Traditional healer support to improve HIV viral suppression in rural Uganda (Omuyambi): study protocol for a cluster randomized hybrid effectiveness-implementation trial.

BACKGROUND: Rural African people living with HIV face significant challenges in entering and remaining in HIV care. In rural Uganda, for example, there is a threefold higher prevalence of HIV compared to the national average and lower engagement throughout the HIV continuum of care. There is an urgent need for appropriate interventions to improve entry and retention in HIV care for rural Ugandans with HIV. Though many adults living with HIV in rural areas prioritize seeking care services from traditional healers over formal clinical services, healers have not been integrated into HIV care programs. The Omuyambi trial is investigating the effectiveness of psychosocial support delivered by traditional healers as an adjunct to standard HIV care versus standard clinic-based HIV care alone. Additionally, we are evaluating the implementation process and outcomes, following the Consolidated Framework for Implementation Research. METHODS: This cluster randomized hybrid type 1 effectiveness-implementation trial will be conducted among 44 traditional healers in two districts of southwestern Uganda. Healers were randomized 1:1 into study arms, where healers in the intervention arm will provide 12 months of psychosocial support to adults with unsuppressed HIV viral loads receiving care at their practices. A total of 650 adults with unsuppressed HIV viral loads will be recruited from healer clusters in the Mbarara and Rwampara districts. The primary study outcome is HIV viral load measured at 12 months after enrollment, which will be analyzed by intention-to-treat. Secondary clinical outcome measures include (re)initiation of HIV care, antiretroviral therapy adherence, and retention in care. The implementation outcomes of adoption, fidelity, appropriateness, and acceptability will be evaluated through key informant interviews and structured surveys at baseline, 3, 9, 12, and 24 months. Sustainability will be measured through HIV viral load measurements at 24 months following enrollment. DISCUSSION: The Omuyambi trial is evaluating an approach that could improve HIV outcomes by incorporating previously overlooked community lay supporters into the HIV cascade of care. These findings could provide effectiveness and implementation evidence to guide the development of policies and programs aimed at improving HIV outcomes in rural Uganda and other countries where healers play an essential role in community health. TRIAL REGISTRATION: ClinicalTrials.gov NCT05943548. Registered on July 5, 2023. The current protocol version is 4.0 (September 29, 2023).

Exploring patient referral practices of traditional healthcare practitioners in Soshanguve, Gauteng Province, South Africa.

Introduction: It may be necessary for healthcare professionals to refer patients to other professionals and institutions that are able to provide the care needed by patients, depending on the severity each case presents, healthcare requirements, and resources available to offer care. In healthcare generally, patient referral is standard procedure; however, in South Africa, referral patterns between allopathic and traditional healthcare practitioners are unknown, and this is a problem yet to be addressed. Objectives: The study objective was to explore patient referral practices from the perspectives of traditional healthcare practitioners of South Africa. Methods: A qualitative, exploratory and descriptive design was employed to collect data from 11 traditional healthcare practitioners who were sampled using snowball sampling. An individual semi structured interview schedule was used to collect data. Content analysis was used to analyze the data. Results: Patient referral was common practice in traditional health practices, however not reciprocal between the traditional and allopathic healthcare. Several indications for patient referral to allopathic healthcare practitioners included management of chronic conditions amongst others. Discussion: Patient referral being an important part of healthcare practices should be promoted and regulation and traditional health practices improved to promote safe referral practices and curb unsafe self-referrals by patients.

A scoping review of the use of traditional medicine for the management of ailments in West Africa.

BACKGROUND: The coexistence of traditional healing practices deeply rooted in cultural and historical contexts and the evolving landscape of modern healthcare approaches in West African societies creates a dynamic interplay between tradition and modernity in healthcare. This study aims to comprehensively map the landscape of traditional medicine use for health in West Africa. METHODS: A scoping review was conducted following the Joanna Briggs Institute (JBI) methodology and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Research questions focused on the links between traditional medicine practices and health in West Africa. The systematic literature search covered PubMed, Web of Science, and CINAHL from database inception to September 2023. A descriptive analysis was conducted highlighting the years of publication, countries of publication, study designs of plant families and plant parts used for making traditional medicines, and the diseases the traditional remedies are for. RESULTS: The search identified 3484 records, with 46 articles meeting the inclusion criteria. Publications spanned from 1979 to 2023, with no observed trend in the number of publications over successive decades. Nigeria had the highest number of publications (54.3%), followed by Ghana (19.6%). The studies employed various designs, including clinical trials, ethnobotanical, ethnopharmacological, and experimental designs. Plant families frequently studied included Combretaceae, Euphorbiaceae, and Rubiaceae. Traditional remedies address various health issues, highlighting their versatility, from general symptoms to specific diseases. CONCLUSION: This scoping review offers an extensive overview of traditional healing practices in West Africa. The studies highlighted in this review stress the necessity for culturally sensitive healthcare interventions. The widespread use of traditional medicine and the variety of practices underscore the importance of encouraging collaboration between traditional healers and modern healthcare professionals. This review also identifies knowledge gaps and areas needing further research, setting the stage for future exploration into West Africa's intricate healthcare landscape.

Understanding maternal Ethnomedical Folklore in Central Uganda: a cross-sectional study of herbal remedies for managing Postpartum hemorrhage, inducing uterine contractions and abortion in Najjembe sub-county, Buikwe district.

Pregnant women in rural Uganda largely rely on medicinal plants for inducing labor, treating postpartum hemorrhage (PPH), and inducing abortion. 90% of the women in both rural and urban Uganda use plants to manage pregnancy symptoms like constipation, heartburn, morning sickness, body aches, nausea, and vomiting. After delivery women continue using plants to manage postpartum complications and for infant care especially herbal baths. This study documented how ethnomedical folklore has been used to aid childbirth, manage postpartum hemorrhage, and induce abortion. METHODS: A cross-sectional ethnobotanical survey was conducted from May - December 2023 in Najjemebe sub-county, Buikwe district. 206 respondents from 12 villages were selected using snowball sampling. Key informants included Traditional Birth Attendants (TBAs) and herbalists. Data was collected using semi-structured questionnaires and focus group discussions. Voucher specimens of the plants were identified and authenticated at Makerere University Herbarium. Data were analyzed using descriptive statistics, Informant Consensus factor (ICF), Use Reports (URs), paired comparisons, and GraphPad Prism® version 9.0.0 software. RESULTS: All respondents (N = 206, 100%), used plants to induce labour, treat PPH, and induce abortion. One hundred four plant species were documented: most cited or preferred were: Hoslundia opposita (N = 109, 53%), Phytolacca dodecandra (N = 72, 35%), and Commelina erecta (N = 47, 23%). The plants belonged to 49 families, Lamiaceae (16.3%) and Fabaceae (14.3%) having the majority of the species. Herbs were 42 (40%) and trees 23 (22%). Oral administration 95(72%) was the commonest, then topical 19 (14.4%) and vaginal 14(10.6%). CONCLUSION: Health surveys revealed that about 27% of deliveries in Uganda take place outside a health facility. Due to the oxytocic effects of plant species reported in this study, they play a triple role of being uterotonics, abortifacients, and treating postpartum haemmorhage. The dilemma lies in the unknown dosages and toxicity levels that could endanger both the mother's and the unborn child's lives. Due to Uganda's high rates of population growth, overall fertility, maternal mortality, and morbidity, policies, and programmes on gendered health provision need to be reevaluated. Integrating herbal medicine into health care systems appears to be a feasible solution.

Integrating traditional medicine into the African healthcare system post-Traditional Medicine Global Summit: challenges and recommendations.

The World Health Organization (WHO) held the inaugural Traditional Medicine Global Summit in India in 2023 to promote the evidence-based integration of traditional medicine (TM) into the global healthcare system. This summit offers many opportunities for Africa, where most people rely on TM for health care. TM is widely accepted and affordable in the region but faces many challenges that limit its potential. This article identifies some of the most pressing challenges to incorporating TM into standard healthcare in Africa. It also proffers useful recommendations on how these issues may be addressed while identifying key stakeholders whose contributions may hamper or enhance the realization of WHO´s goals for TM in the continent.

An updated inventory of medicinal and ritual plants of southern Africa.

ETHNOPHARMACOLOGICAL RELEVANCE: For the first time in two decades, a comprehensive, up-to-date overview of the medicinal and ritual plants of southern Africa is presented. This data is analysed and compared with a previous survey done in 2002. STUDY AIM: The main aim is to update the checklist of medicinal and ritual plants of southern Africa and to determine the number of new records since 2002. We also provide a high-level perspective on the selection of medicinal and ritual plant species in southern Africa, a taxonomic analysis of the new checklist as well as a chronological perspective on the citation of medicinal and ritual species before and after 2002. MATERIALS AND METHODS: The most recently published medicinal and ritual plants checklist for southern Africa was reviewed and updated. A wide range of ethnobotanical literature, including books, field guides and electronic journals, was used. All calculations were done by using formulas and functions in Microsoft Excel and R Studio. RESULTS: 4120 medicinal and ritual taxa and 3784 medicinal and ritual species have been recorded. Compared with the 2002 checklist, there are 1239 new taxa (1228 new species). A strong correlation between available taxa and selected medicinal taxa exists on order level, which corresponds with the results of an analysis done in 2008. The top 10 species-rich medicinal plant families of southern Africa are Asteraceae, Fabaceae, Apocynaceae, Euphorbiaceae, Asphodelaceae, Malvaceae, Lamiaceae, Poaceae, Rutaceae and Rubiaceae. Different patterns of plant family representation can be seen across certain cultural healing systems of southern Africa. The species popularity (number of citations) of Hypoxis hemerocallidea Fisch. & C.A.Mey. Has increased substantially after 2002. Other medicinal and ritual plant species have been consistently researched, such as Artemisia afra Jacq. ex Willd., Carpobrotus edulis (L.) L.Bolus, Aloe ferox Mill., Leonotis leonurus (L.) R.Br. and Gunnera perpensa L. CONCLUSIONS: The numerous new medicinal and ritual plant records that have been reported in the last two decades provide evidence of an incompletely documented ethnobotanical heritage that urgently requires documentation. Patterns of taxonomic diversity on family level indicate distinctive differences between cultural healing systems. Signs of the adaptability and dynamics of traditional healing systems in southern Africa can be seen in the changes in the citation of species over time.

Knowledge and practices of traditional management of child malnutrition and associated pathologies in Benin.

BACKGROUND: Child malnutrition is a major public health challenge, affecting millions of children worldwide, with alarming proportions of children under five in Benin. The complexity of managing this condition is increased by its potential association with opportunistic pathologies. An interesting approach arises from the use of medicinal plants, to address child malnutrition and its associated pathologies. This study aimed to document the knowledge and practices of Beninese mothers and traditional practitioners with regard to the use of medicinal plants to treat child malnutrition and associated diseases. METHODS: A total of 844 Beninese mothers and 201 traditional healers were surveyed between March 2022 and August 2023 in the communes of Karimama, Bopa and Za-Kpota in Benin. The respondents' knowledge of child malnutrition and associated pathologies was explored. The ethnobotanical data collected from the subjects concerned the medicinal recipes used to treat child malnutrition, the medicinal plants that make them up and the methods of use. These data were analyzed using ethnobotanical indices such as the Informant Consensus Factor, the frequency of citation of medicinal recipes types and medicinal plants, and the contribution of plants to medicinal recipes. RESULTS: All respondents cited a total of 82 plant species used to treat child malnutrition and associated diseases. These plants were grouped into 37 botanical families, the most common of which were Fabaceae, Malvaceae and Annonaceae. The leaves were the most commonly used part of the plant species identified. The mothers shared 122 medicinal recipes, ranging from recipes based on a single plant to more complex compositions involving five plants. The most notable plants were Moringa oleifera Lam, Phyllanthus amarus Schumach & Thonn, Senna siamea (Lam.) H.S.Irwin & Barneby, Carica papaya L. and Ocimum gratissimum L. Traditional healers provided 52 plants in 71 recipes, with Moringa oleifera featuring prominently in both single-plant and multiplant formulations. CONCLUSION: This study made it possible to constitute a rich base of medicinal recipes used against malnutrition and associated pathologies, with the preponderant involvement of certain plant species. It is therefore necessary to deepen research on these different identified species in order to scientifically assess their potential.

Traditional Eye Practices: Economics and Visual Status of Users in North Central Nigeria.

BACKGROUND: Traditional medicine is a constellation of practices, approaches, knowledge, and beliefs, which encompass material-based medicines, spiritual therapies, and manual techniques applied individually or combined. AIM: This study seeks to determine the cost and visual status of traditional eye treatments users among new patients at a health facility. MATERIALS AND METHODS: This is part of the study titled "Traditional eye practices: A facility-based study in North Central Nigeria." It is a cross-sectional, facility-based study conducted between July 2013 and June 2014 on new patients seen in the eye unit of Church of Christ in the Nations Rehabilitation Center, Mangu. Interviewer-administered structured questionnaire was used to gather information on patient demographics; cost of traditional eye medication and manipulations and visual status of new patients were recorded. RESULTS: The use of traditional eye treatment was reported by 134 (4.3%) of the 3113 new patients. Traditional operative couching of lens was more expensive than using traditional eye medications (P < 0.001). Payment modality varied, and poor visual status was significantly higher among traditional eye treatment users (P < 0.001). CONCLUSION: Since most respondents who had their eyes couched or used traditional eye medicine were able to pay such high price with dissatisfaction and poorer visual status, they should be able to pay for modern cataract surgery with good outcome. There is a need for health education of the general public about the deleterious effects of traditional eye treatment.

Experiences of traditional health practitioners in the management of female infertility in Harare urban areas: A qualitative study.

Female infertility is a health and social problem that traditional health practitioners (THPs) have been managing in African communities. This study explored the experiences of THPs in the management of female infertility, specifically focusing on their understanding, diagnosis, and treatment methods for female infertility. This was a qualitative study targeting six THPs in Harare urban areas registered with the Traditional Medical Practitioners Council (TMPC) in Zimbabwe. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were followed in the description of the study design, analysis and presentation of findings. The findings revealed that the etiology of female infertility was attributed to biomedical, lifestyle, spiritual, and male factors. Management of infertility depended on the type of THP. Spirit mediums relied on divination and dreams to diagnose and treat female infertility. Herbalists focused on the physical evidence provided by the client through history taking. THPs had a client referral system within their TMPC network. All THPs ultimately used medicinal plants for treating female infertility. THPs play an important role in the management of female infertility. Understanding their contributions to the management of female infertility provides an opportunity to obtain insight into their practices, thus identifying areas that responsible Ministries can use to strengthen traditional health care systems and ultimately improve reproductive health care for women in African communities.

L'infertilité féminine est un problème sanitaire et social que les tradipraticiens (PTS) gèrent dans les communautés africaines. Cette étude a exploré les expériences des THP dans la gestion de l'infertilité féminine, en se concentrant spécifiquement sur leur compréhension, leur diagnostic et leurs méthodes de traitement de l'infertilité féminine. Il s'agissait d'une étude qualitative ciblant six PTH des zones urbaines de Harare enregistrés auprès du Conseil des médecins traditionnels (TMPC) au Zimbabwe. Les lignes directrices COREQ (Consolidated Criteria for Reporting Qualitative Research) ont été suivies dans la description de la conception de l'étude, de l'analyse et de la présentation des résultats. Les résultats ont révélé que l'étiologie de l'infertilité féminine était attribuée à des facteurs biomédicaux, liés au mode de vie, spirituels et masculins. La prise en charge de l'infertilité dépendait du type de THP. Les médiums spirituels s'appuyaient sur la divination et les rêves pour diagnostiquer et traiter l'infertilité féminine. Les herboristes se sont concentrés sur les preuves matérielles fournies par le client grâce à l'anamnèse. Les THP disposaient d'un système de référencement des clients au sein de leur réseau TMPC. Tous les THP utilisaient finalement des plantes médicinales pour traiter l'infertilité féminine. Les THP jouent un rôle important dans la gestion de l'infertilité féminine. Comprendre leurs contributions à la gestion de l'infertilité féminine offre l'opportunité d'avoir un aperçu de leurs pratiques, identifiant ainsi les domaines que les ministères responsables peuvent utiliser pour renforcer les systèmes de santé traditionnels et, à terme, améliorer les soins de santé reproductive pour les femmes des communautés africaines.

An ethnopharmacological survey of medicinal plants traditionally used by the BaKalanga people of the Tutume subdistrict in Central Botswana to manage HIV/AIDS, HIV-associated conditions, and other health conditions.

ETHNOPHARMACOLOGICAL RELEVANCE: While access to antiretroviral therapy (ART) continues to improve worldwide, HIV infection and AIDS persist as serious health challenges, particularly in sub-Saharan Africa. Complementary and Alternative Medicines (CAM), as part of indigenous and pluralistic medical systems, are important contributors to primary health care worldwide. However, this knowledge remains relatively undocumented in many parts of sub-Saharan Africa such as the Tutume subdistrict of Central Botswana, where CAM is widely used including potentially for HIV/AIDS and HIV-associated conditions. AIM OF THE STUDY: To explore the extent to which CAM is used by the BaKalanga Peoples of the Tutume subdistrict, we performed an exploratory community-based project to record medicinal plant use from this relatively undocumented region, with a particular focus on species used for management of HIV/AIDS and HIV-associated conditions. MATERIALS AND METHODS: Using the snowball sampling technique, we recruited 13 Traditional Health Practitioners (THPs) and conducted in-depth interviews to explore medicinal plant uses and treatment regimens. Plant specimens were collected and bio-authenticated. RESULTS: We documented 83 plant species used as CAM to treat or manage a variety of conditions including HIV/AIDS, HIV-associated conditions, and other health conditions. Plants from the family Leguminosae were most frequently reported, comprising 21 species (25.3%), followed by 5 from both Euphorbiaceae and Combretaceae families (6.0%). Four plants (4.8%) were used specifically to manage HIV (Lannea edulis (Sond.) Engl. root, Aloe zebrina Baker root, Myrothamnus flabellifolia Welw. whole plant, and Harpagophytum procumbens var. subulobatum (Engl.) tuber), while an additional 7 (8.4%) were reported specifically for treating combinations of HIV-related symptoms. Notably, 25 (30.1%) have not been reported previously as CAM and/or lack reported bioactivity data. CONCLUSIONS: To our knowledge, this is the first detailed ethnobotanical survey of CAM used by the BaKalanga Peoples of the Tutume subdistrict to manage HIV/AIDS and HIV-associated and other health conditions.

Perceived causes, diagnosis methods and treatment practices of mental illness among traditional healers of the Berta community in Assosa, Ethiopia.

INTRODUCTION: Mental illness is a non-communicable disease that is increasingly contributing to the global burden of diseases and disability. It affects a person's feelings, thinking, behavior, and daily life functioning. OBJECTIVES: The purpose of this study was to explore perceived causes of mental illness, techniques for identifying mental illness, and treatment methods used by traditional healers in the Berta community. METHODS: The study employed a qualitative research method. Data were collected using semi-structured in-depth interviews with seven traditional healers who were selected purposefully. We used thematic analysis to present and analyze the data. RESULTS: The findings of this study indicated that witchcraft, supernatural power, hereditary, substance use, and food poising as the main perceived causes of mental illness among traditional healers in the Berta community. The traditional healers identify mental illness using different techniques such as patient observation, interviews with a patient's family, use of religious books, and use of herbals. The traditional healers in the Berta community identify mental illness based on behavioral symptoms like talking about things that don't make sense, laughing alone, taking off clothes in public places, collecting and carrying dirty materials, eating dirty foods, and harming or intention to harm others. CONCLUSIONS: The traditional healers in the Berta community use herbals, religious books, and bone divination to guide their treatment of persons with mental illnesses. Some of these traditional healing practices options are peculiar to the Berta Community that are used to diagnosize and treat mental illnesses. RECOMMENDATIONS: The traditional healing practices of the Berta community should be recognized, licensed, and supported by the Ministry of Health and the Ethiopian Food and Drug Administration and Control Authority.

Indigenous knowledge system associated with the uses of insects for therapeutic or medicinal purposes in two main provinces of Burkina Faso, West Africa.

BACKGROUND: Some insects are harmful to humans, plants and animals, but some of them can also be a source of proteins, fats, vitamins and minerals and be of therapeutic value. The therapeutic potential requires that medicinal insects and their derived products need to be scrutinized. This study highlights the indigenous knowledge related to their use of medicinal insects in peri-urban and urban areas of Burkina Faso. METHODS: The survey was carried out among 60 traditional healers spread across two phytogeographical zones of Burkina Faso. The questionnaire focused on medicinal insects used by experienced traditional healers. Chi-square tests and principal component analysis were performed to test for significant differences regarding knowledge of how insects in phytogeographically different areas were used therapeutically in connection with different disease categories. RESULTS: A total of 19 species of medicinal insects belonging to 6 orders were cited in connection with treatments of at least 78 pathologies and symptoms. Most frequently mentioned was gastroenteritis. Our study showed that 48.78% of the insects and their products were associated with 46 plant species for the treatment of pathologies. In addition, honey, beeswax and nests were the most widely insect products used. CONCLUSION: The current study allows us to identify medicinal insects as well as their products used in the treatment of pathologies and symptoms, suggesting the presence of a considerable diversity of therapeutically important insect species. These insects are used alone and/or with their products but often in association with medicinal plants. The results constitute a useful database for future studies of medicinal insects in central and western parts of Burkina Faso.

"If it weren't for my traditional healer, I would be dead": Engaging traditional healers to support people living with HIV in rural Mozambique.

Across rural sub-Saharan Africa, people living with HIV (PLHIV) commonly seek out treatment from traditional healers. We report on the clinical outcomes of a community health worker intervention adapted for traditional healers with insight into our results from qualitative interviews. We employed a pre-post intervention study design and used sequential mixed methods to assess the impact of a traditional healer support worker intervention in Zambézia province, Mozambique. After receiving a positive test result, 276 participants who were newly enrolled in HIV treatment and were interested in receiving home-based support from a traditional healer were recruited into the study. Those who enrolled from February 2016 to August 2016 received standard of care services, while those who enrolled from June 2017 to May 2018 received support from a traditional healer. We conducted interviews among healers and participants to gain insight into fidelity of study activities, barriers to support, and program improvement. Medication possession ratio at home (based on pharmacy pick-up dates) was not significantly different between pre- and post-intervention participants (0.80 in the pre-intervention group compared to 0.79 in the post-intervention group; p = 0.96). Participants reported receiving educational and psychosocial support from healers. Healers adapted their support protocol to initiate directly observed therapy among participants with poor adherence. Traditional healers can provide community-based psychosocial support, education, directly observed therapy, and disclosure assistance for PLHIV. Multiple factors may hinder patients' desire and ability to remain adherent to treatment, including poverty, confusion about medication side effects, and frustration with wait times at the health facility.

"If it weren't for my traditional healer, I would be dead": Engaging traditional healers to support people living with HIV in rural Mozambique

Across rural sub-Saharan Africa, people living with HIV (PLHIV) commonly seek out treatment from traditional healers. We report on the clinical outcomes of a community health worker intervention adapted for traditional healers with insight into our results from qualitative interviews. We employed a pre-post intervention study design and used sequential mixed methods to assess the impact of a traditional healer support worker intervention in Zambézia province, Mozambique. After receiving a positive test result, 276 participants who were newly enrolled in HIV treatment and were interested in receiving home-based support from a traditional healer were recruited into the study. Those who enrolled from February 2016 to August 2016 received standard of care services, while those who enrolled from June 2017 to May 2018 received support from a traditional healer. We conducted interviews among healers and participants to gain insight into fidelity of study activities, barriers to support, and program improvement. Medication possession ratio at home (based on pharmacy pick-up dates) was not significantly different between pre- and post-intervention participants (0.80 in the pre-intervention group compared to 0.79 in the post-intervention group; p = 0.96). Participants reported receiving educational and psychosocial support from healers. Healers adapted their support protocol to initiate directly observed therapy among participants with poor adherence. Traditional healers can provide community-based psychosocial support, education, directly observed therapy, and disclosure assistance for PLHIV. Multiple factors may hinder patients' desire and ability to remain adherent to treatment, including poverty, confusion about medication side effects, and frustration with wait times at the health facility.

Traditionally used polyherbals in a southern African therapeutic context.

ETHNOPHARMACOLOGICAL RELEVANCE: In African traditional medicine, there are several plant species that are used in combination with either other plant species or non-plant derived combinations such as sugar and honey, salt and vinegar, milk, fat etc. This review examines the role of these combinations and postulates the scientific and therapeutic validation of such combinations. AIM OF THE STUDY: This study reviewed the ethnopharmacological literature and documented the use of southern African plant combinations to find a scientific rationale for such combinations, and provide recommendations for future studies. MATERIALS AND METHODS: Ethnobotanical books and online databases such as Scopus, ScienceDirect, PubMed and Google Scholar were used to find ethnobotanical studies within the southern African context that focus on the combinations of plants with other plants or various additional ingredients. The scientific literature was examined to determine if evidence was available to substantiate such combinations. RESULTS: One hundred and eighty-seven medicinal plant (plant-to-plant) combinations that are used in the southern African traditional healing system were recorded. These plant combinations were used against infections of the gastrointestinal tract, respiratory tract, and skin as well other non-infectious diseases such as reproductive and psychiatric disorders. Respiratory infections were the most documented infections to be treated using plant combinations. The plant that was documented to be most commonly used in combination with other plants was Artemisia afra Jacq. ex Willd. While plant-plant combinations have drawn a marked interest, comparatively, plant-adjuvant (e.g. milk, sugar, honey, salt, vinegar, fats) combinations have attracted less research interest. Milk was reported as the most used additional ingredient in combination with medicinal plants. The combination of animal urine and dung with medicinal plants has been reported as a treatment for treat prostate infections, the human immunodeficiency virus (HIV). Other ingredients such as clay and flour were also documented, and these are often mixed with medicinal plants to treat fever, stomach ailments, sexually transmitted infections (STI) and skin conditions. Although combination therapy has been frequently reported in ethnobotanical records, over 90% of the combinations reviewed still need to be scientifically validated. CONCLUSION: Scientific reports on the antimicrobial, anti-oxidant, anti-inflammatory and other pharmacological effects of these combinations may offer an understanding of traditional combination therapy. In addition, investigation into the mechanisms of action of these combinations are also recommended to supplement the findings. Nonetheless, the use of plant combinations is still an untapped research area in southern Africa and there is a need to validate the use of those documented combinations to obtain a better understanding of combined traditional medicinal plant use.

Health benefits and biological activities of spiny monkey orange (Strychnos spinosa Lam.): An African indigenous fruit tree.

ETHNOPHARMACOLOGICAL RELEVANCE: Spiny monkey orange (Strychnos spinosa Lam.) is an African endemic fruit tree that is widely consumed by humans and animals for its nutritional value. In folk medicine, different parts of S. spinosa are widely used for the management of the health and well-being of humans and livestock. AIM: We provide a critical appraisal on the ethnobotanical uses, nutritional and pytochemical as well as the biological activities of S. spinosa. METHODS: Articles were mined from online databases such as Google Scholar, PubMed, Science Direct, SciELO and SpringerLink. We captured research outputs that aligned with the scope of the review. RESULTS: Strychnos spinosa remains a commonly consumed fruit due to its high nutritional (e.g. carbohydrates, crude protein and fats) content and energy. In folk medicine, different parts of S. spinosa are prescribed as remedy for diverse medical conditions especially for treating malaria, diabetes, snakebites, skin-related conditions and sexually transmitted infections in humans as well as sleeping sickness in livestock. Together with essential oils, more than 25 compounds have been profiled using Gas chromatography-mass spectrometry (GC-MS), and approximately 45 compounds have been isolated and structurally elucidated using diverse spectroscopic techniques such as UV-visible, Infrared (IR), Nuclear Magnetic Resonance (NMR) and mass spectroscopy (MS). Strychnos spinosa exerts varying degrees of biological activities against different microorganisms (bacteria and fungi) and parasites (plasmodia, trypanosomes and ticks) responsible for many diseases in humans and livestock. Furthermore, low to moderate enzyme-inhibitory effects of S. spinosa extracts suggest its ability to mitigate pains, inflammations and diabetics as well as snakebite venom. Increasing evidence from the in vivo studies support the use of the plant as a popular remedy for managing diabetics in folk medicine. The low cytotoxic effect of the plant extracts against different cell lines could be an indication of its relative safety. CONCLUSION: Strychnos spinosa exhibits various health-promoting benefits due to its diverse nutritional and phytochemical constituents. Given that the majority of the existing evidence on these aforementioned therapeutic properties and safety are in vitro-based, the clinical significance of these results remain limited.

Invasive alien plants and weeds in South Africa: A review of their applications in traditional medicine and potential pharmaceutical properties.

ETHNOPHARMACOLOGICAL RELEVANCE: Traditional pharmacopoeias are constantly evolving and adapting, hence the assimilation of alien plants and weeds into traditional systems of healing. Invasive plants are detrimental to the ecosystem, however they are also potential sources of secondary metabolites with useful biological activities. AIM OF THE REVIEW: The aim of this review was to investigate published reports of traditional use and biological activity of declared invasive alien plants and other weeds in South Africa. MATERIALS AND METHODS: Information was retrieved from scientific databases including Scopus, Web of Science, ScienceDirect, Google Scholar, PubMed, Chemical Abstracts Services and books, theses, dissertations and technical reports. Keywords used for the search engines were "South Africa" or "southern Africa" in conjunction with "(native weeds OR alien invasive)" AND "medicinal". Separate searches were conducted on the individual invasive plant species recorded as having been used in ethnobotanical surveys to determine their known biological activities and chemical components. RESULTS: A total of 89 plant species regarded as invasive species or weeds in South Africa were identified as being used in traditional medicine. The most commonly mentioned plant family was the Asteraceae with a total of 15 species followed by the Fabaceae and Solanaceae with 6 species each. Of the 89 species recorded, 68% were reported to have traditional usage with both phytochemical and biological data available. A history of traditional usage coupled with biological data was available for 12% of species. Records of traditional usage alone were linked to 11% of species. Invasive alien species comprised 61% of recorded species, while native and non-invasive alien weeds formed the remaining 39%. CONCLUSIONS: The exploration of alternative uses for weeds and particularly invasive plants, whether native or alien, as medicines for possible commercialisation may lead to innovative mechanisms for putting such species to good use.

Medicinal Plants for Anti-neurodegenerative diseases in West Africa.

ETHNOPHARMACOLOGICAL RELEVANCE: Neurodegenerative diseases are neuronal diseases that affect the brain components by degenerating the structure and function of the central or peripheral nervous system progressively. It is a leading cause of death and affects huge amount of people worldwide. Plant-based medicines have been utilised in the therapies for many illnesses that have defied western treatments, including neurodegenerative diseases. AIM OF THIS REVIEW: This review presents an overview of the major neurodegenerative diseases and reported prominent medicinal plants used in managing those diseases in West Africa. METHODS: Scientific articles regarding medicinal plants and their usefulness in managing neurodegenerative diseases in West Africa were pooled from different scientific databases. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to filter articles based on their relevance. Pharmacological activity, plant parts used, experimental models, and some isolated chemical compounds of those plants were summarised. RESULTS: In the West Africa region, Fabaceae (19%) and Solanaceae (13%) have the highest representation of plant families used to treat neurological diseases, while Apocynaceae, Asteraceae, Euphorbiaceae have also been utilised. Flavonoids, alkaloids, phenolic compounds, terpenoids, coumarins present in those plants and their derivatives are reported to possess neuro-protective effects. Biochemical enzymes correlating to antioxidants, anti-inflammatory effects are the potential targets against neurodegenerative diseases. CONCLUSION: Medicinal plants for anti-neurodegenerative diseases in West Africa have been documented with their neuropharmacological activities. Plant families such as Fabaceae, Solanaceae, Apocynaceae, Asteraceae, and Euphorbiaceae could be a major natural source for discovery of anti-neurodegenerative drugs, thus the metabolites from them should be given priority for neurological research. This review will provide clues for further investigations on the screening and development of anti-neurodegenerative natural products from West African medicinal plants.

A review of the traditional use of southern African medicinal plants for the treatment of inflammation and inflammatory pain.

ETHNOPHARMACOLOGICAL RELEVANCE: Inflammation is a serious global concern due to its debilitating symptoms, resulting in considerable suffering and lost productivity. Chronic and auto-immune inflammatory diseases are of particular concern. Several pharmaceutical therapies are already available. However, the use of non-steroidal anti-inflammatory drugs (NSAID's) is accompanied by harmful and toxic side effects. Hence, the search for safer alternative therapeutics with limited side effects is imperative. The use of medicinal plants is common practice amongst the southern African population and may provide targets for drug development. AIM OF THE STUDY: This study aims to review and document the medicinal uses and pharmacological properties of southern African medicinal plants used for inflammation and pain-related ailments. MATERIAL AND METHODS: An extensive literature review was undertaken to identify southern African plants used traditionally to treat inflammation. A variety of ethnobotanical books and grey literature, as well as ScienceDirect, Google Scholar and Scopus search engines were used as sources of information. RESULTS: This review identified 555 medicinal plants from 118 families which were traditionally used in southern Africa to treat inflammation and pain. Fabaceae was the most prominent family with 63 species, followed by Asteraceae (54 species) and Apocynaceae (33 species). The top category of ailments indicated include non-specific inflammation with 150 species, followed by inflammatory pain (148 species), headache (114 species) and toothache (114 species). CONCLUSION: Despite a large number of southern African medicinal plants used to treat inflammation and pain, relatively few have been screened for their anti-inflammatory properties. Furthermore, biologically active plant extracts have been tested against relatively few inflammatory markers and considerable further work is required.