Background
Methods
Study setting
Quantitative data collection
Qualitative data collection
Disease definitions
Data analysis and management
Results
Demographics of study participants
Variable | Participants | ||||
---|---|---|---|---|---|
Overall (n = 481) | Diabetes Absent (n = 436) | Diabetes Present (n = 45) | p-value* | ||
Low risk (n = 352) | Increased risk (n = 84) | ||||
Gender | 0.21 | ||||
Male | 123 (26 %) | 89 (25 %) | 19 (23 %) | 15 (33 %) | |
Female | 358 (74 %) | 263 (75 %) | 65 (77 %) | 30 (67 %) | |
Age | <0.01 | ||||
18–39 years old | 172 (36 %) | 143 (41 %) | 24 (29 %) | 5 (11 %) | |
40–59 years old | 191 (40 %) | 135 (38 %) | 37 (44 %) | 19 (42 %) | |
60+ years old | 118 (24 %) | 74 (21 %) | 23 (27 %) | 21 (47 %) | |
Setting | 0.10 | ||||
Rural | 111 (23 %) | 84 (24 %) | 21 (25 %) | 6 (13 %) | |
Urban | 370 (77 %) | 268 (76 %) | 63 (75 %) | 39 (87 %) | |
Ethnicity | 0.50 | ||||
Chagga | 288 (60 %) | 217 (62 %) | 45 (54 %) | 26 (58 %) | |
Pare | 66 (14 %) | 43 (12 %) | 19 (23 %) | 4 (9 %) | |
Sambaa | 27 (6 %) | 22 (6 %) | 3 (4 %) | 2 (4 %) | |
Othera | 100 (20 %) | 70 (20 %) | 17 (20 %) | 13 (29 %) | |
Religion | 0.18 | ||||
Roman Catholic | 192 (40 %) | 149 (42 %) | 31 (37 %) | 12 (27 %) | |
Protestant | 161 (33 %) | 117 (33 %) | 22 (26 %) | 22 (49 %) | |
Islam | 123 (26 %) | 84 (24 %) | 28 (33 %) | 11 (24 %) | |
Hindu | 2 (<1 %) | 1 (<1 %) | 1 (1 %) | 0 (0 %) | |
Education | 0.06 | ||||
None | 31 (6 %) | 21 (6 %) | 4 (5 %) | 6 (13 %) | |
Primary | 349 (73 %) | 260 (74 %) | 63 (75 %) | 26 (58 %) | |
Secondary | 74 (15 %) | 52 (15 %) | 12 (14 %) | 10 (22 %) | |
Post-Secondary | 27 (6 %) | 19 (5 %) | 5 (6 %) | 3 (7 %) | |
Occupation | <0.01 | ||||
Unemployed | 74 (15 %) | 52 (15 %) | 15 (18 %) | 7 (16 %) | |
Farmer/Wage Earner | 199 (41 %) | 157 (45 %) | 32 (38 %) | 10 (22 %) | |
Small Business/Vendors | 158 (33 %) | 121 (34 %) | 25 (30 %) | 12 (27 %) | |
Professionalb | 50 (10 %) | 22 (6 %) | 12 (14 %) | 16 (36 %) | |
History of Smoking | 117 (24 %) | 85 (24 %) | 19 (23 %) | 13 (29 %) | 0.45 |
History of alcohol intake | 318 (66 %) | 236 (67 %) | 54 (64 %) | 28 (62 %) | 0.56 |
Self-Reported Medical History | |||||
Hypertension | 134 (28 %) | 86 (25 %) | 27 (32 %) | 21 (47 %) | <0.01 |
Diabetes | 61 (13 %) | 23 (7 %) | 9 (11 %) | 29 (64 %) | <0.01 |
Heart Diseasec | 18 (4 %) | 10 (3 %) | 3 (4 %) | 5 (11 %) | 0.01 |
HIV | 21 (4 %) | 21 (6 %) | 0 (0 %) | 0 (0 %) | 0.24 |
Stroke | 8 (2 %) | 6 (2 %) | 0 (0 %) | 2 (4 %) | 0.17 |
COPD | 8 (2 %) | 6 (2 %) | 1 (1 %) | 1 (2 %) | 0.55 |
Kidney Disease | 14 (3 %) | 7 (2 %) | 3 (4 %) | 4 (9 %) | 0.03 |
Epidemiology of traditional medicine use
Diabetes Absent; n = 436 (95 % CI) | With Diabetes; n = 45 (%, 95 % CI) | ||
---|---|---|---|
Low risk (n = 352) | Increased risk (n = 84) | ||
Prevalence | |||
…of TM Use | 60.3 % (48.9–70.7) | 56.7 % (43.4–69.2) | 77.1 % (58.5–89.0) |
…of concurrent TM and Biomedicine Use | 4.9 % (2.7–8.9) | 2.6 % (0.8–7.6) | 37.6 % (20.5–58.4) |
Incidence of TM Use (per year) | |||
1–5 times | 47.2 % (38.8–55.7) | 32.0 % (19.9–47.1) | 45.3 % (27.8–64.0) |
6–10 times | 7.7 % (4.6–12.6) | 17.0 % (7.8–33.0) | 5.2 % (1.5–16.1) |
>10 times | 5.4 % (3.1–9.4) | 7.1 % (2.6–18.0) | 26.7 % (10.2–53.8) |
Reasons for TM Use | |||
More Effective | 83.3 % (74.6–89.4) | 81.4 % (62.8–91.9) | 79.6 % (40.4–95.7) |
Lower Cost | 60.1 % (48.2–70.9) | 64.5 % (46.4–79.3) | 55.2 % (32.2–76.2) |
Easier to Access | 69.9 % (61.0–77.6) | 61.6 % (45.0–75.8) | 59.1 % (30.7–82.5) |
Safer | 43.4 % (31.6–56.1) | 39.1 % (25.8–54.2) | 39.5 % (20.4–62.5) |
More Traditional/Religious | 30.4 % (23.4–38.4) | 29.7 % (18.0–44.8) | 42.0 % (24.1–62.3) |
Modes of Healthcare Access | |||
Medical Doctors | 97.3 % (93.4–98.9) | 97.2 % (85.3–99.5) | 90.5 % (58.6–98.5) |
Family and Elders | 50.7 % (38.0–63.4) | 55.4 % (34.4–74.6) | 69.0 % (42.8–86.9) |
Traditional Healers | 5.6 % (2.7–11.0) | 9.9 % (3.0–28.2) | 22.9 % (8.2–49.7) |
Pharmacists | 19.9 % (11.9–31.3) | 22.0 % (10.5–40.5) | 10.6 % (3.9–25.5) |
Herbal Vendors | 3.9 % (1.1–12.2) | 11.4 % (5.7–21.5) | 5.1 % (1.5–16.1) |
Friends/Neighbors | 17.5 % (10.4–27.8) | 16.7 % (9.7–27.4) | 5.2 % (1.7–15.3) |
TM Use | |||
…for Symptomatic Ailments | 57.3 % (49.2–65.0) | 45.1 % (28.8–62.6) | 79.1 % (60.8–90.2) |
…for Chronic Diseases | 27.7 % (19.1–38.0) | 24.5 % (12.9–41.5) | 57.0 % (29.4–80.9) |
…for Reproductive/Fertility Ailments | 22.8 % (14.6–33.9) | 19.7 % (8.8–38.5) | 49.5 % (28.2–70.9) |
…for Malaria/Febrile Illnesses | 56.7 % (43.1–69.4) | 70.9 % (58.2–80.9) | 59.2 % (28.7–84.0) |
…for Spiritual/traditional uses | 8.6 % (4.5–15.7) | 7.0 % (2.2–20.2) | 9.4 % (3.5–22.8) |
…for Neurologic Illnesses | 19.5 % (11.3–31.4) | 19.6 % (10.2–34.5) | 38.2 % (18.9–62.2) |
…for Urogenital Conditions | 15.7 % (9.8–24.4) | 16.7 % (8.2–31.0) | 26.0 % (10.6–51.1) |
…for Cancers | 14.7 % (6.6–29.7) | 9.0 % (3.0–23.8) | 22.9 % (8.0–50.6) |
…for Disease Prevention | 5.9 % (3.3–10.3) | 0.7 % (0.1–5.8) | 11.4 % (3.0–34.9) |
…for Worms/Parasites | 11.1 % (6.9–17.4) | 15.9 % (9.3–25.9) | 22.0 % (8.7–45.7) |
Modes of TM Use | |||
Mix with water | 83.0 % (77.4–87.4) | 85.7 % (75.2–92.3) | 79.8 % (54.6–92.9) |
Drink as a tea | 61.1 % (52.7–68.9) | 47.5 % (31.0–64.5) | 62.7 % (35.0–83.9) |
Drink as a soup | 46.1 % (36.6–55.8) | 35.2 % (25.5–46.4) | 65.5 % (38.3–85.3) |
Chew from the plant | 57.5 % (46.4–67.9) | 47.3 % (31.9–63.3) | 58.3 % (41.6–73.3) |
Drink with milk | 22.8 % (15.7–31.9) | 15.7 % (7.5–30.0) | 39.2 % (19.2–63.6) |
Bath | 26.2 % (17.7–37.0) | 30.3 % (20.7–42.0) | 45.0 % (19.3–73.8) |
Inhalation | 33.9 % (26.5–42.1) | 39.2 % (26.8–53.1) | 42.5 % (24.0–63.3) |
Powders | 17.4 % (9.7–29.2) | 22.9 % (11.8–39.7) | 25.3 % (9.9–51.0) |
As foods to be eaten | 2.4 % (0.8–6.8) | 7.7 % (2.0–25.5) | 4.2 % (1.1–14.9) |
Pill/Vitamin form | 0.6 % (0.2–1.7) | 1.4 % (0.3–6.7) | 2.4 % (0.4–13.0) |
Lotions/Creams | 5.3 % (2.9–9.5) | 5.8 % (2.1–15.1) | 21.0 % (5.9–53.2) |
Traditional medicines used for the treatment of diabetes in Northern Tanzania
Nomenclature | Uses in other African communities | Active Compounds and Pharmacology | Plant Parts in Use | Potential Side Effects and Toxicities | ||
---|---|---|---|---|---|---|
Scientific | English Common Name(s) | Local Vernacular | ||||
Moringa oleiferaa | Moringa; Drumstick tree | Mlonge | Senegal: stimulates breastmilk production, diabetes, anxiety, diarrhea and dysentery, colitis, gonorrhea, and various skin infections Chad: nutritional supplementation Nigeria and Benin: toothaches, GI ailments (dyspepsia, ulcers, and aiding digestion), poor vision, joint pains, diabetes, anemia, hypertension, paralysis, and helminthic infestation Uganda: diabetes, hypertension, HIV/AIDS-related symptoms, stimulates breastmilk production | Leaf extracts have glucose metabolism effects: modulates gene-expression of gluconeogenic liver enzymes, and regenerates pancreatic beta cells Nitrile and mustard oil glycosides: lowers blood pressure Seed kernels: bronchodilatory properties CNS effects: increases glutamate and serotonin; decreases norepinephrine and dopamine; anti-pyretic properties Anti-oxidative properties: may prevent drug-induced nephrotoxicity, myocardial damage, and gastric mucosal irritation Active compounds: salicylic and ferulic acids, flavonoids, phenolic acids, glucosinolates and isothiocanates, tannins and saponins | Flowers Pods/seeds Roots Leaves (Commonly grounded into powder for mixing) | -Abortifacient: causes uterine contractions -Inhibits CYP3A4 (inhibits metabolism of anti-diabetic drugs in the meglitinide class) -Chronic kidney disease (decline in glomerular filtration rate) -Hepatotoxicty (potential at high doses) -Paralysis |
Cymbopogon Citrullusa | Lemongrass | Mchaichai | Southern Africa: diabetes, oral thrush, anti-tussive, anti-emetic, antiseptic, arthritis West Africa (Cameroon & Nigeria): antipyretic/anti-malarial, stimulant, anti-spasmodic, jaundice Mauritius: common cold, pneumonia, fever, GI ailments and dyspepsia | Oil extracts: anti-bacterial, anti-amebic, anti-fungal, antimalarial, anti-protozoal, and antifilarial effects Phenol and flavonoids: antioxidative Citral: insect repellent Active compounds: terpenes, alcohols, ketons, aldehyde, flavanoids, phenols, citral | Leaves Stem Oil extract | -Volume depletion -Diarrhea -Somnolence -Chronic kidney disease (decline in glomerular filtration rate) -Gastritis -Hepatotoxicty (potential) -Hypoglycemia |
Hagenia abyssinicaa | African redwood; East African rosewood | Enjani engashe (Maasai) | Ethiopia: Helminthic infections, Typhoid fever, wound healing, epilepsy, sexually transmitted diseases, and symptomatic ailments (dyspepsia, diarrhea, common cold, and cough) | Essential oils: trypanocidal (anti-spasmodic) and cytotoxic (in vitro activity against leukemic and adenocarcinoma cell lines) Active compounds: kosin (a phloroglucinol), & quercetin glucuronides | Flower and leaf extracts | -Hepatotoxicity -Diarrhea and volume depletion - Gastritis -Optic atrophy (blindness) -Abortifacient |
Nomenclature | Uses in other African communities | Active Compounds and Pharmacology | Plant Parts used | Potential Side Effects and Toxicities | ||
---|---|---|---|---|---|---|
Scientific | Common Name(s) | Local Vernacular | ||||
Aloe vera (ferox and secundiflora species)a | Cape aloes, Aloe Vera | Aloe, Alovera | Southern Africa: arthritis, burns/skin conditions, hypertension, purging/laxative, dyspepsia, anti-inflammatory, cosmetics, eye ailments/conjunctivitis, sexually transmitted diseases, infertility, impotence East Africa (Kenya, Uganda, Ethiopia, and Tanzania): malaria, purging/laxative for cleansing purposes, dyspepsia, skin ulcerations/wound healing including burns, HIV/AIDS, cosmetic, infertility, anti-parasitic | Gel: Prostaglandin- and bradykinase-mediated anti-inflammatory activity. Aloin leaf extracts: increases GI motility and induces emesis Active compounds: glucomannans, thiamine, niacin, riboflavin, bradykinase, anthraquinone glycosides (aloin, barbaloin) | Gel extract Leaves Rind Stem | -Volume depletion and electrolyte imbalance -Hypoglycemia Hyperpigmentation and photosensitivity -Hepatotoxicity -Acute tubular necrosis -Acute interstitial nephritis |
Clausena anisataa | Horsewood | Mjafari | West Africa: bacterial and fungal infections of the skin including boils, ringworm, and eczema East Africa (Tanzania): oral candidiasis, fungal infections of the skin, and epilepsy Southern Africa: epilepsy, arthritis, rheumatism and other inflammatory conditions, hypertension, heart failure and other heart ailments, schistosomiasis, taeniasis and other parasitic infections, constipation and dyspepsia; malaria and other febrile conditions, headaches, eye ailments/conjunctivitis, impotence and infertility | Leaf extracts inhibit ACE: may lower blood pressure Bacteriostatic against gram positive and gram negative bacteria; Fungicidal activity against Aspergilus fumigatus Antiplasmodial: in-vitro dose-dependent schizonticidal effect of leaf extracts on parasitemia In vitro activity against leukemic cell lines Anti-HIV1/2 effects: dose-dependent inhibition of reverse transcriptase and taq polymerase enzymes Hypoglycemic properties (reduction in basal blood glucose levels); Anti-convulsant; ACE inhibition; Cyclooxygenase-1 and -2 (weak) inhibition Active compounds: Clausamine, carbazole alkaloids (girinimbine, murrayamine-A, and ekeberginine), flavonoids, monoterpenes, and coumarins | Leaf, stem, and root extracts | -Heavy metal bio-accumulation (Iron, cadmium, manganese) -Hypoglycemia -Gastritis |
Cajanus cajana | Pigeon pea | Majani ya mbaazi | Ghana: diabetes, dysentery, hepatitis, measles, dysmenorrhea Nigeria: wound healing, aphthae, bedsores, and malaria/fever | Antibacterial activity; hypocholesterolemic effects (diet-induced); inhibits CNS voltage-gated Na channels; induces apoptosis in human breast cancer cells via a ROS-mediated mitochondrial pathway; inhibits TNF-α and IL-1β production Glycemic profile: leaves induce hyperglycemia, seeds induce hypoglycemia Active compounds: Cajanuslactone, stilbene, pinostrobin, cajanol | Leaves Seeds | -CNS depression -Somnolence -Heavy metal bio-accumulation (arsenic, copper, aluminum) -Bronchospasm -Hypoglycemia |
Persea Americanaa | Avocado | Mparachichi, Mwembe, Mafuta | West Africa (Nigeria, Togo, Ivory Coast): anti-diarrheal, diabetes/hyperglycemia, anti-inflammatory, wound healing, antiepileptic, exhaustion, hypertension, gastritis/dyspepsia East Africa (Kenya, Uganda, Tanzania, Zimbabwe, Mozambique): dengue vector control, diarrhea, sore throat, menstrual regulation, hair growth, epilepsy, toothaches, wound healing, tuberculosis, neuralgia) | Anti-inflammatory, limiting lowering (β-Carotene and fatty acids), anticonvulsive (via gabanergic effects) & vasodilatory properties; Inhibits alpha-amylase and enhance glycogenesis; acetogenins inhibit platelet aggregation; larvicidal to Aedes aegypti Active Compounds: Tannins, saporins, alkanols (aliphatic acetogenins), terpenoids, coumarin | Leaves Fruits Seeds Rind Bark | -Increased risk of bleeding when combined with other anti-coagulants -Hypoglycemia -Hyperkalemia (especially among those with impaired kidney function) |
Artemisia afraa | African wormwood | Fivi, Majani mapana artemisia | Southern Africa: coughs, colds, sore throat, gastritis/reflux, hemorrhoids, fevers, malaria, asthma, diabetes | Lowers blood glucose, improves glucose tolerance and balance in lipid metabolism; anti-oxidative properties bactericidal against gram positive and gram negative bacteria | Roots stems leaves | - Chronic kidney disease (decline in glomerular filtration rate) -Acute tubular necrosis -Hypoglycemia |