Traditional Health Practitioners Research Articles

Contribution to the Valorization of Plants Used in the Management of Rheumatic Diseases in Burkina Faso

Joint pain is a real public health problem. According to recent studies, it is increasingly common in sub-Saharan Africa and represents a cause of greater loss of working days than accidents, heart disease and infections. The aim of this study was to study the pharmacochemical and therapeutic evidence of ten (10) plants used in the management of joint pain by traditional health practitioners in Ouagadougou. We conducted a meta-analysis of the data from December 2018 to September 2019. The anti-inflammatory activity of the ten (10) plants retained the maximum consensus internationally. Trichilia emetica Vahl (35.25%), Guiera senegalensis J.F.G.mel. (31%), Calotropis procera (Ait) Ait.F. (28.29%) and Crescientia cujete L. (25.12%) had more than 25% internationally reliability for their effects on joint pain. The structural analogy between conventional drugs and the molecules found in these plants has been confirmed. Additional studies should be carried out in order to improve and secure the use of these plants, which represent a prominent option in the therapeutic offer.

The costs and constraints of pandemic response in Mali*

The costs and constraints of pandemic response in Mali*

Co-Productive Strategies and Grassroots Responses to COVID-19 Pandemic in Urban Settings of Zambia

Abstract This paper focuses on the systemic and grassroots response to the COVID-19 health crisis in the urban settings of Zambia. The research examines the cooperative strategies of local actors – traditional health practitioners, pastors and prophets of Pentecostal and Spirit-type churches and actors of non-governmental and state health organizations in addressing the COVID-19 crisis in Zambian urban settings of Lusaka and Livingstone. The paper explores the levels of perception and conceptualization of the disease held by local community authorities (cultural brokers) and explains how they may differ from state-orchestrated medical explanations and recommendations. The authors argue that local cultural epistemologies, which are activated in times of crisis, can be seen as co-productive strategies in the systemic and executive response to the COVID-19 pandemic.

Phytochemical profile and in vitro antioxidant activity of Emelia M (EMB), Mshikazi and Delosma H herbal medicines as demonstrated in THP-1 and Jurkat leukaemia cell lines.

Three decoctions, namely Emelia M (EMB), Mshikazi and Delosma H are used by traditional health practitioners in KwaZulu-Natal, South Africa to treat and manage leukaemia and related conditions. This study evaluated the in vitro antioxidant activity and phytochemical profile of the aqueous extracts of Emelia M (EMB), Mshikazi and Delosma H decoctions. Antioxidant activity of the extracts was evaluated using1-diphenyl-2-picrylhydrazyl (DPPH), glutathione (GSH), phosphomolybdate and thiobarbituric acid reactive substance (TBARS) assays. Phytochemical screening was used to determine the presence of compounds. The DPPH radical scavenging activity was similar to ascorbic acid for EMB and Delosma H, but not for Mshikazi. At 24 h, EMB increased GSH in both THP-1 and Jurkat cells similar to Delosma H while Mshikazi demonstrated the lowest activity. At 48 h, EMB and Delosma H revealed increased GSH in THP-1 cells with no significant decrease in GSH levels in Jurkat cells. However, EMB showed the lowest lipid peroxidation activity compared to Delosma H and Mshikazi after 24 h treatment of both cells. Phenols, flavonoids, terpenoids, saponins were present in all extracts. Extracts of the three decoctions possess both antioxidant and prooxidant properties through high scavenging activity and increased in lipid peroxidation.

What is the nature of research conducted on regulating traditional health practitioners? A scoping review

Background Widespread use of traditional medicine (TM), the issue of their safety, combined with progressive lobbying from both practitioner groups and the public have made regulation of traditional health practitioners (THPs) an important issue. While there are questions on whether the regulation of THPs are worthwhile endeavour, literature continues to offer limited empirical evidence for clear answers. It is essential to synthesize the available literature in relation to this quest using a scoping study methodology. Methods This scoping review included publications from PubMed, Sabinet and Web of Science databases and included grey literature, primary research, journal reviews, published reports, as well as available policy articles. A methodological framework set out by Arksey and O’Malley was utilized. Results Out of 8040 searched publications, 25 met the criteria for full review. Regulation of THPs proved essential, but ways of regulating them showed many inconsistencies and challenges. The issues of recognition, integration, and colonization effects and the idea of viewing TM through a scientific lens dominated the themes arising from the 25 publications. Conclusion Evidence depicted that regulating THPs would be an arduous task, but the existing literature proved insufficient on the use of such regulations. However, the review calls for more studies looking at THP regulatory mechanisms, especially in developing countries, to learn best practices that embrace indigenous knowledges and promote a decolonized health system.

Ethnobotanical study of medicinal plants used for treating urinary tract problems in eastern Indonesia

Indonesia is one of the wealthiest countries in biological resources that have potential as medicinal plants. Medicinal plants can be an alternative in treating diseases such as urinary tract problems by the people of eastern Indonesia. The study aims to evaluate the use of medicinal plants for various urinary tract problems in east Indonesia, including their efficacy and safety based on the literature review. This research was conducted by interview method and field survey. The data were collected from traditional health practitioners in eastern Indonesia. Data were analyzed using Frequency of Citation (FC) and the Use value (UV). The results showed a total of 222 plants species belonging to 78 families were identified for treating urinary tract problems in east Indonesia. The most prevalent of these was the Euphorbiaceae family. The species which had the highest value were Orthosiphon aristatus (FC 12.52%, UV 0.31), Sericocalyx crispus (FC 7.80%; UV 0.19), Phyllanthus niruri (FC 6.35%; UV 0.16) were the vast majority commonly used plant species in the treatment of urinary tract problems. The most common parts used were leaves (44.87%) and herbs (10.66%). The ethnomedicinal flora in east Indonesia is quite diverse for treating urinary tract problems.

Utilization of complementary and traditional medicine practitioners among middle-aged and older adults in India: results of a national survey in 2017\u20132018

BackgroundLack of information exists about the use of traditional and complementary medicine (TCM) use among middle-aged and older adults in India, which led to studying the estimates of past-12-month Ayurveda/Yoga/Naturopathy/Unani/Siddha/Homeopathy (AYUSH) practitioner and traditional health practitioner (THP) utilization in India.MethodsThe study included 72,262 individuals (45 years and older) from the cross-sectional 2017–2018 Longitudinal Ageing Study in India (LASI) Wave 1.ResultsThe prevalence of past 12-month AYUSH practitioner utilization was 6.5%, THP use 7.0%, and AYUSH or THP use 13.0%. The rate of AYUSH practitioner utilization was determined by older age (≥60 years) (Adjusted Odds Ratio-AOR: 1.20, 95% Confidence Interval-CI: 1.07–1.34), having pain (AOR: 1.48, 95% CI: 1.29–1.69), any bone or joint diseases (AOR: 1.57, 95% CI: 1.35–1.82), current tobacco use (AOR: 1.30, 95% CI: 1.12–1.50), male sex (AOR: 0.76, 95% CI: 0.68–0.85), high subjective socioeconomic status (AOR: 0.72, 95% CI: 0.60–0.87), urban residence (AOR: 0.71, 95% CI: 0.57–0.88), diabetes (AOR: 0.66, 95% CI: 0.55–0.81), chronic heart disease (AOR: 0.52, 95% CI: 0.37–0.73), and having a health insurance cover (AOR: 0.36, 95% CI: 0.30–0.44). The rate of THP utilization was determined by depressive symptoms (AOR: 1.17, 95% CI: 1.01–1.35), sleep problems (AOR: 1.28, 95% CI: 1.08–1.51), having pain (AOR: 1.82, 95% CI: 1.55–2.15), current tobacco use (AOR: 1.35, 95% CI: 1.22–1.51), having health insurance cover (AOR: 0.41, 95% CI: 0.33–0.51), hypertension (AOR: 0.82, 95% CI: 0.71–0.95), diabetes (AOR: 0.50, 95% CI: 0.39–0.65), urban residence (AOR: 0.25, 95% CI: 0.19–0.34), and high subjective socioeconomic status (AOR: 0.70, 95% CI: 0.58–0.85).ConclusionA moderate prevalence of AYUSH practitioner and THP use among middle-aged and older adults in India was found and several factors associated with AYUSH practitioner and THP use were identified.

DEDUCTIBLE MEDICAL EXPENSES FOR INCOME TAX PURPOSES: TRADITIONAL HEALERS, PHARMACISTS AND COSMETIC PROCEDURES

In terms of section 18(1)(b)(i) of the Income Tax Act 58 of 1962 a taxpayer is entitled to a qualifying medical-expenses deduction for services rendered by a registered medical practitioner specifically listed in subparagraph (i). Since the promulgation of the Traditional Health Practitioners Act 35 of 2004 and the later Traditional Health Practitioners Act 22 of 2007 (which replaced the earlier unconstitutional act), section 18(1)(b)(i) has not been amended to provide a qualifying medical-expenses deduction to a taxpayer who consulted a traditional healer instead of a medical practitioner as listed in subparagraph (i). This article attempts to show that no suchamendment is needed. The taxpayer can avail himself of the burden of proof to make a qualifying medical-expenses deduction for services rendered by a traditional healer by applying an expansive interpretation to the words “medical practitioner”. This article furthermore discusses the interpretation problems as a result of the vague meaning of “professional services” and the subsequent possibility to deduct cosmetic expenses as qualifying medical expenses. Lastly, this article discusses the situation where a taxpayer wishes to make a qualifying medical-expenses deduction for schedule 2 medicines prescribed and supplied by a pharmacist, which, it seems, is not allowed.

Traditional Health Practitioners' and Other Community Members' Perceptions of Vultures in the Kruger to Canyons Biosphere Region, South Africa

African vulture populations are currently in rapid decline, due to a range of anthropogenic factors. These include intentional and unintentional poisoning; degradation, fragmentation, and loss of habitat; and the killing of vultures to obtain body parts for use in traditional medicine. Consequently, people living in rural communities adjacent to protected areas may have a negative or positive impact on their local vulture populations, and so understanding their attitudes towards vultures is imperative. We surveyed Traditional Health Practitioners (those who may [unlawfully] acquire vulture parts for use in traditional medicine) and other community members (those who are not Traditional Health Practitioners but who might use traditional medicine containing vulture body parts) to understand how they perceive vultures and the cultural beliefs associated with vultures in the Kruger to Canyons Biosphere Region, South Africa. We conducted 248 structured interviews with 197 community members and 51 Traditional Health Practitioners in nine villages in the Bushbuckridge Local Municipality, Mpumalanga Province, adjacent to protected areas. Our results showed that community members and Traditional Health Practitioners regarded vultures as beneficial to them for ecosystem services, as a cultural resource, and as a means of generating income. Community members and Traditional Health Practitioners generally had positive attitudes toward vultures, and community members were more inclined than Traditional Health Practitioners to like vultures. Both groups of respondents expressed a fear of vultures because of their aggressive feeding behavior and their physical appearance. Our results highlighted that vultures in our study area are traded and used in traditional medicines for various purposes. Contrary to what was previously thought, vultures are indeed used in traditional medicine close to the Kruger National Park. Our interviewees expressed a desire to learn more about vultures, and this could be a starting point to increase conservation education for these species. There is a need to raise awareness of vulture population declines among all community members in Bushbuckridge and to highlight the human health risks of using poison for pest control.

Ethnobotanical and agronomical survey of Brocchia cinerea (Delile) Vis. plant used by people in the Figuig and Draa-Tafilalet regions, Morocco

Context: As part of the development of the natural heritage of Morocco, an ethnobotanical and agronomic study was conducted in the regions of Figuig and Draa- Tafilalet. Aims: To collect detailed information about the usage of Brocchia cinerea plant in human therapy and its incorporation into the feed system of livestock. Methods: The survey was carried out over five months, using semi-structured and structured interviews. A total of 197 interviews with traditional health practitioners and educated villagers were conducted. Results: Interview results showed that Brocchia cinerea is used in indigenous pharmacopeia to alleviate common diseases symptoms of the digestive system (36%), nervous system (19%), respiratory system (17%), ear, nose and throat (ENT) disorders (8%), and rheumatism (7%). The aerial parts of this plant were the most commonly used (36%), and the most preferred method for the preparation of traditional drugs was a decoction (33%). The results obtained from the agronomical survey show that the milk yield and meat production in ruminants noticeably increase after consumption of this plant. Conclusions: The data collected may help prevent the loss of traditional knowledge on the use of plants characterizing the ecosystem of these study areas and may constitute preliminary information required for a future phytochemical study on the plants most frequently used. The agronomic survey carried out can help the range managers improve the forage quality by using Brocchia cinerea for the betterment of animal health and productivity.

Uses of Vultures in Traditional Medicines in the Kruger to Canyons Biosphere Region, South Africa

Vultures provide crucial ecological, economic, and cultural benefits, yet many Old World populations are declining. The illegal trade in vultures for traditional medicines (known as muthi in South Africa) is widely regarded as an important threat to the conservation of African vultures, but there are relatively few studies on the acquisition and trade in vultures for traditional medicine, which limits our understanding (and the effective mitigation) of this threat. We assessed the use of vultures in traditional medicine in the Kruger to Canyons Biosphere Region, South Africa, by conducting questionnaires with 51 traditional healers from the Kukula Traditional Health Practitioners Association in Bushbuckridge, Mpumalanga Province. Traditional healers reported that vulture body parts were used alone, or in combination with plants or minerals, for various purposes, primarily to give clairvoyant abilities, but also to promote good dreams or increased intelligence, to treat illnesses, and to appease the ancestors. Vultures were acquired (for use in traditional medicine) by poisoning and trapping in communal rangelands and inside protected areas (the Kruger National Park, Manyeleti Game Reserve, Sabi Sands Game Reserve, and Bushbuckridge Nature Reserve). Vultures reportedly varied in price from ZAR300 to ZAR1500 (approximately US$17 to US$85) for a whole bird. We estimate that this association of traditional health practitioners uses 400–800 vultures a year. Our survey respondents expressed concern that acquiring vultures through poisoning is unsustainable, because birds are killed en masse, and this may reduce the sustainability of vulture populations for traditional use by future generations. Our respondents suggested the Greater Honeyguide (Indicator indicator) and honey badger (Mellivora capensis) as alternatives for vultures in traditional medicine. There is a need for better law enforcement in our study area to reduce the threat that illegal killing for traditional medicine poses to the region's vultures.

Local management strategies and attitudes towards selected threatened or protected plant species in Limpopo Province, South Africa

Abstract. Rasethe MT, Potgieter M, Pfab M. 2021. Local management strategies and attitudes towards selected threatened or protected plant species in Limpopo Province, South Africa. Biodiversitas 22: 3773-3784. Throughout South Africa, ordinary people are managing and using local natural resources in ways that enhance their lives, but there is a major concern about the sustainability of wild plant harvest. This study aims to investigate the current management strategies employed by local people in the Limpopo Province for selected threatened or protected plant species (TOPS). Semi-structured questionnaires were used to gather information from a total of 333 participants, i.e. 110 community members (CMs), 180 traditional health practitioners (THPs), and 28 traditional leaders (TLs), as well as from 15 conservation officers (COs). The study area included the districts of Capricorn, Sekhukhune, Mopani, Vhembe, and Waterberg. Results indicated that in all districts of the province most CMs and THPs reported that no one managed plant resources in their surrounding communal lands, though TLs indicated that the state was involved with management. Fifty-nine percent of THPs indicated that there are no traditional rules that are applied towards conservation of communal lands, yet 91% of other participants in the Mopani, Sekhukhune, and Capricorn districts indicated that traditional rules are followed. Most CMs in these three districts were allowed to participate in conservation initiatives, although most of them did not know that the plants they were using were threatened and protected in legislation. It is recommended that collaborative partnerships be initiated between government and TLs in relation to managing the threatened or protected plant species in communal lands.

The indigenous meaning of dysmenorrhea: using modified photovoice to document perspectives of traditional health practitioners (THPs) and indigenous knowledge holders (IKHs)

Background: Globally, health understanding and beliefs vary across sub-cultural groups, depending on geographical location. Increasingly, various parts of the world recognize these perspectives to offer culturally sensitive healthcare services at primary level. Understanding the indigenous perspectives of dysmenorrhea meaning from the custodians of knowledge holders may add to the value of literature that may be used to advocate humanized culturally sensitive healthcare. This article aimed to explore and describe the perspectives regarding the meaning of indigenous dysmenorrhea among Batlokwa traditional health practitioners (THPs) and indigenous knowledge holders (IKHs). Methods: A qualitative, explorative study with a modified photovoice design, which included photographs, interviews and lekgotla discussion was employed to engage THPs and IKHs residing in Botlokwa Limpopo province, South Africa. Initially, a purposive sampling technique was used to select the participants, followed by snowball sampling. The participants themselves analyzed the photographs and described their meaning during individual interview using the acronym “PHOTO”. The researchers employed thematic analysis of interviews and Lekgotla discussion, in which themes were identified, formulated and analyzed from the codified data set. Results: In total, eight women participated in the photovoice study. The findings showed that indigenous understanding of dysmenorrhea stems from the African belief about health and illness with special emphasis on importance of holistic meaning. To the THPs and IKHs dysmenorrhea was a broad and integrated trend of a normal or abnormal process of illness that occurs periodically during menstruation. Conclusions: The THP’s and IKH’s indigenous meaning of dysmenorrhea reflects physical, mental, emotional, social, environmental, political and economic dimensions. Therefore, dysmenorrhea should be understood from a holistic approach. With appropriate partnerships and processes in place, this knowledge may be well represented in dominant healthcare systems and health research.

From their own perspectives: a qualitative study exploring the perceptions of traditional health practitioners in northern Uganda regarding cancers, their causes and treatments

BackgroundMany cancer patients in the low- and middle-income countries seek care with traditional health practitioners (THPs) and use traditional and complementary medicines (T&CMs) for treatment of cancers. Little is known about the perceptions and influence of THPs on cancer patients’ help-seeking and treatment decisions. We aimed to explore perceptions of THPs regarding cancers, cancer causes, and preferred treatments for cancers, in order to identify aspects that can inform interventions to improve cancer outcomes in Uganda.MethodsWe conducted this ethnographic study in northern Uganda. In-depth interviews were conducted at the respondents’ homes in quiet, open places, and in the absence of none- respondents. Interviews were audio-recorded and transcribed verbatim within a week of the interviews. Thematic qualitative analysis approaches were used to identify themes and subthemes.ResultsWe included 21 respondents in the study; most were male (16/21), married, with median age of 59 years (range 39 – 80). Most respondents perceived cancer as a new and challenging disease, while one respondent thought of cancer as a result of an imbalance within the body. Most confessed unawareness of the causes of cancers, but believed that cancer could result from the interplay of a number of factors including poor diets, ingestions of chemical agents, and assaults by the spirits of the dead. Some reported that cancers (especially of women’s genital tracts) were sexually transmitted, or caused by accumulation of dirt. Only few healers treated cancers. Most respondents reported that they referred cancer patients to biomedical facilities, sometimes after they have first used their medicines. Most respondents hoped that collaborative research with scientists could help them identify potent T&CMs that cure cancers.ConclusionTraditional health practitioners require training on cancer causes, symptoms and signs, and the necessity for prompt initiation of effective treatments in order to improve cancer outcomes. The predisposition of the majority of respondents to refer cancer patients to biomedical services sets a fertile ground for meaningful cooperation between biomedical and traditional health practices. The national health system in the low- and middle-income countries could formally recognize traditional health practices as a component of the national healthcare system, and encourage the two to practice side by side.

Evidence on collaboration of traditional and biomedical practitioners in the management of antimicrobial resistance in sub-Saharan Africa over 15 years: a systematic review protocol

BackgroundThe overuse of prescribed antimicrobials, concurrent use of traditional medicine, and prescribed antimicrobials have led to antimicrobial resistance. The absence of collaboration between traditional health practitioners and biomedically trained healthcare professionals can contribute to antimicrobial resistance, treatment failure, overdose, toxicity, and misadministration. This scoping review explores the evidence on collaboration between traditional health practitioners and biomedically trained healthcare professionals to reduce antimicrobial resistance and treatment failure in bacterial and viral diseases.MethodsWe will search for electronic databases such as Science Direct, Google Scholar, PubMed, and MEDLINE via EBSCOhost. We will also search reference lists of included studies. A two-stage mapping procedure will be carried out. Stage one (1) will consist of the title, abstracts, and full article screening, respectively. A pilot screening form guided by the defined eligibility criteria will be used. In stage two (2), data will be extracted from the included studies. Two reviewers will conduct parallel screening and data extraction. Mixed methods appraisal tool (MMAT) will be used to assess the quality of the included studies. NVIVO version 11 will be employed to aid pertinent thematic analysis. The outcomes of interest will be as follows: Primary outcome will be preventing and reducing antimicrobial resistance. The secondary effect is the effective collaboration between traditional healthcare practitioners and biomedically healthcare professionals.DiscussionThis review anticipates uncovering pertinent publications reporting the evidence of collaboration between traditional health practitioners and biomedically trained healthcare professionals to reduce antimicrobial resistance in sub-Saharan Africa. The sum-up of evidence acquired from the included studies will help guide future research. The result of the study will be print and electronically exposed.Systematic review registrationPROSPERO, CRD42017072952

Collaboration between African Indigenous and Biomedical Health Practitioners: Perceptions Regarding Tuberculosis Treatment

Despite programmes developed to alleviate tuberculosis (TB) infection worldwide, South Africa is still reporting high rates of infection. Most South Africans believe in and consider using the medicine provided by African indigenous health practitioners (AIHPs) rather than consulting practitioners at modern health facilities. The isolated functioning of these two groups of practitioners motivated the government to establish the Traditional Health Practitioners Act (22 of 2007), to encourage AIHPs and biomedical health practitioners (BHPs) to collaborate on the healing of different diseases, including TB. The Mpumalanga province has been hit the hardest by TB and has a high infection rate. The study aimed at exploring and describing the perceptions of AIHPs and BHPs on collaboration concerning TB treatment in the Ehlanzeni district, Mpumalanga. A semi-structured interview guide was used to collect data from focus groups with 21 AIHPs and in-depth individual interviews with 10 BHPs. The findings of the study reveal differing perceptions, as some BHPs accept the Act and acknowledge collaboration, while others have concerns about standards of care, patient safety, and overdosing. They are reluctant to accept integration, as they see AIHPs as unscientific practitioners who use strong medicine that is detrimental to patients. The AIHPs welcomed the idea of working together and mutual teaching with the aim of empowering each other with knowledge regarding the treatment of TB, for the ultimate benefit of patients.

English

Curative dependence on season of harvest for medicinal plants is an alleged claim by traditional health practitioners. This study aimed to verify these claims by investigating antifungal activity and chemical profiles of two traditionally used medicinal plant species: Turraea holstii and Clausena anisata harvested in the rainy and dry seasons, with a view of establishing appropriate the season for optimal activity. The antifungal activities were determined by Broth micro-dilution method, while chemical profiling of the extracts from the plant materials was done by gas chromatography (GC). Results indicated that extracts of plant materials harvested in dry season showed enhanced antifungal activity as compared to extracts of plant materials harvested in the rainy season, highest potency being 0.39 mg/mL, observed on dichloromethane fractions of both T. holstii and C. anisata. The GC chromatograms showed a general increase in the number and amount of chemical species for extracts of plant materials harvested in dry season as compared to extracts of plant materials harvested in the rainy season. Thus, it is concluded that because the dry season produces the best curative activity, harvesting should focus on this season. Key words: Chemical profile, antifungal activity, extracts, seasonal impacts.

Perceptions of Ghanaian traditional health practitioners, primary health care workers, service users and caregivers regarding collaboration for mental health care

BackgroundIn low- and middle-income countries, the paucity of conventional health services means that many people with mental health problems rely on traditional health practitioners (THPs). This paper examines the possibility of forging partnerships at the Primary Health Care (PHC) level in two geopolitical regions of Ghana, to maximize the benefits to both health systems.MethodsThe study was a qualitative cross-sectional survey. Eight (8) focus group discussions (FGDs) were conducted between February and April 2014. The views of THPs, PHC providers, service users (i.e. patients) and their caregivers, on the perceived benefits, barriers and facilitators of forging partnerships were examined. A thematic framework approach was employed for analysis.ResultsThe study revealed that underlying the widespread approval of forging partnerships, there were mutual undertones of suspicion. While PHC providers were mainly concerned that THPs may incur harms to service users (e.g., through delays in care pathways and human rights abuses), service users and their caregivers highlighted the failure of conventional medical care to meet their healthcare needs. There are practical challenges to these collaborations, including the lack of options to adequately deal with human rights issues such as some patients being chained and exposed to the vagaries of the weather at THPs. There is also the issue of the frequent shortage of psychotropic medication at PHCs.ConclusionAddressing these barriers could enhance partnerships. There is also a need to educate all providers, which should include sessions clarifying the potential value of such partnerships.

Barriers and facilitators of traditional health practitioners’ regulation requirements: a qualitative study

# Background Regulations could create benefits and opportunities for traditional health practitioners (THPs) and traditional medicine (TM) users in this new era of traditional medicine systems (TMS) as the growing international popularity propels this. The 1978 International Conference on Primary Health Care played a significant role in recognising THPs. To date, millions of people across the globe continue to utilise THPs. The issues of safety and scientific validation led the WHO to recommend regulations of TM. This was also supported by pressures from the realisation that culture and spiritual life is associated with traditional healing. This paper seeks to understand barriers and facilitators surrounding THP regulation implementation. # Methods The qualitative research approach involved five focus group discussions sampled from five Kwazulu-Natal district municipalities (one in each district). Participants were selected using district THP councils and a snowballing technique to recruit non-functional THP councils. Data collection tools included case summaries and a focus group discussion guide. Data was analyzed using Braun & Clarke’s (2017) six-phase thematic analysis framework. # Results Themes identified included purposes of being registered with the THP council; registration being viewed as a tax collection instrument; and recognition and legitimacy of THPs. Most THPs were uncertain about why they should be registered and therefore struggled to identify benefits of being registered. Moreover, several THPs viewed registration as tactic to oppress and squeeze them to contribute towards the countries taxation system. Recognition and legitimacy were the only benefits identified, as THPs saw registration as a gateway into mainstream health and believed it would separate them from charlatans. # Conclusions THPs generally had mixed feelings about being registered; most saw very little, if any, potential benefits in being registered, except for recognition and legitimacy. THPs who found registration beneficial, remained sceptical about how it would impact their intellectual property and belief systems. Further exploration of the role of THP associations, their history and evolution and the influence they could have in driving THP regulation implementation process is warranted, especially since THPs found registering with such associations to be beneficial.

Exploring Plant and Behaviour on Usada Herbal Galactagogue Usage among Lactating Mothers in Bali

Background: Breastfeeding is essential for the health of newborn infants and mothers. Basic health research in 2018 shows that exclusive breastfeeding in Bali has not reached the national target. High rates of cesarean section delay breastfeeding initiation, the important predictor of continued breastfeeding. Main concern for lactating mothers about medications, increase the use of herbal galactagogue to aid lactation. The use of traditional medicinal plant in Bali is 40% higher than national average and its existence is strengthened by the issuance of Bali Governor Regulation No. 55 of 2019 concerning Traditional Balinese Health Services. Despite increasing popularity of traditional medicine, there are currently limited data available on the plant list and pattern of use herbal galactagogue. Objectives: to explore the galactagogue plants, pattern of use, perceived effectiveness of herbal galactagogues during breastfeeding among lactating mother’s in Bali. Material and Methods: This study was conducted using a questionnaires and in-depth interviews. The questionnaire and interview guideline was validated by lactation consultants and traditional health practitioners in Bali. The study was approved by Human Research Ethic Committee of Bina Usada Bali. Results: The use of herbal galaktagogue is mostly practiced by highly educated mothers, mother’s occupation as health workers and primiparous. There are 26 types of plants that are often used by lactating mothers in Bali. Majority of respondent begin to use herbal galactagogue after giving birth (82%) for approximately < 1 month. Majority of lactating mothers in Bali perceived effectiveness of herbal galactagogue usage based on breastfeeding adequacy indicators. About 95% respondents feel confidence and have self-empowerment after use herbal galactagogue, resultes in psychological benefits. Conclusions: The use of herbal galactagogue is common amongst lactating mothers in Bali, while information about efficacy and safety is lacking. Futher research is needed to give evidence-based information to support exclusive breastfeeding.