Mhame, P.P., Nyigo, V.A; Mbogo, G.P; Wiketye, V.E., Kimaro, G; Mdemu, A., Ogondiek,
J.W, Imeda, C.P; Malecela-Lazaro, M.N. and Kitua, A.Y.
NATIONAL INSTITUTE FOR MEDICAL RESEARCH
Traditional Medicine Research Department
P.O.Box 9653 Dar-es-salaam, Tanzania.
Title: THE MANAGEMENT OF HIV/ AIDS-RELATED CONDITIONS USING
A TRADITIONAL HERBAL PREPARATION-MUHANSE M4®
IN TANZANIA: A CASE STUDY IN DAR-ES-SALAAM, TANZANIA
Key words: Dar-es-salaam, Tanzania, HIV/AIDS, PLWHA, Traditional medicine, Muhanse M4®, ARVs,
Medicinal plants
ABSTRACT:
Tanzania is one of the countries that have embarked on the programme of providing
ARVs to her citizen in order to prolong their life. Muhanse M4® a traditional herbal
preparation prescribed by Munufu traditional medicine research clinic has been in use by
PLWHA since 1987 to date. The objectives of this study were to determine the
effectiveness, the reasons for its continual use despite the availability of ARVs now and
its affordability. In this study thirty-one adult persons PLWHA were interviewed,
67.74% were women and 32.26 % men and 5 children. Their age ranged between 25 and
50 years, in the order of 25-49-years 93.55 %, and above 49 years 6.45 % and children’s
age ranged from 7-14 years. Muhanse M4® like any traditional herbal preparation is a life
long medication, during the survey it was noticed that 31 adults, 9.68% were on treatment
for 10 year now, 25.81% for 7-9 years, 12.90% for 4-6 years, 35.48% for 1-3 years,
6.45% for 4-6 months and 9.68% within 3 months. Besides the availability of ARVs in
Tanzania yet all interviewed patients, 83.87% preferred to continue using Muhanse M4®
to ARVs, 3.23% prefers both and 12.90% had no answer. Only one out of 31 was in the
opinion to shift to ARVs. 31 PLWHA adults and 5 children have improved much and
have resumed their daily normal life activities except 1 Case. 4 couples managed to get
seven children, six of them delivered normally and one through operation. Muhanse M4®
was found to be cost acceptable by the users since the payment is done by installments.
** All communications shall be addressed to Paulo P.Mhame**
INTRODUCTION
HIV-1 infection and AIDS is still a global public health problem particularly in the subsaharan Africa.Recent data from UNAIDS indicate that in 1998, nearly 33.4million
people were living with HIV/AIDS worldwide.Of these 5.8million people were infected
in 1998 alone, out of these 4million of infection (70%) occurred in sub-saharan Africa
including Tanzania. 2.5million people died due to HIV/AIDS Worldwide making the
cumulative AIDS death to 13.9million.Out of these 2.5million, 250,000 deaths occurred
in sub-saharan Africa, making the cumulative AIDS death in sub-saharan Africa be
11.5million, while this region has a total population of only 10% of the World total
population.
In Tanzania during the year 2001 a total of 14,112 AIDS cases were reported making an
acumulation total of 144,498 cases since 1983 when the first cases were reported.The
Govenrment estimates that the number of people living with HIV infection is probably
five times that of the cumulative number of AIDS cases, making a total of 722,490, with
the overall HIV prevalence of 9.6% for Tanzania mainland.
Dar-es-salaam City is one of the highly affected areas in the country where people living
with HIV/AIDS, it is the second after Mbeya region. For many years now there have
been no drug for the management of the disease.Due to scarcity of drugs for the
management of the disease many of PLWHA opt for traditional health services for the
control of the disease. About 60% of the population depends on traditional medicine for
the management of various diseases and or ailments including HIV/AIDS.
In Tanzania, traditional medicine is a system of medicine, which is not yet formalized,
contrary to the formal health sector; although it shares with the formal health sector the
common goal and that is “to improve the quality of health services of the Tanzanian
population in line with the goal of the National Health Policy”.
Muhanse M4® has a long history in herbal medicine for boosting body immunity of
people in some parts of Tanzania particularly Mufindi and Kilombero districts. Muhanse
M4® is just a standard infusion or weak decoction of ready prepared powder from whole
plant or its parts. The product is one among the many products produced and dispensed
by Munufu traditional medicine research clinic. Munufu traditional medicine research
clinic was established in 1987 at Ubungo. Since then the centre has been dispensing
herbal medicines to PLWHA in order to improve the quality of life of people living with
HIV/AIDS.
OBJECTIVES
Broad Objective:
The broad objective of the study was to determine the effectiveness of Muhanse M4® in
managing HIV/AIDS related conditions.
Specific Objectives:
The specific objectives, which underlined the investigations, were:
 To determine the effectiveness of Muhanse M4® in managing HIV/AIDS related
conditions.
 To determine the reasons for continual use of Muhanse M4® while ARVs are now
available
 To determine the cost affordability of Muhanse M4®
METHODOLOGY
Survey design
This study used both qualitative and quantitative research methods.
Survey areas
This survey was conducted to PLWHA using Muhanse M4® in Dar-es-Salaam City.
Sampling Method
Munufu Traditional Medicine and Research Clinic assisted by systematic notifying
people living with HIV/AIDS using Muhanse M4®. Respondents were obtained through
clinic registry and followed them at their homes and those who visited the clinic for the
collection of their herbal medicines.
Survey population
In this study the survey unit was PLWHA attending Munufu Traditional Medicine and
Research Clinic who are on Muhanse M4® for the management of HIV/AIDS. A total of
31 adults living in Dar-es-salaam were enrolled for the study.
Sample size
There were no intended sample size, however, at the end of the survey 36 PLWHA (31
adults and 5 children) were identified to be on Muhanse M4® , only 31 adults were
enrolled for the study.
Data collection
Swahili language is commonly used in Dar-es-Salaam City; hence, it was used during the
survey. The in-depth interview was conducted to PLWHA attending Munufu Traditional
Medicine and Research Clinic and using Muhanse M4®. A structured questionnaire was
used to collect the information needed.
Data Management, Processing and Analysis
The quantitative was analyzed through cross-tabulations and MS excel. A systemic
comparison of the findings from the in-depth interview and observations was also made.
RESULTS
Social-demographic characteristics of the survey population
Age.
31 PLWHA attending Munufu Traditional Medicine and Research Clinic and using
Muhanse M4® who were included in the survey, were of age ranging from 25 to 50 years
in the order of 25-29 years 19.35%, 30-34 years 12.90%, 35-39 years 32.26%, 40-44
years 19.35%, 45-49 years 9.69%, and 6.45% were of age above 49 years. The survey
noticed that, 7 children were born after their parents were using Muhanse M4® although
they themselves are not using the regime. 5 children aging 7-14 years were found to be
on Muhanse M4® introduced to them by their parents, the two groups of children were
not counted in our survey.
AGE DISTRIBUTION
Percentage
40.00%
30.00%
20.00%
10.00%
0.00%
25-29
30-34
35-39
40-44
45-49
49+
Age of Clients in Years
Gender/sex.
HIV/AIDS is a disease, which affects all gender, but treatment-seeking behaviour may
vary from one sex to another. In this survey it was found that out of 31 adult PLWHA
67.74% who sought traditional medical services are adult women and 32.26% are adult
men.
Sex distribution
Percentage
80.00%
60.00%
40.00%
20.00%
0.00%
Women
Men
Gender
Marriage
HIV/AIDS affects both married and singles who are sexually active and also some of the
children born to parents who are living with HIV/AIDS. In this survey out of 31 adult
PLWHA, 77.42% were found to be HIV positive after they were married, 12.90% were HIV
positive before they were married, 9.68% were found HIV positive while they are single and
they are still single. Some of them have managed to have children while they are on Muhanse
M® . Seven children not on the regime have been born to parents who are using Muhanse M®
, six of them were delivered normally and their mother breast fed them, one was born through
cesarian section and the child is not being breast fed, all are in good health. Three of the seven
children are in primary school and three in nursery. Five children on Muhanse M® born to
some of the parents before enrolling for Muhanse M®
be health and actively attending school.
and who were diagnosed were found to
Percentage
Characteristics of people on
Muhanse
100.00%
80.00%
60.00%
40.00%
20.00%
0.00%
Positive after Positive before
married
married
Still single
Time found HIV Positive
Education.
HIV/AIDS patients like any other patients; there is no educational difference. In this
survey it was found that out of 31 PLWHA, 58.06% of the adult patients are diploma
holders, 19.36% are secondary school leavers, 9.68% are primary school leavers and
12.90% are graduate.
Percentage
Education Level
80.00%
60.00%
40.00%
20.00%
0.00%
Diploma
Secondary Graduate
School
Leaver
Primary
School
Leaver
Treatment
Reasons for seeking medication
Any person found to be HIV sero positive alone without any medical complaints is not
the satisfactory reason to seek medical help. PLWHA also do seek medical assistant
when there is a need. In this survey PLWHA responded that, 6.45% had a complain of
pruritic skin rashes and black spots; 9.68%abdominal pains accompanied with on and off
diarrhea; 12.90% had a history of severe headache; 16.13% had persistence fever and
chest infection which presented with dry cough; 54.84% had severe headache and oral
thrush.
Headache
and Oral
thrush
Headache
alone
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Skin
diseases
Percentage
Causes for medications
s
M
on
th
3
46M
on
th
s
Ye
ar
s
13
Ye
ar
s
46
79
ea
rs
Ye
ar
s
Duration for Treatment
45.00%
40.00%
35.00%
30.00%
25.00%
20.00%
15.00%
10.00%
5.00%
0.00%
10
Y
Percentage
Duration of treatment
Muhanse M4® like any other anti-retroviral therapies they are for life long treatment.
During the survey it was found that 9.68% were on treatment for 10 year now, 22.58%
for 7-9 years 12.90% for 4-6 years, 38.71% for 1-3 years, 6.45% for 4-6 months and
9.68% within 3 months.
Health improvement
Tanzania is providing ARVs to her citizen in order to prolong their life as well as to
improve their quality of life. 96.77% of all interviewed adult patients, responded to have
improved their health conditions in comparison to the time they were not on Muhanse
M4® and that have assisted them to resume their daily normal life activities. Although by
the time of visiting one client appreciated the service, however, she was still weak and
sick and she was ready to shift to ARVs if she could get such an opportunity.
Information on Munufu clinic
Information on Munufu Traditional Medicine and Research Clinic and its traditional
medical care is not secretly done, hence many people know. 45.16% of the customers got
the information through Amana Counseling Office, 32.26% through mass media, 12.90%
through friends, 6.45% through AMREF and 3.23% through contact with the own of the
facility.
Percentage
Knowledge about the Centre
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Amana
Hospital
Mass media
Friends
AMREF
Facility Owner
Preference between ARVs and Muhanse M4®
HIV/AIDS is one of the commonest diseases of human health to day. All patients have
knowledge about HIV/AIDS and that all patients have information about ARVs
availability. 74.20% of them have heard through mass media about the availability of
ARVs, 19.35% have heard through hospital workers and 6.45% through friends. The
government has embarked in the efforts to provide ARVs to her citizen in order to
prolong their life. All of the interviewed patients who are under Muhanse M4® regime,
83.87% preferred Muhanse M4® to ARVs and that they are not ready to shift to the ARVs
available now, 3.23% said both are better for their health and 12.90% had no answer. Of
all 31 adults interviewed, only one was in the opinion to shift to ARVs if such
opportunity will be available.
Percentage
Client's Preference Between ARVs and
Muhanse
100.00%
80.00%
60.00%
40.00%
20.00%
0.00%
Muhanse M4®
Both
No Answer
Advice to other people
Community has various ways of communicating things to others, people who are under
Muhanse M4® regime are now the ones spreading information about the medications to
other people. During the interview about 83.87% of the interviewee have informed other
people about Muhanse M4® regime, 9.68% have not done so and 6.45% had no answer.
Besides the advice to other people, 90.32% of the interviewee had the opinion that the
government should commit herself in supporting such individual effort by being serious
with research and 9.68% had no opinion.
Service costs
In all societies, people are remarkably pragmatic in testing and evaluating new
alternatives in deciding even though it is to their advantage. This is true of health
behaviour, where we can almost speak of a cost-benefit mode of analysis. Medical
services are often more attractive to users if value is placed on them in the form of at least
a token fee. Traditional medicine is said to be more acceptable to the community simply
because at cultural based cost its value is almost a token fee. In this survey although it
was noticed that the cost is not so cultural but customers do pay by installments hence it
is customer friendly.
Sometime they are given medicines without having money at all and later on do pay as
they get money. Besides the fact that the owner is so generous to his customers but some
of them they feel that it would be wealth if the government could assist them by
providing funds to such centres. They agree that the disease is a chronic condition, which
need long term use of medications whether traditional, or not hence it needs much money
to maintain their health to normal level in order to make them continue with their daily
activities.
Observation
In this cross-sectional survey, we observed 31 adults PLWHA who are on Muhanse M4®
to improve much and they have resumed their daily normal life activities. 1 Case was
improved but not to the extend of resuming her daily normal life activities although she
was thanking the centre for allowing her condition to improve to that extend.
To our surprise, out of 31 PLWHA two couples claimed that they have been converted
sero-negative after several months of being on Muhanse M4® and they no longer continue
with the treatment.
DISCUSSION
Traditional systems of medicine in general have had to meet the needs of local
communities of many countries like Tanzania. The already reported fact that over 60% of
Tanzanians living in rural areas rely on herbal remedies for their primary health care,
similarly to our findings showed that even people living in Dar-es-salaam do rely on
herbal medicine for the management of HIV/AIDS. People in Dar-es-salaam have been
enjoying with Muhanse M4® for the management of HIV/AIDS related conditions.
Currently there are no documented records on the use of pure compounds from
Tanzanian plants for immune modulations specifically in HIV victims. However, there is
substantial information and anecdotal evidence on the use of crude plant materials for the
same. The many plants that are used as immunomodulators in HIV affected individuals
are also used to treat other viral diseases such as measles, hepatitis B and influenza.
Phyllanthus niruri /Amarus and Cajanus Cajan are currently being used to traditionally
as remedy for hepatitis B in Tanzania and many other countries in the World. In India for
example Phyllanthus amarus is used in the treatment of viral hepatitis and jaundice. The
active constituents contained in Phyllanthus have been shown to inhibit the surface
antigens of some viruses. In 1992 laboratory investigation of water extract of P. niruri by
Japanese research group, exhibited an inhibition activities of HIV-1 reverse transcriptase
enzyme. Similarly in 2003 a German research organization found that the plant do have
70-75% inhibition of virus besides it has other antimicrobial effects. Muhanse M4®
which is made up of mixtures of medicinal plants may have ingredients which has antiviral effect similar to the example made.
The survey noticed that Muhanse M4® like any other medicines is highly appreciated by
people for the management of HIV/AIDS and its opportunistic infections. 96.77% of all
interviewed patients, responded to have improved their health conditions in comparison
to the time they were not on Muhanse M4® and that have assisted them to resume their
daily normal life activities. People have been using the medications since 1994 to date
and some of them have managed to get children while using Muhanse M4® . People
have improved their health status and they are now back to their normal life, carrying out
their normal activities. Due to that 83.87% prefers Muhanse M4® to ARVs for
prolonging their life because they believe that the government programme has its end,
and once such reaches they will have no other alternative. Muhanse M4® has no time
limit and the person who supplies the product is always available, he has no political
influence controlarly to the government programme which depends highly on the
political situation and availability of government funds. Mass media are informing people
on the side effects of those ARVs, we have been on Muhanse M4 ® for many years now
and we have not experienced any side effects then why move to another with a lot of side
effects.
“…remember people are being warned that the ARVs have many side effects why then
one rush to take such a drug…………..” “…….free is expensive…..”
Traditional medicine like modern medicine is costly in the provision of health services
and for chronic illnesses like HIV/AIDS the situation is even more worse, yet people
prefer to use Muhanse M4® because they can negotiate the price and the modalities of
payment.
People would like to continue using Muhanse M4® for the management of HIV/AIDS
related conditions despite the fact that the government is now providing free of charge
ARVs to patients who meets the conditions to use them. This is because some of them
developed faith in it as they have been using for ten years and some have managed to get
children who are health and are schooling. Some even said what I want, ARV like
Muhanse M4® all are elongating my life one I know the source while another I do not
know the source what will happen when there is no more drug supply I will have to die
but Muhanse M4® is always available.
CONCLUSION AND RECOMMENDATIONS
Conclusion.
Our findings indicate that, Muhanse M4® has customers who has faith in it and more
people are being informed about its importance. Clinical evidences given by the
respondents who uses Muhanse M4® shows that Muhanse M4® has been effective in
clearing opportunistic infections to PLWHA and hence caused them to rely entirely on it
in the management of HIV/AIDS related conditions. Muhanse M4® is believed by users
for the management of HIV/AIDS related conditions and opportunistic infections such
information forms a strong evidence for considering this remedy as effective. The
findings in this study show that all 31 patients interviewed were very familiar with the
existence of ARVs to be provided to people living with HIV/AIDS but almost all have
decided not to mix the two regimes. This is an indication that, Muhanse M4® do offer
what clients want for the maintenance of their health.
Recommendation
The already reported fact that over 60% of Tanzanians living in rural areas rely on herbal
remedies for their primary health care, similarly to our findings showed that even people
living in Dar-es-salaam do rely on herbal medicine for the management of HIV/AIDS
related conditions, pose a scientific challenge to scientists to establish the efficacy, safety
and quality of Muhanse M4® preparation. This calls for an urgent need to; firstly, carry
out an inventory of traditional health practitioners who does provide remedies for the
management of HIV/AIDS related conditions and their opportunistic infections. Secondly
carry out an observational study on the effectiveness of the therapies supplied to the
existing opportunistic infections. Thirdly, to conduct extraction and establish pre-clinical
safety of the traditional herbal preparation. Fourthly, confirm the safety and efficacy of
the safe traditional herbal preparation in clinical trials in humans.
Basing on the fact that, our fore fathers survived on the traditional herbal preparation, and
that, the majority of Tanzanians still rely on these remedies for the management of
HIV/AIDS related conditions and other ailments, the chances of obtaining safe new
phytochemical drugs with good anti-retroviral properties are high.
ACKNOWLEDGEMENT
This report is the outcome of the survey in Dar-es-Salaam City to people living with
HIV/AIDS related conditions who use Muhanse M4® prescribed by Munufu Traditional
Medicine and Research Clinic that was undertaken from 21st November –5th December
2004. The survey was made possible by the active support from Munufu Traditional
Medicine and Research Clinic, the Ministry of Health financially and National Institute
for Medical Research for accepting and facilitating the survey. The survey team wishes to
thank all those who supported the idea and later the activity.
We wish to express our sincere gratitude to customers of Muhanse M4® who have
generously provided most of the information included in this report to the survey team.
This information constitutes the most important and valuable part of innovations of
Munufu Traditional Medicine and Research Clinic. Lastly we wish to express our sincere
gratitude to them all for being willing to share their experiences with us on the use of
herbal medicines and for trust, confidence and cooperation, which their contributions
imply.
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UNAIDS 2004