How regular intake of malaria herbs infused with alcohol can cause liver damage
They asserted that while herbal anti-malaria remedies can serve as prevention against malaria, they should not be taken for too long and not be prepared with alcohol or ethanol.
Pharmacognosists are researchers into the medicinal properties of natural products.
PUNCH Healthwise discovered that most ready-to-drink ‘agbo iba’ sold on street corners, garages, and motor parks and being hawked by self-professed herbal medicine practitioners, are brewed with ethanol or alcohol to ensure the complete extraction of the anti-malaria properties in the plants used.
However, the experts, in separate interviews with PUNCH Healthwise, noted that those addicted to ‘agbo iba’ no longer take them for medicinal purposes but to satisfy their alcohol cravings.
Findings showed that ‘agbo iba’ and ‘agbo jedi’ are the most frequently consumed herbal remedies prepared in the South Western part of the country.
While ‘agbo-iba’ is used to treat and prevent malaria, a life-threatening disease spread to humans by mosquitoes, ‘agbo jedi’ is touted as a laxative for the treatment of backaches, sexual dysfunction and piles, among other ailments.
These herbal medicines are extracted from the leaves and stems of plants known to provide relief and cure from symptoms of malaria and piles.
Locally brewed herbs are common sights at motor parks and along major bus stops, where they are stored in transparent plastic bottles of various sizes and sold to buyers in smaller plastic bags or bottles.
However, the preparation of these herbs, some of which include infusion with alcohol has been a cause of concern to health practitioners, who are wary of the interactions of alcohol and the herbs on the health of the consumers.
Although the World Health Organisation acknowledges the use of herbal remedies in treating malaria, it noted several limitations in terms of standardisation of plant cultivation, preparation of formulations, dosages and quality assurance.
It further highlighted the challenges of clinical safety and efficacy and the lack of uniform preparation and dispensing methods.
According to the WHO, malaria remains one of the world’s killer diseases, with about 76 per cent of Nigeria’s population at risk of the disease.
The World Malaria Report 2023 noted that Nigeria accounted for 27 per cent and 31 per cent of all malaria cases and deaths globally in 2022.
The pharmacognosists further warned against the continuous intake of non-prescription medications and indiscriminate preparation and use of herbal remedies.
Speaking on the matter, a pharmacognosist at the Drug Research and Production Unit, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Osun State, Professor Joseph Agbedahunsi, stated that medicinal plants are also drugs and when not properly prepared and taken in excess, could be harmful.
He further mentioned that although some plants and leaves are extracted and used to manage malaria, constantly taking them can cause adverse effects on the kidneys.
The don also noted that while locally brewed ‘agbo iba’ containing alcohol could still have some curative effects, its use can be abused, leading to addiction.
He warned that persons addicted to locally brewed ‘agbo iba’ stand the risk of organ damage, including the liver.
Agbedahunsi said, “Don’t forget that we have only one liver and once the liver is damaged as a result of the gin and alcohol content present, the person is at risk of liver cirrhosis and if care is not taken, death would occur. If one doesn’t use it the way it should be used, then one is courting trouble.
“Anything you abuse could be dangerous. Using it (‘agbo iba’) every day could be dangerous. I agree that some anti-malaria drugs in orthodox medicine are used as prophylaxis. When we were very young, we had this medicine we used every Sunday. This once-in-a-week medicine is a prophylaxis and after one week its effectiveness would have worn off and as a result, we can take another one without it being toxic.”
Agbedahunsi noted that local herbal sellers use ethanol to achieve complete extraction of the herbal content in the plants, however, consuming them could affect the effectiveness of the herbal drugs.
“When they become addicted to this decoction before they drive, they take it to make them become high. That way, it is no longer taken for the treatment of malaria commonly called fever.
“Many of them use these things indiscriminately and take them because it was given to them. So, they become addicted to the alcohol content and that is the reason they take it and not necessarily for malaria treatment or prevention,” the don said.
The researcher further noted that many locally sold ready-to-drink herbal mixtures are not properly prepared and have not undergone research to determine the right dosage and preparation methods.
“Many of the local and herbal drugs have not undergone research. Do they know the right dosage? The way the ‘agbo’ is prepared is not the way it should be. What should be done is that when you are preparing a decoction, you get the plants, pour in water and get it to boil, allow it to simmer for three hours and allow it to cool after it has cooled, you will decant and store in a coloured amber bottle and store in a fridge.
“The following day when you want to take it, if it is a glass cup that you take, you take it the same way the second and third day. You will find out that you have standardised the dosage of what you’ve taken.
“But by leaving it in the pot till the following day, it would become addictive and on the third day, it has become concentrated and by that, you have altered the dosage completely. Also, when you add water, the active ingredients there would have been reduced gradually and you would not get the same thing. That is one of the limitations of ‘agbo’ and local herbs. If people don’t put in place simple operational procedures, it will not be standardised and sometimes, it would work and sometimes, it would not,” he said.
The don further noted that the inability to identify the particular active species of the medical plants causes inconsistency in the efficacy of the herbs.
The pharmacognosist further asserted that not all feverish conditions are malaria-related, noting that several ailments could present like malaria.
He advised individuals with feverish symptoms to see a physician and undergo laboratory tests before taking anti-malaria drugs or clinically produced herbs.
On his part, a pharmacognosist at the Obafemi Awolowo University, Ile-Ife, Osun State, Ifeoluwa Ogunlowo, stated that malaria can be treated with herbs but the materials used in preparing the herbs are important.
He further noted that using alcohol to extract ‘agbo’ could lead to addiction due to its addictive properties.
He said, “If the ‘agbo’ is prepared with water, it is not going to be sweet and it should not be taken for a long time, a maximum of five days and with adequate rest, the person will be fine.
“The other thing is using alcohol to extract the ‘agbo’. The alcohol in it has an addictive property so there is a tendency that this user will have a craving for agbo and in this case, it may not be in the issue to resolve the malaria. There is no problem with taking herbal remedies but it is necessary to ensure they are not extracted or preserved with alcohol.”
Ogunlowo also mentioned that ‘agbo’ could be taken as a prophylaxis for malaria prevention if prepared with water and consumed in safe dosages.
To reduce the issue of microbial infection, he noted, “The material used to prepare the ‘agbo’ must be clean enough so that the microbial load will be within the limit. Once the ‘agbo’ is spent, there is a need to discard it and make a new one, and all safety precautions such as washing the leaves properly among others must be carried out. But if it is an issue of going to buy a sachet every day and that has a lot of alcohol in it, then the issue of addiction can come in.”
The pharmacognosist highlighted growing concerns over the potential for drug abuse among individuals who frequently crave ‘agbo’ without any medical need.
He urged those addicted to alcohol-extracted ‘agbo’ to gradually reduce their intake and consider herbal remedies extracted with water.
The researcher also warned that constant users of unhygienically produced and alcohol-extracted ‘agbo’ are at risk of risks of liver damage.
“If one is taking a drug and the liver can’t manage it again, it becomes a problem. When people abuse drugs, whether herbal or orthodox, the organs that are most affected are the liver and kidney.
“So, if one is addicted to herbal remedy, one might need to be subjected to a test to confirm if the vital organs have not been affected. Once it is confirmed that the organs are being affected, there is a need to stop immediately. Persons who are on constant medications for the management of hypertension and diabetes have their vitals monitored and the doctor might later review their dosage or replace the drug,” Ogunlowo said.
The pharmacognosist also advised against the prolonged use of drugs, emphasising that individuals on continuous medications should regularly visit their physicians for checkups and reviews.
