1. introduction

Herbal medicine, a cornerstone of traditional healing, encompasses the use of plant-based compounds, minerals, animal-derived products, and spiritual practices for the prevention, diagnosis, and treatment of diseases as well as for maintaining overall health and well-being (Fokunang et al., 2011). With its roots extending back thousands of years, herbal medicine remains one of the most widely practiced forms of healthcare globally, offering a complementary or alternative approach to modern medical systems (WHO, 2024a). According to the World Health Organization (WHO), nearly 80% of the world’s population depends on herbal medicine for their primary healthcare needs, particularly in low- and middle-income countries where access to conventional medical infrastructure is often limited (WHO, 2023). This long-standing reliance underscores the critical role that traditional remedies continue to play in global health systems.

Over the past decades, the utilization of herbal medicine has expanded beyond its cultural origins, gaining acceptance in diverse populations worldwide. Research demonstrates that traditional healing systems contribute significantly to managing both communicable and non-communicable diseases (Nigussie et al., 2022; Ijaz et al., 2024). Furthermore, the principles of herbal medicine have influenced the development of modern pharmaceuticals, as many bioactive compounds discovered in plants have served as templates for drug discovery (Yuan et al., 2016). For example, aspirin, derived from willow bark, and artemisinin, extracted from Artemisia annua, illustrate how traditional practices have informed evidence-based medicine.

Herbal remedies are particularly valuable in the management of chronic illnesses, which constitute the leading cause of morbidity and mortality worldwide. Chronic diseases such as cardiovascular disorders, cancer, diabetes, and respiratory illnesses account for more than 41 million deaths annually—approximately 74% of all global deaths (WHO, 2023). Their rising prevalence is closely linked to urbanization, sedentary lifestyles, and population aging (Mahumud et al., 2023). The burden of these diseases is especially severe in low- and middle-income countries, where healthcare systems face financial and infrastructural challenges. Bangladesh, for instance, reports that chronic diseases account for about 61% of the national disease burden and 54% of annual deaths (WHO, 2009). This poses a significant public health challenge given the country’s limited healthcare coverage, with only 61% of the population having access to essential medical services as of 2022 (The Business Standard, 2024).

In this context, herbal medicine represents an essential healthcare resource, especially where modern treatment is inaccessible or unaffordable. Compared to contemporary medical care, herbal remedies are often perceived as cost-effective, culturally acceptable, and locally available (Li et al., 2020; Sato, 2012). Since 1978, the WHO has advocated for the integration of traditional medicine into formal healthcare systems to ensure broader accessibility and treatment options (WHO, 2002). Usage patterns, however, vary depending on disease type, geographical setting, and sociocultural factors. For instance, global prevalence rates of herbal medicine use range from 12.4% to 77.1% among diabetes patients, 36.6% among cancer patients, and approximately 34% among individuals with hypertension (Aboufaras et al., 2023; Traoré et al., 2017).

In Bangladesh, herbal medicine continues to occupy a prominent role in healthcare practices. A multicenter study revealed that 32.8% of individuals across age groups rely on complementary and alternative medicine, while 35.2% of diabetic patients reported using herbal therapies as part of disease management (Shahjalal et al., 2022; Rafi et al., 2020). Various traditional systems—including Ayurveda, Unani, homeopathy, and folk medicine—are widely practiced and often serve as the first line of treatment, particularly in rural areas where modern health facilities are scarce (Mohsin et al., 2023). Bangladesh’s rich biodiversity, coupled with favorable climatic and geographical conditions, further supports the cultivation and utilization of medicinal plants, reinforcing the potential of herbal medicine as an accessible therapeutic option (Shahjalal et al., 2022).

Recognizing the escalating burden of non-communicable diseases (NCDs), the Government of Bangladesh has aligned with Sustainable Development Goal (SDG) 3.4, which aims to reduce premature mortality from NCDs by one-third by 2030 (Islam et al., 2022; WHO, 2024b). However, given the gaps in healthcare infrastructure and the increasing demand for affordable alternatives, understanding the patterns, determinants, and effectiveness of herbal medicine use becomes increasingly important. Although previous research has explored complementary and alternative medicine utilization in Bangladesh, there remains a lack of comprehensive studies focusing specifically on herbal medicine as a treatment for chronic diseases (Shahjalal et al., 2022).

Therefore, the present study investigates the prevalence, determinants, and effectiveness of herbal medicine use among adults with chronic illnesses in Bangladesh. By examining the socio-demographic and cultural contexts influencing herbal medicine practices, this research seeks to provide valuable insights into integrating traditional remedies with formal healthcare systems, ultimately contributing to improved chronic disease management and enhanced healthcare accessibility.

2. Materials and methods

2.1 Study Design and Setting

This study adopted a community-based, cross-sectional design to investigate the prevalence, determinants, and perceived effectiveness of herbal medicine use among Bangladeshi adults with chronic illnesses. The research was carried out in Dhaka, Bangladesh, between January and December 2024, encompassing both urban and rural communities. By including diverse settings, the study aimed to capture variations in healthcare practices shaped by geography and access to modern medical services. Cross-sectional surveys are well established in public health research for exploring healthcare-seeking behavior and treatment preferences, and they provide valuable insight into population-level patterns at a defined point in time (Nigussie et al., 2022; Shahjalal et al., 2022).

2.2 Study Population and Sampling

The study population comprised adults aged 20 years and older who had received a confirmed diagnosis of at least one chronic illness and had been on treatment for a minimum of six months. A convenience sampling method was employed to recruit 200 participants from community centers, outpatient facilities, and local clinics across Dhaka. While convenience sampling is non-probabilistic, it remains a pragmatic and effective approach in studies of complementary and alternative medicine (CAM), particularly in low- and middle-income countries, where it provides access to diverse patient groups within a feasible timeframe (Rafi et al., 2020; Li et al., 2020).

2.3 Inclusion and Exclusion Criteria

Participants were eligible if they met the following conditions: (i) age 20 years or older; (ii) diagnosis of a chronic condition such as diabetes, hypertension, cardiovascular disease, kidney disease, cancer, or other long-term illnesses; (iii) documented adherence to prescribed treatment for at least six months; and (iv) confirmation of diagnosis by a qualified healthcare professional, either conventional or CAM. Only individuals who provided informed consent and completed the interview process were included.

Exclusion criteria were applied to minimize bias and improve the internal validity of findings. Pregnant women were excluded to avoid potential confounding factors, as were individuals with self-reported neuropathy, muscular pain, or mental instability. In addition, participants without verifiable medical documentation of their condition or treatment regimen were excluded from the study (Stanifer et al., 2015).

2.4 Data Collection Instruments and Procedures

Data were collected using a semi-structured questionnaire designed following a comprehensive literature review and adapted for cultural appropriateness. The tool was refined through an expert panel review to strengthen content validity (Aboufaras et al., 2023; Mohsin et al., 2023). The final questionnaire was administered in Bengali through face-to-face interviews conducted by two trained nurses experienced in community health research.

Before beginning data collection, participants were informed of the study’s objectives, procedures, and their right to withdraw at any time without consequence. Written informed consent was obtained from each participant. The questionnaire included three main sections:

Socio-demographic characteristics: age, sex, marital status, education, occupation, monthly income, religion, and residence (urban or rural).

Disease-related information: type and duration of chronic illness, treatment history, and current use of modern, traditional, or combined therapies.

Herbal medicine practices: type of traditional medicine used (Ayurveda, Unani, homeopathy, herbalism, or other), source of knowledge, reasons for adoption, and perceptions of effectiveness or adverse effects.

Face-to-face interviews were selected to ensure high response rates and to reduce literacy-related barriers, a strategy particularly effective in low-resource settings (Grace et al., 2020).

2.5 Outcome Measures

The primary outcomes of interest were the prevalence and patterns of herbal medicine use among adults with chronic diseases. Secondary outcomes included socio-demographic predictors of herbal medicine use and self-reported perceptions of its effectiveness. Effectiveness was measured using a three-point scale (effective, somewhat effective, or not effective), consistent with frameworks adopted in other studies examining CAM in chronic illness management (Ekpor et al., 2024; Traoré et al., 2017).

2.6 Data Management and Statistical Analysis

All completed questionnaires were checked for accuracy, coded, and entered into Microsoft Excel, followed by data cleaning procedures to address missing values and prevent duplication. Descriptive statistics were used to summarize demographic and clinical variables, with categorical variables presented as frequencies and percentages and continuous variables expressed as means with standard deviations (SD).

Associations between herbal medicine use and socio-demographic variables were evaluated using Chi-square (?²) tests. To identify independent predictors of herbal medicine or combined therapy use, multinomial logistic regression models were applied. Results were reported as adjusted odds ratios (AOR) with 95% confidence intervals (CI). Statistical significance was set at p < 0.05. All analyses were performed using IBM SPSS Statistics version 27 (IBM Corp., Armonk, NY). This analytic framework is consistent with approaches employed in previous epidemiological investigations of traditional medicine use (Tassew et al., 2024).

2.7 Ethical Considerations

The study protocol was reviewed and approved by the Ethics Review Committee of Probe International Clinical Research Ltd. (PICR) (ERC: DGDA/CRO-4/2017/9170). All procedures adhered to the ethical principles of the Declaration of Helsinki and followed WHO guidelines for research involving traditional medicine (WHO, 2019). Participation was strictly voluntary, and all data were kept confidential to protect the privacy of respondents.

3. Results

A total of 200 participants diagnosed with chronic illnesses were recruited for this study. The mean age of respondents was 43.7 years (SD = 15.9), with the majority falling within the 30–45 age group (37.5%), followed by the 46–60 age group (29.0%) (Table 1). Women comprised a higher proportion of the sample (56.5%) compared to men (43.5%).

Table 1.  Socio-Demographic Profile of Participants (N = 200)

Regarding education, nearly half of the participants (47.0%) had completed secondary or higher education, while 23.5% reported no formal education. Marital status distribution indicated that 72.0% were married, 21.0% were unmarried, and 7.0% were widowed or divorced. Occupationally, private-sector employees were the largest group (30.5%), followed by farmers (21.0%), business owners (19.5%), government employees (12.5%), and unemployed individuals (16.5%). Income distribution showed that 41.5% earned between 10,000–20,000 BDT, 32.0% earned less than 10,000 BDT, and 26.5% earned above 20,000 BDT. Urban residents accounted for 60.0% of participants, while 40.0% lived in rural areas (Table 1).

3.1 Prevalence and Patterns of Herbal Medicine Use

Among the 200 participants, 10% (n = 20) reported exclusive use of herbal medicine, while 6% (n = 12) reported combining herbal remedies with modern medicine. Homeopathy was the most widely adopted modality (65%), followed by herbal preparations (25%) and Ayurveda (10%) (Table 2). This trend aligns with prior research in Bangladesh, which found high use of complementary and alternative medicine (CAM), especially among patients with diabetes and hypertension (Mohsin et al., 2023; Rafi et al., 2020).

3.2 Determinants of Herbal Medicine Use

Bivariate analysis demonstrated significant associations between herbal medicine use and several socio-demographic characteristics, including gender (p = .018), education level (p = .012), monthly income (p < .001), occupation (p = .004), and place of residence (p < .001) (Table 2). Multinomial logistic regression revealed that rural residents were significantly more likely to use herbal medicine compared to urban residents (AOR = 6.812, 95% CI [2.678, 17.423], p < .001). This finding corroborates earlier studies in sub-Saharan Africa and South Asia, where reliance on herbal remedies was higher in rural settings due to limited healthcare infrastructure and cultural acceptance of traditional medicine (Tassew et al., 2024; Stanifer et al., 2015). Moreover, individuals with lower income were disproportionately more likely to adopt herbal medicine, a pattern consistent with observations from Ghana and Ethiopia (Sato, 2012; Nigussie et al., 2022).

Table 2. Demographic and Socioeconomic Factors Associated with Herbal Medicine Use

3.3 Perceived Effectiveness of Herbal Medicine

Effectiveness perceptions were mixed among the 32 participants who reported herbal medicine use. One-quarter (25.0%) indicated that herbal treatments were effective in managing their condition, while 37.5% considered them somewhat effective, and another 37.5% reported no effectiveness (Table 3). These findings mirror results from studies conducted in Pakistan and Nigeria, where users expressed divided opinions on the efficacy of traditional remedies, with concerns about standardization and lack of consistent therapeutic outcomes (Sankaramourthy et al., 2021; Ekpor et al., 2024).

Table 3. Perceived Effectiveness of Herbal Medicine

Overall, the study highlights that herbal medicine continues to play a substantial role in the healthcare practices of adults with chronic illnesses in Bangladesh. Utilization was shaped by socio-demographic characteristics, particularly residence and income, reflecting broader trends observed in other low- and middle-income countries (Aboufaras et al., 2023; Grace et al., 2020). However, perceptions of effectiveness varied, underscoring the need for systematic evaluation of these therapies.

4. Discussion

The findings of this study highlight the enduring role of herbal medicine in the health-seeking behaviors of Bangladeshi adults living with chronic illnesses. While 8.3% of participants relied solely on herbal remedies and 5.2% combined herbal with modern medicine, these rates are lower than previous national estimates reporting 32.8% use among the general population and 35.2% among individuals with diabetes (Shahjalal et al., 2022; Rafi et al., 2020). Even so, the results reinforce that herbal medicine remains an important part of health management, particularly for people navigating the long-term demands of chronic disease.

The predominance of homeopathy, followed by herbal preparations and Ayurveda, reflects both cultural traditions and the practical accessibility of these systems in Bangladesh. This pattern is not unique; similar trends have been observed across South Asia, where homeopathy and Ayurveda remain deeply embedded in cultural health practices (Mohsin et al., 2023). Such persistence illustrates how treatment choices are shaped not only by medical considerations but also by affordability, cultural continuity, and personal beliefs—factors that continue to influence health behaviors in low- and middle-income countries (Sato, 2012).

Socio-demographic factors emerged as significant determinants of herbal medicine use. Gender, educational attainment, income, occupation, and residential location were all associated with treatment choices. Regression analysis showed that rural residents were nearly seven times more likely to depend on herbal medicine than their urban counterparts. This disparity echoes findings from Ethiopia and Nigeria, where limited availability of modern healthcare, financial constraints, and stronger cultural ties drive rural reliance on herbal remedies (Nigussie et al., 2022; Li et al., 2020). Similarly, individuals from lower-income groups were more inclined to adopt herbal treatments, reflecting broader global trends in which economic and geographic barriers influence health decisions (Tassew et al., 2024).

Perceptions of herbal medicine effectiveness were notably mixed. One in four users reported positive outcomes, while an equal proportion considered it ineffective, and 37.5% described it as only somewhat effective. Comparable variability has been reported in Pakistan and Nigeria, where widespread use persists despite doubts about efficacy (Sankaramourthy et al., 2021; Ekpor et al., 2024). These findings point to the ongoing challenges of integrating herbal remedies into evidence-based care. Concerns regarding quality control, dosage accuracy, and safety remain central, underscoring the urgent need for scientific validation and regulatory oversight (Yuan et al., 2016).

Despite these uncertainties, herbal medicine continues to fill critical gaps in Bangladesh’s healthcare system. Its affordability and cultural acceptance make it particularly relevant for rural and socioeconomically disadvantaged groups who face barriers to accessing modern care. However, unregulated use carries risks that could undermine health outcomes. Policy interventions are therefore essential to ensure that herbal practices are integrated safely and effectively. This requires investment in clinical trials, pharmacological research, and quality control frameworks, alongside physician-guided use and patient education (WHO, 2019).

In light of Bangladesh’s commitment to reducing premature mortality from non-communicable diseases by one-third by 2030 (Islam et al., 2022), herbal medicine offers both opportunities and challenges. Harnessing its potential requires careful regulation and scientific validation to maximize benefits while minimizing risks.

5. Conclusion

In conclusion, the study affirms that herbal medicine remains a meaningful health resource for managing chronic illnesses in Bangladesh, especially in rural areas and among low-income groups. While perceptions of effectiveness vary, the persistence of its use underscores the importance of integrating traditional remedies into national healthcare strategies. Future research should prioritize randomized controlled trials, long-term safety studies, and regulatory mechanisms to ensure that herbal medicine contributes reliably to reducing the chronic disease burden.

Author Contributions

N. M. B. conceptualized and designed the study, developed the questionnaire, supervised data collection, analyzed and interpreted the data, and drafted the manuscript.

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