Transcript Poster presentation

Pharmacoepidemiology of
herbal drugs in Addis
Ababa and Butajira, Central
Ethiopia.
Gedif Fenta T, Hahn JH
I. Introduction
Ethiopia
AA
 Population
- over 61m,
- 46% under 15 and 4%
over 65 years of age
-85% live in rural areas
 Economy: agriculture
 Half of GDP
 43% Exports
 85% total employment
BJ
Modern Health Care in Ethiopia
 MHC started 1508-1540
 Ministry of Health established in 1949
 Coverage is 51%
Currently the Health Care System is organized
as a four tire referral system.




Specialized Hospitals
Regional Hospitals
District Hospitals
Primary Health Care Units
Health Problems & Indicators
 Communicable
Diseases
 Indicators
Regional Hospitals
100 beds
tech. staff 60
1,000,000popn
.
Indicators
Ethiopia
Infant mortality rate
99.96/1,000
Crude birth rate
44.68/1000
Death rate
17.84/1000
Life expectancy at birth
44.68 years
Population annual growth rate
2.7%
Source: CIA-World Fact Book, 2001 estimates.
Specialised Hospitals
250 beds
tech. staff 120
5,000,000 popn
District Hospitals
50 beds
tech. staff 33
250,000 popn
PHCU (HC+5HP)
10 beds
tech. staff 13+15
25,000 popn (5,000 each for HPs)
II. The objectives of the Study
 To determine the extent to which people use
herbal drugs either in self care basis or
prescribed by the healers
 To describe how healers perceive about the
causes and symptoms of malaria.
 Identify the commonly used plants in the
treatment of malaria.
III. Methodology
 Study Design:
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-
Sources of information: Herbalists & Mothers.
In-depth interview, observations.
Cross-sectional HH survey: structured
questionnaire.
 Sampling & Data Collection:
-
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Convenient sampling technique- to identify
healers.
Systematic random sampling technique using HH
as the final sampling units.
Methodology Contd.
 Description of study areas
- Addis Ababa
- Butajira
 Data entry and analysis
- EPI-Info 6.04
- Qualitative responses manually
IV. Results: HH Survey
 Illness centered approach.
 1197 HHS (600 in AA + 597 in BJ).
 6377 (3172 + 3205) persons were living in the
hhs
 Prevalence of perceived illnesses were 8% in
AA and 4% in BJ
 94% in AA and 89% in BJ took action for their
illnesses.
 Prevalence of herbal drug use was 29.5% (37
and 15.4%)
Results Continued
Reasons for treatment preferences
Reasons
A.A (%)
Butajira (%)
42.6
42.8
Cost related
31.9
28.6
Perceived efficacy
19.1
14.3
Proximity
6.4
14.3
Time consuming nature of
MHCU

modern health care units
Use of herbal drugs in self-care
•35.4% in AA & 12.4% in BJ- self care with herbs
•More females practiced self care with herbs than males
•Top commonly used herbs in self care:- Zingiber officinale,
Ocimum lamifolium, Allium sativum, Ruta chalepensis &
Linum usitatissum.
•12.9%(11.3 in AA and 14.6% in BJ) of the HHs reported hoarding
Herbal drugs.
Results: In depth interview of healers
Demographic characteristics
- 81.1 % were males, 72.2% with
-
age > 45 years
Half of the healers had no any
form of education
17 had church/adult education
17.3% had more than 15 years of
education
Sources of Herbalistic
Knowledge:
1
Family & Prevous use
2
Gift from God
3
Apprenticeship
3
Prevous uses
5
Religous Institution
30
Family
Mode of Service Delivery:
-
-
86.4% practiced on par time basis
and full time practice was
observed in AA only
Average no. of patient seen per
week was 7.
59% did not have fixed payment
rate for their services
0
5
10
15
20
25
30
Herbalists perceived causes and symptoms of
malaria:
 Perceived causes:
 Perceived symptoms:
Top five plants used for
treating malaria:
Causes
Mosquito bite
Dirty environment
Hot/cold weather
Malnutrition
Evil spirit
Small germs in mosquitoes
Symptoms
Fever
Chills
Headache
Feeling of thirst
Back/joint pain
Feeling cold
Vomiting
-Carica papaja ( Caricaceae) * Multiple answers possible
-Adhatoda schimperiana (Acanthaceae)
-Vernonia amygdalina (Compositeae)
-Artimisia rehan (Compositeae)
-Croton macrostachys (Euphorbiaceae)
Frequency
18 (54.5%)
5 (15.2%)
4 (12.1%)
3 (9.1%)
2 (6.1%)
1 (3.0%)
Frequency
21
20
18
9
7
6
4
V. Conclusion and Recommendations
 Herbal remedies still play a pivotal role in the
treatment of large segment of both rural and
urban population of Ethiopia either in selfcare basis or prescribed by traditional
practitioners.
 To promote researches on plants used
traditionally, a prior recording of ethno
pharmacological knowledge is important. In
light of this, the results of the present study
will serve as a basis of information for future
projects to evaluate the potential contribution
of herbalists and their remedies in improving
the Ethiopian health care delivery system.
Summary:
-Prevalence of herbal drug use was 29.5%.
-35.4% in AA & 12.5% in Butajira used herbal drugs for self care
-Inaccessibility of MM and perceived efficacy were major reasons
for choosing HM as health care option.
-Herbal drug hoarding was reported by 12.9% of the HHs.
- Most Herbalists practice TM on par time basis
- Patient load 7 per week
-Herbalists did not largely have fixed payment rate
-16 plants have been reported to be in use to treat malaria; and
used singly or constituents of composite remedies.
Pharmacoepidemiological studies of herbal
medicine: Methodological Challenges
 TMPs in developing countries consider their knowledge as an
esoteric and hesitant to pass to any one except their off
springs. As the result, it is difficult to get sufficient number of
healers who are willing to participate in ethno botanical
studies.
 In most cases data collectors are with some modern
education, and hence informants tend to refrain to give
answers which they think may not be acceptable by the
interviewers, sort of social desirability bias.
 Incomparability of survey results due to: differences in recall
periods, seasons in which the study is conducted and
discrepant definition of herbs.
 Recall bias.
Acknowledgment: This study was funded by the
German Catholic Academic Foreign Service (KAAD).