In the last five years, there has been a rising case of Chronic Kidney Disease (CKD) in Jigawa State, leading to the deaths of residents, especially in Yan Gobir Turakawa and Kafin Hausa Town.
The cause of renal disease, which primarily affects young people, is attributed to the indiscriminate use of herbs as painkillers or for the management of hypertension.
Coffee senna (Mazamfari) is a pantropical or subtropical weed in the Fabaceae (pea) family found in moist, disturbed, or waste areas in lower elevations around the world.
It is a shrub with pinnate leaves, with three to seven pairs of broadly elliptic to egg-shaped leaflets, and yellow flowers arranged in groups of two to four, with six fertile stamens in each flower. It is an aggressive, pantropical weed.
It can cause some side effects, including stomach discomfort, cramps, and diarrhea.
Long-term use can also cause the bowels to stop functioning normally and might cause dependence on laxatives and CKD.
Mazamfari is possibly unsafe when used for longer than 1 week or in doses above 34.4 mg of sennosides twice daily.
With the rising cases of CKD in Kafin Hausa Local Government Area of Jigawa, many researchers and medical practitioners are tirelessly trying to know the real underlying cause of CKD.
In this investigation, Stallion Times reporter, Lukman Abdulmalik identified Mazamfari as one of the many causes of CKD in Kafin Hausa, Turakawa, and Yangobir communities in Jigawa State.
Other causes may include water sources, Gayen Kabewa (Pumpkin leaves), and the reckless use of traditional painkillers.
Jigawa is endowed with vast agricultural land, rivers, and flood plains suitable for crops, livestock, and fishing.
Due to its floodplain, outbreaks of malaria, typhoid, and cholera are common.
According to research conducted by researchgate Jigawa is known for having a high prevalence of hypertensive and diabetic patients who rarely visit hospitals for medical care but instead consume toxic herbs as a remedy.
An investigation by Stallion Times also revealed some of the reasons why many people do not visit medical centers or healthcare centers for treatment or check-ups including poverty, hard-to-reach medical facilities, and fear of conducting a medical checkup or test for fear of an unknown, unseen illness; dominant among these factors is indifference.
Mazamfari the painkiller
A visit by this reporter to Kafin Hausa General Hospital, Kafin Hausa LGA, Jigawa State, known to be among the 27 local government areas in the State suffering from CKD in the last four years.
Kafin Hausa is a local government area under the Hadeija Emirate Council.
From January 2023 to the time of filing this report, Kafin Hausa General Hospital has recorded over 170 cases of CKD.
At the hospital, on 7 May 2023, this reporter met Rame Isiyaku, who was sitting on a sick bed at the Kafin Hausa General Hospital, waiting for tubes to protrude through her arms and connect to a dialysis machine.
Kafin Hausa General Hospital, PC: Stallion Times
When she was brought into the dialysis unit, she appeared pale and unconscious.
Aside from Rame on the sick bed, there was her worried daughter, Fatima Isiyaku, and other family members standing outside the hospital, attempting to raise funds to pay Rame’s medical bills to save her life.
Fatima, who spoke on behalf of her mother, stated that her mother is diabetic and hypertensive and has been suffering from CKD since December 2021.
“My mother has been bed-ridden in the hospital for nine months, receiving two dialysis sessions weekly,” she sobbed.
Fatima disclosed that when her mother started developing some symptoms, which started with a fever, a swollen body, and body weakness.
“I told my friend Hafsat, and she introduced me to a traditional herbs seller who prescribed Mazamfari (it is also referred to as Sanga-sanga or Rai dore in Hausa, Akidi agbara in Igbo, and Agbo rere in Yoruba).
“The herb seller described the leaf as a cleansing measure that helps to get rid of fever, body weakness, hypertension, diabetes, and a swollen body.
Rame Isiyaku, PC: Stallion Times
“He prescribed that we boil the Mazamfari leaf and drink a cup daily. However, he did not state the size of the cup.
“He assured us that all the salt and poison accumulated in her body would begin to appear as soon as she starts urinating after drinking the medicine substance of Mazamfari.”
According to Fatima, the herbs seller told them that Mazamfari is the best recognized local herb cleansing all internal stomach organs and for the treatment of kidneys; it is natural.”
“My Mother (Rame) has consumed the herbs for over 4 months, but instead of her getting better, her condition keeps getting worse.
“She began to develop rashes and foamy urine. So, we decided to take her to Kafin Hausa General Hospital, where a test was carried out and the Doctor confirmed that she has CKD.
“We began visiting the hospital in November 2022. Many drugs were prescribed to her. We are now in the dialysis stage.
“She undergoes two dialysis sessions weekly at the cost of N20,000 per session; currently, we have no money to continue with her dialysis.
When asked if her mother gets medical assistance from Non-governmental organizations, foundations, or state government, she replied: “We have never benefited from any organization or government of the state.”
For a follow-up visit, a voice call to Rame’s family (Fatima) regarding her condition, this reporter was informed that Rame passed away two days after the dialysis on 21 May 2023. Indicating that their visit to the hospital was a little bit late.
On random sampling during the second visit to Kafin Hausa LGA in the first half of Ju 2023 at Ungwar Turawa, Kafin Hausa LGA, an isolated settlement in a corn farm, in a house built of hatches, a case of another CKD victim (Buba Hussaini) was discovered.
They are the only residents living in just two huts built by their father on the farmland.
His son, Rabiu revealed that his father was lying critically ill at the hospital and led this reporter to his father at the health facility.
At the male ward of Kafin Hausa General Hospital, this reporter met a 55-year-old man, Buba Hussaini lying ill on his hospital bed.
Hussaini is married with two wives and five children and resides about 25 kilometers away from the Kafin Hausa General Hospital
He struggled and rose to narrate his ordeal: “I am a farmer and also a cattle rancher.
“Whenever I have a stressful day with my farming work, I get exhausted. As a remedy for my pains, I usually walk down the bush and pick some leaves, such as Mazamfari, or Darbejiya (Neem Tree leaves), and others leaves.
Buba Hussaini, PC: Stallion Times
“I boil these leaves together to make a medicine portion that would relieve me of the pain and rejuvenate me.
“I usually take 2 cups full (he did not say how small or big the cup is) and the next day, I will be healthy and ready to perform my farming tasks.
“I have been drinking concoctions for over 35 years, but recently I noticed strange changes in my body that I had no idea about.”
“Two years ago, I started developing swollen legs, one-sided stomach aches, foamy, and painful urine.
“I continued consuming my normal medicine hoping to get better, but the reverse is the case, so, whenever I consume Mazamfari and I do not get well, I replace it with another traditional herb known as Gayen Kabewa (Pumpkin Leaf).
“Despite my consistent herb medication, the symptoms remained, so I decided to visit Kafin Hausa health facility as an alternative.
“At the Hospital, a test was carried out and the Doctors told me I have what is called CKD.
“I started visiting Kafin Hausa General Hospital in 2020.
“I have been managing the CKD for 1 year 8 Months now, and so far, I have spent over N300,000 on dialysis, drugs, and hospital bills since last year.”
Like Rame, Hussaini too has not received any assistance or financial support from the state government or any organization.
Current situation of Buba Hussaini, PC: Lukman Abdulmalik
Bulaman Kafin Hausa laments the death of residents.
In an interaction with the Bulaman Kafin Hausa, Yunusa Muhammad Sulaiman said: “We have been managing CKD in Kafin Hausa, this disease has resulted in the deaths of many people (including a close friend, Baba Tijanni) in this community, despite their efforts to undergo the last stage of managing the disease; the dialysis.”
“Kafin Hausa has been witnessing CKD in the last eight years, but in the previous three years, as the case got worse, we reached out through voice telephone calls to politicians, especially the ex-Senator representing our District in the 9th Assembly, (Sen. Ibrahim Hassan Hadejia).
Bulaman Kafin Hausa, Yunusa Muhammad Sulaiman, PC: Stallion Times
“I am aware he took the issue to the Senate; there were efforts to bring a solution to the rising cases of CKD, but I am not too sure of what it is.
“People here have accepted this Mazamfari as a treatment herb and they enjoy taking various traditional herbs which have no dosage or any restrictions, and this practice, I am informed is contributing to CKD cases.
“We used to create awareness and enlighten people on the side effects of drinking unregulated herbs and go to the hospital whenever they are ill.
“On numerous occasions, I used to stop the sale of herbs and any traditional concoctions sold in Kafin Hausa markets because most of the sellers had no idea what they were selling or saying about the herbs.
“About two years ago, the government conducted research on different aspects of our livelihood including the type of water we drink and the food we eat, but the research findings were not made available to us.”
“We are sure the government is working to find a solution to the reasons behind the many CKD deaths.”
Phytochemical Analysis of Mazamfari (Coffee Senna Leaf)
Yunusa Rahama, a Dietician at Dala Hospital said: “The flavonoids act as natural anti-oxidants that scavenge a wide variety of free radicals, the phenolic compounds have been recognized as having health-related properties, including anti-cancer, anti-viral, and anti-inflammatory activities.
“Besides, the various parts of the plant have been known to possess anti-bacterial, anti-fungal, anti-diabetic, anti-mutagenic, and hepato-protective properties.
“Traditionally, its roots, leaves, bark, and seeds have been used against various ailments like certain types of fever, menstrual problems, tuberculosis, dieresis, anemia, liver complaints, and as a tonic for general weakness and illness.
“Cassia occidentalis poisoning may be the probable cause of hepatic encephalopathy syndrome (loss of brain function when a damaged liver does not remove toxins from the blood).
Rahama conducted a phytochemical laboratory test and confirmed that the high consumption of Mazamfari also has a high tendency to get CKD.
He said the leaf is also known as Cassia Occidentalis L., commonly called Coffee Senna, Negro-Coffee, Coffee Weed, Stinking Weed, and Foetid Cassia.
“The bitter-sweet leaves of the plant are eaten as a vegetable and as medicine for the treatment of cough, cold, eczema, dyspepsia, and filariasis, and its seeds are also used as a substitute for coffee. While the roasted seeds are sometimes eaten by tribals.
“Several alkaloids, flavonoids, tannins, phlorotannins, chrysophanol, emodin, tetrahydro anthracene, germichrysome, occidentalis A and B, carbohydrates, Saponins, Steroids, Diterpenoids, Triterpenoids, Anthraquinones, and Tannis have been identified from the extracts of the leaves.
“Tests had also established the plant to be poisonous to different animals and humans, although the levels of toxicity vary for different parts of it, the most potent being the pods and beans.”
Dr. Rahama also revealed that certain types of anthraquinones and their derivatives, such as emodin, cardiac glycosides, toxallauminus, and other alkaloids, were among the compounds found to be toxic to Cassia occidentalis (Mazamfari).
“High consumption of the leaf primarily affected the skeletal muscles, liver, kidney, and heart.
“The toxicity’s clinical symptoms were lethargy, recumbence, jerky respiration, tremors, diarrhea, ataxia, hyperpnea, and in-coordination.
“To avoid primary causes, hypertensive patients should monitor their blood pressure regularly, while those with diabetes should control their blood sugar and avoid habits that are known to damage the kidney.
“They should also stop consuming Mazamfari as a medicine treatment for hypertension, diabetes, and body weakness,” he added.
Hussaini of Turakawa in Kafin Hausa is still ill with CKD managing his case with pharmaceutical drugs and dialysis once a week.
“I was told by medical officers that if I continue taking my drugs as prescribed, the chances of dying with the ailment is slim because my condition is not chronic.”
The National Agency for Food and Drug Administration and Control (NAFDAC), is a federal agency that is charged with the responsibility to regulate and control the manufacture, importation, exportation, distribution, advertisement, sale, and use of Food, Drugs, Cosmetics, Medical Devices, Packaged Water, Chemicals and Detergents (collectively known as regulated products).
It has offices across the country including Jigawa State.
A senior staff of NAFDAC in Dutse who wished his identity not to be revealed, in a telephone interview, submitted that Mazamfari is known to the agency.
He noted that the mandate is to regulate the exportation, importation, and advertisement of regulated products such as herbs, drugs, and cosmetics.
“The NAFDAC is aware of CKD, so any traditional herbs that are being sold in the market without the knowledge of the agency, we advised the herbalists to register with their union known as Traditional Practitioners of Nigeria, where they will be accredited.
“We also examine and sample the herbs in our laboratories in Kaduna and Maiduguri to determine side effects.
“After the herbs have passed all laboratory tests and analyses, the herbalist will be issued a license to begin operating.
“However, we do not regulate any herbal medicines that are not packaged and sold openly; we only regulate regulated products.
“We do not encourage Mazamfari sellers to continue marketing the herb without the product being registered.
“In addition, NAFDAC cannot prevent herbalists from producing their herbs as long as their products do not fall under the purview of regulated products.”
Other Sordid Tales of CKD
During the random sampling, Muhammad Uba, popularly known as Mallam Mamman Mai Shayi, from Yan Gobir in Kafin Hausa town offered to talk to the reporter.
He said: “About six months ago, I lost my elder brother Ali Uba, 30, and my elder sister Asabe Uba, 25 to CKD.
He continued, “Both Asabe and Uba experienced similar symptoms, complaining of headaches, fever, and swollen body parts (legs, hands, and face).
“When the symptoms became worse, they were given Mazamfari as medication, but it did not help matters.
“A test confirmed they both had CKD, then, they started taking treatments, and later they were advised to go for dialysis. It is at this point that they both die.”
“Thank God, I don’t take Mazamfari and I will not advise anybody to take it as a form of medication.”
The Record Officer at Kafin Hausa General Hospital, Adanu Usman in an interview disclosed that, “We don’t have any records for the number of CKDs because it is not a part of the diseases we keep record of in our database.
“Though we have recorded so many cases of CKDs, which cannot be estimated.”
Dr. Isah Musa, Senior Medical Officer of Kafin Hausa General Hospital, narrated that: “CKD mostly affects people in communities of Hadeija, Auyo, and Kafin Hausa.
“I cannot affirm the causes of CKD because other patients may have one or two symptoms, but, the patients at risk of developing CKD include hypertensive and diabetic patients, but in Kafin Hausa, a 20-year-old may also be at risk.”
He added that “we have not done any intensive research on the causes of the CKD because the State Government has not provided any funds to execute a study that will reveal the actual causes of the CKD.
“However, there is also abuse of traditional herbs and painkiller drugs, which could lead to developing CKD.
The thriving Mazamfari business
Kafin Hausa Central Market is one of the busiest markets in Jagawa State where a variety of commodities are bought and sold.
A visit to Yan-magunguna (a section of the market where Mazamfari is sold) on a market day revealed how lucrative the business of Mazamfari is; customers and traders come in droves to buy or sell herbs to wholesale buyers and retailers.
The herb itself is a green powdery substance sold in a small polythene bag to buyers in different sizes depending on the quantity a customer wants to buy.
Muhammad Khalid, a 70-year-old popular Mazamfari trader who specialized in the sale of different herbs such as Mazamfari, dogon yaro, sasaken mangoro, and gayen zogale (moringa leaves) to mention a few.
On this market day, his stall was busy with buyers, he scarcely found interactions that were not business-related but managed to say he inherited the business from his late father at the age of 23.
He has 47 years of experience in the business but has no medical background.
He said Mazamfari is one of the fast-growing herbs among the ones he sells.
“Many people come to this Yan-magunguna to buy Mazamfari because our grandparents were told that the leaf cures many illnesses, including severe fever, typhoid, hypertension, diabetes, and other unknown illnesses.”
Yan-magunguna market in Kafin Hausa, PC: Stallion Times
Khalid explained how the power herb is prepared, “After we cut the Mazamfari from the bush, we washed and dried it.
“When the leaves are dried, we pound it into power, which we tie it in polythene bags.”
He said a wrap of Mazamfara substance is prescribed for anybody who complains of fever, hypertension, diabetes, or body weakness to mix with tea or cow milk.
“The patient is expected to drink the mixed Mazamfari 3 times daily for 5 days.
“Each Mazamfari wrap is selling for N100.
Talking about the volume of sales he records a day, he said: “In a day I can sell over 1000 Mazafaris, netting N100,000 because I also sell wholesale.
“However, in a year, I make a turnover of N5 million depending on how the market flows.
“Most customers like my Mazamfari because of its package, buyers from Yobe, Kano, Maiduguri, and Gombe usually patronize the product.
“I also export my Mazamfari to neighboring countries Niger Republic, Chad, and Cameroon.
During a last visit to check on Hussaini in the second week of August 2023, this reporter saw him responding to treatment with the once-a-week dialysis, taking his prescribed drugs, liquid paraffin, Jugyl, Obet paracetamol, Lisinopril tablet, and injections.
Rabiu and his six siblings take turns staying with their father (Hussaini) in the hospital catering to his daily needs, while his two wives take turns bringing prepared food for him and the children; Hussaini complained that his farming business is slowing down and his gradually running out of cash.
Early morning of 5 September 2023, Hussaini was discharged from hospital, not because he is recovered, but due to his inability to continue with the cost dialysis.
He is now at home lying helpless with increased risk of other severe illnesses.
Rame Isiyaku died of CKD on 21 May 2023. Her three children are living with the fear of being contracted with CKD. However, after a medical examination to determine whether CKD is hereditary, it was confirmed that none of her children is infected.
The siblings of Mamman Mai Shayi, Ali, and Asabe Uba died in December 2022, due to a confirmed case of CKD.
Mai-shayi revealed that his siblings consumed high volumes of Mazamfari in their lifetime.
This publication was supported by the Wole Soyinka Centre for Investigative Journalism (WSCIJ) through Stallion Times under the Collaborative Media Engagement for Development Inclusivity and Accountability Project (CMEDIA) funded by the MacArthur Foundation.
