In this study, 81(11%) HCPs strongly disagree to accept TM as an option in controlling COVID-19 outbreak and 163(22.1%) HCPs disagree on accepting TM utilization to control COVID-19 outbreak. But 92(12.5%) HCPs were neutral on accepting TM to control COVID-19 epidemics. On the other side 300(40.7%) and 101(13.7%) HCPs agree and strongly agree to accept TM as a treatment option respectively. One hundred thirteen (15.3%) HCPs strongly disagree to recommend TM utilization to control COVID-19 outbreak and 163(22.1%) HCPs disagree to recommend TM utilization in combating COVID-19 epidemics. But 92(12.5%) HCPs were neutral on recommending TM utilization to combat COVID-19 outbreak. On the other side, 300(40.7%) and 101(13.7%) HCPs agree and strongly agree to recommend TM utilization to control COVID-19 epidemics respectively. The health professionals’ attitude in this study is higher than studies’ finding reported from Debre Tabore town 133 (33.1%)(17), and Merawi town 75(19.1%)(18).The difference might be due to study population difference, and scope variation. The current study considered health care professionals and narrowed to COVID-19 outbreak only but the former studies studied on the community without diseases specification. In this study, eighty six (11.7%) HCPs strongly disagree on preferring MM than TM to control COVID-19 outbreak and 118(16.0%) HCPs disagree on MM preference over TM. But 115(15.6%) HCPs were neutral on preferring MM over TM while controlling COVID-19 outbreak. On the other side, 193(26.2%) and 225(30.5%) HCPs agree and strongly agree on preferring MM over TM respectively. This high preference of MM over TM agree with a study conducted in Merawi town in which majority of respondents prefer modern medicine, and some of the respondents preferred a combination of TM and MM but very few respondents prefer TM over MM, in which 281 (71.7%) of the study participants preferred to use modern medicine than traditional medicines(18). Although the scope study was quite different, there was a 78.6% of modern medicine preference over traditional medicine in another study (19), which have a very high difference with the present study in which 56.7% of HCPs prefer TM over MM to control COVID-19 outbreak. The possible justification might be that the issue, COVID-19 is most exposed to traditional assumptions and influence the attitude of the professionals.
Seventy one (9.6%) HCPs strongly disagree on government involvements to improve TM practice in controlling COVID-19 epidemics, and 92(12.5%) HCPs disagree on it. But 139(18.9%) HCPs were neutral on government involvement to improve TM practice to control COVID-19 epidemics. On the other side, 314(42.6%) and 121(16.4%) HCPs agree and strongly agree on the involvement of a government to improve TM practice respectively. This high positive attitude on the need of government involvement supported by a study from China that reported traditional Chinese medicine treatment was included in the third version of integrative treatment protocol officially(20). One hundred forty (19.0%) HCPs strongly disagree on the better effectiveness of TM in controlling COVID-19 epidemics than MM and 291(39.5%) HCPs disagree on it. But 112(15.2%) HCPs were neutral on the effectiveness of TM than MM in controlling COVID-19 epidemics. On the other side, 65(8.8%) and 129(17.5%) HCPs agree and strongly agree on the better effectiveness of TM over MM respectively. This low positive attitude of professionals on the effectiveness of TM contradicted with a study found from China that showed patients who took Chinese medicine preparations had a smaller death risk than those who did not (0.273, p < 0.05)(21). This low attitude of professionals might be as a result of the poorly developed traditional health care system in Ethiopia. Similar to the present study, the attitude of health care professionals was low in a study conducted in Debre Tabore(17). Like the present study in which half of the respondents disagree on the effectiveness of TM over MM, and in Merawi town, one third of the study subjects (70.2%) disagree on the effectiveness of TMs compared to MM(18). Eighty eight (11.9%) HCPs strongly disagree on integrating TM and MM, and 93(12.6%) HCPs disagree on it. But 103(14.0%) HCPs were neutral on integrating TM and MM. On the other side 217(29.4%) and 236(32.0%) HCPs agree and strongly agree on integrating TM and MM respectively in controlling COVID-19 outbreaks. This agrees with a study from China that indicated integrating traditional Chinese and western medicine played an important role for China’s successful control of COVID-19(22). This current study has a higher positive attitude on integrating MM with TM than the study from Debre Tabore, 91 (22.6%)(17). The difference might be as a result of study population difference, and study scope variation. The present study considered health care professionals only and narrowed to COVID-19 but the former study was community based without diseases specification. However, this positive attitude is very lower than the study done in Shopa Bultum, Southeast Ethiopia, 92%(1).
In this study, 40(5.4%) HCPs strongly disagree on the need of collaboration between MM and TM practitioners to control COVID-19 and 70(9.5%) HCPs disagree on the need of collaboration between the two disciplines. But 96(13.0%) HCPs were neutral on collaborating TM and MM in controlling COVID-19 epidemics. On the other side, 363(49.3%) and 168(22.8%) HCPs agree and strongly agree on the need of collaboration between HCPs and TMPs to treat COVID-19 respectively. The present study’s high attitude on the need of collaboration between traditional and modern medicine is in lined with the recommendation of World Health Organization. WHO recommends to establish mechanisms that would facilitate strong co-operation between traditional herbalists, scientists, and clinicians with acceptable arrangements for improved and loyal collaboration(23). In addition, studies indicated that this time, the collaboration between traditional medicine practitioners and modern medicine practitioners is needed than ever (24–26).
Beyond recommendation and demand evidences, there are start ups of collaboration between TM and MM practitioners. For example, the collaboration of traditional medicine and modern medicine in south Africa can be cite as a first endorsement (27). One hundred eighty three (24.8%) HCPs strongly disagree on TMPs mandate to refer COVID-19 suspected patients to health facilities and 173(23.5%) HCPs disagree on it. But 130(17.6%) HCPs were neutral on TMPs license to screen COVID-19 suspected patients and referring to health facilities. On the other side, 199(27%) and 52(7.1%) HCPs agree and strongly agree on referring COVID-19 suspected patients to health facility respectively. The present study’s report is in line with a study that suggested registration of traditional health practitioners to avoid illegal referrals of patients by allopathic health practitioners to traditional healers and vice-verse(28). However, there is a data that indicated the limitation of traditional healers; they delayed the referring of patients to hospital or health facilities(28). One hundred fifteen (15.6%) HCPs strongly disagree on recruiting TMPs in health facility and 277(37.6%) HCPs disagree on it. But 168(22.8%) HCPs were neutral about recruiting TMPs in health facility. On the other side, 143(19.4%) and 34(4.6%) HCPs agree and strongly agree on recruiting TMPs in health facilities respectively.
The present study displayed a low attitude on recruiting traditional healers in health facility that contradicts with the international labor organization’s statement(29). The international labor organization describe the job description of traditional and complementary medicine professionals; diagnose and treat human physical and mental illnesses, disorders and injuries using methods based on extensive study of specific cultural traditions and approaches towards medicine(29). But this difference might be because of that traditional herbalist in Ethiopia lack exhaustive training opposite to the precondition of international labor organization’s statement. One hundred seventy eight (24.2%) HCPs strongly disagree on better patient satisfaction on TM than MM and 206(28.0%) HCPs selected options disagree on it. But 136(18.5%) HCPs were neutral about better patient satisfaction after taking TM in relative to MM. On the other side 149(20.2%), and 68(9.2%) HCPs agree and strongly agree on better patient satisfaction on TM than MM respectively. The present study’s low attitude on patient satisfaction after taking TM than MM contradicted with a study that conducted at public hospitals in Malaysia revealed that a high level of satisfaction among patients who had received traditional treatment(30). The difference might be as a result of implementing the integrative management approach within the public hospitals in Malaysia(30) and the lack of integration in Ethiopia. In addition, the current study has a low level of attitude regarding patient satisfaction on TM compared to MM than a study conducted in China(31). The justification for such difference might be that the CTM is familiar and has well developed system as well as supported by laboratory. The mean attitude score of health professionals on integrating traditional and modern medicine increases when the health professionals profession is medical laboratory (B = 0.23, p-value < 0.005), but the mean attitude score decreases when the health professionals profession is pharmacy (B= -0.23, p-value < 0.005) or medical doctor (B= -0.83, p-value < 0.001). This variation might be attributable to the lack of training for health professionals about traditional medicine in Ethiopia despite the presence of hundreds traditional herbalists and the poor competence of traditional herbalists may affect HCP attitude. According the 2019 WHO report, there are an estimated 600 herbal medicine providers in Ethiopia but the Government does not officially recognize any traditional and complementary medicine training programmes(32). The mean attitude score of health professionals on integrating traditional and modern medicine increases when the health professionals employed in health center (B = 0.46, p-value < 0.001), private clinic (B = 0.40, p-value < 0.005), or zonal health department (B = 0.29, p-value < 0.005). However, the mean attitude score of health professionals decreases if the professionals are working in private pharmacy (B=-0.95, p-value < 0.001). The justification for such variation might be as a result of the culture developed the working place regarding traditional medicine. As it stated by Farmer in 1999, the culture to which we belong strongly influences our values, including our attitudes towards health. Knowledge, attitudes and skills play an important part in the adaption and maintenance of specific behaviors, including many consciously adopted health-related behaviors(33). In this study, the mean attitude score is decreasing when age and work experience increase by one unit. This might be due to the hostile attitude of the western medical establishment that precluded traditional practitioners’ involvement in public health as a data found from Sri Lanka (34, 35). In Ethiopia, there are contradicting papers about health care professionals’ attitude. Abebe and Ayehu (36) indicated that modern health practitioners stand against the promotion of traditional medicine and its integration with modern health care delivery system. However, Bishaw (37) and Getachew A. et al.(19) confirmed that the alleged antagonism is an exaggeration. Despite such controversy, the Ethiopian traditional herbalist is based on oral report or medico-magical and/or medico-spiritual manuscripts(36, 38, 39), which might be a cause to be overlooked by health care professionals, policy makers and customers.