Diabetes and hypertension contribute to a considerable burden of disease in sub-Saharan Africa (SSA), being largely due to poor diet habits, smoking and alcohol abuse. The study was aimed at providing evidence on the use of traditional medicine (TM) essential for managing these conditions by Zulu and Tswana traditional health practitioners (THPs). Data collection took place in the uMgungundlovu and uThukela Districts in KwaZulu-Natal (KZN) Province, and the Bojanala, Dr Ruth Sekgopomati Districts, in North-West Province, South Africa. Snowball sampling resulted in 863 THPs participating, 437 Zulus and 426 Tswanas face-to-face interviews were conducted using a semi-structured questionnaire to obtain qualitative and quantitative information about the objectives of the study. Most of Zulu and Tswana THPs acquired knowledge from a single source to manage diabetes and hypertension. The Zulu THPs acquired knowledge as a gift from birth while the Tswana’s acquired knowledge from family members. Management was solely based on traditional knowledge, with the two groups having a similar cultural understanding of the two conditions and their clinical features, which were comparable to Orthodox Conventional Medicine (OCM) signs and symptoms. Treatment modalities mainly consisted of ethnopharmacological preparations of herbal mixtures concoctions and decoctions. There were similarities in the Zulu and Tswana THPs cultural understanding of these two diseases, descriptions of clinical features of diabetes and hypertension, and ethnopharmacological preparations used in their management. The findings are intended as a guide to developing a treatment framework that enables a common understanding of traditional practices to manage the two conditions
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