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COVID-19 pandemic emerged as a major public health emergency. Ayurvedic medicines are not generally considered as conventional medicine. Hence, we aimed to assess the prevalence of utilization of Ayurveda as prophylaxis for COVID-19 during the pandemic, factors associated with utilization, and willingness to use Ayurvedic medicines in future prospects.
Methods
This cross-sectional analytical study was conducted in urban Bengaluru, India from April to May 2022. The sample size of the study was 427. Systematic random sampling was done and data were collected using a validated semi-structured questionnaire.
Results
The mean (SD) age of the participants was 38.9 (±14.08) years. The proportion of utilization of ayurvedic medicines was 22.5% (n = 96, 95% CI 18.6–26.7) and social class was significantly associated with non-utilization (p = 0.042). Among the utilizers, 66% of them used Ayurvedic medicines for prevention/post-COVID ailments. More than half (55%, 95% CI 49.7–59.4) of the individuals were willing to use Ayurvedic medicines in the future and level of education was associated with unwillingness (p=0.010).
Conclusion
Nearly three-fourth of the participants were not utilized Ayurvedic medicines during COVID-19 pandemic. Strengthening ayurvedic services and improving awareness may increase the utilization in the community. An integrated health system approach at the policy level is pivotal in mainstreaming Ayurvedic medicines.
The novel disease took its origin in China gained momentum and spread globally. It emerged as a global threat, believed to have a zoonotic origin, and was titled “severe acute respiratory syndrome coronavirus 2 (SARS Cov 2).” The symptomatic phase is characterized by fever, cough, and myalgia, and can progress to severe respiratory failure.
Thus, this ongoing pandemic has been declared a public health emergency of international concern by the World Health Organization (WHO) due to its highly contagious nature in humans.
The pandemic alarmed countries to take mitigatory actions to check the spread of the infection. In this scenario, the discovery of vaccine was a boon to prevent the severity surge of the disease. The western model of evidence-based medicine in the frontline came to rescue, especially in the critical stage care.
In India, along with the mass production of vaccines, potential efforts were made by the Department of AYUSH (Ayurveda, Yoga, Unani, Siddha and Homeopathy) in bringing forth prophylactic measures and guidelines for asymptomatic to mild COVID-19 infection management.
Ayurveda is chiefly concerned with maintaining good health in a healthy individual and curing the diseased. The ayurvedic approach can be understood in two ways: preventive and curative. Swasthavritta is a preventive aspect of Ayurveda.
In recent decades, India has made significant progress in healthcare development, but improvements in awareness and use of alternative medical systems have continued to lag and have yet to be widely implemented.
Despite the impact of modern medicine in India, it is critical to understand the community's health-seeking behavior and awareness of ayurvedic medicines. Understanding the utilization pattern will be beneficial in taking appropriate measures to make Ayurvedic medicines worthwhile as a preventive and regenerative medicine.
Hence, the current study aimed to assess the prevalence of utilization of Ayurvedic drugs during COVID-19, factors associated with utilization, and willingness to use Ayurvedic drugs in future prospects.
2. Materials and methods
2.1 Study design, population and setting
This cross-sectional study was conducted from April to May 2022 among individuals aged 18 years and above in the community of urban Bengaluru. Both Government and private ayurvedic facilities or hospitals are available in this area. During COVID-19, a prophylaxis AYUSH kit was distributed to the community by Accredited Social Health Activists (ASHAs).
2.2 Sample size estimation and sampling technique
Considering 50% of the population utilized Ayurvedic drugs during the COVID-19 pandemic, with 5% absolute precision, and 10% non-response rate, the calculated sample size was 427. Urban Bengaluru consists of five taluks: Bangalore north, Bangalore north (addl), Bangalore South, Bangalore east, and Anekal. Among these taluks, Bangalore North (addl) was selected using a simple random sampling method. Of 198 wards in Bangalore North (addl), Chikkabettahalli was chosen conveniently. From the line list of 10427 households in the Chikkabettahalli locality, the required numbers of households were selected using a systematic random sampling technique (sampling interval of 20). One participant from the selected household was chosen randomly.
2.3 Study tool
A validated semi-structured questionnaire was used for the study. The questionnaire included domains to capture the socio-demographic data and questions to explore utilization and willingness to use ayurvedic drugs.
2.4 Data collection
The student researcher and ASHA workers visited the households for data collection. The selected participant from the line-listed household was interviewed using the questionnaire. The questionnaires included socio-demographic details such as age, gender, marital status, family income, education, occupation, awareness of AYUSH COVID preventive medicines, source of information, utilization of Ayurvedic drugs for COVID-19 as prophylaxis, diagnosis/quarantined status for COVID-19, barriers to use, preferences to use, and preferred place for availing services. There were questions related to willingness to use in the future, and the reasons for unwillingness were assessed through the interview. The following question checked participants' willingness to avail Ayurvedic medicines in future, “Would you like to utilize Ayurvedic medications in future pandemics?” The preferable answer allowed for the question was: (a) Yes; (b) No. Written informed consent was taken before the interview. Privacy and confidentiality were maintained during the interview.
2.5 Operational definitions
Utilization of Ayurvedic drugs: The act of using drugs delivered by a public health care system, those prescribed by registered ayurvedic practitioners, or drugs distributed by recognized Ayurvedic institutions/organizations as COVID-19 prophylaxis. Therefore, the following drugs which are recommended by the AYUSH ministry were considered for the study, Joshaadi kashaya churna, AYUSH 64, Samshamani Vati, Chyavanprash, Shwasakutara ras, Taleesapathradi churna, Marichaadi churna, Tribhuvana keerthi ras.
Willingness to use Ayurvedic drugs: If the individual is ready to use ayurvedic medicines in the future.
2.6 Statistical analysis
The data were entered into EpiCollect 5 mobile application and analysis was done using STATA version 14. Categorical variables were summarized as frequencies and percentages. The outcome variable such as utilization and willingness were summarized as percentages with a 95% confidence interval. The association of sociodemographic factors with the outcome variables was analyzed using the Chi-square test, and an unadjusted prevalence ratio with 95% confidence interval was calculated. A p-value of <0.05 was considered statistically significant.
2.7 Ethics policy
The study protocol was reviewed by the Institute Ethics Committee of K S Hegde Medical Academy, Mangalore (INST.EC/EC/160/2021-22). Written informed consent was obtained from each participant before enrolling them in the study.
3. Results
The mean (SD) age of the participants was 38.9 (±14.08) years. Among them, more than half (n = 237) of the participants were females, 35% (n = 151) were graduates, 32% (n = 137) were monthly salaried, 26% (n = 111) belong to social class 3, and 82% (n = 354) belonged to Hindu community, 75% (n = 319) were married. [Table1].
Table 1Socio-demographic details of individuals aged above 18 years in a selected ward of northern Bengaluru during April–May 2022 (N = 427).
*Modified B G Prasad's classification for May 2021
About 22.5% (n = 96 95%CI 18.6–26.7) of the participants used ayurvedic drugs from a registered practitioner in the last two years and more than three-fourths (n = 331) of them did not use. The lack of a facility, the exorbitant cost of the medicine, palatability, lack of belief in Ayurveda, and other factors were cited by those who did not use the service. About 45.4% of the participants were unwilling to use ayurvedic drugs in future and more than half (n = 233) of the participants were willing to use ayurvedic drugs in future for any ailments/pandemics. The reasons for unwillingness were lack of knowledge, evidence, hospital, and belief. Some participants stated that they were comfortable using allopathic medicines. [Table 2]. More than half (n = 51) of the participants were diagnosed/quarantined for COVID-19 infection, and 63% used ayurvedic medicines for COVID-19 infection. About 34% were used for treatment and 66% were used for the prevention of COVID-19 infection. [Fig. 1].
Table 2Distribution of reasons for non-utilization and willingness to use Ayurvedic medicines among the individuals aged above 18 years in a selected ward of northern Bengaluru during April–May 2022 (N = 331).
Fig. 1Flow chart showing distribution of utilization of ayurvedic medicines during COVID 19 and purpose of use among the individuals aged above 18 years in a selected ward of northern Bengaluru during April–May 2022 (N = 427).
There was no significant association between age, gender, education, occupation, religion, marital status and non-utilization of ayurvedic drugs. Social class 2 had a significant chance of non-utilization (uPR: 1.1 95%CI 1.00–1.39, p = 0.042) when compared to the reference group [Table 3].
Table 3Factors associated with the prevalence of non-utilization of ayurvedic drugs and willingness to use ayurvedic drugs in future prospects (n = 427).
There was no significant association between age, gender, occupation, social class, religion, marital status and unwillingness to use ayurvedic drugs in future prospects. Among various education levels, the chance of unwillingness to use ayurvedic drugs was found to be 1.9 times higher in the class 1–7 category compared to the reference group (uPR: 1.9 95%CI 1.16-3.19 p = 0.010). [Table 4].
Table 4Factors associated with the prevalence of willingness of ayurvedic drugs and willingness to use ayurvedic drugs in future prospects (n = 427).
In this study, the utilization proportion of ayurvedic drugs in the last two years was found to be 22.5%. Low utilization rates might be due to misconceptions and a lack of awareness about the Ayurvedic system of medicine. This study tried to explore the reasons for not utilizing Ayurvedic drugs and 30% of the individuals were not availed because of a lack of nearby facilities.
The utilization rates were more among illiterates, which is inconsistent with the study by Ramesh et al.
found less utilization among no formal education individuals. The proportion of utilization in this study is seen as higher among Christian religions as compared to other religions. This may be because of the cultural practices of the usage of herbal medicines for common illnesses in their community. The other reason is the mentioning of biblical plants and their benefits in their literature.
In the present study, we found no significant association between age, gender, education, occupation, religion and marital status and non-utilization. These results were consistent with a study on Siddha medicine.
According to this study, it was found that the higher the social class more the chance of non-utilization and unwillingness was significantly associated with no formal education and unemployment. The possible explanations are that the facility is too far away, resulting in indirect costs as well as high treatment and drug costs. To our knowledge, other factors might be the easy availability of allopathic medicines with minimal dietary regimens.
Relatives, friends, and neighbours have a 12.2%, 24.4%, and 12.3% influence on the use of ayurvedic medicines, respectively. More than half of the individuals (55%) had taken Ayurvedic medicine for respiratory-related diseases. These findings are not similar to a study done in Chennai.
The plausible reason may be the usage of medicines during COVID-19 pandemic period. It was also found, nearly 41% of individuals had heard about preventive Ayurvedic medicines for COVID 19 infection which disagrees with a study conducted in Siddha medicine,
Among the study participants, 54.6% were willing to use Ayurvedic medicines in future prospects for any ailments or during pandemics. This may be due to the experiences of preventive benefits seen during COVID-19. Individuals with postgraduate and above-educated levels were willing to use Ayurvedic medicines, which could be attributed to their healthy lifestyle-seeking behaviour. It was also found; the Muslim community were more willing to use Ayurvedic medicines in future when compared to other community. This might be due to the Islamic culture's use of herbal medicines or Unani medicines. The unwillingness to use the Ayurvedic medicines was 45% and factors that discouraged to unwillingness were inadequate expertise in practising the medicine, less understanding about the medicines, difficulty in access to the facility, and long duration of healing. If the above factors are addressed properly it will result in greater acceptance of Ayurvedic medicine among non-users.
This is one of the first studies to determine the proportion of willingness to use Ayurvedic medicines. There are some limitations to this study, utilization of Ayurvedic medicines in the last two years was the criteria and this might lead to possible recall bias. As this is a cross-sectional study, a cause-effect relationship between variables, utilization, and willingness cannot be established.
5. Conclusion
The current study reported that public awareness of Ayurvedic medicines for COVID-19 prophylaxis was relatively low in the urban study population. The most common reasons for the non-utilization of Ayurvedic medicines were lack of nearby service facilities, scientific evidence, affordability and palatability of medicines. In order to encourage the adoption and use of Ayurvedic medicines for both preventive and therapeutic purposes, efforts must be made to generate scientific evidence. For the mainstreaming of the Ayurvedic healthcare system, policymakers should lay more emphasis on the integrated health system approach.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.
Data availability
The datasets analyzed during the current study are available from the corresponding author upon reasonable request.
Declaration of competing interest
None.
Acknowledgement
Nil.
References
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Origin, transmission, diagnosis and management of coronavirus disease 2019 (COVID-19).
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