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8/10/2019 Project - Use of Herbal Drugs
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CHAPTER ONE
1.0 INTRODUCTION
Herbal medicine also called botanical medicine or phyto-medicine refers to
using a plants seeds, berries, roots, leaved, barks or flowers for medicinal
purposes. Herbalism has a long tradition of use outside of conventional, medicine.It is becoming more main-stream as improvements in analysis and quality control
along with advances in clinical research show that value of herbal medicine in the
treating and preventing disease.
Plants had been used for medicinal purposes long before recorded history. Ancient
Chinese and Egyptians papyrus writings describe medicinal uses for plants as
early as 3,000 BC. Indigenous cultures (such as African and Native American)
used herbs in their healing rituals, while others developed traditional medical
systems (such as Ayurveda and Traditional Chinese Medicine) in which herbaltherapies were used. Researchers found that people in different parts of the world
tended to use the same or similar plants for the same purposes.
In the early 19thcentury, when chemical analysis first became available, scientists
began to extract and modify the active ingredients from plants. Later, chemists
began making their own version of plant compounds and, over time, the use of
drugs is derived from botanicals.
Recently, the World Health Organization estimated that 80% of people worldwide
rely on herbal medicines for some part of their primary health care. In Germany,
about 600 700 plant based medicines are available and are prescribed by some
70% of German physicians. In the past 20 years in the United States, public
dissatisfaction with the cost of prescription medications, combined with an interest
in returning to natural or organic remedies, has led to an increase in herbal
medicine use.
1.1
RESEARCH OBJECTIVES
The general objective of the research is to determine the factors affecting the
opinion of Lagos State Residents on the use of herbal drugs. The specific objectiveincludes:
i.
To determine the effect of:
a.
Occupation on the use of herbal drugs.
b.
Educational qualification on the use of herbal drugs
c.
Age of the use of herbal drugs
ii To identify problems associated with the use of herbal drugs.
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1.2
SCOPE OF STUDY
The research considers the Lagos populace as to see their view on the use of
herbal drugs. Samples were taken from the following local governments:
1.2.1 Alimosho LG
Alimosho is a Local Government Area in Ikeja Division, Lagos State,Nigeria. It is the largest local government in Lagos with 1,277,714
inhabitants according to the official 2006 Census (however, the Lagos State
Government disputes the official Census figures and claims a population
within the LGA of more than 2 million residents). It has now been
subdivided between several Local Community Development Areas (LCDA).
1.2.2 Ajeromi-Ifelodun LG
Ajeromi-Ifelodun is a Local Government Area in Badagry Division, Lagos
State. It has some 57,276.3 inhabitants/km2
, among if not the world densest.
1.2.3 Kosofe LG
Kosofe is a Local Government Area of Lagos State, Nigeria. Its headquarters
are in the town of Kosofe. It has an area of 81km2 and a population of
665,393 at the 2006 census.
1.2.4 Mushin LG
Mushin is a suburb of Lagos, located in Lagos State, Nigeria, and is one of
Nigerias 774 Local Government Areas. It is located 10km north of the Lagos
city core, adjacent to the main road to Ikeja, and is a largely a congested
residential area with inadequate sanitation and low-quality housing. It had
633,009 inhabitants at the 2006 census.
1.2.5 Oshodi-Isolo LG
Oshodi-Isolo is a Local Government Area (LGA) within Lagos State. It was
formed by the second republic Governor of Lagos State, Alhaji Lateef
Kayode Jakande, also known as Baba Kekere and the first Executive
Chairman of the Local Government was Late Chief Isaac Ademolu Banjoko.
The LGA is part of the Ikeja Division of Lagos State, Nigeria. At the 2006
census it had a population of 621,509 people, and an area of 45km2.
The research studies education, occupation and age as it affects the usage of
herbal drugs and the significance of probable problems to its usage.
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1.3
LITERATURE REVIEW
Tabuti et al (1993) in an article on traditional herbal drugs presented an inventory
of the medicinal plants of Bulamogi country in Uganda, including their medicinal
use, preparation and administration modes. Fieldwork for this study was
conducted between June 2000 and June 2001 using semi-structured interviews,questionnaires, and participant observation as well as transects walks in wild
herbal plant collection areas. They recorded 229 plant species belonging to 168
genera in 68 families with medicinal properties. A large proportion of these plants
are herbaceous. The medicinal plants are mainly collected from the wild. Some
species, such as Sarcocephalus latifoliys (Smith) Bruce, are believed by the
community to be threatened y unsustainable intensities of use and patterns of
harvesting. Particularly vulnerable are said to be the woody or the slow growing
species. Herbal medicines are prepared as decoctions, infusions, powders, or as
ash, and are administered in a variety of ways. Other concoctions consist of juicesand saps. The purported therapeutic claims await validation. Validation in our
opinion can help to promote confidence among users of traditional medicine, and
also to create opportunities for the marketing of herbal medicines and generate
incomes for the community. The processing packaging and storage of herbal
medicines is substandard and require improvement.
Yang et al (1999) in an article on rapidly progressive fibrosing interstitial
nephritis associated with Chinese herbal drugs noted that rapidly progress
fibrosing interstitial nephritis after a slimming regimen containing aristolochicacid has been identified as Chinese herbs nephropathy (CHNP). From 1995 to
1998, we observed 12 Chinese people from different areas of Taiwan who
underwent renal biopsy for unexplained renal failure. Medical history gave no clue
to the causes of impaired renal function except for the ingestion of traditional
Chinese herbs. Although these patients ingested herbal drugs from various sources
for different purposes, their renal biopsy samples showed amazingly similar
histological findings, with extensive hypocellular interstitial fibrosis and atrophy
and loss of tubules in all cases. Glomeruli were apparently intact. They also had
similar clinical features, such as normal or mildly elevated blood pressure, earlyand severe anemia, low-grade proteinuria, glycosuria, and insignificant urinary
sediments. Renal function deteriorated rapidly in most patients despite
discontinuation of the herbal medicines. Seven patients underwent dialysis, and
the remainder experienced slowly progressive renal failure. Bladder carcinoma
was found in one patient. Morphologically and clinically, the nephropathy in our
patients was similar to CHNP, reported in Belgium. Because of the complexity
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and unknown types of herbs used in different clinical situations, unidentified
phytotoxins other than aritolochic acid might be responsible for this unique
disease entity. We conclude that the relation of this nephropathy to the
consumption of Chinese herbs is striking. Using uncontrolled herbal remedies
carries a high risk for developing interstitial renal fibrosing and urothelia
malignancy.
Joshi and Kaul (2001)in a journal on herbal drugs were of the view that among
alternative therapeutic approaches that have shown global popularity during the
past decades, herbal medicine stands out as a major concern in the countries where
allopathic medicine prevails. The sales of herbal products as health care adjuvant
in these countries have increased exponentially. Lack of quality control,
commercial profiteering and exploitation leading to adulterations, lack proper
knowledge about the herbs and their contents that may exhibit drug-drug
interactions and other adverse side-effect, and inappropriate usage of the herbal
products have become a cause for concern in the health care professions,
particularly in the United States. This review provides an incisive description of
the known chemical, pharmacological, clinical and toxicological profiles of four of
the most widely used herbal products.
Choi et al (2002)in a journal on regulation and quality control of herbal drugs in
Korea pointed out that Korea has a great diversity in resources of medicinal plants.
The traditional herbal medicines and their preparations have been widely used in
Korea as well as in China and Japan for thousands of years. One of the
characteristics of Korean herbal medicine preparations is that all the herbal
medicines are incorporated into extractor at the same time and extracted with
boiling water during the decoction process. In this process, a variety of
interactions between the active components of several herbal drugs is more
difficult than that of western herbal drug. In this paper, we would like to present
an overview of the characteristics of regulation and quality control of herbal
medicines in Korea.
Jia et al (2003)in a book on antidiabetic herbal drugs in China stated that over the
centuries, Chinese herbal drugs have served as a major source of medicines for the
prevention of and treatment of disease including diabetes mellitus (known as
Xiao-ke). It is estimated that more than 200 species of plants exhibit
hypoglycaemic properties, including many common plants, such as pumpkin.
Wheat, celery, wax, guard, lotus root and bitter melon. To date, hundreds of herbs
and traditional Chinese medicine formulas have been reported to have been used
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(total aerobic mesophilic count, enterobacteria, coliforms, aerobic sporeformers,
yeasts and moulds, enterococci, lactobacilli, pseudomonades and aeromades) and
selective methods for detection of indicator microorganisms pathogens (E. coli,
enterohaemorrhagic E.coli (EHEC), Salmonella, Campylobacter jejuni,
Psudomonas aeruginosa, Bacillus cereus, Clostridium perfringens, Listeria,
coagulase-positive staphylococci, Candida albicans, potentially aflatoxigenic
moulds) were applied. The microbial load of the samples varied considerably.
While none of the samples contained EHEC, Salmonellae, Pseudomonas,
aeruginosa, Listeriae, Staphylococcus aureus or Candida albicans, four samples
were E.coli positive, two samples were presumptively Campylobacter jejuni
positive and none herbal drugs contained a potentially aflatoxigenic mould flora.
Further details regarding different viable count classes as well as preparation
techniques are discussed.
Ernst (2008) in an article on the adverse effect of herbal drugs in dermatology
noted that herbal treatments are becoming increasingly popular, and are often used
for dermatological conditions. Thus dermatologists should know about their
potential to cause adverse events. This review is aimed at addressing this area in a
semisystematic fashion. Some agents, particularly Chinese herbal creams, have
been shown repeatedly to be adulterated with corticosteroids. Virtually all herbal
remedies can cause allergic reactions and several can be responsible for
photosensitization. Some herbal medicines, in particular Ayurvedic remedies,
contain arsenic or mercury that can produce typical skin lesions. Other popular
remedies that can cause dermatological side-effects include St Johns Wort, Kava,
aloe vera, eucalyptus, camphor, henna and yohimbine. Finally, there are some
herbal treatments used specifically for dermatological conditions, e.g. Chinese oral
herbal remedies for atopic eczema, which have the potential to cause systemic
adverse effects. It is concluded that adverse effects of herbal medicines are an
important albeit neglected subject in dermatology, which deserves further
systematic investigation.
Stedman (2012) in an article on herbal hepatoxicity noted that herbal
hepatotoxicity is increasingly recognized as herbal medicines become more
popular in industrialized societies. Some herbal products may potentially benefit
people with liver disease; however, these benefits remain generally unproved in
humans, and a greater awareness of potential adverse effects is required. Herbal
use is often not disclosed, and this may result in a diagnostic delay and
perpetuation or exacerbation of liver injury. Female gender may predispose to
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hepatotoxicity, and concomitant agents that induce cytochrome P450 enzymes
may also increase individual susceptibility. The range of liver injury includes
minor transaminase elevations, acute and chronic hepatitis, steatosis, zonal or
diffuse hepatic necrosis, hepatic fibrosis and cirrhosis,veno-occlusive disease, and
acute liver failure requiring transplantation. In addition to potential for
hepatotoxicity, drug-drug interactions between herbal medicines and conventional
agents may affect the efficacy and safety of concurrent medical therapy. This
review focuses on emerging hepatotoxin and patterns of liver injury, potential risk
factors for herbal hepatotoxicity, and herb-drug interactions. Appropriate reporting
and regulatory systems to monitor herbal toxicity are required, in conjunction with
ongoing scientific evaluation of the potential benefits of phytotherapy.
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CHAPTER TWO
DATA COLLECTION
2.1
RESEARCH DESIGN
Survey design was used in the study. The data collected was primarily through the
use of a well defined questionnaire. The sampling technique where the entire
population is divided into groups, or clusters and a random sample of these
clusters are selected. All observations in the selected clusters are included in the
sample.
This method was used as the researcher cannot get a complete list of the
population of the state but can get a complete list of groups or clusters or local
government of the state.
This sampling technique was used as it is more practical and/or economical thansimple random sampling or stratified sampling.
2.2 SAMPLE SIZE
A sample size of 100 people was taken from five (5) randomly selected clusters
(local government) in Lagos State. Hence, the population considered in the
research is 500 people.
2.3 DATA COLLECTION METHOD
The type of data to be used as said earlier is primary data, and this would be
collected through the use of questionnaire (Appendix 1).
2.4 PROBLEMS OF DATA COLLECTION
Although the main tool to any research work, the process of getting statistical data
for analysis is always challenging and pains-taking. Quite a number of problems
arose but the core ones are:
i.
Although the data was collected during weekends when most of the targetrespondents will be available, convincing the respondent to respond to the
questionnaire was really cumbersome.
ii. Also, the choice of sample area (Local Government) was not easily made as
detailed information on each LGs in the State was collected and sampling
criteria considered.
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iii.
Finally, the cost of transportation and printing out the questionnaire was
also a problem.
2.5 ANALYTICAL METHOD
The methods considered in the research include:
Chi-Square: It is used to test frequency. The respondents has different options of opinion
to the question which will be presented as frequencies. Hence, the test was used.
Kruskal-walis: The questionnaire captured major likely problem affecting the great use of
herbal drug in Lagos. The kruskal-walis test compares samples from the same population
to see if theres a significant difference.
Wilcoxon Signed- Rank: This test is employed when the null hypothesis in the kruskal-
walis which always supports uniformity of the samples is rejected. It is used to identify
the sample(s) that have different performance.
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CHAPTER THREE
DATA ANALYSIS
It is claiming that individual of different occupation and educations are rapidly embracing
the idea of the use of herbal drugs as it offers cure for a wide range of diseases. The claim
also covers that more and more people are going into the production and sales of herbal
drugs as it is economical and easily-found.
3.1 HYPOTHESIS TESTING
3.1.1 Hypothesis One
Ho: Use of herbal drugs is independent on occupation
Hi: Use of herbal drugs is dependent on occupation
Decision Rule: Accept H0if -value < 0.05, otherwise reject.
Table 3.1.1: Test Statistics
Occupation
Chi-Square
df
symp.Sig.
209.631
5
.000
a.
0 cells (0.0%) have expected
Frequencies less than 5.
The minimum expected cell
frequency is 81.8.
2cal = 209.631and = 0.00
Conclusion: Occupation in Lagos state influence the use of herbal drugs.
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3.1.2 Hypothesis Two
Ho: Use of herbal drugs is independent on education
Hi: Use of herbal drugs is dependent on education
Decision Rule: Accept H0if -value < 0.05, otherwise reject.
Table 3.1.2: Test Statistics
Education
Chi-Square
df
symp.Sig.
303.11
5
.000
b.
0 cells (0.0%) have expectedfrequencies less than 5.
The minimum expected cell
frequency is 81.8.
2cal = 303.11and = 0.000
Conclusion: Education in Lagos state influence the use of herbal drugs.
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3.1.3 Hypothesis Three
Ho: Use of herbal drugs is independent on age of usage
Hi: Use of herbal drugs is dependent on age of usage
Decision Rule: Accept H0if -value < 0.05, otherwise reject.
Table 3.1.3b: Test Statistics
age
Chi-Square
df
symp.Sig.
46.109a
1
.000
c.
0 cells (0.0%) have expectedFrequencies less than 5.
The minimum expected cell
frequency is 250.0
2cal = 46.109and = 0.000
Conclusion: Age of usage in Lagos state influence the use of herbal drugs.
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3.2 TEST ON PROBLEMS WITH HERBAL DRUGS
RS = Repulsive Smell, BT = Bitter Taste, LoD = Lack of Dosage, PQC = Poor
Quality Control and PAP = Poor Appearance Package
= i = 1, 2, 3, . . ., n
SD =
Table 3.2a: Descriptive Statistics
N Mean Std. Deviation Minimum Maximum
RS
BT
LoD
PQC
PAP
5
5
5
5
5
96.0000
89.0000
91.4000
92.0000
94.2000
122.57039
120.39103
81.08206
60.86050
50.42519
2.00
3.00
13.00
5.00
26.00
262.00
258.00
225.00
166.00
165.00
Ho: Pvi~N(0,1)
Hi: Piv N(0,1)
Decision Rule: Accept H0if -value < 0.05, otherwise reject.
X 1n
n - 1
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Table 3.2b: One-Sample Kolmogorov-Smirnov Test
RS BT LoD PQC PAPN
MeanNormal Parameters
a,b
Std. Deviation
Absolute
Most Extreme Differences Positive
Negative
Kolmogorov-Smirnov-z
Asymp.Sig. (2-tailed)
5
96.0000
122.57039
.348
.348
-.222
.779
.579
5
89.0000
120.39103
.360
.360
-.238
.805
.536
5
91.4000
81.08206
.248
.248
-.167
.555
.918
5
92.0000
60.86050
.159
.124
-.159
.355
1.000
5
94.2000
50.42519
.231
.231
-.161
.516
.953
a. Test distribution is Normal.
b.
Calculate from data.
Conclusion: Reject H0that the associated problems (RS, BT, LoD, PQC and PAP) do not
follow the normal distribution (Asymp. Sig. 0.597, 0.536, 0.918, 1 and 0.953 > 0.05).
Hence the non-parametric analysis.
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3.2.1 Kruskal-Wallis Test
H0: RS = BT = LoD =PQC = PAP = 0
vs
H1: Tis 0 (for at least an i)
KN = - 3(N + 1) ~ KN
Decision Rule: Accept H0if -value < 0.05, otherwise reject.
3.2.1a: Test Statistics
a.
Kruskal Wallis Test
b.
Grouping Variable Response
Conclusion: Theres a statistically significant difference between the associated problems
of using herbal drugs (2cal= 4.000, = 0.406)
RS BT LoD PQC PAP
Chi-Square
df
symp.Sig.
4.000
4
.406
4.000
4
.406
4.000
4
.406
4.000
4
.406
4.000
4
.406
i = 1
R12
k
12
N (N+1)
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3.2.2 Wilcoxon Signed- Rank Post-Hoc Test
H0: T1= TK = 0 vs
H1: Tis Tk 0 (for at least an i and k)
Table 3.2.2a: Test Statistics
a.
Wilcoxon Signed Ranks Test
b.
Based on positive ranksc.
Based on negative ranks
Table 3.2.2b: Table of Significance
Pair Z-value
Asymp. Sig. (2-
tailed) Conclusion
RS-BT
RS-LoD
RS-PQCRS-PAP
BT-LoD
BT-PQC
BT-PAP
LoD-PQC
LoD-PAP
PQC-PAP
-1.735
-0.135
-0.405-0,405
-0.135
-0.405
-0.135
-0.674
-0.368
-0.405
0.08
0.893
0.6860.686
0.893
0.686
0.893
0.5
0.713
0.686
Significant difference
No Significant difference
No Significant differenceNo Significant difference
No Significant difference
No Significant difference
No Significant difference
No Significant difference
No Significant difference
No Significant difference
BT-RS
LoD- RS
PQC -RS
PAP- RS
LoD- BT
PQC -BT
PAP- BT
PQC -LoD
PAP-
LoD
PAP -PQC
z
Asymp.Sig.
(2-tailed)
-1.753
.080
-.135
.893
-.405
.686
-.405
.686
-.135
.893
-.405
.686
-.135
.893
-.674
.500
-.368
.713
-.405
.686
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CHAPTER FOUR
SUMMARY, CONCULISON AND RECOMMENDATIONS
4.1 SUMMARY
The research was carried-out to determine rate of herbal drugs usage in Lagos
State using a well-defined questionnaire. The state was divided into clusters (Local
Governments) and a random sample of 100peoples each was taken from five (5)
randomly selected clusters. The response was analyzed using SPSS V21.
4.2 CONCLUSION
Analysis led to the following conclusions:
i. The education, occupation and age of Lagosians positively affect the use of herbal
drugs in that order.
ii.
The associated problems considered (Repulsive smell, Bitter taste, Lack of
Dosage, Poor Quality Control and Poor Appearance Packaging) significantly
contributes to the poor use of herbal drugs in the state.
iii.
The taste and smell of these drugs contributed more than other identified problem
to the poor use of herbal drugs.
4.3 RECOMMENDATIONS
In view of the analysis carried out to improve the spread and appreciation of the
use of herbal drugs i.e her best use, the following suggestions are strongly
recommended.
i.
Other factors responsible for the use of herbal drugs should be sought out like that
is the status of respondents.ii.
The taste and smell of herbal drugs should be considered
iii. A further research is advisable as cases of different sickness springs-out on daily
basis.
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APPENDIX 1
General Response
Response Repulsivesmell
Bitter taste Lack of dosage Poor QualityControl
PoorAppearance of
Packaging
Strongly agreed 193 176 102 166 102
Agreed 262 258 225 123 165
Disagreed 9 4 62 65 75
Stronglydisagreed
14 3 55 101 103
Undecided 2 4 13 5 26
Response Occupation Response Educational
qualification
Response Age
Civil servant 193 FSLC 181 Single 303
Self
employed
262 O LEVEL 97 married 197
Politician 9 Diploma/ON/NCE 102
student 14 BSc/BEd 542 Masters 39
PHD 18
Total 480 Total 491 Total 500
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APPENDIX 2
N-Par Tables
Chi-Square table on Occupation
Observed N Expected N Residual
1.00
2.00
3.00
4.00
Total
103
175
69
134
481
120.3
120.3
120.3
120.3
-17.3
54.8
-51.3
13.8
Chi-Square table on Education
Observed N Expected N Residual
1.00
2.00
3.00
4.00
5.00
6.00
Total
181
97
102
54
39
18
491
81.8
81.8
81.8
81.8
81.8
81.8
-99.2
15.2
20.2
-27.8
-42.8
-63.8
Chi-Square table on Age
Observed N Expected N Residual
1.00
2.00
Total
303
197
500
250.0
250.0
53.0
-53.0
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APPENDIX 3
Kruskal wallis Test Table
Ranks
Response N Mean
Rank
RS
1.00
2.00
3.00
4.00
5.00
Total
1 4.00
1 5.00
1 2.00
1 3.00
1 1.005
BT
1.00
2.00
3.00
4.00
5.00
Total
1 4.00
1 5.00
1 2.50
1 1.00
1 2.50
5
LoD
1.00
2.00
3.004.00
5.00
Total
1 4.00
1 5.00
1 3.001 2.00
1 1.00
5
PQC
1.00
2.00
3.00
4.00
5.00
Total
1 5.00
1 4.00
1 2.00
1 3.00
1 1.00
5
PAP
1.002.00
3.00
4.00
5.00
Total
1 3.001 5.00
1 2.00
1 4.00
1 1.00
5
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APPENDIX 4
Descriptive StatisticsN Percentiles
25th 50th (Median) 75th
RSBTLoD
PQCPAP
555
55
5.50003.5000
34.0000
53.000050.0000
14.00004.0000
62.0000
123.0000102.0000
227.5000217.0000163.5000
165.5000134.0000
RanksN Mean Rank Sum. of Ranks
BTRS
Negative Ranks
Positive Ranks
TilesTotal
4a
1b
0
c
5
2d
3e
0f
5
2g
3h
0i
5
2j
3k
0i
5
2m3n
0o
5
2p
3q
0r
5
2s
3t
0u
5
2v
3w0x
5
1y
3z
1aa
5
3.50
1.00
3.50
2.67
3.00
3.00
4.50
2.00
3.502.67
3.00
3.00
3.50
2.67
2.50
3.33
4.00
2.00
14.00
1.00
7.00
8.00
6.00
9.00
9.00
6.00
7.008.00
6.00
9.00
7.00
8.00
5.00
10.00
4.00
6.00
LoDRS
Negative Ranks
Positive Ranks
Tiles
Total
PQCRS
Negative Ranks
Positive Ranks
Tiles
Total
PAPRS
Negative Ranks
Positive Ranks
Tiles
Total
LoDBT
Negative Ranks
Positive Ranks
Tiles
Total
PQC- BT
Negative Ranks
Positive Ranks
Tiles
Total
PAP- BT Negative Ranks
Positive Ranks
Tiles
Total
PQCLoD
Negative Ranks
Positive RanksTiles
Total
PAPLoD
Negative Ranks
Positive Ranks
Tiles
Total
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PAP - PQC
Negative Ranks
Positive Ranks
Tiles
Total
2ab
3ac
0ad
5
4.50
2.00
9.00
6.00
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STUDENT RESEARCH QUESTIONNAIRE
Please, I am a final year student of University of Nigeria, Nsukka. I really need your
assistance in carrying out a research on A Statistical Analysis of Opinion of Lagos State
Residents on the use of herbal drugs. Please be assured that the information given will
be treated with high confidentially.
Age:------------------------------------------------------------------------------------------------
Educational Level:-------------------------------------------------------------------------------
Occupation:----------------------------------------------------------------------------------------
Age:-------------------------------------------------------------------------------------
Place of Work:------------------------------------------------------------------------------------
Tick the following according to your opinion on the statement.
USAGE OF HERBAL DRUGS SA A SD D U
We use herbal drugs in my family
Herbal drugs are effective
Herbal drugs are expensive
Herbal drugs are common
Herbal drugs should be taken by people above 18yrs
PROBLEMS ASSOCIATED WITH THE USE OF
HERBAL DRUGS
SA A SD D U
Herbal drugs have a repulsive smell
Herbal drugs have a bitter taste
Herbal drugs do not have proper dosage
Herbal drugs do not have quality control
Herbal drugs are not properly package