Over three-quarters of the world's population uses herbal medicines, and this trend is increasing globally. In Nigeria, herbal medicine is an integral part of "traditional medicine" (TM).
TM has a broad range of characteristics and elements which earned it the working definition from the World Health Organization (WHO). Traditional medicines are diverse health practices, approaches, knowledge and beliefs that incorporate plant, animal and/or mineral based medicines, spiritual therapies, manual techniques and exercises which are applied singularly or in combination to maintain well-being, as well as to treat, diagnose or prevent illness [1]. Globally, people developed unique indigenous healing traditions adapted and defined by their culture, beliefs and environment, which satisfied the health needs of their communities over centuries [3].
Herbal medicines, also called botanical medicines or phytomedicines, refer to herbs, herbal materials, herbal preparations, and finished herbal products that contain parts of plants or other plant materials as active ingredients [1]. The plant materials include seeds, berries, roots, leaves, bark or flowers [5].
Many drugs used in conventional medicine were originally derived from plants. Salicylic acid is a precursor of aspirin that was originally derived from white willow bark and the meadowsweet plant (Filipendula ulmaria (L.) Maxim.) [6]. Quinine and Artemesinin are antimalarial drugs derived from Cinchona pubescens Vahl bark and Artemisia annua L. plant, respectively [7,8]. Vincristine is an anticancer drug derived from periwinkle (Cantharnthus rosues Linn. G. Donn.) [9]. Morphine, codeine, and paregoric, derived from the opium poppy (Papaver somniferum L.), are used in the treatment of diarrhea and pain relief [10].
In folklore medicine in Nigeria Rauwolfia vomitoria (Afzel) is used for treating hypertension, stroke, insomnia and convulsion [12] and Ocimum gratissimum L. is used for treating diarrheal diseases [13]. The seeds of Citrus parasidi Macfad. are effective in treating urinary tract infections that are resistant to the conventional antibiotics [14]; pure honey healed infected wounds faster than eusol [15]; dried seeds of Carica papaya L. is effective in the treatment of intestinal parasitosis [16]; the analgesic and inflammatory effects of Garcinia kola Heckel is known to enhance its use for osteoarthritis treatment [17]; and Aloe vera Mill. gel is as effective as benzyl benzoate in the treatment of scabies [18].
Read also: The Rise of Nigerian Basketball
Over 80% of the populations in some Asian and African countries depend on traditional medicine for primary health care [1]. The WHO estimates that in many developed countries, 70% to 80% of the population has used some form of alternative or complementary medicine including Ayurvedic, homeopathic, naturopathic, traditional oriental, and Native American Indian medicine [2]. It is also recognised by the WHO that herbal medicines are the most popular form of traditional medicine, and are highly lucrative in the international medicine market.
Despite the widespread use of herbal medicines globally and their reported benefits, they are not completely harmless. The indiscriminate, irresponsible or non-regulated use of several herbal medicines may put the health of their users at risk of toxicity [20-23]. Also, there is limited scientific evidence from studies done to evaluate the safety and effectiveness of traditional medicine products and practices [1]. Adverse reactions have been reported to herbal medicines when used alone [24] or concurrently with conventional or orthodox medicines [25].
Despite the international diversity and adoption of TM in different cultures and regions, there is no parallel advance in international standards and methods for its evaluation [1,2]. National policies and regulations also are lacking for TM in many countries and where these are available; it is difficult to fully regulate TM products, practices and practitioners due to variations in definitions and categorizations of TM therapies [3].
Previous studies of herbal medicine use in Nigeria were focused on adults with various forms of chronic illnesses [26-28], pregnant women [29] and children with chronic illnesses [30]. The use of herbal medicines among a general population without chronic health conditions has never been evaluated in Nigeria or other African countries.
This is a descriptive study involving the residents of Surulere LGA in Lagos. Lagos is the smallest but most populous state in Nigeria, with an area of 75, 755 hectares. As of 2006 national census, the population of Lagos State was 15 million. About 1.7 million (5%) of these inhabitants live in Surulere LGA. The choice of Surulere LGA was informed by its large population size and heterogeneity.
Read also: Requirements for Nigeria Police Clearance
The study involved 388 participants recruited by cluster and random sampling techniques. This study did not have the approval by an ethics committee; however it was evaluated and approved by the Medical Officer of Health of Surulere Local Government Authority.
A structured interview-administered questionnaire was the instrument used for the study. The questionnaire was translated into Pidgin English and Yoruba Language by a Language specialist and was pre-tested with a sample group of 20 participants who were residents in another Local Government Area in Lagos.
The participants were given written information, in English or Yoruba Language, or Pidgin English, to read prior to taking part in the study. They were informed that accepting to participate in the study is taken as consent from them.
The questionnaire was developed from previous studies on CAM and herbal medicine use in paediatric and adult patients in Nigeria [26-30,32,33]. It was used to obtain the following information: demographics of the participants; history of past and present use of herbal medicine, and the types used.
Information was also obtained on the sources, benefits and adverse effects of the herbal medicines used. The questions asked were both open- and close-ended. The open-ended questions were focused on the types, sources, benefits and adverse effects of the herbal medicines used by the participants.
Read also: Nigeria's Thriving Music
The section also allowed the participants to give multiple responses to the open-ended questions. Surulere LGA was divided into ten clusters, each cluster representing a ward. Participants suffering from any form of chronic illness such as hypertension, asthma, diabetes mellitus, cancer, arthritis, HIV/AIDS, epilepsy, or sickle cell anaemia were excluded.
The participants were interviewed in their respective homes. Each participant was interviewed by either one of the researchers (MA) or research assistants (specifically employed and trained for the study), after the contents of the questionnaire had been explained to them in their native language (illiterate participants) or English (literate participants).
The structured interview adopted in this study allowed us to explain each of the terminologies used in the questionnaire to the participants. Also, the method enabled us to eliminate biases that characterized previous studies involving self-administered questionnaires [27-29,32,33]. Such limitations include the use of terms and concepts that are confusing to participants and poorer response rates from incomplete filling of the questionnaire.
Information about the components of the crude herbal medicines was obtained during the interview from the respondents who had used or were still using crude herbal medicines. For the respondents who had used or still using herbal medicines refined into their packaged forms, the trade names of the herbal products were obtained during the interview and the products sourced later from the market.
The component of the herbal products was obtained from the product label. The native names of the plant species in the crude herbal medicines was used to identify their full botanical names from African Herbal Pharmacopoeia [34]. Data were analysed using SPSS 17.
Results were presented as median with inter-quartile range (IQR) for time related variables and as frequencies and percentages for other variables. The highest number of the respondents (186; 47.9%) was in the age range 21-30 years (median = 43.4 years, inter-quartile range = 24-52 years) and are male preponderant (M: F, 2.3:1). They were single (240; 61.9%), married (147; 37.9%) or divorced (0.3%).
The majority of the respondents (182; 46.9%) was either in or had completed secondary school education. Similarly, 178 (45.9%) respondents had attained a tertiary education; 11 (2.8%) had only primary education and the rest of them never had any formal education.
Herbal medicines were used for various purposes indicated in Table 1. They were used most frequently for malaria (54; 20.8%) and for reducing blood sugar level (42; 16.2%). Herbal medicine non-users avoided the preparation or product because they were ineffective (0.8%); bitter to taste (2.3%); personally, they disliked herbal medicines (23; 17.8%); lack of faith in herbal medicines (28; 21.7%); and herbal medicines were likely unsafe (34; 26.4%).
Bark of pineapple (Ananas comosus (L.) Merr.) fruit, paw paw (Carica papaya L.) leaves and seeds, 'Dongoyaro' (Azadirachta indica A. Palm kernel (Elaeis guineensis A. African breadfruit (Treculia Africana Decne. Ex Trécul), stem bark of African mahogany (Khaya ivorensis A. Twelve different types of herbal medicine preparations and products (either alone or in combination with other herbal medicines) were used by the respondents.
Friends, relatives and colleagues influenced 117 (45.2%) of the respondents to use herbal medicine. The respondents' other sources of information about herbal medicine included their parents (77; 29.7%); health professionals (13; 13%); herbal medicine retailers (11; 4.2%); media: television, radio and newspaper advertisements (3.5%); their spouse (3.5%); and herbal medicine practitioners (0.8%).
There was no statistically significant difference between the status of herbal medicine use and respondents' levels of education (Ï2 = 7.55, p = 0.056). Over half (58%) of the herbal medicine users considered herbal medicines safe to use; 89 (22.9%) believed otherwise; and 74 (19.1%) were uncertain.
Safety of herbal medicines were attributed to their natural origin [88/150 (58.7%)]; efficacy [51/150 (34%)]; and lack of adverse effects [11/150 (7.3%)]. The respondents found herbal medicines effective (159; 41%); ineffective (123; 31.7%) or indeterminate (106; 27.3%). A high proportion (79.2%) of herbal medicine users believed that herbal medicines have no adverse effects.
The use of herbal medicines has been extensively studied in Nigeria among adult and paediatric population with chronic illnesses such as epilepsy [26], hypertension [27], diabetes mellitus [28], cancer [33], sickle cell anaemia and asthma [30]. Only a very few studies have specifically evaluated herbal medicine use among the general population [36,37].
The current study assessed the prevalence of herbal medicine use among a general population of adults without chronic illnesses. A high prevalence of 66.8% observed in our study is similar to the rate (69.4%) observed in another adult population (with or without chronic illnesses) in Nigeria where herbal medicines were used concurrently with conventional medicines [32]. However, the current rate of herbal medicine use was higher than the rates reported in Nigeria among adults with hypertension (39.1%) [27], diabetes mellitus (46%) [28], epilepsy (47.6%) [26] and cancer (51.9%) [33], and similarly higher than the rates (37.8%- 40%) reported among adult patients in a setting of a health maintenance organization in Central Texas city, United States of America [36] and among a general population in Finland, where herbal remedies were defined in the context of alternative medicines [38].
Herbal medicines were used for a variety of health conditions ranging from malaria to blood enrichment (Table 1). Contrasting findings have been reported in the United States where herbal remedies were predominantly used to treat common cold and for general health maintenance [36]. Malaria was the commonest indication for herbal medicine use in this study similar to a previous study in Nigeria [32]. However, only 20% of our population used herbal medicines to treat malaria compare to 80% in the previous study [32].
The wide disparity in the proportions of herbal medicine users for malaria in both studies may be as a result of the differences in herbal medicine definition. While we define herbal medicines as the use of plants' parts for medicinal purposes, other studies defined herbal medicines as finished, labeled medicinal products of plant or non-plant origin.
Malaria is a common public health problem in Nigeria that may adversely affect both human and capital resources. It is of concern that one-fifth of herbal medicine users in our study had no specific reason for the use. The lack of knowledge of potential harms of herbal medicines may have encouraged this practice.
Given the high proportion of the participants (66.8%) who were herbal medicine users and the wide range of indications for their use (Table 1), it is remarkable that only 12 herbal medicine preparations, involving 22 plants species, were used by the respondents. This finding is however contrasting to other studies that reported the use of high number of different plant species for chronic diseases such as diabetes in South Africa [39], inflammatory diseases in South-western Nigeria [40], and a wide range of acute and chronic illnesses in India [41]. The exclusion of participants with chronic illnesses may have accounted for the low use of herbal medicine preparations observed in our study.
The range of herbal medicines used by the respondents is quite different from those reported in other studies in Nigeria [26-30,32,33], Finland [38] and the United States [36]. This may be explained by the varied health conditions and cultural differences in each of the populations studied.
Of the 12 different herbal medicine preparations used by the respondents, four of them ('agbo jedi jedi', 'agbo...
Recent data indicates that 68% of patients are willing to consult traditional medicine practitioners via digital platforms. While awareness of digital health tools is relatively high (52%), actual usage remains limited, highlighting a gap between exposure and active engagement. This proves the need for public sensitization campaigns, particularly targeting older adults and rural populations.
TMPs are not resistant to innovation; rather, they require tailored training, incentives, and digital infrastructure to effectively participate in integrated healthcare systems.
While not entirely opposed to traditional medicine, 34% of medical doctors would support its integration into modern healthcare, provided there are established safety regulations and scientific validation of remedies.
The data indicates that 68% of patients are willing to consult traditional medicine practitioners via digital platforms. While awareness of digital health tools is relatively high (52%), actual usage remains limited, highlighting a gap between exposure and active engagement. This proves the need for public sensitization campaigns, particularly targeting older adults and rural populations.
TMPs are not resistant to innovation; rather, they require tailored training, incentives, and digital infrastructure to effectively participate in integrated healthcare systems.
While not entirely opposed to traditional medicine, 34% of medical doctors would support its integration into modern healthcare, provided there are established safety regulations and scientific validation of remedies.
While not entirely opposed to traditional medicine, 34% of medical doctors would support its integration into modern healthcare, provided there are established safety regulations and scientific validation of remedies.
Table 1: Common Herbal Medicines Used in Nigeria
| Herbal Medicine Name | Reported Use |
|---|---|
| Agbo jedi-jedi | Intestinal worm treatment |
| Agbo-iba | Fever management |
| Oroki herbal mixture | General wellness |
| Other preparations | Malaria, blood sugar reduction, etc. |
You and the Economy (2022) Episode 42: CBN Interventions (Herbal remedies in the Healthcare Sector)
Popular articles:
tags: #Nigeria
