Scholarly article on topic 'Medicinal plants used for management of malaria among the Luhya community of Kakamega East sub-County, Kenya'

Medicinal plants used for management of malaria among the Luhya community of Kakamega East sub-County, Kenya Academic research paper on "Biological sciences"

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{Ethnopharmacology / Malaria / "Medicinal plants" / "Kakamega East / Luhya"}

Abstract of research paper on Biological sciences, author of scientific article — Nillian Mukungu, Kennedy Abuga, Faith Okalebo, Raphael Ingwela, Julius Mwangi

Abstract Background Malaria remains a major health problem worldwide especially in sub-Saharan Africa. In Kenya, 80% of the population is at risk of contracting the disease. Pregnant mothers and children under five years are the most affected by this disease. Antimalarial drug resistance poses a major threat in the fight against malaria necessitating continuous search for new antimalarial drugs. Due to inadequate and inaccessible health facilities, majority of people living in rural communities heavily depend on traditional medicine which involves the use of medicinal plants for the management of malaria. Most of these indigenous knowledge is undocumented and risks being lost yet such information could be useful in the search of new antimalarial agents. Aim of study An ethnobotanical survey was carried out among the Luhya community of Kakamega East sub-County, a malaria epidemic region, with the aim of documenting the plants used in the management of malaria. Materials and methods Semi-structured questionnaires were used to collect information from 21 informants who included traditional medicine practitioners and other caregivers who had experience in use of plants in management of malaria. These were drawn from 4 villages located in Kakamega East sub-county, within Kakamega County based on their differences in topography. Information recorded included plant names, parts used, mode of preparation and administration and the sources of plant materials. A literature search was conducted using PubMed and google scholar to identify the reported traditional uses of these plants and studied antiplasmodial activities. Results In this study, 57% of the informants were aged above 50 years and a total of 61% had either no formal education or had only attained primary school education. A total of 42 plant species belonging to 24 families were identified. Most plants used in the management of malaria in this community belonged to Lamiaceae (18%), Leguminosae (9%) and Compositae (9%) plant families. Plants mostly used included Melia azedarach L, Aloe spp, Ajuga integrifolia Buch. Ham, Vernonia amygdalina Del., Rotheca myricoides (Hochst.) Steane and Mabb, Fuerstia africana T.C.E.Fr., Zanthoxylum gilletii (De Wild.) P.G.Waterman and Leucas calostachys Oliv. Rumex steudelii Hochst.ex A. Rich and Phyllanthus sepialis Müll. Arg are reported for the first time in the management of malaria. Although Clerodendrum johnstonii Oliv. (Jeruto et al., 2011) and Physalis peruviana L.(Ramadan et al., 2015) are reported in other studies for management of malaria, no studies have been carried out to demonstrate their antiplasmodial activity. The plant parts mostly used were the leaves (36%) and stem barks (26%). Majority of these plants were prepared as decoctions by boiling and allowed to cool before administration (66%) while infusions accounted for 28% of the preparations. The literature mined supports the use of these plants for the management of malaria since most of them have demonstrated in-vitro and in-vivo antiplasmodial activities. Conclusion Most of the reported plant species in this study have been investigated for antiplasmodial activity and are in agreement with the ethnomedical use. Two (2) plants are reported for the first time in the management of malaria. There is need for documentation and preservation of the rich ethnomedical knowledge within this community given that most of the practitioners are advanced in age and less educated. There is also the danger of over-exploitation of plant species as most of them are obtained from the wild, mainly Kakamega forest. Therefore, there is need for determining the economically and medicinally important plants in this community and planning for their preservation.

Academic research paper on topic "Medicinal plants used for management of malaria among the Luhya community of Kakamega East sub-County, Kenya"

Author's Accepted Manuscript

Medicinal plants used for management of malaria among the Luhya community of Kakamega East sub-County, Kenya

Nillian Mukungu, Kennedy Abuga, Faith Okalebo, Raphael Ingwela, Julius Mwangi

www.elsevier.com'locate/jep

PII: S0378-8741(16)30584-0

DOI: http ://dx. doi. org/ 10.1016/j.jep.2016.08.050

Reference: JEP10397

To appear in: Journal of Ethnopharmacology

Received date: 23 May 2016 Revised date: 9 August 2016 Accepted date: 27 August 2016

Cite this article as: Nillian Mukungu, Kennedy Abuga, Faith Okalebo, Raphae Ingwela and Julius Mwangi, Medicinal plants used for management of malari among the Luhya community of Kakamega East sub-County, Kenya, Journal o Ethnopharmacology, http://dx.doi.org/10.1016/jjep.2016.08.050

This is a PDF file of an unedited manuscript that has been accepted fo publication. As a service to our customers we are providing this early version o the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form Please note that during the production process errors may be discovered whic could affect the content, and all legal disclaimers that apply to the journal pertain

Medicinal plants used for management of malaria among the Luhya community of Kakamega East sub-County, Kenya.

Nillian Mukungu*a, Kennedy Abugab, Faith Okaleboa, Raphael Ingwelaa, Julius Mwangia

aDepartment of Pharmacology and Pharmacognosy, University of Nairobi, P.O. Box 1967600202 Nairobi

bDepartment of Pharmaceutical Chemistry, University of Nairobi, P.O. Box 19676-00202 Nairobi

nmukungu@uonbi.ac.ke; koabuga@uonbi.ac.ke; faith.okalebo@uonbi.ac.ke; ralphingwela@uonbi.ac.ke; julius.mwangi@uonbi.ac.ke

*Corresponding author. Mobile number +254 721291660

List of abbreviations

AIDS Acquired Immune Deficiency Syndrome

APHRC African Population and Health Research Center

CARTA Consortium for Advanced Research Training in Africa

DelPHE Development Partnerships in Higher Education

DfID Department for International Development

HIV Human Immunodeficiency Virus

IC50 Half Maximal Inhibitory Coefficient

KIPPRA Kenya Institute for Public Policy Research and Analysis

KNBS Kenya National Bureau of Statistics

NCAPD National Coordinating Agency for Population and Development

PMI President's Malaria Initiative

UK United Kingdom

USAID United States Agency for International Development

WHO World Health Organization

Abstract

Background: Malaria remains a major health problem worldwide especially in sub-Saharan Africa. In Kenya, 80 % of the population is at risk of contracting the disease. Pregnant mothers and children under five years are the most affected by this disease. Antimalarial drug resistance poses a major threat in the fight against malaria necessitating continuous search for new antimalarial drugs. Due to inadequate and inaccessible health facilities, majority of people living in rural communities heavily depend on traditional medicine which involves the use of medicinal plants for the management of malaria. Most of these indigenous knowledge is undocumented and risks being lost yet such information could be useful in the search of new antimalarial agents.

Aim of study: An ethnobotanical survey was carried out among the Luhya community of Kakamega East sub-County, a malaria epidemic region, with the aim of documenting the plants used in the management of malaria.

Materials and methods: Semi-structured questionnaires were used to collect information from 21 informants who included traditional medicine practitioners and other caregivers who had experience in use of plants in management of malaria. These were drawn from 4 villages located in Kakamega East sub-county, within Kakamega County based on their differences in topography. Information recorded included plant names, parts used, mode of preparation and administration and the sources of plant materials. A literature search was conducted using PubMed and google scholar to identify the reported traditional uses of these plants and studied antiplasmodial activities.

Results: In this study, 57 % of the informants were aged above 50 years and a total of 61 % had either no formal education or had only attained primary school education. A total of 42 plant species belonging to 24 families were identified. Most plants used in the management of malaria in this community belonged to Lamiaceae (18 %), Leguminosae (9 %) and Compositae (9 %) plant families. Plants mostly used included Melia azedarach L, Aloe spp, Ajuga integrifolia Buch.Ham, Vernonia amygdalina Del., Rotheca myricoides (Hochst.) Steane & Mabb, Fuerstia africana T.C.E.Fr., Zanthoxylum gilletii (De Wild.) P.G.Waterman and Leucas calostachys Oliv. Rumex steudelii Hochst.ex A. Rich and Phyllanthus sepialis Müll.Arg are reported for the first

time in the management of malaria. Although Clerodendrum johnstonii Oliv.(Jeruto et al., 2011) and Physalisperuviana L.(Ramadan et al., 2015) are reported in other studies for management of malaria, no studies have been carried out to demonstrate their antiplasmodial activity.

The plant parts mostly used were the leaves (36 %) and stem barks (26 %). Majority of these plants were prepared as decoctions by boiling and allowed to cool before administration (66 %) while infusions accounted for 28 % of the preparations. The literature mined supports the use of these plants for the management of malaria since most of them have demonstrated in-vitro and in-vivo antiplasmodial activities.

Conclusion:

Most of the reported plant species in this study have been investigated for antiplasmodial activity and are in agreement with the ethnomedical use. Two (2) plants are reported for the first time in the management of malaria. There is need for documentation and preservation of the rich ethnomedical knowledge within this community given that most of the practitioners are advanced in age and less educated. There is also the danger of over-exploitation of plant species as most of them are obtained from the wild, mainly Kakamega forest. Therefore, there is need for determining the economically and medicinally important plants in this community and planning for their preservation.

Chemical compounds studied in this article

Methanol (PubChem CID: 887), Ethanol (PubChem CID: 702), Water (PubChem CID: 962), Chloroform (PubChem CID: 6212), Dichloromethane (PubChem CID: 6344), Ether (PubChem CID: 3283), Ethylacetate (PubChem CID: 8857), Hexane (PubChem CID: 8058).

1. Introduction

The World Health Organization (WHO) estimates that 3.2 billion people are at risk of malaria infection globally. In the year 2015, a total of 214 million cases and 438,000 deaths due to malaria were reported globally. The burden was highest in WHO-Africa region where 90 % of all malaria death occurred (WHO, 2015). In Kenya malaria, still remains a major health problem with 80 % of the population at risk of contracting the disease (PMI, 2015). Malaria affects the

poor and marginalized populations. In most cases such populations live in rural areas and lack access to adequate healthcare facilities (Yusuf et al., 2010). Therefore, such people largely depend on herbal medicines for the management of malaria and other diseases.

Kakamega county lies within the western highlands malaria epidemic region in Kenya (KNBS & ICF Macro, 2011 & USAID, 2013). This region experiences seasonal malaria outbreaks. The epidemics are favored by the high temperature of above 18°C during the long rainy seasons which is optimal for breeding of mosquitoes. The poverty level in this county is estimated at 57 % (NCAPD, 2005). The high malaria incidences, high poverty levels and the proximity to the tropical forest, Kakamega forest, promotes the use of plants in management of various ailments including malaria.

Most of the African societies have a long history of indigenous healing practices. This knowledge is often passed from generation to generation by word of mouth. The Luhya community in Kakamega has a rich culture of herbalism. The practitioners of herbal medicine are well known within the community and are sought after for their skills in management of diseases. However other members of the community who are not herbal practitioners too have some knowledge on use of plants in management off common diseases and only employ within family context such as mothers in management of children illnesses without consulting the recognized herbalists (Wane, 2011). This knowledge is likely to be lost if not documented. This study therefore sought to document the ethnopharmacological knowledge in the management of malaria in Kakamega County.

2. Methods

2.1. Study area

The ethnopharmacological survey was carried out in Kakamega sub-county in Kakamega County. Kakamega County is located in Western Kenya (Figure 1). The county lies within the longitudes 34° 20' 35.29" E- 35° 09' 27.04" E and latitudes 0° 05' 19.12"N- 0° 53' 53.81" N. It boarders several other counties, Bungoma to the North, Trans Nzoia to the North East, Uasin-Gishu and Nandi Counties to the East, Vihiga to the South, Siaya to the South West and Busia to the West. According to the 2009 census, the county has a total population of 1, 660,651 people

with population density of 515 people per km . The poverty level in the county is estimated to be 57 % (KIPPRA, 2013).

Kakamega East District, the focus of this study is one of the 6 districts in Kakamega County. The district is mainly a rural set-up with no single urban center. The entire district is served with only dispensaries and health centers (NCAPD, 2005). The nearest high level health facility, Kakamega County hospital, 20 km away.

Kakamega East District is the home to the Kakamega forest, the only tropical rain forest in Kenya. This forest is the main source of herbal medicines for rural communities in the region (Nyunja et al., 2009). The poor health facilities and proximity to the forest are promote the use of herbal medicines in this community.

KAKAMEGA NORTH

KAKAMEGA CENTRAL

KAKAMEGA E|

Study site

Density people per Km Squared

358 437 480 609 667 709 729

U'San centres with popu'-ation of ^^ more than 2030 people.

Figure 1. Map of Kakamega county showing study site (Source: CRA, 2013)

2.2 Ethical approval for the study

Ethical approval for the ethnobotanical survey was obtained from the Kenyatta National Hospital/University of Nairobi Ethics and Research Committee (P186/03/2015). The community gate keepers, who included village elders and church leaders were consulted and subsequently approved the study to be conducted within the local villages. The participants in this study were provided with information on the nature of study, benefits and risks involved. Those who agreed to participate signed a written consent at the beginning of the study.

2.3. Ethnobotanical Survey

An ethnobotanical survey was carried out between the August and October, 2015 in Kakamega East Sub-county of Kakamega County. The region was subdivided into 4 villages based on the differences in topography. Interviews were conducted using semi-structured questionnaires. The study was concluded when no more new information was realized. A total of 21 respondents, both male and female, who utilized antimalarial plants either for self-medication or for treating others were interviewed. A research assistant known to the locals accompanied the researchers during the interviews. Voucher specimens were prepared for all plants collected and deposited at the Department of Botany, University of Nairobi.

3. Results and Discussion

3.1 Socio-economic characteristics of respondents

The majority (57 %) of respondents in this survey were male aged > 50 years of age (Figure 2). The age ranged between 21 and 85 years. Usually the older members of the society have experience in the practice of traditional medicine and pass it on to the younger generation. The younger generation are also not readily accepted by the community as traditional practitioners as they are considered inexperienced (Lambert et al., 2011). In this study, the older practitioners were more recognized by the community than the younger ones. This explained why more than half the respondents were advanced in years.

Most of the respondents had a primary school level of education (Figure 3). The practice of traditional medicine has been for a long time been restricted to the less educated since the most educated people view it as ancient form of medicine that is primitive and inappropriate. Most of the practitioners only charge a small fee or no fee at all in managing the common diseases such as malaria since the plants are obtained locally making it not a lucrative business.

20-30 31-40 41-50 51-60 60+

Figure 2: Age Groups of Study Respondents

50 • 40

¿2 30

£ 20 Qi

Figure 3: Education Level of Respondents

3.2 Source of Ethnomedical Knowledge

Majority of the respondents (48 %) had acquired the knowledge of the practice of traditional medicine from the older members of their families such as parents and grandparents. However, a relatively large proportion (43 %) had acquired the knowledge though other means such as apprenticeship under practicing herbalists or by reading books about traditional medicine. Only 1 person had acquired the knowledge through formal training. This is similar to findings in other studies where apprenticeship is the commonest means of learning traditional practices (Lambert et al., 2011). In the recent years, there has been a global increase in demand and acceptability of traditional medicine (Abdullahi, 2011). In view of this, there is increase in commercialization of herbal medicines and more people learning about herbal medicine as a source of income. This may be the reason for the higher number (52 %) of people in this study who practice herbalism even though they did not inherit the practice.

3.3 Antimalarial plants diversity

Most of the respondents in this study identified fever as the main symptom associated with malaria. Other symptoms mentioned included headache, vomiting, diarrhea and joint pains. They were also aware of severe form of malaria (cerebral malaria). Only one respondent claimed he could treat cerebral malaria. The rest indicated that such cases should be referred to hospital.

A total of 42 plant species belonging to 39 genera within 24 families were identified (Table 1). A large proportion of these plants were from the Lamiaceae (18 %), Leguminosae (9 %), and Compositae (9 %) families (Figure 4). Most of these plants were shrubs (42%) and trees (27 %) followed by climbers (24%) and herbs (7 %). Plants mostly cited included Melia azedarach L,

Ajuga integrifolia Buch.-Ham and Aloe spp. Rumex steudelii Hochst.ex A. Rich and Phyllanthus sepialis Müll.Arg are reported for the first time in the management of malaria.

Table 1: Plants used in the management of malaria among the Luhya community,

Kakamega East sub-County

Voucher number Family Plant name Local name Growth form Plant Part Used Frequency of citation (%) Mode of preparation

NMA2015/01 Acanthaceae Justicia betonica L. Herb Aerial 14.3 Pound, add cold water/Boil

NMA2015/02 Anacardiaceae Searsia natalensis (Bernh.ex C. Krauss) Busangula Herb Leaves, Stem Bark 4.8 Boil in water

NMA2015/03 Apocynaceae Carissa edulis L. Shikata/Achok a Shrub Root Bark 4.8 Boil in water/Inhale steam

NMA2015/04 Compositae Acmella caulirhiza Del. Shituti Herb Aerial Part 9.5 Pound, add cold water

NMA2015/05 Compositae Microglossa pyrifolia (Lam.) Kuntze Ing'oi Shrub Root, Leaves 9.5 Boil in water

NMA2015/06 Compositae Tithonia diversifolia (Hemsl.) A. Gray Masambu malulu/libinzo Shrub Leaves 9.5 Pound, add cold water

NMA2015/07 Compositae Vernonia amygdalina Del. Musulilitsa Shrub Leaves 19.0 Pound in cold water/ Boil

NMA2015/08 Bignoniaceae Markhamia lutea (Benth.) K.Schum. Lusiola Tree Stem Bark 9.5 Boil in water

NMA2015/09 Bignoniaceae Spathodea campanulata P.Beauv. Mutsulio Tree Stem Bark 14.3 Boil without crushing

NMA2015/10 Canellaceae Warbugia ugandensis Sprague Apachi Tree Leaves, Stem Bark 14.3 Boil in water

NMA2015/11 Curcurbitaceae Cucumis aculeatus Cogn - Climber Leaves 4.8 Pound, add cold water

NMA2015/12 Euphorbiaceae Crotom macrostachuys Hochst. ex Del. Musutsu Tree Stem Bark 4.8 Boil in water

NMA2015/13 Leguminosae Albizia gummifera (J.F.Gmel.) C.A.Sm. Musenzeli Tree Stem Bark 9.5 Boil without crushing

NMA2015/14 Leguminosae Erythrina abyssinica DC. Murembe Tree Stem Bark 4.8 Boil in water

NMA2015/15 Leguminosae Senna didmobotrya (Fresen.) H.S.Irwin & Barneby Lubinu Shrub Leaves 4.8 Boil in water

NMA2015/16 Leguminosae Senna occidentalis (L.) Link Imbindi Shrub Root 4.8 Pound, add cold water

NMA2015/17 Hypericaceae Harungana madagascariensis Lam. ex Poir. Musila Tree Stem Bark 4.8 Boil in water

NMA2015/18 Lamiaceae Ajuga integrifolia Buch.-Ham. Imbuli yu mtakha Herb Aerial 23.8 Pound, add cold water

NMA2015/19 Lamiaceae Clerodendrum Shiteng'oteng' Shrub Leaves 4.8 Pounded in

johnstonii Oliv. o cold water/Boil

NMA2015/20 Lamiaceae Rotheca myricoides (Hochst.) Steane & Mabb. Shisilangokho Shrub Rootbark, Leaves 19.0 Boil in water/Roast

NMA2015/21 Lamiaceae Fuerstia africana T.C.E.Fr. Muvesemu Herb Aerial 19.0 Boiled or roasted

NMA2015/22 Lamiaceae Leucas calostachys Oliv. Lumetsani Herb Aerial 19.0 Pound, add cold water/Boil/St eam

NMA2015/23 Lamiaceae Ocimun kilimandscharicum Gürke M'monyi Herb Aerial 4.8 Inhale steam

NMA2015/24 Lamiaceae Plectranthus barbatus Andrews Shilokha Shrub Leaves 9.5 Chew bud/boil in water

NMA2015/25 Meliaceae Mellia azedarach L Muarubaini Tree Leaves, Stem Bark 47.6 Boil in water

NMA2015/26 Meliaceae Trichilia emetica Vahl Munyama Tree Stem Bark 4.8 Boil in water

NMA2015/27 Menispermace ae Cissampelos mucronata A.Rich. Mukoye Climber Root 4.8 Chewing

NMA2015/28 Moraceae Ficus thonningii Blume Mutoto Tree Stem Bark 9.5 Boil in water

NMA2015/29 Primulaceae Maesa lanceolata Forssk. Mushevesheve Tree Root Bark, Stem Bark 4.8 Boil in water

NMA2015/30 Phyllanthaceae Flueggea virosa (Roxb. ex Willd.) Royle Shrub Aerial 4.8 Boil in water

NMA2015/31 Phyllanthaceae Phyllanthus sepialis Müll.Arg. - Shrub Leaves 4.8 Boil in water

NMA2015/32 Pittosporaceae Pittosporumviridiflor um Sims M'monyo/Mku ngune Shrub Leaves, Stem Bark 4.8 Boil in water

NMA2015/33 Polygonaceae Rumex abyssinicus Jacq. Shikachi Herb Leaves 9.5 Pound, add cold water

NMA2015/34 Polygonaceae Rumex steudelii Hochst.ex A. Rich Alukhava Herb Root 9.5 Pound, add cold water

NMA2015/35 Rosaceae Rubus pinnatus Wild. Butunduli Shrub Leaves, Fruits 4.8 Pounded in cold water/chew

NMA2015/36 Rutaceae Clausena anisata (Willd.) Hook.f. ex Benth. Shihunya bukundu Shrub Leaves 4.8 Boil in water

NMA2015/37 Rutaceae Zanthoxylum gilletii (De Wild.) P.G.Waterman Shikuma Tree Stem Bark 19.0 Boil in water

NMA2015/38 Solanaceae Physalis peruviana L. Mayengo Shrub Leaves 4.8 Inhale steam

NMA2015/39 Solanaceae Solanum incanum L. Indalandalu Shrub Root 4.8 Pound, add cold water

NMA2015/40 Verbenaceae Lantana trifolia L. Shimenenwa Shrub Leaves 9.5 Boil in water/steam

NMA2015/41 Vitaceae Rhoicissus tridentata (L.f.) Wild & Muhoko Climber Root 4.8 Boil in water

R.B.Drumm.

NMA2015/42 Xanthorrhoeace ae Aloe species Shikakha Herb Leaves 43.0 Boil in water

Xanthorrhoeaceae Vitaceae Verbenaceae Solanaceae Rutaceae Rosaceae Primulaceae Polygonaceae Pittosporaceae Phyllanthaceae гд Moraceae

jl Menispermaceae tn Meliaceae

^ Leguminosae Lamiaceae Hypericacea Euphorbiaceae Curcurbitaceae Compositae Canellaceae Bignoniaceae Apocynaceae Anacardiaceae Acanthaceae

0 2 4 6 8 10 12 14 16 18 20

Percent

Figure 4: Frequency of use of plant families in management of malaria in Kakamega East sub-County.

More than 90 % of the plants were referred to by their local names. However four of the plants could not be identified by their local names indicating that they may have been introduced into the region. Justicia betonica L. was referred to as the dark "Imbuli yu mutakha" which refers to Ajuga integrifolia Buch.-Ham that is commonly known in this region. The association of this plant with known plant could be due to the use for malaria or due to the bitter taste associated with both plants. However, the 2 plants have very different morphological characteristics.

Cucumis aculeatus was referred to as "Khaseveve" because of having leaves with morphological similarity to a pumpkin plant's leaves (Liseveve).

The part of plant used as medicine plays an important role in sustainability of herbal medicine. The most commonly used plant parts were the leaves (36 %) and stem barks (25 %) (Figure 5).

Figure 5: Plant parts used in malaria management

The use of roots and root bark is not sustainable for medicinal plants since the plant is uprooted in most cases to obtain these parts. In this study, roots and root barks plant parts accounted for 22 % of all the plants identified. Conservationists warn of over-exploitation of medicinal plants which are valued for their root parts and stem barks (Maroyi, 2013). In this study a total of 47 % of the plants were valued for the root parts or stem barks therefore threatened by overexploitation. Leaves and fruits are the most preferred parts for sustainable plant use since they are the least destructive to the plant and they accounted for 38 % in this study.

3.4 Preparation of antimalarial medicines

Various methods are used in preparation of herbal medicine among the community. The most common preparation were decoctions (70 %), which were made by boiling plant material before use. Other methods included cold maceration (30 %), steaming (12 %), roasting (8 %) to obtain ash or chewing (8 %). In most of the cases, the plant material was harvested and prepared just

before use. Nevertheless, where the plants are not easily accessible, material was preserved by air-drying under shade and stored for future use.

3.5 Sources of plant material

The herbal medicines used for malaria were mainly obtained from the wild (77 %) with only 23 % cultivated. The cultivation of medicinal plants was mainly done for those plants not easily available in the community, the introduced plants or those that face extinction. In this study, Justicia betonica L. an introduced herb, was mainly planted along river beds. Ajuga integrifolia Buch.-Ham which almost faces extinction was also planted by the herbalists. Previous studies carried out in Kenya show that most of the herbal products are exclusively obtained from the wild. This strongly indicates the unsustainability of herbal practice in Kenya (McMullin et al., 2012).

3.6 Reported traditional uses and antiplasmodial activity.

The identified plants in this study have been used in many communities for the management of various ailments including malaria and other febrile illnesses. A total of 38 out of the 42 identified plants have been tested in the laboratory for in-vivo and/or in-vitro antiplasmodial activities as summarized in Table 2. In vitro antiplasmodial activity is classified as high (IC50 <5 ^g/ml), promising (5<IC50 <15 ^g/ml), moderate (15<IC50 <50 ^g/ml) and inactive (IC50 >50 ^g/ml) (Lekana-Douki et al., 2011). Based on this criteria, 14 of the plants from our study are classified as possessing high antiplasmodial activity with Albizia gummifera (J.F.Gmel.) C.A.Sm., Leucas calostachys Oliv., Tithonia diversifolia and Harungana madagascariensis Lam. ex Poir. having the highest antiplasmodial activity of <1 ^g/ml. Although Tithonia diversifolia (Hemsl.) A. Gray has promising antiplasmodial activity, study by Elufioye et al., 2009 showed that it is toxic to the liver and kidney therefore limiting its widespread use in the management of malaria.

Although Clerodendrum johnstonii Oliv.(Jeruto et al., 2011) and Physalis peruviana L.(Ramadan et al., 2015) are reported in other studies for management of malaria, no studies

have been carried out to demonstrate their antiplasmodial activity. Less than half of these plants have antiplasmodial compounds isolated as shown in Table 2.

Table 2: Literature review of the plants used for management of malaria among the Luhya community of Kakamega East sub-County

Plant name Traditional uses In vitro and in vivo antimalarial activities Antimalarial compounds isolated

Justicia betonica L. Lower cholesterol, paralysis, earaches, headaches, bruises diarrhea, vomiting, constipation, pain and inflammation and Malaria (Gangabhavani and Ravishankar, 2013), Ether aerial parts extract had IC50 of 13.36 ^g/ml (Bbosa et al., 2013) No reference

Searsia natalensis (Bernh.ex C. Krauss) Malaria (Gathirwa et al., 2011), diarrhea, HIV (Mugisha et al., 2014) CHCl3 leaf extract had IC50 of 1.8 pg/ml (Katuura, et al., 2007). No reference

Carissa edulis L Sickle cell anemia, fever, epilepsy, pain (Ya'u et al., 2013), malaria (Orwa et al., 2007) DCM, stems extract had IC50 of 33 pg/ml (Clarkson et al., 2004) No reference

Spathodea campanulata P.Beauv. Malaria, herpes, fever, diabetes, dysentery, ulcers, HIV (Lim, 2013) Ethanolic leaf extract had IC50 >68 pg/ml (Rangasamy et al., 2008) Lapachol (Ntie-Kang et al., 2014)

Markhamia lutea (Benth.) K.Schum. Malaria (Lacroix et al., 2009)Anemia, diarrhea, microbial and parasitic infections (Ali et al., 2015) EtOAc, Leaf extract exhibited 70 % parasite suppression (Lacroix et al., 2011) musambins A-C & musambiosides A-C(Lacroix et al., 2009)

Warbugia ugandensis Sprague Worms, fever, gonorrhea, syphilis (Lacroix et al., 2011) (Were et al., 2010) DCM, stem bark extract of IC50 of 8 pg/ml (Wube et al., 2008) with 69% parasite inhibition (Were et al., 2010) coloratane sesquiterpenes.(Onguen et al., 2013)

Vernonia amygdalina Del. Febrifuge, vermifuge, laxative, malaria, wounds and as appetizer (Ifeoma and Chukwunonso, 2011) Ethanolic leaf extract IC50 of 9.83^g/ml (Omoregie et al., 2011) In-vivo parasite suppression of between 57.2-72.7 % in combination with CQ (Challand and Willcox, 2009) Vernolide, vernodalin, vernodalol &hydroxyvernolide (Onguen et al., 2013)

Tithonia diversifolia (Hemsl.) A. Gray Diabetes mellitus, sore throat, menstrual pain, malaria, wounds (Owoyele et al., 2004) ether extract of aerial parts had IC50 of 0.75 ^g/ ml(Goffin et al., 2002) whereas the methanolic extract had 74% parasitemia suppression (Oyewole et al., 2008) Tagitinin C (Onguen et al., 2013)

Acmella caulirhiza Del. Toothache, throat and gum infections, dysentery, DCM extract had IC50 < 10 pg/ml (Owuor et al., 2012) No reference

rheumatism, immune booster and malaria (Grubben, 2004)

Microglossa pyrifolia (Lam.) Kuntze Malaria (Jeruto et al., 2011)Headache, cough, flu, cleansing airway (Moshi et al., 2012) DCM, Leaf extract had IC50 of <15 pg/ml (Muganga et al., 2014) diterpeness (Kohler et al., 2002)

Cucumis aculeatus Cogn Diarrhea, leprosy, migraines, wounds, gonorrhea (Engels et al., 1991), malaria (Njoroge and Bussmann, 2006) Aqueous fruit extract had IC50 of >30 pg/ml (Gakunju et al., 1995) No reference

Crotom macrostachuys Höchst. ex Del. Diabetes, dysentery, wounds, malaria, purgative, stomachache (Gelaw et al., 2012) DCM, leaf extract IC50 of 2pg/ml (Owuor et al., 2012) No reference

Harungana madagascariensis Lam. ex Poir. Anemia, malaria (Iwalewa et al., 2008), fever, nephrosis, jaundice, gastrointestinal disorders (Okoli et al., 2002) Ethanolic stem bark extract had IC50 of <0.5 pg/ml and showed between 28.644.8% Parasite suppression (Iwalewa et al., 2008) Bazouanthrone, feruginin A, harunganin, harunganol A &B (Ntie-Kang et al., 2014)

Rotheca myricoides (Höchst.) Steane & Mabb. Measles, malaria, asthma, wounds, gonorrhea, rabies and eye disease (Hayelom et al., 2012) Methanolic leaf extract, IC50 of 9.51-10.56 |g/ml and 82 % parasite suppression at 600mg/kg (Deressa et al., 2010) No reference

Leucas calostachys Oliv. Colds, headache (Okello et al., 2010) malaria (Nyambati et al., 2013) Aqueous whole plant extract had IC50 of 0.8|g/ml with parasite inhibition of 3.5-5.2 % (Nyambati et al., 2013) No reference

Ocimun kilimandscharicum Gürke Colds, cough, analgesic, sedative, diarrhea, measles (Soni et al., 2012), malaria (Owuor et al., 2012) DCM, Leaves and twigs had IC50 of < 1.5 (Owuor et al., 2012) No reference

Fuerstia africana T.C.E.Fr. Eye ailments, toothache (Kipkore et al., 2014) malaria (Muganga et al., 2010) Pet-ether extract of aerial parts had IC50 of 1.5 pg/ml (Kigondu et al., 2011) Methanolic leaf extract had IC50 <15 pg/ml with > 70 % parasite suppression (Muganga et al., 2014) Ferruginol (Onguen et al., 2013)

Clerodendrum johnstonii Oliv. Abscess, hernia (Quattrocchi, 2012), malaria (Jeruto et al., 2011; Pascaline et al., 2011) No reference No reference

Plectranthus barbatus Andrews Gastritis, respiratory disorders, cough, analgesic, hypertension, stomachache, epilepsy (Fernandes et al., 2012) malaria, break fevers (Al-Musayeib et al., 2012) Methanolic extract had IC50 of 6.5 pg/ml, (Al-Musayeib et al., 2012) No reference

Ajuga integrifolia Buch.-Ham Albizia gummifera (J.F.Gmel.) C.A.Sm. Aqueous leaf extract exhibited 90% parasite Ajugarin-1(Onguen et al., 2013) ergosterol-5,8-

suppression (Gitua et al., 2012) endoperoxide (Ntie-Kang et al., 2014)

Albizia gummifera (J.F.Gmel.) C.A.Sm. Erythrina abyssinica DC. The alkaloidal fraction had IC50 of 0.06 |ug/ml while spermine alkaloid exhibited parasite suppression of 43 to 72% (Rukunga et al., 2007) spermine alkaloids (Rukunga et al., 2007)

Senna occidentalis (L.) Link Malaria , vermifuge, analgesic, laxative, hepatoprotective, diuretic and febrifuge (Silva et al., 2011) EtOH root bark extracts had IC50<3 pg/ml whereas 200 mg/kg of EtOH & DCM extracts exhibited >60% parasitaemia suppression.(Tona et al., 2001) Quinones (Kayembe et al., 2010)

Senna didmobotrya (Fresen.) H.S.Irwin & Barneby Intestinal worms, skin diseases, jaundice, veneral diseases, malaria, fever (Nagappan, 2012) DCM/MeOH. Twigs extract had IC50 of 9.5 pg/ml (Clarkson et al., 2004) No reference

Erythrina abyssinica DC. Abortion , cough, malaria (Lacroix et al., 2011) EtOAc, Bark extract showed 83 % parasite suppression (Lacroix et al., 2011) 5- deoxyabyssinin II and homobutein (Ntie-Kang et al., ^2014)

Trichilia emetica Vahl Diabetes, hypertension (Konaté et al., 2014), malaria (Diarra et al., 2015) DCM/MeOH (1:1), leaves & twigs extract had of IC50 of 3.5 pg/ml (Clarkson et al., 2004) Kurubasch aldehyde (Bero et al., 2009)

Mellia azedarach L. Hepatoprotective, malaria, skin diseases, ulcers, fever, vermifuge, asthma (Qureshi et al., 2016) DCM, Leaf extract had IC50 of 28 pg/ml (Lusakibanza et al., 2010) No reference

Cissampelos mucronata A.Rich Antisnake venom, veneral diseases, malaria, menstrual disorders, wounds, febrifuge (Nondo et al., 2011) EtOAc root extract had IC50 <3.91 with active compound, curine IC50 of 0.24 (Omole, 2012) curine (Ndiege, 2011)

Ficus thonningii Blume Malaria (Falade et al., 2014), Diabetes, diarrhea, mental illness, gonorrhea, urinary tract infections (Dangarembizi et al., 2013) Hexane, leaf extract IC50 of 10.4 pg/ml (Falade et al., 2014) No reference

Flueggea virosa (Roxb. ex Willd.) Royle Fever, stomachache, rheumatism, pneumonia, epilepsy, body pains (Magaji et al., 2007) malaria (Al-Rehaily et al., 2015) MeOH/H2O leaves extract had IC50 of 7.8 (Willcox et al., 2011a) Alkaloids: securinine and viroallosecurinine had IC50 values of 2.7 and 2.9 pg/mL respectively (Al-Rehaily et al., 2015) securinine and viroallosecurinine (Al-Rehaily et al., 2015)

Phyllanthus sepialis Müll.Arg. Tonic in pregnancy (PROTA, 2008) dental hygiene (Bussmann et al., 2006) No reference No reference

Pittosporum viridiflorum Sims Chest complains, purgative, male impotence, asthma, coughs (Dold and Cocks, 2012) malaria (Nyongbela et al., 2013) DCM whole plant extract had = IC50 of 3 pg/ml (Clarkson et al., 2004) triterpenoid estersaponin, active (Nyongbela et al., 2013) pittoviridoside (saponins) (Seo et al., 2002)

Rumex abyssinicus Jacq. Wounds, liver diseases, malaria, gonorrhea (Mulisa et al., 2015) DCM, root extract had IC50 <15 pg/ml, (Muganga et al., 2014) No reference

Rumex steudelii Hochst.ex A. Rich Antifertility, tonsillitis, wounds, eczema, hemorrhoids, leprosy (Solomon et al., 2010) (Gebrie et al., 2005) No reference No reference

Maesa lanceolata Forssk Malaria (Katuura, et al., 2007) Chloroform leaf extract IC50 of 1.6 |g/ml (Katuura, et al., 2007) DCM/MeOH (1:1) twigs extract IC50 of 5.9 |g/ml (Clarkson et al., 2004) No reference

Rubus pinnatus Wild Bleeding gums, expectorant, demulcent, diarrhea (Quattrocchi, 2012), malaria (Lacroix et al., 2011) EtOAc, leaf extract exhibited 20 % parasite suppression (Lacroix et al., 2011) No reference

Zanthoxylum gilletii (De Wild.) P.G.Waterman Stomachache, gonorrhea, back pain, urinogenital infections (Gaya et al., 2013).malaria (Masinde, 2014) DCM/MeOH (1:1) stem bark extract had IC50 of 2.52, 1.48 and 1.43 |g/ml against W2, D6 and 3D7 strains. (Masinde, 2014) Nitidine (Muganga et al., 2014) Seasamine 8-acetonyldihydrochelerythrine (Masinde, 2014)

Clausena anisata (Willd.) Hook.f. ex Benth. vermifuge, febrifuge, measles, hypertension, malaria, analgesic, rheumatism (Okokon et al., 2012) DCM, root extract had IC50 of 10 pg/ml (Clarkson et al., 2004) No reference

Physalis peruviana L. malaria, rheumatism, hepatitis, dermatitis, diuretic (Ramadan et al., 2015) No reference No reference

Solanum incanum L. Pneumonia, liver pain, headache, toothache, stomachache, sore throat (PROTA, 2008), malaria (Nguta et al., 2010) CHCl3/MeOH, leaf extract showed 31 % parasite suppression (Murithi et al., 2014) No reference

Lantana trifolia L. Common cold, asthma, epilepsy, madness, childhood cerebral malaria, sickle cell anemia.(Nalubega et al., 2013) Pet-ether aerial parts extract had IC50 of 13.2 pg/ml (Katuura et al., 2007) No reference

Rhoicissus tridentata (L.f.) Wild & R.B.Drumm. Dysmenorrhea, uterotonic, indigestion, pregnancy &childbirth. (Mukundi et al., 2015), malaria (Gakunju et al., 1995) Aqueous root extract had IC50 > 40 pg/ml (Gakunju et al., 1995) No reference

Aloe species Colds, malaria, Ether leaf extract of No reference

stomachache, anemia (PROTA, 2008)

A.dawei, IC50 of 7.9 pg/ml (Bbosa et al., 2013)

CHCl = Chloroform, DCM =Dichloromethane, EtOAc= Ethyl Acetate, MeOH= methanol, Pet-ether= Petroleum ether 3

Several ethnobotanical studies to identify antimalarial plants have been carried out in Kenya. These studies identify a variety of plants used by different ethnic communities or regions in Kenya. They include the Nandi (Jeruto et al., 2011), Digo in Kwale (Muthaura et al., 2007), Msambweni (Nguta et al., 2010), Kisumu (Orwa et al., 2007), Central Kenya communities (Njoroge and Bussmann, 2006) and Kilifi (Gathirwa et al., 2011). This is the first study to document antimalarial plants used among the Luhya community in Kenya.

The different Kenyan communities utilize plants within the local communities in the management of malaria. The differences in geographical and climatic conditions which determine the flora available in a given region. However some plants have a wider distribution and therefore most likely used by most communities. For instance, Aloe species and Melia azedarach L. are plants utilized in all these studied communities. Very few similarities were observed in the utilization of plants among the Luhya community and the Coast Kenya regions communities (Msambweni and Kilifi). For instance, only 3 plants were used in by both the Luhya and Kilifi communities.

Several similarities were observed in the antimalarial plants used in Central Kenya, Nandi and the Luhya community. For instance, 30 % of the plants used by the Luhya community were also utilized by the Nandi community. The Nandi and Luhya communities boarder each other. The similarities in the use of the plants could be either due to similarities in vegetation as a result or similar climatic conditions. It could also result from the interchange of knowledge within communities. It is therefore important to consider factors such as ecology, culture and even religious context in the protection of indigenous knowledge and not just a matter of ethnic group. To address this, the concept of 'Collective Biocultural Heritage' (BCH) was developed to consider cases where different communities share traditional knowledge within given shared territories and resources. This concept has been utilized in Peru where Inter-Community Agreement for equitable benefit sharing between 6 communities (Swiderska, 2007).

4. Conclusion

This study provides a documentation of plants used in the management of malaria in the Luhya community of Kakamega East sub-county. Most of the plants cited in this study have been reported elsewhere for management of malaria and have demonstrated antiplasmodial activities. This indicative of the rich nature of ethnomedical knowledge in this community. Rumex steudelii Hochst.ex A. Rich and Phyllanthus sepialis Müll.Arg are reported for the first time in the management of malaria. There is therefore need to preserve the ethnomdecine knowledge from this community given that most of the practitioners of traditional medicine are older generation with less education.

Conservation methods need to be put in place to secure the future of traditional medicine practice in this community. The current status of harvesting from the wild and use of roots and barks should be done in a sustainable manner. Members of the community should be educated on sustainable harvesting and cultivation of medicinal plants.

Funding

This research was supported by the Consortium for Advanced Research Training in Africa (CARTA). CARTA is jointly led by the African Population and Health Research Center (APHRC) and the University of the Witwatersrand and funded by the Wellcome Trust (UK) (Grant No: 087547/Z/08/Z), the Department for International Development (DfID) under the Development Partnerships in Higher Education (DelPHE), the Carnegie Corporation of New York (Grant No: B 8606), the Ford Foundation (Grant No: 1100-0399), Google.Org (Grant No: 191994), Sida (Grant No: 54100029), MacArthur Foundation (Grant No: 10-95915-000-INP) and British Council.

Acknowledgement

The authors thank CARTA Africa for funding the research. We are grateful to all the traditional herbal practitioners for their participation in the study. We thank Mr. Patrick Mutiso of the University of Nairobi, herbarium for identifying the plant species.

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Graphical abstact

Aim of study Identify antimalarial plants

Study area Kakamega East sub-County

Study population Traditional practitioners and those with experience in use of plants against malaria

Sample size 21 respondents

Method Ethnobotanical survey

Results 42 plants identified, 2 reported for the first time.