Prevalence of and factors associated with combined use of herbal and conventional medicine by caretakers of children with sickle cell disease in Jinja regional referral hospital; a cross-sectional study.

Abstract

Background: Concurrent use of Herbal (HM) and Conventional Medicine (CM) poses a huge risk of drug-herbal interactions that can result in therapeutic failure or toxicity. However, little is known about the prevalence of combined use of HM and CM and the associated factors by caretakers of children with sickle cell disease (SCD). This study aimed to determine the prevalence of and factors associated with the combined use of HM and CM by caretakers of children with SCD attending the Sickle Cell Clinic (SCC) at Jinja Regional Referral Hospital (JRRH), East-Central Uganda.

Methods: A mixed-method, explanatory design was used. Data were collected between January and March 2022. Quantitatively, a sample size of 394 caretakers of children with SCD aged 1-18 years was targeted. Structured questionnaires were used to collect data on socio-demographic characteristics, caretakers' take on SCD treatment, perceptions of and intentions of the caretakers to use HM, CM, or both, and community and health-related factors. The primary outcome was the combined use of HM and CM. Quantitative data analysis was performed using Stata version 15. A logistic regression model was fitted to determine the factors associated with the use of combined therapy and all factors with a p-value less than 0.05 were considered significantly associated with the primary outcome. After completion of the structured interviews, qualitative data were collected from 26 purposively selected caretakers who reported use of both HM and CM and had participated in the quantitative interviews. Four focus group discussions (FGDs) were conducted to collect data on caretakers’ take on treatment outcomes; cultural, family, friends or relatives’ influence, and caretakers’ considerations when choosing both remedies. Qualitative data were analyzed following a thematic framework approach, using NVIVO software.

Results: A total of 372 (94.4% of the sample) caretakers were interviewed; 341 (91.7%) of whom were females. Respondents’ average age was 34.3 (SD: ±9.8) years. More than half (55.1%, n=205) of the caretakers were aged 18-34 years while 40.9% (n=152) had primary education. Fifty-eight percent (n=217) of the caretakers reported use of only CM, 37.1%, (n=138) used combined therapy while 4.6% (n=17) reported use of HM only. In the multivariate analysis, caretakers aged 60+ years (adjusted odds ratio [AOR] = 11.8; 95% Confidence Interval [95%CI]: 1.2, 115.2), those with lower secondary education (AOR=6.2; 95% CI: 1.5, 26.0), those who believed that HM is beneficial (AOR=3.3; 95% CI: 1.5, 7.6) and those who believed that the use of both CM and HM is safe (AOR=7.7; 95% CI: 3.5, 17.0) were significantly more likely to use combined therapy than their counterparts. Caretakers who intended to use only CM (AOR=0.1; 95% CI: 0.1, 0.3) were significantly less likely to use combined HM and CM. From the qualitative findings, lack of trust in the use of either CM alone or HM alone and recommendations from relatives and friends were the main factors that influenced the use of combined therapy.

Conclusion: Slightly more than half of the caretakers used CM only while more than a third used both. Caretakers’ age and level of education, compliance with recommendations from significant others, and lack of trust in either therapy alone were significantly associated with the use of combined therapy. We recommend that further research be done targeting the understanding of the use of combined medicines.