According to Watt & Breyer-Brandwijk (1962), human poisoning has been reported from eating the fruit, presumably of the bitter form. (As with other members of the Cucurbitaceae, e.g. Cucumis africanus, some plants of L. siceraria produce bitter, poisonous fruits and others non-bitter, edible fruits). Various medicinal uses of the leaves, fruit and seeds have been recorded from various countries, e.g. as a pectoral, an anthelmintic, a purgative and even as a headache remedy.

In southern Africa, the leaves are commonly eaten as a vegetable and are added fresh to maize porridge, or a relish is prepared from them, mixed with other plants. Dried leaves are stored for use in the lean season. The young shoots seem to be an important vegetable, unlike the young fruits that are considered by some to be a famine food. However, in some parts of southern Africa, the young, sweet and green fruit is a popular cooked vegetable, as in many parts of the world. Bitter fruits are not eaten and considered poisonous. Rood (1994) gives recipes for dishes with the young fruit of the calabash as the main ingredient. According to van Wyk & Gericke (2000), a form of small gourd with a coarse skin, is popular in southern Africa as a vegetable known as maranka / maraka, but this is actually a land race of the true squash, Cucurbita pepo.

Until about 25 years ago, South African farmers, particularly from the Ladismith District, Little Karoo, Western Cape, used to cultivate calabashes for the pipe-making industry. The necks of the young fruit were bent regularly in such a way that they grew to form the bowls of pipes. When the fruit was dry and ripe, these necks were sawn off, cleaned and exported to pipe makers overseas. It seems that these calabash pipes became very popular in foreign countries after the Anglo-Boer War, and around 1910 they were sold in the USA for up to 12 dollars. The US Dept. of Agriculture felt that these pipe bowls could be produced far more cheaply locally and in 1909 published a pamphlet detailing the cultivation of the South African pipe calabash and the preparation of these pipes.

Heiser (1979) wrote The gourd book, devoting more than half of it to L. siceraria. Numerous uses of the bottle gourd in various cultures are discussed and illustrated, even the use as penis sheaths in Papua New Guinea ! Kefalidou (2003) stated that bottle gourds were found all over the Mediterranean as early as the Bronze Age (3 rd and 2 nd millennia BC.). Containers crafted from gourds were in constant use in that region until recent times, as bottles for wine and water, dippers, salt containers, life-jackets (made of gourds tied together), and rattles. Summit & Widess (1999) wrote a book on the rich diversity of musical instruments fashioned from bottle and other gourds in many cultures in various countries. Such instruments are played even today, also in the USA.

In rural southern Africa and elsewhere in developing countries, the calabash fruit is still widely used for various kinds of household containers and utensils. Non-bitter types are used to store water, milk and beer. These calabashes and products made from them are commonly sold as ornaments at roadside stalls and curio markets.

Pedro Paulo Salles from the Univeristy of São Paulo has provided some additional information regarding the use of bottle gourds in Brazil. Here they are known as cabaça, abóbora and porongo (or purunga). He notes that they are used for the transport of foods and liquids and for the construction of a range of musical instruments, some by native tribes. They are also used in cookery, especially in the state of Minas Gerais.