Traditional Health Practitioners Research Articles

Aspects of the illegal hunting and trade of vultures in northern KwaZulu-Natal, South Africa

The harvesting and trade of species for use in traditional medicine, or muthi, is predominantly illegal, unregulated, and likely unsustainable, representing a major conservation challenge. In South Africa, vulture populations have declined considerably in recent decades, but evidence shows a consistent use of vultures by traditional health practitioners. However, less is understood about the key factors that underpin the hunting of these birds. We evaluated aspects of the illegal hunting and trade of vultures in northern KwaZulu-Natal Province. Data were collected using in-depth interviews with local hunters and muthi traders. A mixed-method sampling design was used, and data were analysed using the thematic analysis approach. The results revealed that vultures were hunted mainly by local men aged 24–40 years. The vultures were obtained using multiple techniques, but poison (38%) and firearms (31%) were the preferred methods. Vultures were hunted upon request and traded through local networks comprising hunters, traditional health practitioners and muthi traders. Carcasses were sold directly to traditional health practitioners, but some were destined for the local market. Prices for the whole carcass ranged from ZAR500 (US$29) to ZAR2 000 (US$116). Perceptions held by respondents concerning the hunting and trade of vultures alluded to the difficulty of obtaining birds. This was attributed to vultures’ conservation status and the risk of being found in the possession of a vulture or any of its by-products. Live vultures were reportedly hard to find as they mostly inhabited protected areas, and their low numbers were also highlighted as an exacerbating factor. The use of vultures in African traditional medicine is a well-established practice; however, presently, this threatens the long-term persistence of vultures in the wild. Intricate socio-economic influences are at play, and addressing these may facilitate positive conservation outcomes for vultures and other target species in northern KwaZulu-Natal.

Prediction of Lead Molecule Esculetin of Tridax procumbens against Zika Virus Envelope Protein

In the existing field of science, it is necessary for Siddha, Ayurveda therapists, to understand the interactions and to treat the target regions of the human system effectively. One of the most significant nightmares for scientists and medical professionals has been the Zika virus. Since the bite of the Aedes mosquito species has infected people worldwide with the Zika virus (Flavivirus). The human mechanism and infection control interactions of the Zika virus are still unclear. In addition, some herbal products may give a pathway to the treat the zika virus. Many herbs aim to regulate various diseases, but the herb Tridax procumbens has a key collection of pharmacological values for diseases. Traditional health practitioners have struggled to grasp the precise mechanism of linking existence and how to treat the disease, so the current Ayurinformatics approach and the evolving field are an idea of a modern medical science system. Here we examine the interaction of flavonoids procumbenetin and esculetin of Tridax procumbens with zika virus in silico docking and molecular simulation and ADME and toxicity profile for the drug candidate. Hereby we conclude that these two compounds have the property to suppress the ZIKA virus and are stable and active with ZIKA virus. Molecular docking of Esculetin and Procumbenetin with ZIKV 5JHM, they bind with each other on active site pockets ASP98, ARG99, GLY100, TRP101, GLY102, ASN103, GLY104, CYS105, GLY106, LEU107, PHE108, GLY109.

Botanical, phytochemical and pharmacological profile of the mangrove plant Kandelia candel (L.) Druce

Kandelia candel L. Druce (family Rhizophoraceae) is a true / major mangrove that has a wide-spread distribution along the coastal areas of the Indo-west Pacific region of the earth. It is commonly found along the coasts of India and a few South East Asian countries. Its parts have numerous applications in leather, textile, furniture industries, and is also used by the traditional health practitioners / healers to treat diabetes. It is known to be producing a variety of phytochemicals. Extracts and compounds isolated from K. candel have exhibited noteworthy biological activities. An attempt has been made to compile the up-to-date information on this mangrove plant from globally recognised scientific databases. This review would provide necessary informationtoformulate the possible application of this common mangrove in standard as well as complementary medicine.

Acute toxicity and anti-inflammatory activity of an improved traditional medicine developed in Burkina Faso

An Improved Traditional Medicine (ITM) in capsule form presented by traditional health practitioners in Burkina Faso as used for hepatoprotective and hepatocurative treatment for viral hepatitis B. The study's main objective was to investigate the anti-inflammatory properties of this ITM, which is used in treating viral hepatitis B in traditional medicine in Burkina Faso. Phytochemical screening revealed the presence of flavonoids, saponins, tannins, coumarins, alkaloids, sterols and triterpenes. The in vitro anti-inflammatory assay inhibited LOX by 15.69 ± 0.50% at a 100 µg/mL concentration. The LD50 was estimated to be greater than 5000 mg/kg. In vivo activity using the carrageenan anti-oedema test showed good dose-dependent anti-inflammatory activity of ITM at 30, 65 and 130 mg/kg bw. After 3 hours, the extract at various doses reduced edema to over 50% inhibition. After 5 h, oedema was reduced to 85.209% at the 130 mg/kg. However, the reference acetylsalicylic acid (ASA) at 100 mg/kg bw showed a percentage of 85.048% at 5 h. The IC50 obtained after the ABTS, FRAP and LPO antioxidant tests of the phytomedicine were 351.00 µg/mL, 353.20 mM EAA/L and 81.13%. However, the IC50 with the DPPH method was higher than 104 mg/mL. The phytomedicine would have anti-inflammatory and antioxidant properties due to the presence of bioactive phytochemicals on inflammation and free radicals. Keywords: ITM, Phytochemical, Acute toxicity, Anti-inflammatory, Antioxidants

Recognition of language barriers in comprehending non-communicable disease management among rural elderly people in the DIMAMO surveillance area: a case of AWI-Gen participants

BackgroundLanguage plays a critical role in health communication, particularly in the management and understanding of non-communicable diseases (NCDs) among elderly populations. This study aimed to explore the language barriers that affect elderly participants’ comprehension of NCDs, focusing on how these barriers impact their understanding of disease causes, symptoms, treatment, and self-management. The study also investigated how linguistic differences between healthcare workers and patients influence the effectiveness of health interventions in a rural South African context.MethodsThis qualitative phenomenological study was conducted with elderly participants aged 60 years and above, all of whom have chronic diseases. In-depth face-to-face interviews were conducted using an interview guide during the AWI-Gen 2 research feedback sessions in the Ga-Dikgale area. Data analysis was performed using QSR NVivo 10 to identify key themes.ResultsFive major themes emerged regarding participants’ understanding of NCDs and the perceived language barriers. These include Limited Knowledge and Awareness of NCDs, Misconceptions about NCDs, Mixed perceptions regarding NCD causes and treatment, Discrepancies in healthcare workers’ communication, and the Importance of interpreters in facilitating NCD-related communication.ConclusionThe study revealed significant misconceptions about diabetes and hypertension, as well as traditional practices like bloodletting, which were perceived to relieve hypertension symptoms. It also identified critical communication barriers, including limited time for health practitioners to explain diagnoses and treatments. The findings emphasize the need for interpreters and culturally sensitive communication strategies to improve health literacy and care. Collaborative efforts between traditional and western health practitioners are recommended to address these issues and enhance community health interventions.

Traditional medicinal plants used for gastrointestinal disorders by the Nyamwezi traditional health practitioners of Tabora region, Tanzania

Traditional medicinal plants used for gastrointestinal disorders by the Nyamwezi traditional health practitioners of Tabora region, Tanzania

Practices of disease diagnosis and patient monitoring by traditional herbalists in Mpigi district, Uganda: Implications for integration into the conventional health care system

BackgroundThe use of herbs by traditional healers plays a vital role in primary health care in rural Uganda, where most patients still prefer and use herbal medicines. However, specific literature on the traditional healing practices of herbalists is lacking. This study documented the methods traditional herbalists in Mpigi District, Uganda, employ to diagnose disease, monitor patients and handle cases of treatment failure. Materials and methodsAn exploratory study was carried out from June to November 2019 in the rural district of Mpigi in Uganda. In-depth interviews were conducted with 20 herbalists. The interviews were audiotaped, transcribed verbatim, and themes were generated using qualitative content analysis. ResultsThe methods used to diagnose disease included; prior conventional diagnosis, the patient’s description of their experience with the disease condition (including signs, symptoms, and history of disease), physical examination for signs of disease, referral for conventional diagnosis, or to another herbalist, and use of conventional tools. Herbalists use phone calls, patients’ visits, and set review dates to monitor response to therapy. Patient monitoring during therapy emphasizes the improvement or resolution of signs and symptoms of disease and does not consider adverse drug reactions to therapy. Disease conditions that do not respond to therapy are referred to conventional health centres and other traditional health practitioners. ConclusionsDiagnosis of disease and monitoring of patients depends on presenting symptomatology as observed by the herbalist or described by the patient. There is considerable dependence on the conventional health system through referral for diagnosis and management of non-responsive conditions.

Medicinal Plants Used in the Traditional Treatment of Cancer in the District of Bamako, Mali

Aims: This study goaled to enhance the value of traditional medicinal plants used in cancer treatment. Place and Duration of Study: An ethnobotanical survey was conducted in fifteen markets of Bamako district's, from February to August 2023. Methodology: The surveys involved the traditional medicine practitioners in Bamako based on a well semi-structured questionnaire. The information about the cancer and the plant species used to manage it, the mode of use and preparation in addition to the social characteristics of respondents were gathered. Results: A total of 172 traditional health practitioners were questioned in this study with a predominance of female (72.7%). Among the types of cancer known by the respondents, the breast cancer topped the list with 63.48%, followed by the cervical (21.34%) and prostate (8.42%) cancer. Twenty-seven (27) plant species belonged to 19 botanical families were used by these people to treat the cancer. Ximenia americana Linn, Cola acuminata F and Strychnos spinosa Lam were the most frequently cited species, with a frequency of 51.85%. The most represented botanical families were Fabaceae and Acanthaceae. The leaves (34%) were the most widely used medicinal plant parts, followed by leafy branches (20%) and roots (16%). For the preparation of medicinal recipes, 44.44% of the respondents recommended mainly the decoction (44.44%) and spraying (41.70%), These recipes are generally administered by oral route (32.69%) and specific bath (30.76%). Conclusion: These results constitute a preliminary step to the assessment of the anti-cancer properties of some of these registered plant species.

Collaboration between traditional health practitioners and biomedical health practitioners: Scoping review.

Collaboration between traditional health practitioners (THPs) and biomedical health practitioners (BHPs) is highly recommended in catering for pluralistic healthcare users. Little is known about bidirectional collaborations at healthcare service provision level. To map global evidence on collaboration attempts between THPs and BHPs between January 1978 and August 2023. We followed the Arksey and O'Malley framework in conducting this scoping review. Two reviewers independently screened articles for eligibility. A descriptive numerical and content analysis was performed on ATLAS.ti 22. A narrative summary of the findings was reported using the PRISMAScR guideline. Of the 8404 screened studies, 10 studies from 12 articles were included in the final review. Studies came from America (n= 5), Africa (n= 2), China (n= 2) and New Zealand (n= 1). Eight studies reported case studies of bidirectional collaboration programmes, while two studies reported on experimental research. All collaborations occurred within biomedical healthcare facilities. Collaboration often entailed activities such as relationship building, training of all practitioners, coordinated meetings, cross-referrals, treatment plan discussions and joint health promotion activities. This study confirmed that practitioner-level collaborations within healthcare are few and sparse. More work is needed to move policy on integration of the two systems into implementation. There is a need to conduct more research and document emerging collaborations.Contribution:This research illuminates the contextual challenges associated with sustaining collaborations. The data would be important in informing areas that need strengthening in the work towards integration of THPs and BHPs.

Exploring the lived experiences of women with infertility using traditional healthcare services in Harare urban, Zimbabwe.

Infertility has a significant impact on the lives of women. Therefore, affected women often consider the treatment options available to deal with their condition, including traditional healthcare services (THS). The aim of this phenomenological study was to explore the lived experiences of women with infertility problems who sought help from traditional health practitioners in Harare, Zimbabwe. Data from interviews with five women with infertility was explicated using a simplified version of Hycner (1985) five step explication process. Two major themes and eight sub themes emerged from the findings. The major themes were traditional diagnosis experiences and traditional treatment experiences. Consultation and divination were the diagnosis methods experienced by the women with infertility. The THS offered comprehensive management of infertility through couples therapy, as well as pre- and post-natal therapies, which include lifestyle counselling. The findings also showed that women with infertility commonly receive concurrent treatment, including both allopathic and traditional medicine. This presents an opportunity to explore the convergence of traditional and allopathic approaches in the management of infertility in women.

Ethnobotanical survey and anti-candidal activity of plant species used for oral candidiasis

Background: Oral candidiasis is caused by Candida albicans, which is most prevalent in immunocompromised patients.Aim: The study aimed to investigate the antifungal activity of plant species used for oral candidiasis against C. albicans.Setting: The study was conducted in Aganang Local Municipality, Capricorn District, Limpopo province, South Africa.Methods: A survey was conducted using a semi-structured questionnaire supplemented with guided field walks with traditional health practitioners to gather information on medicinal plants used to treat oral candidiasis. Nine plant species (Artemisia afra Jacq. ex Willd., Blepharis subvolubilis subsp. subvolubilis C.B. Clarke, Enicostemma axillare [Lam.], Helichrysum caespititium [DC.] Harv., Solanum incanum L., Waltheria indica L., Ximenia caffra Sond. var. caffra, Ximenia caffra Sond. var. natalensis and Ziziphus mucronata Willd.) were investigated for antifungal activity. The plant material were extracted with solvents of varying polarities: acetone, dichloromethane, ethyl acetate, ethanol, hexane, methanol, and water. The Micro-dilution and bioautography assays were used to determine the antifungal activity of the plant extracts.Results: Leaf extracts of A. afra and S. incanum were more active against C. albicans with MIC values of 0.02 mg/mL. Bioautography assay demonstrated active compounds in S. incanum, W. indica and X. caffra var. caffra extracts developed in Benzene: Ethanol: Ammonia hydroxide (BEA).Conclusion: An ethnobotanical survey is a worthy starting point in selecting potential plant species for ethnopharmacological studies.Contribution: The effectiveness of oral administrations of the medicinal plants was confirmed by the excellent antifungal activity of the aqueous extracts.

Ethnobotanical Survey And Traditional Use Of Indigenous Plants By Shepherd, Gujjar And Bakerwal Communities From Narwav Forest Ranges Of District Baramulla, Jammu And Kashmir, India

Purpose: To explore the medicinal uses of traditional plants of narwav forests with an assessment to preserve the ethnobotanical knowledge related with this area. Methods: The survey of field was conducted during a period of one year. Data were composed through a semi-structuredquestionnaire and discussions with native tribal people and traditional health practitioners inhibited in the side villages and in the study area.

The Influence of Culture on the Cause, Diagnosis and Treatment of Serious Mental Illness (Ufufunyana): Perspectives of Traditional Health Practitioners in the Harry Gwala District, KwaZulu-Natal

Cultural beliefs influence the perceived cause, methods of diagnosis and treatment of mental illnesses. A qualitative study was conducted among traditional health practitioners (THPs) in the Harry Gwala District Municipality to further explore this influence. Purposive sampling assisted in the recruitment of 31 participants (9 males and 22 females). The four key themes this study investigated in relation to mental illness included its causes, methods of diagnosis, common symptoms observed and treatment approaches used by THPs, and the system of patient management. Culturally, mental illness was reported to be caused by witchcraft and an ancestral calling in this study. Mental illness was predominantly diagnosed by spiritual intervention which included divination through consultation with the ancestors, familial background, burning of incense which can also be part of communicating with the ancestors and through examining the patient. The common symptoms included aggression, hallucination and unresponsiveness. Prevalent modes of treatment included the use of a medicinal concoction and performing cultural rituals where ancestors and other spirits were assumed influential. The duration of the treatment process was dependent on guidance from the ancestors. Most causal aspects of mental illness from diagnosis to treatment seemed to be influenced by cultural beliefs and ancestors.

The antipsychotic potential of Salix Mucronata on ketamine-induced rats

Salix mucronata is one of the herbal plants offered by the traditional health practitioners in KwaZulu-Natal, South Africa for the treatment of schizophrenia. This study aimed to investigate the effects of repeated administration of ketamine on social interaction, novelty and motivation in adult, male Sprague Dawley rats. It also aimed to investigate the potential of risperidone and the herbal extract of S. mucronata to reverse impairments that are induced by ketamine. Experimental rats (n=45) received a dose of ketamine at 30 mg/kg via intraperitoneal injection for 5 consecutive days. They were then allocated into their respective treatment groups and given risperidone (APD) and the herbal extract of S. mucronata (TM) at doses of 6 mg/kg and 5 mg/kg, respectively, for 7 consecutive days. Social behaviour was tested using the 3-chambered sociability test, and anhedonia was tested using the sucrose preference test. Ketamine induction elicited social withdrawal and reduced social novelty which were later successfully reversed by risperidone and S. mucronata. The rats showed reduced preference to sucrose post-induction and post-treatment. Ketamine and mild stress caused by scruff restraint elicited reduced weight gain for the animals. No differences were noted on brain mass between controls and experimental groups and also between risperidone and S. mucronata groups. However, reduced brain volume was noted in experimental groups. Dopamine and acetylcholine concentration levels were high in groups which received risperidone and S. mucronata. These findings highlight that the antipsychotic potential of S. mucronata is similar to risperidone.

CULTURAL BELIEFS AND INTERPRETATION OF SYMPTOMS OF SCHIZOPHRENIA IN KENYA

This abstract provides a concise overview of the prevalence of cultural beliefs and their impact on the recognition and treatment of schizophrenia symptoms in Kenya, drawing from a review of relevant literature including "A survey of psychosis risk symptoms in Kenya," "Cultural Aspects of Major Mental Disorders: A Critical Review from an Indian Perspective," "Psychotic Symptoms in Kenya – Prevalence, Risk Factors, and Relationship with Common Mental Disorders," and "Exploring mental health practice among traditional health practitioners: a qualitative study in rural Kenya." This review reveals a complex interaction between traditional cultural beliefs that are held by many Kenyan communities and Western biomedical viewpoints on schizophrenia. Results of a survey conducted in Kenya on psychosis risk symptoms highlight the substantial overlap between symptoms that are distinctive to a culture and those that meet Western psychiatric standards. This overlap emphasizes how crucial it is to use culturally aware methods when diagnosing and treating schizophrenia in Kenya. Studies conducted on psychotic symptoms in Kenya show that a significant proportion of schizophrenia patients experience symptoms that are culturally specific, such as spirit possession and witchcraft beliefs. These culturally particular symptoms frequently impact behavior related to seeking help and adhering with treatment, with traditional healers having a significant role in the treatment of mental illness. Reliance on conventional healers, however, may impede treatment outcomes for people with schizophrenia and prolong the time it takes to receive evidence-based psychiatric therapy. It is important to consider the cultural perceptions and beliefs around the symptoms of schizophrenia in Kenya highlight the critical need for culturally competent methods to mental health treatment. Schizophrenia treatment initiatives must strike a careful balance between honoring various cultural viewpoints and encouraging cooperation between conventional healers and biological professionals. The creation of culturally appropriate therapies and the improvement of mental health literacy in Kenyan communities ought to be the top priorities for future research in order to guarantee that people with schizophrenia have fair access to high-quality mental health care.

Traditional health practitioners' understanding of spirit possession in Gauteng province, South Africa.

Traditional health practitioners (THPs) understand spirit possession as a cultural or religious spirit occupying a person, while the mental healthcare providers understand it as a mental illness. The different understanding is based on manifestations that mimic that of mental illness, such as seeing and hearing things that others cannot see or hear. Spirit possession holds different meanings in different cultures and religions that could be either beneficial or detrimental. Furthermore, spirit possession is understood as a channel of communication between the living and the dead or God or a supernatural phenomenon in which a spirit owns a person. This study explored and interpreted THPs' understanding of spirit possession in Gauteng province, South Africa. Hermeneutic phenomenology study explored and interpreted the THPs' understanding of spirit possession in Gauteng province. In-depth individual interviews were conducted with 12 THPs who were selected through snowball sampling techniques. Data analysis followed Heidegger's and Gadamer's philosophies and Van Manen's six steps of the analytic approach. The findings revealed that THPs understood spirit possession as spiritual illness, ancestral calling and demonic spirit or witchcraft. Traditional health practitioners' understanding of spirit possession could promote mental health and prevent mental illness by providing support to a spirit-possessed person and referral to mental healthcare services. This study contributed that not all manifestations presented by persons with spirit possession are actual and clear-cut mental illness, but could be unwritten cultural and/ or religious illnesses that needs cultural and religious services also.

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.

An in vitro study to elucidate the effects of product Nkabinde on immune response in peripheral blood mononuclear cells of healthy donors.

Introduction: A significant number of the South African population still rely on traditional medicines (TM) as their primary healthcare due to their belief in their holistic healing and immune-boosting properties. However, little to no scientific data is available on the effects of most TM products on cytokine and cellular biomarkers of the immune response. Here, we evaluated the impact of traditional medicine [Product Nkabinde (PN)] in inducing cellular and cytokine biomarkers of inflammation in peripheral blood mononuclear cells (PBMCs) from eight healthy volunteers. Methods: PN was supplied by a local Traditional Health Practitioner (THP). The IC50 (half maximum concentration) of the standardized extract on isolated PBMCs was established using the cell viability assay over 24h of incubation. Luminex and flow cytometry assays were used to measure cytokine and cellular levels in PBMCs stimulated with PN and/or PHA over 24, 48, and 72h, respectively. Results: The IC50 concentration of PN in treated PBMCs was established at 325.3μg/mL. In the cellular activation assay, the percentages of CD38-HLA-DR + on total CD4+ T cells were significantly increased in PBMCs stimulated with PN compared to unstimulated controls after 24h (p = 0.008). PN significantly induced the production of anti-inflammatory IL-10 (p = 0.041); proinflammatory cytokines IL-1α (p = 0.003), TNF-α (p < 0.0001); and chemokine MIP-1β (p = 0.046) compared to the unstimulated control after 24h. At 48h incubation, the production of proinflammatory cytokines IL-1α (p = 0.034) and TNF-α (p = 0.011) were significantly induced following treatment with PN. Conclusion: We conclude that the PN possesses in vitro immunomodulatory properties that may influence immune and inflammatory responses. More studies using PN are needed to further understand key parameters mediating induction, expression, and regulation of the immune response in the context of pathogen-associated infections.

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

ABSTRACT 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.

Antifungal and antioxidant properties of medicinal plants used against fungal infections

Background: Antioxidants present in plant extracts prevent free radicals from causing chronic diseases in humans.Aim: The study investigated 12 medicinal plants (Kleinia longiflora DC., Berchemia discolor [Klotzsch] Hemsl., Persea americana Mill., Sansevieria hyacinthoides [L.] Druce, Dichrostachys cinerea [L.] Wright Arn, Withania somnifera Dunal [Ashgandh], Momordica balsamina L., Lonchocarpus capassa, Pappea capensis, ‘Rhus lancea L. fil’ with ‘Searsia lancea (L.F.) F.A. Barkley’ Peltophorum africanum, Maytenus heterophylla [Eckl. Zeyh.] Robson) for antioxidant activity using the qualitative and quantitative 1,1-diphenyl-2-picrylhydrazyl (DPPH) assay.Setting: The plant species were selected from the ethnomedicinal plant database of over 300 medicinal plants used for therapeutic purposes in Limpopo province.Methods: The plant materials were extracted with solvents of various polarities such as acetone, dichloromethane (DCM), methanol, hexane, and water. The qualitative and quantitative DPPH methods were used to determine the antioxidant activities of plant extracts.Results: The yellow bands revealed the presence of antioxidant compounds against the purple background on the Thin Layer Chromatography (TLC) plates. Methanol, hexane, and water extracts of L. capassa were the most active radical scavengers in the DPPH assay among the six medicinal plants screened. Plant extracts of P. africanum showed strong antioxidant activity by inhibiting DPPH, compared with the standard ascorbic acid.Conclusion: The findings indicate that some extracts can be used as an easily accessible source of natural antioxidants.Contribution: The findings revealed that the plant species investigated displayed noteworthy antioxidant activity, which provides scientific evidence for their utilisation by traditional health practitioners to treat fungal infections.