When local phytotherapies meet biomedicine. Cross-sectional study of knowledge and intercultural practices against malaria in Eastern French Guiana.

ETHNOPHARMACOLOGICAL RELEVANCE: In French Guiana, traditional phytotherapies are an important part of self-healthcare, however, a precise understanding of the interactions between local phytotherapies and biomedicine is lacking. Malaria is still endemic in the transition area between French Guiana and Brazil, and practices of self-treatment, although difficult to detect, have possible consequences on the outcome of public health policies. AIM OF THE STUDY: The objectives of this research were 1) to document occurences of co-medication (interactions between biomedicine and local phytotherapies) against malaria around Saint-Georges de l'Oyapock (SGO), 2) to quantify and to qualify plant uses against malaria, 3) and to discuss potential effects of such co-medications, in order to improve synergy between community efforts and public health programs in SGO particularly, and in Amazonia more broadly. MATERIALS AND METHODS: This cross-sectional study was conducted in 2017 in SGO. Inhabitants of any age and nationality were interviewed using a questionnaire (122 questions) about their knowledge and habits regarding malaria, and their use of plants to prevent and treat it. They were invited to show their potential responses on a poster illustrating the most common antimalarial plants used in the area. In order to correlate plant uses and malaria epidemiology, all participants subsequently received a medical examination, and malaria detection was performed by Rapid Diagnostic Test (RDT) and Polymerase Chain Reaction (PCR). RESULTS: A total of 1566 inhabitants were included in the study. Forty-six percent of them declared that they had been infected by malaria at least once, and this rate increased with age. Every person who reported that they had had malaria also indicated that they had taken antimalarial drugs (at least for the last episode), and self-medication against malaria with pharmaceuticals was reported in 142 cases. A total of 550 plant users was recorded (35.1% of the interviewed population). Among them 95.5% associated pharmaceuticals to plants. All plants reported to treat malaria were shared by every cultural group around SGO, but three plants were primarily used by the Palikur: Cymbopogon citratus, Citrus aurantifolia and Siparuna guianensis. Two plants stand out among those used by Creoles: Eryngium foetidum and Quassia amara, although the latter is used by all groups and is by far the most cited plant by every cultural group. Cultivated species accounts for 91.3% of the use reports, while wild taxa account for only 18.4%. CONCLUSIONS: This study showed that residents of SGO in French Guiana are relying on both traditional phytotherapies and pharmaceutical drugs to treat malaria. This medical pluralism is to be understood as a form of pragmatism: people are collecting or cultivating plants for medicinal purposes, which is probably more congruent with their respective cultures and highlights the wish for a certain independence of the care process. A better consideration of these practices is thus necessary to improve public health response to malaria.

Phytotherapies in motion: French Guiana as a case study for cross-cultural ethnobotanical hybridization.

BACKGROUND: French Guiana is characterized by a very multicultural population, made up of formerly settled groups (Amerindians, Maroons, Creoles) and more recent migrants (mostly from Latin America and the Caribbean). It is the ideal place to try to understand the influence of intercultural exchanges on the composition of medicinal floras and the evolution of phytotherapies under the effect of cross-culturalism. METHODS: A combination of qualitative and quantitative methods was used. Semi-directive interviews were conducted in 12 localities of French Guiana's coast between January 2016 and June 2017, and the responses to all closed questions collected during the survey were computerized in an Excel spreadsheet to facilitate quantitative processing. Herbarium vouchers were collected and deposited at the Cayenne Herbarium to determine Linnaean names of medicinal species mentioned by the interviewees. A list of indicator species for each cultural group considered was adapted from community ecology to this ethnobiological context, according to the Dufrêne-Legendre model, via the "labdsv" package and the "indval" function, after performing a redundancy analysis (RDA). RESULTS: A total of 205 people, belonging to 15 distinct cultural groups, were interviewed using semi-structured questionnaires. A total of 356 species (for 106 botanical families) were cited. We observed that pantropical and edible species hold a special place in these pharmacopeias. If compared to previous inventories, 31 recently introduced species can be counted. Furthermore, this study shows that the majority of the plants used are not specific to a particular group but shared by many communities. However, despite this obvious cross-culturalism of medicinal plants between the different cultural communities of French Guiana, divergent trends nevertheless appear through the importance of 29 indicator/cultural keystone species in 10 cultural groups. Finally, we have emphasized that the transmission of herbal medicine's knowledge in French Guiana is mainly feminine and intra-cultural. CONCLUSION: French Guianese medicinal flora is undoubtedly related to the multiple cultures that settled this territory through the last centuries. Cultural pharmacopeias are more hybrid than sometimes expected, but cultural keystone species nevertheless arise from a common background, allowing to understand, and define, the relationships between cultural groups.