**7. Prevalence of TCAM in Sub-Saharan Africa**

Africa African traditional medicine is said to be one of the oldest and most diverse of all medicine systems, even though the medicines are poorly recorded. In developing countries, TCAM use is driven mostly by tradition and lack of resources. Over the years, the use of TCAM in both rural and urban areas across Africa has increased, but there is a great concern for its safety [45], efficacy, and control, and this poses a great challenge for health authorities and the general public [14]. There have been reports that there is varied prevalence but substantial use of TCAM, more of products (either for self-care and over-the-counter) than practitioner services, among the general population and specific clinical populations [19]. At least 80% of populations in Africa use TCAM [4].

The prevalence of TCAM during pregnancy, childbirth, and pregnancy termination is between 12% and 90.3% [49], but fewer patronage of TCM services during pregnancy but high use in the case of infertility, enhancing libido, general gynaecological conditions, and sexually transmitted diseases [50, 51].

TCAM products are highly used by patients with diabetes: Tanzania (77.1%), Nigeria (43%), Guinea (33%), and Kenya (12.4%) [52]. A higher rate was reported for cancer: Nigeria (65%), Ethiopia (79%), and Ghana (73.5%) [53]. Psychosis in some African countries (Nigeria, Ethiopia, Ghana, and Malawi) was also high (73%) [54]. The elusive COVID-19 was not left out in TCAM use. Massage and steam inhalation with various African herbs and spices were highly used and were believed to be effective for prevention and treatment.

Other reports revealed the following prevalence for noncommunicable diseases (61%), asthma (50%), epilepsy (65.5%), and schizophrenia (76%) [19, 38]. Musculosketetal problems, osteoarthritis, and bone fracture showed high patronage for bonesetters. All other health conditions, such as diarrhea, infantile colic, oral health, etc., were reported with varying prevalence.

In terms of different categories of people, a higher TCAM utilization rate was observed among outpatients than inpatients (72% versus 18.5%) [55]. Among student population, a higher utilization rate of products was found with high school than undergraduates, and much less for medical and paramedical students in both Ghana and Nigeria [56, 57]. Among healthcare professionals, TCAM use was much lower in Nigeria (20.777%) and South Africa (23.5%) [58, 59].

Sociodemographic studies indicated that TCAM users compared with non-TCAM users are more likely to be of low socioeconomic and educational status, unemployed and unskilled, while there were inconsistencies in age, sex, spatial location, and religious affiliation between TCAM users and non-TCAM users. Some reports, however, indicated that urban and semiurban dwellers were found to be younger (20–50 years) than rural dwellers (>58 years). Users were

also found to be higher among married than not married [60] and women more likely than men [13].

The mean prevalence of concurrent use of TCAM products and conventional medicine within the general population and for specific health conditions in SSA was reported to be high but lower among patients with HIV/AIDS, and least with noncommunicable diseases such as diabetes [19].

Most TCAM users (55.8–100%) in SSA fail to disclose TCAM use to their healthcare providers, with the main reasons for nondisclosure being fear of receiving improper care, healthcare providers' negative attitude and a lack of enquiry about TCAM use from healthcare providers.

Evidence suggests that Africans in diaspora still maintain their use of TCAM overseas, and it is commonplace to find them transporting medicines from Africa to their country of abode [61].

The increasing uptake of TCAM services across the continent in recent decades has attracted the attention of policy makers, researchers, and healthcare professionals. In the past 20 years, the WHO regional office for Africa spearheaded the implementation of a regional strategy endorsed by African Heads of State in Lusaka, Zambia to promote the role of TCAM in health systems in the African region [62]. The gains experienced since the adoption of the regional plan include policy formation in 36 countries and research promotion, including the establishment of TCAM research centers in some countries such as Nigeria, Ghana, and South Africa. The regional plan has also promoted the inclusion of TCAM courses into the curricula of healthcare training institutions in countries across the continent. For instance, such plan has seen the inclusion of TCAM courses in some South African and Nigerian universities at both undergraduate and postgraduate levels. In Ghana, universities offer a BSc in herbal medicine. In Guinea, Sierra Leone, and Tanzania, Master's degree in herbal medicine has been made compulsory for pharmacists [62]. It has also promoted the training of TCAM practitioners and the local production and cultivation of medicinal plants, as well as the establishment of intellectual property rights for traditional medicine knowledge in few nations [55]. Despite such progress, most African countries continue to grapple with an absence of TCAM policy or its implementation, inadequate TCAM research infrastructure, and insufficient regulation of TCAM products and practices [15, 62]. For instance, by 2005, only 32% and 27% of the African countries who responded to the WHO global survey had a national policy and law or regulation on TCAM [63].
