Dataset Information

Why urban citizens in developing countries use traditional medicines: the case of suriname.

ABSTRACT: The use of traditional medicines (TMs) among urban populations in developing countries and factors underlying people's decision to use TMs are poorly documented. We interviewed 270 adults in Paramaribo, Suriname, using a stratified random household sample, semistructured questionnaires, and multivariate analysis. Respondents mentioned 144 medicinal plant species, most frequently Gossypium barbadense, Phyllanthus amarus, and Quassia amara. 66% had used TMs in the previous year, especially people who suffered from cold, fever, hypertension, headache, uterus, and urinary tract problems. At least 22% combined herbs with prescription medicine. The strongest explanatory variables were health status, (transfer of) plant knowledge, and health status combined with plant knowledge. Other predictive variables included religion, marital status, attitude of medical personnel, religious opinion on TMs, and number of children per household. Age, gender, nationality, rural background, education, employment, income, insurance, and opinion of government or doctors had no influence. People's main motivation to use TMs was their familiarity with herbs. Given the frequent use of self-collected, home-prepared herbal medicine and the fact that illness and traditional knowledge predict plant use rather than poverty or a limited access to modern health care, the potential risks and benefits of TMs should be put prominently on the national public health agenda.

SUBMITTER: van Andel T

PROVIDER: S-EPMC3638607 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

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Why urban citizens in developing countries use traditional medicines: the case of suriname.

van Andel Tinde T Carvalheiro Luísa G LG

Evidence-based complementary and alternative medicine : eCAM 20130407

The use of traditional medicines (TMs) among urban populations in developing countries and factors underlying people's decision to use TMs are poorly documented. We interviewed 270 adults in Paramaribo, Suriname, using a stratified random household sample, semistructured questionnaires, and multivariate analysis. Respondents mentioned 144 medicinal plant species, most frequently Gossypium barbadense, Phyllanthus amarus, and Quassia amara. 66% had used TMs in the previous year, especially people ...[more]

PMID: 23653663

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Project description:BackgroundSuboptimal medicine use is a global public health problem. For 35 years the World Health Organization (WHO) has promoted essential medicines policies to improve quality use of medicines (QUM), but evidence of their effectiveness is lacking, and uptake by countries remains low. Our objective was to determine whether WHO essential medicines policies are associated with better QUM.Methods and findingsWe compared results from independently conducted medicines use surveys in countries that did versus did not report implementation of WHO essential medicines policies. We extracted survey data on ten validated QUM indicators and 36 self-reported policy implementation variables from WHO databases for 2002-2008. We calculated the average difference (as percent) for the QUM indicators between countries reporting versus not reporting implementation of specific policies. Policies associated with positive effects were included in a regression of a composite QUM score on total numbers of implemented policies. Data were available for 56 countries. Twenty-seven policies were associated with better use of at least two percentage points. Eighteen policies were associated with significantly better use (unadjusted p<0.05), of which four were associated with positive differences of 10% or more: undergraduate training of doctors in standard treatment guidelines, undergraduate training of nurses in standard treatment guidelines, the ministry of health having a unit promoting rational use of medicines, and provision of essential medicines free at point of care to all patients. In regression analyses national wealth was positively associated with the composite QUM score and the number of policies reported as being implemented in that country. There was a positive correlation between the number of policies (out of the 27 policies with an effect size of 2% or more) that countries reported implementing and the composite QUM score (r=0.39, 95% CI 0.14 to 0.59, p=0.003). This correlation weakened but remained significant after inclusion of national wealth in multiple linear regression analyses. Multiple policies were more strongly associated with the QUM score in the 28 countries with gross national income per capita below the median value (US$2,333) (r=0.43, 95% CI 0.06 to 0.69, p=0.023) than in the 28 countries with values above the median (r=0.22, 95% CI -0.15 to 0.56, p=0.261). The main limitations of the study are the reliance on self-report of policy implementation and measures of medicine use from small surveys. While the data can be used to explore the association of essential medicines policies with medicine use, they cannot be used to compare or benchmark individual country performance.ConclusionsWHO essential medicines policies are associated with improved QUM, particularly in low-income countries. Please see later in the article for the Editors' Summary.

Project description:BackgroundThis article is based upon data gathered during a study conducted in partnership with the World Intellectual Property Organization on the patent status of products appearing on the World Health Organization's 2013 Model List of Essential Medicines (MLEM). It is a statistical analysis aimed at answering: in which developing countries are patents on essential medicines being filed?MethodsPatent data were collected by linking those listed in the United States and Canada's medicine patent registers to corresponding patents in developing countries using two international patent databases (INPADOC and Derwent) via a commerical-grade patent search platform (Thomson Innovation). The respective supplier companies were then contacted to correct and verify our data. We next tallied the number of MLEM patents per developing country. Spearman correlations were done to assess bivariate relationships between variables, and a multivariate regression model was developed to explain the number of MLEM patents in each country using SPSS 23.0.ResultsA subset of 20 of the 375 (5%) products on the 2013 MLEM fit our inclusion criteria. The patent estate reports (i.e., the global list of patents for a given drug) varied greatly in their number with a median of 48 patents (interquartile range [IQR]: 26-76). Their geographic reach had a median of 15% of the developing countries sampled (IQR: 8-28%). The number of developing countries covered appeared to increase with the age of the patent estate (r = .433, p = 0.028). The number of MLEM patents per country was significantly positively associated with human development index (HDI), gross domestic income (GDI) per capita, total healthcare expenditure per capita, population size, the Rule of Law Index, and average education level. Population size, GDI per capita, and healthcare expenditure (in % of national expenditure) were predictors of the number of MLEM patents in countries (p = 0.001, p = 0.001, p = 0.009, respectively). Population size was the most important predictor (β = 0.59), followed by income (GDI per capita) (β = 0.32), and healthcare expenditure (β = 0.15). Holding the other factors constant, (i) 14.3 million more people, (ii) $833.33 more per capita (GDI), or (iii) 0.88% more of national spending on healthcare resulted in 1 additional essential medicine patent.ConclusionPopulation was a powerful predictor of the number of patent filings in developing countries along with GDI and healthcare expenditure. The age and historical context of the patent estate may make a difference in the number of patents and countries covered. Broad surveillance and benchmarking of the global medicine patent landscape is valuable for detecting significant shifts that may occur over time. With improved international medicine patent transparency by companies and data available through third parties, such studies will be increasingly feasible.

Project description:BackgroundIn September 2003, the Canadian government committed to developing legislation that would facilitate greater access to affordable medicines for developing countries. Over the course of eight months, the legislation, now known as Canada's Access to Medicines Regime (CAMR), went through a controversial policy development process and the newspaper media was one of the major venues in which the policy debates took place. The purpose of this study was to examine how the media framed CAMR to determine how policy goals were conceptualized, which stakeholder interests controlled the public debate and how these variables related to the public policy process.MethodsWe conducted a qualitative content analysis of newspaper coverage of the CAMR policy and implementation process from 2003-2008. The primary theoretical framework for this study was framing theory. A total of 90 articles from 11 Canadian newspapers were selected for inclusion in our analysis. A team of four researchers coded the articles for themes relating to access to medicines and which stakeholders' voice figured more prominently on each issue. Stakeholders examined included: the research-based industry, the generic industry, civil society, the Canadian government, and developing country representatives.ResultsThe most frequently mentioned themes across all documents were the issues of drug affordability, intellectual property, trade agreements and obligations, and development. Issues such as human rights, pharmaceutical innovation, and economic competitiveness got little media representation. Civil society dominated the media contents, followed far behind by the Canadian government, the research-based and generic pharmaceutical industries. Developing country representatives were hardly represented in the media.ConclusionsMedia framing obscured the discussion of some of the underlying policy goals in this case and failed to highlight issues which are now significant barriers to the use of the legislation. Using the media to engage the public in more in-depth exploration of the policy issues at stake may contribute to a more informed policy development process. The media can be an effective channel for those stakeholders with a weaker voice in policy deliberations to raise public attention to particular issues; however, the political and institutional context must be taken into account as it may outweigh media framing effects.

Project description:BackgroundDevelopment assistance from governments of high income countries represents the vast majority of international funding for global health. Recent stagnation of this important source of funding may affect attainment of major global health goals. The financial crisis is widely accredited as denting governments' outlay for development aid, as well as citizen's support for aid. Europe has also recently experienced record levels of migration; the so called 'European migration crisis'. This study aims to analyse trends in public attitudes towards development aid in European Union (EU) countries, in the context of the European migrant crisis.MethodsEurobarometer survey data from 2011 (prior to the migrant crisis) and 2015 (at the peak of the crisis) was analysed for 27 EU countries. The outcome variables related to people's levels of support to three statements around the importance of supporting people in developing countries, increasing countries' commitments to aid and willingness to pay extra for products from developing countries. EU Member States were categorised as 'arrival' or 'destination' countries in view of migration routes and numbers of asylum applications per 100,000 population, respectively. Multiple linear regression analysis was performed, adjusting for countries' economic status (gross domestic product per capita).ResultsIn general, support for development aid has increased from 2011 to 2015, but was largely unaffected by migration status when applying the regression model. In 2015, the belief that development assistance is 'very important' was significantly higher in countries where migrants first arrived compared to other EU Member States, with a trend towards this association also apparent in 2011.ConclusionsThe positive trends in public support for development aid are encouraging in an age where economic hardships at home, as well as the tone of national political discourses and rising right wing populism appear to suggest otherwise.

Project description:IntroductionTraditional, complementary and alternative medicine (TCAM) are popular healthcare choices among consumers globally. The latest national data on the use of TCAM practitioners in New Zealand (NZ) were collected over a decade ago. Robust data on the use of natural health products (NHPs) and TCAM practices alongside conventional medicines are not yet available in NZ.ObjectivesThis study aimed to develop and test a bespoke questionnaire (All-MedsNZ) that included comprehensive data collection elements exploring NHPs' and conventional medicines' use.MethodsThis was a questionnaire design study involving expert panel feedback, and engagement with TCAM users, in the development process. This work comprised questionnaire development (stage 1) followed by a questionnaire-testing study (stage 2). The questionnaire was developed on the basis of literature review findings and the research team's expertise. The questionnaire content was then validated by an expert panel comprising practitioners in TCAM and conventional medicine. Then, a two-phase study was utilised to test the questionnaire. Phase 1 involved participants (NHP users) completing the web-based questionnaire and providing feedback by answering probing questions added throughout the questionnaire to evaluate users' comprehension of the questions and to identify issues with the questionnaire. In phase 2, selected participants were interviewed online to gain in-depth insights into issues identified in phase one. Based on these findings, the questionnaire was revised.ResultsThe expert panel (n = 9) confirmed the questionnaire had high face and content validity; most original questions were retained. In the questionnaire-testing study, 95 and 27 participants completed the phase 1 and 2 studies, respectively. Most questions achieved a high response rate of ≥ 90%, and participants had no major issues understanding and answering the questionnaire. Problematic questions were those relating to providing product barcodes and photographs, and information on product costs. Most of the NHPs data entered by participants included the brand/generic name, manufacturer/company name, main ingredient(s) and dose form. Generally, these NHP-related data were of acceptable quality. However, information on the main ingredient(s) of products entered by participants was less satisfactory: approximately one-third of the 143 NHPs recorded in the study had the main ingredient(s) missing or incorrectly stated. Interviews with participants reiterated the issues identified in the phase 1 study. The low response rates for some of the questions were partly due to participants' unpreparedness (i.e. not having NHPs/medicines on hand) to complete the questionnaire. In addition, a lack of clarity for the term 'natural health practitioner' led to confusion among some participants.ConclusionOverall, no major design-, method- or questionnaire-related issues were identified in this development and testing work. The questionnaire demonstrated adequate face and content validity and acceptability among participants. The data collected were reasonably complete and of sufficient quality for analysis. Future studies should pilot the revised All-MedsNZ questionnaire with a larger, nationally representative sample to ascertain its feasibility and utility.

Dataset Information

Why urban citizens in developing countries use traditional medicines: the case of suriname.

Publications

Why urban citizens in developing countries use traditional medicines: the case of suriname.

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