Prevalence, Determinants and Outcomes of Traditional, Complementary and Alternative Medicine Use for Hypertension in Low-Income Households in Malaysia and the Philippines

Background: Traditional, complementary and alternative medicine (TCAM) is widely used for a range of conditions, especially in Southeast Asia. This study examines the prevalence and characteristics of TCAM use for hypertension, its determinants, and its association with hypertension management outcomes and wellbeing among low-income adults in Malaysia and the Philippines. Methods: We analysed cross-sectional data from 946 randomly selected adults diagnosed with hypertension (495 in Malaysia, 451 in the Philippines) from low-income communities. We compared the prevalence and characteristics of TCAM use between countries and used multi-level, mixed-effects regression to estimate associations between TCAM use and its determinants, five hypertension management outcomes and wellbeing. Findings: The prevalence of TCAM use was higher in the Philippines than in Malaysia (18·8% vs 8·8%, p<0·001). Biologically-based modalities, e.g. herbal remedies, were the most common type of TCAM used in both countries. Belief that TCAM is effective for hypertension was a positive predictor of TCAM use while belief in Western medicine was a negative predictor. TCAM use was not associated with current use of medications for hypertension, self-reported medication adherence, blood pressure level and control, or wellbeing in either country. Interpretation: A small, but significant, proportion of individuals living in low-income communities in Malaysia and the Philippines use TCAM to manage their hypertension. Recognising that their patients may be engaging in TCAM will enable health care providers to deliver better, more patient-centred care. Funding: This study was supported by a grant from the Wellcome Trust/Newton Fund-MRC Humanities & Social Science Collaborative Award scheme (200346/Z/15/Z). Declaration of Interest: LMP-V, BP conceived and led the analysis and writing of this paper, contributing equally. LMP-V, BP, DB, FAM, AR, MLS, ALD, KY, MM designed, initiated and coordinated the RESPOND study. All authors contributed to study implementation, interpretation of results, critical review and revision all drafts, and approved the final version of this manuscript. All authors agree to be accountable for all aspects of the work. Ethical Approval: Ethical approval for this study was granted by the Observational Research Ethics Committee at the London School of Hygiene & Tropical Medicine (Ref: 12214) and the Research Ethics Boards at the Universiti Putra Malaysia (JKEUPM-2017-229) and the University of the Philippines Manila (UPMREB-2017-481-01). All participants gave informed consent.