<p>In conclusion, the results obtained firstly indicated that the BP, EMEA and WHO were in fairly good agreement on the criteria and specifications that can be used to assesses the pharmaceutical quality of a traditional plant medicine such as Phela. Secondly, the Phela plant powders were found to have acceptable pharmaceutical properties that did not complicate or adversely affected the capsule manufacture. Thirdly, the Phela capsules produced were generally of acceptable pharmacopoeial standard. Fourthly, HPLC fingerprinting and pattern recognition analysis proved useful to examine the chemical stability of selected marker compounds of Phela and indicated that the capsules had no practical shelf life under elevated temperature and humid conditions. Overall, the Phela capsules should thus be suitable for use in a short time clinical trial, but for use in a long period trial the long term stability of the Phela capsules under ambient conditions must still be confirmed.</p>

This thesis is a descriptive study of health care in the Inuit settlement of Gjoa Haven, N.W.T. The purpose of the research was primarily to describe and analyse the interactional networks of health and illness related behaviour that are associated with the Nursing Station. The cultural and organizational background of the administrators and nurses who provide medical services to Inuit are described, as are the attitudes and beliefs held by Inuit about illness and about the health care delivery system.<p>The thesis examines the acculturation of Inuit beliefs and practices related to illness throughout the contact period and focuses particularly on the changing role of the Inuit healer, the anqatquq or shaman. Various influences such as epidemic diseases, missionary activity, and changing economic orientations that have contributed to Inuit dependency patterns and changed beliefs about illness, its causes and cures, are detailed.<p>Theoretically, the thesis is partly a study of the replacement of a traditional medical system by the cosmopolitan medical system and the gradual attenuation of the traditional curer's role. It is also an examination of the manner in which the conflict resulting from differences in attitudes between administrators, nurses and Inuit, affects the delivery and utilization of health services in Gjoa Haven. It demonstrates that where problems occur they are as much a result of conflict between administrators and nurses, as they are due to conflict between nurses and Inuit.<p>The substantive portion of the thesis examines specific domains of interaction such. as health education, agency coordination and native participation and points out areas where failure occurs in each of these arenas. Recommendations are included that suggest strategies for improving the effectiveness of health care delivery and ultimately the health levels of the Inuit population.

This thesis is a descriptive study of health care in the Inuit settlement of Gjoa Haven, N.W.T. The purpose of the research was primarily to describe and analyse the interactional networks of health and illness related behaviour that are associated with the Nursing Station. The cultural and organizational background of the administrators and nurses who provide medical services to Inuit are described, as are the attitudes and beliefs held by Inuit about illness and about the health care delivery system.<p>The thesis examines the acculturation of Inuit beliefs and practices related to illness throughout the contact period and focuses particularly on the changing role of the Inuit healer, the anqatquq or shaman. Various influences such as epidemic diseases, missionary activity, and changing economic orientations that have contributed to Inuit dependency patterns and changed beliefs about illness, its causes and cures, are detailed.<p>Theoretically, the thesis is partly a study of the replacement of a traditional medical system by the cosmopolitan medical system and the gradual attenuation of the traditional curer's role. It is also an examination of the manner in which the conflict resulting from differences in attitudes between administrators, nurses and Inuit, affects the delivery and utilization of health services in Gjoa Haven. It demonstrates that where problems occur they are as much a result of conflict between administrators and nurses, as they are due to conflict between nurses and Inuit.<p>The substantive portion of the thesis examines specific domains of interaction such. as health education, agency coordination and native participation and points out areas where failure occurs in each of these arenas. Recommendations are included that suggest strategies for improving the effectiveness of health care delivery and ultimately the health levels of the Inuit population.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

South Africa has a high HIV/AIDS prevalence. Due to the unavailability of antiretroviral drugs and South African’s trust in traditional healers for health problems, traditional healers are involved in treating HIV/AIDS. This dissertation outlines traditional healers’ role in HIV/AIDS in Tembisa, a township situated in the East Rand section of Johannesburg. People living with HIV/AIDS, traditional healers and health care workers were interviewed. The dissertation also confirms the high prevalence of HIV/AIDS in Tembisa.. According to the dissertation, a reasonable highest number of People Living with HIV/AIDS (PLWAS) 8 out of 10 consulted Traditional healers to seek treatment of HIV/AIDS Opportunistic infections, although three out of eight indicated that consulting traditional healers was not necessarily their own choice. Two PLWAS do not believe in traditional healers and have never consulted them. Five PLWAS’s view was that Traditional healers can treat opportunistic infections effectively and they indicated their own health bear evidence to such claims. The study had shown that, although traditional healers have shown good rapport with their clients, and have earned positive respect due to their involvement in HIV/AIDS prevention and treatment in their communities, there are also challenges with regards to their work that calls for urgent attention. For an example, a highest number of Traditional healers did misrepresent diseases related to sexual intercourse, and also they could not recognize the symptoms of HIV/AIDS. They also hardly gave all biomedical perspective of transmission of HIV/AIDS without being probed. Both the group that believed in traditional healers and those that do not, as well as Biomedicine indicated that using traditional healers alone without biomedicine is not a realistic option.due to their training that is not homogenous and their profession that is rarely regulated. All the participants interviewed were in support of the strong collaboration between traditional healers and Biomedicine. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2005.

This study was aimed at identifying and exploring the perceptions of traditional healers particularly izangoma and izinyanga, on the integration of their practices into the South African National Health System. The main reason behind this research was to establish the position of traditional healers as well as to study their opinions on the issue of integration. The paucity of previous research studies on the 'perceptions of traditional healers on the integration of their practice-s into the national health care system, was the main motivation behind this study. Participants were drawn from the Pietermaritzburg area and selection was based on purposeful sampling. The data of the study was collected by means of semi-structured interviews, which employed open- ended questions. This study was conceptualized within the African world-view and cosmology. The interactive model design by Maxwell (1996) was employed in the design of this study. According to this model the purpose, conceptual context, research questions and methods as well as issues of validity and reliability, are all essential for the coherence of any qualitative study. The ethical considerations of this study were mainly around the issue of informed consent, and this was negotiated and discussed with the participants until they could understand the process of consent. The results of the study reflect the fact that traditional healers are positive about the process of integration. However, the participants were in favol of integration as a process of collaboration and co-operation as opposed to total integration, which was perceived as a process in which one system w0ll-Id dominate and oppress the other. The participants in this study perceive themselves as equal to their western counterparts because oftheir training and ability to treat "spiritual illnesses". Further, they view their role as that of providing alternative healing as well as acting as a medium between people and their ancestors. Education and negotiations were identified as the possible solutions to most problems in the process of integration. The findings of this study further reveal that there is mistrust and suspicion about western healers form traditional healers. As a result of this, improved collaboration between traditional and modem health care systems seems to be the only process, which could benefit all the people of the country. / Thesis (M.A.)-University of Natal, Pietermaritzburg, 2000.

Previous research on healing in Ireland has primarily been the concern of folklorists. Based on interviews with a variety of healers, this thesis broadens our understanding of healing in Ireland by considering the socio-political context within which healing beliefs and practices occur. Theory from the anthropology of the body and the critical interpretive approach within medical anthropology provide means for exploring how the body is used as a symbol to express anxiety about social change in Ireland and how individual bodies are socialized and regulated within an economy of power. Prevailing views of the correct "Irish body" are shown to be important elements of Irish identity, especially vis-a-vis the outside world. By drawing attention to the significance of key themes of healing within contemporary Irish society, this thesis suggests that "Irishness" is inscribed in the body in healing.

<p>In conclusion, the results obtained firstly indicated that the BP, EMEA and WHO were in fairly good agreement on the criteria and specifications that can be used to assesses the pharmaceutical quality of a traditional plant medicine such as Phela. Secondly, the Phela plant powders were found to have acceptable pharmaceutical properties that did not complicate or adversely affected the capsule manufacture. Thirdly, the Phela capsules produced were generally of acceptable pharmacopoeial standard. Fourthly, HPLC fingerprinting and pattern recognition analysis proved useful to examine the chemical stability of selected marker compounds of Phela and indicated that the capsules had no practical shelf life under elevated temperature and humid conditions. Overall, the Phela capsules should thus be suitable for use in a short time clinical trial, but for use in a long period trial the long term stability of the Phela capsules under ambient conditions must still be confirmed.</p>

Eucomis (Family Hyacinthaceae) are deciduous geophytes with long, narrow leaves and erect, densely packed flower spikes. The bulbs are greatly valued in traditional medicine for the treatment a variety of ailments, and are thus heavily harvested for trade in South Africa's "muthi" markets. Eucomis species propagate relatively slowly from offsets and seed, and this, together with their over-utilization ethnopharmacologically, has led to their threatened status. This investigation focussed mainly on the study of the anti-inflammatory activity of plant extracts prepared from the leaves, bulbs and roots, and the development of suitable tissue culture protocols for the bulk propagation of the species under study. Common underlying symptoms in the majority of ailments treated with traditional remedies prepared from Eucomis species are pain and inflammation. Prostaglandins are the primary mediators of the body's response to pain and inflammation, and are formed from essential fatty acids found in cell membranes. This reaction is catalysed by cyclooxygenase, a membrane-associated enzyme occurring in two isoforms, COX-1 and COX-2. Non-steroidal anti-inflammatory drugs (NSAIDs) act by inhibiting the activity of COX. The use of commercially available COX-1 inhibitors is associated with side-effects, including gastric and renal damage. Selective COX-2 inhibitors do not have these undesired effects, and are thus potentially very valuable to the pharmaceutical industry. The relative inhibitory effects of different extracts of Eucomis species on the activities of purified cyclooxygenase enzyme preparations (COX-1 in sheep seminal vesicles, COX-2 in sheep placenta) were assessed. The COX-1 assay was used to screen extracts from 10 species of Eucomis and one hybrid species at a concentration of 250 μg mℓ ¯¹ in the assay. High levels of anti-inflammatory activity were exhibited by the ethanolic extracts prepared from the dried leaves, bulbs and roots. Aqueous extracts (screened at 500 μgmℓ ¯¹) showed much lower levels of activity. In general, the highest levels of anti-inflammatory activity were observed for the ethanol bulb and root extracts. Comparison of the activity of the bulb extracts from bulbs harvested in summer and winter revealed very little difference in COX-1 inhibitory activity. Eucomis extracts were separated using thin layer chromatography. The plates were developed in a solvent system of benzene : 1,4-dioxan : acetic acid, 90:25:4 and stained with anisaldehyde-sulphuric acid. The TLC fingerprints prepared from these extracts showed different chemical profiles for the leaf, bulb and root extracts, but many similarities between the different species. The position of the active R[f] fractions was determined and correlated with the TLC-fingerprints. The most widely utilized species medicinally, E. autumnalis subspecies autumnalis, was chosen for further investigation. The fluctuation of anti-inflammatory activity with season and physiological age was determined. Young plants were found to have high levels of COX-1 inhibitory activity, particularly in the leaves. As the plant matured, higher levels of activity were associated with the bulb and root extracts. The antiinflammatory activity of the leaf, bulb and root extracts varied slightly throughout the year, with the highest levels detected towards the end of the growing season, shortly before the onset of dormancy. This study of E. autumnalis autumnalis was extended to investigate the effects of environmental conditions on the levels of COX-1 inhibitory activity. The extent to which high temperature and light intensity, fertilization of the plants in summer with Kelpak preparations, and cold storage of the dry bulbs during winter, affected the levels of active compounds accumulated, was determined. Kelpak application decreased the anti-inflammatory activity of the leaf, bulb and root extracts, while high temperature / high light intensity had no significant effect on the COX-1 inhibitory activity of the leaf or bulb extracts. The root extract did show a significant increase in anti-inflammatory activity. Bulbs that were removed from the soil and stored at 10°C exhibited significantly higher COX-1 inhibitory activity than the control bulbs maintained in the soil. Higher COX-1 inhibition was observed in the leaf extracts from these plants when harvested half-way through the growing season. No significant difference was observed at this stage between the bulb and root extracts from the different treatments. Bioassay-guided fractionation (using the COX-1 assay) was used to isolate the active principle(s) in the bulb extract. The bulb material was subjected to serial extraction using a Soxhlet apparatus. The ethyl acetate fraction showed the highest levels of COX-1 inhibition, and this was further fractionated using a Sephadex LH-20 column and a solvent system of cyclohexane : dichloromethane : methanol (7:4:1). The most active fraction from this separation was then purified using semi-preparative TLC and HPLC. The primary compound eluting in this fraction had an IC₅₀ value of 14.4 μgmℓ ¯¹ in the COX-1 assay, and 30.5 μgmℓ ¯¹ in the COX-2 assay. This compound was tentatively characterized as a phenol ring attached to a conjugated hydrocarbon chain (with a molecular weight of 390), and was a potent COX-1 inhibitor. The COX-2 / COX-1 inhibitory ratio was calculated to be 2.1. A second, highly active compound, with IC₅₀ values of 25.7 μgmℓ ¯¹ and 21.8 μgmℓ ¯¹ in the COX-1 and COX-2 assays respectively, crystalized from one of the Sephadex LH-20 column fractions. This compound was identified as a spirostane-type triterpenoid, eucosterol, previously isolated from Eucomis species but not specifically linked to the pharmacological activity of the extracts. This compound showed COX-2 / COX-1 inhibitory ratio of 0.8, indicating that it was a selective COX-2 inhibitor. Two further compounds were identified from this extract, after crystallization from different fractions obtained from Sephadex LH-20 chromatography. These were both homoisoflavanones, 5,7-dihydroxy-6-methoxy-3-(4-methoxy benzyl)-chroman-4-one, and 5,7-dihydroxy-3-(4-methoxy benzyl)-chroman-4-one [eucomin], the latter having been isolated previously. The first compound exhibited very low levels of both COX-1 and COX-2 inhibition, and the second compound (eucomin) exhibited high COX-1, but low COX-2 inhibitory activity. The in vitro propagation of the genus Eucomis was undertaken primarily to provide a source of material for experimentation, and also to optimize this technique for the bulk production of plants for commercial and conservation purposes. Multiple shoot production was initiated from leaf explants, in all species studied. A Murashige and Skoog (MS) medium, supplemented with 100 mg ℓ ¯¹ myo-inositol, 20 g ℓ ¯¹ sucrose, and solidified with 2 g ℓ ¯¹ Gelrite® was used. The optimal hormone combination for shoot initiation in the majority of species was determined to be 1 mg ℓ ¯¹ NAA and 1 mg ℓ ¯¹ BA. Optimal root initiation was demonstrated on media supplemented with 1 mg ℓ ¯¹ IAA, IBA or NAA, depending on species. A continuous culture system using this protocol produced 25-30 plantlets per culture bottle, with 10-25 specimens per bottle available for acclimatization. To maximize plantlet survival, different support media used during the acclimatization process were necessary. Certain species responded best on a vermiculite medium, while perlite (which holds less water) was necessary for the optimal survival rate of other species. Acclimatized plantlets were repotted in a sand : soil mix (1:1). Further experimental work aimed to determine the factors affecting the accumulation of anti-inflammatory compounds in in vitro plantlets. Extracts prepared from in vitro plantlets showed high levels of COX-1 and COX-2 inhibitory activity, with a C0X-2/C0X-1 ratio of 1.1. High levels of sucrose (40 g ℓ ¯¹) significantly increased the number of shoots initiated, but had no effect on the anti-inflammatory activity. Low levels of sucrose (10 g ℓ ¯¹) led to a significant decrease in COX-1 inhibition. Changing the levels of nitrogen in the medium (but not the ratio of nitrate to ammonium ions) had no significant effect on the COX-1 inhibitory activity of the extracts. Callus was initiated from leaf explants and experiments were conducted to maximize callus proliferation. Optimal callus growth occurred on an MS medium supplemented with 100 mg ℓ ¯¹ myo-inositol, 30 g ℓ ¯¹ sucrose, 2 g ℓ ¯¹ Gelrite® , and a hormone combination of 10 mg ℓ ¯¹ 2,4-D and 2 mg ℓ ¯¹ kinetin. Callus cultures maintained in the dark grew best. Callus extracts tested in the COX assays (250 μgmℓ ¯¹) showed a higher level of COX-2 inhibition (69%) than COX-1 inhibition (46%). Lastly, the conclusive identification of the species under study was attempted, using DNA fingerprinting. Protocols were developed for the extraction of DNA from the leaves of Eucomis plants, and the optimization of the AP-PCR technique. Random sequence (10-base) oligonucleotide primers were screened, each primer used singly. Primers were selected on the basis that more than five distinct bands were detected. Differences were detected in the amplification products visualized using nondenaturing agarose gel electrophoresis stained with ethidium bromide. This work provides the basis for further studies into the phylogenetic relationships between the various species (and hybrids) of Eucomis. / Thesis (Ph.D.)-University of Natal, Pietermaritzburg, 1999.

Merwilla natalensis (Planchon) Speta is ranked as one of the most commonly sold medicinal plants at most of the informal medicinal plant markets found throughout South Africa. The increasing demand for medicinal plants has resulted in over-exploitation of many of the wild populations. Overharvesting has resulted in M. natalensis being declared vulnerable. Although this species is so popular, and reports state that the bulbs are used for a variety of ailments, very little is known about its pharmacological activity or phytochemical composition. Extracts were made from mature M. natalensis bulbs using hexane, dichloromethane, methanol and water. These extracts were screened for antibacterial, anticancer, anti-inflammatory, antischistosomal and anthelmintic activity. Antibacterial activity was evaluated using the minimal inhibitory concentration (MIC) assay. Methanol extracts displayed good antibacterial activity against both Gram-positive (Bacillus subtilis and Staphylococcus aureus) and Gram-negative (Escherichia coli and Klebsiella pneumoniae) bacteria. Anti-inflammatory activity was evaluated using the COX-1 and COX-2 bioassays. Dichloromethane extracts displayed the highest inhibitory activity against both COX-1 and -2 enzymes. (80% and 91% inhibition respectively) Very good activity was displayed against the free-living nematode Caenorhabditis elegans and the schistosomula worms of Schistosoma haematobium using microdilution techniques. Anticancer activity was evaluated using the biochemical induction assay (BIA) in which DNA-damaging properties are tested for. No activity was found using this assay, however, these results do not prove that M. natalensis does not have other anticancer properties. The phytochemical investigation of mature M. natalensis plants showed the bulbs to contain both saponins and bufadienolides. One of the bufadienolides had the same Rf value as proscillaridin A. Cytotoxicity tests reveal M. natalensis to be extremely cytotoxic, yet the bulbs are commonly sold at traditional medicine markets around South Africa. This cytotoxicity may be accredited to the presence of saponins within the bulbs. No alkaloids or tannins were detected in the bulbs. With the growing population in South Africa, there is an increasing demand for traditional medicines. This increasing demand is placing tremendous strain on natural populations growing in the wild. However, as the demand cannot continue to be met other sources are needed. Tissue cultured plants have been grown at two different regions of South Africa. These plants have been grown under different conditions to determine the optimal ones needed to grow M. natalensis as a commercial crop on small-scale farms. Plantlets taken directly from tissue culture were acclimatized successfully for cultivation by means of simple and cost effective methods. Cultivated plants were harvested on a six-monthly basis for a period of two years. Field cultivation produced bulbs of almost marketable size (±300g fresh weight) after 24 months. Bulb size was not dependent on additional fertilizer or irrigation. No significant differences (p<_0.05) were shown in the average dry weights of bulbs grown under different treatments (control, fertilizer without irrigation, fertilizer with irrigation). Leaf senescence and dormancy of young plants were prevented with irrigation. Flowering occurred after 24 months, with the irrigation and fertilizer plot having the most flowering plants. TLC fingerprinting revealed differences in the chemical composition of the bulbs harvested at different stages of growth. Noticeable differences were found between bulbs cultivated at the different growing sites. Pharmacological screenings were done of the harvested bulbs to investigate the effect of age (time of harvest) and growing conditions on antibacterial, anti-inflammatory and anthelmintic activity. Methanol extracts were screened against Gram-positive (Bacillus subtilis and Staphylococcus aureus) and Gram-negative (Escherichia coli and Klebsiella pneumoniae) bacteria. Variations in activity were found. The time of harvest had a significant effect (p<_0.05) on biological activity, with the younger plants being more active. Antibacterial activity decreased with an increase in plants age. Methanol extracts were also screened for anthelmintic activity against Caenorhabditis elegans. Activity was found to increase with plant maturity. Irrigation was found to increase activity at the low rainfall (Fort Hare) site. Bulbs harvested from the irrigation treatment had significantly higher anthelmintic activity (p<_0.05) than bulbs harvested from treatments without irrigation. Dichloromethane extracts from bulbs grown at both sites had high anti-inflammatory activity. There were no significant differences (p<_0.05) in the activity of bulbs harvested from the different treatment plots. The time of harvest had an effect on the inhibition of prostaglandin synthesis by COX-1 enzymes. This study provides not only scientific verification for the use of M. natalensis to some extent as a medicinal plant, but also important data needed to successfully cultivate this species as a crop for small-scale farming. / Thesis (Ph.D.)-University of Natal, Pietermaritzburg, 2003.