Concepts of homeopathy among general population in Karachi, Pakistan

By | August 28, 2015

Syed Faraz-ul-Hassan Shah (Department of Community Health Sciences, Hamdard College of Medicine & Dentistry, Karachi.), Salman Mansoor ( Graduate of 2009, Hamdard College of Medicine & Dentistry, Karachi. )

Abstract
Objective: To explore the characteristics of patients and their gender influences concerning the use of homeopathic medicine, visiting both homeopathic and conventional medicine (allopathic) clinics.
Methods: This cross sectional study was carried out on 200 patients who attended private and public homeopathic and allopathic clinics or hospitals in Karachi using a pre-tested self-administered questionnaire. Data for demographic variables of frequencies and associations between variables were analyzed on SPSS version 12.0. Significance level was p<0.05.

Results: Out of the total, 64.5% respondents, more among females than males (p<0.01) believed in homeopathy. Although slightly more than a quarter preferred homeopathic treatment than allopathic treatment, 67.5% participants had had homeopathic consultation and treatment in the past. Amongst participants who had opted for homeopathy in any of their illnesses, the majority had it for chronic conditions which included skin lesions and problems of rheumatology.

Conclusion: In this modern era, where people have the choice to decide newer and advanced forms of medical treatment and scientific methods, a large proportion of people still rely on alternative forms of treatment like homeopathy. More awareness regarding use of homeopathic treatment is needed among general population (JPMA 60:667; 2010).

Introduction
The present era offers not only conventional form of western medical treatment, commonly known as allopathic medicine, but also many alternative forms of treatments. Among them, homeopathy is one of the most widely accepted and safe forms of alternative medical treatment practiced worldwide.1,2 Homeopathy was introduced by a German doctor Samuel Hahnemann 200 years ago. It is based on “law of similar” described by him as “let likes be cured by likes” and so named it “homeopathy”. His philosophy was minimal doses that can relieve diseases in those who have symptoms similar to those created by strong and potent doses of the drug.3,4 Furthermore due to its different laws, every individual is treated as a peculiar case in homeopathy.5

Over the last many years, there is a global proportionate rise of patients using homeopathy. In the US alone, there is a 500% increase in overall patients taking homeopathic treatment in a period of seven years,6 while in European countries a considerable increase in the use of homeopathy is documented.7-10 Similarly, studies published in India, Bangladesh, Nepal and Pakistan have also brought to light the use of complementary and alternative medicine along with western allopathic medicine. Homeopathy was found to be widely used for various illnesses of both acute and chronic nature.11-14 However, in Pakistan, there is lack of substantial evidence regarding the beliefs and concepts of homeopathic treatment among general population. This study explores the characteristics of patients and their gender influences for the use of homeopathic medicine visiting both homeopathic and allopathic clinics/hospitals.

Patients and Methods
This study was a non-interventional, exploratory, cross-sectional survey conducted in the months of June and July 2007 using a non-probability convenient sampling technique. The survey was carried out in eight towns of Karachi namely: Gulshan-e-Iqbal, Saddar, North Nazimabad, Gulberg, Shah Faisal, Liaquatabad, S.I.T.E and the Clifton Cantonment Board. All patients attending either homeopathic or allopathic clinics or hospitals were selected as target population. A sample size of 200 patients, equally recruited from homeopathic and allopathic clinics/hospital settings was included in the study.

Data was collected via a pre-tested questionnaire. The questions were designed after an extensive literature search on the topic of homeopathy keeping in view the objectives of the study. The field workers were trained for filling the appropriate responses in the questionnaire. The questionnaire was pilot-tested and all ambiguities were removed before finalization and administration in the study population. Half of the questionnaires were filled by patients who went to homeopathic doctors for their illnesses, while the rest was filled by those who went to the medical practitioners. Permission was sought from the concerned doctor of the clinic or hospital administration to carry out the study. The respondents were informed verbally about the purpose of the study and participation in the study was taken as their consent. Confidentiality of the data and anonymity of participation was ensured to all respondents of the study who had the right to withdraw at any stage of data collection.

Inclusion criteria of our study included all patients of either sex attending homeopathic or allopathic clinics or hospitals. In hospitals, patients attending out-patient department were included. Attendants of the patients and hospital staff were excluded from participating in the study.

Data was checked, cleaned and entered into the computer and was analyzed with the help of SPSS software version-12. Frequencies were tabulated for demographic variables and associations between variables were tested for statistical significance using Student’s Chi-square with differences regarded to be significant at 5% level.

Results
Out of a total 200 patients, females were in slight majority (53.5%) than males (46.5%). Amongst them, 70% were married with Muslim predominance. More than half of the total respondents were either a housewife or were related to a teaching profession. Mean age of the respondents was 39.33 ± 9.2 years with the highest number (33.5%) in the age group between 31 to 45 years. Monthly income of patients was between Rupees 5000 to 15000, this was applicable to nearly a quarter of the respondents, whereas an equal number either did not wish to disclose or were dependents (Table-1).

Table1

Although the majority (71.5%) of the respondents preferred modern western medicine (allopathic) as their treatment option, a large majority 129/200 (64.5%) preferred homeopathy. It was found to be statistically significant with females more in favour (p<0.001). Similarly, 135 out of 200 (67.5%) respondents admitted to have taken homeopathic treatment in the past with females using it significantly more than males (p = 0.05) (Table-2).

Table2

Participants were specifically asked about their reasons for opting for homeopathy. Out of 135 patients who had had treatment in the past, half (50%) of them had homeopathic treatment on advice by others and 24.4% had it as it is preferred in the family. Only 7.4% were attracted by advertisements, print media and other media, 8.1% gave their reasons as it is economically feasible, 3.7% said that they went for homeopathy because of its medication (easy forms), and 6.7% had opted because of their fear or avoidance of surgery (Table-3).

Table3

A large majority of participants (41.5%) preferred homeopathy for diseases of chronic nature, followed by 24.4% for GIT, liver and urinary disorders while only 13.3% preferred it for any acute illnesses. The rest of the respondents preferred homeopathy for skin, cardiovascular and respiratory disorders and joint pain (Table-3). Discussion The majority of patients visiting homeopathic clinics in this study comprised of women between 32 to 45 years of age were mostly married housewives. A predominance of females as compared to males was observed going for a homeopathic consultation, in many other studies conducted worldwide.12,15-18 Although none of the female respondents in our study specifically identified female-related diseases for homeopathic consultation, many studies have documented the use of homeopathy for a wide range of problems and symptoms that concern women’s reproductive health.19-21 The present study also showed that the majority who had opted for homeopathy belonged to a socio-economic class/income block earning less than Rupees 15,000 per month. Furthermore, none of the patients were found to have a professional background. A recent Bangladeshi study also documented more than half of the participants in a similar income range.12 This reflects that homeopathy is more popular amongst lower and lower-middle classes in South Asian regions. In this study, nearly three-fourth of the respondents sought homeopathic treatment on advice of others or family pressure. Another study done in a tertiary care hospital in Karachi showed that the majority (72%) consulted a homeopathic practitioner due to others’ recommendation.14 An Indian study also showed the influence of family and friends as the most common reason for opting alternative treatment.22 Contrary to this, dissatisfaction with the results of conventional treatment was the main reason among Brazilian patients to seek Homeopathy.23 Within South Asian communities, there seems to be a strong social and family influence for making individual decisions. Cost was also one of the considerations for choosing homeopathic treatment by a small proportion of respondents in our study. This was contrary to a recent Bangladeshi study that highlighted cost to be one of the main reasons.12 The rising financial burden for families every year in Pakistan and Bangladesh justifies their intentions to use homeopathy. A large-scale study conducted on 3981 patients in Germany found a predominance of chronic illnesses (>95% of all diagnoses).15 Studies done in Bangladesh, Pakistan and the UK also found a large majority of patients using homeopathic treatment for various skin conditions.12,14,16,24 This could be due to the fact that patients usually homeopaths only after having received conventional treatment for many chronic conditions that includes skin diseases, allergies and diseases of joints.

Conclusion
The results in our study have shown that although many people in Pakistan use conventional western treatment, still a large proportion of the population, especially females still prefer homeopathy as their first choice of treatment. A nationwide survey on patients seeking homeopathic treatment investigating beliefs and process of compliance would give a comprehensive insight attributed to homeopathy.

Acknowledgements
The authors acknowledge Dr Murad Qadir and the medical students who helped to conduct this study. The authors are also thankful to all the participants of the study.

References
1.Dantas F, Rampes H. Do homeopathic medicines provoke adverse effects? A systematic review. Br Homeopath J 2000; 89 Suppl 1: S35-8.
2.Avello LM, Avendaño OC, Mennickent CS. Aspectos generales de la homeopatía [General aspects of homeopathy]. Revista médica de Chile 2009; 137: 115-20.
3.Rahmathullah S. Homoeopathy: the Science and Art of Dynamic Healing. Homeopathy 2009; 98: 68.
4.Curley M. The Sensation in Homeopathy. Homeopathy 2005; 94: 210-1.
5.Vithoulkas G. Homeopathy. In: Bannerman R, Burton J, Chen Wen-Chieh, editors. Traditional medicine and health care coverage: a reader for health administrators and practitioners. Geneva: World Health Organization, 1983; 110-5.
6.Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Van Rompay M, et al. Trends in alternative medicine use in the United States, 1990-1997: results of a follow-up national survey. JAMA 1998; 280: 1569-75.
7.Tindle HA, Davis RB, Phillips RS, Eisenberg DM. Trends in use of complementary and alternative medicine by US adults: 1997-2002. Altern Ther Health Med 2005; 11: 42-9.
8.Thomas K, Coleman P. Use of complementary or alternative medicine in a general population in Great Britain. Results from the National Omnibus survey. J Public Health 2004; 26: 152-7.
9.ECCH. The safety of homeopathy. An ECCH report. Norfolk: European Central Council of Homeopaths, 2009. (Online) Cited November 2, 2009. Available from URL: http://www.homeopathy-ecch.eu.
10.Schneider B, Hanisch J, Weiser M. Complementary Medicine Prescription Patterns in Germany. Ann Pharmacother 2004; 38: 502-7.
11.Singh P, Yadav R, Pandey A. Utilization of indigenous system of medicine & homoeopathy in India. Indian J Med Res 2005; 122: 137-42.
12.Elahee S, Rahman M, Rahman M, Hossain S, Zaki M. Who seek homeopathic treatment? Bangladesh Medical Journal 2008; 37: 37-40.
13.Jacobs J, Jimenez LM, Malthouse S, Chapman E, Crothers D, Masuk M, et al. Homeopathic treatment of acute childhood diarrhea: results from a clinical trial in Nepal. J Altern Complement Med 2000; 6: 131-9.
14.Qidwai W. Utilization of services of homeopathic practitioners among patients in Karachi, Pakistan. J Ayub Med Coll 2003; 15: 33-5.
15.Witt CM, Ludtke R, Baur R, Willich SN. Homeopathic medical practice: long-term results of a cohort study with 3981 patients. BMC Public Health 2005; 5: 115.
16.Sevar R. Audit of outcome in 455 consecutive patients treated with homeopathic medicines. Homeopathy 2005; 94: 215-21.
17.Sevar R. Audit of outcome in 829 consecutive patients treated with homeopathic medicines. British Homoeopathic journal 2000; 89: 178-87.
18.Steinsbekk A, Nilsen TVL, Rise MB. Characteristics of visitors to homeopaths in a total adult population study in Norway (HUNT 2). Homeopathy 2008; 97: 178-84.
19.Cummings B. Homeopathy for pregnancy and childbirth. In: Tiran D, Mack S, editors. Complementary therapies for pregnancy and childbirth. London (UK): Bailliere Tindall, 1995; 181-216.
20.Kaplan B. Homoeopathy: 2. In pregnancy and for the under-fives. Prof Care Mother Child 1994; 4: 185-7.
21.Beal MW. Women’s use of complementary and alternative therapies in reproductive health care. J Nurse-Midwifery 1998; 43: 224-34.
22.Tandon M, Prabhakar S, Pandhi P. Pattern of use of complementary/alternative medicine (CAM) in epileptic patients in a tertiary care hospital in India. Pharmacoepidemiol Drug Safety 2002; 11: 457-63.
23.Patriani Justo CM, dé Andrea Gomes MH. Conceptions of health, illness and treatment of patients who use homeopathy in Santos, Brazil. Homeopathy 2008; 97: 22-7.
24.Jain A. Does homeopathy reduce the cost of conventional drug prescribing? A study of comparative prescribing costs in General Practice. Homeopathy 2003; 92: 71-6.

Courtesy: Journal of Pakistan Medical Association, August 10, 2010

http://www.jpma.org.pk/full_article_text.php?article_id=2229