The governance of traditional medicine and herbal remedies in the selected local markets of Western Kenya

Traditional herbal medicine regulatory implementation in Ethiopia: a qualitative study

Background: Approximately 80% of the Ethiopian population predominantly depends on herbal medicines (HMs) for their primary healthcare needs. Nevertheless, worries regarding the safety, efficacy, and standard of herbal-based treatments have been escalating due to the lack of strong regulatory frameworks. Therefore, the study aimed to assess the presence of regulatory frameworks for traditional herbal medicines and their enforcement in Ethiopia. Methods: The qualitative-phenomenological study design was conducted from November 2021 to March 2022 G.C. The study included 25 regulatory official key informants (KIs) who work for national and regional medicine regulatory agencies, and 15 traditional herbal medicine (THM) practitioners who work at the regional level were purposefully selected for an in-depth interview (IDI). An in-depth interview guide was developed through the purposive sampling technique. The collected data were analyzed using thematic content analysis techniques. Results: The study found that the current national medicine proclamation is deemed inadequate in the regulation of THM. Both conventional and traditional herbal medicines are regulated by a single agency. Weak legal enforcement, a lack of government commitment and support, resource constraints, and inadequate regulatory tools are the main challenges faced in THM regulation. Conclusion: Overall, the study found inadequate legal frameworks and weak THM regulatory implementations in Ethiopia. Consequently, it is critical for all regulatory authorities in Ethiopia to exert their utmost efforts to effectively regulate THM.

Allopathic medicine practitioners' experiences with non-disclosure of traditional medicine use

Background

A pertinent issue impacting patient treatment outcomes is the nondisclosure of traditional medicine (TM) use to Allopathic medicine practitioners (AMPs). For years, TM has been a controversial practice, with patients often using it alongside allopathic medicine without disclosing their use. It is imperitive to learn and understand the experiences of AMPs regarding the disclosure of TM use in Gauteng province to enable them to provide the best possible treatment outcomes for patients who use TM.

Aim

This study aimed to explore the experiences of AMPs regarding non-disclosure of TM use in Gauteng province.

Setting

This study was conducted in four district hospitals where outpatient care and services are rendered in Gauteng Province.

Methods

An interpretive phenomenological analysis (IPA) design was followed. Fourteen purposefully sampled AMPs participated in face-to-face, one-on-one, and semi-structured interviews. Interpretive phenomenological analysis in Atlas.ti was conducted.

Results

Three themes emerged: bedside manner of AMPs; stigmatising TM use; and individual belief systems. The belief of patients' disclosure hesitancy because of fear of judgment by the AMPs underpinned these themes.

Conclusion

Allopathic medicine practitioners are aware that patients who use TM could feel guilty and stigmatised. They acknowledged that patients use TM because of cultural and ethnic reasons, which should not be disregarded.

Contribution

The study highlighted that patients do not disclose their TM use because of AMPs' attitudes, stigmatising TM use, and their prejudices against the cultural beliefs of patients. Allopathic medicine practitioners should establish good communication with patients by providing patient-centred communication to facilitate disclosure of TM use.

Providers' Competencies and Management Practices for Traditional Palliative Cancer Care Service Delivery in Kenya

Background

Many people in developing countries are struggling with chronic diseases yet traditional health services remain under-utilized in the quest for universal health care. Thousands patronize these outlets for care yet little is known about provider's competence and how these competencies inform palliative care decisions and practices. The study documented traditional health practitioners (THPs) competencies and practices for traditional palliative cancer care service delivery in Kenya.

Methods

This study utilized mixed-methods design and was undertaken in major towns across Kenya. A total of 201 Traditional health practitioners were purposely sampled, and interviewed. Five in-depth interviews and 6 focus group discussions were conducted. Quantitative data were analyzed using SPSSv22 while thematic and discourse analysis was carried out for qualitative data.

Results

Majority (92.7%) of the THPs provided general traditional health services. Nearly half of the respondents (47.7%, n = 92) stated that they had received their knowledge and abilities through divine gifting, 71 (36.8%) lineage, 61 (31.6%) apprenticeship, and 39 (20.2%) formal study. Palliative care was determined by patient state and followed consultation with caregivers for 165 (85.5%) of respondents. For 160 respondents (83%), management practices involved a mix of patient examination, conventional medical tests, herbal medicine administration, follow-up or referral. Positive feedback consisted of symptom reduction and function recovery.

Conclusion

Core competencies identified include: knowledge acquisition and specialization, assessment, diagnosis and disclosure, decision making, treatment, follow-up, and referral. Traditional palliative care providers share common health-related beliefs, practices and abilities that influence how they approach and make decisions regarding the health management of their patients, despite marked ethnic diversity. The shared pathways offer a chance to develop a cogent traditional palliative care service delivery model and health policy framework to promote its integration within the health workforce. The leading unmet requirements are knowledge of intellectual property rights, disclosure frameworks, and ethical regulation principles.

Local knowledge, practices, challenges of ethnopharmacologically used medicinal plants in Benin and implications for brain illnesses

Traditional medicine (TM) is a significant resource for primary healthcare management all over the world, and principally in Africa. Quality improvement activities that promote evidence-based practices and the integration of traditional medicine into primary healthcare systems can help improve the quality of patient care. In the Republic of Benin (West Africa), traditional medicine practitioners (TMPs) provide different treatments and ways of use, depending on the ailments and the medicinal plants used. The present study aimed at documenting the knowledge, attitudes and practices of Beninese TMPs regarding the use of medicinal plants and the challenges associated with their activities. A focus group survey was conducted using semi-structured interviews with a sample of 91 TMPs in 8 departments of the Republic of Benin. The respondents had an average age of 50 years old and belonged to various categories of TMPs. Medicinal plants are harvested depending on the season and time of the day, and are dried in the shade before being used as decoctions or infusions. Nevertheless, the majority of TMPs do not conduct the necessary tests for quality control, efficacy or toxicity of the proposed remedies, which raises several scientific interrogations, particularly for the treatment of mental and brain-related disorders. Among ~ 110 plants used in the treatment of several pathologies, 66 were revealed as threatened species. The challenges faced by TMPs are mainly material, financial and technical difficulties. The present study reports the importance of intervention to modernize TM practices in Benin. Quality improvement could enhance healthcare delivery and provide support for evidence-based interventions aimed at addressing behavioral, social, and environmental determinants of health.

India and its pluralistic health system - a new philosophy for Universal Health Coverage

In this article we attempt to put forth insights into using traditional medicine (TM) systems to achieve Universal Health Coverage (UHC). We discuss the need for reimagining India's health system and the importance of an inclusive approach for UHC. We comprehend the challenges with appropriate use of TM systems and the lessons from international experience of integrating TM systems. We highlight the pathways for better utilization of TM systems for UHC in India.

In Vitro Antiproliferative Effects and Phytochemical Characterization of Carissa edulis ((Forssk) Vahl) and Pappea capensis (Eckyl and Zeyh) Extracts

Cancer mortality is a global concern. The current therapeutic approaches despite showing efficacy are characterized by several limitations. Search for alternatives has led to the use of herbal plants including C. edulis and P. capensis. However, there is limited research on antiproliferative effects of these medicinal plants. The study sought to evaluate antiproliferative effects of the plants against human breast and prostate cancers using cell viability, and gene expression assays to determine modulation of apoptotic genes. Further, Liquid Chromatography Mass Spectrophotometer (LC-MS) and Gas Chromatography Mass Spectrophotometer (GC-MS) analyses were performed to confirm phytocompounds in the extracts. The results indicated that ethylacetate extracts of C. edulis and P. capensis had the highest activity against cancer cells with IC50 values of 2.12 ± 0.02, and 6.57 ± 0.03 μg/ml on HCC 1395 and 2.92 ± 0.17 and 5.00 ± 0.17 μg/ml on DU145, respectively. Moreover, the plants extracts exhibited relatively less cytotoxic activities against Vero cell lines (IC50 > 20 μg/ml). The extracts also exhibit selectivity against the cancer cells (SI > 3). Further, mRNA expression of p53 in the treated HCC 1395 was increased by 7 and 3-fold, whereas by 3 and 2-fold in DU145 cells, upon treatment with ethylacetate extracts of C. edulis and P. capensis, respectively. Similarly, several-fold increases were observed in the number of transcripts of Bax in HCC 1395 and HOXB13 in DU145 cells. Phytochemical analyses detected presence of phytocompounds including flavonoids, phenolics, tocopherols and terpenoids which are associated with anticancer activity. Findings from this study provide a scientific validation for the folklore use of these plants in management of cancer.

Ethnobotany of traditional medicinal plants and associated indigenous knowledge in Dawuro Zone of Southwestern Ethiopia

BACKGROUND

The study aimed at documenting the indigenous and local knowledge and use of traditional medicinal plants for treating human and livestock ailments in Dawuro Zone of Ethiopia.

METHODS

A survey was conducted among traditional healers and native administrators through discussion, interviews, and field observations. The snowball sampling technique was used to select 384 traditional healers in purposefully selected 50 villages spanning seven districts for face-to-face individual interviews. The chi-square test was applied to establish associations between traditional healers' demographics, the distance between the village site and the nearest natural forest and a health center, and SPSS V.20 software was used for the analysis.

RESULTS

The traditional healers of the study area reported the use of 274 traditional medicinal plant species belonging to 217 genera and 82 families. Asteraceae (11.68%), Fabaceae (9.49%), and Lamiaceae (9.12%) were the foremost frequently used families. Herb species (54.8%) and leaves (65%) were predominantly sourced from the wild environment. The quantity of medicinal plants used (x² = 278.368, df = 20, P = 0.000) and years of (experience in) traditional healing using herbs (x² = 76.358, df = 10, P = 0.000) varied with distance from the natural forests. The service charge for healing had strong positive association (x² = 24.349, df = 5, P = 0.000) with healer's age (x² = 309.119, df = 184, P = 0.000) and educational level (x² = 851.230, df = 598, P = 0.000) with distance of traditional healer's residence from the medical institution. The agricultural activities, urbanization, low or no charge for the healing service, the secrecy and oral transfer of the knowledge, and the demand for medicinal and other multiple purposes species were some of the factors threatening the resource and the associated knowledge as well as the service in the study area.

CONCLUSION

There are diversified traditional medicinal plants applied for healthcare of the community and domestic animals of the study area. The source of remedies mostly depends on herbs of natural forests, and the leaf was the most frequently used plant part. Developing conservation intervention and sustainable systems of utilization is needed for multipurpose medicinal plants. Finally, integrating with modern system and formalizing, legalizing, and capacitating the traditional medicine practitioners are needed for access of primary healthcare systems to rural communities.

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.

Uso tradicional de especies de plantas en trece provincias de Ecuador

Se valida la hipótesis que el uso tradicional de plantas introducidas y nativas es análogo en Ecuador. Ciento veinticuatro entrevistas se desarrollan en 13 provincias de Ecuador, a 99 mujeres y 25 hombres, 107 del total son mestizos y 17 son indígenas, mayoritariamente comerciantes con estudios primarios y constan de 1 a 60 años de experiencia, que adquirieron el conocimiento del uso tradicional de las plantas de sus padres o madres principalmente. Se registra el uso de 274 especies, 138 (50,36%) del total son introducidas y 136 (49,63%) son nativas, 3 de las cuales son endémicas (1,09%); pertenecientes a 224 géneros incluidos en 88 familias botánicas, originarias de América (61,85%), Asia (15,68%), Europa (10,45%), África (9,58%) y Oceanía (2,44%). Se presentan 28 usos generales, particularmente como medicinal (71 usos terapéuticos), destacando el uso como antiinflamatorio, analgésico, antibiótico, antiespasmódico, diurético, sedante y antigripal. El conocimiento tradicional de las plantas no varía significativamente entre etnias y género; lo opuesto ocurre a nivel de edad y entre especies nativas e introducidas. Existe gran concordancia entre los informantes sobre los usos etnomedicinales de las plantas con un valor del Factor de Consenso de los Informantes (FIC) de 0,98.