Traditional Medicinal Plants Used to Treat Maternal and Child Health Illnesses in Ethiopia: An Ethno-Botanical Approach

Maternal and child morbidity and mortality is highest in sub Saharan African countries including Ethiopia, due to shortfalls in modern health institutions, women improper use of medicinal plants. Scientific utilization of traditional medicinal plants continues to play an important role in improving and maintaining health problems in developing countries. About (80%) of the Ethiopia people depend on traditional medicine for their health care and more than 90% traditional medicine preparations are made from plant origin. The aim of this review was to provide an overview on traditional medicinal plants used to treat maternal and child health illnesses in Ethiopia. Materials and Methods: Databases (Pub Med, Google Scholar, Research Gate, and HINARI) were searched for published studies on the Ethno-botany of medicinal plants used to treat maternal and child health illnesses in Ethiopia. Studies that did not contain full ethno-botanical data of medicinal plants traditionally used to treat maternal and child health illnesses were excluded. Results: In different database search, the investigators found a total of 360 articles. After adjustment for duplicates and inclusion and exclusion criteria, 38 articles were found appropriate for the review. None of the medicinal plants traditionally used to treat maternal and child health illnesses in Ethiopia are confirmed scientifically. Of the 103 plants identified from the various studies, 25 (25.75%) were herbs and the common plant part used was found to be root 40 (41.2%) followed by leaves 32 (32.96%). Based on this study, medicinal plants the most common route of administration was orally 71 (73.13%).In this review, medicinal plants which were abundant for maternal illness the leading were treatment of retained placenta 24 (24.72%) species followed by abortion, which comprise 6 (6.18%).On the other hand, milk feeding diarrhoea and Kwashiorkor 3 (3.09%) comprise high and equal percentage of childhood infection in Ethiopia. Conclusion: Various medicinal plants have been used by Ethiopian people. Most of the plants were herb and the commonly used plant part was root. The most common maternal illness treated by medicinal plant was retained placenta in children milk feeding diarrhoea and Kwashiorkor. There is a need to conduct clinical trials to support traditional claims and to analyse cellular and molecular mechanisms involved. *Corresponding author: Asmare TW, Department of Midwifery, College of Health Sciences, Debre Markos University, Ethiopia, Tel: +251 -921524150; Fax: 251058-771-16-64; Email: talieasmare@gmail.com Received April 09, 2018; Accepted June 22, 2018; Published July 05, 2018 Citation: Asmare TW, Yilkal BA, Mekuannint T, Yibeltal AT (2018) Traditional Medicinal Plants Used to Treat Maternal and Child Health Illnesses in Ethiopia: An Ethno-Botanical Approach. J Tradit Med Clin Natur 7: 277. doi: 10.4172/25734555.1000277 Copyright: © 2018 Asmare TW, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Introduction
Based on WHO traditional medicine is defined as the sum total of all knowledge and practices, whether explicable or not, used in diagnosis, prevention and elimination of physical, mental, or social imbalance and relying exclusively on practical experience and observation handed down from generation to generation, whether verbally or in writing. The emphasis on the use of medicinal plants had been focus on the treatment rather than prevention of diseases [1].
Maternal and child morbidity and mortality is highest in sub Saharan Africa including Ethiopia due to shortfalls in modern hospitals, women improperly use of medicinal plants About (80%) of the Ethiopia people and (90%) of livestock depend on traditional medicine for their health care and more than 90 and of traditional medicine preparations are made from plant origin. Similarly, there has been a continuous growth of demand for traditional medicines globally and in many developing countries health care system [2].
But when we use in scientific way, traditional medicine continues to play an important role in improving and maintaining health in developing countries. High income and knowledge of medicinal plants are important determinants of use of traditional medicine. This challenges the common assumption that poor and marginalized people are most dependent on traditional medicine due to its availability [3].
Ethiopia is believed to be home for about 6,500 species of higher plants of which 12% are endemic [4] making the country among the most diverse floristic regions of the world [5]. However, conservation of these plants and knowledge of their use have generally been neglected since it was considered irrelevant in earlier times [6]. Moreover, the attitude of the society towards the traditional medicine healers was negative and this forced healers to keep the knowledge secret [7].
But currently different studies have been conducted on Ethnobotany of medicinal plants used to treat various human diseases in different parts of Ethiopia; Traditional medicine is commonly assumed to be a crucial health care option for poor households in the country. However, there has not been any review done that comprehensively expresses the Ethno-botany of plants used to treat maternal and child health illnesses. There fore, there is a need to assess the overall traditional preparation techniques and types of plants used in the country scientifically. So this review was aimed to provide an overview of Ethno-botany of medicinal plants used to treat maternal and childhood illnesses among the diversified population in Ethiopia. It gives a comprehensive information on the scientific name of plants, method of preparation, route of administration, plant part used and the habit of the plant used and the study will be an input for further study/ call attention of other investigators on traditional medicine on the treatment of maternal and child diseases and increase quality of care on maternal and child health (MCH) service delivery system in Ethiopia.

Search strategy
Databases (Pub Med, Google Scholar, Research Gate, and HINARY) were searched for published studies done on Ethno-botany of medicinal plants in Ethiopia. Some studies were also identified through a manual Google search. No restriction was applied on the year of publication, methodology, or study subjects. Primary search terms were "maternal and child health review", "Ethiopia", "medicinal plants", and "Ethno botany".

Inclusion/exclusion criterion
Studies which do not contain full information about Ethno botany (method of preparation, growth form, plant part used, route of administration), surveys which did not address maternal and child health illness as a disease treated traditionally by practioners were excluded. Plants which are out of flora list of Ethiopia were also excluded from this review.

Data abstraction
The authors screened the articles based on the inclusion/exclusion criteria. The details of medicinal plants were extracted from each study  using an abstraction forms: Scientific, Family and Local name, habit of plant, plant part used, methods of preparation, specific use and route of administration (Table 1).

Literature search results
The search of the Pub Med, Google Scholar, Research Gate, and HINARY databases and Google provided a total of 350 studies. After adjustment for duplicates, 105 remained. Of these, 40 studies were discarded, since after review of their titles and abstracts, they did not meet the criteria. .The full texts of the 66 studies were reviewed in detail. Finally, 38 studies were included in the review (Figure 1).

Study characteristics
Methodological validity of all the reviewed articles were checked prior to inclusion in the review by undertaking critical appraisal using a standardized instrument adapted from [8]. These studies differed significantly in the number of plants identified. From these 38 articles, almost all were conducted to assess the Ethno-botany of medicinal plants used to treat human diseases. All the studies were conducted in different parts of Ethiopia and are qualitative and mixed type. The studies used purposive sampling to select study articles. The detailed description of each plants collected from different studies is given below ( Table 1).

Method of preparation and route of administration
Traditional medicinal practioners in Ethiopia apply different techniques of preparation like drying, crushing, concoction, decoction and eating with some other plants or animal products (Table 1). They use simple methods and equipments during their remedy preparation. Of the routes commonly used to administer remedies in the treatment of maternal and child health illnesses, oral route was the common route which consists 71 (73.13%) followed by dermal 6 (6.18%) way of administration. About 6% of the medicinal plants among 103 reviewed from published articles, the rout of administration is not specified (Figure 2).

Maternal and child health illnesses treated by traditional medicinal plants
In this study, the investigators were intended to deal both maternal and child health disease treatments of traditional medicinal plants. Based on the information reviewed on published research results, medicinal plants which were abundant for the treatment of retained placenta 24 (24.72%) species followed by treatment of abortion, infertility in women, Menstrual disorder and treatment of Rh disease which comprise the same 6(6.18%) plant species ( Table 2).

Habits of medicinal plants which treat maternal and child illness
In this review paper shows that the most widely used Medicinal plants habit in the reviewed articles the collected plants found to be herbs 25 (25.75%) followed by shrubs 19 (19.57%) (Figure 3).

Plant parts used in the reviewed articles
Every part of different plant species are used against a variety of diseases. In this review the commonly used plant parts were found to be root 40 (41.2%) followed by leaves 32 (32.96%), and stem bark 4 (4.12%) respectively. Among 103 reviewed medicinal plants about 7 (7.21%) were not identified their parts used for the case mentioned. In some cases, more than one organ of the same plant species, particularly a combination of parts, is used in the preparation of different therapies.

Diversity of medicinal plants in terms of families
In this paper review different families of medicinal plants were collected from published research articles. Among them Fabaceae is the most dominant family that holds 8 (7.77%) plant species followed by Solanaceae having 6 (5.82%) species and Cucurbitaceous having 6 (5.82%) species. From the documented medicinal plants 7 (6.79%) plant species at which their family was not clearly stated in the reviewed papers (Table 3).

Conclusions
The plant parts used for treatment of maternal health and child illness in this review was found to be root followed by leaves and it was unlike with other ethno-botanical studies which were leaf was the dominant plant part used and the common rout of administration was through orals. Most of the medicinal plants in this review were herb. The most common maternal illness treated by medicinal plant was retained placenta and whereas in children milk feeding diarrhoea and Kwashiorkor.

Recommendations
From this review the authors suggested to carry out similar studies in areas not previously covered in order to get a full picture of the country's medicinal plants potential for a particular disease like maternal illness. There is a need to conduct clinical trials to support traditional claims and to analyse cellular and molecular mechanisms involved.