Tradational medcine

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Group 3

Traditional Medicine in Ethiopia

ACIPH-HAWASSADecember 11, 2010

9 AM


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List of Group members

Senait Mekonen Shitaye Nega Solomon Nigussie Tariku Mideksa

Tewodros Yallew Weldu Kidane Yeshitila Hailu Yilak Getnet Yodit Assefa

Yohannes Bayessa Yoseph cheru Yosuf Ali Zemichael Mekonen


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Outline of presentation

Acronyms

Introduction-Global & Africa Perspectives Important Definitions General Objectives & Specific objectives Methodologies Back ground Information-The Ethiopian situation

Ethiopian Traditional Medicine Practitioners Association Regulatory situation-Policy/law/Review Organizational structures Researches and studies on TM-Explanation by an expert in the field Concepts about TM Integration and beyond in the health system

TM in Ethiopian health system-integrated? Inclusive? Tolerant? Conclusion Recommendation Acknowledgement References


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ACRONYMS

CAM-Complementary and AlternativeMedicine

DACA-Drug/Food/ Administration and ControlAuthority/ Food, Medicine and Health Care

Administration and Control Authority/

EHNRI-Ethiopia Health and Nutrition ResearchInstitute

TM-Traditional Medicine


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INTRODUCTION-GLOBAL & AFRICA

PERSPECTIVES

Traditional Medicine was the only systemavailable for health care for centuries forprevention ,diagnosis and treatment of social

mental and physical illness.

The potential contribution of traditional

medicine as an alternative or complementaryhealth system in developing countries hasbeen recognized ,WHO .

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Many countries in Africa, Asia and latineAmerica use TM to meet their primarily

health need. Africa 80% of the population uses TM Ghana, Mali, Nigeria and Zambia the 1st line of

treatment for 60% of children with high fever resulting

from Malaria ids the use of Herbal medicine At home.

Source: African Health monitor magazine 2003,volume4,Number1 6


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Use of TM rapidly spreading in industrializedcountries.

China The herbal preparation account for 30-50% of totalmedicinal consumption

Acupuncture ,massage and aromatherapy , widely used inEthiopia and money countries

US CAM therapies used; in 2002, prayer (45.2%), herbalism(18.9%)..

in 2004,nearly 1,400 hospitals found that more than one in fouroffered alternative and complementary therapies such asacupuncture,homeopathy, and massage therapy

Source: Alternative medicine - Wikipedia, the free encyclopedia.htm

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http://en.wikipedia.org/wiki/Herbalismhttp://en.wikipedia.org/wiki/Massage_therapyhttp://en.wikipedia.org/wiki/Massage_therapyhttp://en.wikipedia.org/wiki/Herbalism


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The factors contribute for widespread use oftraditional medicine in developing countries include:

1) the wide distribution of healers, traditional midwivesand lay persons knowledgeable of healing practices,especially in rural areas lacking modern health services,which can alleviate scarcity of modern health services,

2) the cultural acceptability of indigenous healing practices

due to the cultural affinity of the population to that oflocal healers

3) the availability of a wide range of traditional medicalresources (plants, animal products and minerals) andthe potential of developing various medicinal plants and

plant products into pharmaceutical drugs, and4) the success of traditional healers in treating a number ofmental illnesses not amenable to treatment by themodern health services, which are based on the Westernbiomedical model.

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IMPORTANT DEFINITIONS

Traditional Medicine

health practices ,approaches knowledge andbeliefs incorporating Plant, Animal and Minerals,

Spiritual therapies, Manual techniques andExperiences, applied singularly or in a

combination to treat ,diagnose and prevent illness

and maintain well being.

WHO

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Alternative medicine generally used to describe practices used

independently or in place of conventional medicine

complementary medicine used to describe practices used in conjunction with or

to complement

Traditional practitioner means a person who islicensed by the appropriate body to providetraditional medication;

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"integrative" or "integrated medicine indicate combinations of conventional and

alternative medical treatments which have some

scientific proof of efficacy; such practices areviewed by advocates as the best examples of

complementary medicine.

The combination of orthodox and complementarymedicine with an emphasis on prevention andlifestyle changes.

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OBJECTIVES

GENERAL OBJECTIVES:

To assess the status of TM in Ethiopia

Specific objectives:

-To assess how TM is handled and managed in Ethiopia-coordination issues

-To review studies and researches done in TM inEthiopia with more focus on Efficiency and safety ofTMs- Safety and Efficacy issues

-To study the role and contribution of TM in the modernmedicine/National health care or system in Ethiopia-Integration issues


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Methodologies

Brainstorming Review documents, research paper,

literatures, policies, guidelines

Key informant interview

Botanical gardens physical visit

Websites visit

Physical observation of traditional healthservice outlets


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TM-The Ethiopian situation

We go to war with the army we have, not the army we want

Donald Ramsfield
http://ethnomed.org/culture/ethiopian/images_ethiopian/photo-traditional-medicine-ethiopiahttp://ethnomed.org/clinical/pharmacy/images_pharmacy/eth_nutrition208034.jpghttp://ethnomed.org/clinical/pharmacy/images_pharmacy/eth_tradmedicine208291.jpg


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Background information-The

Ethiopian situation

Traditional medicine in Ethiopia includes medicinalpreparations from plant, animal, and mineral

substances, as well as spiritual healing, traditional

midwifery, hydrotherapy, massage, cupping, counter-irritation, surgery, and bonesetting.

- Traditional medical practices and remedies are

recorded in oral tradition and in early medico-religious manuscripts and traditional

pharmacopoeias, which, according to the estimates

of some historians, date back to the 15th century AD.


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Background cont..

TM in Ethiopia is a product of social institution andcultural traditions that have evolved over many

centuries to enhance health.

The ways of TM are diverse as the different cultures ,believes of Ethiopian nation.

Traditional healers is not only concerned with

curing of dieses but also with the protectionand promotion of human physical , spiritual,

social, mental and material wellbeing.

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Background cont..

Traditional medicine practitioners include: Bonesetters Birth attendants

Tooth extractors Herbalists Debtrea, Tenquay Spiritual healers, weqaby, and kalicha

Religious practices Praying and going to church Holy water(Tsebel) and Zemzem

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Background cont..

The Skill of THP believed to by given by GOD

Knowledge on TM is passed orally from fatherto favorite child ,usually a son, by some

spiritual procedure.

Some of the traditional medical practices arerecorded in early medico-religious

manuscripts and traditional pharmacopoeias,

which, according to the estimates of some

historians, date back to the 15th century AD.

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Background cont..

Healers obtain their drugs mainly from naturalsubstances;

Plants

Animals Minerals

Drugs are prepared in various dosage forms Liquids

Ointments Powders and pill

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Background cont..

Drugs are also prepared in a none formulated form andadditives are usually incorporated and more than one drugis used in a single dosage form.

Drugs are administered using different routes, the mainone being: Topical, oral and respiratory (inhalations)

When Side-effects become severe ,antidotes are claimed tobe used.

Healers also impose restriction when certain type of drugs

are taken by patients. Drugs are usually stored in containers like ,bottles, papers,

pieces of cloth, leaves and horns and were kept anywhereat home.

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Problems associated with TM

No recording and data The quantity and quality as well as the safety and

efficacy of data on TM are far from sufficient tomeet the criteria needed to support its use;

Some plants used in TM such as taenicides arewidely known to be Toxic.

Blindness and changes in CNS functions have

repeatedly been found in people who took overdosage ofHA.

Interaction with modern medicine

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Herb/Spice Common Uses DrugsAffected Mechanism Consequences


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Herb/Spice Common Uses Drugs Affected Mechanism Consequences

Garlic

Allium sativum

Nech shinkrut (A)

Tsada shgurti (T)

Qullabbiiadii (O)

CulinaryMedicinal:common cold,

malaria, cough,pulmonary TB,

hypertension,

wounds, STDs,

asthma, parasitic

infections,

toothache,diabetes,

hemorrhoids

AntiplateletsAnticoagulants

Insulin and oralhypoglycemic

agents

Cholesterollowering drugs

Thyroidreplacementtherapy

May be additivewith cholesterol-

lowering drugs

Hypertensive

activity but it isnot known if this

effect is

antihypertensive

drug additive

Decreases T3and T4 levelsMay have bloodthinning

properties

*Possible

increased risk ofbleeding;

*Reverseseffects of orally

administered

thyroxine

Dingetegna (A)

No common

English name

Taverniera

abyssinica

Medicinal onlyfor stomach

upset

Fever reduction

No specific class

Antispasmodicproperties may

affect absorption

of medication

Decreasedabsorption of

medication

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Problems associated with TM

May create delay in the treatment ofcommunicable disease- TB- if they fail to refer ptto modern medicine.

Money harmful practices have been created tohealers including female genital mutation,uvulaoectomy and milk tooth extraction.

No guidelines on the safety measures to use inperforming the practices

Contamination, sterility

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Increasing in numbers of false healers usinghome based medicine which is difficult to

distinguish. Only 10% of practicing healers are true

Ethiopian healers.

No rule and regulation on the storage anddispensing of TM

Sold in open market, with other materials, such as

spices, salt and other food items No strong ways of registering ,licensing and

supervising their activity.

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Statistics

Over 80% of the Ethiopian population rely on traditional medicine .Thisrepresents the majority of the rural population and sectors of the urbanpopulation where there is little or no access to allopathic health care.

In 2000 only 9.45% of all deliveries attended by trained attendants

and health workers* .

Based on 2009/2010 report of MoFED , it has reached to20.3%**

The rest were attended by traditional birth attendants or

relatives

Source: *Ethiopian journal health dev.2006;20(2)

**Ethiopia 2010 MDGs report,MoFED


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Ethiopian Traditional Medicine

Practitioners Association

-Traditional medicine is largely practiced bytraditional medicine practitioners, although,

particularly for certain common health problems, it is

also practiced at home by the elderly and bymothers.

-The Ethiopian Traditional Healers Association was

organized to review the qualifications of practitionerswhere no regulations exist.


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Ethiopian Traditional Medicine

Practitioners Association

In 1986, over 6000 practitioners of traditional medicinewere registered with the Ethiopian Ministry of Health .

Established in 1991

Membership at founding date-400 Membership to date-800 Objectives: To provide a forum for exchange of ideas

and experiences among traditional medicine

practitioners Source of fund: membership and/or internationalaffiliation-Institute of Bio-diversity


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The Need for setting up orstrengthening of structure forTM is become essential for

optimizing its use.

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Qw


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Regulatory situation-Policy/Proclamation/Review

-Proclamation 100 of 1948, Penal Code 512/1957,and Civil Code 8/1987 all state conditions for the

practice of traditional medicine and the importance

of the development and use of traditional remedies.-The 1974 change of government in Ethiopia was

followed by official attention to the promotion and

development of traditional medicine, particularlyafter the adoption of the Primary Health Care

Strategy in 1978.


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Cont

-In November 1979, the Office for the Coordinationof Traditional Medicine (21, 23), as a full-fledged

department directly under the Vice-Minister of

Health, was established to organize, train, andregister traditional medicine practitioners, and to

identify, describe, and register those traditional

medicines with actual or potential efficacy.


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Cont

-The Ministry of Health also incorporated traditionalmedicine into the National Ten-Year Perspective Plan

1984-1994 (24), which called for the organization,

training, and supervised use of traditional medicinepractitioners in strengthening and expanding primary

health care services.


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Cont

The Health Policy and the Drug Policy of 1993 bothemphasized the need to develop the beneficial

aspects of traditional medicine through research and

through its use in the official health delivery services.


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Cont

Proclamation 1999 was issued based on the NationalDrug Policy. In Article 6, Sub-Article 8 of the

Proclamation, it is stated that the Drug

Administration and Control Authority shall preparestandards of safety, efficacy, and quality of traditional

medicines and shall evaluate laboratory and clinical

studies in order to ensure that these standards are

met. The Authority shall also issue licenses for the

use of traditional medicines in the official health

services.


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Cont

PROCLAMATION NO. 661/2009

A PROCLAMATION TO PROVIDE FOR

FOOD, MEDICINE AND HEALTH CARE

ADMINISTRATION AND CONTROL-DACA


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Cont

16th Year No. 9

ADDIS ABABA 13th January, 2010

Proclamation No. 661/2009

Food, Medicine and Health Care Administration andControl Proclamation ..Page 5157

Regulation No.189/2010PART NINE

TRADITIONAL AND COMPLEMENTARY OR

ALTERNATIVE MEDICINE

Ed ti d t i i


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Education and training

No officially recognized education is provided intraditional or complementary/alternative medicine.

Insurance coverage

There is no national health care insurance or privateinsurance covering traditional medicine.


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RESEARCH & STUDIES IN TM IN

ETHIOPIA


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RESEARCH & STUDIES

Example I. Qualitative laboratory analysis for thedetection of conventional drugs in herbal preparationssupplied by healers in major towns of Ethiopia

Study by Asfaw Debella,Dawit Abebe,kissi mudie,Ashenafi Tadele,Awot G/Egezabher - EJHD

2008;22(1):55-62

Result: Active pharmaceutical ingredients were detectedin 39 or 51% of the 76 samples of traditional remediestested. The average price that healers charge for herbal

preparations adulterated with modern drugs was higherthan the full doze of the conventional drugs sold in retailpharmacies. Even the unadulterated preparations werefound to be more expensive than the latter.


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RESEARCH & STUDIES

Among Researcher observations in this study, there weresubstandard practice of

-Patient privacy

-record keeping

-storage of bulk remedies-product labeling

These can be corrected through awareness raisingprograms; however, what cannot be corrected is thedispensing of adulterated remedies with modern drugs,especially with antibiotics, whose negative effect onhealth and life is not limited only to the individual clientbut the community at large.


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RESEARCH & STUDIES

Conclusion:-Adulterated herbal preparation results in untowardeffects including increased emergence of resistantpathogenic strains. Sustained effort in creating

awareness among the communities by health workersand authorities is, therefore, crucial to curb the loomingdanger to public health.

-While existing legal frameworks may be sufficient toconsider punitive measures against perpetrators of suchinappropriate and unauthorized use of anti microbialagents, new ones that particularly govern the activities of

traditional healers need to be put in place.


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Conclusions..

8.There are many gaps between policy and actualpractices. There are clearly deficits in the organized

approach towards ensuring an optimal contribution

of TM to the national health system. For example,there were no regulations to the safety and efficacy,

licensing, as well as the registration and guidelines for

clinical


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Conclusions..

9.Moreover, there is no training institute exist on

traditional medicine. It is well known that trained healers

learn new knowledge quickly and integrate it in to their

practices. Training of adequate modern health

professionals can also provide better understanding of

the traditional system. This acquired knowledge by the

professionals in the two systems of medicine may lead tomutual respect, mutual understanding, productive

collaboration and delivery of effective health

services.


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Conclusions..

10.There is evidence suggesting a declining trend inthe number of traditional resources of medicinal

plants. This calls for an urgent action to document

and preserve the traditional medical knowledgebefore it disappears from the country.


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Recommendation

1. All stakeholders should work in collaboration to develop beneficial aspects of TM and

integrate it to modern medicine .

2. Awareness creation to traditional practitioner trough training about dosing, toxicity and

knowledge transfer of TM should be carried out.

3. Universities and MOH should work in collaboration to incorporate the training as

independent Field

4. Researches & studies should be done intensively in the area of TM Products & preparations.

5. The regulatory body should work with stake holders to control false healers.

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References

-FMOH,DACA,EHNRI websites-A historical overview of traditional medicine practices and policy in in Ethiopia-Ethiop.J.Health

Dev.2006;20(2):127-134

-Federal Negarit Gazeta- PROCLAMATION NO. 661/2009, Regulation No.189/2010, PART NINE,

Traditional and Complementary or Alternative Medicine

-Operational guidelines for monitoring of adverse drug reactions of traditional drugsFeb.2007,Addis Ababa-DACA

-Qualitative laboratory analysis for the detection of conventional drugs in herbal preparations

supplied by healers in major towns of Ethiopia -Ethiopia-Ethiop.J.Health Dev. 2008;22(1)

NB. A few Annexes to the PPT Presentation will be distributed during the presentation


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