Traditional medicine in Kenya: Past and current status, challenges, and the way forward

Ethnobotanical study of medicinal plants used by the people of Mosop, Nandi County in Kenya

Background: Throughout the history, nature has provided mankind with most of their basic needs, which include food, shelter, medicine, clothes, flavours, scents as well as raw materials. Given that they are an integral part of cultural heritage, medicinal plants have played a significant role in human healthcare systems around the world. Investigating various biological resources for use as medicines requires ethnomedicinal studies. Methods: Data on utilization of ethnomedicinal plants from local healers in Kenya's Mosop Sub-County in Nandi County was documented through open-ended, semi-structured questionnaires. A number of quantitative indices, such as the Use Citation (UC), Informant Consensus Factor (ICF), Use Value (UV), Frequency of Citation (FoC) and Relative Frequency of Citation (RFC) were used to convey the potential medical benefits, vitality and variety of the ethnomedicine. Results: 102 informants provided information on 253 ethnomedicinal plant species, classified into 74 families. There were 249 native plant species identified, along with few exotic species: Senegalia senegal (L.) Britton, Persea americana Mill, Carica papaya L. and Solanum betaceum Cav. Of all recorded species, 32% and 27% were herbs and trees, respectively. Among plant parts, leaves were most frequently utilized (27%) and roots (26%), while decoctions (21%) were the most widely used formulations. The dominant family was Asteraceae, with 28 species, followed by Lamiaceae, with 19 species. The highest ICF value was 0.778 for a number of parasitic and infectious illnesses, including ringworms, athlete's foot rot, tetanus, typhoid, intestinal parasites, abscesses, malaria, and amoebiasis. The study's data validates the region's widespread use of traditional medicinal plant remedies. Conclusion: The current study will lay a foundation of knowledge for future research investigations. The abundance of knowledge regarding ethnomedicinal species and their medicinal applications will stimulate further phytochemical and pharmacological research, which could lead to the discovery of potentially significant pharmaceuticals.

Ethnomedicinal uses, phytochemistry, and pharmacology of the genus Sarcophyte: a review

Although medicinal plants have been used by ethnic communities since ancient times to prevent and treat various diseases, only a few have been scientifically documented. Therefore, due to their rare availability and lack of comprehensive scientific information, we reviewed the ethnomedicinal uses, phytochemistry, and pharmacological activities of plants within the genus Sarcophyte. To do this, we used specific search terms and phrases to retrieve relevant information from online sources published in English from 2000 to July 2023. The results showed that there are only two plants in the genus Sarcophyte (Sarcophyte sanguinea Sparrm. and Sarcophyte piriei Hutch.), which are traditionally used to treat a wide range of diseases, especially cancer, and skin, gastrointestinal, and urinogenital tract ailments in humans, and to cure animals in ethnoveterinary practices. It was noted that 13 secondary metabolites have been isolated from the two plants, the most prominent of which are flavonoids (diinsininol, diinsinin, and naringenin). The antioxidant activity of S. piriei is reported based on the scavenging of 2,2-diphenyl-1-picrylhydrazyl (DPPH) (IC50: 4.26 ± 0.22 μg/mL) and 2 -2'-Azino-di-[3-ethylbenzthiazoline sulfonate (ABTS) radicals (IC50: 4.62 ± 0.14 μg/mL), chelating iron (IC50: 1.82 ± 0.01 μg/mL, 3.50 ± 0.09 μg/mL), and nitric oxide (IC50: 9.97 ± 0.88 μg/mL, 9.09 ± 0.11 μg/mL). The methanolic stem extracts of S. piriei possess antimicrobial activity against Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Vibrio fluvialis, and Enterococcus avium, with minimum inhibitory concentration (MIC) values ranging from 0.16 to 0.625 mg/mL, and a minimum bactericidal concentration (MBC) of 1.25 to 5 mg/mL. Cytotoxic effects of the extracts from the two plant species were also demonstrated. Sarcophyte piriei possesses therapeutic potential as evidenced by the inhibitory effects of the aqueous rhizome extract on edema (1,000 mg/kg) and prostaglandin synthesis (IC50 = 0.2 mg/mL). In addition, diinsininol and diinsinin were isolated from S. sanguinea inhibited prostaglandin synthesis (IC50: 9.20 µM, 13.14 µM) and platelet-activating factor-induced exocytosis. Therefore, based on this review, further scientific research is needed to demystify the links between traditional medicinal uses, various secondary metabolites, and the pharmacology of the two plants.

Parents' Knowledge, Attitude, and Practice Regarding Traditional Medicine on Their Children: A Community-Based Cross-Sectional Study in Bisha City, Saudi Arabia

Background The use of traditional medicine (TM) in children is widespread, particularly in developing countries. Parents often rely on TM to treat their children's illnesses or maintain their health. However, the safety and efficacy of TM are often unclear, and there is a need to assess parents' knowledge, attitudes, and practices toward its use. Methods This is a community-based cross-sectional study conducted in Bisha, Saudi Arabia, with a sample size of 555. The study used a modified questionnaire to collect data. The data were collected from March to June 2023. This study involved both descriptive and inferential statistics.  Results The study included 555 participants, most of whom were female, Saudi nationals, and married and had a bachelor's degree. More than half of the participants reported using TM, and most believed that it had fewer side effects and could be taken with allopathic medicines. However, many participants did not believe that TM could prevent or cure all diseases or that it was always safe. The median knowledge score was 4.0, with higher scores associated with older age and higher educational level. Most participants had a positive attitude toward TM, with higher attitude scores associated with younger age, male gender, lower educational level, and healthcare-related occupation. The median practice score was 31.0, with higher scores associated with younger age, male gender, illiteracy, and healthcare-related occupation. Overall, the study highlights the importance of understanding the patterns of use, knowledge, attitudes, and practices of TM in the population, particularly among different demographic groups. Conclusions This study highlights the need for better regulation and supervision of TM outlets to ensure the safety and efficacy of the products. It also emphasizes the importance of consulting healthcare professionals before using TM on children. The findings suggest that healthcare providers should be knowledgeable about TM and provide guidance to parents on its appropriate use.

Phytopharmaceutical practices of traditional health practitioners in Burkina Faso: a cross-sectional study

BACKGROUND

Traditional health practitioners constitute an important part of the health care system in Burkina Faso, particularly in the supply of traditional herbal medicines. Quality and safety of these medicines rely heavily on practices employed during their traditional development. However, traditional phytopharmaceutical practices are poorly described in Burkina Faso. This study aimed to describe the phytopharmaceutical practices of traditional medicine practitioners in Burkina Faso.

METHODS

This was a cross-sectional descriptive ethno-pharmaceutical study, conducted from October 1 to November 30, 2020, among traditional practitioners in four randomly selected health districts: Nongr-Massom (Centre region), Tenkodogo (Centre-East region), Diapaga (East region) and Dafra (Hauts-Bassins region). An anonymous semi-structured face-to-face questionnaire was used to collect socio-demographic data and data on raw materials and finished products.

RESULTS

Sixty-seven (67) traditional health practitioners, aged 56 years on average, including a majority of men (72%), participated in the study. Gathering of wild medicinal plants was the main source of raw materials acquisition (51.5%), which were usually leaves (32.3%). These raw materials were usually sun-dried (43.9%) and packaged mostly in plastic bags (37.2%). They were derived from 60 plant species belonging to 33 botanical families. Fabaceae was the most represented family (18.7%) and Khaya senegalensis Juss. (Meliaceae) the most cited plant species (5.2%). The finished products had an average shelf life of 17 months and were usually prepared as a decoction (31.7%) and administered most often orally (71.4%). Gastrointestinal disorders were the main predictable adverse events of the finished products (54%).

CONCLUSION

This study showed that THPs have important knowledge in the use of medicinal plants, but several shortcomings are observed in their phytopharmaceutical and plant protection practices. Continuous improvement of these practices, through education and training of traditional health practitioners, is essential for the conservation of plant biodiversity and quality assurance of traditional herbal medicines.

Acute oral toxicity, cognitive-enhancing and anti-lipid peroxidation efficacy, and qualitative phytochemistry of the aqueous aerial part extract of Launaea cornuta (Hochst. ex. Oliv. &Hiern) C. Jeffrey

At present, there is no cure for dementia or its related cognitive impairments. Available treatments only provide symptomatic relief and do not alter the disease's progression and they suffer serious drawbacks limiting their clinical use, hence the need for alternative therapies. Although Launaea cornuta has been used traditionally to treat cognitive deficits, its pharmacological efficacy and safety have not been empirically validated, prompting this study. Acute oral toxicity of the extract was examined in Swiss albino mice using the up-and-down procedure described by the Organisation for Economic Cooperation and Development guideline number 425. The Morris water maze technique was adopted in assessing cognitive-enhancing effects of the extract in ketamine-induced cognitive-impaired mice. The malondialdehyde concentrations in the whole brain of experimental mice involved in the MWM experiment were measured to determine the extract's anti-lipid peroxidation efficacy. Qualitative phytochemical screening of the extract was performed using standard procedures. Our results showed that the test extract was safe and did not cause any clinical signs of acute oral toxicity in mice at all doses (LD50 > 2000 mg/kg BW). Moreover, the extract significantly improved cognitive function in ketamine-induced cognitive-impaired mice in a dose-dependent manner, as indicated by reduced escape latency, navigation distance, and longer latency in the target quadrant during the probe trial. The extract also significantly reduced malondialdehyde concentrations in mice in a dose-dependent manner, demonstrating its antioxidative stress efficacy. The studied extract contained various phytochemicals associated with cognitive enhancement and antioxidant efficacy, among other pharmacologic effects. Further empirical studies are needed to determine and characterise the extract's specific cognitive-enhancing compounds, specific mechanisms of action, and complete toxicity profiles.

Traditional Medicine Beliefs and Practices among Caregivers of Children under Five Years-The Child Health and Mortality Prevention Surveillance (CHAMPS), Western Kenya: A qualitative study

BACKGROUND

Approximately 80% of the population residing in sub-Saharan Africa relies on Traditional Medicine (TM). However, literature on factors motivating the use of TM for children under the age of five in these settings is limited. Such information can guide policy formulation for integration of TM into mainstream health care services. This study aimed to describe the motivation on use of TM among caregivers of children residing in rural and urban communities in western Kenya.

METHODS

The socio-behavioral sciences (SBS) arm of the Child Health and Mortality Prevention Surveillance (CHAMPS) program in western Kenya, conducted a cross-sectional qualitative study in Manyatta-an urban informal settlement located in Kisumu town and Karemo-a rural setting in Siaya County. We performed 29 in-depth interviews, 5 focus group discussions and 11 semi-structured interviews with community representatives (n = 53), health workers (n = 17), and community leaders (n = 18). All the participants were purposively sampled. We performed thematic analysis using both inductive and deductive approaches. Data management was completed on Nvivo 11.0 software (QSR International, Melbourne, Australia).

RESULTS

Our findings reveal that some caregivers prefer TM to treat some childhood diseases. Use of TM was informed by illness beliefs about etiology of disease. We observed an appreciation from the study participants that malaria can effectively be treated by Conventional Medicine (CM) while TM was preferred to treat measles and diseases believed to be associated with supernatural etiology such as witchcraft, evil spirit or breaching cultural taboos. TM was also used in instances where CM failed to provide a diagnosis or when CM was 'slow'. TM in such cases was used as a last resort.

CONCLUSION

We observed varied beliefs that motivate caregivers' choice of TM use among children in western Kenya. It is therefore crucial to consider perceptions and socio-cultural beliefs about illnesses when formulating interventions that are geared towards child health.

Magnitude and Determinant Factors of Herbal Medicine Utilization Among Mothers Attending Their Antenatal Care at Public Health Institutions in Debre Berhan Town, Ethiopia

Background

World health organization defined herbal medicines as the practice of herbs, herbal materials, herbal preparations, and finished herbal products. Globally women are the primary utilizer of herbal medicine and even they consume it during their pregnancy period. The World health organization reported that the majority of the global population used traditional medicine. This study aimed to assess the magnitude and determinant factors of herbal medicine utilization among pregnant mothers attending their antenatal care at public health institutions in Debre Berhan town, Ethiopia.

Methodology

Institution-based cross-sectional study was conducted among pregnant mothers who attended their antenatal care at public health institutions in Debre Berhan town, Ethiopia from 12 February 2021 to 12 April 2021. A systematic random sampling method was used to get selected pregnant mothers. Epi data version 3.1 and SPSS version 25 were used for data entry and analysis, respectively. P-value ≤0.05 was used as a cut point of statistical significance in multivariable binary logistic regression.

Results

A total of 422 pregnant mothers were included with a 100% response rate and 277 (65.6%) of them used an herbal medicine during their current pregnancy. Educational level up to primary school [AOR 2.21, 95% CI: 1.17 – 4.18], monthly family income of <2,800 ETB [AOR 1.72, 95% CI: 1.01–2.92], and lack of awareness of the complication of herbal medicine utilization [AOR 10.3, 95% CI: 6.27–16.92] were determinant factors of herbal medicine utilization.

Conclusion

The utilization of herbal medicine among pregnant mothers in this study is high and almost all of them did not disclose their utilization of herbal medicine to their healthcare providers. The ministry of health should integrate traditional medicine with conventional medicines. Midwives and obstetricians should openly discuss regarding benefits and complications of herbal medicine utilization for those pregnant mothers during their antenatal care counseling sessions as routine care.

Antidiarrheal, antimicrobial, and toxic effects of the aqueous and methanolic leaf and fruit extracts of Cucumis dipsaceus (Ehrenb. Ex Spach.)

Introduction: Cucumis dipsaceus is used to treat diarrhoea, microbial infections, among other diseases across the world; however, there is insufficient empirical data to validate its efficacy, toxicity, and safety. Accordingly, we investigated the antidiarrheal, antimicrobial, and toxic effects of the aqueous and methanolic leaf and fruit extracts of C. dipsaceus.Methods: Antidiarrheal activities of the aqueous and methanolic leaf and fruit extracts of C. dipsaceus were investigated using the castor oil-induced diarrhoea technique in a Wistar rat model. The disk diffusion and broth microdilution methods were adopted to determine the antimicrobial activities of the studied plant extracts. The acute oral toxicity effects of the studied plant extracts were investigated in Wistar rats according to the Organisation for Economic Co-operation and Development (OECD) guidelines.Results: The aqueous and methanolic leaf and fruit extracts of C. dipsaceus significantly (P < 0.05) inhibited diarrhoea in a dose-dependent manner in experimental rats. Besides, the studied extracts significantly (P < 0.05) inhibited the growth of Salmonella enteritidis, Escherichia coli, Bacillus subtilis, Pseudomonas aeruginosa, and Candida albicans in varying degrees, as depicted by their growth inhibition zones (>6.00 mm) and minimum inhibitory concentrations (MICs <1000 μg/mL). Moreover, the studied extracts did not cause any observable acute oral toxicity effects in the experimental rats across the 14-day experimental period.Conclusion: The aqueous and methanolic leaf and fruit extracts of C. dipsaceus present a potential source of safe and efficacious lead compounds for developing antidiarrheal and antimicrobial therapies.

Health care seeking behaviors and perspective on indigenous palliative care among cancer patients in Kenya

INTRODUCTION

Holistic integrated community palliative care services remain a mirage to cancer patients. Nonetheless, a number of cancer patients are jamming traditional medicinal places seeking therapy. The results of these visits are undocumented. This study explored healthcare seeking behaviors and perspectives on cancer indigenous palliative care among patients visiting traditional health practitioners in Kenya.

METHODS

A cross-sectional study was undertaken through client exit survey. Face to face interviews were conducted using semi-structured questionnaires with all consenting cancer patients exiting mapped outlets. Data was analyzed using Statistical Package for Social Science Version 22.0.

RESULTS

A total of 433 respondents were interviewed and the majority were female 59.6%, Christians 97.2%, married 89.8% and educated 85.7%. Their mean age was 48.25 ± 15. 58. Education, sex and religion were significantly associated with perceived improvement. The predominant cancer types were breast cancer (22.4%); throat (14.8%), prostate (12.9%), bone (12.5%), cervical (9.9%), stomach (6.0%) and skin cancer (5.1%). The most frequently used traditional medicine was herbal medicine that was driven by unresponsive conditions (42.2%), inaccessible biomedical services (18.8%) and yearning for second opinion (18%) over a condition. Seventy six percent of the respondents reported improved and prolonged quality of life. 78.2% reported improved eating, drinking, standing, walking and doing light duties alone. Patients felt healthier, hopeful, happier, confident and bonded to their families.

CONCLUSIONS

Use of indigenous palliative care is predominant to all major cancer conditions and driven by the quest for cure, successful stories, trustworthiness and beliefs, previous experience and avoiding medical procedures such as surgery.

Engaging globally with how to achieve healthy societies: insights from India, Latin America and East and Southern Africa

The way healthy societies are conceptualised shapes efforts to achieve them. This paper explores the features and drivers of frameworks for healthy societies that had wide or sustained policy influence post-1978 at global level and as purposively selected southern regions, in India, Latin America and East and Southern Africa. A thematic analysis of 150 online documents identified paradigms and themes. The findings were discussed with expertise from the regions covered to review and validate the findings.

Globally, comprehensive primary healthcare, whole-of-government and rights-based approaches have focused on social determinants and social agency to improve health as a basis for development. Biomedical, selective and disease-focused technology-driven approaches have, however, generally dominated, positioning health improvements as a result of macroeconomic growth. Traditional approaches in the three southern regions previously mentioned integrated reciprocity and harmony with nature. They were suppressed by biomedical, allopathic models during colonialism and by postcolonial neoliberal economic reforms promoting selective, biomedical interventions for highest-burden diseases, with weak investment in public health. In all three regions, holistic, sociocultural models and claims over natural resources re-emerged. In the 2000s, economic, ecological, pandemic crises and social inequality have intensified alliances and demand to address global, commercial processes undermining healthy societies, with widening differences between ‘planetary health’, integrating ecosystems and collective interests, and the coercive controls and protectionism in technology-driven and biosecurity-driven approaches.

The trajectories point to a need for ideas and practice on healthy societies to tackle systemic determinants of inequities within and across countries, including to reclaim suppressed cultures; to build transdisciplinary, reflexive and participatory forms of knowledge that are embedded in and learn from action; and to invest in a more equitable circulation of ideas between regions in framing global ideas. Today’s threats raise a critical moment of choice on which ideas dominate, not only for health but also for survival.

Botanical description, phytochemistry, traditional uses, and pharmacology of Crataeva nurvala Buch. Ham.: an updated review

Background

Crataeva nurvala Buch. Ham., an important medicinal plant of the Capparidaceae family, is widely distributed in India and tropical and subtropical parts of the world. It has been reported for its folkloric use in various disorders such as blood purifier, breathing problems, fever, metabolic disorders, wound healing, memory loss, and weak immune system.

Results

The present review has focused on the botanical description and ethnomedicinal and traditional uses of C. nurvala along with its reported pharmacological activities. Chief chemical constituents and pharmacological aspects of C. nurvala have been deeply explored to unravel the unexplored folklore/ethnomedicinal uses of this plant so that the researchers working on this plant may be able to find new insights to continue further investigation on this plant. The pharmacological aspects like anti-diabetic, anti-inflammatory, anti-nociceptive, anti-diarrheal, anti-fertility, anti-pyretic, and anti-cancer potentials evaluated by various in vitro/in vivo methods on this plant have been reported.

Conclusion

Various traditional uses have been reported that need to be scientifically investigated in depth and several pharmacological activities have been reported for the C. nurvala, but more detailed and mechanism-based studies linked to a particular lead compound need to be targeted in the future. Moreover, this plant has not been completely assessed on the basis of its safety and efficacy on humans. It is expected that this review will compile and improve the existing knowledge on the potential utilization of C. nurvala in complementary and alternative medicine.

Herbal Medicine Use During Pregnancy: A Review of the Literature With a Special Focus on Sub-Saharan Africa

Herbal medicine use has grown considerably worldwide among pregnant women, and is particularly widespread in sub-Saharan Africa. However, herbal medicines used across sub-Saharan Africa are associated with important research gaps and a lack of regulatory framework. This is particularly problematic, as herbal medicine use during pregnancy raises several concerns attributed to the herbal ingredient itself, conventional drug-herbal medicine interactions, and contamination or adulteration of herbal remedies. Moreover, several local herbal remedies used by sub-Saharan African pregnant women have never been botanically identified. In this review, an overview of the practice of herbal medicine, including the regulations, challenges and overall safety, is provided. Then, we discuss the prevalence of herbal medicine use during pregnancy across different sub-Saharan African countries, as well as the indications, adverse outcomes, and effectiveness of the most commonly used herbal medicines during pregnancy in that region.