Hypertension is one of the most common chronic cardiovascular diseases affecting up to 20% of the world’s adult population [
Complementary and alternative medicine (CAM) is defined as a variety of ways including different medical and health care systems, various practices, and many products that are not treated as part of modern conventional medicine [
This was a cross-sectional survey of hypertensive patients attending ambulatory clinic at Gondar University Referral Hospital (GURH). The study was conducted from April to June 2016. GURH is located in Gondar town, North West Ethiopia, 727 km away the capital city of Ethiopia. It is one of the oldest and pioneering referral teaching hospitals in Ethiopia with a range of specialists including a chronic disease illness follow-up ambulatory clinic, which currently provides free service for more than 15,000 chronic cardiovascular patients on outpatient level annually.
A convenience sample of adult hypertensive patients attending GURH ambulatory clinic were invited. 423 patients were enrolled in study within two-month data collection period. The inclusion criteria were adult (≥18 year age) hypertensive patients regardless of stage and time since diagnosis, who started taking medication for reduction of blood pressure and visited hypertension outpatient ambulatory clinic from April to June 2016. Those patients who lack understanding of oral Amharic language and had severe physical or psychological problems as well as those who refused to participate were excluded. The two-month follow-up period was chosen for data collection to avoid duplication of the cases as patients return to the ambulatory clinic every two months.
Data collection was performed by five well trained nurses who were working at ambulatory clinic through interviewer-administered questionnaire. The data collection tool was developed after a through literature review of the published studies [
The collected data were entered into and analyzed using the Statistical Package for the Social Sciences (SPSS) software version 21.0 for Windows. Frequencies and percentages were used to express different variables. The baseline characteristics of CAM users and nonusers were compared by using Pearson’s chi-square test. Both bivariant and multivariant logistic regression methods were also employed to identify determinants of CAM use. The results were adjusted for patients’ demographic and clinical characteristics. Odds ratio (OR) with 95% confidence interval (95% CI) were also computed along with corresponding
This study was approved by the ethical committee of University of Gondar. Informed consent was also secured from the participants prior to the data collection and participants’ information obtained was kept anonymous.
Out of 423 hypertensive patients invited to participate, 412 of them completed the survey giving a response rate of 97.39%. More than half of respondents (59.5%) were female and married (69.8%). Majority of respondents were orthodox Christians (85.9%) and 65.3% of them had <100 USD average monthly income. Around two-third (66.9%) of respondents had a family history of hypertension and 36.1% of them develop complication. Other sociodemographic and clinical characteristics of respondents are shown in Table
Sociodemographic and clinical characteristics of respondents, Gondar, 2016 (
Variables | Overall ( | CAM users ( | Non-CAM users ( | |
---|---|---|---|---|
| 0.124 | |||
Mean (SD) | | 60.6 (10.6) | 53.6 (10.6) | |
| | |||
Male | 167 (40.5%) | 115 (41.2%) | 52 (39.1%) | |
Female | 245 (59.5%) | 164 (58.8%) | 81 (60.9%) | |
| | |||
Urban | 225 (54.6%) | 106 (37.9) | 119 (89.5%) | |
Rural | 187 (45.4%) | 173 (62.1%) | 14 (10.5%) | |
| | |||
No formal education | 142 (34.5%) | 123 (44.1%) | 19 (14.3%) | |
Primary | 118 (28.6%) | 54 (19.3%) | 64 (48.2%) | |
Secondary | 83 (20.1%) | 50 (17.9%) | 33 (24.8%) | |
University | 69 (16.7%) | 34 (12.3%) | 35 (26.3%) | |
| 0.229 | |||
Mean (SD) | 28.4 (5.4) | 29.8 (5.2) | 26.9 (5.6) | |
| 0.431 | |||
Single | 17 (4.1%) | 9 (3.2%) | 8 (6%) | |
Married | 283 (69.8%) | 222 (79.5%) | 61 (45.9%) | |
Widowed | 97 (23.5%) | 36 (12.9%) | 61 (45.9%) | |
Divorced/separated | 15 (3.6%) | 12 (4.3%) | 3 (2.2%) | |
| | |||
<100 USD | 269 (65.3%) | 219 (78.5%) | 50 (37.6%) | |
100–150 USD | 83 (20.1%) | 55 (19.7%) | 28 (21.1%) | |
>150 USD | 60 (14.6%) | 5 (1.7%) | 55 (41.3%) | |
| 0.273 | |||
Self-employed | 60 (14.6%) | 40 (14.3%) | 20 (15.1%) | |
Government-employed | 107 (26%) | 70 (25.1%) | 37 (27.8%) | |
Unemployed | 245 (59.4%) | 169 (60.6%) | 76 (57.1%) | |
| 0.328 | |||
Orthodox | 354 (85.9%) | 274 (98.2%) | 80 (60.1%) | |
Muslim | 38 (9.2%) | 3 (1.1%) | 35 (26.3%) | |
Others | 20 (4.8%) | 2 (0.7%) | 18 (13.6%) | |
| 0.432 | |||
≤5 years | 115 (27.9%) | 32 (11.5%) | 83 (62.4%) | |
>5 years | 297 (72.1%) | 247 (88.5%) | 50 (37.6%) | |
| | |||
No | 168 (40.8%) | 83 (29.8%) | 85 (63.9%) | |
Yes | 244 (59.2%) | 196 (70.2%) | 48 (36.1%) | |
| | |||
No | 102 (24.5%) | 58 (20.8%) | 44 (32.3%) | |
Yes | 310 (75.5%) | 221 (79.2%) | 89 (66.9%) |
HTN: hypertension; CAM: complementary and alternative medicine.
The use of CAM was reported by 279 (67.8%) of respondents. The type of CAM modalities was classified as biological based therapies, manipulative and body based therapies, and mind/body intervention. Accordingly, the most common biological based CAM preparations reported by respondents were herbal based medicine (67.5%), honey (44.1%), animal products (34.8%), diet (33.7%), and natural products (vitamins and minerals) (56.3%). Other CAM modalities reported were manipulative and body based therapies (exercise, 50.9%), massage (26.5%), and relaxation (8.6%) as well as mind/body intervention like fasting (22.9%). The pattern and types of various CAM used by respondents are depicted in Table
Types of CAM utilized by respondents, GURH, Ethiopia, 2016 (
Type of CAM | Frequency (%) |
---|---|
| |
Herbal based medicine | 189 (67.5%) |
Honey | 123 (44.1%) |
Animal products | 97 (34.8%) |
Diet | 94 (33.7%) |
Natural products (vitamins and minerals) | 157 (56.3%) |
| |
Exercise | 159 (50.9%) |
Massage | 74 (26.5%) |
Relaxation | 24 (8.6%) |
| |
Fasting | 64 (22.9%) |
Prayers | 85 (30.5%) |
Tsebel (holy water used by orthodox Christians) | 97 (34.8%) |
Listening to music | 19 (6.7%) |
The prevalence and characteristics of CAM use are summarized in Table
Prevalence and characteristics of CAM use among respondents, GURH, Ethiopia, 2016 (
Variables | Frequency (%) |
---|---|
| |
No | 133 (32.2%) |
Yes | 279 (67.8%) |
| |
Complementary to modern medicine | 210 (75.3%) |
Alternative to modern medicine | 22 (7.9%) |
Both | 47 (16.8%) |
| |
Traditional herbalist | 105 (37.6%) |
Families and friends | 85 (30.5%) |
Patients used CAM | 55 (19.7%) |
Health care professionals | 13 (4.6%) |
Others | 21 (7.5%) |
| |
The tradition in resident area encourages CAM use | 50 (17.9%) |
Belief in advantages of CAM | 73 (26.2%) |
Accessibility (availability) | 45 (16.1%) |
For the treatment of other medical conditions | 20 (7.2%) |
Dissatisfaction with modern medicine | 77 (27.6%) |
Others | 14 (5.0%) |
| |
Additional burden | 21 (15.7%) |
Afraid of side effect | 53 (39.8%) |
The doctor did not recommend (prescribe) it | 29 (21.8%) |
Lack of belief in its effectiveness | 30 (22.7%) |
| |
No | 196 (70.2%) |
Yes | 83 (29.8%) |
| |
Fear of response of HCPs | 192 (68.8%) |
Not necessary | 23 (8.3%) |
Insufficient information of CAM | 64 (22.9%) |
| |
No | 223 (79.9%) |
Yes | 56 (20.1%) |
| |
Satisfied | 135 (48.4%) |
Average | 105 (37.6%) |
Dissatisfied | 39 (14%) |
HCPs: Health care professionals.
The determinants of CAM, obtained by using logistic regression analysis, are presented in Table
Predictors of CAM use among respondents using regression analysis, GURH, Ethiopia, 2016 (
Variables | CAM use | Logistic regression analysis | ||
---|---|---|---|---|
Yes | No | COR (95% CI) | AOR (95% CI) | |
| ||||
Urban | 106 | 119 | 1 | 1 |
Rural | 173 | 14 | 3.34 ( | 2.14 (1.162, 5.153) |
| ||||
Male | 115 | 52 | 2.45 ( | 2.23 (1.173, 6.142) |
Female | 164 | 81 | 1 | 1 |
| ||||
No formal education | 123 | 19 | 1 | 1 |
Primary | 54 | 64 | 1.698 (1.875–3.295) | 1.993 (0.404–3.224) |
Secondary | 50 | 33 | 1.1921 (1.025–2.171) | 2.141 (1.872–5.217) |
University | 34 | 35 | 3.124 (1.737–5.872) | 3.140 (1.374–5.245) |
| ||||
<100 | 219 | 50 | 3.179 (1.944–5.566) | 2.076 (1.322–7.566) |
100–150 | 55 | 28 | 2.139 (1.064–4.298) | 1.597 (1.142–5.422) |
>150 | 5 | 55 | 1 | 1 |
| ||||
No | 83 | 85 | 1 | 1 |
Yes | 196 | 48 | 4.593 (1.261–1.348) | 3.236 (1.171–5.113) |
| ||||
No | 58 | 44 | 1 | 1 |
Yes | 221 | 89 | 2.942 (1.603–6.552) | 2.673 (1.583–6.716) |
Currently, CAM therapies are being widely used around the globe by many of chronically ill patients including hypertension [
In our study, traditional herbalist was the most commonly cited source of recommendation about CAM followed by families and friends. In contrast, medical practitioners were the least information source for CAM use (4.6%). This result is also similar to the study done in Germany, where the most prominent sources of information for CAM choice were outside the medical scheme and included families, relatives, and friends (49%) [
As a limitation, the results found regarding CAM use may not be representative because the present study is conducted in only one referral hospital. A larger-scale and multicentered survey that includes more diverse participants is needed to provide more accurate findings.
In summary, this study revealed that CAM use is prevalent among hypertensive patients, herbal based medicine being the most commonly used. Health care providers’ role in orienting CAM use in hypertensive patients was negligible as patients relied mainly on traditional herbalist followed by family and friends for the choice of CAM and were less likely to disclose CAM use to health care practitioners. The patients’ higher magnitude of CAM use along with very low disclosure rate to their health care providers can have a marked potential to cause ineffective disease state management and adverse effects due to CAM use. Health care providers should be open to discuss the use of CAM with their patients as it will lead to better health outcome. With the increasing importance of CAM in modern health care, medical, and nursing education should include information about CAM practices.
Complementary and alternative medicine
Confidence interval
Gondar University Referral Hospital
Hypertension
Odds ratio
Statistical Package for the Social Sciences.
The authors declare there are no competing interests.
No financial support was gained to conduct this study.
The author acknowledges the support of the school of Pharmacy, University of Gondar, in facilitating the data collection process.