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Background: Mercury is a toxic metal however its use in traditional healthcare systems remains widespread. The aim of this study was to determine the prevalence of mercury use by South African Traditional Health Practitioners (THP) and to document reasons for use and administration methods. Methods: A cross-sectional study design was employed. A total of 201 THPs were enrolled from two main metropolitan areas of KwaZulu-Natal (South Africa), and 198 were included in the final analysis. Information on demographic characteristics, reasons for using or not using mercury as well as mercury administration methods were collected. Results: Of the 198 THPs, 78 (39 %) used mercury for healing purposes and 74 (95 %) of the mercury users stated that they were taught to use it by another THP. The two main routes of administration were oral and sub-cutaneous implantations (ukugcaba) at 85 % (n =66) and 59%(n = 46), respectively. The most common responses for mercury administration were for child birth (n = 70; 90 %) and protection against guns (n = 39; 50 %). Conclusion: This is the first study to describe the prevalence and practice of mercury use in South African traditional medicine. Socio-cultural mercury use is a potential source of exposure to both THPs and their patients. In light of such findings, public education messages and regulatory measures need to be effected. [ABSTRACT FROM AUTHOR]