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

3. I. Introduction EthiopiaAA
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

4. 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

5. Health Problems & Indicators
Communicable Diseases
Indicators

6. 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.

7. III. Methodology Study Design: Sampling & Data Collection:
- 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.

8. Methodology Contd. Description of study areas Addis Ababa Butajira
Data entry and analysis
EPI-Info 6.04
Qualitative responses manually

9. 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%)

10. Use of herbal drugs in self-care
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.

11. 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 7.
59% did not have fixed payment rate for their services
Sources of Herbalistic Knowledge:

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

13. 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.

14. Summary: -Prevalence of herbal drug use was 29.5%.
-35.4% 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.

15. 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).