Malaria causes up to 32 percent of deaths in Burkina Faso, and a traditional herbal medicine used locally to fight the mosquito-borne killer is headed for clinical trials as early as July, according to reports in SciDev.net.

The Ministry of Health in Burkina Faso is funding human clinical trails of a herbal mixture of three plants known as Saye, comparing it with conventional malaria drug artemisinin. Saye has been used as a tea to fight malaria for more than 30 years in Burkina Faso.

Saye is a mixture of three plants: the root of the local N’Dribala plant (Cochlospermum planchonii); Phyllanthus amarus and Cassia alata, according to an April 15 report in he Journal of Alternative and Complementary Medicine. It was first licensed as a herbal medicine in Burkina Faso 10 years ago but the compounds that might act against malaria have yet to be identified, SciDev reports.

In Burkina Faso, the law recognizes traditional medicine as part of the health system, according to the Journal of Alternative and Complementary Medicine. The national policy is to integrate traditional medicine into the national health care system in order to improve access to medicines for the whole population. One way of doing this is to strengthen collaboration between people who practice traditional and modern medicine. Another is to promote scientific research on traditional medicine and drugs, consistent with the World Health Organization’s strategy for traditional medicine in Africa.

How Saye was developed

In 1983, Dr. Zéphirin Dakuyo was the first pharmacist at Banfora Hospital in Southwest Burkina Faso, according to the Journal of Alternative and Complementary Medicine. At the time, chloroquine was the first-line treatment for malaria, but it has since been abandoned because of drug resistance.

Patients told Dakuto that they didn’t like the side effects of chloroquine and preferred to treat themselves with herbal medicines, in particular the roots of N’Dribala. However, they didn’t have time to collect the plant so Dakuyo, with support from hospital staff, arranged to have it harvested and packaged for patients. The hospital sold the medicine to malaria patients and community health workers were provided with it to supply to patients.

Hepatitis is also common in Burkina Faso, and N’Dribala is traditionally used to treat jaundice. Dakuyo decided to combine this with Phyllanthus amarus, which had been shown to be effective against hepatitis, as well as Cassia alata, which was also used for treating jaundice, malaria, and constipation. He called this mixture Saye, which literally means “jaundice” in the local Dioula language. Saye is manufactured by mixing the three dried and coarsely chopped ingredients in specified proportions. It is sold in a box of chopped, dried plant parts. Patients are instructed to mix three tablespoons of the dried plant material in two glasses of water, boil the mixture for five minutes, filter it, and drink it.

Dakuyo received feedback from patients that Saye was even more effective than N’Dribala for treating malaria, and patients started buying it for malaria. In 1986, Dakuyo developed capsules of powdered Saye because patients did not have time to boil the herbs every day. Saye tea was officially licensed as an antimalarial medicine in Burkina Faso in 2005.

In 1993, Dakuyo left the hospital to start his own pharmacy, setting up a small factory to produce the herbal medicine. As demand increased and he began producing other herbal products, the factory grew.

To meet demand, Phytofla started a cooperative of medicinal plant producers (Coopérative des Producteurs de Plantes Médicinales, or CPPM) trained to grow, identify, harvest, dry, and store medicinal plants. The coop has 250 members but only 10 cultivate plants; the rest are still harvesting from the wild, according to the Journal of Alternative and Complementary Medicine.

Will the trials work?

It’s hard to predict what the clinical trial will show, said Merlin Willcox, an author of the report and a clinical researcher at the University of Oxford, SciDev reports. Tests on mice examined each of the three plants individually that comprise Saye with mixed results. Drug tests done in petri dishes and trials that showed success on mice often failed on humans.

Tested on mice, Saye as a whole reduced the number of malarial parasites but did not eliminate them.

“It’s not good enough just to reduce (parasites in the blood),” said David Baker, a malaria parasite biologist at the London School of Hygiene & Tropical Medicine in the U.K. “You really need to clear malaria completely, or you need to find something else that will clear it up.” Otherwise, the patient could relapse.

Another problem with using herbal medicines is that it could result in resistance to antimalarials, Baker said, according to the SciDev report.

Future challenges for Saye include creating methods for standardization and quality control, and making sure the cultivated plant contains the same compounds as the wild plant, according to the Journal of Alternative and Complementary Medicine.

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