BACKGROUND: As a hard-hit area during the COVID-19 pandemic, Belgium knew the highest mortality among people from sub-Saharan African descent, compared to any other group living in the country. After migration, people often maintain traditional perceptions and habits regarding health and healthcare, resulting in a high prevalence of traditional, complementary and alternative medicine use among different migrant communities in northern urban settings. Despite being the largest community of sub-Saharan African descent in Belgium, little is known on ethnobotanical practices of the Belgian Congolese community. We therefore conducted an exploratory study on the use of medicinal plants in the context of COVID-19 and perceptions on this new disease among members of the Congolese community in Belgium. METHODS: We conducted 16 in-depth semi-structured interviews with people of Congolese descent currently living in Belgium. Participants were selected using purposive sampling. Medicinal plant use in the context of COVID-19 was recorded through free-listing. Data on narratives, ideas and perceptions on the origin, cause/aetiology and overall measures against COVID-19 (including vaccination) were collected. Interview transcripts were analysed using thematic analysis. RESULTS: Four overarching themes emerged from our data. Firstly, participants perceived the representation of the severity of COVID-19 by the Belgian media and government-and by extend by all governmental agencies in the global north-as exaggerated. As a result, traditional and complementary treatments were seen as feasible options to treat symptoms of the disease. Fifteen forms of traditional, complementary and alternative medicine were documented, of which thirteen were plants. Participants seem to fold back on their Congolese identity and traditional knowledge in seeking coping strategies to deal with the COVID-19 pandemic. Finally, institutional postcolonial distrust did not only seem to lead to distrust in official messages on the COVID-19 pandemic but also to feelings of vaccination hesitancy. CONCLUSION: In the context of the COVID-19 pandemic, participants in our study retreated to, reshaped and adapted traditional and culture-bound knowledge. This study suggests that the fragile and sensitive relationship between sub-Saharan African migrant groups and other social/ethnic groups in Belgium might play a role in their sensitivity to health-threatening situations, such as the COVID-19 pandemic.

Department of Plants and Crops Ghent University 9000 Ghent Belgium

Department of Sociology Health and Demographic Research Ghent University Sint Pietersnieuwstraat 41 9000 Ghent Belgium

Faculty of Tropical AgriSciences Czech University of Life Sciences Prague 165 00 Prague Czech Republic

Institute for Subtropical and Mediterranean Horticulture IHSM UMA CSIC Finca Experimental La Mayora 29750 Algarrobo Costa Malaga Spain

Zobrazit více v PubMed

Sciensano. Belgium COVID-19 Epidemiological Situation—summary. 2021. https://epistat.wiv-isp.be/covid/covid-19.html. Accessed 1 Mar 2022.

Vanthomme K, Gadeyne S, Lusyne P, Vandenheede H. A population-based study on mortality among Belgian immigrants during the first COVID-19 wave in Belgium. Can demographic and socioeconomic indicators explain differential mortality? Popul Health. 2021;14:100797. doi: 10.1016/j.ssmph.2021.100797. PubMed DOI PMC

Woodhead C, Onwumere J, Rhead R, Bora-White M, Chui Z, Clifford N, Connor L, Gunasinghe C, Harwood H, Meriez P, Mir G, Jones Nielsen JJ, Rafferty AM, Stanley N, Peprah D, Hatch SL. Race, ethnicity and COVID-19 vaccination: a qualitative study of UK healthcare staff. Health Ethn. 2021 doi: 10.1080/13557858.2021.1936464. PubMed DOI PMC

Tatjer LC. Multiculturalism in the city: managing diversity. Paper presented to the congress of the European Regional Science Association, Jyväskylä, Finland, 27–30 August. 2003.

Vertovec S. Super-diversity and its implications. Ethn Racial Stud. 2007;30(6):1024–1054. doi: 10.1080/01419870701599465. DOI

Weckmuller H, Barriocanal C, Maneja R, Boada M. Factors affecting traditional medicinal plant knowledge of the Waorani. Ecuad Sustain. 2019;11(16):4460. doi: 10.3390/su11164460. DOI

Pieroni A, Vandebroek I. Traveling cultures and plants: the ethnobiology and ethnopharmacy of human migrations. 1. Berghahn; 2007.

de Medeiros PMD, Soldati GT, Alencar NL, Vandebroek I, Pieroni A, Hanazaki N, de Albuquerque UP. The use of medicinal plants by migrant people: adaptation, maintenance, and replacement. Evid-Based Complement Altern Med. 2012;2012:807452. doi: 10.1155/2012/807452. PubMed DOI PMC

Albuquerque UP, Nascimento ALB, Soldati GT, Feitosa IS, Campos JLA, Hurrell JA, Hanzaki N, de Mereidos PM, Vasconcelos da Silva RR, Ludwinsky RH, Ferreira Júnior WS, Reyes-García V. Ten important questions/issues for ethnobotanical research. Acta Bot Bras. 2019;33(2):376–385. doi: 10.1590/0102-33062018abb0331. DOI

Emery MR, Hurley PT. Ethnobiology in the city: embracing the urban. J Ethnobiol. 2016;36(4):807–819. doi: 10.2993/0278-0771-36.4.807. DOI

Balick M, Kronenberg F, Ososki A, Reiff M, Fugh-Berman M, O’Connor A, Roble B, Lohr M, Atha D. Medicinal plants used by Latino healers for women’s health conditions in New York city. Econ Bot. 2000;54:344–357. doi: 10.1007/BF02864786. DOI

Ceuterick M, Vandebroek I, Torry B, Pieroni A. Cross-cultural adaptation in urban ethnobotany: the Colombian folk pharmacopoeia in London. J Ethnopharmacol. 2008;120:342–359. doi: 10.1016/j.jep.2008.09.004. PubMed DOI

Pieroni A, Sheikh Q, Ali W, Torry B. Traditional medicines used by Pakistani migrants from Mirpur living in Bradford, North England. Complement Ther Med. 2007;16:81–86. doi: 10.1016/j.ctim.2007.03.005. PubMed DOI

van Andel T, Fundiko MC. The trade in African medicinal plants in Matonge-Ixelles, Brussels (Belgium) Econ Bot. 2016;70(4):405–415. doi: 10.1007/s12231-016-9365-8. PubMed DOI PMC

Ceuterick M, Vandebroek I. Identity in a medicine cabinet: discursive positions of Andean migrants towards their use of herbal remedies in the United Kingdom. Soc Sci Med. 2017;177:43–51. doi: 10.1016/j.socscimed.2017.01.026. PubMed DOI

Fonseca FN, Balick MJ. Plant-knowledge adaptation in an urban setting: candomble ethnobotany in New York City. Econ Bot. 2018;72(1):56–70. doi: 10.1007/s12231-018-9405-7. DOI

Phillimore JA, Bradly H, Brand T. Superdiversity, population health and health care: opportunities and challenges in a changing world. Public Health. 2019;172:93–98. doi: 10.1016/j.puhe.2019.01.007. PubMed DOI

Green G, Davison C, Bradby H, Krause K, Morente-Meijas F, Alex G. Pathways to care—how superdiversity shapes the need for navigational assistance. Sociol Health Illn. 2014;36(8):1205–1219. doi: 10.1111/1467-9566.12161. PubMed DOI

Wolf JH. The role of complementary and alternative medicine: accommodating pluralism. Sociol Health Illn. 2003;25(5):503–506. doi: 10.1023/A:1024880914690. DOI

Vandebroek I, Pieroni A, Stepp JR, Hanazaki N, Ladio A, Alves RRN, Picking D, Delgoda R, Maroyi A, van Andel T, Quave CL, Paniagua-Zambrana NY, Narel Y, Bussmann RW, Odonne G, Abbasi AM, Albuquerque UP, Baker J, Kutz S, Timsina S, Shigeta M, Oliveira TPR, Hurrell JA, Arenas PM, Puentes JP, Huge J, Yesil Y, Pierre LJ, Olango TM, Dahdouh-Guebas F. Reshaping the future of ethnobiology research after the COVID-19 pandemic. Nat Plants. 2020;6(7):723–730. doi: 10.1038/s41477-020-0691-6. PubMed DOI

Khadka D, Dhamala MK, Li F, Aryal PC, Magar PR, Bhatta S, Thakur MS, Basnet A, Cui D. The use of medicinal plants to prevent COVID-19 in Nepal. J Ethnobiol Ethnomed. 2021 doi: 10.1186/s13002-021-00449-w. PubMed DOI PMC

Demart S. Congolese migration to Belgium and postcolonial perspectives. Afr Diaspora. 2013;6(1):1–20. doi: 10.1163/18725457-12341239. DOI

Kibungu PK, Bakwaye FN, Belesi HK, Vanhove W, Van Damme P. Ethnobotanical characterization of medicinal plants used in Kisantu and Mbanza-Ngungu territories, Kongo-Central Province in DR Congo. J Ethnobiol Ethnomed. 2021;17(1):8. doi: 10.1186/s13002-020-00428-7. PubMed DOI PMC

Bakwaye FN, Termote C, Kibungu K, Van Damme P. Identification and local importance of medicinal plants used in the Mbanza-Ngungu region, Democratic Republic of Congo. Bois et forêts des tropiques. 2013;316:63–77. doi: 10.19182/bft2013.316.a20531. DOI

Tongco MDC. Purposive sampling as a tool for informant selection. Ethnobot Res Appl. 2007;5:147–158. doi: 10.17348/era.5.0.147-158. DOI

Goodman L. Comment: On respondent-driven sampling and snowball sampling in hard-to-reach populations and snowball sampling not in hard-to-reach populations. Sociol Methodol. 2011;41(1):347–353. doi: 10.1111/j.1467-9531.2011.01242.x. DOI

Konwald M, Axhausen KW. Focusing on connected personal leisure networks: selected results from a snowball sample. Environ Plan A Econ Space. 2012;44(5):1085–1100. doi: 10.1068/a43458. DOI

Clarke V, Braun V. Thematic analysis. J Posit Psychol. 2017;12(3):297–298. doi: 10.1080/17439760.2016.1262613. DOI

Prota4U. Plant Resources of the World (PROW). UniversityFund Wageningen. https://www.prota4u.org/. Accessed 28 May 2021.

Plantentuin Meise. The flora of Central Africa. 2022. https://www.floredafriquecentrale.be/#/en/fac. Accessed 24 Feb 2022.

Rusaati BIW, Gendusa AP, Joo SH, Park JW, Masumbuko CN, Kaboyi GI, Ngbolua KTN, Furaha AM, Rolly NK, Kang JW. A systematic review of antimalarial medicinal plants in Democratic Republic of the Congo. Bois Forets Trop. 2021;347:11–27. doi: 10.19182/bft2021.347.a31882. DOI

Memvanga PB, Tona GL, Mesia GK, Lusakibanza MM, Cimanga RK. Antimalarial activity of medicinal plants from the Democratic Republic of Congo: a review. J Ethnopharmacol. 2015;169:76–98. doi: 10.1016/j.jep.2015.03.075. PubMed DOI

Kaboyi GI, Imani BR, Byamungu IN, Ndabaga CM, Arusi PG, Matendo AF, Kang J. Ethnomedicinal study of plants used in the Uvira Territory (Democratic Republic of Congo) For Sci Technol. 2021;17(3):144–154. doi: 10.1080/21580103.2021.1963327. DOI

Kasali FM, Irenge CA, Hamuli PM, Mulashe PB, Katabana DM, Mokoso JDM, Mpiana PT, Kadima JN. Ethnopharmacological survey on treatment of hypertension by traditional healers in Bukavu City, DR Congo. Evid-Based Complement Altern Med. 2021 doi: 10.1155/2021/6684855. PubMed DOI PMC

WHO. Emergencies preparedness, response: democratic Republic of the Congo. 2021. https://www.who.int/csr/don/archive/country/cod/en/. Accessed 8 June 2021.

Gething PW, Casey DC, Weiss DJ, Bisanzo D, Bhatt S, Cameron E, Battle KE, Dalrymple U, Rozier J, Rao PC, Kutz MJ, Barber RM, Huynh C, Shackleford KA, Coates MM, Nguyen G, Fraser MS, Kulikoff R, Wang HD, Naghavi M, Smith DL, Murray CJL, Hay SI, Lim SS. Mapping plasmodium falciparum mortality in Africa between 1990 and 2015. N Engl J Med. 2016;375(25):2435–2445. doi: 10.1056/NEJMoa1606701. PubMed DOI PMC

Zick A, Pettigrew TF, Wagner U. Ethnic prejudice and discrimination in Europe. J Soc Issues. 2008;64(2):233–251. doi: 10.1111/j.1540-4560.2008.00559.x. DOI

Pettigrew TF. Reactions toward the new minorities of western Europe. Ann Rev Sociol. 1998;24:77–103. doi: 10.1146/annurev.soc.24.1.77. DOI

Rastas A, Nikunen K. Introduction: contemporary African and black diasporic spaces in Europe. Open Cult Stud. 2019;3(1):207–218. doi: 10.1515/culture-2019-0019. DOI

Meuleman B, Davidov E, Billiet J. Changing attitudes toward immigration in Europe, 2002–2007: a dynamic group conflict theory approach. Soc Sci Res. 2008;38(2):352–365. doi: 10.1016/j.ssresearch.2008.09.006. PubMed DOI

Tajfel H, Turner J. An integrative theory of intergroup conflict. In: Hogg MA, Abrams D, editors. Intergroup relations: essential readings. Psychology Press; 2001. pp. 94–109.

Nakashima K, Isobe C, Ura M. How does higher in-group social value lead to positive mental health? An integrated model of in-group identification and support. Asian J Soc Psychol. 2013;16(4):271–278. doi: 10.1111/ajsp.12031. DOI

Michels M, Glöckner A, Giersch D. Personality psychology in times of crisis: profile-specific recommendations on how to deal with COVID-19. Personal Individ Differ. 2021;174:110676. doi: 10.1016/j.paid.2021.110676. PubMed DOI PMC

Shalukoma C, Bogaert J, Duez P, Stevigny C, Pongombo C, Visser M. Medicinal plants of the mountain region of Kahuzi-Biega in the Democratic Republic of Congo: uses, accessibility and consensus among traditional therapists. Bois Forets Trop. 2015;326(4):43–55. doi: 10.19182/bft2015.326.a31282. DOI

WHO. Coronavirus disease (COVID-19). World Health Organization; 2021. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/coronavirus-disease-covid-19#:~:text=symptoms. Accessed 2 June 2021.

RVIM. Malaria. Rijksinstituut voor Volksgezondheid en Milieu; 2019. https://www.rivm.nl/malaria. Accessed 2 June 2021.

Sciensano. Gevalsdefinitie, indicaties voor testen en verplichte melding van Covid-19. 2020. https://covid-19.sciensano.be/sites/default/files/Covid19/COVID-19_Case%20definition_Testing_NL.pdf. Accessed 2 June 2021.

Liu KCSC, Yang SL, Roberts MF, Elford BC, Philipson JD. Antimalarial activity of Artemisia-annua flavonoids from whole plants and cell-cultures. Plant Cell Rep. 1992;11(12):637–640. doi: 10.1007/BF00236389. PubMed DOI

Sanou Y, Mumtaz M. Chemical implications and environmental impacts of COVID-19 pandemic in Burkina Faso 2021; 12(2):183–91.

BBC. Coronavirus: Tanzanian president promises to import Madagascar's 'cure'. 2020. https://www.bbc.com/news/world-africa-52519853. Accessed 28/6/2021.

Prota4u. Artemisia annua L. Prota4u. https://www.prota4u.org/database/protav8.asp?h=M4&t=Artemisia,annua&p=Artemisia+annua#Synonyms. Accessed 8 Mar 2022.

Efferth T, Romeroa MR, Wolf DG, Stamminger T, Marin JJG, Marschall M. The antiviral activities of artemisinin and artesunate. Clin Infect Dis. 2008;47(6):804–811. doi: 10.1086/591195. PubMed DOI

Nair MS, Huang Y, Fidock DA, Polyak SJ, Wagoner J, Towler MJ, Weathers PJ. Artemisia annua L. extracts prevent in vitro replication of SARS-CoV-2. J Ethnopharmacol. 2021;274:114016. doi: 10.1101/2021.01.08.425825. PubMed DOI PMC

Kapepula PM, Kabengele JK, Kingombe M, Van Bambeke F, Tulkens PM, Kishabongo AS, Decloedt E, Zumla A, Tiberi S, Suleman F, Tshilolo L, Muyembe-TamFum JJ, Zumla A, Nachega JB. Artemisia Spp. derivatives for COVID-19 treatment: anecdotal use, political hype, treatment potential, challenges, and road map to randomized clinical trials. Am J Trop Med Hyg. 2020;103(3):960–964. doi: 10.4269/ajtmh.20-0820. PubMed DOI PMC

Cortez MF, Che C. Malaria drug chloroquine no better than regular coronavirus care, study finds. Bloomberg; 2020. https://www.bloomberg.com/news/articles/2020-03-25/hydroxychloroquine-no-better-than-regular-covid-19-care-in-study. Accessed 23 June 2021.

Goodman J, BBC. Coronavirus and chloroquine: has it been approved in US. 2020. https://www.bbc.com/news/51980731. Accessed 2 June 2021.

Khuroo MS. Chloroquine and hydroxychloroquine in coronavirus disease 2019 (COVID-19). Facts, fiction and the hype: a critical appraisal. Int J Antimicrob Agents. 2020;56(3):106101. doi: 10.1016/j.ijantimicag.2020.106101. PubMed DOI PMC

Kandimalla R, John A, Abburi C, Vallamkondu J, Reddy PH. Current status of multiple drug molecules, and vaccines: an update in SARS-CoV-2 therapeutics. Mol Neurobiol. 2020;57(10):4106–4116. doi: 10.1007/s12035-020-02022-0. PubMed DOI PMC

Gasmi A, Peana M, Noor S, Lysiuk R, Menzel A, Benahmed AG, Bjørklund G. Chloroquine and hydroxychloroquine in the treatment of COVID-19: the never-ending story. Appl Microbiol Biotechnol. 2021 doi: 10.1007/s00253-021-11094-4. PubMed DOI PMC

Ayoola GA, Coker HA, Adesegun SA, Adepoju-Bello AA, Obaweya K, Ezennia EC, Atangbayila TO. Phytochemical screening and antioxidant activities of some selected medicinal plants used for malaria therapy in Southwestern Nigeria. Trop J Pharm Res. 2008;7(3):1019–1024.

Gairola S, Naidoo Y, Bhatt A, Nicholas A. An investigation of the foliar trichomes of Tetradenia riparia (Hochst.) Codd [Lamiaceae]: an important medicinal plant of Southern Africa. Flora-Morphol Distrib Funct Ecol Plants. 2009;204(4):325–330. doi: 10.1016/j.flora.2008.04.002. DOI

Taek MM, Prajogo BE, Agil M. Plants used in traditional medicine for treatment of malaria by Tetun ethnic people in West Timor Indonesia. Asian Pac J Trop Med. 2018;11(11):630. doi: 10.4103/1995-7645.246339. DOI

Saotoing P, Vroumsia T, Tchuenguem FFN, Njan NAM, Messi J. Medicinal plants used in traditional treatment of malaria in Cameroon. J Ecol Nat Environ. 2011;3(3):104–117.

Odugbemi TO, Akinsulire OR, Aibinu IE, Fabeku PO. Medicinal plants useful for malaria therapy in Okeigbo, Ondo State, Southwest Nigeria. Afr J Tradit Complement Altern Med. 2007;4(2):191–198. doi: 10.4314/ajtcam.v4i2.31207. PubMed DOI PMC

Djimde A, Plowe CV, Diop S, Dicko A, Wellems TE, Doumbo O. Use of antimalarial drugs in Mali: policy versus reality. Am J Trop Med Hyg. 1998;59(3):376–379. doi: 10.4269/ajtmh.1998.59.376. PubMed DOI

Ceuterick M, Vandebroek I, Pieroni A. Resilience of Andean urban ethnobotanies: a comparison of medicinal plant use among Bolivian and Peruvian migrants in the United Kingdom and in their countries of origin. J Ethnopharmacol. 2011;136(1):27–54. doi: 10.1016/j.jep.2011.03.038. PubMed DOI

Buchmann C. Cuban home gardens and their role in socio-ecological resilience. Hum Ecol. 2009;37:705–721. doi: 10.1007/s10745-009-9283-9. DOI

Folke C, Carpenter S, Walker B, Scheffer M, Chapin T, Rockström J. Resilience thinking: integrating resilience, adaptability and transformability. Ecol Soc. 2010;15:20. doi: 10.5751/es-03610-150420. DOI

Baldassar L, Nedelcu M, Merla L, Wilding R. ICT-based co-presence in transnational families and communities: challenging the premise of face-to-face proximity in sustaining relationships. Glob Netw. 2016;16(2):133–144. doi: 10.1111/glob.12108. DOI

Villa-Torres L, González-Vásquez T, Fleming PJ, González-González EL, Infante-Xibille C, Chavez R, Barrington C. Transnationalism and health: a systematic literature review on the use of transnationalism in the study of the health practices and behaviours of migrants. Soc Sci Med. 2017;183:70–79. doi: 10.1016/j.socscimed.2017.04.048. PubMed DOI

Brown RH. Multiple modes of care: internet and migrant caregiver networks in Israel. Glob Netw. 2016;16(2):237–256. doi: 10.1111/glob.12112. DOI

Alexiades MN. Ethnobotany in the third Millennium: expectations and unresolved issues. Delpinoa. 2003;45:15–28.

Gamble VN. Under the shadow of Tuskegee: African Americans and health care. Am J Public Health. 1997;87(11):1773–1778. doi: 10.2105/AJPH.87.11.1773. PubMed DOI PMC

Ezeome ER, Simon C. Ethical problems in conducting research in acute epidemics: the Pfizer meningitis study in Nigeria as an illustration. Dev World Bioeth. 2010;10(1):1–10. doi: 10.1111/j.1471-8847.2008.00239.x. PubMed DOI

Holt TA, Adams TJ. Medical colonialism. J Med Ethics. 2013;13(2):102–102. doi: 10.1136/jme.13.2.102. DOI

Brandon DT, Isaac LA, LaVeist TA. The legacy of Tuskegee and trust in medical care: is Tuskegee responsible for race differences in mistrust of medical care? J Natl Med Assoc. 2005;97(7):951–956. PubMed PMC

Vinck P, Pham PN, Bindu KK, Bedform J, Nilles EJ. Institutional trust and misinformation in the response to the 2018–19 Ebola outbreak in North Kivu, DR Congo: a population-based survey. Lancet Infect Dis. 2019;19(5):529–536. doi: 10.1016/S1473-3099(19)30063-5. PubMed DOI

Nara R, Banura A, Foster AM. A multi-methods qualitative study of the delivery care experiences of Congolese Refugees in Uganda. Matern Child Health J. 2020;24(8):1073–1082. doi: 10.1007/s10995-020-02951-1. PubMed DOI

Ljunge M. Trust issues: evidence of the intergenerational trust transmission among children of immigrants. J Econ Behav Organ. 2014;106:175–196. doi: 10.1016/j.jebo.2014.07.001. DOI

Madhav N, Oppenheim B, Gallivan M, Mulembakani P, Rubin E, Wolfe N. Pandemics: risks, impacts, and mitigation. Dis Control Prior. 2017;9:315–345. PubMed

American Anthropological Association. Code of ethics of the American Anthropological Association. 2012. http://ethics.americananthro.org/. Accessed 15 May 2021.

ISE/International Society of Ethnobiology. Code of ethics. 2006. https://www.ethnobiology.net/what-we-do/core-programs/ise-ethics-program/code-of-ethics/. Accessed 15 May 2021.

Plant use and perceptions in the context of sexual health among people of Congolese descent in Belgium