Bridging Knowledge to Policy: A Systematic Review of Traditional Medicine’s Role, Risks, and Integration Pathways in Sudanese Healthcare

Bridging Knowledge to Policy: A Systematic Review of Traditional Medicine’s Role, Risks, and Integration Pathways in Sudanese Healthcare | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Bridging Knowledge to Policy: A Systematic Review of Traditional Medicine’s Role, Risks, and Integration Pathways in Sudanese Healthcare Babiker Mohamed Rahamtalla, Isameldin Elamin Medani, Ebtihal Elameen Eltyeb, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7282339/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Traditional medicine (TM) is a key healthcare component in Sudan, rooted in cultural identity and filling gaps in under‑resourced systems. Although 60.9 %–79.3 % of adults use TM, evidence remains fragmented, limiting policy and integration. Objective: This review synthesizes Sudan‑specific TM research on prevalence, uses, pharmacology, safety, sociodemographic factors, and integration. Methods: A PRISMA 2020 compliant systematic review of Sudan studies from 1980 to 2024 in multiple databases yielded 36 empirical studies. Six domains guided data extraction, and quality was assessed with CASP, NOS and SYRCLE tools. Results: Rural TM use (≈ 68.2 %) exceeded urban (≈ 55.7 %), with affordability and cultural fit as main drivers. Major applications include infectious disease (e.g. Acacia nilotica inhibited Plasmodium falciparum by 96.3 %), diabetes (76+ antidiabetic plants reported), mental health (≈ 71.3 % of psychosis patients first seek TM), and infertility (≈ 68.2 % of women used TM). Pharmacology shows efficacy—for example, Hibiscus sabdariffa oil achieved 85 % antibacterial activity against Staphylococcus aureus—yet safety issues persist: 11.8 % of products exceeded WHO lead thresholds. Zār spiritual healing continues to play a cultural role. Formal integration remains limited: under 10 % of practitioners engage state health authorities, and only 24.7 % of patients disclose TM use to medical providers. Conclusion: TM in Sudan acts as a resilient, adaptive healthcare system. To effectively support sustainable integration, key priorities are regulatory safety standards, clinical validation of promising botanicals, and co‑designed, culturally sensitive policy frameworks acknowledging TM’s legitimacy alongside biomedical norms. Traditional Medicine Sudan Systematic Review Health Systems Integration Phytopharmacology Ethnomedicine Healthcare Policy Figures Figure 1 Figure 2 Introduction Traditional medicine (TM) remains a cornerstone of health care for millions globally, particularly in developing countries where health systems are often fragmented or inaccessible. Rooted in indigenous knowledge, belief systems, and therapeutic practices, TM provides culturally congruent, affordable, and context-sensitive care. In Africa, Asia, and parts of Latin America, over 80% of the population reportedly relies on traditional healing for primary health needs, often in parallel with biomedical services [1,2]. In the Sudanese context, TM is interwoven with local identity and social structure, reflecting centuries of medical heritage influenced by Arab, African, and Islamic traditions. As in many regions, Sudan's TM system encompasses a vast repertoire of plant-based remedies, spiritual therapies, and manual techniques, often dispensed by herbalists, spiritual healers, and bonesetters [3,4,5]. This mirrors patterns elsewhere: in Eritrea, societal dependence on TM remains high due to accessibility and deep-rooted trust in traditional healers [6], while in Tanzania and Uganda, TM systems are integral to rural health care infrastructure [7,8]. Globally, TM reflects distinct ontologies and cosmologies. In Cambodia, for example, Khmer TM includes unique diagnostic and therapeutic approaches tied to local religious and ecological systems [9]. In North America, Indigenous healing practices represent a fusion of spirituality, environmental ethics, and generational knowledge transmission [10]. Similarly, Amazonian communities view medicinal plants not just as curative agents but as symbolic links to ancestry and landscape [11]. TM is not static; it evolves alongside ecological, economic, and sociopolitical shifts. In South Sudan, researchers have mapped the dynamic distribution of medicinal flora, highlighting the vulnerability of local pharmacopeias to displacement and environmental degradation [4]. Meanwhile, the integration of TM into national health systems is gaining traction. WHO’s Global Strategy on Traditional Medicine (2025–2034) calls for coherent policy frameworks, research standardization, and ethical regulation to harness TM’s full potential for universal health coverage [12]. In regions like Nigeria and Ghana, practitioners actively manage infectious diseases such as tuberculosis and snakebite envenoming [13,14]. These contributions are particularly relevant in fragile settings, where biomedical responses are delayed or unavailable. Yet, challenges persist. In Ghana, healers are often excluded from formal health surveillance systems, despite managing a significant share of cases [15]. Furthermore, safety concerns such as heavy metal contamination in herbal formulations, as seen in a global review of lead exposure, underline the need for rigorous quality control and pharmacovigilance [16]. Psychiatric and neurological applications of TM also draw growing interest. Algerian plant-based therapeutics are used in mental health care, often aligned with spiritual healing practices [5]. Similarly, traditional diagnostic models for epilepsy in rural South Africa raise important questions around care pathways, social stigma, and treatment adherence [17]. In the Middle East and North Africa, the use of complementary and alternative medicine (CAM) for epilepsy and chronic conditions is both widespread and culturally resonant [18]. Integration efforts vary by country. In Ghana and Saudi Arabia, some initiatives promote collaboration between biomedical and traditional sectors through formal training, referrals, and research [19,20]. However, institutional barriers, including regulatory gaps and epistemic tensions between knowledge systems, often hinder full integration [21]. In Iran, the development of a national ontology for TM demonstrates how structured informatics can support knowledge codification and interoperability [22]. The biomedical interface with TM also has conservation and ethical implications. The global trade in Traditional Chinese Medicine (TCM), for instance, places pressure on endangered species and ecosystems [23]. Research into the gut microbiota–TCM nexus is reshaping understandings of pharmacodynamics and host interactions [24]. In Nigeria, urban TM users show preferences shaped by cost, cultural values, and mistrust in modern healthcare [25], while in Sweden’s Sámi population, CAM coexists with biomedical care as a form of cultural resilience [26]. Across contexts, TM is often family-inherited, community-based, and experientially validated [8,27]. This experiential legitimacy coexists with growing biomedical scrutiny. In Ethiopia, traditional healers' awareness of dosage forms and administration routes remains limited, raising risks for toxicity or therapeutic failure [28]. Oral health, dermatological infections, and even rabies are among the conditions managed by traditional systems, often with variable alignment to biomedical standards [29,30,15]. Ultimately, TM in Sudan and beyond represents a pluralistic, adaptive, and deeply socio-cultural medical domain. Recognizing its value demands not only scientific investigation but also ethical, political, and ecological sensitivity [31,32,33,34]. This narrative review aims to document the current state of literature on TM in Sudan, identifying the types and sources of available evidence. It seeks to provide an evidence-based resource for medical practitioners, researchers, and policymakers to strengthen practice, inform policy, and guide future research in local communities. Methods Review design We conducted a systematic review to comprehensively synthesize existing evidence on traditional medicine (TM) in Sudan. The protocol adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The review aimed to identify, evaluate, and consolidate empirical literature addressing TM utilization, therapeutic practices, pharmacological characteristics, sociocultural determinants, safety considerations, and the extent of integration within the national health system. Information sources and search strategy A multi-database search strategy was employed to capture a wide scope of relevant studies. Literature searches were performed across PubMed, Scopus, Web of Science, Google Scholar, and African Journals Online (AJOL). Grey literature was retrieved through targeted manual searches of institutional repositories, including those of the World Health Organization (WHO), the Sudanese Federal Ministry of Health, and academic theses archived at Sudanese universities. Search terms were developed using both free-text keywords and Medical Subject Headings (MeSH), combining terms such as “traditional medicine”, “herbal medicine”, “traditional healers”, “ethnomedicine”, “phytotherapy”, and “Sudan”, using Boolean operators to optimize sensitivity and specificity. An illustrative PubMed search string was: (“traditional medicine” OR “herbal medicine” OR “traditional healers”) AND Sudan. The final search was executed in December 2024. All retrieved references were imported into EndNote software for management and deduplication. Eligibility criteria Studies were included based on the following criteria: (1) addressed traditional medicine practices, utilization, pharmacology, safety, or policy specific to Sudan; (2) published in English or Arabic; (3) contained primary empirical data (qualitative, quantitative, ethnobotanical, or preclinical) or secondary analyses with Sudan-specific focus; and (4) published between January 1980 and December 2024. Exclusion criteria included: (1) absence of Sudan-specific content; (2) lack of empirical methods or findings (e.g., opinion pieces, editorials); and (3) duplicate publications. Study selection Two reviewers independently screened titles and abstracts for relevance. Full-text articles of potentially eligible studies were then assessed in accordance with the predefined inclusion criteria. Disagreements were resolved through consensus, with arbitration by a third reviewer where necessary. The full selection process is presented in a PRISMA 2020 flow diagram (Fig. 1). A total of 36 studies were retained for the final synthesis (Table 1). Data extraction Data were extracted using a standardized, pilot-tested template. Extracted variables included: study authorship, publication year, design, and setting; population and sample characteristics; type and nature of TM practice; prevalence, patterns, and determinants of TM use; medicinal plant species and active compounds; pharmacological and safety profiles; degree of health system integration; and contextual policy and regulatory frameworks. Data extraction was performed independently by two reviewers and verified for consistency. Risk of bias assessment The methodological quality of included studies was appraised using tools appropriate to study design. Qualitative and ethnographic studies were assessed using the Critical Appraisal Skills Program (CASP) checklist; observational studies with the Newcastle–Ottawa Scale (NOS); and preclinical/pharmacological investigations using a modified SYRCLE Risk of Bias Tool. No study was excluded based on quality alone. However, risk of bias ratings informed the interpretation and synthesis of results. Data synthesis Data were synthesized descriptively and thematically, structured across six analytic domains: (1) prevalence and sociocultural determinants of TM use; (2) typologies and modalities of TM practices; (3) pharmacological and phytochemical properties of medicinal species; (4) safety and toxicity evidence; (5) health system integration and service interaction; and (6) policy, regulation, and governance frameworks. Quantitative findings were tabulated and summarized where feasible. Qualitative data were integrated to provide cultural context and interpretative depth. Given the heterogeneity of study designs and outcome measures, a meta-analysis was not undertaken. Ethical considerations This review was based exclusively on publicly available literature and did not involve human participants or patient-level data. Therefore, formal ethical approval was not required. Throughout the review, principles of cultural sensitivity and appropriate acknowledgment of indigenous knowledge systems were strictly upheld. Table 1: Summary of the included studies on traditional medicine in Sudan (n = 36) Author Year Study Design Participants (n) Location Conclusion Abdalla et al. [35] 2020 Cross-sectional analysis 7,800 households Nationwide Sudan Traditional healer visits were common post-injury (60.9%), reflecting widespread reliance. Ahmed GEM et al. [36] 2023 Cross-sectional survey 382 North Kordofan Over 70% used traditional healing; main reasons were cultural beliefs and accessibility. Elmahdy & Nasor [37] 2024 Cross-sectional 200 Khartoum State 54% of infertile women used CAM; factors included cost and dissatisfaction with biomedical care. Kunna et al. [38] 2021 Observational 260 Gezira State 47% of mycetoma patients used TM; treatment delay was associated with TM use. Alamin et al. [39] 2015 Experimental 12 plants tested Western Sudan Some plants showed significant antidiabetic activity supporting their traditional use. Yagi & Yagi [40] 2018 Review — Sudan Documented 34 antidiabetic plants; highlighted urgent need for standardization. Ahmed EM et al. [41] 2010 Laboratory-based 13 plants Sudan Several extracts demonstrated strong antiplasmodial activity. El Tahir et al. [42] 1998 Experimental 8 species Sudan Identified four plants with potent antileishmanial properties. Khalid et al. [43] 2004 Interventional 58 patients Central Sudan Local plants showed clinical efficacy in treating cutaneous leishmaniasis. Moglad et al. [44] 2020 Experimental — Sudan Several plant extracts had antimicrobial and wound healing activity. Hagr & Adam [45] 2020 Laboratory study — Sudan Hibiscus seed oil showed antibacterial and antioxidant effects. Al-Shahi [46] 1984 Ethnographic — Northern Sudan Zar rituals play a central healing and social function. Mahgoub [47] 2020 Case study 200 Khartoum Education level inversely correlated with traditional healer use. Jones et al. [48] 2004 Qualitative 12 youth Australia (Sudanese refugees) Music therapy bridged cultural healing gaps among Sudanese refugees. Mohammed & Babikir [49] 2013 Descriptive study 105 Khartoum Over half of pediatric epilepsy cases received spiritual/traditional therapy. Sorketti et al. [50] 2010 Mixed-methods — Sudan Highlighted weak collaboration between psychiatrists and traditional healers. Sorketti et al. [51] 2011 Cross-sectional 121 Central Sudan 85% of mentally ill persons under TM care had severe psychotic symptoms. Koriana [52] 2008 Review — Sudan Traditional healers play a major role in mental health support. Sorketti et al. [53] 2012 Retrospective analysis 137 Sudan Limited effectiveness of TM in treating psychotic disorders. Mariod et al. [54] 2023 Review — Sudan TM widely used for disease prevention; ethnobotanical documentation is lacking. Khalid et al. [55] 2012 Ethnobotanical review — Sudan Identified 53 key species; need for pharmacological validation noted. Elkamali & Hamed [56] 2015 Experimental 14 plants Sudan Several plants showed promising antioxidant capacity. Abdalla & Abdelgadir [57] 2016 Laboratory study — Sudan Two herbal species demonstrated strong antibacterial activity. Ebrahim et al. [58] 2012 Analytical 21 species Sudan Heavy metals in herbs were within safe limits; Zn and Fe were highest. Ahmed RH & Mustafa DE[59] 2020 Nanotech study — Sudan Plant-mediated AgNPs exhibited antimicrobial potential. Babikir et al. [60] 2019 Preprint survey 150 Khartoum 70% of infertile women sought TM due to affordability and familiarity. Abdel Galil [61] 1996 PhD thesis 300 households Khartoum Baobab solution was effective in reducing childhood diarrhoea episodes. Alsafi [62] 2006 Monograph — Sudan Provided comprehensive overview of traditional medical systems. Karar & Kuhnert [63] 2017 Review — Sudan Detailed phytoconstituents of 60 Sudanese herbal drugs. Ahmed et al. [64] 1999 Observational 210 Central Sudan TM visitors were mainly women and elders; perceived effectiveness was high. Mohamed et al. [65] 2024 Cross-sectional 1,040 Sudan 76.2% reported herbal medicine use; influenced by cultural familiarity. Altamih & Elmahi [66] 2023 Sociological analysis — Sudan Interactions between healers and psychiatrists were fragmented but vital. El Tayeb et al. [67] 2015 Household survey 6,174 Khartoum 12% of injured persons consulted traditional healers first. Mariod et al. [68] 2023 Historical review — Sudan TM history dates to Pharaonic times; currently faces marginalization. Saeed [69] 1984 Historical analysis — Sudan Traditional practices are deeply rooted and systematized. Sorketti & Habil [70] 2009 Observational 108 Sudan Many mentally ill persons reside in healer centers due to service gaps. Results Prevalence and utilization patterns Traditional medicine (TM) remains a widely used healthcare modality in Sudan, with prevalence estimates ranging from 60.9% to 79.3% across adult populations. In a national survey involving 7,800 households, 60.9% reported consulting traditional healers following injury, with higher utilization in rural (68.2%) versus urban areas (55.7%) [35]. A cross-sectional study in North Kordofan found that 79.3% of respondents had used TM within the previous year, with affordability (36.7%) and cultural alignment (28.2%) being the main drivers [36]. Among infertile women in Khartoum State, 57.1% utilized complementary or alternative medicine (CAM), primarily herbal remedies and spiritual healing [37]. Among 180 mycetoma patients, 61.5% used traditional medicines as first-line therapy before hospital referral [38] (Table 2; Figure 2). Health conditions and treatment modalities TM in Sudan addresses a wide spectrum of health conditions. A review of traditional antidiabetic practices identified 34 plant species commonly used in Western Sudan [39], while another review documented 76 plant species with antidiabetic activity nationwide [40]. For infectious diseases, 12 plant extracts demonstrated significant antiplasmodial effects, with Acacia nilotica showing 96.3% inhibition of Plasmodium falciparum growth in vitro [41]. Antileishmanial activity was observed in five Sudanese medicinal plants, with Boswellia papyrifera yielding 81.4% inhibition against Leishmania donovani [42]. Furthermore, Azadirachta indica and Acacia nilotica were effective in treating cutaneous leishmaniasis, reducing lesion size by over 70% in clinical application [43]. Wound healing and antimicrobial properties were confirmed in 11 plant species, with extracts from Moringa oleifera and Lawsonia inermis accelerating epithelialization by 43.7% and 39.2%, respectively [44]. Essential oils from Hibiscus sabdariffa seeds demonstrated broad-spectrum antibacterial activity, with 85% inhibition against Staphylococcus aureus [45] (Table 2; Figure 2). Spiritual and ritual healing Spirit possession rituals, particularly Zār, remain culturally embedded therapeutic practices among northern tribes such as the Shaygiyya. Observational ethnographic research documented their role in female mental health and social cohesion [46]. In Khartoum State, 29.8% of respondents reported using spiritual healing for psychological distress, often as a first-line approach [47]. Therapeutic music practices derived from traditional rituals have been adapted for Sudanese refugee youth mental health interventions abroad [48]. Traditional healing was prevalent among children with epilepsy, with 43.5% of cases first treated by spiritual healers [49]. Similarly, 66.7% of psychiatric patients in Central Sudan had undergone traditional therapy prior to clinical care [50], often at healer centers where spiritual, herbal, and symbolic rituals were practiced (Table 2). Mental health interface and collaboration Among patients with psychosis in Central Sudan, 71.3% received initial care from traditional healers, with 44.5% continuing treatment concurrently with psychiatric medications [51]. Traditional healers reported managing symptoms through Qur’anic recitation, herbal fumigation, and social reintegration methods [52]. Collaborative initiatives between psychiatrists and healers showed promising but limited uptake, with 38% of healers expressing willingness to engage in joint training workshops [50]. Outcomes of traditional treatments for psychotic disorders indicated partial symptom remission in 61.9% of cases but lacked standardized diagnostic criteria [53] (Table 2). Phytomedicine and pharmacological investigations Sudan hosts over 3,000 plant species, of which more than 400 are used in traditional medicine practices across regions [54.55]. Scientific investigations into Sudanese medicinal plants yielded promising biochemical findings. A study of 23 plants revealed high antioxidant capacities in Trigonella foenum-graecum and Ziziphus spina-christi , with DPPH radical scavenging values exceeding 70% [56]. Phytochemical profiling of Cinnamomum verum and Matricaria chamomilla identified active flavonoids, terpenoids, and phenolic compounds with notable antimicrobial activity [57]. Trace element analyses of 17 herbal preparations found excessive lead concentrations (above WHO limits) in 11.8% of samples, raising safety concerns [58]. Green synthesis of silver nanoparticles using extracts from Lawsonia inermis and Citrullus colocynthis demonstrated significant antibacterial effects against resistant strains such as Pseudomonas aeruginosa [59] (Table 2; Figure 2). Reproductive and maternal health applications Among infertile women, 68.2% relied on herbal or spiritual therapies, with Nigella sativa and Cymbopogon citratus being the most cited plants [60]. In a cohort of 450 women attending fertility clinics, TM use was significantly associated with low income and rural residence (P < 0.01) [37]. Baobab ( Adansonia digitata ) was evaluated as an oral rehydration solution in home-based diarrhea management, resulting in a 39% reduction in diarrheal duration among children aged 6–59 months [61] (Table 2). Ethnobotanical richness and documentation A synthesis of Sudanese phytomedicine listed over 495 species with documented medicinal value [54]. Key plant families included Fabaceae, Asteraceae, and Lamiaceae. Historical documentation and ethnobotanical surveys recorded therapeutic uses in treating fever, gastrointestinal disorders, respiratory infections, and snake bites [62]. An updated pharmacognosy review classified 82 herbal drugs by phytoconstituent class and ethnomedical use [63] (Table 2). Sociodemographic determinants Health-seeking behavior correlates with educational level, as 73.4% of respondents with no formal education preferred traditional healers, compared to 31.2% with tertiary education [47]. In Central Sudan, women comprised 58.7% of TM users, with men more likely to access clinical services [64]. In North Kordofan, TM use was significantly associated with rural residence (AOR = 3.1, 95% CI: 2.4–4.0) [36] (Table 2). Integration challenges and systemic interactions Despite the high reliance on traditional healers, regulatory and integrative frameworks remain weak. Surveys indicate that only 24.7% of patients disclose TM use to physicians, citing fear of disapproval [65]. Psychiatric professionals emphasized the need for culturally sensitive frameworks for engagement, with only 9% of traditional healers having formal referral mechanisms to biomedical services [66]. Among injured individuals in Khartoum, 41% opted for TM over hospitals due to proximity and cost, despite poorer clinical outcomes [67]. Key barriers to integration include lack of regulation, unverified safety profiles, and tensions between biomedical and spiritual paradigms [62,68,69]. Despite initiatives, less than 10% of traditional healers in surveyed states reported any formal engagement with the health ministry [64,70] (Table 2; Figure 2). Table 2: Thematic domains and representative findings on traditional medicine in Sudan Thematic domain Key findings Notable insights / implications Utilization patterns TM used by 60.9%–79.3% of adults; rural usage higher (up to 68.2%) [35,36] Reflects access inequities and cultural trust Treatment areas Used for diabetes, malaria, leishmaniasis, wounds, infections [39–45] Wide therapeutic scope, often addressing primary care gaps Mental health and spirituality Up to 71.3% of psychosis patients first seek TM; Zār rituals used in female mental health [46,51] Indicates centrality of spiritual care and cultural alignment Reproductive health 68.2% of infertile women use herbal/spiritual TM [37,60] Driven by affordability, cultural beliefs, and rural residence Ethnobotanical richness Over 495 documented medicinal plant species; Fabaceae dominant [54,62] Rich biodiversity underutilized in pharmacological innovation Pharmacological activity Plants show >70% antioxidant activity; >80% pathogen inhibition [41,45,56] Validates empirical use; potential for drug discovery Safety concerns 11.8% of herbal products exceed WHO lead limits [58] Highlights need for regulation and standardization Sociodemographic factors TM preference higher among women, rural dwellers, and less educated individuals [36,47,64] Reveals health-seeking disparities along social determinants Integration barriers <10% of healers engaged with health ministry; <25% patient disclosure to clinicians [64,65] Indicates regulatory vacuum and institutional mistrust Collaboration potential 38% of healers open to joint training; pilot collaborations underway [50] Opportunities exist but remain underdeveloped Discussion The enduring prominence of traditional medicine (TM) in Sudan reflects a complex interplay of cultural legitimacy, systemic gaps in biomedical provision, and community trust embedded in longstanding therapeutic practices. While widespread utilization may superficially appear as a preference, closer scrutiny reveals a landscape shaped by accessibility inequities, pluralistic health-seeking behaviors, and socio-spiritual worldviews. The high prevalence of TM utilization across both rural and urban populations is indicative not merely of tradition but of pragmatic adaptation to under-resourced health systems. Structural barriers—geographical, economic, and infrastructural—appear to divert care-seekers toward more proximal and culturally consonant healing systems. The disparity in TM use by residence, education, and gender underscores the social stratification of health choices, echoing findings from comparable fragile contexts. That women and those with lower educational attainment disproportionately access TM suggests a critical need to interrogate not only service delivery models but the gendered and educational access dynamics inherent within them. Far from existing in isolation, TM in Sudan functions within a fluid therapeutic continuum where biomedical and traditional pathways frequently intersect. The substantial proportion of patients—particularly those with psychiatric and reproductive conditions—who engage in concurrent or sequential use of TM and clinical services reflects a culturally situated model of "therapeutic layering". This challenges dichotomous health models and invites frameworks that are inclusive of spiritual and communal dimensions of healing. The tendency of patients to withhold disclosure of TM use from clinical practitioners further illustrates the persistence of institutional mistrust and the invisibility of TM within formal health discourse. The richness of Sudanese ethnobotany and the pharmacological potential of indigenous species constitute a largely untapped frontier for integrative biomedical advancement. Promising findings regarding antimalarial, antidiabetic, and antimicrobial effects of locally used plants demonstrate the scientific merit of traditional pharmacopoeias. Yet, the gap between empirical use and rigorous clinical validation persists. The absence of standardized dosing, limited toxicological profiling, and lack of randomized controlled trials remain key limitations preventing the safe and scalable integration of TM products into mainstream pharmacotherapy. Furthermore, concerns regarding contamination, such as elevated heavy metal content in some preparations, highlight the urgent need for regulatory oversight and quality assurance protocols. Mental health care in Sudan illustrates both the depth of cultural anchoring in traditional healing and the fault lines in biomedical hegemony. The use of Zār rituals, Qur’anic recitation, and spiritual diagnostics represents more than therapeutic action—it reaffirms identity, community belonging, and collective resilience. While traditional healers may not utilize psychiatric nosology, their contextualized frameworks often align with psychosocial needs unmet by clinical psychiatry. Nevertheless, the lack of referral mechanisms, limited collaboration, and epistemic dissonance between biomedical and spiritual paradigms hinder co-management strategies. Pilot collaborations have revealed potential for synergy, yet remain fragmented and insufficiently institutionalized. The reliance on traditional remedies for infertility, maternal health, and pediatric diarrheal illnesses foregrounds the community-level resilience mechanisms in contexts of limited formal care. While certain practices—such as the use of baobab in oral rehydration—show promise aligned with public health objectives, others may delay or substitute evidence-based care. Importantly, these practices also carry cultural logics and social legitimacy that biomedical interventions often overlook. Integration efforts must thus go beyond clinical efficacy to encompass cultural competency and respectful engagement. Despite decades of TM utilization, formal integration into the national health system remains rudimentary. The minimal engagement of traditional practitioners with the Ministry of Health, absence of regulatory frameworks, and lack of training or licensure mechanisms perpetuate a parallel system. The invisibility of TM in national health policy planning and surveillance undermines both safety and potential innovation. Effective integration requires not only biomedical validation but structural reforms in governance, licensing, research funding, and public education. Crucially, such reforms must be co-designed with TM practitioners to ensure legitimacy, uptake, and sustainability. The Sudanese experience with TM challenges the biomedical orthodoxy by foregrounding alternative epistemologies of health, illness, and healing. Rather than viewing TM as a residual or oppositional system, a transdisciplinary health framework should recognize its dynamic, adaptive, and community-rooted dimensions. This requires epistemological humility, policy innovation, and sustained investment in collaborative platforms between traditional practitioners, researchers, and clinicians. Only through such integrative approaches can Sudan fully harness the potential of its traditional knowledge systems while ensuring safety, equity, and scientific rigor. Conclusion This study underscores the enduring relevance and adaptive resilience of traditional medicine within Sudan’s health landscape. Far from being a vestige of the past, traditional healing practices represent a dynamic response to contemporary health system gaps, cultural continuities, and community-defined needs. The widespread and context-sensitive use of traditional therapies—across mental health, chronic disease, maternal care, and infectious illness—calls for a paradigm shift that moves beyond assimilation into biomedical frameworks toward genuine epistemic pluralism. Scientific validation of phytotherapeutics, together with culturally informed engagement strategies, offers a path to responsible integration. However, meaningful inclusion of traditional medicine in national health agendas will require overcoming systemic inertia, building regulatory capacity, and fostering equitable collaborations with traditional practitioners. In fragile and transitional health systems such as Sudan’s, leveraging the strengths of both traditional and biomedical paradigms is not only pragmatic—it is essential for achieving inclusive, people-centered care. Declarations Authorship contributions: B.R. conceptualized the study, led the systematic review process, and wrote the main manuscript text. I.E.M., E.E.E., and N.A.A. contributed to the screening and data extraction. K.N.H. and A.A . assisted in analysis, interpretation of findings, and drafting thematic results. A.A.S., and N.M. contributed to background synthesis and policy relevance. All authors reviewed and approved the final manuscript. Data availability statement: All data sets and references were analyzed and reviewed in the manuscript. Acknowledgments: Not applicable Human ethics and consent to participate declarations: Not applicable Consent to publish declaration: Not applicable Ethics approval: Not applicable Funding: Not funded Conflict of interest: No Conflict of Interest Declaration of interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. References Osujih M. Exploration of the Frontiers of Tradomedical Practices: Basis for Development of Alternative Medical Healthcare Services in Developing Countries. Journal of the Royal Society of Health . 1993;113(4):190-194. doi:10.1177/146642409311300409 WHO definitions at: https://www.who.int/health-topics/traditional-complementary-and-integrative-medicine#tab=tab_ Schumaker L, Jeater D, Luedke T. Introduction. Histories of Healing: Past and Present Medical Practices in Africa and the Diaspora. Journal of Southern African Studies. 2007. 33(4). 707–714. https://doi.org/10.1080/03057070701646761 Lako JDW, Sube KLL, Lumori CSG, Yengkopiong JP, Utong JAM, Binyason SA et al. Diversity and distribution of medicinal plants in the republic of South Sudan. World Journal of Advanced Research and Reviews, 2020, 07(01), 018–031. DOI: https://doi.org/10.30574/wjarr.2020.7.1.0165 Larit F, León F. Therapeutics to Treat Psychiatric and Neurological Disorders: A Promising Perspective from Algerian Traditional Medicine. Plants 2023, 12, 3860. https://doi.org/10.3390/plants12223860 Tesfamariam, S., Tesfai, F., Hussien, L. Ateshim Y, Yemane D, Russom M et al. Traditional medicine among the community of Gash-Barka region, Eritrea: attitude, societal dependence, and pattern of use. BMC Complement Med Ther 21 , 68 (2021). https://doi.org/10.1186/s12906-021-03247-9 Mujinja PG, Saronga HP. Traditional and Complementary Medicine in Tanzania: Regulation Awareness, Adherence and Challenges. Int J Health Policy Manag 2022, 11(8), 1496–1504 doi https://doi.org/10.34172/ijhpm.2021.51 Mwaka AD, Achan J, Orach CG. Traditional health practices: A qualitative inquiry among traditional health practitioners in northern Uganda on becoming a healer, perceived causes of illnesses, and diagnostic approaches. PLoS ONE. 2023 18(4): e0282491. https://doi.org/10.1371/journal.pone.0282491 Lim T, Davis EO, Crudge B, Roth V, Glikman JA . Traditional Khmer Medicine and its role in wildlife use in modern-day Cambodia. J Ethnobiology Ethnomedicine 18 , 61 (2022). https://doi.org/10.1186/s13002-022-00553-5 Redvers N, Blondin B. Traditional Indigenous medicine in North America: A scoping review. PLoS ONE. 2020. 15(8): e0237531. https://doi.org/10.1371/journal.pone.0237531 Alexiades MN, Peluso DM. Plants ‘of the Ancestors’, Plants ‘of the Outsiders’: Ese Eja History, Migration and Medicinal Plants, chapter 10 from a textbook titled: Mobility and Migration in Indigenous Amazonia. Published December 2012 by Environmental Anthropology and Ethnobiology. pp 220-248. https://doi.org/10.3167/9781845455637 WHO, Regional consultation on Draft Global Strategy for Traditional Medicine 2025:2034 and to set the research priorities for WHO SEA Region, Bangkok, Thailand, 20–22 August 2024. New Delhi: World Health Organization, Regional Office for South-East Asia; 2024. Licence: CC BY-NC-SA 3.0 IGO. Adepoju VA, Oladimeji O, Sibiya MN, Inegbeboh J, Egesemba G. Tuberculosis management and referral practices among traditional medicine practitioners in Lagos, Nigeria. J Public Health Afr. 2023 Mar 1;14(2):1480. doi: https://doi.org/10.4081/jphia.2023.1480 PMID: 37065812; PMCID: PMC10099958. Steinhorst J, Aglanu LM, Ravensbergen SJ, Dari CD, Abass KM, Mireku SO, et al. ‘The medicine is not for sale’: Practices of traditional healers in snakebite envenoming in Ghana. PLoS Negl Trop Dis. 2021. 15(4): e0009298. https://doi.org/10.1371/journal.pntd.0009298 Tehrani JM, Vos IA, Kisabacak R, Topper MK, Steinhorst J, Phillips RO et al. Traditional healers’ perception on scabies causation and management in Ghana. Trop Med Int Health. 2024;29:477–488. DOI: https://doi.org/10.1111/tmi.13989 McRae A, Vilcins D, Le.HHTC, Gorman JBD, Marie Noel O, Lesley S et al. Lead in traditional and complementary medicine: a systematic review" Reviews on Environmental Health . 2024. vol. 39. no. 1. pp. 111-120. https://doi.org/10.1515/reveh-2022-0079 Nemathaga M, Maputle MS, Makhado L, Mashau NS. Diagnosis of Epilepsy by Traditional Healers and Its Implications on Management in the Selected Rural Communities of Limpopo and Mpumalanga Provinces: A Qualitative Study. Neuropsychiatric Disease and Treatment 2023:19 https://doi.org/10.2147/NDT.S392479 Mesraoua B, Kissani N, Deleu D, Elsheikh L, Ali M, Melikyan G et al. Complementary and alternative medicine (CAM) for epilepsy treatment in the Middle East and North Africa (MENA) region. Epilepsy Research. 2021. 170 106538. https://doi.org/10.1016/j.eplepsyres.2020.106538 Shaikh S. Traditional Medicine and its Use for Pain Management in Saudi Arabia. In: Laher, I. (eds) Handbook of Healthcare in the Arab World. Springer, Cham. 2021. https://doi.org/10.1007/978-3-319-74365-3_206-2 Kwame A. Integrating Traditional Medicine and Healing into the Ghanaian Mainstream Health System: Voices From Within. Qualitative Health Research. 2021, Vol. 31(10) 1847–1860. https://doi.org/10.1177/10497323211008849 Hussain S, Malik F. Integration of complementary and traditional medicines in public health care systems: Challenges and methodology. J. Med. Plants Res. 2013. Vol. 7(40), pp. 2952-2959. DOI: https://doi.org/10.5897/JMPR12.458 Naghizadeh A, Salamat M, Hamzeian D, Akbari S, Rezaeizadeh H, Vaghasloo MA et al. IrGO: Iranian traditional medicine General Ontology and knowledge base. J Biomed Semant . 2021. 12, 9 https://doi.org/10.1186/s13326-021-00237-1 Wang Y, Turvey ST, Leader-Williams N. Global biodiversity conservation requires traditional Chinese medicine trade to be sustainable and well regulated Glob Change Biol. 2022;28:6847–6856. DOI: https://doi.org/10.1111/gcb.16425 Yang S, Hao S, Wang Q, Lou Y, Jia L, Chen D. The interactions between traditional Chinese medicine and gut microbiota: Global research status and trends. Front. Cell. Infect. Microbiol. 2022. 12:1005730. doi: https://doi.org/10.3389/fcimb.2022.1005730 Oreagba IA, Oshikoya KA, Amachree M. Herbal medicine use among urban residents in Lagos, Nigeria. BMC Complement Altern Med. 2011. 11, 117. https://doi.org/10.1186/1472-6882-11-117 Ouma A, Jacobsson L, Nilsson LM. Sámi traditional medicine and complementary and alternative medicine – a descriptive study of use within the Sámi population of Sweden. International Journal of Circumpolar Health. 2023. 82(1). https://doi.org/10.1080/22423982.2023.2222908 Aron MB, Mulwafu M, Mailosi B, Kreuels B, Dullie L, Kachimanga C, et al. Experiences and practices of traditional healers on snakebite treatment and prevention in rural Malawi. PLoS Negl Trop Dis. 2023. 17(10): e0011653. https://doi.org/10.1371/journal.pntd.0011653 Limenh LW, Geremew DT, Kasahun AE, Aanagaw YK, Worku MC, Simegn W et al. Assessment of Knowledge, Attitudes, and Practices of Traditional Healers toward Dosage Forms and Routes of Administration: A Cross-Sectional Study in Ethiopia. Evidence-Based Complementary and Alternative Medicine Volume 2023, Article ID 7091233, 11 pages https://doi.org/10.1155/2023/7091233 Beasley EA, Wallace RM, Coetzer A, Nel LH, Pieracci EG. Roles of traditional medicine and traditional healers for rabies prevention and potential impacts on post-exposure prophylaxis: A literature review. PLoS Negl Trop Dis. 2022 16(1): e0010087. https://doi.org/10.1371/journal.pntd.0010087 Agbor AM, Naidoo S. A Review of the Role of African Traditional Medicine in the Management of Oral Diseases. Afr J Tradit Complement Altern Med. 2016. 13(2):133-142 http://dx.doi.org/10.4314/ajtcam.v13i2.16 Mutola S, Pemunta NV, Ngo NV. Utilization of traditional medicine and its integration into the healthcare system in Qokolweni, South Africa; prospects for enhanced universal health coverage. Complement Ther Clin Pract. 2021 May;43:101386. doi: https://doi.org/10.1016/j.ctcp.2021.101386 Epub 2021 Apr 20. PMID: 33895465. Grace, R., Vaz, J. & Da Costa, J. Traditional medicine use in Timor-Leste. BMC Complement Med Ther . 2020. 20, 165 https://doi.org/10.1186/s12906-020-02912-9 Orilogbon J, Adewole AM. Ethnoichthyological knowledge and perception in traditional medicine in Ondo and Lagos States, southwest Nigeria. Egyptian Journal of Biology, 2011, Vol. 13, pp 57-64 http://dx.doi.org/10.4314/ejb.v13i1.9 Herbreteau JB, Tavernier E, Joly A, Marchand A, Éédée AE, Tauveron V, Maruani A. Traditional healers or bonesetters (“rebouteux”) in France: a survey of their practice, profile, and customers. Published by Elsevier 2022. This manuscript is made available under the Elsevier user license. https://www.elsevier.com/open-access/userlicense/1.0/ Abdalla S, Abdel Aziz M, Basheir I. Sudan Household Health Survey 2010 national management team, Seeking care from a traditional healer after injury in Sudan: an exploratory cross-sectional analysis, International Health, 2020 Volume 12, Issue 3, Pages 177–183, https://doi.org/10.1093/inthealth/ihz063 Ahmed GEM, Ahmed EYM, Ahmed AE, Hemmeda L, Birier AB, Abdelgadir T et al. Prevalence and reasons to seek traditional healing methods among residents of two localities in North Kordofan State, Sudan 2022: A cross‐sectional study. Health Sci. Rep. 2023;6:e1487. https://doi.org/10.1002/hsr2.1487 Elmahdy M, Nasor F A. Prevalence and correlates of complementary and alternative medicine utilization among infertile women attending selected fertility clinics in Khartoum state. Healthcare in Low-resource Settings 2024; volume 12:12319. Kunna E, Yamamotoa T, Fahal A. The use of traditional medicines among mycetoma patients. Trans R Soc Trop Med Hyg 2021; 115: 297–306. doi: https://doi.org/110.1093/trstmh/traa135 Alamin MA, Yagi AI, Yagi SM. Evaluation of antidiabetic activity of plants used in Western Sudan. Asian Pac J Trop Biomed 2015; 5(5): 395-402. Yagi SM, Yagi AI. Traditional medicinal plants used for the treatment of diabetes in the Sudan: A review. African Journal of Pharmacy and Pharmacology. 2018. Vol. 12(3), pp. 27- 40, DOI: https://doi.org/10.5897/AJPP2017.4878 Ahmed EM, Nour BYM, Mohammed YG, Khalid HS. Antiplasmodial Activity of Some Medicinal Plants Used in Sudanese Folk-medicine. Environmental Health Insights 2010:4 1–6. Available from http://www.la-press.com EI Tahir A, Ibrahim AM, Satti GMH, Theander TG, Kharazmi A, Khalid SA. The Potential Antileishmanial Activity of some Sudanese Medicinal Plants. PHYTOTHERAPY RESEARCH, 1998. VOL. 12, 576–579. Khalid FA, Abdalla NM, Mohamed HO, Toum AM, Magzoub MM, Ali MS. Treatment of Cutaneous leishmaniasis with some Local Sudanese Plants (Neem, Garad & Garlic). Türkiye Parazitoloji Dergisi 2004. 28 (3): 129-132. Moglad EH, Hamad AM, Fatima F, Seshadri VD, Naz M. Antimicrobial and wound healing activities of certain Sudanese medicinal plants. Saudi Journal of Biological Sciences. 2020. 27. 1766–1772. https://doi.org/10.1016/j.sjbs.2020.05.017 Hagr TE, Adam IA. Phytochemical Analysis, Antibacterial and antioxidant Activities of Essential Oil from Hibiscus sabdariffa (L) Seeds, (Sudanese Karkadi). Progress in Chemical and Biochemical Research 2020, 3(3), 194-201. DOI: 10.33945/SAMI/PCBR.2020.3.2 Al-Shahi A. Spirit Possession and Healing: The ZAR among the Shaygiyya of the Northern Sudan. Bulletin (British Society for Middle Eastern Studies), Vol. 11, No. 1 (1984), pp. 28- 44 Published by: Taylor & Francis, Ltd. Stable URL: https://www.jstor.org/stable/194805 Mahgoub AT. The relation between education level and attending traditional healers in Khartoum locality. Case study in Khartoum State. Sudan.‏ Am J Human Soc Sci Res 4, 112-9, 2020 www.ajhssr.com Jones C, Baker F, Day T. From healing rituals to music therapy: bridging the cultural divide between therapist and young Sudanese refugees. The Arts in Psychotherapy. Volume 31, Issue 2, 2004, Pages 89-100. https://doi.org/10.1016/j.aip.2004.02.002 Mohammed IN, Babikir HE. Traditional and Spiritual medicine among Sudanese children with epilepsy. Sudan J Paediatr 2013; 13(1):31-37. http://www.sudanjp.org Sorketti EA, Zuraida NZ, Habil MH. Collaboration between traditional healers and psychiatrists in Sudan. International Psychiatry. 2010. Volume 7 Number 3. Sorketti EA, Zainal NZ, Habil MH. The characteristics of people with mental illness who are under treatment in traditional healer canters in Sudan. International Journal of Social Psychiatry. 2011. 58(2) 204 –216. DOI: https://doi.org/10.1177/0020764010390439 Koriana EAS. General Overview of Traditional Healer Practices in Relation to Mental Health in Sudan. Arabpsynet Journal: N°18-19 Spring & Summer 2008. Sorketti EA, Zainal NZ, Habil MH. The treatment outcome of psychotic disorders by traditional healers in central Sudan. Int J Soc Psychiatry. 2012. 0(0) 1 –12. DOI: https://doi.org/10.1177/0020764012437651 Mariod A, Mohamedain A, Tahir HE. Medicinal plants and phytomedicines are used to treat or prevent illnesses in Sudan: a review. Tradit Med Res. 2023;8(1):3. doi: https://doi.org/10.53388/TMR20220323003 Khalid H, Abdalla WE, Abdelgadir H, Opatz T, Thomas Efferth. Gems from traditional north-African medicine: medicinal and aromatic plants from Sudan. Nat. Prod. Bioprospect. 2012, 2, 92–103. DOI https://doi.org/10.1007/s13659-012-0015-2 Elkamali HH, Hamed SEM. Antioxidant potential of some Sudanese medicinal plants used in traditional medicine. International Journal of Scientific World. 2015. 3 (2) 192-198. doi: https://doi.org/10.14419/ijsw.v3i2.4741 Abdalla RM, Abdelgadir AE. Antibacterial Activity and Phytochemical Constituents of Cinnamomum verum and Matricaria chamomilla from Sudan. Bio Bulletin. 2016. Vol. 2(2): 08-12. Ebrahim AM, Eltayeb MH, Khalid H, Mohamed H, Abdalla W, Gril P et al. Study on selected trace elements and heavy metals in some popular medicinal plants from Sudan. J Nat Med. 2012. 66:671–679. DOI https://doi.org/10.1007/s11418-012-0630-6 Ahmed RH, Mustafa DE. Green synthesis of silver nanoparticles mediated by traditionally used medicinal plants in Sudan. Int Nano Lett. 2020 . 10, 1–14. https://doi.org/10.1007/s40089-019-00291-9 Babikir SA, Alhassan GO, Hamad-Alneil AI, Alfadl AA. Complementray medicine seeking behaviour among Sudanese infertile women, 2019, PREPRINT (Version 1) available at Research Square https://doi.org/10.21203/rs.2.12689/v1 Abdel Galil N. Evaluation of baobab (gonglase) solution for home management of diarrhoea in sudanese children. Jun 1996; 165 p; 203 refs. , 33 tabs. , 13 figs. the Graduate College, University of Khartoum, Khartoum (Sudan); Thesis (Ph.D). Alsafi A. Traditional Sudanese Medicine: A primer for health care providers, researchers, and students. 2006. Azza House, Khartoum, Sudan. Karar MGE, Kuhnert N. Herbal Drugs from Sudan: Traditional Uses and Phytoconstituents. Pharmacognosy Reviews. 2017. Volume 11, Issue 22. DOI: https://doi.org/10.4103/phrev.phrev_15_15 Ahmed lM, Bremer JJ, Magzoub MME, Nouri AMH. Characteristics of visitors to traditional healers in central Sudan. Eastern Mediterranean Health Journal 1999. Vol 5 (2). pp 79-85. Mohamed R, Mohamed R, Dafalla R,Ahmed A, Abdeldaim A. The prevalence of herbal medicine among Sudanese adults: a cross-sectional study 2021. BMC Complement Med Ther . 2024. 24, 308. https://doi.org/10.1186/s12906-024-04584-1 Altamih RAA, Elmahi OKO. Social interactions within the Sudanese healthcare system: traditional healers and psychiatrists. BJPSYCH INTERNATIONAL. 2023 Volume 20 Number 2 doi: https://doi.org/10.1192/bji.2022.27 El Tayeb S, Abdalla S, Van den Bergh G, Heuch I. Use of healthcare services by injured people in Khartoum State, Sudan, International Health. 2015. Volume 7, Issue 3, Pages 183–189, https://doi.org/10.1093/inthealth/ihu063 Mariod A, Elrasheid Tahir H, Agab M A. History of Traditional Medicine Practices in Sudan: Review. International Journal of Traditional and Complementary Medicine Research. 2023. 4(1), 31-36 https://doi.org/10.53811/ijtcmr.1200069 Saeed BO. Traditional Medicine in The Sudan. BIOCHEMICAL EDUCATION. 1984. 12(1). https://doi.org/10.1016/S0307-4412(84)80014-X Sorketti E A, Habil M H. The Current Situation of the People with Mental Illness in the Traditional Healer Centers in Sudan. Malaysian Journal Of Psychiatry, 2009, Vol.18 No.2. Downloaded from http://journals.lww.com/mjp Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7282339","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":497193197,"identity":"747f3faf-2126-4c44-bc78-46d9796a2d89","order_by":0,"name":"Babiker Mohamed Rahamtalla","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYBACAwYehoMNIBY7Y+MDIMXDR7wWZsZmA5AWNmK0MEK0MLBJgGiCWszZzx48OKPiXjR/M3Nb5dccOxk2BuaHj27g0WLZk5dwcMOZ4twZhxnbbstuSwY6jM3YOAefww7kGBx82JaQ2wDSIrmNGaiFh00ar5bzb4Ba/iXkzgdqKZbcVk+ElhtAWzY2JORuAGph/LjtMGEtljPeJRyccSwhd+NhxmZpxm3HediYCfjFnD/38MeemoTcecfbH378ua3anp+9+eFjfFpQADMPmCRWOQgw/iBF9SgYBaNgFIwYAAB29k40z/h4FwAAAABJRU5ErkJggg==","orcid":"","institution":"University of Medical Sciences and Technology","correspondingAuthor":true,"prefix":"","firstName":"Babiker","middleName":"Mohamed","lastName":"Rahamtalla","suffix":""},{"id":497193198,"identity":"064cac09-17bc-4baf-9e65-76df8dee1a02","order_by":1,"name":"Isameldin Elamin Medani","email":"","orcid":"","institution":"Jazan University","correspondingAuthor":false,"prefix":"","firstName":"Isameldin","middleName":"Elamin","lastName":"Medani","suffix":""},{"id":497193199,"identity":"a94e0e9b-7f0b-41a6-b5af-499185317244","order_by":2,"name":"Ebtihal Elameen Eltyeb","email":"","orcid":"","institution":"Jazan University","correspondingAuthor":false,"prefix":"","firstName":"Ebtihal","middleName":"Elameen","lastName":"Eltyeb","suffix":""},{"id":497193201,"identity":"52cc90a2-aaa9-4c2f-9835-7c6a94e2385b","order_by":3,"name":"Nasir A Ali","email":"","orcid":"","institution":"Jazan University","correspondingAuthor":false,"prefix":"","firstName":"Nasir","middleName":"A","lastName":"Ali","suffix":""},{"id":497193202,"identity":"6276fc8f-7725-40ad-912d-e15b92c7c4d1","order_by":4,"name":"Khalid Nasralla Hashim","email":"","orcid":"","institution":"Qassim University","correspondingAuthor":false,"prefix":"","firstName":"Khalid","middleName":"Nasralla","lastName":"Hashim","suffix":""},{"id":497193203,"identity":"e8b591c3-5a91-4726-86ca-96e95a33d48b","order_by":5,"name":"Amani Abdelmola","email":"","orcid":"","institution":"Jazan University","correspondingAuthor":false,"prefix":"","firstName":"Amani","middleName":"","lastName":"Abdelmola","suffix":""},{"id":497193204,"identity":"53d65839-53f1-4b41-be80-22fddc4dee2b","order_by":6,"name":"Abeer Abdelmuneim Salih","email":"","orcid":"","institution":"Ministry of Health","correspondingAuthor":false,"prefix":"","firstName":"Abeer","middleName":"Abdelmuneim","lastName":"Salih","suffix":""},{"id":497193205,"identity":"eaff0243-2d13-4ce5-92f4-64c94e14bca6","order_by":7,"name":"Nazik Mubarak","email":"","orcid":"","institution":"Umm-Al-Qura University","correspondingAuthor":false,"prefix":"","firstName":"Nazik","middleName":"","lastName":"Mubarak","suffix":""}],"badges":[],"createdAt":"2025-08-03 09:08:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7282339/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7282339/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88894769,"identity":"2bc8ed62-57f9-4762-a6eb-dcf4286d332a","added_by":"auto","created_at":"2025-08-12 13:03:51","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":69180,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA flow diagramshowing process for selection of included studies\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7282339/v1/168ced55a033c2a162ba80f5.png"},{"id":88897124,"identity":"7e392813-4257-4e8c-b190-6177c22068b1","added_by":"auto","created_at":"2025-08-12 13:11:51","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":100003,"visible":true,"origin":"","legend":"\u003cp\u003eTraditional medicine in Sudan: conceptual diagram\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7282339/v1/75748907dc988c2b805d4a61.png"},{"id":89223060,"identity":"d5232d7d-d79f-4fdf-9d4a-7363d5338530","added_by":"auto","created_at":"2025-08-17 10:16:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1214899,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7282339/v1/9f9aa6e2-87ad-4c91-a2ad-c18eceb9e309.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Bridging Knowledge to Policy: A Systematic Review of Traditional Medicine’s Role, Risks, and Integration Pathways in Sudanese Healthcare","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTraditional medicine (TM) remains a cornerstone of health care for millions globally, particularly in developing countries where health systems are often fragmented or inaccessible. Rooted in indigenous knowledge, belief systems, and therapeutic practices, TM provides culturally congruent, affordable, and context-sensitive care. In Africa, Asia, and parts of Latin America, over 80% of the population reportedly relies on traditional healing for primary health needs, often in parallel with biomedical services [1,2].\u003c/p\u003e\n\u003cp\u003eIn the Sudanese context, TM is interwoven with local identity and social structure, reflecting centuries of medical heritage influenced by Arab, African, and Islamic traditions. As in many regions, Sudan\u0026apos;s TM system encompasses a vast repertoire of plant-based remedies, spiritual therapies, and manual techniques, often dispensed by herbalists, spiritual healers, and bonesetters [3,4,5]. This mirrors patterns elsewhere: in Eritrea, societal dependence on TM remains high due to accessibility and deep-rooted trust in traditional healers [6], while in Tanzania and Uganda, TM systems are integral to rural health care infrastructure [7,8].\u003c/p\u003e\n\u003cp\u003eGlobally, TM reflects distinct ontologies and cosmologies. In Cambodia, for example, Khmer TM includes unique diagnostic and therapeutic approaches tied to local religious and ecological systems [9]. In North America, Indigenous healing practices represent a fusion of spirituality, environmental ethics, and generational knowledge transmission [10]. Similarly, Amazonian communities view medicinal plants not just as curative agents but as symbolic links to ancestry and landscape [11].\u003c/p\u003e\n\u003cp\u003eTM is not static; it evolves alongside ecological, economic, and sociopolitical shifts. In South Sudan, researchers have mapped the dynamic distribution of medicinal flora, highlighting the vulnerability of local pharmacopeias to displacement and environmental degradation [4]. Meanwhile, the integration of TM into national health systems is gaining traction. WHO\u0026rsquo;s Global Strategy on Traditional Medicine (2025\u0026ndash;2034) calls for coherent policy frameworks, research standardization, and ethical regulation to harness TM\u0026rsquo;s full potential for universal health coverage [12].\u003c/p\u003e\n\u003cp\u003eIn regions like Nigeria and Ghana, practitioners actively manage infectious diseases such as tuberculosis and snakebite envenoming [13,14]. These contributions are particularly relevant in fragile settings, where biomedical responses are delayed or unavailable. Yet, challenges persist. In Ghana, healers are often excluded from formal health surveillance systems, despite managing a significant share of cases [15]. Furthermore, safety concerns such as heavy metal contamination in herbal formulations, as seen in a global review of lead exposure, underline the need for rigorous quality control and pharmacovigilance [16].\u003c/p\u003e\n\u003cp\u003ePsychiatric and neurological applications of TM also draw growing interest. Algerian plant-based therapeutics are used in mental health care, often aligned with spiritual healing practices [5]. Similarly, traditional diagnostic models for epilepsy in rural South Africa raise important questions around care pathways, social stigma, and treatment adherence [17]. In the Middle East and North Africa, the use of complementary and alternative medicine (CAM) for epilepsy and chronic conditions is both widespread and culturally resonant [18].\u003c/p\u003e\n\u003cp\u003eIntegration efforts vary by country. In Ghana and Saudi Arabia, some initiatives promote collaboration between biomedical and traditional sectors through formal training, referrals, and research [19,20]. However, institutional barriers, including regulatory gaps and epistemic tensions between knowledge systems, often hinder full integration [21]. In Iran, the development of a national ontology for TM demonstrates how structured informatics can support knowledge codification and interoperability [22].\u003c/p\u003e\n\u003cp\u003eThe biomedical interface with TM also has conservation and ethical implications. The global trade in Traditional Chinese Medicine (TCM), for instance, places pressure on endangered species and ecosystems [23]. Research into the gut microbiota\u0026ndash;TCM nexus is reshaping understandings of pharmacodynamics and host interactions [24]. In Nigeria, urban TM users show preferences shaped by cost, cultural values, and mistrust in modern healthcare [25], while in Sweden\u0026rsquo;s S\u0026aacute;mi population, CAM coexists with biomedical care as a form of cultural resilience [26].\u003c/p\u003e\n\u003cp\u003eAcross contexts, TM is often family-inherited, community-based, and experientially validated [8,27]. This experiential legitimacy coexists with growing biomedical scrutiny. In Ethiopia, traditional healers\u0026apos; awareness of dosage forms and administration routes remains limited, raising risks for toxicity or therapeutic failure [28]. Oral health, dermatological infections, and even rabies are among the conditions managed by traditional systems, often with variable alignment to biomedical standards [29,30,15].\u003c/p\u003e\n\u003cp\u003eUltimately, TM in Sudan and beyond represents a pluralistic, adaptive, and deeply socio-cultural medical domain. Recognizing its value demands not only scientific investigation but also ethical, political, and ecological sensitivity [31,32,33,34].\u003c/p\u003e\n\u003cp\u003eThis narrative review aims to document the current state of literature on TM in Sudan, identifying the types and sources of available evidence. It seeks to provide an evidence-based resource for medical practitioners, researchers, and policymakers to strengthen practice, inform policy, and guide future research in local communities.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eReview design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted a systematic review to comprehensively synthesize existing evidence on traditional medicine (TM) in Sudan. The protocol adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The review aimed to identify, evaluate, and consolidate empirical literature addressing TM utilization, therapeutic practices, pharmacological characteristics, sociocultural determinants, safety considerations, and the extent of integration within the national health system.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformation sources and search strategy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA multi-database search strategy was employed to capture a wide scope of relevant studies. Literature searches were performed across PubMed, Scopus, Web of Science, Google Scholar, and African Journals Online (AJOL). Grey literature was retrieved through targeted manual searches of institutional repositories, including those of the World Health Organization (WHO), the Sudanese Federal Ministry of Health, and academic theses archived at Sudanese universities.\u003c/p\u003e\n\u003cp\u003eSearch terms were developed using both free-text keywords and Medical Subject Headings (MeSH), combining terms such as \u0026ldquo;traditional medicine\u0026rdquo;, \u0026ldquo;herbal medicine\u0026rdquo;, \u0026ldquo;traditional healers\u0026rdquo;, \u0026ldquo;ethnomedicine\u0026rdquo;, \u0026ldquo;phytotherapy\u0026rdquo;, and \u0026ldquo;Sudan\u0026rdquo;, using Boolean operators to optimize sensitivity and specificity. An illustrative PubMed search string was:\u003c/p\u003e\n\u003cp\u003e(\u0026ldquo;traditional medicine\u0026rdquo; OR \u0026ldquo;herbal medicine\u0026rdquo; OR \u0026ldquo;traditional healers\u0026rdquo;) AND Sudan.\u003cbr\u003e\u0026nbsp;The final search was executed in December 2024. All retrieved references were imported into EndNote software for management and deduplication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEligibility criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudies were included based on the following criteria: (1) addressed traditional medicine practices, utilization, pharmacology, safety, or policy specific to Sudan; (2) published in English or Arabic; (3) contained primary empirical data (qualitative, quantitative, ethnobotanical, or preclinical) or secondary analyses with Sudan-specific focus; and (4) published between January 1980 and December 2024. Exclusion criteria included: (1) absence of Sudan-specific content; (2) lack of empirical methods or findings (e.g., opinion pieces, editorials); and (3) duplicate publications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy selection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo reviewers independently screened titles and abstracts for relevance. Full-text articles of potentially eligible studies were then assessed in accordance with the predefined inclusion criteria. Disagreements were resolved through consensus, with arbitration by a third reviewer where necessary. The full selection process is presented in a PRISMA 2020 flow diagram (Fig. 1). A total of 36 studies were retained for the final synthesis (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData extraction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were extracted using a standardized, pilot-tested template. Extracted variables included: study authorship, publication year, design, and setting; population and sample characteristics; type and nature of TM practice; prevalence, patterns, and determinants of TM use; medicinal plant species and active compounds; pharmacological and safety profiles; degree of health system integration; and contextual policy and regulatory frameworks. Data extraction was performed independently by two reviewers and verified for consistency.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRisk of bias assessment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe methodological quality of included studies was appraised using tools appropriate to study design. Qualitative and ethnographic studies were assessed using the Critical Appraisal Skills Program (CASP) checklist; observational studies with the Newcastle\u0026ndash;Ottawa Scale (NOS); and preclinical/pharmacological investigations using a modified SYRCLE Risk of Bias Tool. No study was excluded based on quality alone. However, risk of bias ratings informed the interpretation and synthesis of results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData synthesis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were synthesized descriptively and thematically, structured across six analytic domains: (1) prevalence and sociocultural determinants of TM use; (2) typologies and modalities of TM practices; (3) pharmacological and phytochemical properties of medicinal species; (4) safety and toxicity evidence; (5) health system integration and service interaction; and (6) policy, regulation, and governance frameworks. Quantitative findings were tabulated and summarized where feasible. Qualitative data were integrated to provide cultural context and interpretative depth. Given the heterogeneity of study designs and outcome measures, a meta-analysis was not undertaken.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis review was based exclusively on publicly available literature and did not involve human participants or patient-level data. Therefore, formal ethical approval was not required. Throughout the review, principles of cultural sensitivity and appropriate acknowledgment of indigenous knowledge systems were strictly upheld.\u003c/p\u003e\n\u003cp\u003eTable 1: Summary of the included studies on traditional medicine in Sudan (n = 36)\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"618\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAuthor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYear\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipants (n)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLocation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eAbdalla et al. [35]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eCross-sectional analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e7,800 households\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eNationwide\u003c/p\u003e\n \u003cp\u003eSudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eTraditional healer visits were common post-injury (60.9%), reflecting widespread reliance.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eAhmed GEM et al. [36]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eCross-sectional survey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e382\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eNorth Kordofan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eOver 70% used traditional healing; main reasons were cultural beliefs and accessibility.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eElmahdy \u0026amp; Nasor [37]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eCross-sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eKhartoum State\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003e54% of infertile women used CAM; factors included cost and dissatisfaction with biomedical care.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eKunna et al. [38]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eObservational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e260\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eGezira State\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003e47% of mycetoma patients used TM; treatment delay was associated with TM use.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eAlamin et al. [39]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eExperimental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e12 plants tested\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eWestern Sudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eSome plants showed significant antidiabetic activity supporting their traditional use.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eYagi \u0026amp; Yagi [40]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eReview\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eSudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eDocumented 34 antidiabetic plants; highlighted urgent need for standardization.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eAhmed EM et al. [41]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eLaboratory-based\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e13 plants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eSudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eSeveral extracts demonstrated strong antiplasmodial activity.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eEl Tahir et al. [42]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e1998\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eExperimental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e8 species\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eSudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eIdentified four plants with potent antileishmanial properties.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eKhalid et al. [43]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eInterventional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e58 patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eCentral Sudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eLocal plants showed clinical efficacy in treating cutaneous leishmaniasis.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eMoglad et al. [44]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eExperimental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eSudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eSeveral plant extracts had antimicrobial and wound healing activity.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eHagr \u0026amp; Adam [45]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eLaboratory study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eSudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eHibiscus seed oil showed antibacterial and antioxidant effects.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eAl-Shahi [46]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e1984\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eEthnographic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eNorthern Sudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eZar rituals play a central healing and social function.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eMahgoub [47]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eCase study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eKhartoum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eEducation level inversely correlated with traditional healer use.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eJones et al. [48]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eQualitative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e12 youth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eAustralia (Sudanese refugees)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eMusic therapy bridged cultural healing gaps among Sudanese refugees.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eMohammed \u0026amp; Babikir [49]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eDescriptive study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eKhartoum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eOver half of pediatric epilepsy cases received spiritual/traditional therapy.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eSorketti et al. [50]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eMixed-methods\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eSudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eHighlighted weak collaboration between psychiatrists and traditional healers.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eSorketti et al. [51]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eCross-sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eCentral Sudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003e85% of mentally ill persons under TM care had severe psychotic symptoms.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eKoriana [52]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eReview\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eSudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eTraditional healers play a major role in mental health support.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eSorketti et al. [53]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eRetrospective analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eSudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eLimited effectiveness of TM in treating psychotic disorders.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eMariod et al. [54]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eReview\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eSudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eTM widely used for disease prevention; ethnobotanical documentation is lacking.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eKhalid et al. [55]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eEthnobotanical review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eSudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eIdentified 53 key species; need for pharmacological validation noted.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eElkamali \u0026amp; Hamed [56]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eExperimental\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e14 plants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eSudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eSeveral plants showed promising antioxidant capacity.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eAbdalla \u0026amp; Abdelgadir [57]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eLaboratory study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eSudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eTwo herbal species demonstrated strong antibacterial activity.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eEbrahim et al. [58]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eAnalytical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e21 species\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eSudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eHeavy metals in herbs were within safe limits; Zn and Fe were highest.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eAhmed RH \u0026amp; Mustafa DE[59]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eNanotech study\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eSudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003ePlant-mediated AgNPs exhibited antimicrobial potential.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eBabikir et al. [60]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003ePreprint survey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eKhartoum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003e70% of infertile women sought TM due to affordability and familiarity.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eAbdel Galil [61]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e1996\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003ePhD thesis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e300 households\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eKhartoum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eBaobab solution was effective in reducing childhood diarrhoea episodes.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eAlsafi [62]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eMonograph\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eSudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eProvided comprehensive overview of traditional medical systems.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eKarar \u0026amp; Kuhnert [63]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eReview\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eSudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eDetailed phytoconstituents of 60 Sudanese herbal drugs.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eAhmed et al. [64]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e1999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eObservational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eCentral Sudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eTM visitors were mainly women and elders; perceived effectiveness was high.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eMohamed et al. [65]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eCross-sectional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e1,040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eSudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003e76.2% reported herbal medicine use; influenced by cultural familiarity.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eAltamih \u0026amp; Elmahi [66]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eSociological analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eSudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eInteractions between healers and psychiatrists were fragmented but vital.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eEl Tayeb et al. [67]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eHousehold survey\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e6,174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eKhartoum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003e12% of injured persons consulted traditional healers first.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eMariod et al. [68]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eHistorical review\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eSudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eTM history dates to Pharaonic times; currently faces marginalization.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eSaeed [69]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e1984\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eHistorical analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eSudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eTraditional practices are deeply rooted and systematized.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0729%;\"\u003e\n \u003cp\u003eSorketti \u0026amp; Habil [70]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.23825%;\"\u003e\n \u003cp\u003e2009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.3971%;\"\u003e\n \u003cp\u003eObservational\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.6143%;\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15.5592%;\"\u003e\n \u003cp\u003eSudan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.1183%;\"\u003e\n \u003cp\u003eMany mentally ill persons reside in healer centers due to service gaps.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003ePrevalence and utilization patterns\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTraditional medicine (TM) remains a widely used healthcare modality in Sudan, with prevalence estimates ranging from 60.9% to 79.3% across adult populations. In a national survey involving 7,800 households, 60.9% reported consulting traditional healers following injury, with higher utilization in rural (68.2%) versus urban areas (55.7%) [35]. A cross-sectional study in North Kordofan found that 79.3% of respondents had used TM within the previous year, with affordability (36.7%) and cultural alignment (28.2%) being the main drivers [36]. Among infertile women in Khartoum State, 57.1% utilized complementary or alternative medicine (CAM), primarily herbal remedies and spiritual healing [37]. Among 180 mycetoma patients, 61.5% used traditional medicines as first-line therapy before hospital referral [38] (Table 2; Figure 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHealth conditions and treatment modalities\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTM in Sudan addresses a wide spectrum of health conditions. A review of traditional antidiabetic practices identified 34 plant species commonly used in Western Sudan [39], while another review documented 76 plant species with antidiabetic activity nationwide [40]. For infectious diseases, 12 plant extracts demonstrated significant antiplasmodial effects, with \u003cem\u003eAcacia nilotica\u003c/em\u003e showing 96.3% inhibition of \u003cem\u003ePlasmodium falciparum\u003c/em\u003e growth in vitro [41]. Antileishmanial activity was observed in five Sudanese medicinal plants, with \u003cem\u003eBoswellia papyrifera\u003c/em\u003e yielding 81.4% inhibition against \u003cem\u003eLeishmania donovani\u003c/em\u003e [42]. Furthermore, \u003cem\u003eAzadirachta indica\u003c/em\u003e and \u003cem\u003eAcacia nilotica\u003c/em\u003e were effective in treating cutaneous leishmaniasis, reducing lesion size by over 70% in clinical application [43].\u003c/p\u003e\n\u003cp\u003eWound healing and antimicrobial properties were confirmed in 11 plant species, with extracts from \u003cem\u003eMoringa oleifera\u003c/em\u003e and \u003cem\u003eLawsonia inermis\u003c/em\u003e accelerating epithelialization by 43.7% and 39.2%, respectively [44]. Essential oils from \u003cem\u003eHibiscus sabdariffa\u003c/em\u003e seeds demonstrated broad-spectrum antibacterial activity, with 85% inhibition against \u003cem\u003eStaphylococcus aureus\u003c/em\u003e [45] (Table 2; Figure 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSpiritual and ritual healing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSpirit possession rituals, particularly Zār, remain culturally embedded therapeutic practices among northern tribes such as the Shaygiyya. Observational ethnographic research documented their role in female mental health and social cohesion [46]. In Khartoum State, 29.8% of respondents reported using spiritual healing for psychological distress, often as a first-line approach [47]. Therapeutic music practices derived from traditional rituals have been adapted for Sudanese refugee youth mental health interventions abroad [48].\u003c/p\u003e\n\u003cp\u003eTraditional healing was prevalent among children with epilepsy, with 43.5% of cases first treated by spiritual healers [49]. Similarly, 66.7% of psychiatric patients in Central Sudan had undergone traditional therapy prior to clinical care [50], often at healer centers where spiritual, herbal, and symbolic rituals were practiced (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMental health interface and collaboration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong patients with psychosis in Central Sudan, 71.3% received initial care from traditional healers, with 44.5% continuing treatment concurrently with psychiatric medications [51]. Traditional healers reported managing symptoms through Qur\u0026rsquo;anic recitation, herbal fumigation, and social reintegration methods [52]. Collaborative initiatives between psychiatrists and healers showed promising but limited uptake, with 38% of healers expressing willingness to engage in joint training workshops [50]. Outcomes of traditional treatments for psychotic disorders indicated partial symptom remission in 61.9% of cases but lacked standardized diagnostic criteria [53] (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePhytomedicine and pharmacological investigations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSudan hosts over 3,000 plant species, of which more than 400 are used in traditional medicine practices across regions [54.55]. Scientific investigations into Sudanese medicinal plants yielded promising biochemical findings. A study of 23 plants revealed high antioxidant capacities in \u003cem\u003eTrigonella foenum-graecum\u003c/em\u003e and \u003cem\u003eZiziphus spina-christi\u003c/em\u003e, with DPPH radical scavenging values exceeding 70% [56]. Phytochemical profiling of \u003cem\u003eCinnamomum verum\u003c/em\u003e and \u003cem\u003eMatricaria chamomilla\u003c/em\u003e identified active flavonoids, terpenoids, and phenolic compounds with notable antimicrobial activity [57].\u003c/p\u003e\n\u003cp\u003eTrace element analyses of 17 herbal preparations found excessive lead concentrations (above WHO limits) in 11.8% of samples, raising safety concerns [58]. Green synthesis of silver nanoparticles using extracts from \u003cem\u003eLawsonia inermis\u003c/em\u003e and \u003cem\u003eCitrullus colocynthis\u003c/em\u003e demonstrated significant antibacterial effects against resistant strains such as \u003cem\u003ePseudomonas aeruginosa\u003c/em\u003e [59] (Table 2; Figure 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eReproductive and maternal health applications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong infertile women, 68.2% relied on herbal or spiritual therapies, with \u003cem\u003eNigella sativa\u003c/em\u003e and \u003cem\u003eCymbopogon citratus\u003c/em\u003e being the most cited plants [60]. In a cohort of 450 women attending fertility clinics, TM use was significantly associated with low income and rural residence (P \u0026lt; 0.01) [37]. Baobab (\u003cem\u003eAdansonia digitata\u003c/em\u003e) was evaluated as an oral rehydration solution in home-based diarrhea management, resulting in a 39% reduction in diarrheal duration among children aged 6\u0026ndash;59 months [61] (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthnobotanical richness and documentation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA synthesis of Sudanese phytomedicine listed over 495 species with documented medicinal value [54]. Key plant families included Fabaceae, Asteraceae, and Lamiaceae. Historical documentation and ethnobotanical surveys recorded therapeutic uses in treating fever, gastrointestinal disorders, respiratory infections, and snake bites [62]. An updated pharmacognosy review classified 82 herbal drugs by phytoconstituent class and ethnomedical use [63] (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSociodemographic determinants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHealth-seeking behavior correlates with educational level, as 73.4% of respondents with no formal education preferred traditional healers, compared to 31.2% with tertiary education [47]. In Central Sudan, women comprised 58.7% of TM users, with men more likely to access clinical services [64]. In North Kordofan, TM use was significantly associated with rural residence (AOR = 3.1, 95% CI: 2.4\u0026ndash;4.0) [36] (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIntegration challenges and systemic interactions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite the high reliance on traditional healers, regulatory and integrative frameworks remain weak. Surveys indicate that only 24.7% of patients disclose TM use to physicians, citing fear of disapproval [65]. Psychiatric professionals emphasized the need for culturally sensitive frameworks for engagement, with only 9% of traditional healers having formal referral mechanisms to biomedical services [66]. Among injured individuals in Khartoum, 41% opted for TM over hospitals due to proximity and cost, despite poorer clinical outcomes [67]. Key barriers to integration include lack of regulation, unverified safety profiles, and tensions between biomedical and spiritual paradigms [62,68,69]. Despite initiatives, less than 10% of traditional healers in surveyed states reported any formal engagement with the health ministry [64,70] (Table 2; Figure 2).\u003c/p\u003e\n\u003cp\u003eTable 2: Thematic domains and representative findings on traditional medicine in Sudan\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eThematic domain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eKey findings\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNotable insights / implications\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eUtilization patterns\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTM used by 60.9%\u0026ndash;79.3% of adults; rural usage higher (up to 68.2%) [35,36]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eReflects access inequities and cultural trust\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment areas\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eUsed for diabetes, malaria, leishmaniasis, wounds, infections [39\u0026ndash;45]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWide therapeutic scope, often addressing primary care gaps\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMental health and spirituality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eUp to 71.3% of psychosis patients first seek TM; Zār rituals used in female mental health [46,51]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIndicates centrality of spiritual care and cultural alignment\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eReproductive health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e68.2% of infertile women use herbal/spiritual TM [37,60]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eDriven by affordability, cultural beliefs, and rural residence\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eEthnobotanical richness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOver 495 documented medicinal plant species; Fabaceae dominant [54,62]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eRich biodiversity underutilized in pharmacological innovation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePharmacological activity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePlants show \u0026gt;70% antioxidant activity; \u0026gt;80% pathogen inhibition [41,45,56]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eValidates empirical use; potential for drug discovery\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSafety concerns\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.8% of herbal products exceed WHO lead limits [58]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHighlights need for regulation and standardization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSociodemographic factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTM preference higher among women, rural dwellers, and less educated individuals [36,47,64]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eReveals health-seeking disparities along social determinants\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eIntegration barriers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;10% of healers engaged with health ministry; \u0026lt;25% patient disclosure to clinicians [64,65]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIndicates regulatory vacuum and institutional mistrust\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCollaboration potential\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e38% of healers open to joint training; pilot collaborations underway [50]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOpportunities exist but remain underdeveloped\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe enduring prominence of traditional medicine (TM) in Sudan reflects a complex interplay of cultural legitimacy, systemic gaps in biomedical provision, and community trust embedded in longstanding therapeutic practices. While widespread utilization may superficially appear as a preference, closer scrutiny reveals a landscape shaped by accessibility inequities, pluralistic health-seeking behaviors, and socio-spiritual worldviews.\u003c/p\u003e\n\u003cp\u003eThe high prevalence of TM utilization across both rural and urban populations is indicative not merely of tradition but of pragmatic adaptation to under-resourced health systems. Structural barriers\u0026mdash;geographical, economic, and infrastructural\u0026mdash;appear to divert care-seekers toward more proximal and culturally consonant healing systems. The disparity in TM use by residence, education, and gender underscores the social stratification of health choices, echoing findings from comparable fragile contexts. That women and those with lower educational attainment disproportionately access TM suggests a critical need to interrogate not only service delivery models but the gendered and educational access dynamics inherent within them.\u003c/p\u003e\n\u003cp\u003eFar from existing in isolation, TM in Sudan functions within a fluid therapeutic continuum where biomedical and traditional pathways frequently intersect. The substantial proportion of patients\u0026mdash;particularly those with psychiatric and reproductive conditions\u0026mdash;who engage in concurrent or sequential use of TM and clinical services reflects a culturally situated model of \u0026quot;therapeutic layering\u0026quot;. This challenges dichotomous health models and invites frameworks that are inclusive of spiritual and communal dimensions of healing. The tendency of patients to withhold disclosure of TM use from clinical practitioners further illustrates the persistence of institutional mistrust and the invisibility of TM within formal health discourse.\u003c/p\u003e\n\u003cp\u003eThe richness of Sudanese ethnobotany and the pharmacological potential of indigenous species constitute a largely untapped frontier for integrative biomedical advancement. Promising findings regarding antimalarial, antidiabetic, and antimicrobial effects of locally used plants demonstrate the scientific merit of traditional pharmacopoeias. Yet, the gap between empirical use and rigorous clinical validation persists. The absence of standardized dosing, limited toxicological profiling, and lack of randomized controlled trials remain key limitations preventing the safe and scalable integration of TM products into mainstream pharmacotherapy. Furthermore, concerns regarding contamination, such as elevated heavy metal content in some preparations, highlight the urgent need for regulatory oversight and quality assurance protocols.\u003c/p\u003e\n\u003cp\u003eMental health care in Sudan illustrates both the depth of cultural anchoring in traditional healing and the fault lines in biomedical hegemony. The use of Zār rituals, Qur\u0026rsquo;anic recitation, and spiritual diagnostics represents more than therapeutic action\u0026mdash;it reaffirms identity, community belonging, and collective resilience. While traditional healers may not utilize psychiatric nosology, their contextualized frameworks often align with psychosocial needs unmet by clinical psychiatry. Nevertheless, the lack of referral mechanisms, limited collaboration, and epistemic dissonance between biomedical and spiritual paradigms hinder co-management strategies. Pilot collaborations have revealed potential for synergy, yet remain fragmented and insufficiently institutionalized.\u003c/p\u003e\n\u003cp\u003eThe reliance on traditional remedies for infertility, maternal health, and pediatric diarrheal illnesses foregrounds the community-level resilience mechanisms in contexts of limited formal care. While certain practices\u0026mdash;such as the use of baobab in oral rehydration\u0026mdash;show promise aligned with public health objectives, others may delay or substitute evidence-based care. Importantly, these practices also carry cultural logics and social legitimacy that biomedical interventions often overlook. Integration efforts must thus go beyond clinical efficacy to encompass cultural competency and respectful engagement.\u003c/p\u003e\n\u003cp\u003eDespite decades of TM utilization, formal integration into the national health system remains rudimentary. The minimal engagement of traditional practitioners with the Ministry of Health, absence of regulatory frameworks, and lack of training or licensure mechanisms perpetuate a parallel system. The invisibility of TM in national health policy planning and surveillance undermines both safety and potential innovation. Effective integration requires not only biomedical validation but structural reforms in governance, licensing, research funding, and public education. Crucially, such reforms must be co-designed with TM practitioners to ensure legitimacy, uptake, and sustainability.\u003c/p\u003e\n\u003cp\u003eThe Sudanese experience with TM challenges the biomedical orthodoxy by foregrounding alternative epistemologies of health, illness, and healing. Rather than viewing TM as a residual or oppositional system, a transdisciplinary health framework should recognize its dynamic, adaptive, and community-rooted dimensions. This requires epistemological humility, policy innovation, and sustained investment in collaborative platforms between traditional practitioners, researchers, and clinicians. Only through such integrative approaches can Sudan fully harness the potential of its traditional knowledge systems while ensuring safety, equity, and scientific rigor.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study underscores the enduring relevance and adaptive resilience of traditional medicine within Sudan\u0026rsquo;s health landscape. Far from being a vestige of the past, traditional healing practices represent a dynamic response to contemporary health system gaps, cultural continuities, and community-defined needs. The widespread and context-sensitive use of traditional therapies\u0026mdash;across mental health, chronic disease, maternal care, and infectious illness\u0026mdash;calls for a paradigm shift that moves beyond assimilation into biomedical frameworks toward genuine epistemic pluralism.\u003c/p\u003e\n\u003cp\u003eScientific validation of phytotherapeutics, together with culturally informed engagement strategies, offers a path to responsible integration. However, meaningful inclusion of traditional medicine in national health agendas will require overcoming systemic inertia, building regulatory capacity, and fostering equitable collaborations with traditional practitioners. In fragile and transitional health systems such as Sudan\u0026rsquo;s, leveraging the strengths of both traditional and biomedical paradigms is not only pragmatic\u0026mdash;it is essential for achieving inclusive, people-centered care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthorship contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eB.R.\u003c/strong\u003e conceptualized the study, led the systematic review process, and wrote the main manuscript text. \u003cstrong\u003eI.E.M., E.E.E.,\u0026nbsp;\u003c/strong\u003eand\u003cstrong\u003e\u0026nbsp;N.A.A.\u003c/strong\u003e contributed to the screening and data extraction. \u003cstrong\u003eK.N.H.\u003c/strong\u003e and \u003cstrong\u003eA.A\u003c/strong\u003e. assisted in analysis, interpretation of findings, and drafting thematic results. \u003cstrong\u003eA.A.S.,\u0026nbsp;\u003c/strong\u003eand\u003cstrong\u003e\u0026nbsp;N.M.\u003c/strong\u003e contributed to background synthesis and policy relevance. All authors reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data sets and references were analyzed and reviewed in the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman ethics and consent to participate declarations:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish declaration:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e Not funded\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u0026nbsp;\u003c/strong\u003eNo Conflict of Interest\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of interest:\u003c/strong\u003e The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eOsujih M. Exploration of the Frontiers of Tradomedical Practices: Basis for Development of Alternative Medical Healthcare Services in Developing Countries. \u003cem\u003eJournal of the Royal Society of Health\u003c/em\u003e. 1993;113(4):190-194. doi:10.1177/146642409311300409\u003c/li\u003e\n\u003cli\u003eWHO definitions at: https://www.who.int/health-topics/traditional-complementary-and-integrative-medicine#tab=tab_\u003c/li\u003e\n\u003cli\u003eSchumaker L, Jeater D, Luedke T. Introduction. Histories of Healing: Past and Present Medical Practices in Africa and the Diaspora. Journal of Southern African Studies. 2007. 33(4). 707–714. https://doi.org/10.1080/03057070701646761\u003c/li\u003e\n\u003cli\u003eLako JDW, Sube KLL, Lumori CSG, Yengkopiong JP, Utong JAM, Binyason SA et al. Diversity and distribution of medicinal plants in the republic of South Sudan. World Journal of Advanced Research and Reviews, 2020, 07(01), 018–031. DOI: https://doi.org/10.30574/wjarr.2020.7.1.0165\u003c/li\u003e\n\u003cli\u003eLarit F, León F. Therapeutics to Treat Psychiatric and Neurological Disorders: A Promising Perspective from Algerian Traditional Medicine. Plants 2023, 12, 3860. https://doi.org/10.3390/plants12223860 \u003c/li\u003e\n\u003cli\u003eTesfamariam, S., Tesfai, F., Hussien, L. Ateshim Y, Yemane D, Russom M \u003cem\u003eet al.\u003c/em\u003e Traditional medicine among the community of Gash-Barka region, Eritrea: attitude, societal dependence, and pattern of use. \u003cem\u003eBMC Complement Med Ther\u003c/em\u003e \u003cstrong\u003e21\u003c/strong\u003e, 68 (2021). https://doi.org/10.1186/s12906-021-03247-9 \u003c/li\u003e\n\u003cli\u003eMujinja PG, Saronga HP. Traditional and Complementary Medicine in Tanzania: Regulation Awareness, Adherence and Challenges. Int J Health Policy Manag 2022, 11(8), 1496–1504 doi https://doi.org/10.34172/ijhpm.2021.51\u003c/li\u003e\n\u003cli\u003eMwaka AD, Achan J, Orach CG. Traditional health practices: A qualitative inquiry among traditional health practitioners in northern Uganda on becoming a healer, perceived causes of illnesses, and diagnostic approaches. PLoS ONE. 2023 18(4): e0282491. https://doi.org/10.1371/journal.pone.0282491\u003c/li\u003e\n\u003cli\u003eLim T, Davis EO, Crudge B, Roth V, Glikman JA\u003cem\u003e.\u003c/em\u003e Traditional Khmer Medicine and its role in wildlife use in modern-day Cambodia. \u003cem\u003eJ Ethnobiology Ethnomedicine\u003c/em\u003e \u003cstrong\u003e18\u003c/strong\u003e, 61 (2022). https://doi.org/10.1186/s13002-022-00553-5 \u003c/li\u003e\n\u003cli\u003eRedvers N, Blondin B. Traditional Indigenous medicine in North America: A scoping review. PLoS ONE. 2020. 15(8): e0237531. https://doi.org/10.1371/journal.pone.0237531\u003c/li\u003e\n\u003cli\u003eAlexiades MN, Peluso DM. Plants ‘of the Ancestors’, Plants ‘of the Outsiders’: Ese Eja History, Migration and Medicinal Plants, chapter 10 from a textbook titled: Mobility and Migration in Indigenous Amazonia. Published December 2012 by Environmental Anthropology and Ethnobiology. pp 220-248. https://doi.org/10.3167/9781845455637\u003c/li\u003e\n\u003cli\u003eWHO, Regional consultation on Draft Global Strategy for Traditional Medicine 2025:2034 and to set the research priorities for WHO SEA Region, Bangkok, Thailand, 20–22 August 2024. New Delhi: World Health Organization, Regional Office for South-East Asia; 2024. Licence: CC BY-NC-SA 3.0 IGO.\u003c/li\u003e\n\u003cli\u003eAdepoju VA, Oladimeji O, Sibiya MN, Inegbeboh J, Egesemba G. Tuberculosis management and referral practices among traditional medicine practitioners in Lagos, Nigeria. J Public Health Afr. 2023 Mar 1;14(2):1480. doi: https://doi.org/10.4081/jphia.2023.1480 PMID: 37065812; PMCID: PMC10099958.\u003c/li\u003e\n\u003cli\u003eSteinhorst J, Aglanu LM, Ravensbergen SJ, Dari CD, Abass KM, Mireku SO, et al. ‘The medicine is not for sale’: Practices of traditional healers in snakebite envenoming in Ghana. PLoS Negl Trop Dis. 2021. 15(4): e0009298. https://doi.org/10.1371/journal.pntd.0009298\u003c/li\u003e\n\u003cli\u003eTehrani JM, Vos IA, Kisabacak R, Topper MK, Steinhorst J, Phillips RO et al. Traditional healers’ perception on scabies causation and management in Ghana. Trop Med Int Health. 2024;29:477–488. DOI: https://doi.org/10.1111/tmi.13989 \u003c/li\u003e\n\u003cli\u003eMcRae A, Vilcins D, Le.HHTC, Gorman JBD, Marie Noel O, Lesley S et al. Lead in traditional and complementary medicine: a systematic review\" \u003cem\u003eReviews on Environmental Health\u003c/em\u003e. 2024. vol. 39. no. 1. pp. 111-120. https://doi.org/10.1515/reveh-2022-0079 \u003c/li\u003e\n\u003cli\u003eNemathaga M, Maputle MS, Makhado L, Mashau NS. Diagnosis of Epilepsy by Traditional Healers and Its Implications on Management in the Selected Rural Communities of Limpopo and Mpumalanga Provinces: A Qualitative Study. Neuropsychiatric Disease and Treatment 2023:19 https://doi.org/10.2147/NDT.S392479 \u003c/li\u003e\n\u003cli\u003eMesraoua B, Kissani N, Deleu D, Elsheikh L, Ali M, Melikyan G et al. Complementary and alternative medicine (CAM) for epilepsy treatment in the Middle East and North Africa (MENA) region. Epilepsy Research. 2021. 170 106538. https://doi.org/10.1016/j.eplepsyres.2020.106538\u003c/li\u003e\n\u003cli\u003eShaikh S. Traditional Medicine and its Use for Pain Management in Saudi Arabia. In: Laher, I. (eds) Handbook of Healthcare in the Arab World. Springer, Cham. 2021. https://doi.org/10.1007/978-3-319-74365-3_206-2 \u003c/li\u003e\n\u003cli\u003eKwame A. Integrating Traditional Medicine and Healing into the Ghanaian Mainstream Health System: Voices From Within. Qualitative Health Research. 2021, Vol. 31(10) 1847–1860. https://doi.org/10.1177/10497323211008849 \u003c/li\u003e\n\u003cli\u003eHussain S, Malik F. Integration of complementary and traditional medicines in public health care systems: Challenges and methodology. J. Med. Plants Res. 2013. Vol. 7(40), pp. 2952-2959. DOI: https://doi.org/10.5897/JMPR12.458 \u003c/li\u003e\n\u003cli\u003eNaghizadeh A, Salamat M, Hamzeian D, Akbari S, Rezaeizadeh H, Vaghasloo MA \u003cem\u003eet al.\u003c/em\u003e IrGO: Iranian traditional medicine General Ontology and knowledge base. \u003cem\u003eJ Biomed Semant\u003c/em\u003e. 2021. 12, 9 https://doi.org/10.1186/s13326-021-00237-1 \u003c/li\u003e\n\u003cli\u003eWang Y, Turvey ST, Leader-Williams N. Global biodiversity conservation requires traditional Chinese medicine trade to be sustainable and well regulated Glob Change Biol. 2022;28:6847–6856. DOI: https://doi.org/10.1111/gcb.16425 \u003c/li\u003e\n\u003cli\u003eYang S, Hao S, Wang Q, Lou Y, Jia L, Chen D. The interactions between traditional Chinese medicine and gut microbiota: Global research status and trends. Front. Cell. Infect. Microbiol. 2022. 12:1005730. doi: https://doi.org/10.3389/fcimb.2022.1005730 \u003c/li\u003e\n\u003cli\u003eOreagba IA, Oshikoya KA, Amachree M. Herbal medicine use among urban residents in Lagos, Nigeria. \u003cem\u003eBMC Complement Altern Med.\u003c/em\u003e 2011. 11, 117. https://doi.org/10.1186/1472-6882-11-117\u003c/li\u003e\n\u003cli\u003eOuma A, Jacobsson L, Nilsson LM. Sámi traditional medicine and complementary and alternative medicine – a descriptive study of use within the Sámi population of Sweden. International Journal of Circumpolar Health. 2023. 82(1). https://doi.org/10.1080/22423982.2023.2222908 \u003c/li\u003e\n\u003cli\u003eAron MB, Mulwafu M, Mailosi B, Kreuels B, Dullie L, Kachimanga C, et al. Experiences and practices of traditional healers on snakebite treatment and prevention in rural Malawi. PLoS Negl Trop Dis. 2023. 17(10): e0011653. https://doi.org/10.1371/journal.pntd.0011653\u003c/li\u003e\n\u003cli\u003eLimenh LW, Geremew DT, Kasahun AE, Aanagaw YK, Worku MC, Simegn W et al. Assessment of Knowledge, Attitudes, and Practices of Traditional Healers toward Dosage Forms and Routes of Administration: A Cross-Sectional Study in Ethiopia. Evidence-Based Complementary and Alternative Medicine Volume 2023, Article ID 7091233, 11 pages https://doi.org/10.1155/2023/7091233\u003c/li\u003e\n\u003cli\u003eBeasley EA, Wallace RM, Coetzer A, Nel LH, Pieracci EG. Roles of traditional medicine and traditional healers for rabies prevention and potential impacts on post-exposure prophylaxis: A literature review. PLoS Negl Trop Dis. 2022 16(1): e0010087. https://doi.org/10.1371/journal.pntd.0010087\u003c/li\u003e\n\u003cli\u003eAgbor AM, Naidoo S. A Review of the Role of African Traditional Medicine in the Management of Oral Diseases. Afr J Tradit Complement Altern Med. 2016. 13(2):133-142 http://dx.doi.org/10.4314/ajtcam.v13i2.16\u003c/li\u003e\n\u003cli\u003eMutola S, Pemunta NV, Ngo NV. Utilization of traditional medicine and its integration into the healthcare system in Qokolweni, South Africa; prospects for enhanced universal health coverage. Complement Ther Clin Pract. 2021 May;43:101386. doi: https://doi.org/10.1016/j.ctcp.2021.101386 Epub 2021 Apr 20. PMID: 33895465. \u003c/li\u003e\n\u003cli\u003eGrace, R., Vaz, J. \u0026amp; Da Costa, J. Traditional medicine use in Timor-Leste. \u003cem\u003eBMC Complement Med Ther\u003c/em\u003e. 2020. 20, 165 https://doi.org/10.1186/s12906-020-02912-9 \u003c/li\u003e\n\u003cli\u003eOrilogbon J, Adewole AM. Ethnoichthyological knowledge and perception in traditional medicine in Ondo and Lagos States, southwest Nigeria. Egyptian Journal of Biology, 2011, Vol. 13, pp 57-64 http://dx.doi.org/10.4314/ejb.v13i1.9\u003c/li\u003e\n\u003cli\u003eHerbreteau JB, Tavernier E, Joly A, Marchand A, Éédée AE, Tauveron V, Maruani A. Traditional healers or bonesetters (“rebouteux”) in France: a survey of their practice, profile, and customers. Published by Elsevier 2022. This manuscript is made available under the Elsevier user license. https://www.elsevier.com/open-access/userlicense/1.0/\u003c/li\u003e\n\u003cli\u003eAbdalla S, Abdel Aziz M, Basheir I. Sudan Household Health Survey 2010 national management team, Seeking care from a traditional healer after injury in Sudan: an exploratory cross-sectional analysis, International Health, 2020 Volume 12, Issue 3, Pages 177–183, https://doi.org/10.1093/inthealth/ihz063\u003c/li\u003e\n\u003cli\u003eAhmed GEM, Ahmed EYM, Ahmed AE, Hemmeda L, Birier AB, Abdelgadir T et al. Prevalence and reasons to seek traditional healing methods among residents of two localities in North Kordofan State, Sudan 2022: A cross‐sectional study. Health Sci. Rep. 2023;6:e1487. https://doi.org/10.1002/hsr2.1487\u003c/li\u003e\n\u003cli\u003eElmahdy M, Nasor F A. Prevalence and correlates of complementary and alternative medicine utilization among infertile women attending selected fertility clinics in Khartoum state. Healthcare in Low-resource Settings 2024; volume 12:12319.\u003c/li\u003e\n\u003cli\u003eKunna E, Yamamotoa T, Fahal A. The use of traditional medicines among mycetoma patients. Trans R Soc Trop Med Hyg 2021; 115: 297–306. doi: https://doi.org/110.1093/trstmh/traa135\u003c/li\u003e\n\u003cli\u003eAlamin MA, Yagi AI, Yagi SM. Evaluation of antidiabetic activity of plants used in Western Sudan. Asian Pac J Trop Biomed 2015; 5(5): 395-402.\u003c/li\u003e\n\u003cli\u003eYagi SM, Yagi AI. Traditional medicinal plants used for the treatment of diabetes in the Sudan: A review. African Journal of Pharmacy and Pharmacology. 2018. Vol. 12(3), pp. 27- 40, DOI: https://doi.org/10.5897/AJPP2017.4878 \u003c/li\u003e\n\u003cli\u003eAhmed EM, Nour BYM, Mohammed YG, Khalid HS. Antiplasmodial Activity of Some Medicinal Plants Used in Sudanese Folk-medicine. Environmental Health Insights 2010:4 1–6. Available from http://www.la-press.com \u003c/li\u003e\n\u003cli\u003eEI Tahir A, Ibrahim AM, Satti GMH, Theander TG, Kharazmi A, Khalid SA. The Potential Antileishmanial Activity of some Sudanese Medicinal Plants. PHYTOTHERAPY RESEARCH, 1998. VOL. 12, 576–579.\u003c/li\u003e\n\u003cli\u003eKhalid FA, Abdalla NM, Mohamed HO, Toum AM, Magzoub MM, Ali MS. Treatment of Cutaneous leishmaniasis with some Local Sudanese Plants (Neem, Garad \u0026amp; Garlic). Türkiye Parazitoloji Dergisi 2004. 28 (3): 129-132. \u003c/li\u003e\n\u003cli\u003eMoglad EH, Hamad AM, Fatima F, Seshadri VD, Naz M. Antimicrobial and wound healing activities of certain Sudanese medicinal plants. Saudi Journal of Biological Sciences. 2020. 27. 1766–1772. https://doi.org/10.1016/j.sjbs.2020.05.017\u003c/li\u003e\n\u003cli\u003eHagr TE, Adam IA. Phytochemical Analysis, Antibacterial and antioxidant Activities of Essential Oil from Hibiscus sabdariffa (L) Seeds, (Sudanese Karkadi). Progress in Chemical and Biochemical Research 2020, 3(3), 194-201. DOI: 10.33945/SAMI/PCBR.2020.3.2\u003c/li\u003e\n\u003cli\u003eAl-Shahi A. Spirit Possession and Healing: The ZAR among the Shaygiyya of the Northern Sudan. \u003cem\u003eBulletin (British Society for Middle Eastern Studies), \u003c/em\u003eVol. 11, No. 1 (1984), pp. 28- 44 Published by: Taylor \u0026amp; Francis, Ltd. Stable URL: https://www.jstor.org/stable/194805 \u003c/li\u003e\n\u003cli\u003eMahgoub AT. The relation between education level and attending traditional healers in Khartoum locality. Case study in Khartoum State. Sudan.‏\u003cem\u003e Am J Human Soc Sci Res 4, 112-9, 2020\u003c/em\u003e www.ajhssr.com \u003c/li\u003e\n\u003cli\u003eJones C, Baker F, Day T. From healing rituals to music therapy: bridging the cultural divide between therapist and young Sudanese refugees. The Arts in Psychotherapy. Volume 31, Issue 2, 2004, Pages 89-100. https://doi.org/10.1016/j.aip.2004.02.002\u003c/li\u003e\n\u003cli\u003eMohammed IN, Babikir HE. Traditional and Spiritual medicine among Sudanese children with epilepsy. Sudan J Paediatr 2013; 13(1):31-37. http://www.sudanjp.org\u003c/li\u003e\n\u003cli\u003eSorketti EA, Zuraida NZ, Habil MH. Collaboration between traditional healers and psychiatrists in Sudan. International Psychiatry. 2010. Volume 7 Number 3. \u003c/li\u003e\n\u003cli\u003eSorketti EA, Zainal NZ, Habil MH. The characteristics of people with mental illness who are under treatment in traditional healer canters in Sudan. International Journal of Social Psychiatry. 2011. 58(2) 204 –216. DOI: https://doi.org/10.1177/0020764010390439 \u003c/li\u003e\n\u003cli\u003eKoriana EAS. General Overview of Traditional Healer Practices in Relation to Mental Health in Sudan. Arabpsynet Journal: N°18-19 Spring \u0026amp; Summer 2008.\u003c/li\u003e\n\u003cli\u003eSorketti EA, Zainal NZ, Habil MH. The treatment outcome of psychotic disorders by traditional healers in central Sudan. Int J Soc Psychiatry. 2012. 0(0) 1 –12. DOI: https://doi.org/10.1177/0020764012437651\u003c/li\u003e\n\u003cli\u003eMariod A, Mohamedain A, Tahir HE. Medicinal plants and phytomedicines are used to treat or prevent illnesses in Sudan: a review. Tradit Med Res. 2023;8(1):3. doi: https://doi.org/10.53388/TMR20220323003 \u003c/li\u003e\n\u003cli\u003eKhalid H, Abdalla WE, Abdelgadir H, Opatz T, Thomas Efferth. Gems from traditional north-African medicine: medicinal and aromatic plants from Sudan. Nat. Prod. Bioprospect. 2012, 2, 92–103. DOI https://doi.org/10.1007/s13659-012-0015-2\u003c/li\u003e\n\u003cli\u003eElkamali HH, Hamed SEM. Antioxidant potential of some Sudanese medicinal plants used in traditional medicine. International Journal of Scientific World. 2015. 3 (2) 192-198. doi: https://doi.org/10.14419/ijsw.v3i2.4741 \u003c/li\u003e\n\u003cli\u003eAbdalla RM, Abdelgadir AE. Antibacterial Activity and Phytochemical Constituents of Cinnamomum verum and Matricaria chamomilla from Sudan. Bio Bulletin. 2016. Vol. 2(2): 08-12.\u003c/li\u003e\n\u003cli\u003eEbrahim AM, Eltayeb MH, Khalid H, Mohamed H, Abdalla W, Gril P et al. Study on selected trace elements and heavy metals in some popular medicinal plants from Sudan. J Nat Med. 2012. 66:671–679. DOI https://doi.org/10.1007/s11418-012-0630-6 \u003c/li\u003e\n\u003cli\u003eAhmed RH, Mustafa DE. Green synthesis of silver nanoparticles mediated by traditionally used medicinal plants in Sudan. \u003cem\u003eInt Nano Lett.\u003c/em\u003e 2020\u003cstrong\u003e. \u003c/strong\u003e10, 1–14. https://doi.org/10.1007/s40089-019-00291-9 \u003c/li\u003e\n\u003cli\u003eBabikir SA, Alhassan GO, Hamad-Alneil AI, Alfadl AA. Complementray medicine seeking behaviour among Sudanese infertile women, 2019, PREPRINT (Version 1) available at Research Square https://doi.org/10.21203/rs.2.12689/v1\u003c/li\u003e\n\u003cli\u003eAbdel Galil N. Evaluation of baobab (gonglase) solution for home management of diarrhoea in sudanese children. Jun 1996; 165 p; 203 refs. , 33 tabs. , 13 figs. the Graduate College, University of Khartoum, Khartoum (Sudan); Thesis (Ph.D).\u003c/li\u003e\n\u003cli\u003eAlsafi A. Traditional Sudanese Medicine: A primer for health care providers, researchers, and students. 2006. Azza House, Khartoum, Sudan.\u003c/li\u003e\n\u003cli\u003eKarar MGE, Kuhnert N. Herbal Drugs from Sudan: Traditional Uses and Phytoconstituents. Pharmacognosy Reviews. 2017. Volume 11, Issue 22. DOI: https://doi.org/10.4103/phrev.phrev_15_15 \u003c/li\u003e\n\u003cli\u003eAhmed lM, Bremer JJ, Magzoub MME, Nouri AMH. Characteristics of visitors to traditional healers in central Sudan. Eastern Mediterranean Health Journal 1999. Vol 5 (2). pp 79-85.\u003c/li\u003e\n\u003cli\u003eMohamed R, Mohamed R, Dafalla R,Ahmed A, Abdeldaim A. The prevalence of herbal medicine among Sudanese adults: a cross-sectional study 2021. \u003cem\u003eBMC Complement Med Ther\u003c/em\u003e. 2024. 24, 308. https://doi.org/10.1186/s12906-024-04584-1\u003c/li\u003e\n\u003cli\u003eAltamih RAA, Elmahi OKO. Social interactions within the Sudanese healthcare system: traditional healers and psychiatrists. BJPSYCH INTERNATIONAL. 2023 Volume 20 Number 2 doi: https://doi.org/10.1192/bji.2022.27 \u003c/li\u003e\n\u003cli\u003eEl Tayeb S, Abdalla S, Van den Bergh G, Heuch I. Use of healthcare services by injured people in Khartoum State, Sudan, International Health. 2015. Volume 7, Issue 3, Pages 183–189, https://doi.org/10.1093/inthealth/ihu063 \u003c/li\u003e\n\u003cli\u003eMariod A, Elrasheid Tahir H, Agab M A. History of Traditional Medicine Practices in Sudan: Review. International Journal of Traditional and Complementary Medicine Research. 2023. 4(1), 31-36 https://doi.org/10.53811/ijtcmr.1200069\u003c/li\u003e\n\u003cli\u003eSaeed BO. Traditional Medicine in The Sudan. BIOCHEMICAL EDUCATION. 1984. 12(1). https://doi.org/10.1016/S0307-4412(84)80014-X\u003c/li\u003e\n\u003cli\u003eSorketti E A, Habil M H. The Current Situation of the People with Mental Illness in the Traditional Healer Centers in Sudan. Malaysian Journal Of Psychiatry, 2009, Vol.18 No.2. Downloaded from http://journals.lww.com/mjp \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Traditional Medicine, Sudan, Systematic Review, Health Systems Integration, Phytopharmacology, Ethnomedicine, Healthcare Policy ","lastPublishedDoi":"10.21203/rs.3.rs-7282339/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7282339/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Traditional medicine (TM) is a key healthcare component in Sudan, rooted in cultural identity and filling gaps in under‑resourced systems. Although 60.9 %–79.3 % of adults use TM, evidence remains fragmented, limiting policy and integration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e This review synthesizes Sudan‑specific TM research on prevalence, uses, pharmacology, safety, sociodemographic factors, and integration.\u003c/p\u003e\n\u003cp\u003eMethods: A PRISMA 2020 compliant systematic review of Sudan studies from 1980 to 2024 in multiple databases yielded 36 empirical studies. Six domains guided data extraction, and quality was assessed with CASP, NOS and SYRCLE tools.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Rural TM use (≈ 68.2 %) exceeded urban (≈ 55.7 %), with affordability and cultural fit as main drivers. Major applications include infectious disease (e.g. Acacia nilotica inhibited Plasmodium falciparum by 96.3 %), diabetes (76+ antidiabetic plants reported), mental health (≈ 71.3 % of psychosis patients first seek TM), and infertility (≈ 68.2 % of women used TM). Pharmacology shows efficacy—for example, Hibiscus sabdariffa oil achieved 85 % antibacterial activity against Staphylococcus aureus—yet safety issues persist: 11.8 % of products exceeded WHO lead thresholds. Zār spiritual healing continues to play a cultural role. Formal integration remains limited: under 10 % of practitioners engage state health authorities, and only 24.7 % of patients disclose TM use to medical providers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e TM in Sudan acts as a resilient, adaptive healthcare system. To effectively support sustainable integration, key priorities are regulatory safety standards, clinical validation of promising botanicals, and co‑designed, culturally sensitive policy frameworks acknowledging TM’s legitimacy alongside biomedical norms.\u003c/p\u003e","manuscriptTitle":"Bridging Knowledge to Policy: A Systematic Review of Traditional Medicine’s Role, Risks, and Integration Pathways in Sudanese Healthcare","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-12 13:03:46","doi":"10.21203/rs.3.rs-7282339/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5e8db551-7bb7-47ac-a35b-0d68ef8060f6","owner":[],"postedDate":"August 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-17T10:08:29+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-12 13:03:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7282339","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7282339","identity":"rs-7282339","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}