Herbs and herbal combinations used to treat suspected malaria in Bo, Sierra Leone Shamika Ranasinghe a , Rashid Ansumana b,c , Joseph M. Lamin b , Alfred S. Bockarie b , Umaru Bangura b , Jacob A.G. Buanie b , David A. Stenger d , Kathryn H. Jacobsen a,n Q1 a George Mason University, 4400 University Drive, Fairfax, VA 22030 USA b Mercy Hospital Research Laboratory, Kulanda Town, Bo, Sierra Leone c Njala University, Bo, Sierra Leone d U.S. Naval Research Laboratory, 4555 Overlook Ave. SW, Washington, DC 20375 USA article info Article history: Received 19 December 2014 Received in revised form 26 February 2015 Accepted 9 March 2015 Keywords: Cross-sectional study Herbal medicine African traditional medicine Malaria Moringa oleifera West Africa abstract Ethnopharmacological relevance: Most adults in West Africa treat acute febrile illnesses with local herbs, but the patterns of herbs used for malaria have not been recently described in Sierra Leone. Materials and methods: We used a population-based cross-sectional approach to interview 810 randomly- sampled rural and urban adult residents of Bo, Sierra Leone, in December 2013 and January 2014 about their use of herbal remedies when they suspect they have malaria. Results: In total, 55% of the participants reported taking one or more of seven herbs to treat symptoms of malaria. Among herb users, the most commonly used anti-malarial herbs were Moringa oleifera (moringa, 52%) and Sarcocephalus latifolius (yumbuyambay, 50%). The other herbs used included Senna siamea (shekutoure, 18%), Cassia sieberiana (gbangba, 18%), Uvaria afzelii (gone-botai, 14%), Morinda chrysorhiza (njasui, 14%), and Craterispermum laurinum (nyelleh, 7%). Combination herbal therapy was common, with 37% of herb users taking two or more herbs together when ill with suspected malaria. Conclusions: Indigenous medical knowledge about herbal remedies and combinations of local herbs remains an integral part of malaria case management in Sierra Leone. & 2015 Published by Elsevier Ireland Ltd. 1. Introduction Traditional medicine involving traditional healers and the use of herbs, animal parts, spiritual therapies, manual therapies, and exercises remains common in sub-Saharan Africa, where more than 80% of the people use herbs to treat their illnesses (WHO, 2002). There are thought to be more than 100 times more traditional healers than conventional medical doctors or nurses in the region, and a high proportion of the more than 300 million West Africans at risk of malaria prefer to use affordable and convenient traditional medicines when they have symptoms of malaria rather than seeking treatment from the formal healthcare system (Bodeker and Kronenberg, 2002; Soh and Benoit- Vical, 2007; WHO, 2002, 2013). The West African region has incredible biodiversity, and many indigenous plants are used as antimalarial agents, even though few formal studies have examined the dosages and delivery mechanisms that are safest and most effective (Soh and Benoit-Vical, 2007). There is a need for additional research on which herbs are most widely used and which combinations of herbs are used in various populations to complement laboratory studies of antiplas- modial ef ficacy. Malaria remains endemic in Sierra Leone, in West Africa. Our pre- vious research in Bo, the second largest city in Sierra Leone, found that the majority of adults in Bo presumptively self-diagnose bouts of malaria based on their symptoms and then treat their acute febrile illnesses at home ( Ansumana et al., 2013). Many adults in Bo will seek professional assistance from a healthcare provider in the formal or informal sector only if they remain febrile after several days of home treatment or if they become alarmingly ill. However, our survey instrument for that study did not ask participants about the particular herbs and other local remedies that they use as home-based malaria treatment. In the follow-up study presented in this paper, we interviewed several hundred adults from both rural and urban areas in the Bo district in southern Sierra Leone about their preferred malaria treatments. We had two primary goals for this analysis. First, we sought to document the traditional medicine knowledge and prac- tices that have been passed down through the generations and across tribal groups in Sierra Leone (Lebbie and Guries, 1995). Sierra Leone 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/jep Journal of Ethnopharmacology http://dx.doi.org/10.1016/j.jep.2015.03.028 0378-8741/& 2015 Published by Elsevier Ireland Ltd. n Correspondence to: Department of Global and Community Health, George Mason University, 4400 University Drive 5B7, Fairfax VA 22030, USA. Tel.: þ1 703 993 9168; fax: þ1 703 993 1908. E-mail addresses: sranasi3@gmu.edu (S. Ranasinghe), rashidansumana@gmail.com (R. Ansumana), jm_lamin@yahoo.com (J.M. Lamin), asbock2@yahoo.com (A.S. Bockarie), umarbans@yahoo.co.uk (U. Bangura), jagbuanie@gmail.com (J.A.G. Buanie), david.stenger@nrl.navy.mil (D.A. Stenger), kjacobse@gmu.edu (K.H. Jacobsen). Please cite this article as: Ranasinghe, S., et al., Herbs and herbal combinations used to treat suspected malaria in Bo, Sierra Leone. Journal of Ethnopharmacology (2015), http://dx.doi.org/10.1016/j.jep.2015.03.028i Journal of Ethnopharmacology ∎ (∎∎∎∎) ∎∎∎–∎∎∎