Malaria control and treatment: the role of indigenous practices in Zimbabwe

Abstract

Beside the use of conventional medicines, Zimbabweans rely on native malaria control and treatment practices. This mini-review therefore seeks to identify and assess applicability of Zimbabwean indigenous practices in the fight against malaria. This work is based on evaluation of literature and data was retrieved from databases such as the Web of Science, Google Scholar, Scopus, PubMed and Research Gate. Five categories of indigenous practices used in the fight against malaria were identified and these are (1) use of herbal and other traditional medicines in malaria, (2) use of traditional environmental indicators, (3) the use of red-hot granite rock and water, (4) burning of dung and plants to deter malaria vectors and (5) spiritual malaria treatment based on faith and traditional healers. Beyond these traditional practices, an overview of medical pluralism, indigenous health practices and decolonisation of public health is presented. It has been shown that herbal medicines are applicable in the fight against malaria. However, burning of plants and dung can be applied in the production of mosquito coils to prevent mosquito bites. Additionally, steaming is just limited to the management of fever and spirituality has no scientific basis on malaria management. Despite the application of indigenous practices in the fight against malaria in Zimbabwe, there is inconclusive evidence on their applicability in the main stream health systems. A comprehensive study should be conducted in order to scientifically evaluate the applicability of these indigenous practices.

IMPACT STATEMENT

Despite the efforts made in the fight against malaria in Zimbabwe, this disease is still one of the most common vector-borne diseases in the country. In addition, to conventional malaria treatment, indigenous practices have been applied in the fight against malaria in Zimbabwe. Beyond the traditional practices, the used use of different approaches in the treatment of malaria (medical pluralism) and decolonisation of mainstream health practices are presented. Among the traditional practices, it has been shown that herbal medicines burning of dung are applicable in the fight against malaria. However, other practices such as, steaming and spirituality lack substantial scientific basis on malaria management. Despite the application of indigenous practices in the fight against malaria in Zimbabwe, there is inconclusive evidence on their applicability in the main stream health systems.

Keywords:

• Indigenous practices
• traditional medicines
• malaria
• Zimbabwean health systems
• medical pluralism
• indigenous knowledge systems
• public (global) health

Reviewing Editor:

• Joe Thomas, Institute of Health and Management, Australia

Subjects:

• Epidemiology
• Microbiology
• Pharmacology

1. Introduction

Malaria is still a major public health problem in Zimbabwe, impacting people of all ages and posing a threat to over 50% of the population (Manyangadze et al., 2017). Nonetheless, the World Health Organization’s (WHO) 2016 report on malaria found that there was a higher likelihood of parasitic infection among 79% of the population. Malaria incidence in 2013 was 139 per 1000 people at risk, a considerable decrease from the reported rate of 139 cases per 1000 inhabitants in 2010 (Manyangadze et al., 2017). Despite the fact that the Roll Back Malaria Program and Zimbabwe National Malaria Control Program have helped to lower malaria occurrences over the past 13 years, a spike in the mortality rate attributed to malaria, from 6.1% in 2012 to 13.8% in 2014, has been noted (Mundagowa & Chimberengwa, 2020). Resistance of the malaria vectors to insecticides and parasite resistance to anti-malarial medications are the main causes of Zimbabwe’s unusually high malaria prevalence, which is consistent with global trends (Gunda et al., 2016). Additionally, altering vector behaviour, climatic change, a lack of finance, the collapse of the economy, political unrest and migration are all factors that contribute to malaria transmission instability and periodic outbreaks in Zimbabwe (Mundagowa & Chimberengwa, 2020).

Artemisinin is not widely available in Zimbabwe and other sub-Saharan African nations, which is correlated with low production levels, relatively high costs, complicated dosage and a lack of clinical expertise with artemisinin-based combinations (Kazembe et al., 2012). Due to the lack of affordable and accessible effective antimalarial medications and innovations for malaria control, the effects of malaria in Zimbabwe were exacerbated (Kazembe et al., 2012; Mugwagwa et al., 2015). Infectious illnesses like malaria continue to be a problem for public health despite advances in our understanding of microbes and the pathogenic control of those pathogens. The unavailability of vaccines and antimicrobial resistance are often the two biggest obstacles to the elimination malaria in Zimbabwe (Mayer et al., 2009). Due to all of these obstacles, it is necessary to find and create innovative and reliable systems to fight against malaria.

A number of studies have outlined the traditional malaria-fighting strategies employed in Zimbabwe (Chapu & Mgocheki, 2017; Dhewa, 2008; Kazembe et al., 2012; Macherera et al., 2017; Makundi et al., 2007; Mavhurume, 2016). Traditional medicine is defined by WHO as knowledge, techniques and abilities based on concepts, values and traditions unique to many societies that are used to improve health and avoid, detect, relieve, or cure physical and mental diseases (WHO, 2013). In Zimbabwe, traditional health care practices include herbal, wildlife and mineral treatments, massage, mysticism and other culturally distinct activities. Some of the indigenous practices against malaria are based on early warning and detection and forecasting (Macherera et al., 2017). Such malaria prevention methods mainly relying on weather variables such as rainfall and their possible impact on malaria outbreak and transmission. According to Mabaso et al. (2006), the high yearly malaria incidence was accompanied by heavy rains in the period between 1988 and 1999. Besides rainfall, temperature was identified has one of predictors of malaria prevalence and transmission. However, the uptake and implementation of these indigenous practices has been limited and more emphasis has been given to scientific issues (Macherera et al., 2017).

In Zimbabwe, individuals from malaria hotspots have the potential to exploit malaria early traditional warning to prepare for malaria outbreaks (Macherera et al., 2017). However, according to Soropa et al. (2015), indigenous knowledge systems are not only meant for decision making at local level, but for researchers, planners and managers to develop strategies which improve communities in the face of climate change and infectious diseases such as a malaria. It has been argued that although tools such as remote sensing, forecast warning and geographic information system are critical in predicting climate and malaria vulnerability, indigenous knowledge systems are simple, accurate and more applicable in local communities (Glantz, 2009). Considering that indigenous knowledge systems have evolved over a long period of time (Eyong, 2007), it is critical to integrate indigenous knowledge systems and scientific surveillance and warning systems in order to reduce vulnerability rural communities to infectious diseases such as malaria and climate change (Jiri et al., 2016).

The application of indigenous knowledge systems on prediction of rainfall (one predictor of malaria prevalence) in Zimbabwe was revealed in a number of studies (Risiro et al., 2012; Soropa et al., 2015). The World Health Organisation has outlined potential malaria detection indicators and early warning systems (Thomson & Connor, 2001). In line with this, a study was conducted in Gwanda district, Matabeleland South, Zimbabwe to assess potential malaria detection indicators and early warning systems used in communities (Macherera et al., 2017). Generally, there is still limited published information on the role of traditional practices in the fight against malaria. Therefore, this paper aims to explore the role of indigenous practices in malaria control.

2. Materials and methods

The current study used a hybrid technique that included quantitative and qualitative methodologies. Based on the Boolean search approach, literature was retrieved from University of South Africa (UNISA) library, Zimbabwean libraries and electronic databases such as Web of Science, Google Scholar, SciELO, Science Direct, Scopus and PubMed. Boolean search methods in this particular instance extended and restricted the search through combining search strings with modifiers and/operators such as OR AND and NOT. An overview of the representative search strings and Boolean search technique applied in this study are summarised: ‘Indigenous practices AND/OR malaria in Zimbabwe’, ‘Zimbabwean indigenous knowledge AND/OR malaria’, ‘Traditional AND Malaria treatment in Zimbabwe’, ‘Malaria prevalence AND/OR Zimbabwean herbal medicine’, ‘traditional early warning AND/OR malaria in Zimbabwe’ and ‘Traditional Medical Practitioners Act AND/OR malaria in Zimbabwe’. This particular technique was instrumental in retrieving relevant literature. However, this was confined to publications in the English language only and therefore might have missed publications in other languages.

Accordingly, data was retrieved from published scientific articles, conference papers, theses, books and grey materials. The individual data sources were qualitatively screened and evaluated based on the main objective of the study. Due to limited information on indigenous practices used in the management of malaria in Zimbabwe before 2000, the literature search in this particular study was limited to the period 2000 to 2023. After screening and analysis, publications on indigenous practices used in the treatment of malaria in Zimbabwe were examined, critically reviewed, and the important findings were summarised and tabulated.

3. Results and discussion

There is a dearth of published information on indigenous practices applied against malaria. This study therefore, outlines indigenous practices in the control and treatment of malaria under the following sub headings: (1) the use of herbal and other traditional medicines in malaria control and treatment, (2) the use of traditional environmental indicators to control malaria, (3) the use of red hot granite rock and water, (4) the burning of dung and plants to deter malaria vectors and (5) spiritual malaria treatment based on faith and traditional healers (Figure 1).

Figure 1. A theoretical framework of indigenous practices in the control and treatment of malaria in Zimbabwe.

3.1. Herbal and other traditional medicines used in malaria control and treatment

There is limited information the use of herbal medicine against malaria in Zimbabwe. Additionally, the available information is mainly based on ethnobotanical surveys without scientific evaluation (Chapu & Mgocheki, 2017; Kazembe et al., 2012; Lukwa et al., 2001; Mbauya, 2015; Ngarivhume et al., 2015). Traditional medicine is one of the most accessible and widely available forms of therapy in Zimbabwe’s resource-limited communities. The indigenous people have a great experience of using traditional therapeutic drugs (Dhewa, 2008; Olsson et al., 2015). Orthodox medicinal practice in Zimbabwe is based on experiences of communities in the framework of the native cultural context. However, the practice is dynamic and evolves over time situationally (Dhewa, 2008; Gureje et al., 2015). Zimbabwean traditional medical practitioners include herbalists, psychic therapists, midwives, fortune tellers, seers and faith healers who design techniques and materials employing indigenous knowledge (Hlatshwayo, 2017; Rupande, 2022). Despite the rising acceptance of ethnomedicine in Zimbabwe, much traditional knowledge remains unrecorded (Usai et al., 2022). However, documentation of traditional medicines is required in order to maintain knowledge, preserve and use them in a sustainable manner.

Traditional remedies are used by around 80% of people in underdeveloped nations since they cannot afford costs associated with western medicines and medical services (Dhewa, 2008). The uptake of traditional remedies is normally high due to the fact that they are more accepted from a spiritual and cultural standpoint (Ferngren, 2016; Pan et al., 2014). The recording of traditional preventive and treatment medicine in Zimbabwe is a huge move in maintaining cultural customs, enabling community participation and inclusion in developing traditional malaria control strategies.

In Zimbabwe, the Traditional Medical Practitioners Act of 1981, attempted to incorporate traditional medicine into the national healthcare system, failed to contribute significantly due to a lack of institutional and financial support (Ngarivhume et al., 2015). However, many residents in Zimbabwe, particularly in rural areas, continue to utilise traditional medicines for basic health care, despite lack of documentation and regulation (Van Wyk & Prinsloo, 2018).

Between 65 and 80% of the world’s population relies on traditional remedies for their primary healthcare needs. According to the WHO, local, additional and complementary therapy of top quality and safety offer various advantages (WHO, 2013). Ease of access, affordability, income, level of education, effectiveness and non-availability of contemporary healthcare services were the prime causes behind the utilisation of Traditional medicines. Zimbabwean traditional medical practices exemplify the country’s cultural diversity (Jidong et al., 2021; Rutto, 2005). Historic Zimbabwean medicines are used for preventive care, therapy and well-being enhancement. Traditional remedies have an important role in Zimbabwean healthcare systems, as evidenced by the country’s health‐care policies (Dhewa, 2008; Razzak & Kellermann, 2002).

Traditional medicine has remained a source of pride for most Africans, particularly the Shona people of Zimbabwe (Bobo & Sukdaven, 2020; Mapira & Mazambara, 2013). According to statistics, 50 percent of the people in Africa utilise complementary therapies on a daily basis, with herbal remedies by far the most popular. Because most of the medication is located in close proximity to the African populations, makes it cheap and accessible (James et al., 2018).

The role of traditional healers was for the first time mainstreamed in Zimbabwe in 1980, with the formation of the Zimbabwe National Traditional Healers Association (ZINATHA) (Chakawa, 2015; Mposhi et al., 2013). Zimbabwe has also been plagued by an influx of herbal medications from countries including Tanzania, China and India, resulting in the spread of traditional remedies throughout the country (Fajinmi et al., 2017). Traditional medicine’s influence in Zimbabwe is inextricably associated with the practices of the traditional healer as the primary physician. Herbal medicines are utilised traditionally for a variety of purposes, including moral preservation, lucky charms, fertility and spirituality issues (Novotna et al., 2020).

3.2. The use of traditional environmental indicators to control malaria

Malaria incidence has been shown to strongly correlate with rainfall and temperature changes. In Zimbabwean communities, plant phenotypic plasticity and insects are mostly utilised markers in the prediction of malaria (Macherera & Chimbari, 2016). Additional malaria predication markers exploited in Zimbabwe include apparent noise originating from mountains (thundering of mountainous regions) and specific ostrich behaviours. According to Macherera and Chimbari (2016), there are five markers of how much rainfall will be received and hence the possibility of malaria outbreak: (1) Arthropod markers, (2) Bird predictors, (3) Animal attributes, (4) Plant phenology and (5) Astronomical and meteorological signals (Table 1).

Table 1. Indigenous practices in prevention and treatment of malaria in Zimbabwe.

Indigenous practice	Remarks on treatment/ prevention /natural products used in Zimbabwe	Applicability in Zimbabwean mainstream health systems	References
Herbal medicine (most of the herbal medicines are taken orally as powders, cold and hot infusions from plant roots, leaves, barks and fruits. However, there is limited information on the dosage used)	According to an ethnobotanical survey conducted in Manicaland Province, Zimbabwe, plant such as Elephantorrhiza goetzei (Harms), Toddalia asiatica (L.) Lam and Pavetta schumanniana F. Hoffm. In this particular study, Aristolochia albida and Cassia abbreviata were the most utilised herbal medicines against malaria.	As method of preserving indigenous practices and traditional medicines such has herbal medicines the Traditional Medical Practitioners Act of 1981 was introduced. This was meant to incorporate traditional medicine into the main stream Zimbabwean health system. With proper scientific evaluation and screening herbal medicines can be the basis of new antimalarial drugs that can be used beyond localised communities.	Ngarivhume et al. (2015)
	An ethnobotanical survey conducted in malaria hotspots of Zimbabwe revealed that the indigenous people are highly confident in herbal medicines which are used against malaria. Some of the plants that are utilised in malaria prone areas include D. nitidula A. amara, V. infausta A. digitata and L. discolour.	Although herbal medicines are used for primary health care needs in Zimbabwe, the claim that combining these medicines with western drugs improve efficacy is not always true. It depends on the type drug interactions which can be antagonistic, synergistic and additive. However, it has been concluded that some antimalarial plant-based drugs can compete with established drugs against malaria. This therefore, indicates that if plant based antimalarial drugs are scientifically evaluated especially for toxicity level can be applied beyond primary health in Zimbabwe.	Kazembe et al. (2012)
	In a survey conducted in Chiredzi dristict, Masvingo Province, Zimbabwe, antimalarial plants including Adonsia digitata roots, Capsicum anuum fruits and Warburgia salutaris bark,	Results from this study indicated plant remedies were combined with antimalarial drugs such as chloroquine. Although plant based antimalarial drugs are used traditionally in primary health care, there is need for assess their efficacy so that they are fully used in hospitals and readily in Zimbabwean pharmacies.	Chapu and Mgocheki (2017)
	In Mola, Kariba district, Mashonaland West Province, Zimbabwe, some of the identified antimalarial plants include Amblygonocarpus andongenis (Olvi.), Carica papaya L. (Caricaceae), Zanha africana (Radlk.), Solanum panduriforme, Diplorhynchus condylocarpon, Euclea divinorum Hiern, Aloe greatheardii Schoni.	Antimalarial herbal medicines can be used as primary health care medicines and with scientific evaluation on efficacy and toxicity can be applied in the main health system.	Lukwa et al., (2001)
	Pant species collected from a number of stations in Zimbabwe along Harare-Nyamapanda road close to Marondera, Mashonaland East Province, Zimbabwe, were assessed for antiplasmodial activities. The targeted plants were Cussonia spicata, Flueggea virosa, Vernonia colorata, Artemisia afra, Clutia hirsute, Vernonia colorata, V. natalensis, Parinari curatellifolia, Hymenodictyon floribundum and Adenia gummifera. Among all these plants, extracts from Vernonia colorata and Artemisia afra active against both PoW (chloroquine-sensitive Plasmodium strain) and Dd2 (chloroquine-resistant Plasmodium).	Based on the bioassays and identified A. afra and V. colorata extracts can be applied as antimalarial drugs. Although the IC50 values were less than 50 µg/ml (1.1–12.6 µg/mL), there need to evaluate toxicity of these extracts and to prescribe quantities that can be utilised. Moreover, in vivo assays and clinical tests should be carried so that these herbal medicines are incorporated into mainstream health system.	Kraft et al., 2003
	In a doctoral study conducted in Chikwanha-Muneri villages of Marange District, Manicald Province, Zimbabwe plants traditionally used to manage malaria were identified and these include Cassia abbreviate, Bridelia cathartica, Burkea Africana, Tragia okanyua, Pterocarpus Angolensi and Afzelia quanzensis.	Antimalarial herbal medicines can be used as primary health care medicines and with scientific evaluation on efficacy and toxicity can be applied in the main health system.
The use of traditional environmental indicators to control malaria Arthropod markers Bird predictors Animal attributes Plant phenology Astronomical and meteorological signals	Insects identified in Gwanda district, Matabeleland South, Zimbabwe, for example termites were shown to mark the start of the rainy season. Additionally, massive white butterflies migrating from west to east in the month of October indicates considerably high rainfall.	Though termites do not reflect the quantity of the rain or the extent of malaria prevalence, it does herald the start of the malaria season. However, white butterflies in this case indicate high malaria prevalence. These markers can be applied in preparing for malaria outbreaks.	Macherera and Chimbari (2016)
	It has been shown that noise of ground hornbills and laying of eggs by guinea fowls from September to November indicates a favourable rainy season. However, Swallows and Migratory birds in November indicate that the rainy season is approaching.	This is applicable in two ways since: (1) Early warning markers for start of malaria and (2) Malaria incident intensity predication.	Macherera and Chimbari (2016)
	It was discovered that if wild animals have a large number of young ones and lions passing by the farmsteads without attacking domesticated animals or humans during the months of September and October, then more rainfall would be obtained in the next season.	This shows that the likelihood of malaria transmission will be substantially high.	Macherera and Chimbari (2016)
	Flowering of plants like Lanchocarpus capassa in October and November and Boscia albitrunca in early and numerous fruits by November indicate significant rainfall in that season. Acasia nigrescens indicates low rainfall and drought if it takes longer to produce new.	Plant phenology indicators indicate the presence of high or low rainfall and hence intensity of malaria prevalence.	Macherera and Chimbari (2016)
	In Gwanda district, Matebeleland South, Zimbabwe, astronomical and meteorological signals such as clouds, humidity and temperature variations are utilised to forecast rainfall patterns.	In this case humidity/rainfall and temperature can be used to predict malaria prevalence and intensity.	Macherera and Chimbari (2016)
The use of red-hot granite rock and water,	A red hot stone is immersed in cold water and begins to boil. The patient and red hot stone are covered under a blanket or cloth (known as kufukira in Zimbabwe).	Although there is limited information linking this traditional method to the fight against malaria, it has been revealed that raising the body temperature strengthens the second line of defence by generating thermal stress, which mimics feverish episodes.	Chapu and Mgocheki (2017)
The burning of dung and plants to deter malaria vectors	A comprehensive survey in Chiredzi district, Masvingo, Zimbabwe, burning of dry pieces of plants such as Spirostachys africana and dung (cow or elephant dung) has been done to deter mosquitoes.	Evidence to suggest that smoke is an efficient repellent and the practice of smoke fumigation of rooms to avoid biting mosquitoes is common. This is a preventive method that can be applied with precautionary measures of preventing indoor air pollution.	Chapu and Mgocheki (2017)
	In most regions of Zimbabwe, hanging fresh leaves of Chenopodium ambrosioides, Lippia javanica, Chrysopogon nigratana and Ocimum canum in the home efficiently provided mosquito bite protection.	This is a preventive method that can be applied. Most plant derived fumigants are employed as mosquito repellents since they contain mosquito repelling essential oils.	Chapu and Mgocheki (2017)
Spiritual malaria treatment based on faith and traditional healers.	In Zimbabwe, the believers believe that malaria may be healed by pleading with God since it is thought that disease is God’s punishment. Additionally, some churches in Zimbabwe recommended congregants to drink plenty of water to avoid contracting the sickness including malaria.	There is no scientific evidence to support applicability of this traditional method in the Zimbabwean health systems.	Treadwell (2001)
	Among the Shona speaking people of Zimbabwe, mashavi (wandering spirits) and mhondoro (wishful spirits) Although mhondoro and mashavi are important, they are not as important as vadzimu in everyday life of some Zimbabweans	There is no scientific evidence to support applicability of this traditional method in the Zimbabwean health systems.	Masaka and Makahamadze (2013)
	In some communities in Zimbabwean, the elderly (as well as departed descendants) are key in maintaining access to and inheritance of disease treatment and prevention through specific dreaming (kurotswa) and ceremonial divinations (kusvikirwa), in which the knowledge is disclosed as a gift	There is no scientific evidence to support applicability of this traditional method in the Zimbabwean health systems.	Masaka and Makahamadze (2013)

The insects recognised by residents of Gwanda district, Matebeleland South, Zimbabwe, mark the start of the rainy season and whether the amount of rainfall is high or low. For example, the presence of a large number of termites indicates the start of the rainy season (Chanza & de Wit, 2014; Macherera & Chimbari, 2016; Risiro et al., 2012). Though such a marker does not reflect the quantity of the rain or the extent of malaria prevalence, it does herald the start of the malaria season. The appearance of massive white butterflies migrating from west to east in the month of October indicates considerably high rainfall and hence a high malaria prevalence (Macherera & Chimbari, 2016).

Most bird actions predict whether the rainy season will be excellent or bad; however a few species simply herald the start of the rainy season (Chanza & de Wit, 2014; Kupika et al., 2019; Musarandega et al., 2018; Risiro et al., 2012). The noise of ground hornbills from September to November as well as the laying of eggs by guinea fowls, indicate a favourable rainy season and a high malaria incidence (Macherera & Chimbari, 2016). However, the appearance of huge numbers of species such as Swallows and Migratory birds in November indicates that the rainy season is approaching.

Wild animals have been recognised as reliable predictors of rainfall and malaria prevalence (Nyahunda & Tirivangasi, 2021). It was discovered that if wild animals have a large number of young ones, more rainfall would be obtained in the next season, leading to high malaria prevalence (Macherera & Chimbari, 2016). Furthermore, lions passing by the farmsteads without attacking domesticated animals or humans during the months of September and October signify of a favourable rainy upcoming season (Macherera & Chimbari, 2016). This shows that the likelihood of malaria transmission will be substantially high.

Plant phenology indicators are based on the presence or absence of leaves, fruits and flowers, which indicate the presence of high or low rainfall (Table 1) and hence intensity of malaria prevalence (Kupika et al., 2019; Mashoko, 2014). For example, if plants like Lanchocarpus capassa flowers in October and November and Boscia albitrunca produces flowers early and numerous fruits by November, there will be a significant rainfall in that season and malaria will be a major problem. However, the presence of many fruits in plants such as Acasia nigrescens indicates low rainfall and drought is signified by the plant taking longer to produce new leaves (Macherera & Chimbari, 2016). In both cases, malaria prevalence is projected to be extremely low.

In Gwanda district, Matebeleland South, Zimbabwe, astronomical and meteorological signals (Table 1) such as clouds, humidity and temperature variations are utilised to forecast rainfall patterns and the intensity of malaria transmission (Macherera & Chimbari, 2016). High rainfall and malaria prevalence are indicated by the presence of a band all around the moon, finely distributed clouds, clouds all along the frontier, hot humidity interchanging with strong winds, gentle breeze from the east to the west and then from the west to the east, increased frequency and intensity of whirlwinds during September and October and misty air during September and October (Macherera & Chimbari, 2016).

3.3. Burning of dung (cow or elephant) and plants to deter malaria vectors

In most regions of Zimbabwe, hanging fresh leaves of Ocimum canum in the home efficiently provided mosquito bite protection. Besides hanging of leaves, plants like Azadirachta indica and Ocimum forskolin have been burnt to generate repellent smoke that has considerably reduced human-mosquito bite (Table 1). Burning of plants to deter mosquitoes has been done in other African countries. In one trial conducted in Kenya, a combination of plant powders burnt directly, produced smoke that repelled malaria vectors such as Anopheles aegypti (Wendimu & Tekalign, 2021).

A comprehensive survey in Chiredzi district, Masvingo, Zimbabwe (Table 1), indicated that most households burn dung (cow or elephant dung) and plant leaves to generate smoke which repel mosquitoes (Chapu & Mgocheki, 2017). Several explanations have been propounded to explain how smoke fumigation of houses may change mosquito feeding behaviour. Plant and dug derived smoke normally obscure human odours and carbon dioxide, which mosquitoes sense when a human being is close by Moore et al. (2006). Additionally, smoke from plants normally interferes with mosquito receptors responsible for detecting chemicals through reducing water vapour in air (Davis & Bowen, 1994). Furthermore, dung and plant smoke is associated with a wide range organic compounds classified as insecticides, repellents and irritants (Moore et al., 2006). Such organic compounds include palmitic acids and capric, oleic.

Mosquito repellent herbs include Chenopodium ambrosioides, Lippia javanica and Chrysopogon nigratana. To deter mosquitoes, dry pieces of plants such as Spirostachys africana are burnt and glowing portions are utilised (Table 1) (Chapu & Mgocheki, 2017). This burning procedure is comparable to how mosquito coils are used nowadays. Elephant dung has historically been burnt and the smoke used for fumigation houses (Dubost et al., 2021; Maphane, 2018; Pennacchio et al., 2010). However, it should be emphasised that burning in poorly ventilated areas can expose occupants to extraordinarily high amounts of indoor air pollution. This is a common issue in low-income countries like Zimbabwe, particularly in rural regions where plants are abundant. It recommended that toxicity levels of the plant or animal waste to be burnt be assessed in order to prevent intoxication of people.

3.4. Spiritual malaria treatment based on faith and traditional healers

Zimbabwe’s Shona people, like monotheism religions have always believed in the power of God in healing of diseases and general well-being (Kazembe, 2009). The connection between human beings with the metaphysical world is important before birth, during life, at death and after death (Machingura, 2012). Among the Shona speaking people of Zimbabwe, mashavi (wandering spirits) and mhondoro (wishful spirits) are powerful spirits in disease (eg, malaria) prevention and treatment (Masaka & Makahamadze, 2013). Although mhondoro and mashavi are important, they are not as important as vadzimu in everyday life of some Zimbabweans (Masaka & Makahamadze, 2013). As a result, Shona cosmology stresses the significance of vadzimu in terms of disease prevention and treatment, life and death. Zimbabweans also believe in taboos, which are important in illness prevention (Machingura, 2012). In some communities in Zimbabwean, the elderly (as well as departed descendants) are key in maintaining access to and inheritance of disease treatment and prevention through specific dreaming (kurotswa) and ceremonial divinations (kusvikirwa), in which the knowledge is disclosed as a gift (Masaka & Makahamadze, 2013).

According to informants, malaria, like other ailments, may be cured through spirituality based on the individual’s your level of commitment and faith. It is believed that nothing seems to be impossible with God (Kpobi & Swartz, 2018). Among other interventions exorcism, anointed oil application and use of holy water have been reported to cure diseases malaria included. In Zimbabwe, the believers believe that malaria may be healed by pleading with God since it is thought that disease is God’s punishment (Treadwell, 2001). Additionally, some churches in Zimbabwe recommended congregants to drink plenty of water to avoid contracting the sickness including malaria. Based on this notion, all forms of illnesses may be effectively cured with water treatment (Bosire et al., 2022; Hjelm & Mufunda, 2010).

3.5. The use of red hot granite rock and water (steaming)

A red hot stone is immersed in cold water and begins to boil. The patient and red hot stone are covered under a blanket or cloth (known as kufukira in Zimbabwe), causing the patient to sweat excessively (Chapu & Mgocheki, 2017). Steaming is commonly advised as an at-home treatment for upper respiratory tract infections. Heat, the most fundamental aspect of steaming, has a substantial influence on host immune response and pathogenicity, as well as activating responsive thermoregulation systems that could really elevate or lower body temperatures to maintain equilibrium (Schieber & Ayres, 2016). Furthermore, raising the body temperature strengthens the second line of defence by generating thermal stress, which mimics feverish episodes (Schieber & Ayres, 2016).

Heat-stress caused by steaming stimulates the immune system (Heinonen & Laukkanen, 2018). Cold exposure following heat stress enhances immune system through an increase in NK cell number and activation, as well as levels of IL-6 in blood (Brenner et al., 1999). Furthermore, reflux occurs in response of blood being redirected in the tissues, which aids in detoxification (Cochrane, 2004). Multiple cellular reactions are triggered by antispasmodic temperatures, including a complex genetic regulation of the heat stress response pathway, inflammatory processes and immune response activation (Singh & Hasday, 2013). During steaming, heat shock proteins are produced and moved to cell membranes (Iguchi et al., 2012). The principal role of these proteins is to regulate and prevent damage in immune cells and denaturation of proteins. Moreover, heat shock proteins contribute significantly in the activation of polymorphonuclear leukocytes, antigen presentation, dendritic cells recruitment and differentiation (Singh & Hasday, 2013).

Increased temperature caused by steam inhalation helps to improve cardiac health by influencing the autonomic nervous system, reducing blood pressure, inflammatory processes and peroxidation. This, however, promotes and increases in heart rate, blood volume and perivascular blood circulation and enhancing cardiovascular health, serum lipids profile and arteriolar regulation (Heinonen & Laukkanen, 2018; Kunutsor et al., 2018; Laukkanen & Kunutsor, 2019). Another advantage of thermal stress is the adjustment in blood pH produced by rapid breathing induced by hyperthermia, which is accompanied by pulmonary alkalosis (Tsuji et al., 2016).

4. Medical pluralism, indigenous health practices and decolonisation of public health

4.1. Medical pluralism and indigenous health practices in Zimbabwe and beyond

Medical pluralism is a practice where different medical systems are adopted based on health beliefs and their ability to treat illnesses (Figure 2). Additionally, medical pluralism involves the integration of alternative and conventional biomedicines for a healthy society (Amzat et al., 2014). Although the reported indigenous practices (Table 1) have been combined with convention biomedicines in treatment and prevent of malaria in Zimbabwe, there is limited published work which indicates direct application of medical pluralism in malaria prevention and treatment in Zimbabwe. In line with this, the presented evidences of medical pluralism focus on other diseases in Zimbabwe and beyond (Choguya, 2015; Grossenbacher et al., 2021; Kajawu et al., 2016; Mandizadza, 2016; Moshabela et al., 2017; Robbins et al., 2021; Subedi, 2019).

Figure 2. Conceptual framework of the interaction of medical pluralism, indigenous health practices and decolonisation of public health.

Although, both conventional and alternative medicines are applied in most societies, it has been noted that there is still reluctance in mainstreaming alternative/traditional medicine in national health care systems. For instance in Zimbabwe, although based on sociocultural values and tradition, traditional birth attendants are empowered to manage pregnancies and perform deliveries, the ambivalence of government policies has excluded them and they are at the periphery of healthcare provision (Choguya, 2015). In Tharus, Nepal the link between medical pluralism or use of indigenous medicine and state health policy was evaluated (Subedi, 2019). Though the application of folk medicine, biomedicine and scholarly traditional medicine is common, officially biomedicine is the most preferred. The medical pluralism in Nepal has since been widened by integrating scholarly traditional medicine into mainstream health care system. Unfortunately, most indigenous medicines are outside state regulation and the legitimacy of indigenous care providers (healers) is still questioned (Subedi, 2019).

This practice of medical pluralism has been applied in many countries (Priya, 2012). For example, in Zimbabwe, Uganda, Tanzania, Kenya, South Africa and Malawi, a study to establish medical pluralism among people living with HIV was conducted and it was revealed that medical pluralism was common where people living with HIV used therapeutics from the biomedical health, traditional and faith-based worlds (Moshabela et al., 2017). According to Grossenbacher et al. (2021), spiritual (religious) ontologies are supposed to be integrated into main health care services and programs. However, there is need to strengthen these ontologies to prevent compromised therapy and holistically support people living with HIV. In another study to describe the pathways to primary care for patients with common mental disorders in Harare, Zimbabwe, it was revealed that most patients seek help from biomedical and traditional care providers. Although patients preferred biomedical care providers, in cases of treatment failure traditional care providers were consulted (Patel et al., 1997).

In most societies including Zimbabwe people normally use a diverse of therapeutic options where one option can be used as a complement or an alternate. In one study conducted in, Zimbabwe, Uganda, Tanzania, Kenya, South Africa and Malawi, there was evidence of mixing therapeutics from faith-based, traditional and biomedical healthcare providers. However, it was shown that medical pluralism in this case introduces mistrust among faith-based, traditional and biomedical healthcare providers and delays proper care of people living with HIV (Moshabela et al., 2017). In a study to examine African Traditional Medical practices on mental disorders, it was reported that herbalists were the most preferred care givers. The African Traditional Medical practices in this case provided treatment which was in congruency with cultural beliefs of patients and this was not true for biomedicine (Kajawu et al., 2016).

More often, therapeutics from different traditions can be combined (Figure 2) in order to treat certain ailments and meet their primary health care needs. For instance, cancer patients from Zimbabwe seek treatment from traditional health practitioners which make use of indigenous knowledge systems based on economic, cultural and affectional perspectives (Mandizadza, 2016). In a separate study done in South Africa, most Traditional Health Practitioners are trained sangomas (traditional healers) and prophets (faith healers). Although this reflects pluralistic approach, it was not applicable across all societies since some churches disregard traditional beliefs. It has been shown that Traditional Health Practitioners normally practice medical pluralism through combining traditional practices and Western medicines (Figure 2) (Galvin et al., 2023). Moreover, use of therapeutics from different traditions has been demonstrated through a cross-cultural comparative study on pre-eclampsia in Zimbabwe, Haiti and Ethiopia. From this study, it was concluded that apart from conventional biomedicine, traditional and faith caregivers should be engaged in order to move towards a life-saving care and pre-eclampsia elimination (Robbins et al., 2021).

4.2. Indigenous health practices and decolonising public health

Although indigenous health practices (Table 1) are experimental, systematic and empirical, they are localised and based on indigenous knowledge of human interactions, plants and animals in a specific location. This therefore, implies that indigenous health practices are situated, holistic, take into consideration nonhuman and human life forms (Stewart-Harawira, 2008). Notably, indigenous health practices take the human world as inseparable from nature and therefore, decolonisation process of public health should be independent of human consequences (Adams, 2016). On the other hand, public (global) health is based on Western conceptions of health which are basically anchored on biomedical, individual and human entities (Hindmarch & Hillier, 2022). In line with Barnabe (2021), public (global) health systems are modelled to suit the dominant society without contextualised indigenous knowledge systems. This implies that global/public health disregards the critical roles of indigenous cultural practices in maintaining wellness and health. However, according to Affun-Adegbulu and Adegbulu (2020), there is a shift towards decolonisation of global health as indicated by an increase in publications, conferences and seminars inclined to subject area recently.

In order to decolonise global health, a Two-Eyed Seeing approach by Mi’kmaq Elders Albert and Murdena Marshall can be adopted as a way of integrating indigenous knowledge systems/health practices and Western science (Martin, 2012). Decolonisation (Indigenisation) of public health is believed to enable the analysis of cultural practices and historical events that may have been lost during the transformation of indigenous to global health (Anderson, 2014). Accordingly, this decolonisation process requires empowerment, involvement and collaboration of leadership and indigenous communities (Barnabe, 2021). Public health can be decolonised can be achieved through partnerships in global health education. In order to achieve this, the educators must incorporate local communities in needs assessments, encouraging cultural safety and promoting positive deviance. However, this calls for local and foreign partners to come up with moral framework which take into account ethical diversity.

It should be noted that in some instances indigenous health practices have been overlooked. For example, in an analysis on women health activism in Zimbabwe by Gumbonzvanda et al. (2021), it is has been found that the Nhanga (Zimbabwe local practice) has represented emotions, narrative and culture which are normally overlooked in public health systems. Such indigenous practices should be should be included in public health systems since they promote transformation at global, community and individual (Gumbonzvanda et al., 2021). For such indigenous health practices and global health interventions to benefit indigenous people there is need for congruency (Aubel & Chibanda, 2022). However, global health strategies are hampered by incongruity between cultural practices and public health systems. Therefore, the decolonisation of public health should be based on the restructuring of interventions and research in order to capture the roles, resources and structure of indigenous Global South cultures.

Indigenous health practices can be globalised through decolonisation of academic publishing spaces. According to Khan (2022), journals involved in global health research and report publishing should provide opportunities for publications from alternative health systems and epistemic standpoints. In line with this, public health decolonisation should occur at ontological and epistemic levels and allows for historicising and depoliticising health through leadership, knowledge and paradigm shift (Büyüm et al., 2020). However, funding should be increased in order to support cultural based health programs and research (Aubel & Chibanda, 2022). Additionally, global health research journals should at all times try to downplay traditional evidentiary hierarchy (Khan, 2022).

5. Conclusion and recommendations

In this work five classes of indigenous practices used in prevention and management of malaria were identified and these are methods were evaluated. According to the findings in literature, there is paucity of published data on this particular subject. However, the identified indigenous practices applied in the fight against malaria are (1) herbal and other traditional medicines for treatment and prevention (2) traditional environmental indicators for prediction of malaria prevalence (3) red-hot granite rock and water for treatment of malaria symptoms (4) burning of dung and plants to deter malaria vectors and (5) spiritual malaria treatment based on faith and traditional healers. Information on the applicability and efficacy of these methods in Zimbabwe is limited. However, herbal medicines have been used in the development of antimalarial drugs and burning of plants and dung can be applied in the production of mosquito coils to prevent mosquito bites. Practices such as steaming and spirituality are just limited to the management of fever and has no scientific basis on malaria management respectively. Despite the application of indigenous practices in the fight against malaria in Zimbabwe, there is inconclusive evidence on their applicability in the main stream health systems. Although there is evidence of medical pluralism involving indigenous health practices in Zimbabwe, there is dearth of published information on direct application of medical pluralism in the fight against malaria. Therefore, it is recommended that indigenous health practices are scientifically evaluated through comprehensive studies. Beyond this literature survey, nationwide surveys should be done to gain more insights into the identified and other existing indigenous malaria control and treatment methods. Additionally, future studies should focus on applicability of medical pluralism and decolonisation of public health in the fight against malaria.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Zakio Makuvara

Zakio Makuvara, the corresponding and first author, is a lecturer and researcher at Great Zimbabwe University. He is currently a PhD student at the University of South Africa, working on antimalarial resistance and the efficacy of antimalarial plants against malaria.

Solomon Ramagoai Magano

Solomon Ramagoai Magano is Professor of Zoology, currently the Executive Dean in the CAES, University of South Africa.

Grace Mugumbate

Grace Mugumbate is a Professor of Chemistry and drug discovery, currently Pro-Vice Chancellor at the Midlands State University.