The use of traditional medicine was due to a combination of inadequacies in the functionality of the health care services, easy accessibility of traditional medicine, influence of community members and influence from traditional healers.
In this study, respondents indicated that the biomedical health care system presented challenges with long distances to health facilities which may be costly and stock outs of diabetic drugs. Other studies have highlighted challenges of inadequate infrastructure in the management of diabetes in sub-Saharan Africa. Access to facilities that can adequately manage diabetes is low [21
]. Availability of drugs is also a challenge in hospitals especially for chronic diseases [22
]. Health care systems in Africa are still adapting to the transition from having a high disease burden of communicable diseases to one that also has a high proportion of non-communicable diseases [21
]. The issue of high access costs is complicated by the fact that compared to biomedical medicine, traditional medicine is cheaper. The herbalists even allow payment in installments which makes it easier for the patients to afford traditional medicine. Other studies have highlighted that patients with diabetes use traditional medicine due to the low cost [23
]. It is costly to treat diabetes in sub-Saharan Africa [24
]. Diabetes is a chronic illness and its effects on the finances of the individual and the household cannot be underestimated. If patients with diabetes are to be exhorted to use biomedical medicine instead of traditional medicine, there should be biomedical medicine at the facilities when patients come for it. This may entail more funding for the diabetic treatment. The number or patients with diabetes is increasing [25
]. The facilities may not be adequate for the increasing number of patients with diabetes but even in those facilities which manage diabetes the supply of drugs is not regular. This calls for an increase in the number of facilities that can adequately manage diabetes possibly by putting these drugs at lower level facilities. There is also need to streamline the procurement and supply chains for diabetic drugs at all levels that manage diabetes patients to ensure a constant supply.
Findings from this study indicate that traditional herbs were easily accessible. Herbalists live within the community and sometimes bring their medicine to parks where they can be easily accessed. A systematic review on studies on diabetes in sub-Saharan Africa indicated challenges of accessing diagnosis and treatment [24
]. A study done in Uganda demonstrated preferential use of health providers because of their proximity [28
]. With the biomedical treatment for diabetes not easily accessible and traditional medicine easily accessible, this could be one of the factors that make patients with diabetes use traditional medicine instead of or concurrently with biomedical medicine. This calls for an increase in the number of health facilities that can manage diabetes so as to reduce the distance the patients with diabetes have to travel to seek treatment.
Traditional medicine is easy to use because one can combine it with the biomedical medicine. In addition, unlike with biomedical medicine, one does not need to eat before taking traditional medicine. The convenience of taking traditional medicine is higher than that for biomedical medicine. It is critical that patients with diabetes are educated on the nature of the treatment of diabetes so that they do not see the restrictions in treatment regimes as an unnecessary burden.
Some patients with diabetes were told by traditional healers that traditional herbs can cure diabetes. This could have been a motivator for the patients continuing to seek such care. The relationship of perceived benefit as a motivation for health care seeking is supported by other studies in South Africa and Asia [29
]. The patients’ beliefs were further strengthened by similar perceptions about herbs as a cure for diabetes within their social networks. Community members encouraged the patients with diabetic symptoms to seek care from traditional healers telling them that the illness will cure. Although beliefs in traditional healers are receding and giving way to biomedical treatment in some parts of Africa [32
], many countries still have populations that use traditional medicine (also called alternative medicine) and this happens in low, middle and high income countries [11
]. However the proportion using traditional medicine increases in more remote areas where medical services are thin [35
]. At the community level, there is need to address the misleading support for traditional herbs as a cure for diabetes. This could be achieved through different fronts. One is sensitizing the community so that the members can identify the symptoms of diabetes as of an illness that is managed in health facilities. Two is educating the patients with diabetes about what to expect when they start treatment so that they may not easily fall prey to people who promise prompt cure with traditional medicine.
The qualitative design was used to explore the reasons why patients with diabetes use traditional medicine. This methodology may not give the magnitude of the practice of using traditional herbs but the qualitative method is preferable for questions that ask the ‘why’. It opens the participants to give reasons for a practice without any restriction to pre-defined options. The limitation of FGDs is that they may not assess the complexity of beliefs nor investigate actual behaviours [37
]. Triangulating methods (using KIIs and FGDs) and study participants (patients with diabetes, health workers and herbalists) was very useful to check the consistency and contradictions across and within groups [38
]. It was not possible to get the views of the patients with diabetes who had abandoned the biomedical treatment for the traditional medicine individually. This is because traditional medicine is still looked upon in Eastern Uganda as a bad practice and it would be difficult to get patients who would admit taking traditional medicine. However some of the patients with diabetes who were involved in the discussions admitted having used herbs before. The involvement of the herbalists also gave us some insights into what herbalists do to get patients.