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ORIGINAL ARTICLE
Year : 2014  |  Volume : 17  |  Issue : 4  |  Page : 140-144

Safety perception and knowledge of commonly used complementary and alternative medicine among physicians in Usmanu Danfodiyo University Teaching Hospital Sokoto, North-Western Nigeria


1 Department of Pharmacology and Therapeutics, College of Health Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria
2 Department of Psychiatry, Usmanu Danfodiyo University Teaching Hospital, Sokoto State, Nigeria

Date of Web Publication11-Dec-2014

Correspondence Address:
Abdulgafar O Jimoh
Department of Pharmacology and Therapeutics, College of Health Sciences, Usmanu Danfodiyo University, Sokoto
Nigeria
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DOI: 10.4103/1118-8561.146819

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  Abstract 

Background: Knowledge and safety perception of physicians concerning commonly used complementary and alternative medicine (CAM) may have influence on decisions of treatment and life of patients. This study determined the knowledge and safety perception of CAM among physicians in an Usmanu Danfodiyo University Teaching Hospital (UDUTH), a tertiary institution in Sokoto, North-Western Nigeria. Materials and Methods: A survey based on an anonymous questionnaire was performed among 221 doctors of UDUTH Sokoto, North-Western Nigeria using a 30-item validated questionnaire to examine their level of awareness and safety perception on CAM. Results: The lifetime prevalence of CAM use among doctors was 69.3% while current CAM use was about 12%. About half (47.5%) of the doctors think CAM use is unsafe. About 84.6%, 86.4%, and 64.3% of doctors think CAM use can cause adverse reactions/side effects, drug interactions, and noncompliance, respectively. Residents/consultants (84.5%) were more likely to correctly identify the standard definitions of CAM compared with house officers/medical officers (77.3%) (P = 0.02). A significantly higher percentage of consultants/residents were found to associate the use of CAM with poor adherence to conventional drugs compared with HO/MO (P = 0.02). Conclusion: This study demonstrates high degree of concern about the safety of CAM as it relates to adverse reactions/side effects, drug interactions, and noncompliance to orthodox medicine among physicians in UDUTH. There was an acceptable level of knowledge of CAM.

Keywords: Complementary and alternative medicine, knowledge and safety perception, physicians


How to cite this article:
Jimoh AO, Bakare AT. Safety perception and knowledge of commonly used complementary and alternative medicine among physicians in Usmanu Danfodiyo University Teaching Hospital Sokoto, North-Western Nigeria. Sahel Med J 2014;17:140-4

How to cite this URL:
Jimoh AO, Bakare AT. Safety perception and knowledge of commonly used complementary and alternative medicine among physicians in Usmanu Danfodiyo University Teaching Hospital Sokoto, North-Western Nigeria. Sahel Med J [serial online] 2014 [cited 2020 May 31];17:140-4. Available from: http://www.smjonline.org/text.asp?2014/17/4/140/146819


  Introduction Top


The National Center for Complementary and Alternative Medicine (NCCAM 2006) in America defines CAM as "a group of diverse medical and health care systems, practice and products that are not presently considered to be part of conventional medicine. [1] Conventional medicine refers to regular medicine and is provided by professionals including medical doctors, nurses and allied health professional. Although, the words complementary and alternative are often used interchangeably, they are really distinct treatment approaches. Complementary medicine is used in addition to conventional medicine [2] and includes radiotherapy, surgery, hormone treatment, and chemotherapy, while alternative medicine is used in place of standard medical treatments [3] and includes treatments such as acupuncture, massage therapy, or herbal medicine.

A high prevalence of CAM use has been reported in South-Western (88.5%) [4] and North-Western (84%) [5] Nigeria. There is a general trend of the worldwide increase in CAM use especially in the developing economies. [4],[5] About 42% of Americans had used CAM therapies in 1998 compared with 34% reported in 1990. [6] A British telephone survey by the BBC of 1209 adults in 1998 reported that around 20% of adults in Britain had used alternative medicine in the past 12 months. [7] About 40% of cancer patients use some form of CAM. [8] In Africa, traditional medicine is used for 80% in place of primary healthcare, and in developing nations as a whole over one-third of the population lack access to essential medicines, [9] probably due to poverty.

A study of academic doctors' views of CAM reported that majority of the doctors expressed skepticism or uncertainty about the value of CAM, while a few expressed enthusiasm. [10] The survey found that 61% of physician felt they had inadequate knowledge about the safety and efficacy of CAM therapies, while 81% believed that more education was required. [11] A survey of GPs in England in 1986 found that 59% regarded specific therapies such as acupuncture, herbal medicine and homeopathy to be useful to the patients. [12] However, a review of research on doctors' attitudes to CAM revealed that doctors raised a number of concerns, including safety, efficacy, and the absence of statutory regulation for most therapies. [13]

Voluntary reporting of CAM use by patients is low as patients are habitually reluctant to notify their doctors of history of CAM use. [14],[15] Side-effect and adverse reaction, drug interactions and interference with the intended action of orthodox medications, low adherence and noncompliance with orthodox medication may all result from the use of CAM. [5],[15],[16] There are currently limited studies on the knowledge and safety perception among doctors, especially in North-Western Nigeria. This is particularly important given recent debates about the integration of CAM within the National Health Scheme following the publication of the smallwood report. [17]

The objective of this work is therefore to determine the level of general and specific knowledge of different CAM in use locally among physicians in Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, Nigeria.


  Materials and Methods Top


0Setting/study population

The study was carried out among 221 doctors at UDUTH Sokoto, a tertiary health care institution in North-Western Nigeria.

Study design/sampling

This was a cross-sectional survey using a purposeful sampling strategy, [18] to identify 221 doctors with either clinical or academic role or both in the teaching hospital.

Questionnaire

A 30-item validated questionnaire was used to examine the participants' level of awareness, knowledge, and safety perception of CAM. Interviews were conducted in July 2013.

The questionnaire was field tested among 10 randomly selected doctors. It took approximately 5-7 min to complete. Participants were informed of the study protocol and those willing to participate anonymously completed the self-administered questionnaire.

Data analysis

Data were collected and analyzed using SSPS version 20 (Statistical package for the social sciences). Categorical variables were presented as frequencies and percentages. The Chi-square test was used to compare categorical variables. P ≤ 0.05 was considered to be statistically significant.


  Results Top


The mean age (standard deviation) of the participants was 33.7 ± 2.8 years. Majority of the participants were males (77.7%). About 48% were married. One hundred and five (47.1%) of the participants were resident doctors, 80 (36.2%) were house officers (HO), while only 11 (5%) were consultants [Table 1].
Table 1: Sociodemographic characteristics of the participants


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The lifetime prevalence rate of CAM use among doctors was 69.3%, while current CAM use was about 12%. One hundred and five participants (47.5%) think CAM use is unsafe with lack of dosing regimen, poor hygiene and lack of content label as the topmost safety concerns. Thirty participants (13.6%) think CAM use is safe, while 78 (35.3%) were not sure of the safety of CAM [Figure 1]. A total of 84.6%, 86.4%, and 64.3% of doctors think CAM use can cause adverse reactions/side-effects, drug interactions, and noncompliance with orthodox medicine respectively. While 37%, 26.7% and 40.3% of the doctors have recorded cases of adverse reactions/side effects, drug interactions, and noncompliance with orthodox medicine respectively resulting from CAM use. [Table 2] shows that compared with HO/medical officers (MO), residents/consultants were more likely to correctly identify the standard definitions of complementary medicine (73.3% vs. 84.5%;
P = 0.0271) CAM (74.3% vs. 88.8%; P = 0004) and alternative medicine (82.9% vs. 88.8%; P = 0.0312). A significantly higher percentage of consultants/residents were found to associate the use of CAM with poor adherence to conventional drugs compared to the HO/MO (72.8% vs. 57.8%; P = 0.0224). About 52.5% of the participants were able to recognize various examples of CAM while 40.3% had an idea about the different varieties of CAM being used in Sokoto [Figure 2]. In addition, (71.9%) of the participants have received reports of CAM use by their patients, but 23.1% of the doctors did not enquire whether their patients use CAM or not. Only 11.9% of the participants routinely recommend CAM to their patients. About 45% of the participants believe that CAM should be integrated with orthodox medicine [Table 3].
Figure 1: Safety perception of complementary and alternative medicine among physicians

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Figure 2: Awareness of complementary and alternative medicine use in Sokoto among the physicians

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Table 2: Comparison of the knowledge of CAM among the physicians


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Table 3: Awareness, safety concern and safety perception among the participants


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  Discussion Top


This study provided a detailed account of physicians' knowledge and safety perception of CAM. The lifetime prevalence of CAM use among doctors was high, while the prevalence of current CAM use was relatively low. Our finding is similar to what was reported in a previous survey of dental students in a teaching hospital where 60.8% had used herbal medication for various ailments, 67.6% indicated unawareness about safety concerns and herbal drug interactions, and 58.7% preferred herbal products over conventional medicine. [19]

About half of the doctors think CAM use is unsafe with lack of dosing regimen, hygiene and content label as the topmost safety concerns. This finding is similar to what was reported in a review of researches on doctors' attitude to CAM, which confirmed that doctors raised a number of safety concern including, lack of proof that therapies work, inadequate knowledge among doctors and absence of statutory regulation for most therapies. [13] Majority of the doctors also think CAM use can cause adverse reactions/side effects, drug interactions, and noncompliance. A study reported that CAM is usually not well researched as conventional medicine which undergoes intense research before being released to the public. [20] In addition, CAM has not been proven to be effective. [21] Previous study also reported that some herbal remedies reacts adversely with orthodox medicine drugs, radiation therapy and anesthetic agents. [22] A case of severe intraoperative bleeding that was attributable to CAM has been reported. [23]

The level of CAM knowledge of the physicians studied was generally fair and contrasted a survey in America, which showed that 61% of doctors felt they had inadequate knowledge about the safety and efficacy of CAM therapies, and 81% believed that more education was required in this field. [11] Majority of the participants were familiar with the various types of CAM used in their locality of practice. In the US, various commonly used CAM therapies in 2002 included prayer (45.2%), herbalism (18.9%), breathing meditation (11.6%), meditation (7.6%), chiropractic medicine (7.5%), yoga (5.1%-6.1%), body work (5.0%), diet-based therapy (3.5%), progressive relaxation (3.0%), mega-vitamin therapy (2.8%) and visualization (2.1%). [4]

Study limitations

This was an exploratory study, and only a small number of physicians were interviewed. We acknowledge that the study themes merit further examination in a larger qualitative study with a broader sample of doctors from a more diverse range of settings.


  Conclusion Top


Our data demonstrate adequate level of knowledge on issues relevant to CAM among the study physician population. These physicians show high degree of concern about the safety of CAM. We recommend continuing medical education on CAM.

 
  References Top

1.
National Centre for Complementary and Alternative Medicine (NCCAM) 2006. Available from: http://www.nih.gov/about/almanac/organisation/NCCAM.htm. [Last accessed on 2014 Jan 10].  Back to cited text no. 1
    
2.
Adams M, Jewell AP. The use of complementary and alternative medicine by cancer patients. Int Semin Surg Oncol 2007;4:10.  Back to cited text no. 2
    
3.
Medicienet. Available from: http://www.medicienenet.com/scupt/main/hp.asp. [Last accessed on 2014 Jan 05].  Back to cited text no. 3
    
4.
Nwachukwu CC, Fatiregun AA, Owoaje ET. Complementary and alternative medicine use in an urban slum area of Ibadan, Nigeria. Proceedings of the Annual General Meeting and Scientific Conference of the Nigerian Medical Association "OYONMA 2011" in Ibadan, Oyo State-Nigeria.  Back to cited text no. 4
    
5.
Jimoh AO, Sani Z, Abubakar K, Mshelia HE. Safety concerns and determinants of complementary and alternative medicine Use in a Sub-urban area of Sokoto North Western Nigeria. J Med Sci 2013;13:737-42.  Back to cited text no. 5
    
6.
Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, et al. Trends in alternative medicine use in the United States, 1990-1997: Results of a follow-up national survey. JAMA 1998;280:1569-75.  Back to cited text no. 6
    
7.
Thomas KJ, Nicholl JP, Coleman P. Use and expenditure on complementary medicine in England: A population based survey. Complement Ther Med 2001;9:2-11.  Back to cited text no. 7
    
8.
Horneber M, Bueschel G, Dennert G, Less D, Ritter E, Zwahlen M. How many cancer patients use complementary and alternative medicine: A systematic review and metaanalysis. Integr Cancer Ther 2012;11:187-203.  Back to cited text no. 8
    
9.
Kasilo OM, Trapsida JM, Mwikisa CN, Lusamba-Dikasa PS. An overview of the traditional medicine situation in the African region. Afr Health Monit 2010;13:7-15.  Back to cited text no. 9
    
10.
Nita M, Alison S. Academic doctors' views of complementary and alternative medicine (CAM) and its role within the NHS: An exploratory qualitative study. BMC Complement Altern Med 2007;7:17.  Back to cited text no. 10
    
11.
Milden SP, Stokols D. Physicians' attitudes and practices regarding complementary and alternative medicine. Behav Med 2004;30:73-82.  Back to cited text no. 11
    
12.
Wharton R, Lewith G. Complementary medicine and the general practitioner. Br Med J (Clin Res Ed) 1986;292:1498-500.  Back to cited text no. 12
    
13.
Botting DA, Cook R. Complementary medicine: Knowledge, use and attitudes of doctors. Complement Ther Nurs Midwifery 2000;6:41-7.  Back to cited text no. 13
    
14.
Hori S, Mihaylov I, Vasconcelos JC, McCoubrie M. Patterns of complementary and alternative medicine use amongst outpatients in Tokyo, Japan. BMC Complement Altern Med 2008;8:14.  Back to cited text no. 14
    
15.
Grant SJ, Bin YS, Kiat H, Chang DH. The use of complementary and alternative medicine by people with cardiovascular disease: A systematic review. BMC Public Health 2012;12:299.  Back to cited text no. 15
    
16.
Ekwunife OI, Oreh C, Ubaka CM. Concurrent use of complementary and alternative medicine with antiretroviral therapy reduces adherence to HIV medications. Int J Pharm Pract 2012;20:340-3.  Back to cited text no. 16
    
17.
Smallwood C. The Role of Complementary and Alternative Medicine in the NHS. London: Freshminds; 2005. Available from: http://www.freshminds.co.uk/PDF/THE%20REPORT.pdf. [Last accessed on 2013 Dec 20].  Back to cited text no. 17
    
18.
Levin KA. Study design III: Cross-sectional studies. Evid Based Dent 2006;7:24-5.  Back to cited text no. 18
    
19.
Sekhri K, Bhanwra S, Nandha R. Herbal products: A survey of student's perception and knowledge about their medicinal use. Int J Basic Clin Pharmacol 2013;2:71-6.  Back to cited text no. 19
    
20.
Ernst E, Cohen MH, Stone J. Ethical problems arising in evidence based complementary and alternative medicine. J Med Ethics 2004;30:156-9.  Back to cited text no. 20
    
21.
Ernest EE, Pittler MH, Stevinson C, White AA. Desktop Guide to Complementary and Alternative Medicine: An Evidenced Based Approach. London: Harcourt Publishers Ltd.; 2001. p. 444.  Back to cited text no. 21
    
22.
Cassileth BR, Deng G. Complementary and alternative therapies for cancer. Oncologist 2004;9:80-9.  Back to cited text no. 22
    
23.
Hills, B. Fake healers Australia $1 billion-a-year alternative medicine industry is ineffective and out of control. Medical Mayhem, 1999. Available from: http://www.BenHills.com. [Last accessed on 2014 Jan 10].  Back to cited text no. 23
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Figure 2]


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