This study was conducted to identify the prevalence and associated factors of the use of crude plants among patients with chronic diseases and to examine the bioactive compounds present in the crude plants used by them. The use of crude herbs at the same time as conventional medicines among patients with chronic diseases should be considered to ensure that patient-centered care is guaranteed. This project report entitled "PREVALENCE AND FACTORS ASSOCIATED WITH THE USE OF COMBINED HERBALS AMONG PATIENTS WITH CHRONIC DISEASES: AN INTERNATIONAL SURVEY IN COMBINATION WITH PACHELOR LABORATORY ANALYSIS" was prepared under the partial diploma of RAJ ANALYSIS. of Science (Hons) Biomedical Science at Universiti Tunku Abdul Rahman.
It is hereby acknowledged that DEEPA RAJENDRAN (ID no: 15ADB01238) completed this graduation project/dissertation/dissertation* entitled “THE PREVALENCE AND FACTORS ASSOCIATED WITH THE USE OF RAW HERBS IN PATIENTS WITH CHRONIC DISEASES: A CROSS-SECTIONAL STUDY IN COMBINATION WITH LABORATORY ANALYSIS" under the supervision of Dr.
INTRODUCTION
Research Background
2 the different definitions used in the studies. In developed countries, such as America, a prevalence of 35% of herbal medicine use is reported (Rashrash et al., 2017). Previous studies reported the use of herbs as evident in patients with chronic diseases (Baharom et al., 2016; Rashrash et al., 2017). Patients with chronic diseases consumed herbs with or without conventional medicine (Dawood et al., 2017).
In Malaysia, Baharom et al. 2013b) reported a 50% prevalence rate of herbs used by patients with diabetes mellitus.
Problem statement
Rather, the primary metabolites are essential compounds that a plant needs to undergo maturation and differentiation; for example, carbohydrates, fats, proteins and nucleic acids (Sharma and Batra, 2016).
Objectives
Medicinal plants found in Malaysia and their benefits
- Presence of bioactive compounds and medicinal uses
- In vitro studies
- Geographical distribution
- Presence of bioactive compounds and medicinal uses
However, there were no tannins or quinones present in the roots of coriander (Kumar et al., 2014). Tannins, alkaloids, reducing sugar, flavonoids and phenolic compounds are present in coriander leaves extracted with methanol (Kumar et al., 2018). All three methanolic, ethanolic and aqueous extracts of coriander seeds revealed the presence of saponins, tannins and cardenolides (Ahmed et al., 2018).
Alkaloids present in coriander leaves are able to dilate blood vessels and treat arrhythmia condition (Kumar et al., 2018).
Prevalence and associated factors of crude herbs use among patients with chronic diseases
Antimicrobial activity of coriander roots suppressed the proliferation of Klebsiella and Bacillus cereus (Kumar et al reported that coriander powder induced better digestion in broilers due to the presence of essential oil (linalool). The aqueous extracts of coriander lowered blood glucose levels more actively in the broilers compared to the extracts in powder form The use of herbs was significant among patients from rural areas, without education and who were diagnosed with comorbidities.
In Turkey, Mollaoglu and Aciyurt (2013) revealed 55.9% of herbal use in patients with chronic diseases, especially hypertension (63.8%).
Overview of the experimental procedure
Cross-sectional survey
- Study site
- Study design
- Target population
- Data sampling and sample size
- Ethical considerations
- Data collection tool
- Data analysis
This study was conducted at Klinik Kesihatan Kampar, a primary care clinic located at Jalan Degong, Kampar (Ministry of Health, 2018), precisely at latitude 4.310422 and longitude 101.153348. Patients who visit Klinik Kesihatan Kampar are those who are perceived to be of lower socio-economic status, who frequent the clinic from sub-rural to rural areas. In addition, Klinik Kesihatan Kampar was also chosen because it is within reach of the city center.
In this study, a cross-sectional study design was used to examine the prevalence of raw herb use among patients with chronic diseases attending Klinik Kesihatan Kampar.
Laboratory analysis
- Plant extraction
- Aqueous extraction
- Solvent extraction
- Phytochemical screening
- Test for quinones
- Test for tannins (Braymer’s test)
- Test for terpenoids (Salkowki’s test)
- Test for saponins (Foam test)
- Test for flavonoids (Alkaline reagent test)
- Test for glycosides
- Thin layer chromatography (TLC) analysis
The frozen samples were mounted on the sample valve using rubber adapters (Gaidhani et al., 2015). Formation of deep blue or black color indicated the presence of phenolics in the plant samples (Ugochukwu et al., 2013). The presence of quinones in plant samples was determined by the formation of yellow precipitate or coloration (Ugochukwu et al., 2013).
32 terpenoids in the extracts were determined by the formation of reddish-brown precipitate (Ugochukwu et al., 2013). The presence of flavonoids was indicated by the change of color from yellow to colorless (Ugochukwu et al., 2013). Formation of yellow precipitate was observed to indicate the presence of glycosides (Ugochukwu et al., 2013).
The mixtures were observed to form reddish brown precipitate or brown colored solution indicating the presence of alkaloids (Ugochukwu et al., 2013). The plates were labeled with the name of the extracts and type of solvent systems to avoid misinterpretations (Karthika et al., 2014). The solvent front was allowed to rise about 1 cm from the top of the plate (Karthika et al., 2014).
Then the TLC plates were kept in an iodine vapor chamber for approx. 15 minutes and the observed spots were traced with the pencil (Karthika et al., 2014). TLC was chosen to separate the compounds in the plant samples because it is both a cost- and labor-saving method (Altemimi et al., 2017).
Cross-sectional survey
- Socio-demographic characteristics
- Prevalence of crude herbs use
- Types of crude herbs
- Parts of crude herbs used
- Patients’ perceptions on crude herbs use
- The association between the age of patients and the crude herbs use A null hypothesis (H 0 ) was assumed that there is no significant association
- The association between the gender of patients and the crude herbs use
- The association between the race of patients and the crude herbs use
- The association between the education level of patients and the crude herbs use
- The association between the employment status of patients and the crude herbs use
- The association between chronic diseases and the crude herbs use In the following subsection, the association between chronic diseases and the
40 Table 4.3: Prevalence of use of raw herbs among patients with chronic diseases attending Klinik Kesihatan Kampar. 41 Table 4.4: The different types of raw herbs used by patients with chronic diseases attending Klinik Kesihatan Kampar. 42 Continued Table 4.4: The different types of raw herbs used by patients with chronic diseases attending Klinik Kesihatan Kampar.
Continued Table 4.5: The parts of raw herbs used by patients with chronic diseases attending Klinik Kesihatan Kampar. Continued Table 4.6: Preparation method of raw herbs used by patients with chronic diseases attending Klinik Kesihatan Kampar. Continued Table 4.7: The medicinal values of raw herbs as perceived by patients with chronic diseases attending Klinik Kesihatan Kampar.
61 Table 4.10: Cross tabulation analysis between patient age groups and use of crude herbs. A null hypothesis (H0) was assumed that there was no significant relationship between patients' gender and the use of crude herbs. A null hypothesis (H0) was assumed that there was no significant relationship between the race of the patients and the use of raw herbs.
0.05, therefore H0 is rejected and there is a significant association between race of patients and use of raw herbs. 64 Table 4.14: Crosstab analysis between the level of education of patients and the use of raw herbs.
Plant extraction
- Percentage of yield for aqueous extraction
- Qualitative phytochemical screening
The highest percentage yield for ethanol extraction was obtained for Psidium guajava (59.6%) followed by Coriandrum sativum (29.6%). The highest percentage yield for aqueous extraction was obtained for Psidium guajava (1.3%) followed by Coriandrum. For solvent extraction, there were seven phytochemical compounds present in Psidium guajava while Coriandrum sativum exhibited six compounds.
Both Psidium guajava and Coriandrum sativum exhibited phenol, tannins, saponins, flavonoids, glycosides and alkaloids in different intensities. Both Psidium guajava and Coriandrum sativum exhibited phenol, quinones, saponins, flavonoids, glycosides and alkaloids in different intensities. The presence of white precipitate (++) indicates the presence of tannins [D] in the soluble extracts of Psidium guajava.
74 Figure 4.4: The phytochemical screening of solvent extract of Coriandrum sativum: [A] Original solvent extract; [B] Phenols; [C]quinones; [D] Tannins; There was no formation of a red-brown layer (-), indicating the absence of terpenoids [E] in the aqueous extract of Psidium guajava. 76 Figure 4.5: The phytochemical screening of aqueous extract of Psidium guajava: [A] Original aqueous extract; [B] Phenols; [C]quinones; [D] Tannins;
77 Figure 4.6: The phytochemical screening of aqueous extract of Coriandrum sativum: [A] Original aqueous extract; [B] Phenols; [C]quinones; [D] Tannins; The respective optimized solvent systems used for Psidium guajava and Coriandrum sativum were toluene:ethyl acetate (60:40) and hexane:ethyl acetate (70:30).
Socio-demographic characteristics
Similarly, two other studies showed that female patients are associated with herbal use (Fan et al., 2013; Medagama et al., 2014). In contrast to other studies (Ching et al., 2013a; Kew et al., 2015), where Malays were the main users of herbs, Indian patients (56.8%) used raw herbs more often in the current study. The lower number of Chinese patients consuming raw herbs in this study is due to the existence of traditional Chinese medicine, in which they may have a stronger belief (Huri et al., 2009).
In the present study, all the weed users earn less than RM 3000 (100%) monthly which is similar to Ching et al. 2015) found that herbal medicine use was high among patients with higher incomes. The use of crude herbs was high among the patients who obtained secondary education (52.3%). In addition, they may have higher access to information about medicinal benefits of crude herbs (Abdullah et al., 2018).
There are two possibilities for the high use of crude herbs by housewives or unemployed patients in this study. First, the low cost of raw plants and secondly, the high concern of housewives for the health and well-being of the family (Mollaoglu and Aciyurt, 2013; . Tulunay et al., 2015). In Sri Lanka, grasses such as Momordica charantia, Coccinia grandis and Costus speciosus were mainly used (Medagama et al., 2014).
This gives a conclusion that the use of crude plants differs between patients of different cultural backgrounds (Medagama et al., 2014). The high number of patients believed in the efficacy of crude herbs (12.4%), which is similar to previous studies (Ching et al., 2013b).
Phytochemical compounds screened in the crude herbs
In the present study, it is found that recommendations from family and friends were the main reason for using raw herbs (15.7%). Family and friends are the closest relationship with patients, thus making patients trust them more (Huri et al., 2009). The high intensity of both of these compounds in the aqueous extracts indicates the high use of Psidium guajava (5.1%) in patients with diabetes mellitus to lower the blood glucose level (5.1%).
In the present study, the ethanolic extracts of Coriandrum sativum leaves and shoots exhibited phytochemical compounds, such as phenols, saponins, flavonoids, glycosides and alkaloids. However, tests for quinones and terpenoids were not performed by Paul et al. 2016) reported the absence of terpenoids, which is similar to the present study. On the contrary, the methanolic extracts of Coriandrum sativum leaves revealed the presence of terpenoids (Patel and Vakilwala, 2016; Ashika et al., 2018).
Altogether, all the solvent extracts used in the previous studies and the present study were unable to detect the presence of quinones in Coriandrum sativum leaves. The findings of this study are comparable to a study done by Chauhan et al. 2012) has revealed the presence of tannins and terpenoids. Differences in phytochemical compositions between the previous study and the present study are due to the geographical location of the plants.
The presence of alkaloids in the leaf extracts is responsible for the antihypertensive effects by dilating blood vessels (Kumar et al., 2018). Phenols and flavonoids are responsible for antioxidant properties that regulate lipid metabolism (Ramadan et al., 2008; Rao et al., 2016).
Thin layer chromatography
Strengths and limitations of study
Future studies
