KNOWLEDGE, ATTITUDE AND PRACTICE OF
USING HERBAL MEDICINE IN THE
TREATMENT OF POLYCYSTIC OVARIAN
SYNDROME (PCOS)
BY
KAMSOCHUKWU EGO OBI
ABSTRACT
This study is to find clinical research on medicinal herbs used in the treatment of Polycystic Ovarian Syndrome (PCOS). Evaluate the relevance of literature according to the most common diagnostic criteria for PCOS, which requires the presence of two out of three features: oligo- or chronic ovulation; polycystic ovaries; hirsutism and/or hyperandrogenism.
This research paper examines the knowledge, attitude and practice of using herbal medicine in the treatment of polycystic ovarian syndrome. Polycystic ovarian syndrome (PCOS) is one of the most frequent problems of gynecological endocrinology and is one of the leading causes of female anovulatory infertility. Between 90 – 95% of women who are attending infertility clinics with anovulation have been shown to have PCOS, Amenorrhoea and oligomenorrhoea are not the only symptoms of PCOS; patients who have PCOS commonly suffer from acne, hirsutism, and obesity.
Generally, in Nigeria, the Christian folk over time have associated herbalism (use of botanical medicine) with witchcraft and voodoo seeing it as a taboo. This study aims to find out the current knowledge, attitude and practice of the use of herbal medicine among females with principal reference to the treatment of Polycystic Ovarian Syndrome. To further investigate the need for more education of females about the efficacy and safety of Herbal Medicine.
Method: In this cross-sectional study, questionnaires were administered to females that attended hospitals and clinics in Awka, Anambra state. A structured questionnaire was used to collect data and data were analysed statistically into frequencies and percentages.
Result: One-fifth of the participants had heard of polycystic Ovarian Syndrome and most knowledge was gotten via health talks. Only 36% were aware that Herbal medicine was used in the treatment of Polycystic Ovarian Syndrome of which only 20% knew specific herbs that were used. On their attitude: the use of botanical medicine for the treatment seems to be a welcome idea which is contrary to the prior perception that only conventional hospitals have a cure for polycystic ovarian syndrome. From the survey, 69% of the respondents felt that Herbal medicine would be effective in the treatment of Polycystic Ovarian Syndrome; 78% stated that it should be explored while 77% said that they would advise a patient to use Herbal medicine. On the practice: 57% of the participants affirmed that they use Herbal medicine.
This research paper provides insight into the need to:
- Further educate females on (i) prevention and treatment of Polycystic Ovarian Syndrome; (ii) the readily available and efficacious indigenous herbs; (iii) the safe use of Herbal medicines with emphasis on proper administration and dosages.
- The need for more Polycystic Ovarian Syndrome treatment centers in Awka.
- Incorporating the use of scientifically proven safe standardized herbal remedies in Polycystic Ovarian Syndrome treatment by trained professionals into our healthcare system. (Starting from primary health care).
Although Herbal Medicine may proffer a less expensive and less harmful means of treating Polycystic Ovarian Syndrome, safety is of primary essence, as there are possible harmful interactions with conventional treatments. (Herb-drug interactions); and some herbs may have potential risks with possible inimical effects on patients. Further studies should be done in this area, particularly for Herbal Medicines used in gynecological treatment.
Keywords: Health, Polycystic Ovarian Syndrome, Infertility, Women, Herbal Medicine
INTRODUCTION
Polycystic Ovarian Syndrome (PCOS) is a disorder of the ovaries, It is caused by the imbalance of hormones Amini, L. et al (2015). Polycystic Ovarian Syndrome (PCOS) is one of the major public health problems among women which is one of the major causes of infertility and is most common in women who are overweight or obese, have unhealthy diet and exercise habits, or have a family history of type 2 Diabetes. Ovaries are gray pink in color and of almond size, they produce eggs and hormones. Women with polycystic ovary syndrome get irregular menses. Normally, an ovary of a woman releases an egg every month, if it does not get fertilized, the egg matures and drops out. This causes menses every month in a woman but in Polycystic ovary syndrome, the ovary does not release the egg and it leads to the formation of a cyst around the Ovary Franks, S.( 2007,).
A combination of nutrition, environment, physiological stress, physical activity and other factors further influences the expression of PCOS towards a distinct set of individual symptom phenotypes. This is why Badawy et al (2011) says that PCOS is an enigma; where conventional medicine combined with integrative medicine could possibly result in better patient outcomes. More than half of women with PCOS develop type 2 diabetes by age 40.
Polycystic Ovarian Syndrome (PCOS) is a problem of metabolic disorder and hormonal imbalance, females with PCOS may have enlarged ovaries. The hormonal imbalance results in the development of several balloon-like cysts in the ovaries.
The imbalance hormones incudes insulin, progesterone estrogen Androgen.
The major causes of PCOS are as follows:
Family History
Insulin Resistance
Hormonal imbalance
Contraceptive pills
Hence, there is a dire need for more awareness about the available preventive measures, management & treatment that can be obtained via the use of less expensive Herbal medicines which may also have less attendant side effects Foster, S. (1999).
Herbal Medicine involves the use of varying parts of medicinal plants by different means of administration in the treatment and alleviation of diseases.
Herbal Medicine
Encyclopedia.com (2022), defines botanical medicine as a vital component of the healing arts that draws on the accumulated and developing knowledge of the medicinal properties of plants in the prevention and treatment of disease. Herbal medicine includes medical herbalism, a healing art that relies on the synergistic and curative properties of plants to treat symptoms and disease and maintain health, and pharmacognosy, the study of natural products. Fauzi (2013).
Simply put, Herbal Medicine comprises plants (or substances derived from plants) that are used to treat or prevent disease. The term Herbal medicine is the use of plant parts which includes plant parts that are not strictly herbs, such as bark, seeds, roots and stems.
HERBAL APPROACH TO POLYCYSTIC OVARIAN SYNDROME
Herbal medicine was always, since pre-history time, been seen as the first line of treatment for all people around the world before conventional medicine started establishing itself at the beginning of the 19th century with the discovery of plant-derived drugs morphine and salicin in 1852 (Griggs, 1997). Modern medical herbalists study and use evidence-based discoveries about medicinal herbs and holistically apply beneficial herbal actions to body systems in light of pharmacokinetics and pharmacodynamics.
MATERIALS AND METHODS
Study Location
The study location is Awka South Local Government Area of Anambra State. The study was conducted in Awka, the Capital City of Anambra State, Nigeria, particularly Awka South Local Government Area situated in the southern region within Anambra State, Nigeria.
Awka South is made up of nine (9) towns, namely: Amawbia, Awka Ezinato, Isiagu, Mbakwu, Nibo, Nise, Okpuno and Umuawulu.
Study Population
Awka is a town in Awka South Local Government Area, it is the seat of Government and has a lot of prominent people both home and abroad. There are three major streets that span this area, which are Zik Avenue, Works Road and Arthur Eze Avenue. In the past, the people of Awka South LGA were well-known for blacksmithing. Today they are respected among the Igbo people in Nigeria for their technical and business skills. The area also has a number of industries, banks, hotels and a number of public and privately owned institutions.
Based on the 2006 National population census, Awka South Local Government had 189,049 people. However, as of today, the dwellers are almost over one million. The Igbo language is commonly spoken, while the religions of Christianity and Paganism are widely practiced in this area. Popular festivals held in Awka South LGA include the New yam festival (Afiolu) and Ofala festivals. Despite the diversity of its dwellers, the Awka South LGA is very peaceful and the relationship between the different groups is cordial. Prominent traditional rulers in Awka South LGA include the Igwe (King), Chiefs and the Governor of the State.
Sample Size
To obtain the sample size, I started by checking for articles in various journals to obtain previously documented percentage prevalence of the use of botanical medicine (herbal Medicine) in the treatment of Polycystic Ovarian Syndrome.
The prevalence 40% was used in the formula below to determine the sample size.
Sample Size (n) = z2pq
d2
where n = sample size z = confidence interval at 95% (1.96) – given p = prevalence of previous study = 40%
q = 1- p
d = precision (acceptable margin of error = 0.05)
n= z2pq
d2
n= (1.96)2 x 0.4 x 0.6
(0.05)2
n= 3.84 x 0.4 x 0.6
0.0025 n= 368.67 = 369
Sample size was found to be 369
Sample Technique
I had discussions with various leaders in hospitals and clinics. I explained to them and the questionnaires were distributed at their gatherings. Some were also distributed by the workers and members of staff of those organizations.
Electronic versions of the questionnaires were sent via WhatsApp.
Due to time constraints, 70% of the sample size was distributed. The total number of printed paper questionnaires distributed was 220. The others were sent electronically.
Simple Random Sampling was done on those who filled the questionnaires using first come first served among the nulliparous and non-nulliparous women.
Those who could not read or write well were assisted in filling out the questionnaires.
Inclusion & Exclusion
Inclusion: Women 20 years old and above
Exclusion: Children (12 years and below); Teenagers (13-19 years) and Men.
Data Instrument
The instruments used for my project research were questionnaires: Paper Questionnaires and Electronic Questionnaires.
The questionnaires comprise of five sections:
Section A: Socio-demographic information
Section B: Knowledge about Polycystic Ovarian Syndrome Treatment
Section C: Attitude towards the Usage of Herbal Medicine
Section D: Practice of the Use of Herbal Medicine
Section E: Opinion on What Government should do
(See Appendix)
Pre-test
Questionnaires were administered to 10% of the sample size before the commencement of the field work. The purpose of this was to ensure that any mistakes in the framing of the questionnaire were corrected and/or sentences reconstructed if not well understood.
Validity & Reliability of Instrument used
The validity of the questionnaire was put to test by the Pre-test. At the end of the Pre-test, questions not well understood by the participants were reconstructed in order that the instrument may be valid for the questions asked.
The reliability of the questionnaire was shown to my supervisor for approval.
Distribution & Collection
The paper questionnaires were distributed manually while the electronic questionnaires were distributed virtually via WhatsApp.
After the paper questionnaires were distributed and collected, they were collated together with the electronic questionnaires in an Excel spreadsheet for further data analysis.
Ethical Consideration
The questionnaire was scrutinized by our lecturer in Research Methodology for ethical problems.
The questionnaire was given satisfactory approval.
DATA ANALYSIS AND INTERPRETATION
This chapter presents the collated data of the questionnaire responses of participants – women that are aged 20 years above.
Questionnaire Response Rate
Number of Paper questionnaires = 220, Number of Electronic questionnaires = 40, Total Number of questionnaires = 260, Total Number of questionnaires Responses: paper questionnaires responses + electronic questionnaire responses = 189 + 32 = 221, Response rate = 85%
Social Demographic Characteristics of Respondents
The Age, Marital Status, Educational Level, Occupation, Ethnic Group, Number of Children, Church Denomination of the respondents were presented in pie charts and histograms for a better understanding of the social demographic characteristics of the respondents.
Age Distribution of Respondents
Respondents were grouped into different age categories.
Table 1 Age Response of Participants
| Age | Frequency | % Distribution |
| 20-29 | 61 | 28 |
| 30-39 | 69 | 31 |
| 40-49 | 51 | 23 |
| 50-59 | 29 | 13 |
| Above 60 | 11 | 5 |
The Highest number of respondents falls within 30-39 years (31%) followed by 20-29 (28%), then 40-49 (23%), 50-59 (13%) and those above 60 (5%) constitute the lowest percentage.
MARITAL STATUS OF RESPONDENTS
Table 2. Distribution of the Marital Status of Respondents
| Status | Number | %Distribution |
| Single | 64 | 29 |
| Married | 128 | 58 |
| Divorced | 11 | 5 |
| Cohabiting | 3 | 1 |
| Widowed | 15 | 7 |
Marital Status of the Respondents. The Highest percentage were those who were married (58%) followed by singles (29%), then the widowed (7%), the divorced (5%) while the least were cohabiting (1%).
Educational Level of Respondents
| Educational Level | Number | Percentage % |
| WAEC/GCE | 55 | 25 |
| Diploma | 33 | 15 |
| BSc | 69 | 31 |
| Masters | 38 | 17 |
| PhD | 3 | 1 |
| None | 23 | 11 |
Most of the respondents have a first degree (69), while the fewest were in the category of those with doctorate degrees (3).
Most of the respondents have a first degree (31%), followed by the WAEC/GCE certificate(25%), then the Masters’ degree(17%), the diploma(15%), those who had none(11%) while the fewest were in the category of those with doctorate degrees (1%).
Occupation of Respondents
|
Occupation |
Number | Percentage % |
| Student | 33 | 15 |
| Housewife | 21 | 10 |
| Civil Servant | 23 | 10 |
| Business owner | 68 | 31 |
| Professional | 56 | 25 |
| Unemployed | 20 | 9 |
Majority being business owners numbered (68), the unemployed minority were (20)
Majority of the Respondents were business owners (31%), then the professionals(25%), the students(15%), the civil servants or house wives (10% each) while the minority were unemployed (9%)
Hospital and clinics of Respondents
The Hospital and clinics were categorized as follows: Eldorado Hospital, Divine Hospital, Kamsolin Natural and Holistic Clinic, Destiny Natural Care; Amaku General Hospital and Others.
| Hospitals and clinics | Number | Percentage % |
| Eldorado Hospital | 46 | 21 |
| Divine Hospital | 75 | 34 |
| Kamsolin Natural and Holistic Clinic | 18 | 8 |
| Destiny Natural Care | 10 | 4 |
| Amaku General Hospital | 8 | 4 |
| Others | 64 | 29 |
The highest number of respondents was from Divine Hospital while the lowest number of respondents were from Amaku.
The majority of the respondents were from Divine Hospital (34%), followed by a mix of members of other hospitals and clinics (29%), then members of the Eldorado (21%), then the Kamsolin(8%) and the smallest group of respondents were from Destiny (4%) as well as Amaku(4%).
Knowledge About Polycystic Ovarian Syndrome
Respondents’ Awareness of Polycystic Ovarian Syndrome
| Response | Number | Percentage % |
| Yes | 200 | 90 |
| No | 21 | 10 |
Shows that 200 of the Respondents (91%) have heard of PCOS while 21 of them (10%)had not.
Respondents Knowledge Of PCOS
| Response | Number | Percentage % |
| Yes | 167 | 76 |
| No | 54 | 24 |
Indicates that 24% of the respondents (54 women) do not know exactly what PCOS is whilst 76% (167 women) do.
Channels by PCOS Knowledge is gotten
Health talks (27%) were the leading ways whereby he respondents got to know about treatments options available for PCOS followed by the internet (15%), the social media (14%) then 12% from TV, 10% each from Newspaper and Friends/Family, 7% from the hospital and finally 5% from others.
Knowledge of facility in Awka where PCOS is Treated
| Response | Number | Percentage % |
| Yes | 63 | 71 |
| No | 158 | 29 |
The majority of the Respondents (71%) did not know any facility in Anambra State where PCOS is treated and 29% knew.
Respondents Knowledge of the use of Herbs for the Treatment of PCOS
| Response | Number | Percentage % |
| Yes | 79 | 36 |
| No | 142 | 64 |
Majority of the respondents (64%) had no knowledge that herbs were used for the treatment of PCOS while 36% were aware.
Specific herbs known by respondents for the treatment of polycystic Ovarian Syndrome
| Herb | Response | Percentage % |
| Angelica sinensis | 16 | 18 |
| Andropogon Zizanioides | 3 | 3 |
| Glycyrrhiza Glabra | 13 | 14 |
| Cinnamomum Verum | 12 | 13 |
| Vitex agnus-Castus | 7 | 8 |
| Cimicifuga Racemosa | 7 | 8 |
| Thuja Occidentalis | 4 | 4 |
| Saraca asoca | 25 | 27 |
| Paeonia Albiflora | 1 | 1 |
| Allium sativum | 2 | 3 |
| Asparagus Recemosus | 1 | 1 |
| Hydrastis Canadensis | 1 | 1 |
The highest known herb by respondents for the treatment of PCOS was Saraca asoca (27%); followed by Angelica (18%); then Glycyrrhiza Glabra (14%); Cinnamomum Verum (13%); Vitex and cimicifuga (8% each) Thuja (4%);Allium (3%); Andropogon (3%);Asparagus (1%) and Hydrastis Canadensis (1%).
DISCUSSION
One-fifth of the survey respondents have a knowledge of polycystic Ovarian Syndrome and the most frequent channel by which this was gathered was via health talks. However, only forty-five percent (45%) knew of the available options for its treatment and fewer still (29%) knew of any facility in Anambra State where Polycystic Ovarian Syndrome is treated. Though they were conversant with certain health givers that provide treatment mainly Orthodox physicians (44%); nurses (23%), naturopaths (17%) and traditional medicine practitioners (16%).
This shows that more awareness needs to be created on where to go for the treatment of this disease.
On the usage of Herbal Medicine as a means of treating Polycystic Ovarian Syndrome, only 36% of the respondents had knowledge of some herbs used. 18% affirmed that they were aware of health givers that use Herbal medicine as part of Polycystic Ovarian Syndrome treatments with traditional medicine practitioners taking the lead (52%) followed by naturopaths (22%), Orthodox physicians were also named by 15% of the respondents. Major modes of administration recorded were via extracts (29%) and juices (21%).
The respondents’ attitude towards the use of Herbal medicine was positive, with 56% believing that it could be used in the treatment of all diseases; 69% felt it would be effective in the treatment of Polycystic Ovarian Syndrome though 64% felt it could not be used alone;78% felt it should be used in conjunction with other techniques. Only 12% felt it should not be used at all.
A little over one-fifth of the respondents (77%) mentioned that they would advise a Polycystic Ovarian Syndrome patient to use Herbal Medicine.
World Health Organization postulates that all people, everywhere, deserve the right care, right in their community. This is the fundamental premise of primary health care. The development of our indigenous Herbal medicine can serve as a major means for achieving this.
Truly, Polycystic Ovarian Syndrome is a major cause of female infertility that is on the increase due to changing lifestyle habits and environmental factors. Prevention is not only better than cure but is most certainly cheaper in all ramifications. So prevention of the disease itself should be the primary and major focus.
This research study points to the fact that people nowadays are more open to the use of Herbal Medicine than in the past.
The research shows that there is a dearth of knowledge of the botanicals (herbs) that can be used for the treatment of polycystic Ovarian Syndrome. Only 20.4% of the respondents were aware of some herbs used.
More awareness needs to be created about the potency and efficacy of our indigenous Herbal medicine so as to save many lives. The promotion of our botanical medicine is critical.
On what the government should be doing: 93% of the participants were of the opinion that the Federal Government should be Funding Research on the development of Herbal medicines for Polycystic Ovarian Syndrome Treatment. 89% felt that they should be allocating funds for the mass production of known effective indigenous Herbal medicines.
CONCLUSION
The use of Herbal Medicine among females in Awka, Anambra State is impressive. 57% of the participants attested to its use. 43% of the respondents even stated that they prefer using Herbal medicine to conventional medicine.
Though the idea of Herbal Medicine use is welcomed and more accepted than in prior years. This research study shows that there is a dearth of knowledge about specific herbs used in the treatment of Polycystic Ovarian Syndrome.
Most of the participants believe in the possible efficacy of Medicine for the treatment of polycystic ovarian Syndrome but may not be conversant with dosages; side effects or interactions with conventional treatment. Further studies and research should not only be geared towards confirming the efficacy of herbal medicines for this purpose but also to possible adverse effects and interaction; plus the right doses and modes of administration.
Recommendations
Center for Disease Control states that the focus of public health is on the health, safety, and well-being of the entire population. On this premise, one can make the following recommendations:
- Government should be actively involved in the sourcing, gathering and proper documentation of indigenous herbal medicines that have been proven to be effective in the treatment of polycystic ovarian syndrome (A drive to encourage Traditional Medicine Practitioners to divulge and provide information so that the knowledge does not die with them) and further research carried out to substantiate the claims. This can be effected from the local government level.
- Then Government should equip health workers with the evolving evidence gathered on herbal medicines used in polycystic ovarian Syndrome treatment.
- Develop programs geared towards understanding, evaluating and validating the discovered herbal medicine used in PCOS treatment.
- Develop training for in-service Healthcare workers on Herbal medicines used in female infertility prevention/treatment to improve their knowledge of the subject.
The main drive for the use of herbal medicine is because of a need for safer, more affordable, more accessible treatment options for PCOS sufferers. Incorporation of local content can proffer a probable solution to this dilemma. Hence one can also further recommend that:
- Policy makers advocate, fundraise and allocate resources for research concerning Herbal medicine use.
- The Local Content Act should be reviewed and expanded to provide a framework, for increased participation in the health sector focusing on the development of our indigenous herbal medicines.
- Development of Healthcare policies concerning integrating medicine in clinical practices.
REFERENCE
Amini, L., Tehranian, N., Movahedin, M., Ramezani Tehrani, F., & Ziaee, S. 2015, “Antioxidants and management of polycystic ovary syndrome in Iran: A systematic review of clinical trials. “, Iranian Journal of Reproductive Medicine, vol. 13, no. 1, pp. 1-8-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4306978/ Accessed 23/02/2017.
Franks, S. 2007, “How good are we at diagnosing polycystic ovary syndrome?”, Clinical Endocrinology, vol. 67, no. 6, pp. 809-810-DOI: 10.1111/j.1365-2265.2007.03007.x.
Badawy, A. and Elnashar, A. (2011) Treatment options for polycystic Ovarian Syndrome.
International Journal of Women’s Health, 3, 25-35.
http://dx.doi.org/10.214/IJWH.S11304.
Fauzi, F.M., Koutsoukas, A., Lowe, R., Joshi, K., Fan, T. & Bender, A 2013, “Chemogenomics approaches to rationalising compound action of traditional Chinese and Ayurvedic medicines.”, Journal of Cheminformatics, vol. 5, no. 1, pp. P44–https://www.repository.cam.ac.uk/bitstream/handle/1810/244355/1758-2946-5-S1-P44.pdf?sequence=2 Accessed 23/03/2017.
Griggs, B.1997,”New green pharmacy: the story of western herbal medicine.”
Vermilion, London., PP.210-211; 1-383.
Foster, S. 1999, “Black Cohosh: A Literature Review “, HerbalGram, American Botanical Council, vol. 45, pp. 35-50-http://cms.herbalgram.org/herbalgram/issue45/article2659.html?ts=1489272031&signature=633d1791a6d302e1ee924efd68dad9b4.
BRIEF PROFILE
Dr. Kamsochukwu Ego Obi
Dr. Kamsochukwu Ego Obi is a consultant Naturopathic Physician at Kamsolin Natural and Holistic Clinic, Awka, Anambra State, Nigeria. She holds a Bachelor of Science degree (Bsc.) in Public Health and Complementary Medicine from ICT University, Messassi, Yaounde, Cameroon (with second class upper); Bachelor of Science degree (Bsc.) in Environmental Science and Resource Management, NOUN (with second class upper); National Diploma in Science Laboratory Technology, Federal Polytechnic, Nakede Owerri, Nigeria; National diploma in Traditional, Naturopathic Medicine, U A College of Science and Technology, Usuofia, Nigeria; Diploma in Acupuncture Therapy, India; Masters Diploma in Acupuncture Therapy, India.
Dr. Kamsochukwu Ego Obi has undergone several Professional Certificate Programmes in different areas of Naturopathic Medicine, and undergone a clinical Internship programme at Harvey Road General Hospital, Yaba, Lagos, Nigeria and also did her Clinical Internship Training at Neurosciences Hyderabad, India.
She has participated in and received numerous Health programmes and awards, namely:
An African Exemplary Leadership Award as an Outstanding Female Health Physician of the Year in 2022, Honourable Chairman of Association of Commonwealth Natural Medicine/Herbal Medicine Practitioners, Nigeria (Anambra State Chapter) and Deputy Director of Medical team of A.N.S. Natural Health Care Limited, all that on her mission to save humanity, toured round several states in Nigeria on quick health restoration programmes, as second-in-command of the Medical team of A.N.S and recovered several chronic cases within a short period using Acupuncture Therapy.
Dr. Kamsochukwu Ego Obi is a lecturer at Green Center Academy for Natural Medicine Practitioners, Southeastern zone, Nigeria. She holds Doctor of Philosophy degree, Ph.D. (Honoris Causa) in Naturopathic Medicine from African American University, Porto-Novo, Republic of Benin.
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