ATTITUDES TO AND USE OF TRADITIONAL MEDICINE IN THE TREATMENT AND MANAGEMENT OF MALARIA IN NIGERIA: CASE STUDY OF ANAMBRA STATE.
This study examines the rationale for the attitudes and uses of traditional medicine in the treatment and management of malaria in Nigeria using Anambra as a case study. The objectives of this paper are four fold: to determine the rationale for the continued usage of traditional medicine in the treatment and management of malaria in Nigeria; to ascertain the gender that uses traditional measures more than the other in the management of malaria; to determine the segment of the population (whether rural or urban) that uses traditional medicine more than the other and to ascertain the potential consequences of the continued use of traditional measures in the treatment of malaria instead of ACTs. A survey method was used and data was analysed using simple frequencies, tables, charts and percentages. The Chi-square test statistics was used to test the postulated hypothesis. Findings from the study revealed among others that huge cultural support enjoyed by traditional medicine, knowledge acquired by Nigerians in the preparation of herbal remedies, the belief by Nigerians in the trustworthiness, accessibility, affordability and quick relief from malaria after the intake of traditional medicines have all contributed to the rationale for its continued use in Nigeria and that rural dwellers consume traditional medicines more than urban dwellers. However, contrary to expectations, the study discovered that more males use traditional medicines more than the females and rural dwellers. Finally, the study revealed that continued use of herbal remedies without proper regulatory framework could lead to multiple cases of adverse drug reactions and failure to cure malaria among others. The study, therefore, recommends, among others, that there is a need for Government to create and sponsor more research schemes that aim toward the optimal utilization of herbal remedies as alternatives to conventional medicines; There is also a need for the Government to massively sensitize the people on the dangers of the indiscriminate use of herbal remedies; There is also a strong need for the Government to strengthen its regulatory oversight on the operations of the herbal medicine practitioners
1.0 Background of Study
Worldwide, malaria kills more than one million people each year. The vast majority of these fatalities occur in Sub- Saharan Africa (SSA), and most of the victims are children less than five years of age (Snow et al 1999; WHO, 2002). In the context of overall childhood mortality, a synthesis of recent studies and reviews suggests that malaria causes at least 20% of all deaths in children under five in Africa (WHO/UNICEF, 2003).
Malaria is the most important parasitic disease in the tropic and remains of highest public health importance. About 90% of all malaria deaths in the world today occur in Africa, south of the Sahara. An estimated one million people in Africa die from Malaria each year and most of these are children under five years old (WHO, 2002).
According to the FMoH, (2003), malaria transmission in Nigeria is holoendemic and more than 90% of the population live in areas with stable malaria. It is one of the leading causes of childhood morbidity and mortality with a prevalence rate of 919/100,000 and is responsible for 25% and 30% of infant mortality and childhood mortality respectively. Malaria is responsible for over 300,000 deaths in children annually most of these deaths result from severe and complicated malaria especially in rural areas (Salako, 1994). Also, about 95-99% of the adult population in Nigeria carries the malaria parasite with less than 30% of this number coming down with illness (Coker et al., 2011).
Malaria is said to be more prevalent in rural areas due to favourable environmental conditions for parasite transmission (McMichael et al., 1996). However, there is significant risk of infection in urban areas. Uncontrolled urbanization leads to an increased number of slums simulating a rural environment and results in increased malaria transmission in some third world urban areas especially Nigeria.
The presence of swamps, gutters and thick vegetation in the cities enhances the breeding of vectors. Agricultural practices around dwellings also increase the risk of mosquito bites. This is because of agricultural practices such as the use of irrigation during rice cultivation, the use of ponds for fish farming and the storage of water in tanks for livestock that provide suitable breeding grounds for anthropophylic mosquitoes. The most common anthropophylic mosquito in Nigeria which causes much of the morbidity and mortality associated with malaria is the anopheles mosquito. Farmers are therefore at high risk of malaria- a disease which seriously impacts on agricultural productivity.
In Nigeria, malaria risks exist throughout the year in the entire country including urban areas (Anumudu et al., 2006). The problems of rural – urban migration, the persistence of poverty in the population, environmental degradation and seemingly intractable problems of providing decent housing, potable water, sanitation and transportation are common in many Nigerian cities and they cumulatively encourage the risks of malaria infection and parasite resistance through the use of inconsistent malaria treatment options.
It is estimated that 92% of the childhood deaths occur at home (Greenwood et al., 1987), mothers and other caretakers are therefore of foremost importance in recognizing mild or severe malaria diseases and seeking treatment for their wards. Most caretakers begin treatment at home with anti malarial drugs and antipyretics purchased over the counter from drug sellers without prescription and usually with inappropriate doses of chloroquine (Derming, 1989; Igun, 1987; Lipowsy, 1992), which often results in poor quality of care and fosters the development of drug resistance (Bermejo, 1993). The ultimate resort after home treatment has failed is the formal health sector which occurs when caregivers take their wards to hospital or clinics to see a physician after futile home management efforts.
However, it is also evident that many caregivers resort to the use of various traditional medicines or herbal remedies in the management of malaria. According to the World Health Organization (WHO), herbal medicines are the first line of treatment for 60% of children with high fever due to malaria in Nigeria, Ghana, Mali and Zambia (WHO, 2003).
Herbal complimentary and Alternative Medicine (CAM) therapies are frequently obtained from traditional herbal medicine practitioners (Uzochukwu et al. 2006; Ajaiyeoba et al., 2004). Majority of Nigerians are known to use and consult traditional medicine for healthcare, social, spiritual and psychological benefits because of poverty and disillusionment with conventional orthodox medical care.
According to the National Agency for Food, Drug Administration and Control (NAFDAC), among the multitude of herbal medicines in circulation in Nigeria, only about twenty have been registered by the National Agency for Food and Drug Agency and Control (NAFDAC), and most of those are imported. Only advertisements with NAFDAC endorsement are allowed in print and electronic media, yet aggressive strategies such as radio, television and motorcade announcements have been adopted by many unregistered CAM practitioners to market their products, which are freely available for purchase in the open market (Obbi et al., 2006).
The importance of traditional medicine in Nigeria healthcare has been recognized by the national government. In December, 2006 they set up a high profile committee to develop, promote and commercialize traditional medicine products.
Prompt and effective treatment of all children with malaria is a critical element of malaria control. People who become ill with the disease need prompt and effective treatment to prevent the development to severe manifestations and death (WHO 2003). Early treatment depends upon prompt recognition of symptoms and signs of malaria in the household, mainly by women. Early treatment also requires that appropriate health services and medication are accessible and utilized (Tanner et al., 1998).
The success of this strategy depends on the behaviour of patients and caretakers of young children and it has been documented that treatment seeking behaviour is related to cultural beliefs about the cause and cure of illness (Bledsoe et al., 1985). In some cases, illnesses are seen as amenable to treatment by modern practitioners, while others are considered best treated by traditional healers (Press, 1980). Illness’ ideas and behaviour may enhance or interfere with the effectiveness of control measures (Klein et al, 1995). An understanding of communities’ attitudes to and rationale for the usage of traditional measures in the treatment and management of malaria is therefore crucial to the success of a specific control measure of malaria.
Globally, millions of deaths attributable to malaria are still being recorded. The disease constitutes a huge epidemiologic burden in Africa and continues to cripple the economic development in the region. In Nigeria, according to the National Malaria Control Programme, the disease is responsible for 60% outpatient visits to health facilities, 30% childhood deaths, 25% of death in children under one year and 11% maternal deaths. The financial loss due to malaria annually is estimated to be about 132 billion naira (N132bn) in form of treatment costs, prevention, loss of man-hours (Pharmanews, 2003) puts it, about 46% of an average household’s income is expended on malaria treatment; hence the disease is a major cause of poverty in Nigeria.
To check this worrisome trend, in April 2000, the international community and the leaders of African nations met at a summit in Abuja, Nigeria and pledged to reduce to half the malaria mortality amongst Africa’s people by 2010 by implementing the proven, effective strategies and actions of the Roll Back Malaria (RBM) initiative (WHO, 2000).
One of the key strategies endorsed by the Abuja accord was to take actions to ensure that by 2005 at least 60% of those suffering from malaria have prompt access to appropriate and affordable treatment and are able to initiate treatment within 24 hours of the onset of symptoms. These targets were further renewed to ensure that by 2010, 80% of vulnerable groups will benefit from preventive measures; 80% of pregnant women will have access to at least two doses in Intermittent Prevention Treatment (IPT).
To achieve this, the Nigerian Government changed its malaria drug policy in 2005 from chloroquine to Artemesinin-based combination Therapies (ACTs) and encouragement of intermittent prevention (IPT) of malaria in pregnancy. This change in drug policy was due to the prevalence of plasmodium falciparum resistance to chloroquine and sulphadoxine-pyrimethamine (SP) for treatment of malaria in pregnancy.
However, despite these efforts aimed at rolling back the spread of malaria, there is considerable evidence to indicate that herbal medicines are the first line treatment for 60% of children with high fever due to malaria in Nigeria (WHO, 2003).
According to Fakeye et al. (2009), this development is worrisome, for many reasons which include the fact that knowledge of potential side effects of many herbal medicines is limited; some herbal products may be teratogenic in human and animal model; data on the extent of use of herbal medicines is scanty especially in sub-Sahara Africa where the legislation for distribution and purchase of herbal medicines is not as stringent as it is for conventional medicines. In addition to these issues, Aluko (2005) asserts that there has been no standardized measurement in the application of herbal drugs as the same cup is used in administering drugs to all and sundry which potentially leads to kidney problems, among others. There, therefore, seems to be a gap between the applicability of the malaria drug policy of the Government and majority of the citizens who prefer traditional treatments in the management of malaria. This study is therefore interested in investigating the attitudes to and uses of traditional medicine in the treatment and management of malaria in Nigeria, using Anambra State as a case study.
Objectives of the Study
The objectives of this study therefore, are to:
- Determine the rationale for the continued usage of traditional methods in the treatment and management of malaria in Nigeria;
- To ascertain the gender that uses traditional measures in treatment of malaria than the other;
- To determine what segment of the population (whether rural or urban) uses traditional medicine more than the other;
- To ascertain the potential consequences of the continued use of traditional measures in the treatment of malaria instead of
The research questions to be used in this study include;
- What are the rationale for the continued use of traditional measures in the treatment and management of malaria instead of the ACTs?
- What gender uses traditional medicine in the treatment of malaria more than the other?
- What segment of the population (whether rural or urban) uses traditional measures in treatment of malaria more than the
- What are the potential consequences of the continued use of traditional medicine in the treatment of malaria in Nigeria?
The following hypothesis were postulated to guide the enquiry;
- Ho: There is no rationale for the continued use of traditional measures in the treatment and management of malaria in Anambra
- Ho: Rural dwellers use traditional measures in the treatment of malaria than urban
- There is no potential consequence for the continued use of traditional medicine in the treatment of malaria
Significance of Study
This study is significant in many respects.
- Findings of this study will add to the existing body of knowledge on the resilience of traditional medicine in the management of
- It will enable the Government and policymakers to appreciate the role of behavioural patterns in determining health seeking behaviours thereby influencing policy making on health
- Knowledge of the users, their characteristics and attitudes to traditional medicine use will be of immense benefit to the Government in designing and implementing policies relating to the prevention and treatment of malaria in
- The study will also improve the understanding of the Government on the socio economic factors that influence the use of traditional
- Using the findings of the study, inferences will be made on the possible consequences of the continued use of traditional medicine in the treatment of malaria in Nigeria. This will also be of immense benefit to policymakers and health care
- It will also be beneficial to the consumers and providers of traditional medicine in appreciating the strengths and weaknesses of both traditional and conventional medicines in the treatment and management of malaria in
Scope of Study
The study focuses on the use of and attitudes to traditional medicine in the treatment and management of malaria in Nigeria. Anambra State was chosen as a case study so as to make it more focused. One community in one Local Government Area will be chosen from each of the three Senatorial Zones in the State. The study will thus not cover the epidemiology, causes or predisposing factors of persons to malaria.
Anambra is a state in south-eastern Nigeria. Its name is an anglicized version of the original ‘Oma Mbala’, the name of the river now known as Anambra which the state is named after. The Capital and the Seat of Government is Awka. Onitsha and Nnewi are the biggest commercial and industrial cities,respectively. Anambra State is comprised of 21 Local Government Areas, 3 Senatorial zones and 8 Federal Constituences.
The state’s theme is “Light Of The Nation”. Boundaries are formed by Delta State to the west, Imo State and Rivers State to the south, Enugu State to the east and Kogi State to the north. The origin of the name is derived from the Anambra River (Omambala) which is a tributary of the famous River Niger.
The indigenous ethnic group in Anambra state are the Igbo (98% of population) and a small population of Igala (2% of the population) who live in the North western part of the state.
Anambra is the eight most populated states in the Federal Republic of Nigeria and the second most densely populated state in Nigeria after Lagos State. The stretch of more than 45 km between Oba and Amorka contains a cluster of numerous thickly populated villages and small towns giving the area an estimated density of 1,500–2,000 persons living within every square kilometer of the area.
Anambra is rich in natural gas, crude oil, bauxite, ceramic and has an almost 100 percent arable soil. Furthermore, Anambra state is a state that has many other resources in terms of agro-based activities like fishery and farming, as well as land cultivated for pasturing and animal husbandry. Anambra State has the lowest poverty rate in Nigeria.
Three Local Governments within the three senatorial zones of Anambra State was selected for this study. They include Awka South LGA in Anambra Central Senatorial Zone, Orumba North LGA in Anambra North Senatorial Zone and Anambra East LGA in Anambra North Senatorial zone.
Anambra East and Orumba North LGAs are regarded as rural LGAs while Awka South LGA was regarded as an urban LGA. Within these three Local Governments, a community each was chosen randomly from the Local Governments.
The rural LGAs mostly have Agriculture as the predominant occupation of the people because of the presence of the Anambra river basin. There are no major industries apart from bakery and hospitality industries that exist in some communities. The LGAs have a rich array of cultures and speak Igbo as their predominant language. They are highly patrilineal as the man is regarded as the head of the household.
The Urban LGA represented by Awka South LGA is predominantly commercial and industrial in nature. The indigenes are mostly engaged in small scale businesses in the form of industries or trading outlets. There are also big scale industries, companies and hotels in this LGA. Due to the presence of those companies, there are lots of improved infrastructural amenities and Government presence in this LGA.
In addition, this Local Government is where the Capital of the State is located. It therefore has a full complement of Government presence as it hosts most Government structures and officials.
The selected communities include; Awka in Awka South LGA; Ajalli in Orumba North LGA and Otuocha in Anambra East LGA.