Complementary Therapies in Clinical Practice 19 (2013) 36e43

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Complementary Therapies in Clinical Practice

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Complementary and alternative medicine use among Mauritian women

Shanoo Suroowan, Fawzi Mahomoodally*
Department of Health Sciences, Faculty of Science, University of Mauritius, Reduit, Mauritius

a b s t r a c t
Keywords: Objective: To assess CAM usage among women in Mauritius.
Complementary and alternative medicine Methods: Cross-sectional survey with a nationally-representative sample (n ¼ 384). Quantitative indices
Women’s health
included informant-consensus factor, use-value, fidelity-value and use-mentions were calculated.
Phytotherapy
Zootherapy
Results: Thirteen therapies were identified and currently are used to treat or manage 26 ailments. These
Mauritius were phytotherapy (30%); yoga (13%); deep-breathing (12%); massage therapy (11%); ayurvedic medicine
(8%); meditation (6%); zootherapy (6%); homeopathy (5%); exercise (3%) and reiki (3%). The most prev-
alent CAM was phytotherapy. Based on the quantitative ethnobotanical indices, plants commonly used
were Acalphya spp., (Copper leaf), Curcuma longa (Tumeric), Cymbopogon citratus (Lemon grass), Eryth-
roxylum hypericifolium (Bois ronde), Lens culinaris (Lentil) and Mentha piperita (Mentha). Interestingly,
the present study is the first attempt to record CAM management of women’s health in Mauritius.
Conclusions: This study can be considered as a primary information resource recording the current use of
CAM by women in Mauritius.
Ó 2012 Elsevier Ltd. All rights reserved.

1. Introduction (mainly Hindus, Muslims, Christians and Chinese).11 Local people

A wide variety of conventional drugs and therapies are currently
available to alleviate or cure a range of common ailments experi-
enced by women. Current literature suggests that there are an
increasing range of allopathic medications available claiming to
improve an array of discomforts experienced during pregnancy.1,2
Despite this, increasing numbers of women select complemen-
tary and alternative medicines (CAM) for symptomatic relief of
common disorders.3,4 There are a number of reports indicating that
women are major users of CAM therapies and CAM use has
increased tremendously over the last decades.6,7 Additionally,
literature tends to suggest that increasingly prevalent choice of
CAM by pregnant women in developed and developing countries,
reflects perceptions of potential fetal damage from side effects of
conventional pharmaceutical treatments.5
Herbal products, homeopathic medicines, and dietary supple-
ments have become increasingly popular and can be obtained
without recourse to medical prescription.8e10
The Republic of Mauritius is a multicultural tropical island
located in the Indian Ocean and with a population of approximately
1.2 million residents. The local population has a deep-rooted
tradition in the use of alternative medicines (particularly phyto-
medicines) which tend to emanate from their respective cultures
* Corresponding author. Tel.: þ230 732 7341, þ230 403 7578.
E-mail address: f.mahomoodally@uom.ac.mu (F. Mahomoodally).
continue to rely heavily on natural therapies for their primary
health care needs as poverty still prevails in many parts of
Mauritius. Nonetheless, even with this innate use of alternative
therapies, the use of CAM have not been scientifically evaluated and
documented. As far as we know, no comprehensive study has been
carried out to systematically document and assess the status of
CAM therapies among indigenous women in Mauritius. Therefore,
the current study sought to evaluate the current status of CAM and
to bring in the limelight of the scientific community the potential of
CAM therapies from Mauritius. Given the dearth of updated infor-
mation on CAM in Mauritius, this work presents an opportunity to
identify valuable information on CAM therapies used by the local
people and provide an opportunity for future pharmacological
research.
2. Research design and methods
2.1. Questionnaire and sampling design
The project was approved by the Department of Health Sciences,
University of Mauritius.
Due to a lack of epidemiological studies and surveys, there was
a need for an initial descriptive study in an endeavour to establish
baseline data for CAM use by Mauritians. The questionnaire was
designed following a comprehensive literature review of similar
studies and surveys conducted in other countries.12e19 The final

1744-3881/$ e see front matter Ó 2012 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.ctcp.2012.07.002
 S. Suroowan, F. Mahomoodally / Complementary Therapies in Clinical Practice 19 (2013) 36e43
questionnaire was composed of 22 questions divided into 4 sections.
A three stage sampling design20 was adopted which consisted of
a pilot test followed by determination of the sample size and
subsequent field trips to towns, villages and CAM centers. In 2011,
the population of the Republic of Mauritius stood at 1,288,684
comprising 634,855 males and 653,829 females.21 Sample size was
calculated based on previous report22 and was estimated to be 384.
2.2. Field interviews
Data was collected during the academic year 2011e2012 through
personal interviews during field trips to different community
settings and visits to CAM centers (see Map). Many of the local
people helped in locating potential participants and CAM centers.
Prior to participation, each participant read and signed a consent
form describing the study and ensuring their confidentiality. As far
as possible, the vernacular languages (‘Kreol’ and ‘Bhojpuri’) were
employed to collect accurate data from the participants.
2.3. Quantitative indices for phytotherapy and zootherapy
The ‘informant consensus factor’ (ICF) was calculated to analyze
the pattern of use of medicinal plants and animals, thus deter-
mining which therapies had the highest representation. The ICF
was also used to check the homogeneity of the data collected.23 All
citations were placed into ailment categories for which the animals
and/or plants were reported to be used. The product of this factor
generally ranges from 0 to 1. A high ICF value (close to 1) showed
that relatively few taxa (usually species) were used by a large
proportion of participants, while a low value showed that the
informants disagree on the taxa that were used in the treatment
within a category of illness. ICF will also be small (i.e. close to 0) if
plants were chosen randomly and/or participant does not clearly
deliver accurate information about the plant. Thus values being
close to 1 indicate a well-defined selection criterion and informa-
tion being transferred correctly. Plants having a high ICF value tend
to indicate a high efficiency in treating certain diseases.23 The ICF
was calculated based on the following formula; ICF ¼ nur-nt/nur-1;
where nur is the number of use citations in each category and nt is
the number of species used.
Map. Location map of Mauritius in the Indian Ocean and study area (black dots indicate sample areas).
37
For each species, the ‘use-value’ (UV) was also calculated. UV
depicts the relative importance of any species known locally.24 The
UV was thus used to determine the relative importance of a partic-
ular species and was calculated based on the following formula:
P P
UV ¼ U/n; where: UV is the use-value of a species; U is the total
number of citations per species and n is the number of informants.
The ‘fidelity level’ (Fl) was also calculated for diseases or ailments
that were reported most commonly. It is a ratio of informants
claiming use of a plant species for a particular purpose and the
number of informants using the plant species to treat any given
disease.25 The Fl was calculated as follows; Fl ¼ Np/N  100; where
Np is the number of informants that claimed the use of a plant
species to treat a particular disease, and N is the number of infor-
mants that used the plants as a medicine to treat a particular disease.
Simple ‘use-mention’ (Um) was also calculated which refers to
the ‘mentions’ of one plant given by all the informants for a specific
disease.25
2.4. Data analysis
Descriptive statistics were conducted to examine the charac-
teristics of the study population, types, access, source and reasons
for CAM use. All data presented in this study were analyzed using
Microsoft Excel 2007 and the Statistical Package for Social Science
(SPSS) version 19.0. Pharmacological and biopharmaceutical data of
different CAM cited were collected from different databases such as
SpringerLink, Science Direct, EBSCOhost, PubMed Central, JSTOR
and EOLOSS amongst others. The primary data collected was
compared with similar studies conducted in other countries and
the possible pharmacology behind the use of a particular CAM
(particularly herbal medicines) was evaluated. Additionally,
ethnobotanical data was gathered from Mauritian university
dissertations, local books, journals and relevant local databases.
3. Results
3.1. Demographic characteristics of respondents
Out of the 384 women interviewed, 332 (86%) gave their consent
to fully participate in the survey. Demographic characteristics of
38 S. Suroowan, F. Mahomoodally / Complementary Therapies in Clinical Practice 19 (2013) 36e43

Table 1 Table 2
Demographic characteristics of the participants. Zootherapy used by the participants.

Indicator Description Frequency (%) Local name/ Part used Preparation Present use FOC UV
Age (years) 20e40 190 (57) common and application
41e60 118 (36) English name/
>60 24 (7) Scientific
name/Family
Marital status Married 174 (52)
Boeuf Meat Meat is placed Menorrhagia 3 0.02
Not married 127 (38)
Beef in a double Postpartum 5
Widow 19 (6)
Bos taurus boiler and bleeding
Separated 12 (4)
Bovidae collected blood
Occupation Student 100 (30) is taken orally
Housewife 90 (27) Pizon Whole Bird is placed Menorrhagia 3 0.02
Non-government officer 80 (24) Squab(Pigeon) bird in steaming Anaemia 5
Government officer 61 (19) Columba spp. water and
Columbidae prepared like a
Education level None 5 (2) soup and taken
Primary 81 (24) orally
Secondary 125 (38) Poule Meat Meat mixed Menorrhagia 2 0.02
Tertiary 121 (36) Chicken with garlic is Postpartum 4
Monthly incomea Rs 0 141 (43) Gallus domesticus placed in a bleeding
Rs 1e10,000 113 (34) Phasianidae double boiler
Rs 10,001e20,000 42 (13) and cooked, the
Above Rs 20,000 36 (11) blood that
collects is
Religion Hindu 194 (59) taken orally
Muslim 94 (29) Bombli Dried fish Cooked in Lactation 7 0.02
Creole 26 (8) Bombay duck lentils and
Chinese 6 (2) Harpadon nehereus given orally
Other 9 (3) Synodontidae
Cerf Horn Fatty substance Headache 2 0.01
Religious belief Extremely religious 21 (6)
Deer is collected
Very religious 59 (18)
Lucanus cervus in a cloth which
Religious 169 (51)
Cervidae is wrapped
Not really religious 75 (23)
on the forehead
No religious ideas 8 (2)
a
Mau Rs; 1 US$ ¼ Rs 30.

participants; age, marital status, highest level of education achieved,
monthly income, religion and ‘religious level’ of respondents are
summarized in Table 1.
3.2. Types, access to and source of CAM knowledge
Herbal medicines were observed to be the most widely accessed
CAM, (30%), followed by yoga (13%), deep breathing (12%), massage
therapy (11%), ayurvedic medicine (8%), meditation (6%), zoother-
apy (6%), homeopathy (5%), exercise (3%), reiki (3%), vitamin
supplements (1%), faith healing (1%) and pranic healing (1%).
Among the five different CAM modalities, biologically-based ther-
apies were most commonly used (75.0%) followed by mind body
interventions (9.5%), whole medical systems (8.2%), manipulative
and body based practices (6.1%) and energy therapies (1.2%).
It was also observed that majority of interviewees (51%) tended
to access CAM therapies from their immediate environment; which
included their own yards and/or from the vicinity of their homes
where they used to cultivate and/or collect medicinal plants and
animals. Few participants (27%) obtained CAM therapies via CAM
centers. Others (12%) bought these natural products from local
pharmacies, 4% obtained CAM from nearby markets, and 3% used
CAM therapies after being guided by local herbalists. Family (40%)
and friends (29%) were a major source of information regarding the
selection and use of a CAM therapy. Few participants (18%)
admitted that CAM therapies were part of their ‘inner self’ and end
up using it while 13% were influenced by media.
As depicted in Table 2, interviewees quoted 5 animal species as
CAM; distributed in 5 distinct families; of which were mammals (3
species) followed by bird (1 species) and fish (1 species). A total of 5
disease categories were treated and/or managed by zootherapy. Bos
taurus, Columba spp., Gallus domesticus and Harpadon nehereus
were all commonly used species (each with a UV of 0.02), while the
less commonly used animal species was Lucanus cervus, (used to
treat and/or manage headache). The informant consensus factor
(ICF) showed high values for all ailment categories (0.71e1.00).
Three categories attained total agreement among respondents
(ICF ¼ 1.00) namely headache, anaemia and lactation; followed
by postpartum bleeding (ICF ¼ 0.88). The least agreement
between the informants was observed in the menorrhagia
category (ICF ¼ 0.71).
Panoply of herbal preparations (29 medicinal plants) were
recorded from the present study and summarized in Table 3. Basic
information for all the different plant remedies were collected such
as local/vernacular name(s), parts used, number of citations, use
value and the dosage. Additionally, an endeavour has been made to
cite relevant scientific reference(s) on the quoted medicinal plants.
Thirteen plants were quoted to be commonly used and showed
maximum FL value (100%). Three plants (Ayapana triplinervis,
Mentha piperita, and Curcuma longa) showed FOC greater than 20.
This study also documented that majority of herbal products were
prepared using leaves of the plant, followed by roots, rhizome, bark,
seed, skin, fruit, stem, and flower. Most of the herbal preparations
were administered orally as decoctions.
Following CAM use; 6% of women interviewed from the present
survey claimed that they were completely healed, 54% reported
much improvements in their health status, 31% acknowledged that
their health status improved slightly, while 9% admitted that the
ailments they suffered from were not cured nor alleviated.
3.3. Quantitative indices
The ICF generated showed that values for all the different
ailment categories reported by the interviewees were high (0.84e
1.00). Six categories attained total agreement among respondents
(ICF ¼ 1.00) namely; headache, antepartum low back pain,
Table 3
Phytotherapy used by the participants.

Scientific name/Family Local name/C.E.N Part(s) useda Preparationb Applicationc Previous investigations Present uses FOC UV FL (%)
Acalphya spp. Feuille rouge/copper leaf Lea De Loc Not reported Postpartum pain 16 0.05 100
Euphorbiaceae
26
Amaranthus viridis Brede malbar/Amaranth Lea De Ora Diabetes, cholesterol Anaemia 4 0.01 100
Amaranthaceae
Ananas bracteatus Ananas marron/Wild Amanas Fru Ra Ora Not reported Abortion 2 0.01 100
Bromeliaceae
Ayapana triplinervis Ayapana/Ayapana Lea De Ora Not reported Abdominal distension 25 0.14 52
Asteraceae Nausea 13 27
Colitis 10 21
Bidens pilosa Lavillebague/Cobbler’s Pegs Flo De Ora Diabetes27 Diarrhea 6 0.04 46
Asteraceae Abdominal distension 7 54

S. Suroowan, F. Mahomoodally / Complementary Therapies in Clinical Practice 19 (2013) 36e43

Cinnamomum zeylanicum Canelle/Cinnamon Brk De Ora Antibiotic, diabetes28e30 Abortion 6 0.04 46
Lauraceae Postpartum bleeding 7 54
Curcuma longa Safran vert/Turmeric Rhi Rc Ora Anti- inflammatory, Postpartum bleeding 35 0.14 78
Zingiberaceae antiviral, antimicrobial31 Postpartum diastasis 10 22
Cymbopogon citratus Citronelle/Lemon grass Lea De Ora Antimicrobial, antioxidant31 Postpartum bleeding 17 0.07 71
Poaceae Abortion 7 29
Dimocarpus longan Longane/Longan Lea De Loc Antimicrobial32,33 Postpartum pain 12 0.04 100
Sapindaceae
Erythroxylum Bois ronde/Oil wood Lea De Ora Not reported Anaemia 17 0.05 100
hypericifolium
Erythroxylaceae
Illicium verum Anie etoilee/Star anis Fru De Ora Respiratory and gastric Abdominal distension 9 0.05 60
Illiciaceae problems, carminative, Colitis 6 40
antispasmodic31

Kalanchoe spp. Feuille sulfate/Kalanchoe Lea Ra Loc Not reported Antepartum swelling of legs 8 0.02 100
Crassulaceae
Lepidium sativum Chansoor/Garden cress See De Ora Not reported Antepartum low back pain 7 0.06 35
Brassicaceae Lentille/Lentil See De Ora Not reported Abdominal distension 13 0.07 65
Lens culinaris Anaemia 35 100
Fabaceae
Mentha piperita Menthe/Mentha Lea De Ora Antimicrobial34 Abdominal distension 38 0.13 90
Lamiaceae Colitis 4 10
Morinda citrifolia Feuille Tortue/Noni leaves Lea De Loc Anticancer, antidiabetic35 Antepartum 12 0.04 100
Rubiaceae swelling of legs
36,37
Moringa oleifera Brede Mouroungue/Moringa Bar De Loc Antioxidant, diabetes Abortion 6 0.07 26
Moringaceae Postpartum bleeding 17 74
Ocimum tenuiflorum Tulsi/Holy basil Lea In Ora Antimicrobial38 Abdominal distension 17 0.08 63
Lamiaceae Cold 10 37
Paederia foetida Liane caca/Skunkvine Lea De Ora Antioxidant39 Abdominal distension 6 0.03 55
Rubiaceae Colitis 5 45
Persea americana Feuille avocat/Avocado leaves Lea De Ora Cholesterol, diabetes, Missed period 7 0.04 50
Lauraceae De Loc hypertension40,41 Postpartum pain 7 50
Pimpinella anisum Gros anis/Aniseed Fru De Ora Antispasmodic, Abdominal distension 14 0.06 70
Apiaceae antimicrobial31 Colitis 6 30
Psidium guajava Feuille goyave/Guava leaves Lea De Ora Antioxidant42 Diarrhea 10 0.03 100
Myrtaceae
Ricinus communis Ricinus/Castorbean Lea Ra Loc Not reported Headache 8 0.02 100
Euphorbiaceae
Sinapis alba Moutarde/White mustard See Oi Loc Not reported Postpartum 13 0.04 100
Brassicaceae diastasis massage
Swertia chiraita Tiraita/Felworts See In Ora Antioxidant, Appetite stimulant 4 0.01 100
Gentianaceae hepatoprotective43e45
(continued on next page)

39
 40 S. Suroowan, F. Mahomoodally / Complementary Therapies in Clinical Practice 19 (2013) 36e43

lactation, missed period, menopause and appetite stimulant. The

FL (%)

ailment category for anaemia also achieved a high agreement

50

28
28

27
20

33
25
50

44

53
100

42
(ICF ¼ 0.96). The least agreement between the informants was
observed for the abortion category (ICF ¼ 0.84), followed by
diabetes (ICF ¼ 0.88), colitis (ICF ¼ 0.88), postpartum pain
0.02

0.02

0.08

0.05

0.12
UV

(ICF ¼ 0.89), antepartum swollen body extremities (ICF ¼ 0.91),

diarrhea (ICF ¼ 0.92), postpartum bleeding and abdominal
distension (ICF ¼ 0.94). The highest UV recorded for the
FOC

7
7

4
3
6

11

17
13
10
medicinal plant species was 0.14 and the lowest was 0.01. Plant
species with highest UV were; Ayapana triplinervis, Curcuma
longa, Mentha piperita, Zingiber officinale and Orthosiphon
Antepartum swelling of legs

aristatus.
Abdominal distension

As summarized in Tables 4AeC, the categories with the major

Postpartum bleeding
Postpartum diastasis

Memory enhancer

agreements were compared to highlight the most important

Postpartum pain

medicinal plant(s) in each group. For this comparison, plants

Chesty cough
Present uses

quoted only once were not considered. The species with the
Abortion
Diabetes

major Fl were compared to the Um values. For headache, ante-

Nausea
Allergy
Colitis

partum, lactation, missed period, menopause, appetite stimulant

and anaemia, it was found that plants with the highest Fl values
were not those with the major number of mentions (high Um). In
general, plants with a Fl value of 100 showed only a couple of
‘mentions’, which in contrast to plants with a high number of
Previous investigations

mentions (38 and 35), but had only Fl of 90 and 78, respectively.
cognitive function,

To avoid any ambiguity and for comparative analysis, all cate-

Nausea, improves

liver fibrosis46,47
Antibacterial31

gories of plants with more Um (for one purpose) were compared

Not reported

Not reported

Antioxidant,
anticancer43

with their Fl. Plants with most Um for all categories were; Mentha
piperita with 38 mentions for abdominal distension (Fl ¼ 90), C.
longa with 35 mentions for postpartum bleeding (Fl ¼ 78), Aya-
pana triplinervis with 25 mentions for abdominal distension
(Fl ¼ 52), O. aristatus with 25 mentions for abdominal distension
(Fl ¼ 66), Citrus sinensis with 19 mentions (Fl ¼ 100), Cymbopogon
Applicationc

citratus with 17 mentions for diarrhea (Fl ¼ 71), Erythroxylum

hypericifolium with 17 mentions for anaemia (Fl ¼ 100), Moringa
Ora

Ora

Ora
Loc

Loc

oleifera with 17 mentions for postpartum bleeding (Fl ¼ 74),

Preparation: De, decoction; In, infusion; Oi, oil; Ra, raw; Rc, rhizome is crushed; Sc, Seeds are crushed.

Ocimum tenuiflorum with 17 mentions for abdominal distension

Part(s) used: Bar, bark; Flo, flower; Fru, fruit; Lea, leaf; Rhi, rhizome; See, seed; Ski, skin; Brk, bark.

(Fl ¼ 63) and Acalphya spp. with 16 mentions for postpartum pain
Preparationb

(Fl ¼ 100).
De

De

De

De
In

3.4. Disclosure to medical doctor and concomitant use of CAM

with conventional medicines
Part(s) useda

Only a small number of participants (11%) had discussed the

type of CAM they were using with their physician. Few partici-
See

Lea
Lea

Lea

Rhi

pants (15%) were observed to use CAM together with drugs

prescribed by their medical doctors. Fifty percent (50%) of the
C.E.N ¼ Common English Name; FOC ¼ Frequency of citation.

Table 4A
Plants with high total use-mentions.
Jawain/Bishop’s weed

Gingembre/Ginger

Plant Total Um
Local name/C.E.N

Tamarind leaves
Feuille Tamarin/
Feuille lila/Lilac

Ayapana triplinervis 48
Thint/Thyme

Curcuma longa 45
Mentha piperita 42
Zingiber officinale 40
Orthosiphon artistatus 38
Application: Loc, local; Ora, oral.

Ocimum tenuiflorum 27
Trachyspermum ammi 25
Lens culinaris 25
Cymbopogon citratus 24
Scientific name/Family

Trachyspermum ammi

Moringa oleifera 23
Tamarindus indica

Lepidium sativum 20
Table 3 (continued )

Zingiber officinale
Thymus vulgaris
Syringa vulgaris

Pimpinella anisum 20
Zingiberaceae
Leguminosae

Citrus sinensis 19
Lamiaceae

Coriandrum sativum 19
Apiaceae
Oleaceae

Erythroxylum hypericifolium 17
Acalphya spp. 16
a
b
c

Um ¼ use-mentions.
 S. Suroowan, F. Mahomoodally / Complementary Therapies in Clinical Practice 19 (2013) 36e43 41

Table 4B family tradition and even the morphology of a plant, appeared to

Plants with high use-mentions for one ailment. influence use of certain herbal remedies.
Plant Category Um FL (%) Mauritius currently enjoys a rich profusion of flora and fauna
Acalphya spp. Postpartum pain 16 100 however; many old and experienced women claimed that medic-
Ayapana triplinervis Abdominal distension 25 52 inal plants they have long been using are becoming rare and some
Citrus sinensis Diarrhea 19 100 expressed concerns that some may be lost completely.
Curcuma longa Postpartum bleeding 35 78
It was noted that herbal preparations for PMS, during preg-
Cymbopogon citratus Postpartum bleeding 17 71
Erythroxylum hypericifolium Anaemia 17 100 nancy, homeopathy for menopausal symptoms and massage
Lens culinaris Anaemia 25 100 therapy for pain, stress, depression and anxiety were common
Mentha piperita Abdominal distension 38 90 practices in Mauritius. In contrast to studies conducted in other
Moringa oleifera Postpartum bleeding 17 74 countries reflexology, acupuncture and Tai Chi were not commonly
Ocimum tenuiflorum Abdominal distension 17 63
Orthosiphon aristatus Abdominal distension 25 66
used among Mauritians.
Zingiber officinale Postpartum bleeding 17 43 It was observed that where women had experienced positive
outcomes from using particular medicinal plants, they were more
Um ¼ use-mentions; FL ¼ fidelity level.
likely to grow these in their own yards for future personal use. Our
findings indicate that plant leaves, followed by seeds and roots
participants were found to have a preference for conventional were most commonly used for the formulation of herbal remedies.
medicines, 44% preferred CAM, whilst 6% reported that they Use of leaves in herbal remedies is a sustainable approach in phy-
considered both therapies to be equal. A significant portion of the totherapy as it increases sustainability of medicinal plant pop-
participants (94.4%) reported they would advise other women to ulations. Many women valued O. tenuiflorum, also known as holy
use same CAM therapies they had used. basil based on its medicinal properties and perceived religious
connotations. In this study, Mauritians demonstrated a sound,
informal knowledge of particular herbal identification, preparation
and application for specific conditions, identification of herbs,
4. Discussion mode of preparation and application This would suggest that
aspects of CAM have been passed down historically, from one
Mauritius is a multicultural developing island where the foun- generation to the next.
dations of CAM practices are strong. Our findings indicate that the Use of complementary and alternative drugs (CAD) including
majority of participants were using a wide range of CAM therapies formulations from ayurveda and homeopathy were not common
for their health management. We recorded a total of 13 distinct Mauritian practices during pregnancy. Women stated that their
CAM practices currently in use to treat or manage 26 different CAM providers were cautious about the negative effects that CAD
ailments. Moreover, a significant number of the participants were could have on the developing child and hence not prescribed
found to use CAM to improve the quality of their life or as during pregnancy. Our data showed that antepartum, pregnant and
prophylactic treatment. The use of biologically-based therapies was postpartum women preferred particular traditional practices
highest indicating that botanical remedies were easily accessible to including herbs and faith healing that had been successfully used
women. by their ancestors. The task of further care to postpartum women
The local population of Mauritius has a long-standing tradition and the newborn child was undertaken by midwives who
in the use of herbal/botanical remedies which might also be due to frequently also functioned as traditional healers helping new
the availability of a broad variety of plant species on the island. mothers recover from uterine bleeding and to promote involution
Among the local population, issues such a accessibility, free of cost, of the uterus. Significantly, herbal use was the prominent CAM
engaged during and after pregnancy.
Among the top ten cited ailment categories employing medic-
Table 4C
Plants with a high fidelity level and their use-mentions for one ailment. inal plants, half related to health conditions experiences during and
post pregnancy, such as postpartum bleeding, postpartum dia-
Plant Category Um FL (%)
stasis, postpartum pain, abortion and antepartum swollen body
Acalphya spp. Postpartum pain 16 100 extremities. Thus women’s perceptions of the medicinal value of
Amaranthus viridis Anaemia 4 100
Ananas bracteatus Abortion 2 100
herbal products during and after pregnancy was high. The role of
Artemisia verlotiorum Menopause 8 100 a spouse and/or family member in managing pregnancy was also
Camellia sinensis Postpartum bleeding 8 73 apparent. Pregnant women acknowledged the impact of emotional
Cinnamomum camphora Postpartum pain 3 100 support and advice from their spouse and parents as factors
Citrus sinensis Diarrhea 19 100
contributing to their ability to manage a healthy pregnancy.
Curcuma longa Postpartum bleeding 35 78
Cymbopogon citratus Postpartum bleeding 17 71 Our results indicated that the management of menopausal
Dimocarpus longan Postpartum pain 12 100 symptoms was positively associated with the use of CAM. None-
Erythroxylum hypericifolium Anaemia 17 100 theless, the number of women who claimed using CAM specifically
Justicia gendarussa. Postpartum pain 7 100 for menopausal symptoms was relatively low. It was apparent that
Kalanchoe spp. Antepartum swelling of legs 8 100
Lens culinaris Anaemia 25 100
though Mauritians tended to use CAM therapies to treat or manage
Mentha piperita Abdominal distension 38 90 menopausal symptoms, only a few were willing to discuss how CAM
Morinda citrifolia Antepartum swelling of legs 12 100 was used to alleviate symptoms such as hot flushes or night sweats.
Pimpinella anisum Abdominal distension 14 70 Despite the high preponderance of CAM usage half of the
Psidium guajava Diarrhea 10 100
women interviewed preferred conventional medicines over CAM
Punica granatum Diarrhea 6 100
Ricinus communis Headache 8 100 when faced with an acute problem. The women attributed this to
Sinapis alba Postpartum diastasis massage 13 100 the belief that conventional medicine was more effective in
Swertia chiraita Appetite stimulant 4 100 managing conditions requiring prompt medical attention, while
Syringa vulgaris Postpartum pain 6 100 CAM was generally perceived as providing effective long term use.
Um ¼ use-mentions; FL ¼ fidelity level. A significant number of women were reluctant to discuss the CAM
42 S. Suroowan, F. Mahomoodally / Complementary Therapies in Clinical Practice 19 (2013) 36e43
they were using to their physician. Fear of reprimand or ignorance
about side effects of CAM and drug interaction could influence
patients’ reluctance to disclose to their doctors, which CAM ther-
apies they were using. Moreover, the lack of physician’s knowledge
of CAM practices and the desire not to appear unconventional made
some physicians hesitant to discuss CAM with their patients.
Among plants reported in the present survey, only Z. officinale
was of particular relevance to women’s health when previous
studies involving its use were analyzed and compared. Z. officinale
has a long-standing use as a traditional remedy for treating and
managing morning sickness, including nausea and vomiting asso-
ciated with early pregnancy. A number of studies substantiate
effectiveness as an anti-emetic.47e50
One of the goals of a CAM field study is to probe the main
medicinal plants that are currently in use.23 In the present inves-
tigation, two quantitative tools were used; with the ICF, the main
categories of medicinal plants were detected and with the Fl and
Um, the most important species from these categories were iden-
tified.23 Based on these quantitative indices it was found that
Acalphya spp. was used for postpartum pain, E. hypericifolium for
anaemia, C. sinensis to treat diarrhea, C. longa and C. citratus, to
decrease or stop postpartum bleeding, Lens culinaris, to treat
anaemia and M. piperita, to treat abdominal distension. Interest-
ingly to date, these 6 plants have not been documented in the
scientific literature as managing women’s health. Currently, there is
no pharmacological study on Acalphya spp., E. hypericifolium and L.
culinaris addressing women’s ailments. Clinical studies tend to
suggest that C. longa has anti- inflammatory, antiviral and antimi-
crobial properties, while C. citratus and M. piperita have been
documented to possess antimicrobial and antioxidant properties.
Despite these reports, no studies appear to have been conducted to
identify the chemical composition and pharmacological actions of
these plants upon women’s health.
The use of medicinal animals was viewed as one aspect of self
management by women for their health. In contrast herbal use, the
practice zootherapy appeared to be scarce.
5. Conclusion and recommendations
In summary, there are a broad range of CAM therapies currently
employed by Mauritian women for their primary health care
management. This study provides a baseline upon which future
research can be developed. Of the 13 different complementary and
alternative medicines reported in this study, herbal preparations
were found to play a significant role when managing women’s
health during pregnancy. Local flora and fauna biodiversity can
therefore be considered important in Mauritius when identifying
the provision of affordable and easily accessed primary health care.
The relatively small number of participants who had discussed
use of CAM with their physicians suggests patients should be
encouraged to discuss their respective CAM use in order to avoid
possible risks of herbaledrug interaction, particularly during preg-
nancy, where the potential for adverse perinatal outcome should be
considered. It is recommended that Acalphya spp., E. hypericifolium,
C. sinensis, C. longa, C. citratus, L. culinaris and M. piperita must be
considered for further pharmacological investigations.
Conflict of interest statement
There are no conflicts of interests to disclose.
Acknowledgments
The authors are also grateful to the University of Mauritius for
financial support.
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