An ethnobotanical survey of traditional medicinal plants used against lymphatic filariasis in South Africa

An ethnobotanical survey of traditional medicinal plants used against lymphatic filariasis in South Africa

South African Journal of Botany 111 (2017) 12–16 Contents lists available at ScienceDirect South African Journal of Botany journal homepage: www.els...

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South African Journal of Botany 111 (2017) 12–16

Contents lists available at ScienceDirect

South African Journal of Botany journal homepage:

An ethnobotanical survey of traditional medicinal plants used against lymphatic filariasis in South Africa L. Komoreng a,⁎, O. Thekisoe b, S. Lehasa a, T. Tiwani a, N. Mzizi a, N. Mokoena a, N. Khambule a, S. Ndebele a, N. Mdletshe a a b

Department of Plant Sciences, University of the Free State, Private Bag X13, Phuthaditjhaba 9866, South Africa Unit for Environmental Sciences and Management, North-West University, Private Bag X6001, Potchefstroom 2520, South Africa

a r t i c l e

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Article history: Received 1 February 2017 Received in revised form 23 February 2017 Accepted 9 March 2017 Available online xxxx Edited by J Van Staden Keywords: Ethnobotany Medicinal plants Traditional healers Lymphatic filariasis Lymphoedema

a b s t r a c t Lymphatic filariasis is a condition where the skin thickens and hardens after excessive swelling associated with lymphoedema. The condition is caused by infection with parasites classified as nematodes. In this study, an ethnobotanical survey of medicinal plants used against lymphatic filariasis in the Eastern Cape, Free State, KwaZuluNatal and Mpumalanga Provinces of South Africa was conducted through the use of structured questionnaires. Information was gathered from 21 traditional healers, 9 herbalists and 12 elderly people. The respondents were asked questions regarding their use of medicinal plants to treat lymphatic filariasis and related ailments. Information entailing plants used to treat lymphatic filariasis, plant parts used, mode of preparation and dosage was recorded. The information collected revealed 46 medicinal plants belonging to 28 families were used against lymphatic filariasis. Members of the Asteraceae family were the most prominent, followed by Hyacinthaceae, Euphorbiaceae and Solanaceae. It was interesting to note that different traditional healers from the four Provinces use similar plants to treat lymphatic filariasis. The most frequently mentioned plants were Elephantorrhiza elephantina, Eucomis autumnalis, Ganoderma sp., Solanum aculeastrum, Hermannia geniculata, Datura stramonium and Pentanisia prunelloides. Leaves and underground plant parts were reported to be the most commonly used plant parts. The most prominent methods of herbal administration used were orally and soaking of the affected body part. This study has documented important ethnobotanical information on medicinal plants used by South African healers and indigenous people in the treatment of lymphatic filariasis and related diseases. © 2017 SAAB. Published by Elsevier B.V. All rights reserved.

1. Introduction Lymphatic filariasis (LF), commonly known as elephantiasis, is a sign of a variation of illnesses where parts of a person's body swell to enormous proportions. LF is characterized by thickening and hardening of the skin and subcutaneous tissue that results in grossly enlarged and very swollen limbs due to lymph accumulation (lymphoedema) (Mandal, 2014). The disease is mostly noticeable in the lower limbs, but also commonly affects breasts, arms and the scrotum in males. This is one of the most painful and intensely disfiguring diseases. LF is caused by infection with round filarial parasites classified as nematodes. The three types of filarial worms are Wuchereria bancrofti (which is responsible for 90% of the cases), Brugia malayi and Brugia timori (WHO, 2016).

Abbreviations: DEC, diethylcarbamazine; LF, lymphatic filariasis; WHO, World Health Organization. ⁎ Corresponding author at: Department of Plant Sciences, Faculty of Natural and Agricultural Sciences, University of the Free State, Private Bag X13, Phuthaditjhaba 9866, South Africa. E-mail address: [email protected] (L. Komoreng). 0254-6299/© 2017 SAAB. Published by Elsevier B.V. All rights reserved.

According to WHO (2014), more than 1.4 billion people in 73 countries are living in areas where LF is transmitted and are at risk of being infected. Currently, over 120 million people are affected by the infection, with 40 million people showing chronic disease symptoms (Molyneux, 2003; WHO, 2009; Maurya et al., 2015). One third of the people infected with LF live in India, one third in Africa and the remainder in South-East Asia, the Pacific, New Guinea and the Americas (Wynd et al., 2007). Within the African region, LF is endemic in 39 countries and the population at risk is estimated at 390 million (Zagaria and Savioli, 2002; Simonsen et al., 2008). South Africa is also burdened by LF, and according to a report by eNCA (2013), treating the disease remains a problem in South Africa. The unavailability of statistical data on LF adds to the problem. Approximately 31% of the South African population are at risk of being infected with bancroftian filariasis (Berger, 2014), with 530,000–1.06 million people having some form of lymphoedema (Davey, 2014). In a report published by Dlamini (2011) and eNCA (2013), patients are often turned away from some of the public hospitals in South Africa, reasons being that there is no treatment in the country or that the disease needs specialist care. People who are affected by this disease suffer from disability, as well as social and financial losses contributing to

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stigma and poverty (Evans et al., 1993, Ramaiah and Ottesen, 2014, Maurya et al., 2015). Prevention of LF is possible by stopping the spread of the infection (WHO, 2014). Its treatment involves a dose of albendazole together with ivermectin or diethylcarbamazine (DEC). Antibiotics may also be used to treat bacterial cellulitis which arises secondary to massive lymphoedema and elephantiasis. Unfortunately, these drugs are ineffective against adult worms, which are the ones that cause the disease (Debrah et al., 2007; Maurya et al., 2015). In addition, Netcare Foundation is providing funds for the treatment of elephantiasis, however, due to the lengthy process, the selection criteria for being accepted onto the programme are strict, resulting in a small number of patients being eligible (Netcare Limited, 2013). Hence, there is a need for an alternative treatment that is cheaper and as effective as allopathic management of the disease. Treating elephantiasis using medicinal plants is a common practice in some parts of the world. There are several herbs that have been prescribed by Ayurvedic medicine, for example, to treat elephantiasis, and some of them have been used for centuries (Agrawal, 1997; Gupta and Tandon, 2004). This study was aimed at gathering information from herbalists and traditional healers on traditional medicinal plants used to treat LF from four provinces in South Africa. 2. Materials and methods


sub-tropical temperatures and experiences high summer rainfalls. This area receives mean rainfall of 620 mm between September and March per annum, and due to the moist climate, the lowveld is a perfect home for mosquitoes to thrive in (, 2015). 2.2. Data collection Data was collected between February 2015 and October 2016. Information was compiled through general conversations with the informants while structured questionnaires were used to obtain additional information about the methods of treatment (Jovel et al., 1996). The main aim and vision of the interviews were explained to the participants and they consented to share their knowledge with us. Their consent to publish the findings was obtained before questioning. The information that was recorded included the age group and gender of the persons interviewed, common names of the plants used, their local uses, parts of the plants used, the mode of preparation and forms of administration of the medicinal plants. Ethical clearance was obtained from the University of the Free State. Plants were collected with the assistance of the traditional healers and herbalists. They were initially identified by their common names and proper identification was done by Dr. E.J.J. Sieben and voucher specimens were prepared and deposited at the herbarium of the University of the Free State (QwaQwa Campus).

2.1. Study area 3. Results and discussion Ethnobotanical surveys were conducted from the Eastern Cape (Intsika Yethu and Nkonkobe Municipal areas), Free State (Dihlabeng, Maluti-a-Phofung and Nketoana municipal areas), KwaZulu-Natal (Abaqulusi and eThekwini municipal areas) and Mpumalanga (Nkomazi municipal area) Provinces of South Africa. The Free State is an inland bean-shaped Province of South Africa. It is the third largest Province; covering about 10.6% of the country's total area and provides for most of the commercial farming of South Africa (, 2015). Four biomes found within the Province are grassland, Nama Karoo, savannah and forest; with 37 vegetation units found within these biomes (Mucina and Rutherford, 2006). The eastern part of the Free State consists of cool to very cold winters, especially towards the mountainous regions, and warm to hot rainy summer days. The Eastern Cape is a second largest Province, covering about 13.8% of the county's total area (South African Government, 2014). Maputaland-Pondoland Albany, the second biodiversity hotspot of South Africa is found in this Province. It is dominated by closed shrublands, low forests with evergreens, succulent trees, vines and shrubs (Hamann and Tuinder, 2012). It is characterized by the southern Drakensberg Mountains, ragged cliffs, northern tropical forest and dense bushes. Indigenous forest plants include yellowwoods, white stinkwood and many exotic plants (Hamann and Tuinder, 2012). The Eastern Cape displays a rainfall pattern with two modes, a winter rainfall zone in the west, and a summer rainfall zone in the east (Hamann and Tuinder, 2012). KwaZulu-Natal consists of three distinct geographical areas, the lowland Indian Ocean coastal region, the central Natal Midlands and the mountainous areas of the Drakensberg and Lebombo Mountains. Savannah grassland and areas of indigenous forest are found between the mountains and the humid, subtropical coastline (, 2015). The area is characterized by a fragmented distribution of medicinal plant species due to the varied land use, topography and climate (Mander, 1998). Kwazulu-Natal is a summer rainfall area, with extremely hot temperatures in summer and heavy snow on the mountains in winter (, 2015). Mpumalanga is a Province where the climate varies due to its topography. The Mpumalanga climate changes from the highveld to the lowveld area, and the vegetation in each area is determined by the climate it experiences. The lowveld has a tropical climate, with warm

The ethnobotanical list with detailed information is presented in Table 1. Information was gathered from 21 traditional healers (12 females and 9 males), 9 herbalists (all males) and 12 elderly people (4 females and 8 males). The ages of the informants ranged from 28 to 80 years old. During the ethnobotanical survey, it was established that all the informants frequently used medicinal plants to treat LF and the related diseases. It was interesting to note that traditional healers/herbalists from the different Provinces use the same plants, but had varying common names, to treat LF. For example, Elephantorrhiza elephantina was used by traditional healers from the Eastern Cape, Free State and KwaZulu-Natal to treat LF. In the Eastern Cape and KwaZulu-Natal the plant is known by Intolwane, whereas in the Free State it is known by Mositsane. All the informants mentioned that they collect plants from the veld. They only cultivate those that are difficult to access. The study revealed that 46 medicinal plants belonging to 28 families were used to treat LF and related ailments in South Africa. Members of the Asteraceae family were the most prominent with 7 species, followed by Hyacinthaceae with 6 species, Euphorbiaceae with 4 species and Solanaceae with 3 species. The rest of the families were represented by either one or two species each. Seven plants were frequently mentioned for the treatment of LF and related ailments by the traditional healers and herbalists from the Eastern Cape, Free State and KwaZuluNatal Provinces. These included E. elephantina, Eucomis autumnalis, Ganoderma sp., Solanum aculeastrum, Hermannia geniculata, Datura stramonium and Pentanisia prunelloides. Dicoma anomala, E. elephantina, and P. prunelloides have been reported to treat and manage a wide range of ailments in Lesotho and are, thus, in high demand (Kose et al., 2015). Plants could be used individually or in combination to treat LF. For example, one of the traditional healers from the Eastern Cape treated LF by using a mixture that contained equal portions of Eucomis comosa, Euphorbia clavarioides and Rumex obtusifolius. Ricinus communis, Drimia depressa, D. stramonium, S. aculeastrum, E. autumnalis, and Withania somnifera have been reported to possess toxic compounds though they are used for medicinal purposes (Taylor and Van Staden, 2001; Van Wyk et al., 2002; Ndhlala et al., 2013; Kose et al., 2015). These plants should, therefore, be handled with care and not be used without proper supervision.


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Table 1 Medicinal plants used for the treatment of lymphatic filariasis in South Africa. Family name

Scientific name

Common name


Plant part used

Method of preparation and administration


Tulbaghia alliacea L.f.











Achyropsis avicularis E.Mey. ex Moq. Alepidea amatymbica Eckl. & Zeyh. Ilex mitis (L.) Radlk.

Decoction and infusion used to treat swelling and wounds associated with ibekelo. Leaves are used to clean wounds.




Acorus calamus L.




Mots'ets'e Umsenge Phoa


Asteraceae Asteraceae

Cussonia paniculata Eckl.& Zeyh. Aster bakerianus Burtt Davy ex C.A.Sm. Berkheya setifera DC. Dicoma anomala Sond.

Rhizome/roots An infusion is made and taken internally for pain and inflammation. Leaves Leaves are rubbed for producing a lather that is applied externally Rhizome/roots Traditionally taken as a tea. May be used externally as a bath additive Leaves Leaf infusion is used to clean wounds and soak swollen limbs.

Mavumbuka Hloenya


Eriocephalus L. sp.

Asteraceae Asteraceae Asteraceae Balanophoraceae

Felicia erigeroides DC. Platycarpha glomerata Less. Senecio speciosus Willd. Sarcophyte sanguinea Sparrm. Kigelia Africana (Lam.) Benth. Chenopodium ambrosioides L. Capparis tomentosa Lam.



Bignoniaceae Chenopodiaceae Capparaceae


Decoction and infusion taken internally as an anthelmintic.


Roots Roots, leaves

Sehalahala sa matlaka


Whole plant

Ixhaphozi Umthuma Idambisa Umavumbuka

Whole plant Roots Leaves Rootstock




The decoction helps get rid of excess fluid in the body. Poultice is prepared with leaves to treat wounds. Root decoction is taken internally for infection. Infusion is used as a purgative for parasites and to treat skin infections. Infusion is used as a purgative for parasites. Treatment for wounds, swelling, pain. Leaf infusions are used to relieve pain and inflammation. Decoction is taken for pains and inflammation. It can be externally applied to treat sores. Infusion is used to treat skin infections.



Whole plant

Tea is prepared and taken at 2–3 hour intervals.

Indoda-ebomvu Intsihlo Ubhoqo Mothokho


Leaves and roots Roots

Decoction used to treat wounds and skin problems.


Infusion and decoction used to treat inflammation.

Leaves Whole plant Whole plant Whole plant

Leaves are made into a poultice to treat sore legs. Infusion and decoction used for easing inflammation. Concoction is drank three times daily. Can also be used to bath to treat wounds, swelling and skin problems Used to treat wounds, swelling and skin problems

Leaves and young roots. Roots and rhizomes

Leaves and roots used to treat headaches, pains and relieving clots from the body. The infusion of the inner parts of the roots is administered as enema


A powder diluted with water is taken orally as an anthelmintic.

Whole fungi

It is externally applied to treat sores.


The irritant foam caused by adding water to the bark is used to treat fever and heal wounds. The whole plant is boiled and taken internally as an anthelmintic. Bulbs and root shavings are boiled in water or milk and used as ingredients in infusions to treat pain and fever Decoctions of the bulb in water or milk are usually administered as enemas.


Ipomoea oblongata E.Mey. ex Choisy


Dioscorea sylvatica (Burch.) Marakalla/Leeto la tlou Spreng Var. Croton sylvaticus Hochst. Mahlabekufeni/Umhloshozane KZN

Euphorbiaceae Euphorbiaceae Euphorbiaceae Euphorbiaceae

Euphorbia clavarioides Boiss. Euphorbia gorgonis A.Berger Ricinus communis L.

iNkalimasane Sehlehle Nkalimasane/Intsema





Elephantorrhiza Mositsane elephantina (Burch.) Skeels Intolwane




Albizia anthelmintica (A. Rich.) Brongn. Ganoderma sp.


Gunnera perpensa (L.)


Drimia depressa (Baker) Jessop Eucomis bicolor Baker.

Ugobho Qobo Moretella





Eucomis autumnalis (Mill.) Chitt





Eucomis comosa Hort. ex Wehrh. Ledebouria sp.





Urginea delagoensis Baker.


Hypoxis latifolia (Baker.) Hook. Hermannia geniculata EckL. & Zeyh.

Ihlanganisa or Umahlanganisa EC, KZN Ilabatheka EC, KZN Seletjane FS Isidikili EC, KZN Ibohlololo KZN, MP Idolo lenkonyana EC


Mesembryanthemaceae Aptenia cordifolia (L.f.) Schwant. Polygonaceae Rumex obtusifolius L.



Whole plant Bulb




Infusion used to soak swollen limbs.


Concoction with E. clavarioides and R. obtusifolius used to heal wounds Decoction is taken orally for fever and pain. The infusion is used to wash wounds. Decoction is used for emetic and enemas.


Infusion is taken as blood-cleansing emetic.

Leaves Roots

Infusion is taken internally for sores and inflammation.

Whole plant

Medicinally used as an anti-inflammatory, and as a dressing (poultice). Ground and mixed with S. aculeastrum. Concoction is drank for

Whole plant

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Table 1 (continued) Family name

Scientific name

Common name



Portulaca oleracea L.




Cassipourea flanaganii (Schinz) Alston Cliffortia linearifolia Eckl. & Zeyh. Pentanisia prunelloides (Klotzsch ex Eckl. & Zeyh.) Walp. Datura stramonium L.




Solanum aculeastrum Dunal.



Withania somnifera (L.) Dunal Rhoicissus tomentosa (Lam.) Wild & R.B. Drumm. Rhoicissus tridentata (L.f.) Wild & R.B. Drumm.

Ubushwa Bofepha Isinwazi Umbovu Mboziso

Rosaceae Rubiaceae


Vitaceae Vitaceae

Unwele Icimamlilo Setima mollo Umhlamvuthwa Lechoe


Plant part used

Leaves and stem Roots and stem Leaves and stem Roots

Method of preparation and administration relief of pain associated with swollen limbs and other body parts. Crushed leaves can be applied directly to the skin. Aqueous infusion and decoction are taken orally and can be applied externally as lotion or wound dressing. Infusion is used to soak and treat swollen limbs Infusion is used to treat sores, boils and internal tumours

Roots and leaves

Concoction is taken internally as a blood purifier.

Fruits Leaves

Fruits and leaves are used fresh, dried, boiled, or charred (ashed) for the treatment of infestations and wounds, and swollen limbs. Root and leaf infusion is used to soak and treat swollen parts.

Roots Leaves Roots Root tuber

Boiled in milk to expel worms. Decoction using methylated spirit is used for inflammation.

EC: Eastern Cape; FS: Free State; KZN: KwaZulu-Natal; MP: Mpumalanga.

The informants use the whole plant or different plant parts (leaves, bark, roots, stem bark and bulbs) to treat LF. Roots, leaves and bulbs/tubers were reported to be the most commonly used plant parts, with bark and fruit being the least used plant parts. Herbalists claim to use underground plant parts most frequently, believing that they contain the highest concentration of potent healing agents (Shale et al., 1999; Appidi et al., 2008). Grinding plant material into fine powder was the preparatory method that was often used for plants used in the treatment of LF. According to Mumbengegwi et al. (2015), grinding of plant material assists the solvent to penetrate the plant's cellular structure. The smaller particle sizes lead to better surface contact with extraction solvents (Azwanida, 2015). Decoction and infusion were the most commonly used methods of preparation. The survey indicated that the most prominent methods of herbal administration used were orally and soaking of the affected limb in a bath containing the herbal preparation. 4. Conclusion This study documented important ethnobotanical information on traditional medicinal plants that are used by South African healers and indigenous people in the treatment of LF and related diseases. Fortysix plants were recorded in the management of LF and related diseases. Underground plant parts are the most harvested; hence, there is a need to educate the healers about the dangers of over-harvesting these medicinal plants. Based on the information collected, screening these plants for bioactivity and for toxicity is important in order to validate the claims made by the healers. Formatting of funding sources This project was financially supported by the Thuthuka grant of the National Research Foundation, South Africa made available to Lisa Komoreng. Acknowledgements The authors are most grateful to the herbalists and traditional healers who provided the information. Dr. Sieben is acknowledged for his assistance with plant identification.

References Agrawal, V.S., 1997. Drug Plants of India. Kalyani publishers, Ludhiana, India. Appidi, J.R., Grierson, D.S., Afolayan, A.J., 2008. Ethnobotanical study of plant used for the treatment of diarrhoea in the Eastern Cape, South Africa. Pakistan Journal of Biological Sciences 11, 1961–1963. Azwanida, N.N., 2015. A review on the extraction methods uses in medicinal plants, principle, strength and limitation. Medicinal and Aromatic Plants 4, 196. Berger, S., 2014. Infectious Diseases of South Africa. Gideon Informatics Inc., Los Angeles, California, USA. Davey, S., 2014. Lymphoedema and wound healing in South Africa. Wound Healing Southern Africa 7, 61–65. Debrah, A.Y., Mand, S., Marfo-Debrekyei, Y., Batsa, L., Pfarr, K., Buttner, M., Adjei, O., Buttner, D., Hoerauf, A., 2007. Macrofilaricidal effect of 4 weeks of treatment with doxycycline on Wuchereria bancrofti. Tropical Medicine and International Health 12, 1433–1441. Dlamini, E., 2011. Elephant man seeks help — and a wife. The New Age (6 August 2011). Evans, D.B., Gelband, H., Vlassoff, C., 1993. Social and economic factors and the control of lymphatic filariasis: a review. Acta Tropica 53, 1–26. Gupta, A.K., Tandon, N., 2004. Reviews on Indian Medicinal Plants. Indian Council of Medical Research, New Delhi. Hamann, M., Tuinder, V., 2012. Introducing the Eastern Cape: A Quick Guide to Its History, Diversity and Future Challenges. Stockholm University, Stockholm Resilience Centre, pp. 1–41. Jovel, E.M., Cabanillas, J., Towers, G.H.N., 1996. An ethnobotanical study of the traditional medicine of the Mestizo people of Suni Mirano, Loreto, Peru. Journal of Ethnopharmacology 52, 95–100. Kose, L.S., Moteetee, A., Van Vuuren, S., 2015. Ethnobotanical survey of medicinal plants used in the Maseru district of Lesotho. Journal of Ethnopharmacology 170, 184–200. Limited, Netcare, 2013. Corporate Social Investment: SA Report Annual Integrated Report. Mandal, A., 2014. What is elephantiasis? Mander, M., 1998. Marketing of Indigenous Medicinal Plants in South Africa — A Case Study in KwaZulu-Natal. Food and Agriculture Organization of the United Nations, Rome, Italy, pp. 1–151. Maurya, S.K., Singh, A.K., Seth, A., 2015. Potential medicinal plants for lymphatic filariasis. Journal of Critical Reviews 2, 1–6. Molyneux, D., 2003. Lymphatic filariasis (elephantiasis) elimination: a public health success and development opportunity. Filaria Journal 2, 13–18. Mucina, L., Rutherford, M.C., 2006. The vegetation of South Africa, Lesotho and Swaziland. Strelitzia 19. South African National Biodiversity Institute, Pretoria. Mumbengegwi, D.R., du Preez, I., Dushimemaria, F., Auala, J., Nafuka, S., 2015. The use of traditional medicinal plants as antimicrobial treatments. In: Chinsembu, K.C., Cheikhyoussef, A., Mumbengegwi, D., Kandawa-Schulz, M., Kasanda, C.D., Kazembe, L. (Eds.), Indigenous Knowledge of Namibia. University of Namibia Press, Windhoek, pp. 89–114. eNCA, 2013. Elephantiasis Patient Takes It in Her Stride (Saturday 26 October). Ndhlala, A.R., Ncube, B., Okem, A., Mulaudzi, R.B., Van Staden, J., 2013. Toxicology of some important medicinal plants in southern Africa. Food and Chemical Toxicology 62, 609–621. Ramaiah, K.D., Ottesen, E.A., 2014. Progress and impact of 13 years of the global programme to eliminate lymphatic filariasis on reducing the burden of filarial disease. PLoS Neglected Tropical Diseases 8, e3319–e3328.


L. Komoreng et al. / South African Journal of Botany 111 (2017) 12–16

Shale, T.L., Stirk, W.A., Van Staden, J., 1999. Screening of plants used by southern African traditional healers in the treatment of dysmenorrhea for prostaglandin-synthesis inhibitors and uterine relaxing activity. Journal of Ethnopharmacology 64, 9–14. Simonsen, P.E., Malecela, M.N., Michael, E., Mackenzie, C.D., 2008. Lymphatic Filariasis Research and Control in Eastern and Southern Africa. DBL- Centre for Health Research and Development, Denmark. South African Government, 2014. South Africa's provinces. Available online. http://govza., 2015. Geography and climate. http// Taylor, J.L.S., Van Staden, J., 2001. Cox-1 inhibitory activity in extracts from Eucomis L'Herit. species. Journal of Ethnopharmacology 75, 257–265. Van Wyk, B.-E., Van Heerden, F., Van Oudtshoorn, B., 2002. Poisonous Plants of South Africa. Briza Publications, Pretoria, South Africa.

WHO, 2009. Global programme to eliminate lymphatic filariasis. Weekly Epidemiological Record 84, 437–444. WHO, 2014. Lymphatic filariasis. Fact Sheet No. 102 Updated March 2014, pp. 1–3. WHO, 2016. Lymphatic filariasis. Fact Sheet Updated October 2016, pp. 1–4. Wynd, S., Melrose, W.D., Durrheim, D.N., Carron, J., Gyapong, M., 2007. Understanding the community impact of lymphatic filariasis: a review of sociocultural literature. Bulletin of the World Health Organization 85, 421–500. Zagaria, N., Savioli, L., 2002. Elimination of lymphatic filariasis: a public-health challenge. Annals of Tropical Medicine and Parasitology 96, S3–S13.