***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Attention and interest in the use of Complementary and Alternative Medicine ( CAM ) has been reawakened globally . Evidence from studies carried out in different parts of the world has established that CAM use is very common and varies among population s. This study investigated the use of CAM among adults in Enugu urban , irrespective of their health status . It provided information on the prevalence of CAM use , forms of CAM remedies used and reasons for utilizing them Methods The study areas were three local government areas in Enugu urban of Enugu State .  Cross-sectional survey using question naires were administered to r and omly selected households . All consenting participants were used for the study Results 732 participants ( 37.2 % males and 62.8 % females ) were used for the study . Ages ranged from 18 - 65 years . 620 ( 84.7 % ) of the adult population have used  CAM  ranging from one single type to twenty different types while 112 ( 15.3 % ) have not used any form of CAM . The most commonly used CAM product was the biological products , followed by prayer/faith healing . Major reasons for using CAM include their natural state and also for health promotion and maintenance . Conclusion There is need for adequate policy formulation and regulation to ensure safety and efficacy of CAM products . Measures to ensure rational use of CAM should be instituted Summary Background . Traditional bone setting ( TBS ) practice is an important part of health care delivery in many developing countries and has been in Nigeria for long . Despite the complications that arise from the cultural practice , TBS services is still in high dem and by a significant number of people . This study was conducted to determine the factors that influence the utilization of TBS practice . Methods . A descriptive cross-sectional study was carried out using a semi structured question naire to gather information from 400 r and omly selected residents of Ilorin West LGA in north central Nigeria . Multistage sampling technique was used in selecting the respondents . Results . The respondents were between the ages of 18 - 72 years with a mean age of 36.3 ± 12.3 . Three hundred and three ( 77.3 % ) of the respondents know of TBS practice as a way of getting treatment for bone injuries . More than two third 210 ( 69.3 % ) of the respondents who know TBS practice as a form of treatment for bone injuries think that TBS therapy is preferable to Orthodox medicine in h and ling bone injuries . Reasons for preference are that it is cheap 134 ( 63.8 % ) , acceptable 123 ( 58.6 % ) and accessible 109 ( 51.9 % ) to them . More than half ( 52.3 % ) of the respondents had patronized TBS treatment  at one time or the other . Main reason for patronage of TBS was influence from family members and friends ( 53.6 % ) . However , factors that influence the respondents decision to utilize TBS treatment include attitude of health workers 310 ( 77.5 % ) , delay in hospitals 284(71.0 % ) fear of amputation 272 ( 54.35 ) and fear of operation 217(54.3 % ) in hospitals . There was a statistically significant ( p < 0.05 ) relationship between respondents age , sex , marital status , occupation , ethnicity as well as the income level of the respondents and the utilization of TBS . Conclusions . Utilisation of TBS is quite popular among the studied population because it is believed to be cheap , acceptable and accessible to them and a high proportion of the respondents utilize TBS notwithst and ing that they live in a community where they have better access to orthodox medical care . Influence from family and friends is the main reason for consulting TBS . Regulations should be made concerning the advertisement of TBS practice by relevant agencies and the public should be made aware through health education on the dangers of TBS treatment Background Traditional herbal medicines are commonly used in sub-Saharan Africa and some herbs are known to be hepatotoxic . However little is known about the effect of herbal medicines on liver disease in sub-Saharan Africa . Methods 500 HIV-infected participants in a rural HIV care program in Rakai , Ug and a , were frequency matched to 500 HIV-uninfected participants . Participants were asked about traditional herbal medicine use and assessed for other potential risk factors for liver disease . All participants underwent transient elastography ( FibroScan ® ) to quantify liver fibrosis . The association between herb use and significant liver fibrosis was measured with adjusted prevalence risk ratios ( adjPRR ) and 95 % confidence intervals ( CI ) using modified Poisson multivariable logistic regression . Results 19 unique herbs from 13 plant families were used by 42/1000 of all participants , including 9/500 HIV-infected participants . The three most-used plant families were Asteraceae , Fabaceae , and Lamiaceae . Among all participants , use of any herb ( adjPRR = 2.2 , 95 % CI 1.3–3.5 , p = 0.002 ) , herbs from the Asteraceae family ( adjPRR = 5.0 , 95 % CI 2.9–8.7 , p<0.001 ) , and herbs from the Lamiaceae family ( adjPRR = 3.4 , 95 % CI 1.2–9.2 , p = 0.017 ) were associated with significant liver fibrosis . Among HIV infected participants , use of any herb ( adjPRR = 2.3 , 95 % CI 1.0–5.0 , p = 0.044 ) and use of herbs from the Asteraceae family ( adjPRR = 5.0 , 95 % CI 1.7–14.7 , p = 0.004 ) were associated with increased liver fibrosis . Conclusions Traditional herbal medicine use was independently associated with a substantial increase in significant liver fibrosis  in both HIV-infected and HIV-uninfected study participants . Pharmacokinetic and prospect i ve clinical studies are needed to inform herb safety recommendations in sub-Saharan Africa . Counseling about herb use should be part of routine health counseling and counseling of HIV-infected persons in Ug and OBJECTIVES Use of complementary and alternative medicines ( CAMs ) is widespread . Several studies have explored why individuals chose to use CAM but there are fewer data to explain how its use ' dovetails ' with conventional medicine . This study aim ed to determine the prevalence of CAM use in the adult population in Australia and the proportion that seek advice or tell their primary care physician after CAM use , and also to investigate which demographic characteristics , health behaviours and health status are associated with CAM use and disclosure . DESIGN A cross sectional survey . METHODS a r and om sample of 1261 adults was interviewed as part of 2010 Queensl and Social Survey , which contained questions about  CAM use , frequency of use , types of CAM used , reasons for use , discussing and reporting CAM use with the doctor and confidence in CAM use . Relationships were explored using bivariate and multiple logistic regression . MAIN OUTCOME MEASURES use of CAM ; sought advice from doctor before CAM use ; informed doctor after CAM use . RESULTS 61.7 % of respondents had used self-prescribed CAM  or visited a CAM practitioner . Being female and being younger predicted CAM use . Being male and in better health predicted seeking advice from the doctor before and also after CAM use . CONCLUSION Our results confirm the relatively high use of CAM in Queensl and , Australia and found that a significant proportion of people did not seek advice from their primary care physician before using CAM , or disclose its use afterwards . These factors should be taken into account in the doctor-patient consultation Background In Africa , herbal medicines are often used as primary treatment for Human immunodeficiency virus ( HIV ) related problems . Concurrent use of traditional herbal medicines ( THM ) with antiretroviral drugs ( ARVs ) is widespread among HIV infected patients . However , the extent of THM use is not known in most setting s in Sub-Saharan Africa . This study aim ed at determining the prevalence and factors associated with THM use among HIV infected patients on highly active antiretroviral therapy ( HAART ) attending The AIDS Support Organization ( TASO ) in Ug and a. TASO is a non-governmental organization devoted to offering HIV/AIDS care and treatment services in the population . Methods This was a cross-sectional study carried out in two TASO treatment centres in Ug and a among 401 r and omly selected eligible participants . We included participants who were 18 years and above , were enrolled on HAART , and consented to participate in the study . Data was collected using an interviewer-administered semi-structured question naire . THM use referred to someone who had ever used or was currently using herbal medicine while on highly active antiretroviral therapy ( HAART ) by the time of the study . Data was captured in Epi- data version 3.1 and exported to STATA version 9.0 for analysis . Results The prevalence of THM use was 33.7 % . Patients on HAART for < 4 years were more likely to use THM ( OR = 5.98 , 95 % CI 1.13 - 31.73 ) as well as those who experienced HAART side effects ( OR = 3.66 , 95 % CI : 1.15 - 11.68 ) . Older patients ( ≥39 years ) were less likely to use THM ( OR = 0.26 95 % CI : 0.08 - 0.83 ) . Participants with HAART adherence levels > 95 % were less likely to use  THM ( OR = 0.09 , 95 % CI 0.01 - 0.65 ) . Conclusion The prevalence of  THM use among participants on HAART was high . This raises clinical and pharmacological concerns that need attention by the health care service providers INTRODUCTION Traditional medicines are an important part of healthcare in sub-Saharan Africa , and building successful disease treatment programs that are sensitive to traditional medicine practice s will require an underst and ing of their current use and roles , including from a biomedical perspective . Therefore , we conducted a mixed- method study in Northern Tanzania in order to characterize the extent of and reasons for the use of traditional medicines among the general population so that we can better inform public health efforts in the region . METHODS Between December 2013 and June 2014 in Kilimanjaro , Tanzania , we conducted 5 focus group discussion s and 27 in-depth interviews of key informants . The data from these sessions were analyzed using an inductive framework method with cultural insider-outsider coding . From these results , we developed a structured survey design ed to test different aspects of traditional medicine use and administered it to a r and om sample of 655 adults from the community . The results were triangulated to explore converging and diverging themes . RESULTS Most structured survey participants ( 68 % ) reported knowing someone who frequently used traditional medicines , and the majority ( 56 % ) reported using them themselves in the previous year . The most common uses were for symptomatic ailments ( 42 % ) , chronic diseases ( 15 % ) , reproductive problems ( 11 % ) , and malaria/febrile illnesses ( 11 % ) . We identified five major determinants for traditional medicine use in Northern Tanzania : biomedical healthcare delivery , credibility of traditional practice s , strong cultural identities , individual health status , and disease underst and ing . CONCLUSIONS In order to better formulate effective local disease management programs that are sensitive to TM practice s , we described the determinants of TM use . Additionally , we found TM use to be high in Northern Tanzania and that its use is not limited to lower-income areas or rural setting s. After symptomatic ailments , chronic diseases were reported as the most common reason for TM use which may be particularly important in Northern Tanzania where non-communicable diseases are a rapidly growing burden OBJECTIVE To investigate the prevalence of use of traditional medicines amongst patients with HIV infection receiving therapies of antiretroviral ( ARV ) drugs at the Aminu Kano Teaching Hospital ( AKTH ) , Kano , Northwest Nigeria , and to assess the attitude of these patients to their ARV therapy . METHODS A cross sectional prospect i ve study using pretested structured question naires administered on 430 patients with antiretroviral therapy attending the AKTH between April and June 2009 . Data was collected on socio-demographic characteristics , use of traditional medicine  and attitude to antiretroviral therapy . RESULTS A mean age of ( 33.6#20381;8.4 ) years old was found with 67.2 % females and 32.8 % males . A total of 29 % had no formal education while 10.5 % had postgraduate education ; 12 % earned above 35,000 naira ( 230 USD ) per month ; 63.8 % were married ; 39.8 % had at least 2 sexual partners ; 27.5 % used  traditional medicine  before commencement of antiretroviral therapy ( ART ) , but only 4.25 % of patients used ARV and traditional medicine concurrently . There was no significant difference in most of the socio-demographic indices between the concurrent users and other patients ( P>0.05 ) . A total of 28.8 % HIV patients , 14.6 % patients used  traditional medicine  before ART and 29.4 % concurrent users had missed at least a dose of their ARVs since commencement of therapy . 148 ( 37 % ) of the patients had their drug regimen changed at least once while 23 ( 20.90 % ) patients receiving traditional medicine before ART and 5 ( 29.41 % ) patients having two treatments had their drug regimen changed . 
    Output:
    
Results Despite the heterogeneity and general low quality of the identified literature , the review highlights a relatively high use of  TCAM alone or in combination with orthodox medicine  , in both general population and in specific health conditions in SSA .
TCAM users compared with non-TCAM users are more likely to be of low socioeconomic and educational status , while there were inconsistencies in age , sex , spatial location and religious affiliation between TCAM users and non-TCAM users .
Conclusion TCAM use in SSA is significant , although most studies emerge from a few countries .