Botanical characterisation , drug indications and sustainability status of traditional oral powdered herbal formulations in Ogbomoso , Nigeria

The Medical and Dental Practitioners’ (Amendment) Decree number 78 promulgated by the Government of Nigeria on 30 September 1992 placed traditional and alternative medicine side by side with orthodox medicine (ABFR & CO 1996). However, a key obstacle to the acceptance of alternative medicine in certain parts of the world lies in the lack of documentation and stringent quality control (Prasad et al. 2012). African herbal products have particularly been called to question on account of adulteration, substitution, contamination, misidentification of ingredients, lack of standardisation, incorrect preparation and/or dosage, inappropriate labelling and/or advertisement (Lau, Woo & Koh 2003; World Health Organization 2003). For these reasons, herbal products from Africa have not enjoyed worldwide acceptability compared to those from other countries such as India and China (Patwardhan et al. 2005).


Introduction
The Medical and Dental Practitioners' (Amendment) Decree number 78 promulgated by the Government of Nigeria on 30 September 1992 placed traditional and alternative medicine side by side with orthodox medicine (ABFR & CO 1996).However, a key obstacle to the acceptance of alternative medicine in certain parts of the world lies in the lack of documentation and stringent quality control (Prasad et al. 2012).African herbal products have particularly been called to question on account of adulteration, substitution, contamination, misidentification of ingredients, lack of standardisation, incorrect preparation and/or dosage, inappropriate labelling and/or advertisement (Lau, Woo & Koh 2003;World Health Organization 2003).For these reasons, herbal products from Africa have not enjoyed worldwide acceptability compared to those from other countries such as India and China (Patwardhan et al. 2005).
The World Health Organization (World Health Organization 2002) refers to quality of herbal drugs on the basis of their reproducible efficacy and safety, while Bauer (Bauer 1998) identifies quality criteria in terms of the scientific definition of the raw materials.Therefore, standardisation and quality control of herbal formulations seem to hinge mainly on their identity and purity.To that extent, correct identification and quality assurance of the starting materials is an essential prerequisite to ensure reproducible quality of herbal medicine, which will contribute to its safety and efficacy

Botanical characterisation, drug indications and sustainability status of traditional oral powdered herbal formulations in Ogbomoso, Nigeria
Read online: Scan this QR code with your smart phone or mobile device to read online.(Kadam et al. 2012).Although many believe that it is difficult to establish comprehensive quality for herbal drugs because of professional secrecy of traditional herbal medical practitioners (THMPs), this challenge has been shown to be surmountable (Obu 2015).The raw medicinal herbs serving as the starting materials for traditional oral powdered herbal formulations (TOPHFs) in Ogbomoso are regarded as 'active ingredients' for these drugs (World Health Organization 2000), and their enumeration formed one of the focal points for this study.
There is ample evidence to show increasing human dependence on herbal drugs for primary healthcare (World Health Organization 1998), but we hardly seek to know where the herbs we use come from.One may wonder why we need to be mindful of the source of medicinal herbs, but the herbs we take as medicine are inextricably connected to the processes that produce them.In fact, we cannot be healthy unless our environment is healthy.Therefore, if we choose to use plants as our medicine, we become accountable for the vegetation or environment that produced the plants.This is the pattern of thinking in sustainable herbal medicine (Medicine Hunter 2012;Pesic 2015).
The strategies for ensuring sustainability of medicinal plants production have been highlighted to include in situ and ex situ conservation efforts, controlled cultivation and sustainable harvesting, among others (Chen et al. 2016;World Health Organization 2003).For these strategies to succeed in a country, the political will is the first requirement.Presently, there is no government policy in place to ensure the sustainability of traditional medicine and the protection of the environment in Nigeria (Osunderu 2009).However, the literature has it that traditional healers in Ogbomoso prepare and market various herbal preparations used for different types of ill health conditions.Among these are the TOPHFs used by different categories of residents of the city (Ogunkunle & Ashiru 2011).There is no information on whether continual exploitation of medicinal plants for TOPHFs in Ogbomoso is sustainable or not.This gap formed another area of consideration in this study.
Against the aforestated background, the objectives of this study were to botanically characterise and ethno-medicinally document the health indications of TOPHFs in Ogbomoso, as well as to examine the conservation status of the medicinal plants alongside the cultivation efforts being made by the THMPs.

Materials and methods
This study was conducted in 2014 in Ogbomoso, Nigeria, located around 8.1333'N latitude and 4.2567'E longitude.
The target population consisted of the THMPs in the study area who produced, sold and provided healing services with TOPHFs.Seventeen THMPs were selected using stratified sampling technique, during which each of the five local government areas (LGAs) was taken as a stratum.Fifteen of the THMPs were eventually found suitable for inclusion, to whom a questionnaire was administered or used as an interview schedule.
Section A of the questionnaire sought the herbal healers' socio-demographic data with 11 questions, while Section B, with 9 questions, was used to gather information on the types of TOPHFs they manufactured and sold, their botanical constituents and sources of the herbs used, the ailments they were meant to treat, and details of preparation of the drugs.
In seeking information about the sources of raw herbal materials, the THMPs were supplied with a list of possible sources (i.e.purchase, collection from the wild, cultivation, etc.) and each of them was asked to tick as many of the options as applicable to him or her.Each of these multiple choices was considered as an independent variable across the 15 participants and counted.Thereafter, a summation of the counts for the 3 alternatives selected was obtained and equated to 100%, from which the relative percentage of each choice was computed.The relative percentage value obtained for cultivation of the required herbal materials was taken as sustainability index for TOPHFs in the study area.
Information on the conservation status or population dynamics of each of the plant species used by the TOPHF manufacturers was obtained by cross-checking its name against the red list of threatened plant species compiled by the International Union for Conservation of Nature (IUCN 2017).
The proportion of the species in the threatened category, taken alongside conservation efforts by the THMPs, was used to project whether manufacturing of TOPHFs in Ogbomoso was sustainable.
Codes (A, B, C, D, etc.) were assigned to the THMPs for anonymity purpose, while their products were labelled with reference to the indications (i.e.health conditions that they treat) of the drugs they produced.In doing this, each health condition was first given a short code of five alphabets, which was then used as a hyphenated prefix to the anonymity code of its manufacturer, such as MALAR-B (i.e.malaria drug from healer B) , PILES-F (i.e.drug for piles from healer F) and TYPHO-E (i.e.drug for typhoid from healer E) (see Table 1).

Information about the traditional herbal medical practitioners contacted and their activities
Out of the 17 THMPs initially recruited in the study, 13 (i.e.76.5%) were men and 4 (i.e.23.5%) were women; 10 of them (about 59%) were over 50 years of age.The majority of the healers (70%) had only primary and/or secondary education, but up to 65% of them had practiced in the profession for more than 30 years.Historically, these people came into the profession by descent (being their family trade), while few others either combined some form of training with this option or depended on their natural gifts or talents to become traditional healers.The THMPs updated their knowledge of medical practice through a wide range of choices, such as by intuition (35.3%), attendance at health talks or meetings (11.0%) and electronic media (5.9%), while 47.8% of them adopted various forms of a combination of these and other choices.Of the 17 THMPs contacted, 15 produced, sold and applied TOPHFs against 17 different types of health conditions, including maintenance of general body homeostasis and the management of some dreaded diseases, such as high blood pressure and diabetes.All of the 15 THMPs (100%) produced oral powdered drugs for malaria therapy, and also sizable proportions of them (6.7% in each case) produced powdered drugs for female infertility, onchocerciasis, diabetes, stomach ulcers and yellow fever (Table 2).

Medicinal plants used by traditional herbal medical practitioners in Ogbomoso to produce traditional oral powdered herbal formulations
A total of 55 medicinal plant species from 33 angiosperm families were listed by the THMPs as constituents of TOPHFs in Ogbomoso, Nigeria.Plants of the families Fabaceae, Cucurbitaceeae and Euphorbiaceae were most widely used, followed by those of Amaryllidaceae, Annonaceae, Apocynaceae, Combretaceae, Rutacecae, Solanaceae and Zingiberaceae.Members of the other 23 families were seldom used by the THMPs (Tables 3-13).The plant parts used as herbs include fruits, seeds, leaves, stem barks, flowers, roots    and rhizomes.Additional information obtained from the THMPs indicated the sources of raw material herbs available to them in relative terms as purchased from herbal markets or suppliers (43.8%), collection from wild vegetation (28.1%) and cultivation of some of the herbs for use (28.1%).
In formulating the powdered drugs, the THMPs collected or purchased the appropriate herbs fresh, partly dried or dried, and if necessary, they properly dried and mechanically milled it into separate powders.Appropriate proportions of each powder for a drug was determined and used by individual manufacturers to compose the drugs.Lastly, the drug was sieved and stored in containers, ready for sale.

Discussion
Indications for TOPHFs produced in Ogbomoso, which have been highlighted in this study (Table 2), are a reflection of the prevalence of malaria, piles, typhoid and high blood pressure among the residents of Ogbomoso.On the other hand, ill health conditions such as onchocerciasis, yellow fever, diabetes and internal ulcers appear to be relatively uncommon, or else, the sufferers of these ailments did not seek healing or management from THMPs.There is ample evidence to show that malaria is a major public health problem in Nigeria, accounting for more cases and deaths than any other country in the world (United States Embassy in Nigeria 2011; World Health Organization 2013).
The preponderance of antimalarial powdered drugs among the traditional healers in the study area is a confirmation that the disease is prevalent in the southwestern parts of the country (Okunade 2001).
The number of plant species being exploited by the THMPs in Ogbomoso is on the higher side, and this calls for the necessity to examine whether production of these drugs in the area is sustainable, and if the local vegetation will not be put in jeopardy soon.About 44% of the TOPHF manufacturers sourced their raw material herbs by buying it from the vendors.Truly, a few of the purchased herbs are collections from outside Ogbomoso land; however, a scrutiny of the lists in Tables 3-13 revealed that a good number of them were obtainable in the savanna woodland to which Ogbomoso belongs (Keay 1989).Therefore, there is the probability that most of these plants were readily available in the past for free collection in the neighbourhoods, but now have to be purchased by the users because of urbanisation and other related factors that have rendered them less accessible (Hsueh 2009;Liu et al. 2015).The natural flora of the study area has been largely impacted to the extent that only 28% of the healers now source their raw materials through collection in the wild.
Information about the quantities of the herbs extracted annually by the TOPHFs manufacturers in Ogbomoso is not available to make categorical statements.However, if it is assumed that 47 of the plant species used for TOHPFs not yet evaluated by the IUCN are not threatened, it is logical to infer from available data from this study and information in the red list of IUCN that production of TOPHFs in the study area is sustainable.In addition, the activities of these traditional drug manufacturers do not, at the moment, appear to pose any threat to the population of these plant species, inasmuch as the herbs from the plants (i.e.stem barks and seeds) can be extracted sustainably.Efforts made by certain THMPs (28.1%) in cultivating some of the plant species they use are also commendable, but there is room for improvement.

TABLE 1 :
Information about the traditional herbal healers who participated in the study.
OND, Ordinary National Diploma; NCE, Nigeria Certificate in Education; HND, Higher National Diploma.†, Talent from God. † †, Of the 17 herbal healers, 15 produced powdered herbal formulations for oral use and their residential homes doubled as factories, with none of them having evidence of registration of their products with National Food and Drug Administration and Control.

TABLE 2 :
List of health conditions indicated for traditional oral powdered herbal formulations manufactured and marketed in Ogbomoso, Nigeria.

TABLE 3 :
Names of plants and their parts used for the formulation of traditional oral powdered herbal formulations for the treatment of arthritis or rheumatism in Ogbomoso, Nigeria.

TABLE 4 :
Names of plants and their parts used for the formulation of traditional oral powdered herbal formulations for the treatment of back and waist pain in Ogbomoso, Nigeria

TABLE 5 :
Names of plants and their parts for the formulation of traditional oral powdered herbal formulations used as blood enricher or enhancer in Ogbomoso, Nigeria.

TABLE 10 :
Names of plants and their parts used for the formulation of traditional oral powdered herbal formulations for the treatment of high blood pressure in Ogbomoso, Nigeria.

TABLE 6 :
Names of plants and their parts for the formulation of traditional oral powdered herbal formulations used as blood purifying or thinning drug in Ogbomoso, Nigeria.

TABLE 7 :
Names of plants and their parts used for the formulation of traditional oral powdered herbal formulations for the treatment of convulsion in Ogbomoso, Nigeria.

TABLE 8 :
Names of plants and their parts used for the formulation of traditional oral powdered herbal formulations for the treatment of male erectile dysfunction in Ogbomoso, Nigeria.

TABLE 9 :
Names of plants and their parts used for the formulation of traditional oral powdered herbal formulations for the treatment of gonorrhoea in Ogbomoso, Nigeria.

TABLE 11 :
Names of plants and their parts used for the formulation of traditional oral powdered herbal formulations for the treatment of malaria fever in Ogbomoso, Nigeria.

TABLE 13 :
Names of plants and their parts used for the formulation of traditional oral powdered herbal formulations for the treatment of typhoid fever in Ogbomoso, Nigeria.