Safety and efficacy of herbal medicines for the management of sickle cell disease in Africa: a systematic review and meta-analysis
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Date
2024-12-16
Journal Title
Journal ISSN
Volume Title
Publisher
PAMJ One Health
Abstract
This systematic review and meta-analysis
evaluated the safety and efficacy of herbal
remedies used to manage sickle cell disease (SCD)
in Africa. Before the advent of western medicine,
people depended on herbal medicines for treating
different illnesses. Using herbal medicines to sickle
cell disease (SCD) is still common in Africa.
However, data on the safety and efficacy of any of
these remedies are limited. We searched PubMed,
Embase, Google Scholar and Web of Science from
inception to 11thJanuary 2024 using the keywords
"herbal medicine" and "sickle cell" and the name
of each of the countries in Africa without language
restrictions. We included cross-sectional studies
that reported the safety or efficacy of herbal
medicine for managing sickle cell disease. Two
reviewers assessed all included studies for
suitability for inclusion in this review. All included
articles were assessed using ROBINS-1, a tool for
assessing the risk of bias in non-randomized
studies of interventions. We used the randomeffect model to pool the efficacy and safety profiles
of the herbal medicines using RStudio version
4.2.2. Overall, we included five studies involving
1,489 individuals with SCD. Of these, 789 (53.0%)
used herbal remedies like Aloe barbadensis (Aloe
vera), Zingiber officinale (ginger), Cymbopogon
citratus (lemongrass), Forever Living products,
Golden Neo-Life Diamite International (GNLD) diet
supplements and ginseng products. About 22.9%
(181 out of 789) of the participants who used
herbal remedies reported side effects, while 38.5%
(304 out of 789) reported improving their
symptoms. There was a high risk of publication
bias in the articles included in this review. The
pooled adverse effects of the herbal medicines for
SCD treatment were 48% lower (Odds ratio: 0.52,
95% confidence interval (CI): 0.26 - 1.05, I²= 82%,
p<0.01) while the pooled efficacy of herbal
remedies for treating SCD was nearly 100% higher
(odds ratio= 2.07, 95% confidence interval 0.99 -
4.32, I²= 78%, p<0.01) among the users than
controls. However, these findings were not
statistically significant. Our findings indicate no
significant difference in the safety and efficacy of
herbal medicines among people with SCD who
used or did not use herbal remedies. However, the
sample sizes of the primary studies were small.
Thus, more extensive controlled studies with
better-defined endpoints are required to inform
the use of herbal medicines in managing SCD in
Africa.
Description
Silvia Awor drafted the research protocol, registered it in Prospero, did data extraction and screening processes and drafted the manuscript. Ronald Kivumbi and Benard Abola participated in data screening, did the meta-analysis and reviewed the manuscript. Felix Bongomin provided expert advice on the subject, did data screening and analysis and reviewed the manuscript. Mark Mohan Kaggwa did data extraction and reviewed the manuscript. Francis Pebolo Pebalo proofread and reviewed the manuscript. David Musoke, Geoffrey Maxwell Malinga, Proscovia Nnamuyomba, Jackie Epila, Acaye Ongwech and Christine Oryema guided the protocol writing and reviewed the manuscript. All authors have read and agreed to the final manuscript.
Keywords
: Herbal remedies, treatment, sickle cell disease, safety, efficacy, Africa, systematic review
Citation
Silvia Awor et al. Safety and efficacy of herbal medicines for the management of sickle cell disease in Africa: a systematic review and meta-analysis. PAMJ-One Health. 2024;15(22)