Security Recommendations for mHealth Apps: Elaboration of a Developer’s Guide

Being the third fastest-growing app category behind games and utilities, mHealth apps are changing the healthcare model, as medicine today involves the data they compile and analyse, information known as Big Data. However, the majority of apps are lacking in security when gathering and dealing with the information, which becomes a serious problem. This article presents a guide regarding security solution, intended to be of great use for developers of mHealth apps. In August 2015 current mobile health apps were sought out in virtual stores such as Android Google Play, Apple iTunes App Store etc., in order to classify them in terms of usefulness. After this search, the most widespread weaknesses in the field of security in the development of these mobile apps were examined, based on sources such as the “OWASP Mobile Security Project, the initiative recently launched by the Office of Civil Rights (OCR), and other articles of scientific interest. An informative, elemental guide has been created for the development of mHealth apps. It includes information about elements of security and its implementation on different levels for all types of mobile health apps based on the data that each app manipulates, the associated calculated risk as a result of the likelihood of occurrence and the threat level resulting from its vulnerabilities - high level (apps for monitoring, diagnosis, treatment and care) from 6?≤?9, medium level (calculator, localizer and alarm) from 3?≤?6 and low level (informative and educational apps) from 0?≤?3. The guide aims to guarantee and facilitate security measures in the development of mobile health applications by programmers unconnected to the ITC and professional health areas.     

Analyzing security issues of android mobile health and medical applications

ObjectiveWe conduct a first large-scale analysis of mobile health (mHealth) apps available on Google Play with the goal of providing a comprehensive view of mHealth apps’ security features and gauging the associated risks for mHealth users and their data.Materials and MethodsWe designed an app collection platform that discovered and downloaded more than 20 000 mHealth apps from the Medical and Health & Fitness categories on Google Play. We performed a suite of app code and traffic measurements to highlight a range of app security flaws: certificate security, sensitive or unnecessary permission requests, malware presence, communication security, and security-related concerns raised in user reviews.ResultsCompared to baseline non-mHealth apps, mHealth apps generally adopt more reliable signing mechanisms and request fewer dangerous permissions. However, significant fractions of mHealth apps expose users to serious security risks. Specifically, 1.8% of mHealth apps package suspicious codes (eg, trojans), 45.0% rely on unencrypted communication, and as much as 23.0% of personal data (eg, location information and passwords) is sent on unsecured traffic. An analysis of the app reviews reveals that mHealth app users are largely unaware of the surfaced security issues.ConclusionDespite being better aligned with security best practices than non-mHealth apps, mHealth apps are still far from ensuring robust security guarantees. App users, clinicians, technology developers, and policy makers alike should be cognizant of the uncovered security issues and weigh them carefully against the benefits of mHealth apps.     

Seeking Medical Information Using Mobile Apps and the Internet: Are Family Caregivers Different from the General Public?

Family caregivers play an important role to care cancer patients since they exchange medical information with health care providers. However, relatively little is known about how family caregivers seek medical information using mobile apps and the Internet. We examined factors associated with medical information seeking by using mobile apps and the Internet among family caregivers and the general public using data from the 2014 Health Information National Trends Survey 4 Cycle 1. The study sample consisted of 2425 family caregivers and 1252 non-family caregivers (the general public). Guided by Comprehensive Model of Information Seeking (CMIS), we examined related factors’ impact on two outcome variables for medical information seeking: mobile apps use and Internet use with multivariate logistic regression analyses. We found that online medical information seeking is different between family caregivers and the general public. Overall, the use of the Internet for medical information seeking is more common among family caregivers, while the use of mobile apps is less common among family caregivers compared with the general public. Married family caregivers were less likely to use mobile apps, while family caregivers who would trust cancer information were more likely to use the Internet for medical information seeking as compared to the general public. Medical information seeking behavior among family caregivers can be an important predictor of both their health and the health of their cancer patients. Future research should explore the low usage of mobile health applications among family caregiver population.     

Utility of a mHealth App for Self-Management and Education of Cardiac Diseases in Spanish Urban and Rural Areas

Analyze the utility of a mobile health app named HeartKeeper in several groups of population and obtain conclusions to be applied to other similar apps. A questionnaire has been designed to evaluate the usage and utility of the HeartKeeper app. The questionnaire information was collected by collaborating cardiologists from 32 patients before and after they used the app. Patients were randomly selected with established quotas within interest groups, so that men and women, patients older or younger than 60 years old and patients living in urban or rural areas were equally represented. Using the appropriate statistical techniques we see that the HeartKeeper app was useful for patients as they qualify with 70 points (out of 100) the overall opinion of the app, it helps them remember more easily taking their pills with a mean improvement of 20.94 points (p < 0.001) and they perceive a global improvement of their health (8.28 points, p < 0.001). We also observe that these improvements do not depend, in general, on the area (urban or rural) where the patient comes from or on their sex. Although older patients needed more help to use the app and used it slightly less frequently, the improvements on several measures considered, such as remembering taking pills, breathing problems or trouble developing activities, depend significantly (p < 0.05) on age with older patients reporting higher improvements than younger ones. The results obtained with the sample of patients considered in this research prove the utility of the HeartKeeper app. This utility is similar in urban and rural areas and for patients of both sexes and, to some extent, depends on the age of the patient with older patients reporting slightly lower frequency of use but higher health improvements than younger ones.     

Using clinical guidelines designed for older adults with diabetes mellitus and complex health status

Samuel C. Durso, MD

JAMA. 2006;295:1935-1940.

Increasingly, adults are living to an advanced age. While many enjoy good health, nearly 50% of adults older than 65 years have 3 or more chronic medical conditions. Furthermore, within any age-sex cohort, older adults exhibit widely heterogeneous health status—ranging from robust to frail. This heterogeneity and individual medical complexity makes care for older patients particularly challenging and requires both careful medical judgment and a clear understanding of the patient's personal values and goals. Most current health care guidelines are disease-specific and do not address this complexity and heterogeneity, thus limiting their utility for guiding physicians in the care of older adult patients. The "Guidelines for Improving the Care of Older Persons With Diabetes Mellitus" are the first guidelines to specifically address this complexity and provide guidance to physicians who must prioritize therapies and goals for older adults with diabetes, comorbid medical conditions, and geriatric syndromes. By providing a rationale for prioritizing recommendations and the inclusion of geriatric syndromes that impact the patient's overall health and diabetic care, these guidelines may serve as a model for the development of other guidelines targeting older adults with complex health status.

     

医养结合养老机构老年人日常生活活动需求未满足状况及影响因素研究

背景　随着我国人口老龄化形势日益严峻,老年人数量逐年上升,医养结合型养老机构规模不断扩大,老年人对养老的需求逐渐扩大,需求未得到满足会造成老年人住院率、再入院率、抢救率甚至死亡率的上升。目的　了解医养结合型养老机构老年人日常生活活动需求未满足状况并分析其影响因素。方法　2019年6-12月,采取便利抽样方法,对四川省53所医养结合型养老机构中的1 325例老年人及其主要照顾者进行问卷调查。对机构老年人采用一般资料调查表、功能活动问卷（FAQ）、Barthel指数评定表（BI）、未满足需求评估表（改编自FAQ和BI）进行统计调查;对主要照顾者采取一般资料调查表进行统计调查。通过单变量分析筛选出影响因素,再运用Logistic回归分析确定风险因素。结果　共调查机构失能老人1 325例,照顾者442例,1 290例（97.36%）失能老年人至少有一项日常生活活动需求未得到满足,其中有5项未满足率超过50%,从低到高依次是平地行走、出行、修饰、娱乐、社交。多因素Logistic 回归分析结果显示：机构失能老年人失能时长越长、FAQ得分越高及其主要照顾者的年龄越大,失能老年人的需求未满足率越高;失能老年人的文化程度和月收入水平越高及其主要照顾者的月收入水平越高,失能老年人的需求未满足率越低（P<0.05）。结论　四川省医养结合型养老机构失能老人的需求未满足情况较严重且受多种因素影响。应提升机构的科学管理水平并重视人文关怀,不断改善失能老年人的需求未满足情况,照顾者也应不断提升自我素养以确保更优的照护,同时政府也应给予更多的财政帮助、鼓励社会捐赠及更加深刻地探讨有关护理的保险制度。     

Mental health and nutritional status among the adult Serbian minority in Kosovo

CONTEXT: Since the beginning of the North Atlantic Treaty Organization intervention in Kosovo in June 1999, few objective data have been available on relevant health indicators for the Serbian ethnic minority in Kosovo. OBJECTIVE: To determine the prevalence of undernutrition among Serbian adults aged 60 years or older and psychiatric morbidity among the adult Serbian population in Kosovo. DESIGN, SETTING, AND PARTICIPANTS: A systematic random sample survey of 212 households was conducted between September 27 and October 2, 1999, in Pristina, the capital city, and in 10 towns in the rural municipality of Gnjilane in Kosovo. Of the 212 households surveyed, 204 adults aged 15 years or older completed the General Health Questionnaire-28 (GHQ-28) and anthropometric measurements were taken for 98 adults aged 60 years or older and for a comparison group of 51 adults aged 18 to 59 years. MAIN OUTCOME MEASURES: Body mass index of less than 18.5 kg/m(2) in older adults; nonspecific psychiatric morbidity among adults; and self-reported use of health care services, access to food rations, and primary sources of prewar and postwar income. RESULTS: Undernutrition was found in 11.2% (95% confidence interval [CI], 5.7%-19.2%) of Serbian adults aged 60 years or older compared with 2.0% (95% CI, 0.1%-11.8%) of Serbian adults aged 18 to 59 years. The mean (SE) total score for the GHQ-28 was 13.0 (0.52). In a comparison of the GHQ-28 scores of the Serbian adults with the Kosovar Albanian adults (data from a recent survey), the mean (SE) score adjusted for age and sex was 12.8 (0.52) vs 11.1 (0.58); P =.03, respectively. The GHQ-28 scores were also higher for the Serbians in the subcategories of social dysfunction (2.8 [0.17] vs 2.2 [0.13]; P =.008) and severe depression (1.9 [0.15] vs 0.9 [0. 09]; P<.001), respectively. Serbian women and persons living alone or in small family units were more prone to psychiatric morbidity. Of the 141 respondents reporting the need for health care services, 83 (57.6%) reported not obtaining such services; 204 of 212 (96.2%) households were on a food distribution list. The majority of prewar income came from government jobs compared with farming and humanitarian aid for postwar income. CONCLUSIONS: The undernutrition of older Serbian adults in Kosovo should be monitored. The high prevalence of symptoms of social dysfunction and severe depression suggest the need for implementation of mental health programs in the Serbian community. JAMA. 2000;284:578-584     

Use of health care services by lower-income and higher-income uninsured adults

Context  More than 45 million individuals in the United States lack health insurance, potentially limiting their access to and use of appropriate health care services. Although the uninsured comprise a range of income levels, little attention has been directed at higher-income uninsured adults and their patterns of care. Objective  To examine whether having higher income attenuates the association between being uninsured and using fewer recommended health care services. Design, Setting, and Participants  Cross-sectional analysis of data from the 2002 Behavioral Risk Factor Surveillance System, drawn from a nationally representative sample of households. Participants were community-dwelling adults (n = 194 943; 50% women) aged 18 to 64 years in 2002. Main Outcome Measures  Self-reported use of screening for cervical, breast, and colorectal cancer; serum cholesterol screening and measurement, aspirin use, and tobacco cessation and weight loss counseling for cardiovascular risk reduction; and serum cholesterol and glycosylated hemoglobin measurement, eye and foot examination, and influenza and pneumococcal vaccination for diabetes management. Results  Among eligible adults, use of cancer prevention services ranged from 51% for colorectal cancer screening to 88% for cervical cancer screening, while use of cardiovascular risk reduction services ranged from 38% for weight loss counseling to 81% for aspirin use, and use of services for diabetes management ranged from 33% for pneumococcal vaccination to 88% for serum glycosylated hemoglobin measurement. In bivariate analyses, health insurance and annual household income were both strongly associated with use of nearly all examined health care services (P values <.01). Using multivariable analysis, increased annual household income did not significantly increase the likelihood of uninsured compared with insured adults receiving recommended health care services for cancer prevention, cardiovascular risk reduction, or diabetes management (P values >.05). Conclusions  Even among higher-income adults, lack of health care insurance was associated with significantly decreased use of recommended health care services; increased income did not attenuate the difference in use between uninsured and insured adults. Efforts to improve the use of recommended health care services among the uninsured should focus on patient education and expanding insurance eligibility for both lower-income and higher-income adults.      

Personal health records: a randomized trial of effects on elder medication safety

Purpose

To examine the impact of a personal health record (PHR) on medication-use safety among older adults.

Background

Online PHRs have potential as tools to manage health information. We know little about how to make PHRs accessible for older adults and what effects this will have.

Methods

A PHR was designed and pretested with older adults and tested in a 6-month randomized controlled trial. After completing mailed baseline questionnaires, eligible computer users aged 65 and over were randomized 3:1 to be given access to a PHR (n=802) or serve as a standard care control group (n=273). Follow-up questionnaires measured change from baseline medication use, medication reconciliation behaviors, and medication management problems.

Results

Older adults were interested in keeping track of their health and medication information. A majority (55.2%) logged into the PHR and used it, but only 16.1% used it frequently. At follow-up, those randomized to the PHR group were significantly less likely to use multiple non-steroidal anti-inflammatory drugs—the most common warning generated by the system (viewed by 23% of participants). Compared with low/non-users, high users reported significantly more changes in medication use and improved medication reconciliation behaviors, and recognized significantly more side effects, but there was no difference in use of inappropriate medications or adherence measures.

Conclusions

PHRs can engage older adults for better medication self-management; however, features that motivate continued use will be needed. Longer-term studies of continued users will be required to evaluate the impact of these changes in behavior on patient health outcomes.     

社区社会环境与中老年居民自评健康的相关性研究

  目的   分析社区社会环境对社区中老年居民自评健康的影响,为构建良好的社区社会环境、促进社区中老年人群健康提供依据。   方法   利用2011年中国健康与养老追踪调查（China Health and Retirement Longitudinal Study, CHARLS）社区和家户调查数据,选取397个社区的7 822名中老年人为研究对象。社区社会环境包括社区社会经济地位、社区社会保障和社区服务三类,自评健康采用五个等级评分。采用三水平广义线性模型分析社区社会环境对中老年自评健康的影响。   结果   自评健康不好的比例为28.8%。三水平广义线性模型结果显示,中老年居民自评健康在城市和社区层面均存在差异,并且社区水平方差缩减比达到35.71%。中、高人均纯收入社区相比低人均纯收入社区,其居民自评健康状况更好（OR=0.84,P<0.05;OR=0.70,P<0.05)。中、高文化程度社区相比低文化程度社区,其居民自评健康状况更好(OR=0.78,P<0.05;OR=0.73,P<0.05)。实行失业补贴的社区其中老年居民自评健康状况更好（OR=0.77,P<0.05）。个体水平上,患有慢性病的中老年人自评健康状况更差（OR=4.46,P<0.05）。城市的中老年自评健康状况较农村更好（OR=0.76,P<0.05）。   结论   社区社会经济地位和社区失业补贴与社区中老年居民自评健康呈正相关。需要特别关注低社会经济地位社区的中老年人健康状况,完善失业保障政策,促进社区中老年居民健康。      

Applications of Paper and Interactive Prototypes in Designing Telecare Services for Older Adults

We present the results of the user studies of the CareMe prototype telecare service for supporting older adults with remote telecare services. The CareMe solution targets older adults who are capable of living independently and outside of a dedicated medical institution or a nursing home, but require occasional medical attention, and formal or informal care. The studies were conducted between November 2013 and March 2014 and followed the participatory design approach. The research questions focused on understanding the difference in the participatory design approach when older adults use paper prototypes vs interactive prototypes, and the difference when older adults use interactive prototypes with poor interface design vs interactive prototypes with rich interface design. In total, 45 older adults living in Slovenia participated in the field trial. They were retired, 32 of whom were nursing home residents and 13 were living independently at home. The study sample’s age distribution was between 64 and 91 years. The analysis of the filed trial results indicated the importance of the factors that influence users’ decision about how and when they use new technology, i.e., the perceived usefulness and the perceived ease-of-use. Main insights gained from the studies show, that it is very difficult to keep older people focused on the topics of discussion and that they have often difficulties to clearly present/express their ideas. Furthermore, abstract concepts, such as paper only prototypes proved to be challenging to cope with, whereas using real applications and services when trying out scenarios using interactive prototypes provided much better experience and feedback.     

Personal health information management among healthy older adults: Varying needs and approaches

ObjectiveWith age, older adults experience a greater number of chronic diseases and medical visits, and an increased need to manage their health information. Technological advances in consumer health information technologies (HITs) help patients gather, track, and organize their health information within and outside of clinical settings. However, HITs have not focused on the needs of older adults and their caregivers. The goal of the SOARING (Studying Older Adults and Researching their Information Needs and Goals) Project was to understand older adult personal health information management (PHIM) needs and practices to inform the design of HITs that support older adults.Materials and MethodsDrawing on the Work System Model, we took an ecological approach to investigate PHIM needs and practices of older adults in different residential settings. We conducted in-depth interviews and surveys with adults 60 years of age and older.ResultsWe performed on-site in-person interview sessions with 88 generally healthy older adults in various settings including independent housing, retirement communities, assisted living, and homelessness. Our analysis revealed 5 key PHIM activities that older adults engage in: seeking, tracking, organizing, sharing health information, and emergency planning. We identified 3 major themes influencing older adults’ practice of PHIM: (1) older adults are most concerned with maintaining health and preventing illness, (2) older adults frequently involve others in PHIM activities, and (3) older adults’ approach to PHIM is situational and context-dependent.DiscussionOlder adults’ approaches to PHIM are dynamic and sensitive to changes in health, social networks, personal habits, motivations, and goals.ConclusionsPHIM tools that meet the needs of older adults should accommodate the dynamic nature of aging and variations in individual, organizational, and social contexts.     

我国中老年人抑郁现况及其影响因素分析

  目的  基于2018年中国家庭追踪调查（China Family Panel Studies, CFPS）数据了解全国45岁及以上中老年人群抑郁情况以及影响因素,为提高中老年人心理健康、缓解其抑郁症状提供实证依据。  方法  研究数据来源于2018年的中国家庭追踪调查数据。流行病学调查用抑郁量表（CES-D）评定抑郁患病情况,使用两水平二分类非条件logistic回归方法分析抑郁症状患病率的影响因素。  结果  采用本次调查中抑郁得分的第80个百分位数得分为临界值,结果抑郁症状检出率为23.61%;女性相比男性更容易患抑郁症状;丧偶者患抑郁的风险更高;文化程度越高,患抑郁的可能性越低;农村地区中老年更容易患抑郁;患慢病和自评健康差的中老年人患抑郁风险更高;睡眠时间是患抑郁症状的一个保护因素。在控制了以上个体层面因素后,沿海、经济较发达地区的中老年患抑郁的可能性低于内陆、经济欠发达的地区。  结论  相关卫生部门应该重点关注女性、丧偶、慢性病中老年的抑郁症状问题;在农村地区和经济欠发达的内陆地区,国家应投入更多的卫生资源,预防和改善中老年的抑郁患病情况。     

Community-integrated home-based depression treatment in older adults: a randomized controlled trial

Context  Older adults with social isolation, medical comorbidity, and physical impairment are more likely to be depressed but may be less able to seek appropriate care for depression compared with older adults without these characteristics. Objective  To determine the effectiveness of a home-based program of detecting and managing minor depression or dysthymia among older aldults. Design and Setting  Randomized controlled trial with recruitment through community senior service agencies in metropolitan Seattle, Wash, from January 2000 to May 2003. Patients  One hundred thirty-eight patients aged 60 years or older with minor depression (51.4%) or dysthymia (48.6%). Patients had a mean of 4.6 (SD, 2.1) chronic medical conditions; 42% of the sample belonged to a racial/ethnic minority, 72% lived alone, 58% had an annual income of less than $10 000, and 69% received a form of home assistance. Interventions  Patients were randomly assigned to the Program to Encourage Active, Rewarding Lives for Seniors (PEARLS) intervention (n = 72) or usual care (n = 66). The PEARLS intervention consisted of problem-solving treatment, social and physical activation, and potential recommendations to patients' physicians regarding antidepressant medications. Main Outcome Measures  Assessments of depression and quality of life at 12 months compared with baseline. Results  At 12 months, compared with the usual care group, patients receiving the PEARLS intervention were more likely to have at least a 50% reduction in depressive symptoms (43% vs 15%; odds ratio [OR], 5.21; 95% confidence interval [CI], 2.01-13.49), to achieve complete remission from depression (36% vs 12%; OR, 4.96; 95% CI, 1.79-13.72), and to have greater health-related quality-of-life improvements in functional well-being (P = .001) and emotional well-being (P = .048). Conclusions  The PEARLS program, a community-integrated, home-based treatment for depression, significantly reduced depressive symptoms and improved health status in chronically medically ill older adults with minor depression and dysthymia.      

我国不同收入组城镇居民医疗保健支出特点分析

对我国不同收入组城镇居民1996年——2005年的医疗保健消费行为进行了考察,运用时间序列的计量模型测算了医疗保健消费的价格弹性和收入弹性。发现：无论是价格弹性还是收入弹性,绝对值均大于1,即医疗保健至少在边际上,属于奢侈品。为确保我国城镇居民人人享有基本医疗保健,国家应更积极地投资于人民健康。     

芦山县农村居民就医首诊行为的影响因素分析

目的：了解雅安芦山县农村居民就医首诊行为,并分析其影响因素,明确农村居民的卫生服务需求,探索基层医疗机构的发展方向。方法：根据相关文献制定《农村居民就医行为调查问卷》,调查了雅安芦山县飞仙关、龙门、隆兴、太平等四个乡镇1093名农村居民,了解其患病后首选就诊医疗机构情况,并对一般情况、健康状况、医疗保险、医疗资源和医疗...     

Are Health Care Professionals Advising Obese Patients to Lose Weight?

Context  Implementation of the National Institutes of Health's 1998 guidelines, which recommended that health care professionals advise obese patients to lose weight, required baseline data for evaluation. Objectives  To describe the proportion and characteristics of obese persons advised to lose weight by their health care professional during the previous 12 months and to determine whether the advice was associated with reported attempts to lose weight. Design  The Behavioral Risk Factor Surveillance System, a random-digit telephone survey conducted in 1996 by state health departments. Setting  Population-based sample from 50 states and the District of Columbia. Participants  A total of 12,835 adults, 18 years and older, classified as obese (body mass index 30 kg/m²), who had visited their physician for a routine checkup during the previous 12 months. Main Outcome Measures  Reported advice from a health care professional to lose weight, and reported attempts to lose weight. Results  Forty-two percent of participants reported that their health care professional advised them to lose weight. Using multivariate logistic regression analysis, we found that the persons who were more likely to receive advice were female, middle aged, had higher levels of education, lived in the northeast, reported poorer perceived health, were more obese, and had diabetes mellitus. Persons who reported receiving advice to lose weight were significantly more likely to report trying to lose weight than those who did not (OR, 2.79; 95% CI, 2.53-3.08). Conclusions  Less than half of obese adults report being advised to lose weight by health care professionals. Barriers to counseling need to be identified and addressed.      

贵阳市高血压患者药物依从性及其影响因素研究

目的：通过分析贵阳市高血压患者药物依从性对血压控制及费用负担影响,评价贵阳市基层卫生服务体系建设和公共卫生政策实施效果。方法：应用分层随机抽样方法,对贵阳市6个社区卫生服务中心的805名高血压患者进行结构式问卷调查。结果：社区高血压患者药物依从性好的比例占55．3％;55—64岁年龄组患者药物依从性不佳的概率是55岁及以下年龄组的0．49倍,高血压2级患者药物依从性不佳的概率是高血压1级的1．42倍;医疗支出占家庭收入比例超过20％的患者,其药物依从性不佳的概率比医疗支出占家庭收入比例小于10％的患者高1．21倍;药物依从性差的主要影响因素是年龄、高血压等级及经济负担。结论：社区应加强55岁以下年龄组高血压患者及65岁以上年龄组高血压患者管理,注重对高血压2级患者的服药指导和监督,以及加强对高血压患者健康教育的工作力度,探索以社区为基础的慢性病管理模式,有效提高高血压患者的药物依从性。     

The use of herbal teas and remedies in Jamaica

We investigated the prevalence of the use of herbs among adults and children in Jamaica in 1996. Two concurrent surveys were conducted in randomly selected urban and rural areas: among adults and among caretakers of young children. From over 90% of the selected households, all caretakers of children under 6 years and one randomly selected adult (18 years or older) were interviewed using structured questionnaires. The 457 adults reportedly used 156 types of herbs: a mean of 6 +/- 3 (mean +/- standard deviation) by the urban adults, and 10 +/- 6 by the rural adults (t-test, p < 0.001). Almost 100% of respondents had at some time used herbs for teas or for treating illnesses. The most common method of preparation was by infusion or boiling in water, then adding sugar. Urban respondents, women and those who were employed were more likely to buy medicines than to use herbal remedies. One hundred and sixty-seven caretakers of 203 children under 6 years were interviewed. The mean number of herbs given to each child was between 2 and 3. The most common herbs were introduced within the first 6 months of life. Many caretaker factors were associated with herbal use. Public health implications include the potential toxicity of some herbs, the possibility that herbal teas given to young children may displace more nutritious foods and delay presentation to health care facilities. The findings will allow policy makers to target those most likely to use herbal preparations or to give them to young children, and target herbs to be analyzed for toxic or beneficial properties.