The sustainability of trade in wild plants-A data-integration approach tested on critically endangered Nardostachys jatamansi.

While the demand for many products from wild-harvested plants is growing rapidly, the sustainability of the associated plant trade remains poorly understood and understudied. We integrate ecological and trade data to advance sustainability assessments, using the critically endangered Nardostachys jatamansi in Nepal to exemplify the approach and illustrate the conservation policy gains. Through spatial distribution modeling and structured interviews with traders, wholesalers, and processors, we upscale district-level trade data to provincial and national levels and compare traded amounts to three sustainable harvest scenarios derived from stock and yield data in published inventories and population ecology studies. We find increased trade levels and unsustainable harvesting focused in specific subnational geographical locations. Data reported in government records and to CITES did not reflect estimated trade levels and could not be used to assess sustainability. Our results suggest that changing harvesting practices to promote regeneration would allow country-wide higher levels of sustainable harvests, simultaneously promoting species conservation and continued trade of substantial economic importance to harvesters and downstream actors in the production network. The approach can be applied to other plant species, with indication that quick and low-cost proxies to species distribution modeling may provide acceptable sustainability estimates at aggregated spatial levels.

High altitude organic gold: The production network for Ophiocordyceps sinensis from far-western Nepal.

ETHNOPHARMACOLOGICAL RELEVANCE: Ophiocordyceps sinensis (Berk.) G.H.Sung, J.M.Sung, Hywel-Jones & Spatafora, a high altitude Himalayan fungus-caterpillar product found in alpine meadows in China, Bhutan, Nepal, and India, has been used in the Traditional Chinese Medicine system for over 2000 years. Heightened demand in China over the past 15 years, coupled with limited production, has led to a price hike and increased economic importance of harvests to rural households throughout the species' range. There is, however, limited knowledge on the actors and profit distribution in the O. sinensis production network, especially from the distribution areas on the southern flanks of the Himalayas. Filling in this knowledge gap is essential to the identification and design of public interventions. AIM OF THE STUDY: To describe and quantify the O. sinensis production network originating from Darchula District in far-western Nepal. MATERIALS AND METHODS: Data was collected, for fiscal year 2014-15, in spring and summer 2016 using standardized collector (n=56) and trader (n=45) questionnaires in Darchula District, and central wholesaler (n=9) questionnaires in cities of Nepal. All questionnaires contained quantitative and qualitative components focusing on key elements of the production network, i.e. value creation, enhancement, and capture; and network and territorial embeddedness. RESULTS: Trade is sustained and significant even at the margins of the distributional range, with 384.1 kg of O. sinensis harvested in and traded from Darchula District in 2014-15, having a collector value of approximately USD 4.7 million and constituting the dominant household-level source of income for collectors. The functioning production network is characterised by conflicts in relation to value creation, a high share of value capture by collectors, limited value enhancement, and a high degree of network and territorial embeddedness. CONCLUSIONS: O. sinensis income is of major economic importance for rural households at the margin of its distribution range in Nepal. Production networks operated by informal actors establishing trust-based relationships allow responses to cross-border market signals, enabling the flow of rural and remote environmental resources to urban centres of demand. There is scope for public interventions, e.g. to determine the drivers of demand.

Risk factors for vaginal fistula symptoms in Sub-Saharan Africa: a pooled analysis of national household survey data.

BACKGROUND: Vaginal fistula (VF) is one of the most severe maternal morbidities with the immediate consequence of chronic urinary and/or fecal incontinence. The epidemiological evidence regarding risk factors for VF is dominated by facility-based studies. Our aim is to estimate the effect size of selected risk factors for VF using population-based survey data. METHODS: We pooled all available Demographic and Health Surveys and Multiple Indicators Cluster Surveys carried out in sub-Saharan Africa that collected information on VF symptoms. Bayesian matched logistic regression models that accounted for the imperfect sensitivity and specificity of self-reports of VF symptoms were used for effect size estimation. RESULTS: Up to 27 surveys were pooled, including responses from 332,889 women. Being able to read decreased the odds of VF by 13% (95% Credible Intervals (CrI): 1% to 23%), while higher odds of VF symptoms were observed for women of short stature (<150 cm) (Odds Ratio (OR) = 1.31; 95% CrI: 1.02-1.68), those that had experienced intimate partner sexual violence (OR = 2.13; 95% CrI: 1.60-2.86), those that reported sexual debut before the age of 14 (OR = 1.41; 95% CrI: 1.16-1.71), and those that reported a first birth before the age of 14 (OR = 1.39; 95% CrI: 1.04-1.82). The effect of post-primary education, female genital mutilation, and having problems obtaining permission to seek health care were not statistically significant. CONCLUSIONS: Increasing literacy, delaying age at first sex/birth, and preventing sexual violence could contribute to the elimination of obstetric fistula. Concomitant improvements in access to quality sexual and reproductive healthcare are, however, required to end fistula in sub-Saharan Africa.

Traditional medicine for the rich and knowledgeable: challenging assumptions about treatment-seeking behaviour in rural and peri-urban Nepal.

Traditional medicine is commonly assumed to be a crucial health care option for poor households in developing countries. However, little research has been done in Asia to quantify the reliance on traditional medicine and its determinants. This research contributes to filling in this knowledge gap using household survey data collected from 571 households in three rural and peri-urban sites in Nepal in 2012. Questions encompassed household socioeconomic characteristics, illness characteristics, and treatment-seeking behaviour. Treatment choice was investigated through bivariate analyses. Results show that traditional medicine, and especially self-treatment with medicinal plants, prevail as treatment options in both rural and peri-urban populations. Contrarily to what is commonly assumed, high income is an important determinant of use of traditional medicine. Likewise, knowledge of medicinal plants, age, education, gender and illness chronicity were also significant determinants. The importance of self-treatment with medicinal plants should inform the development of health policy tailored to people's treatment-seeking behaviour.

People, plants and health: a conceptual framework for assessing changes in medicinal plant consumption.

BACKGROUND: A large number of people in both developing and developed countries rely on medicinal plant products to maintain their health or treat illnesses. Available evidence suggests that medicinal plant consumption will remain stable or increase in the short to medium term. Knowledge on what factors determine medicinal plant consumption is, however, scattered across many disciplines, impeding, for example, systematic consideration of plant-based traditional medicine in national health care systems. The aim of the paper is to develop a conceptual framework for understanding medicinal plant consumption dynamics. Consumption is employed in the economic sense: use of medicinal plants by consumers or in the production of other goods. METHODS: PubMed and Web of Knowledge (formerly Web of Science) were searched using a set of medicinal plant key terms (folk/peasant/rural/traditional/ethno/indigenous/CAM/herbal/botanical/phytotherapy); each search terms was combined with terms related to medicinal plant consumption dynamics (medicinal plants/health care/preference/trade/treatment seeking behavior/domestication/sustainability/conservation/urban/migration/climate change/policy/production systems). To eliminate studies not directly focused on medicinal plant consumption, searches were limited by a number of terms (chemistry/clinical/in vitro/antibacterial/dose/molecular/trial/efficacy/antimicrobial/alkaloid/bioactive/inhibit/antibody/purification/antioxidant/DNA/rat/aqueous). A total of 1940 references were identified; manual screening for relevance reduced this to 645 relevant documents. As the conceptual framework emerged inductively, additional targeted literature searches were undertaken on specific factors and link, bringing the final number of references to 737. RESULTS: The paper first defines the four main groups of medicinal plant users (1. Hunter-gatherers, 2. Farmers and pastoralists, 3. Urban and peri-urban people, 4. Entrepreneurs) and the three main types of benefits (consumer, producer, society-wide) derived from medicinal plants usage. Then a single unified conceptual framework for understanding the factors influencing medicinal plant consumption in the economic sense is proposed; the framework distinguishes four spatial levels of analysis (international, national, local, household) and identifies and describes 15 factors and their relationships. CONCLUSIONS: The framework provides a basis for increasing our conceptual understanding of medicinal plant consumption dynamics, allows a positioning of existing studies, and can serve to guide future research in the area. This would inform the formation of future health and natural resource management policies.

Deforestation and the limited contribution of forests to rural livelihoods in West Africa: evidence from Burkina Faso and Ghana.

Forest degradation in West Africa is generally thought to have negative consequences on rural livelihoods but there is little overview of its effects in the region because the importance of forests to rural livelihoods has never been adequately quantified. Based on data from 1014 rural households across Burkina Faso and Ghana this paper attempts to fill this knowledge gap. We demonstrate that agricultural lands and the non-forest environment including parklands are considerably more valuable to poor as well as more well-off rural households than forests. Furthermore, product types supplied by the non-forest environment are almost identical with those from forests. Accordingly, forest clearance/degradation is profitable for and, hence, probably performed by rural people at large. We attribute rural people's high reliance on non-forest versus forest resources to the two countries' restrictive and inequitable forest policies which must be reformed to promote effective forest conservation, e.g., to mitigate climate change.

Relying on nature's pharmacy in rural Burkina Faso: empirical evidence of the determinants of traditional medicine consumption.

Traditional medicine is believed to constitute a crucial healthcare option for poor or remote households in developing countries that have limited access to allopathic medicine and/or a strong cultural attachment to traditional medicine. However, little research has been performed on medicinal plant reliance in developing countries, and the determinants of medicinal plant consumption at the household level in these countries have not been empirically studied. Quantifying the use of traditional medicine at the household level is, therefore, essential to the development of sustainable healthcare policies in the developing world. This paper quantifies household-level use of traditional medicine and identifies determinants of the choice of traditional treatment in the south central region of Burkina Faso. Structured household interviews (n = 205) were conducted in nine villages of rural Burkina Faso from November 2007 to November 2008 and in November 2009 to collect data on household characteristics (e.g., income, education, demographics), illness frequencies, illness types, and treatment strategies employed. Comprehensive analysis of treatment choice was performed through bivariate analyses. Results indicate that traditional medicine was primarily relied on by middle-aged individuals from relatively uneducated households who were living in villages with limited allopathic medicine service provision. Moreover, a differential approach to medicinal plant consumption was used to distinguish between patients using traditional medicine as a self-care treatment and those visiting a traditional healer. Although poorer households were shown to use traditional medicine as a self-treatment, traditional healers' services were relied on by wealthier households.