PRESENTATION BY: MARTHA NYAWERA NJAMA PROMETRA KENYA THE AFRICA HERBAL ANTI-MALARIAL MEETING- ICRAF- MARCH 20-22, 2006

1. IDENTIFYING ISSUES AFFECTING THE CONSERVATION, CULTIVATION AND PRODUCTION OF POTENT MEDICINAL PLANTS SPECIES RELEVANT TO MALARIA TREATMENT PRESENTATION BY: MARTHA NYAWERA NJAMA PROMETRA KENYA THE AFRICA HERBAL ANTI-MALARIAL MEETING- ICRAF- MARCH 20-22, 2006.

2. CONTENTS • Introduction • TMPs Experience in Treating Malaria in Kenya • List of Commonly Used Plants in Treating Malaria • Sustainable Management and Use of Promising Medicinal Plants

3. CONTENTS CONT’D • Important Factors Worth Considering for Improving the State of Art • Administration of Plant Medicine – A Case Study • Recommendations

4. INTRODUCTION 1.1 Problem: • Malaria infection has been one of the most prevalent and challenging problems in Kenya since time immemorial and although enormous strides have been made in trying to control it, malaria has remained the top killer disease surpassing even new-comers like the dreaded HIV/AIDS and ranging much higher than road accidents. • Initially, malaria had only been rampant in the low lying and humid parts of the country, but now the disease has spread further into the highland areas more especially with the recent emergence of the highland strain in the upper and colder parts of the country.

5. INTRODUCTION CONT’D 1.2 STATUS • Hospital records of a study carried out (1990-1997) in an endemic area of western Kenya showed malaria epidemics occurring almost annually, from May to July, with an annual attack rate of 50%. • It also showed that 32% of the deaths in hospitals were caused by malaria. • A further survey showed that only 8% had travelled to an area with known malaria transmission 30 days before diagnosis..

6. INTRODUCTION CONT’D • Altitude is thought to be a proxy for temperature, so the actual limiting factor for malaria at high altitude is the effect of the lower temperature on the parasite. Thus, despite the effect of altitude on the ambient temperature, microclimate factors (e.g heated houses ) can play an important role in facilitating malaria transmission and epidemics at higher elevations. • The main facilitating factor in all this is the fact that approximately 80% of Kenyan land is arid and semi-arid (lowland) while on the other hand 20% is arable (uplands).

7. INTRODUCTION CONT’D 1.3 Challenges: • In its efforts to bring the disease under control, the government has basically relied on biomedical treatment as the main source. • It has been found that while some of these anti-malarial drugs such as quinine and other synthetic drugs work, others have been found grossly wasting. • While this is the case, the use of herbal drugs to combat malaria has been going on since the beginning of time, with more and more people reportedly turning to herbal medicine for quite some time now due to these three main factors: first, the distance to the biomedical outlets (hospitals and health centers), is simply unmanageable in most rural Kenya.

8. CONT’D • Secondly, anti malaria drugs have become too costly and therefore unaffordable to the common man. • Lastly, malaria is becoming more increasingly resistant to the available biomedical drugs. This is not to mention the fact that in most cases there could be a facility like a health center but with no drugs.

9. TRADITIONAL MEDICINE PRACTITIONERS EXPERIENCE IN MANAGING MALARIA IN KENYA Traditional medicine practitioners (TMPs) have used a wide range of plant based treatments (in various forms) to combat malaria. Some have adopted Artimisia Annua which is prevalent in Chiulu Hills and Kajulu Hills. Others have also tried Artemisia afra (found in Kajiado district and some part of Western Kenya) but whose efficacy has not been tested. However, the main challege to the TMPs remains the mode of preparation and application whether in its raw form, boiled, powder, ash etc and in what quantity.

10. List of Commonly Used Plants for Treating Malaria

11. 3. SUSTAINABLE MANAGEMENT AND USE OF PROMISING MEDICINAL PLANTS 3.1. In-Situ: Plant based medicine can be managed in the wild while taking care of issues like: • Developing methods of low impact harvesting/ taking leaves and not interfering with plant. • Developing regulatory mechanisms and their enforcement to ensure sustainability.

12. CONT’D 3.2 Planting: Prometra Kenya is of the view that medicinal plants can be sustainably managed by planting them in different areas such as; Shambas, fences, boundaries, and backyards. The regulatory mechanisms should be developed and enforced to ensure sustainability.

13. 4. IMPORTANT FACTORS WORTH CONSIDERING FOR IMPROVING THE STATE OF ART 4.1 HARVESTING/STORAGE • Raw materials should be cut and dried in the shade to retain potency then stored in a clean environment away from the elements.

14. CONT’D 4.2. PROCESSING AND VALUE ADDING Experience has shown that processing and value addition of medicinal plant products from their raw form has a direct impact on distribution and marketing as the product becomes easier to carry and more attractive to the customers/clients at least after the first stage of processing. The different modes to consider in this regard include powder, ash, infusions, decoctions, steam, distillation, cream, syrup, gels and solidifying by evaporation, among others.

15. CONT’D 4.3 Marketing: Traditional medicine practitioners believe that medicinal plants from certain areas are more potent than others, thus making movement of plant materials quite dynamic in Kenya today. In addition, a class of business people (vendors) is emerging whose main business is to distribute medicinal plants from the point of growth to the consumer. However, in both cases, there is need to sound a caution as: (i) Little has been done or is now being done to validate the chemical ingredients associated with the medicinal potency of the plants thus distributed.

16. CONT’D (ii) When vendors are relied upon, those who are not knowledgeable in plant identification (vernacular plant names are generic based on the colour, taste, leaves or sap, will be confused and can even cause harm to the patient. Hence people involved in the use of plants from different areas need training in plant identification (plant taxonomy). There is also need for regulatory mechanism to ensure ethics and accountability

17. CONT’D 4.4 ADMINISTRATION OF PLANT MEDICINE: THEVESTIA PERUVIANA - (CASE STUDY) • It happened four years ago in a prominent community in Kenya. A young family of four, a son, a daughter, a mother and a father had retired to their kitchen for an evening meal after a hard day’s work. After a simple dinner of Ugali, sukuma wiki and dried fish, the parents reached for a pot of a plant root decoction that had been prepared as the meal was cooking. The parents had collected roots of this plant from an itinerant plant medicinal vendor from a nearby market a day earlier

18. CASE STUDY CONT’D • The decoction was meant to clear cases of Typhoid and amoebial infection, that had afflicted this family for some time. The father who had taken a mental record of the dosages for this treatment, pulled a mug from a carton stored in an old soot coated pottery suspended by a rope from the roof, and passed it to his wife to rinse. The father carefully poured out the decoction into the mug, about one eighth from the bottom for each child. The couple left for their living house beaming with confidence, convinced that they had fixed the trouble of some bugs that had plagued their children for many days.

19. CASE STUDY CONT’D • Settled in their living house, the couple proceeded to self administer the drug to themselves. The wife filled about three quarters of the mug with the decoction and drowned this before dispensing about the same amount of the decoction to her husband who drunk the same. Looking pleased with themselves once again, the couple retired for the night. • While the two children seemed to have enjoyed a peaceful night, the parents were less fortunate. They started having tummy cramps soon after midnight that appeared to increase in severity every minute. With both down and nursing ravening pain, it took them time even to alert the children. It was about 3.30 am to 4.00 am that the man pulled himself wreathing with pain and

20. CASE STUDY CONT’D • and reached the kitchen where the kids were sleeping. On hearing the news the kids dashed to their uncle’s village about a stone throw away. The uncle and his wife arrived at the fateful house at about 5.00 am, only to find the wife in a coma. They tried to administer some simple first aid, but it was too late. The poor lady passed away about half an hour later. The husband collapsed an hour later as they were struggling to reach a nearby dispensary. • The fateful plant was later identified as Thevestia peruviana (Cha mama in Luo)

21. ADMINISTRATION cont’d • There is need for standardization and training of TMPs in indigenous technology to muster scientific rationalization for example: information on phytochemistry to provide a basis for decision making. It is also important to note that all plants are toxic, all that matters is the amount used.

22. RECOMMENDATIONS • With adequate research on the traditional medicinal plants which our people have used for ages to treat diverse types of diseases, malaria included, there is hope for this making an enomous contribution into the authorized drugs on the market. • Artemisia Annua is a good drug but it is from China. There is therefore need to diversify medicinal plant sources for the treatment and control of malaria with a particular focus on those that grow here, are accessible and easy to cultivate.

23. RECOM CONT’D • 3. There is need for African governments to develop and enforce mechanisms to regulate harvesting, ethics and accountability in sustainable managing the plant based medicines • 4.There is need for standardization and training of traditional medicine practitioners especially in phytochemistry

24. Mrs. Martha Nyawera Njama PROMETRA KENYA P.O. Box 50797 Nairobi, Kenya Tel: +254-721-549006Tel: +254-20-788553 Email: nyambugu@yahoo.comprometrake@yahoo.com THANK YOU FOR READING