Sarawak Journal of Pharmacy 1 (2015) 41-57

View on Traditional Complementary Medicine of Outpatient in Miri Hospital Voon Yit Kian1, Zuklifli bin Mansoor1, Azarin Hanim Abdul Aziz1, Ahmad Syafiq Ahmad Izani1, Kuan Hsieng Yew1, Ong Woei Jye1, Kamarudin Ahmad1 Miri Hospital Pharmacy Department

1

Corresponding author name and email: Kamarudin Ahmad (kamarudin_a @moh.gov.my) Introduction: Complementary and alternative medicine widely used as self-care to treat illness or to promote own health especially in developed countries. In Malaysia, medical practised in diverse ethnicity, such as Chinese Traditional Medicine, Ayuverda, Qi Gong. Affirmed effectiveness towards complementary and alternative medicine shown association with demographic feature and purpose of use of Complementary and Alternative Medicine in common severe medication for instance Diabetes Mellitus, Hypertension. This may contribute psychosocial factor to severe medication compliance.

Objectives: This study introduced to study the purpose of the use of Complementary and Alternative Medicine and its sensed effectiveness in severe illness management among outpatients in Hospital Miri.

Methods: The study designed as cross-sectional study. 245 outpatients adult age more than 18 years old with severe illness recruited voluntarily into study and interviewed face-to-face using NAFKAM International TCAM Questionnaire (I-TCAM-Q). This tool comprises of three items on current status of TCAM use, demographic and view.

Results and Discussion: Indian is minor ethnic group in Sarawak and the study group in this study (3.5%) whereas other ethnic group like Chinese (35.5%), Malay (34%), and other Bumiputera (27%) responded.

Half of the respondents claim use of herbal medicine, 41

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Sarawak Journal of Pharmacy 1 (2015) 41-57

supplement and self-help practices besides prescribed medication regardless of race. Level of education and social economic status showed association with prevalence of herbal medicine and supplement usage significantly with p value 60 19 (9.5%) 12 (63.2%) Level of Education Primary 29 (14.5%) 17 (58.6%) Secondary school 122 (61.0%) 53 (43.4%) 0.181* University 46 (23.0%) 27 (58.7%) Non Formal Education 3 (1.5%) 1 (33.3%) Monthly household income RM3000 37 (18.5%) 18 (48.6%) Occupation Professional 68 (34.0%) 33 (48.5%) Non-Professional 62 (31.0%) 36 (58.1%) 0.084 Self Employed 44 (22.0%) 14 (31.8%) Student 6 (3.0%) 3 (50.0%) Retired 20 (10.0%) 12 (60.0%) Underlying Disease Cardiovascular Disorders 63 (31.5%) 30 (47.6%) Endocrine Disorders 29 (14.5%) 15 (51.7%) 0.149 Respiratory Disorders 28 (14.0%) 11 (39.3%) Endocrine & Cardiovascular Disorders 25 (12.5%) 8 (32.0%) Bone & Joint Disorders 13 (6.5%) 7 (53.8%) Others 42 (21.0%) 27 (64.3%) *Fisher’s exact test ** Health care providers include physicians, chiropractors, homeopathy, acupuncturist, traditional Malay and Chinese medicine practitioners, ayurveda, spiritual healers and herbalists

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Sarawak Journal of Pharmacy 1 (2015) 41-57

Table 5 Association of patients’ socio-demographic characteristics with the use of herbal medicine and dietary supplements n (%) Yes P-value Sex Male 115(57.5%) 74(64.3%) 0.259 Female 85(42.5%) 48(56.5%) Race Malay 71 (35.5%) 43 (60.6%) Chinese 68 (34.0%) 45 (66.2%) 0.566 Indian 7 (3.5%) 3 (42.9%) Others 54 (27.0%) 31 (57.4%) Age 16-30 30 (15.0%) 16 (53.3%) 31-45 78 (39.0%) 42 (53.8%) 0.105 46-50 73 (36.5%) 49 (67.1%) >60 19 (9.5%) 15 (78.9%) Level of Education Primary 29 (14.5%) 11 (37.9%) Secondary school 122(61.0%) 78 (63.9%) 0.042* University 46 (23.0%) 31 (67.4%) No Formal Education 3 (1.5%) 2 (66.7%) Monthly household income RM3000 37 (18.5%) 34 (27.9%) Occupation Professional 68 (34.0%) 50 (73.5%) Non-Professional 62 (31.0%) 37 (59.7%) 0.000 Self Employed 44 (22.0%) 16 (36.4%) Student 6 (3.0%) 2 (33.3%) Retired 20 (10.0%) 17 (85.0%) Underlying Disease Cardiovascular Disorders 63 (31.5%) 37 (58.7%) Endocrinologic Disorders 29 (14.5%) 15 (51.7%) 0.005 Respiratory Disorders 28 (14.0%) 16 (57.1%) Endocrine & Cardiovascular Disorders 25 (12.5%) 23 (92.0%) Bone & Joint Disorders 13 (6.5%) 4 (30.8%) Others 42 (21.0%) 27 (64.3%) *Fisher’s exact test

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Sarawak Journal of Pharmacy 1 (2015) 41-57

Table 6 Association of patients’ socio-demographic characteristics with self help practices n (%) Yes P-value Sex Male 115(57.5%) 81(70.4%) 0.391 Female 85(42.5%) 55(64.7%) Race Malay 71(35.5%) 46(64.8%) Chinese 68(34.0%) 49(72.1%) 0.189 Indian 7(3.5%) 7(100.0%) Others 54(27.0%) 34(63.0%) Age 16-30 30(15.0%) 22(73.3%) 31-45 78(39.0%) 54(69.2%) 0.845 46-50 73(36.5%) 48(65.8%) >60 19(9.5%) 12(63.2%) Level of Education Primary 29(14.5%) 20(69.0%) Secondary school 122(61.0%) 77(63.1%) 0.162* University 46(23.0%) 37(80.4%) No Formal Education 3(1.5%) 2(66.7%) Monthly household income RM3000 37(18.5%) 31(83.8%) Occupation Professional 68(34.0%) 43(63.2%) Non-Professional 62(31.0%) 46(74.2%) 0.613* Self Employed 44(22.0%) 28(63.6%) Student 6(3.0%) 4(66.7%) Retired 20(10.0%) 15(75.0%) Underlying Disease Cardiovascular Disorders 63(31.5%) 39(61.9%) 0.828 Endocrinologic Disorders 29(14.5%) 19(65.5%) Respiratory Disorders 28(14.0%) 20(71.4%) Endocrinologic& Cardiovascular Disorders 25(12.5%) 18(72.0%) Bone & Joint Disorders 13(6.5%) 9(69.2%) Others 42(21.0%) 31(73.8%) *Fisher’s exact test Purpose of CAM use

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Table 7 The use of CAM and its purpose Visiting CAM healthcare providers For Acute Illness To treat long term health condition To improve well being Use Of Herbal Medicine and Dietary Supplements For Acute Illness To treat long term health condition To improve well being Self Help For Acute Illness To treat long term health condition To improve well being *Fisher’s exact test

n 98

Yes (%)

P value

16(16.30) 31(31.60) 51(52.00)

0.000

5(4.10) 28(23.00) 89(73.00)

0.000*

16(11.80) 31(22.80) 89(65.40)

0.000

122

136

Table 8 The use of CAM and its perceived effectiveness n Yes (%) Visiting CAM healthcare providers 98 Very 33(33.70) Somewhat 59(60.20) Not at all 3(3.10) Don’t know 2(2.00) Use Of Herbal Medicine and Dietary 122 Supplements Very 35(28.70) Somewhat 80(65.60) Not at all 1(0.80) Don’t know 6(4.90) Self Help 136 Very 51(37.50) Somewhat 76(55.90) Not at all 3(2.20) Don’t know 5(3.70) *Fisher’s exact test

P value

0.000*

0.000*

0.000*

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Discussion In demographic feature, the number of male respondent is slightly higher than female in to visit physician in last 12 months followed by traditional Chinese medicine and traditional Malay medicine during this study. In general, female gender had been associated with use of TCAM in many studies (18). In comparison with baseline study in Malaysia asthmatic population shows that female were more likely to uses TCAM than men, which contradicts with this study (19, 20). Since the male population in Miri is higher than female, the result from the gender comparison is justifiable (10).

Respondents with education level up till secondary school and university are more likely to visit physician, followed by TCM, TMM and herbalist. These numbers show that higher educational levels of the respondent also play a major role in TCAM in their daily life. In contrast, poverty status doesn’t show any prevalence with other studies (18) found that higher income was prior in use of TCAM as ways to improve health and well-being (18). However poverty status did not influence the preference of the respondents towards the TCAM (19).

Visiting Traditional Chinese Medicine (TCM) practitioner is one of the most popular choice uses by patient in Malaysia which is consistent with the finding from WHO Traditional Medicine Strategy 2000- 2005 (8). An estimated of US$ 500 million spent each year on TCAM alone in Malaysia. Chinese Medicine (CM) has its origin more than 2500 years ago,

which influenced by the teachings and written works of great herbalists,

acupuncturists, philosophers and physicians which further enlarge people belief in TCM (9, 21). Majority of respondent in this study is Chinese which often seek TCM practitioner however TCM is also popular among Malay, Indian and the Native. TCM highlight on restoring balance to body, where in disease state the opposing life forces of yin and yang were not in balance, this might explain the preference of the choice TCM for treatment of long-term health condition by patient as restoring balance to the body is a long-term approach to the body (22).

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Our data also show scarcity of users in Ayurveda and Homeopathy because of lack of practitioner providing service. Siti ZM et al (2009) found that both Ayurveda and Homeopathy is not popular in Malaysia where less than 2% of population use the modalities for health problem and maintaining health (13).

Herbs are the most popular supplements among our respondents. Similar study by Siti ZM et al (2009) shows that herbs commonly used where more than 20% of population use herbs for health problem as well as health maintenance (8).

Praying is one of the most popular self-help practice, one of the reason that could explain the high popularity of this practice could be because of majority of the study respondent are Malay (35.5%) and most Malay are Muslims that practice performing prayer regularly and are familiar to the practice(8). Study conducted by Reza MF et al (2002) have shown the physical activities involved in performing salat could helps in the rehabilitation process in disabled geriatric patients by improving blood flow and increasing muscoskeletal fitness which explain could the scientific theory behind the high perceived effectiveness behind self-praying (23). This is in contrast with study conducted by Siti ZM et al. (2009), which less than 3% of population use prayer for health reason on their approach for health problem and health maintenance.

Self-help practice such as Qi gong also received a high perceived effectiveness which is consistent with the review by Rogers CE et al (2009) where they have shown that Qi gong are able to improve physical function, reduce blood pressure, fall risk, depression and anxiety (24).

Acupuncture rated to have a high perceived effectiveness in relative to other modalities. In China, it have exist for more than 3000 years where needles is use in this modalities to remove the blockage of Qi which result in disease.(25) Acupuncture is a

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collection of different technique which includes acupressure, Shiatsu, auriulotherapy, moxibustion and many more (25). In recent year, evidence have supported the neurochemical basis of acupuncture where relative to deep insertion and continuous manipulation the use of electrical stimulation shown to be even more effective in triggering the release of neuropeptide. It has shown to be effectives to control various types of pain, depression, addiction, gastrointestinal disease, and stroke (25).The scientific evidence presented supported the respondent perceived effectiveness on acupuncture.

Limitation

The data of this study collected through interview where the participant needed to recall the use of TCAM from the past 6 month thus recall bias is unavoidable. Besides, selfreported study may not represent the actual result as patient could have overstate or understate the effectiveness of the medical intervention. We try to lessen this bias by conducting face-to-face interview by a trained interviewer, Finally, this study is a community based survey where the participants are Hospital Miri outpatient population and thus because of the difference in demographic feature of community of East and West Malaysia the study cannot truly represent the national population. However the special racial diversity in Sarawak is worth to explore and researched since no baseline data is available on the pattern of TCAM use in Sarawak.

Conclusion

In the local community, traditional remedies commonly sought after to accelerate the process of healing and in maintaining health. It has evolved to reflect different philosophical backgrounds and cultural origins. The practice of modern medicine may be widespread but the use of traditional medicine is still popular and because hope to a better life.

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