approximately 500 that are in common use nationally and a further ±1000
that are regularly utilised) may be a cause for concern.^66 Inappropriate use
of these species appeared to be associated with a high mortality rate, partic-
ularly among children. Possible causative factors were identified as:
- inappropriate administration of traditional remedies to neonates and
toddlers - excessive or prolonged self-medication, e.g. during pregnancy
- overdosage by an inexperienced prescriber
- overdosage due to the use of a particularly potent biotype or to
seasonal or geographical variation in plant secondary chemistry - a pre-existing disease that may be exacerbated by the traditional
remedy used.
The review noted that there was also a need to give attention to possible
interactions between traditional and western allopathic medicines taken
concurrently. Pending the outcome of toxicological studies, interim preven-
tive measures (aimed at reducing the number of hospital admissions due to
poisoning by traditional remedies) were suggested. These included:
- discouraging long-term use of TMs (1 month)
- counselling pregnant women about the inadvisability of taking any
medication during pregnancy or breast-feeding - discouraging the use of enemas in neonates and young children
- scheduling those traditional medicines known to be associated with
adverse events or fatalities (prescription only, issued by a registered TP)
and withdrawing them from the public marketplace - providing education programmes for healthcare workers, drawing
attention to the fact that the clinical picture seen may be modified in
patients taking TMs - conducting public awareness campaigns in clinics in rural areas,
advising parents of young children about the known toxicity of certain
popular traditional herbs - implementation of a system for reporting adverse events associated
with the use of TMs, as is routinely done for allopathic medicines - development of methods for the detection of key toxin metabolites in
body fluids.^67
A study of current patterns of TM usage in Africa would assist in estab-
lishing to what extent these may have a bearing on the incidence of adverse
events associated with TM use. In South Africa some disruption of tradi-
tional lifestyle has inevitably accompanied migration from rural to urban
milieu. One result is that the traditional healer practising in the city is now
108 | Traditional medicine