Integrating Herbal Medicine Into Mainstream Healthcare In .
Agyei-Baffour et al. BMC Complementary and Alternative Medicine (2017) 17:513DOI 10.1186/s12906-017-2025-4RESEARCH ARTICLEOpen AccessIntegrating herbal medicine intomainstream healthcare in Ghana: clients’acceptability, perceptions and disclosureof usePeter Agyei-Baffour1, Agnes Kudolo2, Dan Yedu Quansah3 and Daniel Boateng1*AbstractBackground: Although there are current efforts to integrate herbal medicine (HM) into mainstream healthcare inGhana, there is paucity of empirical evidence on the acceptability and concurrent use of HM, in the formal healthfacilities in Ghana. This study sought to determine client perception, disclosure and acceptability of integratingherbal medicine in mainstream healthcare in Kumasi, Ghana.Methods: A cross-sectional study was conducted from May to August, 2015. Five hundred patients presenting atthe outpatient departments of Kumasi South, Suntreso and Tafo Government Hospitals in Kumasi were randomlyselected. Interviews were conducted with the use of structured questionnaires. A logistic regression analysis, usingbackward selection, was conducted to determine the influence of socio-demographic and facility related factors on theodds of using HM at the facility. All statistical tests were two-sided and considered significant at a p-value of 0.05.Results: Majority of the study respondents were females (64.8%) and the median age was 36 years. Less than half, 42.2%,of the respondents utilized HM services when they visited the health facility. Reasons for using HM at the facility levelincluded ‘being effective’ (24.4%), ‘easy to access’ (25.3%) and ‘being comparatively cheaper’ (16%). About 86% neverdisclosed previous use of HM to their health care providers. Socio-economic status and perception of service provisioninfluenced use of herbal medicines. Respondents who rated themselves wealthy had increased odds of using herbalmedicines at the health facility as compared to those who rated themselves poor (OR 4.9; 95%CI 1.6–15.3).Conclusion: This study shows that integration of herbal medicine is feasible and herbal medicines may be generallyaccepted as a formal source of healthcare in Ghana. The results of this study might serve as a basis for improvementand upscale of the herbal medicine integration programme in Ghana.Keywords: Herbal medicine, Integration, Acceptability, Perception, Disclosure, Mainstream healthcare, Kumasi, GhanaBackgroundAll over the world, different herbal plants, plant extracts,animal products and mineral substances have been usedbased on varying cultural backgrounds [1] as a way tomanage and treat ill-health, prevent and promote health[2]. Herbal Medicine (HM), also known as Complementary Alternative Medicine (CAM) involves ways of treatingand maintaining health that existed before the arrival of* Correspondence: kingdannie@gmail.com1School of Public Health, Kwame Nkrumah University of Science andTechnology, Kumasi, GhanaFull list of author information is available at the end of the articleorthodox medicine [3]. Anthropologic and cross-culturalperspectives suggests that disease episodes that are recognisable are most likely to be treated outside the perimeterof a formal healthcare system [4].HM is culturally acceptable and widely utilized in mostparts of Africa for a wide spectrum of clinical illnesses[5, 6]. In Ghana, knowledge of HM is almost universalin most homes with evidence of increasing usage, [7]and herbal medicines are used for the treatment andmanagement of both acute (cuts, foot rots) and chronicailments (stroke, fevers, and diabetes, cancer) [8]. Inmany parts of the country, herbal medicines are used to The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication o/1.0/) applies to the data made available in this article, unless otherwise stated.
Agyei-Baffour et al. BMC Complementary and Alternative Medicine (2017) 17:513either treat malaria or compliment allopathic anti-malariadrugs [9–12]. Cryptolepis sanguinolenta, also known as‘nibima’, have for instance been popularly mentioned andclinically shown to be efficacious against malaria, with itsherbal tea formulations, trademarked as Phyto-Laria, beingshown to offer 93.5% cure rate in vivo with no signs oftoxicity [9, 13]. Research on pregnant women visitinghealth facilities for anti-natal care also reported use ofherbal medicines for the treatment of abdominal pains,constipation, to protect their pregnancies and forsmooth delivery [14]. Users of HM are mostly initiatedthrough convincing information from the media, familiesor friends about the efficacy of previously used herbalmedicines [15].Use of healthcare has been linked to the belief and perceptions about diseases and healthcare [16]. The use ofherbs have been associated with common experience,perceptions that herbal medicines were effective, delayedmedical care and sufficient knowledge of herbs [14, 17, 18].Factors such as better efficacy, safe usage, easy access andaffordability are also associated with the practice andutilization of herbal medicines over conventional medicines[5, 7, 14, 19, 20]. Other studies have revealed that the useof herbal medicines is independently associated with sociodemographic characteristics such as age, education level,and marital status [17, 18, 21, 22].In Ghana, efforts have been made to amend the NationalHealth Policy to pave way for the integration of herbalmedicine into mainstream healthcare, following the establishment of a policy of herbal medicine practice in 2005[23]. In 2010, the Traditional Medicine Practice Council(TMPC) was set following the release of the 2nd edition ofthe Ghana Herbal Pharmacopoeia (GHP) in 2007 [24]. In2012, HM practice was formally integrated into the mainhealthcare delivery system in Ghana, with a pilot of about18 government facilities nationwide [24]. Trained HerbalMedical practitioners from the Kwame Nkrumah Universityof Science and Technology (KNUST), Centre for Researchinto Plant Medicine and Tetteh Quarshie MemorialHospital in Ghana are licensed to consult and prescribeHM for clients both in the government and private hospitals in Ghana. Although the acceptance level of herbalmedicines continues to increase, the fact still remains,that there is paucity of data on the acceptability andconcurrent application of HM in Ghana. The incidenceof combining CAM with allopathic medicines withoutthe knowledge of health professionals may jeopardizetherapy as well as cause many side effects or adverseevents. This presents important implementation challengesand therefore needs to be assessed. A recent study thatassessed the perception of trainers and stakeholders aboutthe integration in one of the pilot facilities [25] revealed alack of regulatory policy and protocol for integration,leading to different perceptions of the integration andPage 2 of 9called for multi-facility studies to further look into this.Using quantitative methods and representative samplesfrom three implementing facilities, this study was conducted to determine the acceptability, client perceptionsand disclosures related to herbal medicinal use in the publichealth facilities in the Kumasi metropolis.MethodsStudy design and settingA cross-sectional design was utilized to collect data fromMay to August 2015. We selected the Kumasi metropolisfor this study because the Metropolitan Health Directoratewas piloting the concomitant use of herbal and orthodoxmedicine in some selected health facilities.The population in Kumasi is heterogeneous as seen bythe distinct cultural enclaves with representation of almostall the major ethnic groups in Ghana. The population isdominated by Akans, especially Asantes. According to the2010 population census report, Kumasi had inter-censualgrowth rate of 5.4%. The total population of males andfemales in the metropolis is 972,258 residents and1,062,806 residents respectively [26]. The metropolis isendowed with 189 health facilities out of which 91% aremanaged by private individuals. Doctor to patient andnurse to patient ratios are 1:41,606 and 1:7866 respectivelyand about 81% of the population are registered under theNational Health Insurance Scheme (NHIS). Kumasi is theeconomic nerve of Ghana where people from all over theworld converge to do business. Hence findings from studiesconducted in Kumasi could be a fair representation of whatpertains in Ghana.Study population and samplingThe study population included patients who visitedoutpatient departments in public health facilities (KumasiSouth, Suntreso, and Tafo Government hospitals) inKumasi. Patients who voluntarily agreed and consentedwere enrolled.Sample size was estimated using Cochran’s sample size pÞðqÞformula [27], n0 ¼ t2 ðd2: Where t standard normaldeviation 1.96; p prevalence rate (assumed to be 50%);q proportion of target population estimated to accessHM from the facility, i.e. 1 – p (50%); and d degree ofaccuracy, 5%. This gives a total respondent, n, of 384.Making provision for 10% non-response (1.10 384 422), and design effect of (1.2 422 506), the totalsample was approximated to 500. The sample drawnfrom each facility was calculated per their catchmentsizes, resulting in 212, 112 and 174 participants fromKumasi South, Tafo and Suntreso Government Hospitalsrespectively, (See Additional file 1: Table S1).Study participants were recruited using a systematicrandom sampling technique, by defining a random starting
Agyei-Baffour et al. BMC Complementary and Alternative Medicine (2017) 17:513point and a fixed sampling interval. Based on the numberof expected attendance per facility and the period of datacollection, we estimated the average respondents neededper day from each facility. On each day, per facility, thesampling interval, K, was calculated using the expectedattendance and the average respondents needed. Duringthe visit hours, the first participant identified and interviewed as the starting point and the Kth respondent isapproached, starting the count at the selected startingparticipant. This was repeated until the required samplesize was attained.Data collectionData were collected with the use of structured questionnaires (open ended and closed), which were structuredbased on the study variables including acceptability, use,and disclosure of use. The study instruments were pretested in a similar public facility, prior to the main datacollection, to ascertain participants understanding of thequestions before the actual field work started. In circumstances where it became obvious that the respondentsfound it difficult to answer the questions, the researchteam re-structured or reframed the questions to enhanceclarity. The questionnaires were translated into thelocal language (Twi) and back translated into Englishand research assistance were trained to ensure consistencyin questioning of participants to enhance uniformity andminimize bias.Interviews were conducted in serene locations at theOut-Patience Departments (OPDs) of the various healthfacilities. The interviewers guided the respondents toclearly explain the questions to them where necessary,either in English language or Twi. Participants wereassured of confidentiality of their information and weretaken through the informed consent processes for approvalbefore being interviewed. All study protocols were reviewedand approved by the Institutional Review Board of theKwame Nkrumah University of Science and Technology Committee for Human Research Publications and Ethics(CHRPE) and informed consents was sought from allparticipants.Statistical analysisAll statistical analyses were carried out with StatisticalPackage for Social Sciences (SPSS) Version 22 [28]. Priorto data entry, any blank fields or inconsistencies in eachquestionnaire were resolved. General characteristics aresummarized as proportions and mean standard deviation(SD). Bivariate associations were tested using Pearson andordinal (linear) Chi-square for categorical and ordinal datarespectively. Continuous variables were tested using oneway analysis of variance (ANOVA). A logistic regressionanalysis, using backward selection, was also conducted todetermine the influence of socio-demographic and facilityPage 3 of 9related factors on the odds of using herbal medicine at thefacility. Three models were fitted; model one tested theinfluence of socio-demographic variables, model twohealth facility variables and model 3 a combination ofall covariates. All statistical tests were two-sided andwere considered significant at a p-value of 0.05.ResultsBaseline characteristics of study participantsThe median age (25th, 75th percentile) of the subjectswas 36 years (28, 49 years) and majority, 64.8% werefemales, Table 1. Most of the respondents had formaleducation (senior or middle schools). 56.6% of therespondents were married and 80% had either skilled orsemi-skilled jobs. Majority were Christians (85%) andAkans (82.8%).Herbal medicine utilizationAbout 98.4% of the participants had ever used HM andthis was the usual treatment option for 46.2%, Table 2.42.2% of the respondents utilized herbal medicine whenthey visited health facilities and 85.8% of them werehoped to utilized this service in the future. Pharmaceuticalpre-packaged dosage forms were the commonest (54.2%)source of herbal medicinal products followed by selfprepared formulations (33.8%). Pharmaceutical stores andmarket places constituted the most popular outlets fromwhich herbal medicinal products were purchased. Majorityof the respondents used herbal medicines once a week.The median cost of herbal medicine treatment was GHS15.00 (USD 3.49) and majority perceived this cost asaffordable. The median length of time spent to accessherbal medicine in health facilities was 20 min.Clients’ impression, satisfaction and reasons for use ofintegrated herbal medicine services at health facilityAs shown in Fig. 1, most of the respondents were satisfiedwith the integrated HM services at the health facility. Majority, 53% of the respondents indicated that preferencesfor HM would increase if herbal formulations are provento be an effective treatment option whereas 13% believepositive recommendation of herbal medicines may increaseusage. Others believed that people will opt for herbal medicine because of the high cost (11%) and exhaustive accessassociated with orthodox medicines (5%). 11% also statedthat people would prefer to use herbal medicines becauseof its safety and natural propensity.The disclosure between patients and healthcare providerson use of herbal medicineMost, 98.4% of respondents had never shared informationon their use of herbal medicine with orthodox health careproviders, although majority (56.9%) believed it wasimportant to do so for treatment efficacy reasons, Table 3.
Agyei-Baffour et al. BMC Complementary and Alternative Medicine (2017) 17:513Page 4 of 9Frequency(N 500)Percentage(%)health professionals and the media respectively. Somerespondents disclosed that they struggled to obtain information on the dosage and when to take their medications. 256112.2Predictors of herbal medicine usage at the health facility25-3415631.235-449919.845-5410821.6 547615.2Median36Range15-86Table 1 Background characteristics of respondentsVariablesAge, yearsSex, Females32464.8718.2Level of educationNoneBasic education (Primary and JSS)15514.2Professional certificate213.0Senior High School/Middle school2124.2Tertiary4142.410821.6Marital ed/ 20.4Others499.8Wealthy7114.2Moderately Wealthy31062.0Poor11923.8EthnicitySelf-rated socio-economic statusSD Standard deviation; GHS Ghana cedi; JSS Junior secondary schoolReasons for non-disclosure of HM use included ‘beingunnecessary’ (60.7%) and ‘will be insulted’ (7.8%). About42.3% were not aware of availability of HM at the healthfacility, whiles 13.8% and 2.7% obtained information fromEmployment status, self-rated socio-economic status andsatisfaction with services were associated with use ofHM at the health facility in the fully adjusted model(Table 4). The odds of using HM at the health facilitywas higher among respondents who rated themselves aswealthy or as compared to those who rated themselvespoor. Respondents who believed the cost of HM wereaffordable had higher odds of using HM at the facilitythan those who believed otherwise (OR, 6.7; 95%CI, 2.1,21.7). The model statistics shows that model 3 (full model)was much improved as compared to 1 and 2.DiscussionThis study was conducted to explore the use, perceptions,acceptability and disclosures related to the integratedherbal medicine services in the mainstream healthcare inGhana. We found a generally high level of herbal medicine usage among respondents. Almost all respondents inthis study had ever used herbal medicines and most ofthese were pharmaceutical pre-packaged forms. Ourresults corroborates findings of increased use of herbalmedicines in most parts of the world [29–31]. A studyconducted in the Tanga District in Tanzania, also reporteda 42% prevalence of use of herbal medicines [32]. Previousevidence from studies on specific populations have alsoshown high level of herbal medicine use. For example,study of pregnant women in Nigeria, reported a 67.5%prevalence of herbal medicine usage among pregnantwomen [33]. In Ghana, pregnant women are reported touse herbal medicines for the treatment of abdominalpains, constipation and to enhance smooth delivery [14].These results were however dependent on the geographicarea surveyed and the socio-cultural characteristics andethnic background of the surveyed groups.We further found that, although most patients at thepublic health facilities have ever used herbal medicines,not all of them were utilizing the integrated herbal medicine services at the health facility level. 42.2% of people,who patronize public health facilities, are currently utilizing the services of herbal medical practitioners at thehealth facility. This level of acceptability, 3 years into theintegration program, however shows positive indicationsof possible integration of HM into mainstream healthcare. This suggest that, if HM is well integrated intomainstream healthcare, clients could assess both herbaland allopathic treatments in a formal setting for thetreatment and management of both acute and chronicdiseases. Previous evidence shows success from similarintegration programs in other countries [3]. Countries
Agyei-Baffour et al. BMC Complementary and Alternative Medicine (2017) 17:513Table 2 Use of Herbal medicines among study participantsPage 5 of 9Table 2 Use of Herbal medicines among study participants(Continued)VariablesFrequency PercentageN 500Ever used HM49298.4Currently using HM at health facility21142.2Hope to use HM at health facility42985.8 Family members22Herbal medicine is usual treatment option23146.2 Self-financing36372.621042.0 No money required8617.2Member of your family ever provided care with 358HM, Yes71.6 Other295.8Member of your family currently use HM, YesVariablesFrequency PercentageN 500Source of payment when use HM to treat your health condition4.4Length of time spent to access HM services at the facility (minutes) (n 450)Medium of accessing HM apart from health facility 3031963.8 Pharmaceutical pre-packaged dosage forms27154.2 30–6013126.2 Herbalist/spiritual healer formulations418.2 Median20.00 Self-prepared formulations16933.8 Range0.00–60.00 Other193.8183.7GHC Ghana Cedi; HM Herbal medicinePlace HM are purchased (n 492) Hospital Pharmaceutical stores23749.0 Supermarket30.6 Market places10722.1 Itinerant326.6 Other8718.0 Pharmaceutical pre-packaged dosage forms27855.6 Herbalist/spiritual healer formulations234.6Preferred source of HM products Self-prepared formulations.17434.8 Other255.0Frequency of use of HM as treatment option (n 496) Only when sick27955.8 Regularly7915.8 Occasional11224.4 Other306.0Number of times visited health facility in past 12 months Median2 Range0–15Number of times sought herbal treatment from facility in last 12 months Median2 Range0–9Cost of HM usage at the facility, GHC Median15.00 Range0.00–500.00Perception about cost of seeking HM Affordable26352.6 Not affordable13827.6 Reasonable9919.8like China and Sri Lanka have successfully integratedthese two health systems. In China, 95% of general hospitals offering promotional and curative applications havetraditional medicine departments and traditional Chinesemedicine is used for the treatment of over 200 millionoutpatients and almost 3 million inpatients every year [3].Sri Lanka has also evolved as one of the best health caresystems in Asia and has attained health targets almostsimilar to standards in the Western world as a result ofsuccessful healthcare integration [3]. These indicate thatwith the availability of systematic knowledge, comprehensive methodology and rich clinical experiences, herbalmedicines could be used as effective alternatives tocomplement healthcare provision in Ghana.Disclosure of usage of HMWe found that, although most respondents believed thatit is important to disclose the use of herbal medicine forefficacy reasons, majority had never done so. Evidencefrom a systematic review, also confirm a high rate ofnon-disclosure among users of herbal medicines [34].Most of the non-disclosers in our study believed it werenot necessary to do so whiles others felt they would beinsulted by orthodox practitioners for disclosing theiruse of herbal medicines. In a similar study in the UnitedStates, patients reasons for nondisclosure of alternativemedicine use included ‘doctors not enquiring of theiruse of alternative use’ and ‘beliefs that doctors need notknow or would not understand’ [35]. A study by Braunet al. [36], also reported ‘concerns of undesirable responseby the practitioners’, ‘the perception that the practitionerneed not know about their alternative medicine use’, ‘andpractitioners not asking about it’ as major reasons forpatients lack of disclosure of herbal medicines. It is also
Agyei-Baffour et al. BMC Complementary and Alternative Medicine (2017) 17:513Page 6 of 9Fig. 1 Client’s impression and satisfactionbelieved that perceived legitimacy of alternative medicinetreatments affects disclosure [37].Client’s satisfaction and use of HM at the health facilityThis study also found that satisfaction with services provided influenced the use of HM at the health facilities.Patient satisfaction has been suggested as a major qualityoutcome [38, 39] and the extent to which they are satisfied with their health providers may be an importantconsideration in their health behaviour and health careutilization [40, 41]. Our study found a high level of satisfaction with services provided to herbal medicines usersat the health facilities. Majority of study subjects wereimpressed with the service provision of Herbal Medicalpractitioners.Most of them also believed herbal medical services wereaffordable, although this could stem from a general perception in the Ghanaian community, that, herbal medicine isless expensive than orthodox medicines. In rural communities, herbal practitioners are even willing to accept delayed payment, payment in kind such as fowls, agriculturalseeds, goats, palm oil, salt, or palm wine, or in some casespatients can negotiate the amount [42]. Buor [43] alsoargued that herbal medicines are relatively cheaper thanmodern medicines. This assumption could however holdat the community level, but at the health facility level, withthe advent of NHIS, subscribers of the NHIS scheme willsee the services of herbal medical practitioners as expensive. The current services at the health facilities are notcovered by health insurance. More than 75% paid for thecost of HM by self-financing and the median cost of HMtreatment at the facility among users in this study wasGHS 15.00 (USD 3.49). It could therefore be postulatedthat the patronage of HM could increase if the servicesare covered by the health insurance scheme. Asobserved in this study, inactive NHIS members weremore likely to utilize HM at the health facility as compared to active NHIS members and therefore the extentof utilization could improve if the services are coveredby the NHIS [15].Predictors of use of herbal medicines at the health facilityThis study found that respondents who were semi-skilledhad decreased odds of utilizing HM services as comparedto those who were unemployed. The study also observedincreased propensity of usage of HM among participantswho rated themselves wealthy as compared to those whorated themselves poor. Employment and socio-economicstatus were also significantly associated with utilization ofHM in the bivariate analysis (See Additional file 1: Table S2).Evidence from some national surveys have also shownan association between higher socio-economic statusand use of CAM, although this was not universal acrossall racial/ethnic groups [44]. The use of the integratedHM services among high socio-economic class in thissetting, could however be due to their ability to pay fortheir services, which are not covered by the NHIS.Strength and limitationsThis study provides important quantitative data on theacceptability, use and perceptions of clients on the integrated herbal medicines services in public health facilitiesin Ghana. The availability of such finding is important toinform and guide the scale up of the programme. The useof participants from three facilities in the pilot programmeenhances the generalizability of the study findings andstrengthen the evidence for policy advice. Dwelling onprevious experiences, this study might suffer some recallbias. We however ensured that appropriate questions wereused to tease out responses, thereby ensuring that this bias
Agyei-Baffour et al. BMC Complementary and Alternative Medicine (2017) 17:513Page 7 of 9Table 3 Disclosures between patients and healthcare providerson use of herbal medicineTable 4 Multivariable logistic regression analyses of factorsinfluencing use of herbal medicineVariablesCovariatesFrequencyN 500PercentageEver disclosed or share information on HM used with the health careproviderModel 1 AOR Model 2 AOR Model 3 AOR[95% CI][95% CI][95% CI]Socio-demographic factorsEmployment Yes5410.8 No Unemployed1142885.6 Can’t tell Skilled0.9 [0.5, 1.7]0.7 [0.2, 2.4]183.6 Semi-skilled0.4[0.2, 0.7]**0.1[0.04, 0.4]**–Opinion about the importance of disclosure of HM to health careproviders (n 51)Religion Safety1223.5 Efficacy Christian12956.9 Herb-drug interactions Muslim815.73.1 [1.4,6.5]** Other23.9 Traditional/ None1.7 [0.7, 3.9]Reasons for not disclosing use of HM tohealthcare provider (n 422)Marital status Single337.8 It will not be accepted Married/ Co-habitation0.6 [0.4, 1.0]6114.5 Divorced/Widow1.0 [0.5, 2.1] It is not necessary25660.7 Other reasons7217.1Source of information about availability of HM at the facility (n 485)–1 I will be insultedSelf-rated socio-economic status Poor11 Wealthy8.3[4.0, 17.0]***4.9[1.6, 15.3]** Moderately wealthy4.0[2.2, 7.1]***10.9[7.0, 21.9]** Relatives255.2 Friends193.9 Health professionals6713.8 Media132.7 Not aware20542.3 Other15632.2 Dissatisfied/Verydissatisfied11306.0 1.3[0.4, 4.0]7.3[2.2, 23.9]** Very satisfied21543.01.1[1.0, 1.9]*1.1[0.4. 2.9]** Not Affordable1– Affordable/Reasonable6.7[2.1, 21.7]**Often struggle to get information on howto take medications when using HMPerceive relationship with health providers Cordial Supportive22945.8 Hostile112.2 Other459.0HM herbal medicineis reduced to almost negligible. Also, important information on the point or state of disease condition (mild,serious or worse) where patients consider leaving herbaltreatment was not assessed in this study. We recommendfurther studies to look at the point or state of diseases andthe consideration of HM as well as expanding the studyto cover other regions to gain broader insight into thesubject matter.ConclusionWe found that 42.2% of the study participants who patronized public health facilities, sort for the services of herbalmedical practitioners at the health facility. Three years intothe integration programme, this evidence shows aHealth service related factorsSatisfaction with the services SatisfiedPerception about cost of seeking HMDo not have healthinsurance1.9 [0.9, 3.5]2.2 [1.0, 4.9]*AUC (95% CI)0.70(0.66, 0.75)0.85(0.81, 0.89)0.91(0.88, 0.94)R20.180.500.61 2 Log likelihood607.14405.00345.77OUTCOME use of herbal medicine services at the facility; HM Herbal medicine;AOR Adjusted odds ratio; *p 0.05; **p 0.01; ***p 0.001promising level of acceptability of use of HM at the healthfacility. However, it is an undeniable fact that there are gapsin awareness and reluctance in disclosure to allopathichealth providers. Majority of the respondents did not disclose the use of herbal medicines. Whiles this study points
Agyei-Baffour et al. BMC Complementary and Alternative Medicine (2017) 17:513towards a possible integration of herbal medicines withallopathic care, there is the need for general education andorientation of health service providers and clients on theavailability of HM service in public health facilities. Findingsfrom this study also suggest the need for further educationof health providers on the legitimacy and acceptabilityof herbal medicine to run concurrently with orthodoxmedicine.2.Additional file6.Additional
Health Policy to pave way for the integration of herbal medicine into mainstream healthcare, following the estab-lishment of a policy of herbal medicine practice in 2005 [23]. In 2010, the Traditional Medicine Practice Council (TMPC) was set following the release of the 2nd edition of the Ghana
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