Commercial Use of Moringa Capsule in Bangladesh: A Pharmacy Based Study

Purpose: The study looks at how Moringa oleifera capsules are used in pharmacies in Bangladesh. In addition, the goal is to understand how customers use and prefer moringa capsules. Besides that, the factors influencing the demand and how they do so is also of high interest. The factors are primarily socioeconomic, demographic and health-related problems.

Method: A cross-sectional survey has been conducted with 300 pharmacy representatives from rural and urban parts of Bangladesh. For this study, a stratified sampling approach was used. Data has been collected using structured questionnaires. Several topics of the questionnaire covered demographics, health conditions, purchase behaviors and recommendation sources. Multiple tests were done conducted using IBM SPSS Statistics.

Findings: The study reveals clear differences in moringa capsule sales between urban and rural areas. Urban areas display higher affinity for consumption (56.9 percent vs. 43.1 percent, p = 0.005). It could come from better access to pharmacies, awareness related to health trends, and a higher disposable income. Middle-aged customers (46 - 60 years) make up (67.2 percent) the most usage. They mainly use moringa to treat health issues, such as, diabetes and hypertension. In the case of health conditions such as, diabetes (40 percent overall, p = 0.024) and hypertension, which reflect moringa’s anti-diabetic and anti-hypertensive characteristics. The middle-class (55.2 percent) make up the strongest customer base as a result of health awareness and social media initiatives. Urban customers prefer tablets (67.1 percent) for convenience while rural customers prefer powder (23.9 percent) for the cost and traditional beliefs. Online reviews (43.4 percent) and social networks are strong influences on recommendation. In contrast, there is negligible input from doctors (1.9 percent) and healthcare professionals (17 percent) with little reason. Distribution is centered on Zila areas (56.9 percent) with limited penetration in other areas.

Conclusion: Moringa capsules have been gaining popularity in Bangladesh in steady manner among middle-aged population to be specific. There is a stronger demand for capsules in urban market. However, rural penetration and clinical endorsements leave a lot to be desired. Future efforts have to shift the focus towards rural distribution and affordable pricing with clinical validation.

The whole world is the home of a vast array of trees, among which Moringa Oleifera (MO) deserves special recognition for the many health benefits it provides. This tree is native to Sub-Himalayan tract of northern India. Nowadays, the tree can be found in countries like, South Africa, Madagascar, Bangladesh, Philippines, Afghanistan and more [1]. There is growing popularity for Moringa among consumers and it is being called the “the drumstick tree” while some others call it “the miracle tree”. The tree is native to tropical regions but, it also has a great deal of climate adaptability [2]. Vitamins and minerals can be found in abundance in MO along with antioxidants and different proteins. The tree is also known to contain a number of essential amino acids to go with iron and calcium as well as potassium [3]. These amino acids have reportedly demonstrated bioactive components alongside several other health benefits [4].

Recently, there has been an increasing demand among the global population for dietary supplements. The powder from MO can used for the fortification of food while considering it as a natural supplement. Moreover, the powder can be ingested with ease which supports the decision to add MO for food fortification [5]. What makes Moringa oleifera a miracle tree are the numerous health benefits it provides. Any part of the tree can have any number of medicinal properties. The seeds of MO have its use in animal feed along with soap as well as cosmetic productions. Meanwhile, roots and barks have nutritional properties which that them a great addition to human food. Even the fodder has its use in the case of farm animals along with fertilizer [6]. In that regard, Moringa has served the needs of humans for centuries. Nowadays, it holds much value from an economic, social and nutritional standpoint as well as the medicinal standpoint.

In today’s society stress comes to people from different angles. There is a greater level of awareness among consumers regarding what they are consuming daily. A phobia has quietly grown among consumers with regard to modern therapeutics. The reason is simple: modern therapeutics may contain harmful chemicals. So, consumers are looking for plant-based biomolecules to take care of their bodies. The old saying is that, “Prevention is better than cure”. This saying is slowly but surely being followed by many consumers nowadays [7]. With that said, it is vital to know the level at which moringa-fortified products enhance the quality of life of its consumers. It is vital to keep in mind that, moringa tablets can have several health benefits.

In a country like Bangladesh, moringa is rather easy to cultivate. The people of this country have become used to growing moringa and consuming different parts. Leaves and pods are commonly consumed by the people, but they vary on the basis of local customs. Major areas in Bangladesh where MO is cultivated are Rajshahi, Pabna, Bogra, Chapainawabganj as well as Kushtia among other areas. In these regions, it is common to see Moringa growing along roadsides as well as homesteads. There are no doubts about how well Moringa thrives in saline belts as well as the regions known for droughts. However, the plant has a hard time on soils that undergo heavy saturation with water [8]. It is pivotal to gain more knowledge about the commercial use of moringa. In that regard, moringa capsules as well as tablets are being sold at pharmacies in Bangladesh. At present, there is very little known about the demand for these capsules and tablets from the pharmacy’s perspective. So, there needs to be a study regarding the commercial use of moringa capsules in Bangladesh from the pharmacy’s perspective. This knowledge will help to understand more about the market condition of moringa capsules in the country and develop methods to improve it if necessary.

Moringa is packed with all the essential nutrients. As previously mentioned, the leaves are home to a number of minerals and vitamins. Moringa oleifera is also made up of several phytochemicals, for instance, tannins, sterols flavonoids along with saponins and many more. The plant is gaining more recognition for the anti-cancerous characteristics it displays. These characteristics or benefits stem from glucosinolates, isothiocyanates as well as glycoside compounds and lastly glycerol-1-9-octadecanoate [9]. When moringa leaves become part of the diet, it becomes easier to combat obesity due to their low caloric value. The pod’s high fiber content can act immediately to prevent colon cancer and treat it. Even in immature pods, there is said to 46.78 percent fiber content coupled with 20.66 percent of protein. Moringa leaves continue to provide several health benefits to human body. The leaves are capable of delivering 1,000 mg of calcium. Moringa leaves powder is a bigger source of calcium as it supplies 4,000 mg of calcium. The powder is a fine choice to replace iron tablets to combat anemia, containing 28mg of iron. In addition, MO leaves comprise of 25.5 - 31.03 mg of Zinc per kg, which is the prerequisite amount for daily consumption. The zinc consumption is imperative to help the body with synthesizing DNA along with RNA. According to several studies, if at least 10 g of moringa’s dry leaf powder is added to malnourished children’s diet, it boosts healthy weight gain. It may come as a surprise that, not all moringa-based products can offer the same nutritional value. There is a huge influence of climate as well as location on the nutritional value of these products [10].

In the Asian countries, Moringa has always been preferred as a vegetable. There has been use of Moringa in cooking preparing soups and curries. In addition, the leaves are viewed as greens and consumed as such. The residents of Asian countries have also roasted the MO seeds to eat them like peanuts. Since starchy dishes are part of the culture, it is vital to incorporate a nutritious side dish. For this reason, integrating different parts of Moringa into the diet can go a long way to help with the intake of proteins, minerals as well as vitamins. This plant is well known for the medicinal properties it contains in different parts. The seeds of moringa tree helps to reduce liver lipid peroxides. There is use of pods in treating diarrhea as well as liver problems. Meanwhile, the roots of Moringa have displayed anti-bacterial activities in several studies. Some other studies focusing on the roots have demonstrated that it can act as a cardiac stimulant with anti-inflammatory properties. Studies also show flowers to work wonders on inflammation and muscle diseases. Flowers will also help combat ulcers. In addition, moringa flowers are capable of lowering the serum cholesterol levels as well as phospholipid and triglyceride [11].

Consumers seeking plant-based natural supplements prefer options that can be consumed easily. So, integrating consumption as part of daily routines hold value to consumers. A better understanding of the manufacturing process helps to understand what consumers will look for. The procedure has to incorporate steps that will preserve the nutritional values coupled with natural qualities. In order to preserve its quality, one needs to follow the right cultivation technique. In today’s world, a high number of individuals in different countries take up organic farming to grow moringa. The practice is relevant for maintaining the integrity of moringa leaves. After all, the integrity of the moringa leaves is necessary to meet the customers’ expectations [12].

In the last 12 months or so, more Moringa sticks were imported than before at Dinajpur’s Hili land port. Moringa sticks are now a popular choice of food, backed by its health benefits in Dhaka and Chattogram, two very important cities of Bangladesh. To meet the growing demand, coupled with a shortage in local supply, imports of Indian moringa sticks have been growing. In February, 2024, the country imported a large amount of moringa sticks. These sticks generated a revenue worth TK 52 lakh (5.2 million). Many vendors claimed that the quality of the Indian Moringa is better than the Bangladeshi counterpart. This led to Moringa sticks being sold for TK 100-120 per kg at a wholesale level [13]. It is further recognition of the growing popularity of Moringa as a healthy food option among other vegetables.

Moringa oleifera is a tree with wonderful resource that offers several uses. Entrepreneurs can use them to create a number of valuable products. This will lead to industries becoming competitive in quick time. With that said, the players in the Moringa industry face an uphill battle to preserve the quality of the products without ruining their sustainability issue. For this reason, entrepreneurs must lean towards eco-friendly practices to cultivate Moringa. Farming practices have to be sustainable. In that regard, farmers need to participate in activities such as, organic fertilization, crop rotation along with conserving water. While it is not exactly an easy task to preserve the soil’s health, it is mandatory to try. After all, if the soil’s health deteriorates, it will be difficult to cultivate moringa. At the same time, cultivators have to be aware of the impact Moringa cultivation has on the land [14].

Value-added products are being sought out now more than ever. Among all the Moringa-based value-added products, the powder version has become quite desirable. The powder has to be made with the leaves and it contains a number of medicinal characteristics. In most cases, there are no distinctions made between new and matured leaves to use for powder making. Relevant authorities need to harvest the leaves at the earliest possible hour in the morning and then clean them. When the Moringa leaf powder is prepared, it is usually a key source of provitamin A alongside vitamins B and C. In South India, the leaf powder is used in a small portions to prepare “Idli”, which is a traditional dish. There are a wide variety of dishes that can also be made using Moringa, for instance, Moringa rice powder and Moringa chutney powder [15]. India is now more open to the concept of value-added Moringa products. It is reflected in the increase in the manufacturing and marketing of Moringa leaf tablets, Moringa tea along with capsules [16].

Moringa oleifera’s seeds comprise of thirty six percent oil (approx.) and a very high amount of oleic acid. There are a number of ways to extract Moringa oil. No matter which process is followed, there will be sterol that contains stigmasterol, campesterol alongside β-sitosterol and lastly avenasterol. It is quite possible for Moringa oil to replace olive oil as a healthier option for food consumption matters. The reason for using Moringa oil is its anti-tumor, anti-ulcer, anti-oxidant and anti-fungal properties among other key properties [17]. Cultivating and commercializing Moringa comes with opportunities for economic development. As the demand for healthy food supplements continue to grow, entrepreneurs will have a real chance to establish sustainable businesses that will yield large profits. Moreover, the change towards sustainability will do well for consumers. The expansion of this industry can lead to more opportunities for those involved with the rural economies. If small-scale farmers participate in sensible farming practices, then Moringa cultivation can provide livelihoods [18]. The Moringa industry is sure to provide a promising start for entrepreneurs if they can engage in sustainable practices and also comprehending the market’s dynamics.

The study has been conducted with a total of 300 respondents who represented pharmacies from different parts of Bangladesh. A flowchart (Figure 1) is made to detail the steps that have been taken from designing this study to its execution. This flowchart leaves no steps behind to fully explain the process involved in completing this study. There is an inclusion criteria as well which has been detailed in the flowchart (Figure 1). In order to obtain the relevant information, a cross-sectional survey has been conducted. The purpose of this survey is to investigate consumption patterns along with preferences and some characteristics of the respondents regarding moringa capsules and tablets in pharmacies. For this survey, the data has been collected from both urban and rural pharmacies. The aim is simple, there may be regional differences and that can be captured with this survey.

Figure 1: Step-by-step breakdown of Research process from selection criteria to data analysis.

It is necessary to mention that the survey has been conducted by the trained researchers belonging to Health and Disease Research Center for Rural Peoples (HDRCRP). Of the 300 respondents, all of them were representatives of pharmacies belonging to both urban and rural regions of Bangladesh. In order to represent both these regions, it had been decided to adopt a stratified sampling approach (Figure 1). The pharmacies represented in the study were first inquired about their willingness to participate in this issue. In addition, they had been asked about their desire to sell Moringa-based capsules and other relevant products.

The data has been collected by developing a structured questionnaire. Once the questionnaire had been prepared, it had to be administered to the pharmacy staff (Figure 1). This questionnaire covered issues such as:

• Demographic information (i.e. age groups)
• Reason for consuming moringa (i.e. diseases like diabetes and high blood pressure)
• Purchase behavior (i.e. frequency, preferred form, and brand inquiry)
• Sources of recommendation

Response from the pharmacy staff was collected in-person by trained researchers of HDRCRP. It is necessary to establish accuracy of data as well as completeness of said data. Once the data had been collected, it had to be standardized for the analysis portion. There were are a number of variables employed for this study:

• Age Group: Participants were segmented according to age groups, such as, 18 - 30 years, 31 - 45 years etc.
• Health Condition: Participants had been inquired about the existence of diseases in their bodies and their customers as well. The diseases are: diabetes, high blood pressure, malnutrition and heart disease among others.
• Purchase Characteristics: There was another segmentation based on the purchaser types that visited the pharmacies, for instance, personal use, children, caregivers, others etc. It is equally important to know more about the frequency of purchases, for instance, daily, weekly, monthly and occasionally. The data can also be segmented by choosing the preferred supplement form (tablet, capsule, powder, tea and others.
• Urban vs. Rural: A difference must surely exist among these two regions in terms of sales and preferences.

In order to analyze the collected data, it has to be compiled at first. Once the compilation process ends, it has to be coded and lastly analyzed with the assist from IBM SPSS Statistics. As a software, IBM SPSS is a reliable software to conduct the statistical analysis [19]. On the other hand, this data has been analyzed with the assist of descriptive status. The use of this form of statistics can make it easy to collect data from participants in the form of consented response. On the other hand, a Pearson – Chi square test had been conducted. In this case, the attempt had been made in hopes of assessing the connection among the different variables. This study has been conducted with a p-value that is lower than 0.05 and considered to be statistically significant. The general assumption is that the pharmacies are actively selling moringa capsules and tablets with interest from the customers. However, it remains to be actually seen whether it is the case or not. One highly important feature of the study is the User vs. Non-User Status among customers. Here, user refers to the customers who will consume moringa capsules for perceived health benefits. Meanwhile, the Non-Users are customers who are unlikely to choose moringa capsules to combat health conditions.

Just before the survey has been conducted, the researchers inquired the participants about the willingness to participate. Once they received the verbal consent, the researchers then initiated the process of collecting data from the pharmacy staff. In this study, there is only the data from participants who gave their verbal consent. Meanwhile, this study has initially been approved by the authority representing Health and Disease Research Center for Rural Peoples (HDRCRP).

The survey has been carried out on pharmacy representatives and staff. For this study, a few figures were constructed with the data of the participants. In figure 2, there is a representation of the geographic distribution: urban vs. rural. It has been found that, urban consumers (56.9%) are more likely to buy moringa-based capsules and products over the rural consumers (43.1%) (Figure 2). There may be more popularity of the capsules in urban areas than in rural ones. At the same time, pharmacies in urban areas are easier to access. Urban people have stronger chances of following health trends than those in rural areas. The urban population may view Moringa as a source of health supplement. This shift towards health supplements supports this idea. Besides, it demonstrates the gap in income between these two. Urban people are likely to have a higher disposable income. Even so, the participation of the rural population towards a healthy way of life is notable (Figure 2). There is enough to suggest that the Moringa capsules have made their way into the rural market to some extent.

Figure 2: Moringa capsules for sale based on region.

In figure 3, it is imperative to look at the age groups and their interest in consuming Moringa capsules. There seems to be no interest (zero percent) from the younger population (18 - 30 years). The interest levels increase significantly to 29.3 percent among a slightly older group (31- 45 years). As for the middle-aged group (46 - 60 years), it has the highest interest level at 67.2 percent (Figure 3). In contrast, the elderly population (60+ years) have very little interest (3.4 percent). The highest interest level of the middle-aged group is likely to be influenced by health conditions, for instance, diabetes and hypertension as well as joint pain. It is well known at this point that Moringa oleifera contains anti-diabetic properties [20]. However, it is not that far behind in terms of showing anti-hypertensive properties and can also help with joint pain [21]. Some have been led to believe that this group shows more openness to using herbal supplements for self-care.

Figure 3: Moringa capsules for sale by age group of customers.

The younger demographics’ (18 - 30 years) disengagement can be due to a lack of perceived need. At the same time, there may be some skepticism about natural supplements [22]. There is also a chance that this group is unaware of the health benefits to consuming moringa. Yet, the lack of interest from the oldest age group (60+ groups) is somewhat shocking (Figure 3). The result may reflect a lack of awareness. This age group may place significant reliance on traditional remedial options.

The socioeconomic profile of the consumers is another key issue. This survey found that rich class presents a good portion (37.9 percent) of the population but, the middle class represent the highest majority (55.2 percent) of the population consuming moringa. It is clear that the middle class group is the backbone of the consumer base (Figure 4). The lifestyle of middle class people in Asia has reportedly created many health problems over the years [23]. There is a tendency in this group to balance price sensitivity with health awareness. It is possible for this group to be influenced by social media as well as peer recommendations. The other significant portion of the consumers is the rich class. There is a likelihood that this group views Moringa as a “premium health product” or a wellness trend. Meanwhile, the lower-income groups (poor + lower class = 6.8 percent) have very little representation (Figure 4). It seems that there are some price barriers.

Figure 4: Type of people who consume moringa tablet.

This study also attempts to understand regional administrative distribution. There are three types of areas represented in this study (Zila, Upazila and Union). Zilla accounts for a large portion of this study (56.9 percent) (Figure 5). This goes to show that the product has a concentration around the developed sectors of Bangladesh. There is a minimal level of penetration (8.6 percent) at the Union level (Figure 5). It can be a result of weak distribution networks or limitations in the number of pharmacies present in those regions. Moreover, the awareness levels of the population in those regions may also be limited. There is also a matter of affordability in these areas.

Figure 5: Moringa capsules sale by area.

The class-based consumption by each area is also relevant to this study. Areas in question are urban and rural. Even in this scenario, there is a middle-class dominance. It is quite possible that the middle class group is the one that is universally targeted [24]. A unique case can be made for the rural poor along with lower class population (7.7 percent each) (Figure 6). It can be seen that they consume Moringa more frequently than the urban counterparts. The consumption level can reflect local production as well as traditional herbal knowledge. However, it can also represent an availability through the informal channel. The urban rich consumers represent a premium market. It is due to their growing interest in wellness along with an ability to pay more for the capsules. Meanwhile, the rural disparities represent the price issue and require affordable pricing and packaging (Figure 6).

Figure 6: Type of people who consume Moringa capsules.

Through pharmacies, it is possible to understand the preferred form of moringa supplement of consumers. There are three forms of moringa supplements, which are: tablets, capsules and powder. However, there may be other forms of the supplement which may be in use but without much traction. The study has been done in such a way that it was possible to get data about the preferred form in urban as well as rural areas. In the urban areas, the preferred format appears to be tablets. The underlying cause may be convenience and perceived safety. It is also likely that tablets provide a measured dosage. For this reason, urban areas (67.1 percent) prefer tablets slightly more than the rural areas (60.5 percent) (Figure 7). Meanwhile, capsules are twice as much preferred in urban areas (25 percent) than in rural areas (11.6 percent). The lower preference for capsules in rural areas can be an affordability issue. In addition, capsules may raise suspicion amongst the rural population more than tablets. Lastly, the powder form has more preference in rural areas (23.9 percent) than in urban areas (7.9 percent) (Figure 7). The underlying reason may be the price of moringa powders. At the same time, the powder format may well be aligned with the traditional method of consuming herbal products. There is also other forms preferred by rural areas which could be sachets.

Figure 7: Preferred form of Moringa supplements from customers.

Further tests have been conducted with the collected data based on the clinical characteristics in both urban and rural setting. The data in Table 1 displays significant disparities between these two areas for moringa tablet sales (em>p = 0.005). Urban pharmacies report higher sales (24.4 percent) when compared with their rural counterpart (15.5 percent) (Table 1 for detailed clinical characteristics). In recent times, a trend can be seen in urban areas with an increasing interest towards health supplement products and markets [25]. Not only does the urban population have greater access to pharmacies but also tend to have higher disposable income. Moreover, the urban population has a greater access to health-related information than the rural ones [26]. Here, the p-value is statistically significant, which reinforces the urgent need to improve distribution as well as marketing strategies in the rural areas. In the second section, a classification has been made on the basis of age groups for buying moringa tablets. The age group of 46 - 60 years (59.5 percent combined) is seen to dominate both areas. It is entirely possible that a connection exists between ageing and health concerns that moringa may be equipped to address. On the other hand, there is no participation from the youngest age group (18 - 30 years) (Table 1). With the younger age group, there is a lower prevalence of chronic diseases, which leads to lesser preference for health supplements. In addition, there may also be concerns among this age group about the trustworthiness of such health related products. The third section of the table deals with the type of purchases, whether it be for personal use, for children or for the elderly caregivers. In this case, there is no statistical significance (em>p = 0.166). There has been a higher preference for “personal uses” (49.6 percent overall) in both urban and rural areas. One reason behind it could be that both populations view moringa tablets to be supplementary and not a staple health product. In addition, it is possible for both these groups to buy it for the cost it bears. However, the elderly caregivers (42.6 percent) are not far behind (Table 1). This result aligns with the fact that moringa-based supplements are beneficial for the elderly as they support joint along with bone health [27]. On the other hand, the rural areas’ population highlight more “other” forms of uses. This can be tied to informal healthcare practices. Despite there not being statistically significance, the diversity dictates that rural health behavior has become varied.

The fourth section is regarding the frequency of purchase. There seems to be a non-significant difference in purchase frequency (em>p = 0.799). A significant portion of consumers in both urban and rural settings buy it occasionally (64 percent combined) (Table 1). It suggests that consumption patterns have some irregularity. Meanwhile, the rural consumers show slightly more consistency (14.3 percent) as opposed to the urban counterparts (8.3 percent). Then there is the fifth section that deals with the preferred form of Moringa supplements (tablet, capsule, powder, tea and others). In this case, there is statistical significance of preferred form (em>p = 0.012). This section reveals that, the urban population seeks out tablets and capsules more (67.1 percent and 25 percent) over the rural counterparts (60.5 percent and 11.6 percent) (Table 1). It demonstrates a greater level of trust towards pharmaceutical forms. On the other hand, rural population has a higher preference for powders (23.3 percent), which is nearly three times as much as the preference rate among the urban population (7.9 percent) (Table 1). This disparity is likely to be caused by cost concerns alongside the traditional format of herbal product consumption. However, it may also be a result of the lack of access to the processed form of Moringa oleifera products.

In the sixth section of Table 1, the attempt is made to find out if customers inquire about the brands before the purchase. However, there has been no statistical significance (em>p = 0.904) on this issue. When the results from both urban and rural pharmacies are combined, it reveals that almost half of the customers (44.6 percent) will purchase on the basis of whichever brand’s product is available at any given moment. This attitude is reflected slightly more in urban pharmacies (46.1 percent) than in rural ones (42.2 percent) (Table 1). The result suggests that customers may not be willing to spend too much time on finding a regular brand to adhere to. In fact, the customer’s purchase intentions are likely to be significantly impacted by the product’s availability [28]. On the other hand, the amount of loyal customers (30.6 percent overall) is low. It suggests that the market is yet to be fully developed. There also seems to be no activity regarding brand education. Meanwhile, the rural audience (26.7 percent) is more open to recommendations from the pharmacies than urban ones (23.7 percent) (Table 1). This portion highlights the lack of awareness from the rural audience mixed with an eagerness to learn.

In table 2, there is an inspection about the reasons for using Moringa based on age groups. Here, a number of health conditions were taken into consideration (diabetes, high blood pressure, malnutrition, heart disease, and lastly kidney disease). Of all the prevalent health conditions, only diabetes reveals itself to be statistically significant (em>p = 0.024) (Table 2). It means that the age groups have significant difference when it comes to using Moringa to treat diabetes. This goes for older adults (46 - 60 years and 60+ years) as the usage increase dramatically. The statistically significant p-value confirms that diabetes-related usage of medications is age-sensitive because there seems to be no usage of Moringa-based products among the youngest age group (18 - 30 years). This trend continues with high blood pressure or hypertension as well. The highest usage is reported among the oldest age group (60+ years) at 46.2 percent (Table 2). As it has already been mentioned above that moringa contains anti-hypertensive properties, the prevalence rate of hypertension among the older customers may drive them to consume the Moringa capsules more. There is a contrast from diabetes in the sense that the group representing young adults to middle-aged people (31 - 45 years) are more likely (21.4 percent) to consume Moringa capsules as opposed to middle-aged groups (46 - 60 years) (Table 2). It can be stated that hypertension may be diagnosed early in some people. Given its anti-hypertensive properties and the younger age group’s health awareness, the consumption is higher. On the other hand, the usage may drop with age as they perceive chronic disease management may be more viable with other options.

In the case of heart disease, the middle-aged group (46 - 60 years) reports the highest usage (21.4 percent) of Moringa use. It aligns with the fact that Moringa provides cardiovascular benefits [29]. However, the unexpected part is that the older age group (60+ years) has no usage of Moringa for cardiovascular issues. It suggests that this group may focus on formal medication. The last case deals with kidney disease with only small usage (10.7 percent) among the age group of 31 - 45 years (Table 2). It is clearly a niche use case which could be a result of word-of-mouth use. However, it is not enough to draw any significant conclusion.

From table 3, the aim is to analyze the characteristics of the customers by conditions. The data reveals that, half of the customers (50 percent) buying moringa tablets are currently suffering from diabetes. Meanwhile, the non-users (27 percent) do not have that much of a tendency to buy moringa tablets (Table 3). The overall use for diabetes stands at 40 percent which is the highest cause of usage. There seems to be a connection formed between diabetes and moringa tablet consumption. The near-significant p-value (em>p = 0.071) reveals that a trend exists in which moringa is used to manage diabetes. It maintains consistency with the findings in table 2. Additionally, it is supported by previous mentions of moringa’s anti-diabetic properties. The other notable conditions are high blood pressure (20 percent) and malnutrition (20 percent) (Table 3). However, the prevalence of these two conditions among the users (22.4 percent and 13.8 percent) when compared to non-users depicts inconsistency of use for the aforementioned conditions.

On the other hand, it appears that there is a lower association of heart disease and moringa tablets (12.1 percent among users vs. 23.4 percent among non-users) (Table 3). The same goes for kidney disease (1.7 percent vs. 4.3 percent). These results indicate that moringa capsules may not be considered the primary intervention for the aforementioned conditions. It is entirely possible that a lack of awareness persists among the population about the varied health benefits of moringa capsules with regards to cardiovascular and renal health. From these results, another thing is clear that the moringa capsule market is possibly driven by certain health claims (Table 3). However, the lack of significant p-values for majority of health conditions calls for a more robust study. In addition, the usage or lack thereof can be a result of traditional beliefs still having prevalence.

In table 4, the aim is to understand about the sources of recommendations for use of moringa. It appears that online reviews are dominating (43.4 percent for personal use, 100 percent for children and 34 percent for caregivers) over others (Table 4). The other variables were doctors, health professionals, friends and family members, advertisements and others. Digital media is continually shaping consumer behavior. This trend aligns with the global shift toward consumer-driven health information [30]. Nowadays, social media is responsible for more authentic online reviews about health products. There is a lot more persuasive content now than ever before. The social influence from friends and family members is of great importance in the case of caregivers for the elderly patient (52.6 percent) along with personal use (20.8 percent) (Table 4). It highlights the value of social networks in taking vital health-related decisions. In the case of elderly patients, the caregivers may seek more recommendations to provide the highest quality of care. Yet, there is a shocking lack of influence from doctors (1.9 percent for personal use) alongside healthcare professionals (17 percent for personal use, 13.2 percent for caregivers) (Table 4). A case can be made that moringa capsules use is primarily consumer-driver as opposed to having clinical endorsements. It is possibly a result of insufficient clinical guidelines. At the same time, healthcare professionals may have skepticism regarding the efficacy of these capsules. However, there is very little evidence to suggest that any skepticism may exist.

The study depicts disparities in moringa capsule sales (24.4 percent in urban vs. 15.5 percent rural, p = 0.005) among urban and rural population. It can also be seen that urban consumers (56.9 percent, Figure 2) have a stronger tendency to purchase moringa capsules as they have better access to pharmacies with a higher disposable income as well as health trend exposures. Even so, the rural penetration (43.1 perception) is worth noting (Figure 2). It is possible that their participation is influenced by local cultivation as well as traditional knowledge but, limited by awareness and distribution. Meanwhile, the rural preference for powder (23.3 percent vs. 7.9 percent urban, p = 0.012) is likely to be caused by price and traditional use.

Certain age groups (46 – 60 years) have a higher consumption of moringa (67.2 percent, Figure 3; 59.5 percent in purchase, Table 1), in the case of health conditions. They prefer capsules for diabetes (44.6 percent, p = 0.024) as well as hypertension (16.1 percent, Table 2). The findings support moringa’s anti-diabetic and anti-hypertensive properties as highlighted in previous studies. As the youngest age group (18 – 30 years) shows no interest at all (0 percent), it may well be as they do not have chronic health conditions. Surprisingly, the older age group (60+ years) having little interest (3.4 percent) in using moringa for anything other than diabetes (46.2 percent). This group may lean more towards formal medication or traditional remedies. The study also dived into the socioeconomic condition of the customers who frequently visit pharmacies. It is revealed that the middle class (55.2 percent, Figure 4) are primary users of moringa capsules. One reason can be health awareness while the other reason could be the cost of the capsules. Besides, they might decide to purchase the capsules after witnessing the reviews on social media platforms. The rich class (37.9 percent) are likely to view moringa capsules as premium products. Meanwhile, the lower-income groups’ (6.8 percent) participations are lessened by price barriers. Rural poor/lower-class consumption (7.7 percent each, Figure 6) highlights local production alongside informal channels. If this class is to be targeted then there has to be more focus towards pricing.

Diabetes greatly affects the use of moringa capsules (40 percent overall, 50 percent users, p = 0.071, Table 3) among health conditions. Besides, high blood pressure and malnutrition (20 percent each) affect consumption patterns. Yet, there is an issue related to inconsistency when it comes to the users (22.4 percent and 13.8 percent). The usage is also low in case of heart diseases (12.1 percent vs. 23.4 percent) along with kidney disease (1.7 percent vs. 4.3 percent). It suggests a limit in terms of perception regarding the capsules’ efficacy. The underlying cause could well be weak evidence or low awareness levels.

Online reviews are top choice for recommendations (43.4 percent in personal use, 100 percent for children, 34.2 percent for caregivers, Table 4). Friends and family members are important too. They account for (52.6 percent caregivers, 20.8 percent personal use) significant amount of participants. This suggests trust towards social network. Conversely, the influence from doctors (1.9 percent) along with healthcare professionals (17 percent) has been low. Fellow consumers are likely to recommend moringa capsule use. There is scope to raise concerns regarding the quality of information (em>p = 0.292). The distribution of moringa capsules is concentrated around Zila areas (56.9 percent, Figure 4). Meanwhile, the penetration at Union level is rather low (8.6 percent), possibly due to weaker distribution. In the case of preferred form of moringa product, urban areas have shown a stronger affinity for tablets (67.1 percent). Capsules preferred next (25 percent). Conversely, rural areas have a stronger affinity for powder (23.9 percent, p = 0.212). This data suggests the existence of socioeconomic as well as cultural differences.

While the study aims to be thorough, there is bound to be some limitations and these have been highlighted. These limitations are going to help with future studies as well. For this study, a cross-sectional design has been selected. The problem here is that, there is going to be a snapshot of moringa usage patterns at a certain point in time. In this study, it is hard to capture temporal changes regarding consumption patterns. Perhaps a longitudinal study could assist with understanding the changes in trends. It is also better suited to help understand the long-term effects related to moringa supplement consumption.

The study relies on verbal consent from the pharmacy representatives. So, there has been difficulties with obtaining consent from more representatives. At the same time, the data may also be self-reported, which may not give the clarity needed. In this case, the perception of the representatives is likely to differ from the actual experience of moringa consumers. Moreover, it may be difficult for the pharmacy staff to accurately recall the customers’ behaviors and preferences.

As the study has been conducted using a structured questionnaire, there is always a possibility of the responses being limited in terms of depth. It cannot capture the nuanced information related to moringa consumption. Perhaps a focus group discussion could have captured it. In addition, this study has been conducted with self-reported data on clinical health condition of the customers without any verification. Conditions such as, diabetes and hypertension require thorough medical diagnosis.

There has been no scope in this study to find out about the dosage of the moringa supplements. Dosage is the key to understanding the efficacy. On the other hand, the study’s main focus is on retail pharmacy distribution. It does not have the scope to examine the broader supply chain. For this reason, the study cannot shed light on sourcing, manufacturing as well as quality control procedures.

From limitations stem advice or directions that can lead to a more detail oriented study. It is imperative to opt for clinical efficacy studies. There can be controlled trials that measure the health outcomes from consuming moringa supplements. In addition, these types of studies can benefit from adopting a mixed-method approach. If the quantitative survey is combined with qualitative method, this will result in a thorough understanding of the different factors that influence moringa capsule consumption. On the other hand, it will be better to conduct longitudinal monitoring. If long-term studies are carried out that track consumption patterns alongside health outcomes over a time period then it helps establish causality. Additionally, the long-term studies are better suited to determine the sustainable market trends. It is imperative to acknowledge the limitations in order to understand about the current roadmap of research related to moringa capsules use in Bangladesh.

This study focuses on the recognition and commercial application that Moringa oleifera is gaining through capsules, tablets as well as powders in Bangladesh. A great deal of the study emphasizes the customer’s awareness along with the pharmacy-based beliefs. Since Moringa is rich with so many vital nutrients, it can easily make its way in the market for health and wellbeing. While conducting the study, it has become clear that a steady rise is occurring in terms of demand for moringa-based supplements. The underlying cause could customer satisfaction which results in word-of-mouth marketing as it boosts immunity and blood sugar control among other benefits. It also needs to be stated that, there are some gaps in dosage guidelines.

The growing popularity of Moringa capsules in Bangladesh is further validation of its numerous health benefits. With that said, concerns will remain about the consumption patterns as there seems to be inconsistency related to it. Throughout the study, it was hard to understanding if there are any government policies in place to support the growth of the moringa capsules market. Therefore, it becomes a necessity to put focus on policy development as well as clinical validations that maximizes health benefits of the capsules. At the same time, these policies should also help with the commercialization of the product. If the efforts are coordinated, then Moringa can become a major player in Bangladesh that aids with natural healthcare.

We want to express our gratitude to everyone who has helped with the data collection process required to complete this study.

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Considerations

Before the initiation of the survey questionnaire, the participants had been asked for their verbal consent. The anonymity of the participants is also ensured.

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