Texila International Journal of Nursing ISSN: 2520-3126 DOI: 10.21522/TIJNR.2015.09.02.Art003 Utilization and Effectiveness of Herbal Medicine in Treatment of Malaria in Osun State Michael Oloyede Oladeji1*, Wakili Adelani Tijani2, Oseyemi Akinfolarin3, Moyosore B Adedibu4, Olalekan Amos Oladejo 5, Adeola Oluwatobi Aminu6 1 Rn, M. Sc, PhD in Public Health, Texila American University, United Kingdom 2 Rn, PhD, Professor Futoye, Federal University of Oye-Ekiti, Ekiti, Nigeria 3 B. Sc, Data Analyst Lautech, Ladoke Akintola University of Technology, Ogbomosho, Nigeria 4 Rn, M. Sc, Nurse Manager, Canada 5 Rn, B. Nsc, Registered Nurse, University Hospital of North Tees (Nhs Trust) Bupa Care Services, United Kingdom 6 Rn, M. Sc, Registered Nurse, Capital Personal Independent Payment, Bupa Care Services, United Kingdom Abstract Concern among health professionals has been raised by the ongoing rise in the prevalence of malaria in recent years. Herbal treatments have been deemed the most popular form of traditional medicine in Africa and a high percentage used it for malaria treatment. Poor health care services with unaffordable malaria have been a major barrier to malaria control. This study investigated the use and effectiveness of traditional medicine in treatment of malaria in Osun State, Nigeria. 15 people with malaria across the three senatorial districts of Osun State were selected, using snow balling sampling techniques. Experimental design was utilised to assess the level of knowledge on malaria. Descriptive survey was used to assess the use of traditional medicine, and true experiments to test efficacy of herbal medicine. This study found that respondents have inadequate knowledge of traditional medicine for treatment of malaria and lack adequate knowledge that anopheles mosquito cause malaria. However, use of traditional medicine is high among respondents, with most of the listed herbs achieving a significant point for mean (2.5). Majority of respondents either have malaria parasites hibernated and experience malaria relapse later or the herbal medicine used were ineffective in the first place. The effectiveness of these combined herbs is also dependent on the intensity of the malaria infection. The study concluded that traditional medicine is effective among just in a few of the respondents, who combined, prepared herbs appropriately and took it as prescribed by experienced herbs experts. Keywords; Malaria, Treatment of malaria, Herbal medicine. major barrier [2]. In Nigeria, malaria is endemic, and it affect every part of the country. Aside from this, the effect of malaria infection on individuals, family and communities is huge. [3] estimated that 229 million malaria cases were reported, with 409,000 deaths in 2019. In 2018, there were 228 million cases of malaria recorded, with 411,000 deaths. Africa bears the Introduction The continual increase in the prevalence of malaria in recent times have been a source of concern among health experts [1]. Aside the fact that, malaria control has been a long debated issue, with various efforts towards achieving the control, lack of appropriate vaccine has been a Received: 09.02.2023 Accepted: 10.11.2023 Published on: 30.11.2023 *Corresponding Author: oladejimichealo80@gmail.com 1 highest burden of global death caused by malaria. [3] reported that Africa was home to 94% of malaria cases and deaths. [4] estimated that, there were 214 million cases of malaria in 2015 and 429,000 deaths globally. Malaria is a common infectious disease that is widespread in most tropical regions of the world, especially Asia and Sub-Saharan African countries where malaria infects about 515 million persons a year and is responsible for 1.5 to 2 million deaths per annum [4]. Previous studies have shown that malaria pose economic, physical, and mental consequences for people [5]. Malaria incidence has become pronounced due to climatic change: this led to an increase in temperature of the planet over time, a condition that aid survival of mosquitoes. Therefore, in recent times, the increase in warmth in the atmosphere provide conducive temperature for mosquitoes to infest and infect humans. This continually contributed to malaria relapse overtime, thereby reducing the capacity of recommended anti-malaria drugs [5]. This is most peculiar to areas characterized by nearby rivers or streams, dams, bush, among others. Relapse of malaria symptoms is a bad sign and has continually negated the primary objectives of the health care in Nigeria, which built on ensuring sustainable health care rendition. Malaria before now have been found to have created resistance against paracetamol, Chloroquine among others [6]. The recent Atemeter lumefatrine combinations is gradually becoming ineffective in the face of variability in the risk factors for malaria occurrence among which climatic change is major. However, there have been a divided opinion on the efficacy of herbal medicine, as alternative medicine in treatment of malaria, among researchers. This led to the discovery of numerous herbal-bound antimalarial compounds with significant structural varieties including quinines, triterpenes, sesquiterpenoids, quassinoids, limnoids, alkaloids, lignans, and coumarins [6, 7]. Herbal treatments have been deemed the most popular form of traditional medicine (TM) in Africa and a high percentage used it for malaria treatment [8]. This was also corroborated in [9] who reported that increasing trends in the use of TM implies healthcare services could not satisfy the need of people. This is further explained by poor health care services with unaffordable malaria treatment. While some attributed use of TM to its affordability compared to as the primary health service [10]; others found that communities residing in areas where the healthcare facilities are not accessible tend to find other methods of treatments [11]. Furthermore, cultural affinity which is typical of people of southwestern Nigeria have been found to contribute towards patronage of traditional medicine [12]. However, malaria is still the deadliest human parasitic infection in the world [13]. According to [14], Nigeria bears more than a quarter of the global burden of malaria. Nationally, 97% of the population are at risk of the disease. The result is that malaria accounts for an estimated 60% of out-patient hospital visits, 30% of hospital admissions and 11% of maternal mortalities in the country [15]. This study sought to assess the level of knowledge on malaria including the use and effectiveness of herbal medicine in treatment of malaria in Southwestern Nigeria. Methodology Study Design Experimental design was adopted to cater for quantitative aspect of the study, while descriptive survey aided the quantitative aspect of the study. Experimental design was used where there is time priority in a causal relationship (cause precedes effect), there is consistency in a causal relationship (a cause will always lead to the same effect), and the magnitude of the correlation is great. The causal relationship in this study is to test efficacy of herbal medicine in treatment of malaria. Potential for vaccine related information will also be checked. In this study true experiments 2 Data Analysis will be conducted, using individuals who have been confirmed to be infected with malaria (RDT and MP test will be employed). Data collected was analyzed manually and presented using Table. Sample and Sampling Technique Results This study selected 15 people with malaria across the three senatorial district of Osun State, who are used to taking herbal medicine for malaria treatment. For the experimental, 15 participants was selected across rural areas in Osun State, using snow balling sampling techniques. Demographic Respondents Characteristics Table 1 above presents Frequency Distribution of Demographic Characteristics of the Respondents. On sex of the respondents, 33.5% were male, while 66.5% were female. Majority were female. Regarding the age of the respondents, 25.9% were 18-37 years old, 45.4% were 38-57 years, 23.6% were 58-77 years old, while 5.1% were 78years and above. About tribe, 61.7% of the respondents. Were Yoruba, 11.8% of the respondents were Igbo, 2.9% were Hausa, while 23.6% chose others such as Middle belt such as, Egede, Kogi, among others. About religion of the respondents, 56.3% were Christians, 37.6% were Muslims, while 5.8% practiced any of the African traditional religion. About marital status of the respondents, 23.3% were single, 70.0% were married, 4.5% were separated and 2.2% were divorced. On Occupation, 48.6% were traders, 1.3% were Laborers, 5.8% were students, while 24.9% were unemployed and 19.4% were others. Also 23.6% attended only primary school, 35.2% attended secondary schools, 18.5% attended tertiary institutions and 22.7% had no formal education. Procedure for Data Collection Five (5) persons with malaria was selected from each senatorial across villages. Those areas were visited, and potential participants were consulted and tested for malaria parasite at the time of this study. The head of villages consulted us and informed us when anyone showed major symptoms we listed. Then registered nurses were sent to the said person to test the participants using rapid diagnosis test (RDT). After the malaria parasite was confirmed, a blood sample was further collected for laboratory confirmation of malaria parasite. Then the participant was allowed to take herbal concoction, they usually take whenever they are sick with malaria. The participants were further monitored by the nurse assigned for two weeks and another blood sample were collected to evaluate if malaria parasite remained in the blood stream. Table 1. Frequency Distribution of Demographic Characteristics of the Respondents Question Sex Male Female Total Age 18-37 years 38-57 years 58-77 years 78 years & above Total Tribe of Frequency Percentage 315 624 939 33.5 66.5 100.0 243 426 222 48 939 25.9 45.4 23.6 5.1 100.0 3 Yoruba Igbo Hausa Others Total Religion Christianity Islam Traditional Total Marital status Single Married Separated divorced Total Occupation Traders Labourers Students Unemployed Others Total Level of education Primary school Secondary schools Tertiary institutions No formal education Total 579 111 27 222 939 61.7 11.8 2.9 23.6 100.0 529 356 54 939 56.3 37.9 5.8 100.0 219 657 42 21 939 23.3 70.0 4.5 2.2 100.0 456 12 54 234 183 939 48.6 1.3 5.8 24.9 19.4 100.0 222 330 174 213 939 23.6 35.2 18.5 22.7 100.0 Source: Field survey, 2022 Overall Knowledge 74.40% Low High Figure 1. Overall, Knowledge 4 Table 2 presents frequency distribution of the respondents on use of traditional medicine for treatment of malaria. The majority (VO= 30.6%; O=42.2%) affirmed that they use ewe oronbo (lime leaves), 11.8% rarely use it, while 15.3% never use it. Also, a higher percent (VO=24.6%; O= 31.3%) said Dogonyaro (Neem leaves, stem bark and roots), 27.2% rarely use it, 16.9% never use it. More so, a higher percent (VO=19.5%; O= 35.8%) opines that, Ekpomangoro (mango bark and leaves), 33.2% rarely use it, 11.5% never use it. Furthermore, a higher percent (VO= 22.0%; O= 30.0%) affirmed that Ewe osan (orange leaves), 38.0% rarely use it, 9.9% never use it. Result also shows that, a higher percent (VO= 21.7%; O= 29.4%) of the respondents Eweti (Lemon grass), 42.0% rarely use it, 6.1% never use it. Also, a few (VO= 22.6%; O= 27.5%) held that, Ewe kasu (cashew leaves), 17.9% rarely use it, 31.0% never use it. More so, a higher percent (VO= 28.4%; O= 23.0%) opines that, Ibepe (paw-paw leaves), 23.6% rarely use it, 24.9% never use it. Furthermore, a higher percent (VO= 20.4%; O= 30.4%) affirmed that Ewe ogedeparanta (plantain leaves), 30.0% rarely use it, 19.2% never use it. Result also shows that, a higher percent (VO= 26.8%; O= 24.0%) of the respondents believes that Gwava (guava leaves), 24.7% rarely use it, 24.6% never use it. Furthermore, a few (VO= 14.1%; O= 21.7%) affirmed that Ewe okporokporo (corn leaves), 49.5% rarely use it, 14.7% never use it. Result also shows that, few (VO= 11.8%; O= 19.5%) of the respondents believes that Ewe ewuro (Bitter- leaves), 46.3% rarely use it, 22.4% never use it. Table 2. Frequency Distribution of Respondents showing Ranking Order on Use of Traditional Medicine s/n 1 Items Ewe Oronbo (Lime leaves) 2 Dogonyaro (Neem leaves, stem bark and roots) 3 Ekpomangoro (Mango bark and leaves) 4 Ewe osan (Orange leaves) 5 Eweti (Lemon grass) 6 Ewe Kasu (Cashew leaves) 7 Ibepe (Paw-paw leaves) 8 Ewe Ogedeparanta (Plantain leaves) 9 Gwava (Guava leaves) 10 Ewe Okporokporo (Corn leaves) 11 Ewe Ewuro (Bitter- leaves) 5 F % F % F % F % F % F % F % F % F VO 288 30.6 231 24.6 183 19.5 207 22.0 394 42.0 222 23.6 267 28.4 192 20.4 252 O 396 42.2 294 31.3 336 35.8 282 30.0 276 29.4 258 27.5 226 23.0 285 30.4 225 R 81 11.8 255 27.2 312 33.2 357 38.0 212 22.6 168 17.9 222 23.6 282 30.0 231 N 144 15.3 159 16.9 108 11.5 93 9.9 57 6.1 291 31.0 234 24.9 180 19.2 231 Total 939 100.0 939 100.0 939 100.0 939 100.0 939 100.0 939 100.0 939 100.0 939 100.0 939 % F 26.8 132 24.0 204 24.6 465 24.6 138 100.0 939 % F % 14.1 101 11.8 21.7 183 19.5 49.5 435 46.3 14.7 210 22.4 100.0 939 100.0 OP, SO and PS) of the respondents were highly exposed to mosquito bites. Only about three (AB, UG, DD) respondents were moderately exposed to mosquito bite. Efficacy of Traditional Medicine Table 3 below presents experimental results on exposure to mosquito bite. Results shows that, most (OP, AA, SA, BS, AD, DS, OB, NS, NA, Table 3. Exposure to Mosquito Bite s/n 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Individual Respondents OP AA SA BS AD AB DS OB UG NS NA OP DD SO PS Table 4 below presents symptoms before traditional medicine. The most significant symptoms experience by respondents include, Residents Highly Exposed Highly Exposed Highly Exposed Highly Exposed Highly Exposed Moderately Exposed Highly Exposed Highly Exposed Moderately Exposed Highly Exposed Highly Exposed Highly Exposed Moderately Exposed Highly Exposed Highly Exposed running nose, general body weakness, fever, cough and cold, Leg pain, mouth blister, sour tongue, and headache. Table 4. Subject’s Symptom before Traditional Medicine s/n 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Individual Respondents OP AA SA BS AD AB DS OB UG NS NA OP DD SO PS 6 Major Symptom Running nose Body weakness Cough and Cold Severe Fever Leg pain, Cold Body weakness Fever Mouth blister Sour tongue Headache Fever Body Weakness Mouth blister Cold Table 5 below presents malaria status of respondents as evidence using RDT and laboratory blood test. The above results shows that all the respondents test positive to both RDT and Clinic Malaria test. Table 5. Malaria Status Before s/n 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Individual Respondents OP AA SA BS AD AB DS OB UG NS NA OP DD SO PS Table 6 below presents malaria status 2weeks after use of traditional medicine. The results shows that, two weeks after respondents used their various traditional medicine, a few (BS, NS, SO) evaluated negative to RDT and laboratory blood test malaria infection. RDT + + + + + + + + + + + + + + + Clinic Blood Test + + + + + + + + + + + + + + + Although, while some respondents (OP, AD, AB, DS, OP and DD) still evaluated negative to RDT but positive to laboratory blood test, six respondents (AA, SA, OB, UG, NA and PS) tested positive to RDT and laboratory blood test. Table 6. Malaria Status 2-Weeks after Use of Traditional Medicine s/n 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Individual Respondents OP AA SA BS AD AB DS OB UG NS NA OP DD SO PS RDT + + + + + + Clinic Malaria test + + + + + + + + + + + + 7 Effective/ Hibernation/Relapse H H R E H H H R H E R H H E H malaria status of respondents. More findings show that only a few [3] respondents experienced effectiveness of some combined herbal medicine use in treatment of malaria. Most others that use herbal medicine, either have malaria parasites hibernated and experienced malaria relapse later or the herbal medicine used were ineffective in the first place. More findings shows that malaria parasite is also forming resistance against some herbal concoction used. This is because some respondents, who claim the regular herbs use has been effective for them, still test positive for malaria parasite after taking the same concoction. The findings imply that, only some rightly combined herbal concoction are effective enough to treat malaria. More finding revealed that the effectiveness of these combined herbs in treatment of malaria is also dependent on intensity of the malaria infection. The implication is that, when the right herbs are combined and prepared appropriately as concoction, then taken as prescribed, it works effectively for malaria treatment, as well as protecting the user for some months against reoccurrence of malaria. Discussion Findings in this study revealed that, on a general note, respondents have inadequate knowledge (31.7%) of traditional medicine for treatment of malaria. Although most of the respondents understood common symptoms of malaria, yet majority did not know that anopheles mosquito causes malaria. More so, respondents lacked adequate knowledge that traditional medicine for malaria treatment do not have exact prescription, exact measurement, may do some harm than good and could lead to more complex problem. This agrees with [16, 17] who affirmed that, good knowledge of any public health disease by individuals and communities seems necessary if effective treatment and preventive measures are to be realistic. Findings also revealed that use of traditional medicine is extremely high among the respondents. This was evidenced in the fact that most of the listed traditional herbs attained a significant point for mean [2, 5]. More so, the ranking depicted that, Ewe Oronbo (lime leaves), Dogonyaro (Neem leaves, stem bark and roots) and Ekpomangoro (mango bark and leaves) are the most used herb, among others. This is supported by [18] who found that over 80% of the population particularly in developing countries depend directly on plants for their primary healthcare requirements. This also agrees with [19] in a research conducted in Kebbi, Nigeria, who found that, herbs used in the treatment of malaria: Azadirachta indica (neem leaves), Magifera indica (Mango leaves), Citrus aurantifolia (lime), Carica papaya (paw-paw leaves), and Psidium gujava (guava leaves). Finding shows that, most of those respondents were exposed to malaria bite, ever before they were consulted. This is probably because most of the respondents live across rural areas in Osun State. These areas are characterized by bush, thick forest, waterlogged, open doors, open window without nets, among others. These factors permitted easy access for malaria to bites respondents [20]. This however corroborate the Conclusion The study concluded that, traditional medicine is effective among just a few of the respondents, who combined, prepared herbs appropriately and take it as prescribed by experienced herbs experts. Conflict of Interest There are no conflicts of interest related to this research, the author declares. Acknowledgments I thank my supervisor, Dr. Rajesh Konnur and Professor W. A. Tijani, my research Guide, for their crucial support throughout the several stages of this article. I would like to express my gratitude to my co-authors for their assistance and contributions to this research. I also express my gratitude to my respondents for providing their informed consent and voluntarily participating in the study. 8 References ophthalmic patients to a teaching hospital in southeastern Nigeria: Socio-demographic and clinical correlates. Biomedical Centre Complementary and Alternative Medicine. [10] Abdullahi, A., and Van Zyl-Schalekamp, C. Seneka, A. (2013). Perceived Threat of Malaria and the Use of Insecticide Treated Bed Nets in Nigeria. African Sociological Review 17(1)1-8. [11] Ntim-Amponsah, C, Amoaku, W & OfosuAmaah, S. (2015). Alternate Eye Care Services in a Ghanaian District Medical Journal 39(1):19–23. [12] Nwosu, S & Obidiozor, J. (2014). Incidence and risk factors for traditional eye medicine use among patients at a tertiary hospital in Nigeria. Nigerian [1] Uzochukwu B S, Onwujekwe E O, Onoka C A and Ughasoro M D. (2008). Rural- urban differences in maternal responses to fever in Southeast Nigeria. 2008 [Online]. Available at http://www.pubmedcentral.nih.gov. [2] Ashley EA, Dhorda M, Fairhurst RM, Amaratunga C, Lim P, Suon S, Sopha C (2014) Spread of artemisinin resistance in Plasmodium falciparum malaria. N Engl J Med 371(5):411–423. https://doi.org/10.1056/NEJMoa1314981. [3] World Health Organization (2020) World Malaria Report 2020. World Health Organization, Geneva. https://doi.org/10.30875/60123dd4-en. Journal of Clinical Practice 14: 405 – 107. [13] Maximus, M. T., Bambang, P. E.W. & Mangestuti, A., (2018). Plants used in traditional medicine for treatment of malaria by Tetun ethnic people in West Timor Indonesia. Asian Pacific Journal of Tropical Medicine. Vol. 11(11): pp.630- [4] WHO (2013). WHO Traditional Medicine Strategy 2014–2023. Zlatković, B.K., Bogosavljević, S.S., Radivojević, A.R. and Pavlović, M.A. (2014). Traditional use of the native medicinal plant resource of Mt. Rtanj (Eastern Serbia): Ethnobotanical evaluation and comparison. Journal of 637 https://doi.org10.4103/1995-7645.246339. [14] Mbah, G.O., and Ekweanya, N.M. (2019). Analysis of Utilization of Traditional Medicine for the Treatment of Malaria among Rural Farmers in Abia State, Nigeria. International Journal of Environment, Agriculture and Biotechnology Ethnopharmacology, 151: 704-713. [5] Ashley EA, Dhorda M, Fairhurst RM, Amaratunga C, Lim P, Suon S, Sopha C (2014) Spread of artemisinin resistance in Plasmodium falciparum malaria. N Engl J Med 371(5):411–423. https://doi.org/10.1056/NEJMoa1314981. (IJEAB) Vol-4, Issue- 2. [15] Adebayo JO, Krettli AU (2010) Potential [6] Maximus, M. T., Bambang, P. E.W. & Mangestuti, A., (2018). Plants used in traditional antimalarials from Nigerian plants: a review. J Ethnopharmacol 133(2):289–302. medicine for treatment of malaria by Tetun ethnic people in West Timor Indonesia. Asian Pacific https://doi.org/10.1016/j.jep. [16] Karunamoorthi, K., Jegajeevanram, K., Vijayalakshmi, J. & Mengistie, E. (2012). Traditional Medicinal Plants: A Source of Phytotherapeutic Modality in Resource-Constrained Health Care Settings. Journal of Evidence-Based Complementary & Alternative Medicine 18(1) 67-74 SAGE. https://doi/10.1177/2156587212460241. Journal of Tropical Medicine. Vol. 11(11): pp.630637 https://doi.org10.4103/1995-7645.246339. [7] Alebie, G., Urga, B. & Worku, A., (2017). Systematic review on traditional medicinal plants used for the treatment of malaria in Ethiopia: trends and perspectives. Malaria Journal, vol 16:307 https://doi.org/10.1186/s12936-017-1953-2. [8] Beavogui AH, Delamou A, Camara BS, Camara [17] WHO, (2000a). Traditional and Modern Medicine: Harmonising the two Approaches. D, Kourouma K, Camara R, Djimde A (2020) Prevalence of malaria and factors associated with Western Pacific Region. Geneva: World Health Organisation. infection in children aged 6 months to 9 years in Guinea: results from a national cross-sectional study. [18] Joseph, A., Nestor, G., Mark, A., and Vincent, B. O., (2017). Malaria in Pregnancy: A Demographic and Clinical Surveillance at Mother and Child Parasite Epidemiol Control 11: e00162. https://doi.org/1 0.1016/j.parepi.2020.e00162. [9] Eze, B, Chuka-Okosa, C & Uche, J. (2013). Traditional eye medicine use by newly presenting 9 Hospital Ondo, Southwestern, Nigeria. Journal of Prevention & Infection Control. 2017, 3:1. [19] Singh, S. & Singh, R. (2014). Herbal Medicinal Treatment of Malaria in Aliero Local Government Area, Kebbi, Nigeria. Journal of Medicinal Plants Studies. Volume: 2, Issue: 2. Pp.117-126 ISSN: 2320-3862 Online Available at www.plantsjournal.com. [20] Malaria-carrying mosquitoes bite night and day. (2022). Nature, 605(7911), 592–592. https://doi.org/10.1038/d41586-022-01356-0. 10