Indian Journal for the Practising Doctor

Qidwai W, Waheed S, Ayub S, Syed, IA

Dr. Waris Qidwai, Professor and Chairman, Department of Family Medicine (waris.qidwai(at)aku.edu),
Syed, Iqbal Azam (Assistant Professor), Department of Community Health Sciences (Iqbal.azam(at)aku.edu), The Aga Khan University, Karachi.
Shahan Waheed (docshahan83(at)hotmail.com) and Salma Ayub (slmayub(at)yahoo.com), Medical Students (2007), Karachi Medical and Dental College, Karachi

Correspondence: Dr Waris Kidwai, Professor and Chairman, Department of Family Medicine, The Agha Khan University, Stadium Road, P.O. Box: 3500, Karachi 74800, Pakistan. [Fax: (9221) 493-4294, 493-2095; Phone: (9221) 48594842/ 4930051Ext. 4842; E-Mail: waris.qidwai(at)aku.edu]

ISSN: 0973-516X

Abstract

Background: The use of honey for its nutritional and medicinal properties is common among the general public. It is important to study knowledge, attitude and practices about medicinal uses of honey among patients visiting family doctors.
Methods: A questionnaire-based, cross-sectional survey was conducted at the Family Practice Centre, Aga Khan University Hospital, Karachi, Pakistan, in July and August, 2006. The Questionnaire included data on the demographic profile of the patient and questions in line with study objectives. Ethical requirement including the administration of written informed consent and the provision of confidentiality were ensured. SPSS computer software was used for data management.
Results: 400 patients were interviewed. The mean age of the respondents was 33 years, having an equal gender distribution, a majority with above grade X education and consisting of labourers, students or housewives. 327 (82%) respondents believed in the use of natural products for their medicinal properties, and honey has medicinal uses according to 370 (92.5%). 327 (81.8%) respondents favoured use of honey due to religious reasons, and honey was used in disease prevention and treatment according to a respective 202 (50.5%) and 326 (81.5%). 225 (56.3%) respondents received advice to use honey for its medicinal uses, while 242 (60.5%) advised others. Honey was easily available to 347 (87%) respondents and 256 (64%) had used honey as part of their diet. 42 (10%) respondents believed that the use of honey had problems. Pregnant woman, diabetics and newborn children were required to use honey according to 249 (62%), 156 (39%) and 248 (62%) respondents, respectively. Family members, friends and television were the sources of information on honey for 194 (48.5%), 147 (37%) and 129 (32%) respondents, respectively. Cough and cold, constipation, eye diseases and tonsillitis were the main reasons for use of honey by 96(24%), 37 (9.2%), 26 (6.5%) and 25 (6.2%) respondents respectively.
Conclusion: We found widespread use of honey for a variety of medical conditions. It is important that further research is conducted into its use as well as its effectiveness, tolerability and safety for various medical conditions.

Key words: Honey, herbal remedies, complimentary therapy, alternative therapy

Background

The use of medicines of plant origin has been in practice for well over 5000 years¹. Honey has been used for centuries for its nutritional as well as medicinal properties. The use of such products for their medicinal properties is still widely practiced, and, despite modern advancements of allopathic medicine, has not decreased to this day, but is instead increasing in the developing as well as developed countries^2,3.

The use of honey for its medicinal properties is widespread and has been well documented in literature. The indications for its medicinal uses are several; the uses reported in literature include wound healing⁴, oral ulcers⁵, recurrent herpes simplex infection⁶, and gastrointestinal and ophthalmologic conditions⁷. There are reports indicating its beneficial use in burns and post-operative wound healing.⁷

In case of burns it is useful in bringing early relief as well as healing⁷. It has been used as a wound barrier against tumour implantation in laparoscopic oncological surgery⁷. This shows the potential benefits of honey in modern day surgical procedures. Its use has been found to be therapeutically useful in patients with anal fissures8.

The remarkable spectrum of indications for the use of honey is not, however, without risks. Botulism is a life threatening condition reported to be associated with its use, particularly in infants⁹. Cardiotoxicity including rhythm disorders and myocardial infarction have been reported as a result of use of contaminated honey used in Turkey¹⁰.

The use of honey for its medicinal properties is reported among Pakistani population11. A need existed to study the knowledge, attitude and practices with regards to medicinal uses of honey among them; therefore, we decided to undertake a study with regard to medicinal uses of honey among the family practice patients visiting a teaching hospital for treatment in Karachi, Pakistan.

Methods

A questionnaire-based, crosssectional survey was conducted at the Family Practice Centre, Aga Khan University Hospital, Karachi, Pakistan, in July and August, 2006. 150 family practice patients are seen daily by twelve family physicians at the centre. A questionnaire was developed by the principal investigator after extensive literature search including inputs from colleagues and patients. The questionnaire included data on the demographic profile of the patient including age, sex, marital status, and education. Questions were directed at opinion and practices about medicinal uses of honey among the respondents. The questionnaire was administered in both “English” and “Urdu” languages, depending on patient’s convenience.

The co-investigators interviewed the patients and filled out the questionnaire. A pilot study was conducted before the start of the administration of the final questionnaire. An agreement was reached between the coinvestigators on how to administer the questionnaire in order to ensure uniformity.

The questionnaire was administered in the waiting area outside the physician’s office, prior to the consultation. Patients interviewed were those who agreed to participate in the study. The interviews were conducted throughout the study period and no specific timings were followed. Since a descriptive study was planned and the data was not to be subjected to statistical tests, sample size based on statistical calculations was not considered. Ethical requirement including the administration of written informed consent and the provision of confidentiality were ensured. Patients were interviewed according to their availability and convenience. A systematic random selection of study subjects was not under taken. SPSS computer software was used for data management.

Table I: Demographic Characteristics of Study Population (n=400)

Results

A total of 400 patients, with an equal gender distribution, were interviewed. The mean age of the respondents was 33 years; a majority was literate (above grade X) and consisted of labourers, students or housewives (Table 1). 327 (82%) respondents believed in the use of natural products for medicinal properties, and according to 370 (92.5%) honey had medicinal properties. 327 (81.8%) respondents favoured the use of honey for religious reasons. According to 202 (50.5%) and 326 (81.5%) respondents, respectively, honey was used in disease prevention and treatment. 225 (56.3%) respondents received advice to use honey for its medicinal uses, while 242 (60.5%) advised others to use it medicinally. Honey was easily available to 347 (87%) respondents. 256 (64%) respondents were using honey as part of their diet. 42 (10%) respondents believed that use of honey had problems. According to 249 (62%), 156 (39%) and 248 (62%) respondents, respectively, pregnant woman, diabetic and newborn babies need to use honey regularly (Table 2). Family members, friends and television were the sources of information on honey, respectively, for 194 (48.5%), 147 (37%) and 129 (32%) respondents (Table 3). Cough and cold, constipation, eye diseases and tonsillitis were the main reasons for use of honey by 96(24%), 37 (9.2%), 26 (6.5%) and 25 (6.2%) respondents, respectively (Table 4).

Discussion

The majority of our study population had a good educational background and represented all walks of life, with labourers at one extreme to professionals at the other. Since we interviewed a population visiting a teaching hospital for treatment, the results cannot be generalized to the rest of the population. Because an educated population visiting a specialized modern hospital for treatment was interviewed, we expect a greater use of honey for its medicinal properties in the community.

Nonetheless, we gained valuable information on the subject that can form the basis for further larger studies in the community leading to educational interventional programs to promote use of honey for its medicinal properties.

A majority of the respondents (82%) believe in the use of natural products for medical benefits and even a larger number (92.5%) in the medicinal properties of honey. This finding translates into the use of honey for disease prevention and treatment by a substantial number of respondents. A review of literature does not give an exact prevalence figure on the use of honey but there are reports of its widespread use for nutritional as well as medicinal uses.¹²

Table 2: Study Participants Responses About Medicinal Uses of Honey

Table 3: Sources of Information on Medicinal Uses of Honey for the Respondents (n=400)

Sources	Number (percent)
Family Members	194 (48.5)
Friends	147 (37)
Television	129 (32)
Books	109 (27)
Hakim	98 (24.5)
Doctor	88 (22)
Newspapers	77 (19)

Table 4. Diseases for Which Honey is Used by Study Participants (n=400)

Diseases	Number (percent)
Cough and cold	96 (24)
Constipation	37 (9.2)
Eyes diseases	26 (6.5)
Tonsillitis	25 (6.2)
Obesity	18 (4.5)
Peptic ulcer	17 (4.2)
Skin diseases	15 (3.7)
Indigestion	15 (3.7)
Hiccups	14 (3.5)
Burns	11 (2.7)
Blood disorders	09 (2.2)
Jaundice	07 (1.7)
Tumors	07 (1.7)
Liver disorders	05 (1.2)
Wound healing	04 (1.0)
Hair problems	04 (1.0)
Heart burn	04 (1.0)
Sores	04 (1.0)
Diabetes Mellitus	02 (0.5)
Allergies	02 (0.5)
Weakness	01 (0.25)
Mouth ulcers	01 (0.25)
Asthma	01 (0.25)
Varicose veins	01 (0.25)

It is known that the use of honey has a very special place among the Muslims because it was used by the Holy Prophet, and the Holy Quran as well as the Prophet’s traditions support its use.¹³ Pakistan is a predominantly Muslim country and it is because of this reason that a majority of the respondents favour the use of honey due to religious reasons. This fact can be used for evidence-based promotion of the use honey for its medicinal properties. We earlier reported use of honey in the treatment of cough and cold, sore throat and to improve general health¹¹. Eye diseases, constipation and obesity are other earlier reported indications for the use of honey, according to patients¹¹. The findings of our study with regards to the indications for the medicinal uses of honey are not different from those found in the earlier study.

It is very interesting to learn that not only a majority received advice from others to use honey for its medicinal properties, but an even greater number advised others to use honey for medical benefits. It is important for health care providers not only to educate the general population about the use of honey but also conduct clinical trials to prove the therapeutic benefits of honey in different medical conditions. Honey is a freely available food; it is however important to ensure the availability of honey free from all contamination. A substantial number of respondents report using honey in their diet. It is again important to ensure that we educate our general public with regards to the side effects such as botulism and anaphylaxis that can occur with the use of honey. The message under the present circumstances should be to use uncontaminated honey, and with caution, particularly in infants.

The respondents advocated use of honey during pregnancy, neonatal period and by diabetic patients. It has been reported that honey can be used as a sweetener for diabetic patients since it minimally raises the blood sugar. There is a need for further research into the safety, efficacy and tolerability of honey in these patients.

It is unfortunate to find that family members, friends and television are the main sources of information on the use of honey among the respondents. This demonstrates the low contribution of health workers in health education and a need for family doctors to educate patients about the use of honey so that correct information is given to where it matters.

A need for evidence-based information on the nutritional as well as medicinal uses of honey is warranted to provide proper information to the population.

Conclusion

The researchers have documented the use of honey for its medicinal properties in Pakistan and have found its common usage for a variety of medical conditions. It is important that we conduct further research into its use as well as its effectiveness, tolerability and safety for various medical conditions. Such evidence-based information should then be disseminated to health care providers for promoting use of honey for its medicinal properties.

Acknowledgements

We acknowledge, with thanks the patience, time and information provided by the study participants.

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