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Prevalence of complementary and alternative medicine use in Christchurch, New Zealand: children attending general practice versus paediatric outpatients.

Kris Wilson, Claire Dowson, Dee Mangin.
New Zealand Medical Journal 120(1251):1-9, 2007.
http://www.nzma.org.nz/journal/120-1251/2464/ © NZMA

Abstract

Aims

There is little information about the use of complementary and alternative medicines (CAM) in New Zealand children who attend a general practitioner for intercurrent illness compared to children attending secondary care with a chronic condition where CAM use is high. This study aims to establish whether there are differences in prevalence and non-disclosure rates, information sources, and potential predictors of CAM use in these two populations of children.

Methods

A study-devised CAM-use questionnaire was administered to 50 participants recruited from general practice surgeries and 50 from a paediatric diabetes clinic.

Results

Prevalence of lifetime CAM-use was high (70%) with no significant difference between the two populations sampled. Not disclosing CAM-use to a doctor was common (77%), with the majority unintentional (87%). Parental-use was predictive of child CAM-use (OR 4.73).

Conclusion

CAM-use amongst New Zealand children is higher, and disclosure rates lower, when compared to overseas populations of children. This suggests that there is greater potential for New Zealand children to be at risk of adverse events directly and through interaction with prescribed medicines. Contrary to expectations, CAM-use behaviours and disclosure rates are comparable between GP and outpatient populations—suggesting that all prescribers need to explicitly ask parents about CAM-use with their children, particularly those that report CAM-use themselves.
The estimated prevalence of CAM-use in adults varies widely depending on study methodology and population with prevalence ranges from 9 to 65%, however there is evidence that CAM-use is increasing.[1,2]
A recent study of adults attending an emergency department in New Zealand indicated that 38% of people used CAM, a quarter in conjunction with prescribed medication and just over a third disclosed its use to their medical practitioner.[2] In children, there is emerging evidence from secondary/tertiary care that CAM-use may be as common as in adults.[3] In a recent two-country study involving children with chronic health conditions, CAM-use was high; in Australia prevalence of use was 51%, and in Wales it was 41%.[4,5] Historically this increase in CAM-use has not been supported by the development of adequate legislative and regulatory safeguards in New Zealand;[6,7] however, there are now moves to change this situation. The Interim Joint Expert Advisory Committee on Complementary Medicines (IJEACCM) has been appointed to provide advice about CAM and their active ingredients to the Therapeutic Products Interim Ministerial Council.[8] Increased CAM-use creates an increase in the instances of adverse effects as well as CAM and prescribed medicine interactions in the population.[9,10] Reported incidents of serious adverse effects include anaphylactic reaction, respiratory failure, auto immune hepatitis, and coagulation effects.[9–16]
Children are a particularly vulnerable population for whom drug pharmacokinetics (and therefore doses) cannot necessarily be extrapolated or inferred from adult populations.[4,9,12–16] Furthermore, there are indications that non-disclosure of CAM-use to a health professional is common and may increase the risks of an adverse reaction, particularly if used in combination with prescribed medicines.[10,17] The rate of non-disclosure was high in a population of children with chronic health conditions studied in Australia (63%) and in Wales (66%).[4] To date, it is not clear whether patient non disclosure is intentional, nor whether it is more or less likely to occur in the general practice setting.[17–19] Empirical investigations of CAM-use in children to date have focussed on chronic conditions in the secondary/tertiary sector; prevalence of CAM-use appear higher in these populations than the general population.[20] The prevalence of CAM-use and the rate of non-disclosure among children attending general practice for intercurrent illness are unknown.
In this study we describe the prevalence and range of CAM-use in New Zealand primary and secondary care paediatric populations. We examine factors which may predict use. We also assess rates of disclosure to clinicians in primary and secondary care settings, and the reasons for non-disclosure.

References

1. Cincotta DR, Crawford NW, Lim A, et al. Comparison of complementary and alternative medicine use: reasons and motivations between two tertiary children's hospitals. Arch Dis Child. 2006;91:153–8. NZMJ 23 March 2007, Vol 120 No 1251 Page 8 of 9
   http://www.nzma.org.nz/journal/120-1251/2464/ © NZMA
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6. Ministerial Advisory Committee on Complementary and Alternative Health. Regulation of CAM. Statutory regulation. 2004 [cited 2005 13/9/05].
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14. Wiwanitkit V, Taungjaruwhinai W. A case report of suspected ginseng allergy. Medscape General Medicine. 2004;6:9.
    http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=15520631
15. Woolf AD. Herbal remedies and children: do they work? Are they harmful? Pediatrics. 2003;112(1 Pt 2):240–6.
16. Young RJ, Huffman S. Probiotic use in children. J Pediatr Health Care. 2003;17:277–83.
17. Eisenberg DM, Kessler RC, Van Rompay M, et al. Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey. Annals of Internal Medicine. 2001;135:344–51.
18. Fong D, Fong L. Usage of complementary medicine among children. Aust Fam Phys. 2002;31:388–91.
19. Sikand A, Laken M. Paediatricians' experience with and attitudes toward complementary/alternative medicine. Arch Pediatr Aolesc Med. 1998;152:1059–64.
20. Ernst E. Prevalence of complementary/alternative medicine for children: A systematic review. European Journal of Pediatrics. 1999;158:7–11

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