International Journal of Pharmaceutical and Phytopharmacological Research
ISSN (Print): 2250-1029
ISSN (Online): 2249-6084
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Herbal Medicine: Education and Occupation Influences Its Practice among Residents of Port Harcourt, South-South Nigeria |
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Emuesiri Goodies Moke1*, Emuesiri Kohworho Umukoro1, Jerome Ndudi Asiwe2,3, Adrian Itivere Omogbiya1, Earnest Oghenesuvwe Erhirhie4, Benneth Ben-Azu1, Fortune Ufuoma Anieh1 |
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1Department of Pharmacology and Therapeutics, Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria. 2Department of Physiology, Faculty of Basic Medical Sciences, University of Ibadan, Ibadan, Nigeria. 3Department of Pharmacology, Faculty of Basic Medical Sciences, PAMO University of Medical Sciences, Port Harcourt, Nigeria. 4Department of Pharmacology and Toxicology, Faculty of Pharmaceutical Sciences, Chukwuemeka Odumegwu Ojukwu University, Awka, Nigeria. |
ABSTRACT
Herbal medicine plays an important role in Nigerian society based on its increased patronage. It encompasses the use of naturally occurring, plant-derived substances which are employed to prevent, manage, or treat illnesses. This study was conducted to assess the knowledge, attitude, and practice (KAP) of herbal medicine among the residents of Port Harcourt, Rivers State, Nigeria. A descriptive cross-sectional survey was carried out on 280 residents using self-administered questionnaires comprising demographic information and questions on the knowledge, attitude, and practice of herbal medicine. Data analysis was conducted using SPSS version 21.0 on 244 valid questionnaires. The prevalence of the use of herbal medicine among the respondents was 88.9%, as many (79.1%) believed that best treatment outcomes can be achieved when herbal medicine is used in combination with conventional medicine. Associations between respondents’ demographic characteristics and overall KAP of herbal medicine showed that the level of education and occupation have a significant relationship with the respondents’ practice of herbal medicine. There is a high level of knowledge, attitude, and practice of herbal medicine among residents of Port Harcourt, Rivers State, Nigeria, and education and occupation influence the practice of herbal medicine.
Key Words: Herbs, Conventional medicine, Herb-drug interaction, Efficacy
INTRODUCTION
Traditional herbal medicines are naturally occurring, plant-derived substances with minimal or no industrial processing that have been used to treat illness within local or regional healing practices [1, 2]. A large proportion of the global population has been reported to used traditional herbal medicine, as reports have shown that over 80% of the people in the developing world patronize medicinal plant use in the ailment’s treatment [3]. The World Health Organization (WHO) welcomes inventions around the world, which include traditional medicines, repurposing drugs, and developing new therapies in the quest for potentially treating various diseases and infections [4].
Herbal medicines comprise herbs and herbal preparations which contain parts of plants or other plant materials as active ingredients which are employed to prevent, improve, or treat illnesses [5]. Plants and herbs can be processed and can be taken in different ways and forms, as a whole herb, essential oils, ointments, teas, syrup, salves, rubs, capsules, and tablets that contain ground or powdered form of a raw herb or its dried extract [6]. They can be used to alternatively treat alleviating several health problems like high blood pressure, diabetes, heart diseases, and even certain types of cancer [7].
A major driving force for herbal drug use is the opinion that ‘they are safe because they are natural and have little or no side effects than prescription drugs' [7]. The efficacy and use of medicinal plants significantly contribute to the disclosure of their therapeutic properties. So, even if their chemical constituents are not always completely known, they are frequently prescribed [8]. Increased Interest in herbal medicine is a result of claims of effectiveness, its natural form of therapy, high cost and increased side effects of most modern drugs, and inclination towards self-medication [3]. Medicinal herbs or plants are well known to be an essential potential source of therapeutics or curative aids [8, 9]. The medicinal and therapeutic effects of various herbal plants have been reported in different researches as being antifungal [10], antidiabetic [11-13], anticancer [14, 15], antibacterial [16], anti-inflammatory [17, 18], hepatoprotective [19], antioxidative [20], wound healing [21, 22], antimalarial [23, 24], antidiarrhoeal [25], CNS effects [26, 27], amongst others.
In most countries, herbal medicines and related products are introduced into the market without any mandatory safety or toxicological evaluation. In West Africa, commonly in Nigeria, over 1000 medicinal plants are being used in herbal therapy, although most of their medical effects are yet to be investigated [8]. The lack of clinical trials on traditional herbal and drugs the deficit of the well-documented safety profile of herbal medicine is a major drawback for its continuous use globally [3, 4]. Numerous researches have pointed out possible side effects of herbal medicine if taken irregularly, in excessive amounts, or combined with some other medicines [7, 28].
Although herbal medicine plays an important role in Nigerian society, data on the knowledge, attitude, and practice of its use, especially by residents in Port Harcourt is limited, hence, the need for this study. This study will be of immense benefit in designing and implementing government policies relating to the adoption of herbal medicine for use. It will also be beneficial to the consumers and herbal medicine providers in appreciating the strengths and herbal medicines weaknesses in Nigeria.
MATERIALS AND METHODS
Study design
This study adopted a cross-sectional survey among residents of Port Harcourt to determine the knowledge, attitude, and practice (KAP) of the use of herbal medicine between March and May 2019. Study participants include residents of age 18 years and above within Port Harcourt. The data of the study were collected with the use of 280 questionnaires which captured information on socio-demographic characteristics of the respondents (Section A), and questions that evaluated their use of herbal medicine (Section B through Section D) of which were structured on a four-point scale response option, ranging from strongly agree (4) to strongly disagree (1). The ‘Ethical Committee’ of the Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria gave an approval. Informed oral consent was obtained from the individual respondent as they willingly filled out the well-structured questionnaires.
Data analysis
The questionnaires administered were coded serially after proper sorting and cross-checking. For analysis of data, the Statistical Package for Social Sciences (SPSS) version 21.0 software was used. Using descriptive statistics including standard deviation, percentage, mean, frequency, and parametric statistics including, ANOVA statistics and t-test, obtained data were analyzed. Mean and standard deviation (SD) were used to examine the extent of the knowledge, attitude, and practice of herbal medicine among respondents. The benchmark for estimating the extent was 2.50 out of a total of 4. This means that result with a mean rating ≥ of 2.50 was assigned as “high” while a score of < 2.50 was categorized as “low”. The One-Way Analysis of Variance (ANOVA)and independent samples t-test was used to compare the level of attitude, knowledge, and practice of herbal medicine among respondents based on their social-demographic data. This was done at a 0.05 level of significance.
RESULTS AND DISCUSSION
A total of 280 questionnaires were administered to the respondents, of which only 244 were filled, giving a response rate of 87.1%. One hundred and fourteen respondents (46.7%) were males, 145 (60.4%) were single. The majority of them (164; 68.3%) had tertiary education, while 52 (22.6%) were unemployed (Table 1).
Table 2 shows respondents’ knowledge of herbal medicine. The majority (96.8%) claimed that natural products can be used as medicine, and 228 (93.5%) claimed to be aware of the safety concerns with herbal medicine. Two hundred and six (84.4%) believed that herbal medicine could be used in the treatment of chronic diseases, while 192 (78.7%) opined that herbal medicine is superior to conventional medicine.
Table 1. Social-demographic data of respondents
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Variable |
Frequency |
Percentage |
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Gender (n=244) |
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|
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Male |
114 |
46.7% |
|
Female |
130 |
53.3% |
|
Marital Status (n=239) |
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|
|
Married |
66 |
27.6% |
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Divorced |
20 |
8.4% |
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Widowed |
8 |
3.3% |
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Single |
145 |
60.7% |
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Level of Education (n=240) |
|
|
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No Formal Education |
23 |
9.6% |
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Primary Education |
25 |
10.4% |
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Secondary Education |
28 |
11.7% |
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Bachelor’s degree (B.Sc.) |
124 |
51.7% |
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Master Degree (M.Sc.) |
26 |
10.8% |
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Doctorate (Ph.D.) |
14 |
5.8% |
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Occupation (n=230) |
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|
|
Unemployed |
52 |
22.6% |
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Self-Employed |
69 |
30.0% |
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Civil Servant |
42 |
18.2% |
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Trader |
39 |
17.0% |
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Farmer |
28 |
12.2% |
Table 2. Respondents’ knowledge of herbal medicine
|
S/N |
Statement |
Strongly agree n (%) |
Agree n (%) |
Disagree n (%) |
Strongly disagree n (%) |
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1 |
Natural products can be used as medicines |
190(77.9) |
46(18.9) |
2(0.8) |
6(2.5) |
|
2 |
I am aware of safety concerns with herbal medicines or possible interactions with conventional drugs |
138(56.6) |
90(36.9) |
12(4.9) |
4(1.6) |
|
3 |
I wish to know more about these herbal products |
120(49.2) |
100(41.0) |
21(8.6) |
3(1.2) |
|
4 |
The use of herbal medicine by patients could help in the treatment of chronic diseases |
112(45.9) |
94(38.5) |
23(9.4) |
15(6.1) |
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5 |
The use of herbal medicine by patients with chronic conditions could help in reducing the dose of their conventional medicine |
104(42.6) |
100(41.0) |
29(11.9) |
11(4.5) |
|
6 |
Herbal medicine is superior to conventional medicine |
89(36.5) |
103(42.2) |
33(13.5) |
19(7.8) |
|
7 |
Herbal remedies alone are sufficient |
102(41.8) |
90(36.9) |
28(11.5) |
24(9.8) |
Respondents’ attitude towards herbal medicine is shown in Table 3. Two hundred and twelve (86.9%) reported that herbal medicine is as effective as conventional drugs, 210 (86.1%) believed natural remedies have lesser side effects, and 193 (79.1%) thought that herbal medicine should be used in conjunction with conventional medicine to achieve best treatment outcome.
Table 3. Respondents’ attitude towards herbal medicine
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S/N |
Statement |
Strongly agree n (%) |
Agree n (%) |
Disagree n (%) |
Strongly disagree n (%) |
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1 |
Herbal medicine is as effective at treating physical ailments as conventional drugs. |
111(45.5) |
101(41.4) |
23(9.4) |
9(3.7) |
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2 |
There are fewer side effects when taking natural remedies |
108(44.3) |
102(41.8) |
28(11.5) |
6(2.5) |
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3 |
Herbal medicine involves natural plant formulas that are healthier than taking drugs given by the medical doctor |
96(39.3) |
103(42.2) |
33(13.5) |
12(4.9) |
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4 |
Herbal medicine builds up the body’s defenses and promotes self-healing |
87(36.7) |
115(48.5) |
29(12.2) |
6(2.5) |
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5 |
Herbal medicine is better for your body than pharmacological drugs. |
76(31.1) |
116(47.5) |
40(16.4) |
12(4.9) |
|
6 |
Herbal medicine should only be used after conventional medicine has shown little benefit. |
80(32.8) |
100(41.0) |
56(23.0) |
8(3.3) |
|
7 |
I will not use herbal medicine until it is subject to more rigorous scientific testing. |
74(30.8) |
108(45.0) |
40(16.7) |
18(7.4) |
|
8 |
Using herbal medicine, the body can heal itself without pharmacological drugs |
85(34.8) |
97(39.8) |
47(19.8) |
15(6.1) |
|
9 |
The physician who uses herbal medicine will have more success with helping a patient's medical concerns. |
92(37.7) |
102(41.8) |
36(14.8) |
14(5.7) |
|
10 |
Herbal medicine should be used in conjunction with conventional medicines for the best treatment outcome. |
97(39.8) |
96(39.3) |
36(14.8) |
15(6.1) |
Table 4 illustrates the practice of herbal medicine by respondents. A great proportion (215; 88.9%) reported to have used herbal products as medicine, 193 (79.9%) reported that they will recommend its use to others, and 170 (70.9%) revealed that they informed their herbal medicine practitioner of double use. While most (194; 81.5%) considered herbal medicine as cheaper, 79.1% (189) deemed it more accessible to them hence, their easy usage.
Table 4. Respondents’ practice of herbal medicine.
|
S/N |
Statement |
Strongly agree n (%) |
Agree n (%) |
Disagree n (%) |
Strongly disagree n (%) |
|
1 |
I have used the herbal product as a medicine |
112(46.3) |
103(42.6) |
18(7.4) |
9(3.7) |
|
2 |
I will recommend the use of herbal medicine to others |
99(40.9) |
94(38.8) |
37(15.3) |
12(5.0) |
|
3 |
When using herbal products, I always follow the prescription |
93(38.6) |
102(42.3) |
34(14.1) |
12(5.0) |
|
4 |
If I use herbal medicines and hospital medicine at the same time, I always inform my herbal medicine practitioner of double use |
95(39.6) |
75(31.3) |
47(19.6) |
23(9.6) |
|
5 |
I use herbal medicine because it has no side effect |
85(35.6) |
95(39.7) |
46(19.2) |
13(5.4) |
|
6 |
I consider herbal medicine cheaper |
96(40.3) |
98(41.2) |
36(15.1) |
8(3.4) |
|
7 |
Herbal medicine is more accessible |
98(41.0) |
91(38.1) |
42(17.6) |
8(3.3) |
|
8 |
Sometimes, I obtain herbal products from the farm |
97(40.1) |
97(40.1) |
37(15.3) |
11(4.5) |
|
9 |
A family member has been treated using herbal products |
87(36.1) |
98(40.7) |
41(17.0) |
14(5.8) |
|
10 |
I have been treated with herbal products by an herbal medicine practitioner |
88(37.0) |
75(31.5) |
51(21.4) |
24(10.1) |
Analysis of the level of knowledge, attitude, and practice (KAP) of herbal medicine among respondents showed that the mean for all the variables is higher than the criterion mean of 2.50, which indicates that the level of knowledge, attitude, and practice of herbal medicine among respondents is high (Table 5).
Table 5. Analysis of the knowledge, attitude and practice (KAP) of use of herbal medicine
|
Variable |
N |
Mean |
SD |
Remark |
|
Knowledge |
244 |
3.29 |
.80 |
High |
|
Attitude |
244 |
3.08 |
.85 |
High |
|
Practice |
244 |
3.09 |
.87 |
High |
Criterion Mean = 2.50
Associations between respondents’ demographic characteristics and overall KAP of herbal medicine are shown in Tables 6 and 7. The level of education did not influence respondents’ knowledge and attitude towards herbal medicine; however, the practice of herbal medicine was influenced significantly. Further post-hoc analysis revealed a significant difference in the practice of herbal medicine among residents with primary education, bachelor’s, and master’s degree education. The result showed that residents with primary education were more likely to use herbal medicine, followed by those with no formal education, secondary education, and tertiary education (Table 6). Table 7 shows the influence of occupation on respondents’ knowledge, attitude, and practice of herbal medicine. The result indicated that occupation had no influence on respondents’ knowledge and attitude of herbal medicine but its practice was significantly influenced. Further post-hoc analysis showed that farmers were more likely to practice herbal medicine, followed by self-employed residents and traders. Civil servants were shown to be less likely to practice herbal medicine.
Table 6. Comparison between the level of education and KAP of herbal medicine
|
Variable |
ANOVA |
Sum of Square |
df |
Mean Square |
F |
Sig |
Remark |
|
Knowledge |
Between Groups |
2.656 |
5 |
.531 |
1.738 |
.127 |
Not Significant |
|
Within Groups |
71.807 |
235 |
.306 |
||||
|
Total |
74.463 |
240 |
|
||||
|
Attitude |
Between Groups |
2.418 |
5 |
.484 |
1.501 |
.190 |
Not Significant |
|
Within Groups |
75.720 |
235 |
.322 |
||||
|
Total |
78.137 |
240 |
|
||||
|
Practice |
Between Groups |
8.255 |
5 |
1.651 |
4.466 |
.001 |
Significant |
|
Within Groups |
86.868 |
235 |
.370 |
||||
|
Total |
95.123 |
240 |
|
p < 0.05
Table 7. Comparison between occupation and KAP of herbal medicine
|
Variable |
ANOVA |
Sum of Square |
df |
Mean Square |
F |
Sig |
Remark |
|
Knowledge |
Between Groups |
2.690 |
4 |
.672 |
2.281 |
.062 |
Not Significant |
|
Within Groups |
66.643 |
226 |
.295 |
||||
|
Total |
69.333 |
230 |
|
||||
|
Attitude |
Between Groups |
2.489 |
4 |
.622 |
1.987 |
.097 |
Not Significant |
|
Within Groups |
70.779 |
226 |
.313 |
||||
|
Total |
73.268 |
230 |
|
||||
|
Practice |
Between Groups |
3.980 |
4 |
.995 |
2.612 |
.036 |
Significant |
|
Within Groups |
86.098 |
226 |
.381 |
||||
|
Total |
90.077 |
230 |
|
p < 0.05
The majority of respondents (96.8%) were very much aware of the use of herbal products as medicine, which was as high as the findings of the study conducted in Jos, Nigeria (100%) [30] and another similar study in Wayu town, West Ethiopia (78.6%) [32]. About 94% reported being aware of the safety concerns with herbal medicine, which is much higher than the study conducted in Ethiopia where 60.7% were aware [32]. However, 86.1% believed that natural remedies have lesser side effects. Similarly, over 70% of herbal users in Jos considered it safe for use [30].
A high proportion of respondents (78.7%) opined that herbal medicine was more superior in therapy to conventional medicine, and it can be useful in chronic disease therapy (84.4%). A similar survey reported a far lesser view (35.7% and 28.8%) on the effectiveness of complementary and alternative medicine (CAM) to modern medicine [32, 33]. Most respondents in this study (79.1%) believed that the best treatment outcomes can be achieved when herbal medicine is used in combination with conventional medicine. This finding differs from a study in Ibadan, Nigeria where only 30.5% agreed [31]. One study found that 40% of pregnant women used herbal remedies and about 85% of them alongside conventional drugs [34]. Respondents may have failed to consider the possibility of herb-drug interaction, as many are poorly informed about these products [3].
The prevalence of the use of herbal medicine among respondents was 88.9%, which is consistent with other studies where prevalence was reported at 79.2% [30], 84.7% [35], and 89.7% [31]. This increased use of herbal medicine may be attributable to its low cost and easy accessibility [3, 30].
Associations between respondents’ demographic characteristics and overall KAP of herbal medicine revealed that the level of education and occupation significantly influenced respondents’ practice of herbal medicine, which was more notable among persons with primary education and farmers. This implies that residents with a lower level of education are more likely to use herbal medicine than those with higher levels of education. This correlates with prior findings where, in low resource settings, a lower level of education was associated with herbal medicine use [31, 36-38].
CONCLUSION
There is a high level of knowledge, attitude, and practice of herbal medicine among residents of Port Harcourt, Rivers State, Nigeria. The findings showed that education and occupation influence the practice of herbal medicine. With the increased use of herbal medicine by Nigerians, the need has arisen for government to make much effort in standardizing herbal medicine for general public use.
Acknowledgments: We wish to acknowledge the technical assistance of Adelana O. Lydia, Department of Pharmacology and Therapeutics, Delta State University, Abraka, Nigeria.
Conflict of interest: None
Financial support: None
Ethics statement: Ethical approval was obtained from the ‘Ethical Committee’ of the Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria.
[1] Leonid K, Anna D, Sergey T, Natalya T, Dina P, Irina M, et al. Production of Herbal Protein Isolates with the Enzymatic Hydrolysis Technology. Int J Pharm Res Allied Sci. 2020;9(3):10-5.
[2] Suhluli RJ, Mashhour KM, Albushi AA, Albalawi SL, Alahmari AM, Aljuhani AR, et al. Otitis Media Diagnosis and Management in Family Medicine Practice: Literature Review. Arch Pharm Pract. 2019;10(3):21-5.
[3] Ekor M. The growing use of herbal medicines: issues relating to adverse reactions and challenges in monitoring safety. Front Pharmacol. 2014;4:177.
[4] World Health Organisation (WHO) [Internet]. WHO supports scientifically-proven traditional medicine. WHO Africa; 2020 [accessed 12 May 2020]. Available from: https://www.afro.who.int/news/who-supports-scientifically-proven-traditional-medicine?
[5] Yuan H, Ma Q, Ye L, Piao G. The Traditional Medicine and Modern Medicine from Natural Products. Molecules. 2016;21(5):559.
[6] Benzie IFF, Wachtel-Galor S. Herbal Medicine: Biomolecular and Clinical Aspects, 2nd edition, CRC Press/Taylor & Francis, Boca Raton (FL), 2011.
[7] Kaur J, Kaur S, Mahajan A. Herbal Medicines: Possible Risks and Benefits. Am J Phytomed Clin Ther. 2013;1(2):226-39.
[8] Oladeji O. The Characteristics and Roles of Medicinal Plants: Some Important Medicinal Plants in Nigeria. Nat Prod Ind J. 2016;12(3):102.
[9] Salehi B, Ata A, V Anil Kumar N, Sharopov F, Ramírez-Alarcón K, Ruiz-Ortega A, et al. Antidiabetic Potential of Medicinal Plants and Their Active Components. Biomolecules. 2019;9(10):551.
[10] Samadi FM, Suhail S, Sonam M, Sharma N, Singh S, Gupta S, et al. Antifungal efficacy of herbs. J Oral Biol Craniofac Res. 2019;9(1):28-32.
[11] Moke EG, Ilodigwe EE, Okonta JM, Emudainohwo JOT, Ajaghaku DL, Erhirhie OE, et al. Antidiabetic Activity and Toxicity Evaluation of Aqueous Extracts of Spondias mombin and Costus afer on Wistar Rats. Br J Pharm Res. 2015;6(5):333-42.
[12] Anachuna KK, Oyem CJ, Nwogueze BC, Asiwe JN. Glucose lowering effects and histomorphological changes of Vernonia amygdalina on pancreatic compromised Wistar rats using alloxan monohydrate. Trop J Health Sci. 2018;25(2):27-31.
[13] Okafo SE, Moke EG, Obi CS. Formulation and evaluation of anti-diabetic tablets containing aqueous extract of Moringa oleifera seeds. J Pharm Allied Sci. 2019;16(5):3167-76.
[14] Abdulridha MK, Al-Marzoqi AH, Al-Awsi GRL, Mubarak SMH, Heidarifard M, Ghasemian A. Anticancer Effects of Herbal Medicine Compounds and Novel Formulations: a Literature Review. J Gastrointest Cancer. 2020;51(3):765-73.
[15] Greenwell M, Rahman PK. Medicinal Plants: Their Use in Anticancer Treatment. Int J Pharm Sci Res. 2015;6(10):4103-12.
[16] Khan MF, Tang H, Lyles JT, Pineau R, Mashwani ZU, Quave CL. Antibacterial Properties of Medicinal Plants from Pakistan Against Multidrug-Resistant ESKAPE Pathogens. Front Pharmacol. 2018;9:815.
[17] Ghasemian M, Owlia S, Owlia MB. Review of Anti-Inflammatory Herbal Medicines. Adv Pharmacol Sci. 2016;2016:9130979.
[18] Erhirhie EO, Emeghebo CN, Ilodigwe EE, Ajaghaku DL, Umeokoli BO, Eze PM, et al. Dryopterisfilix-mas (L.) Schott ethanolic leaf extract and fractions exhibited profound anti-inflammatory activity. Avicenna J Phytomed. 2019;9(4):396-409.
[19] Moke EG, Anachuna KK, Edje KE, Ojezele MO. Hepatoprotective effect of methanol seed extract of Citrus tangerina on paracetamol-induced hepatotoxicity in Wistar rats. Niger J Nat Prod Med. 2019;23:83-7.
[20] Moke EG, Mordi JC, Umukoro EK. Effects of Methanol Leaf Extract of Cuphea Hyssopifolia Kunth on Liver Enzymes Activity and Antioxidant Indices of Paracetamol-Induced Hepatotoxicity in Wistar Rats. Afr J Biomed Res. 2020;23(1):123-6.
[21] Hosseinkhani A, Falahatzadeh M, Raoofi E, Zarshenas MM. An Evidence-Based Review on Wound Healing Herbal Remedies from Reports of Traditional Persian Medicine. J Evid Based Complementary Altern Med. 2017;22(2):334-43.
[22] Mapoung S, Umsumarng S, Semmarath W, Arjsri P, Thippraphan P, Yodkeeree S, et al. Skin Wound-Healing Potential of Polysaccharides from Medicinal Mushroom Auricularia auricula-judae (Bull.) J Fungi. 2021;7(4):247.
[23] Ojezele MO, Moke EG, Onyesom I. Impact of generic antimalarial or Phyllanthus amarus and vitamin co-administration on antioxidant status of experimental mice infected with Plasmodium berghei. Beni-Suef Univ J Basic Appl Sci. 2017;6(3):260-5.
[24] Ojezele MO, Moke EG, Adeosun AM. Assessment of Liver and Kidney Functions in Plasmodium Infected Mice Co-Administered with Conventional Antimalarials, Phyllanthus amarus and Vitamins. Trop J Health Sci. 2018;25(2):21-6.
[25] Emudainohwo JOT, Erhirhie EO, Moke EG. Anti-diarrhoeal activity of the aqueous leaf extract of Ageratum conyzoides in Wistar rats. J Appl Sci Environ Manage. 2015;19(2):169-75.
[26] Ben-Azu B, Aderibigbe AO, Omogbiya IA, Ajayi AM, Iwalewa EO. Morin Pretreatment Attenuates Schizophrenia-Like Behaviors in Experimental Animal Models. Drug Res (Stuttg). 2018;68(03):159-67.
[27] Ben-Azu B, Nwoke EE, Aderibigbe AO, Omogbiya IA, Ajayi AM, Olonode ET, et al. Possible neuroprotective mechanisms of action involved in the neurobehavioral property of naringin in mice. Biomed Pharmacother. 2019;109:536-46.
[28] Teschke R, Eickhoff A. Herbal hepatotoxicity in traditional and modern medicine: actual key issues and new encouraging steps. Front Pharmacol. 2015;6:72.
[29] Oreagba IA, Oshikoya KA, Amachree M. Herbal medicine use among urban residents in Lagos, Nigeria. BMC Complement Altern Med. 2011;11(1):117-24.
[30] Ohemu TL, Sariem CN, Dafam DG, Ohemu BO, Okwori VA, Olotu PN, et al. Knowledge, Attitude and Practice of Traditional Medicine Among People of Jos North Local Government Area of Plateau State, Nigeria. Int J Pharmacogn Phytochem Res. 2017;9(10):1353-8.
[31] Akande-Sholabi W, Iluyomade A, Ilesanmi OS, Adisa R. Perception and use of herbal medicines among clients visiting selected community pharmacies in Ibadan, Nigeria. Afr J Biomed Res. 2020;23(2):147-53.
[32] Belachew N, Tadesse T, Gube AA. Knowledge, attitude, and practice of complementary and alternative medicine among residents of Wayu Town, Western Ethiopia. J Evid Based Complementary Altern Med. 2017;22(4):929-35.
[33] D’Avigdor E, Wohlmuth H, Asfaw Z, Awas T. The current status of knowledge of herbal medicine and medicinal plants in Fiche, Ethiopia. J Ethnobiol Ethnomed. 2014;10(1):38.
[34] Nordeng H, Bayne K, Havnen GC, Paulsen BS. Use of herbal drugs during pregnancy among 600 Norwegian women in relation to concurrent use of conventional drugs and pregnancy outcome. Complement Ther Clin Pract. 2011;17(3):147-51.
[35] Okoronkwo I, Onyia-Pat J, Okpala P, Agbo M, Ndu A. Patterns of Complementary and Alternative Medicine Use, Perceived Benefits, and Adverse Effects among Adult Users in Enugu Urban, Southeast Nigeria. Evid Based Complement Alternat Med. 2014:239372.
[36] Joseph O, Muhammed Y, Raji A, Joseph A. Utilization of herbal medicine among inhabitants of an Urban Centre in North-Central Nigeria. Alger J Natur Prod. 2016;4(3):367-78.
[37] Mekuria AB, Erku DA, Gebresillassie BM, Birru EM, Tizazu B, Ahmedin A. Prevalence and associated factors of herbal medicine use among pregnant women on antenatal care follow-up at University of Gondar referral and teaching hospital, Ethiopia: a cross-sectional study. BMC Complement Altern Med. 2017;17(1):86.
[38] Pearson H, Fleming T, Chhoun P, Tuot S, Brody C, Yi S. Prevalence of and factors associated with utilization of herbal medicines among outpatients in primary health centers in Cambodia. BMC Complement Altern Med. 2018;18(1):114.
