Corresponding author: Afaf H. Al-Nadaf ( a_nadaf@mutah.edu.jo ) Academic editor: Valentina Petkova
© 2020 Afaf H. Al-Nadaf, Areeg Awadallah.
This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Citation:
Al-Nadaf AH, Awadallah A (2020) Evaluation for the level of knowledge about herbal medicine use within people and university students in Mutah region. Pharmacia 67(4): 397-403. https://doi.org/10.3897/pharmacia.67.e59319
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Background: Conventional medication; traditional or folk medicine as well as herbal medicines; have been widely used since ancient times. In Jordan traditional medicines are freely available and self-prescribed as well. No previous study has investigated believes and knowledge with regards to herb-drug interaction in Mutah geographical in Jordan.
Objectives: This study aims to investigate and evaluate knowledge and attitude about self-medication using herbal medicine and its drug interaction among the public in Mutah.
Materials and methods: A questionnaire-based survey conducted. Survey took place in different locations in the Mutah region in Al-Karak city from Jordan, during December 2017 and January 2018. Data analyzed by SPSS.
Results: The majority of responders (82%) use self-prepared herbal preparation. While (56%) go for self-medication rather than visiting a physician. About (63%) participants responded that physicians didn’t ask them about if they use any herbal medication and about (50%) not willing to tell their physician about their self-medication. Knowledge about herbs gained from the family in the first place (38%); TV (21%) and friends (15%). Almost (79%) responders agree that herbs are safer and easier to be used compared to physician-prescribed medicine.
Conclusion: A high belief in herbal therapy use. Responders gain their knowledge primarily from their families which they obtain their knowledge primarily from their tradition. They are not aware of their interaction with other therapies. Care-givers in this region should be aware of the high percentage of herbal medicine use and are encouraged to discuss potential use with their patients to avoid future complications.
Awareness, Attitude, Herbal medicine, Herb-Drug interaction, Mutah.
Traditional medicine is defined by the World Health Organization as “The total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness” (
These medicines have been widely used since ancient times, and they are gaining more power despite the development; progression, and advancement in modern healthcare medicine. This medicine applied to treat, investigate, and avert disease in the general public. Commonly, conventional medicines are a complex mixture of several active constituents which may be known or unknown identity (
UK as well as some other European countries has a historical tradition of using herbal medicines (Martins 2013). In these regions this type of medicine is considered as approach for healing that justify their substantial proportion of the global drug market (
In Jordan traditional medicines are freely available and self-prescribed as well. These medicines are not safe or free from side effects, while some are toxic. The major concern about their usage is safety as well as proper procession and preparation. Moreover, as they are sometimes self-prepared or within small scale manufacturing with folk medicine expert humans, they lack adequate labeling; dosing information; suitable quality control; interaction with other preparations, or even food interaction and absence of appropriate patient information. A study by
As mentioned earlier a variety of studies developed to evaluate this situation worldwide. A result demonstrates that most patients do not consider it necessary to disclose their herbal medicine intake to physicians (
This research is a cross sectional study, in all Mutah citizens who are above 18 age. Survey took place in different locations in the Mutah region in Al-Karak city from Jordan, during December 2017 and January 2018. Exclusion: Pharmacy school students from the second year and higher; medicine school students. Moreover, People who were less than 18 years old and those who did not consent to participate. Inclusion: Students from all other university schools; people of both genders who ≥ 18 years of age at the time of surveying.
The cross sectional study was approved by the Scientific Ethics and Research of pharmacy school at Mutah University (Reference: 02-1/2017/2018). Survey took place in different locations in the Mutah region in Al-Karak city from Jordan, during December 2017 and January 2018. The objective of the study was explicitly stated to the participants, and then written informed consent was obtained from all participants.
The participation was completely voluntary without revealing identity in the questionnaire. All the participants were asked to fill a self-administered questionnaire consisting of 20 questions which included both open-ended and close-ended (multiple choice) questions. The closed-ended questions were provided with 2–4 answer options and participants asked to tick the right option. The questionnaire evaluates the participant’s knowledge and practice regarding herbal medicines. Open ended questions considered as data collection source, participants were asked to write which plant remedies, if any, they currently use, for which purpose they were used and how they were applied. The questionnaire was designed in English then translated to Arabic by proficient speakers of both languages and was revised to be suitable to the general population. Participants were randomly selected at the library; cafeteria; and lecture rooms as well as shopping centers and markets. They were given full details of the study and its intended aims then consented to participate. All participants were aware that this study is for research purposes only and their participation was voluntary. No questions were about names or contact information ensuring the privacy of the survey.
All collected and questionnaires kept in a secure place, only available to the principal investigator in accordance with the requirement of Mutah University.
Data were recorded on a data collection form and entered on a Microsoft Office Excel (2007) spreadsheet. Tables were generated using Microsoft Office Excel (2007). Data were described as counts and frequencies (%) using SPSS version 22.
A total of 1000 questionnaires were distributed, but only 926 were completed given an overall response rate of (92.6%). The majority of the participants were Jordanian with only 2.4% of the participants from other nationalities. As shown in Table
Variable | N (%) |
---|---|
Gender | |
Male | 207 (22.4) |
Female | 719 (77.6) |
Marital Status | |
Single | 610 (65.9) |
Married | 294 (31.7) |
Divorced | 4 (0.4) |
Widow | 13 (1.4) |
Education | |
Basic | 175 (18.9) |
Secondary | 128 (13.8) |
Collage | 22 (2.4) |
University | 562 (60.7) |
Occupation | |
Student | 527 (56.9) |
trader | 28 (3) |
Herbalist | 6 (0.6) |
Other | 332 (35.9) |
Student Specialty | |
Scientific Schools | 217 (41.2) |
Medicine | 82 (37.8) |
Pharmacy | 56 (25.8) |
Engineering | 39 (18) |
Nursery | 32 (14.7) |
Science | 6 (2.8) |
Dentist | 2 (0.9) |
Humanities School | |
Sports | 7 |
Business | 4 |
Low | 3 |
English | 2 |
Insurance | |
Insured | 820 (88.6) |
Uninsured | 106 (11.4) |
No. of family member | |
≤ 5 | 274 (29.6) |
6–10 | 556 (60) |
11–15 | 64 (6.9) |
>15 | 8 (0.9) |
During this investigation, we considered that herbal medicine is a natural product either plant or biological materials/preparations that used or intended to be used for therapeutic purposes or alleviation of disease signs and symptoms without medical advice or supervision. Out of the 926 surveyed individuals, 763 respondents (82.4%) indicated that they have used herbs as an alternative to medicine (Table
Variable | N (%) | Gender | |
---|---|---|---|
Female (%) | Male(%) | ||
Do you use herbs as an alternative to medicine | |||
Yes | 763 (83.3) | 606 (84.3) | 157 (76.3) |
Prophylaxis | 286 | 226 | 60 |
Treatment | 477 | 380 | 97 |
No | 163 (16.7) | 113 (15.7) | 50(24.2) |
If you exhibit symptom of disease | |||
Self-medicate with herbs | 525 (56.7) | 422 (58.7) | 103 (49.8) |
Visit a physician | 349 (37.7) | 255 (35.5) | 94 (45.4) |
Other (go to herbalist, ask a friend or family members ;…) | 52 | 41 (7.2) | 11 (5.3) |
Prefer using herbs over seeing a physician | |||
Safer | 399 (43.1) | 320 (44.5) | 79 (38.2 |
Easier | 339 (36.6) | 279 (38.8) | 60 (29.0) |
Lower cost | 98 (10.6) | 56 (13.6) | 42 (20.3) |
Other | 78 (8.4) | 63 (10.8) | 15 (7.2) |
Did you receive any education about herbs | |||
Yes | 521 (56.3) | ||
No | 379 (40.9) | ||
Did Physicians ask about use of herbs | |||
Yes | 323 (34.9) | ||
No | 585 (63.2) | ||
Do you feel that it’s important to tell your physician about herbs you use | |||
Yes | 453 (48.9) | ||
No | 465 (50.2) |
To investigate the scientific base for herbs used as medicine participants asked about their source for knowledge. Their answer was as in Fig.
To establish the respondents experience with herbal medicine, we asked about Illnesses for which herbs are used. Specifically they asked about their behavior about weight loss” How you would react at weight loss”; memory enhancement “Plants Locally Used for Memory enhancement”; skin problems” complementary medicine to treat skin problems “and as anti-wrinkles. About 466 (50.3%) used herbs as weight loss remedy, 453 (48.9%) treat skin problems and 141 (15.2%) anti-wrinkles remedy. Data about other uses for traditional herbal medicine was as follows: majority 501 (65.3%) used herbs to treat Cold and Influenza while 114 (14.9%) for Abdominal pain and 78 (10%) for Headache (Fig.
As an output for open ended question about any other comment that can be added for their practice. Their parents or family members (patients) didn’t tell their physicians that they used herbal medicine instead of prescribed one, and they just go for the physician for monitoring. In cases like cancer, hypertension, post menopause, burns.
One of the oldest known forms of therapy is the use of medicinal herbal plants. It is used by a large percentage of the Jordan population. This may lead to a lot of herb-drug interactions, the cause of which may go unnoticed in several patients due to the lack of knowledge. Herbal medicine is integrated as a crucial part of Jordanian culture and its traditions (Abu-Irmaileh and Afifi 2010;
Eid and Jaradat have reported several plants used by women during pregnancy in west bank Palestine. While Alkhamaiseha and Aljofan surveyed 1226 responders with 57% used herbal products in Saudi Arabia based on their traditional believes while 34% based on family advice (
In our study 562 participants that are 56.9% of the total participants are students. University education (still or graduated) conforms 60.7% while 32.5% have secondary and basic education. This indicates a high level of education and knowledge. High percent that is 88.6% have medical insurance.
It is clear that this area represented by this small group that has a high prevalence of the use of self-prepared herbal preparations they conform 82.4%. From this group, female represents 84.3% who answered yes in addition to 76.3% of the male group. This represents high practice for herbal and alternative medicine in this area. Females or males both have a high tendency for self-medication 56.7% while 37.7% tend to visit a physician. Taking into consideration that financial issues of little impact as 88.6% are medically insured, it is a matter of believers and attitudes. They believe that they are safer. It is important to highlight that this information about herbs is based on scientific knowledge; it is from family resources (Fig.
Our results show that the most likely reason for the increase in use is that the participants believe in the safety of herbal medicine, which is in agreement with previous studies about Jordan that suggested the most influencing factor for herbal usage being the belief in the success and safety of herbal medicines (
Another concern rises here about answering the question if they receive education about herbs. About 56.3% answered yes, this education they means knowledge from family; university education as general information; friends; TV; and community information rather than scientific and health care professionals like physicians or pharmacist as shown in Fig.
Although most of the herbs used to treat simple self-limited ailments like cold and flu; abdominal pain as well as headache as shown in Fig.
Participants alarm an important issue about their parents or other family member’s malpractice about not telling their physicians that they used herbal medicine instead of prescribed one. It’s important to go for more well oriented studies to tackle this behavior and to prepare education system for this sector.
The folk use of natural resources as medicine is not scientifically proved for all illness. Moreover, this persistent behavior about self-medication that attributed to believes and thought rather than economic problems in the absence of health care specialists allocate a high-risk practice. Accordingly, better regulations needed from pharmacist as well as physician’s point of view with other health care professionals. This can be attained by focused on public awareness and education about herbal therapies and behavior. In the present study, the majority of responders (82%) use self-prepared herbal preparation. While (56%) go for self-medication rather than visiting a physician. About (63%) participants responded that physicians didn’t ask them about if they use any herbal medication and about (50%) not willing to tell their physician about their self-medication. Knowledge about herbs gained from the family in the first place (38%). Almost (79%) responders agree that herbs are safer compared to physician-prescribed medicine. Physicians and care-givers in Mutah region should be aware about the use of herbal medicine among wide range of people .Pharmacists and Physicians have to discuss possible risk of this behavior with their patients to avoid future complications and malpractice.
Awareness about traditional medicine use may lead to remarkable changes in the practice; maximize health care services delivered to patients and minimize side effects attributed drug-herb interactions.
The first drawback of the study is that most of our responders are university students; this did not reflect all behavior in this region. The second drawback is most of the responders are female and this doesn’t reflect the actual male-female ratio. Moreover, this reflects most of the female behavior rather than all people here. This can be overcome in the next stage to target all possible places and more directed surveys as well as introduce males to collect data as they can deal with another male because females sometimes find it difficult to deal with male responders or vice versa.
This study provides preliminary concern, that can be considered by Mutah University to integrate ethnobotanics and ethnopharmacology subjects in the curricula of all faculties as elective as well as health faculties as mandatory courses.
AHA: study design, data collection, data analysis, conducting the study, statistical analysis, drafting the manuscript; revising manuscript content, approving final version of manuscript and supervised the study and writing the final approval. AA: conducting the study, data collection, data analysis.
All procedures in the study involving human participants were in accordance with the ethical standards of the Scientific Ethics and Research committee of Mutah University of school of pharmacy ((Reference: 02-1/2017/2018), and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
The authors declare that there is no conflict of interest.
The authors would like to thank Mutah University – College of Pharmacy for providing the resources needed to conduct this study.