Herbal Remedies Remain First Response to Childhood Malaria in Ghana’s North

In the Tamale Metropolis of northern Ghana, where malaria remains one of the most persistent threats to child health, a new study has revealed a striking gap between the availability of modern antimalarial drugs and the treatment choices that caregivers actually make at home. Researchers from the University for Development Studies and Nsoatre Government Hospital surveyed 265 female caregivers of children aged twelve years and younger and found that 37.3 percent had used plant-based medicines as a first-line response to suspected malaria in a child. The findings, published in BMC Complementary Medicine and Therapies, offer a detailed portrait of how households in an urban African setting navigate the boundary between biomedical care and traditional herbal practice, and they identify the socioeconomic fault lines along which that navigation shifts.

The study comes at a time when effective conventional treatment for malaria is theoretically within reach of most Ghanaian families. Artemisinin-based combination therapies, the World Health Organization-recommended standard for uncomplicated malaria, are widely distributed through hospitals, clinics, and licensed over-the-counter medicine sellers, and Ghana’s National Health Insurance Scheme is designed to reduce the financial barrier to seeking formal care. Yet the research team, led by Evans Paul Kwame Ameade of the Department of Pharmacognosy and Herbal Medicine, found that despite this infrastructure, herbal preparations continue to occupy a substantial place in the domestic management of febrile illness. The persistence of plant-based medicine use in an urban metropolis, rather than only in remote rural communities, is one of the most notable aspects of the work.

Methodologically, the investigation took the form of a community-based cross-sectional survey. The researchers recruited participants through convenience sampling and administered a semi-structured questionnaire to female caregivers of children aged twelve years or below. Data were analysed using SPSS version 23, with chi-square tests employed to explore initial associations between caregiver characteristics and the use of plant-based medicines, and logistic regression then applied to adjust for confounding variables and calculate adjusted odds ratios. The ethical protocol, including the use of verbal rather than written informed consent, was approved by the Ethics Committee of the School of Medicine and Health Sciences, a decision the authors justified on the grounds of minimal risk and the community-based nature of household interviews.

The clinical picture that emerged from the survey is familiar to anyone who has studied malaria-endemic settings. Fever and vomiting were the symptoms most commonly cited by caregivers as the triggers for suspecting malaria in a child, a pattern consistent with the way the disease typically announces itself in paediatric patients. When asked where they would prefer to take a child with suspected malaria, 77.6 percent of caregivers named the hospital as their primary healthcare facility. On the surface, this figure suggests strong confidence in formal medical institutions. Yet the same population reported substantial use of herbal first-line treatment, indicating that preference for hospitals and recourse to plants are not mutually exclusive but instead operate as parallel strategies within the same households.

The botanical pharmacopoeia identified by the study reads like a catalogue of the region’s most abundant trees and shrubs. The neem tree, Azadirachta indica, was the most frequently cited antimalarial plant, mentioned by 18.7 percent of caregivers who reported herbal use. It was followed by Carica papaya, the papaya, at 16.5 percent, and Psidium guajava, the guava, at 14.3 percent. Senna occidentalis accounted for 10.0 percent of citations and Mangifera indica, the mango, for 9.6 percent. Each of these species has a long history in West African traditional medicine, and several contain phytochemicals with documented or suspected biological activity. Neem, for instance, is rich in limonoids such as azadirachtin and nimbin, while papaya leaves contain alkaloids and phenolic compounds that have attracted laboratory interest for their effects on malaria parasites and on the platelet changes associated with the disease.

The researchers were careful, however, to frame these findings in terms of practice rather than efficacy. The study documents what caregivers do, not whether the preparations they administer work against Plasmodium infection. This distinction matters clinically. Unvalidated herbal treatments for a febrile illness that may or may not be malaria carry the risk of delaying accurate diagnosis and effective artemisinin-based therapy, which in children can mean the difference between a rapid recovery and progression to severe disease. At the same time, the authors note that caregivers use multiple treatment approaches, and plant-based medicines may be deployed alongside, rather than instead of, conventional drugs, raising additional questions about interactions and dosing that current health communication rarely addresses.

Perhaps the most consequential results are the two factors that independently predicted herbal first-line use. Caregivers from low-income households had dramatically higher odds of using plant-based medicines, with an adjusted odds ratio of 9.449 and a 95 percent confidence interval spanning 1.185 to 75.354, a statistically significant association at p equal to 0.034. The second significant predictor was family size: caregivers with more than two children under the age of five had an adjusted odds ratio of 7.905, with a confidence interval of 1.384 to 45.162 and a p value of 0.020. The wide confidence intervals reflect the modest sample size of 265 participants, and the authors and readers alike should interpret the magnitude of these estimates with appropriate statistical caution. Nevertheless, the direction of both associations is intuitively coherent and aligns with broader patterns in health-seeking behaviour research.

The income effect is particularly telling in the context of Ghana’s health financing reforms. The National Health Insurance Scheme was established precisely to remove cost as a deterrent to formal care, yet the study suggests that economic pressure continues to push households toward remedies that are essentially free for the gathering. A handful of neem leaves or papaya leaves requires no transport fare, no registration fee, and no waiting time. For a mother managing several children under five, each susceptible to the fevers that sweep through the rainy season, the calculus is shaped not only by money but by time and logistics. A caregiver responsible for multiple infants and toddlers may find that preparing a herbal infusion at home is the only feasible response when a child falls ill at night, or when taking one child to hospital would mean carrying the others along.

The public health implications of the study extend beyond Tamale. Malaria control programmes across sub-Saharan Africa have invested heavily in expanding access to diagnostics and artemisinin-based combination therapy, and progress against the disease depends on children receiving confirmed diagnoses and complete courses of effective drugs promptly. If more than a third of caregivers in an urban metropolis with good hospital access begin treatment with plants, then the true scale of herbal first response across more rural settings is likely to be at least as large. The authors argue that understanding the sociodemographic drivers of this behaviour, rather than simply discouraging it, is essential for designing interventions that meet families where they are. Targeted health education aimed at low-income households and at caregivers of large families of young children could address the specific circumstances that make herbal treatment the default choice.

The study also carries a message for the research community. The plants identified by caregivers, led by neem, papaya, and guava, represent a documented corpus of local knowledge that could inform future phytochemical and pharmacological investigation, provided such work proceeds with rigorous standards for safety and efficacy. Meanwhile, the finding that hospitals remain the preferred facility for the overwhelming majority of caregivers suggests that trust in biomedical care is not the obstacle; accessibility, affordability in practice, and the realities of household management are. As Ghana and its neighbours push toward malaria elimination, studies of this kind, grounded in the everyday decisions of mothers and grandmothers, illuminate the gap between what health systems offer and what families actually do, a gap that no single drug or policy can close without understanding the lives of the people it is meant to protect.

Subject of Research: Prevalence and determinants of plant-based medicine use among caregivers treating suspected malaria in children in Tamale, Ghana

Article Title: Use of plant-based medicines for suspected childhood malaria in Tamale Metropolis, Ghana: prevalence and associated factors

Article References: Ameade, E. P. K., Laari, S. M., & Adom, E. (2026). Use of plant-based medicines for suspected childhood malaria in Tamale Metropolis, Ghana: prevalence and associated factors. BMC Complementary Medicine and Therapies. https://doi.org/10.1186/s12906-026-05608-8

Image Credits: AI Generated

DOI: 10.1186/s12906-026-05608-8

Keywords: malaria, plant-based medicines, traditional medicine, child health, Ghana, caregivers, complementary medicine, Azadirachta indica, Carica papaya, public health, Tamale, health-seeking behaviour