Herbal medicine uses to treat people with epilepsy: A survey in rural communities of northern Peru
Introduction
Epilepsy is a chronic disease that affects about 70 million persons worldwide (Ngugi et al., 2010), 80% of whom living in developing countries (Leonardi and Ustun, 2002). The average prevalence of epilepsy is 15.8/1000 (Bruno et al., 2013) in Latin America, and many studies have shown that the disease is a major public health problem in Latin America (Scott et al., 2001). In Peru, 150,000 persons are living with active epilepsy (prevalence of 16.6/1000) (Bruno et al., 2013), and in the rural community of Tumbes, our study area, an epidemiological study was carried out in 2006, with a prevalence of active epilepsy of 17.2/1000. The treatment gap was 76% (Moyano et al., 2014), and nearly half of the cases were due to neurocysticercosis, the first etiology of acquired and preventable epilepsy in developing countries (Montano et al., 2005).
In accordance with WHO recommendations, traditional medicine is officially recognized in Peru. The Instituto Nacional de Medicina Tradicional (INMETRA) was created in 1991 to promote traditional medicine and its incorporation into the Instituto Nacional de Salud (INS) under the Ministry of Health. A national programme of traditional medicine comprising 26 centers in the country is currently under way, and is part of the Essalud social security system in Peru (Carrasco Cortez et al., 2008). The use of traditional medicine is widespread and it has been shown that many people living with epilepsy (PWE) in Peru manage their disease, using spiritual aspects, herbal medicine (HM) (Bussmann and Sharon, 2006) and/or anti-epileptic drugs (AEDs). To date, no study has been designed to document how PWE are treated in this country.
Therefore, due to the high prevalence of epilepsy in a region where the biodiversity index is among the highest in the world, where traditional medicine and traditional healers still play an important role as full-fledged healthcare providers (Bussmann, 2013, Bussmann and Glenn, 2010, Bussmann and Sharon, 2006, Bussmann and Sharon, 2009a, Bussmann and Sharon, 2009b, Bussmann et al., 2007, Bussmann et al., 2010a, Bussmann et al., 2010b, Bussmann et al., 2011), we decided to conduct a study to document the behavior of traditional healers and people with epilepsy on herbal medicine used for epilepsy in Northern Peru (Bussmann and Sharon, 2009b, Millones, 2014).
The main objective of our work was to assess the percentage of use of herbal medicine. Secondary objectives were to define knowledge and perceptions of the disease, identify the herbal species used in the treatment of epilepsy by people with epilepsy and traditional healers, and compare the socio-demographic characteristics of PWE who used herbal medicine with those who did not.
Section snippets
Study setting
The study was a cross-sectional observational and descriptive study. Our study area, the Tumbes region, is close to the Ecuadorian border area on the Northern coast of Peru. The city of Tumbes includes a regional hospital and the Centro de Salud Global (CSG). The first language spoken was Spanish, in the whole population. According to the most recent census, the study area had a population of 12,000 (WHO, 2014). The field work was carried out for 4 months in 31 villages in the Tumbes region
Sample characteristics
Two hundred and sixty-six people with epilepsy were identified prior to the study and of these, 228 were included. Fifteen traditional healers were identified in the study area; 10 were included. The flow-chart presented in Fig. 2 shows the spread of PWE and traditional healers included in our study. Our sample was evenly distributed by gender between men and women. The mean age of the PWE was 39.3 ± 18.4 years. The main socio-professional activities found were housewives and farmers. The
Limitations of the study
This study is the first to focus on comprehensive people with epilepsy care in Peru, addressing both the views of PWE and traditional healers. PWE were recruited through a door-to-door survey in the general population, thus our sample has a good representativeness. However, no patient has been seen only by the traditional healer, which makes extrapolation to the general population difficult. This study is obviously fragmented from a botanical point of view because we were not able to collect
Conclusions
A large majority of the people with epilepsy used and traditional healers recommended traditional medicine and herbal medicine for the treatment of epilepsy. All the traditional healers interviewed thought they know how to treat the disease and were the first health care providers to be consulted by PWE on the first-line. In this context, traditional medicine seems to be PWE's first choice for treating their disease. People with epilepsy thought it is a real alternative medicine in the
Authors’ contribution
EA conducted the study design, manuscript writing, data collection, analysis and interpretation. LM collected the data, interpreted it and corrected the manuscript. GB conducted the study design, provided data analysis, made critical comments and approved the final submission. MN, JJ interpreted the data and corrected the manuscript. VR helped design the study and corrected the manuscript. P-MP completed the study design and corrected the manuscript. FB designed the study, analyzed the data and
Funding
This work was supported by the Limousin Region as part of a thematic call for project “Health and Nature products” and the diagnosis of epilepsy was carried out by an earlier study founded by the Bill & Melinda Gates Foundation (23981).
Acknowledgments
We thank all the members of the Centro de Salud Global at University Cayetano Heredia in Peru and the members of the UMR 152 Research Institute for Development in France.
Conflict of interest
We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome.
Glossary
- AEDs
- Anti-epileptic drugs
- CSG
- Centro de Salud Global
- HM
- Herbal Medicine
- PWE
- People With Epilepsy
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