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PII: S0378-8741(17)32299-7
DOI: https://doi.org/10.1016/j.jep.2017.10.034
Reference: JEP11089
To appear in: Journal of Ethnopharmacology
Received date: 20 June 2017
Revised date: 30 October 2017
Accepted date: 31 October 2017
Cite this article as: Sultan Suleman, Takele Beyene Tufa, Dereje Kebebe, Sileshi
Belew, Yimer Mekonnen, Fanta Gashe, Seid Musa, Evelien Wynendaele, Luc
Duchateau and Bart De Spiegeleer, Treatment of Malaria and Related Symptoms
Using Traditional Herbal Medicine in Ethiopia, Journal of Ethnopharmacology,
https://doi.org/10.1016/j.jep.2017.10.034
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Treatment of Malaria and Related Symptoms Using Traditional Herbal
Medicine in Ethiopia
Sultan Suleman1,2*, Takele Beyene Tufa1,2,3,4, Dereje Kebebe1,2, Sileshi Belew1,2,3, Yimer
Mekonnen1,2, Fanta Gashe2, Seid Musa2, Evelien Wynendaele3, Luc Duchateau5, Bart De
Spiegeleer3
Jimma, Ethiopia.
2
School of Pharmacy, Jimma University, P.O.Box 378, Jimma, Ethiopia.
3
Drug Quality and Registration (DruQuaR) group, Faculty of Pharmaceutical Sciences, Ghent
Bishoftu, Ethiopia.
5
Department of Comparative Physiology and Biometrics, Faculty of Veterinary Medicine,
*Corresponding author
E-mail addresses:
SS: sultan.suleman@ju.edu.et
TBT: takele.beyene@aau.edu.et
DK: dereje.kebebe@ju.edu.et
SB:sbphar2009@gmail.com
YM: yimer.mekonnen@ju.edu.et
FG:fantwark@gmail.com
SM:plss1176@gmail.com
EW: ejwynend.Wynendaele@UGent.be
LD: Luc.Duchateau@UGent.be
BDS: Bart.Despiegeleer@UGent.be
1
ABSTRACT
Ethnopharmacological relevance: Medicinal plants have always been an integral part of
different cultures in Ethiopia in the treatment of different illnesses including malaria and related
and deforestation, there is an increased risk of losing this traditional knowledge. Hence, the use
of the indigenous knowledge should be well documented and validated for potential future use.
Aim of the study: To gather and document information on medicinal plants which are used in
Materials and Methods: First, an ethnomedicinal survey of plants was conducted in 17 districts
of Jimma zone, the Oromia national regional state of Ethiopia. Jimma zone is malarious and
rich in natural flora. A total of 115 traditional healers were interviewed using a semi-structured
questionnaire containing personal data of the respondents, and information on medicinal plants
used to treat malaria and related symptoms. In addition, a literature search using
indigenous use, in-vitro/in-vivo anti-malarial activity reports, and the chemical characterization
Results: From ethnomedicinal survey, a total of 28 species of plants used in the traditional
treatment of malaria and related symptoms in Jimma Zone were collected, identified and
documented. In addition, the literature search revealed that 124 medicinal plant species were
ethnomedicinal survey and the literature search, Asteraceae and Fabaceae were the most
represented families and Allium sativum L., Carica papaya L., Vernonia amygdalina Del.,
Lepidium sativum L. and Croton macrostachyus Del. were the most frequently reported plant
species for their anti-malarial use. The dominant plant parts used in the preparation of remedies
were leaves. About 54% of the medicinal plants documented in the survey have been reported
2
as an anti-malarial plant in the literature search. Furthermore, the in-vitro and in-vivo anti-
plasmodial activity reports of extracts from some of plant species were found to support the
traditional claim of the documented plants. Moreover, literatures indicate that several secondary
metabolites isolated from certain plant species that are traditionally used for the treatment of
Conclusions: The result of the current study showed that traditional knowledge is still playing
an important role in the management of malaria and related symptoms in Ethiopia. Allium
sativum L., Carica papaya L., Vernonia amygdalina Del., and Lepidium sativum L. are the
most commonly reported species as anti-malarial plants and the traditional claim of some
species was supported by known anti-plasmodial activity and bioactivity reports. The finding of
this study is important in the rational prioritization of plant species which are potentially used
for investigating new compounds, which could be efficacious for malaria treatment.
Traditional treatment
1. INTRODUCTION
Malaria continues to have a devastating impact on public health. The WHO estimates that
212 million cases occurred globally in 2015, leading to 429 000 deaths, most of which were in
children aged under 5 years in Africa (WHO, 2016). Approximately, 68% of Ethiopia’s total
Malaria is among the ten top causes of morbidity and admission in Ethiopia (Federal Ministry
of Health of Ethiopia, 2015). Despite major progresses made to improve the health coverage of
the country, a wide range of differences in the coverage of services and distribution of health
facilities persists among regions as well as between urban and rural areas. The available option
3
for the population is, therefore, the use of traditional herbal medicines. Moreover, the
increasing global spread of drug resistance to most of the available and affordable anti-malarial
drugs is a major concern and requires innovative strategies to combat the disease. There is an
urgent need for new chemotherapeutic compounds and thus one of the possible sources for such
new treatments lies in the use of traditional herbal remedies (Bagavan et al., 2011).
Traditional medicines have been used to treat malaria for thousands of years and are the
source of the two main groups (artemisinin and quinine derivatives) of modern anti-malarial
The Ethiopian flora is rich with a lot of medicinal plants and for centuries indigenous
people have been using them for various physical and mental disorders and other diseases
(Debella, 2014). Malaria is one of the public health problem in Ethiopia and people living in
malaria endemic remote rural areas commonly use different medicinal plants for the treatment
of malaria. Despite the wide use of medicinal plants in the traditional health care, the
information has not been documented in a scientific way and there is an increased risk of losing
this traditional knowledge. Therefore, this study was conducted to gather and document
information on medicinal plants that are being used in the traditional treatment of malaria and
related symptoms in Ethiopia, which is useful in rational prioritization of plant species for
further investigation, and integrating these medicinal plants into the modern medicine through
2. METHODS
With the aim of gathering and documenting information on medicinal plants being used
in the traditional treatment of malaria and related symptoms in Ethiopia, the study involved an
4
2.1 Ethnomedicinal Survey
The ethnomedicinal survey of plants traditionally used in the treatment of malaria and
related symptoms was conducted in the 17 malarious districts of Jimma zone. Jimma zone was
purposively selected since almost all the districts are malarious and it is in the rich natural flora
of the southwest of the country. Due to high rainfall, all the districts of the zone are rich in
Jimma zone is one of the 12 zones of Oromia regional state in southwest Ethiopia with
its capital, Jimma town (Figure 1). It is located 357 kms southwest of Addis Ababa. The zone
o o o o
extends between 7 13’- 8 56’ north latitudes and 35 49-38 38’ east longitudes. Jimma zone
generally lies between 1000 and 3500 meters above sea level. The annual rainfall lies between
The ethnomedicinal survey was conducted from September to December 2013. With the
assistance of the local administrator, local people and field assistants, a total of 120 traditional
healers were initially identified in the zone and 115 of them became volunteers to be involved
5
in the study. The traditional healers were approached through community leaders and the
purpose and the benefits of the study were briefly explained to them. Using semi-structured
interview, the ethnomedicinal data were collected on knowledge of malaria and medicinal
plants used for the treatment of malaria and related symptoms, parts used, mode of
At the end of the interview, the reported medicinal plants were collected from natural
vegetation or home garden with the help of the traditional healers. The collected plant
specimens were dried, identified and deposited at Jimma University, Biology department
herbarium. Identification was performed by using taxonomic keys and floras and by
comparison with the already identified herbarium specimen by the botanist of the department of
biology, Jimma University. The name of each plant species has been checked with
http://www.theplantlist.org.
The collected data were entered into SPSS version 16, analyzed and summarized using
simple descriptive statistics. Different indices were also used to summarize the results of the
questionnaire.
The frequency index (FI) corresponds to the percentage of informants that mentions the
use of the plant species for the management of malaria (Mahwasane et al., 2013) and is given
by =
× !! where FC the number of informants who mentioned the use of the species
A literature review was carried out through a computer search of the databases
Medline/PubMed, Google Scholar, ScienceDirect and HINARI using a search strategy with
6
keywords ethnopharmacological survey, ethnomedicine, ethnobotany, traditional medicine,
herbal medicines, medicinal plants, treatment of malaria and Ethiopia. Additionally, the grey
Potentially relevant original articles were selected by the following inclusion criteria:
(1) Describe at least one species of medicinal plants used in the treatment of malaria and related
symptoms, (2) Describe the medical uses, parts used, habitat, methods of preparation and route
of administration of medicinal plants, (3) Studies conducted in Ethiopia, and (4) Published in
English language.
The selection of the articles was done in three steps. In the first step, the relevance of the
studies was checked based on their title. Some articles could be excluded just based on the title.
In the second step, abstracts were evaluated and based on that, the articles were excluded if
they did not match to the inclusion criteria. For the remaining publications, the whole content
of the articles was accessed (Figure 2). The screening process was performed by two
The terms: title, authors, year of publication, study design, study site (region), sample
size, type of respondents, the number of plant species used in the treatment of malaria, habitat,
parts used, and the method of preparation were extracted from the eligible published
papers/articles.
Previous reports on the anti-plasmodial activity of extracts and isolated compounds from
the plant species identified in this study were searched in scientific databases using the
‘scientific name’ of the plant, ‘anti-malarial’ and ‘compound’ as search terms. Activities of
extracts were classified as follows: high or pronounced activity (IC50 ≤ 5 μg/ml); good or
promising activity (5 μg/ml < IC50 ≤ 15 μg/ml); moderate activity (15 μg/ml < IC50 ≤ 50 μg/ml)
and weak activity (50 μg/ml < IC50 ≤ 100 μg/ml). A pure compound is defined as highly active
when it’s IC50 ≤ 1 μg/ml (Jonville et al., 2008; Memvanga et al., 2015).
This study was reviewed and approved by the Ethical Clearance Committee (JURO/04/2013) of
the Jimma University. Verbal informed consent was obtained from all respondents who
participated in the study after explaining the purpose and objectives of the study in the local
language. Participation in the study was voluntary and confidentiality of the information was
8
assured both during and after data collection. The respondents were informed about their right
either not to participate, not to answer any question or all the questions.
3. RESULTS
A total of 115 traditional healers (98 male and 17 female) from the 17 malarious
districts of Jimma zone were involved in the ethnomedicinal survey. Twenty-one of them were
not willing to give sufficient information about the name of the plant they use to treat illnesses
because they had been told by their parents not to tell the information except to their family
members. The study revealed that men have more involvement in traditional medical practice
than women, which could be due to the fact that parents usually prefer boys in the transfer of
the indigenous knowledge. The study also showed that most of the traditional medical
practitioners (83%) were ≥ 40 years old. Most of the healers (63.7%) reported that they
acquired the knowledge from their family; while the remaining proportion gained the
knowledge through other means such as from friends, local elders, Quran and neighbour.
The term ‘Busaa’ (in Afaan oromoo) or ‘Woba’ (in Amharic) was used to denote
malaria and related symptoms in local languages. The healers reported to use different signs
and symptoms, namely headache (103), fever (97), vomiting (68), joint pain (65), shivering
(64), chills (53), loss of appetite (51) and other (8) to diagnose malaria. Moreover, the
traditional healers reported that they conventionally define malaria and related illnesses in
From the traditional healers interviewed, 78% had an experience of treating patients
with malaria and related symptoms using medicinal plants. Most of the respondents (78.3%)
9
3.1.2 Medicinal plants, parts used and habit
traditional healers as being used for the treatment of malaria and related symptoms in Jimma
zone (Table 1). Most of the medicinal plants used were trees (36%), followed by shrubs (32%).
The frequency index result showed that Allium sativum L. and Carica papaya L. showed the
highest incidence of use (Table 1), claimed by 31 (32.9%) and 27 (28.7%) traditional healers,
respectively. Lepidium sativum L., Brassica nigra (L.) K.Koch and Vernonia amygdalina Del.
were also reported by 12 (12.8 %), 9 (9.6 %), and 7 (7.4 %) respondents, respectively.
The plant parts most frequently used were leaves. Most of the plants were collected
from wild. Informants in the study area confirmed that most of medicinal plants can be
collected in all seasons (57.1%), and at any time (85.7%) of the day. Almost all of the herbal
preparations used for the treatment of malaria and related symptoms in this study area were
taken by oral route. Herbal medicines were commonly prepared using water and honey as
excipients, but occasionally remedies were prepared with other excipients including milk,
coffee, butter, table salt, sugar and tea. Some of the remedies were used directly without using
excipients.
10
Table 1. Plant species used in the treatment of malaria and related symptoms by traditional healers (n = 94) of Jimma Zone
Vernacular Name Scientific Name Family Voucher Life form Part(s) used Site of growth Mode of use Dosage Route of No of
No Administration informants
O
Qulubi adi Allium sativum L. Amaryllidaceae DK020 Herb Root Domestic Fresh /Dried Juice Oral 31
A
Papaya Carica papaya L. Caricaceae DK010 Tree Leaf / Fruit / Root Domestic Fresh /Dried Powder Oral 27
/Decoction
ShinfaO Lepidium sativum L. Brassicaceae DK027 Herb Seed Domestic Fresh /Dried Juice Oral 12
SenafichA Brassica nigra (L.) K. Koch Brassicaceae DK024 Herb Seed Domestic Fresh /Dried Powder Oral /Topical 9
GirawaA Vernonia amygdalina Del. Asteraceae DK005 Shrub Leaf / Flower Wild Fresh Juice Oral 7
Tikur asmudA Nigella sativa L. Ranunculacae DK014 Herb Seed Domestic Fresh /Dried Powder Oral 7
DamakaseO Ocimum lamiifolium Hochst. ex Benth Lamiaceae DK002 Shrub Leaf / Flower Wild Fresh /Dried Tea /Powder Oral 6
MakanisaO Croton macrostachyus Hochst. ex Del. Euphorbiaceae DK009 Tree Leaf Wild Fresh Powder Oral /Inhalation 6
AgamA Carissa spinarum L. Apocynaceae DK011 Shrub Leaf/ Root Wild Fresh /Dried Tea Oral 3
BarbareA Capsicum frutescens L. Solanaceae DK003 Herb Fruit Domestic Fresh /Dried Juice Oral 2
Barzafi adiiO Eucalyptus globulus Labill. Myrtaceae DK021 Tree Fruit Domestic Fresh Juice Oral 2
HudhaO Ximenia americana L. Olacaceae DK007 Tree Stem Wild Fresh /Dried Juice Oral 2
LomiA Citrus limon (L.) Osbeck Rutaceae DK012 Tree Fruit Wild Fresh Powder Oral 2
ShiferawA Moringaceae DK015 Tree Leaf Wild Fresh /Dried Juice Oral 2
Moringa stenopetala (Baker f.) Cufod.
AnunnuO Ekebergia capensis Sparrm. Meliaceae DK008 Tree Root Wild Dried Powder Oral 1
AzamirA Bersama abyssinica Fresen. Francoaceae DK017 Tree Leaf Wild Dried Powder Oral 1
DhumugaO Justicia schimperiana (Hochst. ex Nees) T. Anderson Acanthaceae DK013 Shrub Leaf Wild Fresh Juice Oral 1
EmbuayA Solanum incanum L. Solanaceae DK018 Shrub Seed Wild Dried O Oral /Inhalation 1
EnjoriA Rubus steudneri Shweinf. Rosaceae DK001 Shrub Root Wild Dried Powder Oral 1
Jinjible A Zingiber officinale Roscoe Zingiberaceae DK006 Herb Root Domestic Dried Powder Oral 1
QommonyoO Brucea antidysentrica J.F.Mill. Simaroubaceae DK019 Shrub Bark Wild Dried Powder Oral 1
QurquraO Ziziphus mauritiana Lam. Rhamnaceae DK016 Tree Leaf Wild Fresh /Dried Juice Oral 1
SanamakiiO Senna didymebotrya (Fresen.) H.S.Irwin & Barneby Fabaceae DK022 Shrub Leaf Wild Dried Tea Oral 1
SunqooO Trigonella foenum-graecum L. Fabaceae DK023 Herb Seed Domestic Fresh /Dried Juice Oral 1
TelbaA/O Linum usitatissimum L. Linaceae DK026 Herb Seed Domestic Fresh /Dried Juice Oral 1
WanzaA Cordia africana Lam. Boraginaceae DK028 Tree Leaf Wild Dried Powder Oral /Topical 1
SoyyomaO Vernonia species* Asteraceae DK025 Shrub Leaf Wild Fresh Juice Oral 1
Ye medir embuayA Cucumis prophetarum L. Cucurbitaceae DK004 Climber Fruit/ Root Wild Dried Powder Oral 1
Vernacular name: A = Amharic, O = Afaan Oromoo
*the species could not be identified
11
3.2 Literature Search
In this literature search, a total of 124 medicinal plant species belonging to 55 families
and 99 genera were reported to be used in the treatment of malaria and related symptoms in
Ethiopia (Table 2). The number of cited anti-malarial plant species, which were originated from
surveys in all regional states of Ethiopia except Gambella (Appendix 1), varied from study to
study.
The most frequently cited plant species by the studies were Allium sativum L., Carica
papaya L., Vernonia amygdalina Del., Lepidium sativum L., and Croton macrostachyus Del.
and Adhatoda schimperiana Hochst.. In this literature review, only two species of plants which
are endemic to Ethiopia (Leucas stachydiformis Hochst. ex Benth. and Aloe pirottae A. Berger)
were reported to be used in the treatment of malaria (Etana, 2010; Belayneh and Bussa, 2014).
preparations. The modes of preparation include crushing, boiling and squeezing. Certain
additives are frequently used to improve the acceptability of some remedies that are taken
orally. This could be water, honey, sugar, milk, local alcohol and butter.
12
Table 2. Summary of medicinal plants identified from the literature search
Number
Plant species Family Local name Life form Parts used References
of citation Number of
Plant species Family Local name Life form Parts used References
citation
Acacia mellifera (Vahl) Benth. Fabaceae Aygae (Ka) Tree Leaf 1 Teklehaymanot and Giday, 2010
Acacia robusta Burch. Fabaceae Wangeyo (Or) Tree Root 1 Belayneh et al., 2012
Acacia seyal Delile. Fabaceae Tundukiyac (Ko) Tree Gum-bark 1 Mesfin et al., 2014
Acalypha indica L. Euphorbiaceae Habrid (So) Herb Aerial part 1 Mesfin et al., 2012
Acalypha species Euphorbiaceae Subaci (Af) Herb Whole plant 1 Seifu et al., 2006
Acanthus polystachius Delile. Acanthaceae Dendero (Am) Herb Root 1 Giday et al., 2007
Acokanthera schimperi (A. DC.) Belayneh et al., 2012; Mesfin et al., 2012; Belayneh and
Apocynaceae Kararo (Or) Shrub Leaf, Stem 3
Schweinf. Bussa, 2014
Justicia schimperiana (Hochst. ex Nees) T.
Sensel (Am), Gedif and Hahn, 2002; Seid and Tsegay, 2011; Zerabruk
Anderson Acanthaceae Herb Leaf 5
Dhumuga (Or) and Yirga, 2012; Regassa, 2013; Gebeyehu, 2011
Afrocarpus gracilior (Pilg.) C.N.Page Podocarpaceae Zigba (Am) Tree Leaf 1 Dori et al., 2012
Ajuga remota Benth. Lamiaceae Armagusa (Or) Herb Leaf 1 Suleman et al., 2009
Albizia amara (Roxb.) B.Boivin Fabaceae Ondoddee (Or) Tree Bark 1 Mesfin et al., 2014
Allium cepa L. Amaryllidaceae Key shinkurt (Am) Herb Bark 2 Gabriel and Guji, 2014; Getaneh et al., 2014
Gedif and Hahn, 2002; Tadesse et al., 2005; Mesfin et al.,
2009; Amenu, 2007; Gashe and Worku, 2007;
Teklehaymanot et al., 2007; Suleman et al., 2009; Etana,
Qulubi adii (Or), 2010; Gebrehiwot, 2010; Yirga, 2010b, 2010c; Beyene,
Allium sativum L. Amaryllidaceae Herb Bark 22
Nech shinkurt (Am) 2011; Guji et al., 2011; Seid and Tsegay, 2011; Zerabruk et
al., 2012; Lulekal et al., 2013; Megersa et al., 2013;
Regassa, 2013; Teklay et al., 2013; Abera, 2014; Gabriel
and Guji, 2014; Mesfin et al., 2014
Aloe macrocarpa Tod. Asphodelaceae Algae (Sd) Shrub Leaf, Latex 1 Regassa, 2013
Aloe megalacantha Baker. Asphodelaceae Ere (T) Shrub Root 1 Teklay et al., 2013
Table 2. (continued)
13
Leaf,
Aloe pirottae A. Berger Asphodelaceae Hargeysa (Or) Shrub 1 Belayneh and Bussa, 2014
Latex
Leaf, Seifu et al., 2006; Giday et al., 2007; Mesfin et
Aloe sp. Asphodelaceae Eret (Am) Shrub 3
Latex al., 2012
Bark,
Andrachne aspera Spreng. Euphorbiaceae unknown Herb 1 Hunde et al., 2006
Root
Anethum graveolens L. Apiaceae Karmn (So) Shrub Leaf, Root 1 Mesfin et al., 2012
Anogeissus leiocarpa (DC.) Guill. &
Combretaceae Hanse (T) Tree Leaf, Bark 1 Zenebe et al., 2012
Perr.
Artemisia abyssinica Sch.Bip.ex Herb
A.Rich. Asteraceae Sunadohayiso (Sd) Leaf 1 Beyene, 2011
Artemisia afra Jacq. ex Willd. Asteraceae Chikun (Am) Herb Leaf 2 Mesfin et al., 2009; Bekele and Reddy , 2015
Artemisia rehan Choiv. Asteraceae Nechryan (Am) Herb Leaf 1 Gedif and Hahn, 2002
Asparagus africanus Lam. Liliaceae Sariitii, Ged-ay (T) Shrub Leaf 2 Mesfin et al., 2012
Tree Giday et al., 2007; Dori et al., 2012; Mesfin et
Azadirachta indica A. Juss. Meliaceae Kinina (Or), Neem Leaf 4
al., 2012; Belayneh and Bussa, 2014
Balanites aegyptiaca (L.) Del. Zygophyllaceae Bedeno (Or), Tree Leaf, Root 1 Belayneh et al., 2012
Balanites rotundifolia (Tiegh.) Blatt. Zygophyllaceae Qaalayto (Af) Shrub Leaf 2 Seifu et al., 2006; Mesfin et al., 2012
Tree Whole
Bersama abyssinica Fresen. Francoaceae Lolchiisaa (Or) 1 Abera, 2003
part
Boscia coriacea Pax Capparaceae Shodo (Ka) Tree Root 1 Teklehaymanot and Giday, 2010
Brassica carinata A.Braun Tree
Brassicaceae Shaana (Sd) Seed 1 Regassa, 2013
Brassica nigra (L.) K.Koch Brassicaceae Senaficha (Or) Herb Seed 1 Guji et al., 2011
Stem, Abera, 2003; Suleman et al., 2009; Suleman
Brucea antidysentrica J.F. Miller Simaroubaceae Kumegno, Aballo (Or) Shrub 3
Bark and Alemuet al., 2012
Kamppaaraa, Adano
Buddleja polystachya Fresen. Scrophulariaceae Shrub Leaf 2 Bekalo et al., 2009; Gebrehiwot, 2010
(Kon)
Giday et al., 2007; Regassa, 2013; Gebeyehu,
Calpurnia aurea (Ait.) Benth Fabaceae Digita (Am) Tree Leaf 3
2011
Capparis tomentosa Lam. Capparaceae Gumero (Am) Shrub Root 1 Teklehaymanot et al., 2007
Giday et al., 2007; Chekole et al., 2015;
Capsicum annuum L. Solanaceae Mitmita (Am) Herb Fruit 3
Kidane et al., 2014
Table 2. (continued)
Plant species Family Local name Life Parts used Number of References
14
form citation
Tadesse et al., 2005; Amenu, 2007; Giday et al.,
2007; Teklehaymanot and Giday, 2007; Bekalo et al.,
2009; Suleman et al., 2009; Etana, 2010; Giday et al.,
Carica papaya L. Caricaceae Papaya (Am) Tree Leaf, Root 16
2010; Seid and Tsegay, 2011; Beyene, 2011;
Suleman et al., 2012; Megersa et al., 2013; Regassa,
2013; Abera, 2014; Chekole et al., 2015
Carissa spinarum L. Apocynaceae Agamsa (Or) Shrub Root 1 Gebrehiwot, 2010
Cicer arietinum L. Fabaceae Shinbira (Am) Herb Seed 1 Chekole et al., 2015
Menispermacea Guji et al., 2011
Cissampelos mucronata A. Rich Jebcha (G) Climber Root 1
e
Menispermacea Teklehaymanot and Giday, 2007
Cissampelos pareira L. Gud (Ka) Climber Root 1
e
Root, Mesfin et al., 2012
Cissus rotundifolia Vahl Vitaceae Armon (So) Clilmber 1
Root-Bark
Clerodendrum myricoides (Hochst.) Wondimu et al., 2007; Gebrehiwot, 2010; Gebeyehu,
Lamiaceae Maraasisaa (Or) Shrub Root 3 2011
R.Br. ex Vatke
Clutia abyssinica Jaub. & Spach Euphorbiaceae unkown Shrub Leaf, Fruit 1 Seid and Tsegay, 2011
Combretum molle R.Br. ex G.Don Combretaceae Agalo (Am) Shrub Leaf, Bark 1 Mesfin et al., 2014
Whole Mesfin et al., 2014
Commiphora africana (A.Rich.) Endl. Burseraceae Unknown Shrub 1
part
Conyza pyrrhopappa Sch.Bip. ex A.Rich. Asteraceae Dadaho (So) Tree Leaf 1 Mesfin et al., 2012
Root, Mesfin et al., 2014
Cordia africana Lam. Boraginaceae Wanza (Am) Shrub 1
Bark
Crabbea velutina S.Moore Leaf, Dori et al., 2012
Acanthaceae Malgissa (Ks) Shrub 1
Stem
Gedif and Hahn, 2002; Tadesse et al., 2005; Mesfin
et al., 2009; Giday et al., 2007; Suleman et al., 2009;
Croton macrostachyus Hochst. ex Root,
Euphorbiaceae Makanisaa (Or) Tree 12 Etana, 2010; Suleman et al., 2012; Teklay et al., 2013;
Delile. Bark
Abera, 2014; Gebeyehu, 2011; Mesfin et al., 2014;
Bekele and Reddy, 2015
Table 2. (continued)
Number of
Plant species Family Local name Life form Parts used References
citation
Cucumis ficifolius A. Rich. Cucurbitaceae Anundemerit (So) Herb Whole plant 1 Mesfin et al., 2012
15
Cucurbita spp. Cucurbitaceae Gim Hareg /Dursht (Am) Climber Root 1 Teklehaymanot et al., 2007
Datura stramonium L. Solanaceae Manji (Or) Herb Fruit 1 Amenu, 2007
Giday et al., 2007; Belayneh et al., 2012;
Dodonaea angustifolia L.f. Sapindaceae Kitkita (Am) Tree Seed, Leaf, Fruit 4
Teklay et al., 2013; Gebeyehu, 2011
Dodonaea viscosa (L.) Jacq. Sapindaceae unknown Shrub Fruit 1 Yirga, 2010a
Droguetia iners (Forssk.) Schweinf. Urticaceae Yewoba medihanit (Am) Herb Leaf 1 Tolossa et al., 2013
Echinops amplexicaulis Oliv. Asteraceae Joga (G) Herb Root 1 Guji et al., 2011
Echinops hoehnelii Schweinf. Asteraceae Qeber (SK) Herb Root 1 Getaneh et al., 2014
Euclea divinorum Hiern Ebenaceae Baarzaafiiadii (Or) Shrub Root 1 Dori et al., 2012
Euphorbia abyssinica J.F.Gmel. Euphorbiaceae Kulkual (Am) Tree Nectar 2 Belayneh et al., 2012
Ficus platyphylla Delile. Moraceae Hadawa (Ks) Tree Bark 1 Dori et al., 2012
Ficus sur Forssk. Moraceae Odako (Sd) Tree Fruit 1 Beyene, 2011
Foeniculum vulgare Miller Apiaceae Kelela (Or) Herb Root 2 Gedif and Hahn, 2002; Mesfin et al., 2012
Gardenia lutea Fresen. Rubiaceae Gambelo (Sh) Tree Root 1 Giday et al., 2009b
Gardenia ternifolia Schumach. & Tree Leaf, Stem, Abbink, 1993; Yineger et al., 2008; Giday
Rubiaceae Gembala (Ma) 4
Thonn. Bark et al., 2009b; Kidane et al., 2014
Gnidia involucrata Steud. ex A.Rich. Thymelaeaceae Yezinjero telba (Am) Herb Leaf 1 Gebeyehu, 2011
Halothamnus somalensis (N.E.Br.)
Amaranthaceae Mirow (So) Shrub Root 1 Mesfin et al., 2012
Botsch.
Harrisonia abyssinica Oliv. Rutaceae Moy Moy (KW) Tree Root, Bark 1 Teklehaymanot and Giday, 2010
Hydnora johannis Becc. Aristolochiaceae Liko (So) Stem Root 1 Mesfin et al., 2012
Table 2. (continued)
Number
Life
Plant species Family Local name Parts used of References
form
citation
Hypoestes forsskaolii (Vahl) R.Br. Acanthaceae Kuneyta (Kon) Herb Leaf, Root 1 Dori et al., 2012
16
Indigofera articulata Gouan Fabaceae Gabalday (So) Shrub Root 1 Mesfin et al., 2012
Indigofera coerulea Roxb. Fabaceae Gabalday(So) Herb Leaf 1 Mesfin et al., 2012
Indigofera Sp. Fabaceae Wende Ayrowagit (Am) Herb * 1 Seifu et al., 2006
Indigofera spicata Forssk. Fabaceae Shersherit, Am) Herb Root 1 Giday et al., 2009b
Ipomoea kituiensis Vatke Convolvulaceae Laalata (Ko) Climber Leaf 1 Mesfin et al., 2014
Jatropha curcas L. Euphorbiaceae Habet-muluk (So) Shrub Stem 1 Mesfin et al., 2012
Lagenaria siceraria (Molina) Standl. Cucurbitaceae Buqqe hadhaa (Or) Climber Fruit 1 Amenu, 2007
Lantana trifolia L. Verbenaceae Yewoba medihanit (Am) Shrub Root 1 Tolossa et al., 2013
Root, Root
Lawsonia inermis L. Lythraceae Elan (So) Tree 1 Mesfin et al., 2012
stem
Hunde et al., 2006; Mesfin et al., 2009; Amenu,
2007; Ragunathan and Abay, 2009; Etana, 2010;
Guji et al., 2011; Dori et al., 2012; Suleman et al.,
Lepidium sativum L. Brassicaceae Shinfa Herb Seed 13
2012; Megersa et al., 2013; Abera, 2014; Bekele et
al., 2015; Gabriel and Guji, 2014; Mesfin et al.,
2014
Root, Root-
Leptadenia hastata (Pers.) Decne. Apocynaceae Mesker (So) Climber 1 Mesfin et al., 2012
stem
Leucas stachydiformis (Hochst. ex
Lamiaceae Qumudu (Or) Herb Whole plant 1 Etana, 2010
Benth.)
Lobelia sp. Campanulaceae Jibira (Am) Shrub Root 1 Giday et al., 2007
Lycium Shrubawii Roem and Schult Solanaceae Hedalusayto (Af) Shrub Root 1 Seifu et al., 2006
Lysimachia ruhmeriana Vatke Primulaceae Corqqaa Herb Root 1 Bekalo et al., 2009
Maerua oblongifolia (Forssk.) A.Rich.
Capparaceae Ja’a (So) Shrub Leaf 1 Mesfin et al., 2012
17
Table 2. (continued)
Number
Life
Plant species Family Local name Parts used of References
form
citation
Flatie et al., 2009; Etana, 2010; Beyene, 2011;
Melia azedarach L. Meliaceae Almim, kinini, niim Tree Leaf, Root 4
Regassa, 2013
Mentha spicata L. Lamiaceae Nana (So) Herb Aerial part 1 Mesfin et al., 2012
Moringa oleifera Lam. Moringaceae Birbira (Or) Tree Leaf 2 Suleman et al., 2009; Seifu et al., 2006
Tree Bekalo et al., 2009; Dori et al., 2012; Regassa,
Moringa stenopetala (Baker f.) Moringaceae Shiferaw (Am) Root, Leaf 4
2013; Kidane et al., 2014
Myrsine africana L. Primulaceae Kechemo (Or) Shrub Leaf 1 Suleman et al., 2009
Nigella sativa L. Ranunculaceae Tikurazmud (Am) Herb Seed 1 Suleman et al., 2009
Ocimum gratissimum L. Lamiaceae Damakasse (Am, Or) Herb Leaf 1 Suleman et al., 2009
Ocimum lamiifolium Hochst. ex Benth Lamiaceae Damakesse (Am, Or) Shrub Leaf 3 Seid and Tsegay, 2011; Suleman et al., 2009
Ocimum spicatum Deflers Lamiaceae Shero (So) Herb Leaf 1 Mesfin et al., 2012
Olea africana Mill. Oleaceae k'erach (Me) Tree Bark 1 Abbink, 1993
Tree Abbink, 2002; Suleman et al., 2009; Teklay et
Olea europaea L. Oleaceae Weyra (Am) Bark 3
al., 2013
Osyris quadripartita Salzm. ex Decne Santalaceae Wato (Or) Shrub Leaf, Root 1 Belayneh et al., 2012
Otostegia integrifolia Benth. Lamiaceae Tinjut (Am) Shrub Leaf 2 Giday et al., 2007; Teklehaymanot et al., 2007
Not
Phyllanthus maderaspatensis L. Phyllanthaceae unknown Herb 1 Hunde et al., 2006
mentioned
Mesfin et al., 2009; Gebrehiwot, 2010; Chekole
Phytolacca dodecandra L'Hér. Phytolaccaceae Indode (Am) Shrub Leaf, Root 4
et al., 2015; Bekele and Reddy, 2015
Giday et al., 2007; Teklehaymanot and Giday,
Plumbago zeylanica L. Plumbaginaceae Warwaro (Ka) Herb Root 2
2010
Yewoba medihanit
Premna oligotricha Baker Lamiaceae Shrub Leaf 1 Tolossa et al., 2013
(Am)
Prunus persica (L.) Batsch Rosaceae Kok (Am) Tree Seed 1 Giday et al., 2007
Pupalia micrantha Hauman Amaranthaceae Mara’abis (So) Shrub Root 1 Mesfin et al., 2012)
Rhus natalensis Bernh. ex C. Krauss Anacardiaceae unknown Shrub Leaf 1 Mesfin et al., 2014
Ruta chalepensis L. Rutaceae Tenadam (Am) Herb Leaf 2 Amenu, 2007; Mesfin et al., 2014
Salsola somalensis N.E. Br. Amaranthaceae Korsaduma (Or) Shrub Leaf 1 Suleman et al., 2009
18
Table 2. (continued)
Parts Number of
Plant species Family Local name Life form References
used citation
Seifu et al., 2006; Teklehaymanot, 2010; Mesfin et
Salvadora persica L. Salvadoraceae Qadayto (Af) Shrub Root 3
al., 2012
Schinus molle L. Sapindaceae Qundo-berbere (Am) Tree Seed 1 Giday et al., 2007
Herb
Senna italica Mill. Fabaceae Sete Ayrowagit (Am) Leaf 2 Seifu et al., 2006; Yirga, 2010b
Silene macrosolen Steud. ex A. Rich. Herb
Caryophyllaceae Saerosaero (T) Root 1 Teklay et al., 2013
Tree
Syzygium guineense (Willd.) DC. Myrtaceae Duwancho (Ko) Leaf 1 Mesfin et al., 2014
Tree Flatie et al., 2009; Belayneh et al., 2012; Mesfin et
Tamarindus indica L. Fabaceae Roka (Or, S) Seed 3
al., 2012
Turraea mombassana C. DC. Meliaceae Pitercama (Ko) Shrub Root 1 Dori et al., 2012
Zebko (Ka),
Uvaria leptocladon Oliv. Annonaceae Tree Root 1 Teklehaymanot and Giday, 2010
Chochum (Kw)
Gedif and Hahn, 2002; Hunde et al., 2006; Mesfin et
al., 2009; Amenu, 2007; Lulekal et al., 2008; Etana,
Vernonia amygdalina Del. Asteraceae Ebicha (Or) Shrub Leaf 14 2010; Beyene, 2011; Dori et al., 2012; Megersa et
al., 2013; Regassa, 2013; Abera, 2014; Kidane et al.,
2014; Mesfin et al., 2014
Vernonia sp. Asteraceae Heten (Be) Shrub Leaf 1 Flatie et al., 2009
Withania somnifera (L.) Dunal Gizawa (Am), Gedif and Hahn, 2002; Dori et al., 2012; Mesfin et
Solanaceae Shrub Leaf 4
Kumo (Or) al., 2012; Abera, 2014
Zaleya pentandra (L.) C.Jeffrey Whole
Aizoaceae Abuuri (Af) Herb 1 Seifu et al., 2006
plant
Zehneria scabra Sond. Cucurbitaceae Areg-resa (Am) Climber Root 2 Giday et al., 2007; Getaneh et al., 2014
Local name: Af - Afar; Am - Amharic, Be - Berta; G - Gumz; Ka - Kara; Ko - Koorete; Kon - Konso; Kw - Kwego; Ma - Maalee, Me - Me’en; Or - Afan Oromo; Sh - Shinasha, Sd - Sidama;
Sk - Skeko; So - Somali; T - Tigray.
19
3.3 Comparative analysis of the survey with the literature search
The uses of medicinal plants documented in the ethnomedicinal survey of plants used for
the treatment of malaria and related symptoms were compared with the previous
ethnomedicinal studies from different parts of Ethiopia. The comparison showed that 54% of
medicinal plant documented in the survey has been reported previously as an antimalarial plant
in literature search. A high degree of similarity was found with the studies conducted in the
Goma district of the Jimma zone (6 plants overlap), Hawassa city, Southern Ethiopia (6 plants
The similarities between the survey and literature search with respect to the most
frequently cited families, species and parts of the plants used showed that Asteraceae and
Fabaceae are the dominantly represented families. Allium sativum L., Carica papaya L.,
Vernonia amygdalina Del., and Lepidium sativum L. are the top four frequently reported plant
In the ethnomedicinal field survey, 13 plant species that were not reported as anti-malarial
plants in literature search were identified. These included Ekebergia capensis Sparrm,
Capsicum frutescens L., Solanum incanum L., Ximenia americana L., Rubus steudneri
Shweinf., Zingiber officinale Roscoe., Citrus limon L., Ziziphus mauritiana Lam., Senna
didymebotrya Fresen, Trigonella foenum-graceum L., Linum usitatissimum L., Vernonia spp
The literature search of anti-malarial activity reports of plant species documented from
ethnomedicinal surveys and literature search were performed. According to this review, of the
137-plant species identified/documented in this study, the in-vitro and in-vivo anti-plasmodial
activity were reported for 40 and 27 plant species, respectively. Most of the bioactivity studies
20
focused on crude extracts and fractions. The anti-plasmodial activity reports of the plant species
incorporation, and few of the studies used pLDH (Plasmodium lactate dehydrogenase) method
and microscopic method to measure the level of inhibition (Table 3). The anti-plasmodial
activity was assessed on different P. falciparum laboratory strains such as, the chloroquine-
sensitive (D6, D10, 3D7, NF54, FCA-20/Eth) and chloroquine-resistant (W2 and K1 strains).
The in-vitro anti-malarial activity ranges from 0.38 to 100 μg/ml. Among the plants which the
in-vitro activities were reported, 11 and 12 of them have shown the pronounced (IC50 ≤ 5μg/ml)
and promising (5 μg/ml < IC50 ≤ 15 μg/ml) anti-malarial activities respectively (Table 3).
Some crude extracts and fractions from Ethiopian medicinal plants have been evaluated
for in-vivo activity against Plasmodium berghei, ANKA (Table 4). The high activities
demonstrated by these plants render them good candidates for the identification and isolation of
anti-malarial compounds that could serve as a backbone for new drug development.
21
Table 3. In-vitro anti-plasmodial activity reports (n = 21) of medicinal plants used in the treatment of malaria and related symptoms in Ethiopia
Family Species Parts used Solvent Anti-malarial activity IC50 in Method References
µg/ml(a) or µM(b) and strain
Anacardiaceae Rhus natalensis Bernh Leaf H2O 23.8a (D6), 48.3a(W2) [3H]-Hypoxanthine Muthaura et al., 2015
a 3
Asteraceae Artemisia afra Jacq. ex Willd. Aerial part EtOH 7.0 (FCA-2/Eth) [ H]-Hypoxanthine Kassa et al., 1998
Leaf DCM 5.0 a(D10) pLDH Clarkison et al., 2004
Artemisia rehan Choiv. Aerial part EtOH 14.0 a(FCA-2/Eth) [3H]-Hypoxanthine Kassa et al., 1998
Vernonia amygdalina Delile Leaf EtOH 9.7a Microscopy Tona et al., 2004
Leaf PET 2.5a Microscopy Tona et al., 2004
Leaf IOH 2.7a Microscopy Tona et al., 2004
Boraginaceae Cordia africana Lam. Stem bark MeOH 25a(W2) [3H]-Hypoxanthine Muthaura et al., 2015
Brassicaceae Lepidium sativum L. Seed EtOH No effect(FCA-2/Eth) [3H]-Hypoxanthine Kassa et al., 1998
Burseraceae Commiphora africana (A.Rich.) Endl. Stem bark MeOH 10.2a(D6), 9.6 a (W2) [3H]-Hypoxanthine Muthaura et al., 2015
Capparaceae Capparis tomentosa Lam. Leaf DCM 65a(D10) pLDH Clarkson et al., 2004
Root DCM 38 a(D10) pLDH Clarkson et al., 2004
Caricaceae Carica papaya L. Leaf EtOH 18a(D6), 23a(W2) Microscopy Kovendan et al., 2012
Combretaceae Combretum molle R.Br Stem bark Acetone 38.17b(3D7) [3H]-Hypoxanthine Asres et al., 2001
Cucurbitaceae Zehneria scabra (L.f.) Sond. Whole plant DCM:MeOH 5.6a(D10) pLDH Clarkson et al., 2004
Euphorbiaceae Clutia abyssinica Jaub. & Spach Leaf MeOH 7.8a(D6), 11.3a(W2) [3H]-Hypoxanthine Muthaura et al., 2015
H2O 65.2a(D6), 100 a(W2) [3H]-Hypoxanthine Muthaura et al., 2015
Croton macrostachyus Del. Fruit MeOH 0.94a(FAC-2/Eth) [3H]-Hypoxanthine Sorsa et al., 1992
Jatropha curcas L. Leaf EA 2.39a(K1) 5.06a(NF54) [3H]-Hypoxanthine Abiodun et al., 2011
MeOH 11.53a(K1) 31.09a(NF54) [3H]-Hypoxanthine Abiodun et al., 2011
Lamiaceae Ajuga remota Benth. Whole plant MeOH 45.9a(D6), 77.8a(W2) [3H]-Hypoxanthine Muthaura et al., 2015
a a
Ocimum gratissimum L. Leaf EA 1.8 (K1), 3.6 (NF54) [3H]-Hypoxanthine Abiodun et al., 2011
MeOH 22.52a(K1) 29.61a(NF54) [3H]-Hypoxanthine Abiodun et al., 2011
Amaryllidaceae Allium sativum L. Rhizome H2O 48.0a(3D7) Microscopy Manu et al., 2013
Lythraceae Lawsonia inermis L. Leaf PET 27.0b(FcB1-Columbia) [3H]-Hypoxanthine El Babili et al., 2013
Meliaceae Azadirachta indica A. Juss. Leaf EtOH 2.4a(D6) [3H]-Hypoxanthine Benoit et al., 1996
Melia azedarach L. Stem bark MeOH 100a(W2) [3H]-Hypoxanthine Muthaura et al., 2015
Meliaceae Ekebergia capensis Sparrm Stem bark MeOH 10.5a(D6) [3H]-Hypoxanthine Muthaura et al., 2015
Melianthaceae Bersama abyssinica Fresen. Leaf EtOH 4a(FAC-2/Eth) [3H]-Hypoxanthine Kassa et al., 1998
Table 3 (continued)
22
Family Species Parts use Solvent Anti-malarial activity IC50 in Method References
µg/ml(a) or µM(b) or nM(c) or
ng/ml(d) and strain
Menispermaceae Cissampelos mucronata A. Rich Root EtOH 1.3a(KI) [3H]-Hypoxanthine Gessler et al., 1994
EA 0.38a(KI) [3H]-Hypoxanthine Gessler et al., 1994
H2O 1.2 a(KI) [3H]-Hypoxanthine Gessler et al., 1994
Cissampelos pareira L. Root bark MeOH 5.2a(D6), 6.5a(W2) [3H]-Hypoxanthine Muthaura et al., 2015
23
Table 4. In-vivo anti-plasmodial activities of medicinal plants used for the treatement of malaria
and related symptoms in Ethiopia
24
The active anti-plasmodial metabolites from some of the plant species used in the
traditional treatment of malaria and related symptoms in Ethiopia have been isolated. Among
the identified compounds, the majorities were alkaloids and terpenoids chemical classes (Table
Table 5. Anti-plasmodial activity of isolated compounds from plants documented in this study.
25
Cyclopeptide
Nummularine H (24) Ziziphus mauritiana Lam. 4.2b(K1) Panseeta et al., 2011
alkaloids
Cyclopeptide
Hemsine A (25) Ziziphus mauritiana Lam. 7.3b(K1) Panseeta et al., 2011
alkaloids
*The 50 µM dose of allicin, the allicin-treated mice had a 94% decrease in parasitemia compared to controls.
**29% inhibition at the dose of 12.5mg/kg.
*** 73.16% of inhibition in a dose of 100mg/kg/d.
O-
S S
S+ S
S 3
O
O 2
OH
1
OCH3 O CH3
H
O
H OH
HO O
H
O
H CH3
H
OH
OH O 4
O 6
OH 5
O OH
O
OH
CHOH NH
OH O
O
O
O O
O OH
O
O
O
OH
O OCOMe
O O
H
OAc OH NH
O OH O
7 8 OH CO O
O H
OC
H O 10
OH CO
H OH
OH OH OH
OH
OH OH OH 9
OCH3
O
N 1
NH O NH
OH
H3C H CH3
H O
O O N
OH 1'
O O
O O
O
NH OH
NH
OCH3
12 13=H1’=
11
14= H1’=
OCH3 OH
O
OH
N
O
H3C H H
H OH
OH
N
O 17
O
OH O
O OH O O
O
OCH3 O
HO
15 16 O
O
H
H
HO O OCH3 O
O
Me OH O
O O
H
O 21
O
20
N HN
N OH OCH3
HO O
18 HN H
19
C6H5H2C O
O O
O
H
NH O
O
OH
O N HN
N
O
C6H5H2C NH(CH3) HN
24 O
O
O
H NH O
O N
H
O
26
O
22
H
H
O
HN
N H
H
HN
O
O
N N(CH2)2
H
25
Figure 3. The chemical structures of anti-malarial compounds isolated from the plant species.
DISCUSSION
2012). The current malaria control measures targeting the mosquito vector with insecticides
have helped to alleviate the malaria burden in many endemic areas (Greenwood et al., 2008).
However, due to the overwhelming nature of the disease, wide ranges of differences in the
coverage of services and distribution of health facilities that persists among regions as well as
between urban and rural areas, and the failure of most affordable drugs to treat malaria due to
resistance by the parasite, there is still an urgent need to search for new and more effective
antimalarial drugs.
Traditional medicines have been used to treat malaria for thousands of years and are the
source of the two main groups (artemisinin and quinine derivatives) of modern anti-malarial
drugs (Willcox and Bodeker, 2004). In Ethiopia, different sociocultural groups possess detailed
knowledge on the use of antimalarial plants that has been transferred from one generation to
another usually through the word of mouth without proper documentation (Asnake et al., 2016).
It is also believed that this knowledge, belonging to traditional healers is becoming transmitted
less and tends to disappear (Desissa and Binggeli, 2000). Additionally, there is a danger of
losing the knowledge due to the rapid degradation of natural habitats and ecosystems and thus
In this study, the traditional healers reported that they conventionally define malaria and
characteristics of the respondents revealed men have more involvement in traditional medical
27
practice than women, which could be due to the fact that parents usually prefer boys in the
transfer of the indigenous knowledge. Similar results were observed from other studies in
Ethiopia (Giday et al., 2009; Yirga and Zeraburk, 2011; Suleman and Alemu, 2012). Most of
the traditional medical practitioners (83%) were ≥ 40 years old, indicating indigenous
knowledge of traditional herbal medicine is predominantly handled by older people and there is
a less tendency of transfer to the new generation. This could be attributed to the ever-increasing
influence of modernization, leading to loss of interest among the younger generation to learn
and practice it (Giday et al., 2009). Consequently, there is an urgent need for the documentation
of this knowledge. Most of the healers (63.7%) reported that they acquired the knowledge from
their family; while the remaining proportion gained the knowledge through other means such as
from friends, local elders, Quran and neighbour. Similar findings have also been reported in
other studies, where the most frequently cited sources of the indigenous knowledge were family
In this study a wide variety of medicinal plant species (n = 28) belonging to 24 families
were reported by the traditional healers as being used for the treatment of malaria and related
symptoms in Jimma zone. The majority of the medicinal plants used were trees, followed by
shrubs, which is in fact in agreement with studies conducted in Ethiopia (Suleman et al., 2009),
Kenya (Muthaura et al., 2007a, b) and Namibia (Cheikhyoussef et al., 2011), where most of the
anti-malarial herbal remedies were obtained from trees and shrubs. The current study has also
revealed that the leaves part of the medicinal plants was most frequently used for the treatment
of malaria and related symptoms in the study area. Oral based herbal medicines were
commonly prepared using water and honey as excipients. This is in line with studies conducted
elsewhere in Ethiopia where water, honey and milk were the predominant vehicle in the
preparation of traditional herbal remedies (Gedif and Hahn, 2002; Seifu et al., 2006; Guji et al.,
2011).
28
The study results revealed that Allium sativum L. and Carica papaya L. showed the
Ethiopia have also revealed that these species are most commonly used by traditional healers
and communities in the treatment of malaria and related symptoms (Abera, 2003; Berhanu et
al., 2006; Etana, 2010; Parvez and Yadav, 2010; Karunamoorthi et al., 2013; Getaneh and
Girma, 2014). Furthermore, Vernonia amygdalina Del., Allium sativum L. and Carica papaya
L. were used to manage malaria and related symptoms in different parts of African countries
(Karunamoorthi et al., 2013; Toyang and Verpoorte, 2013). The fact that the same plants are
used by different communities for a similar indication could possibly show their effectiveness
and need to be subjected to further scientific investigations. The aforementioned species have a
great role in the traditional treatment of different illnesses in addition to malaria and related
symptoms in Ethiopia. For instance, Vernonia amygdalina Del. for tapeworm, ascaris and
stomach ache (Teklehaymanot et al., 2007), Allium sativum L. for wound/sore, cough,
toothache and itching/ scabies (Teklay et al., 2013), Lepidium sativum L. for intestinal
parasites, 'Mich', and headache, and Carica papaya L. for amoebiasis and intestinal parasites
The systematic review of this study showed that a large numbers of medicinal plant
species (n=124) were reported to be used in the treatment of malaria and related symptoms in
Ethiopia. Among the plant species commonly claimed to be used in the treatment of malaria
and related symptoms, the most frequently cited by the studies were Allium sativum L., Carica
papaya L., Vernonia amygdalina Del., Lepidium sativum L., and Croton macrostachyus Del.
and Adhatoda schimperiana Hochst. Species of plants that were most frequently cited may be
more effective and need to be subjected to further scientific investigations. There are some
species of plants which were commonly cited in this review and that are also known to be used
as sources of anti-malarial remedies in other parts of the world. For instance, Azadirachta
29
indica A. Juss. is used in Nigeria (Olorunnisola et al., 2013), India, Malaysia and Burkina Faso
(Karunamoorthi et al., 2013). The use of Vernonia amygdalina Del. in the treatment of malaria
was reported from Cameroon (Teklehaymanot and Giday, 2010), Nigeria (Olorunnisola et al.,
2013) and Uganda (Karunamoorthi et al., 2013). Furthermore, Carica papaya L. was used in
Cameroon (Titanji et al., 2008), D.R. Congo (Kalonda et al., 2014), Uganda (Katuura et al.,
2007), and Togo (Karunamoorthi et al., 2013) for the same purpose. The literature review has
also revealed that Leucas stachydiformis Hochst. ex Benth. and Aloe pirottae A. Berger are the
two species of plants endemic to Ethiopia claimed to be used in the treatment of malaria (Etana,
2010; Belayneh and Bussa, 2014). However, there are many more species of plants that are
endemic to Ethiopia within the same genera to be claimed for anti-malarial activity. For
instance, more than 12 endemic Vernonia species were claimed to be having anti-malarial
activity exist in the country. This could be because plants of the same genus produce related
compounds. They could lead to a large natural diversity of derivatives of compound of interest
This literature search from different studies revealed that a variety of methods are
employed to prepare remedies, including crushing, boiling and squeezing. Certain additives, it
could be water, honey, sugar, milk, local alcohol and butter, are frequently used to improve the
acceptability of some remedies that are taken orally. A combination of two or more herbal
medicines was also reported in some studies, for example Allium sativum L. with Capsicum
annuum L. (Megersa et al., 2013), Lepidium sativum L. with Allium sativum L. (Mesfin et al.,
2009), and Cordia africana Lam. with Zingiber officinale Roscoe (Mesfin et al., 2014).
The comparative analysis of the survey with the literature search showed that nearly more
than half of (54%) of medicinal plants documented in the survey has been reported previously
30
observed with the studies conducted in the different areas of Ethiopia. Though the highest
similarity was observed with the study conducted in the nearest area to Jimma (Etana, 2010), a
significant similarity was also demonstrated by the study conducted in area which are far from
Jimma (Regassa, 2013; Abera, 2014). According to Houghton and Manby (1985) this similarity
could reflect environmental factors or study methodologies among communities under study.
Furthermore, 13 plant species that were not reported as anti-malarial plants in literature search
were identified in the ethnomedicinal field survey. This could be due to the fact that Jimma is
in the rich natural flora of the southwest of the country. Moreover, this could depict the
The antimalarial activity reports from literature shows that the in-vitro anti-malarial
activity ranges from 0.38 to 100 μg/ml. Among the plants which the in-vitro activities were
[22.2.2.211,14] tri acontane-3,16-dione) (11 and 12, Table 5) of them have shown pronounced
(IC50 ≤ 5μg/ml) and promising (5 μg/ml < IC50 ≤ 15 μg/ml) anti-malarial activities respectively.
For instance, methanolic extract of the fruit of Croton macrostachyus Del., ethyl acetate extract
of the root of Cissampelos mucronata A. Rich. and acetone extract of the whole part of
Gardenia ternifolia Schumach. & Thonn. demonstrated strong anti-malarial activity with IC50
of less than 1 μg/ml which could provide the evidence to support their traditional claim (Sorsa
et al., 1992; Gessler et al., 1994; Ochieng et al., 2010). Furthermore, the dichloromethane
extract of leave part Artemisia afra Jacq. ex Willd., petroleum ether and isoamyl alcohol
extracts of leave of Vernonia amygdalina Del., ethylacetate extract of Ocimum gratissimum L.,
ethanol extract of Azadirachta indica A. Juss. and Bersama abyssinica Fresen. leaves, aqueous
and ethanolic extract of leave and root of Cissampelos mucronata A. Rich and leaves of
31
Buddleja polystachya Fresen have been reported to have promising anti-plasmodial activity
(IC50 ≤ 5 μg/ml) (Gessler et al., 1994; Benoit et al., 1996; Kassa et al., 1998; Tona et al., 2004;
In-vivo antiplasmodial activity evaluation of crude extracts and fractions from Ethiopian
medicinal plants showed good activity against Plasmodium berghei, ANKA (Table 4). The
high activities demonstrated by these plants render them good candidates for the identification
and isolation of anti-malarial compounds that could serve as a backbone for new drug
development.
The literature search also found that active anti-plasmodial metabolites were also isolated
from some of the plant species used in the traditional treatment of malaria and related
symptoms in Ethiopia. Alkaloids and terpenoids were the major chemical classes identified. For
instances, Julianti et al. (2014) isolated the piperidine alkaloids such as compound 10, 11 and
12 (Table 5, Figure 3) from the leave of Carica papaya L., which demonstrated the anti-
malarial activity with IC50 of 0.2 µM, 1.8 µM and 1.0 µM against P. falciparum (K1 strain),
respectively. Another study conducted by Angerhofer et al. (1999) found that among 16
compounds, curine (13) and compound (15) (Figure 3) (IC50 values around 101 nM) and R,S-
tubocurine (14) (IC50 values around 168 nM) (Table 5), are the most promising
Rich.. Panseeta et al. (2011) also isolated anti-plasmodial cyclopeptide alkaloids, Mauritine
M(23), Nummularine H(24) and Hemsine A(25) from the root of Ziziphus mauritiana Lam..
The isolated alkaloids exhibited potent anti-plasmodial activity against the parasite P.
falciparum with the IC50 ranging from 3.7 to 10.3 µM. The bioactive triterpenoids, Meldenin
tetracosatetraene (17) were obtained from Azadirachta indica A. Juss. and Ekebergia capensis
Sparrm. Gedunin (8) is the most active against P. falciparum (K1 strain) with IC50 of 0.72
32
µg/ml (Bray et al., 1990; Joshi et al., 1998; Murata et al., 2008). Moreover, many active
metabolites have been also isolated and characterized from Vernonia amygdalina Del. leaves,
such as sesquiterpene lactones, steroidal saponins (vernoniosides), and flavonoids (luteolin and
its glycosides). The class of sesquiterpene lactones is probably the most peculiar of this plant
and it includes the highly oxygenated derivatives vernolide (21), vernodalol, vernodalinol,
epivernodalol, vernodalin (22), vernomygdalin and vernolepin. Vernolide (21) and vernodalin
(22) (Table 5, Figure 3) exhibited IC50 of 1.87 and 0.52 μg/mL, respectively; against P.
falciparum blood stages in-vitro (Abay et al., 2015). Furthermore, Endale et al. (2013) isolated
labdane diterpenoid, Otostegindiol (19) from Otostegia integrifolia Benth. and it was found to
have anti-malarial activity against P. berghie in-vivo with 73.16% of suppression in a dose of
100 mg/kg/d.
the therapy of malaria and its associated symptoms have clear limitations. Firstly, there are few
clinical data on safety and efficacy. Secondly, there is no consensus, even among traditional
healers, on which plants, preparations, and dosages are the most effective. Thirdly, the
factors. Hence, a successful way to conserve and use these antimalarial plants knowledge to
CONCLUSION
The result of the current study showed that traditional knowledge is still playing an
important role in the management of malaria and related symptoms in Ethiopia. Allium sativum
L., Carica papaya L., Vernonia amygdalina Del., and Lepidium sativum L. are the most
33
literature search showed that a traditional claim of some species was supported by bioactivity
reports. Moreover, some species of plants have shown to contain the compounds with known
anti-plasmodial activity. Finally, the finding from this study is potentially useful in the rational
prioritization of plant species for further investigation to determine their efficacy and safety,
which could contribute to the development of new and efficacious malaria treatment options.
ACKNOWLEDGMENTS
This study was supported by VLIR-IUC-JU. The authors express their gratitude to local
administrators and traditional healers of Jimma zone for their valuable assistance during data
collection. The authors also acknowledge Mr. Zewude Achiso, Department of Biology, Jimma
Authors’ contributions
SS and BDS conceived the idea and designed the study. DK, SB, SM, FG and YM conducted
field survey. TBT, SB and DK performed the literature search. EW and LD analyzed the data.
SS, TBT and DK drafted the manuscript. SS, TBT, MD, EW, LD and BDS critically reviewed
the manuscript. All authors have read and approved the final version.
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Appendex
46
Study # of medicinal
Author, Year Place of study Year of Sample Type of
S.No plant reported
study size respondents
for malaria
1 Megersa et al., 2013 West Wollega (Wayu), West 2010 63 TH 4
Ethiopia
2 Abera, 2014 Gimbi, Southwest Ethiopia 2010 195 GI, KI & TH 6
3 Teklay et al., 2013 Kilte, Tigray, Northern Ethiopia 2011 72 TH & KI 5
47
30 Regassa, 2013 Hawassa, Southern Ethiopia 2012 140 TH & KI 11
31 Seid and Tsegay, Tehuledere district, South Wollo, 2009 67 GI & KI 5
2011 North Ethiopia
32 Suleman et al., 2009 Assendabo (South-West) Ethiopia 2007 NA GI 13
48
High contribution to
global death § Poor access and affordability Anti-malarial drugs
§ Drug resistance
Alternative treatment
Loss of indigenous strategies
knowledge
Ethno-medicinal study
§ Lack of documentation
§ Acculturation
§ Documentation § Deforestation
§ Validation § Urbanization
§ New anti-malarial drug § Drought
§ Lead compound
§ Integration in to health
care system