Life in Erunkan, a slum area of Ketu in Lagos, offers a great study in many things. Olanle, popularly called Ijebu, is one of hundreds of commercial motorcyclists (popularly called okada riders) who regularly find a rendezvous in the area. Like his many colleagues, as busy as Ijebu seems to be in his okada-riding business, he never misses an opportunity to stop over in Erunkan to drink alcoholic herbal concoctions from sellers that abound the filthy neighbourhood.
But if Ijebu and his counterparts only take alcoholic agbo (though there are herbal preparations that are non-alcoholic) during their several breaks in a day, there are numerous others who virtually spend their day in the houses and makeshift shops of herbal concoction sellers, drinking themselves to stupor. While investigations have shown that many rely on herbal medicines for managing health problems, there are also those without genuine reasons other than living their addiction by taking the alcoholic concoctions to get the feel-good factor.
Irrational use of herbal medications is, however, not peculiar to Erunkan; it is a nationwide problem, as many Nigerians prefer to patronise herbal medicine sellers whenever health issues arise. From complaints such as malaria, to typhoid, fibroid, virtually all ailments that can afflict the young and old, herbal medicine practitioners are never short of remedies, making them increasingly popular among the people. These are both educated and non-educated, who sometimes combine traditional herbs with modern drugs. In various parts of the country, herbal medicines represent an array of therapies with proven benefits for the prevention and cure of different ailments.
Experts say the phenomenal growth and popularity herbal medicine is enjoying is not peculiar to Nigeria. Around the world, there is increasing awareness and general recognition that traditional medicines, once derided as primitive and substandard, seem to be the mankind’s saving grace. Having undergone a great metamorphosis from ‘witches brew’ to major medicine in the past three decades, herbal therapy is enjoying a new lease of life in many parts of the world, with traditional medicine fast becoming a force to reckon with in terms of input into the world’s overall healthcare delivery system and economy.
Studies have estimated that out of a global population of over 6.3 billion people, about 4 billion patronise herbal plants to meet their primary healthcare needs. In Nigeria, it has been discovered that approximately half those living in urban cities in various parts of 36 states regularly use natural medicine, with the figures far higher among the preponderant locals eking out their living in the rural areas.
The World Health Organisation (WHO) also encourages, recommends and promotes the use of traditional and herbal remedies because they are easily available at low cost, comparatively safe and people have faith in them. According to the WHO, 75 per cent of the world’s population has therapeutic experience with herbal products. It is also projected that more than 80 per cent of the population within developing countries relies on the use of herbal and other traditional medicines for their primary health care due to their lower cost and time tested nature.
Professionals have traced the rising popularity of herbal remedies to increase in the cost of treatment with modern medicine, fear of side effects of modern drugs and appreciation of natural remedies, which represent the alternative healthcare movement.
Irrational use of medicines explained
Although it is an incontrovertible fact that traditional medicines have become an integral part of healthcare delivery, their consumption is also prone to abuse. According to pharmaceutical experts, what rational use of medicines – be they natural or orthodox – entails is very simple. It means the use of right medicine, in the right dosage, for the right ailment, for the right period of time and at the right price. In other words, rational use of medicines revolves around good prescribing and dispensing. Any deviation from these ground rules amounts to irrational use of drugs.
Rational use of medicines requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community. It involves appropriate patient, indication, medicine, prescribing, dosage, dispensing, administration and duration. The concept of ‘rational use of medicines’ also applies to herbal substances and supplements that are used to try to treat or prevent a wide range of diseases. But this is not always so, especially in developing countries with weak or lack of regulatory mechanisms to protect the interest of ordinary masses.
Around the world, irrational use of drugs is a huge problem governments in many countries are still battling to solve. The global health body, WHO, estimated that more than half of all medicines are prescribed, dispensed or sold inappropriately, and that half of all patients fail to take the medicines correctly. This is said to be more complicated in the field of herbal medicine. The situation is worse in natural medicine because of quacks, since many practitioners are not properly trained in herbal medicine and simply continue to practise without proper licensing, which breed other problems such as absence of standardisation and poor quality control mechanism.
Hazards of abusing herbal medicines
Irrational use of medicines, a major challenge facing many health systems across the world, has also given birth to practices that lead to poor health delivery, thus putting patients at risk and result in wastage of scarce resources that could have been used to tackle other pressing health needs. There are lingering issues about overuse, underuse or misuse of herbal medicines, resulting in wastage of scarce resources and widespread health hazards.
Examples of irrational use of herbal medicines include use of too many herbal medicines per patient (poly-pharmacy); inappropriate use often in inadequate dosage for the wrong indications; over-use of herbal medicine when orthodox medicine would be more appropriate; failure to prescribe in accordance with clinical guidelines; inappropriate self-medication, non-adherence to dosing regimens, among others.
Some side effects of herbal medicines, which may be worsened by irrational use, include bleeding, gastro intestinal disturbances, and hypertension. Many combinations of drugs and herbal remedies can cause interactions, since herbal remedies can affect the way drugs act on the body, either blocking their action or increasing their potency.
Factors fuelling irrational use of drugs are as many and varied as herbal products and their producers. Experts explained that the major forces affecting use of herbal medicines emanate from patients, prescribers, the workplace, and the loose supply system, including industry influences, regulation, drug information and misinformation. Patient demands/expectations, misleading beliefs, lack of appropriate health literacy, and ignorance towards health lead to non-compliance, which in turn can trigger irrational use.
On the part of the prescriber, inadequate training, lack of updated information on herbs can also lead to irrational prescribing, which presents as under, over, incorrect, or multiple prescribing; while faulty dispensing can lead to irrational drug use by inaccurate counting, compounding or pouring, inadequate labeling, unsanitary procedures and poor-quality packaging materials.
One profession, many voices
At an interactive forum in Lagos, made possible by the Nigeria Natural Medicine Development Agency (NNMDA), which reports directly to the Federal Ministry of Science and Technology, herbal medicine practitioners showed why sanitising the industry may be a herculean task. Besides singing discordant tunes, herbal medicine experts are perpetually at daggers drawn with one another as various groups, blocs, interests and associations have continued to fight dirty over the years over who should be recognised as the real leaders and custodians of natural medicine knowledge.
It is an open secret that there is a mini civil war brought about by supremacy tussle between groups such as the National Association of Nigeria Traditional Medicine Practitioners (NANTMP), Herbs Sellers Association of Nigeria and other groups. While some practitioners believe that it is professionally wrong to cook traditional medicine and sell by the road side or hawk, others see nothing wrong in this practice.
At the interactive session, an angry Mrs. Modinat Onike, Financial Secretary of ‘Elewe Omo Herbs Sellers Association of Nigeria, strongly called on the government to ban street hawking of agbo (herbs), saying unregistered herbs hawkers put the lives of users at risk by administering wrong dosage and usage to buyers who patronise them. “We, the registered and known Elewe -Omo herb sellers, are more trained than the herbs hawkers. They are not supposed to hawk cooked herbs. It is a wrong practice according to the practice. We don’t cook the agbo (herbs), we rather give the raw herbs and roots to our clients with instructions on usage and preparation,” she said.
How to promote rational use of herbal medicines
The above reasons are why the body has never been able to rise in unison to press for its rights from the government, said Dr. Sam Etatuvie, Director-General of NNMDA. He is, however, optimistic that his efforts towards bringing all practitioners under one umbrella will yield positive result, saying he is currently engaging the warring interest groups to sheathe their sword in the interest of the profession.
Like conventional medicines, he said licensed herbal medicines hold a product license based on safety, quality, and efficacy. “Hence, it is compulsory that they are accompanied by product leaflets that provide comprehensive information on indications, precautions, how to use the product, side effects, how to store the product and regulatory information for safe use,” NNMDA boss said.
“Education, with its various approaches, has a significant role to play in nurturing the rational use of herbal medicines. Educational strategies for both healthcare practitioners and consumers are essential. There should be focus on the development of problem-based training in pharmacotherapy of herbal medicines.
“Training should emphasise on rational prescribing and dispensing of herbal medicines. Public enlightenment through various media – print and electronic media – could help in creating awareness about rational use of herbal medicines. Guidelines on prescribing, dispensing and consumption of herbal medicines should be prepared and followed; all relevant stakeholders should collaborate to get the much needed guideline on the use of herbal medicines,” he said.
The NNMDA boss, a pharmacist, said his agency has contributed towards promoting rational use of herbal medicines through various activities by training traditional medicine practitioners in the six geo-political zones of the country, printing books on medicinal, aromatic and pesticidal plants in Nigeria. “Adopting rational use of herbal medicines is a good way to reduce cases of unnecessary herbal drug interactions, adverse reactions, poly-pharmacy and wastage. It would also promote safety monitoring. It is, therefore, essential to furnish the public, including healthcare professionals, with adequate information to facilitate better understanding of the risks associated with the use of these products and ensure that all medicines are safe and of suitable quality,” Etatuvie said.
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