Prevalence and Pattern of TCAM use in the study communities
This study revealed some interesting findings, some of which tally with literature and some that do not tally with prevailing trends of traditional, complementary and alternative medicine (TCAM) use. This study shows the prevalence of TCAM therapy use to be 68.5% which is lower than the 74.22% reported in Ethiopia, 77.5% reported in Nigeria  and also less than the 80% reported by the WHO. It was however greater than the prevalence of 58.2% obtained in a systematic survey for Sub Saharan Africa , and greater than the 60.0% TCAM use among respondents in Zimbabwe  and the 592 (55.5%) reported in Malaysia . Differences in prevalence may be due to differences in study sites and in the sample sizes, as most studies in the systematic survey for SSA had sample sizes less than 500. The prevalence of TCAM use in Cameroon was much higher than that reported elsewhere in the industrialized world, ranging between about 29% in the USA  to about 49% in Australia .
Based on the use of TCAM therapy by health District, Tiko (72.2%) and Buea (69.9%) Health districts recorded the highest users of TCAM therapy as compared to Limbe(63.9%) and this difference was statistically significant(X = 5.632 p=0.056). This might be due to differences in location with the availability and accessibility to natural plants, coupled with mount Fako in Buea which is rich in diverse plant flora compared to Limbe. The majority of TCAM users were adults (42.8%), Elders (23.8%) and Pregnant women (18.6%) while children (14.8%) were the least TCAM users. These population category was slightly different from that in Ethiopia where by complementary and alternative medicine was most commonly given to the elderly (32.62%), adults (24.11%), followed by children (17.02%) and pregnant women (2.13%) . The prevalence of herbal medicine use among pregnant women was 18.6% which was less than that obtained in Nigeria 36.8%  but greater than the 2.13%  obtained in Ethiopia. This can be due to the differences in the spatial distribution of the sample population. TCAM is highly use among the young adults despite their level of education and access to orthodox health services, which show that the knowledge and usage of TCAM is evergreen regardless of the ancient age of TCAM. Among the users of TCAM therapy, 61.4% use TCAM products while 18.7% visited TCAM practitioners only, while 20.0% use both. Studies conducted in Africa shows the prevalence of TCAM product use in the general population [22-24] ranging from 4.6% (urban settlement in Ethiopia)  to 94% (semi urban settlements in Nigeria and Ethiopia) [26-27], with an estimated average of 58.2%. Some studies [28-32] reported on TCAM practitioner utilization (1.2%–67% (mean, 28.8%). A lower prevalence (1.2%–44.1% (average, 12.6%) of TCAM practitioner services use was observed in studies with large sample sizes [32-35] compared with other studies [35, 36-37] with smaller samples (37.5%–67% (mean, 53.0%). This was in line with our study with a large sample size of 1100 participants in the general population recording an 18.7% of TCAM practitioner use compared with smaller size sample sizes. This prevalence of TCAM practitioner use may be higher in disease specific subpopulations compared to the general population. Peltzer. et al (2016)  obtained prevalence of TCAM provider use, in Australia 34.7%, in Europe ranging from under 10% in Bulgaria, Poland and Slovenia to 35.4% in France, in Asia from 16.7% in Russia to over 50% in China mainland, the Philippines and Republic of Korea, and over 20% in the USA, Chile and South Africa. The majority of the community members mostly use the services of herbalists, bone setters, followed by diviners. Similar findings were obtained in the Northwest Region of Cameroon where mostly the services of herbalists, traditional bone setters, diviners and traditional birth attendants where sorted for by the general population . Our findings were similar to that in Tanzania where diviners, herbalists, traditional birth attendants, and bone setters were mostly visited by the general population . Close to half of the population use TCAM for acute conditions (44.6%) or for chronic (43.6%) conditions while a small proportion use TCAM to maintain wellbeing. Our findings were not congruent with that obtained by Peltzer. K et al (2019) , in which 53.7% of the participants used TCAM for treating a chronic or long-term health condition, 40.0% used TCAM in order to improve well-being and 6.3% for treating an acute illness. According to Bannerman RH et al.,  complementary and alternative medicine is used by the people for the management of chronic conditions that are costly to society, such as chronic pain and arthritis, and more life-threatening diseases such as heart disease and cancer, which gives strength to the TCAM than orthodox, thus a need for integration to overcome the weaknesses of each.
Community use of TCAM to prevent COVID-19
Allium sativium (garlic), Azadirachta indica, Zingiber officinale, Artemisia annua, Carica papaya were mostly used in combination with other plants to prevent COVID-19 in the communities. Our findings were similar to that obtained in previous studies i.e in Madagascar a combination of artemisia, neem leaves, paw leaves, garlic, ginger, lime and oranges has been adopted as a notable anti-COVID agent . These herbs are boiled together for 30 min and steam-inhaled. Expectedly the steam inhalation clears the lungs of the virus . Our findings were also in line with that obtained in Nigeria in which phenolic compounds and antioxidant properties of these herbal remedies are known to contribute to their therapeutic effects . Consumption of these Nigerian herbal remedies increase the anti-oxidant molecules and enzymes in the body and protect the cells and its membrane from being damaged by the toxic substances [43,44]. Phenolic moieties boost the body's immunity and defense against the threatening virus . Scientists from the academia and Research Institutes have also supported the use of these herbal remedies as anti-COVID agents.
Herbal preparations used by traditional healers for COVID-19
This study brings out a number of herbal remedies used by traditional healers for COVID-19 which was congruent with that obtained by Fongnzossie et al (2021)  who reported the use of herbal remedies including Azadirachta indica, Zingiber officinale, Artemisia annua, Carica papaya for the treatment of COVID-19 with symptoms such as sore throat, cough, catarrh, fever and jointpains. Azadiracta indica (neem) is one of the most used plants in the treatment of malaria in many parts of Africa and Asia where malaria is endemic. Roger, et al.(2020) provides proof that the neem plant can provide anti-viral effects for COVID-19. Similar plants species were reported as potential agents for COVID-19 in Ethiopia . These included, Lepidium sativum , Azadirachta indica , Osyris quadripartite  and Allium sativum . Citrus aurantium L., Citrus limon (L.) Burm. f., Capsicum annuum L., Eucalyptus globulus, Osyris quadripartite, Amaranthus hybridus Linn were also cited as effective against COVID-19 .
Determinants of TCAM use in the General population
Age above 41years, farming as occupation, having attained tertiary education, having a monthly income above 185USD, residing in a rural setting, being knowledgeable on TCAM and having a positive attitude towards TCAM were strongly associated with the use of TCAM. However, age group was different compared with other study as ages between 18–28 and 29–38 years were associated with the use of TCAM in Ethiopia . Similar findings were obtained in the Bui-Division of Cameroon where most patients reported visiting the traditional healers because of the low cost (69%) and low level of income .
Our findings were also congruent with Karl et al  in which middle age, being a female, lower educational status, not having a religious affiliation, larger household size, not having a health insurance, could not pay for medical treatment when needed it were associated with TCAM provider use. Also the authors showed that having a chronic condition or disability, and having positive attitudes towards TCAM (TCAM being better than mainstream medicine and TCAM does not promise more than it can deliver) significantly increased the odds of TCAM provider use. However, our findings were different from that obtained from Cambodia whereby being a female (AOR = 1.42, 95% CI = 1.12–2.67), haven completed less schooling (AOR = 0.66, 95% CI = 0.45–0.96), unemployed or homemakers (AOR = 0.23, 95% CI = 0.13–0.52) and have a gastrointestinal illness (AOR = 0.49, 95% CI = 0.39–0.62) were associated with TCAM use . Findings were similar to that obtained in Ethiopia whereby age (P = 0.02), especially age group between 18 and 28 and 29 and 38 ((P = 0.02 and 0.004, resp.), educational status was also significantly associated with TCAM use (P=0.00). Moreover, occupation (P=0.00) and effectiveness of TCAM (0.002) were found to be associated with TCAM use . Our findings were however different from study in the general population in Ghana which shows that TCAM use was predicted by having low-income levels [odds ratio (OR) 2.883, confidence interval (CI) 1.142–7.277], being a trader (OR 2.321, CI 1.037–5.194), perceiving TCAM as effective (OR 4.430, CI 1.645–11.934) and safe (OR 2.730, CI 0.986–4.321), good affective behavior of traditional medical practitioner (TMP) (OR 2.943, CI 0.875–9.896) and having chronic ill-health (OR 3.821, CI 1.213–11.311) were associated with TCAM use . Differences in the predictors of TCAM use may be due to difference in study population.
Prevalence of TCAM use was measured within a standard pattern of TCAM use within the past 12 months. As a limitation to this study there is the possibility of recall bias and thus an under or over reporting of prevalence for TCAM use. Thus to overcome this, further questions were asked and a large sample size to overcome such limitations.