Indigenous traditional knowledge of medicinal plants used by herbalists in treating opportunistic infections among people living with HIV/AIDS in Uganda

Jackson Mukonzo

This study was conducted to document herbal medicines (HMs) used in the treatment of malaria as well as the existing knowledge, attitudes and practices related to malaria recognition, control and treatment in Budiope county, Uganda.Data was collected using semi-structured interviews, and open- and close-ended questionnaires.The respondents had a good understanding of malaria, and could recognize it and distinguish it from other fever types. They were also aware that malaria was spread by mosquitoes. Malaria prevalence was high, and affected individuals an average of six times a year. Respondents avoided mosquito bites by using mosquito nets, clearing bush around their homesteads, and burning plant parts to generate smoke. They preferred treating malaria using allopathic medicines because, according to them, they lacked the appropriate traditional knowledge necessary to exploit plants for the treatment of malaria. Secondly, allopathic medicines were believed to be superior to HMs in the treatment of malaria. Twenty-seven species were used for the treatment of malaria. The most frequently mentioned were Vernonia amygdalina, Momordica foetida, Zanthoxylum chalybeum, Lantana camara and Mangifera indica. Drugs from these plants were prepared from single species as water extracts and were administered in variable doses over varied time periods.

My data shows the use of various medicinal plant species by herbalists in treating people living with HIV/AIDS in Uganda. It shows the local names of the plants, which parts are used and how they are prepared and administered. The data show the use of 71 plant species from 37 families and 64 genera. This information was gathered through an ethnobotanical survey in Uganda. Ninety herbalists were interviewed across the country

The current ethnobotanical study identified medicinal plant species used to manage HIV/AIDS opportunistic infections by the communities in Rungwe District, Tanzania. Data were collected using questionnaires (n=193), interviews (n=9) and field observations. A total of 31 plant species from 23 families are used in managing HIV/AIDS opportunistic infections. Compositae and Rosaceae were predominantly used in disease management by 15% each. Of the plant parts, leaves were the most used (44%), followed by roots (28%), bark (7%), fruits, seeds and stem (5%) while the least used plant parts were tubers (4%) and the whole (2%). Tuberculosis utilized 60% of the species, Herpes simplex 55%, chronic diarrhea 40%, oral candidiasis 35% and Herpes zoster 30%. Dissotis phaeotricha scored the highest fidelity value (73%), followed by Berberis holstii (60%). The knowledge on medicinal plants among respondents was influenced by; informal education (p<0.01), village location (p<0.01) and ethnic ...

Journal Pre-proof Indigenous traditional knowledge of medicinal plants used by herbalists in treating opportunistic infections among people living with HIV/AIDS in Uganda G. Anywar, E. Kakudidi, R. Byamukama, J. Mukonzo, A. Shubert, H. Oryem-Origa PII: S0378-8741(19)31646-0 DOI: https://doi.org/10.1016/j.jep.2019.112205 Reference: JEP 112205 To appear in: Journal of Ethnopharmacology Received Date: 25 April 2019 Revised Date: 28 August 2019 Accepted Date: 28 August 2019 Please cite this article as: Anywar, G., Kakudidi, E., Byamukama, R., Mukonzo, J., Shubert, A., Oryem-Origa, H., Indigenous traditional knowledge of medicinal plants used by herbalists in treating opportunistic infections among people living with HIV/AIDS in Uganda, Journal of Ethnopharmacology (2019), doi: https://doi.org/10.1016/j.jep.2019.112205. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Published by Elsevier B.V. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 Ethnopharmacological relevance: Currently, more than two thirds of the world’s 36.9 million people living with HIV/AIDS reside in Sub-Saharan Africa. Opportunistic infections (OI) associated with HIV are the single most important cause of mortality and morbidity among HIV/AIDS patients in poor countries. There is widespread use of medicinal plants species to manage the HIV infection and it’s associated OI in Uganda, even by patients already on antiretroviral drugs (ARV). However, much of this information remains undocumented and unverified. Aim of study: The aim of this study was to systematically and comprehensively document the traditional indigenous knowledge and practices associated with the management of HIV/AIDS infections by herbalists in Uganda. Methods: Ethnobotanical data was collected using semi-structured interviews and questionnaires. Ninety traditional medicine practitioners (TMP) or herbalists were interviewed in Arua, Dokolo, Mbale, Bushenyi, Iganga, Rakai, Luwero and Kaabong districts to gather information on the plant species used. Data were analysed and presented using descriptive statistics and the Informant Consensus Factor. Results: We documented 236 medicinal plant species from 70 families and 201 genera. Acacia was the most widely represented genus with five species. The most frequently used medicinal plant species for treating various OI were Erythrina abyssinica (45), Warbugia ugandensis (43), Zanthoxylum chalybeum (38), Acacia hockii (37), Mangifera indica (36), Aloe vera (35), Albizia coriaria (34), Azadirachta indica (32), Psorospermum febrifugum (27) Vernonia amygdalina (22) and Gymnosporia senegalensis (21). Some of the plant species were used for treating all the OI mentioned. There is a high degree of consensus among the TMP on which plant species they use for the different OI, even though they are geographically separated. Herbalists contribute to the widespread practice of simultaneously using herbal medicines and ARV. Some TMP are also engaged in dangerous practices like injecting patients with herbs and encouraging simultaneous use of herbs and ARV. Although the TMP relied on biomedical laboratory diagnoses for confirming the patients’ HIV sero status, they were familiar with the signs and symptoms of HIV/AIDS. Conclusion: There is wide spread use of a rich diversity medicinal plants species and practices by TMP to manage OI in HIV/AIDS patients in Uganda. 44 45 Key words: Medicinal plants; herbalists; opportunistic infections; HIV/AIDS; indigenous; traditional knowledge; Uganda. Indigenous traditional knowledge of medicinal plants used by herbalists in treating opportunistic infections among people living with HIV/AIDS in Uganda Anywar G*1, 4, Kakudidi E1, Byamukama R2, Mukonzo J3, Shubert, A4, Oryem-Origa H1, 1 Department of Plant Sciences, Microbiology & Biotechnology, College of Natural Sciences, Makerere University, P.O.Box 7062, Kampala, Uganda 2 Department of Chemistry, College of Natural Sciences, Makerere University, P.O.Box 7062, Kampala, Uganda 3 Department of Pharmacology & Therapeutics, College of Health Sciences, Makerere University, P.O.Box 7062, Kampala, Uganda 4 Fraunhofer Institute for Cell Therapy & Immunology (IZI), Perlickstraße 104103, Leipzig, Germany Corresponding author: godwinanywar@gmail.com / ganywar@cartafrica.org /ganywar@cns.mak.ac.ug Abstract 46 47 1 48 1.0 Introduction 49 There are about 36.9 million people living with HIV/AIDS (PLHIV) globally, with more than 50 two thirds living in sub-Saharan Africa (SSA), and about 19 million in east and southern 51 Africa alone (UNAIDS, 2018a). Although there has been substantial progress in the fight 52 against HIV/AIDS epidemic in Uganda since it was first reported in 1982 (Mugerwa et al., 53 1996), there is concern that the prevalence rate, which had dropped from 18.5% in 1995 to 54 6.3% in 2010 has stagnated at 7.4% (MoH, 2010). Currently, there are about 1.3 million 55 PLHIV in Uganda (UNAIDS, 2018a). 56 57 Highly active antiretroviral therapy (HAART) or Antiretroviral therapy (ART) is the most 58 effective clinical intervention for reducing mortality in the HIV infection (Mermin et al., 59 2008; De Clercq, 2009). However, it can only control the HIV infection among individuals 60 who are on life-treatment and withdrawal of medication leads to re-emergence of the disease 61 (Mukhtar et al., 2008). In spite of the efforts to increase availability of ART, most of those 62 who require it either cannot afford it or do not have access to it (Larsson et al., 2007; 63 UNAIDS, 2018a). In Uganda, only about 67% of the HIV infected adults are on ART, despite 64 the introduction of the WHO test and treatment guidelines in 2015 (UNAIDS, 2018a). Thus 65 HIV/AIDS is not well managed with prescribed medications in resource-poor areas (Holmes, 66 2017). 67 68 Opportunistic infections (OI) and cancers such as Hodgkin’s disease characterise AIDS 69 (Bedoya et al., 2002; Gea-Banacloche, 2006) and are relatively frequent complications, 70 especially at more advanced stages of immunosuppression. Opportunistic infections are the 71 single most important cause of mortality and morbidity in PLHIV in poor countries (Holmes 72 et al., 2003; Mermin et al., 2008). The OI lower the quality of life of PLHIV; hasten the 73 progression to fully blown AIDS and lower patients’ response to ART (Moore & Chaisson, 74 1996). In Uganda, the Northern and Eastern regions have the highest burden of OI both 75 before and after HAART (Rubaihayo et al., 2016). Therefore continued efforts are needed to 76 develop effective strategies for preventing OI particularly in very advanced HIV infection 77 (Moore & Chaisson, 1996). 78 79 Several governments and international organisations have tried to impose total dependence 80 on conventional medicine in combating the HIV/AIDS epidemic. This is done at the expense 81 of traditional medicines and systems of healing which are often depicted as backward, 2 82 ineffective and superstitious (Holmes, 2017), despite their popularity and widespread use 83 especially in PLHIV (Ahmad, 2005; Mills et al., 2005a, 2005b; Haile et al., 2017). In Uganda 84 for instance, more than 90% of the rural population rely on traditional herbal remedies to 85 meet their daily health care needs (Kamatenesi-Mugisha and Oryem-Origa, 2007). 86 87 Even though previous efforts to find a cure or vaccine for HIV/AIDS have not been 88 successful (Mukhtar et al., 2008), the ethnobotanical or ethnopharmacological approach still 89 remains one of the most effective ways in selecting medicinal plants for screening for 90 therapeutic activity (Svetaz et al., 2010; Bagla et al., 2012). Therefore, this study aimed to 91 document the medicinal plant species used by traditional medicine practitioners (TMP) or 92 herbalists in the treatment of PLHIV in Uganda. 93 94 1.0 Methods 95 2.1 Study area 96 This study was conducted in Uganda in the districts of Arua in the Northwest, Dokolo in the 97 North, Mbale and Iganga in the East, Bushenyi in the West, Rakai in the South, Luwero in 98 the central and Kaabong in the North East (Figure 1). 99 Figure 1: Map of Uganda showing study sites 100 2.2 Ethical considerations 101 Ethical approval for this study was obtained from the Higher Degrees Research and Ethics 102 Committee of the School of Biomedical Sciences, College of Health Sciences, Makerere 103 University, and the Uganda National Council of Science and Technology (UNCST) No. HS 104 2233. Written Prior Informed Consent (PIC) was also obtained from the TMP before 105 interviewing them. 106 107 2.3 Study design 108 An ethnobotanical study was conducted on 90 TMP across the country, between March and 109 September 2017. Different local languages were spoken in the selected districts surveyed. 110 Only TMP who had experience of at least five years and were members of local herbalists 111 associations in their districts were selected for the study. This was done to minimise chances 112 of dealing with quacks. Semi-structured interviews were conducted using questionnaires to 113 gather information such as the causes and symptoms of HIV/AIDS, the medicinal plant 114 species used, how they are prepared and where they are harvested. Field guides and 115 interpreters were used to help in locating the TMP and offering translation services. 3 116 2.4 Collection of plant specimens 117 Field excursions with the TMP were conducted to collect voucher specimens of the plant 118 species following standard procedures described in Martin (1995). The plant specimens were 119 deposited at the Makerere University Herbarium for identification and classified according to 120 the Kew database at http://www.theplantlist.org accessed on 4thJanuary-March, 2018 at 18:09 121 EAT. The plant families were checked against the Angiosperm Phylogeny Group IV. 122 123 2.5 Data analysis 124 Ethnobotanical data obtained were analysed and presented using descriptive statistics such as 125 percentage frequencies and the Informant Consensus Factor (FIC) (Trotter and Logan, 1986). 126 The FIC that is an indicator of the level of agreement on use of medicinal plant species on 127 particular ailments was calculated using the formula: FIC = Nur − Nt Nur − 1 128 Where, Nur = number of use reports from informants for a particular plant use category and 129 Nt = number of taxa or species that are used for that use category for all informants. FIC 130 values range between 0 and 1, where 1 indicates the highest level of informant consensus 131 (Trotter and Logan, 1986). 132 133 3.0 Results 134 3.1 Socio-Demographic characteristics of the TMP 135 The mean age of the TMP was 51.1 and their ages ranged from 24-90 years. Over one third 136 (34.4%) of the TMP had attained primary level education, 30.3% had no formal schooling at 137 all, and 5.5% had tertiary level education, including a university graduate. Most TMP were 138 Christian (74.5%), including a priest. The rest were Moslems (24.4%) and animists (1.1%). A 139 majority of TMP were male (66.7%) and subsistence farmers (73.3 %). The rest were full- 140 time herbalists (3.3%), traditional birth attendants (3.3%) and business people (7.8%). Most 141 of the TMP (67.0%) acquired their knowledge from their parents and grand parents only. The 142 rest of the TMP obtained their knowledge from various sources such as through spiritual 143 calling, friends, fellow herbalists, seminars and workshops and other relatives. 144 145 3.2 Medicinal plant species documented 146 We documented 236 medicinal plant species from 70 families and 201 genera (Table 1). 147 Although most of the plant species documented were used to treat the various opportunistic 148 infections mentioned, some were also used for improving the immunity of patients. Most 4 149 plants (46.7%) were harvested from the wild while the rest were grown in home gardens 150 (39.3%) and purchased from local markets (14.0%). The plant species predominantly used 151 were herbs (41.9%), trees (28.6%) and shrubs (19.7%). One parasitic plant, Hyndora 152 abyssinica was also used. Nearly half (45.9%) of the plant parts used were leaves. The bark 153 (18.1%) and roots (17.3%) are also commonly used, whereas other parts such as bulbs, 154 rhizomes, peels and twigs were infrequently used. The families with most species were 155 Fabaceae (30), Asteraceae (24) and Lamiaceae (11). 156 157 The most important medicinal plant species by frequency of mention were Warbugia 158 ugandensis (43), Erythrina abyssinica (38), Acacia hockii (37), Aloe vera (35), Mangifera 159 indica (30), Zanthoxylum chalybeum (29), Psorospermum febrifugum (27), Azadirachta 160 indica (25), Albizia coriaria (24), Gymnosporia senegalensis (21) and Vernonia amygdalina 161 (19). Some medicinal plants such as A. hockii, E. abyssinica, S. longipedunculata and Z. 162 chalybeum, were used in treating all or most of the OI. 163 164 3.3 Methods of preparation, routes of administration and treatment of OI 165 The herbal medicines were mainly prepared as decoctions (63.4%) and as teas or infusions 166 (11.8%). The other methods of preparation such as tinctures, ash and clay tablets were not 167 frequently used. During preparation, adjuncts such as petroleum jelly (9.5%), clay (1.7%), 168 honey (1.2%) and milk (0.9%) were added to the preparations for various reasons. For 169 instance, wet clay was mixed with crushed herbs and moulded into various shapes and sizes 170 and administered as clay tablets. The clay was used as a preservative and binding agent. Milk 171 and honey were used to improve taste and for perceived therapeutic benefits in cough and 172 sore throats. Most herbs were administered orally (81.6%), then topically (15.0%) as herbal 173 ointments made with petroleum jelly. The other methods included inhalation, herbal or steam 174 baths and eardrops. The most unusual route of administration was through intramuscular 175 injections by one TMP. 176 177 Most TMPs reported that HIV was spread through unprotected sex with infected people 178 (43.7%), sharing sharp objects and contact with body fluids at 19.0% each. A majority (77%) 179 of the TMP used both laboratory tests for confirmatory diagnosis of patients and experience. 180 The TMP relied on signs and symptoms such as herpes zoster and wasting. The TMP from Ik 181 community in Kaabong district did not use laboratory services because they were not readily 182 available in the remote difficult to reach area. Counselling was an important part of the 183 services by TMP. 5 184 A great majority of the TMP (86.7%) noted that patients disclosed their sero status to them. 185 The main reasons patients sought the services of TMP were severe side effects from the ARV 186 like nausea, weakness, and recrudescence or failure of some OI to resolve. Depending on the 187 condition the patients presented, TMP would either advise their patients to discontinue ARV 188 treatment and use herbs only or to combine both ARV and herbs and later discontinue the 189 ARV once they improved. 190 191 192 3.4 Informant Consensus Factor (FIC and OI by TMP 193 International Classification of Primary Care (Bentsen, 1986). (Table 2). Only four conditions 194 had FIC values lower than 0.7 i.e. low sexual drive, heart diseases, pain and paralysis and 195 inappetence, and were not included in table 2. The rest had higher FIC values ranging from 196 0.79-0.95. Most (19.1%) of the medicinal plants species were used to treat Gastrointestinal 197 (GIT) diseases such as diarrhoea, dysentery, stomach aches and ulcers. Skin diseases such as 198 rashes, lesions, sores, boils, ringworms and other mycoses followed at 16.4%, then 199 respiratory tract infections such as cough and pulmonary tuberculosis at 8.5%. Opportunistic 200 infections like Herpes zoster, swollen lymph nodes (lymphadenopathy), persistent cough, 201 wasting and oral thrush were considered typical and characteristic of HIV/AIDS infection by 202 most TMP. 203 204 4.0 Discussion For the FIC analysis, the OI were grouped into 21 broad categories by the TMP and the 205 206 207 4.1 Efficacy of medicinal plants 208 treated by the herbalists are discussed with supporting scientific evidence. 209 4.1.1. Infections 210 Gastrointestinal infections such as chronic diarrhoea are one of the most frequently occurring 211 and devastating complications of HIV infection. People in developing countries are the worst 212 affected with cases as high as 100% previously reported (Colebunders, 1987). Chronic 213 diarrhoea greatly reduces quality of life, results in significant morbidity and mortality and 214 higher costs to health care delivery (Lubeck et al., 1993). In addition, bacterial and fungal 215 infections which are commonly manifested as skin and buccal cavity infections are often the 216 first sign of HIV infection and subsequent conversion to AIDS (Nnoruka, 2005). Over 90% 217 of PLHIV are diagnosed with a skin disease at some point as the disease progresses (Coldiron 218 et al., 1989; Mosam et al., 2004). Candida infections greatly vary but oral candidiasis remains The efficacies of medicinal plants that were highly cited (>15) vis-à-vis the common OI 6 219 the commonest OI in immunocompromised persons, occurring in up to 95% of PLHIV 220 (Dupont et al., 1992; Wadhwa et al., 2007). 221 frequently. About 33.3% of all PLHIV globally are co-infected with TB and 70% of these are 222 in SSA (UNAIDS, 2018b). HIV is thus the leading risk factor for development of TB and TB 223 is the leading cause of death in PLHIV (WHO, 2018). Respiratory tract infections also occur 224 225 W. ugandensis, G. senegalensis, E. abyssinica, A. indica, Psidium guajava, Z. chalybeum, M. 226 indica and A. coriaria were the most highly cited medicinal plant species for the various 227 infections. W. ugandensis and Z. chalybeum have in vitro antibacterial and antifungal 228 activities against several species of bacteria and fungi (Olila et al., 2001; Mwitari et al., 229 2013). G. senegalensis has antimycobacterial and antinflammatory properties (Makgatho et 230 al., 2018). Extracts from E. abyssinica have antimycobacterial activities (Bunalema et al., 231 2011), whereas extracts from M. indica, P. guajava and A. coriaria all have antibacterial 232 activity (Bbosa et al., 2007; Biswas et al., 2013; Nalubega et al., 2011). 233 234 4.1.2 Malaria 235 Malaria is an important cause of disease in people infected with HIV wherever the two 236 infections coexist (Alemu et al., 2013). The plasmodium parasite weakens the ability of the 237 immune system to trigger an efficient immune response. This might explain why patients 238 with malaria are susceptible to a wide range of other infections (Millington et al., 2006). 239 People from malaria-endemic areas that are considered semi-immune to malaria can also 240 develop clinical malaria when infected with HIV (Alemu et al., 2013). HIV and malaria 241 infections interact with and confound each other. HIV infection can increase the risk and 242 severity of malaria infection and the increased parasite burden might facilitate higher rates of 243 malaria transmission. Malaria infection offers a conducive microenvironment for the spread 244 and quick replication of HIV virus among CD4+ cells by strongly activating them and up- 245 regulating proinflammatory cytokines (WHO, 2004). Malaria is thus a risk factor of 246 concurrent HIV infection at the population level (Cuadros et al., 2011). 247 248 Vernonia amygdalina and Aloe vera were the most highly cited medicinal plants for treating 249 malaria. V. amygdalina extracts also have antimalarial activity in vivo in mice infected with 250 chloroquine resistant and sensitive Plasmodium berghei strains (Iwalokun, 2008). V. 251 amygdalina is moderately clinically effective in the treatment of malaria in adult patients 252 (Challand & Willcox 2009). The extracts of A. vera showed good antiplasmodial activity 7 253 against Chloroquine sensitive strain of P. falciparum (MRC-2) in vivo (Kumar et al., 2017). 254 255 4.1.3 Viral infections 256 Herpes zoster or varicella zoster virus is an acutely painful condition in immunocompromised 257 patients that can occur at all stages of the HIV infection (Stewart et al., 1995). Herpes zoster 258 is frequently looked at as an early indicator of HIV and is reported to be a clinical predictor 259 of HIV infection (Colebunders et al., 1988; Tyndall et al., 1995). Although herpes zoster was 260 a frequently cited condition by the TMP, the only plant species highly cited for treating it was 261 Psorospermum febrifugum. P. febrifugum has antiviral properties (Epifano et al., 2013) and 262 antimicrobial compounds such as febrifuquinone and adamabianthrone (Tsaffack et al., 263 2009). In a clinical trial to evaluate the effectiveness of herbal treatments used by TMP for 264 treating herpes zoster in PLHIV in Uganda, Homsy et al. (1999) showed that herpes zoster- 265 associated pain resolved substantially and significantly faster among patients receiving 266 treatment from TMP, in comparison to western treatment with the standard drug Acyclovir. 267 In addition, fewer patients on herbal medicines experienced superinfections and keloid 268 formation. 269 270 Various markers of improved overall health such as increased CD4+ counts and decrease in 271 viral load in PLHIV who are using herbal medicines have been verified in clinical tests 272 (Tshibangu et al. 2004). Acacia, the most widely represented genus with five species is not 273 only popular in managing OI in HIV in Uganda but also in other African countries such as 274 Zambia, (Chinsembu, 2016), Tanzania (Kisangau et al., 2011; Maregesi et al., 2010) and 275 Namibia (Chinsembu and Hedimbi, 2010). The widespread use of Acacia species is 276 supported by scientific evidence of its anti-HIV activity. Nutan et al. (2013) for instance 277 demonstrated the ability of A. catechu to suppress of HIV-1 infection in vitro. A. 278 auriculiformis (Mandal et al., 2005) and A. mellifera (Kanyara and Njagi, 2005) also have 279 proven in vitro anti-HIV activity. Other species from our study with proven anti-HIV activity 280 are: Bridelia micrantha and Combretum molle (Bessong et al., 2005), Ximenia americana 281 (Asres et al., 2001) and Maytenus senegalensis, Prunus africana and Rhus natalensis 282 (Kanyara and Njagi, 2005). Punica granatum (Lansky & Newman, 2007) and Moringa 283 oleifera (Nfambi et al., 2015) have significant immonomodulatory activities in vivo 284 285 4.2 Conservation status medicinal plant species used 286 Some of the plant species documented are listed as threatened under the Nationally 8 287 Threatened Species for Uganda, (2016). Afrocarpus usambarensis is listed as endangered: 288 Milicia excelsa as near threatened and Lovoa trichilioides, Afzelia africana, Vitellaria 289 paradoxa and Prunus africana as vulnerable in the wild. However, plant species that have 290 not been red-listed may be at an even greater risk because they have either not been 291 scientifically evaluated or are data deficient. Holmes, (2017) has reported that numerous 292 African tree species commonly used for medicine are either endangered or vulnerable. 293 Since roots are generally popular and widely used in traditional medicine (Mugisha et al., 294 2014; Lamorde et al., 2015; Chinsembu, 2016), their use puts plants at a higher risk of loss 295 due to the destructive nature of harvesting. The TMP also expressed concern over the scarcity 296 of some herbs especially in Iganga district, where the establishment and expansion of 297 commercial sugarcane plantations have led to the large-scale destruction of natural 298 vegetation. However, TMPs in Luwero, Dokolo, Mbale and Bushenyi have also established 299 medicinal plant gardens to grow some of the important and scarce medicinal plant species. 300 301 302 303 4.3 Preparation and administration of traditional medicine Several preparations were made by combining various herbs in order to: (i) harness the 304 healing properties of different plant species through synergy, (ii) tackle the multiple OI in 305 HIV/AIDS with the different properties of each herb and (iii) lessen the preparation time and 306 dosage burden and (iv) lower the possible side effects of some herbs such as Albizia spp. 307 which contain toxic compounds such as 4′-Methoxypyridoxine (Botha and Penrith, 2008). 308 The judicious and careful use of some plant species by the TMP demonstrates their 309 awareness of plant toxicity and how to mitigate it. Interestingly, one TMP injected his 310 patients with herbs without any formal medical training. Injections can potentially harm 311 patients because they introduce risks of sciatic nerve injection injury and secondary infection 312 through the reuse of syringes or needles that is common in resource poor settings (Kim and 313 Park, 2014; WHO, 2010). 314 315 Some TMP referred their patients to colleagues but in Iganga, some also referred patients to 316 modern health facilities for testing and management. This has been attributed to collaborative 317 efforts between allopathic doctors and TMP, established by some Non-governmental 318 organisations. Davids et al. (2014) have also reported the existence of elaborate referral 319 networks by TMP treating PLHIV in South Africa. 320 321 322 9 323 4.4 Informant consensus factor (FIC) and opportunistic infections categories 324 The FIC values were generally high for most OI, indicating agreement on the medicinal plant 325 species used despite the large species and cultural diversity and spatial distribution of the 326 TMP. This confirms the cultural significance of the used plant species (Heinrich et al., 1998), 327 and indicates that a large proportion of TMP use relatively few taxa or that information was 328 exchanged between informants (Heinrich et al., 1998; Canales et al. 2005). 329 330 4.5 Causes diagnosis and treatment of OI in PLHIV 331 The TMP have a hybrid knowledge system of traditional and western concepts of HIV/AIDS. 332 Davids et al. (2014) made similar findings in South Africa. The ability of TMPs to recognise 333 important signs and symptoms of HIV/AIDS has been reported in many studies across Africa 334 (Lamorde et al., 2010; Kisangau et al., 2011; Tchouya et al., 2015; Chinsembu et al., 2015; 335 Nyamukuru et al. 2017). Because HIV presents with multiple OI, the services of traditional 336 healers are usually focused on treating such infections. Medicinal plant species are widely 337 used in ameliorating the side effects of ARV (Langlois-Klassen-Klassen et al., 2008; 338 Tchouya et al., 2015). The TMP also use herbs to boost energy levels, improve immunity and 339 appetite and general wellbeing of their patients. 340 341 Lamorde et al. (2010) argued that the use of traditional medicines in HIV/AIDS does not 342 appear to be well developed because HIV/AIDS is a relatively new disease. Other infectious 343 diseases have symptoms similar to those in HIV-related illnesses, which have been 344 commonly treated with herbal medicine irrespective of the underlying medical condition. 345 This justifies the widespread use of herbal medicine in SSA (Homsy et al., 1999; Bodeker, 346 2003). 347 348 349 350 4.6 Concurrent use of herbal medicines and ARV and potential herb-drug interactions There are several reports confirming that TMP promote the simultaneous use of herbal 351 remedies and ARV by PLHIV. This has been attributed to the chronic nature of the disease, 352 the complexities of treatment modalities and the difficulty in adhering to treatment regimens 353 (Langlois-Klassen et al., 2007; Nagata et al., 2011; Haile et al., 2017). However, herbs 354 potentially interact with HIV drug metabolising enzymes in the body causing herb-drug 355 interactions that could diminish the medication effects of drugs or lead to drug toxicity (Mills 356 et al., 2005c). However, most interactions might have a negligible clinical significance, 357 although some may pose a serious public health threat (Izzo, 2012). One of the widely used 10 358 herbs in this study, Allium sativum as garlic supplements lowers the plasma concentrations of 359 the ARV saquinavir (Piscitelli et al., 2000). 360 361 Additionally, PLHIV rarely disclose their use of herbal medicines to health care providers 362 due to the negative perceptions about herbal medicines and reprimands from them. However, 363 Lubinga et al. (2011) reported that widespread concomitant use of herbal medicines and ART 364 had no association to poor ART adherence in western Uganda. The concomitant use of herbs 365 with ARV can be explained by the fact that TMP are prominent and respected members of 366 society where they are recognised as competent to provide health care. The TMP can 367 therefore influence health-seeking behaviour of patients (UNAIDS, 2002; Liverpool et al., 368 2004; Dickinson, 2009). In fact, traditional healers provide healthcare to a substantial 369 proportion of PLHIV in high HIV burden countries in SSA (Kisangau et al., 2011; Wanyama 370 et al., 2017) and also constitute a significant proportion of health care providers. The TMP 371 can therefore support the general wellbeing of PLHIV and thereby enhance ARV treatment 372 outcomes (Holmes, 2017). 373 374 However, consulting a TMP because of HIV has been shown to be an independent risk factor 375 for incomplete ART adherence (Wanyama et al. 2017) and causes delays presentation of 376 symptomatic HIV in seropositive persons to a medical clinic by up to several months (Audet 377 et al. 2014). This has negative consequences because the early start of ARV treatment is 378 associated with reduction in risk for most OI and HIV disease in low and middle-income 379 countries (Low et al., 2016). 380 381 Conclusion 382 Herbalists in Uganda use a rich diversity of medicinal plant species to treat opportunistic 383 infections. There is a high degree of consensus among the TMP on which plant species they 384 use for the different opportunistic infections. The TMP contribute to the widespread practice 385 of concurrently using herbal medicines and ARV by encouraging their patients to use herbs 386 concurrently with ARV. The plant species used need to be investigated for therapeutic 387 benefits and safety. 388 Acknowledgement 389 "This research was supported by the Consortium for Advanced Research Training in Africa 390 (CARTA). CARTA is jointly led by the African Population and Health Research Centre and 391 the University of the Witwatersrand and funded by the Carnegie Corporation of New York 11 392 (Grant No--B 8606.R02), Sida (Grant No: 54100029), the DELTAS Africa Initiative (Grant 393 No: 107768/Z/15/Z). The DELTAS Africa Initiative is an independent funding scheme of the 394 African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in 395 Africa (AESA) and supported by the New Partnership for Africa’s Development Planning 396 and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust (UK) 397 (Grant No: 107768/Z/15/Z) and the UK government, " The statements made and views 398 expressed are solely the responsibility of the fellow. We also acknowledge and thank the 399 research assistants Kasozi Dauda, Kibuuka Sserwano Moses, Kizito Medi, Onenarach Walter 400 & Opio Henry, for their dedicated work. 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International Journal of STD & AIDS. 28(10): 1018-27. doi: 10.1177/0956462416685890 WHO, 2004. Malaria and HIV interactions and their implications for Public Health Policy. Geneva, Switzerland: WHO. WHO, 2010. World Health Organisation best practices for injections and related procedures toolkit. Geneva, Switzerland WHO, 2018 ‘HIV-Associated Tuberculosis: factsheet’ https://www.who.int/tb/areas-ofwork/tb-hiv/tbhiv_factsheet.pdf?ua=1 Accessed on 31/Aug/2019 13:014 EAT 18 1 Table 2: Informant consensus factor (FIC) for the different categories of OI treated by TMPs Ailment No of species (Nt) No of citations (Nur) FIC 1. Gastrointestinal Tract diseases 90 534 0.83 2. Skin diseases 77 423 0.82 3. Respiratory tract infections 59 479 0.88 4. Malaria & persistent fevers 49 302 0.84 5. Fatigue 39 307 0.88 6. Sexually Transmitted Infections (STI) 24 233 0.90 7. Mental illness 18 133 0.87 8. Anaemia 13 171 0.93 9. Herpes zoster 13 57 0.79 10. Blood tonic/ cleanser 11 111 0.91 11. Infections (Ear, nose & others) 8 25 0.71 12. Oral diseases 8 49 0.85 13. Cancer 8 68 0.90 14. Lymphadenopathy 5 31 0.87 15. Kidney & liver disease 4 45 0.93 16. Wasting 3 38 0.95 2 1 Table 1 Medicinal plants used to manage HIV/AIDS and its related opportunistic infections by traditional medicine practitioners in Uganda Family, Scientific, Name (Voucher No.) Acanthaceae 1. Acanthus pubescens (Oliv.) Engl. (AG422) 2. Asystasia mysorensis (Roth) T. Anderson (AG434) 3. Dicliptera laxata C.B.Clarke (AG 455) 4. Justicia betonica L. (AG 438) 5. Justicia ladanoides Lam. (AG460) 6. Thunbergia alata Bojer ex Sims (AG442) Amaranthaceae 7. Amaranthus dubius Mart. ex Thell. (AG361) 8. Amaranthus sp (AG 362) Local names Hb Condition(s) treated PU F MoP Matovu [Lug], Muswata [Lus] Tembabagole [Lug] Ffuula [Lus, Gis], Nyarwefora [Ru] Nalongo [Lug], Chloroquine* [Lan] Ekwirigwiny [Lgb] Wankuura [Ru] Sh H H H H Cl Syphilis, tonsillitis Herpes zoster & fever Anaemia Fever & malaria Cough Diarrhoea & abdominal pain R L L R, L L 3 2 10 8 1 1 D D D/In D D D Doodo [Lug] Amaranth* H H Inappetence Inappetence, cough, fatigue, nausea & flu L Sd 1 2 D D/Po 9. Aerva lanata (L.) Juss. (AG369) Mwenza [Ru] H 10. Chenopodium opulifolium Schrad. Mwetango [Lus & Gis] H Kikwansi [Ru] Mujumbajumba [Ru] H H Wounds Headache Ear infection Persistent fevers Skin infections Stomach ache L L L L L L 4 1 1 1 2 1 In B In D O D Mukontambaale [Lus], Kibumbu [Gis] T Fever B 4 D Muyembe [Lug & Gis], Mahembe [Lan], Mengu [Lgb] T B/R/L 30 D/O T Sh Cough, TB, fatigue, anaemia, diarrhoea, abdominal aches, vomiting, body/skin infections Dysentery Wounds Diarrhoea, dysentery, fever, cough, chest pain, wounds B, L B B/L/R 1 1 9 D/Injection D Tea/ D Mugaali [Lug], Ilipaku [Lgb] Kitafeeri [Lug] T T Diarrhoea & respiratory infections Cancer B, L R/L/Fr 4 2 D D Mweyihaho [Ru] H Cough L 1 D /Chew Skin infections, lesions Malaria, fevers Fatigue Condition(s) treated Diarrhoea, fatigue, syphilis L B R PU R/L/B 2 2 1 Fi 6 O D Chew MoP D/ In ex W.D.J.Koch & Ziz (AG 446) 11. Cyathula uncinulata (Schrad.) Schinz (AG481) 12. Dysphania procera (Hochst. ex Moq.) Mosyakin & Clemants. (AG490) Anacardiaceae 13. Lannea barteri (Oliv.) Engl. (AG 377) 14. Mangifera indica L. (AG401) 15. Pseudospondias microcarpa (A.Rich.) (AG 626) 16. Searsia pyroides (Burch.) Moffett (AG 381) Annonaceae 17. Annona senegalensis Pers. (AG489) 18. Anona Muricata L. (AG512) Apiaceae 19. Agrocharis incognita (C.Norman) Heywood & Jury (AG529) 20. Centella asiatica (L.) Urb. (AG388) 21. Alstonia boonei De Wild. (AG390) 22. Daucus carota L. (AG473) Family, Scientific, Name (Voucher No.) 23. Steganotaenia araliaceae Hochst. (AG464) Muziru [Lus] Kakwansokwanso [Lug],Bilkibil [Lgb] Musheshe/Mukanja [Ru], Kakunso [Lus] Kutukumwe [Ru] Mubajjangalabi [Lun] Karoti* Local names Buco [Lgb], Elwilwi [Lan] H T H Hb T 1 Apocynaceae 24. Carrisa spinarum L. Syn. C. edulis (Forssk.) Vahl 25. Cynanchum viminale (L.) (AG514) 26. Cryptolepis sanguinolenta (Lindl.) Schltr. (AG480) 27. Mondia whytei (Hook.f.) Skeels. (AG373) 28. Pachycarpus lineolatus (Decne.) Bullock (AG479) 29. Plumeria rubra L. (AG513) Aristolochiaceae 30. Aristolochia littoralis Parodi (AG491) Asparagaceae 31. Asparagus africanus Lam. (AG463) 32. Dracaena steudneri Engl. (AG385) Empakulo Alacku/Alakalak [Lgb] Kafulu [Lug & Lus] Mulondo [Lug & Lus], Orono [Lan] Loupe [Ik] Musikamoli [Lug], Musikamori [Ru] Sh Cl H Cl H T Joint & body aches & pain Stomach ache Skin infections Fatigue, anaemia, inappetence, diarrhoea Stomach ache Herpes zoster R Ap R R R Sp 1 1 4 3 3 8 D Roast+ Sl D In/Chew Musujja awalaba [Ru] Nakasero [Lug], Pilopilo [Lgb] H Skin allergy/infections, fever Fr/L/Sd 4 D/Swallow seeds/In Minimini [Lgb] Kajjolyenjovu [Lug & Lus] Mugorora [Ru] H T Syphilis, gonorrhoea, cough All symptoms TB & cough Skin rashes R B, R, L B, L 8 8 4 2 H H H H H H H H H Scr H H H H Scr H H H H H H Sh Persistent fevers, hiccough Cancer, cough, indigestion, cleanser, malaria/fever Fevers & malaria STI, skin infections, cough, stomach ache, malaria Malaria, fevers, diarrhoea, stomach aches, ulcers Cleansing, anaemia Infections, diarrhoea, Diarrhoea & dysentery All HIV symptoms, poisoning,, diarrhoea, headache Skin infections Infection e.g. cough, sinuses, blood cleanser Stomach ache Skin rash Diarrhoea & skin infections Fever Ulcers, STI, wounds Vomiting Fatigue, stomach ache Diarrhoea, dysentery, stomach aches, itchy skin Diarrhoea, vomiting, malaria Fever Fever/Malaria Diarrhoea, stomach disorders, cough, L L L L L, Fl R, Ap L L L, B, R L, St R&L R L 2 3 2 3 11 2 2 1 7 1 1 1 1 1 1 3 1 1 4 1 1 19 3 D D/Snf/Cl D/Lick P O D D In + Rock Sl D D D D D D D/Sq D+ B D D O D D/B D D B/D/Sq D Tn D/B D/In D Astaraceae 33. Ageratum conyzoides (L.) L. (AG498) Mubuza [Lug] 34. Artemisia annua L. (AG392) Artemesia* 35. Aspilia africana (Pers.) C. D. Adams (AG505) Makaayi [Lug] 36. Aspilia mossambicensis (Oliv.) Wild (AG497) Operek [Ik] 37. Baccharoides lasiopus (O.Hoffm.) H.Rob. (AG493) Obu/Icro [Lgb] 38. Bidens pilosa L. (AG508) Bukaala [Lus], Ononot [Lan] 39. Berkheya spekeana Oliv. (AG510) Briyo [Lgb] 40. Conyza attenuata DC. (AG494) Kibimbakika [Ru] Kafugankande [Lug], Muhe [Ru],Yagyag [Lgb] 41. Conyza pyrrhopappa Sch.Bip. ex A.Rich. (AG397) 42. Crassocephalum vitellinum (Benth.) S. Moore (AG502) Ntarahondo [Ru] 43. Echinacea angustifolia DC. (AG419) Echinacea* 44. Echinops amplexicaulis Oliv. (AG450) Ekwang [Lan] 45. Erigeron floribundus (Kunth) Sch.Bip. (AG495) Wambera [Ru], Adittong [Lan], Nazaca[Lgb] 46. Gutenbergia cordifolia Benth. ex Oliv. (AG504) Nyakwenga [Ik] 47. Gynura scandens O.Hoffm. (AG511) Kizimyamuriro [Ru] 48. Lactuca inermis Forssk. (AG501) Ebirica [Lgb] 49. Laggera alata Nanth. (AG524) 50. Senecio hadiensis Forssk (AG451) Mugina/mubiri [Lug] 51. Solanecio mannii (Hook.f.) C.Jeffrey (AG521) Mugango [Lug, Ru] 52. Schkuhria pinnata (Lam.) Kuntze ex Thell. (AG516) Quinine* 53. Sonchus oleraceus (L.) L (AG530) Kizimya murro [Ru] 54. Vernonia amygdalina Delile (AG405) Mululuza [Lug, Lus], Lubirizi [Lus] 2 L L L L L Ap L R, L R, B Apply sap 55. Vernonia auriculifera Hiern (AG477) Ekikuuma [Gis] Local names Ruherere [Ru] Sh H Sh Syphilis, fatigue Condition(s) treated Diarrhoea L PU L 4 Fi 1 D MoP D Mussa [Lug & Lus], Mufungedha/Mwisa [Lus] Mwisya [Ru], Ibologo [Lug] Lusambya [Lus], Lusoola [Gis], Sambya [Lug] Kinyarisa [Ru] Kifabakazi [Lug, Lus], Shitsubi [Gis] T B, R L R, L 1 7 15 D D + Hy D T T Wasting & inappetence Cough Fatigue, anaemia, liver disease, inappetence, stomach ache, headache & skin rash Malaria & fevers Cough, chest pain & GIT ulcers B B 1 9 D D Emeku [Lug] T Fevers, convulsions, headaches L 8 Muwafu [Lug] Mubafu [Lus & Ru] T Female organ system, diarrhoea, fatigue, inappetence B 10 D D D Egaboyakubuku [Lug] Sh Skin infections 1 D Abasi/Muya [Lug], Balwegiira [Lus], Balwejiira /Abasi [Gis] Abac [Lan] T Stomach ache, sore throat, ulcers, fatigue, fever, blood infections cough/TB/asthma, diarrhoea, allergies, syphilis, skin lesions/rash L, B, R 43 D/O/Tea/In Sh 66. Boscia salicifolia Oliv. (AG478) Mukolokombi [Lug], Mukorokombi[Ru], Ogadaman [Lan] Ror [Ik] Cleanser Diarrhoea, pain Headaches, blackout R R R 3 1 1 D/Po D D Cannabaceae 67. Cannabis sativa L. (AG410) Njagga [Lug] Enjaaye/ Njaga [Ru] H Cough/TB Cancer, pain, blood, cleanser/ asthma, diarrhoea L L 1 3 Paapali [Lug & Lus], Mupaapali [Lus], Apapalo [Lan], Paipai [Lgb] T Vomiting Skin infections, ulcers, anaemia, cough, fatigue Sh Sh 71. Garcinia buchananii Baker (AG515) 72. Symphonia globulifera L.f. (AG455) Embaluka [Ru] Lusaikye [Lug], Muwaiswa [Lus & Gis], Okuto eterka [Lan] Musaali [Lus] Musaali [Lug] Combretaceae 73. Combretum molle R.Br. ex G.Don (AG499) Family, Scientific, Name (Voucher No.) Endagi [Lug], Khirahi [Gis], Ngulara [Ik] Local names Family, Scientific, Name (Voucher No.) 56. Vernonia campanea S. Moore (AG522) Bignoniaceae 57. Kigelia africana (Lam.) Benth. (AG401) 58. Markhamia lutea (Benth.) K.Schum. (AG367) 59. Steriospermamum kanthium Cham. (AG394) 60. Spathodea campanulata P.Beauv. (AG455) Boraginaceae 61. Ehretia cymosa Thonn. (AG492) Burseraceae 62. Canarium schweinfurtii Engl. (AG500) Cactaceae 63. Cactus spp (AG506) Canellaceae 64. Warburgia ugandensis Sprague (AG383) Capparaceae 65. Capparis tomentosa Lam. (AG397) Caricaceae 68. Carica papaya L. (AG378) Celastraceae 69. Cassine aethiopica Thunb. (AG374) 70. Gymnosporia senegalensis (Lam.) Loes. (AG462) 3 T Sh Tea/D/Milk D B L/R/S/Fr 3 6 Inappetence, syphilis, sexual dysfunction Fatigue, ulcers, headache, cough, skin infections, STI B R, B, L 4 21 D D D D D/O/ B T T Vomiting Cough & mental illness B R 1 2 Tea D T H Syphilis, cough Condition(s) treated B PU 3 Fi D MoP 74. Terminalia schimperiana Hochs t. ex Delile (AG448) Commelinaceae 75. Commelina zambesica C. B. Clarke. (AG503) 76. Tradescantia zebrina var. zebrine (AG496) Convolvulaceae 77. Ipomoea batatas (L.) Lam. (AG517) 78. Ipomoea hildebrandtii Vatke (AG527) Costaceae 79. Costus lucanusianus J.Braun & K.Schum. (AG480) Crassulaceae 80. Bryophyllum pinnatum (Lam.) Oken (AG520) 81. Kalanchoe densiflora Rolfe (AG427) Cucurbitaceae 82. Cucurbita maxima Duchesne (AG406) 83. Kedrostis foetidissima (Jacq.) Cogn. (AG531) 84. Luffa cylindrica (L.) M.Roem. (AG553) 85. Momordica foetida Schumach. (AG518) Dioscoreaceae 86. Dioscorea bulbifera L. (AG519) 87. Dioscorea dumetorum (Kunth) Pax (AG556) Ebenaceae 88. Euclea divinorum Hiern (AG532) 89. Diospyros mespiliformis Hochst. ex A. C. (AG526) Euphorbiaceae 90. Acalypha vallicaulis Müll.Arg (AG533) 91. Croton macrostachyus Hochst. ex Delile (AG540) 92. Euphorbia prostrata Aiton (AG534) 93. Euphorbia hirta 94. Jatropha curcas L. (AG429) 95. Manihot esculenta Crantz (AG426) 96. Ricinus communis L. (AG535) 97. Tragia benthamii Bake (AG550) Family, Scientific, Name (Voucher No.) Fabaceae 98. Abrus precatorius L. (AG487) Kadri [Lgb] T Ulcers, skin lesions &infections L 3 Etobi aroni [Lgb] Etiiza enkye [Ru] H H Diarrhoea & skin infections Diarrhoea L Ap 2 1 Mbooli [Gis], Bitakuri [Ru] Bingirebityo [Ru] H H Skin rash, Herpes zoster Ulcers & bed sores L L 2 1 Kisombi [Lug] H Headaches & mental illness Fl 1 In Kiyondo [Gis], Ereka [Ru] Kkiyondo Ekyeru H H Malaria, diarrhoea Abdominal pain Fevers, malaria, cough, fatigue, ulcers Anaemia L L L, B L 2 2 9 1 D Heat/Sq D Pound/Sq Nsujju [Lug] Zziizi [Lus, Gis] Kyangwe [Lug] Bombo [Lug], Bomo [Lan] Scr Cl Cl Cl Fatigue Inappetence Skin infections Fever & cough Diarrhoea, malaria Fr L L L Sht 2 6 1 4 2 Eat/D Po + Hy O D In Kamahunyu [Gis] Itiyo [Lgb] Cl H Body cleanser Jaundice, fever, malaria Blb Blb 2 1 Eat D Emuc [Lan] Okum [Lan] Sh Skin rashes & infections Skin rashes & diarrhoea L Sht, L 1 1 O O Ofaka [Lgb] Murangara [Ru] Kasandusandu (omunene) [Lus] Kasandosando [Lus] Kiroowa [Lug] Muwogo [Lug] Mukakaala [Lus] Kashogashoga/ Mwerangoro [Ru] Kamyu [Lug] Local names H T H H T Sh H H H Jaundice, fever, dysentery, skin infections Constipation, diarrhoea, cough & STI Diarrhoea &ulcers Diarrhoea Fatigue Fatigue Headache Skin infections, cardiac arrhythmias Skin rashes Condition(s) treated Sh L Ap L Sd L L L R PU 3 2 1 2 2 1 1 2 1 Fi D D In/Tea D In D Sq D/B O MoP Lusiiti [Lug, Lus, Gis] H Oral sores L 2 Pound/Sq 4 D D D D D/Hy/Sg/Sl/Pw D 99. Acacia hockii De Wild. (AG428) 100. Acacia amythethophylla A.Rich. (AG406) 101. Acacia polyacantha subsp.campylacantha (A.Rich.) Akaasana [Lug], Okuto atino [Lan] Omuwologoma [Lug] Kibere [Lug], Morigo [Lgb] Sh Sh Sh 102. Acacia seyal (L.) Willd. (AG570) Naibeere [Lus] Sh 103. Acacia senegal (L.) Willd. (AG566) Katasubwa [Lus] Sh 104. Afzelia africana Pers. (AG471) 105. Albizia coriaria Oliv (AG366) Eiya [Lgb] Omugavu [Lug], Musiita [Lus] Kiluku [Ik] T T Diarrhoea All symptoms, anaemia, blood, cleanser, cough Diarrhoea Fatigue, gonorrhoea, skin infections L B R R 3 37 3 2 D D D/Snf/Cl D Fever, blood tonic Skin infections GIT disorders, diarrhoea, fatigue Diarrhoea, fevers, abdominal infections Cough Malaria, pain, vomiting, stomach aches, aphrodisiac Cancer, heart disease, allergy, nausea, headaches & mental illness, diarrhoea, cough, TB, anaemia Fatigue, stomach & skin lesions Skin rash L/B/Fr B, R B, L R L B B 5 2 1 7 1 2 24 D O/D D D D D D/O B, L 10 7 D/O D Skin rash, diarrhoea Diarrhoea, pain Inappetence Diarrhoea & dysentery Ringworms, candida & fungal infections B 1 1 2 2 1 D D /O Cook D/In D B, R L B, R 26 D/O 38 D B, L 10 D/O L 1 D Brena (AG486) 106. Albizia macrophylla (A. Rich.) Walp. var. ugandensis T Bak.f. (AG558) 107. Albizia zygia (DC.) J.F.Macbr. (AG554) 108. Bauhinia thonningii Schum. (AG571) 109. Cajanus cajan (L.) Millsp. (AG565) T T H 110. Chamaecrista absus (L.) H.S.Irwin & Barneby Ackla [Lgb] Ogali [Lan] Nkolimbo [Lug/ Lus]/, Mpinamuti [Lug], Ntondiigwaaa [Ru] Mucuula [Lug] (AG567) 111. Chamaecrista nigricans (Vahl) Greene (AG424) Ayebi [Lan] H 112. Erythrina abyssinica DC. (AG418) Jjirikiti [Lug], Murinzi/Kiko [Ru], Oluo [Lgb], Muyirikiti [Lus] T 113. Entada abyssinica A.Rich (AG387) Mwolola [Lug, Lus] Musambamadi [Lus, Gis] Ekibundabunzi [Ru] T Sh All OI, stomach ache, ulcers, fatigue, fevers, cough, syphilis, diarrhoea, dysentery, skin infections All OI, fatigue, mental illness, anaemia, chest pain, skin, infections/lesions, ulcers, cancer, stomach aches, diarrhoea, STI, fevers, Syphilis, blood tonic, fever, chest pain, abdominal pain, fatigue, anaemia ulcers, skin ulcers/ lesions Diarrhoea Akangi [Lan] Kiihabukuru [Ru] Mukuna* Mpewere [Lug] Aremu [Lan] Muvuvumira [Lus], Guberubenu [Gis], Mugabagaba [Ru] Bwalula [Lug] T H H T Scr T Epilepsy /convulsions Diarrhoea, ulcers Mental illness, aphrodisiac Allergies, syphilis & other STI’s Diarrhoea & dysentery Skin rashes & general OIs R R Sd B L L 1 1 1 2 1 6 D D Tea D In D/O H Stomach ache & diarrhoea L 1 D 114. Kotschya aeschynomenoides (Bak.) De Wild. & 115. 116. 117. 118. 119. 120. 121. Devign. (AG359) Leucaena leucocephala (Lam.) de Wit (AG575) Macrotyloma axillare (E.Mey.) Verdc. (AG571) Mucuna pruirens (L.) DC. (AG409) Piptadeniastrum africanum (Hook.f.) Brenan (AG579) Rhynchosia goetzii Harms (AG573) Senna didymobotrya (Fresen.) H.S.Irwin & Barneby (AG436) Senna obtusifolia (L.) H.S.Irwin & Barneby (AG580) 5 Sh L L L 122. 123. 124. 125. 126. 127. Senna singueana (Delile) Lock (AG589) Senna spectabilis (DC.) H.S.Irwin & Barneby (AG586) Sesbania macrantha E.Phillips & Hutch. (AG581) Tamarindus indica L. (AG403) Tephrosia vogelii Hook.f. (AG590) Tylosema fassoglensis (Schweinf.) Torre & Hillc. Lokeru [Ik] Mucuula Cilcill [Lgb] Nkooge [Lug], Eti [Lgb] T T H T Sh Cl Kiyugeyuge [Lus] (AG414) Lamiaceae 128. Achyrospermum carvalhoi Gürke (AG544) 129. Ajuga integrifolia Buch. -Ham. (AG541) 130. Basilicum polystachyon (L.) Moench (AG549) 131. Clerodendrum umbellatum Poir. (AG523) 132. Hoslundia opposita Vahl (AG413) 133. Ocimum lamiifolium ex Benth. (AG537) 134. Ocimum basilicum L. (AG534) 135. Ocimum gratissimum L (AG560) 136. Plectranthus lactiflorus (Vatke) Angew (AG536) 137. Tetradenia riparia (Hochst.) Codd. (AG561) 138. Vitex fischeri Gürke (AG437) Lauraceae 139. Persea americana Mill. (AG421) Lythraceae 140. Punica granatum L. (AG423) Malvaceae 141. Hibiscus fuscus Garcke (AG582) 142. Hibiscus sabdarifa L. (AG587) 143. Grewia mollis Juss. (AG583) 144. Melochia corchorifolia L. (AG425) 145. Sida sp. Meliaceae 146. Azadirachta indica A.Juss. (AG598) 147. Carapa grandiflora Sprangue (AG591) 148. Ekebergia capensis Sparrm. (AG435) 149. Lovoa trichilioides Harms (AG593) Kitiinwa [Ru] Ekitiinwa [Ru] Kachumita [Ru] Acer [Lan] Kamunye [Lug], Nfoodo [Lus], Sitimwe [Ru] Enkoma nyangwe [Ru] Kakubansiri [Lug, Lus] Mujaaja [Lus] Marwagahibaare [Ru] Kyewamala [Lug], Muravunga [Ru] Mubengeya/ Nfulubwa/ Ffulubwa [Lug] Cough, diarrhoea STI skin lesions, diarrhoea, stomach aches Diarrhoea, liver disease & cough Skin infections GIT disorders, fatigue, diarrhoea, Fever, convulsions, wasting L L B B, L, Fr L B, R Fl 1 2 4 2 8 2 D D + Sg D D Sq/O D /+ Milk D H H H Sh H H H H H Sh Sh Herpes zoster, skin infection & rashes Malaria Cough Stomach ache Stomach ulcers, skin infections, anaemia, fatigue Hiccough Pain killer, inappetence Itchy skin Skin rashes Oral thrush, skin infections & lesions Cancer, herpes zoster, skin infections/rashes, TB R L L R L Ap Ap, L L L L L 3 1 1 2 9 1 2 1 1 2 1 O D O & B/ D In D D Tea/In D In & B Gargle D Ovakedo [Lug, Ru, Lgb] Vadeko [Lus] T Ulcers, cough, anaemia, fatigue Blood tonic & respiratory infectious Skin infections Herpes zoster L, Sd, B L, Fr L L 9 2 3 1 D D + food O Tn Mukoma mawananga [Lus] Sh Wounds, diarrhoea, general, infections B 2 D Lusaala [Lug] Kirekedde [Lug] Eku [Lgb] Akeeyo [Ru] Mumbane Ru] H H Sh Sh H TB & cough Anaemia, paralysis, abdominal pain, dizziness, UTI Diarrhoea, stomach ache, wounds Skin lesions, infections Skin rash L L, Sd L Ap L 1 1 1 1 1 Lick ash In D Poultice Mac Neem* T R, L, B 25 D Mario [Lgb] T T T Liver, kidney, disease, cough, fever diarrhoea, STI, abdominal pain, swelling & vomiting Skin rash & sores Infections Blood cleanser, fever, diarrhoea, skin infections, malaria Skin lesions, cancer, infections, diarrhoea Oil L R B, Sd,L 1 9 2 1 O D Pound/D O Musonko [Lug] 6 Family, Scientific, Name (Voucher No.) Melianthaceae 150. Bersama abyssinica Fresen. (AG594) Menispermaceae 151. Cissampelos mucronata A. Rich. (AG599) 152. Chasmanthera dependens Hochst. (AG596) Moraceae 153. Ficus natalensis Hochst. (AG600) 154. Ficus platyphylla Delile (AG595) 155. Ficus saussureana DC. (AG610) 156. Milicia excelsa (Welw.) C.C.Berg (AG431) Moringaceae 157. Moringa oleifera Lam. (AG408) Musaceae 158. Musa sp (AG465) Myricaceae 159. Morella kandtiana (Engl.) Verdc. & Polhill (AG601) Myrtaceae 160. Callistemon citrinus (Curtis) Skeels (AG606) 161. Eucalyptus grandis W.Hill (AG609) 162. Psidium guajava L. (AG419) 163. Syzygium cumini (L.) Skeels (AG603) Olacaceae 164. Ximenia americana L (AG605) Onagraceae 165. Ludwigia abyssinica A.Rich. (AG608) Oxalidaceae 166. Oxalis latifolia Kunth (AG607) Passifloraceae 167. Barteria nigritana Hook.f. (AG611) 168. Passiflora edulis Sims (AG365) Pedaliaceae 169. Sesamum calycinum Welw. (AG619) Peraceae 170. Clutia abyssinica Jaub. & Spach (AG612) Family, Scientific, Name (Voucher No.) Local names Hb Condition(s) treated PU Fi MoP Lepengo [Lan] Sh Diarrhoea, stomach ache, malaria, STI L 1 D Mony [Lan] Akeng [Lan] Cl H Stomach ache Haemorrhoids R ST, R 1 1 In O Mutuba [Lug] Mutuba [Lug] Muwo [Lug] Muvule [Lug, Lus, Lan] T T T T Diarrhoea, dysentery, vomiting Malaria UTI’s, syphilis & skin rash Asthma, cough, skin lesions, pain, fatigue. B Sd B B, L 2 1 2 2 D D D D/Tea Molinga* T Fatigue, inappetence, cough, malaria 4 Sauce/Tea Kitooke [Lug], Kisubi [Lus] H Herpes zoster & ulcers Diarrhoea Pl Sp 1 1 O / De Lick Sap Nkikimbo [Lug] Sh Diarrhoea, cough, flu, allergies R 5 T T T T Cough Fatigue, Gonorrhoea Oral sores, Cough Cough, TB, epilepsy, skin rushes Diarrhoea, dysentery & stomach aches, Skin rash 13 2 6 15 13 D D D D D D D Icuki [Lgb] Sh Skin infections, diarrhoea, malaria, ulcers, fever, STI Fr 3 D Crocojafo [Lgb] H Malaria, wounds, skin infections L 2 D Kajampuni [Gis] H Diarrhoea Vomiting L, St 3 D/Sq Abwolo mono [Lan] Katunda [Lus, Ru] T Cl Fever, diarrhoea, headache Fatigue Diarrhoea L R, Fr L 1 4 1 D D D Lutungotungo [Lus] H Inappetence, fatigue L 1 D Mubarama [Ru] Local names Sh Hb Diarrhoea, inappetence Condition(s) treated L PU 3 Fi In/Tea MoP Mwambalabutonya [Lug, Lus] Bottle brush* Kalituusi [Lug] Mupeera [Lug, Ru], Ipeera [Ru], Gova [Lug] Jjambula [Lug, Gis] 7 L, R, Sd L R L L/R/B/Fr L, B Sht, Phyllanthaceae 171. Bridelia micrantha (Hochst.) Baill (AG452) 172. Flueggea virosa (Roxb. ex Willd.) Royle (AG430) 173. Hymenocardia acida Tul. (AG411) 174. Phyllanthus ovalifolus Forssk. (AG376) 175. Phyllanthus nummulariifolius Poir. (AG420) Phytolaccaceae 176. Phytolacca dodecandra L'Hér. (AG614) Poaceae 177. Cymbopogon citratus (DC.) Stapf (AG615) 178. Digitaria abyssinica (A.Ric.) Stapf (AG620) 179. Eleusine coracana (L.) Gaertn. 180. Sorghum bicolor (L.) Moench 181. Sporobolus pyramidalis Beauv. Katazamiti [Lug], Ijio (Obua/cuajo [Lgb] Lukandwa [Lug, Lus] Nabbaluka/Mbaluka [Lug, Lus] Mutulika [Lug] Musheshe [Ru] T Sh T Sh Sh Pain, cough & chest pain Most OI, stomach disorders Skin rashes, fatigue, All symptoms esp. mental illness & aches, cough Itchy skin, skin infections, rashes, lesions L, B Tw, R B L L 8 5 5 2 1 D D O/D D/Snf/Cl O Muhoko [Ru] H Herpes zoster L, Fl 4 B Kisubi [Lug] Lumbugu [Lus] Rumbugu [Gis] H H L R L Sd Sd L 1 2 3 6 2 1 D D Poultice Po On/B D Muwemba [Lug] Arua [Lgb] H H H Blood cleanser Fatigue, stomach disorders Herpes zoster Diarrhoea Skin infections & lesions Boils, swellings, skin infections Musenene [Lus] T Dizziness, headaches L 1 B Bwanda [Lus] H Skin rashes Ap 1 Pw + oil Muhanga [Ru] T Skin infections Sd 2 O Luklolukl [Lgb] Cl Skin infections & lesions L 1 D Kayongo [Lug] H Chest pain & respiratory infections Fr 1 D Mufumbi egyesha [Ru] Mukondwe [Lug], Mukondwa [Lus] H T L R R, L B Sd 2 1 6 2 1 D + Po/ Tea L 3 D B L L Fr PU 2 1 1 3 Fi D O Tea Eat MoP Podocarpaceae 182. Afrocarpus usambarensis (Pilg.) C.N.Page (AG444) Portulacaceae 183. Portulaca quadrifida L. (AG630) Primulaceae 184. Maesa lanceolata Forssk. (AG621) Podostemaceae 185. Zehneria scabra (L.) (AG418) Pteridaceae 186. Pityrogramma calomelanos (L.) Link (AG443) Polygalaceae 187. Rumex usambarensis (Dammer) Dammer (AG368) 188. Securida longipedunculata Fresen. (AG363) 189. Plumbago zeylanica L. (AG633) Ranunculaceae 190. Clematis hirsuta Guill. & Perr. (AG625) Rhamnaceae 191. Maesopsis eminii Engl. (AG416) 192. Gouania longispicata Engl. (AG467) 193. Ziziphus abyssinica Hochst. ex A.Rich. (AG470) Family, Scientific, Name (Voucher No.) Akatekere [Lus] H Sore throat, allergies All symptoms Fatigue, joints & chest pain, cough, ulcers & oral sores Diarrhoea, skin rash Persistent fevers Sisi [Ik] Cl Joint aces, respiratory infections Musizi [Lug] Omufurra [Ru] Lawic Omoko [Lan] Laki [Lgb] Local names T Malaria, fevers, stomach aches Scr Swelling in groin, boils Ulcers, Malaria, stomach aches Sh Diarrhoea, stomach aches, chest pain & infection Hb Condition(s) treated 8 D+Milk D+Hy/Sg/Sl/Com Cook/G. nut Rosaceae 194. Prunus africana (Hook.f.) Kalkman (AG 440) Rubiaceae 195. Afrocanthium lactescens (Hiern) Lantz (AG628) 196. Craterispermum schweinfurthii Hiern (AG442) 197. Gardenia ternifolia Schumach. & Thonn. Subsp.jovis-tonantis (Welw.) Verdc. (AG453) 198. Fleroya rubrostipulata (K.Schum) Y.F.Deng (AG404) 199. Keetia gueinzii (Sond.) Bridson (AG469) 200. Pavetta crassipes K.Schum (AG631) 201. Rubia cordifolia L. (AG454) 202. Sarcocephalus latifolius (Sm.) E.A.Bruce (AG415) Rutaceae 203. Citropsis articulata (Willd. ex Spreng.) Swingle & M.Kellerm (AG439) 204. Citrus limon (L.) Osbeck (AG447) 205. Citrus sinensis (L.) Osbeck (AG466) 206. Harrisonia abyssinica Oliv. (AG432) 207. Zanthoxylum chalybeum Engl. (AG632) Ngwabuzito [Lug], Ntaseesa [Lus], Sirumandu [Gis] T Prostate cancer, epilepsy, heart diseases, diarrhoea, cough, chest pain B, L 6 D/Tea Ogu [Lgb] Musekera/Omuseka [Lug] Kalemanjovu [Lug] Cl T Sh Skin lesions, infections, headaches Ulcers & oral Sores TB, fatigue, fever L B B, L 1 2 3 D Tea D/Snf/Cl/Lick Muziko [Ru] T Munuure [Ru] Anyango [Lan] Mutaamataamu [Lus], Obele [Lgb] Cl Sh Cl Sh Abdominal pains TB & respiratory infections Kidney disease Inappetence, fatigue Cough & chest pain, diarrhoea, ulcers Inappetence, abdominal pain, swelling, vomiting, STI B B, L L L L, Ap R 3 1 1 1 5 3 Mubolo [Lug] Sh Diarrhoea, fatigue, inappetence B 3 D Sh Stomach aches Sh Diarrhoea, cough Sh STI, stomach ache/ulcers, diarrhoea, inappetence, sores Skin rash Headaches & mental illness T All symptoms Skin rash Headaches & mental illness Fr R/B/Fr R, L Ap R, B B/R/L Ap R, B 2 1 1 2 7 29 2 7 D D D/In O Snf/Tea D O Sniff/Tea Buzibira [Lgb] Cl Diarrhoea & dysentery St 1 D Nkalati [Lug] Yet ngok kede [Lan] Komero [Lgb] T T T Mental illness Abdominal pain, swelling & vomiting Stomach aches, skin infections R, B R R, Sd 2 1 2 D D D Kamulali [Lug] Nyaanya [Lug, Gis] Katuntunu [Lug] Losuk [Ik] Katunkuma [Lug] Ocokcok adongo [Lan], Etulatula [Lus] Ocokcok atino [Lan] H H H H Sh Sh H Herpes zoster, Herpes zoster Syphilis Fatigue, diarrhoea Inappetence Skin rashes, lesions, itching, boils Skin rashes, lesions, itching, boils Fr Fr, L L 1 3 1 Fr R R 1 2 1 O Po D D Stm O D Niimu [Lug], Ndima [Lgb] Omuchungwa [Lus], Chungwa [Lan] Akere [Lgb] Entale ya Ddungu [Lug], Ddungu lya ntale [Lus], Rukuts [Ik], Outiku [Lugb] D/Tea Lick P Mac D/Po D/Lick P Cook/D Sapindaceae 208. Cardiospermum halicacabum L. (AG629) Sapotaceae 209. Chrysophyllum albidum G.Don (AG 445) 210. Pouteria adolfi-friedericii (Engl.) A.Meeuse (AG 455) 211. Vitellaria paradoxa C.F.Gaertn. (AG627) Solanaceae 212. Capsicum annuum L. (AG412) 213. Lycopersicon esculentum Mill. (AG461) 214. Physalis minima L (AG468) 215. Withania somnifera (L.) Dunal (AG453) 216. Solanum anguivi Lam. (AG635) 217. Solanum dasyphyllum Schumach. & Thonn. (AG484) 218. Solanum incanum L. (AG433) 9 Family, Scientific, Name (Voucher No.) Talinaceae 219. Talinum portulacifolium (Forssk.) Asch. ex Schweinf Local names Hb Ijuki [Lgb] H Condition(s) treated Stomach aches, diarrhoea PU Ap Fi 1 MoP D (AG474) Theaceae 223. Camellia sinensis (L.) Kuntze (AG472) Majaani [Gis] Verbenaceae Kayukiyuki [Lug & Lus] Musekerannyi [Lus] 224. Lantana trifolia L. (AG375) 225. Lantana camara L. (AG485) Kapanga [Gis] 226. Verbena officinalis L. (AG634) Mugoshoora [Ru] 227. Cyphostemma adenocaule (Steud. ex A.Rich.) Desc. Kabombo akatono [Lug] ex Wild & R.B.Drumm. (AG637) 228. Cyphostemma cyphopetalum (Fresen.) Desc. Ex. Wild Lobere [Lgb] &R. B. Drumm (AG640) 229. Cissus rotundifolia Vahl (AG476) Nkamyo [Lgb] Xanthorrhoeaceae 230. Aloe vera (L.) Burm.f. (AG398) Kigagi [Lug], Kikaaka [Lus, Gis], Rukaka [Gis], Tikorotot [Ik], Tebakore [Lan] 231. Aloe dawei A.Berger (AG380) 232. Aloe sp. (AG441) Kigagi [Lug], Rukaka [Ru] Zingiberaceae 233. Curcuma longa L. (AG383) Ocaoayom [Lan] 234. Zingiber officinale Roscoe (AG449) Ntangawuzi [Lug], Tangawizi [Lan] Zygophyllaceae 235. Balanites wilsoniana Dawe & Sprague (AG400) Naggwalimu [Lug] T Fatigue L 2 D H H H H All symptoms: Cleanser, cough, ear infections Stomach ache, cough Vomiting/skin infections Fever, skin infections L, Fl L Ap L 4 2 1 1 D/In D/ Sl In/B D/B Cl TB R 1 Pw H Diarrhoea & vomiting L 1 Stm H H H Fever/malaria, wasting, UTI Skin infections Fever, skin infections Fever/malaria L L L L 35 26 1 1 D O D D H H Hernia, chest pain Cough & TB Rh Rh 1 2 In Tn T All symptoms Herpes zoster Fatigue, aphrodisiac Rh L R 2 1 2 D O/B D Musongola [Lug] Sh Key: Languages spoken: Lgb=Lugbara, Lan=Langi, Gis=Lugissu, Lus=Lusoga, Ru=Runyankore, Lug=Luganda, Ik=Ik/Karimojong,* = No local name. Western name adopted. Parts Used: PU=Part used, Ap =All-aerial parts Pl=Peel, L- leaves, Sh- Shrub, Tw-Twigs, F=Fruit, Fr=Fronds, Blb= Bulb, Rh=Rhizome, Sc=Scandent, Sht=Shoot, Hb=Habit, H=Herb, Cl=Climber, Rt=Root, T-Tree, FM=Frequency of Mention, MoP= Method of Preparation, D=Decoction, In=Infusion, B=Bath, Tn=Tincture, Po=Porridge, O=Ointment, Stm=Steam, Sq=Squeeze out juice, Pw=Lick powder, Po=Porridge, G.nut=Ground nut paste, Com=Compress, STI=syphilis & gonorrhoea, Hy= Honey, Sl = Salt, Sg= Sugar, Cl=Clay, Mac= Maceration, Snf=Snuff 236. Unidentified 10 Figure 1: Map of Uganda showing study sites 1

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