Pharmacoepidemiology of herbal drugs in Addis Ababa and Butajira, Central Ethiopia. Gedif Fenta T, Hahn JH

I. Introduction Ethiopia  Population - over 61m, - 46% under 15 and 4% over 65 years of age -85% live in rural areas  Economy: agriculture  Half of GDP  43% Exports  85% total employment BJ AA

Modern Health Care in Ethiopia  MHC started  Ministry of Health established in 1949  Coverage is 51% Currently the Health Care System is organized as a four tire referral system.  Specialized Hospitals  Regional Hospitals  District Hospitals  Primary Health Care Units

Health Problems & Indicators  Communicable Diseases  Indicators

II. The objectives of the Study  To determine the extent to which people use herbal drugs either in self care basis or prescribed by the healers  To describe how healers perceive about the causes and symptoms of malaria.  Identify the commonly used plants in the treatment of malaria.

III. Methodology  Study Design : - Sources of information: Herbalists & Mothers. -In-depth interview, observations. -Cross-sectional HH survey: structured questionnaire.  Sampling & Data Collection : - Convenient sampling technique- to identify healers. -Systematic random sampling technique using HH as the final sampling units.

Methodology Contd.  Description of study areas -Addis Ababa -Butajira  Data entry and analysis -EPI-Info Qualitative responses manually

IV. Results: HH Survey  Illness centered approach.  1197 HHS (600 in AA in BJ).  6377 ( ) persons were living in the hhs  Prevalence of perceived illnesses were 8% in AA and 4% in BJ  94% in AA and 89% in BJ took action for their illnesses.  Prevalence of herbal drug use was 29.5% (37 and 15.4%)

Results Continued Use of herbal drugs in self-care 35.4% in AA & 12.4% in BJ- self care with herbs More females practiced self care with herbs than males Top commonly used herbs in self care:- Zingiber officinale, Ocimum lamifolium, Allium sativum, Ruta chalepensis & Linum usitatissum. 12.9%(11.3 in AA and 14.6% in BJ) of the HHs reported hoarding Herbal drugs.

Results: In depth interview of healers Demographic characteristics % were males, 72.2% with age > 45 years -Half of the healers had no any form of education -17 had church/adult education -17.3% had more than 15 years of education Mode of Service Delivery: -86.4% practiced on par time basis and full time practice was observed in AA only -Average no. of patient seen per week was % did not have fixed payment rate for their services Sources of Herbalistic Knowledge :

Herbalists perceived causes and symptoms of malaria:  Perceived causes:  Perceived symptoms: Top five plants used for treating malaria: -Carica papaja ( Caricaceae) -Adhatoda schimperiana (Acanthaceae) -Vernonia amygdalina (Compositeae) -Artimisia rehan (Compositeae) -Croton macrostachys (Euphorbiaceae)

V. Conclusion and Recommendations  Herbal remedies still play a pivotal role in the treatment of large segment of both rural and urban population of Ethiopia either in self- care basis or prescribed by traditional practitioners.  To promote researches on plants used traditionally, a prior recording of ethno pharmacological knowledge is important. In light of this, the results of the present study will serve as a basis of information for future projects to evaluate the potential contribution of herbalists and their remedies in improving the Ethiopian health care delivery system.

Summary: - Prevalence of herbal drug use was 29.5% % in AA & 12.5% in Butajira used herbal drugs for self care -Inaccessibility of MM and perceived efficacy were major reasons for choosing HM as health care option. -Herbal drug hoarding was reported by 12.9% of the HHs. - Most Herbalists practice TM on par time basis - Patient load 7 per week -Herbalists did not largely have fixed payment rate -16 plants have been reported to be in use to treat malaria; and used singly or constituents of composite remedies.

Pharmacoepidemiological studies of herbal medicine: Methodological Challenges  TMPs in developing countries consider their knowledge as an esoteric and hesitant to pass to any one except their off springs. As the result, it is difficult to get sufficient number of healers who are willing to participate in ethno botanical studies.  In most cases data collectors are with some modern education, and hence informants tend to refrain to give answers which they think may not be acceptable by the interviewers, sort of social desirability bias.  Incomparability of survey results due to: differences in recall periods, seasons in which the study is conducted and discrepant definition of herbs.  Recall bias. Acknowledgment : This study was funded by the German Catholic Academic Foreign Service (KAAD).