Group 3

Traditional Medicine in Ethiopia ACIPH-HAWASSA December 11, 2010 9 AM

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

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

ACRONYMS
CAM-Complementary and Alternative Medicine DACA-Drug/Food/ Administration and Control Authority/ Food, Medicine and Health Care Administration and Control Authority/ EHNRI-Ethiopia Health and Nutrition Research Institute TM-Traditional Medicine

INTRODUCTION-GLOBAL & AFRICA PERSPECTIVES

Traditional Medicine was the only system available for health care for centuries for prevention ,diagnosis and treatment of social mental and physical illness. The potential contribution of traditional medicine as an alternative or complementary health system in developing countries has been recognized ,WHO .
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 Many countries in Africa, Asia and latine America 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

 Use of TM rapidly spreading in industrialized countries.

China The herbal preparation account for 30-50% of total medicinal consumption Acupuncture ,massage and aromatherapy , widely used in Ethiopia 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 four offered alternative and complementary therapies such as acupuncture, homeopathy, and massage therapy
Source: Alternative medicine - Wikipedia, the free encyclopedia.htm

 The factors contribute for widespread use of traditional medicine in developing countries include:
1) the wide distribution of healers, traditional midwives and 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 of local healers 3) the availability of a wide range of traditional medical resources (plants, animal products and minerals) and the potential of developing various medicinal plants and plant products into pharmaceutical drugs, and 4) the success of traditional healers in treating a number of mental illnesses not amenable to treatment by the modern health services, which are based on the Western biomedical model.
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IMPORTANT DEFINITIONS
Traditional Medicine
health practices ,approaches knowledge and beliefs incorporating Plant, Animal and Minerals, Spiritual therapies, Manual techniques and Experiences, applied singularly or in a combination to treat ,diagnose and prevent illness and maintain well being.

WHO

IMPORTANT DEFINITIONS
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 is licensed by the appropriate body to provide traditional medication;
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IMPORTANT DEFINITIONS
"integrative" or "integrated medicine
indicate combinations of conventional and alternative medical treatments which have some scientific proof of efficacy; such practices are viewed by advocates as the best examples of complementary medicine. The combination of orthodox and complementary medicine with an emphasis on prevention and lifestyle 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 Ethiopiacoordination issues -To review studies and researches done in TM in Ethiopia with more focus on Efficiency and safety of TMs- Safety and Efficacy issues -To study the role and contribution of TM in the modern medicine/National health care or system in EthiopiaIntegration issues

Methodologies
Brainstorming Review documents, research paper, literatures, policies, guidelines Key informant interview Botanical gardens physical visit Websites visit Physical observation of traditional health service outlets

TM-The Ethiopian situation

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

Donald Ramsfield

Background information-The Ethiopian situation

Traditional medicine in Ethiopia includes medicinal preparations from plant, animal, and mineral substances, as well as spiritual healing, traditional midwifery, hydrotherapy, massage, cupping, counterirritation, surgery, and bonesetting. - Traditional medical practices and remedies are recorded in oral tradition and in early medicoreligious manuscripts and traditional pharmacopoeias, which, according to the estimates of some historians, date back to the 15th century AD.

Background cont..
TM in Ethiopia is a product of social institution and cultural 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 protection and 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 father to favorite child ,usually a son, by some spiritual procedure. Some of the traditional medical practices are recorded 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 natural substances;
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 and additives are usually incorporated and more than one drug is used in a single dosage form. Drugs are administered using different routes, the main one being:
Topical, oral and respiratory (inhalations)

When Side-effects become severe ,antidotes are claimed to be 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 anywhere at 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 to meet the criteria needed to support its use; Some plants used in TM such as taenicides are widely known to be Toxic. Blindness and changes in CNS functions have repeatedly been found in people who took over dosage of HA. Interaction with modern medicine
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Herb/Spice

Common Uses

Drugs Affected

Mechanism

Consequences

Culinary Medicinal: common cold, malaria, cough, Garlic pulmonary TB, Allium sativum hypertension, Nech shinkrut (A) wounds, STDs, Tsada shgurti (T) asthma, parasitic Qullabbiiadii (O) infections, toothache, diabetes, hemorrhoids

Antiplatelets Anticoagulants Insulin and oral hypoglycemic agents Cholesterol lowering drugs Thyroid replacement therapy

May be additive with cholesterollowering drugs Hypertensive activity but it is not known if this effect is antihypertensive drug additive Decreases T3 and T4 levels May have blood thinning properties

*Possible increased risk of bleeding; *Reverses effects of orally administered thyroxine

Dingetegna (A) No common English name Taverniera abyssinica

Medicinal only for stomach upset Fever reduction

Antispasmodic properties may No specific class affect absorption of medication

Decreased absorption of medication

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Problems associated with TM

May create delay in the treatment of communicable disease- TB- if they fail to refer pt to modern medicine. Money harmful practices have been created to healers including female genital mutation, uvulaoectomy and milk tooth extraction.

No guidelines on the safety measures to use in performing the practices

Contamination, sterility
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 Increasing in numbers of false healers using home based medicine which is difficult to distinguish. Only 10% of practicing healers are true Ethiopian healers. No rule and regulation on the storage and dispensing 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 .This represents the majority of the rural population and sectors of the urban population 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 to 20.3%** The rest were attended by traditional birth attendants or relatives
Source: *Ethiopian journal health dev.2006;20(2) **Ethiopia 2010 MDGs report,MoFED

Ethiopian Traditional Medicine Practitioners Association

-Traditional medicine is largely practiced by traditional medicine practitioners, although, particularly for certain common health problems, it is also practiced at home by the elderly and by mothers. -The Ethiopian Traditional Healers Association was organized to review the qualifications of practitioners where no regulations exist.

Ethiopian Traditional Medicine Practitioners Association

In 1986, over 6000 practitioners of traditional medicine were 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 international affiliation-Institute of Bio-diversity

 The Need for setting up or strengthening of structure for TM is become essential for optimizing its use.
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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, particularly after the adoption of the Primary Health Care Strategy in 1978.

Cont
-In November 1979, the Office for the Coordination of Traditional Medicine (21, 23), as a full-fledged department directly under the Vice-Minister of Health, was established to organize, train, and register traditional medicine practitioners, and to identify, describe, and register those traditional medicines with actual or potential efficacy.

Cont
-The Ministry of Health also incorporated traditional medicine into the National Ten-Year Perspective Plan 1984-1994 (24), which called for the organization, training, and supervised use of traditional medicine practitioners in strengthening and expanding primary health care services.

Cont
The Health Policy and the Drug Policy of 1993 both emphasized the need to develop the beneficial aspects of traditional medicine through research and through its use in the official health delivery services.

Cont
Proclamation 1999 was issued based on the National Drug Policy. In Article 6, Sub-Article 8 of the Proclamation, it is stated that the Drug Administration and Control Authority shall prepare standards 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.

Cont
PROCLAMATION NO. 661/2009 A PROCLAMATION TO PROVIDE FOR FOOD, MEDICINE AND HEALTH CARE ADMINISTRATION AND CONTROL-DACA

Cont
16th Year No. 9 ADDIS ABABA 13th January, 2010 Proclamation No. 661/2009 Food, Medicine and Health Care Administration and Control Proclamation ..Page 5157 Regulation No.189/2010 PART NINE TRADITIONAL AND COMPLEMENTARY OR ALTERNATIVE MEDICINE

Education and training

No officially recognized education is provided in traditional or complementary/alternative medicine. Insurance coverage There is no national health care insurance or private insurance covering traditional medicine.

RESEARCH & STUDIES IN TM IN ETHIOPIA

RESEARCH & STUDIES

Example I. Qualitative laboratory analysis for the detection of conventional drugs in herbal preparations supplied 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 detected in 39 or 51% of the 76 samples of traditional remedies tested. The average price that healers charge for herbal preparations adulterated with modern drugs was higher than the full doze of the conventional drugs sold in retail pharmacies. Even the unadulterated preparations were found to be more expensive than the latter.

RESEARCH & STUDIES

Among Researcher observations in this study, there were substandard practice of -Patient privacy -record keeping -storage of bulk remedies -product labeling These can be corrected through awareness raising programs; however, what cannot be corrected is the dispensing of adulterated remedies with modern drugs, especially with antibiotics, whose negative effect on health and life is not limited only to the individual client but the community at large.

RESEARCH & STUDIES

Conclusion: -Adulterated herbal preparation results in untoward effects including increased emergence of resistant pathogenic strains. Sustained effort in creating awareness among the communities by health workers and authorities is, therefore, crucial to curb the looming danger to public health. -While existing legal frameworks may be sufficient to consider punitive measures against perpetrators of such inappropriate and unauthorized use of anti microbial agents, new ones that particularly govern the activities of traditional healers need to be put in place.

Conclusions..
8.There are many gaps between policy and actual practices. 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

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 to mutual respect, mutual understanding, productive collaboration and delivery of effective health services.

Conclusions..
10.There is evidence suggesting a declining trend in the number of traditional resources of medicinal plants. This calls for an urgent action to document and preserve the traditional medical knowledge before it disappears from the country.

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 drugs Feb.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