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ORIGINAL ARTICLE
Year : 2017  |  Volume : 20  |  Issue : 2  |  Page : 59-63

Knowledge and practice of the use of traditional eye medication in a semi-urban community


Department of Ophthalmology, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria

Date of Web Publication18-Sep-2017

Correspondence Address:
Dumebi Hedwig Kayoma
Department of Ophthalmology, University of Benin Teaching Hospital, PMB 1111, Benin City, Edo State
Nigeria
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DOI: 10.4103/1118-8561.215033

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  Abstract 

Background: Traditional eye medications may be harmful causing ocular morbidity. The aim of this study is to determine the knowledge and practice of traditional eye medication (TEM) among adults in a semi-urban community in Edo state. Materials and Methods: A 3 months cross-sectional descriptive study in Ekiadolor community in Ovia North East Local Government Area of Edo state, Nigeria. A cluster sampling technique was used. Four hundred and thirty respondents aged between 18 years and above were included in the study. Results: A total of four hundred and thirty respondents (430) which comprised of 184 (42.8%) males and 246 (57.2%) females with a male to female ratio of 1:1.3 were studied. The age range of the respondents was 21 to 84 years, with a mean age of 49.83 ± 19.99 years (standard deviation). Three hundred and ninety-two (91.2%) of the respondents knew about TEM. Herbal extract was the most known (94.4%). Although 71.6% said TEM was harmful, the prevalence of use of TEM was 48.7%. The male gender, low socioeconomic class, and no or low level of formal education were more likely to use TEM (P = 0.001). Conclusion: The knowledge and practice of TEM are high in this community. There is a great need to educate the people on the overall harmful effect of this practice through public enlightenment campaigns.

Keywords: Adults, knowledge, practice, semi-urban community, traditional eye medication


How to cite this article:
Kayoma DH, Ukponmwan CU. Knowledge and practice of the use of traditional eye medication in a semi-urban community. Sahel Med J 2017;20:59-63

How to cite this URL:
Kayoma DH, Ukponmwan CU. Knowledge and practice of the use of traditional eye medication in a semi-urban community. Sahel Med J [serial online] 2017 [cited 2017 Oct 23];20:59-63. Available from: http://www.smjonline.org/text.asp?2017/20/2/59/215033


  Introduction Top


Traditional medicine refers to health practices, approaches, knowledge and beliefs incorporating plant, animal- and mineral-based medicines, spiritual therapies, manual techniques, and exercises applied singularly or in combination to treat, diagnose and prevent illnesses, or maintain wellbeing.[1]

Traditional eye medicines are biologically based therapies or practices that are instilled or applied to the eye or administered orally to achieve a desired ocular therapy.[2],[3]

These traditional eye medicines are usually prescribed by traditional medicine practitioners and novices. They are either harmful or harmless.[4],[5] Harmless traditional eye practices may be in the form of incantations by traditional healers or face washing with water.[4],[5] Harmful eye medications include ocular instillation of alcohol, herbal extracts, breast milk, ground cowries, donkey or cow dung, human sputum, urine, bird, and lizard feces.[4],[5] These harmful practices usually cause ocular morbidity due to their contact with the eyes.

The common belief is that anything herbal and traditional implies the absence of any adverse effect, and this has led to the frequent use of traditional eye medication (TEM).[6],[7] Herbal ocular “medicines” are responsible for an estimated 8–10% of corneal blindness in Africa.[8] Cultural, religious beliefs, and traditional practices, especially as they relate to health, are strong among Nigerians and influence their health-seeking behavior often in favor of traditional medical care.[9] Osahon [10] reported the prevalence of the use of traditional eye medicine among patients presenting in the eye clinic of the University of Benin Teaching Hospital as 1.72%. The incidence of use of TEM by newly presenting patients was found to be 5.9% at the University of Nigeria Teaching Hospital Enugu.[9] Nwosu [11] in his study on ophthalmic destructive procedures in Onitsha, Nigeria, reported that 37.5% of the patients with infection-related destructive procedures used TEM, while Chinda et al.[12] found a high percentage (30%) of endophthalmitis following the use of TEM at the extreme of age. Chirambo and Benezra [13] found that 25% of blindness among blind school pupils was due to the use of TEM. In a South Indian hospital, 47.7% of the patients used TEM before presenting to the hospital.[14]

TEM use either as sole first line treatment or with conventional therapy has been associated with poor visual outcome.[10]

The aim of this study is to determine the knowledge and practice of the use of TEM among people living in a semi-urban community in Edo state Nigeria.


  Materials and Methods Top


A 3 months cross-sectional descriptive study was carried out in Ekiadolor community in Ovia North East Local Government Area (LGA) of Edo state in Nigeria, between September and November 2011.

It is a semi-urban community, which has a major road that bisects the community into almost equal halves. The indigenous inhabitants are the Binis, and the major spoken languages are Bini and Pidgin English. The community has one comprehensive health center run by the state government. A primary health care center run by the local government and eye care services provided by the Ophthalmology Department of the University of Benin Teaching Hospital at the Health Centre, two primary schools, one secondary school and a tertiary institution. The University of Benin Teaching Hospital is a few kilometers from the community with an accessible road and transportation cost from the community to the hospital is about seventy naira.

The study population comprised of all adults 18 years and above and a cluster sampling technique was used in which the community was divided into two clusters A and B by the only major road in the community. Participants were then selected from cluster A by a ballot system.

A structured interviewer administered questionnaire was used for data collection from respondents. The questionnaire was on the demographic characteristics of the respondents, knowledge of TEM, common eye symptoms necessitating use, harmful effects of the use of TEM, TEM used, routes of administration of TEM, and if eye care services are accessible and available would TEM still be used.

This study was approved by the Ethics and Research Committee of the University of Benin Teaching Hospital. Consent was also obtained from the Chairman of the LGA, the Medical Officer of Health Centre and the traditional ruler of the community.

Data analysis was done using Statistical Package for Social Scientist (SPSS, Chicago IL, United States of America) version 16 (IBM). Findings were illustrated using tables and figure. The relationships between categorical data were analyzed using Chi-square test. A P ≤ 0.05 was taken as significant.


  Results Top


A total of 430 respondents participated in the study. Their age range was 21–84 years with a mean age of 49.83 ± 19.99 years (standard deviation). The age group 61–70 years had the highest frequency (28.1%). The distribution of sociodemographic characteristics is shown in [Table 1]. There were more females (57.2%), with a male to female ratio of 1:1.3. More than half were married (57.2%). The Christians were a majority (70.9%). Subjects with no formal education and primary level of education were predominant (40.7%, 40.9%, respectively). The Binis accounted for more than three quarters (81.6%) of the population. The most frequent social class was social class 5[15] (69.1%).
Table 1: Sociodemographic characteristics of respondent

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Almost all the respondents (91.2%) knew about TEM, more than half (57.4%) said there were no benefits of TEM and 71.6% said there were harmful effects of TEM. [Table 2], shows the respondents practice of TEM. More than three quarters (85.3%) had ever had eye disease, 63.5% had eye disease in the last one year, 83.5% have stopped the use of TEM, while 30.1% said they will still use TEM, even if eye care services are affordable and accessible.
Table 2: Respondents' practice of traditional eye medication

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[Figure 1] illustrates the type of TEM known to respondents; herbal extract was the most frequent (94.4%).
Figure 1: Types of traditional eye medication known to respondents

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The highest use of TEM was among the respondents who had poor vision (71.9%). Other ocular complaints necessitating its use include “white spot” in the eye (13.7%), “red eye” (7.0%), ocular foreign body (5.1%), and ocular trauma (2.3%).

There were various harmful effects of TEM among the respondents of which blindness (20.8%) had the highest frequency [Table 3].
Table 3: Association between sociodemographic factors and the use of traditional eye medication

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About three quarters (85.3%) had ever had eye disease, more than half (63.5%) had eye disease in the last 1 year, 83.5% have stopped the use of TEM, while 30.1% said they will still use TEM, even if eye care services are affordable and accessible.

Eye care service options among the respondents who had eye disease in the past show that “hospital” (38.1%) had the highest frequency. Others were traditional healers (21.8%), religious leaders (6.0%), and “others” (34.1%).


  Discussion Top


This study revealed that majority (91.2%) of the respondents knew about TEM. This is not surprising as this is a semi-urban community and also TEM is widely advertised by the mass media in this environment. Herbal extract was known and used by most of the respondents. This finding is in keeping with other studies in Africa.[9],[16],[17],[18],[19],[20] This is in contrast to a study carried out in a South Indian hospital, where human breast milk was the most common form of TEM used.[14] The other types of TEM used were breast milk, sugar solution, and urine which are rich culture media that encourages the proliferation of microorganisms.

Poor vision (71.9%) ranked the highest among the presenting symptoms necessitating the use of TEM. Ukponmwan and Momoh [16] had similar findings. This could be due to the fact that the modal age group was 61–70 years and age-related conditions such as senile cataract, presbyopia, vitreous degeneration, glaucoma, diabetic retinopathy, hypertensive retinopathy, and age-related macular degeneration are commoner in this age group. This also corroborates with the findings that about 82% of blindness globally occurs in persons who are 50 years and older.[21] It could also be attributed to the fact that vision is the most important function of the eye and so, anything affecting it cannot be ignored by any age group.

The Comprehensive Health Centre and a primary health care center in the community which offers eye care services are semifunctional. This may be the reason why a sizeable proportion (21.8%) of the inhabitants still visits the traditional healer to seek relief of their symptoms. This was also seen by Poudyal et al.[7] in Nepal, where availability of eye care facility in the community did not guarantee patronage by its members. Finance could also be a factor as this is a predominantly farming community.

The prevalence of the use of TEM is quite high (48.7%) among those who have had eye disease in the last 1 year, despite the fact that 71.6% of the respondents knew about the harmful effects of TEM. This finding is similar to that of Ukponmwan and Omuemu [22] carried out in another rural community in the same state in which they reported that 49.5% of persons with eye disease or a past history of eye disease had used TEM.

The decrease in prevalence could also be due to the proximity of a tertiary hospital to the study site. In Eastern Nigeria, Eze et al.[9] and Nwosu and Obidiozor [19] reported that 5.9% and 13.2%, respectively, had used TEM before presenting to the hospital. This wide variation could be due to the difference in study settings as these were hospital-based studies as opposed to the former which were community-based studies.

The association between sociodemographic characteristics and the use of TEM showed that gender, socioeconomic class, and education were statistically significant (P = 0.001 for each variable). Males were more likely to use TEM. This could be due to the fact that they are decision makers as they are the heads of the families. Religion plays a vital role in one's belief as it is represented in this study. Though not statistically significant majority of the respondents who used TEM practiced African Traditional Religion (ATR). Ukponmwan and Omuemu [22] in their study, found a significant association between ATR and the use of TEM. The use of TEM was significantly more common in subjects in the lower socioeconomic classes. This could be due to the fact that members of social class (1-3) are expected to be more knowledgeable on the harmful effects of TEM due to their higher level of education. Respondents with no formal education, primary and secondary education, were more likely to use TEM than those with tertiary education. This was statistically significant. Nwosu and Obidiozor,[19] Mutombo,[23] and Ahmed et al.[24] reported similar findings.


  Conclusion Top


This study demonstrates high practice of traditional eye medication with potential for increased ocular morbidity in the study community.

Health-care workers with an ophthalmologist as the leader of the team should ensure optimal enlightenment on the harmful effects of TEM in our communities. The government should make policies to guide the content of the advertisement made on mass media by the traditional practitioners. Education of people in the community should be encouraged by provision of schools and reduction in school fees or free education.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Prajna NV, Pillai MR, Manimegalai TK, Srinivasan M. Use of traditional eye medicines by corneal ulcer patients presenting to a hospital in South India. Indian J Ophthalmol 1999;47:15-8.  Back to cited text no. 14
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