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Arrowed Search Criteria to Admissions and Deaths Due to Poison Agents, Poisoning and Herbal Medicine for Medical and Paediatric Study

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Arrowed Search Criteria to Admissions and Deaths Due to Poison Agents, Poisoning and Herbal Medicine for Medical and Paediatric Study ANGLIA RUSKIN UNIVERSITY FACULTY OF SCIENCE AND ENGINEERING SCHOOL OF LIFE SCIENCE HERBAL MEDICINE USE IN EKITI STATE, NIGERIA: EPIDEMIOLOGICAL STUDY AND ANALYSIS OF TOXIC CONSTITUENTS AINA OLUJIMI OLUSOLA A thesis in partial fulfilment of the requirements of Anglia Ruskin University for the degree of Doctor of Philosophy Submitted: October 2018 ANGLIA RUSKIN UNIVERSITY Acknowledgment I thank the lord almighty for the gift of life and the resources to come this far. I appreciate the sacrifice and support of my parents Dr. Kolawole and Mrs. Oluwayemisi Aina in ways so invaluable to me. I do not take for granted the blessing you are to me. Thank you a million times. To my Wife Folasade, without whom none of this would have been possible; without whose self-denial of the valuable time away from home I should not have succeeded. You are a jewel of inestimable value and a solid rock. To my children thanks for their patience, I am coming home. To my siblings, thanks for your support and standing in the gap in my absence. I love you all. I especially recognise and thank my supervisors, Dr. Lata Gautam and Dr. Sarah Hall. I really appreciate your selfless, thorough and considerate contributions and mentoring. It was a wonderful privilege that my path to have crossed those of such wonderful people like you. Thanks for believing in me even when I do not. To my external supervisor, Professor Padam Shimkhada, are due profound thanks for time devoted, invaluable contribution and warm, generous reception during our Liverpool meeting. Thanks to laboratory technologists Kevin Bright and Joanne Hooson for their support and direction. It was fun working with you both. I also appreciate Analytix for offering to analyse some of my samples. My sincere thanks and appreciation to every other person from my family, faculty staff, colleagues, research assistants and the larger society who have contributed in one way or another. ii ABSTRACT FACULTY OF SCIENCE AND ENGINEERING SCHOOL OF LIFE SCIENCE DOCTOR OF PHILOSOPHY HERBAL MEDICINE USE IN EKITI STATE, NIGERIA: EPIDEMIOLOGICAL STUDY AND ANALYSIS OF TOXIC CONSTITUENTS AINA OLUJIMI OLUSOLA October 2018 Herbal medicines (HM) use and popularity as a form of complementary and alternative medicine (CAM) continue to increase globally. However, public health and safety concerns also continue to grow. Contamination of HM samples with chlorinated pesticides and heavy metals has been reported, likewise adulteration with prescription medication. In this research, an interdisciplinary method drawn from public health and forensic chemistry was adopted. It examined the knowledge and use of HM in Ekiti state, Southwest Nigeria, with a population of over two million. A survey was used to explore public knowledge, use, and perception of HM effectiveness and safety. Textual analysis, inferential and descriptive statistics were used to analyse survey data. Hospital data from the state was also examined to determine HM related casualty and fatality figures over a period of 5 years (2010 to 2014) and the findings were compared with the survey findings. Ten commonly used HM identified in the survey were then analysed for the possible presence of prescription medicines and heavy metals using Gas Chromatography-Mass Spectrometry (GC-MS) and Inductive Coupled Plasma-Optical Emission Spectroscopy (ICP-OES) respectively. Findings of this research showed that 85.0% of the respondents have used HM in the last two years. Although 57.0% had concerns about the safety of uncertified HM, 37.3% used them anyway, while 31.9% used both uncertified and certified HMs. The use of HM (85.0%) was attributed to its effectiveness by 39.6% of users; while poor service delivery was the primary reason 45.2% of respondents did not use the orthodox health system. There was a significant association between HM use and the age, gender, level of education, religion, annual income and occupation of respondents, using the Chi-square analysis at a significance level of 0.05. Hospital records of patients (n=94,323) showed a small number of HM associated paediatric admissions (0.5%), adult admissions (0.06%), paediatric deaths (3.2%) and adult deaths (0.2%). Analysis of all the studied HMs showed that cadmium and copper were detected at above World Health Organization (WHO) permissible limits and one of the samples also had lead and zinc above the limit. However, none of the target pharmaceutical compounds was detected in the HM samples. This research investigated the issues surrounding the use of HMs, their potential toxicity, casualties, and fatalities. The onset and progression of some medical problems as highlighted in this research may be connected with exposure to heavy metals when present above permissible limits. Additionally, even when metals are present below permissible limits, prolonged exposure may result in accumulative toxicity. Therefore this study highlights a major public health concern and a need to monitor and control HMs through appropriate legislative changes. This is the first multidisciplinary investigation of HMs in the study population and the wider public. Key Words: Herbal medicine, use, and perception, casualty and fatality, drug analysis, heavy metals. iii Table of Contents Acknowledgment……………………………………………………………………………………ii Abstract …………………………………………………………………………………………......iii Table of Contents …………………………………………………………...…….…….…………iv List of Figures……………………………………………………………………………………….ix List of Tables……………………………………………………..………………………………….xi List of Abbreviation ………………………………………………………………………………...xiii List of Appendices……………………………………………………………………………….....xvii CHAPTER 1: INTRODUCTION ............................................................................................ 1 1.1 Herbal medicine use in ancient times .............................................................................. 1 1.2 Complementary and alternative medicine (CAM) ............................................................ 2 1.3 Examples of traditional medicine practice ....................................................................... 3 1.3.1 Traditional Chinese Medical Practice .................................................................... 4 1.3.2 Indian herbal medicine .......................................................................................... 5 1.3.3 African traditional medicine ................................................................................... 6 1.4 Use and belief in traditional medicine in Ekiti State ......................................................... 7 1.4.1 Traditional medicine belief in Nigeria ..................................................................... 7 1.4.2 Traditional Medicine Practitioner and herbal medicine use in Nigeria .................... 8 1.4.3 Traditional and orthodox medicine practice in Ekiti State ..................................... 10 1.5 Use and trade of herbal medicine globally ..................................................................... 11 1.5.1 Developmental and economic implication............................................................ 11 1.5.2 Cultural and socioeconomic aspects of herbal medicine use ............................... 13 1.6 Safety and efficacy of herbal medicine .......................................................................... 13 1.6.1 Safety profile of herbal medicine ......................................................................... 13 1.6.2 Contamination and adulteration of herbal medicine ............................................. 14 1.7 Review of analytical methods for screening of pharmaceutical compounds and heavy metals in herbal medicine ................................................................................................... 16 1.7.1 Analytical method for the screening of selected pharmaceutical adulterants in herbal medicine............................................................................................................ 17 1.7.2 Sample preparation for the extraction of pharmaceutical compounds in herbal products ....................................................................................................................... 20 1.7.3 Analytical method for the screening of heavy metals in herbal medicine ............. 21 1.7.4 Sample preparation for the screening of metals in herbal products ..................... 23 1.8 Quality control of herbal medicine ................................................................................. 25 1.9 Regulatory framework of herbal medicine ..................................................................... 26 1.9.1 Global perspective .............................................................................................. 26 iv 1.9.2 Regulatory framework of herbal medicine in Nigeria ........................................... 27 1.10. Prospect of herbal medicine ....................................................................................... 28 1.10.1 Global prospect of herbal medicine ................................................................... 28 1.10.2 Prospect of herbal medicine in Nigeria .............................................................. 29 1.11. Research aim and objective ....................................................................................... 30 1.11.1 Research questions .......................................................................................... 32 CHAPTER 2: SURVEY OF THE PATTERN AND USE OF HERBAL MEDICINE IN EKITI STATE ...............................................................................................................................
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