Traditional medicine (TM) is defined as “health practices, attitudes, knowledge, and beliefs that incorporate manual therapies, spiritual therapies, plant, animal, and mineral-based medications, and methods and exercises used singly or in combination (1). Approximately, 80% of the global population utilizes TM and the use is higher (95%) among developing countries (2). In Africa, approximately 90% of the population depends on TM use, especially in sub-Saharan Africa. In Ethiopia around 80% of the population relies on herbal medicine as their primary source of health care (2, 3).

Despite there was variation in the utilization of TM to children between countries; parental TM use to children was higher with an estimated rate of 30 to 90.3% (4, 5) and its prevalence rate was higher in low income countries. Its high prevalence in developing countries might be explained as the poor economic status of the parents which leads them to frequently use TM for health of their children compared to the modern medicine (4–7). In Ethiopia even though most of previous studies were conducted in adult population, very few studies reported that the prevalence of parental TM use to children is high which reaches up to 90.3% (8–10).

Evidences documented that socio-demographics characteristics of both children’s (i.e., girl, younger age) and parents’ (i.e., female sex, older age, farmer occupation, rural residence, low income, low educational level, and having a good attitude about TM) were associated with high utilization of TM. In addition, TM-related characteristics such as easy accessibility, low price, and effectiveness of TM were factors primarily associated with increased utilization of TM among children (4, 7, 8, 10–15). In Ethiopia, easily accessibility, low price, low educational level, inaccessibility of modern health services, closely corresponding to the patient’s ideology, and less paternalistic than modern medicine leads people to depend on TM for their healthcare needs (1, 9, 15, 16). Other factors such as presence of different biodiversity, beliefs, cultures, and languages among Ethiopian population also contribute to increased of utilization of TM (9, 17). In Ethiopia, studies conducted so far are very limited; focused on adult TM practices (18–21) and the use of TM has not been widely studied among children. In addition, TM in Ethiopia is not uniformly practiced and its uses are considerably diverse and vary significantly between regions (22). The standard policies and regulations to govern TM use are too weak or do not exist at all. Instead, the users are associated with cultural beliefs. Both TM practices and child health are priority issues of Ethiopia. However, little is known about factors for TM use by parents for children in Ethiopia and to the best of the authors’ literature search; no study have been conducted in the study setting. This study was aimed to determine the prevalence and associated factors of parental TM use for children at the pediatric outpatient department ward (POPD) ward of the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia (UOGCSH), Northwest Ethiopia.

Even though TM plays an important role among the Ethiopian society, the national health system neither studied the full therapeutic potential of TM nor estimated that the accurate potential adverse effects. In Ethiopia more than half of all TM are prescribed, dispensed as well as sold illegally by a traditional healer and half of all users take TM medicine incorrectly (23). Moreover, as children are dependent on their parents and cannot fight for their health rights, some harmful traditional health practices were found to be killing practices for children. These practices violating the children’s health rights and hindering the country from achieving millennium development goal (MDG 4) (24). Excessive utilization of TM to children is associated with negative or dangerous effects such as developing complications and many children are hospitalized due to adverse effects of TM (25, 26). In addition to this, utilization of TM causes delays in seeking medical care in case of fatal diseases especially in children (7, 27–29).

Since neither the full therapeutic potential nor the potential adverse effects of TM is not well estimated (17), better regulation and control of utilization of TM in vulnerable group of population particularly in children is mandatory. For developing policies which are concerned with better control, regulation and appropriate use of TM understanding the factors associated with increased childhood TM utilization is very crucial and it will fill the knowledge gaps regarding extent of parental TM to children and its determinants. The finding of the study will serve as a baseline information for policy decisions of international organizations which works for safe and effective use of TM and it will assist in supporting the achievement of the WHO TM utilization goal “promoting safe and effective use of TM through regulation, evaluation, and integration of TM products, practices and practitioners into health systems as appropriate” (22) and giving direction to minimize the deleterious effect of excessive utilization of TM on the lives of children. Further, this study will provide baseline information for similar studies that are going to be conducted in the future.

Despite there is explosive growth in the utilization of TM among different group of population, neither the full therapeutic potential nor the potential adverse effects of TM is not well estimated (17). Thus, ensuring safe, effective and appropriate utilization of TM through better regulation and control of utilization of TM in vulnerable group of population particularly in children is mandatory. For achieving this, understanding the factors associated with increased childhood TM utilization is very crucial. Thus, purpose of this study was to determine the prevalence and associated factors of parental TM use for children at the pediatric outpatient department ward (POPD) ward of the UOGCSH, Northwest Ethiopia. In the current study, the prevalence of parental TM use for children within the last 12 months was 86.5% (95% CI: 82.50–90.00). Having good perception of the parents regarding the level of efficacy of TM, history of using TM for self, occupation specifically; being housewife, daily laborer, and government employee were significantly associated with parental TM use for children.

This study showed that parental TM use to children was 86.5% (95% CI: 82.50–90.00). This finding was almost consistent with the previously conducted studies in Ethiopia, Motta town (88.2%) (12), Tole District (85.9%) (17), and Mecha District (90.3%) (13). However, it was higher than studies done in Korea (65.3%) (18), Wales (41%) (19), Sudan (70%), Nigeria, (29.5%) and Southern Arizona (64%) (20). The reason for this high prevalence might be Ethiopia’s low socio-economic status in which 90% of its population to relied on TM (30). In addition to the poor economic status of the parents which leads them to use TM more frequently to their children than modern medicine, the presence of different biodiversity, beliefs, cultures, and languages among Ethiopian population may also contribute to increased of utilization of TM to children (9, 17, 27, 29). Further possible explanation for this difference might arise from methodological and cultural differences between the studies area. In addition, the use of TM for their children within the previous 1 month was 17.83%, which was similar to a study conducted in Motta (19.2%) (12) and Fagita Lekoma (17.3%), Ethiopia (11). This result was higher than a research done in Indonesia (6.2%) (16) and Taiwan (4.7%) (15).

In this study the most frequent illness for which TM was indicated were fever (84.3%) and respiratory illness (30.2%). This was in line with a study conducted in Turkey (8). This might be explained by the high prevalence of respiratory infectious disease specifically community-acquired pneumonia in the study setting of the current study (21).

Herbal medicine (94.8%) and religious/pray (83.5%) were the most commonly used types of TM for children. This was supported by previous studies which were conducted to determine the prevalence of caregivers’ utilization of TM for their children (8, 9, 12, 20, 22). An interesting finding in this study was tonsillectomy (77.3%) and tooth extraction (59.6%) were among the most commonly used types of TM. This is finding implies that healthcare providers need to educate parents about the disadvantages of home based tonsillectomy and tooth extraction procedures with the help of traditional healer, as these procedures may put children at high risk for future cardiac illness such as acute rheumatic fever and infective endocarditis.

The parents described that cultural belief (36.9%), religious belief (28.69%), and easy accessibility (17.41%) were their main reasons to use TM for children. Other studies also reported that cultural belief, religious belief, and easy accessibility were the major reasons for using TM for children (11, 23). Literatures also described that, in Ethiopia, as the users are associated with cultural beliefs, TM is not uniformly practiced and its uses are considerably diverse and vary significantly between regions (25, 26). In the present study family (60.17%) and neighbors (34.26%) were the two most frequent sources of information for the parents to use TM for their children. Supporting this finding several studies described that both family and neighbors were the most common sources of information for using TM in children (8, 11, 12, 24).

In this study, most of the parents (87.3%) reported that they did not disclose TM use and not being asked by the health care professional (88.7%) about their use was their primary reason for not disclosing. This was in agreement with previous studies, which showed that 49 to 92% of the parents had not disclosed complementary and alternative medicine use in their children to a physician/nurse (19, 24–26). A significantly higher number (80.8%) of respondents stated that they would discontinue TM if their doctor asked them to stop TM. Similarly, a study in Ghana also found that more than three-fourths (88%) of households said they would withhold herbal medicines if a child was taking modern medicines (27). This finding highlight that, during provision of healthcare services to children, healthcare professionals should ask parents regarding whether they give any TM including herbal medicine to their child not.

In this study compared to parents who had a very poor perception about the level of efficacy of TM, those who had good perception were 3.658 times more likely to use TM for their children. Inconsistent with this finding, previous studies demonstrated that positive attitude, favorable perception and stronger belief about effectiveness of TM and CAM was significantly associated with using TM and CAM (12, 28, 29, 31). In the present study parents who had history of taking TM for themselves were 3.259 times more likely to use TM for their children compared to those who had no history of taking TM. A previous study in Ethiopia also described that parental self-TM use was significantly associated with higher utilization of TM for children (32). Similarly, a study conducted in Iran also explained that parents with previous positive experiences of CAM were significantly more likely to use CAM for their children (30). In this study, parents who were house wife, daily laborer, and government employee were 3.760, 2.860, and 4.134 times more likely to use TM for their children when they compared with parents who were employed in private organization, respectively. This result was comparable with the study conducted in Southwest Ethiopia which indicated that house wife and government employee were more likely to practice TM compared to other group of occupations (33). In Ethiopia, because of its easy accessibility and affordability, TM is used as an alternative medical practice. However, its excess utilization in pediatric age group of population may leads to some adverse clinical effects. Further, despite both TM practices and child health are priority issues of Ethiopia. The standard policies and regulations to govern TM use are too weak or do not exist at all. Thus, assessment of the major reasons for high utilization of TM to children is important for developing strategies which are essential for better control and regulation of TM utilization in children. Thus, finding of this study will fill the information gap regarding the magnitude and factors associated with utilization of TM children specifically in the study setting. Educating of parents about TM is essential and emphasis should be given for future studies on efficacy and safety of TM use in children. Since the current study was conducted cross-section ally, cause-effect relation between practice of parental TM use for children and its significant associated factors cannot be established. As it assessed past history of utilization of TM it experience recall bias. Additionally, it was carried out in a single centered health facility and this may limit the generalizability of the study findings.

This study showed that the prevalence of parental TM use to children was high. Parents who had good perception on level of efficacy of TM, history of taking TM for themselves, housewife, daily laborer and government employee were more likely to use TM for their children. This study highlight parent related characteristics specifically past history of using TM, occupation; housewife, daily laborer and government employee, and their positive perception towards TM efficacy were factors associated with increased use of TM to children. Thus, educating of parents about TM is essential. Further, emphasis should be given for future studies on efficacy and safety of TM use in children.