Use of herbal formulations for the treatment of circumcision wounds in Eastern and Southern Africa

Alfred Maroyi

doi:10.14719/pst.2021.8.3.1126

Authors

Alfred Maroyi Department of Botany, University of Fort Hare, Private Bag X1314, Sovenga 0727, South Africa https://orcid.org/0000-0001-7965-3415

DOI:

https://doi.org/10.14719/pst.2021.8.3.1126

Keywords:

Eastern and Southern Africa, Ethnopharmacology, Indigenous knowledge, Medicinal pl, Traditional male circumcision

Abstract

Medicinal plants used to treat and manage circumcision wounds have remained an integral part of traditional practice in Eastern and Southern Africa. This study reviews the traditional usage of medicinal plants to treat and manage circumcision wounds in Eastern and Southern Africa. Drawing on data from Kenya, Namibia, South Africa and Tanzania, information was collected from different sources including books, theses and electronic scientific search engines such as Scopus, Science Direct, PubMed, SciFinder and Google Scholar. A literature search was also undertaken focusing on medicinal plants used against circumcision wounds that demonstrated antibacterial and anti-inflammatory activities in in vitro studies. Twenty-eight medicinal plants from 15 families are recorded as traditional therapies for circumcision wounds following an extensive literature search. These species used to treat and manage circumcision wounds, and as dressing after circumcision to prevent serious inflammation are mainly (64.3%) members of Amaryllidaceae, Asparagaceae, Asteraceae, Euphorbiaceae and Fabaceae families. Three quarters (75.0%) of these species including Acalypha ornata, Achyranthes aspera, Asparagus africanus, Boophone disticha, Brunsvigia grandiflora, Burkea africana, Colophospermum mopane, Datura stramonium, Dichrostachys cinerea, Helichrysum appendiculatum, H. foetidum, H. longifolium, H. nudifolium, H. pedunculatum, Lippia javanica, Maesa lanceolata, Ptaeroxylon obliquum, Ricinus communis, Searsia natalensis, Triumfetta rhomboidea and Vachellia nilotica have shown antibacterial and anti-inflammatory effects in a set of in vitro models. Further studies are needed such as isolation of phytochemical compounds, in vivo activities, clinical and toxicological studies.

Downloads

Download data is not yet available.

Author Biography

Alfred Maroyi, Department of Botany, University of Fort Hare, Private Bag X1314, Sovenga 0727, South Africa

Professor at the University of Fort Hare. he has 26 years of experience and more than 200 articles are published

References

Salokoski M. How kings are made: How kingship changes: A study of rituals and ritual change in pre-colonial and colonial Owamboland, Namibia. Helsinki: Helsinki University Press; 2006.

Mshana G, Wambura M, Mwanga J, Mosha J, Mosha F, Changalucha J. Traditional male circumcision practices among the Kurya of north-eastern Tanzania and implications for national programmes. AIDS Care 2011;23:1111-16. https://doi.org/10.1080/09540121.2011.554518

Nnko S, Washija R, Urassa M, Boerma JT. Dynamics of male circumcision practices in northwest Tanzania. Sexually Transmit Dis. 2001;28:214-18. https://doi.org/10.1097/00007435-200104000-00005

Froneman S, Kapp PA. An exploration of the knowledge, attitudes and beliefs of Xhosa men concerning traditional circumcision. Afr J Primary Health Care Fam Med. 2017;9:a1454. https://doi.org/10.4102/phcfm.v9i1.1454

Prusente S, Khuzwayo N, Sikweyiya Y. Exploring factors influencing integration of traditional and medical male circumcision methods at Ingquza Hill Local Municipality, Eastern Cape: A socio-ecological perspective. Afr J Primary Health Care Fam Med. 2019;11:a1948. https://doi.org/10.4102/phcfm.v11i1.1948

Meel BL: Traditional male circumcision-related fatalities in Mthatha area of South Africa. Med Sci Law 2010;50:189-191. https://doi.org/10.1258/msl.2010.010017

Mavundla TR, Netswera FG, Bottoman B, Toth F. Rationalization of indigenous male circumcision as a sacred religious custom: Health beliefs of Xhosa men in South Africa. J Transcult Nurs. 2009;20:395–404. https://doi.org/10.1177/1043659609340801

Drain P, Halperin D, Hughes J, Klausner J, Bailey R. Male circumcision, religion and infectious diseases: An ecologic analysis of 118 developing countries. BMC Infect Dis. 2006;6:172. https://doi.org/10.1186/1471-2334-6-172

Williams BG, Lloyd-Smith JO, Gouws E, Hankins C, Getz WM, Hargrove J et al. The potential impact of male circumcision on HIV in Sub-Saharan Africa. PLoS Med. 2006;3:e262. https://doi.org/10.1371/journal.pmed.0030262

World Health Organization/ United Nations Programme on HIV/AIDS (WHO/UNAIDS): New data on male circumcision and HIV prevention: Policy and programme implications conclusion and recommendations. Montreux: WHO/UNAIDS Technical Consultation, 2007.

Taylor J, Lockwood A, Taylor A. The prepuce: Specialized mucosa of the penis and its loss to circumcision. British J Urol. 1996;77:291-95. https://doi.org/10.1046/j.1464-410x.1996.85023.x

Marck J. Aspect of male circumcision in sub-equatorial African culture history. Health Trans Rev. 1997;7:337-59.

Dunsmuir WD, Goldon EM. The history of male circumcision. British J Urology Int. 1999;83:1-12.

Mogotlane SM, Ntlangulela JT, Ogunbanjo BG. Mortality and morbidity among traditionally circumcised Xhosa boys in the Eastern Cape Province, South Africa. Curationis 2004;27:57–62. https://doi.org/10.4102/curationis.v27i2.980

Doyle D. Ritual male circumcision: A brief history. J Royal College Phys., Edinburgh 2005;25:279-85.

Caldwell JC, Orubuloye IO, Caldwell P. Male and female circumcision in Africa from a regional to a specific Nigerian examination. Social Sci Med. 1997;44:1181-93. https://doi.org/10.1016/S0277-9536(96)00253-5

Hellsten SK. Rationalising circumcision: From tradition to fashion, from public health to individual freedom: Critical notes on cultural persistence of the practice of genital mutilation. J Med Ethics 2004;30:248-53. https://doi.org/10.1136/jme.2004.008888

Wilcken A, Keil T, Dick B. Traditional male circumcision in eastern and southern Africa: a systematic review of prevalence and complications. Bull World Health Org. 2010;88:907–14. https://doi.org/10.2471/BLT.09.072975

Dilika F, Meyer JJ. Antibacterial activity of Helichrysum pedunculatum callus cultures. S Afr J Bot. 1998;64:312-13. https://doi.org/10.1016/S0254-6299(15)30908-X

Dilika F, Afolayan AJ, Meyer JJM. Comparative antibacterial activity of two Helichrysum species used in male circumcision in South Africa. S Afr J Bot. 1997;63:158-59. https://doi.org/10.1016/S0254-6299(15)30728-6

Dilika F. The medicinal value of Amaryllidaceae and Asteraceae species used in male circumcision. PhD Thesis. Pretoria: University of Pretoria; 2002.

Papu J, Verster P. A biblical, cultural and missiological critique of traditional circumcision among Xhosa-speaking Christians. Acta Theologica. 2006;2:178-98. https://doi.org/10.4314/actat.v26i2.49044

Venter MA. Some views of Xhosa women regarding the initiation of their sons. Koers 2011;76:559-75.

Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, Nalugoda H, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: A randomised trial. Lancet. 2007;369:657-66. https://doi.org/10.1016/S0140-6736(07)60313-4

World Health Organization (WHO). Male circumcision: Global trends and determinants of prevalence, safety and acceptability. Geneva: WHO Press; 2007.

Boyle GJ, Hill G. Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: methodological, ethical and legal concerns. J Law Med. 2011;19:316–34.

Kilima SP, Shayo HE, Msovela J, Senkoro KP, Mayala BK, Mboera LEG et al. The potential of involving traditional practitioners in the scaling up of male circumcision in the context of HIV prevention in Tanzania. Tanzania J Health Res. 2012;14:48-60. https://doi.org/10.4314/thrb.v14i1.9

Mutabazi V, Kaplan SA, Rwamasirabo E, Bitega JP, Ngeruka ML, Savio D et al. HIV prevention: Male circumcision comparison between a nonsurgical device to a surgical technique in resource-limited settings: A prospective, randomized, nonmasked trial. J Acquired Immune Def Syndr. 2012;61:49–55. https://doi.org/10.1097/QAI.0b013e3182631d69

Mwashambwa YM, Mwampagatwa IH, Rastegaev A, Gesase AP. The male circumcision: The oldest ancient procedure, its past, present and future roles. Tanzania J Health Res 2013;15:199–204. https://doi.org/10.4314/thrb.v15i3.8

Chikutsa A, Maharaj P. Social representations of male circumcision as prophylaxis against HIV and AIDS in Zimbabwe. BMC Public Health 2015, 15:603. https://doi.org/10.1186/s12889-015-1967-z

Rugwiji TT. Circumcision and prevention of HIV and AIDS in Zimbabwe: Male genital cutting as a religio-cultural rite. Theolog Stud. 2018;74:4848. http://dx.doi.org/10.4102/hts.v74i1.4848

Van Wyk BE, Van Oudtshoorn B, Gericke N. Medicinal plants of South Africa. Pretoria: Briza Publications; 2013.

Light ME, Sparg SG, Stafford GI, Van Staden J. Riding the wave: South Africa’s contribution to ethnopharmacological research over the last 25 years. J Ethnopharmacol. 2005;100:127–30. https://doi.org/10.1016/j.jep.2005.05.028

Mulholland DA. The future of ethnopharmacology: A southern African perspective. J Ethnopharmacol. 2005;100:124–26. https://doi.org/10.1016/j.jep.2005.05.013

Karou D, Nadembega WMC, Ouattara L, Ilboudo DP, Canini A, Nikiéma JB, et al. African ethnopharmacology and new drug discovery. Med Aromatic Plant Sci Biotechnol. 2007;1:1–7.

Van Wyk B-E. A review of Khoi-San and Cape Dutch medical ethnobotany. J Ethnopharmacol. 2008;119:331–41. https://doi.org/10.1016/j.jep.2008.07.021

Van Wyk B-E. A broad review of commercially important southern African medicinal plants. J Ethnopharmacol. 2008;119:342–55. https://doi.org/10.1016/j.jep.2008.05.029

Van Wyk B-E. A review of African medicinal and aromatic plants. In Medicinal and aromatic plants of the world: Africa, volume 3. Edited by Neffati M, Najjaa H, Máthé Á. Dordrecht: Springer 2017:19-60.

Watt JM, Breyer-Brandwijk MG. The medicinal and poisonous plants of southern and eastern Africa. Edinburgh: E & S Livingstone; 1962.

Hutchings A, Scott AH, Lewis G, Cunningham A. Zulu medicinal plants: An inventory. Pietermaritzburg: University of Natal Press; 1996.

Maundu P, Berger D, Ole Saitabau C, Nasieku J, Kipelian M, Mathenge S et al. Ethnobotany of the Loita Maasai: Towards community management of the forest of the lost child: Experiences from the Loita ethnobotany project. Paris: People and Plants Working Paper 8, UNESCO; 2001.

Schmelzer GH. Acalypha ornata Hochst. ex A. Rich. In Plant resources of tropical Africa 11: Medicinal plants 1. Edited by Schmelzer GH, Gurib-Fakim A. Leiden:Backhuys Publishers; 2008:26-27.

Kokwaro JO. Medicinal plants of East Africa. Nairobi: University of Nairobi Press; 2009.

Moffett R. Sesotho plant and animal names and plants used by the Basotho. Bloemfontein: Sun Press; 2010.

Roberts M, Roberts S. Indigenous healing plants. Pretoria: Briza Publications; 2017.

Randall RP. A global compendium of weeds. Perth: Western Australia: Department of Agriculture and Food; 2017.

Stepp JR, Moerman DE. The importance of weeds in ethnopharmacology. J Ethnopharmacol. 2001;75:19-23. https://doi.org/10.1016/S0378-8741(00)00385-8

Njoroge NG, Bussmann WR, Gemmill B, Newton LE, Ngumi VW. Utilisation of weed species as sources of traditional medicines in central Kenya. Lyonia 2004;7:71-87.

Palmer CT. The inclusion of recently introduced plants in the Hawaiian ethnopharmacopoeia. Econ Bot. 2004;58:280-93. https://doi.org/10.1663/0013-0001(2004)58[S280:TIORIP]2.0.CO;2

Alencar NL, de Sousa Araujo TA, de Amorim ELC, de Albuquerque UP. The inclusion and selection of medicinal plants in traditional pharmacopoeias-evidence in support of the diversification hypothesis. Econ Bot. 2010;64:68-79. https://doi.org/10.1007/s12231-009-9104-5

Alencar NL, Santoro FR, Albuquerque UP. What is the role of exotic medicinal plants in local medical systems? A study from the perspective of utilitarian redundancy. Rev Brasil Farmacogn. 2014;24:506-15. https://doi.org/10.1016/j.bjp.2014.09.003

Maroyi A. Ethnomedicinal uses of exotic plant species in south-central Zimbabwe. Indian J Trad Knowl, 2018;17:71-77.

Bennett BC, Prance GT. Introduced plants in the indigenous pharmacopoeia of Northern South America. Econ Bot. 2000;54:90-102. https://doi.org/10.1007/BF02866603

Hedberg I, Hedberg O, Madati PJ, Mshigeni KE, Mshiu EN, Samuelson G. Inventory of plants used in traditional medicine in Tanzania. 1. Plants of the families Acanthaceae - Cucurbitaceae. J Ethnopharmacol. 1982;6:29-60. https://doi.org/10.1016/0378-8741(82)90070-8

Bussmann RW, Gilbreath GG, Solio J, Lutura M, Lutuluo R, Kunguru K et al. Plant use of the Maasai of Sekenani valley, Maasai Mara, Kenya. J Ethnobiol Ethnomed. 2006;2:22. https://doi.org/10.1186/1746-4269-2-22

Nankaya J, Nampushi J, Petenya S, Balslev H. Ethnomedicinal plants of the Loita Maasai of Kenya. Env Devel Sustain. 2020;22:2569–89. https://doi.org/10.1007/s10668-019-00311-w

Dilika NF, Nikolova RV, Jacobs TV. Plants used in the circumcision rites of the Xhosa tribe in South Africa. Acta Hortic. 1996;426:165-70. https://doi.org/10.17660/ActaHortic.1996.426.18

Grierson DS, Afolayan AJ. An ethnobotanical study of plants used for the treatment of wounds in the Eastern Cape, South Africa. J Ethnopharmacol. 1999;67:327-32. https://doi.org/10.1016/s0378-8741(99)00082-3

Cocks ML, Dold AP. Cultural significance of biodiversity: The role of medicinal plants in urban African cultural practices in the Eastern Cape, South Africa. J Ethnobiol. 2006;26:60–81. https://doi.org/10.2993/0278-0771(2006)26[60:CSOBTR]2.0.CO;2

Van Wyk B-E, De Wet H, Van Heerden FR. An ethnobotanical survey of medicinal plants in the southeastern Karoo, South Africa. S Afr J Bot. 2008;74:696–704. https://doi.org/10.1016/j.sajb.2008.05.001

Maroyi A. Diversity of use and local knowledge of wild and cultivated plants in the Eastern Cape province, South Africa. J Ethnobiol Ethnomed. 2017;13:43. https://doi.org/10.1186/s13002-017-0173-8

Nair JJ, Van Staden J, Bonnet SL, Wilhelm A. Distribution and diversity of usage of the Amaryllidaceae in the traditional remediation of infectious diseases. Nat Prod Comm. 2017;12:635-39.

Van Wyk B-E, Gericke N. People’s plants: A guide to useful plants of southern Africa. Pretoria: Briza Publications; 2018.

Hutchings A, Johnson C. Glimpses of a Xhosa herbal. Veld Flora 1986;72:59-62.

Hutchings A. Some observations on plant usage in Xhosa and Zulu medicine. Bothalia 1989;19:225-35. https://doi.org/10.4102/abc.v19i2.965

Bhat RB, Jacobs TV. Traditional herbal medicine in Transkei. J Ethnopharmacol. 1995;48:7–12. https://doi.org/10.1016/0378-8741(95)01276-j.

Semenya SS, Potgieter MJ, Tshisikhawe MP. Use, conservation and present availability status of ethnomedicinal plants of Matebele village in the Limpopo province, South Africa. Afr J Biotechnol. 2013;12:2392-2405. https://doi.org/10.5897/AJB12.2572n

Semenya SS, Potgieter MJ. Bapedi traditional healers in the Limpopo province, South Africa: Their socio-cultural profile and traditional healing practice. J Ethnobiol Ethnomed. 2014;10:4. https://doi.org/10.1186/1746-4269-10-4

Bainbridge H. Indigenous use of mopane (Colophospermum mopane) in northwestern Namibia. Desert Pl. 2012;28:23-26.

Brumbaugh MA. Medicinal plants of Namibia. BSc Honours Thesis. Tucson: University of Arizona; 2015.

Philander LA. An ethnobotany of Western Cape Rasta bush medicine. J Ethnopharmacol. 2011;138:578–94. https://doi.org/10.1016/j.jep.2011.10.004

Dold AP, Cocks ML. The medicinal use of some weeds, problem and alien plants in the Grahamstown and Peddie districts of the Eastern Cape, South Africa. S Afr J Sci. 2000;96:467-73.

Hedberg I, Hedberg O, Madati PJ, Mshigeni KE, Mshiu EN, Samuelson G. Inventory of plants used in traditional medicine in Tanzania. 2. Plants of the families Dilleniaceae - Opiliaceae. J Ethnopharmacol. 1983;9:105-28. https://doi.org/10.1016/0378-8741(83)90030-2

Simon, C, Lamla, M. Merging pharmacopoeia: Understanding the historical origins of incorporative pharmacopoeia1 processes among Xhosa healers in Southern Africa. J Ethnopharmacol. 1991;33:231-42. https://doi.org/10.1016/0378-8741(91)90083-p

Bhat RB. Plants of Xhosa people in the Transkei region of Eastern Cape (South Africa) with major pharmacological and therapeutic properties. J Med Pl Res. 2013;7:1474–80. https://doi.org/10.5897/JMPR12. 973

Suntar I. The medicinal value of Asteraceae family plants in terms of wound healing activity. Fabad J Pharm Sci. 2014;39:21-31.

Gerstner J. A preliminary checklist of Zulu names of plants with short notes. Bantu Stud. 1938;12:215-36. https://doi.org/10.1080/02561751.1938.9676078

Swelankomo N. Helichrysum foetidum (L.) Moench; 2021. Available from: http://pza.sanbi.org/helichrysum-foetidum, accessed on 7 January 2020

Maroyi A. Medicinal uses, biological and phytochemical properties of Helichrysum foetidum (L.) Moench (Asteraceae). Asian J Pharmaceut Clinical Res. 2019;12:13-18. https://doi.org/10.22159/ajpcr.2019.v12i7.33607

Xaba PM. Helichrysum nudifolium (L.) Less; 2021. Available from: http://pza.sanbi.org/helichrysum-nudifolium, accessed on 12 January 2021.

Sewani-Rusike CR, Mammen M. Medicinal plants used as home remedies: A family survey by first year medical students. Afr J Trad Compl Alt Med. 2014;11:67-72. https://doi.org/10.4314/ajtcam.v11i5.11

Maroyi A. Helichrysum nudifolium (L.) Less.: review of its medicinal uses, phytochemistry and biological activities. J Pharm Nutr Sci. 2019;9:189-94. https://doi.org/120.29169/1927-5951.2019.09.03.8

Bolofo RN, Johnson CT. The identification of ‘isicakathi’ and its medicinal use in Transkei. Bothalia 1988;18:125-30. https://doi.org/10.4102/abc.v18i1.995

Meyer JJM, Dilika F. Antibacterial activity of Helichrysum pedunculatum used in circumcision rites. J Ethnopharmacol. 1996;53:51-54. https://doi.org/10.1016/0378-8741(96)01411-0

Van Vuuren CJ, De Jongh M. Rituals of manhood in South Africa: Circumcision at the cutting edge of critical intervention. S Afr J Ethnol. 1999;22:142-56.

Dilika F, Bremner PD, Meyer JJM. Antibacterial activity of linoleic and oleic acids isolated from Helichrysum pedunculatum: A plant used during circumcision rites. Fitoterapia 2000;71:450-52. https://doi.org/10.1016/s0367-326x(00)00150-7

Bhat RB. Medicinal plants and traditional practices of Xhosa people in the Transkei region of Eastern Cape, South Africa. Indian J Trad Knowl. 2014;13:292–98.

Maroyi A. Helichrysum longifolium and H. pedunculatum: A comparative analysis of their medicinal uses, chemistry and biological activities. Asian J Pharmaceut Clinical Res. 2019;12:41-46. https://doi.org/10.22159/ajpcr.2019.v12i7.33684

Hutchings A. Ritual cleansing, incense and the tree of life: Observations on some indigenous plant usage in traditional Zulu and Xhosa purification and burial rites. Alternation 2007;14:189–218.

Maroyi A. Lippia javanica (Burm. f.) Spreng: Traditional and commercial uses, phytochemical and pharmacological significance. Evidence-Based Compl Alt Med. 2017;article ID 6746071. https://doi.org/10.1155/2017/6746071

Mabogo DEN. The ethnobotany of the Vhavenda. MSc Thesis. Pretoria: University of Pretoria; 1990.

Oyedemi SO, Oyedemi BO, Falowo AB, Fayemi PO, Coopoosamy RM. Antibacterial and ciprofloxacin modulating activity of Ptaeroxylon obliquum (Thunb.) Radlk leaf used by the Xhosa people of South Africa for the treatment of wound infections. Biotechnol Biotechnolog Equipm. 2016;30:1006-15. https://doi.org/10.1080/13102818.2016.1209434

Chhabra SC, Mahunnah RLA, Mshiu EN. Plants used in traditional medicine in Eastern Tanzania. VI. Angiosperms (Sapotaceae to Zingiberaceae). J Ethnopharmacol. 1993;39:83–103. https://doi.org/10.1016/0378-8741(93)90024-y

Bosch CH. Triumfetta rhomboidea Jacq. In Plant resources of tropical Africa 16: Fibres. Edited by Brink M, Achigan-Dako EG. Leiden: Backhuys Publishers 2012:446-49.

Kiringe JW. A survey of traditional health remedies used by the Maasai of southern Kaijiado district, Kenya. Ethnobot Res Appl. 2006;4:61-73.

Cunningham AB. African medicinal plants: Setting priorities at the interface between conservation and primary health care. Paris: People and Plants Working Paper 1, UNESCO; 1993.

Mander M. Marketing of indigenous medicinal pants in South Africa: A case study in KwaZulu-Natal. Rome: FAO; 1998.

Williams VL, Balkwill K, Witkowski ET. A lexicon of plants traded in the Witwatersrand umuthi shops. Bothalia 2001;31:71-98. https://doi.org/10.4102/abc.v31i1.508

Dold AP, Cocks ML. The trade in medicinal plants in the Eastern Cape province, South Africa. S Afr J Sci. 2002;98:589–97.

Loundou P. Medicinal plant trade and opportunities for sustainable management in South Africa. MSc Thesis. Stellenbosch: University of Stellenbosch; 2008.

Botha J, Weiersbye IM. Ethnobotanic and forage uses of plants on mine properties in the Witwatersrand basin gold fields, South Africa. In Mine Closure. Edited by Fourie A, Tibbett M, Wiertz J. Perth: Australian Centre for Geomechanics 2010:325-42.

Moeng ET. An investigation into the trade of medicinal plants by Muthi shops and street vendors in the Limpopo province, South Africa. MSc Thesis. Mankweng: University of Limpopo; 2010.

Setshogo MP, Mbereki CM. Floristic diversity and use of medicinal plants sold by street vendors in Gaborone, Botswana. Afr J Pl Sci Biotechnol. 2011;5:69–74.

Van Wyk B-E. The potential of South African plants in the development of new medicinal products. S Afr J Bot. 2011;77:812–29. https://doi.org/10.1016/j.sajb.2011.08.011

Maroyi A. Burkea africana Hook. In Plant resources of tropical Africa 7: Timbers 2. Edited by Lemmens RHMJ, Louppe D, Oteng-Amoako AA. Leiden: Backhuys Publishers 2012:174-77.

Petersen LM, Moll EJ, Collins R, Hockings MT. Development of a compendium of local, wild-harvested species used in the informal economy trade, Cape Town, South Africa. Ecol Soc. 2012;17:26. http://dx.doi.org/10.5751/ES-04537-170226

Posthouwer C. Medicinal plants of Kariakoo market, Dar es Salaam, Tanzania. MSc Thesis. Leiden: Leiden University; 2015.

Van Wyk B-E. A review of commercially important African medicinal plants. J Ethnopharmacol. 2015;176:118–34. https://doi.org/10.1016/j.jep.2015.10.031

Hilonga S, Otieno JN, Ghorbani A, Pereus D, Kocyan A, de Boer H. Trade of wild-harvested medicinal plant species in local markets of Tanzania and its implications for conservation. S Afr J Bot. 2019;122:214–24. https://doi.org/10.1016/j.sajb.2018.08.012

Rasethe MT, Semenya SS, Maroyi A. Medicinal plants traded by informal herbal medicine markets in the Limpopo province, South Africa. Evidence-Based Compl Alt Med. Volume 2019:article ID 2609532. https://doi.org/10.1155/2019/2609532

Vasisht K, Sharma N, Karan M. Current perspective in the international trade of medicinal plants material: An update. Current Pharmaceut Design 2016;22:4288–36. https://doi.org/10.2174/1381612822666160607070736

Houghton PJ, Hylands PJ, Mensah AY, Hensel A, Deters A. In vitro tests and ethnopharmacological investigations: wound healing as an example. J Ethnopharmacol. 2005;100:100–07. https://doi.org/10.1016/j.jep.2005.07.001

Agyare C, Asase A, Lechtenberg M, Niehues M, Deters A, Hensel A. An ethnopharmacological survey and in vitro confirmation of ethnopharmacological use of medicinal plants used for wound healing in Bosomtwi?Atwima?Kwanwoma area, Ghana. J Ethnopharmacol. 2009;125:393–403. https://doi.org/10.1016/j.jep.2009.07.024

Walmsley GG, Maan ZN, Wong VW, Duscher D, Hu MS, Zielins ER et al. Scarless wound healing: Chasing the holy grail. Plast Reconstr Surg. 2015;135:907–17. https://doi.org/10.1097/PRS.0000000000000972

Chingwaru C, Bagar T, Maroyi A, Kapewangolo PT, Chingwaru W. Wound healing potential of selected Southern African medicinal plants. J Herbal Med. 2019;17:100263. https://doi.org/10.1016/j.hermed.2019.100263

Teka A, Rondevaldova J, Asfaw Z, Demissew S, Van Damme P, Kokoska L et al. In vitro antimicrobial activity of plants used in traditional medicine in Gurage and Silti Zones, south central Ethiopia. BMC Compl Alt Med. 2015;15:286. https://doi.org/10.1186/s12906-015-0822-1

Madikizela B, Ndhlala AR, Finnie JF, Van Staden J. In vitro antimicrobial activity of extracts from plants used traditionally in South Africa to treat tuberculosis and related symptoms. Evidence-Based Compl Alt Med. 2013;Volume 2013:article ID 840719. https://doi.org/10.1155/2013/840719

Madikizela B, Ndhlala AR, Finnie JF, Van Staden J. Antimycobacterial, anti-inflammatory and genotoxicity evaluation of plants used for the treatment of tuberculosis and related symptoms in South Africa. J Ethnopharmacol. 2014; 153:386–91. https://doi.org/10.1016/j.jep.2014.02.034

Pandey R, Sambasivarao Y, Gurumurthy A. Antibacterial activity of medicinal plants against pathogens from extracts of Achyranthes aspera. Med Aromat Plants 2013;2:5. https://doi.org/10.4172/2167-0412.1000135

Nigussie D, Davey G, Legesse BA, Fekadu A, Makonnen E. Antibacterial activity of methanol extracts of the leaves of three medicinal plants against selected bacteria isolated from wounds of lymphoedema patients. BMC Compl Med Therapies 2021;21:2. https://doi.org/10.1186/s12906-020-03183-0

Khuda F, Iqbal Z, Khan A, Zakiullah A, Nasir F, Shah Y. Anti-inflammatory activity of the topical preparation of Valeriana wallichii and Achyranthes aspera leaves. Pak J Pharm Sci. 2013;26:451-54.

Emeka PM, Badger-Emeka LI, Fateru F. In vitro antimicrobial activities of Acalypha ornata leaf extracts on bacterial and fungal clinical isolates. J Herbal Med. 2012;2:136–42. https://doi.org/10.1016/j.hermed.2012.09.001

Steenkamp V, Fernandes AC, Van Rensburg CE. Antibacterial activity of Venda medicinal plants. Fitoterapia 2007, 78:561-64. https://doi.org/10.1016/j.fitote.2007.02.014

Dzoyem JP, Eloff JN. Anti-inflammatory, anticholinesterase and antioxidant activity of leaf extracts of twelve plants used traditionally to alleviate pain and inflammation in South Africa. J Ethnopharmacol. 2015;160:194–201. https://doi.org/10.1016/j.jep.2014.11.034

Mabona U, Viljoen A, Shikanga E, Marston A, Van Vuuren S. Antimicrobial activity of southern African medicinal plants with dermatological relevance: From an ethnopharmacological screening approach, to combination studies and the isolation of a bioactive compound. J Ethnopharmacol. 2013;148:45–55. https://doi.org/10.1016/j.jep.2013.03.056

Shale TL, Stirk WA, Van Staden J. Screening of medicinal plants used in Lesotho for anti-bacterial and anti-inflammatory activity. J Ethnopharmacol. 1999;67:347–54. https://doi.org/10.1016/s0378-8741(99)00035-5

Jäger AK, Hutchings A, Van Staden J. Screening of Zulu medicinal plants for prostaglandin-synthesis inhibitors. J Ethnopharmacol. 1996;52:95-100. https://doi.org/10.1016/0378-8741(96)01395-5

Kaarina IN, Dan K, Secilia IK. Antipseudomonal potential of Colophospermum mopane and Acrotome inflata, medicinal plants indigenous to Namibia. Afr J Pharm Pharmacol. 2017;11:78-86. https://doi.org/10.5897/AJPP2016.4716

Mudzengi CP, Murwira A, Tivapasi M, Murungweni C, Burumu JV, Halimani T. Antibacterial activity of aqueous and methanol extracts of selected species used in livestock health management. Pharm Biol. 2017;55:1054-60. https://doi.org/10.1080/13880209.2017.1287744

Shandukani PD, Tshidino SC, Masoko P, Moganedi KM. Antibacterial activity and in situ efficacy of Bidens pilosa Linn and Dichrostachys cinerea Wight et Arn extracts against common diarrhoea-causing waterborne bacteria. BMC Compl Alt Med. 2018;18:171. https://doi.org/10.1186/s12906-018-2230-9

Nciki S, Vuuren S, Van Eyk A, De Wet H. Plants used to treat skin diseases in northern Maputaland, South Africa: Antimicrobial activity and in vitro permeability studies. Pharm Biol. 2016;54:2420-36. https://doi.org/10.3109/13880209.2016.1158287

McGaw LJ, Jäger AK, Van Staden J. Prostaglandin synthesis inhibitory activity in Zulu, Xhosa and Sotho medicinal plants. Phytoth Res. 1997;11:113–17. https://doi.org/10.1002/(SICI)1099-1573(199703)11:2<113::AID-PTR27>3.0.CO;2-S

Eftekhar F, Yousefzadi M, Tafakori V. Antimicrobial activity of Datura innoxia and Datura stramonium. Fitoterapia 2005;76:118–20. https://doi.org/10.1016/j.fitote.2004.10.004

Taye B, Giday M, Animut A, Seid J. Antibacterial activities of selected medicinal plants in traditional treatment of human wounds in Ethiopia. Asian Pac J Trop Biomed. 2011;1:370-75. https://doi.org/10.1016/S2221-1691(11)60082-8

Obi CL, Potgieter N, Randima LP, Mavhungu NJ, Musie E, Bessong PO, et al. Antibacterial activities of five plants against some medically significant human bacteria. S Afr J Sci. 2002;98:25-28.

Ondua M, Njoya EM, Abdalla MA, McGaw LJ. Anti-inflammatory and antioxidant properties of leaf extracts of eleven South African medicinal plants used traditionally to treat inflammation. J Ethnopharmacol. 2019;234:27–35. https://doi.org/10.1016/j.jep.2018.12.030

Lourens ACU, Van Vuuren SF, Viljoen AM, Davids H, Van Heerden FR. Antimicrobial activity and in vitro cytotoxicity of selected South African Helichrysum species. S Afr J Bot. 2011;77:229–35. https://doi.org/10.1016/j.sajb.2010.05.006

Aiyegoro OA, Afolayan AJ, Okoh AI. In vitro antibacterial activities of crude extracts of the leaves of Helichrysum longifolium in combination with selected antibiotics. Afr J Pharm Pharmacol. 2009;3:293-300.

Aiyegoro OA, Afolayan AJ, Okoh AI. Studies on the in vitro time kill assessment of crude acetone and aqueous extracts of Helichrysum pedunculatum leaves. Afr J Biot. 2008;7:3718-22. https://doi.org/10.5897/AJB08.578

Shikanga EA, Combrinck S, Regnier T. South African Lippia herbal infusions: Total phenolic content, antioxidant and antibacterial activities. S Afr J Bot. 2010;76:567–71. https://doi.org/10.1016/j.sajb.2010.04.010

York T, Van Vuuren SF, De Wet H. An antimicrobial evaluation of plants used for the treatment of respiratory infections in rural Maputaland, KwaZulu-Natal, South Africa. J Ethnopharmacol. 2012;144:118–27. https://doi.org/10.1016/j.jep.2012.08.038

Asowata-Ayodele AM, Otunola GA, Afolayan AJ. Assessment of the polyphenolic content, free radical scavenging, anti-inflammatory, and antimicrobial activities of acetone and aqueous extracts of Lippia javanica (Burm.f.) Spreng. Pharmacogn Mag. 2016;12:353-62. https://doi.org/10.4103/0973-1296.185770

Elisha IL, Botha FS, McGaw LJ, Eloff JN. The antibacterial activity of extracts of nine plant species with good activity against Escherichia coli against five other bacteria and cytotoxicity of extracts. BMC Compl Alt Med. 2017;17:133. https://doi.org/10.1186/s12906-017-1645-z

Adamu M, Naidoo V, Eloff JN. The antibacterial activity, antioxidant activity and selectivity index of leaf extracts of thirteen South African tree species used in ethnoveterinary medicine to treat helminth infections. BMC Vet Res. 2014;10:52. https://doi.org/10.1186/1746-6148-10-52.

Madikizela B, Ndhlala AR, Finnie JF, Van Staden J. Ethnopharmacological study of plants from Pondoland used against diarrhoea. J Ethnopharmacol. 2012;141:61–71. https://doi.org/10.1016/j.jep.2012.01.053

Elisha IL, Dzoyem JP, McGaw LJ, Botha FS, Eloff JN. The anti-arthritic, anti-inflammatory, antioxidant activity and relationships with total phenolics and total flavonoids of nine South African plants used traditionally to treat arthritis. BMC Compl Alt Med. 2016;16:307. https://doi.org/10.1186/s12906-016-1301-z

Ramadwa TE, Awouafack MD, Sonopo MS, Eloff JN. Antibacterial and antimycobacterial activity of crude extracts, fractions, and isolated compounds from leaves of sneezewood, Ptaeroxylon obliquum (Rutaceae). Nat Prod Comm. 2019;14:1–7. https://doi.org/10.1177/1934578X19872927

Soyelu OT, Masika PJ. Antibacterial and antioxidant activities of some selected plants used for the treatment of cattle wounds in the Eastern Cape. Afr J Biot. 2012;11:3476-81. https://doi.org/10.5897/AJB10.1070

Iqbal J, Zaib S, Farooq U, Khan A, Bibi I, Suleman S. Antioxidant, antimicrobial and free radical scavenging potential of aerial parts of Periploca aphylla and Ricinus communis. ISRN Pharmacol. 2012;article ID 563267. https://doi.org/10.5402/2012/563267

Umaarasu T, Padmavathy K, Thirunavukkarasu D, Rajesh SV, Govindaraj J, Shanmugam G. Evaluation of the antimicrobial activity and phytochemical investigation of the leaf extracts of Ricinus communis Linn. against drug-resistant bacterial pathogens. Drug Invention Tod. 2019;11:1299-1303.

Suurbaar J, Mosobil R, Donkor A-M. Antibacterial and antifungal activities and phytochemical profile of leaf extract from different extractants of Ricinus communis against selected pathogens. BMC Res Notes 2017;10:660. https://doi.org/10.1186/s13104-017-3001-2

Kareru PG, Gachanja AN, Keriko JM, Kenji GM. Antimicrobial activity of some medicinal plants used by herbalists in Eastern province, Kenya. Afr J Trad Compl Alt Med. 2008;5:51–55. https://doi.org/10.4314/ajtcam.v5i1.31256

Korir R, Kimani C, Gathirwa J, Wambura M, Bii C. In vitro antimicrobial properties of methanol extracts of three medicinal plants from Kilifi district, Kenya. Afr J Health Sci. 2012;20:4-10.

Devmurari VP, Ghodasara TJ, Jivani NP. Antibacterial activity and phytochemical study of ethanolic extract of Triumfetta rhomboidea Jacq. Int J Pharmaceut Sci Drug Res. 2010;2:40-42. https://ijpsdr.com/index.php/ijpsdr/article/view/77

Odimegwu CD, Uche IF, Ozioko CL, Ogbuanya CE, Gugu HT, Esimone OC. In vitro antimicrobial evaluation of methanol extract of Triumfetta rhomboidea leaves against some clinical bacterial isolates. Int J Biol Chem Sci. 2011;5:1970-77. https://doi.org/10.4314/ijbcs.v5i5.17

Thawkar B, Kale M, Oswal M, Maniyar K, Kadam K, Kamat S. To study anti-inflammatory activity of 70% methanolic extract of Triumfetta rhomboidea: In vitro study. Res J Pharm Tech. 2016;9:241-44. https://doi.org/10.5958/0974-360X.2016.00044.5

Larsen BHV, Soelberg J, Jäger AK. COX-1 inhibitory effect of medicinal plants of Ghana. S Afr J Bot. 2015;99:129–31. https://doi.org/10.1016/j.sajb.2015.04.004

Kaur G, Sharma AK, Karnwal A. Antimicrobial activity of Acacia nilotica against various clinical isolates. Elixir Appl Bot. 2016;97:42260-262.

Gmaraldeen SM, Magzoub AA, Badri AM, Garbi MI, Saleh MS. Antibacterial activity of Acacia nilotica fruits extract against pathogenic bacteria. Int J Appl Res. 2016;2:103-06.

Eldeen IMS, Elgorashi EE, Van Staden J. Antibacterial, anti-inflammatory, anticholinesterase and mutagenic effects of extracts obtained from some trees used in South African traditional medicine. J Ethnopharmacol. 2005;102:457–64. https://doi.org/10.1016/j.jep.2005.08.049

Turner VW. The ritual process. Chicago: Aldine; 1969.

Carstens P. The socio-economic context of initiation ceremonies among two Southern African people. Canadian J Afr Stud. 1982;16:505–22. https://doi.org/10.1080/00083968.1982.10804010

Weiss HA, Plummer ML, Changalucha J, Mshana G, Shigongo ZS, Todd J et al. Circumcision among adolescent boys in rural northwestern Tanzania. Trop Med Int Health 2008;13:1054-61. https://doi.org/10.1111/j.1365-3156.2008.02107.x

Niang IC, Boiro H. You can also cut my finger!: Social construction of male circumcision in West Africa, a case study of Senegal and Guinea Bissau. Reprod Health Matters 2007;15:22-32. https://doi.org/10.1016/S0968-8080(07)29312-7

Wambura M, Mwanga JR, Mosha JF, Mshana G, Mosha F, Changalucha J. Acceptability of medical male circumcision in the traditionally circumcising communities in Northern Tanzania. BMC Public Health 2011;11:373. https://doi.org/10.1186/1471-2458-11-373

Munthali AC, Zulu EM. The timing and role of initiation rites in preparing young people for adolescence and responsible sexual and reproductive behaviour in Malawi. Afr J Reprod Health 2007;11:150-67.

Maposa RS. Going under the traditional knife: Linking African traditional education and the ethic of identity through Shangani culture, Zimbabwe. J Emerging Trends Educ Res Policy Stud 2011;2:479-84.

Vincent L. Boys will be boys: Traditional Xhosa male circumcision, HIV and sexual socialisation in contemporary South Africa. Cult Health Sex. 2008;10:431-46. https://doi.org/10.1080/13691050701861447

Peltzer K, Kanta X. Medical circumcision and manhood initiation rituals in the Eastern Cape, South Africa: A post intervention evaluation. Cult Health Sex. 2009;11:83-97. https://doi.org/10.1080/13691050802389777

Mensch BS, Bagah D, Clark WH, Binka F. The changing nature of adolescence in the Kassena-Nankana district of northern Ghana. Stud Family Plan. 1999;30:95-111. https://doi.org/10.1111/j.1728-4465.1999.00095.x

Meissner O, Buso DL. Traditional male circumcision in the Eastern Cape: Scourge or blessing? S Afr Med J. 2007;97:371–73.

Nnko S, Washija R, Urassa M, Boerma JT. Dynamics of male circumcision practices in northwest Tanzania. Sexually Transmit Dis. 2001;28:214-18. https://doi.org/10.1097/00007435-200104000-00005

Bailey R, Muga R, Poulussen R, Abicht H. The acceptability of male circumcision to reduce HIV infections in Nyanza province, Kenya. AIDS Care 2002;14:27-40. https://doi.org/10.1080/09540120220097919

Kebaabetswe P, Lockman S, Mogwe S, Mandevu R, Thior I, Essex M et al. Male circumcision: An acceptable strategy for HIV prevention in Botswana. Sexually Transmit Infect. 2003;79:214-19. http://dx.doi.org/10.1136/sti.79.3.214

Westercamp N, Bailey RC. Acceptability of male circumcision for prevention of HIV/AIDS in sub-Saharan Africa: A review. AIDS Behavior. 2007;11:341-55. http://dx.doi.org/10.1080/09540120220097919

Peltzer K, Niang CI, Muula AS, Bowa K, Okeke L, Boiro H et al. Male circumcision, gender and HIV prevention in sub-Saharan Africa: A (social science) research agenda. J Social Aspects HIV/AIDS 2007;4:658-67. http://dx.doi.org/10.1080/17290376.2007.9724889