Traditional Medicine and Childcare in Western Africa:
Mothers’ Knowledge, Folk Illnesses, and Patterns of
Healthcare-Seeking Behavior
Alexandra M. Towns1*, Sandra Mengue Eyi2, Tinde van Andel1
1 Naturalis Biodiversity Center, Leiden University, Leiden, the Netherlands, 2 Le Centre National de la Recherche Scientifique et Technologique, Libreville, Gabon
Abstract
Background: In spite of the strong role of traditional medicine in childcare in the pluralistic healthcare system in Western
Africa, little information is known on mothers’ domestic plant knowledge. Identifying local perspectives and treatments of
children’s illnesses, including folk illnesses, is essential to having a comprehensive understanding of how mothers make
healthcare treatment decisions. We aimed to identify which infant illnesses Beninese and Gabonese mothers knew to treat
with medicinal plants and for which illnesses they sought biomedical care or traditional healers.
Methods: We conducted 81 questionnaires with mothers in Bénin and Gabon and made 800 botanical specimens of cited
medicinal plants. We calculated the number of species cited per illness and the proportion of participants knowledgeable
on at least one herbal remedy per illness. Using qualitative data, we described folk illnesses in each country and summarized
responses on preferences for each of the three healthcare options.
Results: Participants from both countries were most knowledgeable on plants to treat respiratory illnesses, malaria,
diarrhea, and intestinal ailments. Mothers also frequently mentioned the use of plants to encourage children to walk early,
monitor the closure of fontanels, and apply herbal enemas. Major folk illnesses were atita and ka in Bénin and la rate and
fesses rouges in Gabon. Traditional healers were reported to have specialized knowledge of cultural bound illnesses. Malaria
was frequently cited as an illness for which mothers would directly seek biomedical treatment.
Conclusion: Mothers largely saw the three systems as complementary, seamlessly switching between different healing
options until a remedy was found. Folk illnesses were found to give insight into local treatments and may reveal important
neglected diseases. Due to high reported levels of knowledge on treating top statistical causes of infant mortality and folk
illnesses, mothers’ medicinal plant knowledge should be included in the analysis of healthcare-seeking behavior for
childcare.
Citation: Towns AM, Mengue Eyi S, van Andel T (2014) Traditional Medicine and Childcare in Western Africa: Mothers’ Knowledge, Folk Illnesses, and Patterns of
Healthcare-Seeking Behavior. PLoS ONE 9(8): e105972. doi:10.1371/journal.pone.0105972
Editor: Hany A. El-Shemy, Cairo University, Egypt
Received March 13, 2014; Accepted July 31, 2014; Published August 22, 2014
Copyright: ß 2014 Towns et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: The authors confirm that, for approved reasons, there are some access restrictions on the data underlying the findings. The botanical
vouchers collected for this study are publically available at the three herbaria involved in this study and online at the on-line Global Biodiversity Information
Facility (www.gbif.org). Due to ethical restrictions, the interview data are available upon request to Johan Mols, Naturalis Research and Education sector (johan.
mols@naturalis.nl), David Heijkamp, Naturalis ICT sector (david.heijkamp@naturalis.nl), or the corresponding author (alexandra.towns@naturalis.nl).
Funding: This research was funded by the Netherlands Organization for Scientific Research (NWO), Vidi grant nr. 864.09.00 (http://www.nwo.nl/en). The funders
had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: The authors have declared that no competing interests exist.
* Email: alexandra.towns@naturalis.nl
[4], and more specifically, the knowledge of mothers [5–6]. Since
home remedies (self-treatment with herbs) comprise the majority
of African medicine [1,7–8], domestic knowledge needs to be
prioritized in medical research and reinforced in order to improve
healthcare and enhance local populations’ responses to illness.
This point is especially critical in high priority health populations,
such as infants and children in sub-Saharan Africa [9].
African mothers’ knowledge of health is directly associated with
children’s well-being, as women are largely responsible for
childcare [8,10]. Recent ethnobotanical research has found that
mothers’ knowledge of herbal medicine has a positive effect on
child health outcomes, including a decrease in infections [10–11].
Mothers who had high levels of plant knowledge and use have
Introduction
Sub-Saharan African healthcare is essentially pluralistic, structured around three main systems: biomedical care, traditional
healers, and popular knowledge [1–2]. In spite of the promotion of
biomedicine by international healthcare organizations, traditional
medicine remains the primary form of healthcare for more than
80% of African populations [3]. Traditional medical systems
include not only traditional healers, but also the popular
knowledge of local populations, known as domestic medicine or
home remedies. Most ethnobotanical literature on traditional
medicine is concentrated on the knowledge of traditional healers
and largely overlooks domestic medicine, the knowledge of women
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initial market contacts, we utilized snowball sampling to identify
women from surrounding urban and rural communities. We
conducted an ethnobotanical questionnaire on practices related to
childcare, including questions on herbal remedies for specific
illnesses, definitions of folk illnesses, and preferences for the three
types of healthcare. In total we interviewed 43 Beninese and 38
Gabonese mothers. In Bénin we worked with the following ethnic
groups: Fon and related (70%), Yoruba and related (14%), Adja
and related (5%) and mixed ethnicities (11%). In Gabon we
worked with the following ethnic groups: Fang (45%), Mitsogo
(16%), Babungu (16%), Obamba (8%), Bapounou (5%), and other
(Ossimba, Omiene, Bateke) (10%). All women received financial
compensation equivalent to local salaries for their time and
involvement. We conducted the questionnaires orally in French, at
participants’ homes and workplaces, and employed local language
interpreters when needed.
After each of the 81 questionnaires, we accompanied participants to collect the plants that were cited in the interviews. We
used standard botanical collection methods [25] to make vouchers
of plants from the surrounding gardens, forests, and savanna
landscapes. For women that we interviewed on the market, we
purchased plants directly from market stalls and made trips into
the field together to collect fresh samples when possible. In
addition to collecting voucher specimens, we also gathered
detailed information on their use, effects, and local names (see
Tables S1 and S2). We deposited vouchers of all collected plants at
the Herbier National du Bénin (BEN) and the Herbier National du
Gabon (LBV). A complete set of duplicates was exported to the
Wageningen branch of National Herbarium of the Netherlands
(WAG), now merged with Naturalis Biodiversity Center (L), where
the specimens were identified by the research team and several
botanical specialists. Our plant collection did not involve
endangered or protected plant species.
We assessed mothers’ knowledge of domestic medicine by
calculating the number of species for each health issue and the
percentage of mothers who knew at least one herbal recipe for
each illness. We then summarized descriptions of folk illnesses and
selected qualitative data from our interviews to illustrate which
illnesses mothers treated with the three systems of healthcare:
biomedicine, their own plant knowledge, or traditional healers.
Maps of the fieldwork locations were created in ArcGIS 10.1 using
open source geospatial data from DIVA-GIS (http://www.divagis.org/).
been shown to have healthier children [6] and a greater likelihood
to take ill children to a dispensary, suggesting that knowledge in
one healthcare domain corresponds with better overall understanding of health [10].
In spite of these correlations, biomedical studies have largely
measured mother’s health-seeking behavior on factors related to
biomedical care, such as formal education, distance to provider,
and cost of obtaining care [12]. This literature overlooks if and
what role local concepts of illness have in treatment choices and
results in the loss of incorporating this information into infant
health programs [13]. Local concepts of illness include not only
local names, perceptions, and symptoms of biomedical illnesses,
but also cultural bound syndromes, ‘‘a group of folk illnesses, each
of which is unique to a particular group of people, cultural, or
geographical area’’ [14]. Some scholars have cautioned that the
‘‘cultural’’ component of the term cultural bound syndromes
emphasizes the biomedical perspective that biological illnesses are
more objective than folk illnesses [14]. We use the term in order to
designate those illnesses not generally defined and recognized in
biomedicine.
Understanding local perspectives of the treatment of major
children’s illnesses identified by the WHO [15], such as malaria
[13,16] and diarrhea [17,18], as well as the treatment of children’s
folk illnesses [19,20], is essential to having a comprehensive
understanding of childcare in Africa. In this study, we assessed
how mothers make healthcare decisions by identifying which
infant illnesses mothers in Western Africa treat with medicinal
plants and for which illnesses they seek biomedical care or consult
traditional healers. We worked in Bénin and Gabon, two African
countries with diverse populations, vegetation types, cultures, and
levels of human development. Our research was based on the
following research questions: Which children’s illnesses do Beninese
and Gabonese mothers treat with medicinal plants? What are the
major children’s folk illnesses in each country? For which ailments
do mothers seek treatment from biomedical doctors? Which illnesses
do mothers prefer to be treated by traditional healers?
Methods
Study areas
Bénin is located in West Africa, with a surface area of 112,622
sq. km and a population of 9.8 million people [21]. It is ranked
below the Sub-Saharan average in the Human Development
Index (HDI) and considered a country of ‘‘low human development’’ [22]. It has an infant mortality ratio of 58 deaths per 1,000
live births [21]. Gabon is located in Western Central Africa, with a
surface area of 267,667 sq. km, and a population of 1.7 million
people [23]. The UNDP ranked Gabon 106th in the Human
Development Index, slightly above countries of ‘‘medium human
development’’ [24]. It has an infant mortality ratio of 48 deaths
per 1,000 live births [23].
Ethics statement
We adhered to all components of the Code of Ethics of the
International Society of Ethnobiology [26], including carefully
explaining the nature of our research, receiving oral consent,
providing monetary compensation for involvement in the work,
anonymizing informants’ identities during data analysis, and
working in a fully mindful and respectful manner. Oral consent
was acquired in place of written consent due to the largely illiterate
populations with whom we worked. We followed all research
procedures and protocols at Leiden University, Naturalis Biodiversity Center, and the host institutes in each country. For the
Bénin fieldwork, we acquired a formal invitation from the Faculté
des Sciences Agronomiques, Université d’Abomey-Calavi (UAC),
received a research permit (#041511) from the Faculté des
Sciences et Techniques (UAC), and obtained a plant export permit
(#0000591) from the Service de la Protection des Vegetaux et du
Control Phytosanitaire, Ministre de l’Agriculture, de l’Elevage et
de la Peche. For the Gabon fieldwork, the Centre National de la
Recherche Scientifique et Technologique (CENAREST) provided
a letter of invitation (#176). After approving our research
Data collection and analysis
Between April and October 2011 we worked in rural and urban
areas of Bénin, mainly with Fon and Yoruba ethnic groups in the
southern departments Collines, Kouffo, Zou, Plateau, Ouémè,
Atlantique, Mono, and Littoral (Figure 1). From June until
December 2012, we worked with Bantu-speaking ethnic groups
in Gabon, namely, the Fang, Mitsogo, Obamba, and Bapounou
peoples, in the departments of Estuaire, Woleu-Ntem, HautOgooué, Ngounié, and Ogooué-Ivindo (Figure 2).
We started our research at the herbal medicine marketplaces in
each country, taking time to familiarize ourselves with commonly
utilized species, local illnesses and healthcare practices. From these
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Figure 1. Map of the Bénin fieldwork sites in 2011.
doi:10.1371/journal.pone.0105972.g001
proposal, CENAREST granted a research permit (#AR0028/12).
We acquired authorization to enter the National Parks of Gabon
(#000026) from the Agence Nationale des Parcs Nationaux
(ANPN), and authorization to export botanical specimens
(#00145, #00219) from the L’Institut de Pharmacopée et de
Médecine Traditionelles (IPHAMETRA). We received formal
administrative approval from our host institutes and were not
required to submit our proposals to a human subjects review board
for further review.
appearance and thin arms of an infant). It was treated with an
herbal bath with an herbal recipe that included the eggs of a
praying mantis. Various herbal treatments were applied to the
umbilical cord of newborns to hasten the recovery period, as well
as the application of herbs to assist in the healing process of
circumcision.
Children’s folk illnesses in Gabon
Gabonese and Beninese mothers shared the cultural practices of
monitoring the closure of the fontanels, encouraging children to
walk early, and bathing newborns and young children to give
strength. Monitoring the closure of fontanels (abobane in Fang) in
Gabon was considered necessary to avoid ‘‘bad wind or spirits’’
that could enter, resulting in a child’s stunted growth. Herbal
treatments included applying pomade made from leaves directly to
the infants’ head and applying peanut butter to the palate of the
mouth (Table S2). Mothers pointed out that not all children
suffered from open fontanels. Encouraging children to walk early
also was seen as the mothers’ recuperation of independence; they
could do more work because the child could play outside with its
siblings. One of the most commonly mentioned Gabonese folk
illnesses was known as fesses rouges in French (ntcheke in the
Babungu language, kusu in Punu, tzogho in Fang, and kengey in
Teke). Like its literal French translation, the main symptom of
fesses rouges was a red, irritated bottom caused ‘‘by sitting in the
dirt,’’ ‘‘by microbes,’’ or ‘‘during childbirth when heat enters the
body through the anus’’. Treatments included applying herbal
pomades and herbal enemas.
Folk illness la rate (tzit in Fang and kabama in Teke) which in
English is translated as ‘‘the spleen,’’ was characterized by a
tender, swollen left side of the body and a skinny overall physical
build. An earlier stage of la rate, known as ebem in Fang, was
characterized by high fever and green feces. Although most
respondents were not aware of the cause of la rate, some
participants mentioned God’s will, anemia, and malnutrition as
possible causes. Treatments included herbal massages, herbal
enemas, and traditional ‘‘vaccinations’’- the creation of small
incisions on the left side of the body with a razor blade and
application of the fresh juice of plants into the cuts. Folk illness
pogha (in Mitsogo and Babungu languages) was characterized by
fever, fatigue, convulsions, but distinct from the symptoms of
malaria. It was reported to be caused either by God’s will or the
mother’s food consumption when the child was young. Herbal
baths were the primary form of treatment. Included in the
calculations for respiratory-related ailments (Table 1) were several
recipes mentioned by Fang women for respiratory-related folk
illnesses, including onkoe abijel: ‘‘respiratory problems caused by
bad water during delivery,’’ onkouabial: ‘‘bad lungs after birth,’’
and ebulonkuk: ‘‘bad lungs caused by sorcery’’.
Results
Mothers’ knowledge of treating biomedical childhood
illnesses with plants
Beninese participants cited 255 medicinal plant species and
Gabonese participants cited 179 species. All species, together with
vernacular names, scientific names and specific uses, are listed in
Table S1 (Bénin) and Table S2 (Gabon). The highest percentages
of plants in both countries were used to treat those child illnesses
considered to be of major concern by the WHO: diarrhea,
respiratory conditions, and malaria. Over 95% of participants
from Bénin and over 84% of participants from Gabon knew at
least one recipe to treat those diseases (Table 1). Respiratoryrelated ailments included illnesses such as the flu, cough, asthma,
bronchitis, and specific folk illnesses related to respiratory
problems in the case of Gabonese informants. Mothers also
mentioned children’s ailments such as earache, chicken pox, colic,
stomachache and vomiting, which we left out of the table because
few plants and treatments were cited.
Children’s folk illnesses in Bénin
Mothers from Bénin mentioned two main folk illnesses, atita
(Fon) and ka (Fon), and several cultural practices. Atita was
described as a rash with ‘‘red bumps coming from the anus’’ or
‘‘itchy and stinging’’ red bumps in the groin and armpits. It was
reported to be caused by the over-consumption of sugar or peanuts
by the child or by the mother during pregnancy. The most
common treatment for atita was an herbal bath or boiled plants
consumed as tea (Table S1). Ka was described as an infection with
large red bumps that were caused by the heat. It was reported to
be treated by herbal baths, ingested teas, and through applying
macerated plants directly to the infection.
The care and maintenance of open fontanels was a common
practice in Bénin. Mothers’ considered it to be important for the
soft spot of the fontanel to be able to ‘‘breathe’’ and eventually
close. They used various herbal pomades, washes, and ingested
teas for young children whom became ill from the failure of the
fontanels to close. Beninese mothers highly valued their children to
walk early in life. They encouraged their children with massages,
herbal baths, and ingested teas. Walking early was seen as a sign
that the child was developing normally and gaining independence,
which would enable the mother to rest. Enemas were administered
to newborn infants to remove the meconium, as well as to older
infants for daily cleanses and constipation relief. These enemas
frequently contained ground red peppers (Capsicum annuum) or
different species of melegueta pepper (Aframomum spp.) mixed
with water. Strengtheners were used in herbal treatments for
premature birth, to strengthen newborns, and to assist in infant
growth. Delayed and stunted growth were explained by mothers to
be caused either by malnutrition or if an expectant mother came
in contact with a praying mantis (hence the hunched over
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Mothers’ knowledge of treating folk illnesses with plants
Aside from the use of plants for intestinal cleansing, fewer
women knew how to treat folk illnesses than biomedical illnesses
(Table 1). In Bénin, percentages of mothers who knew recipes for
them ranged from 80% for atita to 65% for ka. In Gabon, over
two-third of all participants knew herbal treatments for common
children’s folk illnesses. With the exception of fontanels and walk
early, Beninese folk illnesses like atita and ka were unknown to
Gabonese mothers, while fesses rouges and la rate were not known
in Bénin. Although the terms and perceived causes of atita in
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Figure 2. Map of the Gabon fieldwork sites in 2012.
doi:10.1371/journal.pone.0105972.g002
Bénin and fesses rouges in Gabon do not coincide, the two folk
illnesses were somewhat similar in description. The folk illness
pogha was only mentioned as an illness by mothers in the
Gabonese department of Ngounie.
because they know more about this domain’’. Advanced forms of
illnesses, especially malaria, were commonly reported to be treated
with biomedicine. Seeking traditional healers to treat victims of
sorcery and folk illnesses were strong themes. Traditional healers
were reported to treat illnesses ‘‘that surpass the knowledge of
doctors,’’ and for causes such as sorcery or witchcraft. A minority
of mothers reported that common folk illnesses and asthma were
‘‘men’s knowledge,’’ outside of the maternal domain of skills. It
was not clear if men’s knowledge meant the specialized knowledge
of (male) traditional healers or more generally, fathers in the
community. An 80 year old Fon woman said, ‘‘First try to treat at
home with herbs for a couple of days. If they do not work, go to
the hospital. If this does not work, go to a traditional healer.
Asthma and fetus health are men’s knowledge. Fontanels are
traditional healers’ knowledge’’.
Health-seeking behaviors of Beninese mothers
Although there was little consensus on one preference for
healthcare (Table 2), Beninese women in our study generally
reported starting to treat their children with medicinal herbs,
following up with biomedical care, and seeking traditional healers
as a third resort. An 80-year old Mina woman said ‘‘Traditional
medicine is first. Some use the hospital first, for example for fever
or if one needs blood. A traditional healer is called upon to consult
the fa (oracle) and for sacrifices’’. Women who reported to never
consult traditional healers mentioned the church and prayer as
spiritual forms of treatment. Self-administered herbal medicine
was reported to be preferred for treating children’s illnesses due to
its ability to help defecate well, its use as preventative medicine,
and its perceived effectiveness. Respondents often mentioned using
plants to self-treat for a certain number of days (ranging from two
days to one week) and then seeking biomedical care. Biomedicine
was acknowledged to have the advantage of having advanced
technology and materials but was perceived as being more
expensive. A 36-year old Yoruba woman said, ‘‘Traditional
medicine is used for constipation and atita- those you can treat at
home. Modern medicine is used for difficult cases- they are better
equipped. Traditional healers are consulted for superhuman cases
Health-seeking behaviors of Gabonese mothers
There was also a large range of responses from the Gabonese
women involved in our study (Table 2). Nearly the same number
of Gabonese mothers preferred self-treatment as a first form of
healthcare as mothers who preferred treating children first with
biomedicine. The strongest consensus of women cited specific
illnesses, especially malaria, in which they would seek biomedical
care directly. A 40-year old Obamba woman said ‘‘Use modern
medicine for malaria, etc. We’re evolved for serious illness. Use
traditional medicine if modern medicine doesn’t work, or if it’s not
serious. A ganga is outdated, we no longer use them’’. However,
Table 1. Children’s health issues treated with medicinal plants by mothers in Bénin and Gabon.
# species
(%) N = 255
# participants1
(%) N = 43
# species
(%) N = 179
# participants1
(%) N = 38
Bénin
Bénin
Gabon
Gabon
respiratory-related
53 (21)
42 (98)
49 (27)
32 (84)
diarrhea
39 (15)
41 (95)
27 (15)
34 (89)
malaria
54 (21)
41 (95)
36 (20)
33 (87)
intestinal cleanse*
58 (23)
41 (95)
31 (17)
33 (87)
measles
34 (13)
37 (86)
17 (9)
30 (79)
strengthener*
59 (23)
40 (93)
21 (12)
22 (58)
fontanels*
31 (12)
35 (81)
23 (13)
28 (74)
post-circumcision
32 (13)
37 (86)
14 (8)
21 (55)
Health Issue
walk early*
22 (8)
28 (65)
17 (9)
29 (76)
umbilical cord
13 (5)
32 (74)
12 (7)
24 (63)
convulsions/crisis*
32 (13)
33 (77)
4 (2)
4 (10)
teething
25 (10)
30 (70)
2 (1)
4 (10)
anti-sorcery*
21 (8)
25 (58)
6 (3)
6 (16)
fever
37 (15)
19 (44)
14 (7)
7 (18)
atita*
31 (12)
35 (81)
-
-
ka*
26 (10)
29 (67)
-
-
fesses rouges*
-
-
26 (15)
28 (74)
la rate*
-
-
34 (19)
26 (68)
pogha*
-
-
10 (6)
6 (16)
1
Percentage of mothers from each country who knew at least one herbal recipe.
*Folk illness or treatment.
doi:10.1371/journal.pone.0105972.t001
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Table 2. Most frequent responses by mothers to healthcare seeking options question in Bénin (N = 43) and Gabon (N = 38).
% of mothers
Bénin
% of mothers
Gabon
First choice self-treatment
with plants
42
29
First choice biomedicine
(malaria, anemia, fever)
16
32
First choice
biomedicine (always)
0
21
First choice
traditional healer
7
18
Second choice
biomedicine
30
13
Second choice self-treatment
with plants
0
11
Third choice
traditional healer
23
3
Never consult
traditional healer
5
11
Traditional healer
for sorcery
44
5
Biomedicine for advanced
cases (malaria, anemia)
35
5
Self-treat with plants
for specific illnesses
(diabetes, measles, stomachache)
21
13
Self-treat with plants
for simple cases
(malaria, diarrhea)
28
0
Traditional healer
for specific cases
(fontanels, paralysis)
12
8
Men for specific
illnesses (walk early, asthma)
9
0
Response
Ranking of three health care options
Healthcare choice for specific cases
doi:10.1371/journal.pone.0105972.t002
other women favored the consultation of a ganga, the spiritual
leader of the community, or the nyembe, the spirit in a women’s
secret society, in order to know where to treat the illness. This was
a reoccurring theme, suggesting a strong the role of spirituality and
religion in childcare, especially for folk illnesses. A 50 year old
Fang woman said, ‘‘One should seek modern medicine for an
operation; injections go straight to the blood and therefore work
faster… Traditional medicine depends on God’s grace; prayer
helps too. Go to a ganga for sorcery’’. We found a reoccurring
theme among Gabonese mothers that three systems were largely
complementary. A 42-year old Fang woman said: ‘‘Try traditional
medicine, if it does not work, the genies (spirits) will tell you to go
to modern medicine. Work with the spirits! Between modern
medicine and traditional medicine, there is a good collaboration.
Gabon is currently in good position between the two systems’’. A
61-year old Omiene women said ‘‘The three systems are
complementary; you will find a solution between the three. It
also depends on one’s belief system; some people are hesitant to go
to a ganga’’.
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Discussion and Conclusion
Biomedical illnesses and their treatment
The majority of participants from Bénin and Gabon knew
herbal treatments to treat the top causes of infant mortality:
respiratory problems (98%, 84% respectively), malaria (95%,
87%), and diarrhea (95%, 89%). This outcome suggests that
traditional medicine, and more specifically mothers’ knowledge of
plants, is a major factor in the management of these common
childhood health ailments. Even though mothers were knowledgeable on treating these illnesses, however, they also distinguished situations where they would seek biomedical care prior to
using domestic medicine, such as complicated cases of malaria,
anemia, or fever. Studies in other African countries also found that
mothers preferred to treat malaria with biomedical care [27]. Only
a few mothers mentioned diarrhea specifically as a case that they
would seek biomedical care as a first option, suggesting diarrhea is
largely treated by mothers with plants as was found in a recent
study in Sierra Leone [28]. Likewise, respiratory ailments were not
specifically mentioned as a case for seeking biomedical care. The
high percentage of women who know how to treat these illnesses
and the high number of plants attributed to their treatment suggest
a parallel recognition of major causes of infant morbidity and
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mortality between the mothers and the statistics of the WHO. This
agreement between medical priorities is not always the case, in a
similar study on women’s health in Bénin and Gabon, we found
that local and biomedical priorities did not coincide [29].
as found in a recent study in South Africa [43], this pattern varied
according to illness; each healthcare option was seen to have
specific advantages and disadvantages. Biomedicine was perceived
to have the advantage of advanced technology and materials,
especially for treatments related to blood transfusions. Some
mothers in Bénin reported a preference of using self-collected
herbal medicine over biomedical care due to the expensive of
modern treatment.
Future research can take demographic and socio-economic data
into account to further the understanding of preferences for
childcare treatment [28]. Additionally, our research did not
explore mothers’ attitudes towards the quality of the different
healthcare options. Future studies can ask women if a positive
experience with one form of treatment would influence future
decisions. Infant and child healthcare will be enriched if local
knowledge, illness concepts, and medicinal plants fit into a larger
framework that studies healthcare from a community perspective
[1], including researchers from outside the biomedical field [5].
With the Millennium Development Goals concluding in 2015, and
the reality that both countries have not met their targets of
reducing infant mortality rates [22,24], there is a renewed
opportunity for infant healthcare initiatives to become more
comprehensive.
Folk illnesses and their treatment
Folk illnesses ranked directly after the major biomedical illnesses
for children in terms of mothers’ medicinal plant knowledge. Our
research supports ethnobotanical studies from other parts of the
world that have indicated local populations commonly prefer to
treat folk illnesses with traditional medicine [5,30–31]. While
many participants in our study knew herbal remedies to treat folk
illnesses, it is clear that traditional healers and religion have a
strong role in this domain. Men, more generally speaking, were
also regarded as having specialized knowledge in Bénin. Fathers
also have a role in the treatment of children’s illnesses, in terms of
their own knowledge of medicinal plants [6] and their role in
family decision-making [27].
Folk illnesses are of interest to biomedical health care providers,
not only because they often make up a significant portion of local
health complaints [5] but they may address underlying neglected
diseases. Fontanels are common children’s folk illnesses around the
world, and in other African countries such as Swaziland,
Zimbabwe, Botswana and Malawi [32]. Certain (bulging or
sinking) appearances of the fontanels may be symptoms of a range
of disorders from dehydration to malnutrition to Down Syndrome
[33]. Moreover, when mothers apply paste on the fontanel prior to
arriving at the hospital, doctors cannot fully assess the fontanel
(because of the plant pomades) and may misdiagnose the child’s
illness. La rate resembles the symptoms of sickle-cell disease, a
common yet neglected illness of children in Western Africa [34],
especially its characteristic concentrated pain on the left side and
spleen enlargement [35]. This overlap is a fertile ground for
improved research and educational programs on sickle cell disease
[36]. Enemas for intestinal cleanses, especially for newborns and
small children, were a common practice in both countries. In the
Ivory Coast, Gottlieb [37] found that enemas were used to make a
baby defecate at a given time. Biomedical research has highlighted
the danger in using enemas, especially among young children [38].
Even if these illnesses are not recognized as biological in nature,
their treatment nevertheless has consequences, either positive or
negative, on children’s health. Taking local perspectives and
treatments into account not only informs biomedicine of cultural
concepts of illness and healing [39], it also facilitates an understand
of plant’ effects through pharmacological studies [40], and enables
an understanding of how traditional systems of healing and
biomedicine are already interacting on the ground [41].
Supporting Information
Table S1 Species cited in 43 questionnaires in Bénin:
scientific botanical name, vernacular plant name(s),
plant part used, preparation, use category and collection number.
(DOCX)
Table S2 Species cited in 38 questionnaires in Gabon:
scientific botanical name, vernacular plant name(s),
plant part used, preparation, use category and collection number.
(DOCX)
Acknowledgments
In Bénin, we would like to thank the professors at the University of
Abomey-Calavi, especially A. Akoegninou and B. Sinsin, as well as the staff
of the National Herbarium of Bénin (BEN), and l’Institut de Développement et d’Echanges Endogènes (IDEE). We are grateful to S. Ruysschaert,
K. Ostertag, and L. Atindehou for their assistance in the Bénin fieldwork.
The Gabon fieldwork was supported by the research staff at L’Institut de
Pharmacopée et de Médecine Traditionnelles (IPHAMETRA), the
National Herbarium of Gabon (LBV), HB Bourobou, le Centre National
de la Recherche Scientifique et Technologique (CENAREST), and the
Agence Nationale des Parcs Nationaux (ANPN) in Gabon. The authors
would like to share a special thanks to E. van Vliet E, H. Eyi Ndong, J.P.
Ongoda, A. Izouret, and the Grand Kami of Assiami for their assistance
with the questionnaires. In the Netherlands, we would like to thank M.
Sosef for his logistical support and the expert botanists at Wageningen
University for their assistance with plant identification.
Complementarity of three systems
The lack of any one definitive pattern of healthcare-seeking
behavior among mothers in our study reflected the truly pluralistic
healthcare systems of both countries [1], the dynamic process of
deciding how to care for children [15], and the fact that mothers
see the three African systems of healthcare as largely complementary. Mothers’ general pattern of resort [42] was to self-treat with
plants first, seek biomedical care for specific illnesses or as a second
source of healthcare and to consult the spiritual realm, including
gangas and the nyembe in Gabon, to treat folk illnesses. However,
Author Contributions
Conceived and designed the experiments: AMT TVA. Performed the
experiments: AMT SME. Analyzed the data: AMT SME TVA.
Contributed reagents/materials/analysis tools: AMT TVA. Wrote the
paper: AMT SME TVA.
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