Evaluation of content and cost of traditional eye medication in a resource-poor country - Implications for eye care practice and policy.

BACKGROUND: Cataract, glaucoma, and conjunctivitis are common causes of ocular morbidity in Nigeria. A major obstacle in reducing the burden of ocular morbidity in rural areas is access to eye care services. Up to 80% of the population in developing countries use traditional medications for their primary healthcare needs because they are accessible, available, and affordable. The aim of this study is to evaluate the content and cost of commercialized traditional medications used in the treatment of common eye conditions in Nigeria. PATIENTS AND METHODS: All the registered traditional healers (THs) at an International Trade Fair in Enugu who treated eye problems were identified. Data on their location and scope of their practice were collected by the researchers. Proxy patients consulted THs in the trade fair with simulated cataract, glaucoma, and bacterial conjunctivitis, and treatment was sought. Medication for the treatment of the simulated disorders was paid for and procured. The mode of administration and the cost of the drugs were recorded by proxy patients. Each medication was labeled with a code and sent to the laboratories of the National Agency for Drug Administration and Control for analysis. Data were entered into a database on Microsoft Access and transferred to STATA V12.1 (StataCorp) for analysis. RESULTS: Cataract was treated by 87.5% of all the traditional eye healers interviewed. A total of 32 samples were collected and analyzed. These comprised mainly oral (53.1%) and topical traditional medications (43.8%). The pH of the topical samples ranged from 3.5 to 10, while the mean microbiological load per topical solution was 3.3 × 104 cfu/mL ± 0.96. The cost of treatment of cataract ranged from 4 to 70 USD. CONCLUSION: The content of the majority of the samples of traditional eye medications in this study had high extremes of pH and/or had a high microbial content. The practice of THs should be regulated.

USE OF COMPLEMENTARY AND ALTERNATIVE MEDICINE IN GEORGIA.

In Georgia, like in most countries globally, people commonly resort to complementary and alternative medicine (CAM). However, not much is known about CAM practices there. The aim of the study was to document common practices of CAM in Georgia and related patient attitudes. We collected data from peoples who commonly use CAM at 20 service provision centers in Georgia using cluster sampling from 300 patients. We admininstered a cross-sectional survey and conducted descriptive statistical analyses. People in Georgia use CAM either for prevention to improve general health (33%) or to treat chronic conditions (36%), spending about 25 Euros per month out of pocket. Most (77%) get their knowledge about CAM from family or friends , less than half (44%) from books or media, and 11% from medical providers. A close person's advice or experience was the most common rationale given for CAM use (54%). In our sample, 17% either don't trust or are unsatisfied with conventional medicine, 29% found CAM treatment "very effective" and 61% "quite/partially" effective; only 5% not effective. Conventional treatment was stopped in half of the cases. 35% of respondents informed their physicians of their CAM use, while about half did not. Public mistrust towards conventional medicine, CAM user high satisfaction, relatively low cost of such services in Georgia - are the factors letting us to suggest that CAM use will further increase. Frequent self taking decisions made by patients to stop physician prescribed treatment, not informing physicians on CAM use, as well as other factors put patients health at risk. Further research and capacity building in practice, education and other related aspects are needed to establish evidence-based regulation and standards for CAM in Georgia that ensure informed decision making and patient safety.

Preference and willingness to pay for traditional medicine services in rural ethnic minority community in Vietnam.

BACKGROUND: Traditional medicine (TM) still plays an important role in a number of health care systems around the world, especially across Asian and African countries. In Vietnam, however, little is known about preference for traditional medicine use. This study assessed the prevalence of use, preference, satisfaction, and willingness to pay for TM services amongst rural ethnic minority community. METHODS: A cross-sectional survey in three provinces in the North and South of Vietnam. RESULTS: The results showed a high level of satisfaction with TM services, with more than 90 % of respondents reporting improved health status given the use of TM. Indicators for preference of TM over modern medicine are a longer distance to health station; being in an ethnic minority; being female; and having had higher service satisfaction. Although we did not have a comparison group, the high level of satisfaction with TM services is likely the result of a project targeting community health workers and the public regarding TM education and access promotion. Indeed, the community health workers are credited with relaying the information about TM more than any other sources. This suggests the importance of community health workers and community health centers in the promotion of TM use. CONCLUSIONS: Ethnic minority people prefer the use of traditional medicine services that supports the expansion of national programs and promotion of traditional medications.

[Characteristics and innovation in projects of ethnomedicine and ethnopharmacology funded by National Natural Science Foundation of China].

The overall situation of projects of ethnomedicine and ethnopharmacology funded by the National Natural Science Foundation of China (NSFC) since 2008 has been presented in this paper. The main source of characteristics and innovation of the funded projects were summarized, which may come from several aspects, such as the ethnomedical theories, the dominant diseases of ethnomedicine, special diseases in ethnic minorities inhabited areas, unique ethnomedical therapy, special methods for applying medication, endemic medicinal materials in ethnic minorities inhabited areas, same medicinal materials with different applications. Examples have been provided to give references to the applicants in the fields of ethnomedicine and ethnopharmacology.

Correlates of out-of-pocket and catastrophic health expenditures in Tanzania: results from a national household survey.

BACKGROUND: Inequality in health services access and utilization are influenced by out-of-pocket health expenditures in many low and middle-income countries (LMICs). Various antecedents such as social factors, poor health and economic factors are proposed to direct the choice of health care service use and incurring out-of-pocket payments. We investigated the association of these factors with out-of-pocket health expenditures among the adult and older population in the United Republic of Tanzania. We also investigated the prevalence and associated determinants contributing to household catastrophic health expenditures. METHODS: We accessed the data of a multistage stratified random sample of 7279 adult participants, aged between 18 and 59 years, as well as 1018 participants aged above 60 years, from the first round of the Tanzania National Panel survey. We employed multiple generalized linear and logistic regression models to evaluate the correlates of out-of-pocket as well as catastrophic health expenditures, accounting for the complex sample design effects. RESULTS: Increasing age, female gender, obesity and functional disability increased the adults' out-of-pocket health expenditures significantly, while functional disability and visits to traditional healers increased the out-of-pocket health expenditures in older participants. Adult participants, who lacked formal education or worked as manual laborers earned significantly less (p < 0.001) and spent less on health (p < 0.001), despite having higher levels of disability. Large household size, household head's occupation as a manual laborer, household member with chronic illness, domestic violence against women and traditional healer's visits were significantly associated with high catastrophic health expenditures. CONCLUSION: We observed that the prevalence of inequalities in socioeconomic factors played a significant role in determining the nature of both out-of-pocket and catastrophic health expenditures. We propose that investment in social welfare programs and strengthening the social security mechanisms could reduce the financial burden in United Republic of Tanzania.

Bioeconomy and ethnopharmacology - Translational perspective and sustainability of the bioresources of northeast region of India.

ETHNOPHARMACOLOGICAL RELEVANCE: The ecological environment of Northeast region of India (NER), with its high humidity, has resulted in greater speciation and genetic diversity of plant, animal, and microbial species. This region is not only rich in ethnic and cultural diversity, but it is also a major biodiversity hotspot. The sustainable use of these bioresources can contribute to the region's bioeconomic development. AIM OF THE STUDY: The review aimed to deliver various perspectives on the development of bioeconomy from NER bioresources under the tenets of sustainable utilization and socioeconomic expansion. MATERIALS AND METHODS: Relevant information related to prospects of the approaches and techniques pertaining to the sustainable use of ethnomedicine resources for the growth of the bioeconomy were retrieved from PubMed, ScienceDirect, Google Scholar, Scopus, and Springer from 1984 to 2023. All the appropriate abstracts, full-text articles and various book chapters on bioeconomy and ethnopharmacology were conferred. RESULT: As the population grows, so does the demand for basic necessities such as food, health, and energy resources, where insufficient resource utilization and unsustainable pattern of material consumption cause impediments to economic development. On the other hand, the bioeconomy concept leads to "the production of renewable biological resources and the conversion of these resources and waste streams into value-added products. CONCLUSIONS: In this context, major emphasis should be placed on strengthening the economy's backbone in order to ensure sustainable use of these resources and livelihood security; in other words, it can boost the bio-economy by empowering the local people in general.

Prevalence and factors associated with the use of alternative (folk) medicine practitioners in 8 countries of the former Soviet Union.

BACKGROUND: Research suggests that since the collapse of the Soviet Union there has been a sharp growth in the use of complementary and alternative medicine (CAM) in some former Soviet countries. However, as yet, comparatively little is known about the use of CAM in the countries throughout this region. Against this background, the aim of the current study was to determine the prevalence of using alternative (folk) medicine practitioners in eight countries of the former Soviet Union (fSU) and to examine factors associated with their use. METHODS: Data were obtained from the Living Conditions, Lifestyles and Health (LLH) survey undertaken in eight former Soviet countries (Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine) in 2001. In this nationally representative cross-sectional survey, 18428 respondents were asked about how they treated 10 symptoms, with options including the use of alternative (folk) medicine practitioners. Multivariate logistic regression analysis was used to determine the factors associated with the treatment of differing symptoms by such practitioners in these countries. RESULTS: The prevalence of using an alternative (folk) medicine practitioner for symptom treatment varied widely between countries, ranging from 3.5% in Armenia to 25.0% in Kyrgyzstan. For nearly every symptom, respondents living in rural locations were more likely to use an alternative (folk) medicine practitioner than urban residents. Greater wealth was also associated with using these practitioners, while distrust of doctors played a role in the treatment of some symptoms. CONCLUSIONS: The widespread use of alternative (folk) medicine practitioners in some fSU countries and the growth of this form of health care provision in the post-Soviet period in conditions of variable licensing and regulation, highlights the urgent need for more research on this phenomenon and its potential effects on population health in the countries in this region.

Changes in the trade in native medicinal plants in Brazilian public markets.

Plants continue to be an important source of new bioactive substances. Brazil is one of the world's mega-diverse countries, with 20 % of the world's flora. However, the accelerated destruction of botanically rich ecosystems has contributed to a gradual loss of native medicinal species. In previous study, we have observed a fast and intensive change in trade of medicinal plants in an area of Amazon, where human occupation took place. In this study, we surveyed 15 public markets in different parts of Brazil in search of samples of 40 plants used in traditional medicine and present in first edition of Brazilian Official Pharmacopoeia (FBRAS), published in 1926. Samples of plants commercialized as the same vernacular name as in Pharmacopoeia were acquired and submitted to analysis for authentication. A total of 252 plant samples were purchased, but the laboratory analyses showed that only one-half of the samples (126, 50.2 %) were confirmed as the same plant species so named in FBRAS. The high number of unauthenticated samples demonstrates a loss of knowledge of the original native species. The proximity of the market from areas in which the plant occurs does not guarantee that trade of false samples occurs. The impact of the commerce of the substitute species on their conservation and in public health is worrying. Strategies are necessary to promote the better use and conservation of this rich heritage offered by Brazilian biodiversity.

Dynamics of medicinal plants knowledge and commerce in an urban ecosystem (Pernambuco, Northeast Brazil).

Given the importance of markets and fairs for the commerce of medicinal plants, an ethnobotanical study was undertaken at the Caruaru Fair (Pernambuco, northeastern Brazil) to compare the richness of species sold and their values of relative importance (RI) using two datasets collected with a 4-year interval. The seasonality of these plants' supplies was also analyzed. The Caruaru Fair is located in the 18 de Maio Park. It covers an area 40,000 m(2) and is used by merchants who sell several types of products, such as supplies, handicrafts, clay and aluminum utensils, shoes, clothes and medicinal plants. Semistructured interviews were carried out with the vendors who agreed to take part in the study in order to record which plants were sold and their respective indications. The plants were collected, and the species were determined. The information was analyzed with quantitative tools. A total of 169 plants were identified from both surveys, which were significantly different with regard to species richness (p < 0.05) but did not vary in relation to species' Relative Importance (p > 0.05). In relation to the seasonality of the plant supply, habit may explain the lack of some species during certain periods of the year, as most of the absent plants are herbaceous. In terms of the species most sold locally, it was found that spontaneous tree species are well known and extensively commercialized.

Mapping prevalence and patterns of use of, and expenditure on, traditional, complementary and alternative medicine in New Zealand: a scoping review of qualitative and quantitative studies.

AIM: Traditional, complementary and alternative medicine (TCAM) is a popular healthcare choice worldwide. The extent of data available on TCAM, including prevalence and patterns of use in New Zealand, is unknown. This scoping review aims to map the existing research describing the use of TCAM (including prevalence, access, expenditure and concurrent use with conventional medicines) in New Zealand. METHOD: Research databases (MEDLINE, EMBASE, AMED, IPA (International Pharmaceutical Abstracts), CINAHL, PsycINFO and Scopus) and grey literature (Google Scholar and New Zealand government and relevant organisations' websites) were searched for studies published before 7 June 2019. Studies reporting on the prevalence and/or exploring aspects of TCAM use were included in this review. RESULTS: In total, 72 studies were reviewed. Available data suggest that TCAM use is widespread among New Zealanders, and some consumers pay large sums of money out-of-pocket. A wide range of TCAM practices and products is used by people of all ages and ethnicities and with various health conditions. There is some evidence of consumers using TCAM concurrently with conventional medicines. Studies were generally small, localised and conducted in sub-populations (e.g., specific age groups, health conditions). Different TCAM definitions, data collection tools, methods and prevalence measurement were used across studies, thereby limiting the comparability of data locally and internationally. CONCLUSION: A considerable number of studies/reports on TCAM use are available. Still, there is a lack of comprehensive, nationally representative data on prevalence and patterns of use of TCAM, including its use in relation to conventional medicine(s) in New Zealand.

Cost analysis in a Traditional, Complementary and Integrative Medicine unit in Brazil.

OBJECTIVE: To analyze the costs of a specialized service in Traditional Complementary and Integrative Medicines (TCIM) in Northeast Brazil to provide data on the cost linked to the implementation and maintenance of services of this nature and to identify the average cost per user for the Unified Health System. METHODS: This is a partial, descriptive, quantitative economic assessment, which used secondary data, later grouped in Microsoft Excel spreadsheets. The method used to analyze such costs was absorption costing, from which the service was divided into three costing centers: productive, administrative and auxiliary. RESULTS: After analyzing the data, the total cost of the service in 2014 was estimated at R$ 1,270,015.70, with a proportion of 79.69% of direct costs. The average cost per user in this period was R$ 36.79, considering the total of 34,521 users in individual and collective practices. CONCLUSIONS: The service has a cost per user compatible with a specialized service; however, TCIM offers a comprehensive and holistic approach, which can have a positive impact on quality of life.

Marcgrave and Piso's plants for sale: The presence of plant species and names from the Historia Naturalis Brasiliae (1648) in contemporary Brazilian markets.

ETHNOPHARMACOLOGICAL RELEVANCE: Parallelisms between current and historical medicinal practices as described in the seventeenth century treatise Historia Naturalis Brasiliae (HNB) provide us with an overview of traditional plant knowledge transformations. Local markets reflect the actual plant use in urban and rural surroundings, allowing us to trace cross-century similarities of ethnobotanical knowledge. AIMS OF THE STUDY: We aim to verify in how far the HNB, created in seventeenth-century northeastern Brazil, correlates with contemporary plant use in the country by comparing the plant knowledge therein with recent plant market surveys at national level. MATERIALS AND METHODS: We conducted a literature review on ethnobotanical market surveys in Brazil. We used the retrieved data on plant composition and vernacular names, together with our own fieldwork from the Ver-o-Peso market in Belém, to compare each market repertoire with the useful species in the HNB. We analyzed similarities among markets and the HNB with a Detrended Correspondence Analysis and by creating Venn diagrams. We analyzed the methods of the different markets to check whether they influenced our results. RESULTS: Out of the 24 markets reviewed, the greatest similarities with the HNB are seen in northern Brazilian markets, both in plant composition and vernacular names, followed by the northeast. The least overlap is found with markets in the central west and Rio de Janeiro. Most of the shared vernacular names with the HNB belonged to languages of the Tupi linguistic family. CONCLUSION: The similarity patterns in floristic composition among Brazilian markets and the HNB indicate the current wider distribution and trade of the species that Marcgrave and Piso described in 1648 in the northeast. Migration of indigenous groups, environmental changes, globalized and homogenous plant trade, and different market survey methods played a role in these results. The HNB is a reference point in time that captures a moment of colonial cultural transformations.

The transnational Sowa Rigpa industry in Asia: New perspectives on an emerging economy.

This article advances the hypothesis that "traditional" Asian pharmaceutical industries are rapidly growing in size and prominence in contemporary Asia, and identifies a lack of empirical data on the phenomenon. Addressing this gap, the article provides a quantitative outline and analysis of the Sowa Rigpa (Tibetan, Mongolian and Himalayan medicine) pharmaceutical industry in China, India, Mongolia and Bhutan. Using original data gathered through multi-sited ethnographic and textual research between 2014 and 2019, involving 232 industry representatives, policy makers, researchers, pharmacists and physicians, it assembles a bigger picture on this industry's structure, size and dynamics. Revealing a tenfold growth of the Sowa Rigpa pharmaceutical industry in Asia between 2000 and 2017, the study supports its initial hypothesis. In 2017, the industry had a total sales value of 677.5 million USD, and constituted an important economic and public health resource in Tibetan, Mongolian and Himalayan regions of Asia. China generates almost 98 percent of the total sales value, which is explained by significant state intervention on the one hand, and historical and sociocultural reasons on the other. India has the second largest Sowa Rigpa pharmaceutical industry with an annual sales value of about 11 million USD, while sales values in Mongolia and Bhutan are very low, despite Sowa Rigpa's domestic importance for the two nations. The article concludes with a number of broader observations emerging from the presented data, arguing that the Sowa Rigpa pharmaceutical industry has become big enough to exert complex transformative effects on Tibetan, Mongolian and Himalayan medicine more generally. The quantitative and qualitative data presented here provide crucial foundations for further scholarly, regulatory, and professional engagement with contemporary Sowa Rigpa.

Introduction to the special issue: Saving plants, saving lives: Trade, sustainable harvest and conservation of traditional medicinals in Asia.

This "geographic and thematic" issue of the Journal of Ethnopharmacology focuses on the traditional medicines in trade in Asia on the 30th anniversary of the 1988 Chiang-Mai Declaration, an output of an historic meeting organized by WHO, IUCN and WWF. The emphasis on the Asian countries that represent the highest volume and value of medicinal plants trade in the world is deliberate. Not only because of the scale and speed of changes in traditional medicines trade in Asia, but also to highlight the conservation and sustainable use issues being faced today. In 1988, few studies had been done on the informal sector trade or on medicinal plant value-chains and even fewer studies on cross-border trade in medicinal plants or fungi. At that time, e-commerce in Traditional and Complementary Medicine (T&CM), so common today, did not even exist. And no comparitive, repeat studies of traditional medicines markets had been done at all. Thirty years later, this special issue illustrates how the traditional medicines trade has grown and changed. Links between medicinal plant conservation, scarcity and price on one hand and quality, safety and adulteration on the other are better understood. E-commerce in T&CM has grown exponentially, due to 51% of the world's population having internet access by 2017. Yet despite global policy goals for conservation and sustainable use, the challenges facing medicinal plants conservation are greater than ever before. Consequently, the need for co-operation between the health-care and conservation sectors recognised in 1988 is even greater today. And this is recognised in WHO's 2014-2023 strategy for traditional medicines, which identifies the need to raise awareness about issues of biodiversity and conservation as an important strategic action (WHO, 2013). This Special Issue is a small contribution towards that goal.

Patterns of change: The dynamics of medicinal plant trade in far-western Nepal.

ETHNOPHARMACOLOGICAL RELEVANCE: Combined quantitative and qualitative environmental product trade studies, undertaken in the same location over time, are instrumental in identifying plant species with commercial demand and explaining what drives temporal changes. Yet such dynamic studies are rare, including for Himalayan medicinal plants that have been large-scale traded for millennia. AIM OF THE STUDY: To (i) investigate changes in medicinal plant trade in the past 17 years, and (ii) identify the main factors driving changes, using a study of Darchula District in far-western Nepal. MATERIALS AND METHODS: Medicinal plant production network data were collected from March to August 2016, for the fiscal year 2014-15, for Darchula District in far-western Nepal through 167 quantitative (58 harvesters, 38 sub-local traders, 25 local traders, 25 central wholesalers, and 21 regional wholesalers), 61 qualitative (15 sub-local traders, 19 local traders, 15 central wholesalers, and 12 regional wholesalers) interviews, and four focus group discussions. Results were compared to previously unpublished similar data for Darchula District for the year 1997-98, using quantitative and qualitative interviews with 10 local traders, 20 central wholesalers, and 53 regional wholesalers. Data analysis was guided by an analytical framework derived from Global Production Network theory. Quantitative data were used to estimate changes in 12 indicators while the qualitative information allowed identification of the factors driving observed changes in the indicators. RESULTS: The volume of medicinal plants traded from Darchula District in the fiscal year 2014-15 was 401 t with a harvester value of USD 5.5 million, representing a 2.3 fold increase in volume and 17.2 fold increase in value compared to 1997-98. Trade in the two observation years comprised 30 air-dried plant products (from 28 identified species as well as lichens and a mineral substance); 12 products were traded in both periods, while seven disappeared, and 11 new products entered the trade. The number of traders increased from 10 to 63, mainly due to the emergence of a single high value product yarsagumba (Ophiocordyceps sinensis), a fungus-caterpillar complex which alone contributed 85% of total trade value. Over the observed time period, harvesters and traders increased their margins at the cost of central wholesalers, indicating that market changes favoured lower tier actors, eroding the previously identified passive central wholesaler oligopsony in Nepal. Important drivers of market changes are: (i) rising incomes in China and India, expressed through demand for new products and increasing per unit prices for a range of products, (ii) expanding infrastructure (roads and telecommunications) towards and into harvesting sites, reducing transport costs and increasing market efficiency, and (iii) government interventions, causing disappearance of some species from trade. These market changes also led to increased cultivation at lower altitudes, and a sharp increase in the number of processor industries in Nepal. CONCLUSION: Trade in medicinal plant products in far-western Nepal in the past two decades has increased substantially, doubling in volume and increasing 17 fold in value. There is a backbone of constantly traded species but also species that disappear from trade and new species that enter. Changes favour harvesters and traders at the benefit of central wholesalers whose previous passive oligopsony is disappearing. The three main drivers of change are rising incomes in China and India, expanding infrastructure, and government interventions in Nepal. Commercial medicinal plant resources are a substantial asset that appears to offer opportunities for economic development in far-western Nepal. The trade, however, may pose sustainability threats that are best understood by combining species-level biophysical, trade, and consumer studies.

Twists, turns and trade: A new look at the Indian Screw tree (Helicteres isora).

ETHNOPHARMACOLOGICAL RELEVANCE: This is the first study of global trade in fruits of the widely used traditional medicine, Helicteres isora L. It is used in Ayurvedic, Siddha, Unani medical systems and/or local folk traditional medicines in Bangladesh, India and Pakistan. The roots are used in Traditional Chinese Medicines in China and the fruits in jamu products in Indonesia, Malaysia and Thailand. In addition, H. isora fruits are also used in "traditional" medical systems far beyond the natural distribution of this species, for example in Zulu herbal medicine (South Africa) and Kurdish herbal medicines (Iraq). AIMS OF THE STUDY: This study had three aims: (i) to assess the global trade in H. isora fruits; (ii) to study the H. isora trade from West Timor to Java in terms of actors and prices along the value chain and (iii) to get a better understanding of the potential of this species to improve household income in eastern Indonesia. MATERIALS AND METHODS: This study uses historical records, a contemporary analysis of global trade data (2014-2016) and field assessments of value chains and the biological factors influencing H. isora fruit production. RESULTS: Globally, the major exporter of H. isora fruits is India, which exports H. isora fruits to 19 countries, far beyond the natural geographical distribution of this species. Over a 36-month period (January 2014-December 2016), India exported 392 t of H. isora fruits, with a Free-On-Board (FOB) value of Indian rupiah (INR) 18,337,000 (US$ 274,055). This represents an average annual export quantity of about 130,526 kg/year. Over this three year period, most of these exports (85.5%) were to Indonesia (346.58 t), followed by Thailand (6.85%). Indian H. isora exports are also used in many other medical systems, including Kurdish and Zulu "traditional" medicines in Iraq and South Africa. Formation of an Indian diaspora in Bahrain, Mauritius, South Africa, Tanzania and Trinidad and Tobago over the past 130 years is one of the drivers of H. isora fruit trade outside the natural geographic distribution of the species. In Indonesia, demand for H. isora fruits is supplemented by an intra-island trade in Java and an inter-island trade from East Nusa Tenggara. West Timor, for example, exports around 31-37 t of air-dried H. isora fruits per year to Java. At the farm gate, local harvesters in West Timor get 4000 IDR (c. 0.3 US$) per kg, with businesses in Java paying 25,000 IDR (c.US$2) per kg for H. isora fruits. This is similar to the price paid for H. isora fruits imported from India to Java. CONCLUSIONS: India is the major exporter of whole dried H. isora fruits, including to countries where this species has never been in traditional use. In Indonesia, H. isora fruit extracts are used in the cosmetic industry as well as in jamu herbal medicines, including "Tolak Angin", the country's most popular commercial "jamu" preparation. Indonesia also is the major importer of H. isora fruits from India. In eastern Indonesia, improved income to local villagers from the H. isora fruit trade could come from improved H. isora fruit quality due to better drying techniques. This would also reduce health risks along the supply chain from to mycotoxins that have been recorded on poorly dried H. isora fruits. There also is an opportunity for cultivation of H. isora in small-holder teak plantations in Indonesia, with harvest of H. isora fruits as well as the medicinal bark.

Traditional Knowledge of Gucchi, Morchella esculenta (Ascomycetes), in Doda District, Jammu and Kashmir, India.

The gucchi mushroom, Morchella esculenta, commonly known as the morel, is called thunthoo in the Bhaderwahi dialect spoken in District Doda of Jammu and Kashmir, India, and is an expensive food item that grows wild and is collected manually. Its nutritive and medicinal values are acknowledged. The farming community in the district traditionally collects the mushroom from forested areas through a well-managed community approach. Elders of families and communities have taught farmers how to identify the mushroom, recognize distribution patterns, and collect it. The knowledge and ability to differentiate M. esculenta from other poisonous wild mushrooms has also been inherited from the elders and community members. Women and children collect it from the outskirts of the forested areas and villages; men penetrate deeper into the dense forests in groups. It is either sold fresh to local shopkeepers or dried at home; the majority of gucchi collectors do the latter. Traditionally, the mushrooms are most commonly dried in the sun or the kitchen. The mushroom fetches a remunerative price and supplements the household incomes of the rural folk who collect it. Marketing gucchi has not been reported as a constraint. It has traditionally been used to overcome gastric problems and indigestion, as a tonic, to help heal wounds, and to reduce joint pain. Its medicinal uses are, however, restricted to only the hills and far-flung areas.

The commercialization of traditional medicine in modern Cambodia.

Globally, traditional medicine has long been used to address relatively common illness, mental ill health and during childbirth and post-natal care. However, traditional medicine is primarily provided by the private sector and it is unclear how far expenditures on traditional medicine contribute to household impoverishment. A life history method was used to understand the health seeking experience of 24 households over the last 60 years in Cambodia, a country with high out-of-pocket expenditures for health. The life histories suggest that traditional medicine in Cambodia has been undergoing a process of commercialization, with significant impacts on poor households. In the earlier lives of respondents, payments for traditional medicine were reported to have been flexible, voluntary or appropriate to patients' financial means. In contrast, contemporary practitioners appear to seek immediate cash payments that have frequently led to considerable debt and asset sales by traditional medicine users. Given traditional medicine's popularity as a source of treatment in Cambodia and its potential to contribute to household impoverishment, we suggest that it needs to be included in a national conversation about achieving Universal Health Coverage in the country.

Ayurvedic medicine in Mauritius: Profile of Ayurvedic outlet, use, sale, distribution, regulation and importation.

ETHNOPHARMACOLOGICAL RELEVANCE: Ayurvedic medicine (AM) is a legalised alternative traditional medical system in the multicultural tropical island of Mauritius. A panoply of Ayurvedic specialised shops/centres involved in the provision of Ayurvedic services hereafter termed as 'outlets' operates in different regions of the island and is extensively exploited by a significant number of Mauritians. Nonetheless, there is currently no study geared towards studying the status of AM and profile of Ayurvedic outlets in Mauritius and there is undoubtedly a dearth of standardized regulatory framework governing the practice of AM in Mauritius. The present study attempts to study the profile of Ayurvedic outlets, sale, distribution, regulation and importation of AM in Mauritius. AIM OF STUDY: To evaluate the characteristics profile of Ayurvedic shops/clinics/pharmacies/centres, to document common Ayurvedic products used in the treatment and management of diseases, and to analyse existing regulatory control of AM in Mauritius. MATERIAL AND METHODS: Ayurvedic outlets were identified using a random approach. Once permission granted, outlets were visited where face-to-face interviews with Ayurvedic practitioners/directors/dispensers were undertaken using a semi-structured questionnaire. The characteristics of the outlets with respect to the type of business registration, procurement and dispensing of products, registration and qualification of personnels employed amongst others were studied. The International Classification of Diseases (ICD) 10 was used to classify common AM dispensed to patients. Additionally, information was sought from local authorities pertaining to existing legislation governing the importation and regulation of AM in Mauritius. RESULTS: A total of 16 Ayurvedic outlets ('pharmacies' (n=3), clinics (n=2), shops (n=5) and centres (n=6)) was surveyed. Six outlets dispensed AM strictly on prescription only after consultation with an onsite full-time employed registered Ayurvedic practitioner. Seven outlets offered AM both on prescription and over-the-counter where consultation was not mandatory. The remaining three outlets, where no Ayurvedic practitioner was employed, did not offer consultation at any time and dispensed the medicines over-the-counter most of the time. There is currently no such legal framework that acknowledges the existence of an Ayurvedic pharmacy in Mauritius and no trained Ayurvedic pharmacist was recruited in any of the outlets. It was also found that no specific requirements were in place to establish an Ayurvedic outlet in Mauritius. A wide variety of Ayurvedic formulated and single herb products were recorded to be in use against common diseases. Ayurvedic products were imported from India (n=10), purchased from local suppliers (n=6) or locally manufactured (n=1). The Traditional Medicine Board under the aegis of the pharmacy board is a regulatory body which requires Ayurvedic practitioners to be registered so as to practice AM in Mauritius. Additionally, the government has an Ayurvedic committee, under the aegis of the Pharmacy board in the Ministry of Health and Quality of Life to monitor the importation of AM. However, no legal framework has been enacted to regulate the sale of AM under prescription or under the supervision of an Ayurvedic practitioner. CONCLUSION: The current regulatory framework is such that the sale/use/distribution of AM is not strictly controlled unlike its importation. This has led to a certain form of unregulated practice in the private sector whereby the dispensing and sale of AM are being done over-the-counter without professional recommendations. It is recommended that authorities need to regulate the Ayurvedic medical system in Mauritius by amending stringent laws to ensure safety of patients.