Prevalence of traditional eye medicine use and its associated factors among adult ophthalmic patients in Gondar region of Ethiopia in 2020

Abstract

: Traditional medicines are commonly used throughout the world, especially in Africa. About 13.2–82.3% of the population uses traditional eye medicine. These are forms of biologically based therapies, practices, or partially processed agents that are applied to the eye or administered orally to achieve a desired ocular therapeutic effect. To determine the prevalence and associated factors of traditional eye medicine use among adult ophthalmic patients attending the University of Gondar Comprehensive Specialized Hospital-Tertiary Eye Care and Training Center, Northwest Ethiopia, 2020. A cross-sectional study within the hospital was conducted on 502 newly admitted adult ophthalmic patients who were selected by using a systemic random sampling method from August 15 to 21 October 2020. Of the total (502) subjects, 93.1% of subjects participated in the study. From the total participants, 22.31% (112) (95% confidence interval (CI: 19–26%)) used traditional eye medicine in the past two years. Positive family history of traditional eye medicine use (Adjusted odds ratio(AOR = 11.1(95% CI: 4.8–25.6)), availability of traditional healers (AOR = 3.7 (95% CI: 1.6–8.6)), residency in the rural (AOR = 24.9 (95% CI: 10.4–59.7)), family income of 300–1,500 adjusted odds ratio (AOR) = 6.6 (95% CI: 1.9–22.9)), and ≥ 6 months (AOR = 8.5 (95% CI: 3.02–23.7) were significantly associated with traditional eye medicine use The driving issues for using TEM were the availability and costs of modern medicine. The prevalence of TEM is higher than in the previous study conducted in Ethiopia.

Keywords:

• Prevalence
• traditional eye medicine
• traditional healer Ethiopia
• Gondar

PUBLIC INTEREST STATEMENT

Traditional eye medicine is widely practiced around the world. It is employed by the order of traditional healers or local physicians who are well-known for knowing and practicing the most common traditional medicines, or by oneself. Traditional medicines are derived from plant and animal products, spices, or religious beliefs. These situations are commonly observed in communities, particularly among different regions of the world, especially those who are living in rural areas, including Ethiopians. Despite the fact that communities employ traditional eye medicine as a supplemental therapy, the possible risks are not readily apparent.

1. Introduction

The World Health Organization (WHO) defines traditional medicine as “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, mental, or social imbalance.” Traditional eye medicine is also sometimes called complementary and alternative medicine (CAM; Eticha et al., 2021; Gotmare et al., 2021. Organization WH. WHO, 2013) Traditional eye medicines (TEM) are a form of biologically based therapies, practices, or partially processed organic or inorganic agents that are instilled or applied to the eye or administered orally to achieve a desired ocular therapeutic effect (Enitan et al., 2017; Eticha et al., 2021; Gotmare et al., 2021).

There were large variations in different regions regarding the use of TEM. In China, a plant, the so called pomegranate (Punica granatum), is used in the treatment of atherosclerosis, diabetes, hypertension, hyperlipidemia, and several types of cancer, as well as for peptic ulcers and oral disease (Ge et al., 2021). In in India, TEMs being instilled in the eye by this were: alum water, milk, plant juices, saline water, breast milk, turmeric, jaggery, curd, garlic, goat’s milk, “neem”, powdered horn of deer, excreta of donkey, lemon juice, turpentine oil, coconut oil, warm tea leaves, ginger juice, onion juice, ash of hukkah, mustard oil, fenugreek, carom seeds (ajwain) and leaf extracts (Gotmare et al., 2021). Report in the African population (E Achigbu & Achigbu, 2014; Nwosu & Obidiozor, 2011; Ukponmwan & Momoh, 2010), especially in the East African, a country like Ethiopia’s population trusts traditional healers (TH; Mohammed et al., 2016). TEM use is a largely practiced phenomenon in the Ethiopian populations (Eticha et al., 2021; Kassaye et al., 2006). Among the commonly practiced traditional eye medicines previously were: honey, human saliva, soil, Breast milk, herbal extract, and urine extract are the most famous forms of TEM in East Africa (Eticha et al., 2021; Gotmare et al., 2021; Mselle, 1998; Nyathirombo et al., 2013). Yet, Holy Water, Linseed (Linum usitatissimum), “damakesie” (Ocimum species), Potato (Solanum tuberosum), and Milk have been reported in Ethiopia (Eticha et al., 2021; Munaw et al., 2020; Sitotaw, 2018).

The prevalence of TEM in different countries are different. In India, it ranges from 29–40%(Gotmare et al., 2021), in South Africa 36% (Rakoma, 2017), in South East Nigeria 82.3% (E Achigbu & Achigbu, 2014).

The anti-biotic effects of some plants are potential and commonly reported (Koné et al., 2004). and others are harmless and may be beneficial (Foster & Johnson, 1994). Whereas, complications including keratitis, endophthalmitis, panophthalmitis, staphyloma, and visual reduction or loss have been revealed (Eticha et al., 2021; Mselle, 1998; Nyenze; Yorston & Foster, 1994). Complications with TEM result in multidimensional effects on society (Omar & Aziz, 2010). It ranged up to 54.8% of TEM users due to caustic substances, chemical injury, pathogen entry, boiling or particulate application, and delay for medical treatment (Eticha et al., 2021; Ukponmwan & Momoh, 2010). Due to the unstandardized nature of TEM (Eze et al., 2009), complications resulted. The use of TEM was well studied and applied in consultation with medical practitioners and in collaboration with traditional healers. Furthermore, the implications for using TEM in Ethiopia, Africa, and globally in general were relying on TEM, healers, and limited eye care infrastructure (Eticha et al., 2021; Ge et al., 2021; Nyenze). The Ethiopian government and WHO signed a convention to develop a strategic plan to validate and integrate traditional medicine with modern medicine. But the program is not fully functional (Sitotaw, 2018). TEM related complications on the eye could be enabled by poor educational status, poor access to modern eye care services, and rural residence. But to tackle such potential effects and complications on the eyes, a question should be answered about what could be the prevalence of TEM among the population and its potential factors for usage (Eticha et al., 2021).

2. Methods and materials

2.1. Study design

Institution-based cross-sectional study design

2.2. Study setting and period

The study was conducted at the University of Gondar Comprehensive Specialized Hospital-tertiary eye care and training center from August 15 to 21 October 2020. It is located in Gondar city (738 kilometers away from Addis Ababa). The center has been contributing to the reduction in blindness in Gondar and surrounding catchment areas by providing comprehensive eye care services for roughly 14 million people in 10 zones of Northwest Ethiopia. About 1496 new patients get service in the outpatient department each month. It is a training and research center. (Unpublished sources). The center provides health education, refraction (with spectacle provision), medical and surgical eye disease intervention, with formal and outreach programs.

All new adult ophthalmic patients greater than 18 years of age presenting to UoGCSH-TECTC for the purpose of eye care service were included. Patients linked to emergencies, patients who were unable to communicate, and patients with serious illnesses were excluded from the study. Patients linked to the emergency clinic are those who were presented during the day, usually due to trauma and foreign bodies. So, they didn’t have time for participation. They went for the treatments immediately, as soon as possible. This is ethically sound.

The sample size was determined by using a single population proportion formula with a 13.2% proportion of TEM use from the same study in Nigeria, a 5% level of significance, 3% margin of error, and 10% non-response rate (Nwosu & Obidiozor, 2011). Finally, 539 has been taking as the final sample size to determine the prevalence and associated factors of TEM use.

2.3. Ethical considerations

Ethical clearance was obtained from the University of Gondar, College of Medicine and Health Sciences, School of Medicine ethical review committee. Before the data collection started, informed written consent was obtained from all study participants. Obtaining consent involves explaining the research and assessing participant comprehension using a consent document, usually a written consent form or information sheet. In the case of minorities, informed oral consent from the participant and/or his or her legally authorized representative, proxy, or next of kin (surrogate) was obtained prior to initiating any research activities. The research has minimal risk. In this regard, their full right to withdraw or refuse to participate in the study was respected. Respondent’s data was collected without an identifier, and confidentiality was maintained by locking it with a password. All procedures were conducted in accordance with the Declaration of Helsinki (1964).

2.4. Data collection procedures and quality control

Data was collected through face-to-face interviews using a pretested and structured questionnaire containing information about socio-demographic characteristics, personal factors, eye care-related factors, and environmental factors. The questionnaire was prepared by reviewing related works of literature and scanning and considering the unique socio-cultural facts of the study population. The questionnaire was developed in English and then translated to Amharic and later translated back to English by language experts to ensure accuracy and reliability of data. The interview was done by five trained optometrists.

The Amharic translated version of the questionnaire was pretested at Felege Hiwot Referral Hospital, Bahir Dar by taking 5% of the total sample size, and necessary corrections have been made based on the result. The questionnaire was translated from English to Amharic and then back to English to ensure accuracy, reliability, and consistency. Training was given to data collectors and supervisors for two days to make them familiar with their tasks. The collected data was checked against the daily basis of data collection for completeness, accuracy, and clarity by the principal investigator and supervisor.

2.5. Data management and analysis

The coded data were entered using Epi Info 7 and exported to, processed, and analyzed using SPSS version 20. The analysis was done by the investigator using the same computer package. Frequency and cross-tabulations were used for descriptive analysis of the data. An adjusted odds ratio with a 95% confidence interval was used to measure the strength of the association between outcome and explanatory variables.

The association between dependent and independent variables was analyzed by a binary logistic regression model. The model's fitness was checked using the Hosmer and Lemeshow goodness of fit test, and the result of its p value was 0.437. Bivariable logistic regressions of variables with an a P-value of 0.2 were entered into multivariable analysis, and those with a value of p 0.05 were taken as statistically significant. The final data was presented using tables, figures, and graphs accordingly.

3. Results

In this study, a total of 502 study participants gave valid and complete response (response rate of 93.1%).

3.1. Socio demographic characteristics of study participants

The median age of the study participants was 37, with a range of 18–90 years. Among 502 eligible study participants, more than half of the participants were male: 59.6% (299). About half of the participants are currently married. 54.2% (272), 73.1% (367) of the participants resided in urban areas, and 87.8% (441) were Christian in religion. The educational status of the majority participants were secondary school (27.1%) and no formal educations (26.3) Most of the participants were private workers (23.9%; See, Table 1).

Table 1. Distribution of the prevalence of TEM use in study participants among adult ophthalmic patients attending UoGCSH-CECTC, Northwest Ethiopia, 2020 (N = 502)

Variables	Traditional eye medicine use
	Yes (22.3 %) Total = 112	No (77.7 %) Total = 390
Age in years
18–27	15 (13.4%)	115 (29.5%)
28–36	18 (16.1%)	101 (25.9%)
37–55	41 (36.6%)	102 (26.1%)
56–90	38 (33.9%)	72 (18.5%)
Sex
Male	59 (52.7%)	240 (61.5%)
Female	53 (47.3%)	150 (38.5%)
Residence
Urban	27 (24.1%)	340 (87.2%)
Rural	85 (75.9%)	50 (12.8%)
Marital status
Unmarried	52(46.4%)	178(45.6%)
Married	60 (53.6%)	212 (54.4%)
Educational status
No formal education	45 (40.2%)	87 (22.3%)
Religious Education	7 (6.2%)	10 (2.6%)
Primary school	30 (26.8%)	60 (15.4%)
Secondary school	13 (11.6%)	123 (31.5%)
College/university	17 (15.2%)	110 (28.2%)
Religion
Christian	98 (87.5%)	343 (87.9%)
Muslim	14 (12.5%)	47 (12.1%)
Occupation
Government	12 (10.7%)	97 (24.9%)
Private	21 (18.8%)	99 (25.4%)
Housewife	28 (25.0%)	50 (12.8%)
Farmer	25 (22.3%)	52 (13.3%)
Student	13 (11.6%)	57 (14.6%)
Other	13 (11.6%)	35 (9.0%)
Average family monthly income in Ethiopian Birr
300–1,500	64 (57.1%)	63 (16.2%)
1,501–3,200	21 (18.8%)	105 (26.9%)
3,201–5,000	17 (15.2%)	110 (28.2%)
5,001–28,000	10 (8.9%)	112 (28.7%)
Leadership role
Has role	17 (15.2%)	67 (17.2%)
No role	95 (84.8%)	323 (82.8%)
Family history of TEM use
Yes	82 (73.2%)	80 (20.5%)
No	30 (26.8%)	310 (79.5%)
Availability of TH
Available	61 (54.5%)	70 (17.9%)
Not available	51 (45.5%)	320 (82.1%)
Health insurance
Has	35 (31.2%)	83 (21.3%)
No	77 (68.8%)	307 (78.7%)
History of MEM use
Yes	82 (73.2%)	258 (66.2%)
No	30 (26.8%)	132 (33.8%)
Distance from ECC in hr.(single trip)
0.03–0.33	18 (16.1%)	112 (28.7%)
0.34–0.75	13 (11.6%)	106 (27.2%)
0.76–3	43 (38.4%)	124 (31.8%)
3.1–29	38 (33.9%)	48 (12.3%)
Time of presentation in weeks
0–6	18 (16.1%)	230 (59.0%)
6.1–24	41 (36.6%)	88 (22.6%)
24.1–60	53 (47.3%)	72 (18.5%)
Knowledge
Good	61 (54.5%)	260 (66.7%)
Poor	51 (45.5%)	178 (33.3%)
Attitude
Good	80 (71.4%)	149 (38.2%)
Poor	32 (28.6%)	241 (61.8%)
Awareness
Aware	67 (59.8%)	179 (45.9%)
Not aware	45 (40.2%)	211 (54.1%)

N: total sample size, ECC: eye care center, hr.: hour, #: Number

Role: religious/social/ or any organizational leader or had any position

3.2. Prevalence of traditional eye medicine use

From 502 total study participants, 22.3 % (112) (95% CI: 19–26%) had used TEM in the past two years. Among those who used TEM, over one third (36.6%) (41) were found between the ages of 37 and 55 years, and three-quarters (75.9%) (85) were rural residents. In addition, 87.5% (98) were Christians, 40.2% (45) had no formal education, and (57.1%) (64) had an average family monthly income of 300 to 1,500 ETB. (See, Table 1).

Among the participants who used TEM, 36.8% (45) used holy water in the past 2 years. (See, Figure 1)

Figure 1. The types of TEM used by the study participants among adult ophthalmic patients attending UoGCSH-CECTC, Northwest Ethiopia, 2020.

Of those participants who used TEM, 26.78% (AlSalman et al., 2021) used the TEM for trauma to their eye. (Figure 2)

Figure 2. The types of the eye problems that the TEM was used for by the study participants among adult ophthalmic patients attending UoGCSH-CECTC, Northwest Ethiopia, 2020.

More than 35% of the participants who used TEM delivered the TEM by themselves. (See, Figure 3) Belief in potency was cited by 42.6% of the users as a reason for traditional eye medicine use.

Figure 3. The person who delivered the TEM for the participants with a history of use, Northwest Ethiopia, 2020.

3.3. Factors associated with traditional eye medicine use

From a multivariable logistic regression analysis, residence, average family monthly income, family history of TEM use, availability of TH, and time of presentation were found to be statistically significantly associated with TEM use.

To start from residence, the study participants living in rural areas were 24.96 times (AOR = 24.96 (95% CI: 10.43–59.71)) more likely to use TEM as compared to those residing in urban areas. 6.57 (1.88–22.98)

The study participants who were from families with a monthly income of 300 to 1,500 Ethiopian Birr (ETB) were nearly 6.57 times (AOR = 6.57 (95% CI: 1.88–22.98)) more likely to use TEM as compared to those who had an income of 5,001 to 28,000 ETB.

The odds of TEM use were 11.11 times (AOR = 11.11; (95% CI: 4.83–25.56) higher in study subjects with a positive family history of TEM use as compared to those who had no family history of TEM use.

Regarding TH availability, study participants who live in areas where traditional healers exist were 3.72 times (AOR = 3.72 (95% CI: 1.61–8.60)) more likely to use TEM than those who live in areas where traditional healers do not exist.

Study participants who were presented between 6 weeks and 6 months were 4.98 times (AOR = 4.98 (95 % CI: 1.87–13.28)) more likely to use TEM than those who were presented within 6 weeks. Those who were presented between 6 months and above were 8.46 times (AOR = 8.46 (95% CI: 3.02–23.68) more likely to use TEM than those who were presented within 6 weeks. (See, Table 2 for details.)

Table 2. Factors associated with traditional eye medicine use by study participants among adult ophthalmic patients attending UoGCSH-CECTC, Northwest Ethiopia, 2020 (TEM users = 112)

Variable	n	TEM use (N=502)=100%		COR(95%CI)	AOR(95%CI)	p-value
		Yes=112 (22.3%)	No=390 (77.7%)
Age in years
18-27	n=130	15 (11.5%)	115 (88.5%)	1	1
28-36	n=119	18 (15.1%)	101 (84.9%)	1.36 (0.65-2.85)	1.73 (0.40-7.46)	0.458
37-55	n=143	41 (26.7%)	102 (71.3%)	3.08 (1.61-5.89) *	2.26 (0.53-9.67)	0.268
56-90	n=110	38 (34.5%)	72 (65.5%)	4.04 (2.07-7.87) **	2.34(0.47-11.67)	0.299
Sex
Male	n=299	59 (52.7%)	240 (61.5%)	1	1
Female	n=203	53 (26.1%)	150 (73.9%)	1.43 (0.94-2.19)	2.26 (0.81-6.28)	0.118
Residence
Urban	n=367	27 (7.4%)	340 (92.6%)	1	1
Rural	n=135	85 (63%)	50 (37.0%)	21.40 (12.66-36.18) **	24.96(10.43-59.71)**	0.000
Marital status
Unmarried	n=230	52 (22.6%)	178 (77.4%)	1.03 (0.67-1.57)
Married	n=262	60 (22.9%)	212 (77.1%)	1
Educational status
No formal education	n=132	45 (34.1%)	87 (65.9%)	3.34 (1.79-6.25) **	0.59 (0.11-3.16)	0.538
Religious education	n=17	7 (41.2%)	10 (58.8%)	4.52 (1.51-13.50) *	1.99(0.13-29.75)	0.617
Primary school	n=90	30 (33.3%)	60 (66.6%)	3.23 (1.65-6.34) *	1.67 (0.39-7.15)	0.488
Secondary school	n=136	13 (9.6%	123 (90.4%)	0.68 (0.31-1.47)	0.91 (0.22-3.73)	0.896
College/university	n=127	17 (13.4%)	110 (86.6%)	1	1
Religion
Christian	n=441	98 (22.2%)	343 (77.8%)	1
Muslim	n=61	14 (23.0%)	47 (77%)	1.04 (0.55-1.97)
Occupation
Government	n=109	12 (11.0%)	97 (89.0%)	1	1
Private	n=120	21 (17.5%)	99 (82.5%)	1.71 (0.80-3.67)	2.32(0.52-10.29)	0.267
Housewife	n=78	28 (35.9%)	50 (64.1%)	4.52 (2.12-9.65) **	0.53 (0.08-3.36)	0.506
Farmer	n=77	25 (32.5%)	52 (67.5%)	3.88 (1.80-8.36) *	0.17 (0.02-1.07)	0.059
Student	n=70	13 (18.6%)	57 (81.4%)	1.84 (0.78-4.31)	3.18(0.57-17.75)	0.186
Other	n=48	13 (27.1%)	35 (72.9%)	3.00 (1.25-7.20)	0.31 (0.04-2.53)	0.278
Average family monthly income in ETB
300-1,500	n=127	64 (50.4%)	63 (49.6%)	11.37 (5.45-23.71) **	6.57(1.88-22.98)*0.003
1,501-3,200	n=126	21(16.7%)	105 (83.3%)	2.24 (1.00-4.97) *	0.61 (0.17-2.24)	0.465
3,201-5,000	n=127	17 (13.4%)	110 (86.6%)	1.73 (0.75-3.94)	0.99 (0.28-3.49)	0.998
5,001-28,000	n=122	10 (8.2%)	112 (91.8%)	1	1
Leadership role
Has role	n=84	17 (20.2%)	67 (79.8%)	1
No role	n=418	95 (22.7%)	323 (77.3%)	1.15 (0.64-2.06)
Family history of TEM use
Yes	n=162	82 (50.6%)	80 (49.4%)	10.59 (6.52-17.20) **	11.11(4.8325.56)**	0.00
No	n=340	30 (8.8%)	310 (91.2%)	1	1
Availability of TH
Available	n=131	61 (46.6%)	70 (53.4%)	5.46 (3.47-8.60) **	3.72 (1.61-8.60)*	0.002
Not available	n=371	51 (13.7%)	320 (86.3%)	1	1
Health insurance
Has	n=118	35 (29.7%)	83 (70.3%)	1.68 (1.05-2.68)
No	n=384	77 (20.1%)	307 (79.9%)	1
History of MEM use
Yes	n=340	82 (24.1%)	258 (75.9%)	1.39 (0.87-2.23)	1.59 (0.65-3.87)	0.299
No	n=162	30 (18.5%)	132 (81.5%)	1	1
Distance from ECC in hr.(single trip)
0.03-0.33	n=130	18 (13.8%)	112 (86.2%)	1	1
0.34-0.75	n=119	13 (10.9%)	106 (89.1%)	0.76 (0.35-1.63)	0.36 (0.10-1.28)	0.117
0.76-3	n=167	43 (25.7%)	124 (74.3%)	2.15 (1.17-3.95) *	0.53 (0.17-1.61)	0.296
3.1-29	n=86	38 (44.2%)	48 (55.8%)	4.92 (2.55-9.48) **	0.96 (0.27-3.35)	0.951
Time of presentation in weeks
0-6	n=248	18 (7.3%)	230 (92.7%)	1	1
6.1-24	n=129	41 (31.8%)	88 (68.2%)	5.95 (3.24-10.91) **	4.98(1.87-13.28)*	0.001
24.1-60	n=125	53 (42.4%)	72 (57.6%)	9.40 (5.18-17.08) **	8.46(3.02-23.68)**	0.00
Knowledge
Good	n=321	61(19.0%)	260 (81.0%)	1	1
Poor	n=229	51(22.3%)	178 (77.7%)	1.67 (1.09-2.56) *	1.46 (0.55-3.88)	0.440
Attitude
Good	n=229	80 (34.9%)	149 (65.1%)	4.04 (2.55-6.39) **	1.67 (0.71-3.90)	0.236
Poor	n=273	32 (11.7%)	241 (88.3%)	1	1
Awareness
Aware	n=246	67 (27.2%)	179 (72.8%)	1.75 (1.14-2.69)*	2.16 (0.94-4.98)	0.069
Not aware	n=256	45 (17.6%)	211 (82.4%)	1

n: number of samples in each stratum(sub category of each variables), *: P- value <0.05, **: P-value <0.001, ECC: eye care center, hr.: hour, #: Number

The horizontal (row) sum of each percentage is equal to 100%

COR = crude odds ratio, AOR = adjusted odds ratio, CI = confidence interval

Attitude: there were attitude questions and scores based on the mean. If above the mean, it is considered good. In the same way, knowledge.

4. Discussion

The prevalence of traditional eye medicine use among adult ophthalmic patients attending UoGCSH-TECTC was found to be (22.3 %) (95% CI: 19–26 %). This result was similar to a study conducted in Nigeria (25.7%; EO Achigbu & Achigbu, 2017).

The prevalence of TEM use found in this study was lower than evidences from South Africa (36%; Rakoma, 2017) and Southeast Nigeria (82.3%; KI, 2014), this could be due to cut-off time of 2 years used in this study.

Similarly, this finding was lower than reports from Saudi Arabia (35%; Bifari et al., 2020), Nigeria (48.7%; DH & CU, 2016), Zimbabwe (61.5 %; Jaya & Masanganise, 2014), and Uganda (44.2%; Nyathirombo et al., 2013). The patient population enrolled in this study could hide their TEM use, causing a lower prevalence (EO Achigbu & Achigbu, 2017; Munaw et al., 2020).

It was also lower than the results of studies from India (38%; Choudhary et al., 2015), Malawi (33.8 %; Courtright et al., 1994), Uganda (60%; Arunga et al., 2019) and Saudi(54.2%; AlSalman et al., 2021). This could be due to a difference in the study population (EO Achigbu & Achigbu, 2017; AlSalman et al., 2021; Eze et al., 2009; Oyediji et al., 2019). This study considers only new ophthalmic outpatients to the eye care center. But those studies from India, Malawi, Saudi and Uganda were conducted on patients with specific ophthalmic diseases that may increase the prevalence of TEM use.

On the other hand, this prevalence was higher than the studies from India (8.8%; Pimprikar & Gulhane), Nigeria (1.6% (Ukponmwan & Momoh, 2010), 4.3% (Oyediji et al., 2019), 13.2% (Nwosu & Obidiozor, 2011)), and Ethiopia (12.2%; Munaw et al., 2020). This could be due to the variation in the community served by the eye care centers. The Study in Gondar, Ethiopia was conducted on healthy and urban populations, but this study included diseased and rural communities which made the prevalence higher in this study (Munaw et al., 2020).

TEM use was positively associated with an average family monthly income of 300 to 1,500. The possible reason for the association could be, participants from families with a low average monthly income were unable to afford the modern eye medicine-related and transportation expenses.

The rural residence was found to be a significant factor that made this finding in accordance with reports from Nigeria (Durowade et al., 2018; Eticha et al., 2021; Eze et al., 2009; Nwosu & Obidiozor, 2011; Osahon, 1995). Many people in rural areas believe that diseases are caused by breaking taboos or not conforming to traditional societal rules which leads them to consult TH and use TEM (Eticha et al., 2021; Ukponmwan & Momoh, 2010). This high incidence may also be attributed to the rural underutilization of available promotive and preventive modern eye care services (Eze et al., 2009; Osahon, 1995; Oyediji et al., 2019; Sitotaw, 2018).

The odds of TEM use was higher among study subjects living in TH available area than those who lived in the area where TH did not exist. This was in accordance with the studies from India (Rakoma, 2017) and Ethiopia (Eticha et al., 2021; Munaw et al., 2020). Using easily available TH as an alternative means to seek eye care service, their short waiting time and cheap service could be the reason for this discrepancy (Munaw et al., 2020; Rocha et al., 1997). Misleading messages from TH may also have a role for TEM use (Arunga et al., 2019).

Those with a positive family history of TEM use had a positive association with TEM use. This was consistent with the studies conducted in India (Choudhary et al., 2015; Eticha et al., 2021), Malawi (Bisika et al., 2009), and Ethiopia (Eticha et al., 2021; Munaw et al., 2020). Considering TEM use as a trend and passing it from parents to children to treat abnormal eye conditions (Eticha et al., 2021; Munaw et al., 2020) and respecting the wisdom of older members of the community who carry a high level of respect (Arunga et al., 2019) might be accountable for higher TEM use by subjects with family a history of TEM use.

Participants’ late presentation to the eye care center had a positive association with TEM use. This result was supported by the studies conducted in Malawi and Nigeria (Arunga et al., 2019; Courtright et al., 1994; Eze et al., 2009). Using TEM as an emergency or first aid treatment could be the reason for these high odds. Since the second most commonly mentioned reason for use was the accessibility of TEM and the most frequently reported eye problem that the TEM was used for was trauma, it needs immediate action by easily accessible TEM.

The majority of participants with a history of TEM use reported using TEM for eye trauma. This finding was in accordance with the report from Nigeria (Eze et al., 2009). The easy availability and accessibility of the TEM could be the reason for applying it as an emergency management tool for trauma.

Most of the participants in this study delivered the TEM themselves. It was similar to reports from Nigeria (Eze et al., 2009; Ukponmwan & Momoh, 2010). This might be due to TEM being familiar with the community and it being used immediately by materials available on hand.

Among the reasons accountable for the use of TEM, belief in potency and easy accessibility were the two most commonly cited reasons. This result was in agreement with reports from India, Uganda and Ethiopia (Eticha et al., 2021; Nyathirombo et al., 2013; Pimprikar & Gulhane). This could be due to cultural and spiritual association of TEM with the community.

4.1. Conclusion

The triggering factors for the use of TEM in general are its availability and the high cost of modern medicine. So, intensive health education should be given, and it’s better to make affordable the modern medical service in the hospital.

4.2. Limitation and challenges of the study

The period of data collection was only within two months. This may increase or decrease the prevalence of TEM use.

COVID-19 made some of the participants to be frustrated during the data collection period and it decreased the flow of patients to the hospital.

4.3. Declarations

We, all the authors of this original article declare that, the following points are addressed, incorporated, discussed, within the manuscript and taken during the data collection period to write of the article. These points are:

1. Ethical approval was obtained from Gondar University Ethical review board and consent also taken from each participants based on Helsinki declarations

2. Consent for publication: not applicable for this research

3. All the data are available and incorporated within the manuscript.

4. No special funding resource was obtained

5. All the respected bodies were acknowledged (Gondar University, department of optometry, all the authors, all the participants and BMC journal.

6. No competing interest

7. Authors contributions:

Biruk Lelisa Eticha: proposal and result write up, design, conception, data collection and analysis.

Haile Woretaw Alemu: Editing, conception, design and advising

Aragaw Kegne Assaye: manuscript preparations, design, conception, advising, editing and interpretation of the data

8. All authors information including affiliations were excluded in the original manuscript.

Acknowledgement

Our deepest gratitude goes to the department of optometry, ophthalmology and our colleagues for their general over view of the research proposal and result write up

Disclosure statement

No potential conflict of interest.

Additional information

Funding

No funding was received

Notes on contributors

Biruk Lelisa Eticha

Biruk Lelisa Eticha, Nationality: Ethiopian, Place of work: Gondar, Ethiopia, Sex: male, Lecturer at University of Gondar (BSc, MSc in clinical optometry)

Aragaw Kegne Assaye

Aragaw Kegne Assaye, Date of birth: 30 June 1990, Nationality: Ethiopian, Place of work: Gondar, Ethiopia, Sex: male, Address: mobile, [phone] or [phone], Currently: lecturer at university of Gondar (BSc, MSc in clinical optometry)

Haile Woretaw Alemu

Haile Woretaw Alemu: Nationality: Ethiopian, Place of work: Gondar, Ethiopia, Sex: male, Lecturer at University of Gondar (BSc,MSc in clinical optometry)