Abstract
Herbal medication is the most commonly used form of healthcare in Africa. However, little is known about its use by young Africans in the urban context.
This qualitative study explored opinions about herbal medicine and its uses among young people in the Wakiso district, Uganda.
About a third of interview participants reported using herbal products, a choice influenced by religious faith, family preference, low cost and unavailability of biomedicines. Two participants stated that herbs could be used to deter alcohol dependence.
This study indicated divergent opinions about the value of herbal medicine among young urban Ugandans.
Introduction
About 80% of Africa's population depend upon traditional products for healthcare.1 Common indications in Uganda include malaria, cough, headache, diarrhoea, body pains and eye diseases.2 Preference for herbal medications results from easy access,3 low cost,3 cultural acceptability,3 limited access to hospitals/biomedicines3 and a belief in its efficacy or reduced side-effects.4 It is known that urbanisation is eroding the indigenous knowledge of herbs.2 Herbal use among young people, including suburban East Africans, is poorly researched and observational methods to do so are problematic. To gain insight into their behaviour this study sought to ask young Ugandans about their use of medicinal herbs.
Methods
This research formed part of a larger semi-structured interview (17 participants) and focus group (61 participants) study conducted in Wakiso district, Uganda, in 2013. Participants were aged 15–24 years (the Ugandan government's definition of youth). Interviews explored how health services could better meet the needs of young people and were conducted in English or Luganda, according to participant preference. Data were transcribed verbatim and translated by DL and EM. The translation accuracy was verified by a bilingual speaker. Transcriptions were coded with NVivo version 9 (QSR International, Doncaster, VIC, Australia) and examined by DL and MC using content-analysis5 to identify themes emerging from the data. Figure 1 illustrates the method used in the study.
Study method and major findings relating to herbal medicine use among young people in Wakiso district, Uganda. This figure is available in black and white in print and in color at International Health online.
Results
Of the 17 interview participants (9 male and 8 female) who were directly asked about herbal medicine use, 6 (35%; 6/17) reported personal use of such products (3 male and 3 female). A preference for traditional medicine was reported to be stronger among older people compared to young people. However, some participants expressed strong opinions that they would never use herbal products. Reasons included that such products were ineffective and that healers might be profiteering by selling ordinary plants as medicines. One participant stated that he could not take herbal products because, ‘I'm a born again [Christian] so I cannot go there.’
Further concern was expressed that the ‘wrong’ medicine would be issued, that traditional healers failed to provide instructions on dosage and that herbs needed to be boiled for ‘hygienic’ reasons. Justifications for taking herbal products were their low cost, making treatment available, ‘if we don't have money.’
They were also considered to be something to try before biomedical products, or when these were unavailable. One participant stated that herbal medication had been recommended by her parents. A further reason for use was the natural origin of herbal products:
Respondents cited ‘no[n]-serious’ indications for herbal remedies that were symptom or organ-based: headache, eye problems, stomach, pains, leg pains and cough. It was also reported that herbal medication could be taken for specific diagnoses, including serious ones such as malaria, skin diseases (e.g., ringworm) and heart problems. In the context of injuries, herbal products were stated to be used to treat simple fractures and to prevent bleeding. Only a few participants named products that they had used themselves. These included ginger tea for asthma and mango leaves for the following indications:They can say ‘maybe, let me go there, I can't take a tablet because it's from the industry, let me take this [herbal product], the fresh one (male interview participant, aged 19 years).
Two participants also reported an indication for herbal medication in tackling alcohol addiction. It was said that this could be added secretly to the drink of an excessive user of alcohol in order to curtail the habit. The way this was stated to work as follows:The mango tree leaves, they help to boost one's, should I call it, resistance against this flu and malaria. So, if you feel the temperature is going high, you may use that (male interview participant, aged 15 years).
You squeeze that herb, you put in the alcohol and the person drinks [it and then] you [i.e., they] vomit it out (male focus group participant, aged 17 years).
Discussion
This study is limited by its small sample size, mainly in-school setting and the potential influence of the researcher's identity as a white, male doctor. It supports evidence that a preference for herbal medicine is influenced by religious belief,1 parental knowledge, low cost and limited access to biomedicine.2 It identified a range of illnesses for which herbal medicines might be used, similar to those reported in rural areas.2 These findings have implications for patient safety, especially given the young age of participants. Further research should explore how young Africans access herbal medicines, in particular whether these are foraged or purchased from a healer. Finally, it offers circumstantial evidence that herbal products are administered covertly to drinkers in an attempt to curtail excessive alcohol consumption. Additional research is needed to explore and quantify the role of traditional medicines in tackling alcohol addiction in East Africa.
Conclusions
This indicates a range of views among suburban youth in Uganda over the perceived value of herbal medicines. These were used by about one third of participants. Given the emphatic way that certain individuals dismissed herbal medicine, it is possible that use is undisclosed and even more common than this.
Authors' contributions: DL, MC and HS conceptualised the study; DL and EM conducted all field research; DL and MC conducted data analysis; MC drafted the manuscript and DL and HS revised it. All authors read and approved the final manuscript. DL is the guarantor of the paper.
Funding: None.
Competing interests: None declared.
Ethical approval: Ethical approval was obtained from Brighton and Sussex Medical School Research Governance and Ethics Committee in the UK [13/091/SMI] and Makerere University School of Health Sciences Institutional Review Board [2013–046].
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