Abstract

This project will research local knowledge and use of plant-based traditional eye medicines (TEMs) in Malawi, with the overall goal of increasing communities' access to safe and appropriate eye health care. Researchers will document changes in the prevalence and biodiversity of eye care resources and how this affects their use (and vice versa), as well as the potential benefits and harm of using TEMs. Due to the considerable number of barriers preventing interaction between traditional healers, eye care providers and participating scientists, training activities will focus on developing the capacity of Malawian colleagues to undertake all aspects of current and future research. Activities will link opthalmology institutes, social science centres, non-governmental organizations (NGOs), botanical gardens and herbariums, and traditional medicine biochemistry study centres in Malawi, South Africa and Canada. Research results will help eye care professionals, the Ministry of Health, traditional healers and the general population to develop a better understanding of TEMs. This would include advice on the sustainable use of plant-based eye medicines and the potential benefits of collaboration with traditional healers. Information generated from this project could potentially be used throughout Africa in the development of primary eye care programmes.

Post-Project Summary

Researchers surveyed the use of eye care services in Chikwawa and Zomba districts in Malawi. The survey revealed that 40% of respondents self-treated their last eye condition. Factors associated with self-treatment were gender (women), religion (Christian) and socioeconomic status (lower). Some 54% sought care from a district hospital for the most serious eye disease they encountered. Of the remainder, 13.6% did not seek treatment and 32.7% self-treated, sought treatment from healers, or did both. The most frequent conditions reported were conjunctivitis, pain and redness, cataract, itch and sores, and poor distance vision. Only 4.8% reported that they had experienced none of these. Cataract was the disease of greatest concern, but only 49% of those affected sought treatment from traditional healers or the hospital.

A qualitative study of sociocultural factors was carried out in two villages in Chikwawa district, chosen because of their differing access to services and drugs. The study revealed that there is no single explanation as to why people prefer traditional medicine, self-treatment or modern medicine to treat eye diseases. People alternate sources of care or use them simultaneously to treat a single episode. People believe that modern facilities offer the least expensive option - followed by self-treatment and treatment by a healer - but the travel costs to the hospital were prohibitive for some. People in the village with better access to services (district hospital) and drugs were more likely to use Western eye medicine, but self-treatment was common in both. And, easy access and perceived effectiveness were not necessarily enough to lead people to consult an eye specialist for cataract.

The researchers identified a total of 105 plant species used in eye treatment over the two districts, with an overlap of only 15 species between districts. About 90% of the respondents reported having to walk less than a kilometre to find them. Traditional healers from both villages are still able to find medicinal plants to treat common eye diseases but were finding it harder to locate those used to treat cataract. Respondents in both villages felt that it is more difficult to find medicinal plants now compared to one or two generations ago due to new settlements. However, no one mentioned seeking modern treatment because of lack of access to traditional eye medicines. Barriers to the use of modern eye care services included distance, cost, availability of drugs and attitude of staff. Advice given by relatives and friends also plays an important role in decision-making. It was concluded that while biodiversity of traditional eye medicine is decreasing, scarcity of plant material does not appear to be responsible for changing eye care practices. Also, a healthy relationship between communities and eye care providers is essential if eye diseases are going to be managed effectively and in timely fashion.

Recipient Institution(s)