Monday, April 10, 2017

Papaya leaves and Malaria

Medical Myth #1

Having been on the mission field for almost 10 years, and mostly in the capacity of a medical provider, I have found some very interesting “natural remedies” along the way.  Not being one to discount anything that isn’t “standard care” – I wanted to give them the benefit of the doubt.  A lot of incredible medicine and care has come from “natural remedies.”  However, in my desire to educate people and give them accurate information, I wanted to do the research to determine if these “cures” actually worked or not.  Using a technique I’ve learned from my Public Health Masters class – here is what I have found:
1.      Question:  Do papaya leaves have anti-malaria properties?
P - Patient information:  A 25-year old, national (Equatorial Guinean) otherwise healthy man came to my clinic and wanted to know if chewing/eating papaya leaves will prevent malaria in a chloroquine resistant strain (primarily falciparum) strain of malaria.   
I - Intervention – eating papaya leaves to prevent malaria
C - Comparison – to conventional treatment of chloroquine resistant malaria using mefloquine, doxycycline, or malarone.
O - Outcome – no evidence of malaria in one year
I searched on PubMed using the key words “papaya leaves” and “malaria”.  The results brought up only two studies related to this issue.  This concept is used as a “natural” preventative and is believed in this area, and many other parts of the world. I was therefore a bit surprised at the limited amount of information I was able to find.  As there was limited information, I further looked for a correlation specifically to the alkaloid that is found in papaya leaves – carpaine – and did an additional search for “carpaine” AND “malaria” and came up with the same two articles.  If I attempted to limit the search to RCT (Randomized Control Trial – the gold standard), then no articles appeared.  Their conclusion on both articles was that there is a potential association with the alkaloid compound of carpaine that is found in papaya leaves and it’s ability to prevent malaria, however they had no definitive conclusion, stating that further studies needed to be done.  In addition, there was found to be a varying percentage of carpaine in each leaf from 0.02% - 0.31%.  This further leads to a difficulty in how to “prescribe” papaya leaves to a patient.  Based on this information, I would advise my patient that the best form of malaria prevention was the standard treatment of care, using one of the prescribed treatments for chloroquine resistant malaria. 
Ourif, M., Julianti, T., Hamburger, M. (2014).  Quantification of the antiplasmodial alkaloid carpaine in papaya (Carica papya) leaves.  Planta Med, 80 (13): 1128-42.

Julianti, T., De Mieri, M., Zimmermann, S., Ebrahimi, SN., Kaiser, M., Neuburger, M., Raith, M., Brun, R., Hamburger, M. (2014). HPLC-based activity profiling for antiplasmodial compounds in the traditional Indonesian medicinal plant Carica papaya L. Journal of Ethnopharmacology, 155(1): 426-34.

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