Ethnomedicine and Primary Healthcare in Ilorin, Nigeria

L T Ajibade*, P 0 Fatoba, U A Raheem and B A OdunugaDepartment of Geography,Universuty ofIlorin,I1orin, Nigeria

Received 7 January 2004; revised 13 December 2004

African herbal medicine has been discussed under various headings especially since the realization of the imperativesof the Health for All through an appropriate technology. Traditional medicine because of the African belief system has beenone of the ways through which Health for All is discussed. The present study examines the uses of selected indigenousplants and their implication for Primary Health Care. If the appropriate technology must be adhered to and health care mustbe available and affordable, uses of indigenous plants must be explored and integrated into the Health Care DeliverySystem.

Key words: Indigenous Medicine, Herbal Medicine, Primary Health Care, Nigeria.

IPC Int. C1.7: A61 K3517S; A61PI1l0; A61 PIII2; A61 P09/02; A61 P ll/06; A61P II/OS; A61 P IlII 0; A61P 13/02;A6IPl5/02; A61Pl5/06; A6lPl7/02; A6IPl9/02; A61P21!02; A6lP33/06; A6lP331l0.

Indian Journal of Traditional KnowledgeVol. 4(2), April 2005, pp. 150-15S

Health in the conception of the World HealthOrganisation is a state of complete physical, mentaland social well being not merely an absence ofdisease or infirmity. The Organization also estimatesabout 4% of the world's population die annually ofdifferent forms of diseases regardless of their level ofcivilization. Moreover over 87% of these deaths occurin the developing countries and among civilized andlocalized population. The main causes of these aremalnutrition, insufficient health subsidies, poorcommunication, lack of basic amenities like portablewater, good roads which keep the community in aperpetual state of risk and help to accelerate diseaseepisodes.

Glaring to the Third World countries these basicfacts have improved the exploration of the immediatesurrounding to solve their health and social problems.To many African care users traditional medicine isnot adopted as an alternative but rather as a preferredmethod sometimes even when the orthodox medicalcare is available. The holistic conception of health bythe WHO also led to the development of the PrimaryHealth Care (PHC) approach to solving health careproblems in the world, including third World. Thisapproach suggests the use of appropriate technologiesobtained through affordable cost to reaching the goalof sound health by the population. Man has thereforecultivated the habit of observing plants for thousands

*Corresponding author

of years and had used them for differing purposes.The science of botany today is the result of manyyears of progress and development in plant for theircurative virtues. The Eterspapyrus (15 B C) actuallycontain a classification of Egyptian drugs' plants andtheir uses and these were found among the provenremedies in the Temple of Osiris '.

The classification of plants according to theirvarious uses has been based on the most needed onesfor each region's personal use and their varyingconditions. To this extent the goal of PHC personifiesthe use of local and/or indigenous technologies for thesolution to various health problems. Health seekingsolution is therefore per unit of place and time.Medicine the oldest art in the world exists in everysociety because no society exists without its own artof healing. By and large the methods of healing varyand are determined by the ecological and socio-cultural environments as well as the antecedents ofhistory of the people. All societies therefore have theirown 'taxonomy of diseases'. Medicine thereforebegan as a social art and continued so until the adventof great bacteriologists of the past centuries. Arational explanation is sought in scientific medicine interms of cause and effect; phenomena are observed,described and classified. In this study the method ofthis seemingly scientific but indigenous knowledge ofhealth administration is appraised. The studyidentifies common plants of the tropical environment;describes their use for medicinal purposes and draws

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AJIBADE et al.: ETHNOMEDICINE AND PRIMARY HEALTH CARE IN NIGERIA

the implications of its findings for primary healthcare.

The botanical composition of a specific regioninfluences consciously or sub-consciously theactivities of the inhabitants of this region. Plant servesas a vast resource for food production, shelter,clothing, medicine, etc. Man therefore has a highdependency on plants which leads to its incorporationinto their various ways of maintaining survival andlivelihood including health care. For these reasons thehealth of an average African depends more on hisflora environment than the services of the orthodoxphysician located at a substantial geometricalseparation from him. Apart from revealing the herbalpreference of the African man, this study can alsohelp biogeographers and botanists a lot in differentways including: tracing the origin of certain race ofpeople, tracing human migration, discovering fossilsof long pre-existing plants in time past, discoveringvarious species of particular plants and diffe;ent levelof their organization, and helps in taxonomy.

African herbal medicine has been discussed undervarious headings in recent time especially since themost optimistic declaration of the World HealthOrganisation "Health for All by the Year 2000"leading to its rapid development and incorporationinto health care systems in Africa. The World HealthOrganisation observed that traditional medicalpractitioners who live among the people constitute thebasic core of primary health workers for about 90% ofrural population in developing countries and at leastone out of every six urban dwellers in Africa knowshow to concoct one traditional medicine or the other.Today, the traditional medical is called alternativebecause of the belief system that even the westernpopulace mode of medical treatment is not fromabstract but is based on a good method of extractionof various active ingredients from various naturallyoccurring plants (herbs) which are also present intheir own side of the world.

In the past scholars have x-rayed African medicineand have published works on its variousramifications. Some of these works has received wideattention for quite a number of decadesi'. Thesestudies have brought to lime light numerous medicinalplants and other useful plants which were formerly farfrom the knowledge of the average on-looker of theAfrican ecological resources. Some Indian workershave reported the use of indigenous knowledge incuring certain diseases in North India8 which works

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more slowly but is more thorough and effective thanwestern pharmacology". Modern science hasconfirmed the veracity of some indigenousknowledge". For instance, cucurbit leaves have beenfound to have some chemicals that help to lowercholesterol. The leaves of Allium species (onion,garlic, etc) have been found to prevent ulcer.Elizabeth Kafaru of blessed memory who used to be aColumnist in 'The Guardian' one of the NigerianDaily Newspapers has also proved this. The Neemtree has also been found by the International RiceResearch Institute to have certain chemicals withproperties to serve as insecticides.

Part of the gap that exist from this and some otherworks is that such studies were reports from wideareal units such as a country or continent. The truthhowever is that although ecological homogeneity mayexist local, social and cultural circumstances maydetermine the part of plant used the ailment for whichit is used and the administration procedure. Thepresent study sets to fill this gap by identifying anarea of culturally homogenous people and inhabitingan ecologically similar environment. This is with aview to codifying native herbal medicine in differentareas and further strengthens the position andrelevance of indigenous systems in healthcareadministration.

Study AreaIlorin, Kwara State Capital, is located on Latitude

8°3/N and 4°35/E of the equator. This location fallswithin the middle belt zone of Nigeria making it ageographical transition between the southern ForestZone and the northern Savanna. It is also a major citywithin this zone and within the standard of Nigeriancities. It is important to clarify that the IlorinMetropolis is different from the Emirate of the city.The metropolis is a land made of about 150 sq km anda population of 572,178 inhabitants in 1991. TheIlorin Emirate which is the conception-in this studyrefers to the area covered by the traditional authorityof the paramount ruler - the Emir of florin. This isreferred to as the Ilorin Emirate, this jurisdictioncovers five LGAs namely Ilorin West, Ilorin East,Ilorin South, Asa and Moor (Fig. I). This areaconsists of the Yorubas as the dominant ethnic group.The Barubas, upes and Fulanis are among otherimportant ethnic groups. Within the Emirate, IlorinWest is the predominant municipal while IlorinEast and South contain some rural frontiers. Asa and

152 INDIAN J TRADITIONAL KNOWLEDGE, VOL. 4, No.2, APRIL 2005

I

Fig. 1 - Kwara State showing Location of the Study Area (Source - Kwara State Surveys, Ilorin)

AJIBADE et al.: ETHNOMEDICINE AND PRIMARY HEALTH CARE IN NIGERIA

Mooro LGAs are rural. The area is comprised of localpopulation with low literacy level and poor income.The area also has a high density per household andthere is general sense of over crowding within theurban environment. In its rural area farming is thepredominant occupation of men while womencombine peasantry with distributive trade and localcrafts. Majorities are Muslim with sparse Christianmigrants and traditional worshippers. The effect ofthese brief systems as well as the cultural orientationcombine to produce a district health seekingbehaviour characterized by low patronage of orthodoxmedical care and the enshrinement of the use of otheralternatives when illness occur.

MethodologyThe study was carried out in the indigenous Ilorin

Emirate setting which is made up of five LocalGovernment Areas (LGAs) in Kwara State, Nigeria.These Local Government Areas include Ilorin East,Ilorin West, Ilorin South, Asa and Moro. The sampleobtained from LGAs represent about 32% of the totalnumber of LGAs in the state. The idea here is toselect a mix of both rural and urban population for acritical study of the knowledge and the perception ofefficacy of indigenous medicine. For instance the firstthree local Government areas are urban environmentwith village frontiers while the last two localGovernment areas are predominantly rural. In each ofthese Local Government Areas, five settlements wererandomly selected (Table 1). In each of the selectedsettlements ten respondents were purposively selectedto include elders who are natives and resident in thearea. In some cases identified practitioners werespecifically specially requested and included in thelist of respondents. Consequently two hundred andfifty respondents were involved in the study.

The study area comprises of homogenous Muslimpopulation of Yoruba, Nupe and Fulfude origins whohad interacted for several centuries and possesscommon understanding of their local environment.The structure of the population is also similar in termsof low income, low literacy level and hence ailmentcharacteristics. It is important to note here that sameplant may have 2 - 3 local names, the local name ofplant included here are those with which such plantsare popularly called.

A questionnaire was designed to elicit informationfrom these respondents. Such information includes:local name of plants, area of collection, part of the

153

plant used, and their medicinal uses. Young ones andwomen were randomly interviewed in order toconfirm their knowledge of the medicinal utility ofthe identified plants.

For ease of understanding, analysis and discussion,the acquired information are tabulated under relevantsub-headings.

Results and DiscussionThe study observed that every respondents of the

sampled villages within some specified age in bothsexes has some knowledge of the medicinal value oftheir flora surrounding and uses; depending on theorientation of the inhabitants. In fact it serves as agood source of income when they are preserved byTraditional Healer and sold (Fig. 2). This has beenfacilitated by the creation of mini gardens where somemajor herbal plants were raised for emergency usesand common rural ailments. A few oral interviewsconducted with the young ones and women reveal thatthey were aware of the use of herbs in curing ailmentslike malaria with Magnifera indica Linn. diarrhoeawith Bixa orellana Linn., snake-bite with Calotropisprocera R. Br., etc ..

Regardless of the efforts of the Governmenttowards the provision of health care facilities thebelieve of the people in the study area is that herbalmedicine is superior to other medicine and gives thema pivot elevation point towards herbal medicine.Where Government healthcare facilities exist herbalmedicine is either used concurrently or in isolationwhile the orthodox care serves as immediate first aid.This is because an average African particularly in therural area beliefs that the hospital based care is onlyefficient to the extent that it suppresses the ailment

. only to recur later.Thirty species of medicinal plants were collected

and identified (Figs 3-4). The medicinal utility andparts of the plant used are presented in addition tonames of species (botanical, common and local) inTable 2.

As can be seen from the foregoing discussion andTable 2 tropical plants are of great medicinalimportance. The importance is greater when viewedwithin the context of the health of a typical Africaman. This is so because almost every plant wild ordomestic possesses its own medicinal value and thevalue is enhanced or constrained by the local people'sindigenous knowledge of the plant. Itcan be observedalso that in most cases, one plant can provide

154 INDIAN J TRADITIONAL KNOWLEDGE, VOL. 4, No.2, APRIL 2005

Adansonia digitata Linn. Carica papaya Linn.

E/aeis guineensis Jacq. Dioscorea a/ata Linn.

Fig.3 - Plants used in Primary Healthcare in Nigeria

AJIBADE et al.: ETHNOMEDICINE AND PRIMARY HEALTH CARE IN NIGERIA 155

Ficus.thonningii Blume

Bixa orellana Linn.

Celosia trigyna Linn.

Citrullus vulgaris Schrad.

FigA - Plants used in Primary Healthcare in Nigeria

156 INDIAN J TRADITIONAL KNOWLEDGE, VOL 4, No.2, APRIL 2005

Table I-Selected villages by Local Government Area

LGA ILORIN EAST ILORIN WEST ILORIN SOUTH ASA MOOROSettlement1 Afeyin-Oja Budo-Ago Fufu Afon Shao

2 Agbeyangi Egbejila Owode Ballah Olooru

3 Ateko Ogidi I10ta Temidire Malete

4 ldiapa Oko-Olowo Matanmi Ogbondoroko Bode-Sadu

5 Lajiki Wara Maloko Otte Jebba

Table 2-Plant Names, Parts Used and Indigenous Medicinal Uses of Some Plants

S. o. Botanical ames & Family Common Local Parts used/Active Medicinal Use(s)ame Name component(s)

Anacardium occidentale Cashew Kaju Fruits, leaves & bark Toothache, scurvyLinn. tUrusthiol / Tani!!)(A nacard iaceae)

2 Magnifera indica Linn. Mango Mongoro Leaves & bark (Urushiol) Malarial fever(Anacardiaceae)

3 Celosia trigyna Linn. Pepper Ata Leaves & fruits (Capcicin) Guinea worm infection(Arnaranthaceae)

4 Calotropis procera R. Br. Sodom Apple Bornubornu Leaves, fruits & Roots Hydrocede, headache,(Asclepiadaceae) severe body pain, malarial

fever & convulsion5 Acantliaspernum hispidium D.C. Srarbur Egun-Igba Leaves Yellow fever

(Asteraceae)6 Bixa orellana Linn. Bixa plant Aje Pulp & whole plant Dysentery & kidney

(Bixaceae) disease7 Adansonia digitate Linn. Baobab Ose Bark & leaves (Digoxin & Body pain, ringworm

(Bornbacaceae) Digitoxin)8 Cassia occidentalis Linn. Negro Coffee Rere Leaves (Sennosides) Eczema, purgative,

(Caesalpinaceae) menstrual flow atconception

9 Dauiellia oliveri Hutch. & African balsam Iyaa Leaves Backache, headache,Dalziel (Caesalpinaceae) (Chrysophanic acid) constipation

10 Carica papaya Linn. Pawpaw Ibepe Fruits, roots & leaves Abortion, yellow fever,(Caricaceae) (Papayotin, Papain) malarial fever, diabetes,

convulsion, persistentheadache prior tomadness, stomachache

11 Citrullus vulgaris Schrad. Melon Baara Lea ves & fru its Measles, venereal diseases(Curcubitaccae) / purgative

12 Alcliornea cordifolia Christmas bush Ewe-Epa Leaves, fruits, twigs & Fever, venereal diseases /(Euphorbiaceae) shoots purgative, ringworm, piles

13 Dioscorea a/ala Linn. Water yam lsu Ewura Tuber Cancer(Discoreaceae)

14 Euphorbia hirta Linn. Australian Emi-I1e Leaf extract Asthma, cough, sores,(Eu phorbiaceae) asthma herb dysentery and diarrhoea

15 Jatropha curcas Linn. Physic nut Lapalapa Root, latex from stem & Enlarged spleen, yellow(Euphorbiaceae) leaves fever, coated tongue,

diarrhoea, large wounds,stomach ache, ringworm

16 Ricinus communis Linn. Castor oil plant Lara Seed Purgative(Euphorbiaceae)

17 Pennisetuni perpureum Millet Esisu Stem & leaves Snake bite, continuousSchum (Grarninae) blood flow after

menstruation18 Saccharum officinarum Linn. Sugar lreke Stem (Sucrose) Cough, chicken pox

(Grarninae)Contd ..

Implication For Primary HealthcareThe Primary HeaIthcare proposal declared in 1978

at Alma-Ata prescribes for efficient health caredelivery a range of medical technologies for bringing'Health for All' within the ambit of individuals. Asuccessful PHe is the one with a supportive socialand cultural climate. Here health is viewed as part ofthe total social system and human development whichis indicated by increased awareness and participationby the community of health problems and garner acapacity to organize it to solve these problems. This isthe spirit of the PHe that health care must be based onpractical scientific sound and socially acceptablemethods and technology made universally accessibleto individuals and families through their fullparticipation and at a cost that the community and

AJIBADE et al.: ETHNOMEDICINE AND PRIMARY HEALTH CARE IN NIGERIA 157

Table 2-Plant Names, Parts Used and Indigenous Medicinal Uses of Some Plants--Contd.

S.No. Botanical Names & Family Common Local Parts used/Active Medicinal Use(s)Name Name component(s)

19 Ocimum gratissimum Linn. Fever plant Efinrin Leaves (Thymol) Diarrhoea(Lamiaceae)

20. Entanda africana Guill. & Monkey scandal Igbaliwere Bark Kidney & heart ailmentsPerrot. (Leguminosae)

21 Spigelia anthelmia Linn. Worm-grass, Ewe-Eran Leaves Diarrhoea, de-wormer(Loganiaceae) Worm-weed

22 Azadirachta indica A. Juss. Neem Dongoyiaro Leaves, bark & root Malarial fever, catarrh,(Meliaceae) dysentery

23 Parkia biglandulosa Wight & Locust bean Igba Leaves & bark Malarial fever, skinAm. (Mimosaceae) diseases

24 Ficus thonningii Blume Fig tree Odan Leaves Boil & skin inflammation,(Moraceae) bone dislocation

25 Elaecis guineensis Jacq. Palm tree Ope Oil from fruits, roots & Cough. cuts, gonorrhoea(Palmae) leaves

26 Fleurya aestatuans (L.) Gaud Tropical nettle Fuefue Fruits Mental disorder(Urticaceae) weed

27 Lycopersicon esculetitum Tomato Tumati Leaves & fruits Pains, convulsion, skinMill. (Solanaceae) (Lycopene) care

28 Vitellaria paradoxa Gaert. Shea Butter Emi Leaves & Roots (Fat & Neck pain, Whooping(Sapotaceae) Protein) cough

29 Citrus aurantifolia Swingle Lime Orombo / Fruits & Leaves Internal worm, dizziness,(Rutaceae) Osan malaria

Wewe30 Morinda Lucida Benth. Brimstone Oruwo Roots & leaves Irregular menstruation

(Rubiaceae)

solutions (perceived) to 2-3 or more ailments and theefficacy of this is though difficult to measure thevictim's psychology agrees that the concoction isefficient. Given local variations, there is virtually noailment in Africa where a herbal solution does notexist.

country can afford to maintain at every stage of theirdevelopment in the spirit of self reliance and selfdetermination'".

At the present stage of Nigeria's development andfor that matter many African countries the PHepersonifies the traditional medicine. Given the socialand economic structure of an average Nigerian theincome is very low and unstable and in most casescan barely afford the transport bill to the nearest clinicafter allowances for domestic upkeep had been made,let alone the cost of consultation. For instance in thestudy area only about 47% of the 250 respondentsindicated that they use health care facilities aroundthem but usually as a first. aid and revert to thetraditional method of herbs, roots and leaves of plants'for long lasting care. The remaining did not use itsimply because it is expensive. Therefore affordabilitycondition is defeated. Moreover if care must beprovided at a socially acceptable method andtechnology made universally accessible it is alsolikely to be the use of herbs and plants extractedthrough an ancestral procedure, which constitutes itstechnology over time. In the study area 232 (92%)

further research into possible integration of the two-care delivery systems and the side effects of the crudedrug administration techniques.

The PHC is a most optimistic declaration of intentever made by the international community. It ispremised on the understanding of the varying culturalbackground and belief systems of people. Thisimpacts on their health, and health care problems arebetter solved through an enhanced understanding ofhealth seeking among the world people. Otherwise thePHC would remain just an empty slogan and a fad ininternational development jargon.

158 INDIAN J TRADITIONAL KNOWLEDGE, VOL 4, No.2, APRIL 2005

respondents (male and female) indicated that theyknow how to prepare traditional medicine from localherbs for the treatment of malaria, scurvy, headache,etc. through a scientific process and procedure that arereplicable and acceptable. If technology is simplydefined as the way of doing things, then PHC can besaid to personify traditional medicine.

Finally the Primary Healthcare approach takes intoconsideration the belief system of the people and thepreference for therapeutic alternatives. In the studyarea a significant proportion of the respondentsindicated preference for the use of herbs and otherextractions from their ecological surrounding. Forexample the result of this survey indicated that only19% of the respondents preferred and use only theorthodox medicine in seeking health care. On theother hand, 54% preferred traditional medicine butuse the orthodox as a concurrent alternative. Theremaining 27% preferred the traditional medicine anddo not use the orthodox alternative at all.

ConclusionThe survey include only the use of selected plants

there are a host of others that are not included whichalso possess equal therapeutic value to the extent thatalmost all leaves, roots, stems, barks and fruits ofplants are medicinal and are useful for variousailments.

Aside, this alternative is preferred and affordable.Taxonomy such as the one contained in this study isuseful for institutional interventions either byGovernment or the Non-Governmental organizations(NGOs). This intervention can be in the form ofimproving the technology of extraction, method ofconservation and administration and particularly 111

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