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1.1 Background

Traditional medicine is defined as the sum total of knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures that are used to maintain health, as well as to prevent, diagnose, improve or treat physical and mental illnesses (Elujoba et al, 2005, WHO, 2003). Traditional medicine that has been adopted by other populations (outside its indigenous culture) is often termed alternative or complementary medicine (Wong, 2005).


According to the National Center for Complementary and Alternative Medicine (NCAM) of United States of America (wai Fan, 2005), complementary and alternative medicine therapies can be classified into five broad categories: the first one is Alternative

Medical Systems. These systems are built upon complete systems of theory and practice. Often, these systems have evolved apart from and earlier than the conventional medical approach used in the United States. Examples of alternative medical systems include: Acupuncture, Ayurveda, Homeopathy (Native American healing practices), Naturopathic medicine (Tibetan medicine), and Traditional Chinese medicine.


The second one is Mind-Body Interventions. Mind-body medicine uses a variety of techniques designed to enhance the mind’s capacity to affect bodily function and symptoms. Some techniques that were considered alternative in the past have become mainstream (for example, patient support groups and cognitive-behavioral therapy).

Other mind-body techniques are still considered alternative, including: Art therapy, Biofeedback, Dance therapy, Guided imagery, Humor therapy, Hypnotherapy,

Meditation, Music therapy, Prayer therapy, Yoga.


The third one is Biologically-Based Therapies. Biologically based therapies in complementary and alternative medicine use substances found in nature, such as herbs, foods, and vitamins. Some examples include: Diet, Dietary supplements, Herbal products, and Megavitamins. It also includes the use of other so-called natural but as yet scientifically unproven therapies (for example, using shark cartilage to treat cancer). Herbal medicines include herbs, herbal materials, herbal preparations and finished herbal products that contain parts of plants or other plant materials as active ingredients (WHO, 2000).


The fourth is Manipulative and Body-Based Methods. Manipulative and body-based methods in complementary and alternative medicine are based on manipulation and/or movement of one or more parts of the body. Some examples include: Acupressure,

Alexander Technique, Chiropractic, Feldenkrais method, Massage therapy, osteopathy,

Reflexology, Rolfing, Therapeutic Touch, and trager Approach.


The last method is Energy Therapies. Energy therapies involve the use of energy fields. They are of two types: Biofield therapies are intended to affect energy fields that purportedly surround and penetrate the human body. The existence of such fields has not yet been scientifically proven. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in, or through, these fields. Examples include: Qi gong, Reiki, Therapeutic touch. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields such as Pulsed fields, Magnetic fields and alternating-current or direct-current fields.


The use of complementary and alternative medicines is increasing globally, especially in developing countries (WHO, 2002). Indeed, over 80% of the population in developing countries depend on traditional healing modalities, including herbal remedies for health maintenance and therapeutic management of diseases (WHO, 2002).


In Nigeria and elsewhere in Sub-Saharan Africa, traditional herbal medicines are commonly used to treat a range of diseases. Such practices are wide-spread in rural areas where access to modern health care facilities is limited and cost of modern pharmaceuticals is beyond the means of most people (Ochora, 2006). With the wide spread use of various herbal products which are often concomitantly used with pharmaceutical drugs, herbal – drug interactions have become an important issue in drug safety and clinical practice. Hence prevalence of the concomitant use in the population needs to be determined.


Traditional medicine is widely used in Nigeria with majority of the population (70%) depending on it for primary health care (NCAPD, 2007). However, there is no legal policy framework that regulates their use. It is nevertheless evident that the government attaches great importance to proper use of herbal medicine and has responded to its growing popularity by developing a national policy framework that will provide a sound base for both promoting and regulating its use (NCAPD, 2007). This policy framework is awaiting parliamentary approval.


Regulating traditional medicine products, practices and practitioners is difficult due to variations in definitions and categorisations of traditional medicines therapies. A single herbal product could be defined as a food, a dietary supplement or an herbal medicine depending on the country (WHO, 2003). This disparity in regulations at the National level has implications on international access and distribution of the products. Though a lot of medicinal plants have been documented, further research is needed in the interaction effects of herbs and conventional medicine. In recognition to these gaps vision 2030 in its second Medium Term Plan 2013-2017 will be addressing a number of issues under Natural Products Programme; (Flagship project). The flagship project to be implemented includes documentation, profiling and securing of indigenous knowledge, technologies and associated biological resources; scientific testing and validation

(MoSCA, 2013).


Like in the rest of the country, the use of herbal remedies is on the increase in Nigeria. However, there is lack of proper documentation regarding the utilization and concomitant use of herbal products with conventional medicine. This study sought to investigate the prevalence of concomitant use of herbal products with conventional medicine. The study also determined whether there are reported adverse effects associated with the growing use of herbal medicine and herbs – drugs interaction.


1.2 Statement of the Problem

The use of herbal remedies continues to grow globally at an alarming rate without proper regulation (WHO, 2002). This has forced international health organizations to advise governments to formulate national guidelines for regulation of herbal remedies. The lack of regulation means there are just as many fake remedies and false practitioners as there are genuine treatments, a situation which has fatal consequences. The Nigerian Government in response to this has developed a sessional paper on traditional medicine of 2009 though it has not been debated by parliament (Hansard, 2009). While this sessional paper awaits adoption and enactment of requisite laws to regulate use of herbal medicine, the country has witnessed an unprecedented growth of herbal clinics whose professionalism is very much wanting. Use of herbal products concomitantly with conventional medicines is an issue of public health concern. Studies have documented adverse effects associated with concomitant use (Piscitelli et al 2002, Nyasha et al 2011). However, the extent to which concomitant use is happening locally has not been adequately documented. This is the case even in Nigeria, hence this study.


1.3 Research Questions

This study sought to address the following research questions;

i.What are demographic characteristics of herbal product users in Nigeria? ii.Which herbs are frequently used in Nigeria? iii.Which are the health conditions that elicit use of herbs in Nigeria?

iv.To what extent are herbal medicines used concomitantly with conventional medicines in Nigeria?


1.4 Research Hypotheses

  1. There is no difference in demographic characteristics among the herbal users in


  1. Herbal products are not concomitantly utilised with conventional medicine for treatment of various health conditions, in Nigeria.


1.5 General Objective

The general objective of the study was to investigate the extent of concomitant use of herbal products together with conventional medicine for various health conditions in



1.6 Specific Objectives

The specific objectives of this study were;

  1. To determine the demographic characteristics of persons using herbal products in Nigeria.
  2. To establish which herbs are commonly used in Nigeria.
  • To establish the common diseases and conditions for which herbal medicine is used in Nigeria.
  1. To determine the prevalence of concomitant use of herbal medicines with conventional medicines for similar conditions by herbal products users in Nigeria.


1.7 Justification of the study

To maximize the potential of herbal treatment as a source of health care, a number of issues must first be tackled. They relate to policy, safety, efficacy, quality, access and rational use. These cannot be tackled without adequate data on growing utilization of herbal medicine; hence this study. The study was expected to reveal the level of concomitant use of herbal products with conventional medicine, whether the concomitant use of herbal products with conventional medicine use has any demographic inclination. The widespread use of various herbal products which are often concomitantly used with conventional medicine, have become an important issue in drug safety and clinical practice (Fugh-Berman, 2002, Izzo et al, 2009). The findings of this study are expected to aid in predicting the risk of adverse herbal products – conventional medicine interactions. These will also provide awareness among policy makers responsible for the design of appropriate conventional medicine vigilance system in the country.  Awareness within the medical community and those monitoring adversities would serve well to mitigate risks from potential conventional medicine – herbal products interactions. The results of this study would form the basis for future research since most indigenous herbs are not well investigated and this could point to the needs for biomedical investigation to assess safety and efficacy of popular medical herbs.


1.8 Conceptual Framework

The conceptual framework for this study was based on the Health Belief Model (HBM) which postulates that ―health-seeking behavior is influenced by a person‘s perception of a threat posed by a health problem and the value associated with actions aimed at reducing the threat‖(Becker, 1978). In this model, the ultimate outcomes—―health-seeking behaviour‖ and ―the likelihood of taking recommended preventive health action‖— include the following components:

  1. ―Individual perceptions‖, which, in turn, are composed of perceived susceptibility to threat; that is, illness or disease and perceived seriousness or severity of the threat.
  2. ―Likelihood of action‖ composed of perceived benefits of preventative action minus perceived barriers to preventive action.
  3. ―Cues to action‖, which include motivations to avoid threat, and
  4. ―Modifying factors‖, composed of demographic, psychosocial, and structural variables.

The conceptual framework for this study is described in Figure 1.1

Figure 1.1 Conceptual framework of the study


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