ABSTRACT
This cross-sectional study evaluated the use of complementary and alternative medicine and supplements by diabetics attending Federal Medical Centre, Umuahia; Abia State. A total of 440 diabetic patients were purposively selected from the Diabetic attendance record of the state. Structured questions was used to elicit information on the demographic and socio economic characteristics of respondents, the use complementary and alternatives medicine and supplements among patients attending FMC Umuahia, patients’ knowledge and attitude of the use of CAM and Supplements, Prevalence and Patterns for the use CAM and supplements, Factors Associated with use of CAM and supplements. SPSS (Vession 22) was used to analyse the data, descriptive statistics, pearsons correlation, multiple regression and chi-square test was employed in entry the data. Result showed that 215 (48.9%) of the respondents were 56years above, and 208 (47.3%) were between 46-55year indicating that majority of the sufferers of this illness are mostly elderly ones. More of the respondents were female (274, 62.3%) and 166 (37.7%) are male and this indicated that women are at higher risk of been diabetic later in life, married (405, 92.0%), this may be because of poor nutrition attached to the means of keeping a household or family as 52.9% had 3-4children and 35.3% had 1-2children. They were more of traders (231, 52.5%) and farmers (112, 25.5%) as these occupations are stress and needs loads of energy to be done and thus they consume more of energy giving food which got them diabetic. 208 (47.3%) and 197 (44.8%) earned less than 30,000naira and between 31,000naira-60,000 naira respectively; and as low income earners. Their CAM consumption ranges from 2-3 times weekly, once weekly, and did not consume CAM. This pointed out not too many of them used the selected CAM. Many of the respondents claimed to have consulted the doctor on the use of CAM and supplements while a handful did not. All of them had a source of either from their relatives, from mass media, from social media, from medical doctors, and from friends. A large number of respondents had their services rendered to them by the CAM practitioners. More than half of the respondents used CAM on a weekly basis and their consideration for usage was almost at the same percentage across the options “no,” “yes,” “not decided,” and “no response.” The prevalence, patterns, and factors associated with the use of CAM and supplements revealed that the visiting varied across the duration given. More respondents visited government facility and private facility last for their treatment. The study further recommended that there should be community based programmes on CAM and supplements should be made to enlighten and educate people in general especially in the markets, as more respondents claimed to be traders and artisans, across the federation.
TABLE
OF CONTENTS
Title
Page i
Certification ii
Dedication iii
Acknowledgement
iv
Table
of contents vi
List
of Tables vii
Abstract viii
CHAPTER 1
INTRODUCTION
1.1
Statement
of the Problems 6
1.2 Objectives of the Study 8
1.2.1 General Objective 8
1.2.2 Specific Objectives 8
1.3 Significance of the Study 9
CHAPTER 2
LITERATURE REVIEW
2.1 Diabetes Mellitus 11
2.1.1 Types of Diabetes Mellitus and Symptoms 12
2.1.2 Diabetic Mellitus Patient 14
2.2 Complementary and Alternative Medicine 14
2.2.1 Types of CAM 18
2.2.2 Prevalence
of Complementary and Alternative Medicines (CAM)
Use
among Persons with Diabetes Mellitus 25
2.2.3 Benefits
of CAM use to persons living with DM 30
2.2.4 Reasons
Persons living with DM Give for using CAM 32
2.2.5 Adverse
Effects of CAM among Persons Living with DM 34
2.3 Supplements 37
2.3.1 Botanical
products for diabetes treatment 41
2.3.2 Dietary
supplements for diabetes 44
2.3.3 Food Supplements for
the Prevention and Treatment of Diabetes 51
2.3.4 Supplements for the Treatment of the Co-Morbidities and
Complications of Diabetes 54
CHAPTER THREE
MATERIALS AND METHODS
3.1 Study
Design 57
3.2 Area of
Study 57
3.3 Population
of the Study 58
3.4 Sampling
and Sampling Techniques
3.4.1 Sample size 59
3.4.2 Sampling
procedure 59
3.5 Preliminary
Activities 59
3.5.1 Preliminary
visits 60
3.5.2 Training
of research assistants 60
3.5.3 Informed
Consent 60
3.5.4 Ethical
Clearance 61
3.6 Questionnaire
Construction 61
3.7 Validation
of Questionnaire 61
3.8 Statistical
Analysis 62
CHAPTER 4
RESULTS AND DISCUSSION
4.1 Demographic
and socio-economic characteristics of respondents 67
4.2 Use of
complementary and alternative medicine and supplements
among the
respondents 68
4.3 Patients’
knowledge and attitude on the use of complementary
and alternative
medicine and supplements in the management of
diabetes
mellitus 75
4.4 Prevalence and patterns for the use of complementary
and
alternative
medicine and supplements for diabetic patients 82
4.5 Factors
associated with the use of complementary and alternative
medicine
and supplements 86
4.6 Relationship
between demographic and socio-economic data,
knowledge,
attitude and utilization of complementary and
alternative
medicine and supplements 90
CHAPTER 5
CONCLUSION
AND RECOMMENDATIONS
5.1 Conclusion 93
5.2 Recommendation 94
REFERENCES 96
APPENDICES
Questionnaire
Letter of Introduction
Ethical Clearance
LIST OF TABLES
Table
4.1: Socio-Economic Characteristics
of the Respondents 66
Table 4.2a: Use of Complementary Alternative Medicine
(CAM)
and
Supplements among the Respondents 72
Table 4.2b: Use of Complementary Alternative Medicine
(CAM) and Supplements among
the Respondents 70
Table 4.3: Knowledge and Attitude of the Respondents on the Use
of Complementary and Alternative Medicine and
Supplements in the Management of Diabetes Mellitus 79
Table 4.4: Prevalence and patterns for the use of CAM and
Supplement 84
Table
4.5: Factors Associated With the
Use of Cam and Supplement 89
Table 4.6: Relationship
between Demographic and Socio-Economic
Data, Knowledge, Attitude and Utilization of
Complementary and Alternative Medicine and
Supplements 92
CHAPTER 1
INTRODUCTION
The increasing prevalence and occurrence of diabetes with
a demographic transition in its epidemiology in recent years has become a
menace to the country at large. However, diabetics is one of the chronic
debilitating medical condition that is fast gaining the status of a potential
epidemic in the country despite recent advances
in care and management, precipitates substantial morbidity, mortality and long
term complications on patients and their families (Kaveeshwar, 2014).
World Health Organization (2019) defined diabetes mellitus (DM) as a metabolic
disorder of chronic hyperglycemia characterized by disturbances to
carbohydrate, protein, and fat metabolism resulting from absolute or relative
insulin deficiency with dysfunction in organ systems. The latest
prevalence figure published by the International Diabetes Federation (IDF) is
425 million persons living with DM worldwide, with nearly 50% of these
undiagnosed (International Diabetes Federation,
2017) while in Nigeria, the current prevalence of DM among adults aged
20–69 years is reported to be 1.7% of the overall population (International Diabetes Federation, 2017). In the
same vein, Shaw et al. (2010) and Naghibi-Harat et al. (2016) reviewed that the global prevalence of diabetes is estimated to reach
7.7% by 2030. The developing economies of Africa and Asia contribute a
significant fraction of this figure. There is also a rising burden from the
complications of DM alongside the ever-increasing prevalence of the disease (Uloko et al.,
2008).
Non-compliance with long term management of Type 2
Diabetes Mellitus (T2DM) may lead to serious negative effects on health
systems, such as compromised health benefits and serious economic consequences
in terms of wasted time, money and uncured disease (WHO, 2003). The use of
insulin is considered to be a quantum leap in the management of diabetes,
living with (T2DM) remains a challenge requiring considerable dedication and
commitment to a life-long regimen imposed by this chronic disease (Funnell et al., 2012). In addition, the achievement of good T2DM control is
often difficult due to the required lifestyle changes, including: modifying
eating habits, maintaining optimal body weight, exercising regularly and
self-monitoring of blood sugar (Chang et al., 2007).
However, the relevance of the use of complementary and
alternative medicines (CAM) and supplements for diabetic management cannot be
over-emphasized (Chang et al., 2007),
this is because complementary and alternative medicines (CAM) and use of
supplements are less cost-effective and have less efficacy than modern
treatments (Robb, 2006) and that they are less invasive (Ferro et al., 2010). In addition, they are not
addictive and they are more available compared to other treatments such as
conventional therapies (Ferro et al.,
2010). Although modern treatments of diabetics using conventional strategy have
achieved much progress in blood sugar control during recent decades, therefore
the use of traditional medicine is still the main footstone for caring for such
diabetic patients attending Federal Medical Centre, Umuahia (FMC).
Considering the cost implementation and
adverse effects associated with conventional therapies such as oral
glucose-lowering drugs and insulin, and are sometimes associated with adverse
effects (Barnes et al., 2004; Verhoef et al., 2005; Ceylan et al.,
2005), most diabetic patients opt for
complementary and alternative medicine (CAM) to manage their DM (Monica et
al., 2016). Additional reasons
include patients’ need to have personal control over the course of their
disease, as well as the perceived compatibility of CAM therapies with patients’
values, spiritual/religious philosophy and beliefs regarding the nature and the
meaning of death and illness (Barnes et al., 2004; Verhoef et al., 2005; Ceylan et al.,
2005).
Therefore, the use of complementary and alternative
medicines (CAM) and supplements are alternative treatment strategies for
diabetic patients considering the fact that diabetics are often on multiple
medications due to their co-morbidities, the possibilities of herb-drug
interaction or herb-dietary supplement interactions cannot be ruled out
resulting in adverse drug reactions (Birdee and Yeh, 2010).
Ching et al. (2013) defined complementary and
alternative medicine (CAM) as a group of diverse medical and healthcare
systems, practices, and products that are not generally considered part of
conventional Western medicine. In the same vein, Complementary and Alternative
Medicines (CAM) refers to biologically based practices including substances
found in nature, such as herbs, dietary supplements, multivitamin and mineral
supplements, as well as prayers. Such therapies are used for the prevention and
treatment of diseases and are meant to complement mainstream medicine by:
“satisfying a demand not met by orthodoxy or by diversifying the conceptual
frameworks of medicine” (Bishop et al., 2010; Sewitch and Rajput, 2010;
Littlewood and Vanable, 2008). The US National Center for CAM therapies
divides CAM into four categories:
Mind-body systems; Manipulative and body-based practices; Energy
Medicine; and Biologically based practices (National
Center for Complementary and Alternative Medicine, 2012), while Ching et
al. (2013) reviewed that CAM use can be divided into five categories:
biological based therapies like herbal and dietary supplement; alternative
medical systems; energy therapies; manipulative and body-based systems; and mind-body
interventions like tai chi or yoga (Ching et
al., 2013). Cheng et al. (2007) reported that herbal remedies, vitamins,
spirituality, and exercise are common CAM therapies pursued by diabetic
patients (Cheng et al., 2007).
The prevalence of CAM use among people
living with DM is estimated to be as high as 80% in Africa (Chang et al., 2007). Therefore, the use of CAM and supplements in managing diabetics are
gaining public acceptance and are increasingly used around the globe,
especially among individuals with chronic illnesses such as T2DM (Bishop et al.,
2010; Sewitch and Rajput, 2010; Littlewood and Vanable, 2008). However,
despite the growing popularity of CAM use, there is still insufficient evidence
to draw conclusions about the efficiency of many common CAM therapies,
including herbs and supplements for prevention and management of diabetes (Yeh et al.,
2003). While several comprehensive reviews have found evidence on the
effective use of extracts of plants in the treatment of diabetes, few studies
reported significant side effects of CAM use in T2DM. The presence of such a chronic, debilitating, and possibly
painful illness has been identified as a reason why patients seek out CAM
(Hasan et al., 2009). In addition,
Chang et al. (2007) highlighted that the prevalence of CAM use among diabetic
populations worldwide varies widely. However, Coulter and Willis (2004) suggest
that the growth in CAM use may be related to general societal changes. As
social change and globalization accelerate, faith in the ability of medical
science to solve the problems of human diseases has declined. This change
within society might be interpreted as part of the ascendancy of patient
self-empowerment (Funnell and Anderson, 2004).
In Nigeria, little is known about the prevalence of use
of CAM therapies in general and among diabetic patients in particular. There is
no available data on the prevalence and determinants of CAM use among diabetic
patients visiting Federal Medical Centre, Umuahia-Abia State. Therefore, investigating
the prevalence of CAM use, the causes and modes for use, and patients’
perception of CAM will be crucial since results could help protect the health
of patients, improve the patient-provider communication and coordination, and
help integrate CAM therapies into mainstream medicine. It is on this basis that
this research study is carried out to ascertain the prevalence, perception and
adoption of Complementary and Alternative Medicine and Supplements by Diabetic
Patients attending Federal Medical Centre, Umuahia, Abia State.
1.2
STATEMENT OF THE PROBLEMS
Developing countries like Nigeria witness the
highest burden of DM (Shaw et al.,
2010). In Nigeria, the prevalence of DM was estimated at 1.7% of the overall
population, and most of the patients are in the category of middle aged and
advanced persons including civil servants (Aikins, 2006). Globally, diabetes
accounts for one death every 6 seconds (Internally Displaced Persons, 2016),
and over 80% of these deaths occur in developing countries (World Health
Organization, 2016). DM accounts for about 6.1% of deaths in Africa (WHO,
2016). This rising burden of DM comes with a rising patronage of complementary
and alternative medicine (CAM). Studies from several countries have reported
between 17% and 72.8% prevalence of CAM use among persons living with DM (Chang
et al., 2007). In Africa, the
prevalence of CAM use for chronic conditions such as DM is estimated at 80%
(Ogbera, Dada, Adeleye, & Jewo, 2010).
The use of CAM has been attributed to: poor
access to orthodox treatment (Antwi-Baffour, Bello, Adjei, Mahmood, &
Ayeh-Kumi, 2014), dissatisfaction with orthodox treatments emanating from
strict regimens, adverse reactions from orthodox drugs, coupled with patients’
desire to have direct control over their disease contribute (Astin, 1998).
Furthermore, patients desire to experiment with CAM, the presence of disease
complications, and the belief that CAM use is compatible with their
sociocultural values makes CAM attractive to them (Naja et al., 2014).
The use of CAM has led to adverse drug interactions and
poor adherence to proven orthodox therapy (Matheka & Demaio, 2013). Whereas
some CAM are intrinsically toxic, others contain toxic impurities such as lead,
arsenic, and mercury (Ventola, 2010). CAM use can result in acute complications
such as hypoglycaemic coma and diabetic. CAM remedies can be an important
component of health self-management, depending on the patient’s financial
resources, culture, and self-empowerment (Naghibi-Harat et al., 2016). As a result, many diabetes patients prefer to use
complementary and alternative medicine as an adjunct for diabetes treatment.
Also, complementary and alternative medicine is used as a means to reduce usage
of common medications due to their complications, and they can be bought
without prescription (Wilkinson and Jelinek, 2009).
Despite these associated features of CAM use,
evidence is mounting in support of the use of various CAM and supplements by
diabetic patients to treat a wide variety of complications of diabetes
mellitus. Therefore, there is limited information on the prevalence, use,
adoption and pattern of CAM and supplements in the management of diabetes. It
is on this basis that this study is carried out to ascertain the prevalence and
perceived limitations of the medical paradigm and the apparent failure of
conventional medicine to treat and/or cure chronic illness and catastrophic diseases.
1.2 OBJECTIVES OF THE STUDY
1.2.1 General
Objective
The general objective of this study is to evaluate the
use of complementary and alternative medicine and supplements by diabetics
attending Federal Medical Centre, Umuahia; Abia State.
1.2.2 Specific
Objectives
The specific objectives of this study include to:
i)
determine
the demographic and socio-economic characteristics of diabetic patients
attending Federal Medical Centre, Umuahia,
ii)
assess
the use of complementary and alternative medicine and supplements among
patients with diabetes mellitus attending Federal Medical Centre, Umuahia;
iii)
determine
the patients’ knowledge and attitude on the use of complementary and
alternative medicine and supplements in the management of diabetes mellitus;
iv)
ascertain
the prevalence and patterns for the use of complementary and alternative
medicine and supplements for diabetic patients;
v)
determine
the factors associated with the use of complementary and alternative medicine
and supplements by the subjects,
vi)
determine
the relationship between demographic and socio-economic data, knowledge,
attitude and utilization of complementary and alternative medicine and
supplements.
1.3 SIGNIFICANCE OF THE STUDY
The result of this study will be useful to both diabetic
patients, health workers/professional and the entire public because it will
provide basis for advice/consultation on the prevalence, use, adoption and
knowledge of complementary and alternative medicine and supplements which could
be facilitated through workshop and seminars. Research into the extent of CAM
use, why and how it is used, and disclosure of use to healthcare professionals
is vital as results could help to improve communication between healthcare
professionals and patients and assist in planning better self-management
strategies for patients. Also, a better understanding of CAM use will help the
medical profession be more vigilant and patient centered, particularly during
counseling sessions regarding proper use herbal remedies in the stream of
modern medicine.
This study will add to the existing stock of
knowledge in this field of study. It will also serve as reference material to
students, nutritionists, health practitioners, food industries, the government
and other researchers in the field and other related areas. The research will
serve as a guide for future researches to students on the knowledge, attitude
and perception on the use of complementary and alternative medicine and
supplements by diabetics attending Federal Medical Centre, Umuahia. Findings
will also help the health professionals to fully analyze the importance of
incorporation of utilization of CAM and supplements to further manage
diabetics. This work will aid health practitioners and government agencies like
the ministries of health, information and other non-governmental organizations
in advocating and sensitize diabetic patients on the usefulness of CAM and
supplements oninfant and young child feeding.
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