Abstract
Background
The use of traditional eye medication is still practised in some communities in Nigeria.
Aim
To assess the determinants of the use of traditional eye medication (TEM) by adults in Ekiadolor community.
Method
A descriptive cross-sectional study on the determinants of the use of traditional eye medication among adults was done between the months of September and November 2011 in Ekiadolor community in Edo state, Nigeria.
Results
Out of the 430 participants in this study, 57.2% were females and 42.8% males. Majority of the respondents (92.1%) knew about TEM. The prevalence of the use of TEM was 48.7%. Affordability (21.8%) was the main reason for the use of TEM. The male gender, persons of low socio economic class and people that lacked formal education were more likely to use TEM (p=0.001)
Conclusion
The determinants of the use of traditional eye medication in this community are affordability, low socio economic status and lack of formal education. Formal education is of great importance, as this will go a long way in addressing the issues directly relating to the use of traditional eye medication in our communities.
Keywords: Nigeria, Traditional eye medication, Semi-urban community, Low socio-economic class, Determinants
Introduction
Traditional medicine has been practised from time immemorial1. The traditional healers are highly recognized in the community and well recommended among the people. They are usually seen as “all knowing” in the community as they often claim to act as agents between the physical and spiritual worlds and so the people have great faith in them2.
In the last two decades, there has been a significant rise in the use of TEM worldwide, despite the fact that there is no sound scientific evidence to justify the use of TEM3,4. Approximately 80% of the population from the developing as well as the developed countries use traditional services for either diagnosis, treatment, prevention of diseases or maintenance of good health5.
Psychological, social, cultural and economic factors generally influence how people use health services and eye care services are no exception. Prajna et al6 also included logistics as one of the determinants of the use of TEM. Foster and Johnson7 found in their study that traditional healers communicate well at a psychological level with the patient. Socio – cultural beliefs in evil spirits and witchcraft may lead people to think that the best approach is with spiritual rather than orthodox medicine8,9. Prescribed eye medicines are considered expensive, while TEM is usually affordable7,8,10. In Africa, there is an average of one ophthalmologist per million population, there are relatively few trained nurses and assistants and eye medicines are not available in health facilities7. More than 60% of Nigerians live in the rural areas and most of the ophthalmologist reside in urban areas thus the rural dwellers consider the herbalist as their first line of medical attention3. The distance to health facilities result in patients seeking help from the nearest source8,9. Nwosu9 found that although Primary Health Care centres were accessible, primary eye care was virtually non-existent as there were no trained personnel.
This study was carried out to ascertain the determinants of the use of traditional eye medication in a semi –urban community in Edo state Nigeria.
Patients and Methods
This is a descriptive cross-sectional study which was carried out in Ekiadolor a semi-urban community in Ovia North East Local Government Area of Edo State in Nigeria with a population of 153,84911. The study was done between September and November 2011.
A minimum sample size of 420 was calculated using the appropriate formulae for descriptive study12. A cluster sampling technique was done. Ekiadolor has one major road dividing the community into two (2). Each side of the road was taken as a cluster. Using simple random sampling technique, side A was selected and all respondents who met the inclusion criteria were recruited for this study.
A structured interviewer administered questionnaire for was the tool for data collection. The questionnaire was divided into two sections. Section A, comprised the age, sex, religion, ethnic group, occupation, marital status and level of education. The occupation was grouped using the British General Classification into Social Classes (SC) I – V13. Section B, dealt with the knowledge, practice and types of TEM in the community. Traditional eye medication (TEM) in this study was defined as any unorthodox medication applied to the eyes in the form of herbal extracts, sugar solution, breast milk, urine or animal waste.
Permission was obtained from the Chairman of the Local Government Area, the Medical officer of Health, the traditional ruler of the community. Written informed consent was taken from each participant and all the participants reserved the right to withdraw from the study at any time. Approval for the study was obtained from the Ethics and Research Committee of the University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.
The statistical analysis was done using Statistical Package for Social Scientist (SPSS) version 16. Bivariate and multivariate analysis was used to assess the determinants of use of TEM. The findings were illustrated with the tables while a p- value <0.05 was taken as significant.
Results
There were 430 respondents who participated in this study with a 100% response rate. Table 1 and Table 2 show the socio-demographic characteristics of the respondents. The ages of the 430 respondents were between 21-84 years with a mean age of 49.83+19.99 years. There were more respondents within the age group 61-70 years (28.1%). Females were 57.2% with a male/female ratio of 1:1.3 and more than half (57.2%) were married while majority (70.9%) were Christians (70.9%). Respondents without any form of education formed 40.7% of respondents and those with primary level of education formed 40.9%. The most frequent social class in 69.1% of cases was social class 5.
Table 1. SOCIO-DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS.
| Characteristics | Frequency (n = 430) | Percent |
| Age group (years) | ||
| 21 – 30 | 117 | 27.2 |
| 31 – 40 | 22 | 5.1 |
| 41 – 50 | 65 | 15.1 |
| 51 – 60 | 47 | 10.9 |
| 61 – 70 | 121 | 28.1 |
| 71 – 80 | 9 | 2.1 |
| 81 - 90 | 49 | 11.4 |
| Mean age ± SD = 49.83 ±19.99 years | Range = (21 – 84) years | Skewness = 0.083 |
| Sex | ||
| Male | 184 | 42.8 |
| Female | 246 | 57.2 |
| Marital Status | ||
| Single | 124 | 28.8 |
| Married | 246 | 57.2 |
| Widowed | 60 | 14.0 |
| Religion | ||
| Christianity | 305 | 70.9 |
| ATR* | 115 | 26.7 |
| Islam | 10 | 2.3 |
| Educational level | ||
| None | 175 | 40.7 |
| Primary | 176 | 40.9 |
| Secondary | 63 | 14.7 |
| Tertiary | 16 | 3.7 |
| Tribe | ||
| Bini | 351 | 81.6 |
| Esan | 64 | 14.9 |
| Urhobo | 7 | 1.6 |
| Others | 8 | 1.9 |
| Socio-economic class | ||
| SC 1** | 10 | 2.3 |
| SC 2*** | 28 | 6.5 |
| SC 3**** | 22 | 5.1 |
| SC 4***** | 73 | 17.0 |
| SC 5****** | 297 | 69.1 |
| *African Traditional Religion **Social Class 1***Social Class 2**** Social Class 3*****Social Class 4******Social Class 5 | ||
Table 2. SOIODEMOGRAPHIC VARIABLES AND SEX DISTRIBUTION OF RESPONDENTS.
| Variable | Sex (n = 430) | Test Statistic | p – value | |
| MaleFreq (%) | FemaleFreq (%) | |||
| Age group (years) | ||||
| 21 – 30 | 55 (45.5) | 66 (54.5) | χ2 = 54.930 | <0.001 |
| 31 – 40 | 10 (45.5) | 12 (54.5) | ||
| 41 – 50 | 15 (23.1) | 50 (76.9) | ||
| 51 – 60 | 9 (19.1) | 38 (80.9) | ||
| 61 – 70 | 50 (42.7) | 67 (57.3) | ||
| 71 – 80 | 4 (44.4) | 5 (55.6) | ||
| 81 – 90 | 41 (83.7) | 8 (16.3) | ||
| Religion | ||||
| Christian | 124 (40.7) | 181 (59.3) | χ2 = 3.392 | 0.183 |
| Muslim | 3 (30.0) | 7 (70.0) | ||
| ATR | 57 (49.6) | 58 (50.4) | ||
| Marital Status | ||||
| Single | 61 (49.2) | 63 (50.8) | χ2 = 52.177 | <0.001 |
| Married | 123 (50.0) | 123 (50.0) | ||
| Widowed | 0 (0.0) | 60 (100.0) | ||
| Level of Education | ||||
| No formal | 116 (66.3) | 59 (33.7) | χ2 = 105.826 | <0.001 |
| Primary | 55 (31.3) | 121 (68.8) | ||
| Secondar y | 13 (81.3) | 3 (18.8) | ||
| Tertiary | 0 (0.0) | 63 (100.0) | ||
| Socioeconomic class | ||||
| SC 1 – 3 | 2 (3.3) | 58 (96.7) | χ2 = 44.346 | < 0.001 |
| SC 4 – 5 | 182 (49.2) | 188 (50.8) | ||
| Knowledge of TEM | ||||
| Yes | 167 (42.6) | 225 (57.4) | χ2 = 0.064 | 0.800 |
| No | 17 (44.7) | 21 (55.3) | ||
TEM was known to about 392(91.2%) of the respondents.
Eye medication options used among the respondents who had eye disease in the last one year included TEM traditional eye medication in 133(48.7%), orthodox eye drops in 113(41.4%), eye ointments in 20(7.3%) and tablets in 7(2.6%) respondents.
Table 3 shows reasons for using TEM among the respondents who have had eye disease in the last one year while affordability was the most frequent reason in 29(21.8%).
Table 3. REASONS FOR USE OF TRADITIONAL EYE MEDICATIONS AMONG RESPONDENTS IN THE PAST ONE YEAR.
| Options | Frequency (n = 133) | Percent |
| Affordable | 29 | 21.8 |
| Unaware of orthodox alternatives | 22 | 16.5 |
| Natural | 19 | 14.3 |
| Unsatisfactory orthodox therapy | 18 | 13.5 |
| Accessible | 13 | 9.8 |
| Others | 24 | 18.0 |
Table 4 shows the bivariate relationship between socio-demographic variables, knowledge of TEM and use of TEM. With a year increase in the age, the respondents were 41% less likely to use TEM (OR: 0.59, 95% CI: 0.99 – 1.01). Thus, increasing age decreased the use of TEM. This association was not statistically significant (p=0.597). Seventy four (40.2%) of the male respondents used TEM compared to 59 (24.0%) of the female respondents. The association between sex and use of TEM was statistically significant (p<0.001). The male respondents were more likely to use TEM compared to the female respondents with an odds of 2.13 (95% CI: 1.41 – 3.23).
Table 4. SOCIO-DEMOGRAPHIC VARIABLES, KNOWLEDGE OF TEM BY USE OF TEM AMONG RESPONDENTS.
| Variable | Use of TEM (n = 430) | Test Statistic | p – value | |
| YesFreq (%) | NoFreq (%) | |||
| Age group (years) | ||||
| 21 – 30 | 39 (32.2) | 82 (67.8) | χ2 = 6.680 | 0.351 |
| 31 – 40 | 6 (27.3) | 16 (72.7) | ||
| 41 – 50 | 18 (27.7) | 47 (72.3) | ||
| 51 – 60 | 19 (40.4) | 28 (59.6) | ||
| 61 – 70 | 31 (26.5) | 86 (73.5) | ||
| 71 – 80 | 1 (11.1) | 8 (88.9) | ||
| 81 – 90 | 19 (38.8) | 30 (61.2) | ||
| Sex | ||||
| Male | 74 (40.2) | 110 (59.8) | χ2 = 12.985 | <0.001 |
| Female | 59 (24.0) | 187 (76.0) | ||
| Religion | ||||
| Christian | 88 (28.9) | 217 (71.1) | χ2 = 2.202 | 0.333 |
| Muslim | 4 (40.0) | 6 (60.0) | ||
| ATR | 41 (35.7) | 74 (64.3) | ||
| Marital Status | ||||
| Single | 32 (25.8) | 92 (74.2) | χ2 = 2.609 | 0.271 |
| Married | 79 (32.1) | 167 (67.9) | ||
| Widowed | 22 (36.7) | 38 (63.3) | ||
| Level of Education | ||||
| No formal | 63 (36.0) | 112 (64.0) | χ2 = 30.428 | <0.001 |
| Primary | 62 (35.2) | 114 (64.8) | ||
| Secondary | 7 (43.8) | 9 (56.3) | ||
| Tertiary | 1 (1.6) | 62 (98.4) | ||
| Socioeconomic class | ||||
| SC 1 – 3 | 3 (5.0) | 57 (95.0) | χ2 = 21.946 | < 0.001 |
| SC 4 – 5 | 130 (35.1) | 240 (64.9) | ||
| Knowledge of TEM | ||||
| Yes | 117 (29.8) | 275 (70.2) | χ2 = 2.437 | 0.119 |
| No | 16 (42.1) | 22 (57.9) | ||
Three (5.0%) of the respondents in social class ≤ 3 use TEM compared to 130 (35.1%) of the respondents in social class > 3. The association between social class and use of TEM was statistically significant (p<0.001). The respondents in social class ≤3 were 91% (OR: 0.09, 95% CI: 0.03 – 0.32) less likely to use TEM compared to those with social class > 3.
Thirty two (25.8%) of the respondents who were unmarried used TEM compared to 79 (32.1%) and 22 (36.7%) of the married and widowed respondents respectively. The association between marital status and use of TEM was not statistically significant (p=0.271). Compared to the widows, the single respondents were 18% (OR: 0.82, 95% CI: 0.45 – 1.47) less likely to use TEM while the married respondents were 40% (OR: 0.60, 95% CI: 0.31 – 1.16) more likely to use TEM.
Sixty three (36.0%) of the respondents with no formal education use TEM compared to 62 (35.2%), 7 (43.8%) and 1 (1.6%) of the respondents who had primary, secondary and tertiary education respectively. The association between educational status and use of TEM was statistically significant (p<0.001). Compared to the respondents with tertiary education, the respondents with no formal education 34.88 (95% CI: 4.72 – 257.61) times more likely to use TEM, the respondents who had primary education were 33.72 (95% CI: 4.56 – 249.10) times more likely to use TEM, while the respondents who had secondary education were 48.22 (95% CI: 5.29 – 439.08) times more likely to use TEM.
Table 5 shows the measure of association between socio-demographic predictors, knowledge of TEM and use of TEM. On adjustment for the other covariates in the model, compared to the respondents who had tertiary education, the respondents who had no formal education were 19.45 (95% CI: 2.22 – 170.73) times more likely to use TEM, the respondents who had primary education were 20.04 (95% CI: 2.27 – 176.99) times more likely to use TEM, while the respondents who had secondary education were 26.18 (95% CI: 2.45 – 280.23) times more likely to use TEM. The respondents who knew of TEM were 56% (OR: 0.44, 95% CI: 0.21 – 0.95) less likely to use TEM compared to those who do not know of TEM.
Table 5. LOGISTIC REGRESSION MODEL FOR DETERMINANTS OF USE OF TRADITIONAL MEDICATIONS.
| Predictors | B (regression co-efficient) | Odds ratio | 95% CI for OR | p - value | |
| Lower | Upper | ||||
| Age | -0.002 | 0.998 | 0.985 | 1.011 | 0.750 |
| Sex | |||||
| Male | 0.468 | 1.597 | 0.888 | 2.873 | 0.118 |
| Female* | 1 | ||||
| Level of Education | |||||
| No formal education | -0.084 | 0.919 | 0.450 | 1.878 | 0.817 |
| Ever educated* | 1 | ||||
| Socio-economic class | |||||
| SC 1-3 | -2.237 | 0.107 | 0.029 | 0.390 | 0.001 |
| SC 4-5* | 1 | ||||
| Marital status | |||||
| Never married | 0.051 | 1.053 | 0.480 | 2.307 | 0.898 |
| Ever married* | 1 | ||||
| Religion | |||||
| Christians | -0.355 | 0.701 | 0.396 | 1.242 | 0.224 |
| Non-Christians* | 1 | ||||
| Knowledge of TM | |||||
| Yes | -0.639 | 0.528 | 0.244 | 1.140 | 0.104 |
| No* | 1 | ||||
| *Reference category, R2 = 8.5% - 12.0%, CI = Confidence Interval | |||||
Discussion
The common belief that anything herbal and traditional implies absence of any adverse effect has led to the frequent use of TEM5,14. This study is no exception as 92.1% of the respondents knew about TEM.
The prevalence of the use of TEM which is 48.7%, is high. Ukponmwan et al15 reported a prevalence of 49.5% in a study carried out in another community in the same state. This was at variance with was reported by Omolase et al16 in south-western Nigeria where 8.8% of the community used TEM. Their finding would have been influenced by the presence of a General Hospital with the services of an ophthalmic nurse and also the community was a more literate community with 76.7% of the inhabitants educated.
The main reason for the use of TEM was affordability in 21.8% of respondents and this is not far-fetched as majority of the people were in social class 513. Ademola-Popoola et al17 also reported low cost as a reason for the use of TEM. Some of the respondents (16.5%) also said that they were unaware of orthodox alternatives. This shows that the impact of both the Comprehensive and Primary Health Care Centres are still not adequately felt by the community. In Bukavu ophthalmic district in the Democratic Republic of Congo, Mutombo18 reported preference and proximity as the reasons for the use of TEM and they were all aware of orthodox alternatives.
Majority (60%) of the respondents said they would still use TEM if orthodox health care is made affordable and accessible due to its lack of side effects. Other studies in Africa and India reported similar findings5,14,17. Also, 25% of the respondents said they would still use TEM because it is natural. This could be due to the fact that traditional medicines have generally been described as natural and devoid of any synthetic additives considered to be harmful7. A study in Ivory Coast by Lasker19 on the use of different modes of therapy, inferred that the main determinant to the utilization of either western or traditional medicine is not cultural belief or level of education but “accessibility” to services. Accessibility includes, distance to health facility, the cost of service and the level of communication between the health provider and the consumer.
In using the bivariate relationship between the sociodemographic variable, knowledge of TEM and use of TEM, gender, socioeconomic class and educational status had a significant relationship. Males were more likely to use TEM which is in contrast to the finding by Ahmed et al20 who found out there were more female visitors to traditional healers. Marital status was not statistically associated with the use of TEM, although most of the respondents who used TEM were married. Ahmed et al20 and Eze et al21 found marital status to be significant. The use of TEM was significantly commoner among the respondents in the lower socio-economic class. This could be due to the fact that persons of lower socio economic class are more likely to be less educated and also earn less income. Persons with no formal education, primary and secondary levels of education were more likely to use TEM than those with tertiary education. This was statistically significant and was also reported by Mutombo18, Ahmed et al20 and Nwosu et al22
The limitation of this study is that a section of the community instead of the entire community was studied.
Conclusions
In conclusion, the use of TEM in this community are affordability, low socio economic status and lack of formal education. Formal education is of great importance as this will go a long way in addressing the issues directly relating to the use of TEM in our communities.
Footnotes
Competing Interests: The authors have declared that no competing interests exist.
Grant support: None
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