Traditional and herbal medicines

During a recent conference, an Algerian colleague repeatedly excused himself to visit the restroom just down the hallway to vomit. The reason was kidney stones, and by his own account, he had suffered similar paroxysms of pain in the past, accompanied by episodes of vomiting. By the second day of the conference, as he sat by my side, he exclaimed that this was a problem that had afflicted him for years.

He had dodged surgery and relied only on medications, including injections. Now, he was fed up with those efforts and wanted to use herbal medicine.

That caused some consternation, especially as this was a doctor, a highly trained specialist, sharing such a sentiment. After the conference ended on the third day, we struck up a conversation about his struggles, including his proposal to experiment with herbal medicines. That took us on a broad excursion around the Mediterranean basin and beyond, discussing the prevalence of herbal products as a complement to quality healthcare and as a means of improving access to health services for many more people.

The adherence to traditional medicine is a double-edged sword in Nigeria. It ensures healthcare is accessible to millions, yet it complicates service delivery due to safety gaps and a lack of formal integration with modern health systems.

Some of its positive effects on healthcare delivery include the obvious fact that it expands access. For many people, especially in rural areas, it remains the primary source of care due to the high cost and limited availability of modern medicine, shortages of trained healthcare personnel to diagnose and treat illnesses, and the lack of basic infrastructure to house healthcare facilities. For instance, a single herbal malaria remedy costs around N400 to N2,500, which is often less than orthodox alternatives.

Up to 90 per cent of people in some rural areas rely solely on herbs, effectively filling the void left by an underfunded or non-existent public health system.

Such choices are often driven by cultural beliefs and family traditions, making traditional care a trusted first resort.

During our discussion a couple of weeks ago about the threat a burgeoning population poses to quality healthcare, we saw how expectant mothers routinely preferred to have their babies delivered by traditional birth attendants and even herbal medicine practitioners rather than visit adequately staffed modern facilities located literally within shouting distance of their homes.

The use of such means is not altogether disreputable. Research shows that many herbal products are safe but may not be effective.

A study conducted by the Nigerian Institute of Medical Research, covering 46 products found that not one passed efficacy tests. This can lead to treatment failures, as is often seen, especially in serious diseases such as malaria.

The entire system governing that sector demonstrates a complete lack of standardisation. Dosages are unregulated and quality control is inconsistent.

Some people consume a mug of Agbo Iba, for example, as part of efforts to treat malaria, while others take only a teacupful of the mixture. The number of doses consumed also varies, as does the volume adjusted for weight and age.

With so many different producers of Agbo Iba, most following family practices handed down through generations by oral tradition, each product differs from the others. This hinders official integration into the formal health system.

Some patients visit traditional healers first, delaying the diagnosis and treatment of conditions that require modern medical intervention.

The practitioners they consult are sometimes not honest enough to acknowledge their limitations but instead persist with trial-and-error approaches that only delay appropriate treatment.

The most prudent course is to find ways of incorporating streamlined solutions into the healthcare ecosystem. There is now a strong push to test widely used anti-malarial herbs, such as neem and bitter leaf, and harness their potential safely. The relevant enabling legislation also appears to be on the way.

The government now seems to be moving towards integration, treating traditional healthcare providers as allies rather than rivals. A strategic plan and a code of ethics for practitioners have been unveiled to promote evidence-based practice.

The World Health Organisation Collaborating Centre at the University of Lagos College of Medicine is at the forefront of this effort because it houses the African Centre of Excellence for Drug Research, Herbal Medicine Development and Regulatory Science.

This body is dedicated to developing standards for herbal formulations, quality assurance and toxicological evaluation.

However, its efforts will not be effective without the complementary push from National Agency for Food and Drug Administration and Control and the National Institute for Pharmaceutical Research and Development, which are working to standardise and scientifically validate these remedies.

In Nigeria, neem, locally called Dongoyaro in Yoruba and Dogonyaro in Hausa, is the ultimate multipurpose tree. You will recognise it by its small, bitter leaves and yellowish fruit.

Neem is not native to Nigeria. It actually originated in India, but it has naturalised so completely that many people assume it is indigenous. It thrives so well that it has practically become a weed tree.

Almost every part of it is used for something. Its leaves are boiled to treat malaria and other fevers or used as a cleansing tonic.

The bark is chewed or steeped for dental care and stomach ailments. Oil extracted from its seeds is applied topically as a powerful antiseptic for skin rashes and ringworm, and also serves as a mosquito repellent.

It is bitter but potent, with its extreme bitterness arising from compounds such as azadirachtin, which possess strong antibacterial, antifungal and anti-malarial properties.

It is not just a medicinal plant; it is also a natural pesticide, provides shade, and its twigs are used as chewing sticks (oru). It is literally everywhere in Nigeria, often growing wild as though it were a weed.

While it is highly effective against skin diseases and for repelling insects, research shows that its anti-malarial potency is mild compared with standard drugs. This is why relying on it alone to treat severe malaria can delay proper treatment.

The United Nations has described neem as the “tree of the 21st century” because of its potential for sustainable agriculture, medicine, and the production of biodegradable soaps and toothpaste.

In traditional practice, it is strictly avoided during pregnancy because it can stimulate uterine contractions.

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Local communities have long understood this. Its small, sweet yellow fruits are a favourite of birds such as bulbuls, which disperse the seeds widely. That is why the tree lines roads and fills vacant plots, seemingly growing everywhere without being deliberately planted.

In essence, traditional medicine is vital to keeping the healthcare system afloat, but its full potential is hampered by quality concerns and weak regulation.

The government needs to implement a comprehensive plan of action and establish a code of ethics to standardise practices and set professional conduct rules for practitioners. This would provide an official roadmap for implementation and accountability.

Agencies such as the NIPRD are leading commercialisation efforts through a multi-sectoral committee, while NAFDAC, in partnership with the Nigeria Natural Medicine Development Agency, is conducting clinical trials to validate the safety and efficacy of herbal remedies, including a sickle cell drug now used in more than 40 countries.

Overall, it appears that the government is moving from a hands-off approach to a structured system that integrates evidence-based traditional medicine into the national healthcare framework. It is a significant shift aimed at making these treatments a reliable component of healthcare.

Herbal medicines are used throughout the world. China, India and Germany have legalised and extensively integrated their use.

Within the European Union, the United Kingdom and the United States, herbal medicines are regulated like pharmaceuticals and must not only be registered but must also demonstrate acceptable safety profiles.

Questions and answers

Good morning, doctor. I am a 53-year-old man with no health issues until about three weeks ago, when I was diagnosed with malaria. Since then, I have received treatment at the clinic and now feel much better. My taste buds have returned to normal and I am eating well again. My problem is that since completing treatment with Camosunate, I have been having difficulty sleeping. I also feel a pulling sensation at the back of my head. What should I do, sir? 0803367xxxx

There are a couple of things you can do to determine what the problem is. First, return to the clinic where you were diagnosed and treated so that the doctor can confirm that the malaria parasite has been completely cleared from your blood. Secondly, if your sleeping problem began only after you completed the antimalarial treatment, the medication may bear some remote responsibility for your symptoms. You may therefore require a prescription to help restore your normal sleeping pattern.

Good day, Sunday Doctor. My daughter is 20 years old and is home from school for the holidays. A few days ago, she suddenly started vomiting and complained of stomach pain on the lower right side. She did not have a fever. However, as of this morning, the pain has subsided, and she is eating well again. Last year, she had similar pain and was admitted to a private hospital, where the doctor said she had a urinary tract infection. What could be wrong with her, and what should we do? 0802720xxxx

When you say she is back from school, it is not clear whether you mean a secondary school, polytechnic or university. That information would have helped us assess the kind of medical care she previously received.

However, since she is now at home with you, another doctor should examine her to determine whether the previous diagnosis still stands.

Based on the information you have provided, she could have appendicitis, which may require surgery, or mesenteric lymphadenitis, which usually does not. Therefore, take her to the hospital for proper evaluation as soon as possible.

Good evening, doctor. I woke up a few days ago in the middle of the night with severe burning pain in my throat. I also noticed I was wheezing. I am not asthmatic. I couldn’t sleep again after waking up. The same thing happened again last night. What is the solution? I have never experienced this before. 0703744xxxxx

It is difficult to give you straightforward advice because you did not disclose your age or gender. Since this problem only started recently, it is likely to be an acute condition with varying degrees of seriousness.

You could be suffering from gastro-oesophageal reflux disease (GERD), in which stomach acid flows back into the oesophagus and throat, causing the burning sensation. In that case, you may need an antacid and should also make changes to the quantity of food you eat before bedtime and the interval between your last meal and going to bed.

Good day, doctor. I am a 60-year-old businesswoman. I have not slept well for nearly two weeks and have been having constant headaches. When I checked my blood pressure at a pharmacy yesterday evening, it was 184/104 mmHg, and my pulse was 91. I do not want to have hypertension and remain on medication for the rest of my life. What should I do? Thank you, doctor. 0802345xxxxx

Several factors could be responsible for your symptoms. If you have recently been under stress because of your business, that could explain both the headaches and the poor sleep. In turn, poor sleep can cause your blood pressure to rise, especially at your age.

On the other hand, persistently elevated blood pressure itself may be responsible for the headaches. However, it is not possible to make that determination based on a single blood pressure reading. You should have your blood pressure checked repeatedly over the next several days or visit a clinic in your neighbourhood for a proper examination. That will help determine whether hypertension is the primary problem or a consequence of another condition, and appropriate treatment can then be prescribed.

Good morning, doctor. For a long time, I have had electric shock-like sensations in both hands, along with pain around my neck. Last year, after X-rays and an MRI, a doctor advised me to wear a cervical collar and prescribed some medications. I stopped wearing the collar because people kept commenting whenever they saw me with it. Now the symptoms have returned, and the doctor has travelled abroad. I don’t know what to do. 0815255xxxx

There are several things you can do. First, return to the hospital where the investigations were carried out. Your medical records should still be there, allowing another doctor to review them and continue your treatment.

However, it appears that your treatment was incomplete because you did not comply with the instructions to wear the cervical collar. As a result, you have now suffered a relapse. Therefore, the first step is to resume wearing the collar as previously instructed before returning to the hospital for further evaluation.

Good evening, doctor. My nine-year-old daughter started coughing seriously about a week ago. I bought Coflin for her and she has been taking it four times a day, but the cough has not stopped. What should we do? 0806224xxxxx

Cough has many possible causes, ranging from environmental pollution and allergies to infections. Which of these are you treating?

Cough expectorants do not stop coughing. Rather, they help loosen mucus, making it easier to expel. In your daughter’s case, it is important for a healthcare professional to examine her and determine the underlying cause of the cough so that appropriate treatment can be given.

Good morning, doctor. I have what looks like a pimple on the outer side of my left ankle. It has been there for several years, although I cannot say exactly when it first appeared. I ignored it until about a month ago when it started becoming painful, especially whenever I wear sandals. I went to see a doctor, who simply looked at it and said he suspected skin cancer. That completely ruined my day, and I have been worried ever since. I will send you a recent picture on WhatsApp. Thank you. 0803631xxxx

This is interesting. From the picture, it does not display the typical features of skin cancer. Rather, it looks more like an epidermal cyst.

Nevertheless, you should visit a hospital to have it surgically removed. The tissue should then be sent for histopathological examination, which will establish the definitive diagnosis.