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Guidelines on the Use of Indigenous-Western Anti- Hypertensive Therapies in Belize

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Guidelines on the Use of Indigenous-Western Anti- Hypertensive Therapies in Belize GUIDELINES ON THE USE OF INDIGENOUS-WESTERN ANTI- HYPERTENSIVE THERAPIES IN BELIZE By Danladi Chiroma Husaini Student Number: 61113271 submitted in accordance with the requirements for the degree of DOCTOR OF PHILOSOPHY PUBLIC HEALTH at the UNIVERSITY OF SOUTH AFRICA SUPERVISOR: Prof. David Ditaba Mphuthi September 2020 DEDICATION The researcher dedicates this work to the Lord Jesus Christ, who gave me life, power, wisdom, and the endurance to go through. I also obligate the research in memories of my late younger sister Deborah Ige Zarafi and my late younger brother Solomon Chiroma Husaini. May your gentle souls continue to rest with Jesus! Amen. ii D E C L A R A T I O N Student number: 61113271 I declare that the research on Guidelines on the use of indigenous-western anti- hypertensive therapies in Belize is my work. All the sources that I have used or quoted have been indicated and acknowledged by utilizing complete references. This work has not been submitted before for any other degree at any other institution. I also declare that I have submitted four manuscripts from this thesis for publication. Danladi Chiroma Husaini ………………………………….. Full names ……13th September 2020…………… Date iii ACKNOWLEDGMENTS I wish to acknowledge the support, patience, tolerance, prayers, guidance, and encouragement of my supervisor, Professor David Ditaba Mphuthi. Prof., you are highly recognized and appreciated. To my family Celina (wife), Eldad (son), Elbetah, and Elzarah (daughters), who bore the brunt of my long hours on the laptop, I say thank you. I love and appreciate you. My warm appreciation to my biological dad Reverend Husaini Chiroma, and my Mom, Mrs. Rahila Husaini, for instilling Godly values in me and for encouraging me to study. My gratitude goes to my spiritual parents Mr. and Mrs. Gbile Akanni, and Dr. and Mrs. Peter Odeyemi, for always praying and supporting me to the very end of this work. Finally, I have received help and guidance from friends and great people too numerous to mention. People like Dr. Jane Chiroma, Mr. Garba Ma’aji Sani, Mrs. Dawn Watters, Dr. Joseph Sambu, and my adopted son Mr. Frank Ifeanyi for all their input in this work. iv Guidelines on the use of indigenous-western anti-hypertensive therapies in Belize STUDENT NUMBER: 61113271 STUDENT: Danladi Chiroma Husaini DEGREE: DOCTOR OF PHILOSOPHY (Ph.D. PUBLIC HEALTH) DEPARTMENT: HEALTH STUDIES, UNIVERSITY OF SOUTH AFRICA SUPERVISOR: PROFESSOR DITABA DAVID MPHUTHI ABSTRACT This study’s objectives were to identify, describe, and provide guidelines on using indigenous-western antihypertensive therapies in Belize to examine indigenous therapies’ efficacy in lowering blood pressure. The researcher utilized an explanatory sequential mixed method research design to examine indigenous-western therapies. Data were collected quantitatively from the general public (n=422) and qualitatively from hypertensive patients (n=24) using indigenous therapies and vendors (n=19) of indigenous therapies. The study results identified 47 different medicinal plants used in the management of hypertension in Belize, as reported by participants. Besides, leaves were the most reported plant part used to manage hypertension, while boiling (decoction) was the most common preparation method. The common route of administration was the oral route, and ½ to 1 cup 2 to 3 times daily was the dose and frequency of administration, respectively. The majority of participants using indigenous therapies did not report side effects. Conversely, orally administered hydrochlorothiazide and captopril were the most common western therapies reported by most respondents in the study. The majority of the respondents did not report concomitant use of indigenous-western therapies to manage their hypertension; however, those who used indigenous therapies reported that medicinal plants were efficacious in lowering their blood pressure. Some of the claims by v participants are verified by Western science, thereby authenticating indigenous therapy claims. The researcher developed guidelines on the use of indigenous-western therapies from the results of the study. Collaboration between indigenous healers and Western medical practitioners to provide holistic healthcare approaches was recommended since both sciences have identical foundations and can learn from each other. The government should incorporate indigenous knowledge systems into school curricula. KEY CONCEPTS Indigenous therapies, hypertension, Western therapies, indigenous knowledge systems, public health, medicinal plants, herbs, guidelines, concomitant use, Belize. vi Table of contents DEDICATION ii D E C L A R A T I O N iii ACKNOWLEDGMENTS iv ABSTRACT v CHAPTER 1 1 ORIENTATION TO THE STUDY 1 1.1 INTRODUCTION AND BACKGROUND OF THE STUDY .................................. 1 1.2 BACKGROUND TO THE RESEARCH PROBLEM ............................................ 2 1.3 INDIGENOUS THERAPIES ................................................................................ 5 1.4 RESEARCH PROBLEM ..................................................................................... 8 1.5 RESEARCH AIM/PURPOSE OF THE STUDY ................................................... 9 1.6 RESEARCH OBJECTIVES ................................................................................ 9 1.6.1 Phase 1: Quantitative phase 9 1.6.2 Phase 2 Qualitative phase 9 1.6.3 Phase 3 Guideline development 10 1.7 HYPOTHESIS .................................................................................................. 10 1.8 RESEARCH QUESTIONS................................................................................ 10 1.8.1 Phase I 10 1.8.2 Phase II 11 1.8.3 Phase III 11 1.9 SIGNIFICANCE OF THE STUDY ..................................................................... 11 1.10 DEFINITION OF KEY TERMS .......................................................................... 13 1.10.1 Hypertension 13 1.10.2 Antihypertensive 13 1.10.3 Indigenous therapy 14 1.10.4 Western therapies 14 1.10.5 Vendor 14 1.11 OPERATIONAL DEFINITIONS ........................................................................ 14 1.11.1 Hypertension 14 1.11.2 Anti-hypertensive 14 1.11.3 Indigenous therapies 15 1.11.4 Western therapies 15 vii 1.11.5 Vendor/Bush doctor 15 1.12 THEORETICAL FRAMEWORK ........................................................................ 15 1.13 RESEARCH METHODOLOGY AND RESEARCH DESIGN ............................ 17 1.13.1 Phase I (Quantitative Method) Research Methods 18 1.13.1.1 Research Setting 18 1.13.1.2 Phase I: Population and sample selection 19 1.13.1.3 Sample size and sampling procedures – Phase I 20 1.13.1.4 Phase I: Sample size calculation 21 1.13.1.5 Phase I: Data collection 22 1.13.1.6 Phase I: Data analysis 23 1.13.1.7 Phase I: Data validity and reliability 23 1.13.2 Phase II: Qualitative method 25 1.13.2.1 Phase II: Research design 25 1.13.2.2 Phase II: Population 26 1.13.2.3 Phase II: Sample and sampling technique 26 1.13.2.4 Phase II: Data collection 28 1.13.2.5 Phase II: Data analysis 29 1.14 PHASE III: DEVELOPMENT OF THE GUIDELINES ........................................ 30 1.15 SCOPE AND LIMITATIONS OF THE STUDY .................................................. 31 1.16 STRUCTURE OF THE DISSERTATION .......................................................... 32 1.17 SUMMARY ....................................................................................................... 32 CHAPTER 2 34 LITERATURE REVIEW 34 2.0 INTRODUCTION .............................................................................................. 34 2.1 HYPERTENSION ............................................................................................. 34 2.1.1 Types of hypertension 35 2.1.1.1 Primary hypertension 36 2.1.1.2 Secondary hypertension 36 2.2 PATHOPHYSIOLOGY OF HYPERTENSION ................................................... 37 2.2.1 Vascular smooth muscle cell (VSMC) proliferation 38 2.2.2 Endothelial Cells 38 2.2.3 Signaling Molecules 39 2.2.4 Reactive oxygen species (ROS) 39 2.2.5 Nitric oxide 40 viii 2.2.6 Hydrogen Sulfide 40 2.2.7 Rennin angiotensin mechanism 41 2.2.8 Nuclear Factor Kappa B (NF-KB) 42 2.3 PHARMACOLOGICAL MANAGEMENT OF HYPERTENSION ........................ 43 2.4 MEDICINAL PLANT MODULATION OF BLOOD PRESSURE ......................... 48 2.4.1 Introduction 48 2.4.2 Medicinal plants used for hypertension 49 2.4.2.1 Coriandrum sativum (Cilantro or Coriander) 56 2.4.2.2 Bidens pilosa L. (Beggar’s Tick, Black Jack) 57 2.4.2.3 Zingiber officinale (Ginger) 57 2.4.2.4 Allium sativum (Garlic) 58 2.4.2.5 Camellia sinensis (green tea) 61 2.4.2.6 Hibiscus sabdariffa (Roselle) 63 2.4.2.7 Crataegus spp. (Hawthorns or thorn apple) 64 2.4.2.8 Cymbopogon citratus (Lemongrass) 66 2.4.2.9 Andrographis paniculata (King of Bitter) 67 2.4.2.10 Apium graveolens (Celery) 68 2.4.2.11 Coptis chinensis (Chinese Goldthread) 68 2.4.2.12 Panax (Ginseng) 69 2.5 INTERACTIONS BETWEEN INDIGENOUS AND WESTERN THERAPIES 70 2.6 SUMMARY OF THE CHAPTER ....................................................................... 73 CHAPTER 3 74 RESEARCH DESIGN AND METHODOLOGY 74 3.0 INTRODUCTION .............................................................................................. 74 3.1 RESEARCH DESIGN ....................................................................................... 74 3.2 QUANTITATIVE RESEARCH DESIGN ............................................................ 75 3.3 QUALITATIVE RESEARCH DESIGN ..............................................................
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