Perceptions and use of traditional African medicine in Lubumbashi, Haut-Katanga province (DR Congo): A cross-sectional study

Benefits of Traditional Medicinal Plants to African Women's Health: An Overview of the Literature

Background: In many African areas, herbal products still represent a significant source of healthcare. However, a major gender bias is evident in the literature, as most of the work is carried out by male researchers, collecting data from male traditional practitioners, and thus often neglecting women's specific health issues. This warrants a detailed review of the current knowledge about the major medicinal plants historically and still used for women's health. Objective: This study aims to compile and critically analyze published data on the use of traditional herbal remedies by African women in addressing specific health conditions, in order to evaluate the potential of traditional medicine as a viable alternative or complementary approach to modern healthcare for women globally. Methods: Data were retrieved from databases by combining the following relevant keywords: "abortion, adverse, Africa, attendant, birth, botanical, delivery, developing, drug, ethnomedicine, ethnopharmacology, folk, gynecological, healing, infertility, herb, indigenous, lactation, medicine, native, obstetric, phytomedicine, plant, pregnancy, remedy, side, sub-Saharan, traditional, treatment, women". Results: More than 125 studies, carried out across 12 African nations, revealed that up to 80% of African women resort to herbal medicines. An estimated 200 medicinally important plant species are reported to be utilized by women in different African countries, including Benin, Cameroon, Côte d'Ivoire, Egypt, Ethiopia, Ghana, Kenya, Mali, Nigeria, South Africa, Tanzania, and Zimbabwe. These herbs have many applications, mostly focused on infertility, pregnancy, painful menstruation, breast feeding, breast cancer, and contraception. Interestingly, according to their occurrence of usage, the plants most commonly reported for these conditions that are important to women are ambivalent plants (i.e., used both as foods and medicines) that include Zingiber officinale Roscoe, Allium sativum L., Cucurbita pepo L., and Ricinus communis L. Conclusions: Even though most women, in most African countries, do use traditional medicine, the amount of work published remains quite limited and no data are available in many countries. Therefore, it is desirable to expand African studies in this direction.

The Science-spirituality Nexus: Religion and the COVID-19 vaccination campaigns in Tanzania

Background

The influence of religion on health seeking behaviour is well document in the public health literature. However, the extent to which religious discourses and practices contributed to scepticism towards COVID-19 vaccines, vaccine uptake, and indecisiveness in intention to be vaccinated in Tanzania has not yet been established.

Aim

To explore the nexus between religion and public health in the measures taken against the COVID-19 pandemic in Tanzania by empirically examining how religious actors in opposed the first phased of COVID-19 vaccination campaigns before becoming key supporters of the same campaigns in the second phase.

Setting

The study was conducted in eight regions representing key administrative zones of Mainland Tanzania.

Methods

The article draws on empirical evidence from exploratory mixed-method study combining focus group discussions (FGDs), key informant and semi-structured interviews.

Results

We found that religious narratives and practices in relation to the pandemic were quite dynamic but influential in shaping individuals' decisions including on whether or not to take the COVID-19 vaccine. Religious anti-COVID-19 vaccine narratives accounted for the slow COVID-19 vaccine uptake but when religious leaders were later mobilised to support the COVID-19 vaccination campaign, the vaccine uptake in Tanzania improved considerably.

Conclusion

The study concludes that religious actors play a significant role in influencing public health behaviours, particularly in vaccine uptake.

Contribution

Future public health measures designed to increase vaccine uptake should not overlook the salient role of religious actors in the promotion desired health practices and outcomes.

Inventory of the best-selling medicinal plants on the Lubumbashi markets (DR Congo) and authentication of samples from the 3 most popular species

ETHNOPHARMACOLOGICAL RELEVANCE

Knowledge of the high-sale medicinal plants and their authentication are essential parameters to ensure the safety of people using herbal medicine and to plan the safeguarding of medicinal species threatened with extinction.

AIMS

The present study, carried out in Lubumbashi, Democratic Republic of Congo, aimed to geolocate medicinal plant sales points, list the best-selling species, and authenticate samples of the most popular species on the market.

METHODS

A survey was conducted among the medicinal plant sellers in Lubumbashi's markets and other public spaces, to identify the best-selling species. Samples of the species reported as the most sold were purchased for sales unit weight measurement, and authentication. For the 3 most popular plant species, the identity of 92 samples, purchased from some 25 herbalists, was assessed by combining the microscopic characteristics of powdered drugs with the HPTLC fingerprints of methanolic extracts; for each species, these samples were compared with 1 or 2 botanically authenticated reference samples. As abundant starch granules were detected by microscopy, some samples were suspected of heavy flour contamination, which was confirmed by an enzymatic determination of their starch content.

RESULTS

A total of 108 herbalists (48.1 % women) with a median age of 37 years (range, 20-67 years), and a median seniority of 5 years (0.7-30) were interviewed. From a total of 514 purchased samples, 396 (77.0 %) corresponded to 56 species that could be identified, including 92 samples representing the 3 most frequently sold plant species. The identities of 118 samples (having 82 different vernacular names), could not be determined, due to the lack of voucher specimen. Roots were the most sold organ (56.0 %; n = 514), mainly in powder form (78.7 %), and the median price was 21 USD/kg, at the time of the survey (January to May 2021). The identified specimens were, predominantly, the roots of Terminalia mollis M.A.Lawson (33.3 %), Securidaca longepedunculata Fresen (28.7 %), and stem barks of Nauclea pobeguinii Hua ex Pobég. (23.1 %); from the recorded sales figures, the amounts of material annually sold for these 3 species are estimated at about 5.7, 6.0, and 3.1 tons, respectively. Some sellers reported problems in identifying and/or preserving S. longepedonculata and T. mollis. Among the 92 samples analyzed for the three species, 18.5 % raised problems, including species substitutions (14/17), dilution with flour (1/17), dilution with flour and species substitution (1/17), and detection of a phytochemical variant (1/17), that could arise either from contamination by another species, a particular plant growth environment, or poor storage conditions.

CONCLUSION

The confusion/adulteration rate measured here for highly popular species is quite alarming (18.5 %); but, indeed, roots, especially as powders, are often difficult to differentiate based on the coarse organoleptic examination practiced by herbal traders. Microscopic and phytochemical characteristics reported in this study, quite easy to obtain with basic laboratory equipment, should be systematically applied by the health products regulatory authorities to control the quality of herbals and ensure that patients get the drug desired for their treatment.

Facility capacity and provider knowledge for cholera surveillance and diarrhoea case management in cholera hotspots in the Democratic Republic of Congo - a mixed-methods study

BACKGROUND

Wider healthcare-strengthening interventions are recommended in cholera hotspots and could benefit other types of diarrhoeal diseases which contribute to greater mortality than cholera.

OBJECTIVE

Describe facility capacity and provider knowledge for case management of diarrhoea and cholera surveillance in cholera hotspots in the Democratic Republic of Congo (DRC) among health facilities, drug shops, and traditional health practitioners.

METHODS

We conducted a sequential exploratory mixed-method study, using focus group discussions, facility audits, and provider knowledge questionnaires during September and October 2022 in North Kivu and Tanganyika provinces, Eastern DRC. Content analysis was used for qualitative data. Quantitative data were summarised by facility level and healthcare provider type. Audit and knowledge scores (range 0-100) were generated. Multivariable linear regression estimated association between scores and explanatory factors. Qualitative and quantitative data were triangulated during interpretation.

RESULTS

Overall, 244 facilities and 308 providers were included. The mean audit score for health facilities was 51/100 (SD: 17). Private facilities had an -11.6 (95% CI, -16.7 to -6.6) lower adjusted mean score compared to public. Mean knowledge score was 59/100 (95% CI, 57 to 60) for health facility personnel, 46/100 (95% CI, 43 to 48) for drug shop vendors and 37/100 (95% CI, 34 to 39) for traditional health practitioners. Providers had particularly low knowledge concerning when to check for low blood sugar, use of nasogastric tubes, and dosing schedules. Knowledge about case definitions for cholera was similar between groups (range 41-58%) except for traditional health practitioners for the definition during an outbreak 15/73 (21%).

CONCLUSIONS

Increasing awareness of cholera case definitions in this context could help improve cholera surveillance and control. Increased support and supervision, especially for private providers, could help ensure facilities are equipped to provide safe care. More nuanced aspects of case management should be emphasised in provider training.

Tracing the Disparity Between Healthcare Policy-Based Infrastructure and Health Belief-Lead Practices: a Narrative Review on Indigenous Populations of India

Most Indian tribes have limited access to healthcare facilities and rely heavily on traditional healing practices. This narrative review aimed to identify the disparities in the implementation of healthcare services and in accessing and availing these services by the indigenous population in India. We also have tried to throw light on the plausibility in strengthening the efficiency and efficacy of the public health system, by utilizing the available resources to its maximum potential, so that there will be a measurable outcome in the health status of these populations in India, coherently with the relevant sustainable development goals (SDG). The evidence from published literatures supports the fact that the disparity exists in the health status of indigenous populations in India as compared to the general populations. It emphasizes the need to address the key determinants such as the lack of knowledge, traditional healing practices and poor utilization of healthcare services provided to them. Various factors such as accessibility to healthcare resources, traditional healing practices, lack of awareness regarding healthcare services and schemes provided by the government, insufficient data regarding their issues and challenges and cultural and language barriers worsen the health status of indigenous people. However, our review reiterates that a well-structured and sustainable policy with reframed infrastructure and administration of healthcare system might bring a positive change in the health status of indigenous population in India.

Ethnomedical knowledge of plants used in alternative medicine to treat hemorrhoidal diseases in Lubumbashi, Haut-Katanga province, Southern Democratic Republic of Congo

BACKGROUND

A variety of medicinal plants are used in traditional medicine in Lubumbashi for the management of hemorrhoidal diseases. However, no investigation has been conducted to gather the knowledge required for this type of management in the region. The present study was conducted to inventory the plants used in Lubumbashi to treat hemorrhoidal diseases and to relate their ethnomedical characteristics.

METHODS

This study was conducted between March 2022 and February 2023 by interviews using semi-structured questionnaire with households (n = 1520), herbalists (n = 25), and traditional healers: THs (n = 59).

RESULTS

The 1,604 respondents (sex ratio M/F = 0.9; mean age: 56 ± 3 years; experience: 12 ± 3 years) provided information on 100 taxa, 84 of which are used against internal hemorrhoids, Phyllanthus amarus being the most cited (Citation Index, CI: 0.76). Most of them are trees (38%) or shrubs (32%), belonging to 90 genera and 45 families dominated by the Fabaceae (10%) and Asteraceae (9%). They are indicated in 76 other pathologies, dominated by gastrointestinal disorders (GID), wounds and sexually transmitted infections (CI > 0.57). From these 100 taxa, 117 anti-hemorrhoidal formulations were derived, 11 of which combined more than one plant. In all these recipes, the leaf is the most commonly used part (> 60%) and the liniment (> 45%) is the most popular form of application. For the first time, this study reports 14 taxa as plants used in the treatment of hemorrhoids. Among these taxa, Ficus stuhlmannii, Ficus laurifolia, and Ocimum centraliafricanum are listed as medicinal plants for the first time. Khaya nyasica, and Syzygium cordatum, each with 11 uses, have the highest traditional medicinal value.

CONCLUSION

The findings of this study indicate that a significant number of medicinal plants are used in traditional medicine in Lubumbashi for the treatment of hemorrhoidal diseases. Some of these plants are endemic to the biodiversity area, while others are shared with other cultures and regions. A series of pharmacological studies is currently underway with the objective of validating the anti-hemorrhoidal properties of these plants and in order to identify phytochemical compounds responsible of this activity.

Ethnomedical Knowledge of Plants Used in Nonconventional Medicine for Wound Healing in Lubumbashi, Haut-Katanga Province, DR Congo

Medicinal plants used for wound healing in Lubumbashi have yet to be discovered. Inventory or profile of their taxa has yet to be established. The present study was carried out to survey the plants used in traditional medicine in Lubumbashi to treat wounds and to define their ethnomedical characteristics. The study was conducted between March 2021 and August 2022, using semistructured interview surveys of households (n = 2730), herbalists (n = 48), and traditional practitioners: TPs (n = 128).The 2,906 interviewed (sex ratio M/F = 0.9; mean age: 56 ± 3 years; and experience: 17 ± 4 years) provided information on 166 taxa, 130 used against chronic wounds, among which Securidaca longepedunculata was the top cited. Most of these taxa are shrubs (33%), belonging to 48 botanical families dominated by the Fabaceae (16%). They are indicated in 70 other pathologies. From these 166 taxa, 198 healing recipes are obtained, 11 combining more than one plant. In all these recipes, the leaf (>36%) is the most used part, and the poultice (>36%) is the most popular form of use. Twelve taxa are cited for the first time as medicinal plants, of which Agelanthus zizyphifolius has the highest consensus and Erigeron sumatrensis has the highest usual value. For the various plants used to treat wounds, some of which are specific to the region, further studies should focus on validating this traditional use.

Exploring different health care providers´ perceptions on the management of diarrhoea in cholera hotspots in the Democratic Republic of Congo: A qualitative content analysis

Global cholera guidelines support wider healthcare system strengthening interventions, alongside vertical outbreak responses, to end cholera. Well-trained healthcare providers are essential for a resilient health system and can create synergies with childhood diarrhoea, which has higher mortality. We explored how the main provider groups for diarrhoea in cholera hotspots interact, decide on treatment, and reflect on possible limiting factors and opportunities to improve prevention and treatment. We conducted focus group discussions in September 2022 with different healthcare provider types in two urban and two rural cholera hotspots in the North Kivu and Tanganyika provinces in the Eastern Democratic Republic of Congo. Content analysis was used with the same coding applied to all providers. In total 15 focus group discussions with medical doctors (n = 3), nurses (n = 4), drug shop vendors (n = 4), and traditional health practitioners (n = 4) were performed. Four categories were derived from the analysis. (i) Provider dynamics: scepticism between all cadres was prominent, whilst also acknowledging the important role all provider groups have in current case management. (ii) Choice of treatment: affordability and strong caregiver demands shaped by cultural beliefs strongly affected choice. (iii) Financial consideration on access: empathy was strong, with providers finding innovative ways to create access to treatment. Concurrently, financial incentives were important, and providers asked for this to be considered when subsiding treatment. (iv) How to improve: the current cholera outbreak response approach was appreciated however there was a strong wish for broader long-term interventions targeting root causes, particularly community access to potable water. Drug shops and traditional health practitioners should be considered for inclusion in health policies for cholera and other diarrhoeal diseases. Financial incentives for the provider to improve access to low-cost treatment and investment in access to potable water should furthermore be considered.

Understanding the mix of services for mental health care in urban DR Congo: a qualitative descriptive study

BACKGROUND

Mental health workers (MHWs) are exposed to conflicts of competence daily when performing tasks related to the provision of mental health services. This may be linked to a lack of understanding of their tasks as caregivers and providers. Furthermore, in most low-income settings, it is unclear how the available services are organized and coordinated to provide mental health care. To understand the above, this study aimed to identify the current mix of services for mental health care in the urban Democratic Republic of the Congo (DRC).

METHODS

A qualitative descriptive study was carried out in Lubumbashi from February to April 2021. We conducted 7 focus group discussions (FGDs) with 74 key informants (family members, primary care physicians, etc.) and 13 in-depth interviews (IDIs) with key informants (traditional healers, psychiatrists, etc.). We performed a qualitative content analysis, guided by an analytical framework, that led to the development of a comprehensive inventory of MHWs from the household level to specialized facilities, exploring their tasks in care delivery, identifying existing services, and defining their current organization.

RESULTS

Analysis of transcripts from the FGDs and IDIs showed that traditional healers and family caregivers are the leading providers in Lubumbashi. The exploration of the tasks performed by MHWs revealed that lifestyle, traditional therapies, psychotherapy, and medication are the main types of care offered/advised to patients. Active informal caregivers do not currently provide care corresponding to their competencies. The rare mental health specialists available do not presently recognize the tasks of primary care providers and informal caregivers in care delivery, and their contribution is considered marginal. We identified five types of services: informal services, traditional therapy services, social services, primary care services, and psychiatric services. Analyses pointed out an inversion of the ideal mix of these services.

CONCLUSIONS

Our findings show a suboptimal mix of services for mental health and point to a clear lack of collaboration between MHWs. There is an urgent need to clearly define the tasks of MHWs, build the capacity of nonspecialists, shift mental health-related tasks to them, and raise awareness about collaborative care approaches.