Determinants Of Utilization Of Complementary And Alternative Medicine In The Management Of Malaria
Complementary alternative medicine refers to a wide range of practices which are grounded within cultural beliefs, experiences, religion and spirituality. The use and practice of Complementary alternative medicine has evolved over the years. Evidence especially from low-income developing countries indicate that there is a growing preference and use of CAM among patients with malaria. There is limited information on utilization of CAM in mental health.The aim of this study was to assess the determinants of utilization of complementary and alternative medicine in the management of malaria.
The study findings has revealed that awareness and understanding of CAM promotes utilization of complementary alternative medicine among consumers and practitioners.
A further studies are needed to determine factors that influence patient’s utilization of complementary alternative medicine in mental health.
Table of Content
- Title Page
- Table of Content
- List of Tables
- 1.1 Background of the Study
- 1.2 Statement of the Problem
- 1.3 Objective of the Study
- 1.4 Research Questions
- 1.5 Significance of the Study
- 1.6 Scope of the Study
- 1.7 Limitation of the Study
- 1.8 Definition of Terms
- 1.9 Organisations of the Study
Review of Literature
- 2.1 Conceptual Framework
- 2.2 Theoretical Framework
- 2.3 Empirical Review
- 3.1 Research Design
- 3.2 Population of the Study
- 3.3 Sample Size Determination
- 3.4 Sample Size Selection Technique and Procedure
- 3.5 Research Instrument and Administration
- 3.6 Method of Data Collection
- 3.7 Method of Data Analysis
- 3.8 Validity of the Study
- 3.9 Reliability of the Study
- 3.10 Ethical Consideration
Data Presentation and Analysis
- 4.1 Data Presentation
- 4.2 Analysis of Data
- 4.3 Answering Research Questions
Summary, Conclusion and Recommendation
- 5.1 Summary
- 5.2 Conclusion
- 5.3 Recommendation
1.1 Background to the Study
Complementary Alternative Medicine (CAM) comprises of knowledge, skills and practices based on the theories, beliefs and culture. The knowledge is passed from one generation to another for maintenance of health (WHO, 2001, 2005, 2012, 2014). Complementary alternative medicine include; biological, mind and body, alternative medicine, energy therapies and manipulative body based therapies.
According to Barnes & Powell-Griner (2004) the magnitude of CAM is evidenced by it’s continued uptake of CAM both globally at 80% and 85% in Africa. Majority of the population continue to buy personal products all over including over the internet hence there is a global access to CAM products. This idea has provided an alternative means of promoting self-health as well as disease prevention which aims to reduce the cost of healthcare (Antwi-baffour, Bello, Adjei, Mahmood, & Ayeh-kumi, 2014). There is an upward trend of both chronic illness and health care cost in the health care system around the world which has necessitated the use of complementary alternative medicine (Barnes, Bloom, & Interview, 2008; WHO, 2014).
Researchers recommended the use of CAM in treatment of various illnesses including: substance abuse and alcoholism, attention deficit hyperactivity Brown & Patel (2005), Autism Spectrum (Wendy, 2014), insomnia (Bertisch, Wells, Smith, & Mccarthy, 2012) stress and anxiety (Sarris et al., 2012), depression (Medicine, 2010; Maher et al., 2015; America, 2016), schizophrenia (Thomas, 2016). Utilization of CAM is based on varied reasons as reported by studies; nutrition and lifestyle (Guidance, 2006), wellness (Dale et al., 2014), Some patients avoid use of conventional medicines because of the belief that chemicals have adverse implications on their body systems, but not because they are dissatisfied with conventional medicine (Astin, 1998).
Malaria is a life threatening parasitic disease transmitted by female Anopheles mosquitoes. In Nigeria, malaria is responsible for around 60% of the out-patient visits to health facilities, 30% of childhood death, 25% of death in children under one year and 11% of maternal deaths (National Population Commission, 2008; Noland et al., 2014). Similarly, about 70% of pregnant women suffer from malaria, which contributes to maternal anemia, low birth weight, still births, abortions and other pregnancy-related complications (Federal Ministry of Health Abuja, 2005).
Presently, malaria remains one of the worst menaces of tropical countries of the world. It is a killer and debilitating disease that affects the physical and economic well-being of people living in endemic areas of Africa (WHO, 2008). Pregnant women are among those in the higher risk group (Okwa, 2003). Recent global estimate shows that there are between 300 – 500million clinical cases of malaria and between 1.50 – 2.70million deaths attributed to malaria annually (Greenwood, 2005). Pregnant women are at immense risk of malaria due to natural immune depression in pregnancy (Fievet, 2008). Hence, it is one of the most important health issues affecting pregnant women as it has a risk of jeopardizing the life of the woman or the fetus (WHO, 2010).
Traditional herbal medicine could be described as “herbs, herbal materials, herbal preparations and finished herbal products whose content includes active ingredients parts of plants, or other plant materials, or combinations”. Herbal medicines can be in the form of liquids, powder, capsules, tablets or ointments. Some are pre-packaged while others are prepared when needed and are used not only to cure illness but to maintain or boost one’s health (WHO, 2002). In Africa, reliance on herbal medicines is relatively high and the global use of herbal medicine is growing. Most pregnant women believe that these medicines are ‘natural’ and ‘safe’ com¬pared to modern drugs. Besides, traditional medicine is believed to treat medical problems and improve health status during pregnancy, birth and postpartum care in many rural areas (Khadivzadeh and Ghabel, 2012).
The practice on utilization of complementary alternative medicine as reported by many studies was either concomitant or complement conventional medicine especially comorbid with other conditions and prolonged illness. For example Bertisch et al., (2012) indicated that people use both relaxation and complementary alternative medicine in treatment of insomnia. Githinji (2014) observed that there was concomitant use of herbs with conventional medicine which causes lethal effects to body systems.
World health Organization (WHO) encourages member state countries to implement the policy on traditional medicine, promote and regulate the practice of traditional medicine practitioners. The organization also encourages a link between CAM practitioners, customers, healthcare professional and a system of referral of patients/clients with mental disorders from traditional practitioners to conventional health facilities and vice vasa. However, this has not had a tremendous move because of diversified rules and regulation on CAM. Some countries have established rules and regulation of CAM products, practitioners like European countries (Amster A. Michael, Cogert Greg, Lie A. Desiree, 2001; Sita, 2011).
1.2 Statement of the Problem
Complementary alternative medicine is widely recognized and accepted by most communities for treatment of various diseases for the majority of the population, especially in developing countries (Stradford et al., 2014; Ali & Agyapong, 2016). It is estimated that more than 85% in developing countries and 80% globally utilize CAM (WHO, 2007, 2012). The medicine is reportedly affordable, accessible and available at the community level and requires less technique. Also there is limited information on the utilization of CAM among patients with mental disorders.
According to the WHO, (2014), strategies have been developed to promote utilization of CAM products, services and CAM practitioners. This includes; building knowledge base for active management of CAM, setting policies, strengthening qualityassurance, regulation of CAM products, therapies, CAM practitioners and promoting universal health coverage by integrating CAM service delivery and self-health care. However, these strategies have been partially implemented in Kenya and other countries (Ndetei, M. David, Khasakhala, incolin I; Kingori, Joyce; Oginga, Alan; Raja, 2007; Sita, 2010; Ndetei, Mbwayo, Mutiso, Khasakhal, 2013; Kigen, Ronoh, Kipkore, & Rotich, 2013).
The growing number of patients utilizing CAM is proposed to; availability of information on the internet, marketing forces, active involvement of patients with medical decision making, believe in the effectiveness of CAM. However, In spite of CAM being used, it has been viewed with a lot of questions by conventional health practitioners and the practice faces challenges. They include; inadequate information on CAM, recognition and registration of CAM products, therapies and CAM practitioners and quality assurance (WHO, 2007; WHO, 2014). It is for this reason that the need to assess the factors that influence the utilization of CAM among patients with malaria to provide information on the utilization of CAM with clear and documented policies that will aid in showcasing the whole issue of CAM.
1.3 Objective of the study
- To establish the relationship between awareness of the existence of complementary alternative medicine (CAM) and utilization of CAM among patient with malaria.
- To determine the effect of culture on the patients’ utilization of complementary alternative medicine (CAM).
- To establish the effect of affordability of conventional medicine on the utilization of complementary alternative medicine by malaria patients.
- To establish the effect of duration of malaria of patients on utilization of complementary alternative medicine.
1.4 Research Questions
The study was based on the following research questions:
- What is the relationship between the awareness of the CAM and utilization of CAM by malaria patients ?
- What is the relationship between culture and the utilization of CAM by malaria patients ?
- What is relationship between the Cost of CAM and utilization of CAM by malaria Patients?
1.5 Significance of the Study
The findings from this study would be useful to the following; pregnant women, ministries of health, parastatals, health sectors, policy makers and government.
The study will help them to develop a positive attitude towards antenatal care and the possible dangers in the use of traditional herbal medicine in malaria prevention and treatment among pregnant women.
Health practitioners would benefit from this study; as it would help them in caring adequately and planning well for pregnant women attending antenatal clinic when treating them for malaria.
This study would be of great importance to ministries of health by informing them on the importance of this study is to address the issue concerning the attitude towards the use of traditional herbal medicine for the treatment of malaria among pregnant women attending antenatal care and to organize enlightenment programmes aimed at enhancing the attitudes of pregnant women towards frequent antenatal clinics.
This study will help policy makers to formulate relevant policies on malaria prevention while making informed decisions on the steps to follow in increasing antenatal care attendance levels among pregnant women attending Teaching Hospital in River State
This study would be useful to government and parastatals by educating them on the need to provide concerted health education intervention to improve the attitude and knowledge of pregnant women regarding poor health seeking behavior and adequate strategies for malaria prevention especially with the use of insecticide, treated Net, adequate funding, etc. necessary for controlling and reducing incidence of malaria in the general public.
1.6 Scope of the Study
The study is delimited in scope to the Determinants of utilization of complementary and alternative medicine in the management of malaria in Abraka Delta State, Nigeria. The researcher would chose this site because it is easily accessible and students are sent there for their clinical experiences and cases are referred from primary and secondary health facilities to the institution for expert management.
1.7 Limitation of the Study
The following factors poses to be a limitation during the course of this research
Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.
1.8 Definition of Terms
In this study alternative medicine include herbs, exercise, diet, prayer, massage, chiropractic that are used outside the main stream medicine (conventional, allopathic, orthodox)
Complementary and Alternative Medicine (CAM):
The use of various traditional methods in maintaining health other than conventional medicine and are used accordance to the culture, belief and custom of the individual.
In this context culture was identified as the way of life to a group of people who live in the same geographical ground. Characterized by the whole complex of distinctive spiritual, material, intellectual, emotional features and value systems traditions and beliefs in a society or social group.
Mental health is the positive state of mental wellbeing. Mental health is associated with a positive thinking behaviour, discipline and psychosocial wellbeing.
Traditional Medicine (TM):
Refers to knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different culture, used in the maintenance of health. Indicators of traditional medicine include; increased uptake, value of TM products used, increase in awareness/knowledge about TM, new research on TM products and customers, recognition and regulation about TM, advertisement TM.
1.9 Organization of the Study
This research work is organized in five chapters, for easy understanding, as follows.
- Chapter one is concern with the introduction, which consist of the (overview, of the study), historical background, statement of problem, objectives of the study, research hypotheses, significance of the study, scope and limitation of the study, definition of terms and historical background of the study.
- Chapter two highlights the theoretical framework on which the study is based, thus the review of related literature.
- Chapter three deals on the research design and methodology adopted in the study.
- Chapter four concentrate on the data collection and analysis and presentation of finding.
- Chapter five gives summary, conclusion, and recommendations made of the study.
Summary, Conclusion and Recommendations
This chapter provides a summary of the findings, conclusions and recommendations of this study. The findings are discussed under sections based on the objectives of the study. The conclusions presented in the chapter are drawn from the data analysis and recommendations for future areas of research are identified.
5.2 Summary of the Findings
The purpose of the study was to assess the determinants of utilization of complementary and alternative medicine in the management of malaria.
This study has shown that eighty one percent of patient were aware about CAM but only thirty seven percent utilized CAM. Nurse participants stated that they were aware of CAM through basic training and experience at home and from private hospital. This was oberved (Walker et al., 2017) that nurses gained CAM knowledge through personal experience and influence from peers. Our study indicated that a great percentage that was aware utilized CAM therapies
Similar studies have been conducted in different countries for example, a study conducted by Linder et al, (2007), which argued that knowledge is a barrier to utilization of CAM among older people versus the study conducted in India’s Rural Gujarat area by Schoonover et al. (2012), where CAM is the first line treatment and awareness has been stated to have positive effect on the utilization of CAM.
This is highlighted by World Health Organization whose objective is to build awareness to consumers, practitioners, health professional in the consumption of complementary alternative medicine (WHO, 2014). In line with a study conducted in Sydney and Bologna on CAM use in menopause where women of bologna who had knowledge on CAM utilized more of CAM. A nationwide survey on CAM use in cancer patients in Japan reported that more than half (57.3%) of CAM users had insufficient knowledge about CAM and that they were using CAM without informing their physician (Hyodo Ichinosuke, Amano Noriko, Eguchi Kenji, Narabayashi Masani, Imanishi Jiro, Hirai Midori, 2017).
Our study has shown that majority of the respondents had not utilized CAM because of the following stated reasons; first CAM not effective, not recommended by health care professionals and lastly drug interaction in the body. This was opposite of why others utilized CAM according to Hoeflich (2010) for physical, psychological and spiritual concerns.
Although there is no statistical significance of culture influencing utilization of CAM as analysed in the study as p=0.966. Most of the study respondents reported that use of complementary alternative medicine is in line to the belief and culture of individuals as majority of the respondent stated that the main reason why they are utilizing CAM was according to their own belief, culture and inner self and also to gain control of their own treatment plus faith. This was also founded by (Eisenberg et al., 2014). This is similar to a study conducted by Astin, (1998) that elaborated the use of CAM was associated with holistic orientation to health.
From the study it was clearly indicated that most patients do not share the information about the use of CAM with their health care workers because they fear intimidation, rejection and mistreatment this is similar to this study in United States (Astin, 1998; Barnes et al., 2008).
The findings of the study reveal that there is no enough evidence to show that affordability and cost of complementary alternative medicine has an effect on the utilization of CAM. This is regardless of the fact that the respondents reported that the acquisition of CAM was affordable as patients spent less than a thousand Shillings to get a dose of CAM depending on where an individual seeks these services.
Prior research conducted by Ndetei et al. (2013), on traditional healers and their provision of mental health service in a cosmopolitan Informal Settlement in Nairobi supports this line of thought in which respondents reported that traditional healers were affordable depending on where they seek their services. Some reported that traditional healers are not necessary expensive than health facility instead as some were flexible even in the mode of payment.
This is also similar to a study conducted by Lambart J et al. (2011), where respondents reported that they could pay in instalments to acquire CAM medicine. Contrary to this, a study conducted in Ghana revealed that cost was a significant determinant of CAM use (Kuunibe Naasegnibe & Domanban, 2012)
The research data reveals that there is enough evidence to show that awareness has an effect on the use of CAM. Creation of awareness to the public, health care professional and CAM practitioner to identify the available CAM to include types, mechanism of action, side effects to prevent concomitant use of CAM especialy herbs that cause interacction with antpsychotic, antidepressants. This was supported by one of the key informants (KI3), the media can be regulated on the kind of information that is broadcasted to the public while at the same time encouraged to create awareness of CAM.
- The government through the ministry of health, to create awareness to people on utilization of CAM products and services, include types of CAM, uses, risks involved and regulation of CAM. Equip healthcare professionals with knowledge, skills and experience through curriculum development in medical schools, training of healthcare workers on CAM, workshops and continuous medical education
- Promotion of cultures that are committed to the care and preservation of the environment forest that is a source of herbs that are used both as CAM and the conventional practitioners.
- The government to create policies that will enable people with mental disorders to acquire education and jobs, as a source of income.
- Healthcare professional to take comprehensive history to identify persons with chronic illness who could be using CAM and advice them in order to prevent concomitant use of herbs hence adverse effects. Integrate CAM into the existing primary healthcare system to individualize care for those who prefer using CAM should be given the option.
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