Wubetu et al. BMC Res Notes (2017) 10:157 DOI 10.1186/s13104-017-2482-3 BMC Research Notes

RESEARCH ARTICLE Open Access Ethnopharmacologic survey of medicinal plants used to treat human diseases by traditional medical practitioners in district, Amhara, Northwestern Muluken Wubetu1*, Tefera Abula2 and Getye Dejenu3

Abstract Background: One of the services that plants provide for human beings is their wider medicinal application. Although it is not fully assessed, the practice and wider use of traditional medicine is frequent in Ethiopia. Studies conducted previously are confned to the perceptions of modern and traditional health practitioners about traditional medicine. A total of 45 informants were selected purposefully from the study area. For collecting the data, semi-struc- tured interviewees, observation and feld walks were employed from August 10 to September 30/2014. To summarize the information, descriptive statistical methods were applied. Results: Sixty species of medicinal plants distributed in 42 families were collected and identifed applied locally for the treatment of 55 human disorders. The most commonly treated ones were evil eye, malaria, wound, peptic ulcer disease and rabies. According to this study, leaves were the commonly used plant parts (36.5%) and 39% of the prepa- rations were decoctions. Oral route, 43 (44%) was the commonly used route of application whereas most (54.8%) remedies were administered only once. Fourteen percent of preparations caused vomiting in addition most (40.4%) of the formulations was contraindicated for pregnant patients. Only seventeen percent of the formulations possessed drug food interactions. Most preparations were stored within clothes, 31 (29.8%). There exists a high (ICF 0.8) even- ness of plant use among healers for treating respiratory problems. Alliumsativum (FI 0.75) for evil eye, Phytolacca= dodecandra (FI 0.8) for rabies and Croton macrostachyus (FI 0.78) for treating malaria= were medicinal plants with highest fdelity =levels showing consistency of knowledge on species= best treating power. This study also documented that drought, overgrazing and frewood collection are major threats. Conclusion: Dega Damot district is loaded in its medicinal plant diversity and indigenous knowledge though plants are highly afected by drought, overgrazing and frewood collection. Therefore awareness activities must be created among the district’s population by concerned governmental and nongovernmental organizations about the value of medicinal plants and conservation of these plants. The healing potential and associated adverse issues of the claimed medicinal plants should be assessed before proposing for a broader utilization. Keywords: Medicinal plants, Traditional medical practitioner, Ethnopharmaclogy

*Correspondence: [email protected] 1 Pharmacy Department, Debre Markos University, , Ethiopia Full list of author information is available at the end of the article

© The Author(s) 2017. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/ publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Wubetu et al. BMC Res Notes (2017) 10:157 Page 2 of 13

Background deal with tangible problems like bone setting, simple According to world health organization, traditional traditional surgery, historical evidence shows that there medicine (TM) is the sum total of the knowledge, skills were many prayers for the prevention and cure of vari- and practices based on the theories, beliefs and experi- ous ailments [1, 5–8]. Despite its continued use over ences indigenous to diferent cultures and nations. It is many countries, its popularity and extensive use, TM used in the maintenance of health, prevention, diagno- has not been ofcially recognized in most countries. As sis, or treatment of disorders [1, 2]. Under TM, health a result, training and research in this area have not been practices, remedies, approaches, and beliefs incorporat- conducted intensively on the various aspects of TM. Te ing plant, animal and mineral products, spiritual thera- safety and efcacy of data on TM are not sufcient to pies are all included [3]. Traditional medicine is popular meet the criteria required to support its worldwide use in the developing world and its use is rapidly spreading [4, 5, 9, 10]. in the developed nations. In China, traditional herbal In Dega Damot district about 90% of the population preparations account for 30–50% of the total drug con- relies on traditional health products (unpublished data sumption. In Ghana, Mali, Nigeria and Zambia, the frst from the district) for primary health care aspects. Tere choice for 60% of children with high fever resulting from have been no studies conducted in the study area on malaria is the use of herbal medicines. In Ethiopia up the use and practice of TM. For policies regarding TM to 80% of the population uses TM due to the cultural ultimately geared towards integration of TM into the acceptability of healers and local pharmacopeias, the national health service to be formed and implemented, relatively low cost of TM and difcult access to modern results of this study will be able to protect the interest of health facilities [4]. those making use of this health care option. In Ethiopia, TM plays both preventive and curative roles. Vegetables are the abundant sources of traditional Methods remedies. Various parts of plants like leaves, fowers, Description of the study district seeds, bark, sap and roots are used. Honey, butter, and Tis study involved traditional medical practitioners sheep fat are TM sources from animals. In Ethiopia, tra- residing in Dega Damot district, Northwestern Ethio- ditional medical practitioners put much emphasis on pia. It shares borders with the districts of in the supernatural force as a source of wisdom for healing the north, in the east, and Hulet eju various illnesses. Even though practitioners practically enesie in the west and Jabitehnan in the South (Fig. 1).

Fig. 1 Map of the Dega Damot district (the ofcials who gave permission to use the respective maps were: personnel of Dega Damot district com- munication ofce, west Gojjam zonal communication ofce and Amhara regional state communication beau rue) Wubetu et al. BMC Res Notes (2017) 10:157 Page 3 of 13

Te district’s administrative town, Feres Bet, is located of medicine and health sciences, University of Gondar. at about 400 km north western of the capital, Addis Prior to the initiation of the data collection, the objec- Ababa. According to 2013 data, the population of the tive of the survey was clarifed to the TMPs, verbal con- district is about 170, 575. Te district is administratively sent was obtained from them. Letter of collaboration divided into 32 kebeles and Amharic which belongs to was sent to district ofcials of the study area and biology the Semitic language family is the language of the popu- department at University of Gondar. lation. In Ethiopia, Kebele is the smallest administrative unit. In the district, barley, maize, potato and wheat are Data analysis the main crops cultivated, of which, potato is exported Descriptive statistic procedures like percentage and fre- to neighboring towns of the like Burie, quency distribution were applied for analyzing and sum- Bahirdar and Gondar. marizing the data. To check the level of homogeneity According to 2004–2013 rainfall data, the District has among information provided by traditional practitioners, a high rainfall distribution between July and August and the informants’ consensus factor, ICF [11] was computed a smaller rainfall between January and May. Te mean [ICF = Nur − Nt/(Nur − 1)] monthly rainfall and mean annual rainfall of the District are 60.24 and 708.54 mm, respectively (National Metro- where, Nur = number of use reports from informants logical Service Agency, Bahirdar Branch Ofce, unpub- for a particular plant-use category; Nt = number of taxa lished data). According to data from the health personnel or species that are used for that plant use category for of the district, the top ten diseases in 2014 are malaria, all informants. ICF Values vary between 0 and 1, where diarrhea, helmenthiasis, pneumonia, acute upper respira- ‘1’ represents the highest level of consensus. Te fdel- tory diseases, dyspepsia, typhoid, eye infection, urinary ity level (FL), which shows for the percentage of inform- tract infection and skin infection respectively. ants claiming the use of a certain plant species for the same major purpose, was calculated for the commonly Selection of study subjects reported disorders as: Data were collected from the traditional medical prac- FL (%) = (Np/N) × 100 titioners (TMPs) who were purposively chosen with the help of community leaders and local authorities. Te where: Np = number of traditional practitioners that informants selected were the most knowledgeable ones claim a use of a plant to treat a certain disease; N = num- as recommended by community leaders and local author- ber of informants that use the plants as a remedy to treat ities who involved in the selection process. Te ages of an ailment [12]. the TMPs ranged between 22 and 80 years. A total of 45 (40 male and 5 female) TMPs were included in this study Results from August 10 to September 30/2014. Socio‑demographic data of the informants Totally, 45 TMPs out of which 40 (88.8%) and 5 (11.2%) Data collection techniques males and females, respectively, were involved in this Semi-structured interviews, observation and feld walks study and 55.6% were illiterate. Most of them were mar- were used to collect the research data. To collect infor- ried (86.7%) and 37.8% were older than 56 years. Tirty- mation about local names of plants used, their threats, one (68.9%) were farmers and all TMPs were Ethiopian part(s) used, preparations methods, routes of remedy orthodox tewahido Christian followers. administration and diseases treated, individual inter- Forty percent of healers indicated that they acquired views were conducted (Additional fle 1). Interviews their healing wisdom from their family, whereas 26.6% were carried out in Amharic, language that is spoken by assumed it as a gift from God. Other sources of wisdom the practitioners. For claimed plant, specimen was col- are religious Institutions (22.2%) and preceding sickness lected, and identifed and voucher was reserved at Uni- and corresponding use (11.2%). About 67% of the prac- versity of Gondar. Field observations were performed to titioners had practiced their healing activities for more document habitat of each medicinal plant. As this study than 25 years. has been conducted on wild plants, permission was mandatory to perform the survey. Hence, Dega Damot Diseases treated and medicinal Plants used district agricultural ofce was informed and asked per- About 55 human diseases are treated by TMPs of the mission to conduct the study and collect the medicinal district. Te most commonly treated ones being evil eye, plants. Te study was also ethically approved by the malaria, wound; peptic ulcer disease and rabies (Table 1). Graduate Program Evaluation Committee of the College Tis study revealed that about 60 plant species fnd Wubetu et al. BMC Res Notes (2017) 10:157 Page 4 of 13 as tea for 1 day for fruit of Ruta chalepensis L., fnally inhale it once lina Del . and eat it on empty once stomach to it add small quantityto and it of honey or butter is applied externally until cure Brenan, Carissa spinarum L. and Carissa ) Brenan, latum ( Forssk. Clausena anisata (Wild) Benth . and inhale it wound till the wound cures till the wound wound butter much amount of milk for 1 day much amount of milk for L. and Ruta chalepensis inhale it water (decoction)water taken once daily The juice of whole plant is employed for bathing for juice of whole plant is employed The Stem powder boiled with butter applied daily boiled with butter powder Stem Crushing the leaf and drying it, fnally drinking it Crushing the root and bandage on the site of bite of bite and bandage on the site Crushing the root Crushing the root with the fruit of garlic and the Crushing the root Small quantities of fruit chewed and swallowed and swallowed Small quantities of fruit chewed - amygda of Vernonia Crushing the leaf with leaves Handful of fresh leaf grounded to make and to a paste leaf grounded Handful of fresh Crushing the seed and apply on the infected area Crushing the seed and apply on infected stel - of Pterolobium with the roots Crushing its root Crushing the leaf and drink it Drying then apply on the the seed then crushing, Milk decoction of leaf taken once Powder of leaf taken once mixed with mead of leaf taken once mixed Powder Inhaling the smell of leaf Applying the latex to the wound for 2 days for the wound to Applying the latex Crushing the seed and drink with adulterated Crushing the seed and drink with adulterated Crushing the fruit and boil it, fnally drink it with Inhale the smell of fruit Lepidium sativum Crushing the seed with seeds of Lepidium ml of Powder of bark mixed with little of bark mixed About 80 ml of Powder Fresh pulverized leaf is applied once daily pulverized Fresh Powder of resin taken mixed with molten butter with molten taken mixed of resin Powder Preparation, dose and application Preparation, exorcism leshmaniasis Mental illness/ Bone dislocation Hypertension Snake bite Evil eye Evil Infertility Anthrax Leprosy Cutaneous Cutaneous Evil eye Evil Ascariasis Wound Haematuria Urine retention Common cold Common Wound Dry cough Malaria Common cold Common Evil eye Evil Rectal prolapsed Tinea decalvans Tinea Stabbing pain Used for Used Whole plant Stem Leaf Root Root Leaf Leaf Leaf Seed Root Leaf Seed Leaf Leaf Leaf Latex Seed Fruit Fruit Seed Bark Leaf Resin Part used Tree Tree Shrub Shrub Tree Tree Grass Shrub Tree Bulb Tree Grass Tree Habit Limch Lomi Agam Berbere Abalo Azamira Ankerdad Chikugn Eret Nech Shinkurt Sesa Serdo Grar Amharic name Amharic MW-059 MW-036 MW-008 MW-007 MW-006 MW-005 MW-004 MW-003 MW-002 MW-001 MW-039 MW-049 MW-053 Voucher no. Voucher Rutaceae Rutaceae Apocynaceae Solanaceae Simaroubaceae Melianthaceae Poaceae Asteraceae Aloaceae Alliaceae Leguminosae Gramineae Leguminosae Family name Family Medicinal plants used to treat human diseases used to treat Medicinal plants Clausena anisata ( Wild) Benth. . Citrus aurantifolia Carissa spinarum L. Carissa Capsicum annuum L. Capsicum Brucea antidysenterica J. F. Mill. J. F. antidysenterica Brucea Fresen. Bersama abyssinica L. sativa Avena Artemisia Jack. ex Wild. afra Aloe pulcherrima Gilbert & Sebsebe Allium sativum L. J.F.Gmel) C.A.Sm ( J.F.Gmel) Albizia gummifera Agrostis semiverticillata Christm. Agrostis (Forssk.) Acacia Senegal ( L. ) Wild. Acacia 1 Table Scientifc name Wubetu et al. BMC Res Notes (2017) 10:157 Page 5 of 13 - - , fnally L’Hérit dodecandra num L. and Phytolacca 3 days once for the wound apply it to . and eat with honey Cass (L.F.) sinica Capsicum annuum L. and salt Capsicum smell of the plant ink and placed under the skin of the head which is then taken once mixed with a glass of which is then taken once mixed local beer dissolved with mead dissolved . or milk Cass (L.F.) sinica and taken once mixed with milk of black cow and taken once mixed against startling dreams benzene and wood charcoal and wood benzene tion butter fnally apply to area once area fnally apply to butter Burning the leaf on fre and inhale it Burning the leaf on fre - of Solanum inca Crushing its leaf with the leaves Porridge of the foor eaten three times daily three of the foor eaten Porridge Crushing the leaf and apply it topically Crushing the seed and drink with alcohol Guizotia abys Crushing the seed with seeds of Guizotia Burning the root on fre and fumigate on fre Burning the root Burning the root and inhale it Burning the root Drying and crushing then drink mixing with by Drying, crushing and adding the seed on fre to Drying, to crushing and adding the seed on fre Brushing the decayed teeth with the yellow seed with the yellow teeth Brushing the decayed Fresh leaf is tied on to the site of the problem the site leaf is tied on to Fresh Unspecifed part with of the plant pounded mixed Crushing the leaf with fresh water Crushing the leaf with fresh An inside part of the bark powder is pounded into Root powder taken with honeyRoot or taken pasted powder Guizotia abys Crushing leaf and drink with either Guizotia Handful of seeds from each pounded with onions Handful of seeds from Powder of the semi-parasite worn as amulet of the semi-parasite Powder Drying the leaf, crushing it and then mixing with Drying the leaf, - of infec the area Crushing the leaf and apply it to Drying the leaf then crushing it and mixing with Preparation, dose and application Preparation, niasis Common cold Common Wound Diarrhea Cutaneous leshma - Cutaneous Tape worm Tape Anthrax Acute febrile illness febrile Acute Common cold Common Tape worm Tape Evil eye Evil Decayed teeth Decayed Mumps Headache Acute febrile illness febrile Acute Syphilis Tuberculosis Malaria Menorhagia Nightmare Eczema Skin cancer Hemorrhoids Used for Used Leaf Leaf Seed Leaf Seed Seed Stem Stem Stem Stem Seed Leaf – Leaf Bark Root Leaf Seed Leaf Leaf Leaf Leaf Part used Tree Tree Herb Shrub Shrub Shrub Tree Shrub Shrub Tree Tree Herb Tree Climber Habit Nech Bahirzaf Korch Nech tef Teketsila Enkoko Kebericho Koshim Astenagir Shingug Getem Bisana Dinblal Wanza Azo Hareg Amharic name Amharic MW-016 MW-015 MW-045 MW-014 MW-013 MW-012 MW-011 MW-054 MW-010 MW-048 MW-035 MW-052 MW-058 MW-009 Voucher no. Voucher Myrtaceae Fabaceae Gramineae Loranthaceae Myrsinaceae Asteraceae Flacoutiaceae Solanaceae Boraginaceae Araliaceae Euphorbiaceae Umbelliferae Boraginaceae Ranunculaceae Family name Family continued M. Gilbert . globulus Labill Eucalyptus Erytbrina Schweinf . brucei Eragrostis tef (Zucc.)Trotter Eragrostis Schweinf.) ( Schweinf.) Englerina woodfordioides Embelia schimperi Vatke Echinops kebericho Mesfn kebericho Echinops (A. Rich.) (A. Warb. Dovyalis abyssinica L. stramonium Datura Cynoglossum coeruleum Hochst. A. Rich. coeruleum DC. Cynoglossum . ostinii Chiov Cussonia Croton macrostachyus Del macrostachyus . Croton Coriandrum sativum L. Coriandrum . Lam africana Cordial Clematis simensis Fresen. 1 Table Scientifc name Wubetu et al. BMC Res Notes (2017) 10:157 Page 6 of 13 - - and bandaged once daily everysinica other day come evacuation problem leaves putting it on the area of infection putting it on the area once on empty stomach drink it once egg and allow the steam to get into the vagina the vagina get into to the steam egg and allow cavity the morning and evening for a week the morning for and evening for 3 days for the powder of bark the powder wheat or tef, fnally drying it on fre wheat or tef, fre till it becomes semidryfre Euphorbia abys of Euphorbia with latex of seed mixed Powder Seeds eaten cookedSeeds over eaten at least once daily to Milk decoction of the fresh pulverized roots and Milk roots pulverized decoction of the fresh Crushing the leaf and eat it Putting the stem on fre till it becomes hot then on fre the stem Putting Crushing the leaf and mix with fresh water drink water it Crushing the leaf and mix with fresh Powder of fried resin taken orally mixed with water taken of fried orally mixed resin Powder Fruit juice applied as ear drops Fruit Drying and eat the seed on fre Crushing the fresh leaves and mix with water and and mix with water leaves Crushing the fresh Boil the oil of the seed together with onions and Boil the oil of seed together A cup of seed powder decoction is given orally in decoction is given A cup of seed powder A cup of oil is given in morning in empty A cup of oil is given stomach Washing hair with the latex of the bark hair with the latex Washing Root and leaf powder taken once mixed with milk takenRoot once mixed and leaf powder Fumigate the patient once daily with smoke of Fumigate Crushing the root and drink with milk Crushing the root Applying the latex to the afected area the afected to Applying the latex Crushing the leaf and mixing it with butter Crushing the root and mixing with powder of and mixing with powder Crushing the root Mixing the latex with tef powder and putting it in Mixing powder with tef the latex Preparation, dose and application Preparation, - failure riage niasis Wound Constipation Sexual dysfunction Abdominal cramp Hemorrhoids Anthrax Congestive heartCongestive Earache Peptic ulcer disease Peptic Tape worm Tape Retained placenta Dry cough Rabies Hair fungus Frequent miscar Frequent Epilepsy Malaria Skin cancer Cutaneous leshma - Cutaneous Rabies Jaundice Used for Used Seed Seed Root Leaf Stem Leaf Resin Fruit Seed Leaf Seed Seed Fruit Bark Root Bark Root Latex Leaf Root Latex Part used Herb Herb Herb Tree Tree Shrub Grass Tree Herb Shrub Tree Tree Habit Feto Guaya Andahula Simeza Tsid Amja Gebs Koso Nug Lenquata Shola Kulkual Amharic name Amharic MW-050 MW-044 MW-020 MW-019 MW-057 MW-056 MW-033 MW-018 MW-040 MW-017 MW-038 MW-034 Voucher no. Voucher Cruciferae Leguminosae Crassulaceae Acanthaceae Cupressaceae Guttiferae a Gramineae Rosaceae Compositae Tiliaceae Moraceae Euphorbiaceae Family name Family Gmel. continued Anders. Lepidium sativum L. Lepidium Lathyrus sativus L. Lathyrus Kalanchoe petitiana A.Rich. Nees) T. Justicia schimperiana ( Hochst.ex Nees) T. Juniperus procera Hochst . Juniperus procera Forssk.) Vahl ( Forssk.) Hypericum revolutum Hordeum vulgare Hordeum J. F. (Brace.) Hagenia abyssinica (L.F.) abyssinica Guizotia Cass. Grewia ferruginea Hochst. ex A. Rich.Grewia . Forssk vasta Ficus J.F.Gmel. abyssinica Euphorbia 1 Table Scientifc name Wubetu et al. BMC Res Notes (2017) 10:157 Page 7 of 13 - - nally apply it on the nostril boil it, fnally washing the wound with it boil it, fnally washing the wound safower powder and one glass taken only once powder safower wound cures wound beer with the crushed leaf glass of it once juice given orally for 15 days orally for juice given and bandaged on the goiter once and bandaged on the goiter bia abyssinica every other day minute and spit it minute nostril water, fltered. The resultant juice is given orally in juice is given resultant The fltered. water, 1 month the morning for and drink it Then Then Cass. (L.F.) abyssinica sativum L. or Guizotia eating with honey on empty stomach Juice or infusion of whole plant taken once Infusion of fresh pulverized barkInfusion pulverized of fresh Decoction of fresh pulverized root applied exter root Decoction pulverized of fresh Powder of root and garlic mixed with water and garlic mixed of root Powder Fresh pulverized leaves are placed in the nostril are leaves pulverized Fresh Crushing the seed with seeds of garlic and Crushing the leaf and mixing with benzene, then Crushing the leaf and mixing with benzene, Crushing leaf with fresh water and wash with it water Crushing leaf with fresh Fresh pulverized leaf infused in water solution of leaf infused in water pulverized Fresh Leaf powder taken mixed with once own urine with once own taken mixed powder Leaf Crushing the leaf and apply it to the wound till the the wound Crushing the leaf and apply it to Crushing the root and drink with honey Crushing the root Powder of bark local with diluted taken once mixed Powder Crushing the leaf and washing the area of infection of infection Crushing the leaf and washing area Crushing the leaf with fresh water and drink water one Crushing the leaf with fresh A handful of fresh leaf is grinded and cup of this leaf is grinded A handful of fresh Powder of root and leaf mixed with latex of euphor with latex and leaf mixed of root Powder Chewing the leaf within the mouth for about a Chewing the leaf within mouth for Butter paste of the root powder placed in the powder of the root paste Butter Small quantity of seed and fruit is grounded with Small quantity of seed and fruit is grounded Putting the seed in water till it becomes semisolid the seed in water Putting Boil the seed with water and after cooling drinkBoil the seed with water it Lepidium Crushing the seed with seeds of Lepidium Preparation, dose and application Preparation, illness Menorhagia Malaria Recurrent seasonal Headache Epitaxis Evil eye Evil Wound Acute febrile illness febrile Acute Appendicitis Epitaxis Wound Rabies Jaundice Scabies Anthrax Jaundice Goiter Teeth ache Teeth Headache Hypertension Pain during delivery Pain Peptic ulcer disease Peptic Anthrax Used for Used Whole plant Bark Root Root Leaf Seed Leaf Leaf Leaf Leaf Leaf Root Bark Leaf Leaf Leaf Root Leaf Root Seed Seed Seed Seed Part used Herb Tree Shrub Shrub Herb Shrub Shrub Climber Tree Tree Tree Herb Shrub Habit Muja Lol Tiladam Ambacho Yewusha Milas Yewusha Chakma Gesho Mekan Endod Keret Chife Shinet Gibto Telba Amharic name Amharic MW-051 MW-046 MW-029 MW-028 MW-027 MW-047 MW-026 MW-024 MW-042 MW-023 MW-060 MW-041 MW-021 Voucher no. Voucher Graminaceae Meliaceae Rutaceae Polygonaceae Polygonaceae Euphorbiaceae Rhamnaceae Phytolaccacee Santalaceae Oliniaceae Myricaceae Fabaceae Linaceae Family name Family continued Snowdenia polystachya (Fresen.)Pilg. polystachya Snowdenia Skebergia capensis Sparrm. capensis Skebergia Ruta chalepensis L. Rumex nervosus Vahl Rumex nepalensis Spreng. Ricinus L. communis Rhamnus prinoides L’Herit dodecandra L’Hérit dodecandra Phytolacca Osyris quadripartite Decn. Olinia A. Juss. rochetiana Myrica salicifolia Hochst. ex A.RichMyrica Lupinus albus L. Lupinus Linum usitatissimum L. 1 Table Scientifc name Wubetu et al. BMC Res Notes (2017) 10:157 Page 8 of 13 then drink the fltrate one glass once hyena employed for bathing for employed hyena fumigate with it fumigate fnally drink one cup of it glass once fresh water, drink one glass of it and drink much water, fresh amount of milk afected area for 3 days for area afected by mixing with water and sugar mixing with water by by mixing with water and sugar mixing with water by root and leaf powder and a cup of this decoction and leaf powder root 7 days for times a day orally three is given the nose to help a child to be a fast learner help a child to and the nose to intelligent Crushing the root and mixing with some water and mixing with some water Crushing the root Crushing the root with fresh water and drink water about with fresh Crushing the root Decoction of root, bark and leaf and excrement of Decoction bark and leaf excrement of root, Bathe in the infusion of leaf and root for 7 days for Bathe in the infusion of leaf and root Boil the leaf in water till it evaporates and then till it evaporates Boil the leaf in water Crushing the leaf and mix with some fresh water, water, Crushing the leaf and mix with some fresh Crushing the leaf with water and drinkCrushing the leaf with water about one The root will be crushed and dried the mixed with will be crushed and dried the mixed root The Boil the semi-crushed 2 or 3 days leaf and eat it for Crush the dried seed and apply the powder to the to Crush the dried seed and apply the powder Putting in water, drying it, crushing and the eating in water, Putting Crushing the seed and boil with milk Putting in water, drying it, crushing and the eating in water, Putting A decoction is made from each one teaspoon of each one teaspoon A decoction is made from Powder of seed given in small amount through in small amount through of seed given Powder Preparation, dose and application Preparation, disorder Abdominal cramp Bladder distention Gout Sexual dysfunction Acute febrile illness febrile Acute Diarrhea Bladder distention Malaria Peptic ulcer disease Peptic Wound Weight loss Weight Dry cough Peptic ulcer disease Peptic Syphilis Attention defcient Attention Used for Used Root Root Root, bark and leaf Leaf and root Leaf Leaf Leaf Leaf Root Leaf Seed Seed Seed Seed Root and leaf Seed Part used Bulb Climber Tree Herb Tree Herb Tree Climber Habit Zingibl Haregresa Girawa Sama Aluma Absh Dokma Embuay Amharic name Amharic MW-032 MW-031 MW-030 MW-025 MW-022 MW-037 MW-043 MW-055 Voucher no. Voucher Zingiberaceae Cucurbitaceae Asteraceae Urticaceae Solanaceae Fabaceae Myrtaceae Solanaceae Family name Family continued Zingiber ofcinale Roscoe. f.) Sond. (Linn. f.) scabra Zehneria Vernonia amygdalina Del. amygdalina Vernonia Urtica simensis Descopodium penninervum Hochst. Trigonella foenum - graecu Trigonella Syzygium guineense (Wild.) Dc. L. Solanum incanum 1 Table Scientifc name Wubetu et al. BMC Res Notes (2017) 10:157 Page 9 of 13

applications by the TMPs of the district. Tose plants Method of preparation, routes of administration and dose were identifed and distributed in 42 families. Fami- Traditional medical practitioners used simpler tech- lies, Gramineae and Solanaceae each accounts 4 (9.5%) niques like crushing and powdering with the help of medicinal plants followed by Fabaceae and Leguminosae, easily available materials like water, honey and milk for 3 (7%) each. Most of the plants collected and identifed preparation of remedies to treat various human ailments from the study area were trees (40%), followed by herbs as shown in Table 1. Tis survey also documented that (30%) and shrubs (25%) and (Fig. 2). most of the remedies were given orally, (44%). Topical (26.5%), nasal (25.5%), rectal (2%), vaginal (1%) and sub- Plant parts used cutaneous (1%) routes are also used. Tis study showed According to this survey, the commonly used plant part that TMPs in the district were not aware of the exact was leaf (36.5%), followed by seed (21.2%) (Fig. 3). dose of remedies to be administered. Tey easily deter- mined the dose depending on mainly age. Te doses of 24 preparations were not determined. Healers expressed doses as a glass of, half a cup of or a teaspoon full of.

Dosage forms and frequency of administration Te documented 60 species of medicinal plants were reported to be formulated in various forms. Majority of dosage forms were decoctions 35 (38.9%) followed by liq- uid preparations 18 (20%) as shown in Fig. 4. Most of the preparations were given only once (Fig. 5).

Solvents and additives Forty-three percent of the formulations did not require any additive or solvent. Of the formulations that involve Fig. 2 Frequency distribution of growth form of medicinal plants the use of solvents, water accounted 25 (42.4%) followed

Fig. 3 Frequency distribution of plant parts used to prepare remedies

Fig. 4 Frequency distribution of dosage forms of plant remedies Wubetu et al. BMC Res Notes (2017) 10:157 Page 10 of 13

Table 4 Frequency distribution of side efects of remedies Category Frequency % Age

Those with known side efects Nausea 15 14.4 Vomiting 15 14.4 Diarrhea 8 7.7 Loss of consciousness 8 7.7 Local pain 12 11.5 Fig. 5 Distribution of frequency of administration of plant remedies Headache 6 5.8 Nasal stifness 10 9.6 PUD 4 3.8 Constipation 3 2.9 by milk 8 (13.6). Diferent additives like butter, honey, Abdominal cramp 9 8.7 sugar and others were also incorporated (Table 2). Free from any side efect 12 11.5

Contraindications and side efects According to TMPs of the area, 42 (40.4%) of the formu- problems. Synergistic reactions were observed in poly lations were contraindicated for pregnant patients. No herbal preparations like in the case of remedies for evil contraindication was indicated for 35 (33.6% of the for- eye. mulations (Table 3). Twelve (11.5%) of the preparations Storage were free from any side efect (Table 4). Asked on how they store plant remedies, healers Drug food interactions responded that they don’t normally store plant prepara- According to this study, only 17% of the formulations tions; rather they collect fresh material and formulate possessed drug food interactions, of which 12 (66.7%) remedies. For those medicinal plants which are not easily were exhibited by preparations for gastrointestinal available and which are seasonal, they collect and store in papers, horns or and with in bottles. Only three per- Table 2 Solvents and additives used cent of the total preparations were stored in cool and dry places (Fig. 6). Solvents and additives Number (%) of formulations Informant’s consensus Water 25 (42.4) Alcohol 5 (8.5) Depending on the data obtained, seven use-categories Milk 8 (13.6) (Table 5) were set in which 127 use reports were docu- Benzene 2 (3.4) mented. As depicted below, informant consensus fac- Honey 4 (6.8) tor values and the mean ICF are close to 1. Tere is Salt 1 (1.7) high uniformity in plant consumption for respiratory Sugar 4 (6.8) diseases. Charcoal 1 (1.7) Fidelity level Butter 5 (8.5) Ink 1 (1.7) In the survey, the FL values were analyzed for seven Urine 1 (1.7) plants in treating three medical conditions (Table 6). Tef 2 (3.4)

Table 3 Distribution of contraindication to remedies Category Frequency % Age

Contraindicated to Children 19 18.3 Pregnant women 42 40.4 Elderly 8 7.7 No contraindication 35 33.6 Fig. 6 Frequency of storage of remedies Wubetu et al. BMC Res Notes (2017) 10:157 Page 11 of 13

Table 5 Informants’ consensus score Discussion

Use category Species Use-reports ICF (n­ ur nt/ Tis study revealed that about 60 plant species fnd (#) (n­ ) (Ur) n 1)− t ur − applications by the TMPs of the woreda. Tose plants Gastrointestinal problems 7 15 0.57 were identifed and distributed in 42 families. Families, Central nervous system 9 18 0.53 Graminae and Solanaceae each accounts 4 (9.5%) medici- disorders nal plants followed by Fabaceae and Leguminosae, 3 Respiratory problems 2 6 0.8 (7%). But Fabaceae was the dominant family according Urinary tract problems 7 15 0.57 to the conducted in Hawasa [13], District of Skin problems 8 13 0.42 Oromiya region [14] and Benshangul-Gumuz [15]. In Cardiovascular disorders 13 28 0.55 addition a study done in Spain [16], Korea [17] and Other organ problems 14 32 0.58 and Gena Bosa Districts [18] showed that Asteraceae has Mean ICF 0.57 the highest number of medicinal plants. Caesalpiniaceae was the family with higher number of plants according to the study in Nigeria [19]. Te ailments reported to be handled by the TMPs of the Table 6 FI for plant species used to treat evil eye, malaria and rabies district are those disorders most prevalent in the district. According to the result of this study, the majority of plants Ailments Percentage Species Np N FI (Np/N) were reported to treat wound followed by malaria, evil of informants eye and anthrax. However, a study done in Hawasa [13] Evil eye 30 Allium sativum 6 8 0.75 showed that stomach ache is the disease treated by large 34 Echinops kebericho 7 11 0.64 number of medicinal plants. In addition a study done in Rabies 9 Guizotia abyssinica 4 5 0.8 Sheko ethinic group of Ethiopia [8] showed that skin and 34 Phytolacca dode- 8 9 0.89 gastrointestinal problems were the commonly treated dis- candra eases. According to a study in Lebanon [20], most medici- Malaria 19 Urtica simensis 10 15 0.67 nal plants were used to treat gastrointestinal disorders, 36 Croton macros- 7 9 0.78 kidney and urinary diseases as well as blood and cardio- tachyus vascular diseases. Diarrhea was the commonly treated 5 Euphorbia abys- 5 12 0.42 sinica disease in Benshangul-Gumuz [15].Tis discrepancy may be the result of the diference in the climatic, ethnic, and Np number of TMPs who used the medicinal plant for the same purpose, N number of TMPs who used the medicinal plant for various purposes hygienic conditions the areas. Te current study is also unlike the one done in Israel [21]. Mental illnesses were commonly treated according to the study in Kenya [22]. Te most commonly used plant part was leaf in this Croton macrostachyus (FL = 0.78) is reported by high number of informants (36%) in treating malaria. Allium study area which is in agreement with other studies. [8, 13, 15, 18, 19, 21, 23–26]. Considerable threat to the sativum (FL = 0.75) is more preferable than Echinops kebericho (FL 0.64) in treating evil eye. mother plant radiates to the various parts of the plant. = However, root was the commonly used plant part accord- Threats to medicinal plants ing to a study done in Benshangul-Gumuz [15]. Medici- As shown in Table 7 below, drought, overgrazing and nal plants were formulated in various forms using various frewood collection are the major threats of medicinal solvents and additives. Tey were formulated as decoc- plants. Practitioners leveled drought as the most serious tions, liquid preparations and pastes. Tis is supported threat. by a study done in Korea [17], Israel [21], Gondar zuria woreda [24] and Hawasa [13]. However, in a study done in Chencha [18] and Tewledere districts [27], the majority of remedies were formulated as concoctions. Practition- Table 7 Threats to medicinal plants ers prepare remedies in such a simple manner without Threats to medicinal plants % of TMPs further processing which may be due to lack of education and processing instruments. TMPs of the current study Drought 55.6 area used butter, charcoal, sugar, milk and salt as addi- Overgrazing 22.2 tives to increase the efcacy and potency of the remedies. Firewood collection 15.6 Te rationale behind the use of honey and sugar is just Agricultural expansion 4.4 to make the formulation palatable. Tis is supported by a Soil erosion 2.2 study done in Israel [17] and Hawasa [13]. Wubetu et al. BMC Res Notes (2017) 10:157 Page 12 of 13

Tis study showed that there was no harmony in meas- A total of 127 URs from 60 species of plants were urement or unit used among practitioners. Most inform- recorded which were assigned to seven use categories. ants stated measuring units like cup, spoon, bottle and Analysis of ICF shows that there exists a high evenness handful which lack accuracy. Tis problem was also of plant consumption among the population which is in observed in studies done elsewhere which may be due to harmony with the study in Chencha [18]. Te low ICF for lack of education [13, 14, 19, 28]. skin problems may because of a multifaceted preparation Tis study revealed that higher sizes of preparations of plants required to treat disease. Majority of plant spe- were given orally which agrees with results of other stud- cies have a number of medicinal values, which result in ies [11–13, 15, 17, 22–25, 27–29]. Practitioners prefer higher variety of use reports. simple routes like topical and oral due to their inability to Croton macrostachyus (FL = 0.78) is reported by high administer remedies in other routes like intravenous. Oral number of informants (36%), hence more preferable than administration allows relatively fast physiological action Euphorbia abyssinica (0.42) and Urtica simensis (0.67) of remedies on pathogens and enhance its efcacy. How- in treating malaria. However, despite Allium sativum ever, studies conducted in Sheko ethnic group in South- (FL = 0.75) is reported by less fgures of informants (30%), west Ethiopia [8] revealed that most preparations were than Echinops kebericho (FL = 0.64) which is mentionedd prescribed for administration to the cutaneous route. by relatively higher percentage of practitioners (34%), it According to the result of the current study, most formu- seems that Allium sativum is more preferable than Echi- lations were given only once. Tis may be due to the fact nops kebericho in treating evil eye. But a study done in that most practitioners do not know the actual dose to be Sheko [8] indicated that Ocimum lamiifolium, Phytolacca given and fear the risk that comes at the end of the treat- dodecandra, Amaranthus dubius and Amaranthus graeci- ment due to over dose and continuous administration. zans were the medicinal plants assigned with the highest One-third of the medicinal plants recorded were trees. FL values. Tis discrepancy may be the result of the difer- However, other research works indicate the abundant use ences in the type of diseases dominating the areas, and the of herbs [8, 22, 24, 25, 27, 30]. Te availability of most level of availability of the medicinal plants. woody plants in the area might have enforced the local According to the results of this study, drought is the inhabitants to rely on tress. most serious threat to medicinal plants followed by Most of the formulations were contraindicated for preg- overgrazing. Tis is in conformity with the survey con- nant patients. Tis is due to the healers’ belief that it may ducted in Gemad district [25] and Kilte Awulalo [27], but harm the fetus. No contraindication is indicated for one- according to a study done in Loma and Gena Bosa [26], third of the formulations. Most preparations taken orally agricultural expansion was the major threat followed by cause nausea, vomiting and abdominal cramp whereas, timber and other demands. Tis is probably due to the some of the preparations are free from any side efect which increasing number of population. However, study done in may be due to the lack of follow up of patients by healers Hawasa city [13] indicated urbanization as the most seri- once they gave remedies and due to illiteracy of the patients. ous threat for medicinal plants. Tis study revealed that, only some of the formulations possessed drug food and drug–drug interactions, this Conclusion may be because most practitioners are illiterate, they do Dega Damot district is loaded in its medicinal plant not know about the interaction of their remedies with diversity and indigenous knowledge though plants are modern medicines. In addition practitioners do not fol- highly afected by drought, overgrazing and frewood low the progress of their patients, hence have little infor- collection. Terefore awareness activities must be cre- mation on drug food interaction. Synergistic reactions ated among the district’s population by concerned gov- were observed in poly herbal preparations like in the case ernmental and nongovernmental organizations about of remedies for evil eye. the value of medicinal plants and conservation of these According to this study, practitioners do not normally plants. Te healing potential and associated adverse store remedies which is in contrast to the study done in issues of the claimed medicinal plants should be assessed Addis Ababa [28]. For those medicinal plants which are before proposing for a broader utilization. not easily available and which are seasonal, practition- ers collect and store in papers, horns and with in bottles. Only three percent of the total preparations are stored Additional fle in cool and dry places. Tis may be due to the lack of modern education about drug storage and other health Additional fle 1. Semi-structured interview questions. related issues. Wubetu et al. BMC Res Notes (2017) 10:157 Page 13 of 13

Abbreviations 7. Wondwosen T. Impacts of urbanisation on the traditional medicine of HIV: human immunodefciency virus; ICF: informant’s consensus factor; PUD: Ethiopia. Anthropologist. 2005;8(1):43–52. peptic ulcer disease; TM: traditional medicine; TMPs: traditional medical practi- 8. Mirutse G, Zemede A, Zerihun W. Ethnomedicinal study of plants used by tioners; UR: use-report. Sheko ethnic group of Ethiopia. J Ethnopharmacol. 2010;132:75–85. 9. Elias A, Tesfaye G, Bizatu M. Aspects of common traditional medical Authors’ contributions practices applied for under-fve children in Ethiopia, region, All of the authors had magnifcent contribution in the design of the study, eastern-Harargie district, Dadar Woreda. Commun Med Health Educ. data collection and analysis and preparation of the manuscript. MW and TA 2013;3(6):1–8. played a pivotal role in writing the proposal and designing the study. MW was 10. Sara A, et al. Traditional healing practices among American muslims: instrumental during the data collection, analysis and manuscript preparation. perceptions of community leaders in southeast Michigan. J Immigrant GD involved in the discussion as well as manuscript preparation of this paper. Minor Health. 2011;3(5):17–28. All authors read and approved the fnal manuscript. 11. Bhat JA, Kumar M, Negi A, Todaria N. Informants’ consensus on ethnome- dicinal plants in Kedarnath Wildlife Sanctuary of Indian Himalayas. J Med Author details Plants Res. 2013;7(4):148–54. 1 Pharmacy Department, Debre Markos University, Gojjam, Ethiopia. 2 School 12. Alexiades MN. Collecting ethnobotanical data: an introduction to basic of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia. 3 Public Health concepts and techniques. Adv Econ Bot. 1996;10:53–96. Department, Debre Markos University, Gojjam, Ethiopia. 13. Reta R. Assessment of indigenous knowledge of medicinal plant practice and mode of service delivery in Hawassa city, southern Ethiopia. J Med Acknowledgements Plants. 2013;7(9):517–35. We are indebted to the people of Dega Damot district for their unreserved 14. Moa M, et al. An ethnobotanical study of medicinal plants in Wayu Tuka collaboration and hospitality. We have appreciated the Dega Damot district district, of Oromia regional State, West Ethiopia. J ofces of Rural Agricultural Development, Health, Administration and Plan Ethnobil Ethnomed. 2013;9:68. and Finance for their provision of information during data collection. We thank 15. Teferi F, Teferi G, Kaleab A. Ethnomedical survey of Berta ethnic group university of Gondar and Debre Markos University for their support to conduct Assosa Zone, Benishangul-Gumuz regional state, mid-west Ethiopia. J our study and biology department, university of Gondar for the provision of Ethnobiol Ethnomed. 2009;5:14. some facilities during identifcation of plants. Our gratitude also goes to Mr. 16. Gorka M, et al. Medicinal plants traditionally used in the Northwest Spain. Abyu Eniyew, a botanist at University of Gondar, who identifed the plants. The J Ethnopharmacol. 2013;4(9):01–22. role of the communication ofce and Amhara region com- 17. Mi-Jang S. Ethnopharmacological survey of medicinal plants in Jeju munication beaurue was also instrumental. Island, Korea. J Ethnobiol Ethnomed. 2013;9:48. 18. Mohammed A, Seyoum G. Medicinal plants biodiversity and local health- Competing interests care management system in Chencha district; Gamo Gofa, Ethiopia. J The authors declare that they have no competing interests. Pharmacogn Phytochem. 2013;2(1):284–93. 19. Abubakar M, Musab A, Ahmeda M. The perception and practice of Availability of data and materials traditional medicine in the treatment of cancers and infammations Data and materials will be available on request at any time. by the Hausa and Fulani tribes of Northern Nigeria. J Ethnopharmacol. 2007;111:625–9. Ethical approval and consent to participate 20. Taha D, et al. Survey of medicinal plants currently used by herbalists in The study was ethically approved by the Graduate Program Evaluation Com- Lebanon. Pak J Bot. 2013;45(2):543–55. mittee of the College of medicine and health sciences, University of Gondar. 21. Said O, et al. Ethnopharmacological survey of medicinal herbs in Prior to the initiation of the data collection, the objective of the survey was Israel, the Golan Heights and the West Bank region. J Ethnopharmacol. clarifed to the TMPs, verbal consent was obtained from them. Letter of col- 2002;83:251–65. laboration was sent to district ofcials of the study area and biology depart- 22. David M, et al. Traditional healers and their provision of mental health ser- ment at University of Gondar. vices in cosmopolitan informal settlements in Nairobi, Kenya. Afr Technol Policy Stud Netw. 2013;67:228–57. 23. Gidey Y, Samuel Z. Ethnobotanical study of traditional medicinal plants in Publisher’s Note Gindeberet district, western Ethiopia. Mediterr J Soc Sci. 2011;2(4):49–54. Springer Nature remains neutral with regard to jurisdictional claims in pub- 24. Muthuswamy R, Mequente S. The study of spiritual remedies in orthodox lished maps and institutional afliations. rural churches and traditional medicinal practice in Gondar Zuria district, Northwestern Ethiopia. PHCOG J. 2009;1(3):178–83. Received: 22 December 2015 Accepted: 5 April 2017 25. Kalayu M, Gebru T, Teklemichael T. Ethnobotanical study of traditional medicinal plants used by indigenous people of Gemad district, Northern Ethiopia. J Med Plants Stud. 2013;1(4):32–7. 26. Mathewos A, Sebsebe D, Zemede A. 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