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Ethnomedicinal Application of Native Remedies Used Against Diabetes and Related Complications in Mauritius

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Ethnomedicinal Application of Native Remedies Used Against Diabetes and Related Complications in Mauritius Journal of Ethnopharmacology 151 (2014) 413–444 Contents lists available at ScienceDirect Journal of Ethnopharmacology journal homepage: www.elsevier.com/locate/jep Ethnomedicinal application of native remedies used against diabetes and related complications in Mauritius Anushka Mootoosamy, M. Fawzi Mahomoodally n Department of Health Sciences, Faculty of Science, University of Mauritius, Reduit 230, Mauritius article info abstract Article history: Ethnopharmacological relevance: Notoriously, the tropical island of Mauritius has one of the highest Received 12 August 2013 prevalence of diabetes worldwide and the economic burden associated with it is alarming. The use of Received in revised form native remedies (NRs) is well anchored in the local culture and it continues to be the cornerstone of 27 October 2013 therapy for diabetic patients. However, there is currently a dearth of updated primary data on NRs used Accepted 27 October 2013 by Mauritians against diabetes and diabetes related complications (DRCs). This study was therefore Available online 11 November 2013 designed to record, analyze and document orally transmitted ethnopharmacological knowledge from Keywords: diabetic patients and traditional medicine practitioners (TMPs) in Mauritius concerning NRs commonly Mauritius used against diabetes and DRCs which might open new avenues to initiate novel antidiabetic drugs Diabetes discovery. Diabetes related complications Materials and methods: Data was collected following interviews from diabetic patients (n¼328) and Native remedies TMPs (n¼20). Eleven quantitative indexes, namely informant consensus factor (FIC), fidelity level (FL), Herbal remedies Animal-based remedies use value (UV), relative frequency of citation (RFC), relative importance (RI), cultural importance index (CII), index of agreement on remedies (IAR), cultural agreement index (CAI), quality use value (QUV), quality use agreement value (QUAV) and ethnobotanicity index (EI) were calculated. Statistical analysis such as Pearson correlation and Chi-squared test were performed to determine any association. Results: A total of 111 plant species distributed over 56 families, 30 polyherbal formulations and 16 animal species were documented to be traditionally used against diabetes and DRCs. For the first time 8 endemic plants have been recorded to be used against diabetes and DRCs from Mauritius. The most encountered medicinal plant family was Asteraceae. According to the EI, 16.2% of the native plants in Mauritius were used against diabetes and DRCs. As far as we know, Vangueria madagascariensis, Apium graveolens, Petroselinum crispum and Rubus alceifolius with high RFC values are recorded against diabetes and DRCs for the first time. Sociodemographic characteristics (age, gender, income, religious belief, education and residence) were found to significantly (po0.05) influence the use of NRs. The average FIC for all ailments for plant and animal products were 0.94 and 0.87 respectively. Bryophyllum pinnatum,a native plant to Mauritius scored a high FL value (100%) used against diabetic neuropathy, Allium sativum had the highest RI value (2.00) due to its versatility, Aloe vera had the highest RFC (0.61), the CII (0.640) and the highest CAI value (0.635), Psidium guajava had the highest QUAV (0.961) which indicates its high bioactivity and Allium cepa was reported as the most effective plant species (QUV¼0.965). According to UV, the most important species was Morinda citrifolia (1.21). Panoply of animal products were reported whereby fish (39.7%) was recorded as the most utilised zootherapy and Salmo salar scored the highest FL (100%) for diabetes. Some animal species (n¼14) not previously documented against diabetes and DRCs are reported in the present study. Conclusion: Our present investigation revealed that the use of NRs constitutes the common legacy of Mauritians and despite the penetration of allopathic medicine; NRs continue to play a crucial role in the primary health care system of Mauritius. To this effect, it is of uttermost importance to record this Abbreviations: AR, animal-based remedy; CAI, cultural agreement index; CII, cultural importance index; DRCs, diabetes related complications; EI, ethnobotanicity index; FIC, informant consensus factor; HR, herbal remedy; IAR, index of agreement on remedies; FL, fidelity level; NR, native remedy; QUAV, quality use agreement value; QUV, quality use value; RFC, relative frequency of citation; RI, relative importance; TMP, traditional medicine practitioner; UV, use value; WHO, World Health Organization; AGE, advanced glycation endproduct n Corresponding author. Tel.: þ230 4037578; fax: þ230 4656928. E-mail addresses: [email protected], [email protected] (M. Fawzi Mahomoodally). 0378-8741/$ - see front matter & 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jep.2013.10.069 414 A. Mootoosamy, M. Fawzi Mahomoodally / Journal of Ethnopharmacology 151 (2014) 413–444 knowledge before it disappears. In addition, further experimental investigations are required to elucidate the pharmacological properties of the reported medicinal flora and fauna of Mauritius. & 2013 Elsevier Ireland Ltd. All rights reserved. 1. Introduction present in Mauritius (Mauritian Wildlife Federation, (MWF), 2012). Traditional medicine is omnipresent in the Mauritian community Diabetes is one of the world's greatest healthcare challenges whereby Mauritians still use traditional medicine for the treat- currently affecting more than 371 million people globally and ment and/or management of various ailments. In view of the 4.8 million people died due to diabetes in 2012 (International increasing prevalence of diabetes in Mauritius, there is a growing Diabetes Federation, (IDF), 2012). Diabetes prevalence is expected need to develop new approaches towards the management and to rise to 552 million people by 2030 of which more than 90% of prevention of the disease by exploring the potentials offered by diabetic patients will have Type 2 diabetes (International Diabetes NRs. Traditional antidiabetic plants offer great potential for the Federation, (IDF), 2011a). Moreover, 183 million people (50%) with discovery of new antidiabetic agents with the possibility to diabetes are undiagnosed and 80% of people with diabetes live significantly alter the course of diabetic complications where most in low- and middle-income countries (International Diabetes conventional medicines have failed. Federation, (IDF), 2011b). Diabetes prevalence is exacerbating Nonetheless, there is currently a dearth of documentation on worldwide, and Sub-Saharan Africa including Mauritius is no the use of NRs by Mauritians for the management and treatment exception. In 2010, 12.1 million people were estimated to be living of diabetes and DRCs. Therefore, there is a pressing need to record with diabetes in Africa, and this is projected to increase to 23.9 updated primary scientific information on the different NRs used million by 2030 (Motala and Ramaiya, 2010). In Mauritius, the by Mauritians. Moreover, it is very important to document valu- majority of people with diabetes have Type 2 diabetes (Ministry of able traditional knowledge of NRs with therapeutic activity against Health and Quality of Life, (MOH), 2012). According to recent diabetes and DRCs as it is rapidly disappearing after the death of statistics, Mauritius, with a prevalence of 15.5%, no longer features its old secret keepers and also due to the lack of interest shown by among the top ten countries worldwide with the highest pre- the younger generation toward the use and documentation of valence of diabetes (Republic of Mauritius, (ROM), 2013). Never- traditional knowledge. In addition, it is fundamental to conserve theless, with its rapid urbanisation and its prevalent Asian genetic the medicinal flora and fauna of Mauritius for future genera- background, along with today's sedentary lifestyle and obesity tions and to ensure Mauritius's sovereign rights over its genetic epidemic, Mauritius is still at the forefront of this modern scourge. resources and utilisation by first documenting them. Complications associated with diabetes are the major cause of The main endeavour of the present work is to collect, analyze mortality and morbidity in diabetes (Tarak et al., 2011). Prolonged and document primary ethnopharmacological data from diabetic uncontrolled hyperglycemic level entails complications of diabetes patients and TMPs in the tropical island of Mauritius concerning such as renal failure, amputation, cardiovascular diseases and NRs commonly used against diabetes and DRCs. vision loss (Patel et al., 2012). The World Health Organization (WHO) reported that 50% of people with diabetes die of cardio- vascular disease. Furthermore, of the 37 million cases of blindness 2. Materials and methods due to eye diseases worldwide, diabetic retinopathy is responsible for 4.8% of them and 10–20% of people with diabetes die of kidney 2.1. Study area failure (World Health Organisation, (WHO), 2011). In 2010, out of the 12.1 million adults with diabetes in Sub-Saharan Africa 4.51 The island of Mauritius is part of Sub-Saharan Africa and lies in million had eye complications, 2.23 million need dialysis because the southern hemisphere in the middle of the Indian Ocean with of renal failure, 907,500 have cardiovascular disease and 169,400 coordinates 57130′ east and 20120′ south (Map 1).The population have lost a foot because of amputation (Motala and Ramaiya, comprises of Indo-Mauritians, people of
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