"We Cure Sickle Cell Disease with Herbs": Perspectives of Herbal Medicine Practitioners Treating Sickle Cell Disease in the Acholi Sub-Region.

Background: Sickle cell disease (SCD) is a genetic blood disorder that results in the deformation of red blood cells under low oxygen conditions, causing vaso-occlusive crises and severe complications. While hydroxyurea has been introduced as a treatment for SCD, herbal medicines remain widely used across Africa. Northern Uganda has a high SCD prevalence of 20.5%, yet limited research exists on alternative treatment options within local communities. This study aimed to explore the perspectives of herbal medicine practitioners in the Acholi sub-region. Methods: We conducted in-depth interviews between October and December 2024 involving 24 herbal medicine practitioners in the Acholi sub-region, selected through referrals and non-probability snowball sampling. All data collected were recorded, transcribed verbatim, and analyzed using thematic content analysis, and emerging themes were presented. Results: All participants believed herbal medicine could cure SCD, and the majority reported successfully treating patients. However, some practitioners remembered some patients who reported being sick with sickle cell crises many years after the "cure". "When they report improvement, I stop medication after some time…" thereafter, "I encourage them to go to the hospital, but they do not. They can stay without falling sick for a long time and declare themselves healed". Findings suggest herbal medicines are commonly used for SCD management in the Acholi sub-region. Most herbal medicine practitioners rely on the hospital diagnoses, although a few can tell who has sickle cell disease by looking at or touching them. A lot of mistrust exists between herbal medicine practitioners, the government, and researchers. This hinders efforts to integrate traditional medicine into mainstream healthcare and limits opportunities for scientific validation. Conclusion: Herbal medicine practitioners believe herbs can treat sickle cell disease; however, further research is needed to investigate the nature of these herbs and their mechanisms of action, thereby facilitating the integration of herbal medicine into conventional care. We discuss some implications of the study for practice and policy.