Ali Arazeem Abdullahi1, Anton Senekal2 and Cecilia Van Zyl-Schalekamp2 Abstract
In this study, a qualitative research methodology (methods triangulation) was used to undertake an in-depth sociological analysis of local perception of forest and management of malaria in children younger than five years of age in two selected rural areas of Kwara State, Nigeria. The study found that forests and plants are socially and culturally constructed. They do not simply supply means of livelihoods they also serve as the sources of health and wellbeing. The majority of the caregivers preferred to begin treatment of malaria with these local resources. High level of optimism and conviction about the efficacy of herbal medicines, at least at the onset of symptoms of malaria in children, was demonstrated by the majority of the caregivers, a factor identified by the majority of health officials interviewed as major stumbling block in early utilization of modern health care services. The most frequently mentioned plants and leaves were dogonyaro (Azadirachta indica), ewe akintola (Chromolaena odorata), mango leaves (Mangifera indica), pawpaw (Carica papaya), orange leaves, lemon grass, cashew leaves, and a local resource known as panseke. Where different leaves and plants are mixed together they are called ija-kuja. Although agunmu (ground herbal medicine) is commonly used by the adults, some informants considered it as viable in the management of malaria in children. Modern health care facilities are generally considered as alternative to indigenous medicine. The paper therefore suggests the need to preserve indigenous knowledge of medicine in Nigeria for a sustainable development.
From time immemorial, malaria has been a major public health problem in Nigeria and the rest of Africa. It was a major stumbling-block to the take-off of the Western imperialistic occupations across West African societies as several White colonialists and evangelists died from malaria. Indeed, to many White colonialists, West African societies were the ‘White man’s grave’ (Curtin, 1990: 63). Hence, the fight against the scourge of malaria in West Africa and Nigeria in particular became one of the priorities of the colonialists using Western science and medicine not only to ‘help’ the local people but to match-forward colonialism and ‘civilization’. Ronald Ross has arrogantly observed in 1900 that the fight against:
“Malaria fever is important not only because of the misery it inflicts upon mankind but because of the serious opposition which it has always given to the march of civilization in the tropics... it strikes down not only the indigenous barbaric population but with still greater certainty, the pioneers of civilization – the planter, the trader, the missionary, the soldier” (quoted from Alubo, 1995: 41).
However, more than a century since the war against malaria started in Africa the burden of malaria is yet to be abated. Like other malaria endemic regions, children younger than five years of age are the most vulnerable populations. Approximately 80% of children younger than five years who die from malaria related complications are from Sub-Sahara Africa (SSA) (Crawley et al., 2010). In Nigeria, several reports have shown that more than 250 000 children below the age of five die from malaria every year (FMoH, 2009: 10) representing 30% of infant mortality (Okafor and Amzat, 2007: 156) and 25% of the global malaria deaths in children (Abdullahi et al. 2012; Abdullahi, 2011). Furthermore, more than 50% of outpatient visits, 40% of hospital admissions, and 10% of maternal mortality are due to malaria infections in Nigeria (Okafor and Amzat, 2007: 156).
Retrospectively, several years prior to colonial contact, local people across African indigenous communities, including Nigeria, had coped with and managed the threat of malaria not only because they had developed immunity against malaria as reported by Curtin (1990), but because they had developed a home grown health care system that had endured and subdued the threat of malaria. However, the colonial government appeared to be sceptical, apprehensive and pessimistic about the authenticity, validity, reliability and quality assurance of indigenous knowledge of medicine (IKM). Consequently, the home grown health care system was discountenanced and became an object of ridicule under the colonial tutelage across African societies. In some societies at the time the use of traditional medicine (TM) was completely banned and criminalized. This was the situation across Southern African colonies. The Witchcraft Suppression Act of 1957 and Witchcraft Suppression Amendment Act of 1970 were deliberately enacted to destabilize and criminalize TM practice in South Africa (Abdullahi, 2011). Protests by the traditional medical practitioners against such an institutional gang-up and discrimination against TM were reported in Nigeria in the 1920s (see Erinosho, 1998, 2006). The moves against IKM were due to widespread belief among the colonialists that IKN was ‘unscientific’, ‘backward’ and ‘uncivilised’.
However, in spite of the institutionalized gang-up and negative remarks against IKM across Africa, particularly in Nigeria, IKM has continued to thrive and blossom. The demand for it has grown exponentially. Currently, more than 70% of African population is said to use TM to treat various ailments (Abdullahi, 2011). Recent scientific studies of medicinal plants have identified more than 500 medicinal species used in the management of numerous ailments in Nigeria, many of which are used by traditional healers (Weintritt, 2007: 119). It is in view of this that this study examined IKM used in the management of malaria in children in rural Nigeria with a view to contribute to the on-going global discourses around indigenous knowledge (IK) preservation for sustainable development.
Study Area and Methodology
The study was conducted in Okanle and Fajeromi rural areas in Ifelodun Local Government Area of Kwara State, Nigeria. Kwara State occupies a land area of about 32 500 sq kilometres. It has a population of more than two million people based on the 2006 census (Federal Republic of Nigeria, 2009: 34). The headquarters of Kwara State is Ilorin. The State is bounded in the north by Niger state, Osun and Ondo States in the south, Kogi State in the east and Oyo State in the west. It shares an international boundary with the Republic of Benin. There are two main climate seasons in the State: the dry and wet (raining) seasons with an intervening cold and dry harmattan (windy) period usually experienced between December and January. Figure 1 indicates the map of Kwara State highlighting Ifelodun Local Government where the study was carried out.
Figure 1: Map of Kwara State Indicating Ifelodun Local Government Area. The insert is the map of Nigeria.
Specifically, Okanle Village Area Council was established in 1956 with other seven villages that included Fajeromi (Okanle Descendant Union [ODU], 2009: 3). Both communities are very close to each other and have maintained a cordial relationship over the years. They are less than 2km away from each other. The villages are about 30km from Ilorin along Offa/Ajase Ipo Road and exactly 6km from Idofian town. Both communities are rich in forest resources hence the majority of the people derive their livelihood from the forests through farming and hunting. Apart from providing sources of income to the local people, forest resources are also used to maintain wellbeing, which are readily available in their natural forms. Knowledge about local medicines is usually handed down from generation to generation in oral form. Figure 2 shows the environmental characteristics of Okanle in terms of natural resources where the key to wellness lies. Like the rest of the State, the communities also experience wet or raining season as well as dry season. Even though raining season brings fresh plants and leaves it could also create a breeding ground for mosquitoes responsible for malaria causation. Coincidentally, cases of malaria, especially in children, are most rampant in the communities during raining period.
Data Collection Techniques
This study adopted complementary qualitative methods to collect data. The methods included twenty (20) semi-structured interview, ten (10) in-depth interview and two (2) focus group discussions (FGDs). Respondents were selected using purposive sampling technique. Participants included mothers, fathers and grandparents of children under the age of five years whose child or ward had manifested malaria symptoms at one time or another and who could have used home treatment (HT). However, the majority of the respondents were women because they were in the best position to discuss the issues under investigation. They were involved in domestic responsibilities more than men. The qualitative techniques were employed to achieve the objectives of the study. Other reasons for using these techniques are that a) the majority of the potential respondents were illiterate and therefore could not read nor write; b) it was assumed that the potential respondents were familiar with the interview method as a communicative event considering the fact that discourses about malaria sometimes between health practitioners and caregivers or within members of the family usually occurred in interview format using direct verbal questions; and c) it is common knowledge that qualitative interviewing is useful in exploring an individual’s attitude and values (Byrne, 2004: 182) and that it is a veritable tool that allows the voices of caregivers to be heard in health studies like this (see Gysels et al., 2008). These methods were corroborated with visual methods.
The data for the study were gathered between October and December 2009 and a follow-up took place between September and October 2010. An update of the field work was carried out in May 2013. All interviews and FGDs were conducted in the local language and later transcribed into English for analysis. All interviews and discussions were tape-recorded. A note book (jotter) was also used to take field notes, particularly on non-verbal aspects of the interview that included distractions, respondent’s nervousness or otherwise, key terms and names where important. Interviews usually took place in the evening when people had returned from the farm. Throughout the course of the interviews, the participants were given the freedom to start and end the conversation when they felt like, yet making sure that all elements of the issues were covered. Data were analysed using content analysis.
Results Perceptions of the Forests among the Locals
This section addresses the nuances surrounding local people’s perceptions of the forests and management of malaria in children. Perception is the process by which information is gathered, processed, interpreted and acted upon by a person or a group of persons (Jegede, 2002). Forest perception is therefore important in the understanding of the relationship between the people and the forests. Rural people who have lived around forests have graciously benefited from them and they have also given back to the forests in terms of ownership and protection. In a study of forest perception and forest use among the Tiriki community in Western Kenya Taubert and Pretzsch (2007) found that the local people held the forests tenaciously because apart from providing a home, forests also provide livelihood for a great number of rural people living in and around them. They serve as vital safety nets, helping rural people rising above poverty (Sunderlin et al. 2003), especially where they have been politically neglected by the government. Beyond the alleviation of poverty, forests are enormous sources of natural products for human well-being in rural communities. Experience has shown that extracts from trees and plants contain a variety of bioactive compounds which possess biological activities and which the rural people have utilized through the ages for TM to improve their well-being (Karjalainen et al., 2010). The benefits people derive from the ecosystems are generally referred to as ecosystem services (Millennium Ecosystem Assessment [MA], 2005).
Interviews with the leaders and other members of the communities revealed that the local people studied have a positive attitude towards the forests and perceived it as a major part of their livelihood, identity and well-being. The forests are seen as both cultural and natural rights different from those “rights” provided by the states. The local people see the forests and everything in them as “theirs” and any attempt to ‘snatch’ natural rights away from the people may be met with some degree of hostility and protest. Hence, like the Tirikis of Western Kenya, forests are held tenaciously by the local people studied thereby giving the forests a new ‘developmental’ symbolism and characterisation. The interviews showed that the people are emotionally, spiritually and culturally attached to their forests. Apart from meeting their profane and daily needs such as firewood, grazing ground for cattle and farming, forests provide trees and plants that contain biological components which are transformed into medicines and health diet by the local people. To obtain these medicinal ingredients is highly convenient. Most of the plants are readily available in the forests without any fee attached. This makes them conveniently accessible and affordable to most families (Figures 2&3 show the natural environment of Okanle/Fajeromi). The following submissions were used to buttress argument by the respondents:
“Forests are natural resources bestowed upon us by God. They are our gifts from God. They have become our cultural and natural assets. So, we are grateful to God for this wonderful opportunity. The forests give us everything we need. They are the sources of firewood. They contain varieties of fruits that are good for the body. We eat them and become strong. Can’t you see people here are stronger than people living in urban centres?” (smiling). (One of community leaders).
“Our people here have benefitted from the forests over the years. To the east and west they are blessings of God to us. I have seen a lot of people benefitting from them. This is where we farm and hunt for animals of all kinds. To me, the forest is a place where people get food when they have no food. It is where they get meat when they have no meat. As you can see people here are poor. We depend on these forests for survival.” (Another community leader).
“Apart from serving as sources of food and animal for the majority of the people here, forests are places where we get well when we sick. They house some of the best biological ingredients that are beneficial to human well-being. For instance, to prepare herbs for malaria is simple. All you have to do is enter the forest of your choice and assemble the most appropriate leaves and plants. After preparation take as prescribed. They cost no money.” (A mother in Fajeromi).
Figure 2&3: The Natural Environment of the Study Communities
Perceived Symptoms and Management of Malaria in Children
Biologically, a distinction is often drawn between complicated and uncomplicated malaria. On the one hand, the symptoms of uncomplicated malaria include fever, vomiting, high body temperature, coldness, headache, muscle aches and tiredness. These could be accompanied by shivering, loss of appetite (anorexia) and joint pains (see Crawley et al. 2010: 1470; Makundi et al. 2006: 2). The symptoms of complicated malaria on the other hand include anaemia (blood deficiency), convulsions, coma and even death (see Jamison, et al. 2006: 73). In the communities studied, the majority of the caregivers interviewed believed that malaria in children is manifested through high body temperature, vomiting, headache, uncharacteristic quietness, loss of appetite, shivering and weight loss. From this argument, it surfaces that there may be a correspondence or a point of convergence between biomedical construction of symptoms of malaria (uncomplicated) and community’s representations of malaria symptoms. In other words, biomedical views of symptoms of uncomplicated malaria particularly in children are contained in the traditional views of how malaria is manifested in children. Similar findings have been reported in previous studies. In the study by Ahorlu et al. (1997: 491) in Ghana, headache, high body temperature, vomiting, weakness of body and loss of appetite were mentioned as the principal manifestations of uncomplicated malaria. The perceived symptoms of malaria in children in the current study are illustrated in the following quotation:
“There are many symptoms of malaria in children. Once my child refuses to play around the way he used to; when he is weak and the body temperature is beyond ordinary; then I know malaria is coming. These symptoms, however, vary from child to child. Some children don’t run temperature when they have malaria but they may have a kind of cold. I have come to know these through my everyday experience and not through health talks with any health official. I use to observe the activities of my children and when something goes wrong I quickly notice and react immediately. A responsible mother should know when her child begins to have malaria problems because it is a common problem here. As you can see him now (pointing to her baby), once he starts crying unnecessarily or stops playing or becomes aggressive, then I know it has something to do with malaria”. (a 33 year old mother from Fajeromi with a child under the age of five).
Consequently, following the positive attitude towards the forests, especially as sources of wellbeing and health, treatment of diseases like malaria episode in children usually commences at home with herbal medicines generally known as oogun-ibile or agbo-ibile. High level of optimism and conviction about the efficacy of herbal medicines at least at the onset of symptoms of malaria in children was demonstrated by the majority of the participants. Herbal medicine is usually seen as the first point of treatment and the most convenient. It is also the cheapest form of treatment. It is a home-grown system of care and culturally compelling. The therapies comprised principally of local plants, bark of a tree or root which are usually boiled together to make malaria herbs specifically known as agbo-iba. They are sourced from the nearby forests. The agbo-iba is used as a normal wash either with or without local soap known as ose-dudu after boiling. Some of the leaves are also used as sponge. Agbo-iba is also used as a medicinal drink usually administered at least three times daily as long as the symptoms persisted. As informants argued, this practice has been entrenched in the community’s knowledge of medicine over a period of time. The majority therefore expressed satisfaction with the use of herbal medicine in the management of malaria in children. One of the women interviewed in Fajeromi said with some level of confidence that “everybody in this village knows that I don’t go to the clinic when I’m sick and I don’t take my children there either. I prefer herbal medicines… It’s what I inherited from my parents” (Abdullahi et al. 2012).
Sometimes, children above three years of age are asked to inhale the vapour from warm herbs for a few minutes while covered with thick shrouds (usually blankets) to allow the generation of sweat, which was believed to be a sign of recovery. The use of herbal medicine was despite the fact that there was a community clinic within a distance that can be traversed. This act confirms that most parents usually ignore the modern health facilities, especially at the onset of malaria symptoms in children. Surprisingly, there were no specific individual persons regarded or known as traditional healers professionally endowed with IKM in the rural areas studied. Almost everybody in the village is believed to be a “healer”. A 70 year old grandfather in Fajeromi argued that “almost everybody in this village is a healer. We all know the kind of leaves, plants or root to assemble to treat malaria either in children or adult”. This position has been supported by empirical studies. Some studies have shown that the commonality of malaria in some indigenous communities has rendered the services of the traditional healers unattractive to caregivers as people already knew how to prepare herbal remedies to cure malaria (Abyan and Osman, 1993: 17). The locals learn the medicinal values of leaves, root and bark of trees from each other. However, the elderly people in the village were believed to have more experience than the younger ones.
Some Plants Used in the Treatment of Malaria in Children
Dozens of local plants, leaves and roots are available in the communities studied used in the management of malaria, especially in children. The most frequently mentioned plants and leaves during the interviews were dogonyaro (Azadirachta indica), lemon grass (Cymbopogon citrates), akintola (Chromolaena odorata), cashew leaves and nuts (Anacardium occidentale), pawpaw (Carica papaya), mango leaves, orange leaves and panseke. In most cases, different leaves and plants are mixed together to treat malaria and they are called ija-kuja. It could be drunk or bathed with or steamed. A type of preparation is known as akida or aseda. The name comes from the mode of preparation. In this mode of treatment, mothers prepare herbs using a combination of plants and after use in the first instance they throw it away. This is repeated until the child is well. The nature of preparation of aseda or akida was considered by the majority of the respondents as too tedious and time-consuming. As a result, they opt for a less tedious preparation which includes the mixture of a number of plants with either 7UP drink, osan-wewe (Citrus aurantifolia) also known as oronbo (lime). Although agunmu (ground herbal medicine) is commonly used by the adults, some mothers administered it on children to treat malaria. The agunmu substance can be used together with a locally made eko (pap) or ordinary water or omikan or omidun. It is usually administered 2-3 times daily. The efficacies of these plants were expressed by the majority of the respondents in the following statement:
The injections given in government hospital only suppress malaria. They don’t cure it. To treat malaria holistically in my children you mix a number of local plants. These include ewe mangoro, egbo-egbesi, and ewe laali and many others. I cook them together and give to them to drink and bath. Where necessary, I also administer agunmu on them. The agunmu is added to the pap. The herbs make the baby defecate. I swear, once the baby defecates or urinates, the whole parasites will be forced out of the system even if the parasite was hiding under the finger-nail ... I prefer to use traditional medicine because it is faster and more effective depending on the plants combined ... I believe that traditional medicine is more effective in the management of malaria in children than the white man’s tablets because the herbs will penetrate the nooks and crannies of the body to attack malaria parasites. In fact, I don’t wait for my children to have malaria before I give them herbs. There are different kinds of them. They use it to bath and drink. You can see that my children are looking very healthy (pointing at the children). They hardly have malaria. (a mother in Fajeromi).
I have a belief in traditional medicine than oogun oyinbo (White man’s medicine). People who detest traditional medicine are only wasting their time. The reason is that even most of the Oogun oyinbo are extracted from local plants and trees. So, why would somebody condemn what he or she will eventually use only that it is in a different form? They are well packaged. (A mother in Okanle).
Although there are several local plants and leaves used in the management of malaria in the local communities, the following pictures only showcase very few of them:
Dry Mango leaves (Azadirachta indica) locally known as “ewe mangoro”.
Dry Guava leaves (Psidium guajava).
Dry Alstonia boonei locally known as“ewe ahun”
Malaria is one of the oldest diseases that have threatened the world for a long time. Curtin (1990) noted that malaria constituted a great threat to the realization of Western imperialistic occupations in West Africa during colonial period as many White colonialists succumbed to the disease. Consequently, malaria became one of the major priorities of the colonial administration at the onset of Western imperialism across West African societies (Curtin, 1990). Unfortunately, the threat posed by malaria has continued to linger in the 21st century with more than 40% of the world’s population at risk of malaria in more than 100 endemic countries (Crawley et al. 2010: 1468; Medicines for Malaria Venture [MMV], 2000: 1). Reports have also indicated that more than 400 million clinical cases of malaria are reported around the world every year (Crawley et al. 2010: 1468; Sadiq et al. 2009: 116) while more than 70% of malaria deaths occur among children in Sub-Sahara Africa (Crawley et al. 2010).
Apart from reported deaths attributed to malaria in children, several critical health conditions are also associated with complicated malaria. They include anaemia (moderate or severe), convulsions, kidney failure, jaundice (yellow colouring of the skin and eyes) and coma (Jamison et al. 2006: 73). An association between malaria and diarrhoea has also been documented in Nigeria where children with dehydration are found to manifest malaria parasites (Ibadin et al. 2000: 117). Retinopathy has also been reported in children with severe malaria in Ghana (Essuman, et al. 2010: 4). Like other malaria endemic regions, the worst malaria cases in Nigeria occur in rural areas following certain socio-cultural and environmental bottlenecks (Ajadi et al. 2012). Fortunately, the threat and severity posed by malaria to children was overwhelmingly acknowledged by the majority of the caregivers interviewed in this study, which informed early reaction from parents. Among the people studied, like the rest of Yoruba communities, malaria is commonly known as iba. This termis used to accommodate different phases or dimensions of malaria sometimes with some prefixes and suffixes. For instance, iba-apanju (symptoms of typhoid fever) was considered by the majority as an example of ako-iba (complicated malaria) (Abdullahi et al., 2012). Thus, local people studied demonstrated gook knowledge of symptoms of uncomplicated malaria.
However, while the popular voice in the medical circle advocates for an immediate response to malaria using approved modern health care services, in the communities studied, response to malaria is clouded by cultural imperatives because as observed by scholars every people has a way of investigating and ascertaining the cause, symptoms and treatment of diseases (Jegede, 2005: 122). Among the people studied, management of malaria depends largely on indigenous knowledge of plants and leaves thereby giving natural resources like forests some social meanings. IK, including those of medicine, is an integral part of culture and history of a people (Gorjestani, 2000). It is often seen as problem-solving strategies available to local communities (World Bank, 1998). Forests do not just supply means of livelihoods they also form an essential, integral and intimate part of their social and cultural existence. Most importantly, forests are perceived by the people studied as sources of health and wellbeing. This perception coincides with a submission made by Karjalainen et al. (2010) that forests and trees supply an abundance of ecosystem services that help in creating healthy living. This also agrees with a report by the World Health Organisation in Nigeria, Gambia, Ghana and Mali that more than 60% of children with malaria are treated at home with indigenous medicines (Abdullahi, 2011: 116).
The local plants and leaves used in the management of malaria in the communities studied were believed by the majority to be effective. The statements by some of the respondents that “everybody in this village knows that I don’t take my children to the hospital” and that “most modern drugs are extracts from local trees and plants” are testimonies to the perceived efficacies of local plants in the management of malaria. This cannot be disconnected from the fact that people who have lived in or around the forests have rich knowledge of local medicine which is embedded in IK. IK is a kind of knowledge built up by groups of people through generations of living in close contact with nature. Such knowledge is usually transferred from one generation to the other via oral tradition. According to Brockman (1997:1) IK is built upon the historic experiences of a people and adapts to social, economic, environmental, spiritual and political change. IK is used by the local people at the local level as the basis for making vital decisions concerning health and other important activities (Gorjestani, 2000).
Incidentally, investigations into the biological components and efficacies of local plants in the management of diseases have attracted researchers and this is currently taking a centre stage in academic discourses. Randrianarivelojosia et al., (2003) have documented local plants used by traditional healers in the Eastern region of Madagascar in the treatment of tazo (malaria). Pascaline et al., (2011) have taken an inventory of medicinal plants used by the Nandi people of Kenya in the management of malaria. Pierre et al., (2011) have also documented medicinal plants used in the management of malaria in Cameroon. Each of the chapters in A Text Book of Local Plants From Nigeria is devoted to local plants used in the management of different diseases across Nigeria (Odugbemi, 2008). Specifically, Odugbemi et al. (2007) identified more than 50 local medicinal plants used for malaria therapy in Okeigbo, Ondo State, Nigeria, some of which have been mentioned in the current study. These are presented in tabular form.
Table 2: Medicinal Plants Used in the Management of Malaria in Okeigbo, Ondo state, Nigeria
Human health, biodiversity and ecosystems are intimately connected. Such connections have been established in the current and previous studies. Classical studies such as those of Bronislaw Malinowski (1884-1942) among the Trobriand Islanders off the Coast of Guinea, Edward Evans-Pritchard (1902-1973) among the Nuer people in Southern Sudan, Alfred Reginald Radcliffe-Brown (1881-1955) among the Andaman Islanders in Australia and Emile Durkheim (1858-1917) among the Australian Aborigines have shown that the local people have maintained a close-knit relationship with the nature, especially forests. The forests had served as sources of food and health to the people who have lived in and around them. The forests have not only benefitted rural people they have benefitted humanity in general. For instance, quinine which was used to cure malaria for several hundreds of years was made from the bark of the cinchona tree, commonly found in Peru and Ecuador (Tren and Bate, 2005). Quinine helped to reduce the incidence and prevalence of malaria across Europe prior to the development of resistance in South America which later spread to the rest of the world. At the time, in Italy, malaria-related deaths decreased from 15 000 to just over 2 000 (Bruce-Chwatt and Zulueta, 1980: 94; Tren and Bate, 2005: 10). In the same vein, Artemisinin-based combination therapies (ACTs) which is currently acknowledged as the most effective treatment regimens against malaria parasites, including p. falciparum is a derivative of the Chinese medicinal plant, Artemisia annua with an ancient Chinese name, qinghao (Biesen et al., 2010). Therefore, the argument by one of the respondents in this study that “why would somebody condemn what he or she will eventually use (TM)” further confirms the authenticity of IKM and the connection between nature and human health.
Thus, as the search for anti-malaria vaccines continues, the alternative drugs, usually the artemisinin-based Combination Therapies (ACTs) are becoming too expensive for the poor people who feel the brunt of malaria problem. Reports have shown that of the 34 African countries that have updated their national drug formularies to reflect WHO’s recommendations (Stratton et al. 2008: 859), only eleven of them are distributing ACTs through the public health sector - one on which many people depend (WHO, 2010: xi). Therefore, IKM as explicated in this study and other studies might hold the key to affordable, cheaper and better alternative therapy to malaria in both the children and adults. Hence, there is a controversial proposal in some quarters about the need to integrate IK into modern knowledge in global health discourse (World Bank, 1998).
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1 Department of Sociology, University of Ilorin, Nigeria and University of Johannesburg, South Africa. Corresponding author Email: firstname.lastname@example.org. Cell: +234 806 969 6844
2 Department of Sociology, University of Johannesburg, South Africa.