Prevalence of Use of Complementary and Alternative Medicine Among Psychiatric Patients

Background of the Study

According to WHO, (2012), herbal medicine can be defined as medicine that is made out of plants and is common in many societies in the world including Kenya. When the herbal medicine is used in ways other than traditional, it becomes complementary and alternative medicine (CAM). Other names for CAM are alternative medicine or nonconventional (Wootton, 2015). Therefore, CAM is the opposite of conventional or what we commonly call western medicine (Wieland et al, 2011).

Complementary and alternative medicine cannot be ignored considering it is vital for health care. It is estimated that approximately 80% of the world’s population rely on CAM, in one way or the other, for health care. Also, according to Eisenberg et al (2012), an estimated 80% of the people in developing countries and 80% of Africans rely on CAM to meet their primary health care needs. The annual global market CAM in year 2010 was over US$60 billion and is growing steadily at a rate of fifteen to twenty-five percent (WHO, 2013). Many countries in the world including some Asian countries like China, India and Sri Lanka have realized much success in developing their CAM sector. In these countries, the medicines are very developed, have good documents, and used not only at the family, community, and primary health care levels, but even in hospitals where they offer secondary and tertiary care (Barrett, 2013). Also, herbal practices in these countries have better curriculum and are systematic and comprehensive (Verma, and Singh, 2011; WHO, 2013).

Long before the advent of conventional medicine in Africa, traditional medicines, including the use of herbs was the main remedy for nearly all ailments (Verma, and Singh, 2011). Today, notwithstanding the increasing use of modern medicine in countries like Nigeria and Ghana, CAM use is also hugely practiced and many continue to rely on it for their health care particularly in psychiatric care. In Kenya, about 70% to 75% of the population rely on CAM for their primary health care. Also, herbal medicine is the first line of treatment for more than 60% of children with high fever resulting from malaria (WHO, 2013). There is, on average, one traditional medical practitioner for every 400 people, compared to one doctor to 12,000 people in Kenya (WHO, 2013). It has also been noted that CAM is also used to treat people with psychiatric care.

Studies across the world of patients consulting providers of CAM in low- and middle-income countries have reported high but varying rates of psychiatric disorders, depending on the methods employed and the disorders examined. Saeed et al (2010), did a study in Pakistan and found 61% prevalence of diagnoses using a Psychiatric Assessment Schedule. The most common psychiatric condition was major depressive disorder at 24%, then anxiety disorder at 15% and finally psychosis only at 4%. Abbo et al (2011), mentioned that Uganda after doing a study on patients who had used CA, that the patients at 60.2% had psychiatric disorders based on the DSM-IV standard. Ngoma et al (2013) did for Tanzania and found that 49% of the patients who used CAM had psychiatric disorders mainly depression and anxiety. Mbwayo et al (2013), did theirs in Kenya and noted that overall 64.2% of those who used CAM had psychiatric disorders with a huge percentage having depression, anxiety and Schizophrenia.

These significant figures show that studying about the prevalence of CAM use among psychiatric patients is important and necessary. Indeed, various researchers have found that CAM is real, very accessible, cheap, culturally adequate, and is consistently being argued as an easily accessible health care system that can aid and complement government’s efforts at ensuring quality and equitable health care. In some rural communities, CAM is the only form of health care that is available, affordable and accessible (Darko, 2012). Thus, the study will seek to investigate the prevalence of CAM use among psychiatric patients in Kabarnet Sub County considering the lack of similar studies in the area.

The World Health Organization acknowledges that CAM has become a necessary, readily available and useful way to treat many diseases. However, while the global market of CAM products is big and quickly growing, the potential of this sub-sector remains un-tapped in Kenya and the region, despite being well endowed in cultural and natural resources. Further, the absence of a supportive policy environment is key among the impending factors (National Council for Population and Development, 2015). In spite of the fact that many medical practitioners are unaware of the CAM quality, many patients still seem to be willing to use CAM to sort out their health problems.

There is thus a need to look at the prevalence of CAM use to treat psychiatric disorders among patients at Kabarnet Sub County hospitals. The study area for the research is Kabarnet Sub County, Baringo County. The Sub county is chosen because of its peculiar challenges in health care delivery which include lack of hospitals/clinics, poor access to conventional health care, and inadequate healthcare professionals, inadequate modern diagnostic and surgical equipment. In addition, there is no documented data on the use of CAM among psychiatric disorders. Further, given the limited resources and time, focusing on all the communities in the county would be practically impossible.

To establish the prevalence of use of complementary and alternative medicine among psychiatric patients at Kabarnet Sub County Hospitals, Baringo County

I. To establish the rate of use of complementary and alternative medicine among psychiatric patients at Kabarnet Sub County Hospitals

II. To determine the demographic characteristics of patients using complementary and alternative medicine among psychiatric patients at Kabarnet Sub County Hospitals

III. To establish the types of complementary and alternative medicines used by psychiatric patients at Kabarnet sub-county Hospital.

IV. To assess the extent to which complementary and alternative medicine used concomitantly with conventional medicines.

Study Variables

The independent variables in the study will be the age and gender of psychiatric patients; income, education level and religion of psychiatric patients; length of illness of the psychiatric patients, conditions for which CAM products were used for. The dependent variable will be CAM use among psychiatric patients. This will be measured using the frequency of CAM use, occasions upon which the use becomes relevant and the level of use. The outcome variable will be the effects of CAM use on patients and will include the tests after CAM use that show health improvements or alterations or no change at all.

1.4 Rationale for the Study

The study will be beneficial first to patients with psychiatric disorders with information about the available CAM in use to treat psychiatric disorders in Kenya and how they can interact with what drugs have been known to work. Secondly, the study will help the Kabarnet sub-county Hospitals with information on complementary and alternative medicines for psychiatric disorders which will then help them work on an inclusion and complimentary policy that will help manage the process of treatment in line with the new WHO policy. Thirdly, the study will be helpful to the Ministry of health either initiate or revise their policies touching on complementary and alternative medicines for psychiatric disorders. Lastly, the study will be useful to the nursing education to first get knowledge on complementary and alternative medicines for psychiatric disorders and secondly further studies in the area.

Literature Review

This chapter will look at the prevalence of CAM to treat psychiatric Disorder the demographics of CAM users and some of the notable examples of CAM in psychiatric disorders.

Traditional and herbal medicine has taken the new name, complementary and alternative medicine (CAM). CAM refers to those healing and diagnostic disciplines that exist largely outside the institutions where orthodox or conventional health care is provided (Shaikh and Hatcher, 2015). The relationship between user satisfaction with conventional medicine and prevalence of use of CAM is subtle and complex. Large epidemiological studies in Western countries show that CAM users are no less satisfied with conventional medicine than non-CAM-users (Eisenberg et al, 2011; Saeed et al, 2010). That is, using CAM is not simply due to dissatisfaction with conventional treatment. Repeatedly, CAM users report that using both forms of care together is more useful than either alone (Eisenberg et al, 2011; Darko, 2012).

However, CAM users do complain about the quality of the doctor-patient relationship during the brief consultations typical of conventional medicine (Heiligers et al, 2010). In addition to more satisfying consultations, the philosophies behind CAM have a persuasive appeal which users find compelling. In contrast, conventional medicine is described by CAM users as disjointed and impersonal, and ultimately disempowering (Barrett, 2014). Whereas conventional doctors may be more interested in objective improvements – or changes in psychopathology, perhaps even measured on a rating scale – CAM practitioners acknowledge and take seriously all subjective changes, thus validating the patient and their experience (Zollman and Vickers, 2011). While psychiatrists acknowledge the importance of spirituality and religion, and are more willing than other physicians to talk about them with patients (Curling et al, 2011), they are unlikely to supply a worldview which is as appealing and satisfying as the philosophies motivating CAM use.

Curling et al (2011) mentioned that the treatment of psychiatric disorders in low- and middle- income countries (LMIC) is poor and that there is need to consider urgent delivery of proper health services to the people. It has been found that the epidemiological and health services offered in 58 countries that fall in the LMIC have poor health services (Heiligers et al, 2010). It showed that the number of health personnel like doctors and nurses were very low at less than 60%. Therefore, using CAM is becoming a very attractive way to ensure that health services are given to communities that need it (Jilik, 2013). CAM is quickly being incorporated into the main health systems and are used to help build up the conventional medicines particularly on patients in rural areas where CAM is easily available.

Demographics of CAM users and psychiatric

Disorders Current published work show that CAM as used among male psychiatric patients in Africa range from 8% to 15% (Jensen, 2011). Unfortunately, most of these studies involved males and females who may not be reflective of the general population of psychiatric patients in Africa. Many of the studies were conducted in countries other than Kenya, where attitudes toward unconventional therapies may be different based on gender hence the need for the present study. Additionally, most studies measure CAM use in males and females who have chronic conditions or who were sampled at health care facilities (Jensen, 2011). Further, according to Otieno (2011), herbal medicine is more easily accessible to the female rural populace, who constitute a greater proportion of the total population of the country, especially in the northern and eastern regions of Kenya where modern medical facilities are barely adequate. According to Sawyer et al (2012), access to essential medicines is severely restricted by lack of resources and poverty and the study seemed to indicate that females used CAM more than females.

However, the study was generalized and did not look at the same demographics among psychiatric patients as this study will do. Moreover, although many studies identified the increasing prevalence of CAM use throughout the world, only a few reported on how patients perceived the efficacy of this healthcare modality in specific diseases and what demographics dominate the use of CAM for psychiatric disorders (Clement et al, 2012). According to Clement et al, (2012) the major factor contributing to the increasing popularity of CAM in developed countries and their sustained use in developing countries is the perception that herbal remedies are efficacious, and in some cases more so than allopathic medicines.

Examples of CAMS Used Concomitant to Conventional Drugs Clement et al (2012) discovered that 86.6% believed that herbal medicine were equally or more efficacious than orthodox/conventional medicines for specific ailments and diseases. According to Mensah, the potency and effectiveness of CAM have been proven through research. CAM therapies have shown remarkable success in healing acute as well as chronic diseases (Shaikh and Hatcher, 2015). Buor (2011), for instance discovered that there is a kind of psychological security in the medical approaches of the herbal medicine man which is able to relieve a patient of strong psychic pressure.

CAM medicine provides more effective treatments to certain health problems such as boils, tuberculosis, stroke, arthritis, epilepsy, asthma, infertility, hernia, hypertension, diabetes, malaria, depression, mental illness and disease prevention as well as for the ageing population, where modern medicine has either failed to produce equally good results or has simply ignored the need for systematic attention and research (Darko, 2012). Also, in cases of sexually transmitted diseases, typhoid fever, yellow fever, menstrual and fertility problems, herbal medicines are considered effective (Shaikh and Hatcher, 2015).

Herbal medicines have also shown a wide range of efficacy in the treatment of various diseases such as breast, cervical and prostate cancers, skin infections, jaundice, scabies, eczema, typhoid, erectile dysfunctions, snakebite, gastric ulcer, cardiovascular disorders and managing HIV/AIDS (Verma and Singh, 2011). Significantly, it is evident that some CAM have been recognized internationally for the treatment of psychiatric diseases (IUPAC, 2011). Herbs remain the foundation for a large amount of commercial medications used today for the treatment of psychiatric problems (IUPAC, 2011).

For instance, Artemisinin which is extracted from the Chinese herbal wormwood plant, Artemisia annua’ is the basis of most effective psychiatric drugs the world has ever known (WHO, 2013). Western researchers learned of the plant, for the first time, in the 1980s, but had been used in China for almost 2000 years to treat mental problems. However, due to skepticism surrounding the drug, it was only until 2004 that WHO approved of it for use internationally (IUPAC, 2011). Artemisinin is also effective in combating other diseases and has demonstrated significant potential for the treatment of cancer and schistosomiasis (IUPAC, 2011; Shaikh and Hatcher, 2015).

Moreover, the Neem tree (Azadirachta indica), which is indigenous to West Africa, is effective in the treatment of several diseases. The bark of the Neem tree is perceived to be effective in the management of schizophrenia (Davies, 2014). In addition to this, Davies, accounts that East Indians use it to make a strong soap that cures skin diseases. Africans also chew it to clean their teeth and it works as well as brushing with toothpaste, and supposed to be healthier for the gums. More so, the plant Curcuma Longa is perceived to be effective in the treatment of many mental disease (Davies, 2014).

Methodology

A cross-sectional study using descriptive survey design will be undertaken on patients with psychiatric disorder in Kabaranet Sub County hospitals. The phenomenon investigated will be the prevalence of use of CAM among psychiatric patients. In a cross-sectional study no attempt is made to change behavior or conditions34. Things are measured as is. The study design also enables one to obtain information about the situation at hand at one specific time. It shows the current situation of the condition under study in the desired population.

The independent variables in the study will be the age and gender of psychiatric patients; income, education level and religion of psychiatric patients; length of illness of the psychiatric patients, conditions for which CAM products were used for. The dependent variable will be CAM use among psychiatric patients.

The study will be carried out at Kabarnet Sub County located in Baringo County covering an area of approximately 136.8 square kilometers. It borders West Pokot county to the north and northeast, Nakuru County to the west, Uasin Gishu County to the south and southwest. It is a government health facility located in Kaprogonya sub –location , Kapropita Lacation ,Kabarnet division ,Baringo central constituency in Baringo County.The hospital has a bed capacity of 160 beds in general and psychiatric and 11 cots . There are 117 medical personnel Hospital staff including 83 Nurses and clinical officers, 18 lab technicians and 10 Doctors.

The study population in this study will be all psychiatric patients in Kabarnet Sub County hospitals during the period of study.

Psychiatric patients in Kabarnet Sub County hospital for at least 2months. Healthcare providers, relatives of psychiatry patients whose minimental exam is below 23 of Kabarnet Sub County hospital will be included in the study. All those persons above who will consent to participate in the study.

Criteria Psychiatric patients in Kabarnet Sub County hospitals who will not consent to participate in the study will be excluded.

Sample size will be 30 psychiatry patients out of the 100 target population will be selected. 30 psychiatric patient’s represents 30% of the target population a percentage that (Kothari, 2004) say is acceptable.

Simple random sampling technique will be used to select 30 psychiatric patients out of the 100 target population will be selected. 30 psychiatric patients represents 30% of the target population. Simple random sampling is useful to get a representative number and reduce bias.

The researchers who are medically trained will be used to get the required data from the patients. All the respondents will sign the consent form indicating their willingness to participate in this study. They will be assured of confidentiality, the purpose of study, the potential benefits and possible risks associated with participation explained to them. Two questionnaires will be used, including a questionnaire for psychiatric patients and healthcare professionals or the relative to the patient. A standardized questionnaire for conventional healthcare practitioners will be self- administered. This questionnaire will be used to determine concomitant use of CAM and conventional medicines, report adverse effects of CAM use, use of CAM by conventional health care practitioners and their perception concerning CAM.

Pre-testing of research tools will be conducted in Moi Teaching and Referral Hospital. This will be done on 3 (10%) Psychiatric patients. This will be done to ensure validity and reliability of research instruments. Corrections will be made where necessary in order to make sure the questions asked provide the required information.

Statistical analysis is essential for making sense of quantitative information. Statistics are either descriptive or inferential. Descriptive statistics, generated in the course of data analysis in the present study, will be used to describe and synthesize the data. The software program Statistical Package for the Social Sciences (SPSS) will be employed for data analysis. Frequencies for each variable will be generated and organized into tables using SPSS. A chi-square test will be used to determine the association between CAM use and each of the independent variables related to demographic characteristics; a P value < 0.05 will be considered to be statistically significant.

All permission will be sought form Baraton University ethics committee, the County and Sub County offices and the patients and hospitals themselves.