Non-prescription Plant-Based Aphrodisiacs Inducing Nephritis and Nephrosis in sub-Saharan African Men: A Systematic Review Protocol

Non-prescription Plant-Based Aphrodisiacs Inducing Nephritis and Nephrosis in sub-Saharan African Men: A Systematic Review Protocol | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (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];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Non-prescription Plant-Based Aphrodisiacs Inducing Nephritis and Nephrosis in sub-Saharan African Men: A Systematic Review Protocol View ORCID Profile Senzelokuhle M. Nkabini , Lindiwe Nkabini-Anderson , Fezile Zuma doi: https://doi.org/10.1101/2025.09.16.25335902 Senzelokuhle M. Nkabini 1 Faculty of Humanities, University of Pretoria , South Africa M.Ed. Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Senzelokuhle M. Nkabini For correspondence: u24050352{at}tuks.co.za Lindiwe Nkabini-Anderson 2 Clean Up Project , Amanzimtoti, KwaZulu-Natal: South Africa Find this author on Google Scholar Find this author on PubMed Search for this author on this site Fezile Zuma 3 Clean Up Project , Amanzimtoti, KwaZulu-Natal: South Africa Find this author on Google Scholar Find this author on PubMed Search for this author on this site Abstract Full Text Info/History Metrics Data/Code Preview PDF Abstract Background Sub-Saharan African (SSA) men’s erotic desires for sexual prowess, stamina, and sturdy penile strength have created a ‘multi-million-dollar industry’ for businesses retailing non-prescription plant-based aphrodisiacs (NPBA’s). Globally, the registered and approved NPBA mass-producing sexual enhancement supplements (SES’s) retailing industry, has reached almost $300 million in 2025, and is projected to increase by 6.9% yearly up until 2035. The gross increase will be approximately $600 million. Unlike the global market that heavily relies on manufactured SES’s, a vast majority of male SSA citizens still prefer natural NPBA’s. These NPBA’s are natural plant species (herbs, flowering plants & roots) that are either consumed in their natural form or mixed with warm water to extract the plants or roots properties. Currently in SSA, almost 600 plant species have been discovered in less than 10 countries, and these plants are currently being used as NPBA’s by men. However, due to the SSA region comprising of 49 countries and approximately 1.6 billion citizens, a large majority of untested, and unapproved plant species are currently being used as NPBA’s. This is dangerous because the global, continental (Africa), and regional (SSA) health & medical science communities have not tested the toxicity levels of these NPBA’s. This lack of knowledge has led to health risks such as nephritis (inflammation of the kidneys), and nephrosis (excessive protein loss due to damaged kidney filters) in SSA men. Moreover, the easy access in obtaining NPBA’s in SSA and the excessive usage of them by men, has led to a spike in chronic kidney diseases (CKD) such as nephritis and nephrosis. CKD is currently a growing public health concern in SSA that has received minimal attention due to it being a non-communicable illness. Approximately 174 million SSA citizens are affected by CKD which has caused 77,000 deaths in the region, and the severity of this issue is proven by CKD increasing by 0,85% annually. Currently, the excessive use of unapproved NPBA’s in SSA has been included as one of the leading causes of CKD in men. Methods The primary aim of this systematic review is to map out and synthesise evidence of, NPBA’s inducing nephritis and nephrosis in SSA men from existing literature. The following databases will be utilized to search for studies: PubMed, PsycINFO, ProQuest, ERIC (Education Resources Information Center), Cochrane Reviews, WHO, and Scopus. The Preferred Reporting Items for Systematic and Meta Analyses (PRISMA) ScR flow chart/diagram presented in figure 1 will be utilized to summarize the study selection process. Conclusion Despite CKD/Kidney disease/nephritis & nephrosis not being included as: (i) a part of the NCD’s that cause a large number of deaths globally, (ii) the 4 major NCD’s, that are reported on within several global WHO NCD publications, within Africa and the SSA region this chronic disease is a serious public health crisis. Unfortunately, untested, unapproved, and unregulated NPBA’s that currently exist in SSA, are also suspected of predominantly contributing to this crisis in men. Moreover, throughout the African continent and SSA region, only three countries (Ethiopia, South Africa & Zambia) offer both renal replacement by transplantation, and renal replacement therapy by dialysis. Hence, the escalating death rates caused by CKD/Kidney disease/nephritis & nephrosis. The proposed systematic review will generate findings pertaining to NPBA’s inducing nephritis and nephrosis in SSA men. These findings will/can reveal the current existing literature gaps regarding NPBA’s, CKD, nephritis and nephrosis. Systematic reviews registration PROSPERO (CRD420251146160) Background Sub-Saharan African (SSA) men’s erotic desires for sexual prowess, stamina, and sturdy penile strength have created a ‘multi-million-dollar industry’ for businesses retailing non-prescription plant-based aphrodisiacs (NPBA’s). Globally, the registered and approved NPBA mass-producing sexual enhancement supplements (SES’s) retailing industry, has reached almost $300 million in 2025, and is projected to increase by 6.9% yearly up until 2035 ( 1 ). The gross increase will be approximately $600 million ( 1 ). Unlike the global market that heavily relies on manufactured SES’s, a vast majority of male SSA citizens still prefer natural NPBA’s ( 2 ). These NPBA’s are natural plant species (herbs, flowering plants & roots) that are either consumed in their natural form or mixed with warm water to extract the plants or roots properties ( 2 , 3 ). Currently in SSA, almost 600 plant species have been discovered in less than 10 countries, and these plants are currently being used as NPBA’s by men ( 4 , 5 ). However, due to the SSA region comprising of 49 countries and approximately 1.6 billion citizens, a large majority of untested, and unapproved plant species are currently being used as NPBA’s. This is dangerous because the global, continental (Africa), and regional (SSA) health & medical science communities have not tested the toxicity levels of these NPBA’s. This lack of knowledge has led to health risks such as nephritis (inflammation of the kidneys), and nephrosis (excessive protein loss due to damaged kidney filters) in SSA men. Within the SSA region, both past and present, NPBA’s have occasionally been used for creating interest in sexual intercourse, and maintaining sexual enjoyment throughout the human ageing process ( 6 , 7 , 8 , 9 ). Due to these aphrodisiacs being plant-based, and a part of traditional medicines that have been used to heal various ailments they are either orally consumed, swallowed or administered through the rectum with an enema in their natural state by men ( 6 , 7 , 8 , 9 ). NPBA’s have the natural advantage of being assumed to be safe, healthy and a ‘much-needed’ eliminator of most chronic diseases. This is because of their vegetative form that has not been distorted, and transformed into a tablet/syrup that has a high volume of chemical preservatives to prevent it from decomposing. However, despite the infamousness of NPBA’s being a natural resource that assists with sexual dysfunctions in SSA, they have not been tested for any other side-effects that they might cause to the human body ( 6 , 7 , 8 , 9 ). Moreover, the easy access in obtaining NPBA’s in SSA and the excessive usage of them by men, has led to a spike in chronic kidney diseases (CKD) such as nephritis and nephrosis ( 6 , 7 , 8 , 9 ). CKD is currently a growing public health concern in SSA that has received minimal attention due to it being a non-communicable illness ( 10 ). Approximately 174 million SSA citizens are affected by CKD which has caused 77,000 deaths in the region, and the severity of this issue is proven by CKD increasing by 0,85% annually ( 10 ). Currently, the excessive use of unapproved NPBA’s in SSA has been included as one of the leading causes of CKD in men. The World Health Organisation (WHO) initially created, The Global Action Plan for The Prevention and Control of Non-Communicable Diseases (NCD’s) 2013-2020 in order to decrease the 36 million global deaths (63%) caused by NCD’s ( 11 ). However, this 2013-2020 action plan was only intended for addressing NCD’s such as cardiovascular diseases, all forms of cancers, chronic respiratory illnesses, and diabetes ( 11 ). These aforementioned NCD’s were responsible for 86% of deaths in lower-middle-income countries (LMIC’s), and SSA has approximately 41 countries out of 49 that are defined as LMIC’s ( 11 ). Towards the end of 2013-2020 the Draft Implementation Road Map 2023-2030 for The Global Action Plan for The Prevention and Control of Non-Communicable Diseases 2013-2030 was drafted ( 12 ). The 2023-2030 action plan focuses on: (i) accelerating national response to NCD’s, (ii) prioritising the implementation of interventions to NCD’s, and (iii) ensuring reliable national data on NCD’s risk factors ( 12 ). In spite of this, within the 2023-2030 action plan, the section focusing on its scope, purpose, and modalities does not feature CKD/Kidney disease/nephritis & nephrosis as part of the ‘4 by 4 NCD agenda’ or the ‘5 by 5 NCD agenda’ ( 12 ). Moreover, the WHO NCD data portal does not feature CKD/Kidney disease/nephritis & nephrosis as part of the NCD’s that cause a large number of deaths globally ( 10 , 13 ). This is in spite of the WHO NCD portal featuring diseases and risk factors such as harmful alcohol use, smoking, cancer, diabetes, and diabetes ( 13 ). These diseases and risk factors are one of the many lead causes of CKD/Kidney disease/nephritis & nephrosis. Furthermore, CKD/Kidney disease/nephritis & nephrosis has not been included in the 4 major NCD’s, that are reported on within several global WHO NCD publications ( 11 , 14 , 15 , 16 , 17 ). Nonetheless, this chronic disease does feature in WHO-African Region: Communicable and Non-Communicable Diseases in Africa in 2021/2022 , but this subtlety denotes CKD/Kidney disease/nephritis & nephrosis as an ‘African disease’ instead of being designated as a global public health crisis ( 37 ). Hence, the relevance and necessity of studies such as this systematic review. NPBA’s inducing nephritis and nephrosis in SSA men is part of the global challenges, that the United Nations (UN) wants to address through the 17 sustainable development goals (SDGs) ( 18 ). NPBA’s inducing nephritis and nephrosis in SSA men is included as part of the challenges that should be addressed by SDG 3: Good Health and Well-being . Due to the severity of preventing and controlling NCD’s, WHO has created a sub-section for this SDG titled SDG Target 3.4 Non-communicable Diseases and Mental Health . This sub-section focuses on practical interventions that work towards providing treatment, in order to prevent premature mortality and reduce death rates that are linked to NCD’s ( 19 ). 18 million people under the age of 70 have died due to untreated NCD’s, despite 62% of these premature deaths being preventable ( 19 ). SDG 3 , SDG Target 3.4 , and the Draft Implementation Road Map 2023-2030 for The Global Action Plan for The Prevention and Control of Non-Communicable Diseases 2013-2030 are notable programmes for dealing with NCD’s. However, the lack in recognition of CKD/Kidney disease/nephritis & nephrosis, has created a serious gap in research and knowledge regarding this NCD. Evidence of NPBA’s inducing nephritis and nephrosis in SSA men will be systematically mapped, synthesised, and literature gaps will be exposed through the guidance of primary and secondary research questions. The primary research question that will guide this review is: What factors contribute to SSA men utilizing non-prescribed plant-based aphrodisiacs? The secondary research questions are: What are the experiences of SSA men that use non-prescription plant-based aphrodisiacs? What evidence exists regarding non-prescription plant-based aphrodisiacs inducing nephritis and nephrosis in SSA men? Databases such as PubMed, Cochrane Reviews, and EBSCOhost were utilized to conduct a preliminary database search in order to prevent the duplication of studies. Based on the research teams (SMN, LN-A & FZ) knowledge there has been no other systematic review conducted on NPBA’s inducing nephritis, and nephrosis in SSA men. However, there is a study titled Natural aphrodisiacs consumption by male workers in the former Katanga province, DR Congo ( 8 ). The results from this study found no evidence of nephrotoxicity or hepatotoxicity caused by the consumption of natural aphrodisiacs. The results from this study can be attributed to the investigation only obtaining data from a small sample (research participants), that is located in one province, and within one SSA country. Thus, further research is required hence the results from this systematic review will assist organisations such as WHO, CKD-Africa, International Society of Nephrology, Kidney Disease Improving Global Outcome (KIDIGO), World Kidney Day, National Kidney Foundation, Kidney Research United Kingdom, National Kidney Federation, National Kidney Foundation of South Africa (NKFSA), and the International Society of Nephrology (ISN). Methods The primary aim of this systematic review is to map out and synthesise evidence of, NPBA’s inducing nephritis and nephrosis in SSA men from existing literature. All forms of studies, grey literature and peer-reviewed journal articles focusing on non-prescription plant-based aphrodisiacs, and nephritis & nephrosis in SSA men will be sourced. The primary research question that will guide this review is: What factors contribute to SSA men utilizing non-prescribed plant-based aphrodisiacs? The secondary research questions are: What are the experiences of SSA men that use non-prescription plant-based aphrodisiacs? What evidence exists regarding non-prescription plant-based aphrodisiacs inducing nephritis and nephrosis in SSA men? The P.I.Co (population, interest, context) framework was utilized to address the eligibility, and adequateness of the primary and secondary research questions. This framework (P.I.Co) has been adapted from the P.I.C.O framework, which is used for quantitative systematic reviews ( 20 ). However, due to some systematic reviews focusing on qualitative components, the P.I.Co framework was created ( 20 ). P.I.Co (Population, Interest, Context) framework Population Non-prescription plant-based aphrodisiacs are herbs, flowering plants, and roots utilised to stimulate sexual desire, improve sexual function, as well as enhancing sexual performance ( 21 , 22 ). Age: 19+ years old is the average age range that is allowed to use commercially produced SES’s. However, due to NPBA’s being untested, unregulated, and retailed with no prescription requirement, the age range might be lower. Furthermore, the age range is also dependant on the practiced socio-cultural rituals of each SSA country, and when communities in these SSA countries choose to usher boys into manhood, and teach them about the man’s role in: society, in his family, and in the marital bedroom ( 23 , 24 , 25 ). Interest Nephritis and nephrosis in men, is the inflammation, and overall damage of the kidneys blood vessels which later leads to: blood being present in the urine, high blood pressure, foamy urine, weight gain due to fluid retention, and swelling (around the eyes, feet & ankles) ( 26 , 27 ). Context SSA is a region within the African continent, that has 49 countries ( 28 ). Sources of evidence All studies, grey and empirical literature containing evidence on NPBA’s that induce nephritis and nephrosis in SSA men. Publication Year Range 01/01/2016-30/09/2025 Language: No language restriction Information sources and search strategy All searches will be conducted by SMN, LN-A and FZ for studies and study designs published in peer-reviewed journals, grey literature, published and unpublished dissertations, case studies, reviews, essays, theses and symposium abstracts. The following databases will be utilized to search for studies: PubMed, PsycINFO, ProQuest, ERIC, Cochrane Reviews, WHO, and Scopus. The search strategy will use the Boolean term ‘OR’ to separate words or search terms. The following search terms will be utilised: non-prescription OR plant-based OR aphrodisiac OR inducing OR nephritis OR nephrosis OR sub-Saharan African/ SSA OR men. A preliminary data base search was conducted by the research team using the search terms, and the results are presented in Table 1 . The preliminary search produced all studies, qualitative and quantitative full-text grey literature and peer-reviewed literature with no language restrictions, and published within the search time-line from 01January 2016 till 30 September 2025. View this table: View inline View popup Download powerpoint Table 1: Preliminary database search results View this table: View inline View popup Download powerpoint Table 2: Data charting table Inclusion and exclusion criteria The selection of eligible studies will be based on the title (NPBA’s inducing nephritis and nephrosis), abstract, setting (SSA), study population (SSA men) and the findings in full-text studies, books, grey literature and journal articles relating to NPBA’s, and nephritis & nephrosis in SSA men. All database searches will be conducted on a weekly basis by SMN, LN-A and FZ to ensure new literature is included. Only studies that adhere to the following criteria will be included: (i) NPBA’s, and nephritis & nephrosis in SSA men, (ii) qualitative and quantitative study designs iii) studies and articles published from 2016 to 2025 and, (iv) only studies, books, grey literature or journal articles that are restricted to human ages 19+ years old, full-text, have references/citations and have been peer-reviewed. Studies that are: (i) published before 2016, will be excluded. Data management and study selection The framework, enhancements to the framework and guidelines provided by Arksey and O’Malley’s ( 29 ), Levac et al ( 30 ), Daudt et al ( 31 ), and Johanna Briggs ( 32 ) will guide this review. The Preferred Reporting Items for Systematic and Meta Analyses (PRISMA) ScR flow chart/diagram presented in figure 1 will be utilized to summarize the study selection process ( 33 , 34 ). The authors and the two research assistants will ensure that all retrieved literature will be exported and saved to an Endnote 21.3 library folder, in order to enable the study to be reproduced for a second time at a later stage. Moreover, this process will allow SMN, LN-A and FZ to create separate libraries for each database, in order to import references, remove duplicates, and organize the findings. Download figure Open in new tab Figure 1: The Preferred Reporting Items for Systematic and Meta Analyses (PRISMA) ScR flow chart/diagram Data extraction A data charting table will be used in order to document the extracted data. Studies that meet the inclusion criteria will be included on the charting form. The use of the NVivo data analysis software and Braun and Clarke’s ( 35 ) thematic framework will guide the qualitative analysis. The data extraction form will be updated by SMN, LN-A and FZ on a weekly basis to guarantee accurateness. Risk of bias assessment Studies or articles that only feature few countries that are located in the SSA region will not be included, because the research results from these studies do not represent SSA as a whole. In order to avoid biasness the review will utilise the mixed-method appraisal tool (MMAT) version 2018 to appraise the quality of all included evidence ( 36 ). SMN, LN-A & FZ will be responsible for assigning ratings of 100% for high average sources, 50% average and 25% for low-quality articles. Discrepancies between the protocol and the systematic review Discrepancies between the protocol, the actual review and the reasons and consequences thereof will be reported in the final report. Data synthesis A narrative synthesis will be conducted, which will provide texts and tables in order to synthesize and discuss the data of the studies and the methods, as previously described in the data extraction section. Results The results of this systematic review will be disseminated through publication in peer-reviewed scientific journals. The data will also be made available to humanitarian organisations such as WHO, CKD-Africa, International Society of Nephrology, Kidney Disease Improving Global Outcome (KIDIGO), World Kidney Day, National Kidney Foundation, Kidney Research United Kingdom, National Kidney Federation, National Kidney Foundation of South Africa (NKFSA), and the International Society of Nephrology (ISN). The findings from this study will inform the future research projects that these organisations embark on. Discussion Despite CKD/Kidney disease/nephritis & nephrosis not being included as: (i) a part of the NCD’s that cause a large number of deaths globally, (ii) the 4 major NCD’s, that are reported on within several global WHO NCD publications, within Africa and the SSA region this chronic disease is a serious public health crisis ( 10 , 13 , 11 , 14 , 15 , 16 , 17 ). Unfortunately, untested, unapproved, and unregulated NPBA’s that currently exist in SSA, are also suspected of predominantly contributing to this crisis in men. Moreover, throughout the African continent and SSA region, only three countries (Ethiopia, South Africa & Zambia) offer both renal replacement by transplantation, and renal replacement therapy by dialysis ( 37 ). Hence, the escalating death rates caused by CKD/Kidney disease/nephritis & nephrosis. The proposed systematic review will generate findings pertaining to NPBA’s inducing nephritis and nephrosis in SSA men. These findings will/can reveal the current existing literature gaps regarding NPBA’s, CKD, nephritis and nephrosis. Humanitarian organisations such as WHO, CKD-Africa, International Society of Nephrology, Kidney Disease Improving Global Outcome (KIDIGO), World Kidney Day, National Kidney Foundation, Kidney Research United Kingdom, National Kidney Federation, National Kidney Foundation of South Africa (NKFSA), and the International Society of Nephrology (ISN) can conduct further research on this topic. Data Availability All data produced in the present work are contained in the manuscript Disclosure statement No potential conflict of interest was reported by the authors. Authors contributions SMN, LN-A and FZ conducted the preliminary database search for the protocol, conceptualised, drafted, edited, reviewed, sent out the draft protocol manuscript for constructive feedback, and approved the final manuscript. Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Availability of data material The required data is included in the manuscript. Competing interests The authors have stated that there are no competing interests. Conflict of interest The authors declare that there is no conflict of interest. Funding The authors did not receive any external funding for this protocol. View this table: View inline View popup PRISMA-P (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) 2015 checklist: recommended items to address in a systematic review protocol* Acknowledgments The authors express their gratitude to: the Faculty of Humanities at the University of Pretoria. Footnotes Authors physical address: 1 Faculty of Humanities, University of Pretoria. Hatfield Campus: Hatfield, Lynnwood Rd & Roper St, Pretoria, 0002. Gauteng province, South Africa Email: u24050352{at}tuks.co.za 2 Clean Up Project,728 P Imfume Main Road, Amanzimtoti,4125 KwaZulu-Natal: South Africa. Email: lindiwenkabini680{at}gmail.com 3 Clean Up Project,728 P Imfume Main Road, Amanzimtoti,4125 KwaZulu-Natal: South Africa. Email: zumaf2373{at}gmail.com Discussion Despite CKD/Kidney disease/nephritis & nephrosis not being included as: (i) a part of the NCDs that cause a large number of deaths globally, (ii) the 4 major NCDs, that are reported on within several global WHO NCD publications, within Africa and the SSA region this chronic disease is a serious public health crisis (10,13, 11,14,15,16,17). Unfortunately, untested, unapproved, and unregulated NPBAs that currently exist in SSA, are also suspected of predominantly contributing to this crisis in men. Moreover, throughout the African continent and SSA region, only three countries (Ethiopia, South Africa & Zambia) offer both renal replacement by transplantation, and renal replacement therapy by dialysis (37). Hence, the escalating death rates caused by CKD/Kidney disease/nephritis & nephrosis. The proposed systematic review will generate findings pertaining to NPBAs inducing nephritis and nephrosis in SSA men. These findings will/can reveal the current existing literature gaps regarding NPBAs, CKD, nephritis and nephrosis. Humanitarian organisations such as WHO, CKD-Africa, International Society of Nephrology, Kidney Disease Improving Global Outcome (KIDIGO), World Kidney Day, National Kidney Foundation, Kidney Research United Kingdom, National Kidney Federation, National Kidney Foundation of South Africa (NKFSA), and the International Society of Nephrology (ISN) can conduct further research on this topic. Abbreviations CKD Chronic Kidney Disease ISN International Society of Nephrology KIDIGO Kidney Disease Improving Global Outcome LMIC Lower-Middle-Income-Country MMAT Mixed-Method Appraisal Tool NCD Non-Communicable Disease NKFSA National Kidney Foundation of South Africa NPBA Non-prescription Plant-Based Aphrodisiacs P.I.Co Population. Interest. Context PRISMA Preferred Reporting Items for Systematic and Meta Analyses SES Sexual Enhancement Supplements SSA sub-Saharan Africa SDG Sustainable Development Goals UN United Nations WHO World Health Organisation References 1. ↵ FMI: Future Market Insights . Sexual Enhancements Supplements Market . 2025 . Available from: https://www.futuremarketinsights.com/reports/sexual-enhancement-supplements-market 2. ↵ Ajao AA , Sibiya NP , Moteetee AN . Sexual prowess from nature: A systematic review of medicinal plants used as aphrodisiacs and sexual dysfunction in sub-Saharan Africa . South African Journal of Botany . 2019 May 1 ; 122 : 342 – 59 . doi: 10.1016/j.sajb.2018.08.011 OpenUrl CrossRef 3. ↵ Bitwell C , Indra SS , Luke C , Kakoma MK . A review of modern and conventional extraction techniques and their applications for extracting phytochemicals from plants . Scientific African . 2023 Mar 1 ; 19 : e01585 . doi: 10.1016/j.sciaf.2023.e01585 OpenUrl CrossRef 4. ↵ Abdillahi HS , Van Staden J . South African plants and male reproductive healthcare: conception and contraception . Journal of Ethnopharmacology . 2012 Sep 28 ; 143 ( 2 ): 475 – 80 . doi: 10.1016/j.jep.2012.06.047 OpenUrl CrossRef PubMed 5. ↵ Chakale MV , Lekhooa M , Aremu AO . South African medicinal plants used for health conditions affecting males: An ethnobotanical review . Journal of Herbal Medicine . 2024 Sep 1 ; 47 : 100931 . doi: 10.1016/j.hermed.2024.100931 OpenUrl CrossRef 6. ↵ Liwa CA , Jaka HM . Renal diseases and use of medicinal herbal extracts: a concise update of reported literature in Africa . J Nephrol Renal Ther . 2016 ; 2 ( 008 ). doi: 10.24966/NRT-7313/100008 OpenUrl CrossRef 7. ↵ Netshiluvhi TR . Scientific Validation of South African Aphrodisiac Plants for Erectile Dysfunction: An Exploratory Review . Natural Product Communications . 2025 Jun; 20 ( 6 ): 1934578X251321725 . doi: 10.1177/1934578X251321725 OpenUrl CrossRef 8. ↵ Obadia PM , Mulaji GK , Musambo TM , Kitenge JP , Kuhangana TC , Kayembe-Kitenge T , Nkulu CB , Nemery B , Enzlin P . Natural aphrodisiacs consumption by male workers in the former Katanga province , DR Congo. medRxiv . 2024 Feb 8 : 2024 – 02 . doi: 10.1101/2024.02.07.24302074 OpenUrl Abstract / FREE Full Text 9. ↵ Dube S , Makhubela N , Madikizela LM , Mongalo NI , Pakade VE , Maseko BR , Ncube S . Health Risk Assessment of Metals in African Aphrodisiacs: A case study of aqueous concoctions from Johannesburg and Durban herbal markets , South Africa. Applied Sciences . 2023 Feb 7 ; 13 ( 4 ): 2148 . doi: 10.3390/app13042148 OpenUrl CrossRef 10. ↵ Ayalew BD , Alemayehu ZG , Tamrie YG , Admasu BA , Keraga AS , Nida HW , Sharew TM , Sime BL , Zewdie YA , Tiruneh YM , Jibat N . The Public Health Impacts of Chronic Kidney Disease in Sub-Saharan Africa: A call for action. Journal of Medicine , Surgery, and Public Health . 2025 Jul 21 : 100209 . doi: 10.1016/j.glmedi.2025.100209 OpenUrl CrossRef 11. ↵ World Health Organization . Global action plan for the prevention and control of noncommunicable diseases 2013-2020. InGlobal action plan for the prevention and control of noncommunicable diseases 2013-2020 2013 . Available from: https://iris.who.int/bitstream/handle/10665/94384/9789241506236_eng.pdf?sequence=1 12. ↵ WHO . Follow-up to the political declaration of the third high-level meeting of the General Assembly on the prevention and control of non-communicable diseases. Draft implementation road map 2023–2030 for The Global Action Plan for The Prevention and Control of Non-Communicable Diseases 2013-2030 . 2022 April 27 . Available from: https://apps.who.int/gb/ebwha/pdf_files/WHA75/A75_10Add8-en.pdf 13. ↵ WHO . WHO NCD Data Portal . 2025 . Available from: https://ncdportal.org/ 14. ↵ World Health Organization . Saving lives, spending less: the case for investing in noncommunicable diseases ; 2021 . World Health Organization . Available from: https://iris.who.int/bitstream/handle/10665/350449/9789240041059-eng.pdf?sequence=1 15. ↵ World Health Organization . Toolkit for developing a multisectoral action plan for noncommunicable diseases: overview. Toolkit for developing a multisectoral action plan for noncommunicable diseases: overview . 2022 . Available from: https://iris.who.int/bitstream/handle/10665/353163/9789240043596-eng.pdf?sequence=1 16. ↵ World Health Organization . Invisible numbers: the true extent of noncommunicable diseases and what to do about them. World Health Organization ; 2022 Sep 15 . Available from: https://iris.who.int/bitstream/handle/10665/362800/9789240057661-eng.pdf?sequence=1 17. ↵ World Health Organization . Tackling NCDs: best buys and other recommended interventions for the prevention and control of noncommunicable diseases. World Health Organization ; 2024 Apr 30 . Available from: https://iris.who.int/bitstream/handle/10665/376624/9789240091078-eng.pdf?sequence=1 18. ↵ UN . The sustainable development agenda . 2019 . Available from: https://www.un.org/sustainabledevelopment/development-agenda/ 19. ↵ WHO . The Global Health Observatory. SDG Target 3.4 Non-communicable diseases and mental health . 2025 . Available from: https://www.who.int/data/gho/data/themes/topics/sdg-target-3_4-noncommunicable-diseases-and-mental-health 20. ↵ Hosseini MS , Jahanshahlou F , Akbarzadeh MA , Zarei M , Vaez-Gharamaleki Y . Formulating research questions for evidence-based studies. Journal of Medicine , Surgery, and Public Health . 2024 Apr 1 ; 2 : 100046 . doi: 10.1016/j.glmedi.2023.100046 OpenUrl CrossRef 21. ↵ Saikia Q , Adhikari K , Begum T , Dutta S , Hazarika A , Kalita JC . Erectile dysfunction: basics and its management using plant products . Egyptian Journal of Basic and Applied Sciences . 2024 Dec 31 ; 11 ( 1 ): 25 – 41 . doi: 10.1080/2314808X.2023.2300560 OpenUrl CrossRef 22. ↵ Kyarimpa C , Nagawa CB , Omara T , Odongo S , Ssebugere P , Lugasi SO , Gumula I . Medicinal plants used in the management of sexual dysfunction, infertility and improving virility in the East African Community: a systematic review . Evidence-Based Complementary and Alternative Medicine . 2023 ; 2023 ( 1 ): 6878852 . doi: 10.1155/2023/6878852 OpenUrl CrossRef PubMed 23. ↵ Petroczi A , Naughton DP . The age-gender-status profile of high performing athletes in the UK taking nutritional supplements: lessons for the future . Journal of the International Society of Sports Nutrition . 2008 Jan 10 ; 5 ( 1 ): 2 . doi: 10.1186/1550-2783-5-2 OpenUrl CrossRef PubMed 24. ↵ Palmer E , Rau A , Engelbrecht M . Changing cultural practices: A case study of male circumcision in South Africa . American journal of men’s health . 2020 Jul; 14 ( 4 ) doi: 10.1177/1557988320927285 OpenUrl CrossRef 25. ↵ Ahinkorah BO , Aboagye RG , Okyere J , Seidu AA , Budu E , Yaya S . Child marriage and its association with partner controlling behaviour against adolescent girls and young women in sub-Saharan Africa . BMC Global and Public Health . 2023 Jul 31 ; 1 ( 1 ): 9 . doi: 10.1186/s44263-023-00001-w OpenUrl CrossRef 26. ↵ Vivarelli M , Gibson K , Sinha A , Boyer O. Childhood nephrotic syndrome . The Lancet . 2023 Sep 2 ; 402 ( 10404 ): 809 - 24 . doi: 10.1016/S0140-6736(23)01051-6 OpenUrl CrossRef PubMed 27. ↵ Yang P , Zhang X , Chen S , Tao Y , Ning M , Zhu Y , Liang J , Kong W , Shi B , Li Z , Shen H . A novel serum tsRNA for diagnosis and prediction of nephritis in SLE . Frontiers in Immunology . 2021 Nov 11 ; 12 : 735105 . doi: 10.3389/fimmu.2021.735105 OpenUrl CrossRef PubMed 28. ↵ Kampala , L.T. What is sub-Saharan Africa?2019 . Available from: https://www.economist.com/the-economist.com/theeconomistexplains/2019/03/07/what-is-sub-saharan-africa 29. ↵ Arksey H , O’malley L . Scoping studies: towards a methodological framework . International journal of social research methodology . 2005 Feb 1 ; 8 ( 1 ): 19 – 32 . DOI: 10.1080/1364557032000119616 OpenUrl CrossRef 30. ↵ Levac D , Colquhoun H , O’brien KK . Scoping studies: advancing the methodology . Implementation science . 2010 Sep 20 ; 5 ( 1 ): 69 . http://www.implementationscience.com/content/5/1/69 OpenUrl PubMed 31. ↵ Daudt HM , Van Mossel C , Scott SJ . Enhancing the scoping study methodology: a large, inter-professional team’s experience with Arksey and O’Malley’s framework . BMC medical research methodology . 2013 Mar 23 ; 13 ( 1 ): 48 . http://www.biomedcentral.com/1471-2288/13/48 OpenUrl PubMed 32. ↵ Briggs , J. Joanna Briggs Institute Reviewers’ Manual: 2015 Edition, methodology for JBI scoping reviews . 2015 . Australia : Joanna Briggs Institute . 33. ↵ Moher D , Shamseer L , Clarke M , Ghersi D , Liberati A , Petticrew M , Shekelle P , Stewart LA , Prisma-P Group . Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement . Systematic reviews . 2015 Jan 1 ; 4 ( 1 ): 1 . Doi: http://www.systematicreviewsjournal.com/content/4/1/1 OpenUrl PubMed 34. ↵ Tricco AC , Lillie E , Zarin W , O’Brien KK , Colquhoun H , Levac D , Moher D , Peters MD , Horsley T , Weeks L , Hempel S . PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation . Annals of internal medicine . 2018 Oct 2 ; 169 ( 7 ): 467 – 73 . Doi: 10.7326/M18-0850 OpenUrl CrossRef PubMed 35. ↵ Braun V , Clarke V . Using thematic analysis in psychology . Qualitative research in psychology . 2006 Jan 1 ; 3 ( 2 ): 77 – 101 . DOI: 10.1191/1478088706qp063oa OpenUrl CrossRef 36. ↵ Hong QN , Fàbregues S , Bartlett G , Boardman F , Cargo M , Dagenais P , Gagnon M , Griffiths F , Nicolau B , O’Cathain A , Rousseau M , Vedel I , Pluye P . The mixed methods appraisal tool (MMAT) version 2018 for information professionals and researchers . Educ Inform . 2018 ; 34 ( 4 ): 285 – 91 . doi: 10.3233/EFI-180221 OpenUrl CrossRef 37. ↵ WHO . African Region. Communicable and Non-Communicable Diseases In Africa In 2021/2022 . 2023 . Available from: https://www.afro.who.int/sites/default/files/2023-08/Disease%20outlook%20report_BLF_revised_190823_AHN.pdf View the discussion thread. Back to top Previous Next Posted October 02, 2025. Download PDF Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. 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