Ethnomedicinal Study of Plants Used against Human Ailments in Aseko District, South East Ethiopia

Background Over exploitation of MPs to treat human ailments in highly populated regions caused by deforestation and agricultural expansion disappearing (MP) species diversity in the areas, MPs Hence, this study was aimed to document and analyze the plant-based ethnomedicinal knowledge of the people in order to preserve the existing indigenous knowledge. Ethnobotanical data were collected using semi-structured interview, key informants interview, guided field observations, group discussions & market survey. Quantitative approaches were used to determine Informant Consensus Factor (ICF), pair wise comparison, preference ranking and Fidelity level (FL) values. A total of 96 medicinal plant species belonging to and botanical families were reported to treat human in the Aseko District. Plant Families with the highest number of species were Lamiaceae and Solanaceae, followed by Fabaceae. About 44% of Medicinal Plants (MPs) preparations were reported to be obtained from leaves. Highest ICF values were recorded for gastrointestinal (0.76) & parasitic and febrile illnesses (0.74) indicating best agreement among informants’ knowledge on MPs used to treat aliments in these The highest fidelity level values (100% FL) were recorded for Ocimum gratissimum L against febrile diseases, Rubus steudneri Schw against Asthma and Podocarpus falcatus against Intestinal Parasite) for each, showing conformity of knowledge on species of the best healing potential. Cordia africana was ranked first in a direct matrix ranking exercise of multipurpose Medicinal Plants. The output of preference ranking exercise indicated that Urtica simensis Steudel was the most preferred species to treat gastritis. The results also indicated that those multipurpose medicinal plant species are currently exploited more for construction, firewood and lumbering purposes than for their medicinal role.


Abstract Background
Over exploitation of MPs to treat human ailments in highly populated regions caused by deforestation and agricultural expansion disappearing (MP) species diversity in the areas, MPs Hence, this study was aimed to document and analyze the plant-based ethnomedicinal knowledge of the people in order to preserve the existing indigenous knowledge.

Methods
Ethnobotanical data were collected using semi-structured interview, key informants interview, guided field observations, group discussions & market survey. Quantitative approaches were used to

Conclusion
The study revealed that Aseko district is rich in MP diversity and associated indigenous knowledge.
However, anthropogenic factors (over exploitation) coupled with acculturation threaten the sustainability of MPs in the study area. Promoting a complementary in-situ and ex-situ conservation approach in the District is highly recommendable for MP sustainability. Background 3 The great dependency of human upon plants for their livelihoods was primarily started by domestication about 10, 000 years ago [1]. According to World Health Organization (WHO), about 70 percent of the world's population relies on plants for their primary health care and some 35,000 to 70,000 species has been used as medicaments, a figure corresponding to 14-28% of the 250,000 plants species estimated to occur around the world [1][2][3], Approximately 80% of the worlds' populations from developing countries depend mainly on traditional medicines derived from plant materials [5]. Ethnobotany is the study of "local people's interaction with the natural environment: how they classify, manage and use plants available around them" [1,2]. Traditional medicine is the sum total of knowledge, skills, and practices based on the theories, beliefs, and experiences, indigenous to different cultures, which are used to maintain health, as well as to prevent, diagnose, improve or treat physical and mental illnesses [3,28,29]. It is practiced throughout the world and depends on locally available of natural resources (e.g., plants) and indigenous knowledge. [4] However, the rich indigenous knowledge on many of the traditional plant remedies is subjected to loss as it has mainly been neither passed orally for generations without being properly nor scientifically documented [7] Ethiopian is rich in biodiversity resources and TK (Traditional knowledge) [10]. In Ethiopia, MPs have considerable roles in a healthcare system, where 80 percent of human populations depend on medicinal plants for the treatment of different human health problems [6, 7, 8, and 9]. In Ethiopia, both direct and indirect causes of biodiversity loss attracted attention Ethiopia 's commitment to design and implement conservation strategies to save the country 's genetic resources [6]. Such direct causes (drivers) include habitat conversion, unsuitable resource utilization, invasive species, and climate change whereas the indirect drivers include demographic changes (population growth), poverty, and low level of awareness and weak coordination [6].
Ethiopia is rich in biodiversity and known for having many endemic plants. There are 6027 higher plants species, of which 10% are end emic to the Country [ 11]. This richness in species diversity is associated with the wide ranges of altitude, geographical diversity with high and rugged mountains, flat-topped plateaus and deep gorges, incised river valleys and rolling plains [11]. Although Ethiopian ethnobotanical study of medicinal plant inventories including those of [4, 7-9, 12, 13, 33, 35, 37, 39, 41] have attempted to document medicinal importance of traditional MPs in some cultural groups, though recording of the 85 different ethnolinguistic communities has remained largely unexplored. Therefore, in order to enrich the knowledge of Ethiopia's flora and socio-cultural diversity complete inventory of each ethnic group is highly required.
Accordingly, the present study aimed to fill the knowledge gap by documenting the Traditional Knowledge, utilization, management and conservation of human MPs used in Aseko District, Arsi Zone, Ethiopia. It also aimed to identify the economic potential of MPs in the area.
The topography of the district consists of mountain ranges stretched from west Hararge Zone to Gugu Mountains in Arsi. The altitude of the district ranges between 2946 and 1177 meters above the sea level. the topography is part of Arsi-Bale mountains massif and surrounded by undulating low laying plateau [59]. These mountain ranges are dissected by major and small rivers. Moreover, the district has many hills. The majors are Abakoro, Bako, Dao Gulliso, Komicha, Simo, Woranbus etc. having an altitude more than 2100 m above sea level [15] Due to its altitudinal location, the climatic condition of the district is dominated by moderately cool temperature ('Woyenadega' Agro ecology) (48%), ranging from 15 0 C-20 0 C. The remaining type of climate are cool ('Dega' Agro ecology) (25%) and moderately warm ('Kola' Agro ecology) (27%) having a minimum and maximum temperature of 10 0 C-15 0 C and 20 0 C-25 0 C, respectively. The rainfall pattern is bi-modal, a short rainy season or 'Belg' [from March to April] and a long rainy season/ 'Kiremt' [from June to September and sometimes up to October) [ 15].
The vegetation cover of the study area consists of different species of natural forest, bushes and shrubs. The forest cover of the district was 10,501 hectares in the year 2007.The vegetation of the study area include dry evergreen montain forest with important tree species such as Junipers procera, Cordia africana, Olea europaea, Croton macrostachyus, Bersama abyssinica, Olea capersis sus spp. macrocarpa, Olinia rochetiana and Allophylus abyssinicus. There are also woodlands, bush lands, sub afro-alpine vegetation and grasslands in the study area [14]. Mountainous parts of the district such as Bofe, Worgona, Weranbus and Miro are covered with natural forests containing diverse plant species including trees [15]. The indigenous people inhabiting the area belong to the Oromo ethnic group.
They speak Oromic language, the regional language of Oromia region.

Human population & health status
According to the estimation from ECSA (2007) the total population for the District is 113,187, of which 57, 077 were men and 56,110 were women; 6,284 or 5.55% of its population were urban dwellers.
Selection of informants for household's survey was done following the method described by Krejcie and Morgan [19], Accordingly only individuals who were 20 years old and above were included as the sample informants. This age group was chosen since they could be legally account for their actions but selecting participants below age 20 may require parental approval, which could make the study impractical. The required number of household sampled in each kebele was calculated by the formula [20].
Where, n = sample size for each selected area Accordingly, a total of 95 HHs and further 19% none response rates were selected from 4885 HHs in the three selected Kebeles. As a result, 114 informants were selected for household interviews (HHIs) and 24 KIs making the total sample size equals138 ( Table 2).
A systematic random sampling procedure was used to obtain the required sample units of 114 informants. It was based on selection of units situated at a certain predetermined interval called the sampling interval. It was calculated as follow: Ethnobotanical Data Collection Semi-structured interviews, focus group discussions, Field Observations, guided field walk and market survey were used to collect ethnobotanical data [1, 21, 22, and 23]. Prior to data collection discussion was made with the informants to explain their cooperation to the documentation of their knowledge on MPs in their area and to get their verbal informed consent. Before the actual house-to-house survey starts a pilot, the survey was carried out to test the applicability and clarity of the questionnaire to the respondents. This was done by asking the first five people encountered in each kebele by the principle of first come first served principle.
Independent Field Observations & Guided Field Walk, which gave an opportunity for more discussion with individual informants, followed all semi-structured interviews and the practical identification and collection of traditionally used MPs in their natural environment [21,23]. In addition, the focus group Where, ICF = Informants Consensus Factor nur = number of use citation in each category, nt = number of species used Pair comparison was used for evaluating the degree of preferences or levels of importance of certain selected plants/parts of plants [1,26]. Moreover, rank was made based on the report of the informants. Numbers of pairs were determined by the following formula [27].
Where, N = Total number of pairs n = number of items Direct matrix ranking exercise was done following [1] and Cotton [21] in order to compare multipurpose use of a given species and to relate this to the extent of its utilization versus its dominance Fidelity level index was used to quantify the importance of a given species for a particular purpose in a given cultural group [21]. According to [31, 23 and 32], an index fidelity level was calculated as follows.
Where, Ip = is the number of informants who independently indicated the use of a species for treating a particular disease and I u = is the total number of informants who reported the plant for

Diversity of Medicinal Plant Used Against Human Ailments in Aseko District (District)
A total of 96 MP species belonging to 90 genera and 66 botanical families were reported to be used for treating human ailments in Aseko District (appendix 2 Additional file to be attached). The family Lamiaceae and Solanaceae 5 species each were represented by the highest number of species' followed by Fabaceae and Euphorbiaceae 4 species each (Fig. 4). Each of the remaining 50 families had single species representation. Thus, 24% of families were represented by more than one medicinal plant species.

Sources & Indigenous Knowledge (IK) Transfer in the Study Area
The result of the study shows that the most prominent sources of IK in the study area were parents/family members (62.3%) followed by herbalists (11.6%) (Fig. 5).

Habitats And Habits Of Mps In The Study Area
Identified growth forms of MPs indicated that dominance herbs followed shrubs and Epiphytes were the least the growth forms of MPs in the study area (Fig. 3). MPs collected from the study are predominantly wild species. Out of the 96 species, 67 species (70%) had a wild origin while 29 species (30%) were collected from domesticated areas of homegardens.

Plant Parts and Condition of Mps Used for Remedy Preparation
Despite mentioning different plant parts used for remedy preparation, the majority (44%) of preparations were from leave parts alone followed by roots (19%) and barks (10%).

Modes of Remedy Preparation
Traditional healers in the study area reported that they follow various ways of remedy preparation which depends on the type of ailment. The major modes of remedy preparation were Crushed (20%); pounding and homogenizing plant parts (19%); squeezed (13%); Powdering (12%) and others such as concoction, chewing, burning, cooking, roasting and soaking constitute about (36%) (Fig. 8).

Routes of Administration and Application
Medicinal plant preparations were administered through different routes. Oral application was the best represented (54.41% and most commonly used route of administration followed by topical or dermal application (29.42%,). The remaining remedies were reported to be administered through nasal (7.65%); auricular (2.94%); teeth surface (2.65%); anal (1.18%) and others (1.73%) routes depending on the type of ailment reported by the respective patients ( Fig. 9).

Dosages and Antidotes
Most MPs prescribed and given to patients are applied without any standardized doses with is a

Preference ranking
The finding showed that the preference of particular MP species against particular ailment is not necessarily the same; it varied from district to district. Among the five selected MPs used to treat Gastritis, Urtica simensis Steudel stood first, followed by Ensete ventricosum W (Table 6). N.B Scores in the Table 4 indicate ranks given to MPs based on their efficacy. Highest number (5) given for the medicinal plant which informants thought most effective in treating Malaria and the lowest number (1) for the least effective plant.

Pair Wise Comparison Of Mps Used To Rabies
The results of paired comparison established to calculate the use totaled of MP species used to treat rabies in the study area. Accordingly, Justicia schimperiana stood first followed by Phytolacca dodecandra and Clutia abyssinica (Table 7). Accordingly, Cordia africana was ranked first (most threatened) followed by Hagenia abyssinica (Table 8). The results also indicated that those multipurpose medicinal plant species are currently exploited more for construction, firewood and lumbering purposes than for their medicinal role.

Threats to MPs in Study Area
The main threats for MPs in the area were agricultural expansion (24.3%), which was most hazardous to MPs and their habitats. Most informants' perceived that construction and pesticide are the least destructive factor (Table 9).  The finding showed that knowledge of MPs is passed mainly through family relation like everywhere else in Ethiopia [38][39][40]. Social relations and religions also assist in the diffusion of MPs knowledge among the rural communities. This is particularly true for MPs that are used to treat common ailments such as fibril, headache, and abdominal complaints. However, under difficult cases the community members often contact the specialist healers. Due to the belief held among the community, ordinary people do not use the MPs that are on use by the healers since it is believed that doing so will lead to the loss of MPs healing power. Such restrictions assist in MPs conservation since social restrictions serve to limit MPs harvesting. Melesse Maryo et al. [39] reported similar idea.
Results have also proved the role played by traditional MPs and the local community holding considerable traditional health knowledge in assisting the primary healthcare needs of the District community. The number of MPs harvested in the District is found to be lower than that of other area in the country investigated for their ethnomedicinal wealth [12,41] and higher than that of other areas in the country investigated by [40]. Although cultural, economic, ease of accessibility and efficacy related factors might have played major roles for the people of Aseko to rely on traditional medicine, the cultural factor might have been the most important one resulting in a sentimental devotion to the ancestral medical traditions/practices by continuation it as a highly valued heritage of the society or of the great fathers and mothers.
Dominance of medicinal plant species from families, Solanaceae, Lamiaceae, Fabaceae and Euphorbaceae could be attributed to their wider distribution and abundance in the flora area [50][51][52][53][54][55][56][57][58]. This is also confirmed by consistent recording of ethnomedicinal uses of species from the abovementioned families in different Ethiopian ethnobotanical inventories [9,12]. Most MPs used in the area (39.6%) were found to be herbs. This could relate to the fact that they are easily accessible in the nearby areas than trees and shrubs often harvested from patches of forests distantly located from resident areas. The finding agrees with the general pattern of dominance of herbaceous species seen in most medicinal plant inventories in Ethiopia and other countries [9, 40, and 42]. Wild habitats of Aseko were found to be major pools of traditional MPs providing about 70% of all reported MPs.
However, the investigation showed that these habitats are subjected to anthropogenic impacts and consequently lessening in size due to an ever-increasing population pressure resulting in the loss of many medicinal species sheltering in the wild. The current finding is also in agreement with previous reports of overdependence on wild habitats to harvest MPs [13, 26, and 42] than an effort to cultivate and use them sustainably.
In this study, leaves are the most frequently utilized part of plant organs (44%). Analogous results on different ethnobotanical studies by [43][44][45][46] were reported in different area. It was also observed that residents have been using leaves to identify MPs. Gathering leaves could be promoted as a more sustainable method since in most cases at least a number of leaves are left over on the mother plant which then allows them to carry on its life functions. As roots of medicinal plant species were reported to be harvested for most remedy preparations (19%), next to leaves, overexploitation of entire root parts for remedial preparations shows the threat posed on long-term survival of corresponding MPs.
Mining of root parts of MPs was also commonly reported by other ethnomedicinal records elsewhere [12, 26, and 30]. Harvesting of roots kills the parent plant and could be a severe threat for survival of the often rare and slowly reproducing MPs of the area. Ermias Lulekal et al. [12], Fikru Ayana [42] also reported that utilization of the root part is risky to the survival and ecological aspect of the plant.
Results also showed prominent use ( The fact that most remedies in the study area were applied orally (54.41%) followed by topical or dermal application (29.42%) could be due to the high occurrence of gastrointestinal and dermatological disorders in the study area (Appendix 2 additional to be attached). Predominance of oral and dermal routes of herbal drug application in the study area could be because of high prevalence of gastrointestinal and skin related problems in the area. Dermal of remedial application could also be attributed to the fact that it reduces the chance of intoxication by drugs than when it is administered orally. In addition, both oral and dermal routes permit fast physiological reaction of prepared medicines with the pathogens and upturn its curative power. Patients with skin infections were reported to be treated by rubbing and pasting herbal preparations whereas those with sores were treated by chewing the part of the medicinal plant and spitting the juice on the sore. For internal ailments, herbal preparations were mainly prescribed to be administered orally whereas for a general malaise steam bath and vapour inhalation were commonly reported. In connection to this, reports showed that oral and dermal route of administration of remedies found to enhance the physiological reactions of remedies with the pathogens that in turn increase the healing power of the medicine. In this regard, similar findings were reported away [7, 61; 62].
The number and different types of diseases (55 disease types) (Appendix 1 additional file tobe attached) for which traditional healers were most visited by patients indicated a liking of local people in the study area to visit traditional healers and the nature dispensary. Economic, cultural, efficacy, limited access to modern medicine and availability factors were reported as the key factors which lead the community to hit at the door of traditional healthcare practitioners than the few distantly located healthcare centers with unaffordable prices. Similar findings were reported by [9, 46, and 12].
Visual checkup of patients is the more obvious diagnostic method practiced by all local healers in the area. Although changes in body temperature, skin and eye color, appetite and physical appearance help traditional healers to detect which patients face sicknesses it was only through visual experience that identification of diseases and prescriptions look like to be made. Other researchers [11, 46, and 12] have also reported similar diagnostic methods in different cultural groups. Misidentification of diseases commonly leads to misprescription which may result in adverse effects to patients. Even though dosages of remedies for various ailments were reported to be determined based on age, occurrence of pregnancy, physical fitness/appearance and gender of the patient, there were no standardized measurements or guidelines set by traditional healers.
Overdose of remedies was also reported to bring adverse effects like vomiting, diarrhea, burning sensations and sometimes fainting of the patient. Lack of precision and standardization has been mentioned as a global drawback of the traditional healthcare system [22,12] Traditional healers in our study area reported the use of different antidotes including BESSO, milk, coffee, honey, yoghurt, and butter for reversing adverse effects and stabilizing any disorder. The same pattern of using antidotes was also reported for other cultural groups elsewhere [25, 26, 33, and 12]. reported for other cultural groups in the country [13, 48, and 22]. Thus, our finding can also be used as a base line for a future in-depth study of the moneymaking potential of MPs of the area through successive market survey over number of years and value chain analysis study of potential plants. It was also found that traditional healers show maximum secrecy in handling MPs knowledge. for field data collection materials.

Availability of data and materials
Plants collected were deposited in the Federal University of Hawassa Wondogenet College of Forestry and Natural Resources herbarium (WG-CFNR), and the Federal Ethiopian Biodiversity Institute.

Authors' contributions
JS, ZG and MM were Participated in the study. JS collected the data and analyzed the data. All authors contributed to the writing of the manuscript. All authors read and approved the final manuscript.  Figure 1 Map of study area       Condition of MPs used for remedy preparation in the study area Condition of MPs used for remedy preparation in the study area Modes of remedy preparation in the study area Modes of remedy preparation in the study area Routes of remedy administration in the study area Routes of remedy administration in the study area

Supplementary Files
This is a list of supplementary files associated with this preprint. Click to download. Appendix.docx Appendix.docx