.1%). More than 70% of the participants used vitamin C, D and pain relievers. The most used natural products were citrus fruits (78.8%), honey (63.0%) and ginger (53.1%). The participants reported that family and friends (55.4%) played a major role in advising them to use medications and dietary supplements. Pharmacists ranked second (54.1%), followed by social media platforms (43.3%). Multiple logistic regression analysis highlighted that only the age significantly affected the participants' use of medications and natural products (P < 0.001). The results of this study warrant the need of conducting awareness campaigns guided by trained healthcare providers to educate people and minimize the risk of side effects that may arise from unsupervised use of medications and natural products.

Ethnomedicinal survey and mutagenic studies of plants used in Accra metropolis, Ghana

ETHNOPHARMACOLOGICAL RELEVANCE

Majority of people living in Ghana and many other developing countries rely on traditional medicinal plants for their primary healthcare. These plants are used either alone or in combination to manage a wide range of ailments. However, most of these plants have not been investigated for their mutagenic effects.

AIM OF THE STUDY

This study, therefore aimed at evaluating the mutagenic activity of the most frequently used medicinal plants amongst Ghanaians living within the Accra metropolis, Ghana.

MATERIALS AND METHODS

Validated questionnaires were administered to 53 herbalists and herbal medicines dealers in the Makola, Madina and Nima communities. Plants that were identified as being frequently used were investigated for their mutagenicity using the Ames test.

RESULTS

A total of 110 medicinal plants belonging to 53 families were identified as most frequently used plants in the study sites. These are used to treat various ailments including gastric ulcer, fever, malaria, male impotence, diabetes, typhoid, high blood pressure and candidiasis. Thirteen samples (52%) showed moderate to high mutagenicity in the TA 100 bacterial strain before and after metabolism with rat liver enzyme.

CONCLUSIONS

The study showed that over half of the frequently used medicinal plants showed moderate to high mutagenicity before and after metabolism at the concentration of a 100 μg/mL. This may have implications for the safety of those who use them to manage diseases. These findings will suggest the need for an in-depth study of the mutagenic potentials of plants commonly used by indigenous people and more especially for those exhibiting high mutagenicity in this study.