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available at www.sciencedirect.com
a
Institute for Medical Research, Jalan Pahang, 50588 Kuala Lumpur, Malaysia
b
Institute for Health System Research, Jalan Rumah Sakit Bangsar, 50590 Kuala Lumpur, Malaysia
Available online 6 November 2009
KEYWORDS Summary
Background: The increasing popularity and use of traditional and complementary medicine
Traditional;
(TCAM) in both developed and developing countries, including Malaysia, have raised signicant
Complementary;
public health policy issues. However, currently, there is a paucity of baseline data on such usage
Modalities;
by the Malaysian community.
Malaysia;
Objective: This study was conducted to identify and describe the prevalence and frequency of
Usage;
various TCAM modalities that are being used by the Malaysian population by age, gender, marital
Prevalence
and working status, educational level and ethnic group for health issues and maintenance.
Design: A nationwide interviewer-administered questionnaire survey was conducted in August
2004. An open-ended questionnaire pertaining to TCAM modalities was used to increase the
probability of capturing maximum data. This survey implemented a multistage design, stratied
by state and urban/rural random sampling, proportionate to the size of the state population
and was representative of the Malaysian population. Post-survey classication of modalities was
done accordingly. Complex data analysis was carried out using SPSS 13.0.
Results: Various TCAM modalities that were used by the Malaysian population were identi-
ed and categorised. Biological-based therapies, which included herbal therapy, were most
commonly used for health problems (88.9%) and for health maintenance (87.3%). Under this cat-
egory, herb-based application/herb-based beauty product/herb-based hygiene product group
was most commonly used for health issues (23.6%) while pure herbs were the ones most com-
monly used for health maintenance (29.6%). There was no signicant difference across all groups
in the usage of biological-based therapies for health issues.
Conclusion: The study showed that there is a high prevalence of TCAM use by the Malaysian
population, particularly in the use of herb-based therapies for both health issues and health
maintenance. Thus, a strict guideline for herbal commercialisation as well as public education
is important.
2009 Elsevier Ltd. All rights reserved.
Corresponding author at: Cancer Research Centre, Institute for Medical Research, Jalan Pahang, 50588 Kuala Lumpur, Malaysia.
E-mail address: sitizuraidah@rocketmail.com (Z.M. Siti).
0965-2299/$ see front matter 2009 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ctim.2009.04.002
Use of traditional and complementary medicine in Malaysia 293
Biological-based therapies
This therapy had the highest prevalence by all characteris-
tics. It was used by more than 90% of the 5059, 6069 and
80 years and above age groups. It was also highly used by
Figure 4 Prevalence of modalities used by Malaysian popula-
women (89.8%). The divorcee/widow/widower (91.5%), no
tion for health problem.
formal schooling (91.5%) and housewife (91.5%) groups had
the highest number of users. More than 90% of the users were
Chinese (92.4%), Indians (92.0%), Bumiputra Sabah (97.3%)
and Bumiputra Sarawak (91.2%).
els, the upper secondary reported the highest prevalence of Manipulative and body based
usage (48.2%) even though not statistically different from Approximately, more than a quarter of the age 20 and
other educational level groups. More than half of the respon- above group used this therapy. The female group showed
dents from the schooling and pensioner group also used this signicantly higher prevalence, 37.2% (95% CI, 34.739.8)
therapy. than the male group, 12.4% (10.614.5). Almost 50%
of the divorcee/widow/widower group used this mode
of therapy. Within the educational level group, more
Biological-based therapies than 25% of all groups populations had used this ther-
This therapy had the highest prevalence within all groups. It apy. The housewife group reported signicantly higher
was used by more than 80% of all age groups except 80 years prevalence of use (49.7%, 95% CI, 45.753.8) than the
and above. It was used slightly more by the female group rest of the working status category. The Malay group
(87.5%). All of those cohabiting (100%) used this method of showed the highest prevalence by 32.4% although not
therapy, while the other marital status used to an extent statistically different from the Orang Asli population
of more than 80%. More than 85% of the population from (27.3%).
all educational levels used this therapy. More than 85% of
the population from the working status category used this
modality. More than 80% of the population from all ethnic Whole medical system
groups used this therapy, the highest being the Orang Asli Only 1.7% of the ethnic Malay and 1.8% of Chinese used this
(93.2%). mode of therapy. Less than 5% of all age, sex, marital status,
Table 4 Prevalence of use of T/CM modalities category by age, sex, marital and working status, education level and ethnic
group for health problem.
educational level and working status groups have used this Certain modalities practiced may only represent a minor ele-
method of therapy for health issues. ment of the healing process but a key element in the ethnics
culture.8
The dominant use of herbs in a variety of ways was natu-
Discussion and conclusion rally due to the fact that Malaysia is diverse in ethnicity that
still follows generations of traditional healing practices sup-
This study provided the baseline information for usage ported by vast natural resources. This corroborated previous
of various traditional and complementary therapies in ndings by Tindle et al.9 and Tan et al.10
Malaysia at the nationwide level. In summary, the preva- The preliminary idea of using a pre-coded modalities
lence of TCAM usage is within WHO estimation (5080%) list proved to be non-representative due to the presence of
and is lower than that in the study conducted in Sin- different varieties of traditional and complementary modal-
gapore (76%)5 and Japan (76%).6 This result might also ities compared with Western and Japanese surveys.4,11,12
reect the overall prevalence of TCAM usage in Southeast However, this issue was resolved by means of open-ended
Asia. qualitative questionnaires,13,14 which managed to capture a
The vast range of modalities was a manifestation of comprehensive list of traditional and complementary modal-
ethnic and cultural diversity of the Malaysian population.7 ities used by the Malaysian population. The post-survey
Table 5 Prevalence of use of traditional and complementary medicine by age, sex, marital and working status, education level
and ethnic group for health maintenance.
identication and classication of the type of modalities 10. Tan M, Uzun O, Akcay F. Trends in complementary and alter-
used provided the necessary research tool for future studies native medicine in eastern Turkey. J Altern Complement Med
in a related topic. 2004;10(October (5)):8615.
There are several limitations in the current study. Our 11. MacLennan A, Wilson D, Taylor A. Prevalence and cost of alter-
result showed that there was a very low usage for the native medicine in Australia. Lancet 1996;347:56973.
12. Yamashita H, Tsukayama H, Sujishita C. Popularity of com-
whole medical system, for example, the traditional Chinese
plementary and alternative medicine in Japan: a telephone
medicine, ayurveda and homeopathy. This could be because survey. Complement Ther Med 2002;10:8493.
many respondents described the modalities involved instead 13. Broom Alex. Using qualitative interviews in CAM research: a
of the practice of the healer that they visited. For example, guide to study design, data collection and data analysis. Com-
the respondent might have consulted a traditional Chi- plement Ther Med 2005;13:6573.
nese medicine practitioner who prescribed a Chinese herb. 14. Broom Alex, Barnes Jo, Tovey Philip. Introduction to the
Instead of reporting that she consulted a traditional Chi- research methods in CAM series. Complement Ther Med
nese medicine practitioner, she might have reported that she 2004;12:12630.
had received the herb; thus, these data were recorded and 15. Editorial. Paving the way for complementary medicine? Com-
analysed as herbal therapy and not as traditional Chinese plement Ther Clin Pract 2006;12:17780.
16. Merican I. Traditional/complementary medicine: the way
medicine.
ahead (Editorial). Med J Malaysia 2002.
In conclusion, a high usage of herbs by the Malaysian 17. http://www.fda.gov/opacom/laws/DSHEA.html. Accessed on
population needs to be supported by extensive scien- 1st August 2008.
tic research to gain optimum use without suffering side
effects.15 Thus, strict regulation for the registration of com- Glossary
mercialised herbs is advised and also that public education
is pertinent.16,17 Living quarters: A living unit, structurally separate (surrounded by
walls, fences, etc., and covered by a roof), independent (has
direct access through a public staircase, communal passages or
Acknowledgements landing) and meant for living.
Mind body medicine (Ref: http://nccam.nih.gov/health/
We would like to acknowledge the Director of The Insti- whatiscam/): Mind body medicine focusses on the inter-
tute for Medical Research, all state health directors and all actions among the brain, mind, body and behaviour and the
the eld data collection teams who gave their full commit- powerful ways in which emotional, mental, social, spiritual and
ment during the survey process. This project was funded by behavioural factors can directly affect health.
Ministry of Health, Malaysia. Biologically based therapies (Ref: http://nccam.nih.gov/health/
whatiscam/): The domain of biologically based practices
includes, but is not limited to, botanicals, animal-derived
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