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Leeds Thesis Template Plants and wound healing in Uganda: A mixed methods study Patience Amooti Muwanguzi Submitted in accordance with the requirements for the degree of Doctor of Philosophy The University of Leeds Faculty of Medicine and Health School of Healthcare September 2012 The candidate confirms that the work submitted is their own and that the appropriate credit has been given where reference has been made to the work of others. This copy has been supplied on the understanding that it is copyright material and that no quotation from the thesis may be published without proper acknowledgement. ii Acknowledgements I would like to thank God, the Almighty for making this whole project successful and for His guidance throughout the three years. This study does not represent a singular effort, but the efforts and support of many individuals. My thanks and appreciation go out to my supervisor Professor Andrea Nelson for her thoughtful guidance, ability to push me a bit harder and her ability to keep us focused whilst still looking at the big picture. My co-supervisors, Dr Jim Jolly for his ability to ask critical questions and vast knowledge about the plant world and Dr Jane Cahill for being „the buffer‟ and for her immense expertise in qualitative research methods. Thank you all for your words of wisdom, support and encouragement. Special thanks to Professor Kate Thomas for your co-supervision during the first year of this project. I also extend my gratitude to Ms Ruth Allcroft and the staff in the research office at the School of Healthcare. I greatly appreciate Professor Eileen Ingham from the Institute of Medical and Biological Engineering in the Faculty of Biological sciences at the University of Leeds, for generously allowing us to conduct analysis on the plants in the immunology lab. My heartfelt gratitude goes to Dr Daniel Thomas for accepting to provide supervision for my laboratory work and share his knowledge and expertise and for enabling me to gain confidence in myself as a „plant scientist‟, to Mr Martin Fuller for his expert help with measuring particle size using Environmental scanning electron microscopy and to Ms Fiona Campbell and the staff in the immunology lab for always providing technical support as needed. Thanks to my family; my dear husband Israel Arinaitwe for the love, support, gentle persistent pressure and for keeping the „home fires burning‟; my parents, Charles and Alice Muwanguzi for the never ending support for every „project‟ in my life. My only sister Grace Muwanguzi, for the inspiration and prayers especially through the trying times and for being a loving „yanti‟ to Joshua in my absence. Aunt Margaret for the constant prayers and Joyce Nakatumba Nabende for always being there despite doing her own PhD. To the staff and my fellow PG students in the School of Healthcare, for the co- operation, encouragement and support. iii Thanks to the Ford Foundation International Fellowships Program (IFP) for generously providing funding for the PhD studies both at Leeds and during fieldwork. Special thanks to Mbarara University of Science and Technology for accepting to let me go. Research of this nature is a privilege, and for that I would like to thank the generous people of Mbarara and Isingiro in South Western Uganda, who opened up their hearts and their lives to me while I stayed in their villages and homes. People in these communities were fully supportive and actively interested in what I was doing. I especially thank the traditional healers who took me in as an apprentice, I promise to let others see the world through your eyes by sharing your story. iv Abstract In Uganda, many people rely on traditional healers and medicinal plants for their health needs including managing wounds. To date no studies have been published regarding the local Ugandan practice of the use of medicinal plants for wound healing. This study was undertaken to document Ugandan local knowledge of wound healing, the preparation, administration and identification of local medicinal plants. The mixed methods study comprised three phases: 1. A literature review of the existing literature on plants and wound healing employing systematic techniques. 2. Fieldwork where forty consenting traditional practitioners and local knowledge experts in South Western Uganda were interviewed about their knowledge of wound healing and participated in quantitative surveys regarding medicinal plant use. 3. The interviews and surveys yielded knowledge of wound healing and a list of plants used from which three were selected for relevant phytochemical assays in the laboratory work phase. The literature review found nine studies that reported on the use of medicinal plants for wound healing in Uganda. The interviews provided data which demonstrated that respondents possessed knowledge of the definition, classification, and diagnosis of wounds. The ethnobotanical survey revealed 38 plants as being important for treatment of wounds. The most represented families were Asteraceae (26.3%) and Solanaceae (15.8%); Bidens pilosa L, Musa paradisiaca L., solenostemon latifolius, Ageratum conyzoides L., Hoslundia opposita Vahl. and Microglossa pyrifolia (Lam.) Kuntze were the most widely used. Preliminary phytochemical screening confirmed the extraction efficiency through presence of polyphenol and flavonoid compounds and demonstrated antioxidant activity of the plant extract. Ultimately, this thesis uses the mixed methods approach to gain a fuller and more complete understanding of the research questions. It also demonstrates evidence for the use of selected medicinal plants for wound healing in South Western Uganda and gives a description of the category of professionals involved in traditional medicine using medicinal plants. v Contents Abstract ................................................................................................................. iv Contents .................................................................................................................v List of Figures ....................................................................................................... ix List of Tables .........................................................................................................x Glossary ............................................................................................................... xii Chapter One ...........................................................................................................1 1 INTRODUCTION ............................................................................................1 1.1 Inception of the thesis .............................................................................1 1.2 Synopsis of the thesis .............................................................................3 Chapter Two ...........................................................................................................5 2 RESEARCH CONTEXT ..................................................................................5 2.1 Introduction ............................................................................................5 2.2 Health care structures in Uganda ...........................................................6 2.2.1 Health service delivery ...................................................................6 2.2.2 Health service coverage ................................................................7 2.2.3 Demographic information ...............................................................8 2.2.4 Human resources for health ...........................................................9 2.2.5 The current status of Traditional Medicine in Uganda .................. 10 2.3 Area of study ........................................................................................ 13 2.4 Chapter summary ................................................................................. 15 Chapter Three ...................................................................................................... 16 3 LITERATURE REVIEW ................................................................................ 16 3.1 Introduction .......................................................................................... 16 3.2 Brief history of Traditional Medicine in Africa ........................................ 16 3.2.1 Pre-colonial healthcare ................................................................ 16 3.2.2 Post-colonial healthcare ............................................................... 17 3.3 Introduction to traditional medicine ....................................................... 19 3.3.1 Definitions .................................................................................... 19 3.3.2 Traditional medicine in Africa ....................................................... 22 3.3.3 Aetiological theories and diagnosis of illness ............................... 23 3.3.4 Strengths of traditional medicine .................................................. 25 3.3.5 Criticisms of traditional medicine .................................................. 28 3.4 The practice of traditional medicine ...................................................... 35 vi 3.4.1 Traditional herbalism concepts .................................................... 35 3.4.2 Fundamentals of herbal medicines .............................................. 36 3.4.3 Custodians of local herbal knowledge .......................................... 36 3.4.4 Herbalists....................................................................................
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