The thesis examines the process of social change among Tharaka agao (healers) in the Meru District of Kenya: it analyzes the rationale of the social and cultural processes involved for an existing occupation to become a recognized professional activity in modern Kenya. The thesis argues that a radical redefinition of professional 'jurisdictions' is required in the medical field. The concept of 'jurisdiction' is discussed here in metaphorical terms in order to question the common assumption that professionalization in the Western-type is the only possible model of development for African healers. The first part of the thesis, after information related to the structural and cultural context of Tharaka, provides an overview of the Tharaka experience of management of illness, with an emphasis on health-seeking behaviour and the division of labour in health care. The second part establishes the cultural boundaries of the healing 'jurisdiction' of the Ugao and the mechanisms used to gain the claimed control over it: this is done by presenting and analyzing the ethnographic material which I collected during a period of apprenticeship with three Tharaka healers. The third part investigates the social dimension involved in the development of that 'jurisdiction', by examining group formation among healers and the problems generated within the emerging profession. It also considers the matter of integration of Tharaka healers within the local health care system through an analysis of their interrelationship with the biomedical personnel and the health care facilities. Finally, it discusses the problem of legitimation the whole process of professional development raises at the local and national level.

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The Western liberal approach to informed consent defines autonomy as an independent choice or decision made by an individual as the final authority in medical decision-making. This approach is so dominant that one can fail to see the merits of other traditional and cultural perspectives. In this dissertation, another approach to informed consent is considered -that of communal culture of Africa, a process used in African traditional medicine (ATM) wherein patients make medical decisions and give consent in consultation with the members of their community and the ATM doctor. Often, but not necessarily, the final consent rests on the consensus reached in consultation with the group rather than on that by the individual patient alone. <br>This dissertation argues that the ATM form of consent constitutes legitimate informed consent based on the concept of relational autonomy, commonly called relational autonomy in informed consent (RAIC) in this dissertation. To interpret and enlighten the significance of the ATM approach to RAIC, the analysis in this dissertation examines the ethics of care movement in Western bioethics which also advocates a relational approach to informed consent. This movement presents a concept of persons as relational beings who are socially embedded, thereby interpreting patient autonomy in their relationships with others. This movement provides the hermeneutic to enlighten the significance of the ATM approach as a legitimate model of RAIC. <br>By comparison of the ethics of care approach with that of ATM to RAIC, this dissertation further provides a relational approach to informed consent in order to inform the restrictive emphasis on individual autonomy practiced in Western bioethics, all with a view towards fostering current discourse on global bioethics. The dissertation also provides an applied example of the contribution of ATM's RAIC approach to ethics committees in Africa, focusing in particular, on the decision-making process for patient informed consent. <br>This dissertation is distinct insofar as it focuses on informed consent in ATM, employs ethics of care as a hermeneutic to interpret ATM, advocates integrated model of healthcare ethics committees in ATM. Because ATM forms a large portion of the healthcare systems in Africa, it follows that ATM and its practices should receive more attention in bioethics in the present global era. / McAnulty College and Graduate School of Liberal Arts; / Health Care Ethics / PhD; / Dissertation;

>Magister Scientiae - MSc / BACKGROUND: Following the historical suppression of traditional medicines in South Africa, the government published their National Health Plan in 1994 which made provision for traditional healing as an integral and recognised part of the health care system, inter alia, to establish a regulatory body for traditional medicines. Traditional medicines were included in the National Drug Policy for South Africa in 1996. A policy on traditional medicine was only drawn up in 2008 and is currently still in draft form. Some progress was made towards regulating traditional health practitioners; but very little towards regulating traditional medicines after its adoption into the National Health Plan over a decade ago. The aim of the study was to investigate how traditional medicines in South Africa can be effectively regulated with specific focus on the current status of traditional medicine regulation in South Africa; to highlight the challenges which have impeded progress towards regulating traditional medicines; and a review of regulatory strategies for traditional medicines in Ghana, India and the People’s Republic of China in an attempt to identify viable solutions to pave an effective way for regulating traditional medicines in South Africa.METHODS: The research design was exploratory and qualitative in nature following a deductive thematic analysis of data collected using a traditional literature review process. RESULTS: The delay in regulating traditional medicines in South Africa is due to a number of challenges where the most prominent is due to a lack in national priority to categorise African traditional medicine and to include it into the country’s national health system. Traditional medicines according to the World Health Organisation can be classified for inclusion into national health systems either as integrative or inclusive. Each of these inclusion strategies were presented by the chosen jurisdictions studied. An integrative health care system such as that used by China was found to be resource intensive in nature. An inclusive health care system as used in Ghana and India did not require traditional medicines as an integral part of the health care system and there were no expectations for the same requirements for regulating traditional medicines and allopathic medicines. What became apparent from the study was that irrespective of the inclusion strategy followed, there are still a number of challenges that obstruct the existence of an effective regulatory framework for traditional medicines with an overwhelming common factor of the instrumental role government play.

Philosophiae Doctor - PhD / Introduction: Typha capensis, commonly referred to as bulrush also called "love reed'' growing in Southern Africa's wetlands, is one of South Africa indigenous medicinal plants that are traditionally used to treat male fertility problems and various other ailments. Previous studies revealed that T. capensis has indeed a beneficial effect on male reproductive functions and aging male symptoms. The T.capensis rhizomes are used in traditional medicine during pregnancy to ensure easy delivery, for venereal diseases, dysmenorrhea, diarrhoea, dysentery, and to enhance the male potency and libido. Typha genuses contain flavones and other phenolic compounds, which exhibit anti-oxidative capacity. Materials and Methods: This study encompasses three parts (part 1: Exposure of different cell lines to crude aqueous extracts of T. capensis rhizomes; part 2: HPLC analysis of Typha capensis crude rhizome extract and exposure of different cell lines to the F1 fraction of the summer season; part 3: Compound identification by means of NMR spectrometric analysis and exposure of different cell lines to bioactive compounds (Quercetin and Naringenin) isolated from T. capensis rhizomes. Part 1: TM3-Leydig cells and LNCaP cells incubated with different concentrations of crude aqueous extract of T. capensis rhizomes (0.01, 0.02, 0.1, 1, 10 and 100 μg/ml) and control (without extract) for 24 and 96 hours, after incubation. The following parameters were evaluated: cell morphology and viability (determined by means of MTT assay). Part 2: The crude extract HPLC profiles were obtained by preparing the extracts for different seasons (Autumn, Winter, Spring, Summer). TM3-Leydig cells, LNCaP cells and PWR-1E cells incubated with different concentrations T. capensis rhizomes extract F1 fraction of the summer season (0.01, 0.02, 0.1, 1, 10 and 100 μg/ml) and control (without extract) for 24 and 96 hours, after incubation. The following parameters were evaluated: cell morphology was observed and recorded, viability (determined by means of MTT assay), testosterone production (testosterone ELISA test), cell early apoptosis (determined by means of Annexin V-Cy3 binding), DNA fragmentation (determined by means of the TUNEL assay). Part 3: NMR spectrometric analysis was performed on a 13C spectra were recorded at 400 MHz. TM3-Leydig cells and LNCaP cells incubated with different concentrations of bioactive compounds (Quercetin and Naringenin) isolated from T. capensis rhizomes, for acute exposure (24, 96 hours) and chronic exposure (96 hours), after incubation, the following parameters were evaluated: cell morphology and viability (determined by means of MTT assay), testosterone production (testosterone ELISA test), cell early apoptosis (determined by means of Annexin V-Cy3 binding) and DNA fragmentation (determined by means of the TUNEL assay). Results: Part 1: for TM3-Leydig cells the results reveal no observable morphological changes and no significant influence on cell viability except at highest concentration indicating cellular stress. However, LNCaP cells showed a decline in cell viability at the incubation period 96 hours (-82.4%) more than 24 hours (-64.7%) indicating more cell death. Part 2: HPLC data showed that the most effective fraction was the F1 fraction from the summer harvest. Results revealed that the T. capensis rhizome extract F1 fraction of the summer season significantly enhanced testosterone production in TM3 cells and was more toxic towards cancer cells (LNCaP cells ) compared to the normal cell lines (TM3-Leydig, PWR-1E cells). Part 3: NMR data showed 2 bioactive compounds which were identified as Quercetin and Naringenin. The assays showed that LNCaP cells are more sensitive to the cytotoxic effects and apoptosis induction of both compounds, whereas, the assays resulted in weak effects toward TM3-Leydig cells. However, testosterone production in TM3-Leydig cells was significantly enhanced at low concentrations of Quercetin and Naringenin at all exposure types (acute and chronic) testosterone beak significantly at around 0.100 and 0.125 μg/ml (P<0.0001), stimulatory activity in a dose-dependent manner. Conclusion: Typha capensis enhanced the production of testosterone and might be useful to treat male infertility and aging male problems. Results further reveal that the F1 fraction from the summer harvest had highest biological activity. This study, for the first time, investigated the effects of bioactive compounds (Quercetin and Naringenin) yeilded from aqueous extraction of Typha capensis rhizomes in cell lines investigating male reproductive functions. Active compounds present in the rhizomes have caused an increased production of testosterone level in TM3-Leydig cells. Furthermore, the active compounds of Typha capensis rhizomes in the high dose had a negative effect on the percentage of DNA fragmentation in LNCaP cells. When compared to the effect of the low dose, the two compounds induced significant apoptosis in cancer cell line (LNCaP) compared with the normal cell line (TM3-Leydig). The isolated compounds are significantly selective towards the cancer cells than the normal cell compared with the exposure of bioactive compounds used in this study.

Magister Artium - MA / This mini-thesis provides empirical evidence on the level of public participation and its correlation with trust, reciprocity, class and power amongst African traditional health practitioners (ATHPs) in the regulation of African traditional medicines (ATMs) in South Africa. Data on public participation of ATHPs was collected and analysed, using a social capital theoretical model created from an adaptation of Putnam’s (2000) concepts of trust and reciprocity as central to social capital theory. The analysis further employed Bourdieu’s (1968) thinking to link power and class to the concept of social capital and borrowed from feminist and historical materialism theories. The thesis sought to test how the analysis of power and class, once politicised, could be used to convert Putnam’s notion of trust and reciprocity into "critical trust” and “critical reciprocity”, based on hyper-reflexive engagement of social agents with their own reality within social networks. ATHPs were requested to rank themselves from a scale of high to low to determine their level of involvement. Public participation (the dependant variable) was tested against acts of reciprocity, trust, power and income or class (the independent variables) to ascertain correlation. Data was analysed using STATA, a computer-based programme for analysing quantitative data. The findings of the study showed that income and power play a significant role in determining public participation. The level of one’s income and power determines whether one is active or passive in participation. The high levels of trust and reciprocity demonstrated by ATHPs towards government had no particular significance in facilitating active participation instead trust, in particular, played a negative role, in that it demobilised ATHPs from active participation since they trusted that government will protect their best interest in the regulation process. The argument in this thesis is that trust and reciprocity has to be converted into ‘critical trust’ and ‘critical reciprocity’ through active questioning and analysis of power and class dynamics for it to activate and invoke conscious active participation. A follow-up study is necessary to test the possibility and success of such a conversion for public participation.

>Magister Scientiae - MSc / Sutherlandia frutescens (L.) R. Br. (Fabaceae), indigenous to the Western Cape region of South Africa, is found in a Mediterranean-type climate known for its many environmental stressors that can influence the levels of metabolites found in plants. Sutherlandia frutescens contains many known potential active constituents among them, flavonoids such as sutherlandins 3 and 4 (Su3 and Su4) and terpenoids such as sutherlandiosides B and D (SuB and SuD). Whether the profiles and levels of Su3, Su4, SuB and SuD are significantly affected by the environmental factors found in this area is however, unknown. iBatech™ is an ethanolic plant extract that is manufactured by researchers in the Department of Medical Biosciences, UWC, for use as a pesticide. HPLC analysis performed on Lycopersicon species treated with the iBatech™ product have shown that it also caused an increase in the concentrations of total polyphenols in the plant (Klaasen et.al., unpublished data). Whether the treatment with iBatech™ might also cause an increase in the polyphenols such as sutherlandins 3 and 4 and sutherlandiosides B and D is also unknown. The objectives of this study were to determine the concentrations of sutherlandins 3 and 4 (Su3 and Su4) and sutherlandiosides B and D (SuB and SuD) in S. frutescens collected from different sites and after the treatment with the iBatech™ product. The specific objectives were: a) to locate and categorize sites where S. frutescens is grown, based on a selection of pertinent environmental growth factors, b) to determine and compare the concentrations of sutherlandins 3 and 4 and sutherlandiosides B and D in S. frutescens collected from the different environmental growth sites and after treatment with the iBatech™ product. To realize these objectives, S. frutescens samples were collected from eight different sites and broadly categorized into three environmental categories. A high-performance liquid chromatography (HPLC) method using diode array ultraviolet detection (HPLC-DAD) for the simultaneous analysis of flavonoids and terpenoids was developed and validated, and used for the profiling and determination of the average levels of sutherlandins 3 and 4 and sutherlandiosides B and D in the samples from the sites and that treated with the iBatech™ product. The Kruskal-Wallis test was used to determine statistically significant differences among the environmental categories. The post ANOVA, Dunn's Multiple Comparison test was performed to determine which groups were significantly different. The Mann-Whitney, two-tail, t-test was used to compare each environmental category to the standard and the column statistics of the raw data was analyzed to determine significant differences among samples from the same environmental category. In the samples collected from the sites, the values represent the average levels of metabolites for each environmental category whereas the significance values indicated were among samples from the same environmental category. The levels for sutherlandin 3 were Afriplex™ (Std.) 2495.08, the natural field (NF) 2810.33 (P=0.0005), the cultivated field (CF) 2519.81 and the greenhouse (GH) 2580.25. The levels for sutherlandin 4 were significantly different when comparing the (NF) 1495.67 (P=0.0001), (CF) 3114.42 (P=0.0140) and (GH) 2361.72 (P=0.0001), with the CF group showing the highest levels of Su4 and the NF showing the lowest. The levels for sutherlandioside B were (NF) 189.7 (P=0.0189), (CF) 594.56 (P=0.0140) and (GH) 326.72 (P=0.0001), however, the CF group showed the highest average levels for SuB. The levels for sutherlandioside D were (NF) 144.1 (P=0.0192), (CF) 544.37 (P=0.0308) and (GH) 387.49 (P=0.0001), with the NF category having the lowest average levels. In the iBatech™ treated samples, the values indicate the average levels of three samples in each treatment group. The levels for sutherlandin 3 were (control) 9758.43, the (50%) 2232.63 and the (100%) 2031.97 treatment groups. The levels for sutherlandin 4) were (control) 2241.63, the (50%) 2247.47 and the (100%) 2392.60, with the 100% treatment group having the highest levels. The levels for sutherlandioside B were (control) 289.66, the (50%) 284.93 and the (100%) 332.30. The levels for sutherlandioside D were (control) 282.77, the (50%) 280.60 and the (100%) 315.13 treatment groups, with the 100% treatment group having the highest levels. The levels of Su3, Su4, SuB and SuD were significantly different (P=0.0001) among all treatment groups. In conclusion, the data shows that only sutherlandin 4 (Su4) was significantly different when comparing the environmental groups. Due to the significant differences in the Su3, Su4, SuB and SuD levels among samples from the same group the levels of these metabolites cannot be correlated with the environmental groups.

Doctor Educationis / Diabetes has since been a global epidemic; an estimated 5.0 million deaths of diabetes in the world have been recorded; one in 11 adults have diabetes (415 million); and by 2040, one adult in 10 (642 million) will have diabetes. In Africa, more than two thirds of people with diabetes are undiagnosed, and 42 million have diabetes in the Sub-Saharan region with 324 877 adult deaths in South Africa (IDF, 2015). The global prevalence (age-standardized) of diabetes has nearly doubled since 1980, rising from 4.7% to 8.5% in the adult population. This reflects an increase associated with risk factors such as overweight or obese (WHO, 2016). Medicinal plants on the other hand, have played a significant role in the treatment and prevention of diabetes for centuries. In South Africa, indigenous medicinal plants have increasingly been used in the treatment of diabetes. In this study, a new anti-diabetes herbal compound named Jiang Tang 2016 (JT2016), made of three well researched South African indigenous medicinal plants is investigated for its hypoglycemic effects in HFD/STZ induced diabetic SD rats. These plants have been used for centuries in the indigenous system of medicine against various ailments, they are easily accessible, they grow in abundance, and are economically sustainable

This mini-thesis provides empirical evidence on the level of public participation and its correlation with trust, reciprocity, class and power amongst African traditional health practitioners (ATHPs) in the regulation of African traditional medicines (ATMs) in South Africa. Data on public participation of ATHPs was collected and analysed, using a social capital theoretical model created from an adaptation of Putnam’s (2000) concepts of trust and reciprocity as central to social capital theory. The analysis further employed Bourdieu’s (1968) thinking to link power and class to the concept of social capital and borrowed from feminist and historical materialism theories. The thesis sought to test how the analysis of power and class, once politicised, could be used to convert Putnam’s notion of trust and reciprocity into "critical trust” and “critical reciprocity”, based on hyper-reflexive engagement of social agents with their own reality within social networks. ATHPs were requested to rank themselves from a scale of high to low to determine their level of involvement. Public participation (the dependant variable) was tested against acts of reciprocity, trust, power and income or class (the independent variables) to ascertain correlation. Data was analysed using STATA, a computer-based programme for analysing quantitative data. The findings of the study showed that income and power play a significant role in determining public participation. The level of one’s income and power determines whether one is active or passive in participation. The high levels of trust and reciprocity demonstrated by ATHPs towards government had no particular significance in facilitating active participation instead trust, in particular, played a negative role, in that it demobilised ATHPs from active participation since they trusted that government will protect their best interest in the regulation process. The argument in this thesis is that trust and reciprocity has to be converted into ‘critical trust’ and ‘critical reciprocity’ through active questioning and analysis of power and class dynamics for it to activate and invoke conscious active participation. A follow-up study is necessary to test the possibility and success of such a conversion for public participation. / Magister Artium - MA

MA (Psychology) / Department of Psychology / See the attached abstract below