Enabling factors facilitating the use of neem-based remedies for the management of malaria in the Lower Shire District of Chikwawa, Malawi.

Background: Malaria remains a major public health threat in Malawi, affecting mostly children under five and pregnant women. Despite the availability of chemotherapy and chemoprophylaxis, resistance to sulfadoxine pyrimethamine and the high cost and complicated regimen of artemether-lumefantrine have accelerated the use of home-based remedies for the management of malaria in Chikwawa district, Malawi. This study aimed to determine factors that facilitate the use of herbal remedies within communities in the management of malaria in the presence of free health care services, with the intention of assessing the feasibility of developing improved herbal products as anti-malarial prophylaxis.

Materials and methods: Data on factors driving the use of neem-based preparations commonly used in the management of malaria were collected through qualitative interviews and focus group discussions. Qualitative data were analysed drawing on the Framework Analysis approach.

Results: Neem and moringa were identified as the principal plants used for the management of malaria, with neem being the most frequently used. Factors favouring the communal use of neem-based remedies included the habit of resorting to herbal remedies as first aid treatment, lack of drugs and proper medical care in modern health facilities, and the need for preventive anti-malarial remedies during the high-transmission season. The perceived effectiveness of neem-based herbal remedies was based on their fast action against the symptoms of malaria, thereby providing immediate relief to the patient, which might explain their wide-scale use for malaria treatment.

Conclusions: Local communities prefer to use neem and/or moringa remedies for their primary healthcare needs in the management of malaria because of their ease of access, preparation and administration without frequent adverse events, as opposed to ACTs. These remedies are already being used as prophylaxis in unimproved/non-standardised formulation. This suggests that standardised herbal preparations would be culturally acceptable at community level. Evidence-based research is required to validate parasitological and clinical efficacy and determine safety of these anti-malarial herbs.