Complementary and Alternative Medicine Use Among Patients at Gulu Regional Referral Hospital Mental Health Unit

This cross-sectional study of 407 patients at Gulu Regional Referral Hospital in post-conflict northern Uganda reveals a high lifetime prevalence (63.4%) of Complementary and Alternative Medicine use—primarily herbal, spiritual, and traditional practices—driven by cultural beliefs and social recommendations, with significant associations to education, residence, marital status, and religion, highlighting an urgent need for integration into formal mental health care due to low reporting rates to providers.

The Gist

Imagine you are walking into a hospital in Northern Uganda, specifically the Gulu Regional Referral Hospital. You might expect to see doctors in white coats handing out pills and talking about brain chemistry. But if you look closely at the patients waiting in the chairs, you'll see a different picture playing out in their minds and homes.

This research paper is like a detective story that tries to solve a mystery: What are mental health patients actually doing to feel better?

Here is the story of the study, broken down into simple, everyday concepts.

The Big Mystery: Two Different Worlds

In many parts of the world, when someone feels sad, anxious, or "out of their mind," they go to a doctor. But in this part of Uganda, there are two different worlds of healing happening at the same time:

1. The Modern World: Hospitals, psychiatrists, and medicine (like antidepressants).
2. The Traditional World: Herbal roots, prayers, spiritual healers, and community rituals.

The researchers wanted to know: Are people choosing one or the other, or are they doing both?

The Findings: The "Double-Booked" Patients

The study interviewed 407 patients. The results were surprising, like finding out that 6 out of 10 people are secretly taking a second job.

• The "Double-Dipping" Rate: About 63% of the patients had tried traditional or spiritual healing at some point in their lives. Even more interesting? Among those who tried it, almost everyone was still doing it right now.
• The Shift in Strategy: When patients first got sick, they often tried herbal medicine (like taking a special tea or root). But as time went on and the illness became chronic (long-lasting), they switched gears. The most popular treatment for current patients wasn't herbs anymore; it was spiritual practices (prayer, deliverance, and faith healing).
  • Analogy: Think of it like fixing a leaky roof. First, you try a bucket (herbs). If the rain keeps coming, you realize the problem is bigger, so you call the priest to bless the house (spiritual healing).

Why Are They Doing This?

You might think, "Maybe they hate the doctors?" The study says no. Only a tiny fraction (less than 1%) were unhappy with modern medicine.

Instead, they are using traditional methods because:

1. The "Gossip Chain": 85% of people started using these methods because a friend, neighbor, or family member told them to. In this community, trust is built through relationships, not just brochures.
2. Cultural Beliefs: Many people believe mental illness is caused by spirits or ancestors. If the problem is spiritual, they feel they need a spiritual fix.
3. Faith as a Coping Mechanism: This region has a history of conflict. Religion and faith have become a way for people to survive hard times.

Who is Most Likely to Use These Methods?

The researchers found some interesting patterns, like a map showing where the "traditional healing" traffic is heaviest:

• The Urban Paradox: You might think people in cities rely only on modern tech, but city dwellers were actually more likely to use CAM than rural folks. Why? Because the city is full of prayer centers and herbal clinics!
• The "Long-Haulers": People who had been sick for a long time (more than 2 years) were more likely to use CAM. It's like a marathon runner who tries different shoes when the first pair doesn't work.
• The Faith Factor: People who identified as "Born Again" Christians were much more likely to use spiritual healing than Catholics or Protestants. Their faith style emphasizes miracles and spiritual warfare, which fits perfectly with spiritual healing.
• Education: Surprisingly, people with just a primary school education were more likely to use CAM than those with university degrees.

The Silent Danger: The "Secret Ingredient"

Here is the most critical part of the story. Imagine you are baking a cake. You add flour, sugar, and eggs. But then, you secretly add a handful of mysterious berries that might react badly with the eggs. If you don't tell the baker, the cake could explode.

• The Problem: 76% of patients did NOT tell their doctors that they were using herbs or spiritual healing.
• The Risk: This is dangerous. Herbs can interact with psychiatric drugs, making them stop working or causing side effects. It's like driving a car with the brakes cut while the mechanic thinks everything is fine.

The Conclusion: Building a Bridge

The authors of the paper aren't saying "Stop using herbs" or "Stop praying." They are saying: "Let's stop pretending the other world doesn't exist."

They suggest that doctors and traditional healers need to stop being strangers and start being teammates.

• The Goal: Create a system where a doctor knows a patient is praying, and a spiritual healer knows a patient is taking medicine.
• The Vision: Instead of two separate paths, we need a bridge where modern science and traditional wisdom walk together to help the patient heal.

In short: In Northern Uganda, mental health patients are playing a "double game," using both modern medicine and ancient traditions. The challenge isn't to stop them, but to make sure the two worlds talk to each other so the patients stay safe and get the best care possible.

Technical Summary

1. Problem Statement

Mental health disorders represent a significant global public health challenge, often referred to as the "pandemic of the 21st century." In Sub-Saharan Africa, particularly in post-conflict regions like Northern Uganda, there is a substantial treatment gap where conventional mental health services are scarce. Consequently, patients frequently turn to Complementary and Alternative Medicine (CAM), including traditional, spiritual, and herbal remedies.

However, there is a critical lack of empirical data regarding CAM utilization specifically within the post-conflict context of Northern Uganda. Furthermore, a "communication gap" exists where patients often utilize CAM alongside conventional treatment without disclosing this to healthcare providers, creating risks for drug interactions, fragmented care, and delayed effective treatment. This study aims to bridge this knowledge gap by establishing the prevalence, forms, and socio-demographic determinants of CAM use among patients at the Gulu Regional Referral Hospital (GRRH).

2. Methodology

• Study Design: A cross-sectional quantitative study conducted in a hospital setting.
• Setting: Gulu Regional Referral Hospital (GRRH), the main referral facility for Northern Uganda and neighboring districts. Data collection occurred between June 17 and August 8, 2025.
• Population & Sampling:
  • Target: Outpatients and inpatients at the GRRH Mental Health Unit.
  • Sample Size: 407 participants, calculated using the Kish–Leslie formula (based on an estimated 80% prevalence of concurrent orthodox/traditional treatment use) with a 6% non-response allowance.
  • Sampling Method: Convenience sampling was employed to recruit patients during clinic hours or while in the inpatient ward.
• Inclusion/Exclusion Criteria:
  • Included: Age ≥2 years, registered patients, ability to consent (or guardian consent).
  • Excluded: Severe cognitive impairment/dementia, inability to respond due to acute illness, or prior participation in similar CAM studies within the last 6 months.
• Data Collection:
  • A structured, pre-tested questionnaire (Cronbach's alpha = 0.86) was used to gather socio-demographic data, clinical diagnoses, and CAM usage patterns (lifetime and current).
  • Data was collected by researchers in a quiet environment between 08:00 and 15:00.
• Data Analysis:
  • Software: STATA version 18.0 and Microsoft Excel 2021.
  • Statistical Methods: Descriptive statistics (frequencies, percentages) and bivariate analysis using Modified Poisson regression to calculate Prevalence Ratios (PR) with 95% Confidence Intervals (CI). A p-value < 0.05 was considered statistically significant.

3. Key Contributions

• Context-Specific Evidence: Provides the first robust data on CAM utilization in a post-conflict Northern Ugandan setting, a region previously underrepresented in mental health literature.
• Dual Analysis of Usage: Distinguishes between "lifetime" prevalence and "current" usage, revealing a shift in modalities over time (e.g., from herbal to spiritual).
• Identification of the Disclosure Gap: Quantifies the critical lack of communication between patients and providers regarding CAM use, highlighting a major patient safety risk.
• Socio-Demographic Profiling: Identifies specific predictors (education, residence, religion, illness duration) that correlate with CAM use, moving beyond general assumptions.

4. Key Results

Prevalence of CAM Use:

• Lifetime Prevalence: 63.4% (258/407) of patients had used CAM at some point.
• Current Prevalence: 41.3% (168/407) were currently using CAM.
• Disclosure: Only 23.6% of CAM users disclosed their usage to their conventional healthcare providers.

Types of CAM Used:

• Lifetime Users: Herbal medicine was most common (50.4%), followed by spiritual practices (33.7%) and traditional medicine (19.8%).
• Current Users: A significant shift occurred; Spiritual practices became the dominant modality (88.7%), suggesting that as illness becomes chronic, patients increasingly attribute it to spiritual causes.
• Cross-over: High integration was observed; 79.5% of spiritual healing users also utilized other CAM modalities.

Reasons for Use:

• Social Recommendations: 84.8% (driven by family/friends).
• Cultural/Religious Beliefs: 63.4%.
• Dissatisfaction with Conventional Medicine: Negligible (0.8%), indicating CAM is used as a complement rather than a replacement.

Predictors of CAM Use (Significant Factors):

• Education: Primary education level was associated with higher use (PR = 1.36) compared to no formal education.
• Residence: Urban residents were more likely to use CAM than rural residents (PR = 1.23), likely due to the accessibility of prayer centers and herbal clinics in urban areas.
• Marital Status: Separated individuals had higher use (PR = 1.39).
• Religion: Born Again Christians were significantly more likely to use CAM compared to Catholics (PR = 0.72) and Protestants (PR = 0.76).
• Illness Duration: Longer duration of illness (>6 months) was strongly associated with CAM use (PR range 1.55–1.72), indicating "treatment fatigue" or perceived inadequacy of biomedical interventions.
• Non-Significant Factors: Age, sex, and income were not statistically associated with CAM use in this setting.

5. Significance and Implications

• Clinical Safety: The low disclosure rate (23.6%) poses a severe risk for herb-drug interactions and treatment failure. The study argues for the routine, non-judgmental inquiry of CAM use during clinical consultations.
• Policy Development: There is an urgent need for national policy guidelines that integrate CAM into standard mental health care, rather than treating it as a separate or opposing system.
• Collaborative Models: The findings support the development of collaborative care models involving psychiatrists, traditional healers, and religious leaders to create a holistic, culturally sensitive treatment pathway.
• Public Education: Campaigns are needed to educate the public on the responsible use of CAM alongside conventional medicine and to encourage transparency with healthcare providers.

Limitations:
The study acknowledges limitations including its cross-sectional design (precluding causal inference), potential recall bias, the use of convenience sampling, and the high homogeneity of the sample (93.1% Acholi tribe), which may limit generalizability to other ethnic groups in Uganda.

Conclusion:
CAM use among mental health patients in Northern Uganda is pervasive and deeply rooted in cultural and religious beliefs. While it serves as a vital coping mechanism, the lack of integration with conventional care and the low rate of disclosure present significant challenges to patient safety and effective treatment. Urgent policy and clinical interventions are required to bridge this gap.