Investing in traditional medicine: leveraging evidence and innovative research to strengthen the fight against malaria in Nigeria

Abstract

Traditional medicine (TM) has been a cornerstone of healthcare across various cultures, especially in Africa, where it has played an integral role in the management of diseases such as malaria. Despite the popularity and historical significance of TM, scientific validation remains a key challenge, hindering its widespread acceptance in modern healthcare systems. This study explores the potential of traditional African medicine, particularly in the context of Nigeria, as a vital resource in the fight against malaria. Drawing on the success of plants like Artemisia annua in the development of modern anti-malarial drugs, the research emphasizes the need for comprehensive investment in TM research. With Nigeria facing the highest malaria burden globally, the research advocates for increased funding, scientific investigations into the efficacy of traditional remedies, and enhanced regulation of herbal medicine. The paper also highlights the growing trust and reliance on herbal remedies in rural areas of Nigeria and the importance of ensuring their safety through pharmacological testing. This study examines these issues through an analysis of existing literature, historical applications, and documented successes of herbal treatments. By integrating traditional medicine into national health systems, Nigeria could unlock new strategies for combating malaria and other infectious diseases, advancing toward sustainable health outcomes.

Background

For centuries, humans have employed natural remedies made from plants and microbes to treat and prevent disease [1]. According to fossil evidence, people have been using plants as medicine for at least 60,000 years [2]. Traditional medicine has been a cornerstone of healthcare in Africa long before the advent of orthodox medicine, and it remains vital to public health [3]. Given the ongoing burden of infectious diseases such as malaria, traditional medicine continues to play a significant role in disease management, particularly in regions with limited access to modern healthcare. The World Health Organization (WHO) defines traditional medicine as ‘‘the culmination of all knowledge, skill, and methods based on the theories, beliefs, and experiences that are specific to all cultures, whether or not they can be explained, and utilized to maintain health as well as to prevent, diagnose, treat, or improve physical and mental illness’’ [4]. Herbal remedies, a subset of traditional medicine, specifically refer to the use of medicinal plants for therapeutic purposes [5].

Chinese traditional medicine is evidence of how it can be a great tool in the war against infectious diseases, as it has significantly contributed to the treatment of COVID- 19 and other illnesses and is now widely accessible in 183 nations and areas throughout the world [6, 7]. It was also discovered that 15 African ethnomedicinal herbs used in conventional medicine might be helpful for the cure, management, and prevention of COVID- 19 [8]. It has also been revealed that in the Nigerian healthcare system, approximately 90% of people in rural areas rely solely on herbs, which is currently the subject of attention for the management of health-related issues [9].

This herb contains artemisinin, an active ingredient that is key to anti-malarial medicine today, and this plant is grown and used locally today to treat malaria [10–12]. The establishment of the Research Initiative on Traditional Antimalarial Methods (RITAM) in 1999 was to advance research on traditional antimalarial treatments, which has created guidelines for standardizing and enhancing the caliber of ethnobotanical, therapeutic approaches, and clinical studies on herbal antimalarial drugs. Through this initiative, systematic reviews and multiple studies have been conducted on herbs, such as Vernonia amygdalina (bitter leaf), Cinchona, Argemone mexicana, and Azadirachta indica (neem) for malaria treatment. These studies demonstrate that traditional healers employ a wide range of herbs as anti-malarial remedies. Notably, herbs frequently used by these healers have shown significantly higher efficacy in both in vitro and in vivo studies against Plasmodium species compared to those used less frequently or not at all [13].

An analysis of three traditional herbs, including Markhamia tomentosa, Polyalthia longifolia, and Trichilia heudelotii plants used in the management of malaria in Nigeria showed a high level of chemo-suppression of the malaria parasite [14]. There is a pressing need for increased funding and research in African traditional medicine, as many of these practices currently lack the rigorous scientific validation required for wider acceptance within the global scientific community. Advancing knowledge in pharmacology and toxicology is crucial to ensuring their safety and efficacy [3]. Significant breakthroughs could emerge if the Nigerian government and policymakers prioritize investments in traditional medicine, drawing inspiration from China’s Project 523 initiative, which led to the groundbreaking discovery of artemisinin [15]. While traditional medicine plays a vital role in healthcare, challenges such as standardization, safety concerns, and regulatory gaps persist. Addressing these issues through research and quality control is crucial for its effective integration into modern healthcare. This study examines the progress of traditional medicine in disease management and malaria control in Africa, with a particular focus on Nigeria. It explores the growing trust in traditional medicine within the country, provides recommendations, and outlines policy strategies and future directions. The study emphasizes the critical need for investment in Nigeria's traditional medicine to strengthen the fight against malaria.

Evidence: the malaria burden in Nigeria and the need for investment in traditional medicine

Malaria infection remains a global public health challenge, particularly in Africa. Nigeria bears the highest malaria burden globally, with over 51 million cases and 207,000 deaths annually —accounting for 30% of Africa’s total malaria burden [16] (see Table 1). Globally, approximately 214 million malaria cases occur each year, placing 3.2 billion people at risk of infection [17]. In 2023, Nigeria accounted for 25.9% of global malaria cases and 30.9% of malaria-related deaths in the African region, according to the World Malaria Report [19]. Additionally, malaria remains widespread, with 97% of Nigerians (approximately 173 million people) at risk of infection [18–21] (see Table 1).

Table 1.

Evidence: Cases of malaria in Nigeria from 2001 to 2023 created by FOO, SCE and reviewed by all Authors

Year	Total Malaria Cases in Nigeria	Most affected group (Children/Pregnant woman)	Number of malaria death in Nigeria
2001	2,253,519	Children < 5 years	4317
2002	2,605,381	Children < 5 years	4092
2003	2,608,479	Children < 5 years	5343
2004	3,310,229	Children < 5 years	6032
2005	3,532,108	Children < 5 years	6494
2006	3,982,372	Children < 5 year	6586
2007	2,969,950	Children < 5 years	10,289
2008	2,834,174	Children < 5 years	8677
2009	4,295,686	Children < 5 years	7522
2010	3,873,463	Children < 5 years	4238
2011	4,306,945	Children < 5 years	3353
2012	6,938,519	Children < 5 years	7734
2013	12,830,911	Children < 5 years	7878
2014	16,512,127	Children < 5 years	6082
2015	16,702,261	Children < 5 years	9330
2016	23,956,669	Children < 5 years	7397
2017	20,219,268	Children < 5 years	8720
2018	20,482,380	Children < 5 years	14,936
2019	23,376,793	Children < 5 years	26,540
2020	21,580,055	Children < 5 years	1811
2021	23,608,797	Children < 5 years	7828
2022	66, 721, 582	Children < 5 years	6734
2023	–	Children < 5 years	5704

Compiled from WHO Annexes: world malaria report 2024

Malaria prevalence in Nigeria varies significantly by region, age group, and socioeconomic status. The disease is more prevalent in northwestern Nigeria (34%) compared to the southern and southeastern regions (16%). It disproportionately affects children under five and pregnant women, who are at higher risk of severe complications. Among children, those from the lowest socioeconomic backgrounds experience malaria rates seven times higher than those from wealthier backgrounds [17]. Rural areas, where healthcare access is limited, report higher infection rates than urban centres.

The dominant malaria parasite in Nigeria is Plasmodium falciparum, responsible for 97% of cases. Other species, such as Plasmodium ovale and Plasmodium malariae, are present but less common [18]. While Plasmodium vivax and Plasmodium knowlesi have been linked to malaria in other parts of the world, they are not found in Nigeria. Malaria transmission in the country is driven by the female Anopheles mosquito, which thrives in warm, humid, and rainy environments. Environmental factors such as temperature, humidity, and seasonal rainfall significantly impact malaria prevalence, making tropical regions like Nigeria highly susceptible to year-round transmission [18].

The impact of malaria extends beyond public health, affecting Nigeria’s economic and social development. The disease places a heavy burden on healthcare facilities, increases child mortality, reduces workforce productivity, and contributes to school absenteeism. Economically, malaria slows development and hinders Nigeria’s progress toward Sustainable Development Goal 3 (Good Health and Well-being) [22–24]. Given its widespread impact, there is an urgent need for innovative strategies to reduce malaria prevalence and improve disease control measures.

Trust and usage of traditional medicine for malaria treatment in Nigeria

According to WHO estimates from 1985, approximately 65% of the world's population relied on herbal or traditional treatments [25]. More recent data from the WHO in 2022 suggests that 88% of the world’s population now uses traditional medicine [26]. This reflects an increasing reliance on traditional medicine. According to studies, the two main obstacles to effective malaria control have been the lack of vaccinations and Plasmodium resistance to anti-malarial medications [27]. Nevertheless, some indigenous Nigerians believe that herbal remedies, a key component of traditional medicine, offer an alternative treatment for malaria as more than one disease can be treated with a single herb [28].

In Nigeria specifically, a significant portion of the population relies on medicinal plants, such as Neem (Azadirachta indica), Bitter Leaf (Vernonia amygdalina), Nutmeg, Brimstone Leaf, Spanish Cedar, and Sunflower, due to their perceived anti-malarial properties [29]. One reason for the continued trust in herbal remedies is their multi-component nature, which may reduce the likelihood of Plasmodium developing resistance—an ongoing issue with synthetic anti-malarial drugs [30]. Additionally, herbal treatments are often more affordable and widely accessible than conventional medicine. Many people also believe that herbal remedies have fewer side effects, as they are perceived to be natural and free from synthetic additives [31].

Beyond efficacy claims, cultural and social factors also play a role in shaping public trust in traditional medicine. Many individuals adopt herbal remedies based on anecdotal evidence, such as personal or family experiences. Additionally, faith, spirituality, and historical traditions influence people's willingness to continue using these treatments [32, 33]. Some believe that traditional medicine is ancestrally inspired, reinforcing their desire to preserve cultural healing practices.

In addition to these factors, marketing strategies by herbal medicine manufacturers and vendors have significantly boosted their visibility. Furthermore, media advertisements, including television and radio promotions, also played a key role in increasing consumer awareness and enhancing the perceived credibility of herbal treatments [34, 35]

The progress and current developmental status of traditional medicine towards disease management and malaria in Africa and Nigerian traditional medicine (TM) research capacity

During the pandemic, the WHO recognized the role of traditional medicine (TM) in healthcare and advocated for research and clinical trials to evaluate its safety and efficacy [36]. This support was reflected in the WHO guidelines promoting evidence-based integration of traditional medicine into COVID- 19 treatment strategies and funding initiatives for clinical studies [37]. The booming Chinese market, where traditional medicine generates more profit than the country's entire medical industry, with a value exceeding €36.8 billion [38], highlights the significant economic potential of TM.

Moreover, traditional medicine (TM) has made significant progress between 2000 and 2018 [39]. Ever since then, TM has been integrated into health practice and national health systems in various African nations (WHO-AFRO) [39]. Ghana, Nigeria, and South Africa have made significant strides in integrating traditional medicine (TM) into their national health systems through policy and regulatory frameworks [40] In Ghana, the inclusion of traditional remedies in the National Essential Medicines List (NEML) reflects the government's commitment to TM integration in public health. The Traditional Medicine Practice Council further regulates practitioners and ensures TM’s legal recognition [41]. Nigeria has a strong TM heritage, particularly in rural areas where it serves as a primary healthcare option. The National Policy on Traditional Medicine promotes collaboration between traditional and biomedical practitioners, supporting TM’s role in universal health coverage [42]. In South Africa, post-apartheid health strategies embraced TM, leading to the Indigenous Knowledge Systems policy, which recognizes traditional healers and emphasizes the preservation and validation of indigenous medical knowledge [43]. These frameworks highlight each country’s efforts to formalize and integrate TM within mainstream healthcare.

Over 37 countries, in collaboration with policymakers and legal frameworks, have incorporated traditional medicine practices into different national health programmes (see Table 2). This table is based on data compiled from WHO Member State submissions (2000–2018), the WAHO Herbal Pharmacopoeia (2013), and African pharmacopoeia reports supported by the WHO and the Organization of African Unity. Between 2000 and 2018, data revealed that 38 nations had implemented national guidelines for traditional medicine (TM) activities within their ministries of health. These countries made significant progress in key areas, including regulation and policy frameworks, product development, and research initiatives. Additionally, efforts have been directed toward quality assurance, integration of TM into national health systems, and fostering collaborations to strengthen TM practices.

Table 2.

Progress and integration of TM into WHO African countries as of December 2018 created by SCE, FOO and reviewed by all Authors

African Countries	Legal TM practice framework	African Nations that added TM in their national health strategic plans & health policies	African Nations with TM policy plan and implementation	African Ministries of Health with National TM programs	African Research Institutes for TM Research	Indigenous manufacturing of TM products	Countries with plans to include TM into the provision of national health services
	No. so far countries = 38	No. so far countries = 30	No. so far countries = 28	No. so far countries = 38	No. so far countries = 34	No. so far countries = 19
Algeria				✓
Angola				✓
Benin	✓		✓	✓	✓	✓
Burundi	✓			✓
Burkina Faso	✓	✓	✓	✓	✓	✓
Cameroon	✓	✓	✓	✓	✓	✓
Cape Verde	✓	✓		✓
Central African Republic	✓		✓
Chad	✓		✓	✓	✓
Comoros		✓		✓
Republic of Congo	✓	✓	✓	✓		✓
Cote d’Ivoire	✓	✓	✓	✓	✓	✓
Democratic Republic of Congo	✓	✓	✓	✓	✓	✓
Eritrea	✓	✓	✓	✓
Ethiopia	✓	✓	✓	✓	✓
Equatorial Guinea	✓			✓	✓
Gabon	✓	✓	✓	✓	✓
Gambia		✓	✓	✓
Ghana	✓	✓	✓	✓	✓	✓	✓
Guinea	✓	✓	✓	✓	✓	✓
Guinea Bissau	✓		✓	✓
Kenya		✓		✓	✓
Lesotho	✓
Liberia	✓			✓
Madagascar	✓	✓	✓	✓	✓	✓
Malawi	✓	✓	✓	✓
Mali	✓	✓	✓	✓	✓	✓	✓
Mauritania	✓	✓	✓	✓
Mauritius	✓	✓	✓	✓	✓	✓
Mozambique	✓	✓	✓	✓	✓	✓
Namibia	✓	✓		✓
Niger	✓	✓		✓
Rwanda	✓	✓	✓	✓	✓	✓
Sao Tome & Principe		✓	✓
Senegal	✓	✓	✓	✓	✓
Seychelles					✓
Sierra Leone	✓	✓		✓	✓
South Africa	✓	✓		✓	✓
South Sudan			✓
Eswatini				✓	✓
Togo	✓	✓		✓	✓	✓
Uganda	✓	✓	✓		✓
United Republic of Tanzania	✓	✓	✓	✓	✓	✓
Zambia	✓	✓	✓	✓	✓
Zimbabwe	✓	✓	✓	✓	✓
Nigeria	✓	✓	✓	✓	✓	✓

The above table was a compilation of traditional medicine information submitted by WHO Member States between 2000 and 2018, the WAHO herbal pharmacopoeia for the economic community of West Africa States Member States, First Edition, 2013 with WHO support, the African pharmacopoeia for Benin, Burkina Faso, Cote d’Ivoire, Guinea, Mali, Niger, Senegal, and Togo (multilingual dictionary and monographs of African medicinal plants), and the African pharmacopoeia by the Organization of African Unity, Scientific and Technical Research Commission

Numerous studies have explored the use of traditional medicine (TM) for malaria treatment and other infectious diseases, including clinical trials, observational studies, and ethnobotanical research. Some studies have investigated the efficacy of herbal formulations in managing malaria and HIV/AIDS, while others have focused on the pharmacological properties of medicinal plants used in traditional healing [44, 45]. In Burkina Faso, a study evaluated the use of traditional medicine for the treatment and management of viral hepatitis, demonstrating the potential of herbal formulations in alleviating liver-related complications. The findings highlight the continued reliance on TM for chronic infectious diseases, emphasizing the need for further clinical validation and integration into national healthcare policies [46]. Another study conducted in Mali indicated that 66 plants subjected to in vitro and in vivo tests are efficient for malaria treatment [47]. Similarly, research in Cameroon has identified 17 active compounds with antiplasmodial properties, with Dacryodes edulis emerging as a promising natural treatment for uncomplicated malaria [48]. In addition to the TM breakthrough for malaria treatment, a Ugandan study has shown that out of five traditional medicines, two can be used for malaria treatment and can also serve as a relief medication for prostate hypertrophy [49].

In Nigeria, the National Institute for Pharmaceutical Research and Development (NIPRD) has played a crucial role in traditional medicine research. NIPRD conducted a randomized, placebo-controlled, double-blind crossover clinical trial on NIPRISAN, a phytomedicine developed for sickle cell disease. The study demonstrated that NIPRISAN significantly reduced the frequency and severity of sickle cell crises, improved haemoglobin levels, and decreased hospital admissions related to sickle cell complications [50]. Additionally, the treatment was well-tolerated with no major side effects, reinforcing its potential as a safe and effective herbal therapy for sickle cell management. During the COVID- 19 pandemic, NIPRD investigated claims of traditional medicine-based COVID- 19 cures, assessing their safety and efficacy through scientific evaluation. The agency also launched capacity-building programmes for TM practitioners and supported local hand sanitizer production from indigenous materials [51].

Nigeria has made progress in TM integration, as shown by 2018 data comparing its advancements with other African nations (see Table 2). However, policy updates are needed in herbal medicine certification, clinical trial standardization, and regulatory guidelines to ensure quality, safety, and efficacy. To fully unlock TM’s potential, the government should increase funding for research, strengthen regulatory frameworks, and integrate TM into national healthcare, with support from WHO and the African Union.

The need for traditional medicine investment in Nigeria

Nigeria has the world’s highest malaria prevalence [18, 52]. Also, evidence has shown that 60% of Nigerian children with high fevers caused by malaria are treated first with herbal remedies [52]. A study conducted in southeastern Nigeria reported that the respondents had great trust in traditional medicine in the management of malaria and saw orthodox methods of malaria treatment as having several side effects [53]. In Nigeria, rural residents rely more on herbal remedies and other conventional medications to treat malaria; unfortunately, the use of uncertified herbal medicine is most common [50].

Despite the growing popularity of medicinal plants as local therapeutic choices for malaria treatments, most have not been systematically investigated and evaluated [52]. Even though plant extracts are effective against malaria, research carried out on 43 different plant species used in traditional medicine for malaria treatment revealed that 37% of the plants were effective against malaria [54]. The measurement methods used in the conventional setting have never undergone extensive testing to identify the most effective, harmful, or side effects. They are often given if the sick person can tolerate them. As a result of frequent usage and trust in traditional medicine across Nigeria and the prevalence of cases and deaths of malaria as shown in Table 1.

Recommendation, policy strategies, and future directions

According to the WHO 2014–2023 Traditional Medicine Strategy [55], sustaining the ecosystem of innovation for traditional medicine (TM) requires government commitment and health sector involvement. Collaborations among innovators, industry leaders, and international organizations are crucial for advancing research into TM. Given Nigeria’s high malaria burden and the growing public trust in TM, the government must prioritize investment in TM through annual budget allocations, increased funding for NIPRD, and the establishment of additional pharmaceutical and traditional medicine institutes. These initiatives will strengthen national preparedness, enhance local drug production, and improve vaccine readiness for malaria and future infectious disease outbreaks.

Furthermore, the unregulated use of TM without proper prescriptions poses significant health risks. To mitigate these risks, it is imperative to increase research, development, and investment in TM. The government and stakeholders must ensure the standardization of herbal medicine production by training local vendors on safe preparation and hygienic packaging practices.

In addition, a comprehensive strategic policy is needed to scientifically validate effective herbal preparations while identifying and eliminating unsafe practices in TM production. Pharmacological testing should establish appropriate dosages to prevent misuse and potential toxicity. Studies indicate that public confidence in TM is influenced by demographic factors such as lineage, profession, and socioeconomic status. With NIPRD’s research capacity and successful TM trials, standardizing TM practices could lead to significant breakthroughs in disease management. Therefore, proper investment in TM could be a key strategy in combating malaria and other infectious diseases.

To build on these efforts, Nigeria must adopt a dual strategy that incorporates both vaccination programs and TM integration in malaria control. Notably, the RTS, S/AS01 malaria vaccine, introduced in 2015, and the R21/Matrix-M vaccine, approved in 2023, have been recommended by the WHO to combat malaria in Africa [56]. However, given the country’s malaria burden, combining vaccination initiatives with TM research and integration could offer a holistic approach to malaria elimination.

Conclusion

Traditional medicine holds significant promise in addressing the pressing health challenges of malaria in Nigeria. The evidence suggests that herbal remedies not only provide an affordable and culturally accepted treatment option but also demonstrate potential efficacy against malaria-causing parasites. However, for TM to contribute effectively to public health, there must be increased investment in scientific research, as well as standardization and regulation of these treatments.

With substantial progress already made by institutions like the National Institute for Pharmaceutical Research and Development (NIPRD), Nigeria is well-positioned to lead the integration of traditional medicine into modern healthcare. Policymakers must prioritize funding for TM research, create robust regulatory frameworks, and foster collaborations with international bodies.

By investing in traditional medicine, Nigeria can unlock untapped resources, strengthen malaria prevention and treatment efforts, and improve access to effective therapies in rural and underserved areas. This strategic integration of traditional and modern medicine will not only enhance malaria control but also contribute to global health goals, advancing towards a more resilient and sustainable healthcare system.

Author contributions

FOO—Conceptualization, designing, project administration, investigation, writing—original draft, final draft, writing-review and editing. CCA—Writing-original draft, collection, and data assembly, second draft, manuscript review and editing SCE—Conceptualization, Re-designing, project administration, investigation, writing—original draft, second draft, final draft, writing-review and editing and supervisor. GOO—Writing-original draft, collection, and data assembly, second draft, manuscript review and editing. DOO—Writing-original draft, collection, and data assembly, second draft, manuscript review and editing. TS—Writing-original draft, collection, and data assembly, second draft, manuscript review and editing. DCIWriting-original draft, collection, and data assembly, second draft, manuscript review and editing. UWD—investigation, writing—original draft, second draft, final draft, writing-review and editing and supervisor. PCU—Writing-original draft, collection, and data assembly, second draft, manuscript review and editing. TOO—investigation, writing—original draft, second draft, final draft, writing-review & editing and supervisor. CNE—writing—original draft, collection, and data assembly, final review, writing review and editing. Table 1: Evidence: Cases of malaria in Nigeria from 2001 to 2023 created by FOO, SCE and reviewed by all Authors. Table 2: Progress and integration of TM into WHO African countries as of December 2018 created by SCE, FOO and reviewed by all Authors. Manuscript writing—All Authors Final Approval of the Manuscript—All Authors.

Funding

We have no funding for this manuscript.

Availability of data and materials

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.