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Ethnobotanical Study of Plants Used in the Management of HIV/AIDS-Related Diseases in Livingstone, Southern Province, Zambia

Ethnobotanical Study of Plants Used in the Management of HIV/AIDS-Related Diseases in... Hindawi Publishing Corporation Evidence-Based Complementary and Alternative Medicine Volume 2016, Article ID 4238625, 14 pages http://dx.doi.org/10.1155/2016/4238625 Research Article Ethnobotanical Study of Plants Used in the Management of HIV/AIDS-Related Diseases in Livingstone, Southern Province, Zambia Kazhila C. Chinsembu Faculty of Science, Department of Biological Sciences, University of Namibia, Private Bag 13301, Windhoek, Namibia Correspondence should be addressed to Kazhila C. Chinsembu; kchinsembu@unam.na Received 25 September 2015; Accepted 11 February 2016 Academic Editor: Rahmatullah Qureshi Copyright © 2016 Kazhila C. Chinsembu. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Faced with critical shortages of sta,ff long queues, and stigma at public health facilities in Livingstone, Zambia, persons who suffer from HIV/AIDS-related diseases use medicinal plants to manage skin infections, diarrhoea, sexually transmitted infections, tuberculosis, cough, malaria, and oral infections. In all, 94 medicinal plant species were used to manage HIV/AIDS-related diseases. Most remedies are prepared from plants of various families such as Combretaceae, Euphorbiaceae, Fabaceae, and Lamiaceae. More than two-thirds of the plants (mostly leaves and roots) are utilized to treat two or more diseases related to HIV infection. Eighteen plants, namely, Achyranthes aspera L., Lannea discolor (Sond.) Engl., Hyphaene petersiana Klotzsch ex Mart., Asparagus racemosus Willd., Capparis tomentosa Lam., Cleome hirta Oliv., Garcinia livingstonei T. Anderson, Euclea divinorum Hiern, Bridelia cathartica G. Bertol., Acacia nilotica Delile, Piliostigma thonningii (Schumach.) Milne-Redh., Dichrostachys cinerea (L.) Wight and Arn., Abrus precatorius L., Hoslundia opposita Vahl., Clerodendrum capitatum (Willd.) Schumach., Ficus sycomorus L., Ximenia americana L., and Ziziphus mucronata Willd., were used to treat four or more disease conditions. About 31% of the plants in this study were administered as monotherapies. Multiuse medicinal plants may contain broad-spectrum antimicrobial agents. However, since widely used plants easily succumb to the threats of overharvesting, they need special protocols and guidelines for their genetic conservation. There is still need to confirm the antimicrobial efficacies, pharmacological parameters, cytotoxicity, and active chemical ingredients of the discovered plants. 1. Introduction secure themselves and their families because other sources of income are not sufficient [3]. Livingstone has the highest human immunodecfi iency virus According to Byron et al. [4], women combine sex with (HIV) prevalence level in Zambia. Although the average thesaleofmaterialproductstoearnhigherprotfi swhenthey HIVprevalencerateinZambiaisabout 13%, theHIV go to themarketintownand endupcontracting HIV. At infection rate in Livingstone is about 25.3%, significantly 3.1%, womeninLivingstone hadthe highestprevalenceof higher than the national average [1]. During the period 1994– sexually transmitted infections (STIs) in Zambia [1]. Migrant 2002, Livingstone’s HIV prevalence was stable at around labourers, especially sugar cane cutters from Mazabuka 30% [2]. Located in Southern Province, Livingstone is the (Zambian town with the second highest HIV prevalence at tourist capital of Zambia, home to the famous Victoria 18.4%), are oen ft blamed for being high-risk transmitters Falls. eTh refore, many socioeconomic factors conspire to of HIV. In several sites in Livingstone, there are designated fuel the town’s growing HIV epidemic. Transactional sex is venues where people meet new sexual partners [2]. These very common in Livingstone, attributable to local or foreign sexual venues are linked to high partner turnover and due to tourists and high levels of poverty; receiving money or gifts for sex is the only means for vulnerable women to n fi ancially major challenges in on-site condom availability, unprotected 2 Evidence-Based Complementary and Alternative Medicine sex is common among guests [2]. Livingstone also has low Zambia is among the Sub-Saharan African countries with rates of male circumcision at 11% [1]. the most acute shortages of trained personnel in the health In Livingstone, studies have reported sexual behaviours sector [14]. Predictably, use of traditional medicines was with a high potential for HIV transmission, yet there are reported among 75% of inpatients at the UTH and among few signs of HIV preventive interventions [3]. Despite the 68% of those seeking services for HIV counselling and testing rollout of antiretroviral therapy (ART), Cataldo and others [11]. Studies have shown that individuals that use traditional [5] stated that Zambian HIV-infected persons still seek medicines are also associated with alcohol, have two or treatment from traditional healers. u Th s, although some more sexual partners, engage in dry sex, and harbour STIs. western trained health care providers remain suspicious of Corollary, identification of persons who access traditional traditional healers, most agree that traditional healers play medicines may be an important target population for HIV an important and complementary role in the provision of prevention because many HIV risky behaviours are common eeff ctive HIV prevention or treatment [6]. Kaboru [7] also among clients of traditional healers [11]. found that many biomedical health practitioners believe that Besides, traditional healers are still consulted because Zambian traditional healers can help control HIV/AIDS. they are deemed to provide client-centred and personalised Undoubtedly, several patients seek herbal remedies for health care that is customized to the needs and expectations conditions related to acquired immune deficiency syndrome of patients, paying special respect to social and spiritual (AIDS) before seeking care at health centres [8]. This is matters [15]. Indeed, whilst the majority of HIV/AIDS because there are many deficiencies in the provision of patients that need treatment can access ART from local biomedical services for STIs and HIV/AIDS in Zambia [7]. hospitals and health centres, several constraints of the ART Unlike hospital staff with poor attitudes, traditional healers programme compel many HIV-infected people to use tra- are also kinder and more compassionate to patients [7]. ditional medicines to manage HIV/AIDS-related conditions According to Ndulo et al. [9], traditional healers attend to [16]. Others use ethnomedicinal plants to offset side eeff cts patients with sexually transmitted infections (STIs), in both from ART [17]. The use of medicinal plants in Livingstone is rural and urban areas; therefore, efforts should be made also part of the medical pluralism whereby the introduction to promote cooperation between traditional and biomedical of allopathic medicines has not really dampened beliefs in health care providers, so that treatment of patients and their indigenous diagnosis and therapeutic systems [18]. partners could be improved. Traditional management that Even though there are some anecdotal reports regarding concurs with biomedical practices could thus be a starting the traditional uses of ethnomedicinal plants to manage point for discussion and cooperation. various diseases in Livingstone, knowledge on specific plant Moreover, traditional healers have good knowledge of species used to manage HIV/AIDS-related diseases is still STIs [9]. Most of them use herbal preparations in the form scanty and not well recorded. This paper is an inaugural and of roots or powders administered orally to induce diarrhoea, modest report on medicinal plants used in the management vomiting, and diuresis. Traditional healers also correctly cite of HIV/AIDS opportunistic infections in Livingstone, South- symptoms associated with STIs such as urethral or vaginal ern Province, Zambia. Documentation of putative anti-HIV discharge. eTh refore, Makasa et al. [10] observed that about plantspecies mayhelppreservethiscriticaltacit indigenous 15% of patients with genital ulcer disease seek treatment knowledge resource. Plus, indigenous knowledge, coupled from traditional healers. Although the use of traditional with a history of safe use and ethnopharmacological efficacy medicine is associated with nonadherence to ART, health care of medicinal flora, also presents a faster approach to discover providers at hospitals should open lines of communication new chemical compounds that may be developed into novel with traditional healers [11]. Makasa et al. [10] also noted the antiretroviral drugs. need to increase awareness among traditional healers that handle patients presenting with STIs and to refer certain cases 2. Materials and Methods to health facilities, especially when patients do not respond to traditional medicines. 2.1. Study Area. eTh study was carried out in Chibe- Traditional healers far outnumber modern health care lenga, Burton, Dambwa, Hillcrest, Libuyu, Linda, Malota, providers in Zambia where the Traditional Health Practi- Maramba, Ngwenya, andZakeyo; theseformthe urbanand tioners Association has over 40,000 members compared to a rural settlements of Livingstone, provincial headquarters of paltry 1,000 conventional medical doctors that are practicing Southern Province until 2012 (Figure 1). eTh geographical ∘ 󸀠 ∘ 󸀠 nationwide [11]. er Th e were 1,390 medical doctors practicing coordinates of Livingstone are 17 51 0 south, 25 52 0 east. in Zambia; the doctor to population ratio was 1 to 17,589 The town is situated about 981 metres above sea level near the instead of the World Health Organization recommended Victoria Falls on the Zambezi River close to the Zimbabwean ration of 1 to 5,000 [12]. At the entrance of Zambia’s University border. Situated in agroecological region I, Livingstone has Teaching Hospital (UTH), a signpost reads “kindly take note a humid subtropical climate. Its average annual rainfall is that members of staff at UTH work under very critical short- about 690–740 mm. The mean maximum temperature is age of manpower,” a stark reminder of the dearth of health high, 35 CinOctober,and themeanminimum temperature ∘ ∘ ∘ staff and severe crisis facing the country. Given the glaring is low, 7 C in June. Recorded high (41.1 C) and low (−3.7 C) personnel shortages in many public health care facilities [13], temperatures in November and June, respectively, have been involvement of traditional healers in the management of documented. Rainy season occurs between November and HIV/AIDS opportunistic diseases is a ubiquitous narrative. March when it is wet, hot, and humid. 󸀠󸀠 󸀠󸀠 Evidence-Based Complementary and Alternative Medicine 3 (a) (b) Figure 1: (a) Map of Zambia showing the location of Livingstone. (b) Townships in Livingstone town. According to the Holdridge life zones system of biocli- 2.2. Ethnobotanical Data Collection. Ethnobotanical data matic classification, Livingstone is situated in or near the were collected using methods similar to that of [17–19]. subtropical dry forest biome. eTh terrain in Livingstone Briefly, snowball sampling was applied during ethnobotanical is well vegetated with over 1,000 plant species represented surveys of thirty knowledge holders including 10 traditional by riparian forests and woodlands, Kalahari woodlands, healers that use plants to treat HIV/AIDS-related diseases. Colophospermum mopane (J. Kirk ex Benth.) J. Leonard Before conducting interviews, the aim of the study was woodlands, and deciduous woodlands mostly consisting of clearly explained and knowledge holders were asked for Brachystegia glaucescens Hutch. and Burtt Davy and the their consent. en Th the knowledge holders were individually tall mahogany Entandrophragma caudatum Sprague. eTh engaged in semistructured interviews supplemented with vegetation is quite similar to that in adjoining Sesheke District questionnaires. During the conversations, data on respon- as reported by Chinsembu [18] except for a few dominant dent characteristics and information related to medicinal uses plant species. of plants for the management of HIV/AIDS-related diseases Between 1907 and 1935, Livingstone was the capital city were captured. All interviews were conducted in local lan- of Northern Rhodesia, now Zambia. eTh town is named aer ft guages, Tonga/Tokaleya, and Lozi. Research assistants acted DavidLivingstonewhoin1840asayoungScottishdoctorand as Tonga/Tokaleya/Lozi to English translators. ordained minister sailed from Britain to the Cape to work as Data were collected during two stages consisting of pri- a medical evangelist with the London Missionary Society. In mary and secondary samplings. eTh primary stage involved 1855, Dr. David Livingstone became the rst fi European to see an exploratory and descriptive study of eight knowledge the Victoria Falls when he was taken there by Sekeletu, chief holders that manage HIV/AIDS-related infections. The focus of the Subiya/Kololo people. Although contemporary life is a of the exploratory study was to gain critical insights into blend of values and traditions of more than 70 of Zambia’s the work of the knowledge holders, distil pertinent issues, ethnically diverse people, the main tribes in Livingstone and gauge whether a detailed ethnobotanical survey would are the Tonga/Tokaleya and Lozi; many of them live in be feasible. Knowledge holders were asked about the main townshipssuchasMaramba.Archaeologicalartifactssuggest symptoms of HIV/AIDS, their healing practices, and sources the existence of the Tonga for at least 900 years in southern of ethnomedicinal knowledge. The following data in rela- Zambia’s Zambezi Valley. eTh Lozi migrated into Western tion to the plants were also recorded: vernacular names Zambia from the Luba/Lunda Kingdom of Mwata Yamvwa (Tonga/Tokaleya/Lozi), plant habits, plant parts used, the in Zaire, present day Democratic Republic of the Congo. HIV/AIDS-related conditions treated with the plants, and the After Zambia’s independence in 1964, President Ken- modes of preparation and application of the plant remedies to neth Kaunda’s government built motor vehicle and radio the patient. assembly plants in Livingstone, attracting migrant workers. The secondary sampling stage was a follow-up and These manufacturing industries closed soon aeft r President detailed descriptive study of 22 knowledge holders who Frederick Chiluba became president of Zambia in 1991. In veriefi d prior ethnobotanical data obtained from others recent years, the town’s economic fortunes have dwindled during the exploratory inquiry. To allow for triangulation of except for a slight influx of investment in the tourism sector ethnomedicinal use, only plants mentioned by at least three characterized by the opening of modern hotel chains like knowledge holders in the descriptive study (for each disease Sun International. Commercial sex work is common among condition) were eligible for documentation [20]. On-the-spot women; many of them are from neighbouring Zimbabwe identification of familiar plant species was done in the eld fi . where the socioeconomic situation remains dire. Voucher numbers for plants were assigned and specimens for 4 Evidence-Based Complementary and Alternative Medicine plants were collected in herbarium plant presses for identifi- (53.2%), about a quarter were shrubs (24.5%), and there cation and conrfi mation. Botanical names were veriefi d using were approximately equal proportions of climbers (11.7%) and the International Plant Name Index (IPNI). herbs (10.6%). The most used families were Fabaceae (22%), Com- bretaceae (9%), Euphorbiaceae (6%), and Lamiaceae (5%) 2.3. Data Analysis. Quantitative analysis of ethnobotanical (Figure 2). The most plant parts used were leaves (33%), roots data was done by calculating percentage frequencies, famil- (25%), bark (22%), and stems/stem barks (20%) (Figure 3). iarity index𝐹 , and factor informant consensus (𝐹 ). The 𝑖 IC Pods/seeds (2%) and tubers (1%) were least used. Plant 𝐹 ,arelative indicatorofthe familiarityofaplantspecies,is exudates in the form of sap were also harvested from den fi ed as the frequency a given plant species is mentioned as 2% of the plants. Figure 4 presents the proportions of an ethnomedicine divided by the total number of knowledge plant species used to treat various HIV/AIDS-related dis- holders interviewed in the study [21]. eTh 𝐹 was calculated as ease conditions: skin infections (16.4%), diarrhoea/dysentery follows: (15.0%), gonorrhoea (12.7%), syphilis (10.0%), tuberculosis (TB)/pneumonia (8.6%), cough (8.2%), malaria (6.8%), and 𝐹 = ×100, (1) oral infections (5.0%). Figure 5 illustrates that of all the plants that were used where𝑁 is the number of informants that mention a species to ameliorate skin conditions, most of them were used to as a medicine and𝑁 is the total number of respondents. manage skin soresorulcers(33.0%),rashes(28.0%),herpes The 𝐹 was the number of use citations in each ailment IC zoster (15.0%), boils (10.0%), and abscesses (7.0%). About category (𝑁 )minus thenumberofspecies used (𝑁 ), ur 𝑡 5% of allplantsusedonskinconditionstreated general divided by the number of use citations in each category minus infections. Of all the ethnomedicinal plants used to manage one [22]: STIs, the majority of them were used for gonorrhoea (40.0%), syphilis (32.0%), and HIV (7.0%) (Figure 6). 𝐹 =𝑁 − . (2) IC ur Eighteen plants were utilized to treat four or more disease (𝑁 −1) ur conditions: Achyranthes aspera L., Lannea discolor (Sond.) Engl., Hyphaene petersiana Klotzsch ex Mart., Asparagus 𝐹 values are low (near 0) if plants are chosen randomly IC racemosus Willd., Capparis tomentosa Lam., Cleome hirta or if informants do not exchange information about their Oliv., Garcinia livingstonei T. Anderson, Euclea divino- use. Values are high (near 1) if there was a well-defined rum Hiern, Bridelia cathartica G. Bertol., Acacia nilot- selection criterion among informants and/or if information ica Delile, Piliostigma thonningii (Schumach.) Milne-Redh., was exchanged between informants. High𝐹 values are also IC Dichrostachys cinerea (L.) Wight and Arn., Abrus precatorius obtained when only one or a few plant species are reportedly L., Hoslundia opposita Vahl, Clerodendrum capitatum (Willd.) used by a high number of knowledge holders to treat a Schumach., Ficus sycomorus L., Ximenia americana L., and particular disease, and low𝐹 values imply that respondents IC Ziziphus mucronata Willd. Only 31% of the plants in this study disagree over which plant to use [23]. were administered as monotherapies. The 𝐹 values are given in Table 1. Informants were more 3. Results familiar with the medicinal uses of the following fourteen most frequently used plants: Cassia abbreviata Oliv., Com- Of all the thirty knowledge holders included in the study, only bretum imberbe Wawra, Diospyros mespiliformis Hochst. ex eight were female. This gender difference may be explained by A.DC., Fockea angustifolia K. Schum., G. livingstonei, Kigelia the fact that male knowledge holders in the community were africana (Lam.) Benth., Mimosa pigra L., Syzygium cordatum more comfortable to talk about STIs than female knowledge Hochst., Syzygium guineense DC., Terminalia prunioides M. holders who face cultural restrictions when it comes to A. Lawson, Peltophorum africanum Sond., Plumbago zey- talking about matters related to sex, STIs, and HIV/AIDS. lanica L., X. americana,and Z. mucronata. According to The average age of the healers was 48 years. About 70% of the Table 2,𝐹 values for the various disease conditions show IC knowledge holders received their medicinal plant knowledge that consensus was high over plants used to treat malaria, oral from their older family members and the remainder from infections, and fever/flu/colds/headache. spiritual and supernatural powers such as ancestral spirits, dreams, and visions. Only six traditional healers had an apprentice under their tutelage; the rest did not train other 4. Discussion people. Medicobotanical data including the plants’ scientific The highest proportion of plants in Livingstone was used names, vernacular names, families, voucher numbers, habits, to manage skin diseases, probably because they contain frequency indices, parts, HIV/AIDS-related diseases treated, antimicrobial agents. A similar scenario was obtained in modes of preparation, and application are described in Sesheke (Zambia) and Rundu (Namibia). This speaks to Table 1. Overall, 94 plant species from 39 families were used thefactthatskininfectionsare quitecommonduringHIV by various knowledge holders to manage HIV/AIDS-related infection. Many of the plants for skin diseases in Livingstone diseases in Livingstone, Southern Province, Zambia (Table 1). were used to manage skin infections in other geographical Their growth habits were as follows: almost half were trees settings. For instance, Afolayan et al. [24] and Hedimbi and Evidence-Based Complementary and Alternative Medicine 5 fi fi fi ff ff fl Table 1: Plants used to manage HIV/AIDS related diseases in Livingstone, Southern Province, Zambia. Frequency index, Family Botanical name Vernacular name Growth form Diseases treated Plant parts used, preparation, and mode of administration voucher number Acanthaceae Barleria kirkii T. Anderson Chavani Herb 13.3, L144 HIV/AIDS Leaf decoction is drank Cancer, pneumonia, cough, diarrhoea, fungal Root infusion or whole plant decoction is drank; paste of Amaranthaceae Achyranthes aspera L. Tantajulo Herb 20.0, L186 infections of the skin, genital warts plant is applied to skin Gonorrhoea, syphilis, herpes zoster, herpes Crushed leaves or roots are boiled in water, decoction is Anacardiaceae Lannea stuhlmannii (Engl.) Eyles Mungangacha, Mucheche Tree 83.3, L245 simplex, skin infections, HIV/AIDS drank; stem bark decoction is used to wash aected skin Fruit pulp eaten to relieve diarrhoea; root infusion drank to Anacardiaceae Lannea discolor (Sond.) Engl. Mungongwa Tree 50.0, L235 Diarrhoea, gonorrhoea relieve gonorrhoea Friesodielsia obovata (Benth.) Muchinga Shrub 20.0, L216 Skin rashes Pounded leaves rubbed into skin Annonaceae Verdc. Annonaceae Artabotrys brachypetalus Benth. Mulandabala Climber 13.3, L230 Skin infections Crushed leaves rubbed into skin Apiaceae Steganotaenia araliacea Hochst. Mupelewa Tree 60.0, L113 Headache Root decoction is drank Palm fruit is eaten raw or boiled to treat malaria and cough; Hyphaene petersiana Klotzsch ex Malaria, cough, tuberculosis, skin rashes, Arecaceae Kakunka, Mapokwe Tree 20.0, L217 seeds are used to treat TB; sap is applied to heal skin rashes Mart. sores related to STIs and STIs Asclepiadaceae Fockea angustifolia K. Schum. Mutindika, Nanyama Herb 83.3, L210 Cough Tuber is eaten raw Asparagaceae Asparagus setaceus (Kunth) Jessop Mutandamyoba Climber 50.0, L207 Eczema Whole plant is crushed and rubbed into aected skin Asparagaceae Sansevieria deserti N. E. Br. Musombo, Mukonje Herb 13.3, L360 Oral infections Leaves are chewed and then spitted Asparagaceae Asparagus racemosus Willd. Mutandamyoba,Ilutwa Climber 20.0,L433 Pneumonia,cough,diarrhoea,syphilis Whole plantisboiled; decoctionisdrank Asteraceae Vernonia amygdalina Delile Musoboyo Shrub 83.3, L481 Coughs, tuberculosis, malaria Leaves are boiled; decoction is drank Syphilis, herpes simplex, diarrhoea, boils, Bignoniaceae Kigelia africana (Lam.) Benth. Muzungula Tree 83.3, L485 Stem bark and leaves are boiled colds, u Treats swollen pancreas in patients on Burseraceae Commiphora mollis Engl. Muntyokela Tree 50.0, L312 Stem bark is crushed and boiled; decoction is drank antiretroviral therapy Capparaceae Boscia salicifolia Oliv. Mulaba, Kabombwe Tree 70.0, L406 Syphilis, HIV/AIDS Roots are ground and left in water; infusion is drank Syphilis rashes; HIV/AIDS; cryptococcal Rootsare crushedand boiled anddecoction is drank; Capparaceae Capparis tomentosa Lam. Chonswe Shrub 20.0, L329 meningitis, oral candidiasis, herpes zoster, crushedleavesare appliedtosores or soaked in waterusedto herpes simplex, chronic diarrhoea wash the mouth Mulangazuba, Pneumonia, tuberculosis, fungal infection of Capparaceae Cleome hirta Oliv. Herb 13.3, L303 Leaf infusion is drunk Kalungukachisiungwa the skin, malaria Maytenus senegalensis (Lam.) Celastraceae Mukuba Shrub 50.0, LV235 Tuberculosis Leaves are crushed and soaked in water; infusion is drank Exell Hippocratea africana Loes. ex Celastraceae Mulele Climber 60.0, LV280 Malaria Root decoction is drunk Engl. Parinari curatellifolia Planch. ex Chrysobalanaceae Mubulabula, Mula Tree 13.3, LV245 Toothache, diarrhoea Fruit eaten raw Benth. Cryptococcal meningitis, herpes zoster, herpes Clusiaceae Garcinia livingstonei T. Anderson Mutungwa, Mukwanaga Tree 83.3, LV226 simplex, skin rashes Tuberculosis chronic Fruit eaten raw or in porridge diarrhoea Roots are crushed and soaked in water overnight; ltrate is Combretaceae Combretum collinum Fresen. Mukunza, Mulamana Tree 43.3, LV187 Chronic diarrhoea, tuberculosis, cough drank Stem bark is crushed and soaked in water overnight; ltrate Combretaceae Combretum imberbe Wawra Mubimba, Muzwili Tree 83.3, LV238 General STIs, tuberculosis is drank Mukalanga, Kalanga, Stem bark is crushed and soaked in water overnight; ltrate Combretaceae Combretum apiculatum Sond. Tree 50.0, LV220 General STI syndromes; tuberculosis Nkalanga is drank 6 Evidence-Based Complementary and Alternative Medicine fi ff fi fi ff fi Table 1: Continued. Frequency index, Family Botanical name Vernacular name Growth form Diseases treated Plant parts used, preparation, and mode of administration voucher number Fresh leaves are crushed and soaked in water overnight; Combretaceae Combretum elaeagnoides Klotzsch Mukalanga, Mukupo Tree 30.0, L576 Malaria, tuberculosis, diarrhoea filtrate is drank Roots are crushed and soaked in water overnight; ltrate is Combretaceae Combretum hereroense Schinz Namazubo Tree 53.3, L437 Gonorrhoea drank Terminalia prunioides M. A. Mutala, Mukonono, Outer parts of roots are dried, crushed, and mixed with Combretaceae Tree 83.3, L247 Gonorrhoea, syphilis, HIV/AIDS Lawson Mulumbu water overnight; infusion is drank Numinambelele, Fresh leaves are crushed and soaked in water overnight; Combretaceae Combretum mossambicense Engl. Silutombolwa, Climber 36.7, LV475 Gonorrhoea, syphilis filtrate is taken orally Mutombololo Combretaceae Combretum paniculatum Vent. Mutombolo Shrub 50.0, L322 Malaria, diarrhoea Leaves are pounded and soaked in water; infusion is drank Young stems are cut and boiled, and decoction is applied to Connaraceae Byrsocarpus orientalis Baill. Kazingini Shrub 13.3, L521 Skin abscesses and boils skin Dioscorea cochleari-apiculata De Dioscoreaceae Mpama Climber 13.3, L511 Syphilitic sores, chancroid Root decoction drank Wild. Diospyros mespiliformis Hochst. Ebenaceae Mchenja Tree 83.3, L109 Malaria Crushed roots are boiled; ltrate is drank ex A.DC. Diospyros quiloensis (Hiern) F. Ebenaceae Musiaabwele Tree 50.0, LV339 Gonorrhoea, syphilis, malaria Crushed stem bark is boiled; ltrate is drank White Syphilis, gonorrhoea, genital herpes, oral Roots are ground and boiled in water and decoction is taken Ebenaceae Euclea divinorum Hiern Munyansyabweli Tree 20.0, LV140 candidiasis, abscesses, diarrhoea orally Erythroxylum zambesiacum N. Roots are cut into small pieces and boiled, and decoction is Erythroxylaceae Mubalubalu Tree 16.7, LV277 Malaria, headache Robson administered orally Stem bark is boiled; decoction is drank and used to wash Euphorbiaceae Croton gratissimus Burch. Mungai, Kanunkila Mpati Tree 66.7, LV399 Syphilis sores Euphorbiaceae Croton megalobotrys Mu¨ll. Arg. Mutua, Mutuatua Tree 60.0, S149 Gonorrhoea Leaves are boiled and decoction is drank Pseudolachnostylis maprouneifolia Euphorbiaceae Mukunyu Tree 23.3, S108 Diarrhoea, pneumonia Stem bark decoction is drank Pax Oral infections, diarrhoea, gonorrhoea, Leaves and fruits are chewed raw to act as mouthwash; stem Euphorbiaceae Bridelia cathartica G. Bertol. Munyanyamenda Shrub 13.3, S154 malaria bark infusion is drank Margaritaria discoidea (Baill.) G. Euphorbiaceae Mulyankanga Shrub 16.7, S119 Skin rashes and sores; headache Stem bark L. Webster Euphorbiaceae Phyllanthus reticulatus Lodd. Mwichechele Shrub 26.7, S260 Herpes simplex Crushed leaves are rubbed to aected areas of skin Fabaceae Acacia albida Delile Musangu, Muunga Tree 50.0, S100 Syphilis sores, herpes zoster Crushed leaves and stem bark are applied to heal sores Fabaceae Acacia nigrescens Oliv. Mwabaa, Mukwena Tree 60.0, S78 Herpes zoster Leaves and stem bark are boiled, decoction used to Mumbu, Mukotokoto, Leaves and stem bark are crushed and boiled; decoction is Fabaceae Acacia polyacantha Willd. Tree 50.0,S63 Gonorrhoea,herpeszoster Luntwele drank or used to wash aected skin Leaves are pounded and soaked in water overnight and then Fabaceae Afzelia quanzensis Welw. Mupapa, Mukamba Tree 76.7, S27 General STIs drank Fabaceae Albizia amara (Roxb.) Boivin Kankumbwila,Mukangola Tree 60.0, S44 Gonorrhoea, diarrhoea Stem bark infusion is drank Stem bark and leaves are mixed, crushed, soaked in water, Fabaceae Lonchocarpus capassa Rolfe Mukololo Tree 13.3, S31 Gonorrhoea, cough and ltered and infusion is drank Roots are soaked in water and infusion is drank to treat STIs; Fabaceae Peltophorum africanum Sond. Muzenzenze Tree 83.3, K203 General STIs, oral infections leaves are crushed and soaked in water; infusion is used to wash mouth Fabaceae Pterocarpus antunesii Harms Mukambo Tree 26.7, K166 Diarrhoea Stem bark infusion is drank Fabaceae Acacia goetzei Harms Mwaba Tree 46.7, K88 Cough, pneumonia Root decoction is drank Tuberculosis, diarrhoea, gonorrhoea, dental Fabaceae Acacia nilotica Delile Mukoka Tree 66.7, K56 Twigs used as chewing sticks to treat dental caries caries Evidence-Based Complementary and Alternative Medicine 7 fi fi fi fi fl ff Table 1: Continued. Frequency index, Family Botanical name Vernacular name Growth form Diseases treated Plant parts used, preparation, and mode of administration voucher number Fabaceae Cassia abbreviata Oliv. Mululwe Tree 83.3, K39 Gonorrhoea, diarrhoea Root infusion is drank Dalbergia melanoxylon Guill. & Fabaceae Musonkomo Shrub 13.3, K17 Diarrhoea Root decoction is drank Perr. Piliostigma thonningii Stem bark and roots are boiled; decoction is drank to heal Fabaceae Musekese Tree 60.0, K12 Coughs, skin rashes, gonorrhoea, syphilis (Schumach.) Milne-Redh. coughs and STIs; leaf infusion is used to wash infected skin Fabaceae Acacia ataxacantha DC. Lubamfwa Shrub 50.0, K60 Gonorrhoea, syphilis Roots are boiled and decoction is drank Acacia schweinfurthii Brenan & Roots, stem bark, and leaves are mixed, pounded, and Fabaceae Lubua, Mokoka Shrub 33.3, L34 Gonorrhoea, syphilis Exell soaked in water and infusion is drank Dichrostachys cinerea (L.) Wight Gonorrhoea, syphilis; oral candidiasis, and Stem bark is boiled and decoction is drank, used to wash oral Fabaceae Katenge, Mugee Shrub 66.7, L79 &Arn. skin rashes cavity, or used to disinfect skin by washing Leaves and small and young stems are dried, pounded into Fabaceae Mimosa pigra L. Muchabachaba, Sichatubabi Shrubs 83.3, L56 Diarrhoea, genital ulcers, gonorrhoea powder, mixed with water, and ltered and extract is drank or used to wash genital ulcers Fabaceae Sesbania sesban Britton Mbelembele Shrub 13.3, L77 Malaria Roots are boiled and decoction is administered orally Whole plant is pounded, soaked in water overnight, and Fabaceae Indigofera colutea (Burm. f.) Merr. Kapalupalu Herb 13.3, L59 Diarrhoea ltered, and infusion is drank to alleviate diarrhoea Whole plant is crushed, boiled in water, and ltered; Gonorrhoea, syphilitic ulcers, genital herpes; Fabaceae Abrus precatorius L. Musolosolo Climber 60.0, KC280 decoction is drank; crushed leaves soaked in water and used oral candidiasis, ulcer boils to wash mouth and syphilitic ulcers Pods and beans are boiled and consumed for body building Mucuna pruriens (L.) DC. Muyuyu Climber 20.0, KC245 Weight loss, lack of libido in men Fabaceae and to act as an aphrodisiac Flacourtiaceae Flacourtia indica (Burm. f.) Merr. Mutumbula Shrub 13.3, KC350 Diarrhoea Leaves chewed raw Flacourtiaceae Oncoba spinosa Forssk. Mukumbuzu Shrub 16.7, KC2 Dysentery Roots and fruits are boiled and decoction is drunk Kirkiaceae Kirkia acuminata Oliv. Musanta, Muzumina Tree 13.3, KC18 Diarrhoea Stem bark infusion is drank Fruit eaten raw or leaves burnt and smoke inhaled as cough Lamiaceae Vitex payos (Lour.) Merr. Mfudu, Muyankonga Tree 30.0, KC36 Coughs medicine Roots are boiled and decoction is drunk; sugary fruits are Coughs, u, fever, loss of libido in men; skin Lamiaceae Hoslundia opposita Vahl Musombwani Shrub 60.0, KC48 eaten raw to boost libido; crushed leaves are rubbed into skin wounds to heal wounds Lamiaceae Premna senensis Klotzsch Mumpika Shrub 13.3, KC360 Syphilitic sores, skin ulcers Leaf infusions applied to sores Lamiaceae Vitex petersiana Klotzsch Mufulibulimbo, Mukoma Shrub 23.3, KC312 Gonorrhoea Leaf decoction is drank to treat gonorrhoea; Clerodendrum capitatum (Willd.) Gonorrhoea, erectile dysfunction, pneumonia, Lamiaceae Shamanya Herb 60.0, L402 Leaf and root decoctions drunk Schumach. diarrhoea Loganiaceae Strychnos potatorum L. f. Musisilombe Tree 40.0, KC464 Syphilis Infusions of leaves are drank Mutimi, Muhuluhulu, Loganiaceae Strychnos innocua Delile Tree 20.0, KC216 Gonorrhoea, sore throat Eat fruit pulp Mwabo Azanza garckeana (F. Hom.) Malvaceae Makole, Munego Tree 60.0, KC143 Malaria Eat raw fruit, cook, and eat as relish Exell & Hillc. Malvaceae Sida alba L. Mulyangombe, Babani Shrub 20.0, KC525 Gonorrhoea Roots and leaves are boiled; decoction is drank Leaves are boiled and ltered through wire sieve and Malvaceae Hibiscus vitifolius L. Mubaluba Herb Chronic diarrhoea decoction is drank Khaya nyasica Stapf ex Baker f. Mululu Tree 43.3, KC113 Fever Stem bark infusion is drank Meliaceae Trichilia emetica Vahl Musikili Tree 56.7, KC217 Fever, pneumonia; skin rashes Root decoction is drunk; leaves rubbed onto skin Meliaceae 8 Evidence-Based Complementary and Alternative Medicine ff fi ft fl Table 1: Continued. Frequency index, Family Botanical name Vernacular name Growth form Diseases treated Plant parts used, preparation, and mode of administration voucher number Whole plant is cut into small pieces and boiled and Menispermaceae Cissampelos mucronata A. Rich. Itende Climber 73.3, KC210 Syphilis, chancroid decoction is drank aer ltering Ficus capensis Hort. Berol. ex Diarrhoea, tuberculosis, skin sores, genital Fresh leaves are boiled in water and decoction is drank or Moraceae Mukuyu Tree 60.0, KC207 Kunth & C. D. Bouche´ warts used to wash warts and skin sores Cough, tuberculosis, periodontitis, and oral Fresh leaves are boiled in water and decoction is drank or Moraceae Ficus sycomorus L. Mukuyu Tree 76.7, KC360 candidiasis used to wash the mouth Myrtaceae Syzygium cordatum Hochst. Katope Tree 83.3, KC433 Diarrhoea Stem bark decoction is drunk Myrtaceae Syzygium guineense DC. Mutoya, Katope Tree 83.3, KC481 Abscesses, skin rashes, diarrhoea Fruits eaten raw; stem decoction applied to aected skin Candidiasis, malaria, throat infection, Roots, leaves, and fruits are crushed while fresh and mixed Olacaceae Ximenia americana L. Munchovwa, Muchonfwa Tree 83.3, KC318 tonsillitis, gonorrhoea, diarrhoea, skin rashes with water overnight and taken orally Pedaliaceae Sesamum angolense Welw. Bwengo Herb 13.3, KC267 Skin rashes Leaves are crushed and used as soap to bath skin Plumbaginaceae Plumbago zeylanica L. Sikalutenta Shrub 83.3, KC318 Generally treats all STI symptoms Root infusion is drank Leaves areboiledand drunkasatea; sometimeshoney is Ranunculaceae Clematis brachiata Ker Gawl. Kalatongo Climber 20.0, KC354 Coughs, headache, fever added as a sweetener Berchemia discolor (Klotzsch) Rhamnaceae Mwiiyi, Mwinji Tree 60.0, KC235 Cough Use fruit in porridge Hemsl. Rhamnaceae Ziziphus mauritiana Lam. Masawu, Masawu Tree 40.0, KC226 Gonorrhoea, syphilis Fruit eaten raw, apply to wound, and put into porridge Gonorrhoea, syphilis, boils, pneumonia, Rhamnaceae Ziziphus mucronata Willd. Muchechete, Mwichechete Tree 83.3, KC144 Root or leaf infusion is drank cough Sapotaceae Mimusops zeyheri Sond. Mukalanjoni Tree 40.0, KC120 Oral candidiasis Fruit is eaten or root infusion is used as a mouthwash Tiliaceae Grewia avescens Juss. Namulomo, Mukunyukunyu Shrub 40.0, KC199 Diarrhoea Eat fruit pulp to relieve diarrhoea Tiliaceae Corchorus tridens L. Delele Herb 13.3, KC101 Syphilitic ulcers, chancroid Root infusion drank or applied to ulcers Mulungalunga, Vitaceae Cissus quadrangularis L. Climber 40.0, KC78 Malaria, gonorrhoea Sap is drank; whole plant infusion is drank Chamulungelunge Evidence-Based Complementary and Alternative Medicine 9 Amaranthaceae 1% Tiliaceae Acanthaceae Arecaceae Anacardiaceae 2% 1% 1% Rhamnaceae 2% Apiaceae Vitaceae 3% Ranunculaceae Sapotaceae 1% 1% Annonaceae 1% 1% Asclepiadaceae 2% Plumbaginaceae 1% Pedaliaceae 1% 1% Asparagaceae 3% Olacaceae Myrtaceae 1% Asteraceae 2% 1% Bignoniaceae Moraceae 1% 2% Burseraceae Menispermaceae 1% 1% Capparaceae Meliaceae 3% 2% Celastraceae 2% Malvaceae Loganiaceae Chrysobalanaceae 3% 2% 1% Clusiaceae 1% Lamiaceae Combretaceae 5% 9% Kirkiaceae 1% Connaraceae Flacourtiaceae 1% 2% Dioscoreaceae 1% Ebenaceae 3% Erythroxylaceae Euphorbiaceae 1% 6% Fabaceae 22% Figure 2: Percentage use of plant families. Chinsembu[25]documentedthe useof Asparagus species Lannea stuhlmannii was used to treat skin infections in the treatment of eczema in South Africa and Namibia, in Livingstone. The Lannea species were used to treat skin respectively. Friesodielsia obovata wasusedtotreat skin diseases in South Africa [27]. Chinsembu and Hedimbi [17] infections in the Zambezi Region of Namibia [26]. found that Lannea zastrowina was used as a remedy for skin Capparis tomentosa is also used to treat skin rashes and rashes and herpes zoster in Katima Mulilo in Namibia. Else- herpes zoster in Katima Mulilo, Namibia [17]. Many Acacia where, Lannea species were known to have antibacterial [29] species are also used to manage skin conditions in Southern and antiviral [30] properties, making them good candidates Africa [27]. Kenyans use Trichilia emetica and Syzygium for treating microbial skin infections. guineense to treat skin cancers [28]. Leaves of one of the gfi The plant Kigelia africana, used in this study to manage trees, Ficus capensis, were also a remedy for skin sores. Skin boils, was also used in Ghana to treat skin ailments includ- diseases lie at the centre of both Christian and Islamic faiths. ing fungal infections, boils, psoriasis and eczema, leprosy, Indeed,theuseoffigstotreatskindiseasessuchasboilsiswell syphilis, and cancer [31]. eTh plant is known to contain documented in the Bible; see 2 Kings 20:7 where a poultice of iridoids which confer antibacterial properties [32]. Euclea common figs ( Ficus sp.) was applied to heal boils. divinorum and Ximenia americana, skin remedies described 10 Evidence-Based Complementary and Alternative Medicine Pods/seeds Tubers Table 2: Informant consensus factor (𝐹 ) for different ailments. IC 2% 1% Number of Number of Ailment 𝐹 IC species citations Fruits 12% Diarrhoea/dysentery 0.73 33 120 Roots 25% Whole plant Skin infections 36 108 0.67 5% STIs 0.67 70 210 Sap 2% Malaria 0.82 15 77 TB/pneumonia 0.73 19 68 Oral infections 0.81 11 55 Stems/stem bark Cough 0.76 20% 18 71 Fever/flu/colds/headache 0.80 10 45 Libido/erectile dysfunction 412 0.73 Leaves Meningitis 0.80 33% Weight loss 14 1.00 Cancer 1.00 Figure 3: Percentage use of plant parts. in this study, were also documented as skin treatments by [48]. Syzygium cordatum Hochst, due to its antibacterial properties, is an antidiarrhoeal remedy in Swaziland [49]. [27] in South Africa. Plants such as Acacia, Kigelia africana, Many plants used to treat STIs in Livingstone were also and Maytenus senegalensis are used as ethnomedicine for skin used to manage STIs in Sesheke District, Zambia [18]. This is infections [33]. because inhabitants of both Livingstone and Sesheke mainly Some of the plant taxa used to manage diarrhoea in belong to the Lozi ethnic group. eTh refore, they tap into a this studyhavealsobeenreportedtotreat diarrhoeain similar ancestral vein of indigenous knowledge. For example, other studies. Achyranthes aspera L. is a known treatment for in both Livingstone and Sesheke, gonorrhoea was treated diarrhoea [34, 35]; Asparagus racemosus roots have been used with a couple of species of the genera Lannea, Combretum, traditionally in Ayurveda for the treatment of diarrhoea and Terminalia, Diospyros, Ximenia, and Ziziphus. dysentery [33]; K. africana is a known antidiarrhoeal remedy eTh Lozi people of Seshekeused52plant speciesin and Parinari curatellifolia attenuates diarrhoea [36, 37]. 25 families and 43 genera to treat gonorrhoea, syphilis, chancroid, chlamydia, genital herpes, and anogenital warts. Oncoba spinosa is an antidote for diarrhoea in Ethiopia STIs were frequently managed using the following plants: [38]. Studies in Nigeria showed that extracts of Acacia nilotica Terminalia sericea, Strychnos cocculoides, Ximenia caffra , produced comparable antidiarrhoeal activity similar to lop- Cassia abbreviata, Cassia occidentalis, Combretum hereroense, eramide, a drug widely employed against diarrhoeal disorders Combretum imberbe, Dichrostachys cinerea, Boscia albitrunca, [39]. Garcinia livingstonei was a remedy for diarrhoea in Momordica balsamina, and Peltophorum africanum [18]. KwaZulu-NatalProvince, SouthAfrica[40]; adecoction Ziziphus mauritiana,alsoknown as MasauinNyanja, is a from the roots Combretum collinum was drunk for the wild fruit plant very rich in vitamin C. It contains 20 to 30% treatment of diarrhoea [41]; Bridelia cathartica, Flacourtia sugar, up to 2.5% protein, and 12.8% carbohydrates. The plant indica, and Kirkia acuminata are prescriptions for diarrhoea is a remedy for STIs because aqueous extracts and powders in Zimbabwe [42, 43]. have broad-spectrum antibacterial activity. Its extracts are Members of the genus Grewia were used as a remedy also used as a dressing to prevent bacterial infections and for diarrhoea in Katima Mulilo [17] and Mimosa pigra was to aid in wound healing during male circumcision among harvested to treat diarrhoea in Rundu [18]. Rakotomalala et the Lunda and Luvale people of Zambia [50]. eTh anti-HIV plant Ximenia americana contains oleic, hexacos-17-enoic al. [44] showed that M. pigra is rich in tryptophan, quercetin, (ximenic), linoleic, linolenic, and stearic acids. Its oil consists and several phenolic compounds which confer antioxidant of very long chain fatty acids with up to 40 carbon atoms. X. and anti-inflammatory properties. Dalbergia melanoxylon americana is also used to manage STIs including gonorrhoea has antidiarrhoeal eeff cts [45]. in Western Province, Zambia [18]. Studies in Tanzania found that Indigofera colutea has Euclea divinorum, a treatment for gonorrhoea in Liv- antimicrobial activities and hence can be used to manage ingstone, had antibacterial action with minimum inhibitory diarrhoea. Ficus capensis has vibriocidal and antiamoebic concentration values ranging from 25.0 mg/mL to 0.8 mg/mL actions [46] and therefore is used to treat diarrhoea in and moderate cytotoxicity [51]. Ximenia americana and Cro- Lubumbashi in the neighbouring Democratic Republic of the ton megalobotrys, known as Mtswanza and Muchape (resp.) Congo [47]. An anti-inflammatory bioflavonoid, gossypin, among the Kore-kore people of Chiawa District in Zambia, is found in Hibiscus vitifolius, a good remedy for diarrhoea arealsopreparedasformulationsfor gonorrhoea [52]. Evidence-Based Complementary and Alternative Medicine 11 Oral infections, 5.0 HIV/AIDS, 2.3 TB/pneumonia, 8.6 General STIs, 2.3 Syphilis, 10.0 Cancer, Libido/erectile dysfunction, 1.8 0.5 Headache, 1.8 Genital Cough, 8.2 ulcers, 0.9 Fever, 1.8 Flu/colds, 0.9 Genital warts, 1.4 Weight Herpes Other, 5.9 loss, 0.5 simplex, 0.9 Gonorrhoea, 12.7 Diarrhoea/dysentery, Chancroid, 1.4 15.0 Meningitis, 0.9 Malaria, 6.8 Skin infections, 16.4 Figure 4: Proportions of plants used to treat different disease conditions. General skin Studies show that HIV/AIDS is associated with low libido infections in men, sometimes because of depression and poor moods 5% [59, 60]. Men on ART were also associated with sexual dysfunction [61]. Unsurprisingly, loss of libido and erectile Rashes dysfunction in men were commonly associated with HIV 28% infection in Livingstone. HIV-infected men sueff ring from loss of libido and erectile dysfunction often used herbs to restore their sexual prowess. Mucuna pruriens,aplantwith Sores/ulcers 33% antibacterial activity [62], is also known to improve fertility, sexual behaviour, and erectile function in animals [63–65]. Extracts of the plant Hoslundia opposita corrected erectile Boils dysfunction in Livingstone men living with HIV infection 10% andwerealsocommonlyusedtomanagenoninsulindepen- dent diabetes mellitus in Tanzania [66]. Erectile dysfunction Herpes zoster andlossoflibidoare common in menwithdiabetes[67]. Eczema 15% 2% Abscesses 7% 5. Conclusions Figure 5: Percentage distribution of plants used to treat various skin In Livingstone, Southern Province, Zambia, traditional heal- conditions. ers and other knowledge holders use 94 medicinal plant species to manage HIV/AIDS-related diseases mainly skin infections, diarrhoea, STIs, TB, cough, malaria, and oral infections. Majority of the plants belonged to the families Many species of Acacia areusedtotreat TB andpneu- Fabaceae and Combretaceae. Most plant leaves and roots monia, owing to their antibacterial and anti-HIV activities were utilized to treat two or more disease conditions related [53, 54]. Acacia nilotica leaf, bark and root ethanol, or ethyl to HIV infection. es Th e multiuse medicinal plants probably acetate extracts were active against Mycobacterium aurum, contain broad-spectrum antimicrobial agents but may also MIC = 0.195–1.56 mg/mL [55]. Combretum imberbe contains face the threats of overharvesting, thus requiring special pentacyclic triterpenes, with MIC = 1.56–25𝜇 g/mL against regulations for their genetic conservation. Mycobacterium fortuitum [55]. Maytenus senegalensis is a The indigenous knowledge of medicinal plants is quite known anti-HIV and antimycobacterial treatment in Uganda consistent especially for managing common HIV/AIDS- and Tanzania [56, 57]. A Cleome species was used to treat related conditions such as malaria, oral infections, fever, flu, TB in Livingstone. In South Africa, Hurinanthan [58] found colds, and headache. Although the results of this study are that Cleome monophylla leaf extract had anti-HIV-1 reverse consistent with ethnobotanical and antimicrobial data from transcriptase activity. Cleome gynandra is a treatment for many reports in the literature, further studies are needed chancroid in Sesheke and a remedy for malaria in other parts to confirm the antimicrobial efficacies, pharmacological, of Zambia [17, 18]. cytotoxicity, and active chemical ingredients of the plants. 12 Evidence-Based Complementary and Alternative Medicine Genital ulcers General STIs 3% 7% Chancroid 4% Syphilis 32% Gonorrhoea 40% Herpes HIV simplex 7% 3% Genital warts 4% Figure 6: Percentage distribution of plants used to treat various STIs. Competing Interests [6] A.Burnett,R.Baggaley, M. Ndovi-MacMillan,J.Sulwe,B. Hang’Omba, and J. 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Ethnobotanical Study of Plants Used in the Management of HIV/AIDS-Related Diseases in Livingstone, Southern Province, Zambia

Evidence-based Complementary and Alternative Medicine : eCAM , Volume 2016 – Mar 16, 2016

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Copyright © 2016 Kazhila C. Chinsembu.
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10.1155/2016/4238625
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Hindawi Publishing Corporation Evidence-Based Complementary and Alternative Medicine Volume 2016, Article ID 4238625, 14 pages http://dx.doi.org/10.1155/2016/4238625 Research Article Ethnobotanical Study of Plants Used in the Management of HIV/AIDS-Related Diseases in Livingstone, Southern Province, Zambia Kazhila C. Chinsembu Faculty of Science, Department of Biological Sciences, University of Namibia, Private Bag 13301, Windhoek, Namibia Correspondence should be addressed to Kazhila C. Chinsembu; kchinsembu@unam.na Received 25 September 2015; Accepted 11 February 2016 Academic Editor: Rahmatullah Qureshi Copyright © 2016 Kazhila C. Chinsembu. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Faced with critical shortages of sta,ff long queues, and stigma at public health facilities in Livingstone, Zambia, persons who suffer from HIV/AIDS-related diseases use medicinal plants to manage skin infections, diarrhoea, sexually transmitted infections, tuberculosis, cough, malaria, and oral infections. In all, 94 medicinal plant species were used to manage HIV/AIDS-related diseases. Most remedies are prepared from plants of various families such as Combretaceae, Euphorbiaceae, Fabaceae, and Lamiaceae. More than two-thirds of the plants (mostly leaves and roots) are utilized to treat two or more diseases related to HIV infection. Eighteen plants, namely, Achyranthes aspera L., Lannea discolor (Sond.) Engl., Hyphaene petersiana Klotzsch ex Mart., Asparagus racemosus Willd., Capparis tomentosa Lam., Cleome hirta Oliv., Garcinia livingstonei T. Anderson, Euclea divinorum Hiern, Bridelia cathartica G. Bertol., Acacia nilotica Delile, Piliostigma thonningii (Schumach.) Milne-Redh., Dichrostachys cinerea (L.) Wight and Arn., Abrus precatorius L., Hoslundia opposita Vahl., Clerodendrum capitatum (Willd.) Schumach., Ficus sycomorus L., Ximenia americana L., and Ziziphus mucronata Willd., were used to treat four or more disease conditions. About 31% of the plants in this study were administered as monotherapies. Multiuse medicinal plants may contain broad-spectrum antimicrobial agents. However, since widely used plants easily succumb to the threats of overharvesting, they need special protocols and guidelines for their genetic conservation. There is still need to confirm the antimicrobial efficacies, pharmacological parameters, cytotoxicity, and active chemical ingredients of the discovered plants. 1. Introduction secure themselves and their families because other sources of income are not sufficient [3]. Livingstone has the highest human immunodecfi iency virus According to Byron et al. [4], women combine sex with (HIV) prevalence level in Zambia. Although the average thesaleofmaterialproductstoearnhigherprotfi swhenthey HIVprevalencerateinZambiaisabout 13%, theHIV go to themarketintownand endupcontracting HIV. At infection rate in Livingstone is about 25.3%, significantly 3.1%, womeninLivingstone hadthe highestprevalenceof higher than the national average [1]. During the period 1994– sexually transmitted infections (STIs) in Zambia [1]. Migrant 2002, Livingstone’s HIV prevalence was stable at around labourers, especially sugar cane cutters from Mazabuka 30% [2]. Located in Southern Province, Livingstone is the (Zambian town with the second highest HIV prevalence at tourist capital of Zambia, home to the famous Victoria 18.4%), are oen ft blamed for being high-risk transmitters Falls. eTh refore, many socioeconomic factors conspire to of HIV. In several sites in Livingstone, there are designated fuel the town’s growing HIV epidemic. Transactional sex is venues where people meet new sexual partners [2]. These very common in Livingstone, attributable to local or foreign sexual venues are linked to high partner turnover and due to tourists and high levels of poverty; receiving money or gifts for sex is the only means for vulnerable women to n fi ancially major challenges in on-site condom availability, unprotected 2 Evidence-Based Complementary and Alternative Medicine sex is common among guests [2]. Livingstone also has low Zambia is among the Sub-Saharan African countries with rates of male circumcision at 11% [1]. the most acute shortages of trained personnel in the health In Livingstone, studies have reported sexual behaviours sector [14]. Predictably, use of traditional medicines was with a high potential for HIV transmission, yet there are reported among 75% of inpatients at the UTH and among few signs of HIV preventive interventions [3]. Despite the 68% of those seeking services for HIV counselling and testing rollout of antiretroviral therapy (ART), Cataldo and others [11]. Studies have shown that individuals that use traditional [5] stated that Zambian HIV-infected persons still seek medicines are also associated with alcohol, have two or treatment from traditional healers. u Th s, although some more sexual partners, engage in dry sex, and harbour STIs. western trained health care providers remain suspicious of Corollary, identification of persons who access traditional traditional healers, most agree that traditional healers play medicines may be an important target population for HIV an important and complementary role in the provision of prevention because many HIV risky behaviours are common eeff ctive HIV prevention or treatment [6]. Kaboru [7] also among clients of traditional healers [11]. found that many biomedical health practitioners believe that Besides, traditional healers are still consulted because Zambian traditional healers can help control HIV/AIDS. they are deemed to provide client-centred and personalised Undoubtedly, several patients seek herbal remedies for health care that is customized to the needs and expectations conditions related to acquired immune deficiency syndrome of patients, paying special respect to social and spiritual (AIDS) before seeking care at health centres [8]. This is matters [15]. Indeed, whilst the majority of HIV/AIDS because there are many deficiencies in the provision of patients that need treatment can access ART from local biomedical services for STIs and HIV/AIDS in Zambia [7]. hospitals and health centres, several constraints of the ART Unlike hospital staff with poor attitudes, traditional healers programme compel many HIV-infected people to use tra- are also kinder and more compassionate to patients [7]. ditional medicines to manage HIV/AIDS-related conditions According to Ndulo et al. [9], traditional healers attend to [16]. Others use ethnomedicinal plants to offset side eeff cts patients with sexually transmitted infections (STIs), in both from ART [17]. The use of medicinal plants in Livingstone is rural and urban areas; therefore, efforts should be made also part of the medical pluralism whereby the introduction to promote cooperation between traditional and biomedical of allopathic medicines has not really dampened beliefs in health care providers, so that treatment of patients and their indigenous diagnosis and therapeutic systems [18]. partners could be improved. Traditional management that Even though there are some anecdotal reports regarding concurs with biomedical practices could thus be a starting the traditional uses of ethnomedicinal plants to manage point for discussion and cooperation. various diseases in Livingstone, knowledge on specific plant Moreover, traditional healers have good knowledge of species used to manage HIV/AIDS-related diseases is still STIs [9]. Most of them use herbal preparations in the form scanty and not well recorded. This paper is an inaugural and of roots or powders administered orally to induce diarrhoea, modest report on medicinal plants used in the management vomiting, and diuresis. Traditional healers also correctly cite of HIV/AIDS opportunistic infections in Livingstone, South- symptoms associated with STIs such as urethral or vaginal ern Province, Zambia. Documentation of putative anti-HIV discharge. eTh refore, Makasa et al. [10] observed that about plantspecies mayhelppreservethiscriticaltacit indigenous 15% of patients with genital ulcer disease seek treatment knowledge resource. Plus, indigenous knowledge, coupled from traditional healers. Although the use of traditional with a history of safe use and ethnopharmacological efficacy medicine is associated with nonadherence to ART, health care of medicinal flora, also presents a faster approach to discover providers at hospitals should open lines of communication new chemical compounds that may be developed into novel with traditional healers [11]. Makasa et al. [10] also noted the antiretroviral drugs. need to increase awareness among traditional healers that handle patients presenting with STIs and to refer certain cases 2. Materials and Methods to health facilities, especially when patients do not respond to traditional medicines. 2.1. Study Area. eTh study was carried out in Chibe- Traditional healers far outnumber modern health care lenga, Burton, Dambwa, Hillcrest, Libuyu, Linda, Malota, providers in Zambia where the Traditional Health Practi- Maramba, Ngwenya, andZakeyo; theseformthe urbanand tioners Association has over 40,000 members compared to a rural settlements of Livingstone, provincial headquarters of paltry 1,000 conventional medical doctors that are practicing Southern Province until 2012 (Figure 1). eTh geographical ∘ 󸀠 ∘ 󸀠 nationwide [11]. er Th e were 1,390 medical doctors practicing coordinates of Livingstone are 17 51 0 south, 25 52 0 east. in Zambia; the doctor to population ratio was 1 to 17,589 The town is situated about 981 metres above sea level near the instead of the World Health Organization recommended Victoria Falls on the Zambezi River close to the Zimbabwean ration of 1 to 5,000 [12]. At the entrance of Zambia’s University border. Situated in agroecological region I, Livingstone has Teaching Hospital (UTH), a signpost reads “kindly take note a humid subtropical climate. Its average annual rainfall is that members of staff at UTH work under very critical short- about 690–740 mm. The mean maximum temperature is age of manpower,” a stark reminder of the dearth of health high, 35 CinOctober,and themeanminimum temperature ∘ ∘ ∘ staff and severe crisis facing the country. Given the glaring is low, 7 C in June. Recorded high (41.1 C) and low (−3.7 C) personnel shortages in many public health care facilities [13], temperatures in November and June, respectively, have been involvement of traditional healers in the management of documented. Rainy season occurs between November and HIV/AIDS opportunistic diseases is a ubiquitous narrative. March when it is wet, hot, and humid. 󸀠󸀠 󸀠󸀠 Evidence-Based Complementary and Alternative Medicine 3 (a) (b) Figure 1: (a) Map of Zambia showing the location of Livingstone. (b) Townships in Livingstone town. According to the Holdridge life zones system of biocli- 2.2. Ethnobotanical Data Collection. Ethnobotanical data matic classification, Livingstone is situated in or near the were collected using methods similar to that of [17–19]. subtropical dry forest biome. eTh terrain in Livingstone Briefly, snowball sampling was applied during ethnobotanical is well vegetated with over 1,000 plant species represented surveys of thirty knowledge holders including 10 traditional by riparian forests and woodlands, Kalahari woodlands, healers that use plants to treat HIV/AIDS-related diseases. Colophospermum mopane (J. Kirk ex Benth.) J. Leonard Before conducting interviews, the aim of the study was woodlands, and deciduous woodlands mostly consisting of clearly explained and knowledge holders were asked for Brachystegia glaucescens Hutch. and Burtt Davy and the their consent. en Th the knowledge holders were individually tall mahogany Entandrophragma caudatum Sprague. eTh engaged in semistructured interviews supplemented with vegetation is quite similar to that in adjoining Sesheke District questionnaires. During the conversations, data on respon- as reported by Chinsembu [18] except for a few dominant dent characteristics and information related to medicinal uses plant species. of plants for the management of HIV/AIDS-related diseases Between 1907 and 1935, Livingstone was the capital city were captured. All interviews were conducted in local lan- of Northern Rhodesia, now Zambia. eTh town is named aer ft guages, Tonga/Tokaleya, and Lozi. Research assistants acted DavidLivingstonewhoin1840asayoungScottishdoctorand as Tonga/Tokaleya/Lozi to English translators. ordained minister sailed from Britain to the Cape to work as Data were collected during two stages consisting of pri- a medical evangelist with the London Missionary Society. In mary and secondary samplings. eTh primary stage involved 1855, Dr. David Livingstone became the rst fi European to see an exploratory and descriptive study of eight knowledge the Victoria Falls when he was taken there by Sekeletu, chief holders that manage HIV/AIDS-related infections. The focus of the Subiya/Kololo people. Although contemporary life is a of the exploratory study was to gain critical insights into blend of values and traditions of more than 70 of Zambia’s the work of the knowledge holders, distil pertinent issues, ethnically diverse people, the main tribes in Livingstone and gauge whether a detailed ethnobotanical survey would are the Tonga/Tokaleya and Lozi; many of them live in be feasible. Knowledge holders were asked about the main townshipssuchasMaramba.Archaeologicalartifactssuggest symptoms of HIV/AIDS, their healing practices, and sources the existence of the Tonga for at least 900 years in southern of ethnomedicinal knowledge. The following data in rela- Zambia’s Zambezi Valley. eTh Lozi migrated into Western tion to the plants were also recorded: vernacular names Zambia from the Luba/Lunda Kingdom of Mwata Yamvwa (Tonga/Tokaleya/Lozi), plant habits, plant parts used, the in Zaire, present day Democratic Republic of the Congo. HIV/AIDS-related conditions treated with the plants, and the After Zambia’s independence in 1964, President Ken- modes of preparation and application of the plant remedies to neth Kaunda’s government built motor vehicle and radio the patient. assembly plants in Livingstone, attracting migrant workers. The secondary sampling stage was a follow-up and These manufacturing industries closed soon aeft r President detailed descriptive study of 22 knowledge holders who Frederick Chiluba became president of Zambia in 1991. In veriefi d prior ethnobotanical data obtained from others recent years, the town’s economic fortunes have dwindled during the exploratory inquiry. To allow for triangulation of except for a slight influx of investment in the tourism sector ethnomedicinal use, only plants mentioned by at least three characterized by the opening of modern hotel chains like knowledge holders in the descriptive study (for each disease Sun International. Commercial sex work is common among condition) were eligible for documentation [20]. On-the-spot women; many of them are from neighbouring Zimbabwe identification of familiar plant species was done in the eld fi . where the socioeconomic situation remains dire. Voucher numbers for plants were assigned and specimens for 4 Evidence-Based Complementary and Alternative Medicine plants were collected in herbarium plant presses for identifi- (53.2%), about a quarter were shrubs (24.5%), and there cation and conrfi mation. Botanical names were veriefi d using were approximately equal proportions of climbers (11.7%) and the International Plant Name Index (IPNI). herbs (10.6%). The most used families were Fabaceae (22%), Com- bretaceae (9%), Euphorbiaceae (6%), and Lamiaceae (5%) 2.3. Data Analysis. Quantitative analysis of ethnobotanical (Figure 2). The most plant parts used were leaves (33%), roots data was done by calculating percentage frequencies, famil- (25%), bark (22%), and stems/stem barks (20%) (Figure 3). iarity index𝐹 , and factor informant consensus (𝐹 ). The 𝑖 IC Pods/seeds (2%) and tubers (1%) were least used. Plant 𝐹 ,arelative indicatorofthe familiarityofaplantspecies,is exudates in the form of sap were also harvested from den fi ed as the frequency a given plant species is mentioned as 2% of the plants. Figure 4 presents the proportions of an ethnomedicine divided by the total number of knowledge plant species used to treat various HIV/AIDS-related dis- holders interviewed in the study [21]. eTh 𝐹 was calculated as ease conditions: skin infections (16.4%), diarrhoea/dysentery follows: (15.0%), gonorrhoea (12.7%), syphilis (10.0%), tuberculosis (TB)/pneumonia (8.6%), cough (8.2%), malaria (6.8%), and 𝐹 = ×100, (1) oral infections (5.0%). Figure 5 illustrates that of all the plants that were used where𝑁 is the number of informants that mention a species to ameliorate skin conditions, most of them were used to as a medicine and𝑁 is the total number of respondents. manage skin soresorulcers(33.0%),rashes(28.0%),herpes The 𝐹 was the number of use citations in each ailment IC zoster (15.0%), boils (10.0%), and abscesses (7.0%). About category (𝑁 )minus thenumberofspecies used (𝑁 ), ur 𝑡 5% of allplantsusedonskinconditionstreated general divided by the number of use citations in each category minus infections. Of all the ethnomedicinal plants used to manage one [22]: STIs, the majority of them were used for gonorrhoea (40.0%), syphilis (32.0%), and HIV (7.0%) (Figure 6). 𝐹 =𝑁 − . (2) IC ur Eighteen plants were utilized to treat four or more disease (𝑁 −1) ur conditions: Achyranthes aspera L., Lannea discolor (Sond.) Engl., Hyphaene petersiana Klotzsch ex Mart., Asparagus 𝐹 values are low (near 0) if plants are chosen randomly IC racemosus Willd., Capparis tomentosa Lam., Cleome hirta or if informants do not exchange information about their Oliv., Garcinia livingstonei T. Anderson, Euclea divino- use. Values are high (near 1) if there was a well-defined rum Hiern, Bridelia cathartica G. Bertol., Acacia nilot- selection criterion among informants and/or if information ica Delile, Piliostigma thonningii (Schumach.) Milne-Redh., was exchanged between informants. High𝐹 values are also IC Dichrostachys cinerea (L.) Wight and Arn., Abrus precatorius obtained when only one or a few plant species are reportedly L., Hoslundia opposita Vahl, Clerodendrum capitatum (Willd.) used by a high number of knowledge holders to treat a Schumach., Ficus sycomorus L., Ximenia americana L., and particular disease, and low𝐹 values imply that respondents IC Ziziphus mucronata Willd. Only 31% of the plants in this study disagree over which plant to use [23]. were administered as monotherapies. The 𝐹 values are given in Table 1. Informants were more 3. Results familiar with the medicinal uses of the following fourteen most frequently used plants: Cassia abbreviata Oliv., Com- Of all the thirty knowledge holders included in the study, only bretum imberbe Wawra, Diospyros mespiliformis Hochst. ex eight were female. This gender difference may be explained by A.DC., Fockea angustifolia K. Schum., G. livingstonei, Kigelia the fact that male knowledge holders in the community were africana (Lam.) Benth., Mimosa pigra L., Syzygium cordatum more comfortable to talk about STIs than female knowledge Hochst., Syzygium guineense DC., Terminalia prunioides M. holders who face cultural restrictions when it comes to A. Lawson, Peltophorum africanum Sond., Plumbago zey- talking about matters related to sex, STIs, and HIV/AIDS. lanica L., X. americana,and Z. mucronata. According to The average age of the healers was 48 years. About 70% of the Table 2,𝐹 values for the various disease conditions show IC knowledge holders received their medicinal plant knowledge that consensus was high over plants used to treat malaria, oral from their older family members and the remainder from infections, and fever/flu/colds/headache. spiritual and supernatural powers such as ancestral spirits, dreams, and visions. Only six traditional healers had an apprentice under their tutelage; the rest did not train other 4. Discussion people. Medicobotanical data including the plants’ scientific The highest proportion of plants in Livingstone was used names, vernacular names, families, voucher numbers, habits, to manage skin diseases, probably because they contain frequency indices, parts, HIV/AIDS-related diseases treated, antimicrobial agents. A similar scenario was obtained in modes of preparation, and application are described in Sesheke (Zambia) and Rundu (Namibia). This speaks to Table 1. Overall, 94 plant species from 39 families were used thefactthatskininfectionsare quitecommonduringHIV by various knowledge holders to manage HIV/AIDS-related infection. Many of the plants for skin diseases in Livingstone diseases in Livingstone, Southern Province, Zambia (Table 1). were used to manage skin infections in other geographical Their growth habits were as follows: almost half were trees settings. For instance, Afolayan et al. [24] and Hedimbi and Evidence-Based Complementary and Alternative Medicine 5 fi fi fi ff ff fl Table 1: Plants used to manage HIV/AIDS related diseases in Livingstone, Southern Province, Zambia. Frequency index, Family Botanical name Vernacular name Growth form Diseases treated Plant parts used, preparation, and mode of administration voucher number Acanthaceae Barleria kirkii T. Anderson Chavani Herb 13.3, L144 HIV/AIDS Leaf decoction is drank Cancer, pneumonia, cough, diarrhoea, fungal Root infusion or whole plant decoction is drank; paste of Amaranthaceae Achyranthes aspera L. Tantajulo Herb 20.0, L186 infections of the skin, genital warts plant is applied to skin Gonorrhoea, syphilis, herpes zoster, herpes Crushed leaves or roots are boiled in water, decoction is Anacardiaceae Lannea stuhlmannii (Engl.) Eyles Mungangacha, Mucheche Tree 83.3, L245 simplex, skin infections, HIV/AIDS drank; stem bark decoction is used to wash aected skin Fruit pulp eaten to relieve diarrhoea; root infusion drank to Anacardiaceae Lannea discolor (Sond.) Engl. Mungongwa Tree 50.0, L235 Diarrhoea, gonorrhoea relieve gonorrhoea Friesodielsia obovata (Benth.) Muchinga Shrub 20.0, L216 Skin rashes Pounded leaves rubbed into skin Annonaceae Verdc. Annonaceae Artabotrys brachypetalus Benth. Mulandabala Climber 13.3, L230 Skin infections Crushed leaves rubbed into skin Apiaceae Steganotaenia araliacea Hochst. Mupelewa Tree 60.0, L113 Headache Root decoction is drank Palm fruit is eaten raw or boiled to treat malaria and cough; Hyphaene petersiana Klotzsch ex Malaria, cough, tuberculosis, skin rashes, Arecaceae Kakunka, Mapokwe Tree 20.0, L217 seeds are used to treat TB; sap is applied to heal skin rashes Mart. sores related to STIs and STIs Asclepiadaceae Fockea angustifolia K. Schum. Mutindika, Nanyama Herb 83.3, L210 Cough Tuber is eaten raw Asparagaceae Asparagus setaceus (Kunth) Jessop Mutandamyoba Climber 50.0, L207 Eczema Whole plant is crushed and rubbed into aected skin Asparagaceae Sansevieria deserti N. E. Br. Musombo, Mukonje Herb 13.3, L360 Oral infections Leaves are chewed and then spitted Asparagaceae Asparagus racemosus Willd. Mutandamyoba,Ilutwa Climber 20.0,L433 Pneumonia,cough,diarrhoea,syphilis Whole plantisboiled; decoctionisdrank Asteraceae Vernonia amygdalina Delile Musoboyo Shrub 83.3, L481 Coughs, tuberculosis, malaria Leaves are boiled; decoction is drank Syphilis, herpes simplex, diarrhoea, boils, Bignoniaceae Kigelia africana (Lam.) Benth. Muzungula Tree 83.3, L485 Stem bark and leaves are boiled colds, u Treats swollen pancreas in patients on Burseraceae Commiphora mollis Engl. Muntyokela Tree 50.0, L312 Stem bark is crushed and boiled; decoction is drank antiretroviral therapy Capparaceae Boscia salicifolia Oliv. Mulaba, Kabombwe Tree 70.0, L406 Syphilis, HIV/AIDS Roots are ground and left in water; infusion is drank Syphilis rashes; HIV/AIDS; cryptococcal Rootsare crushedand boiled anddecoction is drank; Capparaceae Capparis tomentosa Lam. Chonswe Shrub 20.0, L329 meningitis, oral candidiasis, herpes zoster, crushedleavesare appliedtosores or soaked in waterusedto herpes simplex, chronic diarrhoea wash the mouth Mulangazuba, Pneumonia, tuberculosis, fungal infection of Capparaceae Cleome hirta Oliv. Herb 13.3, L303 Leaf infusion is drunk Kalungukachisiungwa the skin, malaria Maytenus senegalensis (Lam.) Celastraceae Mukuba Shrub 50.0, LV235 Tuberculosis Leaves are crushed and soaked in water; infusion is drank Exell Hippocratea africana Loes. ex Celastraceae Mulele Climber 60.0, LV280 Malaria Root decoction is drunk Engl. Parinari curatellifolia Planch. ex Chrysobalanaceae Mubulabula, Mula Tree 13.3, LV245 Toothache, diarrhoea Fruit eaten raw Benth. Cryptococcal meningitis, herpes zoster, herpes Clusiaceae Garcinia livingstonei T. Anderson Mutungwa, Mukwanaga Tree 83.3, LV226 simplex, skin rashes Tuberculosis chronic Fruit eaten raw or in porridge diarrhoea Roots are crushed and soaked in water overnight; ltrate is Combretaceae Combretum collinum Fresen. Mukunza, Mulamana Tree 43.3, LV187 Chronic diarrhoea, tuberculosis, cough drank Stem bark is crushed and soaked in water overnight; ltrate Combretaceae Combretum imberbe Wawra Mubimba, Muzwili Tree 83.3, LV238 General STIs, tuberculosis is drank Mukalanga, Kalanga, Stem bark is crushed and soaked in water overnight; ltrate Combretaceae Combretum apiculatum Sond. Tree 50.0, LV220 General STI syndromes; tuberculosis Nkalanga is drank 6 Evidence-Based Complementary and Alternative Medicine fi ff fi fi ff fi Table 1: Continued. Frequency index, Family Botanical name Vernacular name Growth form Diseases treated Plant parts used, preparation, and mode of administration voucher number Fresh leaves are crushed and soaked in water overnight; Combretaceae Combretum elaeagnoides Klotzsch Mukalanga, Mukupo Tree 30.0, L576 Malaria, tuberculosis, diarrhoea filtrate is drank Roots are crushed and soaked in water overnight; ltrate is Combretaceae Combretum hereroense Schinz Namazubo Tree 53.3, L437 Gonorrhoea drank Terminalia prunioides M. A. Mutala, Mukonono, Outer parts of roots are dried, crushed, and mixed with Combretaceae Tree 83.3, L247 Gonorrhoea, syphilis, HIV/AIDS Lawson Mulumbu water overnight; infusion is drank Numinambelele, Fresh leaves are crushed and soaked in water overnight; Combretaceae Combretum mossambicense Engl. Silutombolwa, Climber 36.7, LV475 Gonorrhoea, syphilis filtrate is taken orally Mutombololo Combretaceae Combretum paniculatum Vent. Mutombolo Shrub 50.0, L322 Malaria, diarrhoea Leaves are pounded and soaked in water; infusion is drank Young stems are cut and boiled, and decoction is applied to Connaraceae Byrsocarpus orientalis Baill. Kazingini Shrub 13.3, L521 Skin abscesses and boils skin Dioscorea cochleari-apiculata De Dioscoreaceae Mpama Climber 13.3, L511 Syphilitic sores, chancroid Root decoction drank Wild. Diospyros mespiliformis Hochst. Ebenaceae Mchenja Tree 83.3, L109 Malaria Crushed roots are boiled; ltrate is drank ex A.DC. Diospyros quiloensis (Hiern) F. Ebenaceae Musiaabwele Tree 50.0, LV339 Gonorrhoea, syphilis, malaria Crushed stem bark is boiled; ltrate is drank White Syphilis, gonorrhoea, genital herpes, oral Roots are ground and boiled in water and decoction is taken Ebenaceae Euclea divinorum Hiern Munyansyabweli Tree 20.0, LV140 candidiasis, abscesses, diarrhoea orally Erythroxylum zambesiacum N. Roots are cut into small pieces and boiled, and decoction is Erythroxylaceae Mubalubalu Tree 16.7, LV277 Malaria, headache Robson administered orally Stem bark is boiled; decoction is drank and used to wash Euphorbiaceae Croton gratissimus Burch. Mungai, Kanunkila Mpati Tree 66.7, LV399 Syphilis sores Euphorbiaceae Croton megalobotrys Mu¨ll. Arg. Mutua, Mutuatua Tree 60.0, S149 Gonorrhoea Leaves are boiled and decoction is drank Pseudolachnostylis maprouneifolia Euphorbiaceae Mukunyu Tree 23.3, S108 Diarrhoea, pneumonia Stem bark decoction is drank Pax Oral infections, diarrhoea, gonorrhoea, Leaves and fruits are chewed raw to act as mouthwash; stem Euphorbiaceae Bridelia cathartica G. Bertol. Munyanyamenda Shrub 13.3, S154 malaria bark infusion is drank Margaritaria discoidea (Baill.) G. Euphorbiaceae Mulyankanga Shrub 16.7, S119 Skin rashes and sores; headache Stem bark L. Webster Euphorbiaceae Phyllanthus reticulatus Lodd. Mwichechele Shrub 26.7, S260 Herpes simplex Crushed leaves are rubbed to aected areas of skin Fabaceae Acacia albida Delile Musangu, Muunga Tree 50.0, S100 Syphilis sores, herpes zoster Crushed leaves and stem bark are applied to heal sores Fabaceae Acacia nigrescens Oliv. Mwabaa, Mukwena Tree 60.0, S78 Herpes zoster Leaves and stem bark are boiled, decoction used to Mumbu, Mukotokoto, Leaves and stem bark are crushed and boiled; decoction is Fabaceae Acacia polyacantha Willd. Tree 50.0,S63 Gonorrhoea,herpeszoster Luntwele drank or used to wash aected skin Leaves are pounded and soaked in water overnight and then Fabaceae Afzelia quanzensis Welw. Mupapa, Mukamba Tree 76.7, S27 General STIs drank Fabaceae Albizia amara (Roxb.) Boivin Kankumbwila,Mukangola Tree 60.0, S44 Gonorrhoea, diarrhoea Stem bark infusion is drank Stem bark and leaves are mixed, crushed, soaked in water, Fabaceae Lonchocarpus capassa Rolfe Mukololo Tree 13.3, S31 Gonorrhoea, cough and ltered and infusion is drank Roots are soaked in water and infusion is drank to treat STIs; Fabaceae Peltophorum africanum Sond. Muzenzenze Tree 83.3, K203 General STIs, oral infections leaves are crushed and soaked in water; infusion is used to wash mouth Fabaceae Pterocarpus antunesii Harms Mukambo Tree 26.7, K166 Diarrhoea Stem bark infusion is drank Fabaceae Acacia goetzei Harms Mwaba Tree 46.7, K88 Cough, pneumonia Root decoction is drank Tuberculosis, diarrhoea, gonorrhoea, dental Fabaceae Acacia nilotica Delile Mukoka Tree 66.7, K56 Twigs used as chewing sticks to treat dental caries caries Evidence-Based Complementary and Alternative Medicine 7 fi fi fi fi fl ff Table 1: Continued. Frequency index, Family Botanical name Vernacular name Growth form Diseases treated Plant parts used, preparation, and mode of administration voucher number Fabaceae Cassia abbreviata Oliv. Mululwe Tree 83.3, K39 Gonorrhoea, diarrhoea Root infusion is drank Dalbergia melanoxylon Guill. & Fabaceae Musonkomo Shrub 13.3, K17 Diarrhoea Root decoction is drank Perr. Piliostigma thonningii Stem bark and roots are boiled; decoction is drank to heal Fabaceae Musekese Tree 60.0, K12 Coughs, skin rashes, gonorrhoea, syphilis (Schumach.) Milne-Redh. coughs and STIs; leaf infusion is used to wash infected skin Fabaceae Acacia ataxacantha DC. Lubamfwa Shrub 50.0, K60 Gonorrhoea, syphilis Roots are boiled and decoction is drank Acacia schweinfurthii Brenan & Roots, stem bark, and leaves are mixed, pounded, and Fabaceae Lubua, Mokoka Shrub 33.3, L34 Gonorrhoea, syphilis Exell soaked in water and infusion is drank Dichrostachys cinerea (L.) Wight Gonorrhoea, syphilis; oral candidiasis, and Stem bark is boiled and decoction is drank, used to wash oral Fabaceae Katenge, Mugee Shrub 66.7, L79 &Arn. skin rashes cavity, or used to disinfect skin by washing Leaves and small and young stems are dried, pounded into Fabaceae Mimosa pigra L. Muchabachaba, Sichatubabi Shrubs 83.3, L56 Diarrhoea, genital ulcers, gonorrhoea powder, mixed with water, and ltered and extract is drank or used to wash genital ulcers Fabaceae Sesbania sesban Britton Mbelembele Shrub 13.3, L77 Malaria Roots are boiled and decoction is administered orally Whole plant is pounded, soaked in water overnight, and Fabaceae Indigofera colutea (Burm. f.) Merr. Kapalupalu Herb 13.3, L59 Diarrhoea ltered, and infusion is drank to alleviate diarrhoea Whole plant is crushed, boiled in water, and ltered; Gonorrhoea, syphilitic ulcers, genital herpes; Fabaceae Abrus precatorius L. Musolosolo Climber 60.0, KC280 decoction is drank; crushed leaves soaked in water and used oral candidiasis, ulcer boils to wash mouth and syphilitic ulcers Pods and beans are boiled and consumed for body building Mucuna pruriens (L.) DC. Muyuyu Climber 20.0, KC245 Weight loss, lack of libido in men Fabaceae and to act as an aphrodisiac Flacourtiaceae Flacourtia indica (Burm. f.) Merr. Mutumbula Shrub 13.3, KC350 Diarrhoea Leaves chewed raw Flacourtiaceae Oncoba spinosa Forssk. Mukumbuzu Shrub 16.7, KC2 Dysentery Roots and fruits are boiled and decoction is drunk Kirkiaceae Kirkia acuminata Oliv. Musanta, Muzumina Tree 13.3, KC18 Diarrhoea Stem bark infusion is drank Fruit eaten raw or leaves burnt and smoke inhaled as cough Lamiaceae Vitex payos (Lour.) Merr. Mfudu, Muyankonga Tree 30.0, KC36 Coughs medicine Roots are boiled and decoction is drunk; sugary fruits are Coughs, u, fever, loss of libido in men; skin Lamiaceae Hoslundia opposita Vahl Musombwani Shrub 60.0, KC48 eaten raw to boost libido; crushed leaves are rubbed into skin wounds to heal wounds Lamiaceae Premna senensis Klotzsch Mumpika Shrub 13.3, KC360 Syphilitic sores, skin ulcers Leaf infusions applied to sores Lamiaceae Vitex petersiana Klotzsch Mufulibulimbo, Mukoma Shrub 23.3, KC312 Gonorrhoea Leaf decoction is drank to treat gonorrhoea; Clerodendrum capitatum (Willd.) Gonorrhoea, erectile dysfunction, pneumonia, Lamiaceae Shamanya Herb 60.0, L402 Leaf and root decoctions drunk Schumach. diarrhoea Loganiaceae Strychnos potatorum L. f. Musisilombe Tree 40.0, KC464 Syphilis Infusions of leaves are drank Mutimi, Muhuluhulu, Loganiaceae Strychnos innocua Delile Tree 20.0, KC216 Gonorrhoea, sore throat Eat fruit pulp Mwabo Azanza garckeana (F. Hom.) Malvaceae Makole, Munego Tree 60.0, KC143 Malaria Eat raw fruit, cook, and eat as relish Exell & Hillc. Malvaceae Sida alba L. Mulyangombe, Babani Shrub 20.0, KC525 Gonorrhoea Roots and leaves are boiled; decoction is drank Leaves are boiled and ltered through wire sieve and Malvaceae Hibiscus vitifolius L. Mubaluba Herb Chronic diarrhoea decoction is drank Khaya nyasica Stapf ex Baker f. Mululu Tree 43.3, KC113 Fever Stem bark infusion is drank Meliaceae Trichilia emetica Vahl Musikili Tree 56.7, KC217 Fever, pneumonia; skin rashes Root decoction is drunk; leaves rubbed onto skin Meliaceae 8 Evidence-Based Complementary and Alternative Medicine ff fi ft fl Table 1: Continued. Frequency index, Family Botanical name Vernacular name Growth form Diseases treated Plant parts used, preparation, and mode of administration voucher number Whole plant is cut into small pieces and boiled and Menispermaceae Cissampelos mucronata A. Rich. Itende Climber 73.3, KC210 Syphilis, chancroid decoction is drank aer ltering Ficus capensis Hort. Berol. ex Diarrhoea, tuberculosis, skin sores, genital Fresh leaves are boiled in water and decoction is drank or Moraceae Mukuyu Tree 60.0, KC207 Kunth & C. D. Bouche´ warts used to wash warts and skin sores Cough, tuberculosis, periodontitis, and oral Fresh leaves are boiled in water and decoction is drank or Moraceae Ficus sycomorus L. Mukuyu Tree 76.7, KC360 candidiasis used to wash the mouth Myrtaceae Syzygium cordatum Hochst. Katope Tree 83.3, KC433 Diarrhoea Stem bark decoction is drunk Myrtaceae Syzygium guineense DC. Mutoya, Katope Tree 83.3, KC481 Abscesses, skin rashes, diarrhoea Fruits eaten raw; stem decoction applied to aected skin Candidiasis, malaria, throat infection, Roots, leaves, and fruits are crushed while fresh and mixed Olacaceae Ximenia americana L. Munchovwa, Muchonfwa Tree 83.3, KC318 tonsillitis, gonorrhoea, diarrhoea, skin rashes with water overnight and taken orally Pedaliaceae Sesamum angolense Welw. Bwengo Herb 13.3, KC267 Skin rashes Leaves are crushed and used as soap to bath skin Plumbaginaceae Plumbago zeylanica L. Sikalutenta Shrub 83.3, KC318 Generally treats all STI symptoms Root infusion is drank Leaves areboiledand drunkasatea; sometimeshoney is Ranunculaceae Clematis brachiata Ker Gawl. Kalatongo Climber 20.0, KC354 Coughs, headache, fever added as a sweetener Berchemia discolor (Klotzsch) Rhamnaceae Mwiiyi, Mwinji Tree 60.0, KC235 Cough Use fruit in porridge Hemsl. Rhamnaceae Ziziphus mauritiana Lam. Masawu, Masawu Tree 40.0, KC226 Gonorrhoea, syphilis Fruit eaten raw, apply to wound, and put into porridge Gonorrhoea, syphilis, boils, pneumonia, Rhamnaceae Ziziphus mucronata Willd. Muchechete, Mwichechete Tree 83.3, KC144 Root or leaf infusion is drank cough Sapotaceae Mimusops zeyheri Sond. Mukalanjoni Tree 40.0, KC120 Oral candidiasis Fruit is eaten or root infusion is used as a mouthwash Tiliaceae Grewia avescens Juss. Namulomo, Mukunyukunyu Shrub 40.0, KC199 Diarrhoea Eat fruit pulp to relieve diarrhoea Tiliaceae Corchorus tridens L. Delele Herb 13.3, KC101 Syphilitic ulcers, chancroid Root infusion drank or applied to ulcers Mulungalunga, Vitaceae Cissus quadrangularis L. Climber 40.0, KC78 Malaria, gonorrhoea Sap is drank; whole plant infusion is drank Chamulungelunge Evidence-Based Complementary and Alternative Medicine 9 Amaranthaceae 1% Tiliaceae Acanthaceae Arecaceae Anacardiaceae 2% 1% 1% Rhamnaceae 2% Apiaceae Vitaceae 3% Ranunculaceae Sapotaceae 1% 1% Annonaceae 1% 1% Asclepiadaceae 2% Plumbaginaceae 1% Pedaliaceae 1% 1% Asparagaceae 3% Olacaceae Myrtaceae 1% Asteraceae 2% 1% Bignoniaceae Moraceae 1% 2% Burseraceae Menispermaceae 1% 1% Capparaceae Meliaceae 3% 2% Celastraceae 2% Malvaceae Loganiaceae Chrysobalanaceae 3% 2% 1% Clusiaceae 1% Lamiaceae Combretaceae 5% 9% Kirkiaceae 1% Connaraceae Flacourtiaceae 1% 2% Dioscoreaceae 1% Ebenaceae 3% Erythroxylaceae Euphorbiaceae 1% 6% Fabaceae 22% Figure 2: Percentage use of plant families. Chinsembu[25]documentedthe useof Asparagus species Lannea stuhlmannii was used to treat skin infections in the treatment of eczema in South Africa and Namibia, in Livingstone. The Lannea species were used to treat skin respectively. Friesodielsia obovata wasusedtotreat skin diseases in South Africa [27]. Chinsembu and Hedimbi [17] infections in the Zambezi Region of Namibia [26]. found that Lannea zastrowina was used as a remedy for skin Capparis tomentosa is also used to treat skin rashes and rashes and herpes zoster in Katima Mulilo in Namibia. Else- herpes zoster in Katima Mulilo, Namibia [17]. Many Acacia where, Lannea species were known to have antibacterial [29] species are also used to manage skin conditions in Southern and antiviral [30] properties, making them good candidates Africa [27]. Kenyans use Trichilia emetica and Syzygium for treating microbial skin infections. guineense to treat skin cancers [28]. Leaves of one of the gfi The plant Kigelia africana, used in this study to manage trees, Ficus capensis, were also a remedy for skin sores. Skin boils, was also used in Ghana to treat skin ailments includ- diseases lie at the centre of both Christian and Islamic faiths. ing fungal infections, boils, psoriasis and eczema, leprosy, Indeed,theuseoffigstotreatskindiseasessuchasboilsiswell syphilis, and cancer [31]. eTh plant is known to contain documented in the Bible; see 2 Kings 20:7 where a poultice of iridoids which confer antibacterial properties [32]. Euclea common figs ( Ficus sp.) was applied to heal boils. divinorum and Ximenia americana, skin remedies described 10 Evidence-Based Complementary and Alternative Medicine Pods/seeds Tubers Table 2: Informant consensus factor (𝐹 ) for different ailments. IC 2% 1% Number of Number of Ailment 𝐹 IC species citations Fruits 12% Diarrhoea/dysentery 0.73 33 120 Roots 25% Whole plant Skin infections 36 108 0.67 5% STIs 0.67 70 210 Sap 2% Malaria 0.82 15 77 TB/pneumonia 0.73 19 68 Oral infections 0.81 11 55 Stems/stem bark Cough 0.76 20% 18 71 Fever/flu/colds/headache 0.80 10 45 Libido/erectile dysfunction 412 0.73 Leaves Meningitis 0.80 33% Weight loss 14 1.00 Cancer 1.00 Figure 3: Percentage use of plant parts. in this study, were also documented as skin treatments by [48]. Syzygium cordatum Hochst, due to its antibacterial properties, is an antidiarrhoeal remedy in Swaziland [49]. [27] in South Africa. Plants such as Acacia, Kigelia africana, Many plants used to treat STIs in Livingstone were also and Maytenus senegalensis are used as ethnomedicine for skin used to manage STIs in Sesheke District, Zambia [18]. This is infections [33]. because inhabitants of both Livingstone and Sesheke mainly Some of the plant taxa used to manage diarrhoea in belong to the Lozi ethnic group. eTh refore, they tap into a this studyhavealsobeenreportedtotreat diarrhoeain similar ancestral vein of indigenous knowledge. For example, other studies. Achyranthes aspera L. is a known treatment for in both Livingstone and Sesheke, gonorrhoea was treated diarrhoea [34, 35]; Asparagus racemosus roots have been used with a couple of species of the genera Lannea, Combretum, traditionally in Ayurveda for the treatment of diarrhoea and Terminalia, Diospyros, Ximenia, and Ziziphus. dysentery [33]; K. africana is a known antidiarrhoeal remedy eTh Lozi people of Seshekeused52plant speciesin and Parinari curatellifolia attenuates diarrhoea [36, 37]. 25 families and 43 genera to treat gonorrhoea, syphilis, chancroid, chlamydia, genital herpes, and anogenital warts. Oncoba spinosa is an antidote for diarrhoea in Ethiopia STIs were frequently managed using the following plants: [38]. Studies in Nigeria showed that extracts of Acacia nilotica Terminalia sericea, Strychnos cocculoides, Ximenia caffra , produced comparable antidiarrhoeal activity similar to lop- Cassia abbreviata, Cassia occidentalis, Combretum hereroense, eramide, a drug widely employed against diarrhoeal disorders Combretum imberbe, Dichrostachys cinerea, Boscia albitrunca, [39]. Garcinia livingstonei was a remedy for diarrhoea in Momordica balsamina, and Peltophorum africanum [18]. KwaZulu-NatalProvince, SouthAfrica[40]; adecoction Ziziphus mauritiana,alsoknown as MasauinNyanja, is a from the roots Combretum collinum was drunk for the wild fruit plant very rich in vitamin C. It contains 20 to 30% treatment of diarrhoea [41]; Bridelia cathartica, Flacourtia sugar, up to 2.5% protein, and 12.8% carbohydrates. The plant indica, and Kirkia acuminata are prescriptions for diarrhoea is a remedy for STIs because aqueous extracts and powders in Zimbabwe [42, 43]. have broad-spectrum antibacterial activity. Its extracts are Members of the genus Grewia were used as a remedy also used as a dressing to prevent bacterial infections and for diarrhoea in Katima Mulilo [17] and Mimosa pigra was to aid in wound healing during male circumcision among harvested to treat diarrhoea in Rundu [18]. Rakotomalala et the Lunda and Luvale people of Zambia [50]. eTh anti-HIV plant Ximenia americana contains oleic, hexacos-17-enoic al. [44] showed that M. pigra is rich in tryptophan, quercetin, (ximenic), linoleic, linolenic, and stearic acids. Its oil consists and several phenolic compounds which confer antioxidant of very long chain fatty acids with up to 40 carbon atoms. X. and anti-inflammatory properties. Dalbergia melanoxylon americana is also used to manage STIs including gonorrhoea has antidiarrhoeal eeff cts [45]. in Western Province, Zambia [18]. Studies in Tanzania found that Indigofera colutea has Euclea divinorum, a treatment for gonorrhoea in Liv- antimicrobial activities and hence can be used to manage ingstone, had antibacterial action with minimum inhibitory diarrhoea. Ficus capensis has vibriocidal and antiamoebic concentration values ranging from 25.0 mg/mL to 0.8 mg/mL actions [46] and therefore is used to treat diarrhoea in and moderate cytotoxicity [51]. Ximenia americana and Cro- Lubumbashi in the neighbouring Democratic Republic of the ton megalobotrys, known as Mtswanza and Muchape (resp.) Congo [47]. An anti-inflammatory bioflavonoid, gossypin, among the Kore-kore people of Chiawa District in Zambia, is found in Hibiscus vitifolius, a good remedy for diarrhoea arealsopreparedasformulationsfor gonorrhoea [52]. Evidence-Based Complementary and Alternative Medicine 11 Oral infections, 5.0 HIV/AIDS, 2.3 TB/pneumonia, 8.6 General STIs, 2.3 Syphilis, 10.0 Cancer, Libido/erectile dysfunction, 1.8 0.5 Headache, 1.8 Genital Cough, 8.2 ulcers, 0.9 Fever, 1.8 Flu/colds, 0.9 Genital warts, 1.4 Weight Herpes Other, 5.9 loss, 0.5 simplex, 0.9 Gonorrhoea, 12.7 Diarrhoea/dysentery, Chancroid, 1.4 15.0 Meningitis, 0.9 Malaria, 6.8 Skin infections, 16.4 Figure 4: Proportions of plants used to treat different disease conditions. General skin Studies show that HIV/AIDS is associated with low libido infections in men, sometimes because of depression and poor moods 5% [59, 60]. Men on ART were also associated with sexual dysfunction [61]. Unsurprisingly, loss of libido and erectile Rashes dysfunction in men were commonly associated with HIV 28% infection in Livingstone. HIV-infected men sueff ring from loss of libido and erectile dysfunction often used herbs to restore their sexual prowess. Mucuna pruriens,aplantwith Sores/ulcers 33% antibacterial activity [62], is also known to improve fertility, sexual behaviour, and erectile function in animals [63–65]. Extracts of the plant Hoslundia opposita corrected erectile Boils dysfunction in Livingstone men living with HIV infection 10% andwerealsocommonlyusedtomanagenoninsulindepen- dent diabetes mellitus in Tanzania [66]. Erectile dysfunction Herpes zoster andlossoflibidoare common in menwithdiabetes[67]. Eczema 15% 2% Abscesses 7% 5. Conclusions Figure 5: Percentage distribution of plants used to treat various skin In Livingstone, Southern Province, Zambia, traditional heal- conditions. ers and other knowledge holders use 94 medicinal plant species to manage HIV/AIDS-related diseases mainly skin infections, diarrhoea, STIs, TB, cough, malaria, and oral infections. Majority of the plants belonged to the families Many species of Acacia areusedtotreat TB andpneu- Fabaceae and Combretaceae. Most plant leaves and roots monia, owing to their antibacterial and anti-HIV activities were utilized to treat two or more disease conditions related [53, 54]. Acacia nilotica leaf, bark and root ethanol, or ethyl to HIV infection. es Th e multiuse medicinal plants probably acetate extracts were active against Mycobacterium aurum, contain broad-spectrum antimicrobial agents but may also MIC = 0.195–1.56 mg/mL [55]. Combretum imberbe contains face the threats of overharvesting, thus requiring special pentacyclic triterpenes, with MIC = 1.56–25𝜇 g/mL against regulations for their genetic conservation. Mycobacterium fortuitum [55]. Maytenus senegalensis is a The indigenous knowledge of medicinal plants is quite known anti-HIV and antimycobacterial treatment in Uganda consistent especially for managing common HIV/AIDS- and Tanzania [56, 57]. A Cleome species was used to treat related conditions such as malaria, oral infections, fever, flu, TB in Livingstone. In South Africa, Hurinanthan [58] found colds, and headache. Although the results of this study are that Cleome monophylla leaf extract had anti-HIV-1 reverse consistent with ethnobotanical and antimicrobial data from transcriptase activity. Cleome gynandra is a treatment for many reports in the literature, further studies are needed chancroid in Sesheke and a remedy for malaria in other parts to confirm the antimicrobial efficacies, pharmacological, of Zambia [17, 18]. cytotoxicity, and active chemical ingredients of the plants. 12 Evidence-Based Complementary and Alternative Medicine Genital ulcers General STIs 3% 7% Chancroid 4% Syphilis 32% Gonorrhoea 40% Herpes HIV simplex 7% 3% Genital warts 4% Figure 6: Percentage distribution of plants used to treat various STIs. Competing Interests [6] A.Burnett,R.Baggaley, M. Ndovi-MacMillan,J.Sulwe,B. Hang’Omba, and J. Bennett, “Caring for people with HIV eTh author has no conflict of interests or competing interests in Zambia: are traditional healers and formal health workers to declare. Professor Chinsembu is the chair of the steering willing to work together?” AIDS Care,vol.11, no.4,pp. 481–491, committee on the scientific validation of plants for HIV/AIDS treatment in Namibia. [7] B.B.Kaboru, The Interface between Biomedical and Tradi- tional Health Practitioners in STI and HIV/AIDS Care: A Study on Intersectoral Collaboration in Zambia, Institutionen Acknowledgments for ¨ folkhals ¨ ovetenskap/Department of Public Health Sciences, The author is grateful to all respondents who provided critical [8] S. C. Munthali, Acceptability of antiretroviral drugs among adults data and to all the research assistants who helped with data living in Chawama, Lusakaa [MPH dissertation], University of collection. Zambia, Lusaka, Zambia, 2011. [9] J. Ndulo, E. Faxelid, and I. 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