Background.

Diabetes mellitus is a complicated health condition with multiple causes and many treatment options. Various myths may influence diabetics’ health-seeking behavior, and they may use traditional medicines, which include normal foods and herbs, for primary health care. The aim of this study was to determine patients’ and herbalists’ practices and perspectives regarding the use of traditional medicines and the role of traditional medicines in the management of diabetes. Methods and Findings. We conducted a cross-sectional study with a mixed-methods design. We interviewed 140 patients attending diabetic clinics using a structured questionnaire, conducted focus group discussions with an additional 20 diabetic patients, and conducted in-depth interviews with 8 local herbalists. The majority of the diabetic participants believed that diabetes is caused by a high-carbohydrate diet. Of the 140 participants who answered the questionnaire, 67.2% reported using traditional medicines to manage their diabetes, including 58.6% who reported using both conventional medicines and traditional medicines. Some participants believed that combining conventional and traditional medicines improved the effectiveness of treatment. Reasons given for using traditional medicines included the high cost of conventional treatment and the availability and accessibility of the traditional medicines. The most commonly used traditional medicines were indigenous vegetables and medicinal plant products including amalanth leaves, hare lettuce leaves, nightshade leaves, spider plant leaves, okra pods, moringa leaves and seeds, soursop leaves, black plum back, avocado seed, and lemongrass. Conclusion. Patients and herbalists provided a range of perspectives regarding the use of traditional medicines to treat diabetes. Further research is needed to identify bioactive compounds present in commonly used traditional medicines and their efficacy.

IntroductionDiabetes mellitus is a common metabolic health problem. Globally, the prevalence of diabetes in adults has risen rapidly from 4.7% in 1980 to 8.5% in 2014 [1]. Hyperglycemia is one of the features of diabetes [2]. Hyperglycemia increases the risk of diabetes and associated complications including heart attack, stroke, kidney disease, limb amputations, poor vision, and nerve damage [1, 3]. Diabetes and its complications are leading causes of death worldwide, the increased percentage of death worldwide [1].It has been estimated that in Africans about 80% of cases of diabetes are undiagnosed. This may be because diabetes is often asymptomatic or produces only mild symptoms, which may be ignored or attributed to other causes [2, 4]. Many people believe in spiritual and alternative treatments and use these treatments in preference to seeking care from medical doctors [5]. Many people also believe in traditional ways of living, and this influences their health-seeking behavior. Traditional medicines, which include normal foods and herbs, are used as the main form of primary health care.Studies reported that 80% of people in developing countries depend on traditional medicines as the primary remedy for various ailments [6, 7]. Worldwide, plant-based traditional medicines are the most commonly used form of treatment for a range of health problems. These traditional medicines play an important role in primary health care in many developing countries. Tanzania is among the countries where the majority of the population depends on traditional medicines for the management of their health problems, including diabetes [8]. Lunyera et al. [9] reported that 77% of diabetic patients in Northern Tanzania use traditional medicines for the management of diabetes. Maregesi [10] reported that there are various traditional medicines used by diabetic patients in Northern Tanzania, many of which have not been documented, and their pharmacological properties with respect to blood glucose control have not been studied. The use of traditional medicines may be attributable to sociocultural perspectives within the community, and they may contribute to disease-related complications. Most traditional medicines are common foods which include vegetables, flowers, fruits, seeds, spices, and herbs. Some foods provide health benefits beyond their nutritional value, and are effective in the prevention and treatment of various diseases [11, 12]. The objective of this study was to describe patients’ and herbalists’ perspectives and practices regarding the use of traditional medicines and the role of traditional medicines in the management of diabetes in Northern Tanzania.

Materials and Methods

 Study DesignWe conducted a cross-sectional study with a mixed-methods design which included a quantitative and a qualitative component. The methods were complementary and enabled triangulation of the data [13]. Focus group discussions (FGDs) and in-depth interviews (IDIs) were used to gather qualitative data on patients’ and herbalists’ perspectives on the use of traditional medicines in the management of diabetes mellitus. A structured questionnaire was used to gather quantitative data from the patients to supplement the data provided by participants in the FGDs.2.2. Study SettingThe study was conducted in Kilimanjaro Christian Medical Centre (KCMC) in Kilimanjaro, and Mount Meru Hospital in Arusha. These facilities provide specialized diabetes care in Northern Tanzania. The Kilimanjaro Region has a population of 1.64 million, and the Arusha Region has a population of 1.69 million [14]. KCMC is a zonal referral hospital located on the slopes of Mount Kilimanjaro, established by the Good Samaritan Foundation (GSF) in 1971. Mount Meru Hospital is a government-owned regional referral hospital located in the foothills of Mount Meru in Arusha municipality, established in 1926.

Study PopulationThe study participants were diabetic outpatients and local herbalists or traditional medicine vendors. Participants were required to be older than 20 years in order to ensure that they were able to provide reliable information. Pregnant women were excluded because of the possibility that they may have had gestational diabetes, which resolves after giving birth.2.4. Sample Size Determination and Sampling TechniquesPurposive sampling was used to select hospitals, patients and herbalists [15]. The patients were stratified according to their sex; two strata of 10 patients each were formed, in which FGDs and questionnaire participants were randomly drawn by counting numbers and selecting all even numbers to include in the interview. There were 4 FGDs with 5 participants in each. One FGD for males and one FGD for females were conducted at each hospital. Snowball sampling was used to recruit herbalists to participate in in-depth interview (IDI); 4 potential participants were picked from each region (Kilimanjaro and Arusha) at their working place/shops for interview. The sample for questionnaire participants was obtained by using a formula adapted from Gelaw, Abdela [4], with the following parameters: 9.1% prevalence of diabetes (P), 5% margin of error (E), and a standard normal deviation (Z) of 1.96, and a contingency of 10%.

 ResultsSociodemographic CharacteristicsTable 1 shows the sociodemographic characteristics of 140 participants who answered the questionnaire. Of these participants, 66.4% were female, 50.7% were aged between 41 and 60 years, 55.7% were from KCMC, 63% had a primary level of education, 48.6% were self-employed, and 64.2% had had diabetes for more than five years.

ConclusionThis study assessed patients’ and herbalists’ perspectives and practices regarding the use of medicinal plants and traditional medicines in the management of diabetes. The majority of participants used medicinal plants and traditional medicines in the management of their diabetes, either alone or in combination with conventional medicines. Most of the traditional medicines were plant products that were affordable and widely available locally. Although traditional medicines have potential benefits, they also have potential adverse effects. There is currently limited knowledge of the physiological effects of most of the traditional medicines that were widely used, so it is not possible to assess whether these medicines were beneficial, harmful, or both. In view of this, the findings reveal a need for further research to identify the bioactive compounds present in these medicinal plants and to determine their efficacy at a physiological level.