Bridging Knowledge to Policy: A Systematic Review of Traditional Medicine’s Role, Risks, and Integration Pathways in Sudanese Healthcare

Background: Traditional medicine (TM) is a key healthcare component in Sudan, rooted in cultural identity and filling gaps in under‑resourced systems. Although 60.9 %–79.3 % of adults use TM, evidence remains fragmented, limiting policy and integration. Objective: This review synthesizes Sudan‑specific TM research on prevalence, uses, pharmacology, safety, sociodemographic factors, and integration. Methods: A PRISMA 2020 compliant systematic review of Sudan studies from 1980 to 2024 in multiple databases yielded 36 empirical studies. Six domains guided data extraction, and quality was assessed with CASP, NOS and SYRCLE tools. Results: Rural TM use (≈ 68.2 %) exceeded urban (≈ 55.7 %), with affordability and cultural fit as main drivers. Major applications include infectious disease (e.g. Acacia nilotica inhibited Plasmodium falciparum by 96.3 %), diabetes (76+ antidiabetic plants reported), mental health (≈ 71.3 % of psychosis patients first seek TM), and infertility (≈ 68.2 % of women used TM). Pharmacology shows efficacy—for example, Hibiscus sabdariffa oil achieved 85 % antibacterial activity against Staphylococcus aureus—yet safety issues persist: 11.8 % of products exceeded WHO lead thresholds. Zār spiritual healing continues to play a cultural role. Formal integration remains limited: under 10 % of practitioners engage state health authorities, and only 24.7 % of patients disclose TM use to medical providers. Conclusion: TM in Sudan acts as a resilient, adaptive healthcare system. To effectively support sustainable integration, key priorities are regulatory safety standards, clinical validation of promising botanicals, and co‑designed, culturally sensitive policy frameworks acknowledging TM’s legitimacy alongside biomedical norms.