EXPERIENCE AND UTILIZATION OF TRADITIONAL MEDICINE AMONG THE COMMUNITY OF BAHIR DAR CITY, AMHARA REGION, NORTH WEST ETHIOPIA
ABEBU TEGENAW, LEMLEM W/SELASIE, MATEBE MUCHE, TEKA GEMECHU, TILAHUN TEWABE, AMARE BELACHEW, AYELE SEMACHEW, ASHAGRE MOLLA
ABSTRACT
Background; Traditional medicine refers to health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies , manual techniques and experience applied singularly or in combination to treat, diagnose and prevent illness or maintain wellbeing.
Traditional Medicine has always been close to the large society, especially to those in developing countries, for meeting their primary healthcare needs. This popularity of TM has once again been proved by the present study, as it reveals that TM is widely practiced and accepted, particularly by the rural population.
Objectives; The main objective of this study was to assess the experience and utilization of traditional medicine in Bahir Dar city and to create awareness about the side effects of use of traditional medicine.
Methods; A community based cross sectional study design was conducted from March-June 18/06/2016 E.C. Since Bahir Dar city has 17 kebeles from these 3 kebeles were selected randomly, which are kebele 07, kebele 13 and kebele 10. Then total of 634 households of selected kebele were selected by systemic random method by using their skip interval which is 12. Total of 634 households are interviewed. The data was collected through house to house interview by using structured questionnaires and it was analyzed by spss version 20 and it was interpreted.
Results; Among 634 participants 373(%) are females and 261(%) are males. The mean(+-s.d) age of the participants was 33.3(+-12.48). From those participants 421(66.4%) have used traditional medicine.
Conclusion; Majority of the populations of aBahir Dar City( 66.4% ) have used traditional medicine.
Key words; Traditional medicine, experience, utilization
‘
Background
Traditional medicine refers to health practices, approaches, knowledge and beliefs incorporating plant, animal and mineral based medicines, spiritual therapies, manual techniques and experience applied singularly or in combination to treat, diagnose and prevent illness or maintain wellbeing [1]. Traditional medicine also refers to medicines derived from natural sources such as plants and animals without being processed chemically [2].
Traditional medicine may also be referred to as folk medicine, alternative medicine, indigenous medicine or natural medicine. There are a number of advantages associated with using TM as opposed to pharmaceutical products such as; it reduced risk of side effect, it is effective with treating chronic illnesses, it is cheap to afford and it is available. Whereas it has different disadvantages such as; lack of dosage instruction, it has poison risk associated with wild herbs, it has medication interruption and it has lack of regulation [3].
Herbal medicine is used to treat many conditions, such as allergies, asthma, eczema, premenstrual syndrome, rheumatoid arthritis, fibromyalgia, migraine, menopausal symptoms, chronic fatigue, irritable bowel syndrome, and cancer, among others [4].
TM has been commonly used over the years for treatment, prevention of diseases and health promotion as well as for enhancement of quality of life worldwide. Traditional Chinese medicine has history of more than 3000 years ago. The book Devine farmer’s classic of herbalism was compiled about 2000years ago in china and is the oldest known herbal text in the world [5].
Medicinal plants are an integral part of the African healthcare system since time immemorial [6]. Majority of African people use traditional medicine. Examples of African traditional medicine practices that are recognized by almost all communities in Africa region include general traditional health services, traditional midwifery, bone setting and mental health care. Traditional health services that are not recognized by all communities and governments include divination and circumcision [7].
Before the establishment of science-based medicine, traditional medicine was the dominant medical system for millions of people in Africa but the arrival of the Europeans was a noticeable turning point in the history of this ancient tradition and culture [8].
In developed countries factors responsible for the growing of TM are beyond accessibility, affordability, and cultural compatibility. But it is due to anxiety about the adverse effect of chemical drugs and increase reported cases of chronic illnesses [9].
It is impossible to pinpoint the birth of TM in Ethiopia, but certainly the evolution of curative practices closely follows the path of disease. Despite western medicine becoming more wide spread in Ethiopia, Ethiopians tend to relay more on TM [10].
In Ethiopia more than 95% of preparation of TM is from plants. Ethiopian TM practitioners use TM for the treatment of chronic illnesses that are not threatened by modern medicine such as;-AIDS, cancer, arthritis, rheumatoid &Parkinsonism [11].
1.2: STATEMENT OF THE PROBLEM
Traditional medicine is the sum total of the knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness [1].
Trends in the use of traditional and complementary medicine are on the increase in many developed and developing countries [12].
Billions of US dollars are spent annually on traditional medicine in many developed countries. For example, in 2012, 32 billion dollars were spent in the United States of America on dietary supplements, an amount expected to increase to 60 billion dollars in 2021.TheWorld Health Organization estimates that the global market of traditional medicine is approximately US $83 billion annually [4].
There are indications that CAM is gaining widespread acceptability in Australia, France and Canada with 46%, 49% and 70% of the population respectively using TM [13].
There are a number of problems that challenge the use of TM in Africa such as acceptance of western religion, education, urbanization and globalization [9].
A number of factors have been identified as a responsible for the wide spread use of TM and, for assessing and evaluating the effectiveness of the medicine across the world [14].
Un regulated or inappropriate use of traditional medicines and practices can have negative and dangerous effects. For example the herb ‘Ma Huang’ is traditionally used in china to treat respiratory congestion. This herb used in US as dietary aid, that whose overdose led to at least a dozen death, heart attack, and strokes. In Belgium, at least 70 people required renal transplant or dialysis for interstitial fibrosis of kidney after taking a herbal preparation made from the wrong species of plant as a slimming treatment [15].
Irrational use of medicine is a major problem worldwide. It is estimated that more than half of all medicines are prescribed, dispensed or sold inappropriately and that half of all patients fail to take them correctly. This contributes to enormous health and economic impacts both at a personal and national level [14].
Since there is lack of detail documentation of traditional, which is generally transmitted orally, serious adverse effects can result from misidentification or misuse of healing plant [3]. All plant extracts were found to induce significant DNA damage without affecting the cell viability.T.schimperiand and R.steudelii were the most potent DNA damaging extracts and G.lotoides and P.zeyilina is the least patent [16].
The Ethiopian government firmly supports and encourages traditional medicine through its policies as part of national heritages. Despite this commitment on the policies, the governments to implement and provide increased resource for the study, as well as sustainable use of traditional medicine and their integration with modern medical practice has been limited [17]. Medicinal plants represent a significant contribution to human and livestock health and it has been suggested that their use is one of the most significant ways in which humans directly reap the benefits provided from bio diversity [18].
Since researches done on experience and utilization of traditional medicine particularly in Bahir Dar city are limited, this research will be done to fulfill this gap and to have adequate information about traditional medicine in this city in order to take action accordingly.
‘
CHAPTER THREE; JUSTIFICATION AND SIGNIFICANCE OF THE STUDY
This research will be used to create awareness about the side effects of traditional medicine in the community. In addition to this the result of this research will be used for researchers as base line information about traditional medicine particularly in Bahir Dar city. It also gives information for both city and regional administrators to take action accordingly.
Currently our country Ethiopian policy gives more focus and work at the integration of traditional medicine with modern medicine that the result of this research will use for both regional and federal policy makers as guide line in order to make polices that enable to achieve this goal.
OBJECTIVES
4.1 General objective
To assess the experience and utilization of traditional medicine among community of Bahir Dar city, 2016
4.2 Specific objectives
1. To assess prevalence of utilization of traditional medicine in Bahir Dar City.
2. To identify the main reasons for the use of traditional medicine for the people who live in Bahir Dar City
METHODS AND MATERIALS
Study area
The study was conducted in Bahir Dar city, located in northwest of Ethiopia or the capital city of Amhara regional state which is found 564KM from Addis Ababa. Bahir Dar city has 318,429 numbers of populations and 17 kebeles. Bahir Dar is situated on the southern shore of Lake Tana, the source of Blue Nile having attitude and longitude of 11036 N 37023E and an elevation of about 1,800 meters above sea level.
5.2 Study design and period
A community based descriptive cross sectional study design was conducted from May 6-May 16/09/08 E.C
5 .3 Source population
All the households in Bahir Dar city were the source population of the study.
5.4 Study population
All the households in the selected Kebeles were the study population.
5.5 Study unit
All the households in the selected Kebeles which were selected by using skip interval.
5.6 Eligible criteria
5.6.1 Inclusion criteria
The study population was included the head of the household or the spouse and living for at least 6 months in the city.
5.6.2 Exclusion criteria
The study excluded
– Individuals less than 18 years old.
– Individuals who are severely ill and not able to communicate.
5.7 Sample size determination
The sample size was determined by using single population proportion formula
Using p=71% [23] and using 2 as design effect, 634 households
5.8 Sampling techniques
Bahir Dar city has 9 sub cities, which comprises in to 17 kebeles. So, we were select 20% of these kebeles randomly by lottery method. We select three kebeles randomly which are kebele 07, 13 and 10.Then we were select households in the selected kebeles by using systematic random method by using their skip interval. Each selected kebeles has 3500, 3800 and 450 households respectively. We need totally 634 households from 3 kebeles for interviewing. We will do sample size proportionate for each selected kebeles.
Sample size proportion= (total number of households in the kebele)( sample size)
Total number of households in 3 kebeles
Sample size proportion for kebele 07= (3500) (634)/7750=286
Kebele 13= (3800)(634)/7750=310
Kebele 10= (450)(634)/7750=37
So, We will select 286,310 and 37 households from kebele 07,13 and 10 respectively by using skip interval k value.
K value=Total number of households of 3 kebeles
Total number of selected households in 3 kebeles
=3500+3800+450 /286+310+37=7750/634=12.2=12
So, We data will be collected by skipping 12 households in three selected kebeles.
5.9 Study variables
5.9.1 Dependent variables
Experience and utilization of traditional medicine
5.9.2 Independent variables
Sex, age, income, marital status, occupation, religion, ethnicity & educational status.
5.10 Operational definitions
Have experience of utilization of traditional medicine; participants who use at least one of traditional medicine once in their life time.
Have no experience of utilization of traditional medicine; participants who never use traditional medicine in their life time.
5.11 Data collection procedures
The data will be collected by us using structured questionnaires. The questionnaires contain open ended, multiple choice and yes or no type questions. The mechanism of data collection will be by interviewing individuals.
5.12 Data Analysis
Data cleansing and data transferring was done immediately after daily data collection activities accomplishment. Finally the data was analyzed by spss version 20.0soft ware.
5.13 Data quality control
Before data collected we data collectors was discuss on questionnaires and about the mechanism of data collection to have similar understanding .In addition to this pretest will be performed in 5% sample size in one of non-selected kebeles in Bahir Dar city to check the validity of questionnaires
.5.14 Ethical considerations
The study was carried out after letter of permission obtained from Bahir Dar University College of medicine and health science department of nursing. Before interview was began we were assure participants that the information they give will be used for only research purpose and it will be kept confidential. After that oral consent was obtained from participants to begin the interview.
CHAPTER SIX; Results
Socio demographic data
A total of 634 respondents with respondent rate of 100% were studied. Among those participants 373 (58.8%) were females and the rest 261(41.2%) were males.
The age of participants was ranged from 18 to 90with mean age of 33.76 with standard deviation of (+or-) 12.48.The age of one hundred ninety four (30.6%) of participants is within the range of 18-28,one hundred twenty seven(20.0%) are in the range of age 29-38,87(13.7%) are in range of age 39-48 and 226(35.6%) are age greater than 48 years.
Regarding to marital status from the total of participants in this study 414(65.3%) participants were married, 194(30.6%) were single, 17(2.7%) were widowed and the rest 9(1.4%) were divorced.
Regarding to religion from the total of 634 participants 559(88.2%) of them were followers of Orthodox Christianity, 60(9.5%) were Muslim and 15(2.4%) were protestant.
The educational status of the participants is from the total of the participants 116(18.3%) were can not read and write, 176(27.8%) are learnt up to primary school, 121(19.1%) secondary, 63(9.9%) preparatory and the rest 158(24.9%) were joined university and college. Among the participants 244(38.5%) were governmental employee, 167(26.3%) were house wife, 81(12.8%) were labor worker, 28(4.4%) were merchant and the rest 53(8.4%) were students. The ethnicity of the participants was 589(92.9%) were Amhara, 29(4.6%) Agew, 9(1.4%) Oromo and the rest 7(1.1%) Tigrie (Table 1).
Utilization of traditional medicine
In this study from the total of 634 participants who were interviewed 421(66.4%) of participants have used traditional medicine but the rest 213(33.6%) have never used traditional medicine.
From those participants who used TM 138(32.8%) use TM currently, 139(33.0%) used in the last one year, 66(15.7%) used in the last two years, 78(18.5%) used before two years ago.
From the users of traditional medicine 379(90.0%) of participants used herbal medicine and the rest 18(4.3%) used uvuloectomy type of TM and the rest 24(5.7%) are other types of medication such as wood for fracture.
As this study revealed that from those participants who use TM 125(29.7%) used TM for preventing different illness and the rest 296(70.3%) used for treatment.
From those participants who used TM for prophylaxis purpose forty four(35.2%) used for cough, seven(5.6%) used for asthma, seven(5.6%) used for gastritis, forty six(36.8%) used for malaria and acute febrile illness, one(0.8%) used for reproductive related specially for preventing repeated abortion and four(3.2%) used for chronic illness, two(1.6%) for other symptomatic illnesses, one(0.8%) for skin diseases and the rest thirteen(10.4%) for other illness such as evil eye.
Among the 296 participants who used TM for treatment 49 (16.6%) used for cough,17 (5.7%) used for asthma,46 (15.5%) used for gastritis, 55 (18.6%) used for malaria and acute febrile illnesss,7(2.4%) used for reproductive related illness,41(13.9%) for chronic illness( from the chronic illness 30(73.1%) used for arthiritis,5(12.1%) used for diabetes mellitus and 6(14.8%)used for hypertension) ,3(1%) are used for other symptomatic illness,29 (9.8%) used dermatological problems and 49(16.6%) used for the treatment of other health problems such as fracture, hepatitis, hemorrhoid rabies, evil eye, headache, tape worm and eye problems
This study result shows that out of those participants who use herbal medication157 (41.4%) get plants from TMP, 147(38.8%) from home garden, 48(12.7%) from the market and the rest 27(7.1%) from the forest.
From those participants who use plants as a medication 269(71.0%) used leaves, 57(15.0%) stem, 9(2.4%) root and 44(11.6%) seeds.
The most common routs of administrations the utilizers have used are 293(69.6%) oral, 31(7.4%) anal, 60(14.3%) topical 25(5.9%) nasal and 12(2.9%) other such as tieing the medication on the neck and surgical removal of uvula by sharp instruments.
According to our study result shows that the most common forms of medications participants used are 27(6.4%) gaseous,310 (73.6%) liquid, 68(3.8%) powder form and others.
Similarly the most common methods of preparations of the medication are 283(67.2%) squeezing, 63(15.0%) concoction, 47(11.2%) pounding ,9(2.1%) crushing and the rest 19(4.5%) others.
In our study the frequency of utilization of TM among participants who used traditional medicine was 74(17.7%) used TM only once, 74(17.6%) used TM twice and the rest 273(64.8%) used TM more than two times in their life time.
In this study from those participants who used traditional medicine 73(17.3%) have experienced different side effects .The most side effects are 28(38.4%) allergic reaction to the medication, 28(38.4%) diarrhea and 13(17.8%) exaggerate the severity of existed disease and the rest 4(5.5%) are other side effects such as headache, permanent disability (both physical and psychological), psychosis. gangrene etc.
From those participants who experience Side effects 25(34.2%) were stop taking the medication, 26(35.6%) were go to traditional medicine practitioner and the rest 19(26.0%) were go to modern medicine in order to treat the side effects they experience
In this study the main reasons of participants why used traditional medicine are 223(53.0%) of participants say that thy use TM because of modern medicine failed, 89(21.1%) because of traditional medicine is more effective than modern medicine, 81(19.2%) because of TM is less costy than modern medicine and the rest 27(6.4%) are due to lack of modern medicine.
About the dosages of the medication 212(50.4) of the participants take the medication occasionally when they feel sick, 106(25.2%) once daily, 52(12.4%) only once and the rest 51(12.1%) take weekly once.
From the total of participants who use TM 148(35.2%) of the participants in this study prefer traditional medicine due to 64(43.2%) it is effective, 47(31.8%) it is less cost and the rest 37(25.0%) it easy to afford and available.
From total of the participants 213 (33.4%) of them never use traditional medicine in their life time. The main reasons of the participants why they did not use Traditional medicine are 98 (46.0%) due to fear of side effects 96(45.1%) are due Traditional medicine less effective than modern medicine and other such as it is forbidden to go to TMP in religion.
2. Discussion
The prevalence of Traditional Medicine utilization in our study is 66.4%. Our finding is somewhat lower when compared to another studies conducted in Ethiopia. The study conducted in Amhara region in merawi town in 2015 states that the prevalence of utilization of TM was 70.9% [23], study conducted in Eastern Harrgie in 2011 shows that the prevalence of utilization TM in Ethiopia was 90% [21] and another study conducted in Arsi Zone in 2011 also shows that the prevalence of utilization of traditional medicine in Ethiopia was 94.22% [20].
This difference between the other studies and our study may be probably due to there is high coverage rate of modern medicine institutions both private and public in Bahir Dar city when compared to other places since it is the capital city and other reason for this discrepancy may be associated with the time gap in which the studies are conducted because technology is developed from time to time that as technology develops the coverage of modern medicine became increased and the knowledge and attitudes of the society is changed, because of increased coverage different mass medias which disseminate information about advantage and disadvantage of utilization TM and increase literacy rate has its own effect in utilization of traditional medicine.
This study shows that the most types of TM practiced in Bahir Dar city were 90.0% herbal medication and 4.3% uvuloectomy. Similarly the study conducted in merawi revealed that among the practiced TM the commonest are herbal medication 64% and uvuloectomy 20.1% [23].The difference may be due to adequate information was disseminated about the disadvantages of uvuloectomy in Bahir Dar City and the residents of this city may have good knowledge about disadvantages of uvuloectomy. Another justification to this difference of prevalence of uvuloectomy may be the increased educational level status of the participants will decrease the prevalence practice of harmful traditional medicine such as uvuloectomy that since Bahir Dar is the capital city of Amhara region where as Merawi is one rural town. So the literacy rate of the population in Bahir Dar may be higher than Merawi and it may be also due to cultural difference the areas.
Our study result shows that the most common parts of the plant used by participants in Bahir City are (71.0%) leaves,(15.0%) stem,(2.1%) roots and the rest(11.2%) are seeds. In similar manner the other study conducted in Merawi town shows that the most common parts of plant are leaves, stem and seeds were mainly used for treatment [23]. In addition to this study also reveals that most of the participants who use herbal medication for treatment 38.8% of them get plants from home garden,12.7% from the market,41.4% from traditional medicine practitioners and the rest 7.1% from forests. Similarly the study conducted in Merawi Town shows that plants that are used for treatment are obtained from home garden, market and traditional medicine practitioners [23]. And another study conducted in o room region shows that the majority of plant species 81.6% that are used for treatment of different illness were collected from wild or forest while the rest 28.4 from home garden [ 24]. The difference between the result of our study and these studies is may be due the difference in availability of forests in the study area.
This study also shows that the most common types of routes of administrations of traditional medications are oral(69.6%),dermal(14.3%),nasal(5.9%) ,anal(7.4%) and the rest 2.9%are others such as, tieing the medication on neck and removal of uvula by sharp material to prevent future uveitis which is similar with the result of the study conducted in Arsi zone in 2011 shows that most of the remedies were administered through oral(53.85%),dermal or topical (36.54%) , anal(5.77%) and buccal(3.85%)[20] and another study conducted in Merawi zone shows that most commonly used routes of administrations are oral, topical and inhalational routes of administration[23].Slight difference in prevalence of routes of administration may be related to different reasons such as, the difference in type of disease they are used to treat, different prevalence of disease in each areas and difference experience of Traditional medicine practitioners.
Our study result also shows that the most common methods of preparations of medications in Bahir Dar City were squeezing(67.2%),concoction(15.0%),pounding(11.2%) and crushing (2.1%) which similar with study conducted in Arsi Zone shows that the methods of preparations were pounding(27.54%),crushing(18.84%),concoction(15.95%) and squeezing(13.04%)[20]. The only difference is the magnitude of each methods of preparations has gap that this may be related to the difference experience of Traditional medicine practitioners, difference experience the population in each study areas and the type of being treated.
In this study from the total of participants who use traditional medicine 70.3% of them use traditional medicine for treating (16.6%) cough, asthma (5.7%),peptic ulcer disease(15.5%), malaria and other febrile illness(18.6%), reproductive related illness(2.4%),chronic illness (13.9%),symptomatic illness (1%) and the rest 9.8% used for treating skin diseases. In similar way the study conducted in Tanzania revealed that 42% of population in Tanzania used Traditional Medicine for the treatment of symptomatic illness, 15% for chronic illness,11% for reproductive related problems and the res 11% for treatment of malaria and other febrile illness[22]. The discrepancy of the results of two studies may be related to the difference in disease prevalence in the study areas which are Tanzania and Ethiopia. Another study conducted in Ethiopia revealed that headache, cough, peptic ulcer disease, asthma, cold, skin disease and hypertension are reported to be treated with the different plant preparation which is in line with our study result [23].
The most common forms of preparations are 73.6% liquid, 16.2% powder, and the res 6.4% are gaseous form. Which is similar with the study in Merawi in 2015 the people prepare the plants in different dosage forms such as, liquid, solid and gaseous [23].
Our study revealed that 17.3% of the population used Traditional Medicine experience side effect related to using TM. Which are 38.4% allergic reaction.38.4% diarrhea, and 17.8% increase severity of illness which is similar with the result of the study conducted in Merawi town 22.7% of the population experience adverse effects after the use of TM and the most common are bleeding, fistula, psychosis and exacerbation of existed illness[23]. The only difference is the type of side effect they experience it may be due to different species of plants which are used to treat, the type of disease being treated, the experience of TMP, the general condition of the patient treated and patient performance or ability to take the medication in correct time, dose and route.
This study also shows that the main reasons to use of TM in Bahir Dar city are 53% of the participants says that they used TM because of after modern medicine is failed,21.1% of the participants use TM because of they believe that TM is more effective than modern medicine to treat certain diseases (especially chronic illness such as arthritis, asthma, diabetic mellitus, hypertension and psychosis illness) ,219.1% are due to TM is less costly than modern medicine and the rest only o.2% of them says they use TM because there is no available modern medicine. In the same direction there are researches done in Ethiopia in the previous years the reasons of using TM. The study conducted in Assosa Benshangule Gumize regional state shows that most of people use TM 54.8% believed that TM is more effective,24.2% claimed the use of TM only hen modern medicine failed, while 19.1% preferred Traditional medicine because of low cost and remaining 1.9% claimed that lack of access to modern medicine prompt them to use TM[25]. And another study conducted in Dembia district north west Ethiopia in 2010 shows that the main reasons behind the preference of TM to that of modern medicine was that TM is more effective than modern medicine and there are also factors influencing the preference such as affordability, accessibility and acceptability[19].
‘
Conclusion and recommendation
In Bahir Dar City more than two third of the population have experience of utilization of traditional medicine. The most common type of Traditional Medicine peoples used in this City is herbal medication. The most common parts of the plants used as a medication in this City were leaves, stems and roots. Similarly the routes of administration the people administer the medications were oral, anal, dermal and nasal. The most common methods of preparation of the medications are squeezing, concoction, pounding and crushing and the most common forms of the medications are liquid, gaseous and powder.
The people of the Bahir Dar City used traditional medicine for both treating and preventing different illness such as asthma ,peptic ulcer disease, malaria and other febrile illness, cough, reproductive related problems, skin disease ,hemorrhoid, hepatitis, fracture and others. There are different reasons to using Traditional Medicine in Bahir Dar City such as because modern medicine failed, TM is more effective than modern medicine and TM is less costy. From the users of TM significant proportion of them experience adverse effects related to using TM.
The most common side effects were diarrhea and exacerbation of existing illness. The managements taken by TM users to treat the side effects are stop taking the medication, go to TMP and go to modern medicine. Finally we will recommend for regional health bureaus to create awareness for the community about advantage and disadvantages of using TM since most of the users experience side effect related to TM.
Further observational and/ experimental research should be done to identify the ingredients of traditional medication, storage, dosage and administration and their therapeutic effects.
References
1. Traditional medicine definitional. Http; // www.who.int/medicines/areas/traditional/en accessed on 15/06/08.
2. Chemistry team; examples of traditional medicine, their source and uses. Chemistry team 95.blogspot.com (2012).
3. Jeanne Grunert.advantages and disadvantages of herbs. Love to know available at http//www.herbs.lovetoknow.com accessed on 14/06/08.
4. Steven D.Ethrich, NMD, solutions Acuprtre a private practice specializing in complementary and alternative medicine, phoenix, AZ [2015].
5. Herbal medicine-herbal medicine. http;//www.ncbi.nlm.nih.gov>ncbi.accessed on 13/06/08.
6. M.Fawzi Mohammodally.Traditional Medicine in Africa: An appresial of ten potent African plants. Evidence based complementary and alternative medicine. Vol (2013), no617459, p (14).
7. Clinical practices of African traditional medicine. African health. http;//www.aho.afro.who.int/en/ahm/issue/1/accessesed on 12/06/08E.C.
8. Wikipedia Atom feed Traditional African Medicine. A kapsikicrab sorcerer of Rhumsiki. Extreme North province Cameroon uses a form of divination by interpreting the changes in position of various objects as caused by a fresh-water crab.
9. Ali Arazeem Abdllah. Trends and challenges of traditional medicine. African journal of traditional and alternative medicine.(2011);vol8(5 supple):p(115-123).
10. Alevtina Gall, BS, BA; Zerihun Shenkute, RPH. David Kiefer, MD; J.Carey Jackson, MD, MPH, MA. Ethnomed.org.home; November 03/2009.
11. Traditional and modern medicine EPHC. Http;//www.ephi.gov.et/index.php.accessesed on 15/06/08E.C.
12. Yayesh Limenh, Shemsu Umer & Mesay W/maryam ethinobotanial study on traditional medicinal plants in dega damot woreda, amhara region north Ethiopia, 2013.
13. Journa Afr J Tradit complement Afern Med V.8 (Suppl).
14. Tenaw Gualu Messe, Yohannes Ayalew, Girma Alem Getie, Hymanot Zeleke Mitiku and Girmay Tsegaye. Prevalence and factors associated with paternal traditional medicine use for children in motta town, Amhara Regional State, Ethiopia. Alternative and integrative medicine.2001
15. Traditional medicine available at http//www.allcountries.org./health/traditional medicine accessed on 11/06/08.
16. Potential genotoxicity of plant extracts used in Ethiopia traditional medicine. Journal of ethno pharmacology. Vol 122, issue1, 25 february2009, p (136-142).
17. Kebede Derbie Kassaye, Alemayehu Alemberbir, Biniyam Getasew, Yenus Wusman, Jimma University. Historical overview of traditional medicine practices and policy in Ethiopia. The Ethiopian Journal of health development vol.20 (2) 2006; p (127-134).
18. Ketema Tolossa, Etana Debela, Spiridouala Athanasiadou, Adugna Tolera, Gebeyehu Gagna and Houdijk.Ethio medical study of plants used for treatment of human and livestock ailments by traditional healers in south Omo, Southern Ethiopia.
19. Muthuswamy Ragunathan, Hawi Tadesse and Rebecca Tujubal. Across sectional study on the perception and practice of modern and traditional practitioners about traditional medicine in Dembia district north west Ethiopia, 2008.Pharmacogn Mag.2010 Jan-mar; Vol 6(21): no pmc2881649,p(19-25)
20. Akawak Garil Ragharendra yarlagdda and Messay Wolde Mariam. Knowledge, Attitude, practice and management of traditional medicine among people of Burka Jarto kebele, west Ethiopia, 2015 vol 7; issue2; page (136-144)
21. Elias Ahmed Sadik, Tesfaye Gobena and Bizatu Mengstu Aspects of traditional medicine practices applied for under five children in Ethiopia, Eastern Harrgie, district, daddar wereda, 2011E.C.
22. JhonW.Staniter,UptalD.Petal,Francis Karia,Nathan Thelman,Vennance Maro,Dionis Shimbi D.etal(2015).The determinants of traditional medicine use in Northern Tanzania. Mixed method study: plos one10 (4) (0122638)
23. Samuel Masresha Wassie, Leul Lisanework Aragie, Belaynew Wassie Taye, and Laychiluh Bantie Mekonnen. Knowledge, Attitude and utilization of traditional medicine among community of Merawi town North West Ethiopia, evidence based complementary and alternative medicine.2015, no.138073.page7
24. Medicinal plants used in traditional medicine by Oromo people, Ghimbi district, south west Ethiopia.
25. Teferi Flatie, Teferi Gedif, Kaseab Asres and Tsige Gebre-Mariam. Ethno medical survey of Berta ethnic group Assossa Zone, Benshagul Gumz regional state, mid-west Ethiopia. Journal of ethno biology and Ethno medicine, 01 May 2009.
26. Wubet Birhan, Mirute Giday and Tilahn Teklehymanot.The contribution of traditional healers’ clinics to public health care system in Addis Ababa, Ethiopia. Journal of Ethno biology and Ethno medicine. Dec 2015.
27. Questionnaire on the use of complementary and alternative medicine by cancer patients in Nigeria.
ur text in here…