CHAPTER 1: INTRODUCTION
1.1 Background of the Study
to WHO, (2012), herbal medicine can be defined as medicine that is made out of
plants and is common in many societies in the world including Kenya. When the
herbal medicine is used in ways other than traditional, it becomes complementary and alternative
medicine (CAM). Other names for CAM are alternative medicine or nonconventional
(Wootton, 2015). Therefore, CAM is the opposite of conventional or what we
commonly call western medicine (Wieland et al, 2011).
and alternative medicine cannot be
ignored considering it is vital for health care. It is estimated that
approximately 80% of the world’s population rely on CAM, in one way or the other, for health care. Also, according
to Eisenberg et al (2012), an estimated 80% of the people in
developing countries and 80% of Africans rely on CAM to
meet their primary health care needs. The annual global market CAM in year 2010 was over US$60 billion and is growing
steadily at a rate of fifteen to twenty-five percent (WHO, 2013).
Many countries in the world including some Asian countries
like China, India and Sri Lanka have realized much success in developing their CAM sector. In these countries, the medicines are very
developed, have good documents, and used not only at the family, community, and
primary health care levels, but even in hospitals where they offer secondary
and tertiary care (Barrett, 2013). Also,
herbal practices in these countries have better curriculum and are systematic and
comprehensive (Verma, and Singh, 2011;
Long before the advent of conventional medicine in
Africa, traditional medicines, including the use of herbs was the main remedy
for nearly all ailments (Verma, and
Singh, 2011). Today, notwithstanding the increasing use of modern
medicine in countries like Nigeria and Ghana, CAM use
is also hugely practiced and many continue to rely on it for their health care
particularly in psychiatric care.
Kenya, about 70% to 75% of the population rely on CAM for their primary
health care. Also, herbal medicine is the first line of treatment for more than
60% of children with high fever resulting from malaria (WHO, 2013). There is,
on average, one traditional medical practitioner for every 400 people, compared
to one doctor to 12,000 people in Kenya (WHO, 2013). It has also been noted
that CAM is also used to treat people with psychiatric care.
across the world of patients consulting providers of CAM
in low- and middle-income countries
have reported high but varying rates of psychiatric disorders, depending on the
methods employed and the disorders examined. Saeed et al (2010), did a study in
Pakistan and found 61% prevalence of diagnoses using a Psychiatric Assessment
Schedule. The most common psychiatric condition was major depressive disorder
at 24%, then anxiety disorder at 15% and finally psychosis only at 4%. Abbo et
al (2011), mentioned that Uganda after doing a study on patients who had used
CA, that the patients at 60.2% had psychiatric disorders based on the DSM-IV
standard. Ngoma et al (2013) did for Tanzania and found that 49% of the
patients who used CAM had psychiatric disorders mainly depression and anxiety.
Mbwayo et al (2013), did theirs in Kenya and noted that overall 64.2% of those
who used CAM had psychiatric disorders with a huge percentage having
depression, anxiety and Schizophrenia. These
significant figures show that studying about the prevalence of CAM use among
psychiatric patients is important and necessary.
various researchers have found that CAM is real, very accessible, cheap,
culturally adequate, and is consistently being argued as an easily accessible
health care system that can aid and complement government’s efforts at ensuring
quality and equitable health care. In some rural communities, CAM is the only
form of health care that is available, affordable and accessible (Darko, 2012). Thus, the study will
seek to investigate the prevalence
of CAM use among psychiatric patients in Kabarnet Sub County considering the
lack of similar studies in the area.
1.2 Statement of the problem
Health Organization acknowledges that CAM has become a necessary, readily
available and useful way to treat many diseases. However, while the global market of CAM products is big and quickly
growing, the potential of this sub-sector remains un-tapped in Kenya and the
region, despite being well endowed in cultural and natural resources. Further,
the absence of a supportive policy environment is key among the impending
factors (National Council for
Population and Development, 2015). In spite of the fact that many
medical practitioners are unaware of the CAM quality, many patients still seem
to be willing to use CAM to sort out their health problems. There is thus a
need to look at the prevalence of CAM use to treat psychiatric disorders among
patients at Kabarnet Sub County hospitals.
study area for the research is Kabarnet
Sub County, Baringo County. The Sub county is chosen because of
its peculiar challenges in health care delivery which include lack of
hospitals/clinics, poor access to conventional health care, and inadequate
healthcare professionals, inadequate modern diagnostic and surgical equipment.
In addition, there is no documented data on the use of CAM among psychiatric
disorders. Further, given the limited resources and time, focusing on all the
communities in the county would be practically impossible.
1.3 Research Objectives
1.3.1 Main Objectives
establish the prevalence of use of complementary and alternative medicine among
psychiatric patients at Kabarnet Sub County Hospitals, Baringo County
1.3.2 Specific Objectives
To establish the
rate of use of complementary and alternative medicine among psychiatric
patients at Kabarnet Sub County Hospitals
To determine the
demographic characteristics of patients using complementary and alternative
medicine among psychiatric patients at Kabarnet Sub County Hospitals
To establish the types of complementary
and alternative medicines used by psychiatric patients at Kabarnet sub-county
To assess the extent
to which complementary and alternative medicine used concomitantly with
The independent variables in the study will be the age and gender of
psychiatric patients; income, education level and religion of psychiatric
patients; length of illness of the psychiatric patients, conditions for which
CAM products were used for.
The dependent variable will be CAM use among psychiatric patients. This will
be measured using the frequency of CAM use, occasions upon which the use
becomes relevant and the level of use.
The outcome variable will be the effects of CAM use on patients and will
include the tests after CAM use that show health improvements or alterations or
no change at all.
Rationale for the Study
The study will be beneficial first to patients with
psychiatric disorders with information about the available CAM in use to treat
psychiatric disorders in Kenya and how they can interact with what drugs have
been known to work. Secondly, the study will help the Kabarnet sub-county
Hospitals with information on complementary and alternative medicines for
psychiatric disorders which will then help them work on an inclusion and
complimentary policy that will help manage the process of treatment in line
with the new WHO policy. Thirdly, the study will be helpful to the Ministry of
health either initiate or revise their policies touching on complementary and
alternative medicines for psychiatric disorders. Lastly, the study will be
useful to the nursing education to first get knowledge on complementary and
alternative medicines for psychiatric disorders and secondly further studies in
CHAPTER 2: LITERATURE REVIEW
chapter will look at the prevalence of CAM to treat psychiatric Disorder the
demographics of CAM users and some of the notable examples of CAM in
2.2 Prevalence of CAM to treat Psychiatric
and herbal medicine has taken the new name, complementary and alternative
medicine (CAM). CAM refers to those healing and diagnostic disciplines that
exist largely outside the institutions where orthodox or conventional health
care is provided (Shaikh and Hatcher,
The relationship between user
satisfaction with conventional medicine and prevalence of use of CAM is subtle
and complex. Large epidemiological studies in Western countries show that CAM
users are no less satisfied with conventional medicine than non-CAM-users
(Eisenberg et al, 2011; Saeed et al, 2010). That is, using CAM is not simply
due to dissatisfaction with conventional treatment. Repeatedly, CAM users
report that using both forms of care together is more useful than either alone
(Eisenberg et al, 2011; Darko, 2012). However, CAM users do complain about the
quality of the doctor-patient relationship during the brief consultations
typical of conventional medicine (Heiligers et al, 2010). In addition to more
satisfying consultations, the philosophies behind CAM have a persuasive appeal
which users find compelling.
contrast, conventional medicine is described by CAM users as disjointed and
impersonal, and ultimately disempowering (Barrett, 2014). Whereas conventional
doctors may be more interested in objective improvements – or changes in
psychopathology, perhaps even measured on a rating scale – CAM practitioners
acknowledge and take seriously all subjective changes, thus validating the
patient and their experience (Zollman and Vickers, 2011). While psychiatrists
acknowledge the importance of spirituality and religion, and are more willing
than other physicians to talk about them with patients (Curling et al, 2011),
they are unlikely to supply a worldview which is as appealing and satisfying as
the philosophies motivating CAM use.
et al (2011) mentioned that the treatment of psychiatric disorders in low- and
middle- income countries (LMIC) is poor and that there is need to consider
urgent delivery of proper health services to the people. It has been found that
the epidemiological and health services offered in 58 countries that fall in
the LMIC have poor health services (Heiligers et al, 2010). It showed that the
number of health personnel like doctors and nurses were very low at less than
using CAM is becoming a very attractive way to ensure that health services are
given to communities that need it (Jilik, 2013). CAM is quickly being
incorporated into the main health systems and are used to help build up the
conventional medicines particularly on patients in rural areas where CAM is
2.3 Demographics of CAM users and
published work show that CAM as used among male psychiatric patients in Africa range
from 8% to 15% (Jensen, 2011).
Unfortunately, most of these studies involved males and females who may not be
reflective of the general population of psychiatric patients in Africa. Many of
the studies were conducted in countries other than Kenya, where attitudes
toward unconventional therapies may be different based on gender hence the need
for the present study. Additionally, most studies measure CAM use in males and
females who have chronic conditions or who were sampled at health care
facilities (Jensen, 2011).
Further, according to Otieno (2011), herbal medicine
is more easily accessible to the female rural populace, who constitute a
greater proportion of the total population of the country, especially in the
northern and eastern regions of Kenya where modern medical facilities are
barely adequate. According to Sawyer et al (2012), access to essential
medicines is severely restricted by lack of resources and poverty and the study
seemed to indicate that females used CAM more than females. However, the study
was generalized and did not look at the same demographics among psychiatric
patients as this study will do.
although many studies identified the increasing prevalence of CAM use
throughout the world, only a few reported on how patients perceived the
efficacy of this healthcare modality in specific diseases and what demographics
dominate the use of CAM for psychiatric disorders (Clement et al, 2012).
According to Clement et al, (2012) the major factor contributing to the
increasing popularity of CAM in developed countries and their sustained use in
developing countries is the perception that herbal remedies are efficacious,
and in some cases more so than allopathic medicines.
CAMS Used Concomitant to Conventional Drugs
Clement et al (2012) discovered that 86.6%
believed that herbal medicine were equally or more efficacious than
orthodox/conventional medicines for specific ailments and diseases. According
to Mensah, the potency and effectiveness of CAM have
been proven through research. CAM therapies have
shown remarkable success in healing acute as well as chronic diseases (Shaikh and Hatcher, 2015). Buor
(2011), for instance discovered that there is a kind of psychological security
in the medical approaches of the herbal medicine man which is able to relieve a
patient of strong psychic pressure.
CAM medicine provides more effective treatments to certain
health problems such as boils, tuberculosis, stroke, arthritis, epilepsy,
asthma, infertility, hernia, hypertension, diabetes, malaria, depression,
mental illness and disease prevention as well as for the ageing population,
where modern medicine has either failed to produce equally good results or has
simply ignored the need for systematic attention and research (Darko, 2012).
Also, in cases of sexually transmitted diseases, typhoid fever, yellow fever,
menstrual and fertility problems, herbal medicines are considered effective (Shaikh and Hatcher, 2015). Herbal
medicines have also shown a wide range of efficacy in the treatment of various
diseases such as breast, cervical and prostate cancers, skin infections,
jaundice, scabies, eczema, typhoid, erectile dysfunctions, snakebite, gastric
ulcer, cardiovascular disorders and managing HIV/AIDS (Verma and Singh, 2011).
Significantly, it is evident that some CAM have been recognized internationally for the treatment
of psychiatric diseases (IUPAC, 2011).
Herbs remain the foundation for a large amount of commercial medications used
today for the treatment of psychiatric problems (IUPAC, 2011). For instance, Artemisinin which is extracted from
the Chinese herbal wormwood plant, Artemisia annua’ is the basis of most
effective psychiatric drugs the world has ever known (WHO, 2013). Western
researchers learned of the plant, for the first time, in the 1980s, but had
been used in China for almost 2000 years to treat mental problems. However, due
to skepticism surrounding the drug, it was only until 2004 that WHO approved of
it for use internationally (IUPAC, 2011).
Artemisinin is also effective in combating other diseases and has demonstrated
significant potential for the treatment of cancer and schistosomiasis (IUPAC, 2011; Shaikh and Hatcher, 2015).
the Neem tree (Azadirachta indica), which is indigenous to West Africa,
is effective in the treatment of several diseases. The bark of the Neem tree is
perceived to be effective in the management of schizophrenia (Davies, 2014). In addition to this,
Davies, accounts that East Indians use it to make a strong soap that cures skin
diseases. Africans also chew it to clean their teeth and it works as well as
brushing with toothpaste, and supposed to be healthier for the gums. More so,
the plant Curcuma Longa is perceived to be effective in the treatment of
many mental disease (Davies,
CHAPTER 3: METHODOLOGY
3.1 Research Design
A cross-sectional study using descriptive survey
design will be undertaken on patients with psychiatric disorder in Kabaranet
Sub County hospitals. The phenomenon investigated will be the prevalence of use
of CAM among psychiatric patients. In a cross-sectional study no attempt is
made to change behavior or conditions34. Things are measured as is.
The study design also enables one to obtain information about the situation at
hand at one specific time. It shows the current situation of the condition
under study in the desired population.
3.2 Study variable
The independent variables in the study will be the age
and gender of psychiatric patients; income, education level and religion of
psychiatric patients; length of illness of the psychiatric patients, conditions
for which CAM products were used for. The dependent variable will be CAM use
among psychiatric patients.
3.3 study area
The study will be carried out at Kabarnet Sub County
located in Baringo County covering an area of approximately 136.8 square
kilometers. It borders West Pokot county to the north and northeast, Nakuru
County to the west, Uasin Gishu County to the south and southwest.
It is a government health facility located in Kaprogonya sub –location ,
Kapropita Lacation ,Kabarnet division
,Baringo central constituency in
Baringo County.The hospital has a bed
capacity of 160 beds
in general and psychiatric and 11 cots . There are 117 medical personnel
Hospital staff including 83 Nurses and clinical officers, 18 lab technicians
and 10 Doctors.
3.4 Study population
The study population in this study will be all
psychiatric patients in Kabarnet Sub County hospitals during the period of
3.4.1 Inclusion Criteria
Psychiatric patients in Kabarnet Sub County hospital
for at least 2months. Healthcare providers, relatives of psychiatry patients whose
minimental exam is below 23 of Kabarnet Sub County hospital will be included in
the study. All those persons above who will consent to participate in the
3.4.2 Exclusion Criteria
Psychiatric patients in Kabarnet Sub County hospitals who
will not consent to participate in the study will be excluded.
3.5 Sample size determination
Sample size will be 30 psychiatry patients out of the
100 target population will be selected. 30 psychiatric patient’s represents 30%
of the target population a percentage that (Kothari, 2004) say is acceptable.
3.6 Sampling Technique
Simple random sampling technique will be used to select 30 psychiatric
patients out of the 100 target population will be selected. 30 psychiatric
patients represents 30% of the target population. Simple random sampling is
useful to get a representative number and reduce bias.
3.7 Data collection
The researchers who are medically trained will be used
to get the required data from the patients.
All the respondents will sign the consent form
indicating their willingness to participate in this study. They will be assured
of confidentiality, the purpose of study, the potential benefits and possible
risks associated with participation explained to them. Two questionnaires will
be used, including a questionnaire for psychiatric patients and healthcare
professionals or the relative to the patient. A standardized questionnaire for
conventional healthcare practitioners will be self- administered. This
questionnaire will be used to determine concomitant use of CAM and conventional
medicines, report adverse effects of CAM use, use of CAM by conventional health
care practitioners and their perception concerning CAM.
Pre-testing of research tools will be conducted in Moi
Teaching and Referral Hospital. This will be done on 3 (10%) Psychiatric
patients. This will be done to ensure validity and reliability of research
instruments. Corrections will be made where necessary in order to make sure the
questions asked provide the required information.
3.8 Data Analysis and Presentation
Statistical analysis is essential for making sense of
quantitative information. Statistics are either descriptive or inferential.
Descriptive statistics, generated in the course of data analysis in the present
study, will be used to describe and synthesize the data. The software program
Statistical Package for the Social Sciences (SPSS) will be employed for data
analysis. Frequencies for each variable will be generated and organized into
tables using SPSS. A chi-square test will be used to determine the association
between CAM use and each of the independent variables related to demographic
characteristics; a P value < 0.05 will be considered to be statistically significant. 3.9 Ethical Consideration All permission will be sought form Baraton University ethics committee, the County and Sub County offices and the patients and hospitals themselves.