Malaria control and treatment: the role of indigenous practices in Zimbabwe

Figures & data

Figure 1. A theoretical framework of indigenous practices in the control and treatment of malaria in Zimbabwe.

Table 1. Indigenous practices in prevention and treatment of malaria in Zimbabwe.

Indigenous practice	Remarks on treatment/ prevention /natural products used in Zimbabwe	Applicability in Zimbabwean mainstream health systems	References
Herbal medicine (most of the herbal medicines are taken orally as powders, cold and hot infusions from plant roots, leaves, barks and fruits. However, there is limited information on the dosage used)	According to an ethnobotanical survey conducted in Manicaland Province, Zimbabwe, plant such as Elephantorrhiza goetzei (Harms), Toddalia asiatica (L.) Lam and Pavetta schumanniana F. Hoffm. In this particular study, Aristolochia albida and Cassia abbreviata were the most utilised herbal medicines against malaria.	As method of preserving indigenous practices and traditional medicines such has herbal medicines the Traditional Medical Practitioners Act of 1981 was introduced. This was meant to incorporate traditional medicine into the main stream Zimbabwean health system. With proper scientific evaluation and screening herbal medicines can be the basis of new antimalarial drugs that can be used beyond localised communities.	Ngarivhume et al. (2015)
	An ethnobotanical survey conducted in malaria hotspots of Zimbabwe revealed that the indigenous people are highly confident in herbal medicines which are used against malaria. Some of the plants that are utilised in malaria prone areas include D. nitidula A. amara, V. infausta A. digitata and L. discolour.	Although herbal medicines are used for primary health care needs in Zimbabwe, the claim that combining these medicines with western drugs improve efficacy is not always true. It depends on the type drug interactions which can be antagonistic, synergistic and additive. However, it has been concluded that some antimalarial plant-based drugs can compete with established drugs against malaria. This therefore, indicates that if plant based antimalarial drugs are scientifically evaluated especially for toxicity level can be applied beyond primary health in Zimbabwe.	Kazembe et al. (2012)
	In a survey conducted in Chiredzi dristict, Masvingo Province, Zimbabwe, antimalarial plants including Adonsia digitata roots, Capsicum anuum fruits and Warburgia salutaris bark,	Results from this study indicated plant remedies were combined with antimalarial drugs such as chloroquine. Although plant based antimalarial drugs are used traditionally in primary health care, there is need for assess their efficacy so that they are fully used in hospitals and readily in Zimbabwean pharmacies.	Chapu and Mgocheki (2017)
	In Mola, Kariba district, Mashonaland West Province, Zimbabwe, some of the identified antimalarial plants include Amblygonocarpus andongenis (Olvi.), Carica papaya L. (Caricaceae), Zanha africana (Radlk.), Solanum panduriforme, Diplorhynchus condylocarpon, Euclea divinorum Hiern, Aloe greatheardii Schoni.	Antimalarial herbal medicines can be used as primary health care medicines and with scientific evaluation on efficacy and toxicity can be applied in the main health system.	Lukwa et al., (2001)
	Pant species collected from a number of stations in Zimbabwe along Harare-Nyamapanda road close to Marondera, Mashonaland East Province, Zimbabwe, were assessed for antiplasmodial activities. The targeted plants were Cussonia spicata, Flueggea virosa, Vernonia colorata, Artemisia afra, Clutia hirsute, Vernonia colorata, V. natalensis, Parinari curatellifolia, Hymenodictyon floribundum and Adenia gummifera. Among all these plants, extracts from Vernonia colorata and Artemisia afra active against both PoW (chloroquine-sensitive Plasmodium strain) and Dd2 (chloroquine-resistant Plasmodium).	Based on the bioassays and identified A. afra and V. colorata extracts can be applied as antimalarial drugs. Although the IC50 values were less than 50 µg/ml (1.1–12.6 µg/mL), there need to evaluate toxicity of these extracts and to prescribe quantities that can be utilised. Moreover, in vivo assays and clinical tests should be carried so that these herbal medicines are incorporated into mainstream health system.	Kraft et al., 2003
	In a doctoral study conducted in Chikwanha-Muneri villages of Marange District, Manicald Province, Zimbabwe plants traditionally used to manage malaria were identified and these include Cassia abbreviate, Bridelia cathartica, Burkea Africana, Tragia okanyua, Pterocarpus Angolensi and Afzelia quanzensis.	Antimalarial herbal medicines can be used as primary health care medicines and with scientific evaluation on efficacy and toxicity can be applied in the main health system.
The use of traditional environmental indicators to control malaria Arthropod markers Bird predictors Animal attributes Plant phenology Astronomical and meteorological signals	Insects identified in Gwanda district, Matabeleland South, Zimbabwe, for example termites were shown to mark the start of the rainy season. Additionally, massive white butterflies migrating from west to east in the month of October indicates considerably high rainfall.	Though termites do not reflect the quantity of the rain or the extent of malaria prevalence, it does herald the start of the malaria season. However, white butterflies in this case indicate high malaria prevalence. These markers can be applied in preparing for malaria outbreaks.	Macherera and Chimbari (2016)
	It has been shown that noise of ground hornbills and laying of eggs by guinea fowls from September to November indicates a favourable rainy season. However, Swallows and Migratory birds in November indicate that the rainy season is approaching.	This is applicable in two ways since: (1) Early warning markers for start of malaria and (2) Malaria incident intensity predication.	Macherera and Chimbari (2016)
	It was discovered that if wild animals have a large number of young ones and lions passing by the farmsteads without attacking domesticated animals or humans during the months of September and October, then more rainfall would be obtained in the next season.	This shows that the likelihood of malaria transmission will be substantially high.	Macherera and Chimbari (2016)
	Flowering of plants like Lanchocarpus capassa in October and November and Boscia albitrunca in early and numerous fruits by November indicate significant rainfall in that season. Acasia nigrescens indicates low rainfall and drought if it takes longer to produce new.	Plant phenology indicators indicate the presence of high or low rainfall and hence intensity of malaria prevalence.	Macherera and Chimbari (2016)
	In Gwanda district, Matebeleland South, Zimbabwe, astronomical and meteorological signals such as clouds, humidity and temperature variations are utilised to forecast rainfall patterns.	In this case humidity/rainfall and temperature can be used to predict malaria prevalence and intensity.	Macherera and Chimbari (2016)
The use of red-hot granite rock and water,	A red hot stone is immersed in cold water and begins to boil. The patient and red hot stone are covered under a blanket or cloth (known as kufukira in Zimbabwe).	Although there is limited information linking this traditional method to the fight against malaria, it has been revealed that raising the body temperature strengthens the second line of defence by generating thermal stress, which mimics feverish episodes.	Chapu and Mgocheki (2017)
The burning of dung and plants to deter malaria vectors	A comprehensive survey in Chiredzi district, Masvingo, Zimbabwe, burning of dry pieces of plants such as Spirostachys africana and dung (cow or elephant dung) has been done to deter mosquitoes.	Evidence to suggest that smoke is an efficient repellent and the practice of smoke fumigation of rooms to avoid biting mosquitoes is common. This is a preventive method that can be applied with precautionary measures of preventing indoor air pollution.	Chapu and Mgocheki (2017)
	In most regions of Zimbabwe, hanging fresh leaves of Chenopodium ambrosioides, Lippia javanica, Chrysopogon nigratana and Ocimum canum in the home efficiently provided mosquito bite protection.	This is a preventive method that can be applied. Most plant derived fumigants are employed as mosquito repellents since they contain mosquito repelling essential oils.	Chapu and Mgocheki (2017)
Spiritual malaria treatment based on faith and traditional healers.	In Zimbabwe, the believers believe that malaria may be healed by pleading with God since it is thought that disease is God’s punishment. Additionally, some churches in Zimbabwe recommended congregants to drink plenty of water to avoid contracting the sickness including malaria.	There is no scientific evidence to support applicability of this traditional method in the Zimbabwean health systems.	Treadwell (2001)
	Among the Shona speaking people of Zimbabwe, mashavi (wandering spirits) and mhondoro (wishful spirits) Although mhondoro and mashavi are important, they are not as important as vadzimu in everyday life of some Zimbabweans	There is no scientific evidence to support applicability of this traditional method in the Zimbabwean health systems.	Masaka and Makahamadze (2013)
	In some communities in Zimbabwean, the elderly (as well as departed descendants) are key in maintaining access to and inheritance of disease treatment and prevention through specific dreaming (kurotswa) and ceremonial divinations (kusvikirwa), in which the knowledge is disclosed as a gift	There is no scientific evidence to support applicability of this traditional method in the Zimbabwean health systems.	Masaka and Makahamadze (2013)

Figure 2. Conceptual framework of the interaction of medical pluralism, indigenous health practices and decolonisation of public health.

Ngarivhume, T., Van’t Klooster, C. I. E. A., de Jong, J. T. V. M., & Van der Westhuizen, J. H. (2015). Medicinal plants used by traditional healers for the treatment of malaria in the Chipinge district in Zimbabwe. Journal of Ethnopharmacology, 159, 224–237. https://doi.org/10.1016/j.jep.2014.11.011

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Chapu, G., & Mgocheki, N. (2017). A Survey on traditional and modern prophylactic methods of malaria management in a resettlement area in the Southern Lowveld of Zimbabwe. International Journal of Tropical Disease & Health, 21(1), 1–17. https://doi.org/10.9734/IJTDH/2017/30433

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Lukwa, N., Mutambu, S. L., Makaza, N., Molgaard, P., & Furu, P. (2001). Perceptions about malaria transmission and control using anti-malaria plants in Mola, Kariba, Zimbabwe. Nigerian Journal of Natural Products and Medicine, 5(1), 4–7. https://doi.org/10.4314/njnpm.v5i1.11713

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Kraft, C., Jenett‐Siems, K., Siems, K., Jakupovic, J., Mavi, S., Bienzle, U., & Eich, E. (2003). In vitro antiplasmodial evaluation of medicinal plants from Zimbabwe. Phytotherapy Research: PTR, 17(2), 123–128. https://doi.org/10.1002/ptr.1066

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Macherera, M., & Chimbari, M. J. (2016). A review of studies on community based early warning systems. Jàmbá: Journal of Disaster Risk Studies, 8(1), 1-11. https://doi.org/10.4102/jamba.v8i1.206

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Treadwell, P. (2001). God’s judgement? Syphilis and AIDS: Comparing the history and prevention attempts of two epidemics. iUniverse.

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Masaka, D., & Makahamadze, T. (2013). The proverb: A preserver of Shona traditional religion and ethical code. The Journal of Pan African Studies, 6(5), 132–143.

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