The purpose of the study was to determine the prevalence of THM use by hypertensives in a convenient sample of the PURE cohort. The study showed that of the 135 participants who indicated using THM, 21% used THM in the treatment and management of hypertension. This estimate is similar to that observed in a study in Nigeria (21%) . However, it is lower than the estimates reported in other countries such as Morocco (80%)  and India (63.9%) . Also, a community-based study in Nigeria reported an estimate of 29% of the participants who employed CAM to manage hypertension . Interestingly, another study in Nigeria revealed that majority of hypertensive patients considered traditional medicine as the only viable cure for hypertension . Although the current study is limited in terms of geographical representation, it begins to show how South Africa, particularly within the back communities, compares to other countries in terms of THM use among patients with hypertension.
The use of THM by the study participants for other varied illnesses ranged from common cough and cold to respiratory problems and diabetes. Also, some respondents indicated using THM for general well-being and maintenance of health. This, to a certain degree, reflects the role of THM in managing certain disease conditions over and above the western medical practices in South Africa. In fact, it mirrors the patterns of THM use in other regions of African and the world. For example, THM accounts for 65% of all health care in India, 71% in Chile, 40% in China and over 80% in most of the African countries , especially in their rural communities where traditional herbal medicine is often the most culturally acceptable choice of health care .
Our study revealed that age, marital and employment statuses were significantly associated with THM use for hypertension, a pattern that has also been reported in another study . However, other studies that examined similar demographics did not show any association between age, marital and employment status and the use of THM [27, 28]. The association observed between employment status and the use of THM for hypertension is an indication of the health seeking behaviour of the respondents. Our study showed that THM was mostly used for treating hypertension by either the unemployed or the retirees. The rising cost of for managing chronic diseases within the formal healthcare system in South African could be one of the reasons why the retired and unemployed participants in the current study chose to use THM for hypertension .
The prescription of THM for hypertension in this study was influenced by family, friends or self-administration. A similar report has shown that users of herbal medicinal products in the United States do not seek professional advice in selecting herbal medicines, but rather rely on friends’ or relatives’ recommendations . The use of THM for various illnesses has been strongly associated with family influence and cultural traditions. Family expectations of receiving treatment from traditional healers and cultural beliefs are some of the reasons for continuous dependence on THM [30, 31]. The practice of self-diagnosis and medication of traditional medicine knowledge is wide spread in urban areas of developing countries. Cocks and Dold, observed that all age groups and social categories of people who took part in their study medicated for both themselves and their family members .
The wide spread of traditional health shops offering a wide choice of medicines for diverse ailments and problems in various cities in South Africa is a source of concern with regards to the efficacy and ultimately the safety of such herbal products. The apparent lack of THM prescriptions by trained personnel for hypertension in this study is indicative of indigenous knowledge for healing purposes being handed down from one generation to another within household settings. In a review of the use and practice of traditional/complementary medicine in South Africa, Peltzer, observed a decrease in the use of traditional healers from between 3.6-12.7% to 0.1% in South Africa in the last 13 years . However, in our study, we observed that the participants who use THM for other health conditions apart from hypertension were more likely to obtain their prescription from traditional healers.
While half (51%) of the participants indicated occasional THM use, 48% indicated 1–3 times a day use. The frequency of use of THM and the length of time herbal remedies have been used by the participants are indicative of a heavy dependence on THM not only in managing hypertension but also in treating it. This however poses a threat to the health of the participants as the possibility of herb-drug interaction is high among those who use dual therapy. Co-administration of herbal remedies with cardiovascular medications with narrow therapeutic index (warfarin and digoxin) has been found to potentiate or reduce the effect of these medications . Health care professionals should be aware of increased THM usage amongst their patients and thus be able to give proper medical advice with regards to potential adverse effects or possible herb-drug interactions.
The study had several limitations that need to be acknowledged. Firstly, the small sample size affected the external validity of the study. Thus this study cannot be generalized to a broader population. Secondly both the estimates of the prevalence of THM use and hypertension were based on self-reported behaviour, and we speculate some degree of under-reporting which is a possibility in survey of this nature . Also, the types/levels of hypertension and the length of time since diagnosis were not assessed in this study. However, this study still provides insight into the use of THM among participants self-reporting hypertension.