Socio-cultural profile of Bapedi traditional healers as indigenous knowledge custodians and conservation partners in the Blouberg area, Limpopo Province, South Africa

An exploratory study on becoming a traditional spiritual healer among Baganda in Central Uganda

Traditional medicinal knowledge and healing practices of indigenous spiritual healers play important roles in health care, and contribute towards achieving Universal Health Care. Traditional spiritual healers (TSHs) are grouped into three categories. One category of Baganda TSHs, Balubaale, engage ancestral spirits during health management. Balubaale are socially significant but not legally accepted. Their initiation and training practices have not been documented in Uganda. The study purpose was to understand and establish the training of traditional spiritual healers. Twelve (10M, 2F); practicing TSHs in Central Uganda were purposively selected and recruited between 15th July 2019 and 29th April 2020, and were prospectively interacted with for 24 months. Transcribed data was coded and thematically analyzed using ATLAS ti. 22 computer software and presented based on an inductive approach. Findings show key areas of TSHs training include connecting with ancestral spirits and the spiritual powers of non-materials and materials such as living and non-living things through rituals. Spiritual healers train in diagnosis and health management based on ancestral spirits and they finally pass out in a communal ceremony witnessed by family and community members. We conclude that TSHs undergo training and are supervised and supported by experienced spiritualists, family and the community. We recommend similar studies among other ethnic groups to contextualize the process of becoming a TSH, compare and harmonize findings to facilitate inter-medical systems communication and policy considerations.

Ethnomedicinal survey and in vitro confirmation of anti-inflammatory and antispasmodic properties of the termite strain Macrotermes bellicosus used in traditional medicine in the Republic of Benin

ETHNOPHARMACOLOGICAL RELEVANCE

Insects and insect-derived products play a vital role in traditional medicine in many parts of the world since ancient times. Among these insects, fungus-growing termites like Macrotermes bellicosus (M. bellicosus) are widely used in nutrition and traditional medicine in various societies of sub-Saharan Africa.

AIM OF THE STUDY

Aim of the present study was to explore the traditional applications of M. bellicosus and subsequently investigate the anti-inflammatory and spasmolytic activity of samples collected in Benin.

MATERIAL AND METHODS

An ethnomedicinal survey with thirty active healers in Benin was conducted and the anti-inflammatory activity of an ethanolic extract of M. bellicosus was investigated. Thus, LPS-induced TNFα release from differentiated human macrophages (THP-1) and IL-8 release from cytokine (IL-1β/TNFα/IFNγ)-challenged human intestinal epithelial cells (Caco-2) was measured by enzyme-linked immunosorbent assay. Furthermore, the influence of M. bellicosus extract on basal tone and induced contractions in isolated rat small intestinal preparations was determined to examine the influence on intestinal motility.

RESULTS

The survey of 30 active healers demonstrated that M. bellicosus and its products (termites' mound and fungus comb) are used in Benin for therapeutic purposes mainly to treat infectious and inflammatory diseases including digestive disorders, snake bites and diarrhea. It was found that M. bellicosus extract inhibited both LPS-induced TNFα release from human macrophages and cytokine-induced IL-8 release from intestinal epithelial cells comparable to budesonide. In addition, isometric contraction measurement with isolated rat small intestinal preparations demonstrated a mild spasmolytic effect of the termite extract in higher concentrations with a suppression of induced contractions and relaxation of basal tone.

CONCLUSION

M. bellicosus which is used in traditional medicine in Benin to treat infectious and inflammatory diseases showed anti-inflammatory activity by inhibiting pro-inflammatory cytokine release and a moderate influence on intestinal motility.

An Ethnobotanical Study of Traditional Knowledge and Uses of Medicinal Wild Plants among the Marakwet Community in Kenya

Traditional plant knowledge and uses of medicinal wild plants were investigated among the Marakwet community in Kenya. Data were collected through interviews with seven traditional healers and 157 questionnaires for local community members. Traditional names of the plants by traditional healers and local community members were prepared as a checklist. Loss of traditional medicinal names of plants was ascertained with up to 60% overlapping in their nomenclature. The traditional medicinal plants treated 41 diseases within the region, of which local community members understood common ones for treating stomachache (94.8%), diarrhea (70.7%), chest problems (65.5%), and typhoid (63.8%). It was also clear that there was low knowledge index of medicinal plants by the local community members (23.6%) based on knowledge of traditional healers. Clearly, medicinal plants for treatment of malaria, diabetes, tetanus, and pneumonia were recognized by over 40% of the local community members, while plants treating arteriosclerosis, meningitis, arthritis, trachoma, smallpox, rheumatic fever, and gout were known by less than 10% of the respondents. Among plants, the use of roots for treatment was known by over 67% of the local community members compared to fruits, bark, bulb, and flowers (<10%). This low traditional medicinal knowledge in a community relies on the traditional medicinal plants, calling for an urgent need to document the information and perpetuate this knowledge from one generation to another. This can be achieved by collecting the information and developing a database of medicinal plants for future research and potential development of new drugs.

Nature's Contributions to Human Health: A Missing Link to Primary Health Care? A Scoping Review of International Overview Reports and Scientific Evidence

Nature's contributions to human health (NCH) have gained increased attention internationally in scientific and policy arenas. However, little attention is given to the role of the health care sector in this discussion. Primary health care (PHC) is a vital backbone for linking knowledge and practice within the organization of health care. The objective of this scoping review is to evaluate how international overview reports and scientific literature on NCH address to PHC. More specifically, we extracted data on arguments, practice supporting tools and guidelines, challenges and constraints, and management approaches to integrate NCH and PHC. The scientific literature search was run in Web of Science. Two independent reviewers screened the scientific publications. Through the scientific literature search, we identified 1,995 articles of which 79 were eligible for analysis. We complemented the search with a selection of six international overview reports. Both the international overview reports and the scientific publications paid limited attention to the role of PHC regarding NCH. To cope with the current challenges and constraints to integrate NCH and PHC, more evidence on NCH, further development of PHC practice supporting tools, bottom–up integrated approaches, and closer interdisciplinary collaborations are required.

Determinants, Prevalence and Trend of Use of Medicinal Plants Among People Living with HIV: A Cross-Sectional Survey in Dschang, Cameroon

People living with HIV (PLHIV) in Cameroon often seek care from traditional health practitioners (THPs) and use medicinal plants (MP). Most MP, however, still lacks evidence for their efficacy and safety, and their use, often undisclosed to referring physicians, may interfere with standard therapies. Therefore, we conducted a survey of 247 PLHIV in Dschang to assess the determinants, prevalence and trend of MP use. Besides, we surveyed 16 THPs about the use of MP in PLHIV and HIV-related knowledge. 54.9% PLHIV declared using in total 70 plants, 91.3% users were satisfied with MP, and unwanted effects were reported in 2 cases. MP users were less educated than nonusers, had longer disease duration and were more often unemployed. Only 3 THPs used MP in PLHIV, and most of them had insufficient knowledge of HIV. Results may be useful for education on HIV and integration of traditional medicines with conventional therapeutics.

Traditional, complementary and alternative medicine use in Sub-Saharan Africa: a systematic review

Background

The WHO estimates that a considerable number of people in Sub-Saharan Africa (SSA) rely on traditional, complementary and alternative medicine (TCAM) to meet their primary healthcare needs, yet there remains a dearth of research evidence on the overall picture of TCAM utilisation in the region.

Methods

We conducted a literature search of original articles examining TCAM use in SSA between 1 January 2006 and 28 February 2017, employing Medline, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Scopus, ProQuest, PubMed, Embase and African Journals Online databases. A critical appraisal of relevant articles reporting a quantitative or mixed-method design was undertaken.

Results

Despite the heterogeneity and general low quality of the identified literature, the review highlights a relatively high use of TCAM alone or in combination with orthodox medicine, in both general population and in specific health conditions in SSA. TCAM users compared with non-TCAM users are more likely to be of low socioeconomic and educational status, while there were inconsistencies in age, sex, spatial location and religious affiliation between TCAM users and non-TCAM users. Most TCAM users (55.8%–100%) in SSA fail to disclose TCAM use to their healthcare providers, with the main reasons for non-disclosure being fear of receiving improper care, healthcare providers’ negative attitude and a lack of enquiry about TCAM use from healthcare providers.

Conclusion

TCAM use in SSA is significant, although most studies emerge from a few countries. Factors associated with TCAM use in SSA are similar to those observed in other regions, but further research may be required to further elucidate challenges and opportunities related to TCAM use specific to SSA.

Integrating traditional medical knowledge into mainstream healthcare in Limpopo Province

In most African states, the majority of the population depend on indigenous healing knowledge for their healthcare. This knowledge is in danger of being obliterated due to a number of factors such as it being not documented, low life expectancy where people die before transferring it to the next generation and the governments failing to incorporate it into the mainstream health system that is often overloaded. This qualitative study adopted a hermeneutic phenomenology to investigate the development of a framework to integrate knowledge of traditional healing into the mainstream healthcare system in the Limpopo province. Data were collected through interviews with traditional healers chosen through snowball sampling technique augmented by observations and analysis of legislation, notes, records and other forms of documents held by healers. Data were analysed and interpreted thematically according to the objectives of the study. The study established that indigenous medical knowledge is marginalised, and healers are not getting support from the government despite the important role they play in the national health systems. Traditional healing is not properly regulated creating a loophole for anyone to practise as a healer. A framework that points the link factors that attempt to create an understanding of how knowledge of traditional healing can be managed and integrated into the mainstream healing is proposed. It is concluded that failure to recognise traditional healing and integrate it in the mainstream health system will continue to hamstring the health system with resources in South Africa.

Sphenostylis stenocarpa (ex. A. Rich.) Harms., a Fading Genetic Resource in a Changing Climate: Prerequisite for Conservation and Sustainability

The southeastern part of Nigeria is one of the major hotspots of useful plant genetic resources. These endemic species are associated with a rich indigenous knowledge and cultural diversity in relation to their use and conservation. Sphenostylis stenocarpa (ex. A. Rich.) Harms., (African Yam Bean (AYB)), is one such crop within the family of Fabaceae. Its nutritional and eco-friendly characteristics have value in ameliorating malnutrition, hidden hunger and environmental degradation inherent in resource-poor rural and semi-rural communities throughout Africa. However, lack of information from the custodians of this crop is limiting its sustainable development. Therefore, ethnobotanical surveys on the diversity, uses, and constraints limiting the cultivation and use of the crop in southeastern Nigeria were carried out. Five-hundred respondents were randomly selected and data collected through oral interviews and focused group discussion (FGD). Semi-structured questionnaires (SSQ) were also used to elicit information from a spectrum of AYB users comprising community leaders, farmers, market women and consumers in five States. Results showed that the majority of the respondents lacked formal education and were of the age group of 40-50 years, while the female gender dominated with limited access to land and extension officers. Seed coat colour largely determined utilization. Long cooking time, requirement for staking materials, aging of farmers and low market demand were among the major constraints limiting further cultivation and utilization of AYB. In-situ conservation was by hanging dried fruits by the fireside, beside the house, storing in earthenware, calabash gourds, cans and bottles. It is concluded that there is urgent need to scale up conservation through robust linkages between contemporary scientific domains and indigenous peoples in order to harness and incorporate the rich indigenous knowledge in local communities for enhanced scientific knowledge, biodiversity conservation and its sustainable utilization for food security.

Prevalence and determinants of depression among patients under the care of traditional health practitioners in a Kenyan setting: Policy implications

In Kenya, there is paucity of information on depression among traditional health practitioner (THP) patients, particularly in rural areas. The aim of this study was to estimate prevalence and identify determinants of major depressive disorder (MDD) among patients of THP in rural Kenya using the World Health Organization (WHO) Mental Health Gap Action Programme Intervention Guideline (mhGAP-IG). All adult patients seeking care from trained THPs (either traditional healers such as diviners and herbalists or faith healers, who use treatments such as prayers, laying hands on patients, or providing holy water and ash to their patients) over a period of 3 months (September 2014 to November 2014) were screened for depression using mhGAP-IG and their sociodemographic characteristics recorded. Overall, the prevalence of depression among THP patients was 22.9%. Being older, female, single, divorced or separated, as well as unemployment and lack of education were found to be significant determinants of depression. Patients with MDD frequently presented with suicidal behavior (32.9%, OR = 5.94, p < .0001) compared to those that had at least one psychotic symptom (26.3%, OR = 3.65, p < .0001). A measure of the accuracy of THPs' assessment of MDD showed 86% specificity and 46% sensitivity and the area under receiver operating characteristics (ROC) curve was 0.686. Our findings shed light on the prevalence of depression among THP patients and thus highlight the need for further research on diagnostic tools for use among THPs in order to avoid substandard care and promote reliance on more evidence-based methods of care.

Gender and leadership for health literacy to combat the epidemic rise of noncommunicable diseases

Until recently, the noncommunicable diseases (NCDs) epidemic has been considered only a significant burden to men in high-income countries. However, latest figures indicate that half of all NCD-related deaths affect women, especially in low- and middle-income countries (LMICs), with global responses to the NCD epidemic overlooking the significance of women and girls in their approaches and programs. This case study highlights the burden of disease challenging South Africa that disproportionately affects women in the country and suggests that the country, along with other LMICs internationally, requires a shift in the gender-based leadership of health literacy and self-empowerment.

Use of Safety Pin on Garments in Pregnancy: A Belief and Cultural Practice with Potential Harmful Effect

Background

Culture has been known to influence practices and beliefs of people world over. Several cultural practices have been noted among pregnant women who were passed from one generation to the next with its potential harmful and beneficial effect. The use of safety pin in is one of such cultural practices that are widely practiced by many pregnant Nigerian women.

Objective

We sought to gain a deeper understanding of the source of knowledge and motivation behind the use of safety pin on garments during pregnancy as well as explore potential harmful side effects of this cultural practice.

Methodology

A total of 419 pregnant women completed questionnaires for a hospital-based cross-sectional study. Safety pin knowledge and motivation for use on garments were assessed using a pre-tested 16 item questionnaire. Consenting women either completed a self-administered structured questionnaire or utilized the help of trained research assistants. Chi-square tests were used to assess relationships between safety pin use on garments and predictor variables. Analysis was done with Statistical Package for Social Sciences version 17.

Results

Of 419 participants, over half (n = 227) reported safety pin use on garments in pregnancy. About two-thirds (n = 177) of women who use safety pin reported older female relatives as their source of information. The mean age of the participants was 29.1 ± 5.74 (range 16–45 years). Traditional religion worshippers were more likely (81.2%) and Christians were least likely to use safety pin (50.7%) during pregnancy. Pregnant women with a tertiary education (50.4%) were least likely to use safety pin compared with women with no or less than a tertiary level of education. Protection of pregnancy against demons/witchcrafts was the reason given by 129 (56.8%) of participants using safety pin in pregnancy.

Conclusion

The use of safety pin on garments during pregnancy is a common cultural practice in southwest Nigeria. Our findings also suggest that religion and education are important determinants of safety pin use. Although our study did not find a statistically significant difference in safety pin prick incidents among safety pin users, it remains a potential source of harm. Thus, there is a need to establish community and hospital based strategies that address potential cultural harmful practices while promoting culturally appropriate healthcare services.

The role of traditional health practitioners in Rural KwaZulu-Natal, South Africa: generic or mode specific?

Background

Traditional health practitioners (THPs) play a vital role in the health care of the majority of the South African population and elsewhere on the African continent. However, many studies have challenged the role of THPs in health care. Concerns raised in the literature include the rationale, safety and effectiveness of traditional health practices and methods, as well as what informs them. This paper explores the processes followed in becoming a traditional healer and how these processes are related to THP roles.

Methods

A qualitative research design was adopted, using four repeat group discussions with nine THPs, as part of a larger qualitative study conducted within the HIV Treatment as Prevention trial in rural South Africa. THPs were sampled through the local THP association and snowballing techniques. Data collection approaches included photo-voice and community walks. The role identity theory and content analysis were used to explore the data following transcription and translation.

Results

In the context of rural Northern KwaZulu-Natal, three types of THPs were identified: 1) Isangoma (diviner); 2) Inyanga (one who focuses on traditional medical remedies) and 3) Umthandazi (faith healer). Findings revealed that THPs are called by ancestors to become healers and/or go through an intensive process of learning about traditional medicines including plant, animal or mineral substances to provide health care. Some THPs identified themselves primarily as one type of healer, while most occupied multiple healing categories, that is, they practiced across different healing types. Our study also demonstrates that THPs fulfil roles that are not specific to the type of healer they are, these include services that go beyond the uses of herbs for physical illnesses or divination.

Conclusions

THPs serve roles which include, but are not limited to, being custodians of traditional African religion and customs, educators about culture, counsellors, mediators and spiritual protectors. THPs’ mode specific roles are influenced by the processes by which they become healers. However, whichever type of healer they identified as, most THPs used similar, generic methods and practices to focus on the physical, spiritual, cultural, psychological, emotional and social elements of illness.