Survey on the Traditional Use of Medicinal Herbs in Haiti: A Study on Knowledge, Practices, and Efficacy Prevention

The use of medicinal herbs is highly developed in Haiti. However, there is a significant lack of knowledge in the literature on medicinal plants and their uses. The objective of this study was to determine the knowledge and practices of Haitian families for the prevention/treatment of COVID-19, influenza, and respiratory diseases, as well as the mode of preparation and administration of the plants. Individuals were interviewed using the TRAMIL questionnaire as the information holder. The data obtained were analyzed by calculating 5 indices (relative frequency of citation, use value, the family use value, informant consensus factor, and fidelity level). The study surveyed 120 Haitians and collected 75 plants from 43 botanical families. The botanical family most used for all these preventions and remedies is the Lamiaceae. The highest ranked species with a relative frequency of citation value > 0.3. Infusion, decoction, and in the form of punch are the methods used for the remedies. The study found that the use of herbal remedies is still prevalent in the study area, and many of the commonly used plants have been scientifically validated. However, some plants, such as Samyda rosea Sims, lack sufficient research and are recommended for further investigation.


Introduction
The use of traditional plant-based medicine in Haiti and the Caribbean comes from a combination of African, European, and Indigenous cultural influences, first during the colonial period, which was influenced by the medical conceptions prevailing in Europe from the 16th to the 19th century through the practice of medicine leaves, and second, during the slave period, through African heritage: under the weight of a hard life, the Black slaves tried to cure their ills by resorting to their own knowledge of African medicinal plants for which they found substitutes of American origin or species adapted from their native lands [1].This knowledge is based on empirical observations but has repeatedly proven its accuracy [2].
In Haiti, the use of medicinal plants is highly developed as the majority of the population uses them, mainly in rural areas but also in the cities [1].Traditional medicine is often used in Haiti due to its accessibility and affordability compared to conventional drugs, as well as its potential for fewer side effects and a wider range of plant species to choose from for medicinal purposes [1,3].The use of plants with healing properties is as old as human civilization.According to WHO, in 2008, nearly 80% of the world's population currently relied on herbal medicines for their primary healthcare needs [4].Natural products play a dominant role in the discovery of leads for the development of drugs for the treatment of human diseases [5].Moreover, the effectiveness of medicinal plants used as traditional treatment has been proven by scientific studies [6,7].Literature data show Plants 2024, 13, 2383 2 of 28 that several plant extracts, commonly used for the treatment of infectious diseases such as influenza and cold illnesses, demonstrate antiviral, anti-influenza, antibacterial, and anti-inflammatory activities [8][9][10][11][12].Those infectious diseases are caused by pathogens (bacteria, viruses, parasites, and fungi) and are spread, directly or indirectly, from one person to another [13].An example of a recent disease is coronavirus 2019 (COVID- 19), also known as Coronavirus Disease 2019, a new pandemic resulting from severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), which was first reported in late 2019 in Wuhan, China [14][15][16].Human-to-human contamination is the main mode of transmission of COVID-19 through droplets generated by breathing, sneezing, and coughing [17,18], just like the influenza/cold virus.Other forms of contamination are also possible, such as airborne from infectious aerosols [19,20], contact with an infected surface, and environments in which we live and work [21].The most common signs and symptoms are fever, cough, myalgia or fatigue and shortness of breath [22], dysfunction of smell and taste [23].Other symptoms are reported as diarrhea, vomiting, or abdominal pain [24] and also psychological problems such as anxiety and depressive symptoms [25].COVID-19 has disrupted the lives of many people around the world and has had a huge effect on the health, economy, environment, and social sectors [26].At this time, there is no specific treatment for the SARS-CoV-2 virus that causes COVID-19.
In Haiti, where conventional health systems are not very accessible, treating oneself with plants is the patient's first resort [3].Due to the traditional plant knowledge of Haitians, the following study was conducted in the western department of Haiti between July and September 2021 to obtain data on the types of plants used for the treatment and/or prevention of these diseases: influenza, colds, COVID-19, and respiratory diseases (Figure 1).Ethnopharmacological information has an undeniable value of its own as it not only preserves age-old tradition but also effectively guides modern research on bioactive ingredients [27].
Plants 2024, 13,2383 2 of 34 the treatment of human diseases [5].Moreover, the effectiveness of medicinal plants used as traditional treatment has been proven by scientific studies [6,7].Literature data show that several plant extracts, commonly used for the treatment of infectious diseases such as influenza and cold illnesses, demonstrate antiviral, anti-influenza, antibacterial, and antiinflammatory activities [8][9][10][11][12].Those infectious diseases are caused by pathogens (bacteria, viruses, parasites, and fungi) and are spread, directly or indirectly, from one person to another [13].An example of a recent disease is coronavirus 2019 (COVID-19), also known as Coronavirus Disease 2019, a new pandemic resulting from severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), which was first reported in late 2019 in Wuhan, China [14][15][16].Human-to-human contamination is the main mode of transmission of COVID-19 through droplets generated by breathing, sneezing, and coughing [17,18], just like the influenza/cold virus.Other forms of contamination are also possible, such as airborne from infectious aerosols [19,20], contact with an infected surface, and environments in which we live and work [21].The most common signs and symptoms are fever, cough, myalgia or fatigue and shortness of breath [22], dysfunction of smell and taste [23].Other symptoms are reported as diarrhea, vomiting, or abdominal pain [24] and also psychological problems such as anxiety and depressive symptoms [25].COVID-19 has disrupted the lives of many people around the world and has had a huge effect on the health, economy, environment, and social sectors [26].At this time, there is no specific treatment for the SARS-CoV-2 virus that causes COVID-19.
In Haiti, where conventional health systems are not very accessible, treating oneself with plants is the patient's first resort [3].Due to the traditional plant knowledge of Haitians, the following study was conducted in the western department of Haiti between July and September 2021 to obtain data on the types of plants used for the treatment and/or prevention of these diseases: influenza, colds, COVID-19, and respiratory diseases (Figure 1).Ethnopharmacological information has an undeniable value of its own as it not only preserves age-old tradition but also effectively guides modern research on bioactive ingredients [27].In this study, we delved into the realm of Haitian folklore medicine.Using a TRAMIL (Program of Applied Research to Popular Medicine in the Caribbean) inspired methodology, we conducted an ethnobotanical survey through face-to-face interviews and telephone conversations.Our research meticulously documented the local use of medicinal plants in Haiti, underscoring their crucial role in community healthcare.We carried out a In this study, we delved into the realm of Haitian folklore medicine.Using a TRAMIL (Program of Applied Research to Popular Medicine in the Caribbean) inspired methodology, we conducted an ethnobotanical survey through face-to-face interviews and telephone conversations.Our research meticulously documented the local use of medicinal plants in Haiti, underscoring their crucial role in community healthcare.We carried out a comprehensive analysis comparing the use of these plants in treating various infectious diseases.Moreover, we evaluated several ethnobotanical indices to gain a deeper understanding of the cultural and medicinal significance of these plants.This investigation aims to pave the way for the scientific community to explore new antiviral strategies and for the local community to enhance their traditional medicine practices.

Profile of Medicinal Plant Users
A total of 120 families were interviewed in this study, with one member in each family.Each person in the survey represents a household in general, meaning that several members of the same household are not represented in the survey as multiple different participants, but rather, they are considered to be one respondent for each household.In other words, the survey is designed to capture the opinions and behaviors of households as a unit rather than individual family members separately.Therefore, if multiple members of a household participated in the survey, their responses would be aggregated and considered to be one for that particular household.The representatives of the 120 families were 81.67% (98/120) female and 18.33% (22/120) male.A total of 81% of the respondents were women in our survey because, in Haiti, women appear to be better informed than men [3].They were all adults between the ages of 18 and 70 years, with an average age of 39 years (Table 1

Plant Families and Remedies
The plants collected represent 75 plants divided into 43 botanical families.The 120 Haitians participants who were interviewed mentioned a total of 149 remedies for flu/cold, respiratory diseases, and COVID-19.Each family participating in the survey could use more than one remedy for a given condition.

Plants, Remedies, and Methods of Administration
A total of 149 remedies were reported for 75 plants, with 16 used for respiratory diseases, 53 for COVID-19, and 55 for flu and/or colds.Traditional preparations included
Infusion is the most preferable method of preparation for the softer parts, such as flowers and leaves, because the plant part does not boil with water [28].Examples of flu remedies are the flowers and leaves of Moringa oleifera L. and the flowers of Hibiscus rosa-sinensis L., the latter given mainly to children by most of the families interviewed.The harder parts, such as roots, rhizomes, underground parts, seeds, and fruits, are proposed to be prepared in decoction because boiling with water extracts the maximum of bioactive compounds.We have as an example the Cymbopogon citratus (DC) Stapf.that is used in decoction form (root and leaf).When it is with the leaves only, the decoction time is minimum specified by the informants and can also be used in infusion.
Punch is a commonly used preparation method for COVID-19 remedies (Table 4) [33], which consists of a mixture of up to 6 plants believed to help fight against symptoms and complications.Certain punch remedies may incorporate protein-rich ingredients like milk and eggs, which can fortify the immune system and provide essential strength, while others may feature the addition of rum [33].Proteins, being essential macronutrients, play a crucial role in antibody production and can aid in the fight against COVID-19 [34].Inhalation of hot steam with plants like Eucalyptus globulus Labill, Syzygium aromaticum L., Zingiber officinale Roscoe, or the effects of oils like Ricinus communis, is another method that has been used for specific plants.This method is believed to help thin mucus and fight against microbes in the throat or nose [28,29,33].For fruit/leaf and/or edible juices, families consume more fruit and vegetables to strengthen their immune systems.Also, there are plants like Eupatorium odoratum L. and Allium cepa L., or they can rub/blend to take a spoonful of juice against flu [28,33].For baths and/or massages [28,29,33], we have, for example, the oil of Ricinus communis L., which is used to massage the body that has  Decoction of garlic pods with cinnamon bark and clove grains with ginger root, and after a few minutes of boiling, it is necessary to add the leaves of Bitter Gourd and siam weed [33]

Allium sativum L. & Citrus aurantiifolia
Swingle & Zingiber officinale Roscoe 3 Boil 2 to 3 cloves of garlic, the lime with its skin, and the grated ginger [33] Allium sativum L. & Aloe vera L. Burn 2 1 big spoon of aloe gel, then add half a glass of white rum and let macerate for 5 mn.Then, in a mixer, we put 5 lay pods and a spoon of honey syrup.Then, when the 5 mn approximately has elapsed we put the aloe to macerate with the rum in the mixer.Also, immediately after, we add half a glass of water proportioned to the rum and let mix the whole for 6 to 7 mn [33] Aloe vera L. Burn 1 Swallow a small butcher of aloe gel with water all morning [33] Aloe vera L. Burn & Zingiber officinale Roscoe 2 2 or 3 pieces of ginger plus 6 cloves of garlic plus a purple onion, we mix them, and we take only the juice after sieving, and we take one or two spoons  Infusion and/or decoction of the whole plant.Or put 2 tablespoons of powdered thyme, add hot water, let it wait for 4-5 min, then cut a lemon, squeeze it, and add 2 spoonfuls of honey [33] Zingiber officinale Roscoe 1 Decoction: Cut the ginger into small pieces or use a grater.Boil it for 10 to 15 min.When it is good, add honey or brown sugar [33] Therefore, for all the remedies quoted in the survey, 88% are administered orally and recommended 1 to 2 times a day for prevention against COVID-19 and up to 3 times a day for people with COVID-19.For punches (Table 4) that have both medicinal and aromatic plants with protein additives or rum it is recommended once a day.In Haiti before COVID-19, people with flu/cold and respiratory diseases used to take the remedies up to 2 times a day [28,29].For some remedies COVID-19, unlike other teas that families took in the form of a mixture before COVID-19 for flu/cold, there are more herbs added in the decoctions COVID-19, which are aimed at combating flu/cold, fever, and pain associated with the disease [33].For contraindications most of the complex punch remedies are not recommended for children and pregnant or nursing women.In the worst case, they are advised only once a day for those who are severely affected at a lower dose.For decoctions and/or infusions, there was only mugwort (Artemisia vulgaris L.) that some families have drawn attention to the toxicity, and as a solution, there are some families that use it more or put a small amount (a small branch) in 1 to 2 L of water.

Plants and Fidelity Levels
The level of fidelity (FL) of a given plant for a given use was calculated to rank the recorded plant species according to their claimed relative efficacy.Species with RFCs less than 0.1 (Table 2) were not included in the FL calculations (Table 5).Table 5 shows the FL% value for the efficacy of a certain plant to treat a certain disease (Table 6) or to be designated for primary use.For the treatment of influenza, the species recorded at 100% FL were Abrus precatorius L., Argemone mexicana L., Cissus sicyoides L., Corchorus siliquosus L., Guazuma ulmifolia Lam., Lantana camara L., Musa x paradisiaca L., Passiflora foetida L., Prosopis juliflora Sw DC, Rhoeo spathacea (Sw.)Steam., Saccharum officinarum L., Senecioides cinerea L. O. Ktze, Verbascum thapsus L., Waltheria indica L. followed by Samyda rosea Sims (96.72%),Malpighia emarginata DC (92.11%),Mentha nemorosa wild.

Discussion
This study documents the traditional medicinal plants used for the prevention and/or treatment of influenza, respiratory diseases, and COVID-19 in eight communes of the West Department in Haiti.Using the TRAMIL method, herbal remedies identified in the survey were included in the data when the calculated frequency (Freq = Ni/Np × 100) was 20% or higher [94].Also, a minimum value of five was set for the values Ni and Np.The TRAMIL group chose this minimum frequency to exclude anecdotal uses.Plants commonly used to treat various conditions, such as Mormordica charantia L., Zingiber officinale Roscoe, Aloe vera L., and Eupatorium odoratum L., have been found to possess antimicrobial properties that can help the body fight against bacterial and viral infections [10,57,95,96].The extract of Mormordica charantia L. in Trinidad and Tobago has demonstrated strong potential in inhibiting multi-resistant clinical bacterial isolates [95].The presence of kaempferol and quercetin derivatives, including rutin, in the extract, suggests that these compounds may be responsible for the observed activity [95].Aloe vera L. in Iran has been clinically proven to reduce the frequency of infections and fever and increase the count of white and red blood cells in 60 children who have acute lymphocytic leukemia.In the survey, the 120 informants used different parts of the plants [97].Different parts of plants produce chemicals that are known as bioactive secondary metabolites [57].These metabolites include alkaloids, quinines, flavones, lectins, polypeptides, flavonols, flavonoids, coumarin, tannins, terpenoids, essential oils, etc.These compounds are available and can be derived from leaves, bark, roots, flowers, fruits, and seeds [38,57,98].Regarding the pathologies, the remedies for the prevention and treatment of COVID-19 are the most cited.For not only did Haitians use remedies with one herb but also with several herbs as a mixture as they targeted almost all symptoms related to COVID-19, such as: cough, respiratory problems, fever, gastrointestinal problems, pain, etc.As recently reported by the authors [99], herbal mixtures reduce hospitalization rates and time to recovery from symptoms.Most recipes involved decoctions.Administration was either oral or applied topically for soreness.Several plants that were frequently mentioned in the survey, such as Zingiber officinale Roscoe, Mormordica charantia L., Aloe vera L., Allium cepa L., Allium sativum L., Syzygium aromaticum L, Citrus aurantiifolia (Christm.)Swingle, Eupatorium odoratum L., Cinnamomum verum J. S. Presl, Citrus aurantium L., Artemisia vulgaris L., and Phyllanthus niruri L., have been validated through pharmacological studies for their antiviral, antibacterial, or pain management properties.These plants were found to be potential remedies for COVID-19 in the study, as they were mentioned frequently with an RFC value higher than 0.3.However, there is limited information available regarding the pharmacological properties of Samyda rosea Sims (also known as Samyda dodecandra Jack.), which was also frequently cited.This plant is naturalized in Haiti and can be found in other Caribbean regions like Cuba, Bonaire, and Curacao [100].Haitians have been using it mainly against flu for many years (FL = 96.72%),but there is no literature available regarding its use elsewhere.For the other most cited plants in the survey, despite their frequent use in natural medicine, the Caribbean wild variety is poorly studied for pharmacological activities related to COVID-19 and its corresponding symptoms.
Zingiber officinale Roscoe (Ginger) aromatic herb with leafy stem and horizontal rhizomes, native to and naturalized in India, was the most frequently cited herb in the remedies; it was described as being used mainly against COVID-19 (FL = 75.789%) in a study the authors showed that ginger compounds, specifically 6-gingerol, 8-gingerol, and 6-shogaol, can induce rapid relaxation in human airway smooth muscle and attenuate airway resistance in mice [101].Recently, another study showed that 6-gingerol, a compound found in Z. officinale (ginger), has significant anti-influenza activity against the PR8 strain of the H1N1 influenza virus, with an IC50 value of 2.25 ± 0.18 µM [102].In Morocco, it is traditionally used for gastrointestinal disorders (FL = 86%) [103] and The administration of an acetone extract (at 1000 mg/kg), zingiberene (at 100 mg/kg, the main terpenoid of the extract), and 6-gingerol (at 100 mg/kg) resulted in significant inhibition of HCl/ethanol-induced gastric lesions, with reductions of 98%, 54%, and 54%, respectively [10,104].The hydroethanol extract of ginger shows antibiotic activity against Gram-positive and Gram-negative bacteria [10,105].10-Gingerol and 6-gingerdiol had potent antifungal activity against 13 human pathogens at concentrations below 1 mg/mL [106].Treatment of ginger root with boiling water abolished the antibacterial effect against E. coli, Salmonella typhimurium, Vibrio parahaemolyticus, Pseudomonas aeruginosa, Proteus vulgaris, Staphylococcus aureus, Mycobacterium phlei, Streptococcus faecalis and Bacillus cereus except that against the growth of Micrococcus luteus.This indicates that the antibacterial principle is heat labile [10,107].It has been shown that fresh ginger could prevent human respiratory syncytial virus (HRSV) infection largely by inhibiting viral attachment [9].This may partly explain the common use of Zingiber officinale Roscoe against COVID-19 with associated symptoms.
Mormordica charantia L is a plant that originated from Asia and has been naturalized in the Caribbean [28,29].Although it is a climbing plant that can reach 3 to 4 m in height [28], in Haiti, it is traditionally used mainly to combat fever (FL = 92.391%)as a possible treatment against COVID-19.The fleshy part and seeds of the plant are also a good source of phenolic compounds, such as catechin, epicatechin, and gallic acid [108].The plant is used in traditional medicine as an antidiabetic, anthelmintic, laxative, or aphrodisiac [12,108].The different parts of the plant are also used to treat ailments related to colic, diarrhea, eczema, fever, hemorrhoids, inflammation, malaria, dysentery, sores, anemia, cough, scabies, asthma, wounds, and infections [12].The protein purified from Bitter Gourd seed possessed effective antiviral activity against a wide range of influenza A subtypes, including H1N1, H3N2, and H5N1 [11].Another study conducted in Trinidad and Tobago found that the plant extract contains phenolic acid derivatives and flavonoid glycosides that have strong antimicrobial potential against multi-resistant clinical bacterial isolates, likely due to the presence of flavonoids such as quercetin, kaempferol, quercitrin, and rutin [95].These reports therefore correlate with the traditional uses of Mormordica charantia L.
Aloe vera L. (Aloe) is an ornamental and medicinal plant native to North Africa.Aloe is used in traditional medicine and the treatment of burns and wounds.It has various therapeutic properties such as antiviral, antidiabetic, laxative, protective against radiation, antiallergic, anti-inflammatory, anticancer and immunostimulant, antibacterial, anti-oxidant, and photoprotective activities [39,96].In Haiti, it was described as being used mainly against COVID-19 (FL = 100%).Recently, researchers have assessed the antibacterial, anti-oxidant, photoprotective, and cytotoxic activities of extracts from Aloe vera L. The results indicated that the n-butanol fraction, as well as the acetone and methanol extracts, demonstrated antibacterial effects against a variety of bacterial strains, including S. aureus, B. cereus, E. coli, P. aeruginosa, and A. baumanii, with MIC values ranging from 1.25 to 10 mg/mL [96].Another study aimed to evaluate the antibacterial potential of methanol and acetone extracts of aloe vera against various bacterial strains [109].The findings revealed that the methanol extract exhibited the highest antibacterial activity against B. cereus, with a zone of inhibition of 22.33 mm, while the acetone extract exhibited lower values of zones of inhibition, ranging from 6.00 mm for E. coli to 7.33 mm for S. pyogenes [109].The extracts showed greater antibacterial activity against Gram-positive bacteria compared to Gram-negative bacteria.Moreover, the study authors identified Pyrocatechol, Cinnamic acid, p-coumaric acid, and Ascorbic acid as the active compounds responsible for the maximum antibacterial activity [109].
Allium cepa L. (onion) is a perennial herbaceous plant characterized by its bulb.It is native to Asia and cultivated in various countries.In this survey, almost all families using onion in remedies specified red onions, which they use for COVID-19 with symptoms such as cough and respiratory problems (FL = 55.737%).However, according to the literature, red onions have more pronounced anti-oxidant activities than white onions [109].Moreover, it has been demonstrated that red onions can increase the rate of respiration [110], which could be beneficial against respiratory viruses such as COVID-19.In fact, it has been suggested that breathing in the odor emanating from a raw cut onion for a few minutes could be helpful against such viruses [110].In another study, four polysaccharide fractions were extracted from onion and tested for their antibacterial activity against Gram-positive bacteria (S. aureus, B. subtilis) and Gram-negative bacteria (E.coli, S. typhimurium).The results showed that all four polysaccharide extracts inhibited the growth of both types of bacteria [111].
Allium sativum L. (Garlic) is an annual bulbous herb that originates from Central and South Asia and is widely cultivated in warm and dry climates worldwide [112].In this survey, Haitians reported using garlic with an FL of 94.23% and a UV of 0.41 to prevent COVID-19 and its various symptoms.In contrast, a study from Morocco reported a lower FL of 64% and a UV of 0.10 for the use of garlic in microbial infections [103].Garlic is commonly used in food and traditional medicine to treat various ailments, including colds, fever, coughs, asthma, and wounds, and as an antimicrobial agent [38,112].A study has identified organosulfur compounds, such as allicin and its derivatives (ajoene, allitridin, and garlicin), as the most promising compounds responsible for garlic's therapeutic activities, especially in the prevention of viral infections [112].Garlic has been used in African traditional medicine, such as in Ethiopia and Nigeria, to treat various infections, including sexually transmitted diseases, tuberculosis, respiratory tract infections, and wounds [112].Allicin has been identified as one of the main organosulfur compounds responsible for antiviral activity [113].In vitro and in vivo studies have demonstrated the antiviral potential of garlic and its organosulfur compounds against a wide range of viruses [112].
Syzygium aromaticum, also known as clove, is native to Indonesia but is now cultivated in many parts of the world [90].In our study, clove was reported as a COVID-19 remedy with a frequency of 81.967%.According to a study, the aqueous extract of clove seeds showed antimicrobial activity against Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus with minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) values of 0.06 and 0.10 mg/mL, respectively [90].Another study found that the MeOH crude extract of Syzygium aromaticum inhibited the growth of Gram-negative anaerobic periodontal pathogens, including Porphyromonas gingivalis and Prevotella intermedia [114].Eight active compounds were identified, including 5,7-dihydroxy-2-methylchromone 8-C-β-d-glucopyranoside, biflorin, kaempferol, rhamnocitrin, myricetin, gallic acid, ellagic acid and oleanolic acid [114].These findings suggest that clove has potential antimicrobial properties that could be useful in the treatment of COVID-19 and other infections.
Citrus aurantiifolia (Christm.)Swingle (Lemon) is a shrubby tree widely cultivated in warm subtropical and tropical regions of the world.The Haitians use the native lemon mainly for flu (FL = 52.542).In the literature, lemon oil has antimicrobial, fungicidal, insecticidal, and anticancer properties [31].In a study, the results showed promising in vitro anti-oxidant and cytotoxic activities, especially for the essential oil of the leaves [31].The essential oil of Citrus aurantifolia (Christm.)Swingle was extracted using hydrodistillation, and its antimicrobial activity was assessed against a representative range of Gram-positive bacteria, Gram-negative bacteria, and yeasts, including both ATCC and clinical strains.The disc diffusion and broth microdilution methods were used for evaluation.The major components of the lime essential oil were found to be β-pinene (12.6%), limonene (53.8%), γ-terpinene (16.5%), terpinolene (0.6%), α-terpineol (0.4%), and citral (2.5%).These compounds are likely responsible for the oil's good antimicrobial activity, particularly against Gram-positive bacteria such as Staphylococcus aureus, Bacillus subtilis, and Staphylococcus epidermidis [115].
Eupatorium odoratum L. (Siam weed).A study performed a phytochemical analysis on siam weed to study the anti-oxidant and antimicrobial activities of ethanolic and aqueous extracts of its leaves [57].The authors show that the ethanolic extract of leaves showed antioxidant activity and antibacterial properties superior to those of the aqueous extract [57].This may explain the use of this plant by the Haitians for flu (FL = 84%).The study examined the antibacterial activity of Eupatorium odoratum L leaf extracts against several bacterial strains, including Klebsiella oxytoca, Salmonella enterica, Shigella sonnei, and Vibrio cholerae.The results showed that the extracts displayed antibacterial activity within the range of 0.156 to 1.25 mg/mL.Among the strains tested, V. cholerae exhibited the highest susceptibility to the extracts, with a minimum inhibitory concentration (MIC) of 0.156 mg/mL for the dichloromethane extract and 0.312 mg/mL for the butanol extract.The study also identified sinensetin and scutellareintetramethyl ether as the active components responsible for the antibacterial properties of Eupatorium odoratum L. [116].
Cinnamomum verum J. S. Presl.(Cinnamon) native to Sri Lanka and southern India but also distributed in Southeast Asia, China, Burma, Indonesia, Madagascar, the Caribbean, Australia, and Africa.In a study, authors show the antibacterial effect of methanol, ethanol, petroleum ether, and ethyl acetate extracts of C. verum against Staphylococcus aureus, Bacillus subtilis, Escherichia coli, and Pseudomonas aeruginosa.Ethyl acetate extract was reported to possess the strongest antibacterial activity against Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa, while Bacillus subtilis had shown the maximum sensitivity towards petroleum ether extract [30].In another study, the chemical composition of cinnamon bark extract was analyzed, revealing cinnamal and coumarin as the main compounds [117].The extract showed antimicrobial activity against various pathogenic and spoilage microorganisms, including Staphylococcus aureus, Staphylococcus epidermidis, Salmonella abony, Escherichia coli, and Candida albicans, except for some strains of Pseudomonas species [117].It also reduces the metabolism of bacterial cells, coagulates cellular materials, and limits the rate of replication [30,118].These studies can explain the use of this plant by the Haitians for flu FL = 61.22%.
Citrus aurantium L. is used in traditional medicine in India for treating stomach aches, vomiting, high blood pressure, dysentery, diarrhea, cardiovascular analeptic, as a sedative, for boils, and for urinary tract infections.Its essential oil from fruit peels has anti-oxidant, antimicrobial, antifungal, antiparasitic, and anti-inflammatory activities [32].In our study, Haitians use Citrus aurantium L. mainly for flu (FL = 70.21%).In a study the auteurs show essential oil extracted from leaves exhibited strong antifungal activity against two strains of Candida albicans, with fungicidal effect.The MIC of essential oil against Candida albicans strains was 0.15-0.31%(v/v) [32].Another study investigated the antibacterial properties of citrus oil and identified d-limonene as its primary chemical constituent [119].The results showed that the essential oil exerted dose-dependent antibacterial activity, with a greater impact on S. aureus (5.8-7.9 mm) compared to E. coli (1.7-3.1 mm), as demonstrated by the diameter of the zone of inhibition [119].
Artemisia vulgaris L. (mugwort) is one of the important medicinal plant species of the genus Artemisia and probably the most common in Haiti today.This medicinal plant has a wide spectrum of therapeutic properties, among which are antimalarial, anti-inflammatory, antihypertensive, anti-oxidant, antitumor, immunomodulatory, hepatoprotective, antispasmodic and antiseptic [44].The antimicrobial activity of mugwort oil was studied against Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, Enterobacter cloacae, Escherichia coli, Salmonella typhimurium, and Candida albicans using the disc diffusion method in comparison with the positive control (ceftazidime and ketoconazole) [44,120].In a study, the antibacterial activity of the methanol extract and essential oil of A. vulgaris was investigated, with both showing significant activity against the test organism [121].The methanol extract exhibited higher activity against Bacillus subtilis and Enterococcus spp., with zones of inhibition of 12.48 mm and 12.06 mm, respectively [121].The essential oil of A. vulgaris was found to contain mono-and sesquiterpenes, including sabinene, β-thujone, chrysanthenone, camphor, borneol, and germacrene [121].In our study, Haitian use mugwort only for COVID-19, and they mentioned in the survey that they need a very small quantity for the infusions, and this corresponds with these studies [122,123].It is reported to become toxic at high or repeated doses, as is the case with some other Artemisia species.
Phyllanthus niruri L. this plant is also commonly used to treat hypertension, diabetes, and intestinal infections.It also has a lipid-lowering effect and hepatoprotective activity [98].In a study, the methanolic extract of Phyllanthus niruri L. demonstrated antibacterial activities against all the Gram-positive and Gram-negative was investigated against pathogenic bacteria responsible for common infections of the skin and urinary and gastrointestinal tracts [124].In this survey, Haitian use it for COVID-19.
The plants described above, including Zingiber officinale Roscoe, Mormordica charantia L., Aloe vera L., Allium cepa L., Allium sativum L., Syzygium aromaticum L., Citrus aurantiifolia (Christm.)Swingle, Eupatorium odoratum L., Cinnamomum verum J. S. Presl, Citrus aurantium L., Artemisia vulgaris L., and Phyllanthus niruri L. contain active ingredients that can be found in the recipes for herbal remedies for COVID-19 and symptoms [37,56,57,125].These substances can act against flu, fever, and pain.Other secondary substances, such as flavonoids, anthranoids, cyanogenic glycosides, and alkaloids, can act on many symptoms of covid.To take only the example of flavonoids here, let's say that quercetin, rutin, naringin, and apigenin, found in several species used in recipes, are recognized and sought after for their antiviral, antibacterial, and anti-inflammatory properties.A study using computational Plants 2024, 13, 2383 20 of 28 analysis has suggested that various flavonoids, such as kaempferol, quercetin, luteolin-7-glucoside, apigenin-7-glucoside, naringenin, catechin, and epigallocatechin, may hold significance as potential inhibitors of the SARS-CoV-2 M pro [126].Another study found that quercetin may be effective in treating early-stage COVID-19.The quercetin group recovered faster and had more negative SARS-CoV-2 tests than the control group [127].
Studies suggest that environmental factors like temperature, humidity, and air pollution may affect COVID-19 transmission [17][18][19][20][21]128,129].No specific drug has been validated for COVID-19 treatment in large-scale studies, but remdesivir shows promise as an antiviral.Other treatments, such as umifenovir combined with lopinavir/ritonavir and hydroxychloroquine with azithromycin, have shown some efficacy.Research on teicoplanin and monoclonal and polyclonal antibodies is ongoing.The pandemic has significantly increased deaths, particularly among those with comorbidities like hypertension, obesity, cardiovascular issues, diabetes, and respiratory disorders, overwhelming healthcare systems [128].Rapid identification and risk stratification of high-risk patients, along with appropriate resource allocation, are crucial for healthcare systems globally.
In response to the pandemic, Haitians have extensively used herbal remedies for COVID-19 prevention and treatment, involving mixtures of herbs targeting symptoms like cough, respiratory issues, fever, gastrointestinal problems, and pain.Typically, these remedies are decoctions, infusions, or punches, often including 6 to 7 plant extracts with ingredients like milk, eggs, and honey.Similarly, traditional Chinese medicines have been used as preventative measures based on past use against H1N1 and SARS, but clinical data on their effectiveness for COVID-19 is lacking [128,130].Six traditional Chinese medicines were notably prevalent, requiring rigorous clinical studies for validation.Additionally, enhancing immunity with vitamins (A, D, and E) and minerals has been suggested as a preventative measure [129].Therefore, even if the treatment is successful, it is difficult to indicate an active and beneficial component.Further studies are needed to protect high-risk groups and to investigate the efficacy of herbal mixtures.In the research for new antibacterial, antiviral, and even anti-analgesic molecules with new modes of action, it will be interesting to identify the compounds responsible for the activities and thus to discover new mechanisms to relieve these ailments.

Data Collection
The interviews were conducted in Haitian Creole (native language) in the field and also by telephone for certain areas: Carrefour, Gressier, Léogâne and Croix-des-Bouquets.They were a total of 120 people with one person per family.Three of these people were "machann fèy" or, in English, medicinal plant traders, and the others were people who had acquired knowledge of the use of medicinal plants from their parents or relatives.
The interview methodology (Figure 4) adopted for this survey was inspired by that used by TRAMIL (TRAditional Medicine in the Islands) which is an applied research program on the popular use of medicinal plants in the Caribbean.TRAMIL's mission is to scientifically validate the traditional uses of medicinal plants for primary health care [28].The interviews were conducted in the form of discussions in order to collect information about medicinal plants used for respiratory diseases, influenza, colds, and COVID-19.All participants provided oral prior informed consent before the interviews.The participants were asked to share their experiences (or those of relatives) of the plants they used for the mentioned ailments.During these interviews, the local names of the plants used in the treatment of the conditions, the parts of the plants, the route of administration, and the methods of preparation were recorded on a Microsoft Excel page.During the survey, photos of some plants were requested and provided by the interviewees over the phone.In the process, the plant specimens concerned were collected and then stored in the herbarium of the biomolecule department of COVACHIM-M2E, Faculty of Science, University of West Indies.The identity of each plant species mentioned by the families was verified and their scientific names confirmed by the books: plantes médicinale en Haïti [29], pharmacopée caribéenne [28] and flore illustrée des phanérogames de Guadeloupe et de Martinique 1 and 2 [100], the site Tramil [94] and the botanist at the University of West Indies.
tos of some plants were requested and provided by the interviewees over the phone.In the process, the plant specimens concerned were collected and then stored in the herbarium of the biomolecule department of COVACHIM-M2E, Faculty of Science, University of West Indies.The identity of each plant species mentioned by the families was verified and their scientific names confirmed by the books: plantes médicinale en Haïti [29], pharmacopée caribéenne [28] and flore illustrée des phanérogames de Guadeloupe et de Martinique 1 and 2 [100], the site Tramil [94] and the botanist at the University of West Indies.
The sampling technique used in this study is stratified sampling.In stratified sampling, the entire population U of N units is divided into a number (K) of mutually exclusive and exhaustive groups, which are called strata [131], each of which corresponds to a commune.The sample size (N = 120) has been selected as being representative of the population.From each of the strata, samples of suitable sizes are selected independently by some suitable sampling design.Eligible participants were people ages ≥ 18 years, Haitian living in the country for 18 years before.People were excluded if they had a disability that prevented them from hearing, understanding, or answering questions, and people who were members of the same family.

Data Analysis
Relative frequency of citation (RFC) was used to demonstrate the importance of each species.RFC was calculated with this formula: RFC = FC/N; where FC is the number of families mentioning the use of the species, and N is the total number of families participating in the survey [132].
The use value (UV) demonstrates the relative importance of the suggested plant species.UV was calculated using the following formula: UV = (∑Ui)/N where Ui is the number of use statements cited for a given plant species and N is the total number of families surveyed [132].The UV was useful in determining the most commonly used plant species; these were those that were most frequently indicated in the treatment of a condition [132].
The family use value (FUV) was calculated to identify the importance of medicinal plant families.It was calculated as FUV = ∑ UVs/ns × 100 where UVs: use values of the species, and ns: total number of species within each family [133].The sampling technique used in this study is stratified sampling.In stratified sampling, the entire population U of N units is divided into a number (K) of mutually exclusive and exhaustive groups, which are called strata [131], each of which corresponds to a commune.The sample size (N = 120) has been selected as being representative of the population.From each of the strata, samples of suitable sizes are selected independently by some suitable sampling design.Eligible participants were people ages ≥ 18 years, Haitian living in the country for 18 years before.People were excluded if they had a disability that prevented them from hearing, understanding, or answering questions, and people who were members of the same family.

Data Analysis
Relative frequency of citation (RFC) was used to demonstrate the importance of each species.RFC was calculated with this formula: RFC = FC/N; where FC is the number of families mentioning the use of the species, and N is the total number of families participating in the survey [132].
The use value (UV) demonstrates the relative importance of the suggested plant species.UV was calculated using the following formula: UV = (∑Ui)/N where Ui is the number of use statements cited for a given plant species and N is the total number of families surveyed [132].The UV was useful in determining the most commonly used plant species; these were those that were most frequently indicated in the treatment of a condition [132].
The family use value (FUV) was calculated to identify the importance of medicinal plant families.It was calculated as FUV = ∑UVs/ns × 100 where UVs: use values of the species, and ns: total number of species within each family [133].
The Informant Consensus Factor (ICF) was calculated to test for homogeneity of information using the following formula [134]: ICF = (Nur − Nt)/(Nur − 1) With Nur is the number of utilization reports for each disease category and Nt is the number of plant species used.The diseases were classified as respiratory, influenza, cold, and COVID-19 in order to calculate the ICF.The ICF is the value suggestive of how uniformly participants agree on the use of a particular plant species to treat a particular disease category.The ICF value ranges from 0 to 1.A value near 1 indicates that few plant species were used by a large group of participants.Alternatively, a low value indicates disagreement among participants regarding the use of a plant species for the treatment of a specific disease within a disease category.Medicinal plants presumed to be effective in the treatment of a certain disease have higher ICF values.
The level of fidelity (FL) of each plant was first determined, i.e., the ratio of the number of families that independently suggested the use of a species for the same diseases (Ip) to the total number of families that mentioned the plant for a major disease (Iu).FL was calculated by the following formula [135]: FL = (Ip × 100)/Iu.A high FL value means that the plant species was frequently used to treat a specific disease category by the participants.

Conclusions
According to the TRAMIL methodology, medicinal plant uses that are mentioned with a frequency of 20% or more are considered significant.Our study, conducted in Haiti, revealed that several plants are commonly used to treat influenza, colds, and respiratory diseases and are also used for COVID-19.Most of the frequently cited plants were tested for their antibacterial and/or antiviral activities, but the molecules responsible for these activities have not been identified or isolated for most of these plants.Additionally, Samyda dodecandra rosea Sims, which is the most commonly cited plant for influenza treatment in Haiti, has not been tested for biological activity in the literature.Therefore, it is recommended that further pharmacological studies be conducted on these plants.
We want to highlight that in this study, the intellectual property of indigenous knowledge owners and participants is explicitly recognized in accordance with the Nagoya Protocol on Access and Benefit Sharing of the Convention on Biological Diversity.

Figure 1 .
Figure 1.Haiti maps with study areas (Dots correspond to survey locations).

Figure 1 .
Figure 1.Haiti maps with study areas (Dots correspond to survey locations).

Figure 3 .
Figure 3. UV value for plants used for flu and colds.

Figure 3 .
Figure 3. UV value for plants used for flu and colds.
massage the stomach in the case of strong flu or the leaves for baths with other plants like Mormordica charantia L. and Ocimum basilicum L.

Table 2 .
Percentage (%) of botanical families most used for all these preventions and remedies.

Table 3 .
The list of plants mentioned, Creole vernacular names, families, their RFC value, and their traditional uses.RFC = relative frequency of citation.N/A = not available.Traditional plant for flu, COVID-19, and respiratory disease.The voucher specimens are stored at the COVACHIM laboratory in Guadeloupe and, for some, at the URE laboratory at the Faculty of Sciences (UEH) in Haiti.

Number of Families Citing It in the Survey RFC Parts Used and Mode of Preparation Flu, Cold, Respiratory Diseases and for a Few COVID-19 Symptoms References
Plants 2024, 13, 2383 9 of 28

Table 4 .
Some oral herbal preparations for the prevention and treatment of COVID-19.Some remedies used to prevent/treat COVID-19 by Haitians using up to 6 plants in mixtures or punch with other ingredients.
Allium cepa L. & Aloe vera L. Burn & Myristica fragrans 3 punch with milk and an egg, a large spoonful of aloe gel [33] Allium sativum L & Aloe vera L. Burn & Cinnamomum verum L. & Zingiber officinale Roscoe 4 Punch with milk, egg, and rum [33] Allium sativum L & Cinnamomum verum L. & Citrus aurantiifolia Swingle & Mormordica charantia L. & Syzygium aromaticum & Zingiber officinale Roscoe 6 Boil Bitter Gourd and chop a compartment of garlic, then add a few grains of clove and cinnamon, then prick a lime, and finally add a little ginger and put the whole in decoction.After boiling, before drinking it, squeeze the lemon juice [33] Allium sativum L & Cinnamomum verum L. & Curcuma longa L. & Mormordica charantia L. & Syzygium aromaticum 5 Decoction of 5 garlic cloves with a piece of turmeric and some peels of cinnamon, and then add the leaves of Bitter Gourd after a few minutes of boiling [33] Allium sativum L. & Cinnamomum verum L. & Mormordica charantia L. & Eupatorium odoratum L. & Syzygium aromaticum & Zingiber officinale Roscoe 6

Table 5 .
List of herbal preparations and related information used for the treatment of COVID-19.

Table 6 .
The list of plants mentioned and parts used.N/A = not available.