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Traditional Herbal Medicine Use Among Hypertensive Patients in Sub-Saharan Africa: A Systematic Review

  • Blood Pressure Monitoring and Management (G Ogedegbe and JA Staessen, Section Editors)
  • Published:
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Abstract

Hypertension is increasingly common in sub-Saharan Africa, and rates of hypertension control are low. Use of traditional herbal medicines (THM) is common among adults in sub-Saharan Africa and may affect hypertension therapy. We searched Ovid MEDLINE, Ovid EMBASE, and Web of Knowledge in June 2013 to find studies about THM use among hypertensive patients living in sub-Saharan Africa. Two independent reviewers evaluated titles and abstracts. Qualifying references were reviewed in full text. Data were extracted using a standardized questionnaire. Four hundred and eighty-one references were retrieved, and four articles from two countries met criteria for inclusion. The prevalence of THM use was 25–65 % (average 38.6 %). THM was the most common type of complementary and alternative medicines used by patients (86.7–96.6 %). Among THM users, 47.5 % concomitantly used both allopathic medicine and THM. Increased age (p < 0.001), male sex (RR 2.58), belief in a supernatural cause of hypertension (RR 2.11), and family history of hypertension (OR 1.78) were positively associated with THM use, while belief that hypertension is preventable was negatively associated with THM use (OR 0.57). More than one-third of adults with hypertension in sub-Saharan Africa use THM. Half of these patients use THM concurrently with allopathic medicine. Healthcare workers in sub-Saharan Africa must discuss THM use with their hypertensive patients. More research is urgently needed to define the impact of THM use on hypertension control and outcomes in sub-Saharan Africa.

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Acknowledgements

This project was supported in part by grants from the United States National Institute of Health/National Institute of Allergy and Infectious Diseases (AI098627), the National Institutes of Health Fogarty International Center (R25TW009337) and a United States Agency for International Development (USAID) leadership training program.

Author information

Authors and Affiliations

  1. Department of Clinical Pharmacology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania

    Anthony C. Liwa

  2. Department of Internal Medicine, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania

    Luke R. Smart & Robert N. Peck

  3. Center for Global Health, Department of Medicine, Weill Cornell Medical College, New York, NY, USA

    Luke R. Smart, Daniel W. Fitzgerald & Robert N. Peck

  4. Department of Ecology and Evolutionary Biology, Yale College, New Haven, CT, USA

    Amara Frumkin

  5. Samuel J. Wood Library/CV Starr Biomedical Information Center, Weill Cornell Medical College, New York, NY, USA

    Helen-Ann B. Epstein

  6. Bugando Medical Centre, Bugando Hill Road, Box 1370, Mwanza, Tanzania

    Luke R. Smart

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  1. Anthony C. Liwa
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Corresponding author

Correspondence to Luke R. Smart.

Ethics declarations

Conflict of Interest Anthony C. Liwa, Helen-Ann B. Epstein, and Robert N. Peck declare that they have no conflict of interest.

Luke R. Smart has received a grant from the National Institutes of Health Fogarty International Center (Grant #: R25TW009337).

Amara Frumkin has received paid travel accommodations from Yale Global Health Field Research Initiative.

Daniel W. Fitzgerald has received a grant from the United States National Institutes of Health, National Institute of Allergy and Infectious Diseases (Grant Number: K24 AI098627) and payments from the United States Agency for International Development (USAID) leadership training program.

Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Blood Pressure Monitoring and Management

Anthony C. Liwa and Luke R. Smart contribution equally

Appendix: Database Search Strategy

Appendix: Database Search Strategy

Medline (OVID SP)

  • #1 exp africa south of the sahara/

  • #2 (africa* adj (central or east or eastern or west or western or south or southern) ).mp

  • #3 (subsahara* or sub-sahara* or “sub sahara*”).mp

  • #4 (cameroon* or central africa* republic or chad or chadian or congo* or democratic republic of the congo* or equatorial guinea* or gabon*).mp

  • #5 (burundi* or djibouti* or eritrea* or ethiopia* or kenya* or rwanda* or somalia* or sudan* or tanzania* or uganda*).mp

  • #6 (angola* or botswana* or lesotho* or malawi* or mozambique* or namibia* or south africa* or swaziland* or zambia* or zimbabwe*).mp

  • #7 (benin* or “burkina faso*” or “cape verde*” or “cote d’ivoire*” or “ivory coast” or gambia* or ghana* or guinea* or guinea-bissau* or “guinea bissau*” or liberia* or mali or malian or mauritania* or niger* or nigeria* or senegal* or “sierra leone*” or togo*).mp

  • #8 or/1-7

  • #9 exp hypertension/ or exp antihypertensive agents

  • #10 (hypertensi* or antihypertensi*).mp

  • #11 ((high or increased or elevated) adj blood pressure).mp

  • #12 or/9-11

  • #13 medicine, african traditional/ or medicine, traditional/

  • #14 (african traditional medicine or traditional healing or traditional healer* or african medicine or ethnomedicine* or native medicine or ethnopharmaceutical* or ethnobotanical* or natural remed*).mp

  • #15 or/13-14

  • #16 8 and 12 and 15

Embase (OVID SP)

  • #1 exp Africa south of the sahara/

  • #2 (africa* adj (central or east or eastern or west or western or south or southern) ).mp

  • #3 (subsahara* or sub-sahara* or “sub sahara*”).mp

  • #4 (cameroon* or central africa* republic or chad or chadian or congo* or democratic republic of the congo* or equatorial guinea* or gabon*).mp

  • #5 (burundi* or djibouti* or eritrea* or ethiopia* or kenya* or rwanda* or somalia* or sudan* or tanzania* or uganda*).mp

  • #6 (angola* or botswana* or lesotho* or malawi* or mozambique* or namibia* or south africa* or swaziland* or zambia* or zimbabwe*).mp

  • #7 (benin* or “burkina faso*” or “cape verde*” or “cote d’ivoire*” or “ivory coast” or gambia* or ghana* or guinea* or guinea-bissau* or “guinea bissau*” or liberia* or mali or malian or mauritania* or niger* or nigeria* or senegal* or “sierra leone*” or togo*).mp

  • #8 or/1-7

  • #9 exp hypertension/ or exp antihypertensive agent

  • #10 (hypertensi* or antihypertensi*).mp

  • #11 ((high or increased or elevated) adj blood pressure).mp

  • #12 or/9-11

  • #13 african medicine/ or herbal medicine/

  • #14 traditional healer/ or traditional medicine/

  • #15 (african traditional medicine or african medicine or native medicine or native remed*).mp

  • #16 (tradition$ adj3 (healing or healer* or healed) ).mp

  • #17 (ethnomedicine* or ethnopharmaceutical* or ethnobotanical*).mp

  • #18 or/13-17

  • #19 8 and 12 and 18

Web OF KNOWLEDGE (Thomson Reuters)

  • #1 Topic=(cameroon* OR chad OR chadian OR congo* OR “central africa* republic” OR “democratic republic of the congo*” OR equatorial guinea* OR gabon*) OR Topic=(burundi OR djibouti* OR eritrea* OR ethiopia* OR kenya* OR rwanda* OR somalia* OR sudan* OR tanzania* OR uganda*) Timespan=All years Search language=English

  • #2 Topic=(angola* OR botswana* OR lesotho* OR malawi* OR mozambique* OR namibia* OR “south africa*” OR swaziland*) OR Topic=(zambia* OR zimbabwe* OR benin* OR “burkina faso*” OR “cape verde*” OR “cote d’ivoire*” OR “ivory coast”) OR Topic=(gambia* OR ghana* OR guinea* OR guinea-bissau* OR “guinea bissau*” OR liberia* OR mali OR malian) Timespan=All years Search language=English

  • #3 Topic=(mauritania* OR niger* OR nigeria* OR senegal* or “sierra leone*”) Timespan=All years Search language=English

  • #4 Topic=((africa OR african) NEAR/2 subsahara*) Timespan=All years Search language=English

  • #5 Topic=((africa OR african) NEAR/2 sub-sahara*) Timespan=All years Search language=English

  • #6 Topic=((africa OR african) NEAR/2 “sub sahara*”) Timespan=All years Search language=English

  • #7 Topic=((africa OR african) NEAR/2 (central OR east OR eastern OR west OR western OR south or southern)) Timespan=All years Search language=English

  • #8 #7 OR #6 OR #5 OR #4 OR #3 OR #2 OR #1 Timespan=All years Search language=English

  • #9 Topic=(hypertensi* OR antihypertensi*) Timespan=All years Search language=English

  • #10 Topic=((“blood pressure”) NEAR/2 (high OR increased OR elevated)) Timespan=All years Search language=English

  • #11 #10 OR #9 Timespan=All years Search language=English

  • #12 Topic=(ethnobotanical* OR ethnopharmaceutical* OR ethnomedicine) Timespan=All years

Search language=English

  • #13 Topic=(africa* NEAR/2 medicine) Timespan=All years Search language=English

  • #14 Topic=(native NEAR/2 (medicine OR remed*)) Timespan=All years Search language=English

  • #15 Topic=(folk NEAR/2 medicine) Timespan=All years Search language=English

  • #16 Topic=(traditional NEAR/2 (heal* OR medicine OR remed*)) Timespan=All years

Search language=English

  • #17 Topic=(natural NEAR/2 remed*) Timespan=All years Search language=English

  • #18 #17 OR #16 OR #15 OR #14 OR #13 OR #12 Timespan=All years Search language=English

  • #19 #18 AND #11 AND #8 Timespan=All years Search language=English

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Liwa, A.C., Smart, L.R., Frumkin, A. et al. Traditional Herbal Medicine Use Among Hypertensive Patients in Sub-Saharan Africa: A Systematic Review. Curr Hypertens Rep 16, 437 (2014). https://doi.org/10.1007/s11906-014-0437-9

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  • DOI: https://doi.org/10.1007/s11906-014-0437-9

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