Perceptions and Acceptance of herbal medicine Utilization among The Egyptian Population during the COVID-19 pandemic

doi:10.21203/rs.3.rs-5130272/v1

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Perceptions and Acceptance of herbal medicine Utilization among The Egyptian Population during the COVID-19 pandemic

https://doi.org/10.21203/rs.3.rs-5130272/v1

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Medicinal plants provide a wide range of health benefits, including strong antiviral effects. Additionally, many herbal treatments are known for their anti-inflammatory properties and their ability to boost the immune system, making them a valuable preventive option against viral infections. This study aimed to evaluate public awareness, attitudes, and practices regarding herbal medicine during the COVID-19 pandemic. Data were collected through an online survey conducted from April 2021 to May 2023 in Egypt, with participants from across the country. The survey was divided into three main sections to assess beliefs and attitudes towards herbal medicine. The first section looked into participants' experiences with coronavirus infection, the second examined health beliefs related to coronavirus and herbal medicine, and the third evaluated general knowledge, attitudes, and practices regarding herbal medicine. A total of 910 participants took part, with 60.7% expressing satisfaction with the results of using herbal medicines, and 49.5% reported using herbal medicine during their coronavirus infection. The median knowledge score about herbal medicine in this survey was 8 out of 10. Overall, the study revealed that participants had a good understanding of herbal medicine, held positive attitudes towards it, and were open to its use.

COVID-19

public awareness

Egypt

herbal medicine

The increasing occurrence of epidemics, especially viral infections, presents a major challenge to public health. [1] Over the past decade, new infectious diseases such as swine flu, bird flu, and severe acute respiratory syndrome (SARS) have become more widespread globally. [2] COVID-19, an acute respiratory illness, shares many symptoms with other respiratory viruses. [1] Recently, drugs like Avigan, chloroquine, favipiravir, and remdesivir have been recommended for treating COVID-19, while the global search for more effective treatments continues. [3, 4]

With the persistent efforts of scientists and pharmaceutical companies, approximately 30 new allopathic compounds, natural ayurvedic products, and traditional Chinese medicines have been identified as potential treatments for COVID-19. [5] Countries that have implemented COVID-19 vaccinations anticipate a reduction in disease severity and believe that the virus may eventually become endemic, persisting only in localized areas for a few years. [6] SARS-CoV-2 has shown susceptibility to antiviral drugs previously effective against SARS-CoV and other coronaviruses. [7]

Studies have highlighted that many plant-based derivatives have been used as medicine globally, particularly in Asia and parts of Africa. [8, 9] Recently, there has been a growing interest in herbal medicines derived from plants and natural foods. [10] Several physicians and researchers have explored the use of herbal medicines in clinical trials to treat SARS-CoV-2 infections, resulting in a promising alternative therapy. [11] Panyod et al. (2020) and Silveira et al. (2020) emphasized the importance of considering the therapeutic potential of herbal treatments, given their widespread antiviral activity. [12, 13] Nigam et al. and Wang et al. noted that ginger (Zingiber officinale), honey, garlic (Allium sativum), turmeric (Curcuma longa L.), Artemesia, and Nigella sativa seed oil possess various therapeutic properties, including antiviral, anticancer, antioxidant, antifungal, immunomodulatory, cholesterol-lowering, respiratory protection, and antidiabetic effects. [14, 15] Herbal medicines have also been effective in mitigating SARS-CoV-2 and other infectious diseases. According to recent research, herbal medicine may help manage and reduce the risk of COVID-19. [16]

China’s National Health Commission, in conjunction with Western medicine, has issued recommendations on the use of herbal therapy for treating COVID-19. [17] Specifically, certain secondary metabolites found in herbal compounds, such as alkaloids, flavonoids, and polyphenols, exhibit antiviral properties by binding to viral proteins and enzymes, thereby inhibiting replication. Tannins and lignins can also prevent viral entry into host cells by forming a protective barrier around the cell membrane. [18] These bioactive compounds derived from herbs could potentially inhibit the novel coronavirus strain, SARS-CoV-2. Developing a therapeutic mechanism against SARS-CoV-2 using these compounds could be beneficial.

COVID-19 has created a global health crisis of unprecedented scale, and understanding public perceptions and beliefs about the safety and effectiveness of medicinal herbs is crucial. It is important to educate the public about the safety and efficacy of medicinal herbs during a pandemic. Further research is needed to establish the safety and efficacy of medicinal herbs in this context, which could fill gaps in the literature and provide more evidence-based knowledge on herbal medicine during pandemics. This knowledge could guide healthcare professionals and the public in the use of medicinal herbs during pandemics and help develop guidelines and regulations for their use. A previously study suggests that people at high risk of contagious diseases, including COVID-19, often turn to complementary medicines for prevention. However, there are limited studies on this topic in Egypt. This study aims to assess public beliefs, attitudes, and practices regarding herbal medicine during the COVID-19 pandemic.

2.1 The study design:

An online survey was conducted in Egypt from April 2021 to May 2022.

2.2 Sampling technique:

Participants were participated through an online survey.

2.3 Data collection:

Data was gathered using a structured online questionnaire distributed across Egypt. Completing the questionnaire took approximately 15 minutes. The questionnaire was designed based on guidelines and information from the FDA. [19]

The questionnaire was divided into four sections:

Demographic Data: Information on participants' age, gender, marital status, education level, current residence (city or rural area), and occupation.
Experience with Coronavirus Infection: Participants' personal experiences with COVID-19.
Health Beliefs: Participants' beliefs about coronavirus and herbal medicine.
General Knowledge, Attitudes, and Practices: Participants' overall knowledge, attitudes, and practices concerning herbal medicine.

For the last three sections, responses were recorded as "Yes," "No," or "Maybe." To assess overall knowledge, participants were given a score of 1 for each correct answer and 0 for incorrect or unknown answers, resulting in a total score ranging from 0 to 10. Participants were classified as having good knowledge if they scored above 8 (over 80%), and as not having good knowledge if their score was below this threshold. [20, 21]

3.1 Demographic Data of Participants
A total of 910 participants completed the study. The largest group (40.8%) was aged between 35 and 45 years. Among them, 64.4% were married, and 87% held a college degree. About 60% were employed in non-medical fields, and 70.1% lived in urban areas. Table 1 presents the detailed demographic percentages of the participants.

3.2 Participants' Experiences with Coronavirus Infection:
The vast majority of participants (92%) reported contracting the coronavirus, and 76.1% indicated they did not have any chronic conditions. Additionally, 85% had a close family member who had been infected with the virus. Recovery time varied, with 51% stating it took 3-4 weeks for a family member to recover, and 23.3% reported it took over 4 weeks. Furthermore, 42% had a family member who required hospitalization due to the infection.

Post-COVID syndromes reported in families included fatigue (69%), shortness of breath (57.6%), cough (68.4%), chest pain (61.9%), difficulty concentrating (50.4%), depression (58.2%), increased heart rate (61.2%), smell issues (47.9%), taste problems (41.4%), elevated blood sugar levels (19.6%), eye inflammation (34.4%), blood clots (10.8%), hair loss (19.2%), nausea (26%), and headache (37.5%). However, 22.3% reported no post-COVID symptoms. Additionally, 23.5% of participants had a family member who died due to coronavirus, and 12% were still adhering to precautionary measures. Table 2 provides a detailed account of participants' experiences with the virus.

3.3 Health beliefs regarding the coronavirus and the vaccine:

95% of respondents believed that a person can contract the coronavirus more than once. Among all participants, 79% thought that even those vaccinated against the coronavirus could still be reinfected. Additionally, 54% believed that herd immunity alone could protect everyone from the virus. When asked about the effectiveness of the current coronavirus vaccines, 42.8% rated it as high, 46.3% as moderate, and 10.9% as low. Regarding vaccination status, 88% reported having received two doses of the COVID-19 vaccine.

Among the participants, 49.5% reported using herbal medicine. There was a notable disparity in responses to the question, "What are your sources of information about herbal medicine?" with 37.5% citing Ministry of Health guidelines, 55% pointing to social media, and 7.5% relying on family and friends. In this study, herbal medicines were primarily obtained from herbal stores (42%), pharmacies (26.5%), online (7%), and supermarkets (24.5%).

When it came to reasons for using herbal medicine, the most frequently mentioned were ‘personal experience’ (65.2%), the ‘natural’ origins of herbal medicine (49.8%), ‘ease of access and availability of herbal remedies’ (49%), and ‘advice from family and friends’ (46%). On the other hand, the top reasons for not using herbal medicine among those who hadn't used it included ‘lack of experience or knowledge’ (46.8%), ‘longer time to see effects’ (51.7%), ‘being healthy with no need for it’ (39.5%), and ‘lack of expert guidance’ (27.6%).

Table 3 illustrates the health beliefs related to coronavirus and herbal medicine.

3.4 General knowledge, attitudes, and practices of participants toward herbal medicine

A significant portion of the participants (62.1%) believed that herbal medicines are safe. Additionally, 27.5% felt that herbal medicines are more effective than conventional drugs, and 59.5% stated that herbal medicines have fewer side effects compared to conventional drugs. Most participants (60.7%) viewed herbal medicines as effective for treating minor health issues, while 28% believed in their effectiveness for more serious conditions. Furthermore, 60.7% of the respondents expressed satisfaction with the results they experienced from using herbal medicines. However, the majority (50.5%) also believed that herbal medicines take a long time to show their effects, and 62% were concerned that using herbal medicines might delay their recovery.

Table 4 illustrates the general knowledge, attitude and practices of the participants towards herbal medicine.

Total knowledge:

The median knowledge score in this survey was 8 out of 10, indicating that participants had a satisfactory understanding of herbal medicines.

The COVID-19 pandemic continues to pose a global threat. In response, the use of herbal medicines has gained attention, particularly given the worldwide spread of COVID-19 and the need to safeguard public health. A study conducted across 32 countries revealed that around 24.5% of adults are turning to traditional herbal remedies. [22] This study specifically examines public beliefs, attitudes, and practices related to herbal medicine during the COVID-19 pandemic in Egypt. Understanding Egyptian participants' awareness and beliefs about herbal medicine is particularly significant, as Egypt's awareness level is often reflective of the broader Middle Eastern region. This is due to the widespread reach of Egyptian media across the Middle East, meaning that awareness campaigns in Egypt could have a regional impact.

While many medicinal plants and their formulations have been shown to improve health in various diseases, research on the effectiveness of different plant genera against SARS-CoV-2 is still limited. Therefore, studies on these herbs should be conducted in a detailed and systematic manner. In this study, the questionnaire covered a broad range of topics, including participants' experiences with coronavirus infection, their health beliefs about the virus and herbal medicines, and their general knowledge, attitudes, and practices concerning herbal medicine.

Demographic data from the study showed a higher percentage of female participants, many of whom were married, lived in cities, had graduated from college, and worked in non-medical fields. This suggests that women may have greater concerns about infection, a stronger inclination to care for their health, and a greater interest in sharing and testing their knowledge about herbal medicine. Moreover, women were observed to use herbal medicines more frequently than men, indicating that they might be more knowledgeable about the therapeutic properties of plants and more involved in maintaining their families' health. The study also found a link between education levels and the use of herbal medicine to alleviate COVID-19 symptoms, possibly because gathering information on medicinal herbs often depends on one's education. News coverage and social media have played a role in raising public awareness of COVID-19's severity and consequences. [23] Understanding the causes of diseases is the first step in promoting public education. Public knowledge including how diseases are transmitted, preventive measures, and information on herbal medicine is crucial for combating coronavirus infections, especially since the development of new drugs requires extensive trials and lengthy regulatory processes. [23, 24]

As the pandemic persists, people have increasingly turned to alternative health measures. This has led to a higher demand for products such as vitamins, supplements, and natural remedies like herbs and essential oils. Many have also adopted healthier diets and lifestyles to boost their immunity and protect themselves from the virus.

Herbal medicine has been claimed not only to enhance the immune system against the coronavirus but also to effectively prevent and treat SARS-related diseases. [25] It has also been noted for its ability to relieve cold and flu-like symptoms such as fever, cough, fatigue, sneezing, sore throat, and muscle pain. Additionally, herbal medicine can complement modern medicine, creating synergistic effects in treating SARS-related diseases. [16] As a result, the use of herbal medicine is recommended for both the prevention and complementary treatment of COVID-19.

Nearly 82% of respondents were considered knowledgeable about herbal medicines and had a positive attitude toward them. However, only 49.5% of the study participants used herbal medicine during the pandemic. The study used a specific cutoff point (more than 80%) to classify participants as having satisfactory knowledge about the coronavirus. This contrasts with a previous study that found low acceptance of herbal medicine in Egypt. [26]

Previous research has identified commonly used medicinal herbs such as ginger, lemon, black seed, myrrh, mint, honey, and anise, which are used for both nutritional and medicinal purposes. [27, 28] This highlights the variety of natural formulations that could be considered for combating COVID-19 and other viral infections. A study by Alyami et al. explored the use of herbal products to prevent COVID-19, aligning with the suggestion that herbs can play a crucial role in boosting individual immunity. [29] Other investigations into the effects of various herbal supplements on COVID-19 treatment have found significant benefits from ginger, lemon/orange, vitamin C, honey, black seed, and costus. [30] Several plant-based biochemical components can help alleviate common symptoms of COVID-19, such as fever and cough. [31] Adopting a balanced diet that includes healthy foods and medicinal herbs is an essential step in supporting the immune system and preparing for potential future waves of the virus.

Participants who had previously contracted the coronavirus, had chronic diseases, or had a family member hospitalized due to COVID-19 were particularly concerned about the infection and showed a high level of acceptance for herbal treatments. Those who recognized COVID-19 as a serious threat were also more inclined to use herbal medicine. Increasing public knowledge about the safety of herbal medicine should be a priority to encourage its widespread use. [32]

Many participants reported that their families had suffered from post-COVID-19 syndrome, with cough and depression being the most common symptoms. Depression has been identified as the most prevalent neuropsychiatric disorder following COVID-19. [33] Previous studies have found that about 10% of COVID-19 patients experienced a persistent cough for up to four months after recovery. [34–36]

Most participants adhered to precautionary measures to protect themselves from COVID-19, indicating their awareness of the virus's dangers and their fear of infection. About two-thirds of respondents believed that herd immunity could protect everyone from the coronavirus. People typically become immune after infection or vaccination, reducing the number of infections and the virus's reproduction rate. It has been reported that achieving herd immunity requires that 86% of the population be vaccinated. [37]

There were varying levels of confidence in the vaccine's effectiveness, as reflected in the responses to the question, "How effective do you think the current coronavirus vaccines are?" Here, 42.8% rated the vaccines as highly effective, 46.3% as moderately effective, and 10.9% as having low effectiveness. This highlights the importance of building public trust in COVID-19 vaccines, which can be accomplished by launching advertising campaigns and providing transparent information about the vaccines. [24]

Communities should actively listen to concerns, provide answers to questions, and correct any misinformation. [38] Given that public trust in vaccination is relatively low, successful COVID-19 vaccination programs depend on the belief that available vaccines are safe and effective. [39] Lucia et al. emphasized the need for transparency and addressing safety concerns. Supporting COVID-19 vaccination through public messaging, news releases, and combating misinformation is crucial. [24, 40]

While 37.5% of participants reported that they obtained information about herbal medicine from Ministry of Health guidelines, other studies have shown that social media and scientific articles published in the media were the most common sources of information. [41, 42]

During the COVID-19 pandemic, 60.7% of participants considered using herbal medicine to treat common illnesses. Previous studies have listed commonly used herbal medicines, with ginger, honey, garlic, and perilla being among the most frequently cited. [25] These herbs were mainly used to treat sore throat, cough, nasal congestion, and fever. [25]

It is essential to keep the public and healthcare workers informed about new research and information regarding herbal medicine. Participants with higher education levels were found to be more knowledgeable, likely due to their ability to understand educational messages. Higher educated individuals also tend to access a wider range of information sources about herbal medicine, which may not be as readily available to those with lower education levels.

The study participants demonstrated a good understanding of both coronavirus and the effectiveness of herbal medicine. However, despite their general acceptance of herbal medicine, there are concerns due to the lack of sufficient clinical trials and doubts about its efficacy. Therefore, providing adequate information about herbal medicine is essential. Media and social media campaigns are crucial in combating misinformation. Healthcare professionals should be open to discussing and recommending herbal medicine when it could lead to better health outcomes. The growing recognition of the role of medicinal herbs in treating infections suggests that educating the public about their benefits and the importance of healthy eating could be an effective way to improve public health and reduce infection rates. The findings of this study are important for future research on the use of herbal medicines in Egypt and will be valuable for policymakers and manufacturers making decisions in the field of herbal medicine.

Ethics approval:

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board (or Ethics Committee) of faculty of pharmacy Beni-suef University.

Consent to participate:

“Not applicable.”

Consent for publication:

“Not applicable.”

Competing interests:

The authors declare no conflicts of interest

Clinical trial number

Not applicable

Funding:

No funding

Author Contribution

Conception and design, Mohamed E.A. Abdelrahim. and Marwa O. Elgendy; methodology, Doaa G. El-Hosari, Sara O. Elgendy, and Marwa O. Elgendy; software, Marwa O. Elgendy; validation and investigation, Marwa O. Elgendy, and Doaa G. El-Hosari; original draft preparation, Sara O. Elgendy, Mohamed E.A. Abdelrahim, and Marwa O. Elgendy; writing review and editing, Sara O. Elgendy, Mohamed E.A. Abdelrahim, Marwa O. Elgendy, and Doaa G. El-Hosari; visualization, Doaa G. El-Hosari; supervision, Mohamed E.A. Abdelrahim and Marwa O. Elgendy. All authors have read and approved to the final version of the manuscript”.

Acknowledgements:

Not applicable

Availability of data and material:

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Tables 1 to 4 are available in the Supplementary Files section.

No competing interests reported.

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You are reading this latest preprint version

Perceptions and Acceptance of herbal medicine Utilization among The Egyptian Population during the COVID-19 pandemic

Status:

Version 1

Abstract

1. Introduction

2. Materials and Methods

2.1 The study design:

2.2 Sampling technique:

2.3 Data collection:

3. Results

4. Discussion

5. Conclusions

Declarations

Competing interests:

Clinical trial number

Funding:

Author Contribution

Acknowledgements:

Availability of data and material:

References

Tables

Additional Declarations

Supplementary Files

Status:

Version 1