When traditional herbalists in Ghana started using herbs to treat malaria, long before the introduction of orthodox medicine, little did they know the scientific properties of such herbs. One medicinal plant that has been used in Ghana for a long time to treat malaria is “Nibima”. Its botanical name is cryptolepis sanguinolenta.
 
A number of communities in Ghana use the plant to treat malaria. In some local dialects in Ghana, it is known as “Nibima” in Twi, “Kadze in Eve and Gangnamau in “Hausa”.

Cryptolepis sanguinolenta is a creeping plant, which has yellow flowers and yellow roots. Extracts from the roots of this plant is what is used to produce herbal medicine for the treatment of malaria. The roots of the luxuriant woody climber, with simple leaves, taste very bitter.
 
Nibima was what local people in Ghana used until 1975 when the Centre for Scientific Research into Plant Medicine (CSRPM) was established in Mampong in the Eastern Region of Ghana. The Centre then made further scientific studies into the plant.
 The success of Nibima would reduce imports of malaria drugs and make it more accessible and affordable to Ghanaians.  According to the Ministry of Health of Ghana, annually government spends about GHC770 in the management of malaria. The Nibima drug extracted from the cryptolepis plant which is produced in 330 milliliter bottles and costs GHC1.00 ($1) has so far shown no adverse reaction. Its cure rate is between 68 to 70 per cent as against the standard cure rate of 90 to 95 per cent. The centre believes the cure rate needs to be improved. The Centre for Scientific Research into Plant Medicine is now researching to combine Nibima with other anti malarial plants to make it more effective to meet international standards as a potential herbal anti malarial from Ghana. For now Nibima treats malaria only in adults. The centre hopes to further develop it to be able to treat malaria in children.  The Deputy Director of the Centre, Dr. Archibald Ayitey Sittie, said the centre is now moving to convert liquid forms into capsules and tablets as well as infusions such as tea bags. The center also hopes to freeze-dry extracts of this medicinal plant for easy use. 
 
SCIENTIFIC STEPS
Since the 1970s, the centre has been collaborating with the Kwame Nkrumah University of Science and Technology in the Ashanti Region of Ghana to identify compounds in the plant and to find out its pharmacological effects. A preclinical study in respect of the plant’s toxicity was also done. Nibima has been tested on various animal models to see its safety implications while efficacy studies have also been carried out. All the tests proved right. According to Dr. Sittie “enough background work has been done to support the claim that Nibima treats malaria in adults”.
In fact it is one of ten traditional medicines that have been registered with the Food and Drugs Board in Ghana.
 
CHALLENGES
The cryptolepis plant has a huge potential for Ghana in the fight against malaria but a number of challenges abound. The plant which grows in the wild now faces extinction. The plant can be found in some parts of the Eastern, Western, Ashanti and Volta regions of Ghana and is being used by traditional herbalists and local manufacturers to produce various types of medicines to treat malaria. A survey conducted by the centre confirmed that the plant is on the decline as a result of too much use and deforestation. “We used to purchase this raw material at GHC1.00 a kilo but as I speak it costs about GHC 4.00 to 5.00 Ghana Cedis a kilo. This quantum jump is making it difficult to sell the product at an affordable price for the Ghanaian public”, lamented the

Director of the Centre, Prof. Laud Okine. He said he believes that herbal medicine should not be expensive. The centre is therefore moving into the raw material production through wide scale cultivation of the plant to sustain production of the medicine for the public. The centre is nursing the seedlings for transplantation into fields. It is also collaborating with out growers to buy the seedlings to grow. “We need to encourage large scale cultivation since a kilo of the plant cost more than a kilo of cocoa”, Dr. Sittie added. “The future of cryptolepis is very bright as a source of employment also for Ghanaians but of concern is competition from the movement into alternative medicines which makes the centre not attractive to funding sources”. Another challenge is that Nibima has not been made an officially endorsed alternative treatment for malaria by the Ministry of Health of Ghana.
 
PLANS FOR CRYPTOLEPIS PLANT
Meanwhile, in a recent budget statement to the Parliament of Ghana, the Minister of Finance and Economic Planning of Ghana Dr. Kwabena Dufuor acknowledged efforts being made in the area and announced that clinical trials of Nibima would be undertaken by the Noguchi Memorial Institute for Medical Research in Ghana in collaboration with a strategic investor, Phytorica Ltd under a Public-Private Partnership agreement. The centre is therefore hoping that sooner than later Nibima will be officially endorsed so that Ghana can become a producer and exporter of the herbal medicine not only to other Africa countries but to the world just as the Chinese and Indians.

When the Centre was established, it was given the mandate to research, develop and promote traditional medicine practice in Ghana. It was also to collaborate in the collation, publication and dissemination of results of research among others. This is to the extent that the Ghanaian public even today believes that it is a regulatory body. Initial work undertaken by the centre was to go round and collect information from Ghanaian traditional herbalists on samples of plants, recipes and herbal preparations, dosage and where such medicinal plants could be found. Plants so revealed now have been documented with prepared specimens after the scientists researched again to validate what had been found. Out of this the centre has been able to formulate about 35 herbal preparations from the 78 medicinal plants collected into liquids, powders, tea, ointments and capsules making the centre a wealth of knowledge not only on traditional medicine but also on information and particulars of traditional herbalists in Ghana.

During a visit by members of AMMREN Ghana Chapter to the Center, the Deputy Director of the Center, Dr. Archibald Ayitey Sittie, paid glowing tribute to the founder of the center the late Dr. Kwaku Oku Ampofo who was a medical practitioner, herbalist, sculptor and a musician. He said the founder had the co-operation of traditional herbalists at the time who provided the necessary information on the medicinal plants. “Today, nobody wants to give information. The traditional herbalists say the scientists have been stealing from them. But I think the time has come for Ghanaian scientists and traditional herbalists to take Ghanaian herbal medicine beyond its borders”.

Research has shown that worldwide, an estimated 200 to 300 million malaria infections occur each year with 2 to 3 million deaths.  90 per cent of these deaths occur in sub-Saharan Africa. In Ghana, malaria is the leading cause of morbidity, accounting for between 40 to 45 per cent of out patient attendance. It is a leading cause of death among children under five years and pregnant women and also affects productivity throughout Ghana.
 
In late 2005, Ghana adopted a new drug policy due to malaria parasite resistance to chloroquine. Currently, the first line drug for the treatment of uncomplicated malaria is the WHO recommended combination therapy, artesunate-amodiaquine. However, initial problems encountered by the Ghanaian public with regards to the side effects of the locally manufactured artesunate-amodiaquine coupled with the high cost of the combination therapy ( about $3), have driven many Ghanaians to resort to monotherapy to treat their malarias.

It is therefore hoped that cheaper herbal treatment would come in to help fight malaria, especially among the poor and vulnerable.