Indonesian Journal of Innovation and Applied Sciences (IJIAS), 3 (2), 181-193 181 Volume 3 Issue 2 June (2023) DOI: 10.47540/ijias.v3i2.752 Page: 181 – 193 Healthcare Professionals and Patient Perceptions on the Use of Herbal Medicines to Control Diabetes Mellitus and Hypertension in Nigeria Nwankwo Ogechukwu Lucy1, Ogbonna Brian Onyebuchi2 1Department of Pharmacognosy and Traditional Medicine, Nnamdi Azikiwe University, Nigeria 2Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Nigeria Corresponding Author: Ogbonna Brian Onyebuchi; Email: bo.ogbonna@unizik.edu.ng A R T I C L E I N F O A B S T R A C T Keywords: Diabetes Mellitus, Disease Control, Herbal Medicine, Hypertension, Medicinal Plants. Received : 18 December 2022 Revised : 13 February 2023 Accepted : 30 June 2023 The perception that herbal medicines are generally safe and non-toxic, has all necessitated patients' use of herbs in the management of diabetes and hypertension. The study evaluated healthcare professionals' and patients' perceptions of the use of herbs to control diabetes mellitus (DM) and hypertension. The study utilized a randomized sampling method for the survey; an online form was designed and used for data collection. The questionnaire was sent to professional and non-professional groups having the target population (patients and relatives. The results showed that the majority of the participants stated the use of Vernonia amagdalena in the management of HTN (33.0%) and DM (9.9%). Other plants mentioned include Moringa leaves HTN n (5.5%), DM n(6.6%); Carica papaya; HTN (9.9%), DM (8.2); Ginger, and DM (12.6%). Dogoyaro/Agbo (4.9%). Notable antidiabetic plants reported in this study include Rauwolfia vomitoria (1.1%), Ugu leaves (2.2%), Hibiscus (zobo) (4.4%), Ocimum gratiscimum (1.1%), cucumber (1.1%), neem plant (3.8%). Previous knowledge on Diabetes Mellitus between the patients and healthcare workers was P=0.038 while previous knowledge on hypertension was p=0.029. The knowledge of herbal product(s) used in diabetes was p=0.043 while knowledge of herbal product(s) used in hypertension was p=0.019, at p<0.05. It was thus concluded that the participants believe that herbal medicines can relieve disease within a short period, are effective at the correct dosage, have fewer side effects or no side effects at the proper doses, and can effect a complete cure if standardized, affordable, better tolerated in the body. INTRODUCTION The prevalence of diabetes mellitus (DM) is one of the most alarming statistics concerning health problems globally. The major concern regarding this observation relates to the development of the chronic complications associated with DM such as microvascular such as retinopathy, nephropathy, and neuropathy or macrovascular which is cardiovascular disease (CVD) including hypertension, cerebrovascular accidents (CVA), and peripheral vascular disease (PVD). It is well-recognized that DM and Hypertension negatively affect the quality of life in individuals. A non-communicable disease (NCD) is a non-infectious health challenge the complications of diabetes cause considerable morbidity and mortality worldwide and, as such, cannot be spread from one individual to another. The disease condition can progress for a long period in an individual. This condition is otherwise referred to as a chronic disease. Some risk factors may include detrimental diets, inadequate physical activity, smoking, passive smoking, and inordinate use of alcohol (Judith & Erica, 2018). NCDs are frequently dominant in low-income and middle- income countries. The World Health Organization (WHO) estimated that by 2020, 80% of global deaths will be attributed to NCDs. In sub-Saharan Africa (SSA) alone, the NCDs burden is expected to increase by 27% in that time frame (WHO 2013; Andrew et al., 2020). INDONESIAN JOURNAL OF INNOVATION AND APPLIED SCIENCES (IJIAS) Journal Homepage: https://ojs.literacyinstitute.org/index.php/ijias ISSN: 2775-4162 (Online) Research Article https://ojs.literacyinstitute.org/index.php/ijias http://issn.pdii.lipi.go.id/issn.cgi?daftar&1587190067&1&&2020 Indonesian Journal of Innovation and Applied Sciences (IJIAS), 3 (2), 181-193 182 The major types of NCDs are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma), and diabetes (WHO 2021). Excess salt/sodium intake has been attributed to over 4.1 million deaths annually, which is a risk factor for cardiovascular disease. About 1.5 million annual deaths attributable to alcohol use are from NCDs, including cancer (WHO 2021). Over 1.6 million deaths annually can be attributed to low physical activity (James et al., 2018). The practice of nature cure (herbs) provides a way of understanding the scale and scope of the non-communicable disease as a public health crisis (WHO 2021). Hypertension is a common global health challenge. Hypotension is dangerous because it causes the heart to very hard and contributes to atherosclerosis, besides increasing the risk of heart disease and stroke, it can also lead to other conditions such as congestive heart failure, kidney disease, and blindness. About 75 to 80% of the world population use herbal medicines, mainly in developing countries, for primary health care because of their better acceptability with the human body and lesser side effects. In the last three decades, a lot of concerted efforts have been channeled into researching the local plants with hypotensive and antihypertensive therapeutic values (Tabassum, & Ahmad, 2011). Patients may choose to supplement their pharmacological regimen with dietary supplementation in many forms, like vitamin and/or mineral mixtures, but the most popular supplements taken by the patients are those considered to be of natural origin, (herbal medicine). Regrettably, significant controversy exists regarding the efficacy of dietary supplements in general and that of herbal medicines, particularly regarding pathophysiological factors related to the treatment of patients with type 2 diabetes. The controversy exists because reported efficacy data for many natural products are only in the form of uncontrolled studies and anecdotal reports. Thus, poor quality control measures may also cause inconsistent effects for certain herbal medicines. There is a paucity of consistent and reproducible efficacy data in humans to suggest any recommendations for most herbs or bioactive supplements as adjunct treatments for risk factors related to diabetes. Traditional, complementary, and alternative medicine (TCAM) comprises indigenous healthcare practices that do not include an orthodox healthcare system o intervention. In the African setting, it may account for local herbal medicines or products, and indigenous healthcare practices (James et al., 2018). It is therefore important to access the public opinion on the use of herbs to control this diabetes mellitus and how effective they are in maintaining their blood sugar levels considering the cost burden. The economic burden of orthodox medicines and the major risk factors of NCDs like diabetes and hypertension has been attributed to modernization, the perception that herbal medicines are generally safe and non-toxic, has all necessitated patient's use of herbs in the management of diabetes and other similar conditions hence justifies the need to evaluate the impact of herbal medicines in disease prevention, health promotion, and public health. The study evaluated healthcare professionals' and patients’ perceptions of the use of herbs to control diabetes mellitus (DM) and hypertension. METHODS Study design The study will be a descriptive, cross-sectional study using a questionnaire (online or physical). The survey instrument will be developed based on a literature review of diabetes mellitus, including its medications and preventive measures. A well- structured questionnaire, which will include three sections. The first section comprises the demographic characteristics of the participants such as age, gender, place of work, and years of experience. The second section will be regarding the knowledge of NCDs, hypertension, and diabetes mellitus in particular and prevalence, and the last section will estimate the attitude and perception of herbal medication in diabetes and its relevance in health promotion, disease prevention, and public health. Study area and setting The study will be conducted in Nigeria. Based on the United Nations estimates that the population of Nigeria as of September 2017 was 193.3 million (Worldometers.info, 2017). The pooled hypertension and Diabetes Mellitus (DM) prevalence of 5.77% observed in a meta-analysis suggests that 11.2 million Nigerians (1 out of every 17 adults) are living with DM and hypertension. Indonesian Journal of Innovation and Applied Sciences (IJIAS), 3 (2), 181-193 183 Regional differences in the prevalence of DM and hypertension, with the highest rate observed in the South-South region of Nigeria and the lowest rate seen in the North-Western zone (Gezawa et al., 2013). Sample size determination Diabetes mellitus and hypertension are major causes of morbidity and mortality both in developing and developed countries like Nigeria, hence, every individual above 18 years of age will be recruited physically or online for the survey. The estimated target population size was two and fifty (250) individuals, drawn from both healthcare providers and patients or patient's relatives, especially those that have previously prescribed, dispensed, or used herbal preparation in the management of diabetes mellitus and hypertension. A total of one hundred and eighty-two (182) online responses were retrieved from the survey, the same was used for the data analysis as presented in chapter three. Eligibility criteria Inclusion criteria – patients, patient relatives, who might have directly or indirectly experienced diabetes, current diabetic patients and relatives, and healthcare providers above 18 years of age, from every part of Nigeria. Sampling methods and study instrument A randomized sampling method was used for the survey (clearly describe the randomization unambiguously here), and an online form was designed and used for data collection. The form (questionnaire) was sent to professional and non- professional groups having the target population (patients and relatives). Validation of study instrument The online questionnaire (google form) was designed and forwarded to the project supervisor for content evaluation and modification. The content was evaluated and subsequently corrected by the supervisor. Thereafter, it was sent and distributed across various social media platforms to generate data from healthcare providers, patients, and patient's relatives. Outcome measures Healthcare professionals and patient's or patient relatives’ perceptions of the use of herbs to control diabetes mellitus (DM) and hypertension, with regards to the type, effectiveness, and relative safety compared to orthodox medicine. Data analysis Data generated from the survey were analyzed using one-way analysis of variance (ANOVA) with SPSS software version 23.0, and GraphPad Instat Version 3.0. RESULTS AND DISCUSSION Data revealed that more females participated in the study compared to their male counterparts, with a percentage distribution of 54.9% (female) and 45.1% (male) respectively. With 12.7 standard deviations from the mean. 2.2% of the participants had no formal education, 4.4% had secondary education, while 93.4% had tertiary educational qualifications, with some having Postgraduate diploma-PGD (12.1%), Master of Science – MSc (39.7%), and Doctor of Philosophy - Ph.D. (20.9%), respectively. Table 1. Gender Distribution and Educational Qualification of Participants Gender n % 82 45.1 Female 100 54.9 Mean 91 50 SD 12.7 7.0 Educational Qualification No Formal Education 4 2.2 Primary 0 0.0 Secondary 8 4.4 Tertiary 170 93.4 Mean 45.5 25.0 SD 83.1 45.6 Higher Education None 68 37.4 PGD 22 12.1 MSc 54 29.7 PhD 38 20.9 Mean 45.5 25.0 SD 19.9 10.9 SD – Standard Deviation Indonesian Journal of Innovation and Applied Sciences (IJIAS), 3 (2), 181-193 184 Location of Study Participants Participants were drawn across Nigeria, as Google form was distributed in all possible social platforms to generate responses. The majority of the participants were Lagos state (13.7%), this was closely followed by Anambra (11.0%), Bayelsa (10.4%), Oyo (7.7%), Delta (7.1%), Akwa Ibom (7.1%), and Imo (6.6%) states, respectively. Figure 1. Location of Study Participants 5 13 20 19 5 13 11 7 3 12 4 2 4 25 6 3 8 14 8 2,7 7,1 11,0 10,4 2,7 7,1 6,0 3,8 1,6 6,6 2,2 1,1 2,2 13,7 3,3 1,6 4,4 7,7 4,4 0 5 10 15 20 25 30 Location of Study Participants Frequency (N) Percent (%) Indonesian Journal of Innovation and Applied Sciences (IJIAS), 3 (2), 181-193 185 Table 2. The table of the relationship between the age range of participants and the frequency of distribution Age of Participants N % 18 – 25 20 11.0 26 – 39 94 51.6 40 – 59 66 36.3 60 – 79 2 1.1 Mean 45.5 25 SD 42.1 23.1 Table 3. The frequency of Marital Status and Religion of the respondents Marital Status n % Single 56 30.8 Married 120 65.9 Widow/Widower 6 3.3 Mean 60.7 33.3 SD 57.1 31.4 Region Christianity 172 94.5 Muslim 10 5.5 Mean 91 50.0 SD 114.6 62.9 Table 4. Participant Category, place of work, and household type Participant Category, place of work, and household type n % Healthcare Provider 46 25.3 Patient Relative 42 23.1 Pharmacists 46 25.3 Patient 42 23.1 Medical Doctor 2 1.1 Medical Lab Scientist 4 2.2 Mean 30.3 16.7 SD 21.3 11.7 Place of Work Public 92 50.5 Private 52 28.6 Self-employed 36 19.8 Unemployed 2 1.1 Mean 45.5 25.0 SD 37.4 20.5 Household Type Stay with immediate family (spouse/children) 136 74.7 Stay with Minos 12 6.6 Stay alone 30 16.5 Stay with caregiver 4 2.2 Mean 45.5 25.0 SD 61.3 33.7 Indonesian Journal of Innovation and Applied Sciences (IJIAS), 3 (2), 181-193 186 Table 5. The frequency distribution of the social history of the respondents Social History n % Alcohol intake Yes 72 39.6 No 110 60.4 Salt Intake Yes 170 93.4 No 12 6.6 Beverages consumption Yes 167 91.8 No 14 7.7 Sugar Intake Yes 148 81.3 No 34 18.7 Cigarette smoking Yes 6 3.3 No 176 96.7 Deliberate exercise Yes 130 71.4 No 52 28.6 Food allergy Yes 32 17.6 No 150 82.4 Mean 90.9 50.0 SD 65.6 36.0 Table 6. Previous knowledge on Hypertension and Diabetes mellitus Previous knowledge and Experience N % Precious knowledge on Diabetes? Yes 154 84.6 No 28 15.4 Precious knowledge on Hypertension? 0.0 Yes 152 83.5 No 30 16.5 What is Diabetes? 0.0 Increased Blood sugar 178 97.8 Increased Blood salt level 4 2.2 Experienced diabetes? 0.0 Yes 24 13.2 No 158 86.8 Relative Diabetic? Yes 106 58.2 No 76 41.8 What is Hypertension? 0.0 Increased Blood pressure 182 100.0 Experienced Hypertension? Yes 44 24.2 No 138 75.8 Relative hypertensive? Yes 146 80.2 No 36 19.8 Mean 97.1 53.3 SD 64.4 35.4 Indonesian Journal of Innovation and Applied Sciences (IJIAS), 3 (2), 181-193 187 Table 7. Assessment of Hypertension and Diabetes Mellitus Assessment of Hypertension and Diabetes mellitus How often do you check blood sugar N % Once a week 35 19.2 Once in a month 52 28.6 When symptoms persist 41 22.5 Frequently 34 18.7 When needed 20 11.0 How often do you check blood pressure? Once a week 42 23.1 Once in a month 54 29.7 When symptoms persist 34 18.7 Frequently 18 9.9 When needed 34 18.7 Kind of treatment sort after when blood pressure or sugar is high Herbal medicine 34 18.7 Orthodox (conventional) 74 40.7 Both 51 28.0 Don't know 23 12.6 Knowledge of herbal product(s) used in Diabetes Yes 64 35.2 No 118 64.8 Knowledge of herbal product(s) used in hypertension Yes 50 27.5 No 132 72.5 Herbal and conventional medicine, which is more effective in managing Diabetes or Hypertension? Conventional Medicine 57 31.3 Herbal Medicine 13 7.1 Both 56 30.8 Don't Know 56 30.8 Mean 49.6 27.3 SD 29.0 15.9 Table 8. Herbs used in the management of Hypertension and Diabetes Mellitus Antihypertensive Plants N % Anti-diabetic Plants N % Abere seed 2 1.1 Bitter leaf 18 9.9 Allium sativum 8 4.4 Beetroot 2 1.1 Moringa leaves 10 5.5 Rauwolfia vomitoria 2 1.1 Aloe vera 2 1.1 Ugwu leaves 4 2.2 Avocado, kiwi 2 1.1 Hibiscus (zobo) 8 4.4 Bitter leaf (Vernona amagdalena) 60 33.0 Garsonia (bitter cola) 2 1.1 Curry leaf 2 1.1 Moringa leaves 12 6.6 Nuchwuanwu Leaves 4 2.2 Eucalyptus 2 1.1 Indonesian Journal of Innovation and Applied Sciences (IJIAS), 3 (2), 181-193 188 Chanca piedra 2 1.1 Bryophyllum pinnatium 2 1.1 Bryophyllum pinnatum 4 2.2 Chanca piedra 2 1.1 Efirin Utazi leaf 2 1.1 Cucumber 2 1.1 Carica papaya 18 9.9 Digitalis 2 1.1 Occimum gratissimum 2 2.2 Avacado seeds 2 1.1 Cucumber 4 2.2 Ocimum basilicum 2 1.1 Dogoyaro/Agbo 9 4.9 Hyptis suaveolens 2 1.1 Gymnemia Sylvester 4 2.2 Lapell green tea 2 1.1 Honey 2 1.1 Lemon grass 4 2.2 Green Garden 4 2.2 Matchstick plant 2 1.1 Lapell green tea 4 2.2 Mukta bati 2 1.1 Madhunasin 2 1.1 Palm kernel nut 2 1.1 Red potatoes 4 2.2 Parsley leaves 2 1.1 Neem 4 Ginger 23 12.6 Okra 4 Scent leaves 2 1.1 STC- 30 4 2.2 Sobo flowers Hibiscus sabbri 2 1.1 Boiled utazi leaves 4 2.2 Unripe pawpaw 15 8.2 2.2 Neem plant 7 3.8 2.2 Unripe plantain 2 1.1 Mean 6.3 3.0 Mean 4.8 2.4 SD 11.3 5.9 SD 5.6 3.0 Table 9. Cost-effectiveness of Herbs used in the management of Hypertension and Diabetes Mellitus Herbal medicine and conventional medicine, which is cost-effective N % Herbal Medicine 59 32.4 Conventional Medicine 47 25.8 Both 26 14.3 Don't Know 50 27.5 Which has improved your health in managing Diabetes or Hypertension Herbal Medicine 46 25.3 Conventional Medicine 54 29.7 Both 26 14.3 Don't Know 56 30.8 Can you recommend any herbal mixture to your friend or family? Yes 76 41.8 No 106 58.2 Can you share the benefits of herbal products with your Healthcare provider? 0.0 Yes 98 53.8 No 84 46.2 Mean 60.7 33.3 SD 25.6 14.1 Indonesian Journal of Innovation and Applied Sciences (IJIAS), 3 (2), 181-193 189 Table 10. Correlation Analysis of Categories of Participants and Previous Knowledge on Diabetes, Hypertension, and the Use of Herbal Medicines Category Previous knowledge on Diabetes mellitus Chi-square (x2) Df P-value Yes No 16.269 5 0.039 Healthcare Provider 46 0 Patient Relative 24 18 Pharmacists 46 0 Patient 32 10 Medical Doctor 2 0 Medical Lab Scientist 4 0 Previous knowledge on Hypertension 8.365 5 0.029 Healthcare Provider 46 0 Patient Relative 24 18 Pharmacists 46 0 Patient 30 12 Medical Doctor 2 0 Medical Lab Scientist 4 0 Knowledge of herbal product(s) used in Diabetes 16.301 5 0.043 Healthcare Provider 4 42 Patient Relative 3 39 Pharmacists 46 0 Patient 8 34 Medical Doctor 2 0 Medical Lab Scientist 1 3 Knowledge of herbal product(s) used in hypertension 5.999 5 0.019 Healthcare Provider 2 44 Patient Relative 2 40 Pharmacists 41 5 Patient 2 40 Medical Doctor 2 0 Medical Lab Scientist 1 3 Several Nigerian medicinal plants have been reported to possess antidiabetic and antihypertensive properties. The study revealed some species of Nigerian medicinal plants with anti-diabetic and antihypertensive properties based on evidence-based and first-hand experience by healthcare providers, patients, and patient's relatives. Data revealed that more females participated in the study compared to their male counterparts, with a percentage distribution of 54.9% (female) and 45.1% (male) respectively. With a 12.7 standard deviation from the mean (this is presented in Table 1). This could be due to the inability of some persons not having internet access or data subscription as at the time of the survey, etc. The study was conducted nationwide, hence participants were drawn across all the states including FCT of Nigeria, as Google form was distributed on all possible social media platforms to generate responses. The majority of the participants were Lagos State (13.7%), this was closely followed by Anambra (11.0%), Bayelsa (10.4%), Oyo (7.7%), Delta (7.1%), Akwa Ibom (7.1%), and Imo (6.6%), Enugu (6.0%), Rivers and Osun state (4.4% each), FCT (3.8%), Ogun (3.3%), states, respectively. Fewer responses were gotten from the Northern part of Nigeria such as Kwara, Kaduna, which were 2.2% each, and 1.6% from Gombe state Indonesian Journal of Innovation and Applied Sciences (IJIAS), 3 (2), 181-193 190 (this is shown in Figure 1.). This shows that majority of the participants were from the western part of Nigeria, where most herbal medicines or traditional medicines practice is well known across Nigeria. Age Distribution and Religion of Participants It is generally believed that religion always affects the perception and the pattern of how people live and make their choices as regards to management and treatment of certain ailments using orthodox or herbal medicines, respectively. From the survey, it was observed that the majority of study participants were young people, while the rest population was distributed across various age groups. 51.6% out of the total population were between the age group of 26 – 39, 36.3% were 40 – 59 years of age, 11.0% were between 18 – 25 years and only 1.1% were between 60 – 79 years old (Table 2). It is believed that religion affects the lifestyle and use of certain remedies in the management of various disease conditions. Almost all participants (94.5%) were Christians, while 5.5% Muslims were recorded. 65.9% were married, 30.8% were single while 3.3% were either widows or widowers (this is presented in Table 3). Similar results were in a study conducted by Judith and colleagues in 2018, where most of the survey respondents were more of young persons, etc., (Judith & Erica, 2018). Educational background and Category of participants Another factor that might influence the use of some (herbal of orthodox) remedies to a very large extent is the level of exposure which could be attributed to the standard or level of education one has acquired. About 2.2% of the participants had no formal education, 4.4% had secondary education, while 93.4% had tertiary educational qualifications, with some having Postgraduate diploma - PGD (12.1%), Master of Science – MSc (39.7%), and Doctor of Philosophy - Ph.D. (20.9%), respectively. 37.4% of the participants had no higher education (this is shown in Table 3.4). Different categories of participants were observed in the study, based on an online form designed to generate their responses. The majority of the participants (25.3%) were healthcare providers, 25.3% were pharmacists, 1.1% were medical doctors, 2.2% were medical laboratory scientists, while 23.1% each were patients and patient's relatives respectively. More than half of the study population (50.5%) were government or public servants, 28.6% were private or NGO workers. Almost all the subjects (74.7%) were staying with their immediate family (i.e., spouse and/or children), while 16.5% stays alone, 2.2% stays with health caregivers, while 6.6% lives with minos (Table 5). The social lifestyle of individuals often affects the substances (herbal or orthodox) they consume. Almost all participants use or take salt (93.4%), 39.6% consume alcohol and related substances, 81.3% take sugar while only 3.3% smoke cigarettes. 71.4% participate in a deliberate exercise, and 17.6% reported having experienced food allergies/reactions (Table 6), this also relates to the study by Judith & Erica, (2018). Participants had the correct knowledge on hypertension and diabetes mellitus. 84.6% indicated they know about diabetes, while 83.5% indicated their understanding of hypertension. 13.2% and 24.2% have experienced diabetes and hypertension respectively. Also, a higher percentage of the population affirmed that their relatives currently or have managed either diabetes or hypertension. Assessment of diabetes and hypertension It was observed that the majority of the participants assess their blood sugar (28.6%) and pressure (29.7%) once every month. 40.7% of the population uses orthodox medicines while 18.7% sort after herbal medicines in the management and treatment of diabetes and hypertension, respectively. 35.2% and 27.5% had prior knowledge of herbs used in the management of diabetes and hypertension, respectively. Finally, 7.1% believe that herbal medicines are more effective than the conventional medicines currently used in the treatment of diabetes and hypertension. Some of the participants stated that they only check their sugar (22.5%) or blood pressure (18.7%) when symptoms persist (Table 8, shows this information). Herbal Medicines used in the management of Hypertension and Diabetes mellitus Various herbal plants and remedies were listed by study participants as used by them or relatives or have been recommended or dispensed to patients in the management of hypertension (HTN) and diabetes mellitus (DM). The majority stated that they have used Bitter leaf (Vernonia amagdalena) in the management of hypertension (33.0%) and diabetes mellitus (9.9%). Other plants mentioned Indonesian Journal of Innovation and Applied Sciences (IJIAS), 3 (2), 181-193 191 include Moringa leaves HTN (5.5%), DM (6.6%); Carica papaya; HTN (9.9%), DM (8.2); Ginger, DM (12.6%), respectively. Other herbs reported by study participants used in hypertension include Abere seed (1.1%), Allium sativum (4.4%), aloe vera (1.1%), Nuchwuanwu Leaves (2.2%), Bryophyllum pinnatum (2.2%), Ocimum basilicum (1.1%), Cucumber (2.2%), etc., others were okra (2.2%), Dogoyaro/Agbo (4.9%). Notable antidiabetic plants reported in this study include Rauwolfia vomitoria (1.1%), Ugwu leaves (2.2%), Hibiscus (zobo) (4.4%), Ocimum gratiscimum (1.1%), cucumber (1.1%), neem plant (3.8%), (Table 9). This confirms the report by Ozougwu (2017) in the article Nigerian medicinal plants with anti-diabetic and anti-hypertensive properties. Cost-effectiveness of herbal medicines The cost of treatment is another factor that has been reported to influence the use of medicinal agents by different individuals. A greater proportion of the participants (32.4%) stated that herbal medicines are more cost-effective than their conventional (orthodox) counterparts. Also, 25.3% thought that herbal medicines have helped improve their lifestyle in the management of diabetes and/or hypertension (Table 10). On a general note, many of the participants perceive that herbal medicines are more cost-effective than orthodox medicines. Correlation Analysis of Categories of Participants and Perception, Previous Knowledge on Diabetes, Hypertension, and the Use of Herbal Medicines There was significant relationships between the participant's previous knowledge of diabetes, hypertension, and the use of herbal medicines. In line with this, there was a positive significant difference among the participants' category and previous knowledge on diabetes mellitus. Also, participants were not aware of the use of herbal medicines in the treatment of diabetes mellitus and hypertension. It was then observed, among the participants, pharmacists were 100% aware of the use of herbal medicines in the management of diabetes and hypertension. This could be attributed to the undergraduate and postgraduate curriculum currently obtainable in all accredited Schools of Pharmacy. CONCLUSION The participants of this study had previous knowledge and use of herbal medicines. Some believe that herbal medicines can relieve disease within a very short period, are effective at the right dosage, have fewer side effects or no side effects at the right doses, and can affect a complete cure if standardized, affordable, and better tolerated in the body. Bitter leaf was the most frequently reported plant used in the management of diabetes and hypertension by study participants. Some stated that Bitter juice helps to check diabetes, while scent leaf (Ocimum gratiscimum) juice and Ugu juice are used for BP control with minimal side effects, quick onset of action, possibilities of treating other unknown diseases, decreased blood sugar, decreased cholesterol level, decreased blood sugar, decreased cholesterol level, easy access, and cost- effectiveness. There was a significant difference among participant's category and their previous knowledge and perception of the use of herbal medicines in the management of diabetes and hypertension at p-value < 0.05. REFERENCES 1. 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