Treatment outcomes of alcohol use disorder by traditional medicine practitioners using plant derivatives in southwestern Uganda: findings from in-depth interviews.

Background: Globally, 5.1% of the global burden of disease and injury is attributable to alcohol in addition to its significant negative socio-economic impact. Uganda is ranked among the highest alcohol consuming countries in Africa with a reported alcohol per capita consumption of 9.5 liters, much higher than the 6.3 for the African region. Additionally, almost 10% of Ugandans aged 18 and older have an alcohol use disorder. African traditional medicine plays an important role towards universal health coverage in sub-Saharan Africa especially in rural areas. Anecdotal evidence shows that herbal medicines are used by traditional medicine practitioners (TMPs) to treat alcohol drinking problems in Uganda. Data on the outcomes of alcohol treatment by TMPs is scarce. We aimed at documenting the treatment outcomes and secondary benefits of people treated by TMPs using plant derivatives in southwestern Uganda. Methods: This was a cross-sectional semi-structured qualitative study that investigated alcohol drinking history and treatment outcomes of adults living in Bushenyi district, southwestern Uganda. We used a semi-structured questionnaire to conduct face-to-face in-depths interviews with individuals who had been treated for alcohol drinking problems by TMPs using plant derivatives. Three trained research assistants collected the data using audio recordings backed by field notes. The audio recordings were transcribed verbatim and two independent researchers coded the transcripts guided by a priori themes developed by the research team. Results: We conducted 44 in-depths interviews, majority of the participants (70.5%, 31/44) were male with a mean age of 47 years. Most participants (86.2%, 38/44) consumed spirits in addition to other types of alcohol and the mean duration of alcohol drinking before seeking treatment was 14 years. Most participants (93.3%, 41/44) abstained from drinking after treatment by the TMPs with only 6.7% (3/44) continuing to drink but less amounts. All participants described additional benefits after treatment including improvement in health, family relations and image in society. Conclusion: People who were treatment for alcohol drinking problems by traditional healers using plant derivatives in this study described personal and social benefits after stopping drinking. This calls for further research to the plants used.

Ethnomedicinal plants used for malaria treatment in Rukungiri District, Western Uganda.

BACKGROUND: Malaria remains a major global health challenge and a serious cause of morbidity and mortality in sub-Saharan Africa. In Uganda, limited access to medical facilities has perpetuated the reliance of indigenous communities on herbal medicine for the prevention and management of malaria. This study was undertaken to document ethnobotanical knowledge on medicinal plants prescribed for managing malaria in Rukungiri District, a meso-endemic malaria region of Western Uganda. METHODS: An ethnobotanical survey was carried out between May 2022 and December 2022 in Bwambara Sub-County, Rukungiri District, Western Uganda using semi-structured questionnaire. A total of 125 respondents (81 females and 44 males) were randomly selected and seven (7) key informants were engaged in open interviews. In all cases, awareness of herbalists on malaria, treatment-seeking behaviour and herbal treatment practices were obtained. The ethnobotanical data were analyzed using descriptive statistics, informant consensus factor and preference ranking. RESULTS: The study identified 48 medicinal plants belonging to 47 genera and 23 families used in the treatment of malaria and its symptoms in the study area. The most frequently cited species were Vernonia amygdalina, Aloe vera and Azadirachta indica. Leaves (74%) was the most used plant organ, mostly for preparation of decoctions (41.8%) and infusions (23.6%) which are administered orally (89.6%) or used for bathing (10.4%). CONCLUSIONS: Indigenous knowledge of medicinal plants used as prophylaxis and for treatment of malaria still exist among the local communities of Bwambara Sub-County. However, there is a need to investigate the antimalarial efficacy, phytochemical composition and safety of species (such as Digitaria abyssinica and Berkheya barbata) with high percentage use values to validate their use.

Developmental stages influence in vivo antimalarial activity of aerial part extracts of Schkuhria pinnata.

ETHNOPHARMACOLOGICAL RELEVANCE: Malaria remains a dire health challenge, particularly in sub-Saharan Africa. In Uganda, it is the most ordinary condition in hospital admission and outpatient care. The country's meager health services compel malaria patients to use herbal remedies such as Schkuhria pinnata (Lam.) Kuntze ex Thell (Asteraceae). Although in vivo studies tested the antimalarial activity of S. pinnata extracts, plant developmental stages and their effect at different doses remain unknown. AIM OF THE STUDY: This study aims to determine the effect of the plant developmental stage on the antimalarial activity of S. pinnata in mice and to document the acute oral toxicity profile. METHODS: Seeds of S. pinnata were grown, and aerial parts of each developmental stage were harvested. Extraction was done by maceration in 70% methanol. The antimalarial activity was evaluated using chloroquine-sensitive Plasmodium berghei on swiss albino mice, in a chemosuppressive test, at 150, 350, and 700 mg/kg, p.o. Standard drugs used were artemether-lumefantrine (0.57 + 3.43) mg/kg and chloroquine (10 mg/kg) as positive controls. Distilled water at 1 mL/100g was used as a negative control. The Lorke method was adopted to determine the acute toxicity of extracts. RESULTS: The flowering stage extract had a maximum suppression of parasitemia at 700 mg/kg (68.83 ± 4.49%). Extract at other developmental stages also significantly suppressed the parasitemia (in the ascending order) fruiting (50.71 ± 1.87%), budding (54.92 ± 7.56%), vegetative (55.39 ± 2.01%) compared to the negative control (24.7 ± 2.7%), p < 0.05. Extracts from all developmental stages increased survival time, with the flowering stage having the highest survival time at 20.33 ± 0.88 days. All extracts had an LD50 of 2157 mg/kg, implying that extracts are safe at lower doses. CONCLUSION: Together, our findings revealed that the S. pinnata extracts at the flowering stage had superior antimalarial activity compared to other plant developmental stages. Extracts from all developmental stages have demonstrated a dose-dependent suppression of malarial parasites and increased survival time with an LD50 of 2157 mg/kg. Thus, for better antimalarial activity, local communities could consider harvesting S. pinnata at the flowering stage. Further studies are needed to isolate pure compounds from S. pinnata and determine their antimalarial activity.

Medicinal plants used to treat "African" diseases by the local communities of Bwambara sub-county in Rukungiri District, Western Uganda.

ETHNOPHARMACOLOGICAL RELEVANCE: In Africa, traditional medicine encompasses a diverse range of practices, including herbalism and spiritualism, where some diseases are believed to be "African" since they can only be traditionally treated. Indigenous knowledge on the management of "African" diseases using medicinal plants is still handed down orally from generation to generation by tribal societies of tropical Africa, and with the rapid westernization of these societies there is a pressing need to record local knowledge before it is lost forever. AIM: This study documented medicinal plant species associated with the management of "African" diseases by the local communities of Bwambara sub-county in Rukungiri district, Western Uganda. METHODS: A cross-sectional study was conducted using semi-structured questionnaires and interviews. The data collected included names of plant species, plant parts used, diseases treated, methods of preparation, and mode of administration of the herbal remedies. A total of 196 informants participated in the study. Data were analyzed and presented using descriptive statistics and the Informant consensus factor. RESULTS: We documented 67 medicinal plant species distributed over 27 families and 62 genera. The most commonly reported species belong to Asteraceae family. The most frequently used medicinal species were Chenopodium opulifolium (27), Sesbania sesban (26), Thevetia peruviana (25), Leonotis nepetifolia (23), Momordica foetida (23), Euphorbia hirta (21) and Cassia mimosoides (20). Leaves were the most commonly used plants parts and decoctions were the main method of preparation. Water was the main medium used for the preparation of the remedies which were administered orally while petroleum jelly was the main medium for those which were used as ointments. The medicinal plant species reported are used to treat 39 conditions which were clustered into 10 International Classification of Primary Care (ICPC) disease categories. There is a high degree of consensus among the informants on which medicinal plant species they use for different diseases especially disorders in the following categories: neurological (FIC = 0.90), general and unspecified (FIC = 0.87), digestive (FIC = 0.86) and female genital (FIC = 0.82). CONCLUSION: Local communities of Bwambara sub-county in Rukungiri district, Western Uganda use a rich diversity of medicinal plant species in the management of various "African" diseases. Therefore, collaboration between users of medicinal plants and scientists is paramount, to help in the discovery of new drugs based on indigenous knowledge.

Medicinal plant species used by local communities around Queen Elizabeth National Park, Maramagambo Central Forest Reserve and Ihimbo Central Forest Reserve, South western Uganda.

ETHNOPHARMACOLOGICAL RELEVANCE: The application of ethnobotanical indigenous knowledge is very important in improving primary healthcare systems among the local communities living around and within protected areas in South Western Uganda. In this area, there are biodiversity endowed Queen Elizabeth National Park (QENP), Maramagambo Central Forest Reserve (MCFR) and Ihimbo Central Forest Reserve (ICFR). Despite the rich floral diversity and cultural heritage, there is no published documentation on the use of medicinal plants in this area. This information can be used as a basis for the selection of medicinal plants for further phytochemical and pharmacological studies. STUDY AIM: This study identified and documented the use of medicinal plants, plant parts used, and mode of preparation and administration by the local communities living around and within QENP, MCFR and ICFR. MATERIALS AND METHODS: A cross-sectional study was used to collect data from 202 informants using semi-structured questionnaires, open interviews and field visits. Ethnobotanical data was analyzed using use reports (UR), frequency of citation (FC) and Informant Consensus Factor (FIC). The plants species were identified by botanists and voucher specimens were deposited. RESULTS: A total of 302 medicinal plant species were mentioned by informants, out of which only 211 species belonging to 65 families and 165 genera were collected, identified and documented. The remaining 91 species were not available for collection and informants stated that they had become very rare within the study area. Herbs (35.8%) were the main source of herbal medicine. Leaves (60.4%) were the most commonly used plant parts used in the preparation of herbal remedies. Most of the medicinal plants were harvested from the wild, either growing in abundance (41%) or as rare species (21%). The most common mode of administration was oral, while other exceptional modes such as touching with bare hands and sweeping over the affected part were reported for the first time. The medicinal plant species were reported to treat 134 physical ailments, which were grouped into 16 ICPC-2 disease categories. Digestive disorders (854 UR) and general and unspecified disorders (507) scored the highest FIC value of 0.83. The highest number of medicinal plants (146 plant species) was used for treatment of digestive disorders. Among the species with higher use reports, Gouania longispicata had the highest frequency of citation (FC = 174) and was mentioned to be used to treat 41 physical ailments. The most important ailment treated by Gouania longispicata was allergy with 102 use reports. CONCLUSIONS: A variety of medicinal plants are used by communities living near protected areas in South Western Uganda. Most species were used in the treatment of digestive disorders, followed by general and unspecified disorders. Much as allergy has not been identified as a major threat by the health sector in Uganda, the study found out that it is one of the prevalent ailments in the study area. While the therapeutic value of some of the documented medicinal plant species, especially those with higher frequency of citation have been scientifically validated, the efficacy and safety of other species with wide application need to be investigated. In this study, we recommend further scientific studies on Gouania longispicata to validate its wide usage in the study area.