8Traditional herbal medicines used in neonates and infants less than six months old in Lagos Nigeria

Niger J Paed 2016; 43 (1): 40 - 45

ORIGINAL

Nwaiwu O

Traditional herbal medicines used in

Oyelade OB

neonates and infants less than six

months old in Lagos Nigeria

DOI:http://dx.doi.org/10.4314/njp.v43i1.8

Accepted: 10th November 2015

Abstract : Background: Herbal

Results: Medicinal plant species

medicine use in children , adults

used for the treatment of common

Nwaiwu O (

)

and other groups have

been

ailments including diarrhea , ab-

Oyelade OB

documented but little informa-

dominal cramps , skin rashes, Fe-

Department of Pharmacology,

Therapeutics and Toxicology,

tion is known about the use

ver (malaria) , jaundice, convul-

Faculty of Basic Medical Science,

herbal medicine mixtures in neo-

sions, Insomnia and weight loss

College of Medicine of the University

nates

and infants less than six

in neonates and infants less than

of Lagos, Lagos Nigeria.

months old. This is important

6months were documented.

Email: obiyo_nwaiwu@yahoo.com,

because pharmacokinetics and

A high percentage of the mothers

onwaiwu@unilag.edu.ng

pharmacodynamics changes

be-

(72%) agreed they

used herbal

tween infants and adults may re-

medicines in neonates and infants,

sult in age-related differences in

although 96% of them did not no-

drug metabolism. This study was

tice any adverse effect while 100%

carried out to document the herbal

of the mothers perceived the herbs

medicines used for common ail-

to be efficacious. Herbal

medi-

ments in neonates and infants less

cines are administered as a poly-

than six months in Lagos, Nigeria.

herbal compound, containing 4-6

Methods: With the aid of ques-

plants

tionnaires and personal interviews

Conclusion: The use of herbal

during field trips to herbal medi-

medicines is common amongst

cine markets and infant welfare

neonates and infants less than six

clinics a survey was undertaken to

months old . Further studies on

collect information

on herbal

the

efficacy and safety of these

medicine use by neonates and

medicines which are administered

infants less than six months from

as polyherbal mixtures is recom-

traditional healers and

nursing

mended.

mothers during July and Sep-

tember 2014. Demographic Infor-

Keywords: Herbal medicine sell-

mation and types of herbal medi-

ers, Nursing

mothers , Herbal

cines used by the respondents,

medicines, Neonates, Infants less

indications for their use and ad-

than 6 months, Ethno botanical

verse effects of the herbal medi-

survey.

cines they used were obtained.

Introduction

women ¹⁰ ,

breastfeeding

children ^11, ,children

with

chronic health conditions , the paediatric age group

in general,

13,14

Many complementary and alternative therapies, such as

medical inpatients , outpatients ,HIV pa-

herbal remedies, are used

in many parts of the

tients , and the general population

16,17,18

world Plants constitute good therapeutic agents for

However, no studies have focused on the

use of

human diseases and are available without prescrip-

herbal medicine among the neonates and

infants less

tion or prescribed by herbal practitioners. With in-

than 6 months . These patients are specially affected

creasing challenges of

drug resistance , affordability

because

they

are also exposed if their mothers

and availability of good quality , safe and effective

take herbs. Like conventional medicines the circulat-

medicines , herbal medicines have become very im-

ing constituents of herbal medicines in the maternal

portant in our health care system as an option .

blood stream are transferred into human breast milk.

Use of herbal medicine globally and amongst Nigerians

Anatomical, physiological and biochemical changes that

is well documented. Studies have documented herbal

occur

from

birth

affect

pharmacokinetics/

medicine use in adults , cancer patients , presurgical

pharmacodynamics and therefore the bioavailability of

, asthma patients ,

patients or day case anaesthesia

drugs. Immaturity of glomerular filtration, renal tubular

hypertensive and diabetic patients patients , pregnant

8,9

secretion and tubular reabsorption at birth and their

maturation determine the different excretion of drugs in

naire. Permission to visit hospitals was obtained from

the neonate . Identification of the types of herbal

the Lagos State Health Service Commission.

medicines used in this age group and their indica-

tions is important as it adds to existing knowledge

Data analysis

and is a useful database for future scientific studies

on the

scientific basis for the use of herbal medi-

Data is presented as frequency tables and a bar chart.

cines in the very young infant.

The objective of

this study is to document the use of herbal medi-

cines in neonates and infants less than six months

old in Lagos Nigeria.

Results

A total of 30 questionnaires were administered to the

herbal sellers in the markets: Itire, Mushin, Oyingbo and

Methods

Aguda in Lagos metropolis. Herb sellers were knowl-

edgeable about local morbidity patterns in neonates

The study was done in Lagos metropolis . Lagos is

and infants and the herbal medicines used in the treat-

located in South West Nigeria . Lagos has a tropical

ment of such ailments. Questionnaires were distributed

wet and dry climateand experiences two rainy seasons,

to 100 nursing mothers but only 78of them responded .

with the heaviest rains falling from April to July and a

Majority of the herb sellers and nursing mothers had

weaker rainy season in October and November.

20,21

secondary education ( Tables 1&2) .Children of twelve

percent (9) of the nursing mothers were neonates.

Fig 1: City of

(Fig 2) The herbal medicines are administered as a

Lagos

20,21

polyherbal compound, containing 4-6 plants

Table 1: Educational levels of the herbs sellers

Level of Education

Number

Percentage

of herbal sellers

No education

13.3

Primary

Secondary

53.3

Ethnobotanical survey, sampling technique and data

Tertiary

collection

Total

100

Data was collected from July 2014-September 2014.

Table 2: Educational levels of the nursing mothers

Herb sellers (aka “ELEWE OMO” by Yoruba)

from

Itire, Aguda, Mushin and Oyingbo markets in Lagos

Level of Education

Number

Percentage

of herbal sellers

Metropolis were randomly selected by convenient sam-

pling

and visited. A total of 30 questionnaires were

No education

administered to the herbal medicine

sellers .A second

Primary

survey involved

nursing mothers with neonates and

Secondary

infants less than 6 months old attending mother and

Tertiary

child care clinic in Massey Street children Hospital and

Total

100

Randle General Hospital in Lagos state. One hundred

Fig 2: Age of children of nursing mothers

nursing mothers were selected randomly and inter-

viewed . Demographic data (educational levels and age

of children ) , common illnesses among infants less

than 6 months and

neonates for which herbs are

prescribed , types of herbal plants , duration of treat-

ment ,perception of efficacy, perception of

safety and

occurrence of adverse events

were discussed and

documented. Discussions were held in English and

local Yoruba language .Voucher

specimens were

collected from the herbal sellers and identified at

the Department of Botany University of Lagos.

Table 3 shows herbal Remedies used in infants and neo-

Ethical considerations

nates. The list shows a list of plant species used as

herbal mixtures in the Lagos area , presented by fam-

The proposal was submitted to the research and ethic

ily and genera and parts of the plant used.

committee of Lagos University Teaching Hospital and

an exemption from review

was obtained. Informed

consent was also obtained from the herb sellers and

nursing mothers before administration of the question-

Table 3: Herbal plant mixtures used in neonates and infants

Herbal plant mixtures for hotness of the body;(anti malaria)

less than 6 months old.

Botanical name

Family

Common

Local

Part used

Abdominal spasms (spasmolytic herbal plant mixtures)

name

Botanical name

Family

Common

Local name

Part used

Alstoniaboonei

Apocynaceae

Stool wool

Ahun

Bark

name

Aliumcepa

Liliaceae

White onion

Alubosa

Bulb, leaves

funfun

Aristolochiaalbida

Aris-

Dutch-

Paranfunfun

stem, root

tolochiaceae

man’s pipe

Enanthiachlor-

Annonaceae

African

Awopa

Bark

Cryptolepissan-

Apocynaceae

Nibima

Paran pupa

atem, root

antha

yellow wood

guinolenta

Curcuma longa

Zingib-

Turmeric

Atale

Rhizome

Aliumascaloni-

Liliaceae

Spring

Alubosaelew

Leaves,

eraceae

pupa

cum

onion

Bulb

Citrus auranti-

Rutaceae

Lime

Osan-

Leaves, stem,

Calliandrahaema-

Leguminosae

Corpse

Tude

Leaves,

folia

wewe

fruit

tocephala

awakener

Twigs,

Khayaivorensis

Meliaceae

Red mahog-

Epoogan

Bark

Roots

any

Eugenia aromatic

Myrtaceae

Clove

Kanafuru

Flower

Nuclealatifolia

Rubiaceae

African

Egboeg-

Bark, stem,

peach tree

besi

root

Ananas cosmos

Bromeliaceae

Pineapple

Pineap-

Fruit

Anti convulsant herbalplant mixtures

ple

Botanical name

Family

Common

Local name

Part used

Citrus paradise

---

Grape

Fruit

name

Axonopuscom-

Poaceae

Tropical

Idi

Leaves

Crinum glaucum

Amarylli-

Crinum lily

Isumeri

Bulb, Flower

pressus

carpet grass

daceae

stalk

Olaxsubscor-

Olacaceae

Egboifon

Roots, stem,

pioidea

bark

Herbal plant mixtures for treatment of yellowness of skin and

Aliumascaloni-

Liliaceae

Spring

Alubosaelew

Leaves, Bulb

eyes (neonatal jaundice)

cum

onion

Botanical

Family

Common

Local name

Part used

Tertrapleurater-

Legumino-

Aidan

Aridan

Bark, Pod

trapt era

sae

name

Croton lobatus

Euphor-

Cascarilla

Eru

Root, Bark,

Carica Papaya

Caricaceae

Pawpaw

Ibepe

Fruit

biaceae

Leaves

Aliumcepa

Liliaceae

White

Alubosa-

Bulb

Onion

funfun

Antidiarrhoea herbal plant mixtures

Alsto-

Apocyna-

Stool Wool

Ahun

Root,

niaboonei

ceae

Bark,

Botanical name

Family

Common

Local

Part used

name

Leaves

Senna fistula

Leguminosae

Indian labur-

Aidantoro

Pods,

num

Leaves

Gongronemalati-

Asclepiada-

Amaranth

Madu-

leaves

Amongst the Nursing mothers, a high percentage of the

folium

ceae

globe

maro,

mothers (72%) agreed they

used herbal medicines in

Utazi

neonates and infants, while 100% of the mothers per-

Cryptolepissangui-

Asclepiada-

Jamaican

Paran pupa

stem,

nolenta

ceae

climbing fern

Root

ceived the herbs to be efficacious. Most of the women

Aristolochiaalbida

Aris-

Dutchman’s

Paranfun-

stem,

(96%) did not report any adverse outcomes with herbal

tolochiaceae

pipe

fun

root

Bidenspilosa

Compositae

Spanish

Abeere

Flowers,

medicines on their neonates and infants while 4% of

needle

leaves

them reported vomiting as a

common

adverse out-

Eugenia aromatic

Myrtaceae

Clove

Kanafuru

Flower

come.

Rauvolfiavomitoria

Apocynaceae

Jamaican

Epoorira

Bark

dogwood

Table 4 shows the indications for herbal medicines

Aristolochiaringens

Aris-

Dutchman’s

Akogun

Stem,

and duration of treatment.

tolochiaceae

pipe

root

Aliumascalonicum

Liliaceae

Spring onion

Alubosaele

Leaves,

Bulb

Table 4: Herbal medicine sellers indications and duration of

Pteleiopsissuberosa

Combreta-

Epookuku

Bark

treatment for herbal medicines in neonates and infants less

ceae

Pseudocedrela-

Meliaceae

Dry cedar

Emi gbe-

Leaves

than 6months

kotschyi

giri

Indications for

No of herbal

Percent-

Duration of

Senna fistula

Leguminosae

Indian labur-

Aidantoro

Leaves

num

herbal medicines

sellers who

age ( %)

treatment

Anthocleistadja-

Loganiaceae

cabbage tree

Egbosapo

Bark,

sell herbal

lonensis

leaves

medicines for

Alstoniaboonei

Apocynaceae

Stool wool

Ahun

Bark

the indications

Anti Diarrhea

100

1week

Herbal plant mixturesfor skin diseases

Abdominal

1week

Botanical name

Family

Common

Local

Part used

cramps

name

Skin rashes

>2weeks

Khayaivorensis

Meliaceae

Red ma-

oganwo

Bark

Malaria (Fever)

1-3days

hogany

Daniellia

Legumino-

African

Iya

Leaves

Jaundice

2weeks

sae

balsam

Spasms / convul-

>2weeks

Khayaivorensis

Meliaceae

Mahogany

Mahog-

Stem, root,

sions

any

bark

Insomnia

1-3days

Echinopslongifolius

Compositae

Iregbe

Root

Detariummicrocarpum

Legumino-

Sweet detar

Ogbogbo

Bark

Weight gain

>2weeks

sae

Discussion

The present study shows that there is

acceptance

and use of traditional medicine in neonates and in-

fants less than 6 months old. Information was

obtained from both herb sellers and

nursing mothers.

lated that its antioxidant components

might inhibit

This is important because traditional herbalists in Ni-

nitric oxide (NO) production in macrophages which

geria use various herbal preparations to treat various

will lead to increased degradation of tryptophan and

types of ailments, including diarrhea, cough, convul-

thereby starve the parasite of an essential amino acid

leading to its death

49,50

sions, skin diseases and others

and women are ma-

. Different extracts of enanthia-

jor caregivers and their knowledge of herbal medicine

chloranthia have also been reported to exert antim-

icrobial activities including antibacterial

51,52

has been shown to have

positive effects on child

health outcomes

23-27

However, the use of these herbs in the very young

are of major concern. Major challenges include un-

In this study, both herb sellers and participating nurs-

determined dosage regimens, immaturity of metabolic

ing mothers had different levels of education. A

and excretory functions, content , preparation , quality

large number of the participants had secondary and

of mixtures and duration of treatment (prolonged sys-

tertiary

education. Previous studies

had shown that

temic exposure). Adverse reactions due to herbal medi-

there was no statistically significant effect of respon-

cines occur when used alone

or concurrently with

conventional or orthodox medicines

15,18

dents’ levels of education on their use of herbal medi-

. In this study

cines

most of the women (96%) did not report any adverse

reactions with herbal medicines on their neonates and

The morbidity and mortality pattern in children vary

infants suggesting good tolerability while 4% of them

with age .In this study, the indications for which

reported vomiting after herbal medicine intake. There

herbal medicines were prescribed are similar to the

are very few clinical data on safety, kinetics

and effi-

published morbidity patterns in neonates and very

cacy. Further research is recommended on the use of

young infants. In infants and children malaria present-

these herbal medicines. Randomized clinical trials are

ing as fever is an important cause of morbidity and

needed to evaluate and validate the pharmacological

mortality . Bacterial infections, in particular pneumonia,

properties of medicinal plants before they can be recom-

gastroenteritis, meningitis and tuberculosis, respiratory

mended for use in neonates and very young infants.

tract infection, diarrhoeal disease skin rash, are also im-

portant diseases. Amongst neonates the major indica-

tions for admission include

infections, sepsis, jaun-

dice, low birth weight , tetanus , birth asphyxia and

Conclusions

prematurity

28-37

The use of herbal medicines is common amongst neo-

Herbal medicines have been used

either alone or in

nates and infants less than six months. Health care

combination with conventional medicines and other

workers

who care for children should be aware that

herbal medicines. Polyherbal mixtures locally called

neonates and infants less than six months also re-

‘Agbojedi - jedi’, agbo - iba’, have been used and docu-

ceive herbal medicines . Further studies to

evaluate

mented in our setting . The data on herbal medicines

efficacy , safety , potential adverse effects and drug

obtained in this study contain herbs already identified

herb interactions are needed.

in previous documentations, as useful herbal remedies

38-46

in Nigeria

Acknowledgements

The efficacy of some of these plants

have been

confirmed. For example the anti malarial activity of

We are grateful to all the herbal sellers from Itire,

aqueous extract of stem back of Enantiachlorantha

Aguda, Mushin and Oyingbo markets in Lagos metropo-

has been investigated in PlasmodiumBerghi infected

lis and nursing mothers with infants less than 6 months

mice. It has potent antimalarial activities compara-

including neonates attending mother and child care

ble to that of chloroquine and the stem bark of E.

clinic in Massey Street children Hospital and Randle

chlorantha

consist of preponderant alkaloids such as

General Hospital in Lagos for giving us Information.

9-methoxycanthin -6-one and phenolics, could be re-

sponsible

for the pharmacologic activity of the ex-

Conflict of interest: None

tract . The antimalarial activity may be due to the

Funding: None

antioxidant effect of its alkaloids. It has been postu-

References

Kathi JK, Sunita V, Richard W.

Reza S-N, Ghorbani A ,Bagheri

Wilcox ML, Bodekar G. Tradi-

The Task Force on Complemen-

FV and Rakhshandeh H. Chronic

tional herbal medicines for

tary and Alternative Medicine, the

Administration of a Combination

malaria. BMJ 2004.329:31-34.

Provisional Section on Comple-

of Six Herbs Inhibits the Progres-

Eisenberg DM, Kessler RC, Foster

mentary, Holistic, and Integrative

sion of Hyperglycemia and De-

C, Norlock FE, Calkins DR, Del-

Medicine The Use of Complemen-

creases Serum Lipids and Aspar-

banco TL. Unconventional medi-

tary and Alternative Medicine in

tate Amino Transferase Activity in

cine in the United States: preva-

Pediatrics, P ediatrics 2008 ;122,

Diabetic Rats. Advances Pharma-

lence, costs, and patterns of use. N

( 6) , 1374-1386.

cological Sciences .2012,

Engl J Med. 1993;328(4):246 – 252

Ezeome ER, Anarado AN: Use of

15. Langlois-Klassen D, Kipp W,

27. Oshikoya KA, Njokanma OF,

complementary and alternative

Jhangri GS, Rubaale T: use of

Chukwura HA, Ojo OI: Adverse

medicine by cancer patients at the

traditional herbal medicines by

drug reactions in Nigerian chil-

University of Nigeria Teaching

AIDS patients in kaharole dis-

dren. Paediatric Perinatal Drug

Hospital, Enugu,Nigeria. BMC

trict , western Uganda. Am J Trop

Therapy 2007, 8:81-88.

28. Udo JJ , Anah MU, Ochigbo SO,

Complement Altern Med .2007,

Med Hyg.2007; 77(4) :757-763.

7:28.

16. Fakeye TO, Tijani A, Adebisi O: A

Etuk IS, Ekanem AD. Neonatal

OnyekaTC ,EzikeHA, NwokeOM,

survey of the use of herbs among-

morbidity and mortality in Calabar,

OnyiaE A, OnuorahEC, Anya SU

patients attending secondary-level

Nigeria: a hospital-based study.

and NnachetaTE. Herbal medi-

health care facilities in Southwest-

Niger J Clin Pract. 2008;11(3):285

cine: a survey of use in Nigerian

ern Nigeria. J Herb Pharmacother .

-9.

presurgical patients booked for

2007, 7:213 – 227 .

29. Owa JA, ,Osinaike AI. Neonatal

ambulatory anaesthesia BMC

17. Yusuff KB, Tayo F: Frequency,

morbidity and mortality in Nige-

Complement Altern Med 2012,

types and severity of medication

ria . Indian J Pediatrics . 1998. 65;

12:130

use-related problems among medi-

3: 441-449

Adeyeye OO, Onadeko BO,

cal outpatients in Nigeria. Int J

30. Petit PL, van Ginneken JK. Analy-

Ogunleye O, Bamisile RT,

Clin Pharm 2011, 33:558 – 564.

sis of hospital records in four Afri-

Olubusi A: The use of comple-

18. Oreagba IA, Oshikoya KA and

can countries, 1975-1990, with

mentary and alternative medicine

AmachreeM . Herbal medicine use

emphasis on infectious diseases. J

by asthma patients receiving care

among urban residents in Lagos,

Trop Med Hyg. 1995;98(4):217-27

31. Osinusi K , OyejideCO.Morbidity

in an urban tertiary centre in Nige-

Nigeria. BMC Complement Altern

ria . Int J Biol Med Res .

Med 2011, 11:117

pattern among Nigerian children

2011,2:1026 – 1030.

19. Dambisya YM and Tindimwebwa

from a poor urban community. Afr

Nwako SO, Fakeye TO: Evalua-

G. traditional remedies in chil-

J Med Med Sci.1989 ;18(1):43-7.

32. Olamijulo JA , OlaleyeO.Perinatal

tion of use of herbal medicines

dren around eastern cape, South

among ambulatory hypertensive

Africa. East Afr Med J 2003. 80:8

mortality in Lagos University

patients attending a secondary

20. "'The lagos pressure group on the

Teaching Hospital: a five year

health carefacility in Nigeria. Int J

environment " . Limge Online. Re-

review. Niger Q J Hosp Med .

Pharm Practice 2009, 17:101 –

trieved 4 April 2015.

2011 ;21(4):255-61.

105.

"Weather BBC Weather Lagos

33. Tapsoba H, Deschamps JP: Use of

Olayemi SO, Nwaiwu O, Fasan-

Nigeria". BBC. Retrieved 15 may

medicinal plants for the treatment

madeO,Aro AO, Ibrahim A. Clini-

2015.

of oral diseases in Burkina Faso. J

cal outcomes in hypertensive or

21. Panghal M, Arya V, Yadav S,

Ethnopharmacology 2006,104:68-

diabetes, patients who concomi-

Kumar S, Yadav JP: Indigenous

78.

tantly use complementary medi-

knowledge of medicinal plants

34. Saikia AP, Ryakala VK, Sharma P,

cines in Lagos Nigeria. East Afr

used by Saperas community of

Goswami P, Bora U: Ethnobotany

Med J 2014. 91 ; 11 : 1-6

Khetawas, Jhajjar District, Hary-

of medicinal plants used by Assa-

10. Fakeye TO, Adisa R, Musa IE:

ana, India. J Ethnobiology Eth-

mese people for various skin ail-

Attitude and use of herbal medi-

nomedicine 2010.

ments and cosmetics. J Ethnophar-

cines among pregnant women in

22. Miller EM .Maternal health and

macology 2006, 106:149-157.

Nigeria. BMC Complement Altern

knowledge and infant health out-

35. Fawole OA, Finnie JF, Van Staden

Med . 2009, 9:53.

comes in the Ariaal people of

J: Antimicrobial activity and

11. Sim TF, Sherriff J, Hattingh HL,

northern Kenya. Soc Sci Med .

mutagenic effects of twelve tradi-

Parsons R and Tee LBG The use

23. Tanner S, Chuquimia-Choque ME,

tional medicinal plants used to

of herbal medicines during breast-

Huanca T, McDade TW, Leonard

treat ailments related to the gastro-

feeding:a population-based survey

WR, etal. (2011) The effects of

intestinal tract in South Africa.

in Western Australia. BMC Com-

local medicinal knowledge and

South Afr J Botany 2009, 75:356-

plement Altern Med 2013, 13:317

hygiene on helminth infections in

362.

12. Oshikoya KA, Senbanjo IO, Njo-

an Amazonian society. Soc Sci

36. Sofowora A. Medicinal plants and

kanma OF, Soipe A: Use of com-

Med 72(5):701 – 709.

traditional medicine in Africa.

plementary and alternative medi-

24. Vandebroek I. Intercultural health

Chichester: Wiley, 1982. 256 p.

cines for children with chronic

and ethnobotany: How to improve

Adeleye IA, Opiah L. Antimicro-

health conditions in Lagos Nige-

healthcare for underserved and

bial activity of extracts of local

ria. BMC Complement Altern Med .

minority communities? J Ethno-

cough mixtures on upper respira-

2008, 8:66.

pharmacol.2013;148(3): 746 – 754.

tory tract bacterial pathogens. West

13. Towns AM, EyiS M, Andel TV.

25. McDade TW, Reyes- Garcı´a V,

Indian Med J 2003; 52:188-90.

Traditional Medicine and Child-

Blackinton P, Tanner S, Huanca T,

37. OdugbemiT. Outlines and pictures

care in Western Africa: Mothers’

et al. Ethnobotanical knowledge is

of medicinal plants from Nige-

Knowledge, Folk Illnesses, and

associated with indices of child

ria;University of Lagos press.

Patterns of Healthcare-Seeking

health in the Bolivian Amazon. Proc

Revised edition 2008.

Behavior. Plos one . 2014:9 (8)

Natl Acad Sci 2007; 104(15): 6134 –

38. Adisa R, Fakeye TO .Assessment

8 ;e105972

6139.

of Knowledge of community phar-

14. KemperK J, VohraS, WallsR.

26. Black RE, Cousens S, Johnson HL,

macists regarding common phyto-

The Task Force on Complemen-

Lawn JE, Rudan I, et al.

pharmaceuticals sold in Southwest-

tary and Alternative Medicine, the

Global,regional, and national

ern Nigeria. Trop J Pharm

Provisional Section on Comple-

causes of child mortality in 2008: a

Res , 2006: 5(2):619-625.

mentary, Holistic, and Integrativ

systematic analysis. Lancet.

The Use of Complementary and

2010;375(9730): 1969 – 1987 .

Alternative Medicine in Pediatrics.

Pediatrics 2008; 122, ( 6)1375

39. Astin JA .Why patients use alter-

45. Rinne E: Water and Healing - Ex-

49. Mahmoud M.S., Gliani AH and

native medicine? Results of a na-

periences from the Traditional

Khwaja et al . The invitro effect

tional study. J Am Med Ass ,

Healers in Ile-Ife, Nigeria. Nordic

of aqueous extract of `` Nigella

1998;279:1548-53.

J African Studies 2001, 10:41-65.

sativa seeds on nitric oxide

40. Eisenberg D, Davis R, Ett-

46. Ayoade AA, Musbau AA. Anti-

production . Phytothr. Res , 2003;

ners .Trends in alternative medi-

malarial Bioactivity of Enan-

17: 921-924.

cine use in the United States. J Am

tiachlorantha stem bark . M edici-

50. Agbaje , EO and Onabanjo

Med Ass 1998, 280:1569-75.

nal plants, Phytochemistry, Phar-

A.O .The effects of extracts of

41. Ernst E. Herbal medicines put into

macology therapeutics 2010 ; (1):

Enantiachlorantia in malaria .

context. Brit Med J . 2003;

441-447 .

Ann. Trop . Med. Parasitol 1991,

327:881-2.

47. Adesokun .A.A ., Akanji MA

85 (6) : 585-590.

42. Fakeye T. O., Onyemadu O.

and Yakubu MT . Antibacterial

51. Chan , K . Choo , C . Abdullah

Evaluation of knowledge base of

potentials of aqueous extracts of

N.R and Ismail Z. Antiplasmo-

hospital pharmacists and physi-

Enantiachlorantia stem bark. Afr.j.

dial studies of Eurycomalongifo-

cians on herbal medicines in

biotechnol 2007; 6 (22) : 2502-

lia jack using the lactate dehy-

Southwestern Nigeria. Pharm.

2505 .

drogenase assay of plasmodium

Pract. 2008. 6, 88 – 92.

48. Daubenar , W. Interleukin -1 in-

falciparum, J . Ethnopharmacol ,

43. Furnharm A. Why do people

hibit gamma interferon -induced

2004;92: 223-227.

choose and use complementary

bacteriostasis in human uroepi-

therapies?In Complementary medi-

thelial cells . Infection and Im-

cine an objective Appraisal Edit-

munity , 1999 ;67 : 5615 -5620.

edby: Ernst E. Oxford: Butter-

worth-Heinemann.1996.

44. World Health Organization. Tradi-

tional medicine. Fact sheet

2007: 134 [http://www.who.int/

mediacentre/factsheets/fs134/en/].