Complementary and alternative medicine use among patients with tuberculosis at a tertiary hospital in Sierra Leone: A cross-sectional study

Background: Complementary and alternative medicine (CAM) is widely used alongside biomedical treatment in sub-Saharan Africa, yet evidence among patients with tuberculosis (TB) is limited. Concurrent herbal and anti-TB drug use raises concerns about safety, communication, and symptom attribution. We aimed to estimate the prevalence and describe patterns of CAM use, and to explore sociodemographic associations and disclosure practices among adults receiving TB care. Methods: We conducted a cross-sectional study at Connaught Hospital, Freetown, between February and April 2024. Adults ([≥]18 years) with microbiologically confirmed TB were consecutively enrolled. Structured interviews assessed CAM use in the past 12 months, modalities, motivations, adverse experiences, and disclosure. Prevalence was estimated using descriptive statistics. Multivariable logistic regression explored sociodemographic associations with CAM use. Results: Among 160 participants (median age 35 years; 68.1% male), 109 (68.1%, 95% CI 60.6-74.8) reported CAM use. Herbal remedies were the most common modality (74.3% of users), particularly ginger (34.9%) and garlic (20.2%). The primary motivation was symptom relief (73.4%). Only 27.6% of CAM users disclosed use to a healthcare provider, most commonly because they reported not being asked (57.5%). In multivariable analysis, only student status was independently associated with lower odds of CAM use (aOR 0.16, 95% CI 0.05-0.56). Conclusions: CAM use was common among adults receiving TB care and was characterized by frequent herbal use and low disclosure. Routine, non-judgmental inquiry about CAM use may improve communication and patient safety during TB treatment.