1

Effect of treatment Knowledge, Attitudes and Practices

(KAP) on Asthma with Traditional remedy among Adults in
India - Hyderabad , KAP study

Abstract:
Background: This study analyzes scientific studies on the efficacy of "ichthyotherapy" as a
treatment for asthma. Annually, a significant number of individuals suffering from respiratory
ailments visit Hyderabad, India, in search of an exceptional remedy. During a
certain occasion, the Telangana government encourages the dissemination of "Fish
Prasadam." This conventional therapy involves the insertion of a confidential herbal mixture
into a little Murrel fish, which is then ingested by the individual seeking treatment. Further
Turmeric (Curcuma longa) is known for its anti-inflammatory and antioxidant properties.
Material and Methods: A statistical study was performed to analyze the magical properties
of the remedy for asthma amongst N=1837 participants. This research used a cross-sectional
design to assess the knowledge, attitude, and practices (KAP) related to the utilization of a
traditional herbal cure for treating asthma among patients. A questionnaire study was further
performed. Results: The study demonstrated very significant differences between the
groups, with p-values less than 0.001 for both ANOVA and Levene's test. This suggests that
the group differences seen in the analysis of variance (ANOVA) and the assessment of
variances using Levene's test are not likely to be the result of random chance. Instead, they
reflect the presence of genuine differences between the groups being compared. Conclusion:
This research investigated the public's view of "Fish Prasadam" as a treatment for asthma.
The results showed significant variations across groups in terms of their knowledge, attitude,
and practices (KAP) related to this traditional cure (p-value < 0.001). These results indicate
that more research should be conducted on the knowledge, attitudes, and practices (KAP)
related to Fish Prasadam, as well as its potential therapeutic benefits.

Keywords: Asthma, traditional medicine, Unani Medicine, Anti-inflammatory,

Bronchoconstriction.

INTRODUCTION:
Asthma is a prominent worldwide health concern that affects individuals of all age groups.
Unani medicine provides a range of formulations to address respiratory issues, one of which
is Sufoof Dama Haldi Wala (SDHW). The objective of this research was to create quality
criteria for solar domestic hot water (SDHW) systems by using a range of scientific metrics.
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SDHW is prepared using a traditional formula that combines wheat (Triticum aestivum) and
turmeric (Curcuma longa). The produced SDHW was assessed for its physical qualities,
including color and texture, as well as its moisture content, acidity/alkalinity (pH),
extractable components, and ash concentration. The microbiological tests evaluated the total
number of bacteria and the existence of certain pathogenic germs. In addition, the research
detected the existence of diverse plant compounds and quantified particular components via
the use of Atomic Absorption Spectrophotometry, a scientific method. The study determined
that SDHW is a flavorless substance, appearing as a pale yellowish-black powder with a
smooth and glossy appearance. The defined quality criteria guarantee consistent attributes
after thorough investigation. The tests verified a microbiological profile that is safe, with a
low quantity of bacteria and the absence of hazardous microorganisms, as well as levels of
heavy metals that are below permissible limits. The elemental analysis yielded useful
information about the composition of the formulation. It is essential to maintain quality
control of herbal formulations to ensure their acceptability in contemporary medicine. This
study establishes the groundwork for a uniform document on SDHW, which sets the stage for
future investigations into its possible therapeutic attributes and advancement [1].

Asthma is a widespread, long-lasting illness that affects individuals of all age groups
worldwide. It is very prevalent in youngsters, being the most common chronic condition in
this age range. This prevalent ailment has a substantial influence on the overall quality of life,
leading to restrictions in daily activities and financial burden owing to the expenses
associated with medicine. According to the (WHO), the number of persons affected by
asthma globally in 2016 was estimated to be over 339 million. India alone accounted for 37.9
million cases [2]. Asthma is the result of an intricate interaction between hereditary and
environmental variables. This interaction results in inflammation of the airways, causing
them to become narrower and perhaps leading to the formation of mucus. This process
triggers symptoms such as coughing, difficulty breathing, and wheezing. Although traditional
medicine provides methods to treat the condition, there is yet no remedy available.
Significantly, more than 80% of fatalities connected to asthma transpire in low- and lower-
middle-income nations, underscoring the inequalities in the availability of efficacious
remedies [3]. Unani medicine, a traditional medical system, provides many formulations for
the treatment of respiratory problems, including as asthma (known as Dama) [4]. These
compositions are renowned for their efficacy and cost-effectiveness [4]. A specific
formulation called Sufoof Dama Haldi Wala (SDHW) has been used for many years to treat
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asthma and other respiratory ailments. This information is described in Bayaze Kabir Vol. II
[4]. Nevertheless, despite its previous historical use, SDHW now does not possess well-
defined quality criteria. The process of standardization is an essential and pivotal stage in
gaining acceptance for herbal medicine. Standardization is a crucial procedure that guarantees
the quality, purity, and effectiveness of herbal compositions [5]. This method is crucial for
providing a valid rationale for incorporating ancient treatments into contemporary medicine
[5]. In response to this need, the current research sought to develop precise benchmarks for
solar domestic hot water (SDHW) systems by analyzing a range of physicochemical
properties [5].

LITERATURE REVIEW:

In Hyderabad, India, during the monsoon season, the Bathini family carries out a unique
ritual known as "fish prasadam" to treat asthma and other respiratory illnesses. This tradition,
which has been practiced for over 173 years, involves swallowing a live murrel fish filled
with a yellow herbal paste. Patients consume the fish whole, without water, and vegetarians
are offered an alternative of the herbal paste mixed with jaggery. The Bathini family also
provides specific dietary recommendations and advises patients to take the fish prasadam for
three consecutive years [6][7]. While asthma is a chronic condition, effective treatments and
lifestyle changes can manage symptoms and allow for a normal life [5]. However, a
controversial ritual in Hyderabad, India, offers a supposed cure: the fish prasadam [6, 7].
Every June, during the monsoon season, asthmatic patients gather for this unique practice [6,
7]. The Bathini family administers "fish prasadam," a live murrel fish filled with a yellow
herbal paste, which patients swallow whole [6, 7]. This practice has continued for over 170
years [6, 7]. For vegetarians, an alternative involving the herbal paste mixed with jaggery is
offered [6, 7]. The Bathini family prescribes a specific diet and recommends consuming the
fish prasadam for three consecutive years, claiming it permanently cures asthma and other
respiratory problems [6, 7]. However, the family keeps the herbal formula secret, stating it
was received from a saint in 1845 [6, 7]. The ritual has drawn criticism for the lack of
transparency regarding the ingredients and its potential health risks [5]. Dr. C.L. Venkata Rao,
of the Indian Medical Association, challenged the practice in court, arguing that any
undisclosed medication falls under drug regulations [8]. The Bathini family defends their
tradition, stating the medicine loses its potency if revealed and that commercialization would
be detrimental [6, 7]. They claim the formula has been passed down through generations and
has successfully treated hundreds of thousands [3, 4]. However, these claims lack official
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verification [8]. Dr. Ajit Vigg, a respiratory specialist, disputes the efficacy of the fish
prasadam, citing no scientific evidence and even observing worsened conditions in some
patients [8].

MATERIAL AND METHODS:

A statistical study was performed to analyze the magical properties of the remedy for asthma
amongst N=1837 participants. This research used a cross-sectional design to assess the
knowledge, attitude, and practices (KAP) related to the utilization of a traditional herbal cure
for treating asthma among patients. The sample consisted of people who had been diagnosed
with asthma. These individuals were chosen using a simple random selection method from
the patient register of a local healthcare centre. The data were gathered via a well-designed
questionnaire that was constructed by drawing upon existing literature and consulting with
experts. The questionnaire included many aspects, including demographic information,
knowledge of asthma and its treatment, attitudes towards traditional treatments, and current
practices. All subjects provided informed consent. Demographic data was summarized using
descriptive statistics, while correlations between KAP scores were assessed using statistical
analysis.

RESULTS:
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Fig. 1 shows the gender distribution of the participants in the survey

Fig. 2 shows the type of diet intake by the different participants involved in the survey.

Fig. 3 shows the education status of the different participants involved in the survey.
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Fig. 4 shows the statistical analysis about the knowledge of magical treatment.

Fig 5: Frequency bar-graph of Just a try, already experienced and mostly don’t know
answered participants involved in the survey.

Null hypothesis (Ho): The statistical study reveals that the knowledge, attitude, perception,
and practice of the participants have no relation to the magical remedy used for treating
asthma.

Alternative hypothesis (H1): The statistical study reveals that the knowledge, attitude,
perception, and practice of the participants have a relation to the magical remedy used for
treating asthma.
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Table 1:
1. One-way ANOVA:
Source Degree of Sum of Mean F-statistics P-value
freedom square square
Groups 17 4709.5091 277.0299 965.3977 7.772e-16
(between
groups)
Error (within 33045 9482.5733 0.287
groups)
Total 33062 14192.0824 0.4293

One-Way ANOVA Test, using F distribution degree of freedom (17, 33045) (right-
tailed):

Our study indicates that the average of at least one group is statistically distinct from the
averages of the other groups. We arrived at this result by rejecting the null hypothesis (H₀)
due to the p-value being lower than the selected significance threshold (α). Put, the observed
disparities between specific group means are too significant to be ascribed to mere chance.
The p-value of 7.77 x 10^-16 (about 7.8 x 10^-16) is very less. This suggests a very low
likelihood (almost 0%) of erroneously rejecting a valid null hypothesis (type I error). A
smaller p-value indicates a higher level of evidence against the null hypothesis and more
support for the alternative hypothesis (H₁). The F-statistic (965.397711) exceeds the
threshold normally used to determine that there is no meaningful difference (0 to 1.6231 in
this situation). This further strengthens our refusal to accept the null hypothesis. The
measured effect size (f) of 0.7 suggests a substantial disparity between the group means. This
magnitude is regarded as significant. In addition, the η² value of 0.33 indicates that 33.2% of
the variability in the data can be accounted for by the group membership, similar to how R²
explains variance in linear regression.

Table 2:

2. Levene’s test verification:

Source Degree of Sum of Mean F-statistic P-value
freedom square square
Groups 17 630.3041 37.0767 143.3772 1.332e-15
( between
groups)
Error (within 33045 8545.2887 0.2586
groups)
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Total 33062 9175.5928 0.2775

Analysis and Interpretation:

Our data indicates a significant statistical difference in variances among some groups. We
reached this conclusion by rejecting the null hypothesis (H₀) based on a p-value of 1.33 x
10^-15, which indicates a very low probability of obtaining the observed results by chance.
The p-value suggests an extremely low probability of randomly discovering such differences.
Put, the groups show notable differences in the distribution of their data. The p-value of 1.33
x 10^-15 indicates strong evidence against the null hypothesis (H₀) of equal variances across
groups. This provides substantial evidence in favour of the alternative hypothesis (H₁) that
the variances are really different. The computed F-statistic (143.377244) significantly
exceeds the range generally associated with no meaningful difference (0 to 1.6231). The high
F-value strengthens our rejection of the null hypothesis and affirms considerable variations in
variances across the groups. The effect size (f) observed, which is 0.27, is classified as
medium. Although it indicates a discernible disparity in variances across the groups, the
extent of the difference could be more significant. The η² (Eta Squared) value of 0.069
suggests that about 6.9% of the overall variation may be attributed to the differences between
group variances. This corresponds to a substantial but modest proportion, analogous to how
R² in linear regression elucidates the amount of variability explained by the model. In
summary, Levene's test results indicate that there are significant differences in the variances
of the groups being compared. The rejection of H₀, the very small p-value, the high F-
statistic, and the medium effect size all point to the conclusion that not all groups have equal
variances.

DISCUSSION:

Asthma, a persistent inflammatory respiratory disorder, poses considerable difficulties in its

management [9]. Although bronchodilators and corticosteroids provide temporary relief from
symptoms, they have several limitations such as possible adverse effects and inability to
modify the illness [9]. This underscores the need for novel treatment methodologies. Herbal
remedies show potential for effectively addressing chronic illnesses such as asthma [9].
Curcumin, a biologically active chemical included in turmeric (Curcuma longa), has been
identified as a promising candidate because of its wide range of medicinal effects [10].
Research has shown that it has anti-inflammatory and antioxidant properties, which may have
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positive effects on asthma [10]. The mechanisms of curcumin include the suppression of
inflammation. Studies indicate that curcumin's ability to reduce inflammation is achieved via
many methods [10]. It has the potential to hinder the creation of chemicals that cause
inflammation, such as iNOS and free radicals. Additionally, it can block the activation of NF-
κB and AP-1 pathways, which are implicated in inflammation [10]. In addition, curcumin
may reduce the levels of pro-inflammatory cytokines (IL-2, IL-5, GM-CSF) and prevent the
release of histamine from mast cells, hence enhancing its anti-inflammatory properties [10,
11]. Although curcumin has shown promising benefits in asthma models in animal research
[10], there is still a lack of extensive human trials [9]. Kobayashi et al. provided evidence of
curcumin's capacity to inhibit the production of inflammatory chemicals in white blood cells
from asthmatic patients in response to allergens [11]. These findings indicate that curcumin
may have the potential to regulate cytokine production, eosinophil activity, and IgE
generation, thereby potentially aiding in the management of allergic asthma [12].
Nevertheless, further human research is required to validate these results [13][14]. Turmeric,
a botanical species native to the tropical regions of South Asia, has a longstanding history of
use in the field of medicine. Turmeric is traditionally used in culinary preparations such as
curry, and research indicates that frequent consumption of curry may have potential benefits
for those with asthma [15].

CONCLUSION: This research examined the public's opinion and possible advantages of
"Fish Prasadam," a traditional asthma cure that entails the insertion of a confidential herbal
combination into a fish. The research did not directly assess the effectiveness of the fish
treatment, but instead used statistical techniques to examine survey data from 1837
participants. The findings demonstrated substantial statistical differences between the groups
(p-value < 0.001), indicating that these changes are unlikely to be attributed to random
chance. Therefore, additional inquiry into the KAP (knowledge, attitude, and practices)
related to this traditional asthma therapy is warranted.
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