Use of indigenous and indigenised medicines to enhance personal well-being: a South African case study

"Trust in God, but tie your donkey": Holy water priest healers' views on collaboration with biomedical mental health services in Addis Ababa, Ethiopia

This exploratory qualitative study examines holy water priest healers' explanatory models and general treatment approaches toward mental illness, and their views and reflections on a collaborative project between them and biomedical practitioners. The study took place at two holy water treatment sites in Addis Ababa, Ethiopia. Twelve semi-structured interviews with holy water priest healers found eight notable themes: they held multiple explanatory models of illness, dominated by religious and spiritual understanding; they emphasized spiritual healing and empathic understanding in treatment, and also embraced biomedicine as part of an eclectic healing model; they perceived biomedical practitioners' humility and respect as key to their positive views on the collaboration; they valued recognition of their current role and contribution in providing mental healthcare; they recognized and appreciated the biomedical clinic's effectiveness in treating violent and aggressive patients; they endorsed the collaboration and helped to overcome patient and family reluctance to the use of biomedicine; they lamented the lack of spiritual healing in biomedical treatment; and they had a number of dissatisfactions and concerns, particularly the one-way referral from religious healers to the biomedical clinic. The study results show diversity in the religious healers' etiological understanding, treatment approaches and generally positive attitude and views on the collaboration. We present insights and explorations of factors affecting this rare, but much needed collaboration between traditional healers and biomedical services, and potential ways to improve it are discussed.

Evaluation of the in vitro effects of commercial herbal preparations significant in African traditional medicine on platelets

BACKGROUND

Commercial herbal medicines (CHMs) marketed as immune boosters are gaining wide popularity in South Africa, in the absence of control and regulatory guidelines. These commercially packaged and labelled herbal preparations, acquired in various retail outlets, are used without consulting either a conventional health provider or a traditional health practitioner. Although they are indicated for immune-boosting purposes, they might exert many other beneficial and unwanted effects on physiological systems. Platelets are crucial in haemostasis and important for the immunological system. The aim was to investigate the effect of the CHMs used to strengthen the immune system on the activity of human platelets.

METHODS

Six CHMs commonly used as African traditional medicines in Pretoria, South Africa, were tested for their effects on healthy, isolated human platelets, using a bioluminescence method. The tested herbal medicines were Intlamba Zifo™, Maphilisa™ Herbal medicine, Matla™ African medicine for all diseases, Ngoma™ Herbal Tonic Immune Booster, Stametta™ Body Healing Liquid, and Vuka Uphile™ Immune Booster and serial-diluted standards of each from 10 to 10,000 times. The luminol-enhanced luminescence activity of the platelets was measured after incubation with the herbal medicines and activation with phorbol myristate acetate (PMA) or N-formyl-methionyl-leucyl-phenylalanine (fMLP).

RESULTS

Five herbal medicines, namely Intlamba Zifo™, Maphilisa™ Herbal medicine, Matla™ African medicine for all diseases, Stametta™ Body Healing Liquid, and Vuka Uphile™ Immune Booster exerted comparable weak inhibitory effects on both PMA and fMLP-induced platelets, which were concentration dependent at high doses, and inversely related to concentration at low doses. Intlamba Zifo™, Matla™ African medicine for all diseases, Stametta™ Body Healing Liquid, and Vuka Uphile™ exhibited weak, but non-systematic stimulatory effects at low doses, which were not statistically significant. Ngoma™ Herbal Tonic Immune Booster had weak, inhibitory effects at high doses and weak stimulatory effects that were inversely related to concentration at low doses.

CONCLUSION

The findings suggest a potential beneficial role of the CHMs in the suppression of platelets' reactivity and in enhancing the immune system. Caution, however, should be exercised as platelet inhibition and stimulation predispose to the risk of bleeding and thrombosis, respectively.

Are plants used in the Eastern Cape province for cosmetics fully commercialized?

Plants have been used for years for various cosmetic purposes. In the Eastern Cape province of South Africa, a large proportion of the population reliant (to some extent) on botanical resources for beauty and health. Despite the use of these botanical resources for various cosmetic purposes, only a few have been fully commercialized or used as ingredients in cosmetic formulation. The present study aimed to review plant species that are fully explored commercially for cosmetic products in the Eastern Cape province. A survey of cosmetic products with plant-based ingredients was done covering the major supermarkets (SPAR, Shoprite, and Pick n Pay), cosmetic shops (Clicks), and pharmacies in the Eastern Cape province, and electronic databases including Embase, Google Scholar, Medline, PubMed, Scopus, SciFinder^®, Springer, Science Direct, and Web of Science were used as data sources for ethnobotanical information. Surprisingly, out of 150 plant species used by both Xhosa men and women for various cosmeceutical purposes, only six plant species have been used commercially with regard to cosmeceutical application. These plants species belong to five major plant families, namely Lamiaceae (two species), Asphodelaceae (one species) Cucurbitaceae (one species), Oleaceae (one species), and Verbenaceae (one species). The findings revealed that the use of Eastern Cape plants for cosmetic purposes has not been fully explored commercially. Thus, there is a need for cosmeceutical industries to explore these species commercially in order to develop new possible cosmetic products for local and international markets.

'That is how the real mad people behave': Beliefs about and treatment of mental disorders by traditional medicine-men in Accra, Ghana

BACKGROUND

Traditional healing methods are considered central to mental health care in low-income countries such as Ghana, because they are perceived to be more easily accessible, more affordable and generally ascribe similar causal beliefs to those of the patients. However, not much is known about the work of traditional healers largely because their methods are shrouded in mysticism and secrecy. There is a need to understand the ideology and beliefs of traditional healers surrounding mental disorders, including knowledge about their practices in mental health care.

AIMS

In this article, we discuss the causal beliefs and treatment methods of traditional medicine-men from Accra, Ghana. We also describe their diagnostic and treatment methods for mental disorders.

METHODS

Eight medicine-men, indigenous to the Greater Accra Region, were interviewed through individual semi-structured interviews. The data were analysed through thematic analysis.

RESULTS

The medicine-men's beliefs about mental illness were dominated by supernatural ideas. Mental illness was also seen as a form of punishment or resulting from envy, and there was a strong reliance on spiritual direction from the gods for diagnosis and treatment.

CONCLUSION

These themes are discussed with emphasis on their potential implications for patients, as well as for collaborative efforts.

The Cultural Importance of Plants in Western African Religions

This paper explores the importance of elements of the natural world, and particularly plants, among people of different religious affiliations in western Africa. Plants play an overriding role in African folk religions, which in turn are closely associated with health practices and influence management decisions concerning natural resources. In spite of the extensive literature documenting ritual plant use, the cultural importance of plants in this context has not been systematically assessed. Our objective was to see whether the importance of plants was reflected in people's conceptions of global (i.e., Christianity, Islam) and folk religions (i.e., Vodoun and Bwiti) in Benin (West Africa) and Gabon (Central Africa). By performing a cultural domain analysis (CDA) with 96 individuals, we found that, regardless of the religious affiliation of informants, plants and other elements of the natural world were more present in people's notions of folk religions than in global religions. We conclude by reflecting on the potentials and limitations of the data presented here as a starting point to explore the topic of cultural keystone species.

Integrating Traditional Healers into the Health Care System: Challenges and Opportunities in Rural Northern Ghana

Traditional medicine is widespread in Ghana, with 80% of Ghanaians relying on its methods for primary health care. This paper argues that integrating traditional and biomedical health systems expands the reach and improves outcomes of community health care. Moving beyond literature, it stresses the importance of trust-relationships between healers and biomedical staff. Insights are based on qualitative research conducted in Ghana's Northern Region (2013-2014). Five challenges to integration emerged out of the data: a lack of understanding of traditional medicine, discrimination, high turnover of biomedical staff, declining interest in healing as a profession, and equipment scarcity. Besides challenges, opportunities for integration exist, including the extensive infrastructure of traditional medicine, openness to collaboration, and grassroots initiatives. Contemplating challenges and opportunities this paper provides recommendations for integration, including: identify/select healers, promote best practices, institute appropriate forms of appreciation/recognition of healers, provide aid and equipment, use communication campaigns to promote integration and steer attitudinal change towards healers among biomedical staff. Most crucial, we argue successful implementation of these recommendations depends on a concerted investment in relationships between healers and biomedical staff.

"All I Need Is Help to Do Well": Herbs, Medicines, Faith, and Syncretism in the Negotiation of Elder Health Treatment in Rural Ghana

This qualitative research sought answers to questions about how elders in Agate, Ghana, coped with the challenges of illness in a rural village and in particular how they negotiated treatment for their illnesses within a flawed and limited healthcare system. In our study, 22 of 28 interviewees used all methods available to them (biomedical approaches [doctors and/or hospitals and/or doctor-prescribed medications], herbs, over-the-counter medicines [i.e., acetaminophen painkillers], and faith-based methods [praying/fasting/laying of hands/holy food and/or water]) in attempts to heal their illnesses. A syncretism existed in the negotiation of treatment options. All participants in our study used some form of what we term "Treatment Blending" (TBL), the use by a single participant of more than one of the aforementioned treatment methods for illness. Our research also revealed a widespread use of multiple spiritual systems (at the same time) and practitioner overlap (visiting a doctor, a traditional healer, and/or Christian pastor). Elders, in multiple cases, demonstrated the daily practice of one religion while seeking healing through another framework. TBL among our participants was a reflection of the lives elders lead in which illness and healing cannot be separated from the spiritual, the idea of an omnipresent God who is the ultimate "doctor," and ancient African traditions of herbs and rituals that possess deeper meaning for both physical and psychological healing and well-being. This ran parallel with the syncretism of religion itself in Ghana and suggests possible related paths through which to improve the healthcare system for elders in rural Ghana utilizing local faith-based groups and the elders themselves to assist.

Questionnaire survey of the pan-African trade in lion body parts

The African lion is in decline across its range, and consumptive utilisation and trade of their body parts and skins has been postulated as a cause for concern. We undertook a pan-African questionnaire and literature survey to document informed opinion and evidence for the occurrence of domestic and international trade and consumption in African lion body parts across current and former range states. Sixty-five people from 18 countries participated in the online questionnaire survey (run from July 2014 to May 2015), with information provided for 28 countries (including 20 out of 24 countries believed to have extant populations). Respondents were experts within their professional spheres, and 77% had ≥6 years relevant experience within lion conservation or allied wildlife matters. Their opinions revealed wide sub-regional differences in consumptive use, drivers of trade, and access to lions that impact wild lion populations in different ways. Traditional medicine practices (African and Asian) were perceived to be the main uses to which lion body parts and bones are put domestically and traded internationally, and there is reason for concern about persistent imports from former lion range states (mainly in West Africa) for parts for this purpose. The domestic, rather than international, trade in lion body parts was perceived to be a bigger threat to wild lion populations. Parts such as skin, claws, teeth and bones are thought to be in most demand across the continent. The impact of international trade on wild populations was acknowledged to be largely unknown, but occasionally was judged to be ‘high’, and therefore vigilance is needed to monitor emerging detrimental impacts. Seventeen countries were nominated as priorities for immediate monitoring, including: South Africa, Tanzania, Zimbabwe, Mozambique, Zambia, Botswana, Kenya, Nigeria, and Cameroon. Reasons for their selection include: prevalence of trophy hunting, ‘hot spots’ for poaching, active domestic trade in lion body parts, trade in curios for the tourist market, and histories of legal-illegal wildlife trade. This survey, and increased incident reports since mid-2015 of lion poisoning and poaching in Mozambique, Zimbabwe and South Africa, and sporadic poaching events in Uganda and Tanzania, are signalling an escalating trend in the trade of lion products that is an increasing threat to some national populations. The evidence is sufficient to make more detailed investigation of this trade a conservation priority.

The Immune Effects of an African Traditional Energy Tonic in In Vitro and In Vivo Models

Most of the African traditional medicines (ATM) are formulated as energy tonics to boost and maintain immune defences. In this study, we aimed to evaluate the immune effects of a traditional energy tonic using peripheral blood mononuclear cells (PBMCs), THP-1 monocytes, and bacteria infected rats. When tested in mitogen and peptidoglycan stimulated PBMCs, this energy tonic showed minimal cytotoxicity, while in acute toxicity studies in rats it did not exhibit any significant toxicity at doses up to 2000 mg/mL/kg. The energy tonic doses between 100 and 10 μg/mL were shown to stimulate secretion of cytokines and increase sIL-2R levels in PHA-treated PBMCs. Similar doses in PG-S. aureus-stimulated PBMCs significantly (p < 0.05) increased IL-1α, IL-2, and GM-CSF while causing a significant (p < 0.05) decrease in sIL-2R levels. NF-κβ transcriptional activity was increased in LPS stimulated THP-1 cells. In Sprague Dawley rats pretreated with the energy tonic and then infected with S. aureus, there were insignificant increases in cytokines and sIL-2R when compared to bacteria infected only and 5% Enrofloxacin treated rats. Posttreatment with energy tonic doses after infection with S. aureus did not enhance inflammatory cytokines significantly but changed the immune response profile and decreased corticosterone levels. This ATM showed promising immunomodulatory effects on isolated immune cells and modulated the immune response of rat models infected with S. aureus.

Medicinal plants used in Lesotho for treatment of reproductive and post reproductive problems

ETHNOPHARMACOLOGICAL RELEVANCE

Reproductive healthcare has been highlighted as a major challenge in Lesotho mainly due to the high prevalence of HIV/AIDS and sexually transmitted infections. As a result other reproductive ailments have not received much attention, particularly because healthcare facilities are already limited and many of them are inaccessible. For these reasons, medicinal plants play a major role in primary healthcare system in the country, in addition the plants are easily accessible, more affordable, and their use forms part of the cultural heritage. However, documentation of medicinal plants used for reproductive ailments is scattered, more importantly the biological and pharmacological properties, as well as toxicity of many of these plants are not yet known.

AIM OF THE STUDY

To document the plants used by both male and female Basotho (residing in Lesotho) for the treatment of reproductive ailments, to explore their recorded biological and pharmacological effects as well as their toxicity, and to establish if these plants are used for similar purposes in other southern African cultures.

MATERIALS AND METHODS

The results stem from published findings of recent interviews of traditional medicinal practitioners in the Maseru District of Lesotho, first author's own experiences and observations from the Qacha's Nek District as well as comprehensive literature survey including numerous books and unpublished data. Electronic databases such as Google, Google Scholar, PubMed, and ScienceDirect were also used to search for the chemical compounds, pharmacological activity, and toxicity of the plants.

RESULTS

A total of 87 plant species are reported to be used for the treatment of several reproductive problems such as infertility, complications associated with pregnancy (twelve plants are used to treat conditions such as colic, heartburn, nausea, and constipation), cleansing and/ or toning of the uterus (with a purpose either to induce pregnancy or to get rid of the placenta, for example Withania somnifera and Zantedeschia albomaculata), difficult childbirth, as well treatment of breast and cervical cancer, cysts, fibroids, and testicular tumours (e.g. Hypoxis hemerocallidea). For the toning of the uterus, it is common to use a combination of plants, e.g. Gunnera perpensa, Scabiosa columbaria, and Eriospermum ornithogaloides.

CONCLUSIONS

Of the 87 plants used for reproductive healthcare, the highest number (31) is used for the treatment of infertility (in both men and women). The pharmacological effects, active compounds, and toxicology of many of these plants are not yet known.

Patterns in medicinal plant knowledge and use in a Maroon village in Suriname

ETHNOPHARMACOLOGICAL RELEVANCE

Traditional medicine plays an important role in the primary health care practices of Maroons living in the interior of Suriname. Large numbers of medicinal plants are employed to maintain general health and cure illnesses. Little is known, however, on how knowledge of herbal medicine varies within the community and whether plant use remains important when modern health care becomes available.

AIM OF THE STUDY

To document the diversity in medicinal plant knowledge and use in a remote Saramaccan Maroon community and to assess the importance of medicinal plants vis a vis locally available modern healthcare. We hypothesized that ailments which could be treated by the village health center would be less salient in herbal medicine reports.

METHODS

During three months fieldwork in the Saramaccan village of Pikin Slee, ethnobotanical data were collected by means of participant observations, voucher collections and 27 semi-structured interviews and informal discussions with 20 respondents. To test whether knowledge of medicinal plant species was kept within families, we performed a Detrended Correspondence Analysis.

RESULTS

In total, 110 medicinal plant species were recorded, with 302 health use reports and 72 uses, mostly related to general health concerns (42%), diseases of the digestive system (10%), musculoskeletal system and fever (each 7%). Bathing was the most important mode of application. Most health use reports related to cure (58%) and health promotion (39%), while disease prevention played a minor role. Traditional medicine not only treated cultural illnesses, but also health concerns that could be treated with locally available modern medicines. Knowledge of medicinal plant species is not strictly kept within families, but also shared with friends. Certain recipes and applications, however, may be specific family knowledge.

CONCLUSION

Medicinal plants play a very important role in the daily lives of the Pikin Slee villagers. Plant use reflects actual health concerns, but as modern medicines are available for most of these concerns, the use of herbal medicines seems to be a deep rooted cultural preference, especially when concerned with cultural illnesses and health promotion. Locally provided healthcare could be enriched if traditional knowledge, illness concepts, and medicinal plant uses could fit into a larger, community-oriented framework.

Ritual uses of palms in traditional medicine in sub-Saharan Africa: a review

Palms (Arecaceae) are prominent elements in African traditional medicines. It is, however, a challenge to find detailed information on the ritual use of palms, which are an inextricable part of African medicinal and spiritual systems. This work reviews ritual uses of palms within African ethnomedicine. We studied over 200 publications on uses of African palms and found information about ritual uses in 26 of them. At least 12 palm species in sub-Saharan Africa are involved in various ritual practices: Borassus aethiopum, Cocos nucifera, Dypsis canaliculata, D. fibrosa, D. pinnatifrons, Elaeis guineensis, Hyphaene coriacea, H. petersiana, Phoenix reclinata, Raphia farinifera, R. hookeri, and R. vinifera. In some rituals, palms play a central role as sacred objects, for example the seeds accompany oracles and palm leaves are used in offerings. In other cases, palms are added as a support to other powerful ingredients, for example palm oil used as a medium to blend and make coherent the healing mixture. A better understanding of the cultural context of medicinal use of palms is needed in order to obtain a more accurate and complete insight into palm-based traditional medicines.

Difficulty, despair and hope – an insight into the world of the health professionals treating paediatric pain in sub-Saharan Africa

The recognition and treatment of paediatric pain in sub-Saharan Africa brings many challenges and barriers for health professionals to overcome. This paper aims to give a unique insight into the world of the health professional through a dynamic cycle of interpretation via Interpretative Phenomenological Analysis. In-depth interviews with six health professionals were conducted and revealed four main themes: a burden-filled workload, mythology, lack of education and pharmacology. Findings showed how working in this field affects health professionals personally; the task of treating children who suffer unnecessary pain is emotive and potentially damaging. The way in which parents, health professionals and children view pain in terms of their everyday existence and within the context of their culture seems fundamental to gaining a better understanding of the barriers to providing pain relief to children in sub-Saharan Africa.

Nephrotoxicity of alternative medicine practice

The use of alternative medicine is highly prevalent around the world; in many areas, this is so because of lack of access to, or trust in, Western medicine, and also because they are considered "natural" and therefore safe. The kidney is an organ vulnerable to toxic insults by virtue of its anatomy and function. Reports of nephrotoxicity associated with alternative medicine use encompass all forms of renal dysfunction, ranging from electrolyte abnormalities and proteinuria to acute and CKD, renal failure, and death. In countries where intensive care and dialysis support are not available, mortality is high. Mechanisms of alternative medicine-associated kidney injury include direct nephrotoxicity, which may be augmented by underlying predisposing conditions such as dehydration; contamination, or adulteration of remedies; inappropriate use or preparation of a remedy; or interactions with other medications. The use of alternative medicines is underreported to clinicians. Because many patients strongly believe in the powers of alternative medicines, it is important that alternative medicines not be demonized as a whole, but that their use and consequences be closely observed and reported to build a more comprehensive understanding of their impact in our clinical practice and to foster research on the potential harm or, in some cases, possible benefits.

Pharmacological, genotoxic and phytochemical properties of selected South African medicinal plants used in treating stomach-related ailments

ETHNOPHARMACOLOGICAL RELEVANCE

The evaluated medicinal plants are used in South African traditional medicine in treating stomach-related ailments.

AIMS OF THE STUDY

The study aimed at evaluating the pharmacological, genotoxic and phytochemical properties of the seven selected medicinal plants used for treating stomach-related ailments.

MATERIALS AND METHODS

Ethyl acetate (EtOAc), ethanol (EtOH) 70% and water extracts of the selected plant parts were evaluated for their antimicrobial and anthelmintic activities using microdilution assays. Gram-positive bacteria (Enterococcus faecalis and Staphylococcus aureus), Gram-negative bacterium (Escherichia coli) and Candida albicans were used for antimicrobial assays. Caenorhabditis elegans was used for the anthelmintic assay. Plant extracts were also assayed for their cyclooxygenase-inhibitory activity against cyclooxygenase-1 and -2 enzymes. The Ames test was used to evaluate the genotoxicity of the plant extracts. A spectrophotometric method was used to determine the total phenolics, gallotannins, flavonoids and saponins.

RESULTS

Twelve extracts exhibited minimum inhibitory concentration (MIC) <1 mg/mL against the bacterial test strains, and five extracts exhibited MIC <1 mg/mL against Candida albicans. The EtOAc extract of Tetradenia riparia had the best minimum lethal concentration (MLC) value (0.004 mg/mL) against Caenorhabditis elegans. All the EtOAc extracts exhibited percentage inhibition in the range of 50.7-94.7% against COX-1 and -2 enzymes at 250 μg/mL. All the plant extracts were non-mutagenic towards Salmonella typhimurium tester strains TA98, TA100 and TA1537 without metabolic activation. Phytochemical analysis revealed relatively high amounts of total phenolics, gallotannins and flavonoids in the evaluated plant extracts.

CONCLUSIONS

The general pharmacological activities exhibited by some of the plant extracts in this study support the traditional uses of the selected plants in treating stomach-related ailments. The Ames test showed that all the plant extracts were non-mutagenic but cytotoxicity tests are needed to ascertain the safety for long-term consumption.

Anger regulation in traumatized Cambodian refugees: the perspectives of Buddhist monks

Recent research has highlighted the importance of traditional methods of healing in relation to the treatment of psychological distress in non-Western populations. This pilot study, conducted in Massachusetts, investigates what Buddhist Cambodian monks consider to be the causes, phenomenology and appropriate intervention strategies for anger among Cambodian refugees. Six monks were interviewed at four major temples in Massachusetts. Findings suggested that anger was common in the Cambodian community, was frequently triggered by marital discord, and commonly resulted in verbal and physical violence and, sometimes, suicidality. Buddhist-based anger management strategies identified as useful by the monks included education about Buddhist doctrines, mindfulness meditation practices, and the use of herbal medication and holy water. These anger regulation strategies and treatments are discussed in the context of Buddhist beliefs and Western psychological interventions.

'Whether you like it or not people with mental problems are going to go to them': a qualitative exploration into the widespread use of traditional and faith healers in the provision of mental health care in Ghana

Limited research has been conducted to explore the factors that support or obstruct collaboration between traditional healers and public sector mental health services. The first aim of this study was to explore the reasons underpinning the widespread appeal of traditional/faith healers in Ghana. This formed a backdrop for the second objective, to identify what barriers or enabling factors may exist for forming bi-sectoral partnerships. Eighty-one semi-structured interviews and seven focus group discussions were conducted with 120 key stakeholders drawn from five of the ten regions in Ghana. The results were analysed through a framework approach. Respondents indicated many reasons for the appeal of traditional and faith healers, including cultural perceptions of mental disorders, the psychosocial support afforded by such healers, as well as their availability, accessibility and affordability. A number of barriers hindering collaboration, including human rights and safety concerns, scepticism around the effectiveness of 'conventional' treatments, and traditional healer solidarity were identified. Mutual respect and bi-directional conversations surfaced as the key ingredients for successful partnerships. Collaboration is not as easy as commonly assumed, given paradigmatic disjunctures and widespread scepticism between different treatment modalities. Promoting greater understanding, rather than maintaining indifferent distances may lead to more successful co-operation in future.

Stakeholder's perceptions of help-seeking behaviour among people with mental health problems in Uganda

Introduction

Mental health facilities in Uganda remain underutilized, despite efforts to decentralize the services. One of the possible explanations for this is the help-seeking behaviours of people with mental health problems. Unfortunately little is known about the factors that influence the help-seeking behaviours. Delays in seeking proper treatment are known to compromise the outcome of the care.

Aim

To examine the help-seeking behaviours of individuals with mental health problems, and the factors that may influence such behaviours in Uganda.

Method

Sixty-two interviews and six focus groups were conducted with stakeholders drawn from national and district levels. Thematic analysis of the data was conducted using a framework analysis approach.

Results

The findings revealed that in some Ugandan communities, help is mostly sought from traditional healers initially, whereas western form of care is usually considered as a last resort. The factors found to influence help-seeking behaviour within the community include: beliefs about the causes of mental illness, the nature of service delivery, accessibility and cost, stigma.

Conclusion

Increasing the uptake of mental health services requires dedicating more human and financial resources to conventional mental health services. Better understanding of socio-cultural factors that may influence accessibility, engagement and collaboration with traditional healers and conventional practitioners is also urgently required.

Integrating top-down with bottom-up conservation policy in Africa

Developed nations intervened in conservation policy across Africa during the 20th century to address needs to protect species and biodiversity that were based on their own perceptions and priorities. In the 21st century, conservationists in Africa have revised these perceptions and begun the process of identifying conservation priorities from an African perspective and in consideration of Africans' priorities. Although foreign conservation interveners struggled to identify mechanisms to which local people would respond, African conservationists are now demonstrating how to integrate the continent's unique socioeconomic circumstances into efforts to protect biodiversity. In Africa effective conservation policy must include the generation of wealth, reduction of disease and hunger, and support of traditional land-use practices.

Bathe the baby to make it strong and healthy: plant use and child care among Saramaccan Maroons in Suriname

ETHNOPHARMACOLOGICAL RELEVANCE

Young children are vulnerable to a range of illnesses and evil forces. Ethnobotanical folk remedies often play a major role in combating these afflictions. Here we show that plant use is highly valued and practiced within the Saramaccan Maroon Society in Suriname to maintain the general health and well-being of children.

AIM OF THE STUDY

To assess the plant use importance in child care, we (1) quantified diversity and current status of herbal pharmacopoeia used in child care and (2) elucidated the reasons why care takers (mostly mothers) use these plants.

METHODOLOGY

We collected botanical vouchers of plants used in child care, carried out an ethnobotanical household survey with 105 women and interviewed 19 key informants.

RESULTS

A total of 178 plant species were used in child care for different purposes. Preventive practices were preferred over curing remedies and plants were most frequently used to keep young children strong and healthy. Child care had a strong magical connotation. Bathing proved to be the most important type of application, often combined with drinking small amounts of the bath water.

CONCLUSIONS

Plants play an important role in child care, but more research is needed on how Maroon plant use reflects actual health problems in young children in the Surinamese interior.

Acute kidney injury associated with the use of traditional medicines

The use of traditional medicine is common worldwide, with rates of use of over 80% in some populations. Considering the large number of people using traditional remedies throughout the world, it does seem that most do so without major adverse effects. Nevertheless, many folk medicines can cause kidney injury. Drug-induced nephrotoxicity reportedly contributes to up to 26% of cases of hospital-acquired acute kidney injury (AKI) and 18% of cases of community-acquired AKI globally, and folk remedies account for up to 35% of cases of AKI in the developing world. The kidney is highly susceptible to toxic insults because its intrinsic functions expose it to exceptionally high concentrations of any particular toxic substance. Clinical syndromes of nephrotoxicity can be defined according to the predominant regions of the kidney affected by the toxin, and reversibility of the injury is likely related to the severity and nature of the injury and also to the duration of toxin exposure. In countries with well-developed health-care systems, a large proportion of patients with nephrotoxicity will recover at least some renal function with adequate supportive care and dialysis. Health-care practitioners in all countries should be aware of the high prevalence of the use of alternative therapies and should be proactive in obtaining this information from patients. In poorer countries, where large proportions of the population rely on traditional medicine, attempts should be made to integrate traditional healers into the health-care system.

Bioprospecting the African Renaissance: the new value of muthi in South Africa

This article gives an overview of anthropological research on bioprospecting in general and of available literature related to bioprospecting particularly in South Africa. It points out how new insights on value regimes concerning plant-based medicines may be gained through further research and is meant to contribute to a critical discussion about the ethics of Access and Benefit Sharing (ABS). In South Africa, traditional healers, plant gatherers, petty traders, researchers and private investors are assembled around the issues of standardization and commercialization of knowledge about plants. This coincides with a nation-building project which promotes the revitalization of local knowledge within the so called African Renaissance. A social science analysis of the transformation of so called Traditional Medicine (TM) may shed light onto this renaissance by tracing social arenas in which different regimes of value are brought into conflict. When medicinal plants turn into assets in a national and global economy, they seem to be manipulated and transformed in relation to their capacity to promote health, their market value, and their potential to construct new ethics of development. In this context, the translation of socially and culturally situated local knowledge about muthi into global pharmaceuticals creates new forms of agency as well as new power differentials between the different actors involved.

Traditional healing in South Africa: ethical implications for social work

Within health-care settings, culturally competent practice presupposes an understanding of the socio-cultural meanings attached to illness and disability and the people who are likely to be consulted with respect to providing health care and restoring well-being. Large numbers of South Africans are known to consult with traditional healers in preference to or in conjunction with western, allopathic health-care professionals. The present study represents a secondary analysis of data from various studies conducted on Black African, Muslim, Hindu and Chinese traditional healing systems in South Africa. Common themes that emerged from the analysis included the attribution of illnesses and disorders to spiritual factors, punishment and superstitious beliefs. Treatment approaches included the use of natural substances, prayer and rituals, and procedures that were designed to restore equilibrium. The participants also articulated their views on medical pluralism, collaboration between western and traditional health-care practitioners, and reasons why people consulted with traditional healers. The findings are discussed in terms of their ethical implications for social work.

Initiation rites as a perceived stressor for Isixhosa males with schizophrenia

Although traditional initiation forms a pivotal part of Xhosa culture, it may be a stressful life event for the individual. In this study, 75 Xhosa males diagnosed with schizophrenia were interviewed to examine their perceptions of the role of initiation in the onset and course of their illness. In all, eight patients (10.7%) perceived the initiation rites as a stressful event that had triggered the onset of a psychotic episode, and six (8%) felt it precipitated a relapse. Our findings suggest that initiation rituals may be perceived as a stressful life event influencing the onset and course of schizophrenia. This underlines the importance of understanding the cultural background of patients.

Use of traditional healers and modern medicine in Ghana

PURPOSE

To gain understanding of the use of traditional and modern medicine among the people in Ghana, West Africa.

METHODS

Data were collected from nine participants using a semi-structured questionnaire developed by the researchers based on review of the literature.

FINDINGS

Data analysis was performed manually using reduction methodology to develop broad themes. Findings indicated that choices in healthcare modalities by literate Ghanaians included either traditional or modern medicine, or blending of both. Strong influences on these choices were the level of education and related themes, influence of family and friends, and spiritual/religious beliefs.

IMPLICATIONS

Findings indicate that traditional and modern medicines will always be part of Ghanaian healthcare delivery and efforts should be made to integrate traditional practitioners into the national healthcare delivery system.

Traditional phytotherapy and trans-cultural pharmacy among Turkish migrants living in Cologne, Germany

This article reports on an ethnopharmaceutical field study carried out among Turkish migrants in Cologne, western Germany, which recorded 79 botanical taxa and 115 plant-based preparations, encompassing 167 folk phytotherapeutical uses, as well as a few other biological (animal and mineral derived) remedies. One-fourth of the recorded remedies were represented by food-medicines. Half of the ingredients quoted came originally from Turkey; only a few plants were gathered from the wild or cultivated in the Cologne area. This article discusses the Turkish migrants' frequent use of aerial parts of Sideritis species, the fruits of Pistacia terebinthus and the seeds of Peganum harmala from the perspective of modern phytopharmacology, phytotherapy and toxicology. It considers cultural adaptation related to the use of folk pharmaceuticals by analysing the ingredients of the Turkish folk pharmacopoeia and comparing them with those of the Turkish medical ethnobotany and of the phytotherapy of the host country (Germany). Only one third of the remedies mentioned by Turkish migrants living in Cologne are also known in German evidence-based phytotherapy, and less than 10% of the recorded phytotherapeutic uses are common to both pharmacopoeias. This article concludes by suggesting hypotheses on future changes affecting the knowledge and use of medicinal plants within the Turkish community of Cologne.

Traditional pharmacopoeias and medicines among Albanians and Italians in southern Italy: a comparison

A cross-cultural comparison of traditional household remedies in primary health care and ritual healing practices in two economically and socio-demographically similar communities in Lucania (inland southern Italy) was considered: Ginestra/Zhurë, inhabited by ethnic Albanians, who migrated to the area during the 15th century, and Castelmezzano, inhabited by autochthonous South-Italians. In Ginestra/Zhurë, the number of traditional natural remedies (mainly derived from local medicinal plants) was only half of that in the local folk pharmacopoeia quoted in Castelmezzano. However, ritual magic-healing practices still play a central role among the Albanians in Ginestra/Zhurë, while they do not in Castelmezzano. Reasons for this shift, as well as components that have affected cultural adaptation phenomena and transitions among the Albanians are discussed.

The use of non-prescribed medication in the first 3 months of life in rural South Africa

OBJECTIVE

This paper describes the use of non-prescribed medications given to a cohort of infants in the first 3 months of life in a rural South African district, and discusses some of the implications for primary health care.

METHODS

As part of an ongoing study on breastfeeding, a cohort of 110 infants were visited at home at 6 and 12 weeks of age. Any medications given to the infant since the last visit, the reasons for their administration, and any visits made to traditional healers were recorded via a semi-structured questionnaire. Determinants of administration of non-prescribed medication were analysed, including maternal age, education, infant gender and socio-economic factors.

RESULTS

A total of 107 (97%) infants received non-prescribed medications in the first 3 months of life: 98 (89%) rectally and 64 (58%) orally. The most common enema contained traditional Zulu medicine made from herbs, given more than once weekly, usually for perceived constipation; the most common oral medication was gripe water, given once daily, mainly for 'colic' or 'wind'. Twenty-nine (26%) mothers had consulted a traditional healer, most commonly because of concerns about a capillary naevus, thought to cause pain. Mothers with a 'clean' water supply were more likely to give non-prescribed oral medications than those without (OR=2.7 and P=0.0223), whilst those who had no education were less likely to administer them than those who had completed school (OR=0.19 and P=0.0326).

CONCLUSIONS

Non-prescribed medications are given almost universally to young infants in our area, irrespective of socio-economic class. Health professionals need to be aware of the extent of, and reasons for, administration of non-prescribed medications to young infants, so that effective health messages can be targeted at mothers and caregivers.