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Medicinal plants used by traditional healers for the treatment of malaria in the Chipinge district
in Zimbabwe
Ngarivhume, T.; van 't Klooster, C.I.E.A.; de Jong, J.T.V.M.; Westhuizen, J.H.
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Journal of Ethnopharmacology
DOI:
10.1016/j.jep.2014.11.011
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Citation for published version (APA):
Ngarivhume, T., van 't Klooster, C. I. E. A., de Jong, J. T. V. M., & Westhuizen, J. H. (2015). Medicinal plants
used by traditional healers for the treatment of malaria in the Chipinge district in Zimbabwe. Journal of
Ethnopharmacology, 159, 224-237. https://doi.org/10.1016/j.jep.2014.11.011
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Download date: 13 Jun 2020
Journal of Ethnopharmacology 159 (2015) 224–237
Contents lists available at ScienceDirect
Journal of Ethnopharmacology
journal homepage: www.elsevier.com/locate/jep
Research Paper
Medicinal plants used by traditional healers for the treatment
of malaria in the Chipinge district in Zimbabwe
Talkmore Ngarivhume a,b, Charlotte I.E.A. van’t Klooster c,
Joop T.V.M. de Jong c, Jan H. Van der Westhuizen d,n
a
Department of Chemistry, Walter Sisulu University, NMD campus, P.O. Bag X1, Mthatha 5117, South Africa
Department of Chemistry, University of the Free State, P.O. Box 339, Bloemfontein 9300, South Africa
c
Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam (UvA), P.O. Box 15718, 1001 NE Amsterdam, The Netherlands
d
Directorate: Research Development, University of the Free State, P.O. Box 339, Bloemfontein 9300, South Africa
b
art ic l e i nf o
a b s t r a c t
Article history:
Received 20 August 2014
Received in revised form
23 October 2014
Accepted 7 November 2014
Available online 18 November 2014
Ethnopharmacological relevance: Because about 50% of the Zimbabwean population is at risk of
contracting malaria each year, the majority of people, especially in rural areas, use traditional plantbased medicines to combat malaria. This explorative ethnobotanical survey was undertaken to document
how malaria is conceptualized and diagnosed by traditional healers, and to record the medicinal plants
used in the prevention and treatment of malaria, their mode of preparation and administration.
Materials and methods: The research was conducted in three villages in Headman Muzite's area and in
Chiriga village. These villages are located in the Chipinge district in the Manicaland Province in
Zimbabwe.Traditional healers were selected with the assistance of the headman of the Muzite area
and a representative of the Zimbabwe National Traditional Healers Association. Semi-structured interviews were conducted with 14 traditional healers from four villages in the Chipinge district in Zimbabwe.
Results: In total, 28 plants from 16 plant families are used by the healers who manage malaria with
medicinal plants. The most cited plant is Cassia abbreviata Oliv. (Leguminosae) followed by Aristolochia
albida Duch (Aristolociaceae) and Toddalia asiatica (L.) Lam. (Rutaceae). Roots (55.3%) are the most
common part used. Most of the plant parts used to treat malaria are stored as dried powders in closed
bottles. The powders are soaked in hot or cold water and the water extract is taken as the active
medicine. The healers consider their medicinal knowledge as a spiritual family heritage. Only 25% of the
healers refer the malaria patients that do not respond to their treatment to hospital – they believe evil
spirits cause their remedies to failure and they would rather try a different plant or perform a cleansing
ceremony.
Conclusions: Local knowledge of medicinal plants in the treatment of malaria still exists in all four
villages surveyed and traditional healers appear to play an important role in primary health care services
in this remote rural area in Zimbabwe. This explorative survey underscores the need to preserve and
document traditional healing for managing malaria and for more future scientific research on the plants
to determine their efficacy and their safety. This could improve their traditional anti-malarial recipes and
might contribute to a better integration of Zimbabwean traditional medicine into the national health
system in the future.
& 2014 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY
license (http://creativecommons.org/licenses/by/3.0/).
Keywords:
Malaria
Medicinal plants
Traditional medicine
Chipinge district
Zimbabwe
1. Introduction
World-wide, an estimated number of 3.4 billion people are still at
risk of malaria. In 2012 approximately 207 million cases of malaria
occurred globally with most cases (80%) and deaths (90%) occurring
in Africa. Most deaths (77%) occur in children under the age of
Abbreviations: MOHCW, Ministry of Health and Child Welfare;
ZINATHA, Zimbabwe National Traditional Healers' Association
n
Corresponding author. Tel.: þ 27 514012782; fax: þ 27 514012591
E-mail address: vdwestjh@ufs.ac.za (J.H. Van der Westhuizen).
five (WHO, 2013). In other words, malaria continues to be a major
cause of morbidity and mortality. It is caused by five species
of parasite that affects humans. All the parasites belong to the genus
Plasmodium: Plasmodium falciparum, Plasmodium vivax, Plasmodium
ovale, Plasmodium malariae, Plasmodium knowlesi. Of these, Plasmodium vivax and Plasmodium falciparum are the most important. The
latter is the most deadly form and it predominates in Africa.
Approximately 15 million people belonging to the five countries in
the low-transmission Southern African subregion (Botswana, Namibia,
Swaziland, Zimbabwe and South Africa) are at some risk of malaria
and 10 million people are at high risk. In 2012 the number of
http://dx.doi.org/10.1016/j.jep.2014.11.011
0378-8741/& 2014 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/3.0/).
T. Ngarivhume et al. / Journal of Ethnopharmacology 159 (2015) 224–237
confirmed malaria cases reported for this region was 283,000 of
which 98% were from Zimbabwe. The reported number of deaths
from malaria in this sub-region was 437 in 2012, of which 80%
occurred in Zimbabwe (WHO, 2013). Malaria is highly seasonal and
mostly caused by Plasmodium falciparum in Zimbabwe. Anopheles
arabiensis is the major vector for malaria. Resistance to antimalarial
drugs and the absence of vaccines are major challenges in controlling
malaria (Midzi et al., 2004; Kurth et al., 2009; Mayer et al., 2009).
It is estimated that about 50% of the country's population is at risk
of contracting malaria each year (WHO, 2013). According to the
Ministry of Health and Child Welfare of Zimbabwe (MOHCW, 2008),
54 of the 59 rural districts in Zimbabwe have malaria levels which
vary from very high and seasonal to sporadic. The incidence of malaria
in 33 (61%) of the districts is classified as high (Midzi, et al., 2004;
MOHCW, 2008) and therefore warranting intervention. These are
mostly low-altitude districts with warm and wet summers. Although
the highest malaria prevalence occurs between February and April,
some areas have year-round transmission.
The National Malaria Control Programme is the unit in the
Department for Disease Prevention and Control in MOHCW that
spearheads the prevention and control of malaria. This unit has
reintroduced dichlorodiphenyltrichloroethane (DDT) for indoor
residual spraying as the main strategy to reduce the transmission
of malaria by reducing the prevalence of mosquitos (MOHCW,
2008). The objectives set by the Ministry of Health of Zimbabwe
include achieving the prevention of malaria and personal protection of over 80% of the population by strengthening community and other stakeholders' participation which would maximize
people's access to malaria control interventions (MOHCW, 2008).
However, the Traditional Medical Practitioners Act, promulgated in
1981, which aimed to integrate Zimbabwean traditional medicine
(TM) into the national health system, made no significant contribution because it was not followed up with the necessary
institutional and financial support. And so, although TM practices
remain largely undocumented, unregulated and, consequently,
poorly integrated into the formal health sector, many people still
use traditional plant-based medicines for primary health care in
Zimbabwe, especially in rural areas.
Documentation of TM and plants traditionally used for the prophylaxis and treatment of malaria in Zimbabwe constitutes an important
step not only in preserving the local traditions and indigenous knowledge but also in improving access to and participation in improving
225
traditional malaria control interventions by the communities. Documentation of TM could facilitate future research on the safety and
efficacy of medicinal plants and could provide a starting point for
identifying single chemical entities with antimalarial activity which
could lead to the development of standardized phytomedicines.
Because the drug-resistance of Plasmodium falciparum and the resistance of Anopheles mosquitos to insecticides are widespread, the search
for new antimalarial drugs is increasingly important.
So far only a limited number of studies (e.g. Vundule and
Mharakurwa, 1996; Lukwa et al., 1999; 2001; Kraft et al., 2003;
Kazembe et al., 2012) have been conducted in Zimbabwe on
traditional healers' use of medicinal plant for the treatment of
malaria. The aim of this study was to collect comprehensive data
from traditional healers on medicinal plant-based remedies commonly used to treat malaria in order to document their methods of
preparation and administration, together with information on
how the healers conceptualize and diagnose malaria to contribute
to the overall documentation of anti-malarial plant species used by
traditional healers in Zimbabwe.
2. Materials and Methods
2.1. Study area
This explorative study was conducted in the Manicaland
Province in the Chipinge district of Zimbabwe (Fig. 1).
The villages of Chindedzwa (32.6251E, 20.5271S), Mazundu
(32.5591E, 20.5091S), and Zuzunye/Madhlope (32.5441E, 20.5631S)
where the research took place are located in Headman Muzite's area
which is a mountainous area near the south-eastern border of
Zimbabwe and south-western Mozambique. The village of Chiriga
(32.6621E, 20.2691S) is located 45 km further towards the north-west
in a flat countryside and at lower altitude. Both areas have a poorly
developed road network and infrastructure. The people belong to the
Ndau ethnic group and the main language spoken is Ndau, a dialect of
Shona. The major source of livelihood is subsistence farming with
limited assistance from agricultural extension officers. The communities are well known for their traditional beliefs and use of plants for
primary health care and are all located within the Chipinge district
which has high seasonal malaria hot spots (Midzi et al., 2004;
MOHCW, 2008).
Fig. 1. Map of Zimbabwe and research area. Source: Dr C. Barker, Geography Department, Free State University.
226
T. Ngarivhume et al. / Journal of Ethnopharmacology 159 (2015) 224–237
2.2. Data collection
Ethnobotanical fieldwork for this explorative study was conducted between March and April 2012. After consultation with the
local headman and the Zimbabwe National Traditional Healers
Association (ZINATHA), it was decided to conduct the research in
the four villages (Chindedzwa, Mazundu, and Zuzunye/Madhlope
and Chiriga). With the assistance of ZINATHA, a total of 17
traditional healers were initially identified, of whom only 14 were
available to be interviewed between March and April 2012. Two of
the 14 healers interviewed claimed not to have any malarial
remedies and said that they did not treat malaria. Data was
collected through a survey employing open-ended semi-structured interviews with 12 traditional healers (three per village)
providing information on bio-data, herbal anti-malarial medicines,
vernacular plant names and methods of preparation and administration of these anti-malarial remedies (see Appendix A). The
healers were also asked to state the causes of malaria, how they
diagnosed and treated the disease and how they could minimize
transmission. They were also asked about their alternatives in case
of remedy failure and the possible causes of such failure. Furthermore, healers were asked if they referred their malaria patients to
local hospitals or clinics. The interviews were conducted by the
researchers in the official language of Shona. Plants used to
manage malaria in each of the villages were compared to establish
consensus. The semi-structured interviews have been analyzed
and responses grouped into classes expressing similar ideas. The
recorded plants have been entered in a separate Excel spreadsheet.
The interviews were supplemented by direct observation and
transect walks. During the transect walks, plants were collected
under the supervision of the traditional healers. Plant voucher
specimens (MAL2001–MAL2026) were collected and deposited at
the Herbarium of the Harare Botanical Gardens in Zimbabwe for
identification. Plant names have been checked and updated with
the online website (www.theplantlist.org) of the Royal Botanic
Gardens, Kew, accessed on 3 April 2014.
Ethical approval for this study was obtained from the headmen
of the studied areas and the ZINATHA. All respondents were asked
to sign a prior informed-consent form after the objectives and
possible consequences of the study had been explained. The prior
informed consent (PIC) form was translated into the local Shona
language.
The use value (Trotter and Logan, 1986), a quantitative method
that demonstrates the relative importance of species known
locally, was calculated for the Chipinge district according to the
following formula: UV¼ U/N, where UV refers to the use value of a
species; U to the number of citations per species; and N to the
number of informants.
Table 1
Demographic characteristics of respondents (n ¼14).
Characteristic
Gender
Male
Female
Education
Primary education
Secondary education
Extra teaching qualification
Extra agricultural college
Religion
Christian
Traditionalist
Etnicity
Ndau tribe which (subtribe of the Shangani)
Years of experience as healer
Between 1–10 years
Between 11–20 years
Between 21–30 years
Between 31–40 years
Between 41–50 years
51- 4years
Frequency
8
6
14
3
1
1
7
7
14
2
6
2
0
3
1
3.2. Diversity of medicinal plants and their uses
A total of 28 plant species were recorded to be used in antimalarial remedies (Table 2). Twenty-six specimens were collected
and identified at the Harare Botanic Garden, Zimbabwe. Unfortunately, the other two species could not be found, even in faraway
areas (between 20 and 30 km away). They are known locally as
munyabangwa and muranga, are collected by traditional healers from
urban areas only and sold in towns and cities. For this reason, the
plants could not be collected on the spot and scientific names could
not be established.
The identified 26 species comprised trees (38.5%), shrubs (30.8%),
climbers (23.0%) and herbs (7.7%), and belong to 16 families. Most
plant species belong to the Apocynaceae (15.4%), Compositae (11.5%)
and Leguminosae (11.5%), followed by the Aristolochiaceae, Rubiaceae
and Cucurbitaceae (7.7%). The other 10 families contributed one
species each (3.8%). Twenty (76.9%) of the collected species are used
for treatment only, four (15.4%) for prevention only and two (7.7%) are
used for both treatment and prevention. The plant most cited was
Cassia abbreviata (Leguminosae) followed by Aristolochia albida (Aristolociaceae), Toddalia asiatica (Rutaceae) and Strychnos potatorum
(Loganiaceae). Two species (Momordica foetida and Capsicum annuum)
are cultivated while the rest are wild species. Euclea natalensis
(Ebenaceae) is not considered to have antimalarial properties but is
added to improve appetite and body strength. Use values of the
recorded plant species have been calculated which showed a highest
use value of 0.67 for Cassia abbreviata.
3. Results
3.3. Mode of preparation and administration
3.1. Socio-demographic details respondents
All 14 traditional healers belong to the Ndau tribe which is a subtribe of the Shangani people. They comprised 57% men and 43%
women and were between the ages of 40 and 83 (the majority were
between 50 and 65 years old). The average age for female healers was
45 years while the male average age was 62 years. The healers had
little formal education
mostly up to primary level only
while
three of them had extra qualifications (Table 1). Only two of the
interviewed healers were formally employed, one as a secondary
school principal and the other as an agriculture extension officer. Four
of the 12 healers who provided extensive information on malaria are
spiritualists and bone throwers, and eight are locally renowned
herbalists.
Most of the parts of the plant used to treat malaria are stored as
dried powders in closed bottles, except Capsicum annuum, Momordica balsamina and Momordica foetida. The powders are soaked in
hot or cold water and the water extract is taken orally as the active
medicine. The fruit of Capsicum annuum (syn. Capsicum frutescens)
is swallowed directly without chewing since it is very bitter.
Momordica balsamina and Momordica foetida are eaten as prophylactic vegetables (relishes) during meals from freshly collected
plant material. Remedies based on mixtures of different plants are
common. In a few cases, different healers use different parts of the
same plant.
The amounts of powder used to make the concoction were
described in terms of a full, half or quarter of a teaspoon or tablespoon
Table 2
Plants used in the prevention and treatment of malaria.
Family
Scientific name
Collection
number
Local name
Part used
Purpose
Preparation
Growth
form
Village
Times stated
(per village)
Use value
(per species)
Apocynaceae
Catharanthus roseus (L.) G. Don
Diplorhynchus condylocarpon (Müll.Arg.)
Pichon
Holarrhena pubescens Wall. Ex G. Don
Tabernaemontana elegans Stapf
Aristolochia albida Duch.
MAL18
MAL15
Muruwa
Mutowa
Root
Stem bark
Treatment
Treatment
Decoction
Cold infusion
Shrub
Tree
Chindedzwa
Chiriga
1
1
0.08
0.08
MAL02
MAL11
MAL25
MAL25
MAL13
Masunungure
Muchenya
Ruzangariro
Ruzangariro
Chividze
Root
Root
Tuber
Tuber
Root
Treatment
Treatment
Treatment
Both
Treatment
Decoction
Hot infusion
Hot infusion
Hot infusion
Hot infusion
Tree
Shrub
Climber
Climber
Climber
2
1
2
3
1
0.17
0.08
0.42
MAL01
MAL27
Mupopo
Chipenembe
Root
Leaf
Treatment
Treatment
Decoction
Hot infusion
Tree
shrub
Mazundu
Mazundu
Chindedzwa
Mazundu
Zuzunye/
Mahlope
Chindedzwa
Mazundu
1
1
0.08
0.08
MAL14
MAL03
Muphahla
Muhloni
Root
Root
Treatment
Treatment
Hot infusion
Cold infusion
Tree
Shrub
Mazundu
Chindedzwa
1
1
0.08
0.25
MAL03
MAL19
Muhloni
Ngaka
Root
Leaf
Shrub
Climber
Chiriga
Mazundu
2
1
0.17
MAL19
Ngaka
Leaf
Climber
1
MAL20
Muchukubaba
Leaf
Zuzunye/
Mahlope
Mazundu
MAL20
Muchukubaba
Plant
Herb
Tree
Tree
Tree
Tree
Aristolochiaceae
Aristolochia heppii Merxm
Caricaceae
Compositae
Ebenaceae
Euclea natalensis A.DC.
MAL23
Mushangura
Root
Lamiaceae
Ocimum angustifolium Benth.
MAL09
Mufuranhema
Tuber
Treatment Cold infusion
Prevention Relish, especially during rainy
season
Prevention Relish, especially during rainy
season
Prevention Relish, especially during rainy
season
Prevention Relish, especially during rainy
season
Treatment Take with porridge. May cause
diarrhoea
Treatment Cold infusion. May induce nausea
Leguminosae
Cassia abbreviata Oliv
MAL21
MAL21
MAL21
MAL21
Murumanyama
Murumanyama
Murumanyama
Murumanyama
Root/bark
Root
Bark/Root
Root/bark
Treatment
Prevention
Treatment
Treatment
Cold
Cold
Cold
Cold
Elephantorrhiza goetzei (Harms) Harms
MAL08
Chiurayi
Root
Treatment
Hot infusion
Tree
Senna septemtrionalis (Viv.) H. S. Irwin &
Barnaby
Strychnos potatorum L. f.
MAL24
Mumwahuku
Root
Treatment
Decoction
Shrub
MAL06
MAL06
Mudyambira
Mudyambira
Root
Root/stem
Treatment
Treatment
Decoction
Decoction
Tree
Tree
Menispermaceae Cissampelos mucronata A. Rich.
MAL06
MAL17
MAL17
Mudyambira
Root
Chipombafodya Tuber
Chipombafodya Tuber
Treatment
Treatment
Treatment
Decoction
Hot infusion
Hot infusion
Tree
Climber
Climber
Passifloraceae
MAL04
Muore
Root
Prevention Cold or hot infusion
Climber
MAL04
Muore
plant
Prevention Cold or hot infusion
Climber
Herb
Tree
Cucurbitaceae
Momordica balsamina L.
Momordica foetida Schumach
Loganiaceae
Adenia cissampeloides (Planch ex Hook)
Harms
or
or
or
or
hot
hot
hot
hot
infusion
infusion
infusion
infusion
Climber
Climber
Shrub
Plumbago zeylanica L.
Prunus persica (L.) Batsch
MAL10
MAL12
Mhisepise
Mupirikisi
Root
Leaf/root
Treatment
Both
Cold infusion
Hot infusion
Rubiaceae
Crossopteryx febrifuga (Afzel. ex G. Dion)
Benth.
MAL05
Chikobengwa
Stem bark
Treatment
Cold infusion or take with porridge Tree
MAL05
Chikobengwa
Stem bark
Treatment
Take with porridge or cold infusion Tree
Zuzunye/
Mahlope
Chiriga
Chindedzwa
Mazundu
Zuzunye/
Mahlope
Zuzunye/
Mahlope
Mazundu
Mazundu
Zuzunye/
Mahlope
Chiriga
Mazundu
Zuzunye/
Mahlope
Chindedzwa
Zuzunye/
Mahlope
Chiriga
Zuzunye/
Mahlope
Zuzunye/
Mahlope
Mazundu
0.17
1
1
0.08
1
0.08
1
2
3
2
0.67
1
0.08
1
0.08
1
1
0.25
1
1
1
0.17
1
0.17
1
1
1
0.08
0.08
1
0.25
1
227
Plumbaginaceae
Rosaceae
Zuzunye/
Mahlope
Chiriga
1
T. Ngarivhume et al. / Journal of Ethnopharmacology 159 (2015) 224–237
Carica papaya L.
Baccharoides adoensis (Sch. Bip. ex Walp.)
H. Rob.
Brachylaena huillensis O. Hoffm.
Erythrocephalum zambesianum Oliv. &
Hiern
0.08
228
2
0.33
2
2
0.33
2
Tree
Tree
Tree
Zuzunye/
Mahlope
Mazundu
Zuzunye/
Mahlope
Mazundu
Cold infusion
Root
Root
Munyabangwa
Muranga
Muranga
Treatment
Cold and hot infusion
Cold infusion
Root
Munyabangwa
Treatment
Treatment
Shrub
Fruit
Mhiripiri
All the respondents were aware that mosquito bites might
transmit malaria. However, 35.7% of the interviewees reported
that eating fruits such as mangos, guavas and melons, drinking
water from unprotected wells, and exposure to morning dew may
cause malaria as well. The disease is commonly known as malaria
by the healers, though the older respondents (65 years old and
above) refer to it as muswarara and ndangaranga. While muswarara means ‘goose pimples’ in the local Shona language, ndangaranga indicates a ‘state of dizziness or lack of balance’. The common
use of the term malaria as opposed to local terms could reflect the
extensive education campaign on malaria that the MOHCW conducted throughout the country.
The general patterns of diagnosing malaria were similar among
the healers from the four villages. The symptoms of malaria,
according to the healers, are presented in Table 3. The most
important symptoms were feeling cold/goose pimple and headaches. None of the interviewees indicated sweating and wasting
away of the body with time, suggesting that the infections tend to
be short-lived. The healers would diagnose an infection as malaria
if the patient presented with at least three of the listed symptoms.
The healers were aware that their patients might not get better
after taking their remedies. In such cases, 25% of the healers
referred the patients to hospital. However, most of the healers
attributed the lack of a patient's improvement to evil spirits
(41.7%). These healers would cleanse the patient of the bad spirits
and might repeat or give a different prescription thereafter. Other
healers believed the lack of patients' improvement was a result of
misdiagnosing a patient with malaria (16.7%), a compromised
immune system of the patient (8.3%) or non-compliance in taking
the remedies (8.3%).
Not identified
Not identified
Not identified
Table 3
Symptoms that are used by traditional healers to diagnose malaria.
Not identified
Capsicum anuum L.
Solanaceae
MAL07
Prevention Swallow 4 fruits 3 times a day for
3 days
Treatment Cold and hot infusion
Tree
0.08
1
0.25
2
1
Chiriga
Zuzunye/
Mahlope
Mazundu
Tree
Tree
Decoction
Decoction
Treatment
Treatment
Gato
Gato
Rutaceae
MAL16
MAL16
Root
Tuber
0.08
1
1
Chiriga
Chindedzwa
Cold infusion or take with porridge Tree
Cold infusion
Shrub
Treatment
Treatment
Chikobengwa
Muchena
MAL05
MAL22
Stem bark
Root
Local name
Pavetta schumanniana F. Hoffm.
ex K. Schum.
Toddalia asiatica (L.) Lam
or even a pinch. The concoctions were usually prescribed to be taken
two or three times a day for between three and seven days or until the
patient had healed. Most healers were very clear about their recipes
and dosages but not precise about quantities of plant material and
volume (e.g. handful and teacup). Different dosages for the same
concoction were described by different healers. The most common
volume of water used was 750 ml. This is the most freely available
container since cooking oil is sold in 750 ml bottles. Other volumes
mentioned were one or two litres or a teacup. No clear pattern or any
consistency existed between healers as far as dosage was concerned.
The healers claimed that patients did not always comply with
their prescribed dosages. This could be a problem in the malaria
treatment. Successful administration of the treatment might also
depend on the patient's capacity to persist with the treatment. For
example, 750 ml of the very bitter concoction of Cissampelos
mucronata roots should be taken three times a day for seven days.
3.4. Perceptions about, causes and symptoms of malaria
Collection
number
Scientific name
Family
Table 2 (continued )
Part used
Purpose
Preparation
Growth
form
Village
Times stated
(per village)
Use value
(per species)
T. Ngarivhume et al. / Journal of Ethnopharmacology 159 (2015) 224–237
Symptom
Frequency (no. of healers that mentioned it)
Feeling cold/goose pimple
Headache
Fever
Sweating
Loss of appetite
Body weakness/feeling sleepy
Vomiting
Dizziness
Nausea
Pain
6
10
8
1
4
5
2
2
2
1
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3.5. Prevention practices
Besides the administration of herbal remedies to reduce the
chance of contracting malaria, the respondents' measures to
prevent malaria, are the use of treated bed nets, the destruction
of mosquito breeding and resting areas, and the reduction of
unwanted undergrowth and puddles within and around the
homesteads. These practices are ‘overseen’ by village/community
health workers and environmental health workers, who are
government employees. Other preventive practices mentioned
are the use of drinking water from protected wells only, not eating
fruits such as green mangos, guavas and melons, and avoiding
morning dew. In addition, the healers were aware that indoor
residual spraying killed the mosquitoes. However, there was no
reference to the use of repellents, neither commercial nor traditional ones by the healers themselves.
4. Discussion
4.1. Traditional knowledge
Traditional knowledge and the use of plant-based medicines
remain important in the prevention and treatment of malaria in the
Chipinge district and probably in other rural areas of Zimbabwe.
This is important because traditional African medicine is often
quickly accessible and affordable to the rural communities in Africa.
Government clinics are often difficult to reach (the nearest Gwenzi
clinic to Chipinge is about 12 km on a poorly maintained gravel
road) and are poorly resourced: community health workers in the
villages often run out of commercial drugs while traditional herbal
medicines provided by traditional healers are quick and constantly
available at the time of need.
The healers interviewed were mostly men (57%) with an
average age of 62. The female healers were younger with an
average age of 45 years. The large percentage of female healers is
surprising because it is often claimed that Africans believe that
traditional healers should be male (Okello and Ssegawa, 2007;
Bekalo et al., 2009; Cheikhyoussef et al., 2011).
The traditional healers from the four villages in Chipinge
district all understood that malaria is transmitted by mosquitos.
This may be due to government's anti-malaria interventions in the
area. However, other factors were also mentioned to play a role.
Some healers mentioned that people need to avoid eating some
fruits such as green mangos, guavas and melons, drinking water
from unprotected wells and exposure to morning dew. Tabuti
(2008) reports that, in Uganda the respondents believe that
drinking dirty water is responsible for causing malaria. Dirty water
is also mentioned in Lukwa et al.'s (2001) study at Kariba in
Zimbabwe in which 87.3% of healers mentioned that mosquitoes
transmit malaria and 12.4% did not know the cause of malaria. In
Ghana, Ahorlu et al. (1997) found that respondents believed that
malaria was caused by eating raw or overripe fruits such as
mangos while exposure to morning dew was reported in Kenya
by Dye et al. (2010). Important symptoms reported in this study
are headache, fever and feeling cold/goose pimples as was also
reported by Tabuti (2008).
The failure of a remedy is generally believed to be caused by
evil spirits which need to be exorcised before the plant-based
remedies will be effective again. Only 25% of the healers send their
patients to hospital after a remedy has failed. The low referral to
hospitals could reflect the efficacy of the remedies and/or a lack of
understanding of the disease by healers and the communities at
large. This is a worrying trend given the progressive and virulent
nature of malaria.
229
Most of the remedies described in this study are administered
orally as water-based concoctions. This is in agreement with the
findings of Adekunle (2008), Musa et al. (2011) and Maroyi (2013).
Although there was agreement about the general mode of preparation (most commonly soaking dried plant material in water),
there was a wide variation in the quantities of plant material
soaked in a specific amount of water. The concentration of active
ingredient in the concoctions and the amount ingested by the
malaria patients thus differed widely. Randrianarivelojosia et al.
(2003) and Ugulu (2012) report similar observations. This wide
variation in the amount of the active ingredient ingested and the
low compliance creates the possibility of subminimum doses.
Roots (55.3%) are usually regarded as the most important parts
of the plant. Next, the bark (13.7%) and tubers (12.8%) followed by
leaves (10.6%) and fruit (2.1%). Also whole plants (4.3%) are used in
the remedies. These observations resonate with those of
Bussmann (2006), Musa et al. (2011), Cheikhyoussef et al. (2011)
and Maroyi (2013). It deviates from the work of Bekalo et al.
(2009), Ogbe et al. (2009) and Rahmatullah et al. (2012) who
observe that leaves are the most used plant parts. Bark, leaves or
roots from the same plant are also used interchangeably by
different healers. Randrianarivelojosia et al. (2003) make a similar
observation.
The healers were aware of the possibility of unfair bioprospecting practices from institutions such as pharmaceutical companies
and were concerned about legal protection of their intellectual
property and a possible lack of proper compensation, similar to the
findings described by Uprety et al. (2012) amongst the aborigines
of Canada. We were thus surprised by the absence of significant
resistance from the healers to supply us with traditional knowledge and plant material. We attribute this to the involvement of
the local headman and ZINATHA and the prior informed-consent
forms that explained the objectives, benefits, risks and general
procedures of the survey in Shona before the start of the project.
In order to develop the use of herbal medicines, the plant
species must be easy to collect. However, the healers believe that
cultivated medicinal plants are less potent than those harvested
from the wild and therefore the latter is still preferred. Only two of
the recorded species (Momordica foetida and Capsicum annuum)
are cultivated while all other species are still collected from the
wild. This agrees with the findings of Bussmann (2006) in South
Turkana, Kenya, Okello and Ssegawa (2007) in Uganda, and Simbo
(2010) in Babungo and Cameroon and Musa et al. (2011) in Sudan.
4.2. Plants used in the treatment of malaria
Medicinal plants play a major role in many communities over
the world in the treatment and prevention of disease and the
promotion of general health. Previous studies have shown that
more than 1200 medicinal plants from 160 families are used
worldwide to treat malaria or fever (Willcox and Bodeker, 2004)
and still many anti-malarial plant species remain to be discovered.
The present study documented 28 plants which were used in the
prevention and treatment of malaria by traditional healers in four
villages in the Chipinge district in Zimbabwe (Table 2).
The low correlation in the plants used in villages that are close
to each other and even in the same village by the three healers
involved is surprising. This may be due to the secret spiritual
family heritage considerations discussed above. Because of this, no
focus-group discussion was performed in this study. Significant
discrepancies thus exist between healers from the same area as far
as the plant species and part of the plant used are concerned. Of
the 26 plant species identified in this survey, 13 were used in
Mazundu village, 12 in Zuzunye/Mahlope village, 8 in Chindedzwa
village and 7 in Chiriga village. The most overlap was with the root
or bark of Cassia abbreviata that is used in all four villages and was
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mentioned by eight of the 12 healers. Strychnos potatorum roots
and Crossopteryx febrifuga bark are commonly used in Zuzunye,
Mazundu and Chiriga villages. Adenia cissampeloides root or bark
is used for treatment in Chindedzwa and Zuzunye villages, while
Momordica balsamina and Momordica foetida whole plants are
used for prevention in Zuzunye and Mazundu villages and
Aristolochia albida tuber is used for treatment in Chindedzwa
and Mazundu villages. This low overlap might be due to the
explorative character of the study in which no saturation could be
reached. The plant mostly cited was Cassia abbreviata (Leguminosae) followed by Aristolochia albida (Aristolociaceae) and Toddalia
asiatica (Rutaceae). These plants are also known in literature as
medicinal plant species. Little correspondence between the uses of
the same species in the same village was surprising. The greatest
agreement of species and plants parts was recorded in Mazundu
village, where three of the 13 species, Cassia abbreviata roots or
bark, Holarrhena pubescens roots and Aristolochia albida tubers, are
used by at least two of the three interviewed healers. Zuzunye/
Mahlope reflected the least overlap of species used where only
Cassia abbreviata is used by two of the three healers that were
interviewed.
The conservation status of the collected plants has been
checked by consulting the IUCN Red List of Threatened Species
(version 2014.1, www.iucnredlist.org, downloaded on 9 July 2014).
Brachylaena huillensis is listed as ‘low risk’ but might become
‘nearly threatened’ in future; Catharanthus roseus and Senna septemtrionalis as ‘not threatened’; and Holarrhena pubescens as of ‘least
concern’. The other species are not on the list. The online Catalogue of
Life website (http://www.catalogueoflife.org) showed no further conservation issues on any of the reported plants. However, the fact that
roots and bark are the most commonly used parts in the remedies
suggests that the continuous collection of plants may threaten local
populations of plants in the future.
4.3. A brief literary review of the antiplasmodial activity of extracts
from the antimalarial plants identified in this study and identified
secondary metabolites
In vitro antiplasmodial activity of crude extracts of 12 of the 26
plants identified as antimalarial treatments in this study have
been reported in the literature namely Adenia cissampeloides,
Aristolochia heppii, Carica papaya, Cassia abbreviata, Catharanthus
roseus, Cissampelos mucronata, Crossopteryx febrifuga, Holarrhena
pubescens, Momordica balsamina, Momordica foetida, Plumbago
zeylanica and Toddalia asiatica. These results are summarized in
Table 4. Secondary metabolites, some with antiplasmodial activity,
have been reported from seven of these 12 plants and from
Aristolochia albida. The published phytochemical investigations of
these eight plants are discussed below.
The potential of antiplasmodial and antimalarial compounds
with known molecular structures from African medicinal plants
was reviewed by Amoa et al. (2013) and Ntie-Kang et al. (2014).
These included alkaloids, terpenoids, flavonoids, coumarines, phenolics, polyacetylenes, xanthones, quinones, steroids, and lignans.
They concluded that African flora hold an enormous potential for
the development of phytomedicines for malaria.
The more promising plants from this ethnobotanical survey are
briefly reviewed below in terms of their known photochemistry,
other traditional uses and related medicinal species.
The bark of Cassia abbreviata yielded a 4-methoxyflavan (Volker
et al., 1998), flavan-3-ols (afzelechin and epiafzelechin) and proanthocyanidin dimers (proguiboergtinidins) (Malan et al., 1996). Similar
compounds, including proanthcyanidin trimers, have been isolated
from the root bark and leaves and twigs (Erasto et al., 2003; Mongolo
and Mafoko, 2013). Kiplagat et al. (2012) isolated an antiplasmodial
flavanone (5-hydroxy-40 ,8-dimethoxyflavanone) and a 3-methoxyflavan
(40 ,7-dihydroxy-4-methoxyflavan) from the root bark.
The bark of Cassia abbreviata is also used to treat sexually
transmitted diseases in Zimbabwe (Kambizi and Afolayan, 2001),
bovine Dermatophilosis (Ndlovu, Masika, 2013), bilharzia, skin
disease, cough, pneumonia, fever, abdominal pain, headache and
snakebite (Erasto et al., 2003). Watt and Breyer-Brandwijk (1962)
reported its use by the Bushman in the Kalahari (Botswana and
South Africa) for dysentery, diarrhoea, severe abdominal pain and
toothache. A review of Cassia abbreviata's ethnomedicinal uses,
toxicity, phytochemistry, possible propagation techniques and
pharmacology was published in 2013 by Mongalo and Mafoko.
Other species in the genus Cassia used traditionally against
malaria are Cassia fistula L., used in Tanzania, Zimbabwe, Mozambique and Brazil. The leaves, containing the most active extracts,
yielded bioactive phytol (a diterpene alcohol), lutein (a xanthophyll) and di-lineolylgalactopyranosyl-glycerol as antiplasmodial
compounds upon activity-guided fractionation (Grace et al., 2012).
Antiplasmodial alkaloids and a chromone were isolated from the
flowers of Senna siamea (Lam.) H.S. Irwin & Barneby (synonym
Cassia siamea Lam.), used traditionally in Indonesia (Oshimi et al.,
2009). The stem bark yielded the antiplasmodial compound
emodin (6-methyl-1,3,8-trihydroxyanthraquinone) and lupeol
(a triterpenoid). The leaves also yielded antiplasmodial alkaloids
(Morita et al., 2007). Senna alata (L). Roxb. (synonym Cassia alata
L.) and Senna occidentalis (L.) Link. (synonym Cassia occidentalis L.)
are used traditionally in the Democratic Republic of Congo and
quinones with antiplasmodial activity were isolated from these
two plants (Kayembe et al., 2010). These authors also isolated
terpenes from Sarracenia alata (Kayembe et al., 2012).
All parts of Toddalia asiatica are used to treat malaria in Kenya
but the roots were considered to be the most potent. OketchRabah et al. (2000) isolated an antiplasmodial 10 -butene-coumarin
from the ethyl acetate extract of the root. Alkaloids with antiplasmodial activity were isolated from the metanolic extract of the
root bark by Gakunja et al. (1995) and Nyahanga et al. (2013).
Nyanga and co-workers also isolated antiplasmodial coumarins.
Recently eight new alkaloids were isolated from the roots by Jiang
Hua et al. (2014). Columbin (a diterpenoid furanolactone) was
isolated from the whole plant and found to be active against
Trypanosoma brucei (Nok et al., 2005).
The genus Aristolochia contains about 500 herbaceous plants
which are widely used in traditional medicine (Wu et al., 2004).
More than 60 species have been studied phytochemically and
contain a variety of compounds including aristolic acid and derivatives, terpenoids, aristolactams, aporphines, protoberberines, isoquinolines, benzylisoquinolines, amides, flavonoids, lignans, biphenyl
ethers, coumarins, tetralones, terpenoids, benzenoids, steroids etc.
(Kuo et al., 2011). Aristolochic acid and derivatives occur in many
Aristolochia species have been found to be nephrotoxic, carcinogenic
and mutagenic (Abdelgadir et al., 2011). Kubmarawa et al. (2007)
reported that the roots of Aristolochia albida Duch. were used in
Nigeria against malaria and that it contains tannins. Kamagaju et al.
(2007) reported that the seeds of this plant species were used in
Rwanda to treat malaria as well and that preliminary investigations
showed that species was rich in alkaloids. This plant species has also
been used to treat skin disease, dysentery, colic, snakebite and as an
adjuvant (Watt and Breyer-Brandwijk, 1962).
The genus Strychnos comprises about 100 species and is well
known for its alkaloid content including strychnine and curare.
Frederich et al. (2002) reviewed the antiplasmodial activity of 69
Strychnos alkaloids. They found weak or no antiplasmodial activity in
monoindoles and potent activity in the usambarine-type bisindoles.
Twenty-four alkaloids were isolated from the roots of Strychnos
potatorum (Massiot et al., 1992). Phillipe et al. (2005) found no
antiplasmodial activity in the EtOAc extract of the stem of this plant.
T. Ngarivhume et al. / Journal of Ethnopharmacology 159 (2015) 224–237
231
Table 4
Literature review on identified plants.
Species
Method of preparation of concoction, part used and country with Pharmacology
reference source
Adenia cissampeloides
Aristolochia albida (syn.
Aristolochia aethiopica)
No reference found to the treatment of malaria or fever
Roots prepared in treatment against malaria: various countries in
Africa (Neuwinger, 2000), roots prepared in malaria treatment and
fever: Ghana (Iwu, 2014); plant used in treatment of malaria: no
country specified (Leeuwenberg, 1987 in Heinrich et al., 2009).
Plant is powdered and used as an insect repellent against malaria:
Zimbabwe (Kazembe and Chauruka, 2012)
Aristolochia heppii
Baccharoides adoensis (syn.
Vernonia adoensis)
Brachylaena huillensis
Capsicum anuum
Carica papaya
Cassia abbreviata
Catharanthus roseus
Cissampelos mucronata
Crossopteryx febrifuga
Diplorhynchus
condylocarpon (syn.
Aspidosperma
condylocarpon)
Elephantorrhiza goetzei
Erythrocephalum
longifolium (syn.
Erythrocephalum
zambesianum )
Euclea natalensis
Holarrhena pubescens
Momordica balsamina
Momordica foetida
The dried roots are eaten: Mozambique (Mulhovo, 1999 in Fowler,
2006), leaves or fruits are used to treat malaria: Uganda (Stangeland
et al., 2011)
No reference found to the treatment of malaria or fever
Fruits are eaten against malaria: Ethiopia (Giday et al., 2007)
Crushed leaves are applied on the body to use as insect repellent in
the prevention of malaria; Ethiopia (Karunamoorthi and Hailu, 2014),
decoction of leaves prepared to treat malaria: Comores Islands (Kaou
et al., 2008) and in Uganda (Stangeland et al., 2011). Decoction of the
leaves and roots are drunk against malaria: Ethiopia (Giday et al.,
2007; Traore et al., 2013). Leaves are burnt and grinded and prepared
in a drink: Zimbabwe (Lukwa et al., 2001). Decoction of leaves are
boiled with Azadirachta indica and drunk or used in steambath:
Ghana (Asase et al., 2005).
Plant (parts unknown) used against black water fever: East Africa
(Bally, 1937), decoction of the roots used as an antimalarial remedy:
Tanzania (Haerdi, 1964 in Lye et al., 2008) and to treat fever of
malaria: East-Africa (Kokwaro, 1976) Decoction of roots drunk against
fever and malaria: East and Southern Africa (Chhabra et al., 1987).
Decoction prepared from leaves against fever (Brendler and Eloff,
2010)
Ethanolic whole plant extract IC50 1.56 m/mL (Annan et al., 2012)
No reference
Plant active as insect repellent 100% for 1 h, 84% for 2 h, but fell
rapidly to 46% by 2.5 h post application (Kazembe and Chauruka,
2012)
Very high anti-plasmodial activity (Stangeland et al., 2010)
No reference
No reference
Methanolic leaf extract IC50 0.2–1.8 mM (Julianti et al., 2014)
Antimalarial activity tested (Weenen et al., 1990). An extract has
been marketed under the name ‘Cassia beareana’ and is said to be
diaphoretic (Anon. (n.d.) in Watt and Breyer-Brandwijk, 1962;
Palgrave, 2002)
Anti-malarial activity detected against Plasmodium falciparum
(Ponarulselvam et al., 2012), high antiplasmodial activity (Gakunja
et al., 1995; Gathirwa et al., 2007)
No reference found to the treatment of malaria or fever
In vitro antimalarial activity against Plasmodium falciparum (Gessler
et al., 1994)
Decoction of bark scrapings drunk & used to wash to treat malaria: In vivo antiplasmodial activity of ethanolic bark extract (Elufioye
Burkina Faso (De la Pradilla, 1988 in Fowler, 2006 ), bark is used as a and Agbedahunsi, 2004); Crude alkaloids from leaves IC50 4–10 mg/
remedy for fever: Central & S. Africa (Githens, 1948 in Fowler, 2006), mL (Sanon et al., 2003a, 2003b).
parts of the tree provide a remedy for fever: Central & S. Africa
(Palgrave, 2002; Watt and Breyer-Brandwijk, 1962), the bark is
decocted and drunk, or used to bathe the patient: Côte d'Ivoire
Kerharo and Bouquet, 1950 in Fowler, 2006), the shrub is used as a
remedy for fever: Ghana, Guinea (Gelfand et al., 1985 in Fowler,
2006), decoction of the bark is used to treat fever: Malawi,
Mozambique (Morris, 1996 in Fowler, 2006), leaves are used to treat
malaria: Mozambique (Mulhovo, 1999 in Fowler, 2006), scrapings of
the fresh roots are eaten against malaria: Tanzania (Haerdi, 1964 in
Fowler 2006, Hedberg et al., 1982), bark is used as remedy for malaria
and fever: Tropical Africa (Githens, 1948 in Fowler, 2006; Watt and
Breyer-Brandwijk, 1962), the bark is infused as remedy for malaria:
Zambia: (Haapala et al., 1994 in Fowler, 2006), leaves are used as an
enema to cure fever: Zimbabwe (Gelfand et al., 1985 in Fowler, 2006).
Root infusion prepared from leaves against malaria to bathe patient No reference
or taken orally: Zambia (Vongo, 1999 in Fowler, 2006), bark is used in
water against malaria: Zimbabwe (Lukwa et al., 2001).
Infusion of the roots is drunk, and used to immerse the naked patient No reference
as a remedy for fever (Gelfand et al., 1985 in Fowler, 2006).
Root decoction with leaf juice is drunk for malaria: Tanzania (Haerdi, No reference
1964 in Lye et al., 2008)
Leaves are used to treat malaria and fever: Uganda (Adjanohoun et al.,
1993 in Lye et al., 2008; Tabuti et al., 2003; Ssegawa and Kasenene,
2007; Tabuti, 2008).
Leaves used to treat fever externally: Kenya (Omino & Kokwaro,
1993), decoction prepared from leaves and roots used to wash
children with fever: East Africa (Greenway, 1941; Kokwaro, 1976 in
Lye et al., 2008), decoction prepared from the roots and drunk to treat
malaria (Haerdi, 1964 in Lye et al., 2008).
Plant reported to be efficient in treating malarial symptoms:
Mozambique (Bandeira et al., 2001; Mulhovo, 1999 in Fowler, 2006)
Infusion prepared from the leaves to treat malaria: Tanzania (Gessler
et al., 1995), leaves are used against malaria (Kakudidi et al., 2000;
Tabuti et al., 2003; Ssegawa and Kasenene, 2007; Tabuti, 2008;
Adjanohoun et al., 1993 in Lye et al., 2008), leaves are used against
fever: Uganda (Kakudidi et al., 1996 in Lye et al., 2008).
No reference
Methanolic bark extracts – IC50 28 mg/mL (Simonsen et al., 2001);
Chloroform leaf extract IC50 5.7 mg/mL (Sinha et al., 2013)
Active against liver stages of Plasmodium berghei (Ramalhete et al.,
2011 and 2014)
In vitro and in vivo antiplasmodial activity of methanolic leaf
extract (Froelich et al., 2007 and Waako et al., 2005)
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Table 4 (continued )
Species
Method of preparation of concoction, part used and country with Pharmacology
reference source
Ocimum angustifolium
(syn. Becium
angustifolium)
Pavetta schumanniana
No reference found to the treatment of malaria or fever
No reference
Decoction of roots drunk against malaria (Haerdi, 1964 in Lye et al.,
2008)
Leaves used to treat malaria and decoction of the roots drunk to treat
malaria: Samburu in western Kenya (Heine et al., 1988 in Lye et al.,
2008); the herb is used as a sudorific: India (Watt and BreyerBrandwijk 1962). The plant is used as a fever remedy: Nigeria
(Gelfand et al., 1985 in Fowler, 2006), decoction of the leave is drunk:
Ethiopia (Giday et al., 2007).
Decoction of the seed is used orally to treat malaria: Ethiopia (Giday
et al., 2007)
Leaves are used to treat malaria; Uganda (Adjanohoun et al., 1993 in
Lye et al., 2008)
No reference found to the treatment of malaria or fever
No reference
No reference
No reference found to the treatment of malaria or fever
No reference
Decoction of aerial parts used to treat malaria: Madagascar
(Rasoanaivo et al., 1992), decoction of plant prepared and drunk
against malaria (Brendler and Eloff, 2010), roots and leaves used to
treat malaria: Uganda (Katuura et al., 2007a, 2007b), treat fever and
malaria (Heine et al., 1988 in Lye et al., 2008), plant used against
malaria (Njoroge and Bussmann, 2006); decoction of plant used
orally against malaria: East Africa (Orwa et al., 2008).
Significant activity found against Plasmodium falciparum (Katuura
et al., 2007b); Methanolic root extract IC50 2.2 & 1.8 mg/mL
(Oketch-Rabah et al., 2000); Root and fruit extract IC50 2.43 and
1.87 mg/mL respectively (Orwa et al., 2013); Parasitaemia
suppression in mice (Muregi et al., 2007)
Plumbago zeylanica
Prunus persica
Senna septemtrionalis (syn.
Cassia septemtrionalis)
Strychnos potatorum (syn.
Strychnos heterodoxa/
Strychnos stuhlmannii)
Tabernaemontana elegans
(syn. Conopharyngia
elegans)
Toddalia asiatica
Strychnos potatorum is also known to be used to treat microbial
infections, diarrhoea and diabetes (Mallikharjuna et al., 2007).
Crossopteryx febrifuga is the only species in the Crossopteryx
genus. The alkaloids crossopterine and crossoptine and the glycoside
B-quinovine have been isolated from it (Elufioye and Agbedahunsi,
2004). Quercetin derivatives, other flavonoids (Tomás-Barberán and
Hostettmann, 1988), a bisdesmonic terpene and a triterpene
(Gariboldi et al., 1990) were isolated from the stem bark. A triterpene
saponin characterized by a novel ursadienedioic acid aglycone moiety
was isolated from the root bark (Babady-Bila et al., 1991). A syrup
produced from the fruit is one of the “improved traditional medicines” used in Mali and is well known amongst the population and
prescribed by up to 76% of biomedical health workers for dry coughs
(Willcox et al., 2012). The leaves are used to treat antiamoebic and
spasmolytic antidiarrheal activities. The active ingredient was in the
polyphenolic fraction (Tona et al., 2000). The bark is also used to treat
diarrhoea, dysentery and fevers (Tomás-Barberán and Hostettmann,
1988).
Baccharoides adoensis var. kotschyana (synonym Vernonia
kotschyana) is used in Mali to treat gastrointestinal disorders and
wound healing. This has been attributed to the immunomodulating properties of acidic polysaccharides isolated by Nergards et al.
(2004).
Catharanthus roseus is a well-studied medicinal plant. More
than 130 terpenoid indole alkaloids (MIAs) including two commercially important cytotoxic dimeric alkaloids used in cancer
chemotherapy has been reported from it (Van der Heijden et al.,
2004). However, little reference could be found in the literature
regarding its traditional use to treat malaria.
Holarrhena pubescens is a well-known medicinal plant in India
and Southern Africa. It has been extensively studied for its
alkaloids and steroids (Siddiqui et al., 1993, 2001). The stem bark
is used to treat amoebic dysentery, helminthic infections, diarrhoea, toothache and as a tonic. The steroidal alkaloids, holamide
and pubscinine, were isolated from the ethanolic extract and
demonstrated to have hypotensive properties (Aftab et al., 2009).
Methanolic leaf extract IC50 17 mg/mL (Simonsen et al., 2001);
In vitro antiplasmodial activity (Clarkson et al., 2004)
No reference
No reference
An antimalarial steroidal alkaloid has been isolated from Holarrhena pubescens (synonym Holarrhena antidysenterica (Roth)
Wall. ex A.DC) (Dua et al., 2013). The leaves of Holarrhena
pubescens contains the flavonoid naringin, naringenin glycosides
and the triterpenes lupeol, lupeol β-hydroxyhexadecanoate and
ursolic acid (Pittaya et al., 2006). Three known pentacyclic triterpenoids namely lupeol, betulinaldehyde, and betulinic acid and a
steroidal compound stigmasterol were isolated from the seeds
(Bhattachartya et al., 2009).
Momordica balsamina, known as African pumpkin, is a vegetable used as food, mainly in sub-Saharan Africa. It has also been
used in traditional African medicine in Africa to treat diabetes and
malaria. Triterpene-type triterpenoids and phenylpropanoid glycosides were isolated from it (De Tommasi et al., 1991; Ramalhete
et al., 2009). The presence of chlorogenic acids in the leaves of
Momordica foetida, Momordica balsamina and Momordica charantia
L. (esters of p-coumaric, caffeic and ferulic acid and quinic acid)
was established (Madala et al., 2014). Phenylethanoid and phenylpropanoid glycosides have been isolated from the Brazilian plant
Stachytarpheta cayennensis (Rich. Vahl) (Verbenaceae) used as a
remedy for malaria (Froelich et al., 2007). Five new pimarane
diterpenes were isolated from the aerial parts (De Tommasi et al.,
1995).
Momordica foetida is closely related to M. balsamica and
Momordica charantia. Similarly to M. balsamica it is used to treat
diabetes and malaria. Cucerbane triterpenoids were isolated from
a chloroform extract of the leaves (Mulholland et al., 1997).
Froelich et al. (2008) isolated O-glycopuranosides (of two flavanones, a flavonol and a chromone from the leaves of Momordica
foetida from extracts with antiplasmodial activity. Momordica
charantia has been intensively investigated because of its antidiabetic properties. More than 50 cucerbane triterpenoids were
isolated and characterize the closely related Momordica charantia
(Chen et al., 2009). No references could be found for Pavetta
schumaniana. The related species Pavetta crassipes K. Schum
contains flavonoids (Asusheyi et al., 2014) including a quercetin-
T. Ngarivhume et al. / Journal of Ethnopharmacology 159 (2015) 224–237
3-O-rutinoside which has good antimicrobial activity (Bello et al.,
2011). Its significant antimalarial activity was attributed to alkaloids (Sanon et al., 2003a, 2003b).
The medicinal properties of Plumbago zeylanica reviewed by Jain
et al. (2014) is an important medicinal plant in Africa and Asia.
Plumbagic acid glucosides, naphthoquinones and coumarins have
been isolated from the roots (Lie-Chwen Lin et al., 2003).
Adenia cissampeloides has been poorly studied and no pure
compounds have been reported from it or related species. Njoku
et al. (2011) identified tannins, saponins, phlobatannins, flavonoids, terpenoids, steroids, alkaloids, carbohydrates and glycosides
with TLC and spray reagents. Similar results were published for
Adenia lobata (Jacq.) Engl. used to treat cancer in Nigeria (Agoreyo
et al., 2012).
In vitro antiplasmodial activity does not necessarily translate into
antimalarial drugs since there may be poor bioavailability and toxicity.
The opposite is also true as the molecules with antimalarial properties
may occur as prodrugs in plant extracts and need to be metabolized
enzymatically in humans to bioactive compounds.
Variability in the composition of the plants due to different
chemotypes or physiological stage of the plant or climatic and soil
conditions may influence the composition of plant extracts from
the same species. It is not known to what extent this is taken into
account by healers when collecting plant material. Gessler et al.
(1994) demonstrates that plants mentioned in the literature for
anti-malarial properties do not necessarily show high activity in
an in vitro test. This was for example the case with Cassia
abbreviata which gave only moderate results in their in vitro test
(IC50 ¼10–50 mg/ml), although it has been known to be used as an
anti-malarial treatment in various countries. Some plants may be
used in the treatment of malaria, not for their antiplasmodial
properties but because of other therapeutic health properties.
These would include reducing fever, convulsions and headache,
and possibly even immuno-stimulatory effects (Rasoanaivo et al.,
1992; Gessler et al., 1994).
Different levels of activity found in samples of material from the
same plant species but collected in different regions suggest that the
locality and probably also the time of collection may be important in
the amount and composition of their active components (Capasso,
1985; Gessler et al., 1994). Gessler et al. (1995) report that the chemical
composition of the various plant constituents is affected by the climatic
conditions and the locality under which the plant species are growing.
Klayman (1985) confirms that the active compounds of Artemisia
annua can vary significantly within the same plant species growing in
different continents.
Another problem is that plants are often used in mixtures and are
perhaps only fully active in this combination, due to synergistic effects.
Elford et al. (1987) show that certain flavonoids act synergistically
with artemisinin against Plasmodium falciparum in vitro at concentrations in which they exhibit no individual antiplasmodial activity.
5. Conclusion
Local traditional knowledge and the practice of plant-based
medicine are still widespread in rural areas such as the Chipinge
district in Zimbabwe and traditional healers play an important role
in primary health care. This is probably because of the frequent
incidence of malaria and the remoteness of the villages. Easy
access to the plants and the simplicity of preparing medicines
from plants are essential as well.
The data gathered in this survey could assist in identifying
plant species and extraction methods to develop herbal drugs
against malaria in Zimbabwe. The most widely used plants for the
treatment of malaria reported in this study such as Cassia
abbreviata and Aristolochia albida should be prioritized for further
233
research. In vitro screening programmes, based on this and other
ethnobotanical study results, could be important in validating the
traditional use of herbal remedies and for providing leads in the
search for new active principles. Another method to improve
traditional medicines is the Retrospective Treatment Outcome Study
(RTO). The advantage of applying this method developed by Graz
et al. (2005) and described in further detail by Willcox et al. (2011)
is that it adds clinical information and statistical analysis to
ethnobotanical studies. Scientific validation of herbal medicine
may eventually lead to more widespread use of traditional
medicines in cheaper health care systems, as in India and China,
provided that thorough toxicological investigations, clinical studies and randomized controlled trials are carried out. African
traditional knowledge and medicine thus have the potential to
play a large role in primary healthcare, particularly in poor and
isolated rural areas. This underscores the value of traditional
knowledge and the need to collect and preserve traditional health
practices.
The wide variation in plant species used by traditional healers
in the same area, the absence of standardised preparations and
dosages and the low rate of referral to hospitals when a treatment
has failed is worrying. This and the lack of scientific knowledge on
the toxicity and active ingredients probably explain the low
acceptability and adoption of African traditional medicine into
national health systems. Traditional healers should be educated as
to when patients, particularly children below the age of two and
pregnant women, should be referred to clinics and hospitals. The
toxicity and efficacy of traditional medicines should be scientifically validated to enable the manufacture of safe and effective
standardized herbal treatments. This is not an easy task due to the
complex composition of herbal extracts and the uncertainty about
whether single chemical entities are metabolized to active drugs
after ingestion and whether more than one chemical entity acts in
synergy.
Work is in progress to manufacture extracts of the 26 plant
species collected during this ethnobotanical survey and to screen
these extracts in antiplasmodial bioassays. The results will be
published separately.
Authors' contributions
TN conceptualized the study and CK and JJ reviewed the research
proposal. TN conducted the ethnobotanical survey and analyzed the
field data. TN, CK and JvdW drafted the manuscript. All the authors
participated in writing and giving feedback on the manuscript. All
authors have read and approved the final manuscript.
Acknowledgement
This work is part of the Multi-disciplinary University Traditional Health Initiative (MUTHI), a plant research capacity building
project, which receives financial support from European Union
FP7-AFRICA-2010, Grant number 266005. We thank the Walter
Sisulu University for study leave to perform the survey. We are
grateful to the headman of the Muzite area and the Zimbabwe
National Traditional Healers Association who allowed us to work
in the areas involved and assisted us with the identification of
recognized traditional healers and obtained their collaboration.
Our sincere thanks go to the traditional herbalists for participating
in this study. We are also grateful to the Harare Botanical Gardens,
Zimbabwe, for accepting voucher specimens and identifying the
plant species and the assistance of the Zimbabwe Forestry Commission for allowing us to collect the plant material. We thank
Dr C. H. Barker from the Department of Geography at the
234
T. Ngarivhume et al. / Journal of Ethnopharmacology 159 (2015) 224–237
University of the Free State for drawing the Zimbabwe and Muzite
area maps and Mr B. Hwata from the Geography Department at
Bindura University for GIS data.
Appendix A. Supporting information
Supplementary data associated with this article can be found in
the online version at http://dx.doi.org/10.1016/j.jep.2014.11.011.
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