Ethnopharmacological use of potassium permanganate in South African traditional medicine.

BACKGROUND: Potassium permanganate (KMnO4), which is widely available, is often used by traditional health practitioners (THPs) in South Africa (SA) without taking its potentially harmful properties into account. The crystalline KMnO4 salt is sold at traditional medicine markets and shops throughout SA. However, to date, traditional uses of KMnO4 remain undocumented. OBJECTIVE: To describe KMnO4 use by THPs in KwaZulu-Natal, SA. METHODS: This sub-study is part of a larger study investigating substances used in SA traditional medicine that are collectively known as imikhando in isiZulu - literally translated as 'ore'. THPs (N=201) were interviewed in the local language (isiZulu) by trained interviewers. Information on the reasons for using/not using KMnO4, the source of information on its use and modes of administration were collected. RESULTS: KMnO4 was used as a constituent of traditional medicine by 158 (79%) THPs. Their knowledge of KMnO4 use was acquired predominantly from fellow THPs (n=134; 85%). Reasons for use included skin rash or wounds (n=99, 63%) and to treat aches, pains and swelling (n=74; 47%). The main modes of administration were in the bath (n=94; 60%), orally (n=67; 42%) and in herbal compresses (n=66; 42%). The principal reason of the 43 THPs for not administering KMnO4 was not knowing how to use it (n=29; 71%). CONCLUSIONS: This study has identified traditional medicine users at risk of manganese toxicity owing to commonly used sociocultural practices. In particular, reports of oral ingestion and use in enemas are cause for concern. This public health issue needs regulatory measures and education programmes to enlighten the population against possible harm caused by KMnO4 exposure.

Drug-resistant tuberculosis in patients with minimal symptoms: favourable outcomes in the absence of treatment.

SETTING: Referral hospital for drug-resistant tuberculosis (DR-TB) in KwaZulu-Natal Province, South Africa. OBJECTIVE: To review the clinical outcomes of patients (age  14 years) with a laboratory-confirmed diagnosis of DR-TB who had minimal symptoms and/or did not have chest radiographic evidence of active disease at referral. These patients were not started on treatment, but were enrolled in an observation programme with follow-up at 2, 6 and 12 months. RESULTS: Of 3345 referred patients diagnosed with DR-TB, 192 (6%) were enrolled in the observation programme. The median duration from initial sputum collection in primary care to examination at our hospital was 92 days (IQR 64-124). After 12 months, 120 (62%) patients were well, 36 (19%) were lost to follow-up, 30 (16%) had deteriorated and were started on second-line anti-tuberculosis treatment and 6 (3%) had died. Bilateral disease (OR 4.25, 95%CI 1.14-15.77, P = 0.030) and previous TB (OR 2.14, 95%CI 1.10-4.19, P = 0.026) were independent predictors of an unfavourable end result in a multivariate model. CONCLUSION: In our high-burden setting, most patients diagnosed with DR-TB who had minimal symptoms at referral remained well without treatment. Longitudinal observation, coupled with symptom checking and chest radiograph, is a viable strategy.

An ethnobotanical survey of mosquito repellent plants in uMkhanyakude district, KwaZulu-Natal province, South Africa.

ETHNOPHARMACOLOGICAL RELEVANCE: The aim of the study was to document plants traditionally used to repel mosquitoes in the uMkhanyakude district, KwaZulu-Natal, South Africa. The specific objectives of the study were to: (1) identify plant species and their parts being used; (2) determine the condition of plant material used and the method of application. MATERIALS AND METHODS: Data was collected from 60 respondents in five villages in the district using standardised and pre-tested questionnaires. RESULTS: Thirteen plant species are used in the study area to repel mosquitoes. These species belong to 11 genera from 9 families. Meliaceae and Anacardiaceae were the most represented families with two species each. The most frequently recorded species were Lippia javanica (91.67%), followed by Aloe ferox (11.67%), Sclerocarya birrea (5%), Melia azedarach (3%), Balanite maughamii (3%) and Mangifera indica (3%). Leaves were the most (38%) common plant part used. The majority (82%) of the plant parts were used in a dry state. Burning of plant materials to make smoke was the most (92%) common method of application. Nine plant species, namely: A. ferox, Calausena anista, Croton menyharthii, S. birrea, B. maughamii, Olax dissitiflora, Trichilia emetic, M. indica, and Atalaya alata are documented for the first time as mosquito repellents. CONCLUSION: This documentation provides the basis for further studies in developing new, effective, safe and affordable plant-derived mosquito repellents especially for Africa where malaria is highly prevalent. The study also plays a part in documenting and conserving traditional knowledge of mosquito repellent plants for future use.