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Herbal medicines for child healthcare from Ghana
j o u r n a l o f h e r b a l m e d i c i n e 4 ( 2 0 1 4 ) 24–36
Available online at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/hermed
Original research article
Herbal medicines for child healthcare from Ghana Alex Asase ∗ , Mavis L. Kadera Department of Botany, University of Ghana, P.O. Box LG 55, Legon, Ghana
a r t i c l e
i n f o
a b s t r a c t
Article history:
Child healthcare is a very important issue around the world as more than 10 million children
Received 17 January 2013
in developing countries die before their fifth birthday every year. Most cultures in the world
Received in revised form
use herbal medicines for child healthcare but this use is poorly documented in the litera-
5 April 2013
ture. The objective of this study was to investigate herbal medicines used in child healthcare
Accepted 14 May 2013
among the Ga people living in southern Ghana. The study was conducted through interviews
Available online 23 October 2013
with 11 key informants, household surveys with 68 (ca. 80% women) people, and ethnobo-
Keywords:
plant taxa were reported used for the management of 20 child health conditions belonging
tanical voucher specimens were collected. A total of 42 herbal medicines prepared from 44 Child health
to seven disease categories. The herbal medicines were used largely for the management of
Herbal remedies
diseases of the digestive system (14.3%), skin and sub-cutaneous tissues (30.9%) as well as
Medicinal plants
infectious and parasitic diseases (38.1%). Both multiple and single plant prescriptions were
Ga people
reported used and they were mostly (75%) administered internally. In conclusion, herbal medicines could play a very important role in child healthcare in Ghana, but research on the scientific authentication of the traditional claims is needed. © 2013 Elsevier GmbH. All rights reserved.
1.
Introduction
The Millennium Development Goal 4 (MDG 4) of United Nations calls for a two-thirds reduction in under-five child mortality rates. All regions of the world have seen significant reductions in under-five mortality rate with five out of the nine regions showing reductions of more than 50% between 1990 and 2010 (Hill et al., 2012). Sub-Saharan Africa and Oceania have only achieved approximately 30% of under-five mortality rate. Child mortality is rated very high in most developing countries of the world where it is estimated that more than 10 million children in developing countries die before their fifth birthday every year (WHO, 1997). In Ghana, the health condition of children is very important. The average annual rate of reduction (AARR) of child mortality for Ghana for the period 1990–2009 was 2.9% which
∗
means that the country is not on track to achieve MDG4 target (UNICEF, 2011). Besides, there are also significant inequities in child health outcomes and interventions (Zere et al., 2012). In many cultures around the world child healthcare involves the use of herbal medicines (Heuveline and Goldman, 2000; Ellis et al., 2007). Similarly, although there are modern health facilities for the treatment of common health conditions as they affect children in Ghana, many Ghanaians continue to depend on herbal medicines for treatments (Mshana et al., 2001). The use of herbal medicines for children therefore deserves special attention. Despite the extensive documentation on herbal medicines used for the management of various health conditions in Ghana (e.g. Mshana et al., 2001) there is currently a paucity of literature on the use of such herbal medicines specifically for management of child health conditions. Generally, herbal medicines used for management of child health are poorly
Corresponding author. Tel.: +233 244128800. E-mail addresses: [email protected], [email protected] (A. Asase). 2210-8033/$ – see front matter © 2013 Elsevier GmbH. All rights reserved. http://dx.doi.org/10.1016/j.hermed.2013.05.002
j o u r n a l o f h e r b a l m e d i c i n e 4 ( 2 0 1 4 ) 24–36
documented in the literature even if they could play an important role in healthcare promotion, disease prevention and cure (McDade et al., 2007; Ruysschaert et al., 2009). Consequently, there is an urgent need to increase our knowledge about the role that herbal medicines could play in child healthcare in Ghana and largely within the sub-Saharan African region. The objective of this study was to investigate herbal medicines used in the management of child health conditions among the Ga people living in southern Ghana. The study focused on children under five years of age including the neonatal stage which is considered as the first 28 days of life by neotologist (Winch et al., 2005). Specifically, this paper reports on consensus on medicinal plants used, diversity of the plants used as well as the methods of preparation and application of the herbal medicines.
2.
Materials and methods
2.1.
Study area and people
This study was carried out in Accra and its surrounding districts. Accra is the largest and capital city of Ghana with an estimated population of 2,291,352 people. It is located at circa latitude 5◦ 33 0 N and longitude 0◦ 12 0 W. The city was first settled in the 15th century when the Ga people migrated there from their previous settlement at Ayawaso, about 16 km north of Accra. The vegetation of the study area is coastal savanna (Hall and Swaine, 1981). Mean monthly temperature ranges from 24.7 ◦ C in August to 28 ◦ C in March, with an annual average of 26.8 ◦ C. Relative humidity is generally high, varying from 65% in the mid-afternoon to 95% at night. There are five government hospitals in the Accra metropolis (Ghana’s premier hospital, Korle Bu Teaching Hospital; Princess Marie Louise Children’s hospital; Achimota Hospital; Ridge Hospital; and La General Hospital) plus several quasi-government hospitals such as the Police Hospital, 37 Military Hospital, University of Ghana Hospital, Trust Hospital (SSNIT) and Cocoa clinic. In addition, six Polyclinics are located within Accra and surrounding communities. There are also a number of private clinics and hospitals within the metropolis. The Ga people are believed to be descendants of the Igbo ethnic group in Nigeria. They migrated through the Gulf of Guinea to the then Gold Coast (now Ghana). The present day Ga people include natives of Osu, La, Kwabenya, Ofankor, James-Town, Teshi, Nungua and Tema. The major occupation of the people is fishing and farming. Since ancient times, the Ga people have been using herbal medicine for the management of their health problems and the well-being of their children. Child healthcare is considered of a very high importance among the Ga people and traditionally they use a wide variety of herbals to this end.
2.2.
Methods
This study was conducted from August, 2011 to July, 2012 in close collaboration with the native Ga people. Data on herbal medicines being used for management of child health conditions was collected in three different ways. Before data collection, verbal prior-informed consent was obtained from
25
respondents as is the tradition in the study area. Firstly, eleven key informants (herbal practitioners) were selected based on peer recommendations (Asase et al., 2012) and interviewed using a structured questionnaire (see Appendix S1). The practitioners were interviewed individually and each of them was asked about child health conditions they treated, species of plants used, plus modes of preparation and administration of the remedies. Household interviews with 68 (ca. 80% women) respondents at Dome, a suburb of Accra, on herbal medicines used for management of child health conditions were conducted using a mixture of closed and open-ended questions. The household interviews usually included mothers (and/grand-mothers) who are considered as very knowledgeable about herbal medicines used for management of child health conditions (Ruysschaert et al., 2009). We asked in-depth questions concerning management of child health conditions during the household interviews. Supplementary data was collected by interviewing one herbalist each at La and Makola markets. Herbalists were interviewed on herbal medicines being sold for management of child health conditions and how the herbals were used following the previous method (Asase and Oppong-Mensah, 2009). Interviews were held in the Ga language using a local interpreter. The plant materials reported being used during the interviews was collected as voucher specimens with respondents from the field following standard ethnobotanical methods (Martin, 1995). Samples of the plant material being sold by herbalists were also obtained as voucher specimens following previous work (Asase and Oppong-Mensah, 2009). The voucher specimens were used in the identification of the species of medicinal plants by comparison with already authenticated specimens at the Ghana Herbarium in the Department of Botany at the University of Ghana. The assistance of local botanist colleagues was also sought in the identification of the plants.
3.
Results and discussion
3.1.
Herbal medicines and disease categories
In total, 42 herbal medicines were reported as used for the management of 20 child health conditions among the Ga people living in southern Ghana. The 20 child health conditions belong to seven disease categories according to the International Classification of Diseases (http://bioportal.bioontology. org/ontologies/47178) (Table 1). In this study, the herbal medicines reported were largely used for the management of diseases of the digestive system (14.3%), skin and subcutaneous tissues (30.9%) as well as infectious and parasitic diseases (38.1%) as shown in Table 1. According to the World Health Organization (WHO), of the total 7.6 million children who died before 5 years of age, 4.4 million (58%) died of infectious diseases (WHO, 2010). Two of the herbal medicines were reported as being used for protection against evil forces and this report is similar to the situation found among the Saramaccan Maroons in Suriname (Ruysschaert et al., 2009). It is very important to note that the local name “atridii” was used by a respondent to denote a number of infectious and parasitic diseases such as fevers, malaria and typhoid.
26
j o u r n a l o f h e r b a l m e d i c i n e 4 ( 2 0 1 4 ) 24–36
Table 1 – Disease categories and herbal medicines used for child healthcare. Disease categories
Examples of commonly treated healthcare conditions/ailments
Diseases of the digestive system Diseases of the musculoskeletal and connective tissue Diseases of the nervous systems and sense organs Diseases of the skin and sub-cutaneous tissues Endocrine, nutritional and metabolic disease, and immunity disorders Infectious and parasitic diseases Symptoms, signs and ill-defined conditions
3.2.
Diversity of plants used in herbal medicines
The 42 herbal medicines were made from 44 species of plants (Tables 2 and 3). Thirty-five of the 44 species representing 79.5% were identified to species level. The most frequently mentioned plants being used were Azadirachta indica A. Juss, Citrus aurantiifolia Swingle, Khaya anthotheca (Welw) C.DC. and Zingiber officinale Roscoe (in order of decreasing number of citations) and thus these species could be described as of cultural significance in management of child health conditions in the study area (see Heinrich et al., 2009). Nineteen of the species were cited only once (e.g. see Table 2) and this observation might be indicative of idiosyncratic knowledge of the use of those plants for management of child health conditions (Asase et al., 2012). Trees were the primary source of medicine (59%) followed by herbaceous plants (25%) as shown in Fig. 1.The most important families in terms of number of species were Meliaceae and Rutaceae; each of them represented by three species. Many species of the families Meliaceae and Rutaceae have been reported with medicinal properties in Ghana (Mshana et al., 2001). The large number of species belonging to these taxonomic families in Ghana could be another reason to account for their wide spread use. The following families, Apocynanceae, Compositae, Curcubitaceae, Myrtaceae and Solanaceae were represented by two species each while 19 families were represented by one species
Fig. 1 – Proportions of plant growth forms used in herbal medicines.
No. of herbal medicines
Constipation and piles Fracture Headache Boil and skin rashes Loss of appetite Fevers and malaria Spiritual well-being
6 1 1 13 3 16 2
each. A number of the species of plants reported as used in this study have been previously documented as being used for the treatment of the same ailments in other parts of Ghana. For example, A. indica and Vernonia ameygdalina Schreber. have been widely documented for the treatment of malaria and fevers in Ghana (Abbiw, 1990; Irvine, 1961). It should also be noted that some commonly used species such as A. indica are not native and how they came to be incorporated in the Ga pharmacopoeia needs to be investigated.
3.3.
Single and multiple plant prescriptions
The herbal medicines reported included single (45.2%) and multiple plant prescription remedies (Tables 2 and 3). The use of single and multiple plant prescriptions in the treatment of diseases has previously been documented (Wodah and Asase, 2012). Both fresh and dried plant materials were used in the preparation of the single and multiple-plant prescription medicines although fresh materials were generally used. The reason might be that it is comparatively easier to use fresh plant materials than dried materials in the preparation of herbal medicines because fresh plant materials are used as they are collected and do not require extra time and energy to prepare. More fresh plant materials were used in the preparation of multiple herbal medicine prescriptions than single herbal medicine prescriptions and vice versa (Fig. 2). Leaves were the most commonly used plant material and formed about 34% of the plant parts used in the herbal medicines. The reason why leaves are commonly used in herbal medicines is because they contain high concentrations of active agents (Vitalini et al., 2009) and are easy to collect. Other plant materials frequently used included whole plants (34%), fruits (12%), roots (6%) and stems (6%). The proportion of the different parts used differed between single and multiple plant prescriptions as shown in Fig. 3. For example, more fruit materials were used in multiple plant prescriptions compared to single plant prescriptions while seed materials were commonly used for single plant prescriptions. The plant materials were commonly prepared as decoctions, infusions and by grinding as well as in certain cases direct application of the plant materials. Multiple plant prescription remedies were generally prepared by boiling while a variety of methods were reported used in the preparation of the single plant medicines. The methods of application of the herbal medicines included both external and internal routes (Fig. 4). Approximately 75% of the herbal medicines were administered internally largely through drinking unlike the situation in Suriname where ca. 90% of treatments used for child healthcare were administered externally (Ruysschaert et al., 2009).
Table 2 – Herbal medicines for child healthcare: single plant prescriptions. Remedy no.
Species
Local name
No. of total citations
Family
Growth forms
Diseases (local names)
Plant parts
Mode of preparation and application
Juice from the leaf blended with local soap. After bathing the child, apply topically to the affected area Chopped plant material added to local gin (akpeteshie). Dose: one teaspoon of infusion and taken three times daily Inhalation of powdered stem bark twice a day Boiled decoction for sit-bath twice a day Boiled leaf decoction given as a drink as required Powder from inner bark scrapings added to a teaspoon of porridge or liquid Ground plant material added to water used as an enema via a syringe Ground roots with added salt applied to the finger as an ointment and covered with a bandage twice daily Chewing and swallowing of seeds
1
Aloe vera (L) Burm. F.
Aloe
1
Aloaceae
Herb
Ringworm
Leaves
Fresh
2
Alstonia boonei De Wild.
Nyamedua
1
Apocynaceae
Tree
Skin rashes (Oseege)
Roots, stem
Fresh
3
Anacardium occidentale L. (Alasa) Azadirachta indica A.Juss.
Alasa
1
Anacardiaceae
Tree
Headache (Yitsoyfala)
Stem bark
Dried
Kintso
10
Meliaceae
Tree
Malaria (Atridii)
Leaves, bark
Fresh
Azadirachta indica A. Juss. Azadirachta indica A. Juss.
Kintso
10
Meliaceae
Tree
Fevers (Atridii)
Leaves
Fresh
Kintso
10
Meliaceae
Tree
Loss of appetite
Bark
Dried
7
Capsicum frutescens L.
Shito
6
Solanaceae
Herb
Constipation (Musuywaa/Musunwale)
Whole plant
Fresh
8
Carica papaya L.
Akpakpa
3
Caricaceae
Tree
Swelling of fingers (Amodin/Waagkakaa)
Roots
Fresh
9
Carica papaya L.
Akpakpa
3
Caricaceae
Tree
Worms infestation
Seeds
Fresh
10
Chromolaena odorata DC.
Achieampong
2
Compositae
Shrub
Cuts (Ashwa)
Leaves
Fresh
11
Citrullus lanatus (Thunb.) Matsum. & Nakai Citrus aurantiifolia (Christm.)
Waaterwu
1
Cucurbitaceae
Vine
Seeds
Fresh
Unknown
8
Rutaceae
Tree
Constipation (Musunwale/Musuywaa) Boil (Asene)
Fruit
Fresh
4 5 6
12
j o u r n a l o f h e r b a l m e d i c i n e 4 ( 2 0 1 4 ) 24–36
Condition of plant material used
Ground leaves applied topically to the affected areas and covered with a bandage Seeds are chewed Mixture of ground “black stone” and plant fruit juice smeared around the boil starting from the lower part to the upper part
27
28
Table 2 (Continued) Remedy no.
Species
Local name
No. of total citations
Family
Diseases (local names)
Spiritual sickness (Evasion of evil spirits that bring bad luck to a person or unexplained illness or crying of a child). Skin rashes (Oseege)
Plant parts
Condition of plant material used
Mode of preparation and application
Leaves
Dried
Inhalation of smoke from burning dried leaves of the plant by masking off air with a cloth
Stem
Dried
Leaves
Fresh
Tincture prepared using local gin (akpeteshie) or beer extract given as a drink Hand rubbed leaves mixed with water while praying which is then used to rinse the body of the child after bathing
Leaves, roots, stem
Dried
13
Elaeis guineensis Jacq.
Nmatsu
2
Arecaceae
Tree
14
Khaya anthotheca C.DC.
Unknown
7
Meliaceae
Tree
15
Momordica charantia L.
Nyanyra
2
Cucurbitaceae
Climber
16
Ocimum gratissimum Seem.
Sulu
4
Lamiaceae
Herb
Spiritual sickness (Evasion of evil spirits that bring bad luck to a person or the unexplained illness or crying of a child). Cuts (Ashwa)
17
Pimpinella anisum L.
Nkiti nkite
1
Umbilliferae
Herb
Boil (Asene)
Seeds
Dried
18
Uvaria globosa Hook.f.
Anyele
2
Annonaceae
Climber
Day-blindness (Kooko)
Leaves, roots
Dried
19
Zanthoxylum zanthoxyloides (Lam.) B. Zepernick & Timler
Haatso
3
Rutaceae
Shrub
Skin rashes (Oseege)
Roots, stem
Dried
Massage affected areas with an infusion of the leaves, root and stem The aligali (ground anise seeds and palm oil) mixed with water is smeared on the boil starting from the lower part to the upper part Boiled decoction taken internally as a drink Mixture of chopped roots and stem bark with local gin (akpeteshie). Dose: one tablespoon twice a day until recovery
j o u r n a l o f h e r b a l m e d i c i n e 4 ( 2 0 1 4 ) 24–36
Growth forms
Table 3 – Herbal medicines for child healthcare: multiple plant prescriptions. Remedy no 20
21
23
24
25
Diseases (local names)
Plant parts
Condition of plant material
Mode of preparation and application
Meliaceae
Tree
Severe stomach ache (Musukoo)
Fresh
Boiled decoction given as a drink as required
Herb
Leaves, stem bark / roots Leaves
Ameo
Solanaceae
Kakatsofa
Zingiberaceae
Herb
Whole plant
Fresh
Solanaceae
Herb
Meliaceae
Tree
Ameo
Solanaceae
Kakatsofa Shito
Local name
Azadirachta indica A.Juss. Solanum lycopersicum L. Zingiber officinale Boehmer. Capsicum frutiscens L.
Kintso
Azadirachta indica A.Juss. Solanum lycopersicum L. Zingiber officinale Boehmer. Capsicum frutescens L.
No. of total citations per formulation 5
Shito Kintso
8
Fresh
Fruit
Fresh/dried Fresh
Herb
Leaves, stem bark / roots Whole plant
Zingiberaceae
Herb
Whole plant
Fresh
Solanaceae
Herb
Whole plant
Fresh
Meliaceae
Tree
Leaves, stem bark/ roots
Fresh
Malaria (Atridii)
Solanum lycopersicum L. Zingiber officinale Boehmer. Capsicum frutescens L.
Ameo
Solanaceae
Herb
Whole plant
Fresh
Kakatsofa
Zingiberaceae
Herb
Whole plant
Fresh
Shito
Solanaceae
Herb
Whole plant
Fresh
Rutaceae
Tree
Stem
Dried
Zingiberaceae
Herb
Whole plant
Fresh
Myrtaceae
Tree
Leaves
Fresh
Rutaceae
Tree
Fruit
Fresh
Liliaceae
Herb
Bulbs
Fresh
Palmae
Tree
Seeds’ oil
Fresh
1
Kakatsofa
Psidium guajava L
Gowa
Citrus aurantiifolia (Christm.) Swingle
Unknown
Allium cepa L.
Sabolai
Elaeis guineensis Jacq.
Nmatsu
3
1
Fractures (Kuumo/salsa blow)
Chicken pox (Oseege)
Blurred vision (Kookoo)
Boiled decoction given as a drink as required
Plant materials ground together and smeared on affected area twice daily
Boiled decoction given as a drink as required
A mixture of boiled plant materials with oil, salt and water. Dose: one tablespoon thrice daily
29
Kintso
Hatso
Boil (Ameo). These are painless boils filled up with fluid as a result of excess body heat.
Boiled decoction given as a drink as required
Fresh
Azadirachta indica A.Juss.
Zanthoxylum zanthoxyloides (Lam.) B. Zepernick & Timler Zingiber officinale Boehmer.
3
Family
j o u r n a l o f h e r b a l m e d i c i n e 4 ( 2 0 1 4 ) 24–36
22
Growth forms
Species
30
Table 3 (Continued) Remedy no 26
27
29
30
31
32
Local name
No. of total citations per formulation
Family
Growth forms
Diseases (local names)
Plant parts
Meliaceae
Tree
Malaria (Atridii)
Azadirachta indica A.Juss. Citrus limon L.
Kintso Unknown
Rutaceae
Tree
Aloe vera (L) Burm. F.
Aloe
Aloaceae
Herb
Persea americana Miller.
Unknown
Lauraceae
Tree
Citrus aurantiifolia (Christm.) Swingle Azadirachta indica A.Juss.
Unknown
Rutaceae
Tree
Meliaceae
Tree
Caricaceae
Tree
3
6
Kintso
Skin rashes (Osegee/Gbe)
Fevers (Atridii)
Condition of plant material
Mode of preparation and application
Leaves, stem bark or roots Fruits or leaves
Fresh
Boiled decoction given as a drink as required
Whole plants
Dried
Leaves
Fresh
Fruit
Fresh
Leaves
Fresh
Leaves
Fresh
Fresh
Carica papaya L.
Akpakpa
Ananas comosus Miller. Citrus aurantiifolia (Christm.) Swingle Species (unknown)
Blofogme
Bromeliaceae
Herb
Fruit Peel
Fresh
Unknown
Rutaceae
Tree
Fruit
Fresh
Atsiampon
Unknown
Tree
Leaves
Fresh
Vernonia ameygdalina Schreber.
Unknown
Compositae
Tree
Leaves
Fresh
Citrus aurantiifolia (Christm.) Swingle
Unknown
Rutaceae
Tree
Fruit
Fresh
Species (unknown)
Atsiampoo Baa
Unknown
Tree
Leaves
Fresh
Ananas comosus Miller Citrus aurantiifolia (Christm.) Swingle
Blofogme
Bromeliaceae
Herb
Peel
Fresh
Unknown
Rutaceae
Tree
Fruit
Fresh
Azadirachta indica A.Juss. Chromolaena odorata DC.
Kintso
Meliaceae
Tree
Leaves
Fresh
Compositae
Tree
Leaves
Fresh
Achieampong
3
2
1
1
Fevers (Atridii)
Fevers (Atridii)
Fevers (Atridii)
Fevers (Atridii)
Mixture of ground plant material with “black soap” used for bathing twice daily
Boiled decoction given as a drink as required
Boiled decoction given as a drink as required
A cupful of ground leaves in water with lime added, taken internally twice daily
Boiled decoction given as a drink as required
Boiled decoction given as a drink as required
j o u r n a l o f h e r b a l m e d i c i n e 4 ( 2 0 1 4 ) 24–36
28
Species
33
35
36
Fresh / dried
Herb
Leaves, stem bark or roots Whole plant
Rutaceae
Tree
Fruit
Fresh
Apocynaceae
Tree
Bark
Fresh/dried
Euphorbiaceae
Tree
Leaves, stem and roots
Fresh / dried
Solanaceae
Herb
Leaves
Fresh
Unknown
Meliaceae
Tree
Wakyeba
Marantaceae
Unknown
Khaya anthotheca C.D Sarcophrynium brachystachys Schumann. Citrus aurantiifolia (Christm.) Swingle Alstonia boonei De Wild. Phyllanthus amarus Schumach.
Fresh/dried
Tree
Kintso
Nyamedua
2
4
Awuba/Awintear/So
Fevers/Malaria (Atridii)
Measles (Oseege)
Fresh / dried
Solanum lycopersicum L. (Ameo
Ameo
Phyllanthus amarus Schumach. Achyranthes aspera L. Morinda lucida Benth.
Awuba/Awintear/So
Euphorbiaceae
Tree
Leaves
Fresh
Tumumu Kpoti
Amaranthaceae Rubiaceae
Herb Tree
Whole plant Stem
Fresh Dried
Khaya anthotheca C.DC.
Odypon
Meliaceae
Tree
Leaves
Fresh/dried
Musa paradisiaca L. Sarcophrynium brachystachys Schumann. Bambusa vulgaris Schreber. Citrus aurantiifolia (Christm.) Swingle Species (unknown) Species (unknown) Species (unknown)
Anm daa Wakyeba
Musaceae Marantaceae
Tree Herb
Leaves Whole plant
Fresh/dried Fresh/dried
Pamplo
Gramineae
Grass
Fresh/dried
Unknown
Rutaceae
Tree
Leaves, young stem and roots Fruit
Dundum Falatso Tsofatsuru
Unknown Unknown Unknown
Tree Tree Tree
Leaves, bark Leaves, bark Leaves, bark
Fresh Fresh Fresh
5
1
Boil (Ameo)
Fevers/Malaria (Atridii)
Boiled decoction of all the whole plants, given as a drink as required
Boiled decoction given as a drink as required
(1) Enema using a boiled decoction of the whole plant (2) A boiled decoction of the stem bark of Morinda lucida used as a drink
A boiled decoction of all the plants taken as a drink for a week as required
j o u r n a l o f h e r b a l m e d i c i n e 4 ( 2 0 1 4 ) 24–36
34
Leaves, stem bark or roots
Meliaceae
Azadirachta indica A.Juss.
Fresh
31
32
Table 3 (Continued) Remedy no 37
39
Local name
No. of total citations per formulation 1
Growth forms
Diseases (local names)
Musaceae
Tree
Diarrhoea
Family
Musa paradisiaca L.
Anm daa
Vitellaria paradoxa C.F.Gaertn. Phyllanthus amarus Schumach. Eugenia caryophyllatus Capsicum frutescens L. Species (unknown) Species (unknown)
Nkuntso
Sapotaceae
Tree
Awuba/Awintear/So
Euphorbiaceae
Tree
Peple
Myrtaceae
Tree
Shito Bagaluwa Falatso
Solanaceae Unknown Unknown
Herb Tree Tree
Species (unknown)
Dundu
Unknown
Tree
Species (unknown)
Oshish
Unknown
Unknown
Trichilia monadelpha P. Browne.
Tandru
Meliaceae
Tree
Uvaria globosa Hook.f. Khaya anthotheca C.DC. Momordica charantia L.
Anyele
Annonaceae
Tree
Odupon
Meliaceae
Tree
Nyanyra
Cucurbitaceae
Vine
Zingiber officinale Boehmer. Rauvolfia vomitoria Afzel. Trichilia monadelpha P. Browne.
Kakatsofa
Zingiberaceae
Herb
Apocynaceae
Tree
Meliaceae
Tree
1
1
Unknown Tandru
3
Typhoid (Atridii)
Typhoid (Atridii)
Plant parts
Condition of plant material
Mode of preparation and application
Leaves and roots
Fresh/dried
Boiled decoction of all the plants which is given as a drink as required
Leaves, stem bark / roots Leaves, stem / roots Leaves, stem / roots Fruits Fruits Leaves, stem / roots Leaves, stem / roots Leaves, stem / roots
Fresh / dried
Leaves, stem and roots
Dried
Leaves, stem / roots Leaves, stem / roots Leaves
Dried
Whole plants
Fresh/dried
Leaves, stem / roots Stem bark / Roots
Fresh / dried
Fresh / dried Fresh / dried Dried Dried Dried Dried Dried
Dried Fresh
Fresh / dried
Boiled decoction of all the plants which is given as a drink as required
j o u r n a l o f h e r b a l m e d i c i n e 4 ( 2 0 1 4 ) 24–36
38
Species
Sulu Aentii Bagaluwa Niyameday Falatso
Lamiaceae Fabaceae Unknown Unknown Unknown
Herb Shrub Tree Tree Tree
Species (unknown) Species (unknown)
Kolitso Sisakowe
Unknown Unknown
Unknown Herb
Khaya anthotheca C.DC.
Odupon
Meliaceae
Tree
Musa paradisiaca L. Sarcophrynium brachystachys Schumann. Ocimum gratissimum Rauvolfia vomitoria L. Zingiber officinale Boehmer. Phyllanthus amarus Schumach.
Anm daa Wakyeba
Musaceae Marantaceae
Sulu Mlai Kakatsofa Awuba/Awintear/So
5
Stem Stem Leaves, stem bark/ roots Leaves, stem bark / root Whole plant Whole plant
Fresh Dried Dried Dried Dried
Leaves, stem bark / roots
Fresh/dried
Tree Herb
Leaves Leaves
Fresh / dried Fresh / dried
Lamiaceae Apocynaceae Zingiberaceae
Herb Tree Herb
Whole plant Leaves Whole plant
Fresh / dried Fresh / dried Fresh / dried
Euphorbiaceae
Tree
Leaves, stem / roots
Fresh / dried
Loss of appetite
Fresh Fresh Boiled decoction of all the plants which is given as a drink as required
j o u r n a l o f h e r b a l m e d i c i n e 4 ( 2 0 1 4 ) 24–36
40
Ocimum gratissimum Senna alata Miller. Species (unknown) Species (unknown) Species (unknown)
33
34
Table 3 (Continued) Remedy no 41
Local name
No. of total citations per formulation
Growth forms
Diseases (local names)
Meliaceae
Tree
Loss of appetite
Family
Plant parts
Condition of plant material
Mode of preparation and application
Whole plant
Fresh/dried
(1) Boiled decoction of whole plant or (2) Infusion of plant material in alcohol taken internally as a drink as required
Khaya anthotheca C.DC.
Odupon
Musa paradisiaca L. Sarcophrynium brachystachys Schumann. Ocimum gratissimum Rauvolfia vomitoria L. Zingiber officinale Boehmer. Phyllanthus amarus Schumach.
Anm daa Wakyeba
Musaceae Marantaceae
Tree Herb
Leaves Leaves
Fresh / dried Fresh / dried
Unknown Mlai Kakatsofa
Lamiaceae Apocynaceae Zingiberaceae
Herb Tree Herb
Whole plant Leaves Whole plant
Fresh / dried Fresh / dried Fresh / dried
Awuba/Awintear/So
Euphorbiaceae
Tree
Leaves, stem / roots
Fresh / dried
Musaceae
Tree
Leaves
Fresh/dried
9
Musa paradisiaca L.
Anm daa
1
Candidiasis from birth (White)
Khaya anthotheca C.DC. Trichilia monadelpha
Odupon
Meliaceae
Tree
Whole plants
Fresh / dried
Tandru
Meliaceae
Tree
Fresh / dried
Capsicum frutescens L. Phyllanthus amarus Schumach. Zanthoxylum zanthoxyloides (Lam.) Vitellaria paradoxa C.F.Gaertn. Species (unknown)
Shito Awuba/Awintear/So
Solanaceae Euphorbiaceae
Herb Tree
Haatso
Rutaceae
Tree
Nkuntso
Sapotaceae
Tree
Bagaluwa
Unknown
Tree
Species (unknown)
Tsofatsuru
Unknown
Tree
Species (unknown)
Falatso
Unknown
Tree
Leaves, stem / bark Whole plant Leaves, stem / roots Leaves, stem/ bark Leaves, stem / roots Leaves, stem / roots Leaves, stem / roots Leaves, stem / roots
Fresh / dried Fresh / dried Fresh / dried Fresh / dried Fresh / dried Fresh / dried Fresh / dried
Boiled decoction of all plant materials taken internally as a drink as required
j o u r n a l o f h e r b a l m e d i c i n e 4 ( 2 0 1 4 ) 24–36
42
Species
j o u r n a l o f h e r b a l m e d i c i n e 4 ( 2 0 1 4 ) 24–36
Fig. 2 – Form of plant materials used, i.e. fresh or dried, for the preparation of herbal remedies. Error bars represent 95% confidence limits.
The external means of application of the herbal medicines included massage, smearing and bathing. The use of herbal medicines for bathing babies to make them strong and healthy is a major practice among the Saramaccan Maroons in Suriname (Ruysschaert et al., 2009). Indeed, bathing children with herbal medicine is a common practice in many cultures (Hilgert and Gil, 2007; Zumsteg and Weckerele, 2007).
3.4.
Other ingredients added
It is very important to note that the herbal medicines prescribed contained other non-plant ingredients such as “black stone” (tinkalo), salt (sodium chloride), local gin (akpeteshie) and palm oil although plants formed the major constituents in these remedies. The addition of non-plant materials to herbal medicines has previously been documented (Asase and Oppong-Mensah, 2009; Chintamunnee and Mahomoodally, 2012) and sometimes it is just to improve the taste of the remedy. However, the use of local gin (akpeteshie) in herbal
35
Fig. 4 – Routes of administration for herbal medicines in child healthcare. Error bars represent 95% confidence limits.
medicines as found in this study was very interesting since this could be rather deleterious to children especially where the levels of the alcohol used are not monitored. The safety of herbal medicines in children is an issue of major concern especially concerning the efficacy, toxicity, drug-interactions and formulation of the herbals (Choonara, 2003). Therefore it is important that the quality of such herbal medicines be properly monitored and verified to ensure safety in children.
4.
Conclusion
This study has indicated that the Ga people living in southern Ghana use a large diversity of plant materials in their environment for the preparation of remedies for management of child health conditions. The herbal medicines were frequently reported as used for management of diseases of the digestive system, skin and sub-cutaneous tissues as well as infectious and parasitic diseases which are considered among the major causes of under-five child mortality in the world. The findings of this study therefore demonstrate the important role that herbal medicines could play in child healthcare delivery in Ghana. Scientific verifications of the traditional uses of the herbal medicines are however required in order to ensure the safety of children who are given such medications. Further studies in other areas of Ghana will enhance our understanding of the role of herbal medicine in child healthcare in this country.
Conflict of interest There is no conflict of interest in this research.
Acknowledgments Fig. 3 – Proportions of plant parts used in the preparation of herbal medicines.
We are most grateful to the interviewees for sharing knowledge about the uses of plants in their environment and for
36
j o u r n a l o f h e r b a l m e d i c i n e 4 ( 2 0 1 4 ) 24–36
assistance throughout the study. Thanks to staff of the Ghana herbarium at Department of Botany, University of Ghana for help with identification of plants and Mrs. Gladys Odey Schwinger for their support.
Appendix A. Supplementary data Supplementary material related to this article can be found, in the online version, at doi:10.1016/j.hermed.2013.05.002.
references
Abbiw DK. Useful plants of Ghana. Kew: Intermediate Technology Publications, London Publications Department, Royal Botanic Gardens; 1990. p. 337. Asase A, Hesse DN, Simmonds MSJ. Uses of multiple plants prescriptions for treatment of malaria by some communities in southern Ghana. Journal of Ethnopharmacology 2012;144:448–52. Asase A, Oppong-Mensah G. Traditional antimalarial phytotherapy remedies in herbal markets in southern Ghana. Journal of Ethnopharmacology 2009;126:492–9. Chintamunnee V, Mahomoodally MF. Herbal medicine commonly used against non-communicable disease in the tropical island of Mauritius. Journal of Herbal Medicine 2012;2(4):113–25. Choonara I. Safety of herbal medicines in children. Archives of Disease in Childhood 2003;88:1032–3. Ellis AA, Winch P, Daou Z, Gilroy KE, Swedberg E. Home management of childhood diarrhoea in southern Mali-implications for the introduction of zinc treatment. Social Science and Medicine 2007;64:701–12. Heinrich M, Edwards S, Moerman DE, Leonti M. Ethnopharmacological field studies; a critical assessment of their conceptual basis and methods. Journal of Ethnopharmacology 2009;124:1–17. Heuveline P, Goldman N. A description of child illness and treatment behaviour in Guatemala. Social Science and Medicine 2000;50:345–6. Hilgert NI, Gil GE. Reproductive medicine in northwest Argentina: traditional and institutional systems. Journal of Ethnobiology and Ethnomedicine 2007;3:19, http://dx.doi.org/10.1186/1746-4269-3-19. Hill K, You D, Inoue M, Oestergaard MZ. Technical Advisory Group of the United Nations Inter-agency Group for Child Mortality Estimation. Child mortality estimation: accelerated progress in reducing global child mortality, 1990–2010. PLOS Medicine 2012;9(8)., http://dx.doi.org/10:1371/journal.pmed.1001303.
Martin G. Ethnobotany – a manual of methods. London: Earthsacn Publishers Limited; 1995. Hall JB, Swaine MD. Distribution and ecology of vascular plants in tropical rainforest: forest vegetation in Ghana. The Hague: W. Junk; 1981. McDade TW, Reyes-García V, Blackinton P, Tanner S, Huanca S, Leonard WR. Ethnobotanical knowledge is associated with indices of child health in Bolivian Amazon. Proceedings of the National Academy of Sciences of the United State of America 2007;104:6134–9. Mshana RN, Abbiw DK, Addae-Mensah I, Adjanouhoun E, Ahyi MRA, Ekpere JA, Enow-Rock EG, Gbile ZO, Noamesi GK, Odei MA, Odunlami H, Oteng-Yeboah AA, Sarpong K, Sofowora A, Tackie AN. Traditional medicine and pharmacopoeia: contribution to the revision of ethnobotanical and floristic studies in Ghana. Accra: Institute for Scientific and Technological Information; 2001. p. 919. Irvine FR. Woody plants of Ghana. Oxford University Press; 1961. Ruysschaert S, van Andel T, Van de Putte K, Van Damme P. Bathe the baby to make it strong and healthy: plants use and child care among Saramaccan Maroons in Suriname. Journal of Ethnopharmacology 2009:148–70. UNICEF. United Nations Children’s Fund: The State of the World’s Children 2011: adolescence – an age of opportunity New York; 2011, http://www.uis.unesco.org/Library/Documents/stateworld-children-adolescence-age-opportunity-education2011-en.pdf Vitalini S, Tomè F, Fico G. Traditional uses of medicinal plants in Valvestino (Italy). Journal of Ethnopharmacology 2009;121(1):106–16. WHO, 2010. http://www.who.int/gho/child health/mortality/ mortality causes text/en/index.html WHO. Integrated management of childhood illness: a WHO/UNICEF initiative. Bulletin of the World Health Organization Supplement 1997;75:123. Wodah D, Asase A. Ethnopharmacological use of plants by Sisala traditional healers in northwest Ghana. Pharmaceutical Biology 2012;50(7):807–15. Winch PJ, Alam MA, Akther A, Afroz D, Ali NA, Ellis AA, Baqui AH, Darmstdat GL, Arifeen SE, Seraji MHR. Local understanding of vulnerability and protection during the neonatal period in Sylhet district, Bangladesh: a quantitative study. Lancet 2005;366:478–85. Zere E, Kirigia JM, Duale S, Akazili J. Inequities in maternal and child health outcomes and interventions in Ghana. BMC Public Health 2012;12:252, http://www.biomedcentral.com/ 1471-2458/12/252 Zumsteg IS, Weckerele CS. Bakera, a herbal steam bath for postnatal care in Minahasa (Indonesia): documentation of plants used and assessment of method. Journal of Ethnopharmacology 2007;111:641–50.
Available online at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/hermed
Original research article
Herbal medicines for child healthcare from Ghana Alex Asase ∗ , Mavis L. Kadera Department of Botany, University of Ghana, P.O. Box LG 55, Legon, Ghana
a r t i c l e
i n f o
a b s t r a c t
Article history:
Child healthcare is a very important issue around the world as more than 10 million children
Received 17 January 2013
in developing countries die before their fifth birthday every year. Most cultures in the world
Received in revised form
use herbal medicines for child healthcare but this use is poorly documented in the litera-
5 April 2013
ture. The objective of this study was to investigate herbal medicines used in child healthcare
Accepted 14 May 2013
among the Ga people living in southern Ghana. The study was conducted through interviews
Available online 23 October 2013
with 11 key informants, household surveys with 68 (ca. 80% women) people, and ethnobo-
Keywords:
plant taxa were reported used for the management of 20 child health conditions belonging
tanical voucher specimens were collected. A total of 42 herbal medicines prepared from 44 Child health
to seven disease categories. The herbal medicines were used largely for the management of
Herbal remedies
diseases of the digestive system (14.3%), skin and sub-cutaneous tissues (30.9%) as well as
Medicinal plants
infectious and parasitic diseases (38.1%). Both multiple and single plant prescriptions were
Ga people
reported used and they were mostly (75%) administered internally. In conclusion, herbal medicines could play a very important role in child healthcare in Ghana, but research on the scientific authentication of the traditional claims is needed. © 2013 Elsevier GmbH. All rights reserved.
1.
Introduction
The Millennium Development Goal 4 (MDG 4) of United Nations calls for a two-thirds reduction in under-five child mortality rates. All regions of the world have seen significant reductions in under-five mortality rate with five out of the nine regions showing reductions of more than 50% between 1990 and 2010 (Hill et al., 2012). Sub-Saharan Africa and Oceania have only achieved approximately 30% of under-five mortality rate. Child mortality is rated very high in most developing countries of the world where it is estimated that more than 10 million children in developing countries die before their fifth birthday every year (WHO, 1997). In Ghana, the health condition of children is very important. The average annual rate of reduction (AARR) of child mortality for Ghana for the period 1990–2009 was 2.9% which
∗
means that the country is not on track to achieve MDG4 target (UNICEF, 2011). Besides, there are also significant inequities in child health outcomes and interventions (Zere et al., 2012). In many cultures around the world child healthcare involves the use of herbal medicines (Heuveline and Goldman, 2000; Ellis et al., 2007). Similarly, although there are modern health facilities for the treatment of common health conditions as they affect children in Ghana, many Ghanaians continue to depend on herbal medicines for treatments (Mshana et al., 2001). The use of herbal medicines for children therefore deserves special attention. Despite the extensive documentation on herbal medicines used for the management of various health conditions in Ghana (e.g. Mshana et al., 2001) there is currently a paucity of literature on the use of such herbal medicines specifically for management of child health conditions. Generally, herbal medicines used for management of child health are poorly
Corresponding author. Tel.: +233 244128800. E-mail addresses: [email protected], [email protected] (A. Asase). 2210-8033/$ – see front matter © 2013 Elsevier GmbH. All rights reserved. http://dx.doi.org/10.1016/j.hermed.2013.05.002
j o u r n a l o f h e r b a l m e d i c i n e 4 ( 2 0 1 4 ) 24–36
documented in the literature even if they could play an important role in healthcare promotion, disease prevention and cure (McDade et al., 2007; Ruysschaert et al., 2009). Consequently, there is an urgent need to increase our knowledge about the role that herbal medicines could play in child healthcare in Ghana and largely within the sub-Saharan African region. The objective of this study was to investigate herbal medicines used in the management of child health conditions among the Ga people living in southern Ghana. The study focused on children under five years of age including the neonatal stage which is considered as the first 28 days of life by neotologist (Winch et al., 2005). Specifically, this paper reports on consensus on medicinal plants used, diversity of the plants used as well as the methods of preparation and application of the herbal medicines.
2.
Materials and methods
2.1.
Study area and people
This study was carried out in Accra and its surrounding districts. Accra is the largest and capital city of Ghana with an estimated population of 2,291,352 people. It is located at circa latitude 5◦ 33 0 N and longitude 0◦ 12 0 W. The city was first settled in the 15th century when the Ga people migrated there from their previous settlement at Ayawaso, about 16 km north of Accra. The vegetation of the study area is coastal savanna (Hall and Swaine, 1981). Mean monthly temperature ranges from 24.7 ◦ C in August to 28 ◦ C in March, with an annual average of 26.8 ◦ C. Relative humidity is generally high, varying from 65% in the mid-afternoon to 95% at night. There are five government hospitals in the Accra metropolis (Ghana’s premier hospital, Korle Bu Teaching Hospital; Princess Marie Louise Children’s hospital; Achimota Hospital; Ridge Hospital; and La General Hospital) plus several quasi-government hospitals such as the Police Hospital, 37 Military Hospital, University of Ghana Hospital, Trust Hospital (SSNIT) and Cocoa clinic. In addition, six Polyclinics are located within Accra and surrounding communities. There are also a number of private clinics and hospitals within the metropolis. The Ga people are believed to be descendants of the Igbo ethnic group in Nigeria. They migrated through the Gulf of Guinea to the then Gold Coast (now Ghana). The present day Ga people include natives of Osu, La, Kwabenya, Ofankor, James-Town, Teshi, Nungua and Tema. The major occupation of the people is fishing and farming. Since ancient times, the Ga people have been using herbal medicine for the management of their health problems and the well-being of their children. Child healthcare is considered of a very high importance among the Ga people and traditionally they use a wide variety of herbals to this end.
2.2.
Methods
This study was conducted from August, 2011 to July, 2012 in close collaboration with the native Ga people. Data on herbal medicines being used for management of child health conditions was collected in three different ways. Before data collection, verbal prior-informed consent was obtained from
25
respondents as is the tradition in the study area. Firstly, eleven key informants (herbal practitioners) were selected based on peer recommendations (Asase et al., 2012) and interviewed using a structured questionnaire (see Appendix S1). The practitioners were interviewed individually and each of them was asked about child health conditions they treated, species of plants used, plus modes of preparation and administration of the remedies. Household interviews with 68 (ca. 80% women) respondents at Dome, a suburb of Accra, on herbal medicines used for management of child health conditions were conducted using a mixture of closed and open-ended questions. The household interviews usually included mothers (and/grand-mothers) who are considered as very knowledgeable about herbal medicines used for management of child health conditions (Ruysschaert et al., 2009). We asked in-depth questions concerning management of child health conditions during the household interviews. Supplementary data was collected by interviewing one herbalist each at La and Makola markets. Herbalists were interviewed on herbal medicines being sold for management of child health conditions and how the herbals were used following the previous method (Asase and Oppong-Mensah, 2009). Interviews were held in the Ga language using a local interpreter. The plant materials reported being used during the interviews was collected as voucher specimens with respondents from the field following standard ethnobotanical methods (Martin, 1995). Samples of the plant material being sold by herbalists were also obtained as voucher specimens following previous work (Asase and Oppong-Mensah, 2009). The voucher specimens were used in the identification of the species of medicinal plants by comparison with already authenticated specimens at the Ghana Herbarium in the Department of Botany at the University of Ghana. The assistance of local botanist colleagues was also sought in the identification of the plants.
3.
Results and discussion
3.1.
Herbal medicines and disease categories
In total, 42 herbal medicines were reported as used for the management of 20 child health conditions among the Ga people living in southern Ghana. The 20 child health conditions belong to seven disease categories according to the International Classification of Diseases (http://bioportal.bioontology. org/ontologies/47178) (Table 1). In this study, the herbal medicines reported were largely used for the management of diseases of the digestive system (14.3%), skin and subcutaneous tissues (30.9%) as well as infectious and parasitic diseases (38.1%) as shown in Table 1. According to the World Health Organization (WHO), of the total 7.6 million children who died before 5 years of age, 4.4 million (58%) died of infectious diseases (WHO, 2010). Two of the herbal medicines were reported as being used for protection against evil forces and this report is similar to the situation found among the Saramaccan Maroons in Suriname (Ruysschaert et al., 2009). It is very important to note that the local name “atridii” was used by a respondent to denote a number of infectious and parasitic diseases such as fevers, malaria and typhoid.
26
j o u r n a l o f h e r b a l m e d i c i n e 4 ( 2 0 1 4 ) 24–36
Table 1 – Disease categories and herbal medicines used for child healthcare. Disease categories
Examples of commonly treated healthcare conditions/ailments
Diseases of the digestive system Diseases of the musculoskeletal and connective tissue Diseases of the nervous systems and sense organs Diseases of the skin and sub-cutaneous tissues Endocrine, nutritional and metabolic disease, and immunity disorders Infectious and parasitic diseases Symptoms, signs and ill-defined conditions
3.2.
Diversity of plants used in herbal medicines
The 42 herbal medicines were made from 44 species of plants (Tables 2 and 3). Thirty-five of the 44 species representing 79.5% were identified to species level. The most frequently mentioned plants being used were Azadirachta indica A. Juss, Citrus aurantiifolia Swingle, Khaya anthotheca (Welw) C.DC. and Zingiber officinale Roscoe (in order of decreasing number of citations) and thus these species could be described as of cultural significance in management of child health conditions in the study area (see Heinrich et al., 2009). Nineteen of the species were cited only once (e.g. see Table 2) and this observation might be indicative of idiosyncratic knowledge of the use of those plants for management of child health conditions (Asase et al., 2012). Trees were the primary source of medicine (59%) followed by herbaceous plants (25%) as shown in Fig. 1.The most important families in terms of number of species were Meliaceae and Rutaceae; each of them represented by three species. Many species of the families Meliaceae and Rutaceae have been reported with medicinal properties in Ghana (Mshana et al., 2001). The large number of species belonging to these taxonomic families in Ghana could be another reason to account for their wide spread use. The following families, Apocynanceae, Compositae, Curcubitaceae, Myrtaceae and Solanaceae were represented by two species each while 19 families were represented by one species
Fig. 1 – Proportions of plant growth forms used in herbal medicines.
No. of herbal medicines
Constipation and piles Fracture Headache Boil and skin rashes Loss of appetite Fevers and malaria Spiritual well-being
6 1 1 13 3 16 2
each. A number of the species of plants reported as used in this study have been previously documented as being used for the treatment of the same ailments in other parts of Ghana. For example, A. indica and Vernonia ameygdalina Schreber. have been widely documented for the treatment of malaria and fevers in Ghana (Abbiw, 1990; Irvine, 1961). It should also be noted that some commonly used species such as A. indica are not native and how they came to be incorporated in the Ga pharmacopoeia needs to be investigated.
3.3.
Single and multiple plant prescriptions
The herbal medicines reported included single (45.2%) and multiple plant prescription remedies (Tables 2 and 3). The use of single and multiple plant prescriptions in the treatment of diseases has previously been documented (Wodah and Asase, 2012). Both fresh and dried plant materials were used in the preparation of the single and multiple-plant prescription medicines although fresh materials were generally used. The reason might be that it is comparatively easier to use fresh plant materials than dried materials in the preparation of herbal medicines because fresh plant materials are used as they are collected and do not require extra time and energy to prepare. More fresh plant materials were used in the preparation of multiple herbal medicine prescriptions than single herbal medicine prescriptions and vice versa (Fig. 2). Leaves were the most commonly used plant material and formed about 34% of the plant parts used in the herbal medicines. The reason why leaves are commonly used in herbal medicines is because they contain high concentrations of active agents (Vitalini et al., 2009) and are easy to collect. Other plant materials frequently used included whole plants (34%), fruits (12%), roots (6%) and stems (6%). The proportion of the different parts used differed between single and multiple plant prescriptions as shown in Fig. 3. For example, more fruit materials were used in multiple plant prescriptions compared to single plant prescriptions while seed materials were commonly used for single plant prescriptions. The plant materials were commonly prepared as decoctions, infusions and by grinding as well as in certain cases direct application of the plant materials. Multiple plant prescription remedies were generally prepared by boiling while a variety of methods were reported used in the preparation of the single plant medicines. The methods of application of the herbal medicines included both external and internal routes (Fig. 4). Approximately 75% of the herbal medicines were administered internally largely through drinking unlike the situation in Suriname where ca. 90% of treatments used for child healthcare were administered externally (Ruysschaert et al., 2009).
Table 2 – Herbal medicines for child healthcare: single plant prescriptions. Remedy no.
Species
Local name
No. of total citations
Family
Growth forms
Diseases (local names)
Plant parts
Mode of preparation and application
Juice from the leaf blended with local soap. After bathing the child, apply topically to the affected area Chopped plant material added to local gin (akpeteshie). Dose: one teaspoon of infusion and taken three times daily Inhalation of powdered stem bark twice a day Boiled decoction for sit-bath twice a day Boiled leaf decoction given as a drink as required Powder from inner bark scrapings added to a teaspoon of porridge or liquid Ground plant material added to water used as an enema via a syringe Ground roots with added salt applied to the finger as an ointment and covered with a bandage twice daily Chewing and swallowing of seeds
1
Aloe vera (L) Burm. F.
Aloe
1
Aloaceae
Herb
Ringworm
Leaves
Fresh
2
Alstonia boonei De Wild.
Nyamedua
1
Apocynaceae
Tree
Skin rashes (Oseege)
Roots, stem
Fresh
3
Anacardium occidentale L. (Alasa) Azadirachta indica A.Juss.
Alasa
1
Anacardiaceae
Tree
Headache (Yitsoyfala)
Stem bark
Dried
Kintso
10
Meliaceae
Tree
Malaria (Atridii)
Leaves, bark
Fresh
Azadirachta indica A. Juss. Azadirachta indica A. Juss.
Kintso
10
Meliaceae
Tree
Fevers (Atridii)
Leaves
Fresh
Kintso
10
Meliaceae
Tree
Loss of appetite
Bark
Dried
7
Capsicum frutescens L.
Shito
6
Solanaceae
Herb
Constipation (Musuywaa/Musunwale)
Whole plant
Fresh
8
Carica papaya L.
Akpakpa
3
Caricaceae
Tree
Swelling of fingers (Amodin/Waagkakaa)
Roots
Fresh
9
Carica papaya L.
Akpakpa
3
Caricaceae
Tree
Worms infestation
Seeds
Fresh
10
Chromolaena odorata DC.
Achieampong
2
Compositae
Shrub
Cuts (Ashwa)
Leaves
Fresh
11
Citrullus lanatus (Thunb.) Matsum. & Nakai Citrus aurantiifolia (Christm.)
Waaterwu
1
Cucurbitaceae
Vine
Seeds
Fresh
Unknown
8
Rutaceae
Tree
Constipation (Musunwale/Musuywaa) Boil (Asene)
Fruit
Fresh
4 5 6
12
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Condition of plant material used
Ground leaves applied topically to the affected areas and covered with a bandage Seeds are chewed Mixture of ground “black stone” and plant fruit juice smeared around the boil starting from the lower part to the upper part
27
28
Table 2 (Continued) Remedy no.
Species
Local name
No. of total citations
Family
Diseases (local names)
Spiritual sickness (Evasion of evil spirits that bring bad luck to a person or unexplained illness or crying of a child). Skin rashes (Oseege)
Plant parts
Condition of plant material used
Mode of preparation and application
Leaves
Dried
Inhalation of smoke from burning dried leaves of the plant by masking off air with a cloth
Stem
Dried
Leaves
Fresh
Tincture prepared using local gin (akpeteshie) or beer extract given as a drink Hand rubbed leaves mixed with water while praying which is then used to rinse the body of the child after bathing
Leaves, roots, stem
Dried
13
Elaeis guineensis Jacq.
Nmatsu
2
Arecaceae
Tree
14
Khaya anthotheca C.DC.
Unknown
7
Meliaceae
Tree
15
Momordica charantia L.
Nyanyra
2
Cucurbitaceae
Climber
16
Ocimum gratissimum Seem.
Sulu
4
Lamiaceae
Herb
Spiritual sickness (Evasion of evil spirits that bring bad luck to a person or the unexplained illness or crying of a child). Cuts (Ashwa)
17
Pimpinella anisum L.
Nkiti nkite
1
Umbilliferae
Herb
Boil (Asene)
Seeds
Dried
18
Uvaria globosa Hook.f.
Anyele
2
Annonaceae
Climber
Day-blindness (Kooko)
Leaves, roots
Dried
19
Zanthoxylum zanthoxyloides (Lam.) B. Zepernick & Timler
Haatso
3
Rutaceae
Shrub
Skin rashes (Oseege)
Roots, stem
Dried
Massage affected areas with an infusion of the leaves, root and stem The aligali (ground anise seeds and palm oil) mixed with water is smeared on the boil starting from the lower part to the upper part Boiled decoction taken internally as a drink Mixture of chopped roots and stem bark with local gin (akpeteshie). Dose: one tablespoon twice a day until recovery
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Growth forms
Table 3 – Herbal medicines for child healthcare: multiple plant prescriptions. Remedy no 20
21
23
24
25
Diseases (local names)
Plant parts
Condition of plant material
Mode of preparation and application
Meliaceae
Tree
Severe stomach ache (Musukoo)
Fresh
Boiled decoction given as a drink as required
Herb
Leaves, stem bark / roots Leaves
Ameo
Solanaceae
Kakatsofa
Zingiberaceae
Herb
Whole plant
Fresh
Solanaceae
Herb
Meliaceae
Tree
Ameo
Solanaceae
Kakatsofa Shito
Local name
Azadirachta indica A.Juss. Solanum lycopersicum L. Zingiber officinale Boehmer. Capsicum frutiscens L.
Kintso
Azadirachta indica A.Juss. Solanum lycopersicum L. Zingiber officinale Boehmer. Capsicum frutescens L.
No. of total citations per formulation 5
Shito Kintso
8
Fresh
Fruit
Fresh/dried Fresh
Herb
Leaves, stem bark / roots Whole plant
Zingiberaceae
Herb
Whole plant
Fresh
Solanaceae
Herb
Whole plant
Fresh
Meliaceae
Tree
Leaves, stem bark/ roots
Fresh
Malaria (Atridii)
Solanum lycopersicum L. Zingiber officinale Boehmer. Capsicum frutescens L.
Ameo
Solanaceae
Herb
Whole plant
Fresh
Kakatsofa
Zingiberaceae
Herb
Whole plant
Fresh
Shito
Solanaceae
Herb
Whole plant
Fresh
Rutaceae
Tree
Stem
Dried
Zingiberaceae
Herb
Whole plant
Fresh
Myrtaceae
Tree
Leaves
Fresh
Rutaceae
Tree
Fruit
Fresh
Liliaceae
Herb
Bulbs
Fresh
Palmae
Tree
Seeds’ oil
Fresh
1
Kakatsofa
Psidium guajava L
Gowa
Citrus aurantiifolia (Christm.) Swingle
Unknown
Allium cepa L.
Sabolai
Elaeis guineensis Jacq.
Nmatsu
3
1
Fractures (Kuumo/salsa blow)
Chicken pox (Oseege)
Blurred vision (Kookoo)
Boiled decoction given as a drink as required
Plant materials ground together and smeared on affected area twice daily
Boiled decoction given as a drink as required
A mixture of boiled plant materials with oil, salt and water. Dose: one tablespoon thrice daily
29
Kintso
Hatso
Boil (Ameo). These are painless boils filled up with fluid as a result of excess body heat.
Boiled decoction given as a drink as required
Fresh
Azadirachta indica A.Juss.
Zanthoxylum zanthoxyloides (Lam.) B. Zepernick & Timler Zingiber officinale Boehmer.
3
Family
j o u r n a l o f h e r b a l m e d i c i n e 4 ( 2 0 1 4 ) 24–36
22
Growth forms
Species
30
Table 3 (Continued) Remedy no 26
27
29
30
31
32
Local name
No. of total citations per formulation
Family
Growth forms
Diseases (local names)
Plant parts
Meliaceae
Tree
Malaria (Atridii)
Azadirachta indica A.Juss. Citrus limon L.
Kintso Unknown
Rutaceae
Tree
Aloe vera (L) Burm. F.
Aloe
Aloaceae
Herb
Persea americana Miller.
Unknown
Lauraceae
Tree
Citrus aurantiifolia (Christm.) Swingle Azadirachta indica A.Juss.
Unknown
Rutaceae
Tree
Meliaceae
Tree
Caricaceae
Tree
3
6
Kintso
Skin rashes (Osegee/Gbe)
Fevers (Atridii)
Condition of plant material
Mode of preparation and application
Leaves, stem bark or roots Fruits or leaves
Fresh
Boiled decoction given as a drink as required
Whole plants
Dried
Leaves
Fresh
Fruit
Fresh
Leaves
Fresh
Leaves
Fresh
Fresh
Carica papaya L.
Akpakpa
Ananas comosus Miller. Citrus aurantiifolia (Christm.) Swingle Species (unknown)
Blofogme
Bromeliaceae
Herb
Fruit Peel
Fresh
Unknown
Rutaceae
Tree
Fruit
Fresh
Atsiampon
Unknown
Tree
Leaves
Fresh
Vernonia ameygdalina Schreber.
Unknown
Compositae
Tree
Leaves
Fresh
Citrus aurantiifolia (Christm.) Swingle
Unknown
Rutaceae
Tree
Fruit
Fresh
Species (unknown)
Atsiampoo Baa
Unknown
Tree
Leaves
Fresh
Ananas comosus Miller Citrus aurantiifolia (Christm.) Swingle
Blofogme
Bromeliaceae
Herb
Peel
Fresh
Unknown
Rutaceae
Tree
Fruit
Fresh
Azadirachta indica A.Juss. Chromolaena odorata DC.
Kintso
Meliaceae
Tree
Leaves
Fresh
Compositae
Tree
Leaves
Fresh
Achieampong
3
2
1
1
Fevers (Atridii)
Fevers (Atridii)
Fevers (Atridii)
Fevers (Atridii)
Mixture of ground plant material with “black soap” used for bathing twice daily
Boiled decoction given as a drink as required
Boiled decoction given as a drink as required
A cupful of ground leaves in water with lime added, taken internally twice daily
Boiled decoction given as a drink as required
Boiled decoction given as a drink as required
j o u r n a l o f h e r b a l m e d i c i n e 4 ( 2 0 1 4 ) 24–36
28
Species
33
35
36
Fresh / dried
Herb
Leaves, stem bark or roots Whole plant
Rutaceae
Tree
Fruit
Fresh
Apocynaceae
Tree
Bark
Fresh/dried
Euphorbiaceae
Tree
Leaves, stem and roots
Fresh / dried
Solanaceae
Herb
Leaves
Fresh
Unknown
Meliaceae
Tree
Wakyeba
Marantaceae
Unknown
Khaya anthotheca C.D Sarcophrynium brachystachys Schumann. Citrus aurantiifolia (Christm.) Swingle Alstonia boonei De Wild. Phyllanthus amarus Schumach.
Fresh/dried
Tree
Kintso
Nyamedua
2
4
Awuba/Awintear/So
Fevers/Malaria (Atridii)
Measles (Oseege)
Fresh / dried
Solanum lycopersicum L. (Ameo
Ameo
Phyllanthus amarus Schumach. Achyranthes aspera L. Morinda lucida Benth.
Awuba/Awintear/So
Euphorbiaceae
Tree
Leaves
Fresh
Tumumu Kpoti
Amaranthaceae Rubiaceae
Herb Tree
Whole plant Stem
Fresh Dried
Khaya anthotheca C.DC.
Odypon
Meliaceae
Tree
Leaves
Fresh/dried
Musa paradisiaca L. Sarcophrynium brachystachys Schumann. Bambusa vulgaris Schreber. Citrus aurantiifolia (Christm.) Swingle Species (unknown) Species (unknown) Species (unknown)
Anm daa Wakyeba
Musaceae Marantaceae
Tree Herb
Leaves Whole plant
Fresh/dried Fresh/dried
Pamplo
Gramineae
Grass
Fresh/dried
Unknown
Rutaceae
Tree
Leaves, young stem and roots Fruit
Dundum Falatso Tsofatsuru
Unknown Unknown Unknown
Tree Tree Tree
Leaves, bark Leaves, bark Leaves, bark
Fresh Fresh Fresh
5
1
Boil (Ameo)
Fevers/Malaria (Atridii)
Boiled decoction of all the whole plants, given as a drink as required
Boiled decoction given as a drink as required
(1) Enema using a boiled decoction of the whole plant (2) A boiled decoction of the stem bark of Morinda lucida used as a drink
A boiled decoction of all the plants taken as a drink for a week as required
j o u r n a l o f h e r b a l m e d i c i n e 4 ( 2 0 1 4 ) 24–36
34
Leaves, stem bark or roots
Meliaceae
Azadirachta indica A.Juss.
Fresh
31
32
Table 3 (Continued) Remedy no 37
39
Local name
No. of total citations per formulation 1
Growth forms
Diseases (local names)
Musaceae
Tree
Diarrhoea
Family
Musa paradisiaca L.
Anm daa
Vitellaria paradoxa C.F.Gaertn. Phyllanthus amarus Schumach. Eugenia caryophyllatus Capsicum frutescens L. Species (unknown) Species (unknown)
Nkuntso
Sapotaceae
Tree
Awuba/Awintear/So
Euphorbiaceae
Tree
Peple
Myrtaceae
Tree
Shito Bagaluwa Falatso
Solanaceae Unknown Unknown
Herb Tree Tree
Species (unknown)
Dundu
Unknown
Tree
Species (unknown)
Oshish
Unknown
Unknown
Trichilia monadelpha P. Browne.
Tandru
Meliaceae
Tree
Uvaria globosa Hook.f. Khaya anthotheca C.DC. Momordica charantia L.
Anyele
Annonaceae
Tree
Odupon
Meliaceae
Tree
Nyanyra
Cucurbitaceae
Vine
Zingiber officinale Boehmer. Rauvolfia vomitoria Afzel. Trichilia monadelpha P. Browne.
Kakatsofa
Zingiberaceae
Herb
Apocynaceae
Tree
Meliaceae
Tree
1
1
Unknown Tandru
3
Typhoid (Atridii)
Typhoid (Atridii)
Plant parts
Condition of plant material
Mode of preparation and application
Leaves and roots
Fresh/dried
Boiled decoction of all the plants which is given as a drink as required
Leaves, stem bark / roots Leaves, stem / roots Leaves, stem / roots Fruits Fruits Leaves, stem / roots Leaves, stem / roots Leaves, stem / roots
Fresh / dried
Leaves, stem and roots
Dried
Leaves, stem / roots Leaves, stem / roots Leaves
Dried
Whole plants
Fresh/dried
Leaves, stem / roots Stem bark / Roots
Fresh / dried
Fresh / dried Fresh / dried Dried Dried Dried Dried Dried
Dried Fresh
Fresh / dried
Boiled decoction of all the plants which is given as a drink as required
j o u r n a l o f h e r b a l m e d i c i n e 4 ( 2 0 1 4 ) 24–36
38
Species
Sulu Aentii Bagaluwa Niyameday Falatso
Lamiaceae Fabaceae Unknown Unknown Unknown
Herb Shrub Tree Tree Tree
Species (unknown) Species (unknown)
Kolitso Sisakowe
Unknown Unknown
Unknown Herb
Khaya anthotheca C.DC.
Odupon
Meliaceae
Tree
Musa paradisiaca L. Sarcophrynium brachystachys Schumann. Ocimum gratissimum Rauvolfia vomitoria L. Zingiber officinale Boehmer. Phyllanthus amarus Schumach.
Anm daa Wakyeba
Musaceae Marantaceae
Sulu Mlai Kakatsofa Awuba/Awintear/So
5
Stem Stem Leaves, stem bark/ roots Leaves, stem bark / root Whole plant Whole plant
Fresh Dried Dried Dried Dried
Leaves, stem bark / roots
Fresh/dried
Tree Herb
Leaves Leaves
Fresh / dried Fresh / dried
Lamiaceae Apocynaceae Zingiberaceae
Herb Tree Herb
Whole plant Leaves Whole plant
Fresh / dried Fresh / dried Fresh / dried
Euphorbiaceae
Tree
Leaves, stem / roots
Fresh / dried
Loss of appetite
Fresh Fresh Boiled decoction of all the plants which is given as a drink as required
j o u r n a l o f h e r b a l m e d i c i n e 4 ( 2 0 1 4 ) 24–36
40
Ocimum gratissimum Senna alata Miller. Species (unknown) Species (unknown) Species (unknown)
33
34
Table 3 (Continued) Remedy no 41
Local name
No. of total citations per formulation
Growth forms
Diseases (local names)
Meliaceae
Tree
Loss of appetite
Family
Plant parts
Condition of plant material
Mode of preparation and application
Whole plant
Fresh/dried
(1) Boiled decoction of whole plant or (2) Infusion of plant material in alcohol taken internally as a drink as required
Khaya anthotheca C.DC.
Odupon
Musa paradisiaca L. Sarcophrynium brachystachys Schumann. Ocimum gratissimum Rauvolfia vomitoria L. Zingiber officinale Boehmer. Phyllanthus amarus Schumach.
Anm daa Wakyeba
Musaceae Marantaceae
Tree Herb
Leaves Leaves
Fresh / dried Fresh / dried
Unknown Mlai Kakatsofa
Lamiaceae Apocynaceae Zingiberaceae
Herb Tree Herb
Whole plant Leaves Whole plant
Fresh / dried Fresh / dried Fresh / dried
Awuba/Awintear/So
Euphorbiaceae
Tree
Leaves, stem / roots
Fresh / dried
Musaceae
Tree
Leaves
Fresh/dried
9
Musa paradisiaca L.
Anm daa
1
Candidiasis from birth (White)
Khaya anthotheca C.DC. Trichilia monadelpha
Odupon
Meliaceae
Tree
Whole plants
Fresh / dried
Tandru
Meliaceae
Tree
Fresh / dried
Capsicum frutescens L. Phyllanthus amarus Schumach. Zanthoxylum zanthoxyloides (Lam.) Vitellaria paradoxa C.F.Gaertn. Species (unknown)
Shito Awuba/Awintear/So
Solanaceae Euphorbiaceae
Herb Tree
Haatso
Rutaceae
Tree
Nkuntso
Sapotaceae
Tree
Bagaluwa
Unknown
Tree
Species (unknown)
Tsofatsuru
Unknown
Tree
Species (unknown)
Falatso
Unknown
Tree
Leaves, stem / bark Whole plant Leaves, stem / roots Leaves, stem/ bark Leaves, stem / roots Leaves, stem / roots Leaves, stem / roots Leaves, stem / roots
Fresh / dried Fresh / dried Fresh / dried Fresh / dried Fresh / dried Fresh / dried Fresh / dried
Boiled decoction of all plant materials taken internally as a drink as required
j o u r n a l o f h e r b a l m e d i c i n e 4 ( 2 0 1 4 ) 24–36
42
Species
j o u r n a l o f h e r b a l m e d i c i n e 4 ( 2 0 1 4 ) 24–36
Fig. 2 – Form of plant materials used, i.e. fresh or dried, for the preparation of herbal remedies. Error bars represent 95% confidence limits.
The external means of application of the herbal medicines included massage, smearing and bathing. The use of herbal medicines for bathing babies to make them strong and healthy is a major practice among the Saramaccan Maroons in Suriname (Ruysschaert et al., 2009). Indeed, bathing children with herbal medicine is a common practice in many cultures (Hilgert and Gil, 2007; Zumsteg and Weckerele, 2007).
3.4.
Other ingredients added
It is very important to note that the herbal medicines prescribed contained other non-plant ingredients such as “black stone” (tinkalo), salt (sodium chloride), local gin (akpeteshie) and palm oil although plants formed the major constituents in these remedies. The addition of non-plant materials to herbal medicines has previously been documented (Asase and Oppong-Mensah, 2009; Chintamunnee and Mahomoodally, 2012) and sometimes it is just to improve the taste of the remedy. However, the use of local gin (akpeteshie) in herbal
35
Fig. 4 – Routes of administration for herbal medicines in child healthcare. Error bars represent 95% confidence limits.
medicines as found in this study was very interesting since this could be rather deleterious to children especially where the levels of the alcohol used are not monitored. The safety of herbal medicines in children is an issue of major concern especially concerning the efficacy, toxicity, drug-interactions and formulation of the herbals (Choonara, 2003). Therefore it is important that the quality of such herbal medicines be properly monitored and verified to ensure safety in children.
4.
Conclusion
This study has indicated that the Ga people living in southern Ghana use a large diversity of plant materials in their environment for the preparation of remedies for management of child health conditions. The herbal medicines were frequently reported as used for management of diseases of the digestive system, skin and sub-cutaneous tissues as well as infectious and parasitic diseases which are considered among the major causes of under-five child mortality in the world. The findings of this study therefore demonstrate the important role that herbal medicines could play in child healthcare delivery in Ghana. Scientific verifications of the traditional uses of the herbal medicines are however required in order to ensure the safety of children who are given such medications. Further studies in other areas of Ghana will enhance our understanding of the role of herbal medicine in child healthcare in this country.
Conflict of interest There is no conflict of interest in this research.
Acknowledgments Fig. 3 – Proportions of plant parts used in the preparation of herbal medicines.
We are most grateful to the interviewees for sharing knowledge about the uses of plants in their environment and for
36
j o u r n a l o f h e r b a l m e d i c i n e 4 ( 2 0 1 4 ) 24–36
assistance throughout the study. Thanks to staff of the Ghana herbarium at Department of Botany, University of Ghana for help with identification of plants and Mrs. Gladys Odey Schwinger for their support.
Appendix A. Supplementary data Supplementary material related to this article can be found, in the online version, at doi:10.1016/j.hermed.2013.05.002.
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