The Use of Traditional Health Care Among Indonesian Family

Background: The use of traditional medicine and complementary and alternative medicine has increased signiﬁcantly over the past few years. The main reasons for the increasing use of traditional medicine is a growing trend for patients to take a more proactive approach to their own health and to seek out different forms of self-care. This study aimed to investigate the dominant risk factors that related to use of traditional health care among Indonesian family Methods: The study used household data from 2013 National Health Survey Indonesia. Using cox regression, we then could present dominant risk factors that related to use of traditional health care among Indonesian family Results: Total subjects had been analyzed were 294,959 subjects. The proportion of those who used of traditional health care were 30,4% (78,775/294,959). Dominant risk factors related to used of traditional health care were type area, level of education, employment status, level of economic, and knowing about the availability of health care. Compared with those who were in rural, those who were in urban had 14% more likely to used of traditional health care. Household who had higher education level had 85% more likely to used of traditional health care. Household who were employed had 18% more likely to used of traditional health care. Household who had higher economic level had 45% more likely to used of traditional health care. Furthermore, household who knowed about the availability of health care had 32% more likely to used of traditional health care. Conclusion: Household subjects who were in urban area, employed, had higher level of education and economic, knowed the availability of health services were more likely to used of traditional health care

The use of traditional medicine and complementary and alternative medicine has increased significantly over the past few years. Almost half the population in many industrialized countries now regularly use some form of T/CAM (United States, 42%1; Australia, 48%2; France, 49%3; Canada, 70%4), and considerable use exists in many developing countries (China, 40%; Chile, 71%; Colombia, 40%; up to 80% in African countries5,6). 1 Traditional medicine is the sum total of the knowledge, skill, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement or treatment of physical and mental illness. The terms "complementary medicine" or "alternative medicine" refer to a broad set of health care practices that are not part of that country's own tradition or conventional medicine and are not fully integrated into the dominant health-care system. They are used interchangeably with traditional medicine in some countries. 2 Traditional medicine and complementary medicine is widely used around the world and valued for a number of reasons. For many millions of people, herbal medicines, traditional treatments, and traditional practitioners are the main source of health care, and sometimes the only source of care. This is care that is close to homes, accessible and affordable. It is also culturally acceptable and trusted by large numbers of people. The affordability of most traditional medicines makes them all the more attractive at a time of soaring health-care costs and nearly universal austerity. Traditional medicine also stands out as a way of coping with the relentless rise of chronic non-communicable diseases. 2 The main reasons for the increasing use of traditional medicine is a growing trend for patients to take a more proactive approach to their own health and to seek out different forms of self-care.
The public in many countries is using health care services that are outside the purview and understanding of the dominant medical system. Complementary and traditional medical services are often used alongside (and in addition to) conventional medical treatments. 1 Health care utilization is the use of health care services by people. 3 It is the objective of policy makers that health facilities are used whenever necessary. The health care utilisation of a population is related to the availability, quality and cost of services, as well as to social-economic structure, and personal characteristics of the users. 4,5,6 Social, cultural, and political values, as well as socioeconomic factors, influence T/CAM use in industrialized societies. 7,8,9,10 In most developing nations, distance plays a key role in determining utilization of health services. Buor found that distance is the most important factor that influences the utilization of health services in the Ahafo-Ano south district of Ghana. 11 In a study in rural areas in Nigeria on the effects of distance on utilization revealed that longer travel times and greater distances to health centers in rural areas constituted barriers to repeated visits. 3 This study aimed to identify risk factors that related to use of traditional health care among Indonesian family

METHODS
This analysis used households data of the National Basic Health Research (Riskesdas) data year 2013 in Indonesia. Riskesdas 2013 was a cross-sectional community based study designed mainly to describe health problem of Indonesians and oriented to the evaluation of achievement of health indicator. The population of Riskesdas 2013 was all households in 33 provinces, 497 districts. Samples of households and household members in Riskesdas 2013 was designed separately to the sample list of households and household members from national economic survey (Susenas) 2013. The number of samples analyzed were 294,959 households. 12 The collection of Riskesdas 2013 data was using households and individual questionnaires. Data was conducted by interview using questionnaires and questionnaire's guidelines. Respondents for household questionnaire were heads of households or housewives or members of households that can provide information. In households questionnaire contained information on whether all members of the households were interviewed directly, accompanied, represented, or not at all were interviewed. 12 The collection of individual data on the various age groups conducted by interview using a individual questionnaire. Respondents for individual questionnaire were every member of the households. Especially for household members who aged less than 15 years or the respondents who were sick, interviews were conducted to other members of households who could accompany. Before the Riskesdas data collection in the field, enumerators were trained by the technical team Riskesdas. 12 The quality assurance of 2013 Riskesdas data had been done by testing the instruments and doing validation. The testing of instruments was conducted by researchers, academia, and professional organizations. Validation was done by a team of universities (Indonesia, Airlangga, and Hasanuddin Universities). 12 Management process of Riskesdas 2013 data consisted of two stages. The first stage was done at the districts or cities that consisted of activities: data collection, receiving-batching, editing, data entry, and electronic data transmission. The second phase was done in the center working unit consisting some activities some reception and aggregation of data across districts or cities, data cleaning, provincial data merging, com bining national data, national data cleaning, imputation, weighting, and electronic data storage. 12 The data consisted of household data as use of traditional health care, types of traditional health care, types of area, the levels of education of household heads, household heads employment status, types of occupation of household heads, household quintiles, the availability of health facilities and the travel time to health facilities.The types of traditional health care were herbs and skill. Types of area were urban and rural. The levels of education of households head were high, medium, and low. The status of head household employment were employed, and unemployed. The households expenditure quintiles were quintile 1 to quintile 5. The availability of health facilities were knowing of respondents about the availability of health care in respondents' residency.
Risk factors that related to use of traditional health care among Indonesian family were analyzed using the complex sample analysis with logistic regression.
Ethical clearance was granted from the Research Ethical Commission of Institute for Health Research and Development, Ministry of Health. Table 1 showed that the proportion of households that used of traditional health care were 30.4% (78,775/294,959). Those who used of traditional health care and did not use of traditional health were differently distributed with respect to type area, level of education, employment status, level of economic, and knowing about the availability of health care.

DISCUSSION
The purpose of study was to identify potential risk factors affecting use of traditional health care among Indonesian families. Social, cultural, and political values, as well as socioeconomic factors, influence traditional medicine and complementary and also alternative medicine (T/ CAM) use in industrialized societies. In developing countries, the affordability, availability, and cultural familiarity of traditional medicine, as well as family influences, contribute to the continued use of traditional medical providers and medicines.
The proportion of households who used of traditional health care were 30.4% (78,775/294,959). Those who used of traditional health care and did not use of traditional health were differently distributed with respect to type area, level of education, employment status, level of economic, and knowing about the availability of health care.
Traditional medicine therapies are commonly used in developing countries because they are often more widely available and more affordable than conventional therapies. In addition, because Traditional medicine practices are, often, woven into everyday life and belief systems, and because traditional healers are trusted members of the community, Traditional medicine is often the first source of health care at the community level. Conventional health care may be a last resort, especially if the nearest primary health care facility is some distance from the community. 2 In resource-limited countries, especially in rural areas, there are usually fewer conventional health care practitioners than traditional medicine practitioners. In India, traditional medicine is the only available source of health care for a large part of the rural population. 13 This situation has been aggravated as large numbers of trained and licensed conventional health care workers leave their native countries for better opportunities elsewhere (the "brain drain" phenomenon); sub-Saharan Africa has been particularly hard hit. 13 In developed countries, patients have become more informed about their health and use print media, television, and the Internet to get information on which to base their health decisions. As a result, alternative therapies are appealing because they are perceived as more natural and therefore safer compared to "manufactured" pharmaceutical products. 14 A perceptual difference between cultures may be that people in developing countries are more likely to view traditional medicine as their primary source of medical care, whereas people in developed countries generally view alternative treatments as complementary to, rather than competitive with, conventional medicine. In the China multivariate analysis, rurality, poor self-reported health and presence of arthritis were associated with TM use. In Ghana and India, lower income, depression and hypertension were associated with TM use. 13 Different from the findings in Ghana and India, others have found that those of a lower socio-economic status, who were unemployed, lived in rural areas and reported low health status were more likely to report use of traditional healers. 16,17,18,19 In industrialized countries, members of the dominant culture who have lower incomes and educational levels tend not to use complementary medicine. This may be because they have less disposable income and less exposure to information about complementary therapies.
In conclusion, this study identified factors affection use of traditional health care among Indonesian families. Households who were in urban, had higher education level, were employed, had higher economic status, knowing about the availability of health care were more likely to use traditional health care.
Public in many countries are using health care services that are outside the purview and understanding of the dominant medical system. Complementary and traditional medical services are often used alongside (and in addition to) conventional medical treatments. It is necessity for health professionals to have regulation ofnpractitioners and guidelines for licensing and establishment of standards of practice.