TRADITIONAL MEDICINE AND TREATMENT
OF DIABETES IN TANZANIA
PRESENTER: DR. SHEILA MAREGESI
PHARMACOGNOSY DEPARTMENT- SCHOOL OF PHARMACY
MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES TANZANIA
Businet Diabetes Symposium
VLIR-OUS Sweet Care Conference
7-9th December, 2016
PRESENTATION OUTLINE
Introduction
Importance and History of Traditional medicine in Tanzania
Diabetes status and Prevalence of TMs use in Tanzania
Documentation of Traditional Medicines in the management
of diabetes
Scientific studies on antidiabetic activity of the documented
TMs
Examples of natural products used as antidiabetic medicines
Conclusion
INTRODUCTION: The United Repbulic of Tanzania
Figure 1: Tanzania and its bordering countries
(Source: CIA World Fact Book)
•It is located in the Eastern
part of Africa and is 31st
largest country in the
world. It is the largest
country in East Africa,
occupying an area of about
945,087 sq. km with the
total land area is of 885,321
sq. km.
•The current population of
Tanzania is 55,829,548
The capital city: DODOMA situated at the heart of
Tanzania the Lion rock is an attractive touristic site
The largest city: DAR ES SALAAM located
along the Indian ocean
Tanzania one of the world's greatest reservoirs of
biological diversity due the presence of extensive
National parks, the 'Eastern Arc' mountains,
wetlands, coastal forests, marine and fresh water
systems ideal ecology for plant and animal
species.
Among the 15,000 higher plants recorded in East
Africa, 12,000 species are found in Tanzania with
about 2,600 being endemic species.
40% of the world's wild coffee varieties
INTRODUCTION: Biological diversity of Tanzania
About 80% of the famous African violet flowers
are found in the rural areas of Tanzania
There are about 8270 species of marine
invertebrates characterized by endemism among its
members with over 1000 fish species.
About 1000 bird species
More than 60,000 insects and other anthropods
--Introduction: Biological diversity of Tanzania cont--
Mount Kilimanjaro, Africa’s highest peak in Africa ,
Many large and ecologically significant wildlife parks,
such as Ngorongoro Crater, the Serengeti National Park
Tanzanite, Diamond, Gold among other minerals
Some of the Remarkable features of Tanzania
Objectives of the Presentation
To describe the importance of Traditional Medicine
(TMs) in Tanzania,
To show Government commitment in TMs
To present literature data on traditional medicines for
treatment of diabetes in Tanzania based on ethnomedical
survey conducted some parts of the country.
To provide a benchmark for mapping way forward
for the search of traditional diabetic medicines from
Tanzania natural resources
•Traditional medicine is an outcome of the
experiences `and knowledge of natives through their
culture to treat overall physical and mental health.
•According to WHO definition; Traditional medicine
refers to health practices, approaches, knowledge and
beliefs incorporating plant, animal and mineral based
medicines, spiritual therapies, manual techniques and
exercises, applied singularly or in combination to treat,
diagnose and prevent illnesses or maintain well-being.”
(WHO, 2000)
IMPORTANCE OF TRADITIONAL
MEDICINE IN TANZANIA
Why do the people use traditional medicines?
•Traditional medicines are used as first aid, stop-gap
measure before the patient is referred to modern health
facilities or the only form of treatment where
conventional medicine is not available or affordable.
•In Tanzania about 60% of the urban population
and up to 80% of the rural population use TMs for
their health care services. Most of TMs (90%) are
botanical products.
•There about 75,000 Traditional medicine
practitioners in Tanzania
-- Definition and Importance of Traditional Medicine conti ---
•In the pre-colonial period: Practice of TRM started
far back beyond the establishment of allopathic Health
care systems. Traditional healers (TH) also called
Traditional medical Practitioners were the main
provider of health care services.
•In the colonial period (1890-1961): The authority of
Traditional healers and practice of TRM were very
much suppressed.
HISTORY OF TRADITIONAL MEDICINE (TMR)
PRACTICE IN TANZANIA
In the colonial period 1929: Two ordinances
were introduced; Witchcraft ordinance and
Medical Practitioners and Dentists ordinances were
introduced. The later gave provision of TH to
practice TRM in their localities.
•Post independence: Promotion of TM
practice
1968: new Medical Practitioners and Dentists
ordinances was issued approving TH to exist
and operate.
--- HISTORY TMR) PRACTICE IN TANZANIA ---
In 1974 The government established a Traditional
medicine Research Unit (TMRU) in the School of
Medicine. Later in 1991 TMRU was upgraded to the
Institute of Traditional medicine and given the
mandate to do research in TMs, treatment and
practices.
In 1982: Formation of Traditional medicine section in
MoHSW
--- HISTORY TMR) PRACTICE IN TANZANIA ---
In 1996: Formation of Tanzania Traditional Health
Practitioners Association by TH and Traditional Birth
Attendants (TBA
In 2002, the Traditional and Alternative Medicine
Act of Parliament No. 23 was passed whose
functions are to regulate traditional and alternative
medicines practice and establishes the Traditional
and Alternative Health Practice Council.
In 2005, Traditional and Alternative Health
Practice Council (TAHPC) was established for the
regulation of traditional medicine herbal medicine and
alternative medicine remedies
--- HISTORY TMR) PRACTICE IN TANZANIA ---
Regulate alternative medicine remedies, methods
and appliances;
Regulate traditional medicine remedies in order:
to regulate local marketing of traditional remedies;
to guarantee safe use by the population and to ensure
that the sale of remedies is not done outside a region
under which he/she practices without approval of the
Council;
Regulate herbal medicine and other traditional
medicine practices;
--- FUNCTIONS OF TAHPC ---
To enforce registration of traditional and
alternative medicine facilities and regulate
importation and exportation of traditional medicine
remedies, herbal medicine and alternative medicine
remedies.
To protect medicinal plants grown within the
country.;
To manage traditional medicine remedies at the
practioner's level; and
To provide for sustainable management,
utilization and development of material medicaused in traditional medicine.
--- FUNCTIONS OF TAHPC ---
Traditional and Alternative Medicine is one of
the components in the Primary Health Service
Development Programme 2007-2017 which is
one of the major Government undertakings in the
Social Services Sector with the following
objectives;
• To facilitate the provision of quality traditional
and alternative medicine services to all people to
enable them improve their wellbeing.
•To Promote standardization and formulation of
value added traditional medicine products
through the application of Traditional Model
Research and development
• To establish and strengthen registration of
traditional health practitioners
• To Institute Quality Assurance Programmes and
Certification of Traditional Medicine Products
The International Diabetes Federation
(IDF) estimates that 19.8 million people
have diabetes in Africa where
approximately 75% are still undiagnosed..
Type 2 diabetes (T2D) contributes up to
90% of all cases of diabetes.
Countries with the highest estimated
numbers of persons with diabetes include
Nigeria (3.9 million), South Africa (2.6
million), Ethiopia (1.9 million), and Tanzania (1.7 million). The prevalence
in urban versus rural Tanzania is 5.8% and 1.7%, respectively.
Diabetes Status in Africa and Tanzania
Chiwanga et al., 2016. Glob Health Action. 9 : 31440;
2. Moller and Flier, 1991. N. Engl. J. Med. 325: 938 - 948.
Study site
(district)
(Number) &
Interviewee
knowledge
Recorded
TMs
References
Study 1 (Focused) Handeni (169)
None
66Moshi et al., 2000, East Cent. Afri, J. Pharm. Sci. 3: 30 - 39
Study 2 (Focused) Kilosa (65)
None
54Moshi et al., 2002. Pharmaceutical Biology 40(7): 552-560.;
Study 3 (Focused) Moshi (481)
Knowledgeble
8Lunyera et al,, 2016. BMC Comp. &Alt.Med. 16: 282.
Study 4 (Non focused) Kagera Not mentioned 3Moshi et al., Journal of Ethnobiology and Ethnomedicine 8:14
Study 5 (Non focused) Tabora Not mentioned 7Augustino et al., 2011. J. Med.Plants Res.5(27):6352 - 6372
Total 138
Number of Documented Antidiabetic Traditional Medicines
•Some of these TMs are used in other countries for the same purpose
and have proven to possess antidiabetic activity (hypoglycemic,
insulin secretagogue activity and glucose tolerance) in animal model
experiments.
Documentation -TMs specific for diabetes treatment
Study 3: Traditional medicine practices among community members with
diabetes mellitus -Northern Tanzania: an ethnomedical survey (in Moshi
Distrit )
Participants
(Diabetic
patients,
Doctors,
Nurses,
Traditional
medicine
vendors).
________
481
No of
Diabetic
cases
______
9.4%
Prevalence
of TMs use
among
Diabetic
cases
________
77.1%
Prevalence of
Diabetic cases
using TMs
specifically for
diabetes
__________
40.3%
TMs and
biomedicine
use
concurrently
__________
37%
Reported
plants based TM
________________
Aloe vera,
Artemisia afra,
Cajanus cajan,
Clausena anisata,
Cymbopogon citrullus
Hagenia abyssinica
Moringa oleifera,
Persea americana
** The information reliable informants**
SCIENTIFIC STUDIES ON ANTIDIABETIC
ACTIVITY OF THE DOCUMENTED TMs
Improve Diabetic
condition
Worsen Diabetic Condition
Securinega virosa
Phylanthus amarus
Cassia auriculata
Ricinus communis
Albizia versicolor
Croton macrostachys
Maytenus putterlickioides
Lannea stuhlmanii
Albizia versicolor
Croton macrostachys
Maytenus putterlickioides
Lannea stuhlmanii
> 30% of the recorded TMs have
demonstrated antidiabetic activity in various
test methods using mice in other studies.
Study 3: Traditional medicine practices among community members with diabetes
mellitus in Northern Tanzania: an ethnomedical survey [9]
No. of
Participants
________
481
No of
Diabetic
cases
_______
9.4%
Prevalence
of TMs
use among
Diabetic
cases
________
77.1%
Prevalence
of Diabetic
cases using
TMs
specifically
for diabetes
__________
40.3%
TMs and
biomedicine
use
concurrently
_________
37%
Reported
Plants
________________
Aloe vera,
Artemisia afra,
Cajanus cajan,
Clausena anisata,
Cymbopogon
citrullus,
Hagenia abyssinica
Moringa oleifera,
Persea americana
Plants and Prevalence of TMs use among knowlegeable interviewee
•Informants: diabetic patients, nurses, medical doctors, traditional
healers and herbal vendors reported fewer but more reliable data
with 60% proven to have antidiabetic activity.
Photographs of antidiabetic plants
Majority of the Traditional medicine are still
undocumented since the knowledge is still passed
verbally among family members.
The validity/reliability of data obtained from
symptom-based approach remains questionable
because majority of the Traditional healers did not
understand diabetes!
PROBLEMS OF TRADITIONAL MEDICINES USED
TO TREAT DIABETES IN TANZANIA
•Despite Tanzania being rich in its diverse natural
resources in terms of flora, fauna and minerals,
very little has been reported in a systematic
manner and no comprehensive scientific
research accomplished to establish the
efficacy/safety of traditional antidiabetic
medicines or to identify/isolate bioactive
molecules for drug development.
•Natural resources are being depleted, with major
developmental and environmental implications e.g
species exintiction.
------ PROBLEMS OF TRADITIONAL MEDICINES USED TO TREAT DIABETES IN TANZANIA ----
Some antidiabetic medicines of natural origin
used in modern medicine (worldwide) include;
• Metformin,
• Picnogenol,
• Acarbose,
• Viglitol,
• Voglibose,
• Insulin etc.
CONCLUSION
•TMs are used in the treatment of diabetes in Tanzania
and sometimes together with conventional medicines as
reported, a negative medical phenomenon.
•We suggest to perform both acute and chronic toxicity
studies to establish TMs safety prior to further work to
identify bioactive compounds or preparation
standardized herbal formulation.
• To promote the use of safe and effective traditional
medicine by developing standardized herbal products
since allopathic medicine does not suffice the need.
•From the fact that, some edible insects like
Thasus gigas are believed to treat diabetes in
Mexico.
•In the future, we should expand our researches
to the animal kingdom particularly, common
edible insects/anthropods such as;
Grasshoppers, Termites, and Chaborous.
-------- CONCLUSION -------
ASANTENI KUSIKILIZA!
THANK YOU FOR LISTENING!
