INTRODUCTION

The World Health Organization defines complementary and alternative medicine (CAM) as the set of health care practices, which are not part of the country’s tradition (traditional medicine) and are not fully integrated and articulated with the health system ¹. These therapies usually offer a holistic and person-centered approach, which allows healthcare to integrate the biopsychosocial and spiritual spheres of the users ².

The use frequency of CAM therapies by the population varies according to the place studied. In Latin America, despite the acceptance of these therapies and the cultural factors linked to them, there are only estimates of their use, which indicate that approximately 7 out of 10 Latino patients resort to non-conventional therapies, such as the use of medicinal plants for their health care ³. On the other hand, the social and cultural determinants that influence patients’ use of CAM or traditional medicine are different between urban and rural populations ⁴. A previous study estimated that being part of an indigenous ethnic group was a significant factor in the decision to use or not use CAM therapies ⁵.

In Peru, information on the use of these therapies is quite limited. A study of outpatients in Metropolitan Lima estimated 29.6% use of CAM therapies ⁶; similar studies but carried out in the Peruvian Amazon, urban or rural jungle have not been found.

Ucayali is one of the most important regions in the Amazon because of its health indicators for certain noncommunicable diseases, for example, the highest number of diabetes cases are reported in Ucayali ^{( 7}; among several other diseases in which CAM has the best available evidence of safety and efficacy. On the other hand, the province of Coronel Portillo is home to 77.3% of the population of the Ucayali region, the 3 studied districts represent 88% of the province’s population ⁸ who are mostly dedicated to minority commerce: agriculture, livestock farming, hunting and forestry, with a significant presence of indigenous people ⁹. In this sense, the objective of this study was to evaluate the use of CAM therapies and their associated sociodemographic factors in the province of Coronel Portillo during 2013.

THE STUDY

FINDINGS

During fieldwork, 917 surveys were conducted in the 3 selected districts: 509 (55.5%) in Callería; 232 (25.3%) in Manantay; and 176 (19.2%) in Yarinacocha. The majority of the participants were women (68.3%) and primarily in the age range from 18 to 30 years (29.2%). In addition, 38.6% were dedicated to house care and 79.9% had incomes of less than 1,436 soles per month (Table 1).

It was found that 179 respondents (19.5%) had used CAM in the last 12 months, of which 36 (20.1%) reported that they used these methods in conjunction with conventional therapies and only 22 (12.2%) reported to their treating physician that they were using CAM therapies.

It was determined that 68.7% of the people who used CAM refer that they went to private establishments (independent), while 20.7% went to the Seguro Social de Salud (EsSalud). A lower percentage went to religious organizations (3.5%), to facilities of the Ministerio de Salud (0.6%), among others (3.5%). When asked about the reasons the respondents had for using CAM, 45.8% mentioned that they were doing it on the recommendation of a family member or friend; 15.6% referred to using it because conventional medicine did not provide a solution to their health problem; and 13.9% considered these therapies to be effective.

The CAM therapy most used by the respondents was phytotherapy (62.0%); followed by acupuncture (17.9%), tai chi (10.1%), trophotherapy (8.9%), reflexology (7.3%) and massotherapy (5.6%). Other reported methods were chiropractic yoga, geotherapy, and, to a lesser extent, magnetic hydrotherapy, and homeopathy (Figure 1).

Figure 1 Distribution of complementary and alternative medicine therapies used in 3 districts of the province of Coronel Portillo (Ucayali) in 2013. 

In the bivariate analysis, a statistically significant relationship was found between the use of CAM therapies and educational attainment (p < 0.001), occupation (p < 0.001) and monthly income (p < 0.001) (Table 2).

DISCUSSION

The frequency of CAM therapies use was found to be 19.5%, phytotherapy or use of medicinal plants was the most used. These results are consistent with the findings of Mejía Gálvez et al. in a study of outpatients in Metropolitan Lima, where phytotherapy was used by 29.6% ⁶; and to those of Gamarra Condezo, who reported a 24.7% frequency of use in Huánuco ¹². Medina Larico found 69 species of plants used for medicinal purposes in the native community of Nuevo Saposoa, in the same province where this study was conducted ¹³. Additionally, Chuspe Zans also showed that ancestral knowledge about the use of native plants is preserved in the Uni ethnic group of the Aguaytia province ¹⁴ and in the Shipiba ethnic group of the Masisea district (province of Coronel Portillo) ¹⁵.

During the bivariate analysis we found a statistical association between occupation, income, and educational attainment. In the case of the factors “occupation” and “economic income”, previous studies have shown contradictory results. The systematic review by Bai James et al. summarizes the findings of 10 studies in which a statistical relationship was found between CAM use, low socioeconomic status, and not having formal employment (or being self-employed) ¹⁶. These findings are consistent with the study made by Peltzer and Pengpid, who found an association between low socioeconomic indicators and the use of CAM therapies ¹⁷. However, the studies carried out by Wemrell et al. and Johny et al. found no significant association between use of CAM therapies and socioeconomic status in users from Sweden ¹⁸ and Malaysia ¹⁹, respectively.

Similar to the findings from our study, Abdullah et al. found that higher education (technical or university) was associated with greater use of CAM therapies in Malaysia ²⁰. However, there are studies that haven’t found a relationship between educational attainment and CAM use ¹⁹, and there are even studies that found that university education is a protective factor against the use of CAM therapies ^{17 , 20}. However, unlike this study, previous research does not use probabilistic samples for the selection of the people surveyed, so this research allows us to establish conclusions that can be very similar to what happens in the area of the population studied.

Within the limitations of this study, it should be mentioned that the use of data collection instruments such as data collection sheets implies the inherent probability of information bias and memory bias by the respondents. On the other hand, not considering the use of complex sampling alters the final estimates, and the age of the data may mean that these findings are no longer applicable today. However, the results of this study are relevant because of the lack of information on the use of CAM in the Amazon population. Future studies should consider other types of sampling and prospective designs to avoid, if possible, these limitations.

In addition, aspects such as family composition or whether or not the person providing the information was the head of the family were not studied in depth; therefore, it is recommended that further research add these aspects to the data collection instruments.

In conclusion, almost a fifth of the studied sample used CAM therapies in the last 12 months, besides, the educational attainment, occupation and economic income turned out to be factors associated to the use of these therapies. This research provides relevant information about the situation of CAM use by the Amazonian population, in its socio-cultural context and socioeconomic dynamics.