Prevalence, determinants and outcomes of traditional, complementary and alternative medicine use for hypertension among low-income households in Malaysia and the Philippines

Abstract

Background Traditional, complementary and alternative medicine (TCAM) is used to treat a broad range of conditions. In low- and middle-income countries (LMICs), TCAM use is particularly common among those with low socio-economic status. To better understand the patterns and impact of TCAM use on the management of non-communicable diseases in these populations, this study examines the prevalence and characteristics of TCAM use for hypertension, its determinants, and its association with hypertension management outcomes and wellbeing among low-income adults in two Southeast Asian countries at different levels of economic and health system development, Malaysia and the Philippines. Methods We analysed cross-sectional data from 946 randomly selected adults diagnosed with hypertension from low-income rural and urban communities in Malaysia (n = 495) and the Philippines (n = 451). We compared the prevalence, characteristics and household expenditure on TCAM use between countries and used multi-level, mixed-effects regression to estimate associations between TCAM use and its determinants, and five hypertension management outcomes and wellbeing. Results The prevalence of TCAM use to manage hypertension was higher in the Philippines than in Malaysia (18.8% vs 8.8%, p < 0.001). Biologically-based modalities, e.g. herbal remedies, were the most common type of TCAM used in both countries, mainly as a complement, rather than an alternative to conventional treatment. Households allocated around 10% of health spending to TCAM in both countries. Belief that TCAM is effective for hypertension was a positive predictor of TCAM use, while belief in conventional medicine was a negative predictor. TCAM use was not strongly associated with current use of medications for hypertension, self-reported medication adherence, blood pressure level and control, or wellbeing in either country. Conclusions A small, but significant, proportion of individuals living in low-income communities in Malaysia and the Philippines use TCAM to manage their hypertension, despite a general lack of evidence on efficacy and safety of commonly used TCAM modalities. Recognising that their patients may be using TCAM to manage hypertension will enable health care providers to deliver safer, more patient-centred care.

Self-care practices for common acute conditions in the Philippines: a scoping review

“…Despite this legislation, the Philippines still has challenges to better integrate T&CM in the formal health system compared to other countries in the Western Pacific Region such as China, Japan, and the Republic of Korea that already have policies and regulatory systems in place (Park and Canaway, 2019). The lack of effectiveness and safety studies, despite the widespread use of T&CM highlight the need to invest in research that assesses their safety, effectiveness and interactions with other T&CM modalities and Western medications (Palileo- Villanueva et al, 2022). Data on these can be used to inform how T&CM should be integrated into the health system.…”

The policy environment of self-care: a case study of the Philippines

“…However, since then, no TCAM bill has been passed into law, and a strong TCAM regulation is still lacking in the country. Similarly, most of the published TCAM studies in the country still focused on drug development studies and studies on the behavioural aspects of TCAM use ( Palileo-Villanueva et al. , 2022 ).…”

Safety classification of herbal medicine use among hypertensive patients: a systematic review and meta-analysis

“…Several behavioral risk factors are associated with nonadherence to medication (Burnier and Egan, 2019); complementary and alternative medicine (CAM) use is believed to be one of the contributing factors (Krousel-Wood et al, 2004;Krousel-Wood et al, 2010;Dhar et al, 2017). Among different types of CAM, herbal medicine (HM) is the most popular treatment used by HTN patients (Ali-Shtayeh et al, 2013;James et al, 2018b;Kifle et al, 2021;Palileo-Villanueva et al, 2022). HM has gained popularity as a treatment option for HTN, driven by personal beliefs, preference for natural remedies, cultural traditions, and barriers to accessing conventional care (Liwa et al, 2014;Rahmawati and Bajorek, 2017;Azizah et al, 2021).…”