Pharmacoepidemiology of herbal drugs in Addis Ababa and Butajira, Central Ethiopia.

Gedif Fenta T, Hahn JH

I. IntroductionEthiopia 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

AA

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

P H C U (H C + 5 H P )1 0 b ed s

tech . s ta ff 1 3 + 1 52 5 ,0 0 0 p op n (5 ,0 0 0 each fo r H P s )

D is tric t H osp ita ls5 0 b ed s

tech . s ta ff 3 32 5 0 ,0 0 0 p op n

R eg ion a l H osp ita ls1 0 0 b ed s

tech . s ta ff 6 01 ,0 0 0 ,0 0 0 p op n

S p ec ia lised H osp ita ls2 5 0 b ed s

tech . s ta ff 1 2 05 ,0 0 0 ,0 0 0 p op n

.

Indicators Ethiopia

Infant mortality rate

Crude birth rate

Death rate

Life expectancy at birth

Population annual growth rate

99.96/1,000

44.68/1000

17.84/1000

44.68 years

2.7%

Source: CIA-World Fact Book, 2001 estimates.

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:

- Sources of information: Herbalists & Mothers.- In-depth interview, observations.- Cross-sectional HH survey: structured questionnaire.

Sampling & Data Collection:

- 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 ContinuedReasons for treatment preferences

Reasons A.A (%) Butajira (%)

Time consuming nature of

MHCU

42.6 42.8

Cost related 31.9 28.6

Perceived efficacy 19.1 14.3

Proximity 6.4 14.3

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

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

30

5

3

3

2

1

0 5 10 15 20 25 30

Family

Religous Institution

Prevous uses

Apprenticeship

Gift from God

Family & Prevous use

Sources of Herbalistic Knowledge:

Herbalists perceived causes and symptoms of

malaria: Perceived causes:

Perceived symptoms:

Causes Frequency Mosquito bite 18 (54.5%) Dirty environment 5 (15.2%) Hot/cold weather 4 (12.1%) Malnutrition 3 (9.1%) Evil spirit 2 (6.1%) Small germs in mosquitoes 1 (3.0%)

Symptoms FrequencyFever 21Chills 20Headache 18Feeling of thirst 9Back/joint pain 7Feeling cold 6Vomiting 4* Multiple answers possible

Top five plants used for treating malaria:-Carica papaja ( Caricaceae)-Adhatoda schimperiana (Acanthaceae)-Vernonia amygdalina (Compositeae)-Artimisia rehan (Compositeae)-Croton macrostachys (Euphorbiaceae)

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 self-care 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).