Abstract
Background:
Herbal medicines are not regulated by regulatory authorities and are often not of proven safety and efficacy. Anecdotal reports suggest widespread use of traditional herbal medicine (THM) for treatment of stroke in Africa, but verifiable data are limited in published literature.
Objective:
To assess the frequency and reasons for THM use among Ghanaian stroke survivors.
Methods:
We conducted a cross-sectional survey of 106 consecutive stroke survivors presenting for care at a tertiary medical center in Kumasi, Ghana between June and October 2020. Information on demographic, clinical, vascular risk factors and use of THM were collected in a non-judgmental manner and analyzed.
Results:
Among the cohort, 46 (43.4%) reported use of any THM for their stroke management. There was a trend towards fewer women who reported use of THM 34.8% vs 53.3%, p = 0.06. Of those reporting use of THM, 78% had blood pressure >140/90 mmHg vs. 56% among those not exposed to THM (p=0.02). Top reasons proffered for use of THM were: expecting them to aid faster recovery from stroke (n=30), expecting them to cure stroke (n=18), and expecting them to be of superior effectiveness compared to approved conventional medications of proven efficacy/safety (n=1).
Conclusion:
Almost half the individuals in this contemporary sample of Ghanaian stroke survivors reported use of THM with expectations for improved outcomes. More counseling is required to inform patients about potential safety issues with THM use, and more research is needed to explore risk/benefit of promising THMs to improve stroke outcomes.
Keywords: Herbal medicines, Stroke types, Africa, Hypertension
INTRODUCTION
Traditional herbal medicine (THM) use is rife in sub-Saharan Africa (SSA) with prevalence ranging between 38.5-90%.1,2 As defined by the National Institutes of Health, herbal medicines are any products originating from plants and used to preserve or recover health. Despite its wide acceptance and use in the community, many herbal treatments lack scientific evidence of safety and effectiveness.3 In SSA, THM are used to treat chronic medical disorders including hypertension.1,4 Among stroke survivors, there is little data on use of THM on the continent although anecdotal evidence exists for such practice.
In this brief communication, we report the prevalence and reasons for use of herbal medicine use among Ghanaian stroke survivors and compare demographic and clinical characteristics of those using herbal medicines versus those who were not.
METHODS
This is a cross-sectional survey conducted at the Neurology clinic of the Komfo Anokye Teaching Hospital in Kumasi, Ghana.5 The study was approved by the Kwame Nkrumah University of Science and Technology ethics committee and all study participants provided informed consent. We approached consecutive stroke survivors who reported to clinic for routine care for potential enrollment into the study. Two trained Research Assistants administered questionnaires to collect data on demographic characteristics of participants, clinical history, presence of vascular risk factors, any use (present or past), reasons for use and route of administration of THM. We also measured blood pressures were measured using a standardized protocol with 3 readings taken approximately 5 minutes apart using an automated monitor and averaging the second and third readings.
We compared demographic and vascular risk factor data among stroke cases who reported using THM versus those who did not report using THM. Student’s T-tests were used for parametrically distributed continuous data and Chi-squared tests for categorical data. All statistical tests of hypotheses were two-sided. Statistical analysis was performed with GraphPad Prism version 6.
RESULTS
Of 106 stroke survivors interviewed between June and October 2020, 46 (43.4%) reported ever using herbal medicines for their stroke management. Among those with use of herbal medicines, 25 (54.3%) used orally administered herbal medicines and 21 (45.7%) applied it topically. There were 19 (41.3%) who were currently using THM at the time of interview and the rest had used it in the past. Table 1 shows a comparison of those who report ever using THM and those without any use. There was a trend towards fewer women who reported use of herbal medicines 34.8% vs 53.3%, p = 0.06. The demographic and clinical characteristics between the two groups were comparable except for proportions with blood pressure control. Nearly 78% of those exposed to herbal medications had BP >140/90 mmHg versus 56% among those not exposed to herbal medications, p=0.02. The reasons for use of herbal medicines were (i) for faster recovery from stroke (n=30), (ii) will help cure stroke (n=18) and (iii) herbal medicines were more efficacious than orthodox medicines (n=1).
Table 1.
Comparison of demographic & clinical characteristics Stroke Survivors according to Herbal medicine use
| Characteristic | Herbal medicine n = 46 |
No herbal medicine n = 60 |
P-value |
|---|---|---|---|
| Age, mean ± SD | 56.0 ± 9.7 | 58.9 ± 14.6 | 0.25 |
| Female, n (%) | 16 (34.8) | 32 (53.3) | 0.06 |
| Location of residence | 0.68 | ||
| Rural | 8 (17.4) | 8 (13.4) | |
| Semi-urban | 16 (34.8) | 26 (43.3) | |
| urban | 21 (45.6) | 26 (43.3) | |
| Unemployed | 20 (43.5) | 22 (36.7) | 0.47 |
| Stroke types | 0.53 | ||
| Intracerebral hemorrhage | 15 (32.6) | 17 (28.3) | |
| Ischemic stroke | 24 (52.2) | 37 (61.7) | |
| Sub-arachnoid hemorrhage | 3 (6.5) | 1 (1.7) | |
| untyped | 4 (8.7) | 5 (8.3) | |
| Modified Rankin Score | 1.6 ± 1.2 | 1.9 ± 1.2 | 0.31 |
| Diabetes diagnosed | 11 (23.9) | 15 (25.0) | 0.90 |
| Hypertension diagnosed | 46 (100.0) | 58 (96.7) | 0.21 |
| Dyslipidemia | 31 (67.4) | 41 (68.3) | 0.92 |
| Current alcohol use | 4 (8.7) | 2 (3.3) | 0.24 |
| Previous cigarette smoking | 6 (13.0) | 3 (5.0) | 0.14 |
| Systolic BP, mean ± SD | 154.7 ± 23.6 | 148.1 ± 25.2 | 0.17 |
| Diastolic BP, mean ± SD | 92.5 ± 14.6 | 88.7 ± 17.1 | 0.22 |
| BP >140/90mmHg | 36 (78.3) | 34 (56.7) | 0.02 |
| BP >130/80mmHg, n (%) | 43 (93.5) | 46 (76.7) | 0.01 |
DISCUSSION
Approximately 45% in this convenience sample of Ghanaian stroke survivors in this study reported using THM along with allopathic medicines. The concurrent use of herbal medicines and allopathic medicines for chronic diseases such as hypertension6 and HIV7 is common in Africa. Interestingly, the frequency estimate of THM among Ghanaian stroke survivors, is similar to the reported 46% use of complementary and alternative medicine (CAM) nationwide among stroke survivors in the United States.8 Nonetheless, it should be noted that the range of CAM therapies is broader than THM, and unlike our Ghanaian current study, the US study was a nationally-representative analysis.
We observed a trend towards women being less likely to use herbal medications in our survey, which contrasts with data from other similar studies.4 In concordance with data from Africa,9 hypertension was a cardinal risk factor reported among 98% of stroke survivors in this study. With this in mind, it is noteworthy that those who reported using herbal medications were significantly more likely to have uncontrolled blood pressure than those who did not use herbal medicines. There is a potential for therapeutic interactions between allopathic medications for hypertension management and herbal medication including altered drug metabolism, loss of hypertension control and exaggerate hypotensive effect.10
Patients who use herbal medicines seldom volunteer information regarding their beliefs and practices to physicians, hence a non-judgmental history taking is required to elicit this information in clinical practice. Most of the stroke survivors who used herbal medications cited faster recovery from motor deficits and cure for stroke as common reasons for their behavior. It is possible that lack of knowledge regarding risk factor control in stroke and the role of physiotherapy in augmenting motor recovery after stroke,11 among our study population are potential drivers for the practice herbal medicine use. Our findings support a common notion of pluralistic healthcare seeking behavior characterized by utilization of multiple therapeutic modalities with combinations of biomedical and complementary or alternative treatments to achieve faster healing from ailments. In low-income settings traditional healers are consulted for most types of illnesses and thus could be critical allies for important public health initiatives. Thus more research is needed to define the beneficial effects or otherwise of herbal medicines in risk factor control and rehabilitation after among stroke survivors in sub-Saharan Africa. Limitations of this study include conducting the survey in a hospital setting instead of a community setting, potential for recall bias and our inability to draw causal relationships between herbal medicine use and outcomes such as blood pressure control. A mixed methods approach may be required to provide more in-depth information on this subject and guide the development of interventions to address THM in our stroke population.
Highlights.
There are limited data on use of herbal medicine for stroke management in Africa
43% of stroke survivors in this Ghanaian study reported using herbal medicine
Most herbal medicine users expected faster recovery from stroke
Users of herbal medicine often had uncontrolled blood pressure
Footnotes
Disclosures: None for both authors
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